Your body is telling you

Psychosomatics of urinary incontinence after childbirth

If you leak urine when you cough, sneeze, laugh or jump, doctors call it stress urinary incontinence. It is a common problem, and pregnancy and childbirth make it more likely by weakening the pelvic floor muscles. It can be treated, and training these muscles usually comes first. See a doctor first: a gynaecologist or urologist will examine you and choose treatment, and there is nothing to be ashamed of. The Ladder method adds questions about what you hold on to and whether you allow yourself to be weak.

Aizhan LiAuthor of the Ladder method
Updated 24 October 2026

When to see a doctor

Book a doctor’s appointment if you notice:

You leak when you cough, sneeze or laugh
You leak when running, jumping or lifting
You leak when you stand up quickly or during sex
A sudden strong urge, and you don't make it to the toilet
You wear a pad every day “just in case”
You are ashamed to tell even a doctor

If with the leaking you have pain or burning when you pee, blood in your urine, a fever, pain in your lower back, or you cannot pee at all, see a doctor the same day. If incontinence starts suddenly together with weakness or numbness in your legs, call 103.

Start with a gynaecologist or GP, and you may later need a urologist. The protocol advises keeping a bladder diary: how much you drink, how often you go to the toilet and when you leak. The NHS says separately that you should not feel embarrassed talking to a doctor about it.

What medicine knows

The Kazakhstan Ministry of Health clinical protocol “Stress urinary incontinence in women” (revised 2024) describes it as involuntary leaking of urine when pressure in the tummy rises: when you cough, sneeze, laugh, exercise, stand up suddenly or have sex, with no urge to pee beforehand. “Stress” here does not mean nerves but pressure on the bladder.

The UK National Health Service (NHS) calls urinary incontinence a common problem that affects millions of people. Stress incontinence is usually the result of weakened or damaged muscles that hold urine in: the pelvic floor muscles and the urethral sphincter. Pregnancy and vaginal birth, obesity, a family history and age make it more likely.

The protocol grades it by severity: mild, when urine leaks only with a hard cough or running; moderate, when walking calmly or with light effort; severe, when changing position. There is also urge incontinence, when urine leaks with a sudden strong urge, and mixed incontinence (NHS).

The first treatment for mild and moderate incontinence is non-surgical: pelvic floor muscle training, or Kegel exercises. The Kazakhstan Ministry of Health protocol also recommends them to women who have just given birth and have episodes of leaking, as prevention. The NHS says an exercise programme lasts at least 3 months: at least 8 contractions at least 3 times a day. If it does not help, the doctor discusses medicine, electrical stimulation or surgery.

Sources

In the Ladder method

In the Ladder method incontinence after childbirth is not explained by emotions: its cause is in the pelvic floor muscles, and it is treated with exercises and by a doctor. The questions for yourself here are about what happens inside you alongside this body.

Many women keep quiet for years: it is embarrassing, “it's my own fault”, “everyone is like this after giving birth”. You get a feeling that your body has let you down and you can no longer hold yourself together. With this feeling it is easy to start devaluing your whole self.

On the ladder this shows up as steps made of shame and “I just have to put up with it”. Once you can see them, it is easier to get to a doctor and start the exercises. A gynaecologist or urologist chooses the treatment.

These are questions for reflection, not an explanation of what causes the condition and not a treatment.

Quick check: what may be behind it

What stops you from telling a doctor about it?
Where in your life do you feel you can no longer hold everything together?
Who can you say “I need help” to?

Frequently asked questions

Will incontinence after childbirth go away on its own?

Sometimes it gets better, but it is not wise to rely on time alone. The Kazakhstan Ministry of Health protocol advises women who have just given birth and have episodes of leaking to train their pelvic floor muscles. The NHS advises seeing a doctor for any type of urinary incontinence.

Do Kegel exercises help?

Yes, pelvic floor muscle training comes first in the protocol, with a high level of evidence. The protocol describes 30 to 50 contractions a day lasting from 1 to 15 or 20 seconds, and the NHS advises keeping it up for at least 3 months. It is best to check with a specialist that you are squeezing the right muscles.

Why is it so embarrassing to talk about?

Because the topic is intimate, and many women have heard “everyone is like this after giving birth, just put up with it”. The NHS says plainly that incontinence is a common problem and you should not feel embarrassed talking to a doctor. In the Ladder method this shame can be looked at as a step of its own.

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