Why Am I Still Leaking Pee Months After Giving Birth | HER Body PT

JAN 2025

Frustrated?  I know it!  Leaking pee months after giving birth is probably the #1 reason women reach out for physical therapy help.

Here are the top  5 reasons this might occur:

1. The pelvic floor is weak and/or uncoordinated.  Carrying a baby on top of those muscles for so many months can cause lengthening/stretching of the pelvic floor muscles which results in weakness.  Additionally, some women lose connection with those muscles during pregnancy and when we can't tap into them easily, leaking can occur due to lack of awareness and coordination. 

2. Poor pressure management.  If you find pee running down your leg with a cough or sneeze, this can be a sign that a pressure problem is present and when the pelvic floor is under pressure, the "gates" open and leaking can occur. 

3. Tight or overactive pelvic floor muscles.  This one usually surprises women because more often than not, we assume leaking is due to weakness.  If the pelvic floor muscles are too tight and grippy, is loses its ability to function appropriately.  A tight pelvic floor cannot generate the power it needs.  Sometimes, we have to lengthen BEFORE we strengthen.

4. Hormonal changes.  Low Estrogen levels in particular can influence the health of your pelvic floor.  Although these changes are normal postpartum, for some women they can cause problems, especially when paired with any of the above issues.

5. Lack of targeted rehab.  In many countries, outside the US, pelvic floor rehab is a standard part of postpartum care.  When a patient is scheduled for a total knee replacement, you better believe that patient is usually referred to "pre hab" and post op rehab.  Why aren't we doing that with pregnant women?  If we can catch some of these issues before/during pregnancy, perhaps they will not be present postpartum...or at least mitigated.  Self care postpartum is essential and women deserve to have a team supporting them throughout the first year and beyond.