Why Am I Leaking Urine After Having a Baby?

Why Am I Leaking Urine After Having a Baby? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

“I started leaking urine when I cough, sneeze, laugh, run, or exercise after having my baby. Is this normal after childbirth, and can physical therapy help?”

The Short Answer

Urinary leakage can occur during pregnancy and after childbirth, but it should not automatically be dismissed as something a person simply has to live with.

Leakage that occurs with activities such as:

• Coughing
• Sneezing
• Laughing
• Running
• Jumping
• Lifting
• Exercising

is commonly described as stress urinary incontinence.

Pregnancy and childbirth can affect the pelvic floor, abdominal wall, connective tissues, pressure-management strategies, and overall physical capacity. However, urinary leakage can have multiple contributing factors, and symptoms alone do not establish a specific diagnosis.

A physical therapist with appropriate pelvic health training can evaluate relevant muscle performance, movement, breathing, functional activities, and exercise tolerance and develop an individualized rehabilitation program when physical therapy is appropriate.

Is Urine Leakage Common After Pregnancy?

Yes.

Urinary leakage is a relatively common postpartum symptom.

That does not mean it should automatically be considered an unavoidable consequence of childbirth.

Research published in the British Journal of Sports Medicine in 2025 examined 65 studies involving more than 21,000 postpartum participants. The review found moderate-certainty evidence that pelvic floor muscle training reduced the odds of urinary incontinence compared with control conditions. 

A separate 2025 systematic review published in Physical Therapy also concluded that physical therapist interventions—particularly pelvic floor muscle exercises—may positively affect postpartum urinary incontinence, while noting limitations and variability across available studies. 

The practical message is:

Postpartum leakage is common, but help may be available.

What Is Stress Urinary Incontinence?

Stress urinary incontinence refers to involuntary urine leakage associated with increases in pressure during physical activity.

People may notice leakage while:

• Coughing
• Sneezing
• Laughing
• Running
• Jumping
• Lifting a child
• Exercising
• Performing higher-impact activities

The word “stress” in this context refers to physical pressure or loading—not psychological stress.

During these activities, the abdominal and pelvic floor systems must coordinate to manage changes in pressure.

When this system is not functioning effectively for the demands of the task, leakage may occur.

Why Can Pregnancy Affect the Pelvic Floor?

The pelvic floor is a group of muscles and connective tissues located at the bottom of the pelvis.

These structures contribute to:

• Bladder and bowel control
• Support of pelvic organs
• Sexual function
• Pressure management
• Trunk and pelvic coordination

Pregnancy creates substantial changes throughout the body.

Factors may include:

• Increasing abdominal load
• Hormonal changes
• Changes in posture and movement
• Changes in abdominal-wall function
• Increased pressure on pelvic structures
• Reduced activity in some individuals

Childbirth may add additional physical demands depending on the type of delivery and the individual's circumstances.

However, postpartum symptoms are highly individual.

Two people who experienced similar pregnancies or deliveries may have very different recovery needs.

Does Leakage Mean My Pelvic Floor Is Weak?

Not necessarily.

Pelvic floor muscle weakness can contribute to urinary leakage in some individuals, but the situation may be more complex.

A pelvic floor may demonstrate differences in:

• Strength
• Endurance
• Coordination
• Timing
• Relaxation
• Ability to respond to pressure
• Integration with breathing and abdominal activity

For that reason, simply telling every postpartum patient to “do Kegels” may not address the actual problem.

An individualized evaluation can help determine which impairments are relevant.

Should Every Postpartum Woman Do Kegels?

Not automatically in exactly the same way.

Pelvic floor muscle training has strong evidence supporting its role in urinary incontinence management, but an appropriate exercise program depends on the individual's presentation.

Some people may need greater emphasis on:

• Strength

Others may need:

• Endurance
• Coordination
• Relaxation
• Breathing
• Functional integration

Correct muscle activation is also important.

A recent 2026 systematic review and meta-analysis found pelvic floor muscle training reduced urinary incontinence and improved quality of life in women, supporting its role as an evidence-based treatment approach. 

However, exercise prescription should still be individualized rather than assuming one routine is appropriate for everyone.

What If I Am Not Sure Whether I Am Doing a Kegel Correctly?

You are not alone.

Many people are unsure whether they are correctly contracting their pelvic floor muscles.

Some may unintentionally:

• Hold their breath
• Tighten the buttocks excessively
• Brace the abdomen
• Bear down rather than lift
• Perform a very weak contraction
• Have difficulty relaxing afterward

A pelvic health physical therapist may provide education and feedback to help the patient better understand pelvic floor muscle coordination.

The specific assessment method depends on clinical need, patient comfort, therapist training, informed consent, and applicable professional standards.

Is Pelvic Floor Therapy Only About Kegels?

No.

Pelvic health physical therapy can involve much more than isolated pelvic floor contractions.

Depending on examination findings, rehabilitation may address:

• Pelvic floor muscle performance
• Breathing coordination
• Abdominal muscle function
• Hip muscle performance
• Functional lifting
• Squatting
• Carrying a baby
• Walking
• Returning to exercise
• Running progression when appropriate
• Pressure management
• Bowel and bladder habits
• Activity modification
• Patient education

The objective is to improve function in everyday life—not simply to complete a certain number of contractions.

Why Do I Leak When I Cough or Sneeze?

Coughing and sneezing create a rapid increase in pressure through the trunk and abdomen.

The pelvic floor must respond quickly to help maintain continence.

If the system does not adequately coordinate with that sudden demand, leakage may occur.

Physical therapy may therefore address not only maximum muscle strength but also:

• Timing
• Coordination
• Endurance
• Pressure management
• Functional strategies

These may then be integrated into everyday activities.

Why Do I Leak When Running?

Running creates repeated impact and requires coordinated control from the:

• Pelvic floor
• Abdominal wall
• Hips
• Legs
• Trunk

Someone may feel comfortable during walking yet experience leakage during running because running places greater and more repetitive demands on the body.

That does not automatically mean running is harmful.

It may indicate that the person needs a more gradual return-to-running progression or additional rehabilitation before tolerating that level of activity.

Do I Have to Stop Exercising If I Leak?

Not necessarily.

Physical activity provides important health benefits.

The goal is generally not to make patients afraid of exercise.

Instead, depending on symptom severity and clinical findings, exercise may be temporarily modified while physical capacity is progressively restored.

For example, an individualized program may temporarily adjust:

• Running
• Jumping
• Heavy lifting
• High-impact classes
• Exercise duration
• Exercise intensity

while strengthening and functional training progress.

The appropriate approach varies between individuals.

Can Physical Therapy Help Postpartum Urinary Leakage?

Yes.

Pelvic floor muscle training is one of the most extensively studied conservative interventions for urinary incontinence.

A 2025 systematic review and meta-analysis found that postpartum pelvic floor muscle training was associated with a 37% reduction in the odds of urinary incontinence compared with control groups in the included randomized trials. 

Another systematic review focused specifically on physical therapist interventions found that pelvic floor muscle exercise programs may have a positive effect on postpartum urinary incontinence, though protocols varied substantially among studies. 

Depending on the patient's examination, physical therapy may include:

• Pelvic floor muscle training
• Breathing exercises
• Abdominal and trunk strengthening
• Hip strengthening
• Functional exercise
• Movement coordination training
• Pressure-management education
• Progressive return to impact
• Lifting strategies
• Home exercise programs
• Education regarding bladder habits
• Biofeedback when clinically appropriate and within the therapist's training

Treatment should be individualized.

Is Postpartum Rehabilitation Only for the First Six Weeks?

No.

Postpartum recovery does not suddenly end at a specific date.

Patients may seek help:

• Several weeks postpartum
• Several months postpartum
• A year later
• Several years after childbirth

This is particularly relevant because Los Angeles-area pelvic health practices are currently promoting educational programs emphasizing that postpartum recovery can extend well beyond the traditional six-week checkup. One local September 2026 workshop specifically addresses persistent leakage, pelvic pressure, core recovery, and safe return to exercise. 

If symptoms continue to interfere with exercise or everyday life, an individualized evaluation may still be appropriate.

Does Having a C-Section Protect Me From Pelvic Floor Problems?

Not necessarily.

Cesarean delivery changes some of the physical demands associated with childbirth, but pregnancy itself also places substantial demands on the pelvic floor, abdominal wall, and surrounding structures.

People who deliver by C-section can still experience:

• Urinary leakage
• Pelvic symptoms
• Abdominal weakness
• Pain
• Difficulty returning to exercise
• Functional limitations

A postpartum rehabilitation plan should therefore be based on symptoms and examination findings rather than delivery type alone.

Can Physical Therapy Help With the Core After Pregnancy?

Potentially.

The pelvic floor works together with the abdominal wall, diaphragm, trunk muscles, hips, and other systems involved in movement and pressure management.

Postpartum rehabilitation may therefore include abdominal and trunk exercises when appropriate.

The 2025 postpartum exercise systematic review found low-certainty evidence that abdominal muscle training reduced inter-rectus distance in individuals with diastasis recti, while pelvic floor muscle training improved urinary continence outcomes. 

This supports looking at postpartum rehabilitation as more than isolated pelvic floor contractions.

What About Diastasis Recti?

Diastasis recti refers to increased separation between the two sides of the rectus abdominis muscle along the midline connective tissue.

It is common during pregnancy and can remain postpartum.

However, the presence of separation alone does not automatically mean the abdominal wall is damaged or that exercise should be avoided.

A physical therapist may assess:

• Abdominal muscle function
• Functional strength
• Movement
• Breathing
• Pressure management
• Exercise tolerance

Treatment should focus on function rather than creating fear around a measurement alone.

Is Urinary Leakage “Normal” After Having a Baby?

A useful distinction is:

Common does not necessarily mean something must be ignored.

Many postpartum patients experience urinary leakage.

That does not mean symptoms should automatically be accepted indefinitely.

This growing need for pelvic healthcare is being recognized nationally. In July 2026, APTA reported that demand for pelvic health physical therapy is outpacing access, highlighting both workforce shortages and growing patient need. 

Los Angeles is seeing similar growth in pelvic health services, including expanded specialty pelvic PT access and postpartum programs. 

What Does Research Say?

The evidence supporting pelvic floor muscle training continues to strengthen.

A 2025 systematic review and meta-analysis involving 65 studies and 21,334 postpartum participants found moderate-certainty evidence that pelvic floor muscle training reduced the odds of postpartum urinary incontinence. 

A 2025 systematic review published in Physical Therapy, the journal of the American Physical Therapy Association, examined physical therapist interventions aimed at preventing postpartum urinary incontinence and found generally positive effects from pelvic floor muscle exercise programs, while also emphasizing heterogeneity among studies. 

Most recently, a June 2026 systematic review and meta-analysis involving 14 studies and 2,192 participants reported improvements in urinary incontinence and quality of life with pelvic floor muscle training. 

Another 2025 systematic review evaluating different exercise approaches found that alternative exercise programs such as stabilization, breathing, Pilates, yoga, and hip exercises could also improve urinary incontinence compared with inactive controls, reinforcing the idea that rehabilitation can extend beyond isolated pelvic floor exercise. 

The evidence supports an active, individualized rehabilitation approach rather than assuming postpartum leakage should simply be tolerated.

Why Is This Topic Especially Relevant Right Now?

Pelvic health physical therapy is experiencing significant growth.

On July 6, 2026, APTA released its State of Pelvic Health Physical Therapy findings and reported that patient demand for pelvic health services is growing faster than access to trained providers. 

Locally, the Los Angeles pelvic rehabilitation market is also expanding. A pelvic health PT organization opened an additional Glendale location in January 2026, citing pregnancy, postpartum recovery, bladder-control problems, pelvic pain, and related concerns among the conditions driving demand. 

A Los Angeles pelvic health practice is also holding a September 14, 2026 postpartum recovery workshop focused specifically on leakage, pelvic pressure, core recovery, and return to exercise. 

For Nova Physical Therapy, this creates an especially relevant opportunity to answer one of the questions many postpartum patients are searching:

“Do I just have to live with leaking after having a baby?”

The evidence-based answer is no—not necessarily.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, a postpartum physical therapy evaluation may include, when clinically appropriate:

• Medical and pregnancy history
• Symptom history
• Bladder-related functional limitations
• Breathing assessment
• Abdominal muscle-performance assessment
• Hip muscle-performance assessment
• Functional movement assessment
• Squatting
• Lifting assessment
• Walking assessment
• Exercise tolerance assessment
• Return-to-impact considerations
• Pelvic floor muscle assessment when appropriate, within therapist training and with informed patient consent
• Goal setting

Not every patient requires the same examination.

Pelvic floor-related assessment and treatment should always respect:

• Patient consent
• Privacy
• Professional training
• Clinical necessity
• Applicable California laws and regulations

California's Physical Therapy Practice Act governs physical therapist practice in the state, and the Physical Therapy Board of California regulates licensed physical therapists and physical therapist assistants. 

Do I Need an Internal Pelvic Floor Examination?

Not every postpartum patient automatically requires an internal examination.

The need for any pelvic floor examination depends on:

• The patient's symptoms
• Clinical goals
• Therapist training
• Whether the examination will meaningfully affect treatment
• Patient comfort
• Informed consent

A patient has the right to understand what is being recommended and why.

If a patient does not consent to a particular examination or intervention, alternative assessment strategies may be considered when clinically appropriate.

Physical therapy should remain collaborative and patient-centered.

When Should You Seek Medical Attention?

Postpartum symptoms sometimes require medical evaluation in addition to or instead of physical therapy.

Seek appropriate medical care for symptoms such as:

• Fever
• Heavy or abnormal bleeding
• Severe or rapidly worsening pelvic or abdominal pain
• New inability to urinate
• Blood in the urine
• Signs of infection
• Significant new neurological symptoms
• New severe leg swelling
• Chest pain
• Severe shortness of breath
• Other rapidly worsening or concerning postpartum symptoms

Urgent symptoms should not be managed solely through routine physical therapy.

Persistent urinary symptoms may also require coordination with a physician, urogynecologist, urologist, obstetrician-gynecologist, or another appropriate healthcare professional depending on the presentation.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

Postpartum patients are often told that leaking, weakness, discomfort, or difficulty returning to exercise is simply something that happens after having a baby.

We believe patients deserve a more individualized answer.

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized treatment plans
• Patient education
• Pelvic floor exercise when appropriate
• Abdominal and hip strengthening
• Functional movement
• Progressive return to exercise
• Privacy and informed consent
• Long-term health and wellness

Our goal is not simply to perform pelvic floor exercises.

We want to understand how symptoms are affecting your ability to:

• Exercise
• Run
• Lift your baby
• Return to work
• Cough or sneeze without leakage
• Participate in recreational activities
• Feel confident during everyday movement

Rehabilitation should be built around those functional goals.

Frequently Asked Questions

Is it normal to leak urine after having a baby?

Urinary leakage is common postpartum, but that does not mean it must be accepted indefinitely. Evidence supports pelvic floor muscle training and individualized rehabilitation for many people experiencing urinary incontinence. 

Why do I leak when I sneeze after pregnancy?

Coughing and sneezing rapidly increase pressure within the trunk. If pelvic floor timing, coordination, or muscle performance is not sufficient for that demand, leakage may occur.

Can physical therapy help postpartum urinary leakage?

Yes. Multiple systematic reviews support pelvic floor muscle training and physical therapist-led interventions for postpartum urinary incontinence. 

Do I just need to do Kegels?

Not necessarily. Pelvic floor strength is only one potential component. Rehabilitation may also address coordination, relaxation, breathing, abdominal function, hip strength, functional movement, and return to exercise.

Can I start pelvic floor physical therapy months after giving birth?

Yes. There is no rule that rehabilitation must begin within the first six weeks. Persistent symptoms can still be evaluated later in the postpartum period.

Can I have pelvic floor problems after a C-section?

Yes. Pregnancy itself affects the pelvic and abdominal systems, so symptoms can occur regardless of delivery method.

Why do I leak when I run but not when I walk?

Running requires higher levels of repeated impact and pressure management. Someone may have enough capacity for walking but not yet tolerate the demands of running.

Do I need an internal pelvic examination?

Not automatically. Any pelvic floor examination should be clinically appropriate, performed by a properly trained provider, and completed only with informed patient consent.

Can abdominal exercises help postpartum recovery?

They may be part of an individualized rehabilitation program. Current evidence supports postpartum abdominal exercise for certain functional outcomes, although the appropriate program depends on the patient's presentation. 

Does diastasis recti mean I cannot exercise?

No. The presence of abdominal separation alone does not automatically mean exercise must be avoided. Exercise should be selected based on symptoms, function, and individual examination findings.

How long does postpartum urinary leakage take to improve?

Recovery varies. Symptom severity, childbirth history, muscle performance, exercise adherence, health factors, and individual response all influence progress. A specific recovery time cannot be guaranteed.

Schedule an Evaluation

If urinary leakage after pregnancy is affecting your ability to exercise, run, lift, cough, sneeze, work, care for your baby, or participate confidently in everyday activities, Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on improving pelvic floor function, strength, movement, physical capacity, and return to everyday activities.

Contact Nova Physical Therapy today to schedule your comprehensive physical therapy evaluation in North Hollywood.

Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, or treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.

Urinary leakage and postpartum pelvic symptoms can have multiple causes. Leakage with coughing, sneezing, running, lifting, or exercise does not establish a specific diagnosis.

Treatment recommendations should be individualized based on a licensed physical therapist's evaluation, clinical judgment, professional training, medical history, patient presentation, current evidence, informed consent, and applicable California laws and regulations.

Pelvic floor examinations and interventions should be performed only when clinically appropriate, by appropriately trained professionals, and with patient consent.

Physical therapists screen patients and refer to physicians or other appropriate healthcare professionals when findings require additional medical evaluation.

If you experience fever, heavy or abnormal bleeding, severe or rapidly worsening pain, inability to urinate, blood in the urine, significant neurological symptoms, chest pain, severe shortness of breath, significant new leg swelling, or other concerning postpartum symptoms, seek appropriate medical attention.

Individual results may vary. Nova Physical Therapy does not guarantee specific outcomes, recovery times, continence outcomes, or return-to-exercise timelines from physical therapy, pelvic floor exercises, or any other healthcare intervention discussed in this article.

References

1. Beamish NF, Davenport MH, et al. Impact of Postpartum Exercise on Pelvic Floor Disorders and Diastasis Recti Abdominis: A Systematic Review and Meta-analysis. British Journal of Sports Medicine. 2025;59(8):562–575. 
2. Cabrera-Martos I, et al. Physical Therapist Interventions to Prevent Postpartum Urinary Incontinence: A Systematic Review. Physical Therapy. 2025;105(5):pzaf017. 
3. Joshi R, Rathi M. A Systematic Review With Meta-Analysis on the Role of Pelvic Floor Muscle Exercises on the Severity of Symptoms and Quality of Life in Women With Urinary Incontinence. Archivos Españoles de Urología. June 2026;79(5):752–764. 
4. Alternative Exercise Regimens for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis.2025. 
5. American Physical Therapy Association. APTA Report Finds Demand for Pelvic Health Physical Therapy Outpaces Access. July 6, 2026. 
6. Physical Therapy Board of California. Physical Therapy Practice Act.

Current resources: APTA report on pelvic health physical therapy access · 2025 postpartum exercise systematic review on PubMed · 2025 physical therapist postpartum urinary incontinence review · Physical Therapy Board of California Practice Act

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