Your Guide to Urinary Incontinence After Childbirth

Incontinence often starts during pregnancy but can linger long after. Fortunately, Kegels aren't the only solution.


Not long ago, I was bouncing with my 3-year-old twin boys in one of those street fair blow-up castles when—oops!—I felt a bit of urine spurt out. It happens a few times a year, typically during a forceful sneeze, and it's a reminder that all is not the same, bladder-wise, as before I got pregnant.

Doctors call it urinary incontinence. I prefer "the spritz," the term used in the TV commercials for Poise pads. Whatever you call it, leakage is incredibly prevalent among moms, especially if you delivered vaginally. Women who had a vaginal birth were more likely to have urinary incontinence a year postpartum, compared to women who had C-sections, says a new study published in Obstetrics & Gynecology.

"Even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50 percent of women," says Roger Goldberg, M.D., director of urogynecology research at the University of Chicago NorthShore University HealthSystem and author of Ever Since I Had My Baby (Random House).

Most cases resolve in the first year after birth. However, five years after delivery, one-third to one-half of women report some degree of spritzing; 10 percent to 20 percent of women report having leakage that they consider "socially bothersome." Fortunately, a variety of methods, ranging from do-it-yourself pelvic-floor exercises (Kegels) to a simple surgical procedure, can help you stay dry.

Who Leaks and Why

Incontinence comes in two varieties: stress and urge. If you leak when you forcefully laugh, sneeze, cough, run, jump or lift weights, you have stress incontinence. "It's really common in the third trimester because of the pressure of the uterus on the bladder," says Sangeeta Mahajan, M.D., division chief of female pelvic medicine and reconstructive surgery at University Hospital's Case Medical Center Department of OB-GYN in Cleveland. Compounding the problem are the hormones that make your tissues and joints more elastic for delivery: They also reduce bladder support, allowing urine to leak.

About two-thirds of women with stress incontinence also experience urge incontinence, which is caused by an overactive bladder. You get the sudden urge to go, even though your bladder may be nearly empty, and leak before you can get to the bathroom.

Women older than 35 and obese women are at greater risk for prenatal leakage of both varieties. After childbirth, the biggest risk factor for stress incontinence is having had a vaginal delivery, especially one involving forceps or other interventions that can injure pelvic nerves and muscles. A Norwegian study of 12,000 women found that among women who did not leak during pregnancy, 20 percent did so six months after a vaginal delivery, compared with 8 percent who had elective Cesarean sections. Among prenatal leakers, half who delivered vaginally were spritzing six months later, compared with 23 percent of those who had a C-section.

Shutting Off the Faucet

Though it might be tempting to schedule a C-section to lower your odds of incontinence, experts advise against this. For one thing, susceptibility is to some degree genetic, and a substantial number of women who choose C-sections end up leaking anyway.

What's more, research shows, two decades after giving birth, women who delivered via C-section are no better off, leakage-wise, than women who delivered vaginally. "Things tend to equalize due to wear and tear and gravity," Goldberg explains. Besides, C-sections pose their own risks, to both mom and baby.

If you're leaking while pregnant, Kegel exercises may not be enough to stop the spritz; experts believe that the weight of the uterus combined with pregnancy hormones make for an overpowering combo. But it still pays to start getting your pelvic-floor muscles in shape: Research suggests that after delivery, Kegel exercises, if done properly, can help minimize both stress and urge incontinence (see "My Vagina Workout," below). "You can Kegel immediately, right in your hospital bed," says Missy Lavender, founder of the Women's Health Foundation, a nonprofit group that educates women about pelvic health.

If your leakage is persistent, you can be fitted for a pessary, a small silicone ring that acts as a "speed bump" for the urethra; you place it inside the vagina in the morning and remove it at night. Some women use a pessary only when they jog or play tennis.

"Bladder sling" surgery, which has a 90 percent success rate for stress incontinence, may be the best option for frequent leakage as long as you aren't planning any future pregnancies. In a quick, minimally invasive procedure, the surgeon inserts a U- shaped, mesh sling that permanently supports the urethra. What kind of treatment you seek depends on whether your activities are disrupted. Consider surgery, Mahajan says, "if you have to wear a pad every day or if you can't live the way you want to. Don't let your bladder rule your life."

My Vagina Workout

As an occasional leaker, I'd likely benefit from strengthening my pelvic-floor (aka vaginal) muscles. The problem: Kegels bore the heck out of me, so I blow them off. So I was surprised to find that The Myself pelvic muscle trainer ($99;, a battery-powered gizmo that offers visual feedback and three strength levels, makes a vagina workout kind of fun (no, not in that way).

Lying down, you insert a super-tampon-sized plastic sensor, then press a button to inflate a balloon inside it. A handheld device that resembles an oversized iPod, complete with screen, guides you through a five-minute workout, instructing you when to squeeze and relax. A series of bands indicates how strong your pelvic-floor muscles are. In my case, not very: Turns out, Kegeling is tough.

"Most women recruit their abs and buttocks instead of their vaginal muscles," says Providence, R.I., urogynecologist Star Hampton, M.D. I found myself clenching my glutes and holding my breath— two big no-no's—and I couldn't hold the squeeze nearly as long as the device asked me to. With or without a pelvic-muscle trainer, your goal should be to do two sets of 10 Kegels twice daily; start by holding each for one second, and work up to five seconds.