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  • Review Article
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Urinary incontinence during pregnancy and in the postpartum period

Nature Reviews Urology (2025)Cite this article

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Abstract

Pregnancy and childbirth involve anatomical and physiological changes in the pelvic floor that can negatively affect the urinary-continence mechanism. Thus, in both periods, the rates of urinary incontinence increase notably, with stress urinary incontinence being the most common type. The pathophysiological mechanisms involved in urinary incontinence in pregnancy and postpartum are not fully understood. Stress urinary incontinence is more closely linked to urethral sphincter deficiency than to impaired urethral support, although both conditions have been noted during pregnancy and postpartum. The primary risk factors for pregnancy-related urinary incontinence are maternal age, body mass index and parity. Postpartum, urinary incontinence is mainly associated with urinary incontinence during pregnancy and vaginal delivery. Currently, the only option to prevent urinary incontinence in pregnancy and early postpartum is performing intense pelvic floor muscle training (PFMT) during pregnancy under supervision, although the effectiveness of PFMT for treating urinary incontinence during pregnancy and postpartum has yet to be clarified. Further research is needed to assess the effect of PFMT in incontinent women during pregnancy and postpartum, and to identify women who are most likely to benefit from this treatment.

Key points

  • Urinary incontinence is commonly observed during pregnancy and postpartum, although incidence and prevalence rates vary considerably across studies.

  • Women who develop urinary incontinence during pregnancy are more likely to experience this symptom in the postpartum period and later in life than women who do not.

  • Increased BMI before and during pregnancy might contribute to the occurrence of urinary incontinence in pregnancy, suggesting an opportunity for possible preventive strategies.

  • Vaginal delivery is associated with postpartum urinary incontinence, but data regarding the effect of specific variables related to vaginal delivery and their connection with urinary incontinence are conflicting.

  • Currently, performing intense and supervised pelvic floor muscle training during pregnancy is considered an effective method of preventing urinary incontinence in pregnancy and early postpartum.

  • Pelvic floor muscle training should be provided to all women during pregnancy and after delivery by a health professional, regardless of continence status.

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  1. Department of Obstetrics and Gynaecology, Donostia University Hospital, San Sebastián, Spain

    Irene Diez-Itza

  2. Department of Medical and Surgical Specialties, University of the Basque Country, Leioa, Spain

    Irene Diez-Itza

  3. Obstetrics and Gynaecology Research Group, Biogipuzkoa Health Research Institute, San Sebastián, Spain

    Irene Diez-Itza

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  1. Irene Diez-Itza
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Diez-Itza, I. Urinary incontinence during pregnancy and in the postpartum period. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01091-x

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