I get asked this question more than almost any other in my practice.

It usually sounds like: “I’ve been leaking a little when I sneeze. Is that just normal now? My friend said it happens to everyone after having a baby.”

Here is my answer: it is common. It is not normal. And it is not something you have to live with.

The distinction matters because “normal” implies it is expected, acceptable, and unchangeable. Common means it happens a lot, but something that is common can still be addressed, improved, and often resolved.

 

How Common Is Postpartum Leaking?

Very. Research estimates that approximately one in three women experience some form of urinary incontinence in the postpartum period. For women who had vaginal deliveries, the rates are higher in the short term. But incontinence after C-section is also common, the months of pregnancy alone, without vaginal delivery, can affect pelvic floor function.

The fact that it is so common is part of why it gets normalized. When a significant portion of the women around you are experiencing the same thing, it begins to feel like the territory that comes with motherhood. And healthcare providers, under time pressure, often do not address it proactively, which further reinforces the impression that it is just something to accept.

It is not.

 

Why Postpartum Leaking Happens

Stress urinary incontinence (the type triggered by sneezing, coughing, laughing, jumping, or heavy lifting) is caused by insufficient closure pressure at the urethra when intra-abdominal pressure spikes suddenly.

Normally, the pelvic floor pre-activates a fraction of a second before a cough or sneeze, bracing the urethra against the pressure increase. After delivery (or after months of pregnancy loading the pelvic floor without rehabilitation) this timing mechanism can be disrupted. The pelvic floor is present. It just is not firing at the right moment.

Urgency incontinence (the sudden, overwhelming urge to urinate) is a different mechanism. It involves the detrusor muscle (the bladder wall) contracting involuntarily before the bladder is full, often triggered by sounds, running water, or arriving home. This type is more common in women with an elevated or overactive pelvic floor tone.

Both types are functional problems, not structural ones. The bladder is not broken. The urethra is not permanently damaged. The coordination system governing their function has been disrupted, and it can be restored with appropriate rehabilitation.

 

What Makes It Worse

Several things increase the likelihood of postpartum incontinence persisting or worsening:

Returning to high-impact activity too soon, before the pelvic floor has regained its coordination. Box jumps, running, double-unders, heavy lifting all require a functional pelvic floor to manage the pressure spikes.

Doing Kegels incorrectly, or doing Kegels when the pelvic floor is already tight rather than underactive. As I covered in a separate article, Kegels are not the right answer for every type of incontinence.

Dehydration. Concentrated urine is more irritating to the bladder lining and can worsen urgency.

Chronic constipation. Straining increases pelvic floor loading and worsens both types of incontinence over time.

Ignoring symptoms and hoping they resolve, which is the most common approach and the one that leads to symptoms becoming a long-term pattern.

 

What Actually Helps

The most evidence-supported treatment for postpartum stress incontinence is supervised pelvic floor rehabilitation, not just Kegel instruction, but coordinated re-education of pelvic floor timing and integration with the deep core.

When a trained provider assesses the pelvic floor and identifies whether the issue is underactivity, overactivity, or a coordination deficit, the treatment can be targeted appropriately. The results are meaningful and well-documented. Pelvic floor rehabilitation consistently reduces or eliminates stress incontinence in postpartum women who engage with a complete program.

Chiropractic care contributes through the nervous system and musculoskeletal dimensions: restoring lumbar and sacral mechanics that affect pelvic floor function, addressing the stress-response state that elevates pelvic floor tone, and building the foundational coordination between the diaphragm, core, and pelvic floor that manages intra-abdominal pressure effectively.

 

FAQ

How long does postpartum incontinence typically last?

Mild incontinence in the first six weeks often resolves as initial tissue healing occurs. Incontinence that persists beyond three to six months without rehabilitation tends not to resolve on its own and often worsens when physical demands increase. Early intervention produces the best outcomes.

Will it go away when I stop breastfeeding?

The hormonal changes of weaning can affect pelvic floor tissue quality, and some women notice symptom changes around this time. However, incontinence driven by coordination deficits does not resolve with hormonal changes alone. Rehabilitation addresses the functional problem regardless of hormonal status.

Is surgery ever necessary for postpartum incontinence?

Surgery is occasionally considered for severe cases that do not respond to conservative care. However, most postpartum incontinence presentations respond well to conservative rehabilitation. Surgery before a complete trial of pelvic floor rehabilitation is premature in the vast majority of cases.

 

You Are Not Just Living With This Now

Postpartum incontinence is addressable. The tissue and coordination that were affected by pregnancy and delivery can be rehabilitated. Most women who commit to a complete pelvic floor rehabilitation program see significant improvement or full resolution.

If you have been accepting leaking as your new normal, come in. It does not have to be.

Schedule at cospineandjoint.com/schedule-appointment

With care,
Dr. Nisha Copeland, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment/