Leaking pee, also known as urinary incontinence, is very common after birth. In fact, one-third of moms will experience urine leakage within the first three months postpartum. Studies that looked at long-term prevalence found that there was little improvement over time if the issue was not addressed. 

Most moms will not experience leakage every day but will find that their symptoms are exacerbated during certain activities, such as coughing, sneezing, running or lifting. This type of urine leakage is called Stress Incontinence. Stress incontinence occurs when the stress on the bladder is greater than the strength of the sphincter muscles that stop the flow of urine. These muscles are part of the muscle group called the pelvic floor. After birth, these muscles become weak and need focused strengthening. In fact, the prevalence of Stress Incontinence is double after a vaginal birth versus a cesarean section.

Another type of incontinence is called Urge Incontinence. This type of urine leakage occurs immediately after a strong and sudden urge to pee. The urge is usually tied to a trigger, such as when you place your key into the lock of your front door (called key-in-lock syndrome). This has less to do with the strength of the pelvic floor muscles and more to do with poor bladder training. Oftentimes, moms have a mix of both.

If you sometimes leak urine and are at a loss of where to start, here are 5 things that you can start doing today to regain bladder control:

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1. Strengthen

If the muscles that stop the flow of urine are weak, you have to strengthen them. Studies show that focused pelvic floor strengthening, either by kegels or vaginal weights, are the most effective way to solve incontinence. 

The hard part is knowing if you’re doing your pelvic floor exercises correctly. An in-person pelvic floor PT is the best way to know, but here are some other ways to fine-tune your contraction from home:

Stop your urine flow:  The pelvic floor is a group of muscles that create a sling from your tailbone in the back to your pubic bone in the front. When trying to specifically strengthen to solve incontinence, you want to focus on the muscles in the front. You can practice this by trying to stop your urine stream next time you’re on the toilet. This is not the best place to do your kegel exercises, but it is a good way to learn what kegels feel like.

Feel the muscles: If you lie down and place your fingers along the inside of your sit bones, you should be able to feel the muscles tense during a contraction. You can even place your fingertips over your vagina and gently press into the tissue. Imagine drawing your vagina up and away from your fingers and feel how tension builds up in the muscles. Having tactile feedback can be very helpful when learning how to contract the muscles.

Now that you know how to kegel, you have to practice. Here’s a simple protocol:

Quick Flicks: Quick contraction, hold x 2 seconds, release. Repeat 10 times, 3 times/day.

Endurance Holds: Slow contraction, hold x 10 seconds, release. Repeat 10 times, 3 times/day.

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2. Fix your posture

Postpartum “mommy posture” increases downward pressure onto the bladder, which can increase a sense of urinary urgency and make it harder to contract the pelvic floor muscles.  The most common cause is a slouched rib cage that pushes down on the abdominal and pelvic organs. Stacking the rib cage in a more neutral alignment over the pelvis creates a lifting effect that can help with both urinary incontinence and prolapse. Learn more on how to fix mommy posture here. 

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3. Exhale on exertion

Coordinating your breath with movement helps your pelvic floor stabilize around the bladder during harder activities. The general rule of thumb is to exhale on exertion. The tip to “blow before you go” is also helpful in using your breath to pre-contract your deep core and pelvic floor before an activity. It’s also easy to implement wherever you are. Just start blowing out through pursed lips and feel how your deep core automatically turns on. Next time you pick up your little one, get up off the floor or try to lift all the grocery bags in one-go, start breathing out through pursed lips first.

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4. Eliminate bladder irritants

Our urine is created from the foods and drinks we put into our body, so it makes sense that what we eat might affect our bladder. Urine is acidic, but if the foods we eat cause it to be even more acidic, it can irritate the inner lining of our bladder. When that happens, the bladder will start contracting to get the urine out. And if you don’t have great bladder control, you might find yourself in the middle of an accident.  

Decreasing or eliminating common bladder irritants is a way to decrease leakage while working on strengthening the muscles. It’s not a forever thing (unless there’s another underlying condition going on), but it can be helpful while waiting for the muscles to get stronger. It can also be helpful for retraining urge incontinence.

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5. Retrain your bladder

If you have urge incontinence, retaining the signaling between your bladder and brain is essential. It’s hard work, but consistent effort makes a big difference! 

Our bladder is highly trainable, meaning creating healthy bladder habits can calm down excessive signaling of urgency. It also means that poor bladder habits can ramp them up. So what do you do?

First, identify your triggers. Is it when you get to the front door? Or when you hear running water? Think through any recent leakage events and write down potential triggers. 

Now that you know, you’ll be more prepared next time. Slowing down your breath, walking slowly and performing kegels all help to suppress the urge. 

If you’re triggered by putting the keys into the front door lock, start by taking out the keys while still in your car. As you leave the car, walk slowly towards the front door and practice some kegels along the way. When you get to the door, pause to take some deep breaths and perform more kegels before putting the key in the door. Once the key is in the lock, pause again. You’ll probably start feeling a wave of urgency rise, but staying calm, breathing and contracting your muscles will help you “ride the wave.”  Now turn the key to unlock the door and pause once again. Once you’re in the house, slowly walk to the bathroom. Anything that is rushed will signal urgency to the brain and cause increased urgency in the bladder. The goal is to slow the process down and wait long enough for the urge to subside. Once it’s gone, you can go to the bathroom.

It takes practice, but you can do it! If you’re triggered by another scenario, think through the situation and come up with a plan before you’re in the situation again.