Bladder Leakage Isn’t Normal — Even After Having Kids

It’s one of the most common things women don’t talk about. It’s also one of the most treatable.

If you leak a little when you sneeze, laugh, jump on the trampoline, or run for the tram, you are very much not alone. Roughly four in ten Australian women experience some form of bladder leakage, and in the first year after giving birth, about a third of women do. The numbers are high enough that it’s easy to assume this is just what bodies do — especially women’s bodies, especially after kids.

It isn’t. Common is not the same as normal, and it’s definitely not the same as permanent. At All for One in Yarraville, Hampton East, and Kensington, our women’s health physiotherapists work with women every week who’ve been told — or told themselves — that leakage is just part of life now. Most of them leave treatment surprised by how much can change.

What “Normal” Actually Means

There’s a cultural shrug around bladder leakage that sounds like “well, I’ve had kids, what did I expect?” It’s understandable — most of us were never told otherwise. But Continence Health Australia, alongside every major clinical guideline, is clear: urinary incontinence is common, and it’s treatable. It’s not a normal function of ageing, motherhood, or running.

The distinction matters because 70 percent of people living with incontinence never seek help, and one in three have had it for more than five years (Continence Health Australia, 2024). That’s a lot of women quietly accepting something that could have been addressed in a matter of weeks or months.

What’s Actually Going On

Bladder leakage isn’t one condition — it’s a family of conditions, and the right treatment depends on the type.

Stress incontinence

This is the most common type in women, especially postnatally. It’s the leakage you get when there’s a sudden increase in pressure on your bladder — a sneeze, a cough, a jump, a heavy lift. The pelvic floor muscles, the urethra, or both aren’t generating enough support to keep the bladder closed under that pressure. It’s a mechanical problem, which is why it responds so well to targeted treatment.

Urge incontinence

This is the “I need to go right now” type — a sudden, strong urge followed by leakage before you can get to the bathroom. The bladder muscle itself is contracting when it shouldn’t. It’s more common in women around menopause and beyond, and it responds to a different set of strategies: bladder retraining, fluid and dietary adjustments, pelvic floor work, and sometimes medication.

Mixed incontinence

Exactly what it sounds like — a combination of both. Common in women over 50, and entirely treatable with the right combined approach.

Why It Happens

Pregnancy and birth are the headline causes, but they’re not the only ones. Pregnancy itself places sustained load on the pelvic floor regardless of how you deliver. Vaginal birth can cause muscle, nerve, or connective tissue strain — research suggests vaginal delivery roughly doubles the risk of stress incontinence compared to caesarean, though the absolute difference is small enough that caesarean is not recommended as prevention (Tähtinen et al., 2016).

Beyond birth, other factors contribute. Menopause plays a significant role — oestrogen helps maintain the elasticity and tone of the tissues around the bladder and urethra, and as it drops, those tissues change. Stress incontinence peaks in the perimenopausal years, between 45 and 49. Chronic cough and constipation add repeated pressure to the pelvic floor, day after day. Higher body weight increases load on the pelvic floor and is consistently associated with higher rates of leakage, with each five-unit increase in BMI linked to a 60 percent rise in daily incontinence. Age plays a role, but rarely on its own.

The good news is that most of these factors are either modifiable, treatable, or manageable — and the pelvic floor itself responds remarkably well to training.

The Treatment That Actually Works

Pelvic floor muscle training, supervised by a women’s health physiotherapist

Pelvic floor muscle training — PFMT — is the first-line, evidence-based treatment for urinary incontinence in women. Not a maybe, not a complementary add-on: first-line, as recommended by the International Continence Society, NICE, and the RACGP. The international Cochrane review, which pooled data from 31 trials and nearly 1,800 women, found that women who did PFMT were around eight times more likely to report being cured of stress incontinence compared to those who didn’t. Fifty-six percent of women in the PFMT group reported being cured, compared with six percent in the control group (Dumoulin et al., 2018).

That’s a significant effect, and it comes from training a muscle group that most women have never been properly taught to use.

Why “doing your Kegels” at home often doesn’t work

Here’s the catch. A significant proportion of women asked to contract their pelvic floor do it incorrectly on the first try — squeezing glutes, pushing down instead of lifting up, holding breath, bracing through the abdominal wall. A women’s health physiotherapist assesses exactly what your pelvic floor is doing, gives you real-time feedback, and builds a program that progresses as your strength and control improve. Research consistently shows that supervised PFMT outperforms unsupervised or generic Kegel advice, particularly when it comes to using the right muscles at the right intensity (Hagen et al., 2023).

At All for One, that assessment is the starting point. From there, your program might involve one-on-one appointments with your women’s health physio, integration into our Clinical Pilates sessions (physio-led, small groups of up to four, individualised programming with a one-on-one review every six weeks), or both — depending on what your body needs and where you want to get to.

What About Exercise? Should I Stop Running?

This comes up almost every consultation. If high-impact exercise triggers leakage, the instinct is to stop. It’s understandable — and it’s usually the wrong move.

A notable finding from postpartum research: stress incontinence tends to increase in women who don’t exercise between three and twelve months postpartum, while it stays stable in women who keep moving, including those doing high-impact exercise. Physical activity during pregnancy and postpartum is not, in itself, associated with incontinence (Hage-Fransen et al., 2021). Sedentariness is a risk factor of its own.

The right approach isn’t to stop running — it’s to get your pelvic floor assessed, build strength with targeted training, and return to high-impact movement in a way your body can support. A structured postnatal PFMT program has been shown to reduce the risk of ongoing urinary incontinence by around 37 percent and the risk of pelvic organ prolapse by more than half (Woodley et al., 2020).

When to Seek Help

Book a women’s health physiotherapy appointment if:

• You leak when you sneeze, cough, laugh, jump, run, or lift
• You feel a strong, sudden urge to urinate and can’t always make it
• You’re waking more than once overnight to go to the toilet
• You’ve recently given birth and something doesn’t feel right — pressure, heaviness, weakness, or leakage
• You’ve been putting up with it for years

You don’t need a GP referral. You don’t need to wait until it’s “bad enough.” And you don’t need to be recently postnatal — we regularly see women who had their kids fifteen or twenty years ago and decided it was time.

Certain things warrant a more urgent conversation: blood in your urine, recurrent urinary tract infections (more than three in a year), significant pelvic pressure or bulging, or pain. Your women’s health physiotherapist will let you know if anything needs to be looped in with your GP or a specialist.

The Long View

The pelvic floor is a muscle group — or more accurately, a coordinated system of muscles — and like any muscle group, it responds to the right kind of training. What that training looks like is different at different life stages. In the fourth trimester, it might be gentle activation work and breathing coordination. In the years of running after toddlers, it might be load-based strengthening that lets you lift, jump, and carry without leakage. In midlife and through menopause, it might be part of a broader approach that includes strength training, pelvic floor work, and conversations about hormonal changes.

At All for One, our women’s health physiotherapists work alongside our Clinical Pilates team, our strength coaches, and our dietitians — which means your program can evolve as your body and life do. You’re not being handed a sheet of exercises and sent on your way. You’re getting a plan, regular check-ins, and the support to stick with it.

Start With an Assessment

If you’ve been living with leakage — whether it’s been weeks, months, or decades — the first step is a women’s health physiotherapy assessment. We’ll work out what’s happening, what’s driving it, and what the fastest, most effective path forward looks like for you.

Book at All for One in Yarraville, Hampton East, or Kensington. Same team, same standard of care, same belief that common doesn’t mean you have to live with it.

Frequently Asked Questions

Is it normal to leak urine after having a baby?

It’s common — around one in three women experience bladder leakage in the first year postpartum — but it’s not normal in the sense of being something you have to accept. Pelvic floor muscle training with a women’s health physiotherapist is the evidence-based first-line treatment, and most women see significant improvement with the right program.

Will bladder leakage go away on its own after childbirth?

For some women it improves in the early months postpartum, but for many it persists. Research shows that between 10 and 20 percent of women with postpartum incontinence still have symptoms five years after birth, and the proportion stays significant at ten and twenty years. Early treatment leads to faster and more complete recovery.

How long after birth can I see a women’s health physiotherapist?

You can book as early as six weeks postpartum — the standard “all clear” checkpoint — but you can also come earlier for education, gentle guidance, and reassurance. You don’t need to wait until something feels wrong.

Can pelvic floor exercises really cure bladder leakage?

A 2018 Cochrane review found that women who did pelvic floor muscle training were around eight times more likely to report being cured of stress incontinence compared to those who didn’t. Fifty-six percent reported being cured, compared with six percent in the control group. Results are strongest when the program is designed and supervised by a qualified physiotherapist.

Why don’t my Kegels seem to work?

Many women contract their pelvic floor incorrectly when first asked — pushing down instead of lifting, using the wrong muscles, or holding their breath. A women’s health physiotherapist assesses exactly what you’re doing and builds a program that actually targets the right muscles at the right intensity. It’s why supervised PFMT outperforms generic advice.

I’m years past having kids — is it too late?

No. Women’s health physiotherapy is effective at any age and any stage, including decades after childbirth and through and beyond menopause. The pelvic floor is a muscle group and responds to training the same way other muscle groups do.

Can I still run or do high-impact exercise if I’m leaking?

Usually yes, with the right approach. Research suggests women who keep exercising postpartum — including with high-impact activity — don’t see incontinence worsen over time, while sedentary women often do. The right path is an assessment and a structured return-to-running program, not giving up exercise.

Is bladder leakage different during menopause?

The pattern can shift. Stress incontinence peaks in the perimenopausal years, and urge incontinence becomes more common with age. Hormonal changes affect the tissues around the bladder and urethra. Pelvic floor muscle training remains effective, and your GP may discuss additional options like local oestrogen therapy where appropriate.

Where can I see a women’s health physiotherapist in Melbourne?

All for One offers women’s health physiotherapy across three Melbourne locations: Yarraville, Hampton East, and Kensington. You don’t need a GP referral to book. Visit allforone.com.au to make an appointment.

References

Continence Health Australia. (2024). Key statistics on incontinence. https://www.continence.org.au

Dumoulin, C., Cacciari, L.P., & Hay-Smith, E.J.C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, (10), CD005654.

Hage-Fransen, M.A.H. et al. (2021). Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 267, 101–110.

Hagen, S. et al. (2023). Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence — a systematic review and meta-analysis. International Urogynecology Journal, 34, 1927–1945.

Tähtinen, R.M. et al. (2016). Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: A systematic review and meta-analysis. European Urology, 70(1), 148–158.

Woodley, S.J. et al. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, (5), CD007471.

Wang, X. et al. (2023). Prevalence and factors of urinary incontinence among postpartum: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 23, 761.

Royal Australian College of General Practitioners. (2024). Managing female stress urinary incontinence in a post-mesh era. Australian Journal of General Practice.