How Long Does Postpartum Incontinence Last?
Wondering how long your postpartum incontinence will last? Consider this your guide to navigating postpartum incontinence. Disclaimer: it’s lengthy because I don’t prescribe kegels as a blanket exercise prescription. You deserve so much more than that!
Understanding Postpartum Incontinence
What is postpartum incontinence?
Postpartum incontinence is the involuntary leakage of urine during the postpartum period. Though very common, this is not normal physiology. Good news! There is holistic, non-invasive treatment for this and if it is something you are experiencing and think it’s a life sentence, it’s not and you have come to the right place.
Types of incontinence new mothers may experience
There are 4 different types of urinary incontinence and are all treated differently.
Stress urinary incontinence: this occurs primarily with things like laughing, jumping, coughing, or sneezing
Urge urinary incontinence: this type of leakage occurs when you hear running water, are walking towards the toilet and don’t make it in time, or when you put the key in the door/are getting inside your house
Overflow incontinence: this type of incontinence occurs when you lack sensation of your bladder and your bladder literally overflows (this is common after a neurological injury)
Functional incontinence: this occurs with functional movements like picking something up or getting out of a chair
Of these, stress and urge are the most common in the postpartum period. They can occur together (mixed incontinence) or separately.
Causes of urinary incontinence after childbirth
Stress urinary incontinence typically occurs more after a vaginal birth while urge urinary incontinence occurs more frequently after a cesarean birth.
Why?
Urge urinary incontinence is typically the result of a more tense pelvic floor, while stress urinary incontinence is usually due to pelvic floor coordination issue.
This is why I don’t give kegels as a blanket prescription ;)
Why do these occur with specific types of birth?
We usually see more pelvic floor tension following a cesarean birth which leads to pain with intercourse and/or urinary urgency.
Pelvic floor coordination and/or strength is usually more of an issue following a vaginal birth leading to delayed contraction of the PFM when needed.
Duration and Recovery
How long does postpartum incontinence last?
Oh man, I wish this was black and white, but….. It depends.
A lot of it depends on how long it takes to seek treatment, because unfortunately this is not usually something that just goes away on its own if it hasn’t resolved by 4-6 weeks.
If pelvic floor physical therapy is the route you choose to take for healing, most patients that come through our clinic usually see positive changes within 3 visits, with resolution coming around the 8th visit.
By resolution, I mean doing whatever it is you want to be doing urinary leakage free without it living rent free in your head.
Factors influencing recovery time for incontinence
Several things play into symptom resolution for incontinence including but definitely not limited to:
Postpartum mental health
Postpartum help
Compliance with home exercise program
Severity of the incontinence
Type of incontinence
Other symptoms present
Stress levels
When to seek medical advice for persistent incontinence
If incontinence is still present when you have your 6ish week postpartum check up, I recommend asking for a referral to pelvic floor PT. If it hasn’t resolved on its own by this point, it likely won’t.
If your provider tells you it’s normal because you’ve given birth or recommends just doing kegels please seek pelvic floor PT on your own. In most states, physical therapy is direct access which means you do not need a referral to start physical therapy.
In the state of Texas, you can start PT on your own but need a signed plan of care within 10 business days by a provider. Providers who can sign a POC include:
Physician
PA
NP
Chiropractor
Dentist
At Texas Pelvic Health, we take care of this on the back end for you. We ask for your provider and then handle the faxing and communicating with them.
If you are postpartum, but well beyond 4-6 weeks (postpartum is for life), you would still benefit from PT for incontinence. We have seen patients in their 70s and 80s have symptom resolution from incontinence.
Managing and Treating Incontinence
Pelvic floor exercises to manage postpartum incontinence
Our exercise prescription for incontinence varies based on type of incontinence and root cause of the incontinence.
Here are a few examples:
Stress incontinence
Core strengthening
Glute strengthening
Pressure management
Breathing exercises
Urge incontinence
Pelvic floor relaxation
Single leg stability
Core exercises
And if you have mixed incontinence (a combo of both), you’ll likely be doing a little of both of these.
Lifestyle changes to reduce symptoms of incontinence
Because of the close proximity of the rectum to the bladder, managing any constipation is huge for treating urinary incontinence. We often find that when constipation is present, (both types of) incontinence is worse.
Stress management also plays a huge role in treating incontinence. You know how most women hold their stress in their upper traps & jaw when they get stressed? The pelvic floor is another place women carry their stress and hold tension. So, being aware of this and managing the stresses of life is huge for treating postpartum incontinence.
Other BIG things we recommend include staying hydrated and limiting bladder irritants including coffee, tea, soda, artificial sweeteners, and juice. We recommend 60-80 oz of water/day ESP if you are breastfeeding. If that’s the case, consider increasing by 20 oz/day.
Medical treatments for severe postpartum incontinence
Medical treatments for severe postpartum incontinence includes medication, surgery, or a pessary.
Medication (usually oxybutin) works well for some, with the primary adverse effects being dry mouth and dry eyes. We often see patients who have been prescribed medication and take it while seeing us with the goal being to come off of the medication.
The primary surgery for incontinence is a bladder sling. A sling is placed around the urethra to help support the neck of the bladder to reduce incontinence.
Lastly, a pessary is a nice non-invasive option. A pessary is a support device that is sized and fitted to each individual (similar to a sports bra) and can be worn all the time or only with symptom provoking activities. A pessary can be used similar to medication – use it while training your muscles to do what you want them to do, and then wean from it. You can read more about pessaries here.
Prevention and Preparation
Tips to prevent postpartum incontinence during pregnancy
A few things you can do during pregnancy to prevent postpartum incontinence include:
Pelvic floor PT - to connect to your pelvic floor
Push preparation
Continue exercising/moving
Manage constipation
Core strengthening
How to prepare your pelvic floor before childbirth
Did you know your pelvic floor should relax during birth rather than contract? I cringe so hard every time I hear kegels recommended during birth. A kegel is a pelvic floor muscle contraction & during a vaginal birth your muscles should relax.
Learning how to push properly is a game changer and mitigates pelvic floor injury during birth.
Additionally, finding the position(s) that feel the best/most effective to labor in and push in are very beneficial.
Making sure you know how to correctly engage and relax all of the core muscles during pregnancy helps so much during the postpartum period.
You can read a lot more about how to prepare for a vaginal birth here.
Role of pelvic floor therapy during and after pregnancy
Pregnancy is truly the ideal time to begin pelvic floor therapy. Things we work on during pregnancy include:
Treatment of any pelvic pain, low back pain, or abdominal pain
Strengthening with safe and effective exercises
Teach you how to push
Teach you birthing positions for the first and second stage of labor with and without an epidural
Perineal massage to decrease the likelihood of 3rd and 4th degree tears
Teach you safe and effective exercises to begin strengthening your core postpartum
We recommend beginning pelvic floor therapy once/month in the 1st trimester, and as long as you are not having any significant pain, follow the same schedule your midwife/OBGYN follows and increase frequency each trimester.
We have heard so many amazing birth stories from our patients who put in the work during pregnancy, and typically a smooth birth means less postpartum issues.
Good news! We are currently taking new patients with prolapse inRockwall, Canton, and Sulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.
