Incontinence after childbirth: what is normal and what helps

Key facts at a glance

• About one in three women has urinary incontinence after giving birth, up to one in ten faecal incontinence – this is common, not embarrassing
• For most, it improves on its own in the first weeks and months
• Pelvic floor training during pregnancy has been shown to reduce the risk – the guideline recommends offering it to all pregnant women
• The postnatal course is a covered benefit in Germany: up to 10 hours, until the end of the ninth month after the birth
• A caesarean section is not a protective strategy against incontinence

Nobody mentions it in the antenatal class, and afterwards hardly anyone talks about it: losing urine when coughing, laughing or standing up after giving birth is one of the most common consequences of pregnancy. This article sorts out what is normal, what really prevents it and when help is needed – based on the current Cochrane analysis and the German guideline.

How common it is

The 2020 Cochrane review, which evaluated 46 studies with 10,832 women, summarises the situation briefly:

“About a third of women have urinary incontinence after childbirth, up to a tenth faecal incontinence.”

A third. Anyone who notices in the postnatal period that the pelvic floor no longer holds what it held before pregnancy is in the largest group – not in a marginal one.

Why it happens

During pregnancy, the pelvic floor carries additional weight for months, and the hormonal changes make the tissue softer and more elastic – good for the birth, unfavourable for continence. The German Continence Society describes what happens then: the sphincter muscles tense less well, “it dribbles”, especially when lifting, sneezing or laughing.

During the birth, injuries are added: overstretched muscles, a perineal tear or episiotomy, irritated nerves. As risk factors, the professional society names a high birth weight of the child, the course and duration of the birth and a pelvic floor that was weak to begin with. The guideline adds body weight: with a BMI above 25, the risk rises.

The good news is right there at the Continence Society: “Once the injuries have healed and overstretched muscles and tendons have recovered, the incontinence also lessens.” For many, the symptoms disappear within a few weeks.

What really prevents it: training before the birth

Here the evidence is clearest. The S2k guideline “Urinary incontinence in women” formulates as a recommendation with the highest strength of consensus:

“Antenatal physiotherapy can reduce the risk of developing urinary incontinence and should therefore be offered to all pregnant women.”

The Cochrane analysis provides the figures. Continent pregnant women who train specifically during pregnancy have

• in late pregnancy, a 62 percent lower risk of losing urine (moderate quality of evidence)
• three to six months after the birth, a 29 percent lower risk (high quality of evidence)

The guideline expressly dispels a common worry: that a pelvic floor trained “too strongly” could hinder vaginal birth or cause greater injuries “is unfounded”. Cochrane also found no adverse effects of the training on the course of the birth in 46 studies.

And the caesarean section?

Studies do show a lower incontinence rate after caesarean section. But the guideline does the maths: between 7 and 9 women would have to give birth by caesarean section to protect one from pelvic floor disorders – with all the risks the procedure entails. Its recommendation: a caesarean section solely to prevent incontinence “should not be recommended”. Women at increased risk should, however, be specifically informed in order to weigh up benefit and risk.

After the birth: what helps – and what the studies leave open

Honesty is called for here, because the data are mixed.

The guideline states: treating urinary incontinence with pelvic floor training in women after childbirth “increases the chances of continence 12 months after the birth”. The Cochrane authors are more cautious: for women in whom incontinence persists after the birth, it is uncertain whether pelvic floor training makes the difference – unlike in middle-aged women, where effectiveness is well documented. Presumably a targeted, supervised programme works better than a general course for everyone.

What the guideline says about implementation: the training should last at least 6 to 12 weeks, with more than three sessions a week of under 45 minutes each. And: supervised training – whether in a group or individually – is more effective than unsupervised practice at home.

The postnatal course is a covered benefit

Under Section 24d SGB V, you are entitled to midwifery care during pregnancy, at and after the birth; postnatal care runs until twelve weeks after the birth, beyond that with a doctor's order. The midwifery care contract between the insurance funds and the midwives' associations regulates the postnatal course specifically:

• Postnatal exercise in a group of up to ten participants: up to 120 units of 5 minutes, i.e. 10 hours
• Individual instruction according to a defined set of criteria: up to 5 hours
• billable as long as the unit is provided by the end of the ninth month after the birth
• also possible as a video course; self-learning units can replace part of it

Ten hours of supervised training, at no cost – use them. Anyone who wants or needs to continue afterwards can obtain a physiotherapy prescription through their gynaecologist.

Pessaries

For stress incontinence, the guideline expressly names pessary therapy as an option that should be offered – a device inserted into the vagina that supports the urethra, for example during sport. It does not replace training, but can bridge the time.

When you should have yourself examined

• if the symptoms have not decreased after the postnatal course – i.e. after a few months
• if stool or wind can no longer be held, especially after a higher-degree perineal tear – this belongs in professional hands early
• with pain, a feeling of downward pressure or the feeling that “something is hanging out”
• if you avoid activities in everyday life because you are afraid of losing urine

Contacts are your gynaecologist, your midwife and specialised pelvic floor centres. What is examined there and which forms of incontinence are distinguished is explained in our article on stress and urge incontinence.

Bridging the time

Until the pelvic floor holds again, care makes sense – and is not a sign of giving up. For the typical small amounts on exertion, thin, anatomically shaped pads are enough; they are medical aids under Section 33 SGB V and a covered benefit with a doctor's prescription. Which product type fits is explained in our article on pad, pants or brief; how the supply process works, in medical aids on prescription.

Frequently asked questions

When may I start pelvic floor training after the birth?

This depends on the course of the birth and on injuries. The Continence Society advises agreeing the timing with your midwife or gynaecologist. The postnatal course usually begins a few weeks after the birth.

I had a caesarean section – can't this happen to me?

It can, less often, but it happens. Pregnancy itself puts strain on the pelvic floor, regardless of the mode of birth. The postnatal course is worthwhile after a caesarean section too.

Is it worse after the second or third birth?

The guideline recommends informing women about the “risk of postpartum pelvic floor insufficiency, which increases with age”. With every pregnancy and every year of life, the strain increases – all the more reason for prevention.

Can I get pads on prescription?

Yes, absorbent incontinence aids are prescribable medical aids. For consumables, the co-payment is capped at 10 euros a month, from 2027 at 15 euros.

Your next step

We stock thin, discreet pads from TENA, HARTMANN and SENI – for the transitional period and for sport. With a prescription, we handle the coordination with your health insurance fund.

Sources

• Woodley SJ et al.: Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women, Cochrane Database of Systematic Reviews 2020, CD007471
• S2k guideline “Urinary incontinence in women”, AWMF register number 015-091, December 2021 – recommendations E4-16, E4-18, E4-19, E4-21 (in German)
• Section 24d SGB V – medical care and midwifery care, Federal Ministry of Justice (in German)
• Contract on the provision of midwifery care under Section 134a SGB V, version from 1 April 2026, GKV-Spitzenverband – fee items 4030X and 4040X (in German)
• Pregnancy, Deutsche Kontinenz Gesellschaft e.V. (in German)