Pregnancy, birth and the pelvic floor

Why it happens

• the growing uterus presses on the bladder, so you need to go more often;
• pregnancy hormones make ligaments and connective tissue softer and more elastic;
• during a vaginal birth the pelvic floor muscles, nerves and ligaments are stretched a great deal and sometimes injured;
• after birth the muscles need time to regain strength.

According to the study in Kazakhstan, the odds of incontinence were higher in women after vaginal births, multiple births and giving birth to a large baby.

During pregnancy

Pelvic floor training. International guidelines recommend offering pelvic floor exercises to all women during their first pregnancy. According to a Cochrane review, pregnant women without symptoms who trained regularly had roughly a 60% lower risk of incontinence in late pregnancy. The exercises are safe for most pregnant women, but if there are complications (threatened miscarriage, bleeding), check with your doctor first.

What else helps:

• monitoring weight gain with your doctor;
• preventing constipation: fibre, fluids, movement;
• staying active: walking, swimming, pregnancy exercise classes;
• not cutting back on drinks, even if you have to go more often.

If you already leak, be sure to tell your obstetrician. It's a common, treatable problem — not something you just have to put up with.

The first weeks after birth

• Start with gentle pelvic floor squeezes lying down, as soon as it feels comfortable and your doctor agrees. After a caesarean, wait for your surgeon's go-ahead.
• Don't lift anything heavier than your baby; ask for help where you can.
• Avoid straining: prevent constipation and, if needed, ask your doctor about gentle laxatives.
• Drink enough while breastfeeding.
• Tighten your pelvic floor in advance when lifting your baby or coughing.

Returning to sport

Don't rush back to high-impact exercise. Running, jumping, strength training and ab exercises are usually resumed no earlier than 3 months after birth, and only if there's no leakage, heaviness in the vagina or pain. Start with walking, swimming and pelvic floor recovery. If you leak during exercise, it's a signal to reduce the load and seek specialist advice.

When to see a doctor

Some leakage in the first weeks after birth is common and often settles on its own. See a doctor if:

• leakage hasn't improved 6–8 weeks after birth;
• it interferes with daily life;
• you feel heaviness, pressure or a "bulge" in the vagina;
• you leak wind or stool;
• you have pain, burning when passing urine or a temperature;
• symptoms first appear some time after the birth.

Use your postnatal check-ups to ask about your bladder and pelvic floor: a doctor can check your muscle strength and teach you the right technique.

Your next pregnancy

If you had incontinence after a previous birth, tell your doctor early in your next pregnancy. Keep up pelvic floor training and weight management. The mode of delivery is discussed individually.

Sources

1. Woodley SJ, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471.
2. NICE guideline NG123. 2019. nice.org.uk
3. Ryspayeva Zh, et al. IJERPH. 2026;23(7):893. mdpi.com