What if postnatal physiotherapy does not relieve leaking urine?

Leaking urine after birth can happen with coughing, sneezing, lifting, exercise, or a sudden urge to urinate. These patterns can reflect different bladder and pelvic floor problems, so one exercise plan may not address every contributor. Persistent symptoms can also be affected by constipation, urinary infection, pelvic organ support changes, scar discomfort, or difficulty relaxing the pelvic floor.

The issue may be the exercise technique, the amount of loading, the timing of contractions, or the need to include bladder training and bowel care. A review can also check whether leakage is linked to urgency, activity, a full bladder, or continuous dribbling.

Contact your pelvic health physiotherapist, midwife, GP, or another clinician for a fresh assessment. Record when leakage happens, whether you feel urgency, how often you pass urine, fluid intake, bowel symptoms, and whether there is pain or a feeling of pressure or bulging.

Do not repeatedly add harder exercises without guidance; overworking a tense pelvic floor can make some symptoms harder to control. Follow the plan you were given while waiting for review, avoid holding your breath during lifting, and address constipation if it is present. The clinician may recommend a urine check, an examination, a revised physiotherapy programme, or referral for bladder and pelvic floor care. See [Leaking Urine](/symptoms/leaking-urine/) and [Postnatal Physiotherapy](/treatments/pelvic-floor-and-rehabilitation/postnatal-physiotherapy/).

Seek prompt medical advice for burning urine, fever, blood in the urine, new back or side pain, trouble emptying the bladder, or rapidly worsening leakage. Contact a clinician promptly for continuous leakage, a new vaginal bulge, loss of bowel control, numbness around the saddle area, or new leg weakness.

Urgent assessment is needed for inability to pass urine with painful bladder swelling, severe weakness or numbness, or symptoms suggesting a serious infection. Otherwise, leakage that remains bothersome or limits movement, work, or sleep is a reason to arrange a non-urgent review.

Ask: What type of leakage do my symptoms suggest? Could infection, constipation, pelvic organ support, or bladder irritation be involved? Am I contracting and relaxing the pelvic floor correctly? Should I change my exercise or bladder-training plan? Do I need a urine test, examination, or specialist referral?