Do I Have to Wait Until I’m Done Having Kids to Do Something About My Urine Leakage?

Short answer: No.

If you leak urine when you cough, sneeze, run, jump, lift, or exercise after having a baby, you may have been told—or simply assumed—that there is no point in treating it until you are finished having children.

After all, why fix something if another pregnancy might affect it again?

But that can mean spending years living with bladder leakage while you decide whether you want another child, try to become pregnant, have another baby, or simply wait for life to settle down.

You do not have to put your life on hold—or put up with bladder leakage—while you decide whether your family is complete.

There are several treatment options for stress urinary incontinence that can be appropriate for women who may want future pregnancies.

First: What Kind of Leakage Are We Talking About?

Stress urinary incontinence (SUI) is leakage that happens when pressure increases inside the abdomen and bladder. You might notice leaking when you:

• Cough or sneeze

• Laugh

• Run or jump

• Lift weights

• Pick up your baby or toddler

• Do high-impact exercise

• Move quickly with a full bladder

Pregnancy and childbirth can affect the muscles and connective tissues that support the bladder and urethra. While stress urinary incontinence is common after pregnancy, common does not mean you have to live with it.

And treatment does not automatically mean surgery.

Pelvic Floor Rehabilitation: Often the Best Place to Start

Pelvic floor rehabilitation is one of our first-line treatment options for postpartum stress urinary incontinence.

And it involves much more than simply doing Kegels.

A pelvic floor physical or occupational therapist can evaluate pelvic floor strength, coordination, muscle tone, breathing mechanics, core function, and how your body manages pressure during everyday activities and exercise.

This is especially important for active women. Sometimes the issue isn't simply that the pelvic floor is "weak." It may be that the pelvic floor and core aren't coordinating appropriately when you run, jump, lift, or increase abdominal pressure.

The goal isn't just to make your pelvic floor stronger. It is to help your pelvic floor work better with the rest of your body.

Pelvic floor rehabilitation can be used whether you recently delivered a baby, are years postpartum, are actively trying to conceive, or aren't sure whether another pregnancy is in your future.

Breastfeeding? Hormonal Changes Can Affect Your Pelvic Floor Too

Breastfeeding naturally lowers estrogen levels. This temporary hormonal state can affect the tissues of the vagina and urinary tract, sometimes contributing to vaginal dryness, irritation, urinary symptoms, discomfort with sex, and changes in tissue quality.

This is a normal physiologic response to lactation, and it does not mean you need to stop breastfeeding.

For women with bothersome symptoms, low-dose vaginal estrogen may be an option. Vaginal estrogen works primarily at the local tissues and can be considered during lactation through an individualized discussion with your clinician about symptoms, timing, risks, benefits, and breastfeeding considerations.

You should be able to breastfeed for as long as you want to. You also shouldn't have to simply suffer through uncomfortable genitourinary symptoms while doing it.

Pessaries and Incontinence Devices: Support When You Need It

Some women want an option they can use during specific activities—like running, CrossFit, tennis, hiking, or a workout class—without taking medication or having a procedure.

An incontinence pessary is a small device worn inside the vagina that provides additional support underneath the urethra and can help reduce stress urinary leakage.

Think of it as extra mechanical support for your bladder outlet.

For some women, a pessary can be worn regularly. Others use one primarily for exercise or other activities that trigger leakage.

Pessaries are removable, reversible, and do not interfere with your ability to become pregnant in the future.

What If Rehabilitation and a Pessary Aren't Enough?

This is where the conversation gets particularly interesting for women who aren't ready for—or don't want—a traditional incontinence surgery.

One option is Bulkamid® urethral bulking.

Bulkamid is a soft, water-based gel that is injected into the wall of the urethra. The additional volume helps the urethra close more effectively when pressure increases, reducing stress urinary leakage.

Unlike a midurethral sling, Bulkamid does not involve placing a strip of mesh underneath the urethra.

The procedure itself is typically quick and minimally invasive. It does not require any incisions, and patients return to daily activities the next day. Including working out, running, and sex. There are typically no significant postoperative activity restrictions, making it an appealing option for women who cannot—or simply do not want to—plan their lives around a surgical recovery.

Why I Like Bulkamid as an Option for Busy Women

There is a particular group of women for whom I think urethral bulking deserves much more attention:

Women who aren't sure they're done having children but also aren't willing to spend the next several years leaking.

Maybe you think you want another baby—but not for two or three years.

Maybe you haven't decided.

Maybe your partner hasn't decided.

Maybe you're 35, 38, or 40 and genuinely don't know what your family will look like yet.

Maybe you are in your 20’s and leaking every day, you have tried everything to fix it, and you don’t want to spend the next 25 years of your life worried about leaking.

In the meantime, you are running, working, exercising, traveling, parenting, carrying children, and living your life.

You shouldn't have to organize all of that around your bladder.

Bulkamid can be considered in women who may desire future fertility because it does not prevent a future pregnancy. Pregnancy and vaginal delivery can, of course, affect continence symptoms and potentially change the results of any treatment. For that reason, more definitive stress incontinence surgeries such as a midurethral sling are often deferred until childbearing is complete.

But deferring definitive surgery doesn't mean deferring treatment.

For the right patient, Bulkamid can help bridge that gap.

At Core and Floor, we do not currently perform Bulkamid injections in our office. However, we can evaluate your leakage, discuss whether urethral bulking is an appropriate option for you, and help coordinate treatment when indicated.

You Have More Options Than "Wait"

If you are leaking urine after having a baby, your choices are not limited to:

Live with it
or
Have surgery.

There is an entire spectrum in between.

Pelvic floor rehabilitation can improve strength, coordination, and pressure management. Vaginal estrogen may help address genitourinary tissue changes associated with breastfeeding. Pessaries can provide immediate mechanical support during exercise and everyday activities. And for appropriate patients, Bulkamid offers a minimally invasive treatment option without the recovery associated with traditional surgery.

The right choice depends on your symptoms, your goals, your lifestyle, and your plans—or lack of plans—for another pregnancy.

Your bladder doesn't need to wait for your family plan.

At Core and Floor, we believe postpartum pelvic floor symptoms deserve treatment now—not someday when you're officially "done" having babies.

Whether you're six months postpartum, six years postpartum, planning another pregnancy, or still figuring it out, we can help you understand your options and build a treatment plan that works for the life you're living today.