Let's Talk about Sex...and Incontinence
It's bad enough having to worry about whether you're going to make it to the bathroom on time to avoid an accident. But worrying about leakage during sex -- that can really bring you down. If incontinence is stressing out your sex life, at least you're in good company. According to the American Foundation for Urologic Disease (AFUD), one in three women with stress incontinence avoids sexual intimacy because of fear of leakage during intercourse.
Here are some tips on how to not let incontinence slow down your sex-life:
1. Prepare for sex.
One thing to take into account is when during sex you're more likely to leak: If you have stress incontinence, you're more likely to leak with penetration due to pressure on the bladder. If you have urge incontinence, you're more likely to leak during orgasm. (Since women's orgasms often don't happen during intercourse, you can prepare for that moment separately.)
Either way, there are lots of things you can do to decrease the likelihood of involuntary leakage during sex while you're working on a longer-term solution. You'll need to experiment to see which of these makes a difference for you:
- Avoid coffee or tea for several hours prior to sex.
- Drink plenty of water well before having sex, but don't drink any fluids for an hour before sex.
- Practice "double voiding" prior to sex: Go the bathroom, then fully relax the bladder (some people recommend massaging the abdomen) and go again.
- Put towels down, so you're not worrying about linens if you do leak.
- Don't be shy about taking a "bathroom break" during sex. For women with urge incontinence, taking a bathroom break between foreplay and intercourse or between intercourse and "after-play" can make sex much more relaxing.
2. Talk about it.
No, this probably isn't an easy topic to bring up with your partner. But isn't it worth a few minutes of blushing if the payoff is returning to your previously joyous sex life? You might start by mentioning that you've been to the doctor to get help with a problem you're really embarrassed to discuss. Tell your partner how much you miss your formerly great sex life together, and let him know that your reluctance hasn't been because of lack of interest but because of fear of leakage and embarrassment.
You may be pleasantly surprised by your partner's supportive reaction; it's likely that the problem isn't nearly the issue for him you've been thinking it is. After all, men have aging-related issues that affect their sexual performance, too. Your guy is probably all too familiar with the fear and shame that can accompany age-related changes affecting sex. If talking privately isn't solving your sexual issues, working with a couples counselor or sex therapist can make it easier to talk about difficult topics.
3. See a specialist.
Ask your doctor for a referral to a urologist who specializes in incontinence. This isn't an easy topic to bring up, but knowing how common it is might make it easier. Experts estimate that nearly one out of three women over age 40 struggle with incontinence at some point, but only 20 percent of them seek help. Wouldn't you rather find a solution than remain a silent sufferer? Specify that you'd like a recommendation for someone who keeps up with recent research and training and is familiar with newer, more experimental therapies, such as biofeedback.
If you have any friends with whom you'd feel comfortable discussing this issue, ask if they've found a doctor they like. Personal referrals are a great way to find specialists who "get it." Some hospitals and medical centers have specialized bladder health clinics where you're likely to get up-to-the-minute expertise.
4. Strengthen your muscles with pelvic floor therapy.
Working with a physical therapist, you can rebuild strength in the deep abdominal muscles that support the bladder, using a program of exercises known as Kegels. (Many women try doing pelvic floor exercises on their own and don't get the full benefit because they're not doing them correctly.) Working with a pelvic floor therapist (PFT) with specialized training has been shown to increase the effectiveness of Kegels; one study found that when women worked with a PFT, 80 percent were able to control their incontinence.
Two additional techniques can boost the effectiveness of pelvic floor therapy:
Biofeedback. Computers attached to sensors can help you and your physical therapist know which muscles you're working, measure muscle strength, and check whether you're doing pelvic floor exercises correctly. Kegels can have the additional benefit of strengthening the muscles in the vaginal wall, so you and your partner may notice a sexual benefit as well. Interestingly, sex is great for the Kegel muscles, so as your revitalize your sex life, you may strengthen your bladder control as well.
Electrical stimulation. Some clinics offer electrical stimulation (also called pelvic floor muscle electrical stimulation, or PFES) in combination with biofeedback for people with severely weakened pelvic floor muscles. A low-grade electric current causes the muscles to involuntarily contract so patients can experience what that contraction feels like, learn to replicate it themselves, and regain muscle control.
5. Practice bladder control.
Your urologist can work with you on a process known as "bladder retraining," which involves determining your natural pattern of urination, then setting up and following a fixed schedule of timed toilet trips, whether you feel like going or not. When you feel the need to go between intervals, you buy time by using urge-suppression techniques such as Kegels, distraction, and relaxation. You'll also learn techniques, such as double voiding, to completely empty your bladder when you go. Over time you'll work to increase the intervals between bathroom trips and the amount of liquid your bladder can hold.
6. Try medication.
Many doctors consider medication for incontinence a last resort, but if you've tried bladder retraining and pelvic floor exercises, and incontinence is still seriously impacting your sexual relationship, then medication is a smart next step. There are a number of drugs classed as anticholinergics and antispasmodics that block the signal that triggers involuntary contractions of the bladder.