Urinary Leakage During Pregnancy: What's Normal, What Helps, and What to Do Next
Written and reviewed by Anna McMaster, PT, DPT, PRPC
It happened. You sneezed and a tiny bit of pee leaked out. Ugh. I'm sorry that happened, but don't fret, you are far from alone, and there are things we can do to help right now, during pregnancy, and postpartum too.
Why Does Leakage Happen During Pregnancy?
Urinary leakage during pregnancy happens primarily because of the extra pressure the growing weight of your baby places on your bladder and pelvic floor muscles. As your uterus expands, it sits directly on top of your bladder, reducing its capacity and making it harder for your pelvic floor to do its job of keeping everything in.
There are two main types of urinary incontinence (UI) that pregnant women experience:
Stress Urinary Incontinence (SUI) is leakage that occurs when added stress is placed on the pelvic floor muscles and they can no longer hold their contraction, allowing a bit of urine to escape with a cough, sneeze, run, laugh, or even vomiting. This is the most common type during pregnancy. Research shows that approximately 42% of women experience SUI in the later weeks of pregnancy, making it the highest prevalence point throughout pregnancy and the first year postpartum.
Urge Urinary Incontinence (UUI) is leakage that occurs after a feeling of intense urgency, that sudden "I really really need to go right now" sensation that doesn't give you much warning. UUI is less common during pregnancy than SUI but worth knowing about, especially if frequent urgency is bothering you.
Some women experience a combination of both, called Mixed Urinary Incontinence (MUI).
What You Can Do About It Now
Try "The Knack." Did you know that your pelvic floor muscles automatically contract just before you cough or sneeze to prevent leakage? This reflex can become less reliable during pregnancy. What you can do is try to catch yourself right before you sneeze or cough and perform a strong, quick pelvic floor contraction, hold it during the cough or sneeze. This technique, known as "The Knack," helps manually compensate for that automatic reflex when it isn't firing fast enough.
Don't just do a bunch of kegels blindly. This is important: a weakened pelvic floor is not always the cause of leakage. Sometimes the issue is a pelvic floor that is too tight, or a timing problem with when the muscles contract. Doing kegels when your pelvic floor is already overactive can actually make things worse. If you're not sure which issue you're dealing with, this is exactly why seeing a pelvic floor PT is so valuable, they can assess what's actually going on and give you exercises that address the real problem.
Stay well hydrated. Counterintuitively, not drinking enough water can actually irritate your bladder and worsen urgency symptoms. Aim for consistent fluid intake throughout the day rather than large amounts at once.
What Happens After Baby?
For many women, urinary leakage resolves on its own after delivery, as the extra pressure on the pelvic floor is relieved. However, research shows that approximately 26% of women continue to experience UI postpartum. And here's the stat worth paying attention to: research following women for 12 years after birth found that nearly 38% still experienced UI more than a decade later — which is exactly why early intervention matters.
Risk factors for UI continuing postpartum include vaginal delivery, perineal tears or episiotomy, delivering a larger baby, instrumental delivery such as forceps, older maternal age, higher BMI, and a history of UI before or during pregnancy. Having one or more of these risk factors doesn't mean you're destined for long-term leakage, it just means being proactive about your pelvic floor care is even more important.
When to See a Pelvic Floor PT
Here's the honest truth: if you have any leakage at all, it's worth seeing a pelvic floor physical therapist. Leakage is common, but it is not something you just have to live with. Contrary to what you might have heard, it's rarely just about doing more kegels. A pelvic floor PT will assess the full picture, muscle strength, coordination, tension, and timing, and give you a personalized plan that actually addresses the root cause.
Ideally, seeing a pelvic floor PT during pregnancy sets you up for a better postpartum recovery. But if you're reading this postpartum and still dealing with leakage, it is never too late to get support.
For a personalized pelvic floor program designed by a pelvic floor PT for every stage of pregnancy and postpartum, Amie is here to help.
References
Sangsawang B., Sangsawang N. (2013). Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. International Urogynecology Journal, 24(6), 901-912.
Chen H., et al. (2023). The prevalence, associated factors, and impact of urinary incontinence in pregnant and postpartum women in Nanjing, China: a cross-sectional study. BMC Pregnancy and Childbirth.
MacArthur C., et al. (2016). Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 123(6), 1022-1029.
Zhao Y., et al. (2023). Prevalence and factors of urinary incontinence among postpartum women: systematic review and meta-analysis. BMC Pregnancy and Childbirth.
Woodley S.J., et al. (2020). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 5, CD007471.
Dumoulin C., et al. (2021). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 5, CD005654.