Leaking Urine During the Third Trimester
Written by Bodyful Physical Therapy and Wellness
Leaking Pee During Pregnancy: Third Trimester Urinary Incontinence
Are you in your third trimester of pregnancy and experiencing new or sudden onset of urinary incontinence?
Urinary leakage during pregnancy is common, but that does not mean it is normal or something you have to simply tolerate.
Leaking pee during pregnancy—especially with coughing, sneezing, laughing, or movement—is a frequent issue in the later stages of pregnancy. For many, it is temporary. However, you can lessen the severity, reduce episodes of coughing and peeing, and improve postpartum outcomes through prenatal pelvic floor physical therapy.
In this blog, you’ll learn about the causes, implications, and solutions for urinary leakage during the third trimester—and how prenatal PT can help.
What Is Urinary Leakage During Pregnancy?
Any involuntary loss of urine, whether small dribbles or full leakage, is considered urinary incontinence. There are different types of incontinence, and understanding which type you are experiencing is important.
One common form during pregnancy is stress urinary incontinence. This occurs when increased pressure is placed on the bladder and pelvic floor—such as with coughing, sneezing, laughing, jumping, lifting, or running.
If you’re unsure what your pelvic floor muscles are, you can read more about them in our comprehensive guide here.
Why Coughing and Peeing Happens in Pregnancy
Stress incontinence during pregnancy often relates to poor intra-abdominal pressure management.
Your abdomen and core muscles play a primary role in managing intra-abdominal pressure. As your baby grows, pressure on the bladder increases. At the same time, your abdominal muscles lengthen to accommodate pregnancy. This is a normal and adaptive change—but lengthened muscles are less effective at generating force.
When this is combined with:
Poor postural habits
Inefficient breathing patterns
Increased load from daily activities
…the likelihood of leaking pee during pregnancy increases.
This is why coughing and peeing often go together in the third trimester. The good news is that this pattern is very responsive to targeted prenatal pelvic floor physical therapy.
Urge Incontinence During Pregnancy
Another form of leakage during pregnancy is urge incontinence—a sudden, intense need to urinate followed by leakage before reaching the bathroom.
This can happen when:
Increased bladder pressure is paired with a tight pelvic floor
Pelvic floor muscles over-recruit and pull on the urethra or bladder fascia
Tight muscles struggle to relax and close the urethra efficiently
The pelvic floor muscles do not have sufficient endurance to suppress the urge to urinate
Tight muscles are not strong muscles. When rushing to the bathroom, they may struggle to keep urine in.
The nervous system also plays a role. The bladder is a reflexive organ that responds to signals from the brain. Chronic stress, trauma history, or hyper-focus on bladder sensations can increase sensitivity and urgency.
This does not mean symptoms are “in your head.” It means there are evidence-based ways to work with your nervous system to change symptoms. This is why we take a somatic approach to care. You can read more about our approach here.
When To Seek Help?
Occasional leaking may feel manageable, but it is often an early sign of pelvic floor dysfunction.
If you want to be proactive, even one assessment with a prenatal pelvic floor physical therapist can provide tools to reduce symptoms and improve postpartum recovery.
You should consider seeking care if:
Leaking persists or worsens
Leakage occurs with coughing, sneezing, or movement regularly
Symptoms affect comfort, confidence, or quality of life
Leakage is paired with pelvic pain or discomfort
If you experience pelvic numbness, loss of urinary urge sensation, sudden groin pain that is worse in weight bearing, contact your medical provider immediately before seeking PT care.
Prenatal Pelvic Floor Physical Therapy:
The Key to Managing Leaking Pee During Pregnancy
When it comes to leaking pee during pregnancy, a prenatal pelvic floor physical therapist should be your primary provider.
Pelvic floor PTs specialize in the muscles, fascia, nerves, breathing mechanics, and pressure systems that influence continence.
At Bodyful, we focus on three essential elements:
1. Pelvic Floor Coordination (with Relaxation), Strength, Power, and Endurance
Strength is not about doing endless “Kegels” without quality coordination with your movement system.
A healthy pelvic floor must have power, lengthen appropriately for bowel movements and delivery, coordinate well with movement and have endurance. Many pregnant clients have pelvic floor muscles that are over-recruited and unable to relax efficiently. This is common because of your pregnant posture.
In prenatal pelvic floor physical therapy, we train neuromuscular coordination so your pelvic floor can respond appropriately to changes in abdominal pressure—helping you stay continent when coughing or sneezing.
2. Breathing Techniques
The respiratory diaphragm plays a major role in abdominal pressure management. Breath-holding or inefficient breathing can increase downward pressure on the bladder.
Even with a strong pelvic floor, poor breathing patterns can cause leakage. This is why prenatal PT always assesses what’s happening above the bladder.
3. Posture
Your posture influences how pressure moves through your body.
If your ribcage is not stacked over your pelvis, pressure can increase on the bladder—much like a kinked balloon creating pressure at the bottom.
This posture becomes almost impossible in third trimester pregnancy when you are upright.
Individualized postural assessment and correction during prenatal pelvic floor physical therapy can significantly reduce urinary leakage by giving you corrective exercises to practice.
Manual Therapy, Exercise, and Body Awareness
At Bodyful, change happens through nervous-system-informed manual therapy paired with targeted exercise.
When indicated and with consent, we may assess pelvic floor muscles internally. We also offer gentle visceral fascial mobilization for the bladder and abdominal structures—an excellent option for those who prefer non-internal work.
Our exercise approach includes extensive posture training, corrective exercises to improve your core strength, and hip and shoulder stabilization integration—essential for treating leaking pee during pregnancy.
All care is trauma-sensitive, paced, and collaborative.
Lifestyle Strategies to Reduce Leakage
Daily habits matter.
Do not restrict fluids—concentrated urine irritates the bladder
Avoid pushing to pee—relax and breathe instead
Limit bladder irritants when possible (caffeine, carbonation, acidic foods)
These strategies complement prenatal pelvic floor PT but do not replace individualized care.
The Importance of Postpartum Pelvic Floor Care
If you are leaking during your third trimester, postpartum pelvic floor care is strongly recommended.
Early support can reduce the risk of worsening symptoms, including pelvic organ prolapse.
You can safely begin pelvic floor PT during pregnancy if cleared for exercise and penetrative sex. Postpartum, internal assessment typically begins after your 6-week OBGYN check—but PT care can start sooner without the intra-vaginal work.
Even one session can make a meaningful difference.
Pelvic Floor Muscles Involved In Urinary Leakage
Support Is Available
Urinary leakage during pregnancy is manageable with pelvic floor PT.
A prenatal pelvic floor physical therapist can create an individualized, efficient, and evidence-based plan to support you now and postpartum.
If you’d like to work with a prenatal pelvic floor specialist at Bodyful and you have additional questions, you may book free 15-minute consultation to speak directly with one of our Doctors of Physical Therapy.
Bodyful Physical Therapy and Wellness is located in Oakland, CA, serving the Bay Area in person and offering virtual prenatal pelvic floor physical therapy throughout California.
