Why You're Still Leaking at 3 Months (And What to Do)

You have made it to three months postpartum. You are sleeping in longer stretches, finding some rhythm to your days - and still leaking when you sneeze. Or laugh. Or pick up the baby too quickly. If you were expecting this to have resolved itself by now, you are not alone. And if someone has already told you to "just do your Kegels", you may be starting to wonder why they are not working.

Here is what is actually going on - and what to do about it.

Two types of leaking, two different causes

Not all postnatal incontinence is the same. The two most common types are stress incontinence and urge incontinence, and they respond to different treatment approaches.

Stress incontinence is leaking that happens when intra-abdominal pressure increases suddenly - sneezing, coughing, jumping, laughing, lifting. The pelvic floor is unable to generate enough closing pressure fast enough to prevent urine loss. This is the most common type after vaginal birth and is typically related to muscle weakness, coordination problems, or both.

Urge incontinence is the sudden, overwhelming need to urinate that arrives with little warning, sometimes followed by leaking before you reach the bathroom. It often involves bladder overactivity and is more related to nervous system and bladder behaviour than pure muscle strength. Some women experience a mixture of both - called mixed incontinence.

Understanding which type you have matters because the treatment for each is different.

Why Kegels alone often fall short

Kegel exercises - repeated pelvic floor contractions - are the most commonly recommended postnatal advice. For many women, they help. But they are frequently not enough on their own, and for some women they can actually make things worse.

First, the technique problem. Research consistently shows that a significant proportion of women perform Kegels incorrectly - bearing down rather than lifting, using breath-holding, or recruiting their glutes and thighs instead of the pelvic floor. Doing the wrong thing repeatedly is not helpful and may reinforce poor patterns.

Second, the strength-only approach misses the coordination piece. Leaking during a sneeze happens in milliseconds. The pelvic floor needs to be able to contract quickly and reflexively, before the pressure spike arrives. Training slow, sustained holds builds endurance but does not necessarily train the fast-twitch reflex your pelvic floor needs.

Third, strength is only one variable. Load management, breathing mechanics, pressure management during exercise, and the progressive return to activity all influence continence outcomes. Pelvic floor rehabilitation done well addresses the whole system.

What a hypertonic pelvic floor looks like

Here is something that surprises many women: a pelvic floor that is too tight can also cause leaking. A hypertonic (overactive or high-tone) pelvic floor has muscles that are chronically contracted and cannot relax fully. A muscle that cannot relax properly cannot generate a strong contraction when it needs to. It can also irritate the bladder from below, contributing to urge symptoms.

If you find that Kegel exercises make your symptoms worse, or if you experience pelvic heaviness, pain with sex, difficulty fully emptying your bladder or bowel, or chronic pelvic tension, a hypertonic pelvic floor is worth investigating. The treatment for this involves down-training - learning to release and lengthen the pelvic floor - rather than more squeezing.

This is exactly why individual assessment by a pelvic floor physiotherapist is so important. Without knowing the tone and coordination of your pelvic floor, prescribing exercises is guesswork.

What evidence-based treatment looks like

For stress incontinence, the Cochrane Collaboration's systematic reviews consistently show that structured pelvic floor muscle training is an effective treatment. The key word is structured - a progressive programme that trains both strength and fast-twitch coordination, with correct technique.

For urge incontinence, bladder training (gradually increasing the time between urinating), urge suppression techniques, and lifestyle modifications (fluid management, caffeine reduction) are the first-line approaches. Pelvic floor training also helps by improving the ability to suppress urgency signals.

Both types benefit from attention to breathing mechanics and pressure management during daily activities - lifting, exercise, and even getting up from lying down.

When improvement takes longer than expected

If you have been doing the right exercises with correct technique for six to eight weeks and seeing no improvement, please see a pelvic floor physiotherapist for assessment. Persistent leaking beyond three months warrants individual clinical review. It is possible there is an underlying structural issue (like a levator ani muscle tear) that needs to be understood before the rehabilitation approach is refined.

The Postnatal Recovery programme addresses all of these dimensions - technique, progression, fast-twitch training, breathing, and load management. If you are working through it and not seeing progress, that is useful information, not a failure. Your body may simply need a more individualised approach alongside the programme.