Why am I leaking urine after delivery?
Because the muscles that hold urine in have been stretched. The pelvic floor is a sling of muscle between the pubic bone and the tailbone. It supports the bladder, uterus and bowel and closes the urine passage when you cough. Pregnancy hormones, the weight of the baby and its passage through the birth canal stretch this sling and can bruise the nerves that control it.
The stretch is greater after a long labour, a large baby, a forceps or vacuum delivery, or a bad tear. A caesarean lowers the risk but does not remove it. Leaking with a cough, sneeze or laugh is stress incontinence. A sudden urge with leaking before you reach the toilet is urge incontinence. Many women have both.
See a doctor soon
If you cannot pass urine at all, if there is blood in the urine, if burning comes with fever, or if you cannot control motion (stool) or wind after delivery, do not wait for the six-week check. These need to be seen within a day or two. Call or WhatsApp the clinic.
How common is it, and does it go away?
Roughly one in three women leak urine in the first three months after a vaginal birth. As the swelling settles and the nerves recover, most women improve by three to six months, faster if they exercise the pelvic floor. A smaller number are still leaking at a year, and untreated leaking can return around menopause, which is why the exercises matter now.
How do I do pelvic floor exercises?
Pelvic floor exercises (Kegel exercises) are the first treatment. Start as soon as passing urine is comfortable, usually within a few days of delivery.
- Find the muscles. Imagine stopping wind and urine at the same time; you should feel a lift inside, not a push down, with buttocks, thighs and belly relaxed. Do not practise by stopping the flow.
- Sit or lie with your knees bent and breathe normally; holding your breath pushes down instead.
- Slow squeezes. Squeeze and lift, hold for three seconds, then relax for three seconds. Build up to a ten-second hold, ten times.
- Quick squeezes. Ten fast, strong squeeze-and-let-go movements.
- Do both sets three times a day, for example at each feed.
- Tighten just before you cough, sneeze, laugh or lift the baby, and hold it through.
- Keep going. Most women notice a change in six to twelve weeks. Continue daily for at least six months, then one set a day.
If you cannot feel the muscles, Dr. Ragavi checks the squeeze during a short examination and corrects it. A lady attender is present.
What bladder habits help?
- Pass urine every three to four hours. Going "just in case" every half hour teaches the bladder to hold less.
- Drink normally, about one and a half to two litres a day. Strong urine irritates the bladder.
- Avoid constipation. Straining on the toilet loads the pelvic floor.
- When the urge comes suddenly, stand still, do a few quick squeezes, breathe out, and walk to the toilet once it passes.
What if it is not settling by three to six months?
Book a check, or sooner if the leaking is getting worse. Look out too for signs of the uterus or bladder coming down (prolapse): something coming down or a ball at the opening, heaviness by evening, or needing to press to empty the bladder or bowel. Prolapse after delivery is common and treatable.
At the visit, Dr. Ragavi Vikram asks how and when you leak, tests the urine for infection, and examines the pelvic floor and any prolapse. Read more about urine leakage and prolapse treatment in Chennai. Patients from Velachery, Nanganallur and Keelkattalai usually see her at RV Clinic Madipakkam.
What treatments are there?
At the clinic, treatment starts with supervised pelvic floor training and bladder retraining, plus treating anything that makes it worse: a urine infection, constipation, a cough. While you breastfeed, low oestrogen thins the tissues around the urine passage, and a little oestrogen cream applied locally can help. For urge leaking that does not settle, there are tablets that calm the bladder, chosen with breastfeeding in mind. For prolapse, a soft silicone ring placed in the vagina (a pessary) supports the uterus while the muscles recover.
Surgery is for the minority whose leaking or prolapse does not improve after months of treatment. Dr. Ragavi performs pelvic reconstruction surgery herself at Unittas Multispeciality Hospital. No operation is done at either clinic.
Frequently asked questions
Delivery aagi aaru maasam aachu, innum urine leak aagudhu. Normal-a?
Six months on, it should have improved a lot. If it has not, book a check. It is treatable at any stage, and most women do not need surgery.
I had a caesarean. Why am I leaking?
Pregnancy itself stretches and softens the pelvic floor, whichever way the baby was born. It usually settles, and the same exercises help.
Will I need surgery?
Most women do not. Surgery is considered only when exercises and other treatment have not worked after several months, and it is done at the affiliated hospital.
Book a consultation
Still leaking at three months, or something feels like it is coming down? Call or WhatsApp the clinic. Appointments are usually available the same day at Madipakkam and Thalambur.