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Postpartum urinary leakage: Why, When, How Much and for How Long?

The significance of the changes associated with pregnancy and childbirth to a woman’s body cannot be overstated. Life will, in so many ways, never be the same. Hopefully, however, urinary leakage, so prevalent during pregnancy and immediately after delivery, will not be one of those permanent changes. Almost all women experience pelvic pressure, urinary frequency and urgency sometime during pregnancy. By late in pregnancy, many women will experience urinary leakage – thus the common late third trimester uncertainty about whether a damp sensation is the result of urine leak or amniotic fluid (‘water has broken’) and the baby is on the way!  Immediately, and for several months after delivery, particularly if a woman has delivered vaginally or attempted to do so, many, many women experience urinary leakage. This can vary from small drops of urine to total loss of bladder control requiring pads. There are a number of factors which can contribute to the development of leakage: the sustained pelvic pressure of the baby’s head during development, the stretching of tissues in the pelvis as passage occurs through the vaginal canal, and the additional body weight and normal hormonal changes associated with delivery and breastfeeding.

The good news, however, is that many, if not most, women will return fairly quickly to their pre-pregnancy urinary function. That does not mean that women cannot or should not effect their own recovery with a variety of strategies that promote and speed pelvic floor health. And the tendency for so many women to ‘bounce back’ quickly may lead some providers to dismiss the anxiety and worry women feel about urine leakage. Also, it may lead to misguided attempts to minimize or placate concerns that go well beyond the ‘normal’ interval or degree and represent more serious conditions which can and should be treated.

So how can you know what is normal and when to seek medical attention?

A good benchmark is that it might take as long as it did to grow and carry your child for normal function to return. However, a fairly steady trend toward progression and improvement should occur over that time. Also, while moderate or smaller changes might well persist, a massive change in urinary function that lasts many weeks or months beyond delivery should be evaluated.

  • Be vocal about how much leakage you are experiencing and when this is occurring.
  • Attempt to identify and describe whether your symptoms are totally new or an exacerbation of urinary issues that existed prior to delivery.
  • Advise your providers if you are also experiencing vaginal or urinary discomfort or pelvic pain.

Your provider will evaluate for infection, vaginal or bladder injury and other causes of leakage. Assuming the evaluation is normal, there are a number of interval steps you can take to promote and expedite your return to normal bladder function.

Some simple strategies that can improve urinary function significantly include:

  • Adequate consumption of H20 and avoidance of bladder irritants like caffeine. While there is no perfect amount of fluid intake, breastfeeding women definitely need more water. Paradoxically, dehydration can lead to over concentrated urine which can be very irritating to the bladder
  • Gentle exercise and gradual weight loss
  • Regular timed voiding — new babies are very demanding but putting off bathroom visits for hours and hours can lead to worsening urgency and leakage.
  • Daily vaginal lubricants to promote vaginal health (with or without hormone component)
  • Oral medications (if not breastfeeding)
  • Kegel exercises
  • Consultation with a pelvic floor physical therapist

With proper attention and care, post op urinary issues shouldn’t hold you back from enjoying an active lifestyle and your brand new baby!

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