Evidence  

https://www.racgp.org.au/getattachment/9168d17f-0cec-4c20-9263-8e6d44db899d/attachment.aspx 

Stanley K Santiagu, Mohan Arianayagam, Audrey Wang  

Most urinary incontinence can be evaluated and treated in the primary care setting after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle treatment.  

Education 

One in three women who have ever had a baby will experience incontinence. The more babies you have, the greater the risk of leaking urine. 

What is the bladder’s role? 

The bladder is a storage organ that sits in your pelvis. Urine (wee) is made by your kidneys and is stored in the bladder until you are ready to empty it. 

When you go to the toilet your bladder outlet muscles (urethral sphincter and pelvic floor) relax and your bladder contracts (squeezes) emptying the urine. Your brain controls your bladder by sending messages through the nerves in your spinal cord to tell it when to hold on and when to empty. 

Why do you leak urine after having a baby?  

It is rare for the bladder itself to be damaged during birth, but the muscles and nerves are often over stretched, more so in full term pregnancies. The muscles can sometimes be left weak and cannot keep all the urine in the bladder. The bladder then leaks.  

Leaking urine known as ‘urinary incontinence after childbirth is very common and more often in full term births than a preterm birth. 

Some new mothers may leak urine when they laugh, sneeze, cough or exercise. This is known as stress incontinence. 

You are more likely to develop stress incontinence after birth if you: 

• have bladder or bowel problems before pregnancy – they are likely to get worse after the birth 
• bladder problems during the pregnancy 
• are having your first baby 
• are having a large baby 
• have a long labour, especially a long second stage of labour 
• have a difficult delivery, such as needing stitches, tearing, or needing a vacuum cup or forceps during the delivery 

Women who have a caesarean can also develop bladder problems. Having a caesarean can reduce the risk of severe incontinence from 10% to 5% for the first baby, but after the third caesarean women are just as likely to develop bladder problems as women who give birth vaginally. 

Postpartum urinary incontinence can range from a few drops to the complete emptying of your bladder. You may also feel like you have to go all the time; this is known as urge incontinence. While less common than stress incontinence, it can definitely happen to postpartum women. 

Most women who leak urine after childbirth find that it goes away in the first few weeks, as the stretched muscles and tissues recover. It is recommended that you start pelvic floor exercises as early as 2 days after birth, but always check with your healthcare team before you start.  

However, for some women it can take months while others find their pelvic floor never recovers fully. 

Another Incontinence issue to be aware of is Urinary retention which is the inability to empty the bladder completely. This may result in leaking small amounts of urine (wee) on a regular basis. 

If you are experiencing urine leakage, you can talk to your, doctor, midwife, maternal and child health nurse, continence nurse or a women’s physiotherapist. Remember dealing with it early can reduce the risk of it becoming a life-long problem. 

What can you do to help Incontinence? 

Use good toilet habits  

• It is normal to go to the toilet four to six times each day 
• Don’t get into the habit of going to the toilet ‘just in case’. Try to go to the toilet only when your bladder is full 
• You should pass about 300-400ml each time you go to the toilet; and  
• It is OK to get up once each night to pass urine. Try not to go just because you have to get up to the baby. 

Look after your pelvic floor muscles  

• Keep your pelvic floor muscles strong with pelvic floor muscle exercises

Keep good bowel habits  

• Avoid constipation  
• Do not strain when using your bowels. This puts extra load onto your pelvic floor muscles and may weaken the muscles. The pelvic floor muscles help with bladder and bowel control  
• Eat two pieces of fruit and five serves of vegetables daily; and  
• Keep active. Physical activity helps to keep your bowels regular. 

Drink fluid every day  

• Fluid is everything you drink. Fluid includes milk, juice and soup. The best fluid to drink is water; and  
• Reduce intake of caffeine drinks (coffee, tea), alcohol and fizzy beverages. These drinks can irritate your bladder. 

Seek Help  

Seek help from your doctor, continence physiotherapist or continence nurse advisor if you:  

• wet yourself when you cough, sneeze, laugh or lift, even if it is only a few drops  
• leak when you stand up or do sports or other activity  
• have an urgent need to pass urine and you have a strong feeling of not being able to hold on  
• leak on the way to the toilet and don’t always get to the toilet on time  
• pass small amounts of urine often through the day 

The following video answers the question about why women have an increased risk of leaking urine (wee) after childbirth. The video also provides information on pelvic floor exercises, good bladder and bowel habits and where to go for help in a simple and easy to understand manner. 

Produced by the Continence Foundation of Australia in association with Jean Hailes for Women's Health. Based on the one in three women who ever had a baby wet themselves booklet developed by the National Continence Program, an Australian Government initiative. 

Empowerment  

As annoying as incontinence can be, there are ways to improve the situation in those first few weeks after birth. It is also not something you need to live with, should your symptoms last longer than that. 

In many cases incontinence can be prevented, better managed and even cured. Talk to your doctor, a continence health professional or contact the National Continence Helpline on 1800 33 00 66. 

The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services. 

Useful Links  

Special thanks to The Continence Foundation of Australia for content sharing and providing support for families.   

Continence Foundation of Australia 

www.continence.org.au 

The national peak body for continence awareness, management, education, research and advocacy. Free information and resources are provided to individuals, carers and professionals.  

National Continence Helpline 

1800 33 00 66 

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 

https://ranzcog.edu.au/wp-content/uploads/2022/05/Stress-Urinary-Incontinence-KK19.pdf 

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