You sneeze, laugh with a friend, or lift the pram into the boot, and you feel a small leak. You tell yourself it’s natural, that it’s “from the birth”, that it will go away on its own. Sometimes it does. Often it doesn’t.
Leaking urine after giving birth is very common. But common doesn’t mean normal. It’s a sign that your pelvic floor needs some attention, and the good news is that a great deal can be done.
What happens to the pelvic floor in pregnancy and birth
The pelvic floor is a group of muscles, ligaments and connective tissue that closes the base of the pelvis, rather like a hammock. It supports the bladder, uterus and bowel, helps you control urine, wind and stools, and plays a part in sexual function and in the stability of your spine.
During pregnancy, this hammock carries a load that grows month by month. Hormones make the tissues more elastic to prepare the body for birth. Your posture changes, your breathing changes, your tummy stretches.
In a vaginal birth, the pelvic floor muscles stretch a great deal to let the baby through. There may be an episiotomy, a tear, a ventouse or forceps delivery, or a long pushing stage. After a caesarean, the baby did not pass through the pelvic floor, but it still carried the whole pregnancy, and the abdominal scar also changes how your trunk manages pressure.
That’s why leaking after birth can happen whatever kind of birth you had.
The most common types of leakage
Not all leaks are the same, and understanding yours helps guide treatment.
- Stress leakage: happens when pressure inside the abdomen rises suddenly, when you cough, sneeze, laugh, jump, run or lift something heavy.
- Urgency: a sudden, strong need to pass urine that is hard to put off, sometimes with a leak before you reach the toilet.
- Mixed leakage: a combination of both.
You might also notice related signs: difficulty holding in wind, a feeling of heaviness in the vagina, discomfort during sex, or pain around a scar. All of this belongs to the same area and deserves to be looked at together.
What may lie at the root
At A Raiz da Cura we don’t just look at a “weak” muscle. We try to understand why the system stopped working well. Some possible causes:
- Muscles that have lost strength or coordination after being stretched in labour, and no longer switch on in time when pressure rises.
- Muscles that are too tense, especially after a tear or after pain, and can’t fully contract or fully let go. A tense muscle can fail too.
- Scars (perineal or caesarean) with limited mobility, which change how the surrounding tissues work.
- Breathing and the abdomen: after pregnancy, the way you breathe and use your abdominal wall changes. If the diaphragm, abdominal muscles and pelvic floor aren’t working as a team, pressure ends up pushing downwards.
- Posture and daily habits: long hours feeding while hunched over, carrying the baby on one side, straining on the toilet.
- Constipation, which is common after birth and puts extra load on the pelvic floor.
Every woman has a different combination. That’s why generic exercises aren’t always enough.
How we can help
Pelvic physiotherapy starts with a conversation: how your pregnancy and birth went, what your days look like, what you feel and when. Then, with your consent, we assess the pelvic floor. This may include an internal examination, always explained beforehand and only if you feel comfortable.
From there, your care may include:
- Pelvic floor retraining: learning to contract and relax properly, with the right strength and timing, and then bringing that into everyday movements.
- Breathing and abdominal work, so that pressure is well managed when you cough, lift your baby or return to exercise.
- Hands-on therapy for scars, tight tissues and areas that have lost mobility.
- Visceral osteopathy, where appropriate, looking at how the pelvic and abdominal organs relate to each other and how freely they move.
- Practical guidance: positions for feeding and for opening your bowels, how to lift your baby, and how to return to physical activity safely.
Many women notice improvement over the course of their care, but everyone progresses at their own pace. Our work complements the care of your obstetrician, gynaecologist or GP; it doesn’t replace it.
What you can do now
- Don’t cut back on water to “leak less”. Very concentrated urine irritates the bladder and can make urgency worse.
- Avoid going to the toilet “just in case” all the time. It trains the bladder to ask more often.
- Breathe out as you exert yourself: when lifting your baby or the car seat, let the air out slowly rather than holding your breath.
- Look after your bowels: fibre, water and a small stool under your feet on the toilet help you avoid straining.
- Don’t start running or jumping just because six weeks have passed. Before returning to impact, an assessment is worthwhile.
When to seek help
Book a pelvic physiotherapy assessment if:
- you are still leaking urine, wind or stools weeks after the birth;
- you feel heaviness, pressure or a “bulge” in the vagina;
- you have pain during sex or around your scar;
- you want to return to exercise and aren’t sure your body is ready.
Speak to your doctor or seek medical care promptly if you have a fever, burning when you pass urine, blood in your urine, severe pain around your scar or perineum, signs of infection (redness, heat, foul-smelling discharge), or if you become unable to pass urine.
You don’t have to get used to it
Many women spend years wearing pads “to be safe” and giving up things they enjoy. You don’t need to get used to that. Listening to what your body is communicating is the first step.
If you recognise yourself in this article, send us a message on WhatsApp. We’ll talk with you, answer your questions and find a time for an appointment that suits you.