Postpartum Incontinence: What You Need to Know.

You sneeze, and—oops. A friend makes you laugh, and—oops. You run after your rambunctious dog, and—oops.

Experiencing occasional incontinence is one of those post-pregnancy side effects that takes women by surprise. Many women just accept it (and try to avoid triggering it), but you don’t have to. We spoke with Richmond urogynecologist Dr. Tovia M. Smith, of Virginia Women’s Center, about common misconceptions around incontinence and treatment options.

I can’t talk to my doctor about postpartum incontinence—it’s so embarrassing!

Many women are embarrassed about incontinence, or they don’t know who to turn to, Dr. Smith says. That’s why “here at Virginia Women’s Center, we really make a point to ask about it.”

Incontinence is one of those post-pregnancy side effects that takes many women by surprise. It’s totally normal and expected, Dr. Smith reassures her patients. “Many women don’t seek care because they aren’t that bothered by it,” she says, and that’s OK. At the same time, if postpartum incontinence is affecting your quality of life, it’s time to talk to your doctor.

Incontinence will go away on its own in a few months—right?

After childbirth, your body needs time to recover and function normally. If you’re not nursing, your period usually returns around the third month postpartum. If you are nursing, you may not get your period for several months.

Having regular periods means “your body’s back to its new normal, hormonally speaking,” Dr. Smith explains, and that means episodes of incontinence should decrease: “The majority of women do improve, to the point where it’s no longer a major quality-of-life issue.” But if you’re still leaking six months postpartum (and not nursing), it may be time to seek advice from your doctor.

If I’d had a C-section, I wouldn’t have problems with incontinence now.

Having a C-section does not necessarily prevent it, Dr. Smith says. While prolonged pushing (2+ hours) or having a forceps delivery are associated with an increased risk, postpartum incontinence is caused by many factors.

Number one is hormones. During pregnancy, progesterone levels are elevated, which relaxes muscles such as the esophagus (leading to reflux) and the urethral sphincters, which control the flow of urine from the bladder. “I call it the loosey-goosey hormone,” Dr. Smith says.

Another factor is pregnancy-related trauma to the nerves that run through the pelvic floor to the urethra. The weight of carrying a baby for nine months, plus the trauma of childbirth, can damage nerves and impair the brain-to-bladder connection. “I don’t know when I have to pee anymore,” women tell Dr. Smith.

Other causes are simply environmental. New moms may be drinking a lot of water if they’re nursing, but they’re so busy caring for their newborn that they often forget to go to the bathroom.

Incontinence is a problem for me, but there’s nothing I can do about it. 

When postpartum incontinence is persistent and affecting a woman’s quality of life, there are several treatment options. The first is Kegel exercises, which aren’t as simple as women think they are! Dr. Smith recommends working with a physical therapist on muscle training to strengthen the pelvic floor and improve biofeedback to “really make that brain to pelvic connection.”

Another option is a pessary, a small device that increases the resistance in the urethra. Dr. Smith shows women how to put it in place and take it out. A pessary is completely removable and reversible.

When incontinence persists, Dr. Smith asks two questions: “Is this bothersome enough to you to take a surgical step? And are you done with childbearing?” If the answer to both is yes, she may recommend a urethral sling, which lifts the urethra and exerts pressure to help control the flow of urine.

For many women, the biggest relief they feel is simply knowing they’re not alone in dealing with postpartum incontinence. The first step toward a solution is making an appointment by calling 804.288.4084.