Severe tears & pelvic floor injury
Still Leaking Urine Months After Birth? When It's More Than "Normal"
The short answer
Some bladder leaking in the first weeks after birth is common, and often improves with pelvic floor exercises. But if you're still leaking months later, especially with heaviness, a bulge, or weak pelvic floor muscles that don't respond to exercises, it can be a sign of a more serious injury. That includes levator avulsion (the main pelvic floor muscle tearing away from the bone) or prolapse. These injuries are strongly linked to forceps births. They're often missed, and you deserve a proper assessment. Where the injury followed care that fell short, compensation may be available.
The leaks no one talks about.
You cross your legs before you sneeze. You don't jump on the trampoline with your kids. Running is out of the question. You know exactly which shops have toilets.
Maybe you were told at six weeks to "do your pelvic floors", and you did, faithfully, for months. And it's still happening.
Maybe you've started to believe this is just what happens to women after babies. That you have to accept it.
Leaking is common. But you don't have to accept it, and sometimes it's a sign of something that should have been picked up.
You're far from alone. Continence Health Australia says almost 4 in 10 Australian women experience incontinence, and many notice changes after childbirth.
The two main types of leaking
| Type | What it feels like | Common causes after birth |
|---|---|---|
| Stress incontinence | Leaking when you cough, sneeze, laugh, run, jump or lift | Weak or injured pelvic floor muscles, damage to the support around the urethra, levator avulsion |
| Urge incontinence | A sudden, strong need to wee, and leaking before you get there | Bladder overactivity. It can be linked to prolapse or bladder injury, including bladder damage from unrecognised retention after birth |
Many women have a mix of both.
When it's common, and when it's not
In the first weeks after a vaginal birth, the pelvic floor has been stretched, and some leaking is common. For many women it improves over the first few months, especially with physiotherapy.
It's worth getting checked properly if any of these apply:
- You're still leaking three months or more after the birth
- It's getting worse, not better
- You can't feel your pelvic floor muscles working, or one side feels different
- You also have heaviness, dragging or a bulge in the vagina
- You also have bowel symptoms, such as wind you can't control or urgency
- You had a forceps birth, a long pushing stage, or a large baby
- Exercises haven't helped after a proper program with a pelvic health physiotherapist
Queensland Health lists the common signs of prolapse, which often come alongside leaking.
The injuries that can sit behind leaking
Levator avulsion.
The levator ani is the main muscle of your pelvic floor. In an avulsion, part of it tears away from the pubic bone during birth. Women with an avulsion have markedly weaker pelvic floor muscles. That's why exercises alone often don't fix their leaking. Professor Hans Peter Dietz has written that avulsion reduces pelvic floor strength by about a third. I explain this injury in detail in "Levator avulsion: the birth injury no one told you about".
Prolapse.
When pelvic floor support is damaged, the bladder can drop. That can cause leaking, difficulty emptying, and recurring infections. See prolapse after a forceps birth.
Severe tears and nerve injury.
A difficult birth can also stretch the nerves that control the pelvic floor and bladder, and severe tears can damage surrounding tissue. My article on severe pelvic floor damage and incontinence covers these injuries together.
The forceps link
Research led from Western Sydney University found that forceps were significantly associated with levator trauma, as was a longer pushing stage. Avulsion occurred in 13% of vaginal births in that study, and in none of the caesareans.
In plain terms: if you had forceps and you're still leaking, the possibility of a muscle injury should be properly investigated, not just treated with "more exercises".
If this is landing for you, and you're realising your leaking may have a cause no one has looked for, I'm happy to listen. No pressure.
Getting the right assessment and treatment
See a pelvic health physiotherapist.
This is often the best first step. They can assess your muscles, check for asymmetry that might suggest an avulsion, and design a program. RANZCOG notes that physiotherapist-led intervention has been shown to reduce urinary incontinence after instrumental birth. The Australian Physiotherapy Association's 2025 position statement recommends a postnatal check around six weeks, and support for 12 months or more.
Ask about imaging.
If your symptoms aren't improving, ask about a 3D/4D pelvic floor ultrasound and referral to a urogynaecologist. That's the usual way an avulsion is confirmed.
Know the cost barrier, and that it's not your fault.
The Australian Physiotherapy Association has warned that demand for pelvic health physiotherapy far outstrips access and funding. Women's Agenda founder Angela Priestley has written about her own pelvic floor problems only improving once she found, and could afford, a pelvic floor physiotherapist. If your injury was caused by negligence, these costs can be part of a claim.
Free help now.
The National Continence Helpline, through Pelvic Floor First, is free on 1800 33 00 66.
When leaking may point to negligence
Leaking after birth isn't automatically anyone's fault. But a claim may be worth exploring if:
- You weren't told the risks of forceps before they were used. See "Why didn't anyone tell me forceps could do this?"
- The birth was mismanaged, for example a pushing stage allowed to go on too long, or forceps used when a caesarean was the safer choice. See birth trauma after forceps or vacuum delivery.
- Your injury was missed or dismissed for months, and the delay made things worse. See "It's normal after a baby".
- A severe tear was missed or poorly repaired. See severe perineal tears.
Compensation can cover physiotherapy, surgery, continence products, lost income, and the impact on your daily life. My article on living with a pelvic floor injury, and what a claim can cover explains how.
Frequently asked questions
How long is it normal to leak after giving birth?
Some leaking in the first weeks is common and often improves over a few months. If you're still leaking at three months, or it's getting worse, get a proper assessment.
Why haven't pelvic floor exercises fixed my leaking?
Exercises help many women. But if the muscle itself is torn from the bone, as in a levator avulsion, exercises alone may not be enough. That's why an assessment matters.
Can leaking urine after birth be a medical negligence claim?
It can be, if the injury causing it followed care that fell short. That includes not being warned about forceps risks, a mismanaged birth, or an injury that was missed. Independent experts review your records to work this out.
Is there a time limit?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
You may have quietly rearranged your life around this: what you wear, where you go, what you no longer do.
You deserve to know whether it had to be this way. So here's a question: what's the first thing you'd do again if the leaking stopped?
Keep reading: Birth trauma and obstetric negligence
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
