Urinary incontinence in pregnancy: causes, symptoms, and treatment options

You look forward to those first flutters of movement and seeing the bulge of a tiny foot push against your belly. Less magical: leaking pee when you sneeze (and cough and laugh). Involuntary urine leakage, known as urinary incontinence, may be embarrassing, but it’s a common experience that affects more than half of women during pregnancy. As your baby grows, increased pressure on your bladder and changes to your pelvic floor can lead to leaks.

You don’t have to just deal with urinary incontinence during pregnancy. Pelvic floor exercises, lifestyle changes, and other techniques can help reduce leaks and improve bladder control during pregnancy.

Here, learn more about what causes urinary incontinence during pregnancy, plus practical strategies to help manage and treat it — including exercises and tips from Hinge Health physical therapists.

What is urinary incontinence in pregnancy?

Urinary incontinence during pregnancy is when you involuntarily or accidentally leak urine while you are pregnant. It can occur during any stage of pregnancy. Urinary incontinence takes different forms and can trigger leakage for different reasons. 

• Stress urinary incontinence (SUI) is the most common type of incontinence during pregnancy. Stress incontinence involves involuntary urine leakage when you do things that put extra pressure on your bladder, such as sneezing, coughing, or laughing, exercising, lifting, or bending over. Other activities, like jumping or squatting, can also cause an accidental leak.

• Urge incontinence can also affect some people during pregnancy. This is when you experience urine leaks after a sudden and intense urge to urinate.

• Mixed incontinence is when you experience more than one type of incontinence.

Causes of urinary incontinence in pregnancy

Urinary incontinence during pregnancy can be caused by changes in pelvic floor muscles, pressure from your expanding uterus, hormonal changes, a history of previous vaginal births, and existing bladder or pelvic floor issues before pregnancy. 

It often occurs when your pelvic floor muscles and other tissues that support your bladder don’t work as well as they should. Here’s more on common causes of urinary incontinence during pregnancy:

• Pelvic floor muscle strain. The pelvic floor is a group of muscles and connective tissues that stretch from the pubic bone to the tailbone, providing support for the bladder, bowel, and other pelvic organs, and playing a key role in continence. During pregnancy, changes in your body can place added pressure on the pelvic floor, sometimes straining these muscles and tissues. The muscles around the pelvis may also change during pregnancy, which can contribute to tension in the pelvic floor, explains Holly Tipp, PT, DPT, a Hinge Health physical therapist. This can make it more likely that activities that increase pressure in the abdomen — such as sneezing, laughing, or bending over — may occasionally lead to urine leakage.

• Your expanding uterus. The uterus sits behind and above your bladder. As your baby grows and your uterus expands, it can put pressure on your bladder and contribute to incontinence.

• Hormone changes during pregnancy. Pregnancy hormones make the pelvic floor muscles and connective tissues softer and more flexible, which helps the body prepare for birth. These changes are normal, but they can lead to less pelvic floor support, which may contribute to incontinence during pregnancy. 

• Nausea and vomiting. “Hormone changes during pregnancy can also cause nausea and vomiting,” says Dr. Tipp. Frequent vomiting can put extra strain on the pelvic floor muscles, which may sometimes lead to episodes of urine leakage. “As nausea and vomiting subside, symptoms of incontinence often improve as well,” she adds.

• Previous vaginal births. Research shows that women who’ve had a previous vaginal birth, especially with assistance from forceps or a vacuum, may be more likely to experience incontinence during pregnancy compared to those who have not given birth before. Vaginal delivery can bring changes to the muscles and nerves in the pelvic floor, bladder, or urinary sphincter (the ring of muscle that helps keep the urethra closed). These changes may lead to urine leakage.

• Bladder or pelvic floor issues before pregnancy. If you’ve had urinary incontinence before pregnancy, you’re more likely to experience urinary incontinence during pregnancy. The same is true for pelvic floor dysfunction. If you have a history of pelvic pain conditions or pelvic surgery, you may be at a higher risk of urinary incontinence during pregnancy, explains Dr. Tipp.   

Symptoms of urinary incontinence in pregnancy

Urinary incontinence symptoms depend on the type of incontinence. Stress incontinence is the most common type of incontinence in pregnancy, and can occur at any stage during pregnancy. With stress incontinence, you may leak urine with activities that put extra pressure on your bladder. The amount of urine leaked is usually small. If your bladder is full, you may pass larger amounts of urine. Stress incontinence symptoms include leaking urine with:

• Sneezing

• Coughing

• Laughing

• Exercising

• Lifting heavy

• Bending over

• Jumping

• Squatting

Some people may also develop urge incontinence during pregnancy. Urge incontinence involves a sudden and intense urge to pee, followed by leakage — often without warning and whether your bladder is full or not.

Mixed incontinence may occur during pregnancy as well. This is when you experience symptoms of more than one type of urinary incontinence — most often a mix of stress and urge incontinence.

When to see a doctor

Urinary incontinence is common during pregnancy. However, you should contact your healthcare provider if you experience any of the following:

• Symptoms of a urinary tract infection (UTI), such as urinary frequency combined with pain or burning with urination, foul-smelling urine, or cloudy urine

• Fever and chills (may indicate an infection)

• Pain of discomfort when you pee (dysuria)

• Nausea and vomiting (along with urinary symptoms)

• Visible blood in your urine (hematuria)

• Severe or sudden lower abdominal, lower back, or bladder pain

• Leaking thin, odorless, and clear fluid, or fluid that is straw-colored or tinged with brown or green (may be amniotic fluid)

• An inability to urinate at all (may indicate urinary retention, which is a medical emergency)

Treatments for urinary incontinence in pregnancy

To treat symptoms of urinary incontinence during pregnancy, your healthcare provider may recommend pelvic floor physical therapy and targeted exercises, bladder training, and techniques to engage your pelvic floor right before you sneeze or cough to help prevent leaks. Here’s a closer look at ways to treat urinary incontinence during pregnancy:

Pelvic floor physical therapy

Physical therapy (PT) and targeted exercises are key treatments for urinary incontinence during pregnancy due to pelvic floor muscle issues. Pelvic floor muscles help support your bladder and bowel by tightening (contracting) and releasing (relaxing) when needed. If these muscles or the surrounding tissues aren’t providing as much support — such as during or after pregnancy — you may notice changes in bladder control or occasional urine leakage. Weakness in the muscles around your hips can also play a role.

Targeted exercises can help strengthen, stretch, and coordinate muscles involved in bladder control, making it easier to prevent urine leaks during pregnancy and after childbirth. A physical therapist (PT) can assess your pelvic floor and related muscles and create an exercise plan tailored to your specific needs and stage of pregnancy. Physical therapists can also teach you how to adjust your daily activities to reduce urine leakage, recommend posture and movement strategies that support bladder control, and provide guidance on behaviors and habits that can help prevent symptoms from interfering with your everyday life. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. (See examples of pelvic floor exercises below.)

Bladder training

These are techniques that can help you train the muscles that control your bladder. Bladder training is most often used for people who urinate more frequently than “normal” (which is about seven times per day with two to four hours in between). It can also help manage urinary incontinence during pregnancy. Here’s how to do bladder training:

1. Set an interval goal. Decide on a target amount of time you want to wait between bathroom visits (say, two hours between trips to the bathroom).

2. Make a schedule. Plan out and write down the actual times you’ll go to the bathroom based on your interval goal. For example, if you wake up at 7 a.m. and choose a two-hour interval, you’d set bathroom times at 7, 9, 11, and so on. Having a schedule helps keep you accountable and makes it easier to track your progress over time.

3. Practice urge suppression if you feel the urge to urinate before your scheduled time. Delaying even five minutes can help your bladder learn to wait to empty.

4. Gradually adjust the interval between bathroom breaks until you reach three to four hours between trips.

Perform the ‘Knack’

Engaging your pelvic floor right before you cough or sneeze helps close your urethra so you avoid leaks. Pelvic floor physical therapists call this technique the ‘Knack.’ You can use it for any situation (sneezing, laughing, blowing your nose, straining during exercise, etc.) that increases abdominal pressure. “Practice it with a fake cough or laugh to get the hang of it,” says Dr. Tipp.

Here's how to Knack:

• Do a Kegel to contract the muscles in and around your urethra, vagina, and anus. 

• Maintain the contraction and perform a cough, then relax your pelvic floor muscles.

• Contract your muscles again and cough with more force, or perform repeated coughs.

• Vary the length of the contractions with a mix of quick (two seconds) and long (five to 10 seconds) holds to train your pelvic muscles for endurance and rapid response.

• Avoid holding your breath, pulling your stomach in, straining, or contracting other nearby muscles.

These exercises target specific muscles and functions involved in bladder control to help manage urinary incontinence during pregnancy.  Diaphragmatic breathing  promotes flexibility and endurance in the pelvic floor, while seated Kegels strengthen your pelvic floor muscles to help match the pressure from coughing or sneezing. Squats focus on the glutes and hips, areas closely connected to bladder support. Abdominal bracing builds strength and stability in the core to help maintain good pelvic floor function and prevent leakage when your body is under stress. Seated back bends stretch and release tightness in the pelvic floor, hips, inner thighs, and back, supporting greater comfort and flexibility for bladder control.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Tips to manage urinary incontinence in pregnancy

There are several simple lifestyle and self-care strategies — such as practicing healthy toilet habits, limiting bladder irritants, staying hydrated, and managing constipation — that can help manage urinary incontinence during pregnancy and reduce urine leakage. Here’s more about each option:

Practice healthy toilet habits 

A few simple changes to your bathroom routine can reduce strain on your bladder and pelvic floor. Consider the following tips:

• Aim to urinate every two to four hours. Avoid going “just in case” too early or waiting too long when you really need to go — both can be hard on your bladder. Try to listen to your body’s natural cues and avoid either extreme.

• Try not to push or strain to empty your bladder or bowels. Straining can put stress on your pelvic floor muscles. Instead, place a small stool or box underneath your feet so your knees sit higher than your hips. This can help relax your pelvic floor and make it easier to pass stool.

• Choose a relaxed position when you urinate. Make sure you’re fully supported — this helps your pelvic floor muscles relax, supports a steady urine stream, and allows your bladder to empty completely. Avoid hovering over the toilet seat.

Limit bladder irritants

If the lining of your bladder becomes inflamed or irritated by certain foods or beverages, it can lead to urine leakage and other symptoms. Consider cutting bladder irritants from your diet or reducing your intake.

Stay hydrated

Many people limit their fluid intake as a way to manage stress incontinence. But concentrated urine is actually a bladder irritant and can make things worse. Proper hydration or consuming water after bladder irritants can improve incontinence symptoms. You may need more hydration than usual during pregnancy to support your body and your growing baby. The American College of Obstetricians & Gynecologists recommends drinking 8 to 12 cups of water per day during pregnancy.

Manage constipation

Eat plenty of fiber, stay hydrated, and keep moving to help prevent constipation, which can put extra pressure on your bladder and increase the likelihood of urine leaks.

Is it safe to hold your pee during pregnancy?

Holding your urine for a short period of time — such as waiting a few minutes to reach a restroom — is generally not any less safe during pregnancy than it is when you’re not pregnant. However, it’s best not to make a habit of holding your pee for long stretches, as this can contribute to urinary tract infections (UTIs), which are more common during pregnancy, says Dr. Tipp. Regularly delaying urination can also have a negative effect on healthy bladder habits and bladder training, making it harder to recognize and respond to your body’s natural cues.  Aim to use the bathroom every two to four hours and listen to your body’s cues.

PT tip: Common doesn’t mean normal

“Urinary incontinence during pregnancy is common, but that doesn’t mean it’s something you just have to live with,” says Dr. Tipp. “There are effective strategies to help reduce leaks and improve bladder control.” 

Strengthening your pelvic floor muscles with exercises like Kegels provides important support for your bladder, and because these muscles are also connected to your core and hips, it’s helpful to stretch and strengthen all these areas together, she explains. Everyday habits matter, too. A physical therapist can look at the whole picture and develop a comprehensive plan to help you manage bladder control during pregnancy.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Cho, S. T., & Kim, K. H. (2021). Pelvic floor muscle exercise and training for coping with urinary incontinence. Journal of Exercise Rehabilitation, 17(6), 379–387. doi: 10.12965/jer.2142666.333

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5. NIH. (2019, July 5). Symptoms & Causes of Bladder Control Problems (Urinary Incontinence) | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/symptoms-causes

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