Incontinence, or loss of urinary control and in some cases defecation control, can be one of the most difficult and common conditions to live with for both men and women. Incontinence can be caused by a myriad of things including medications, illness, cancer, surgery, stress, and aging. Neurological issues such as Multiple Sclerosis, Parkinson’s Disease, a stroke, autoimmune diseases, brain injury or spinal cord injury may also play a role in this personal bodily function and can cause many issues. Other names for this common ailment are overactive bladder, bladder leakage, enuresis, and post-micturition dribble.
Medically speaking, there are different types of incontinence and they all occur and happen at different times for different reasons.
Stress incontinence happens when sudden pressure is put on the bladder or abdomen like coughing, laughing, sneezing, lifting or exercising.
Urge incontinence happens by first a sudden extreme urge to urinate, followed by the release of all urine with no control. You might also feel the need to urinate more frequently through the night and day as well. Urge incontinence can also be caused by an illness.
Overflow incontinence is a constant dribble or drips of urine that happens because the bladder is not emptying properly.
Functional incontinence happens when a physical or mental block prevents you from making it to the bathroom in time. This could mean your rheumatoid arthritis flares and you cannot get out of your pants fast enough not to avoid the accident.
Mixed incontinence is having two or more of the aforementioned types of incontinence at one time.
Intimacy with Incontinence
If dealing with incontinence was not hard enough, discussing your intimate needs with your partner while this condition tries to rule your life might feel even more difficult to handle. Discussing such a topic brings on instant feelings of embarrassment, fear, frustrations around failed intimacy, and relationship feelings as well. If you are dealing with incontinence, having this conversation with your partner could be the change that builds your confidence and helps your love life return once again. Most commonly, a partner would simply tell the other that they might notice a bit of dribbling urine and once they were comfortable, could run through their “worst case scenario” of what might or could happen. Intercourse, foreplay, most types of sexual intimacy involve bodily fluids. So really, what’s another fluid?
In the case that dribbling does occur, do not allow it to ruin your moment. Keep a level head, clean up if you need to, and go back to loving on and connecting with your partner. Urine is sterile so there is no need for germ-panic. Do your best to cover the area before you begin, so any leakage would be no real clean up issue. Here are a few basic tips that can help ease the worry with urine incontinence:
- Avoid drinking fluids within the hours before your intimacy begins
- Empty your bladder as close to the act of intimacy as possible. Remember that leaks happen, and they are okay.
- Protect your area by laying down a towel or extra sheet in case there are leaks or messy moments. Body fluids are messy and totally normal during any sort of intimate or sexual time.
- Take bathroom breaks! Taking a moment while shifting from kissing, to foreplay, to your next intimate act does not have to happen without a moment to breathe or use the bathroom.
- Practice and experiment different positions and types of foreplay that avoid putting extra pressure on the bladder or specific areas that need to be avoided for your needs. This might take some practice, but practice does make perfect and the more you get to know yourself, the more comfortable you will be.
Commonly Asked Questions about Incontinence & Intimacy
Is sexual intercourse still safe if I am leaking urine? Yes, sexual intercourse is still considered safe. Urine is a sterile bodily fluid.
Can intercourse hurt my bladder and break it more? Unless you are a female or with a female with a prolapsed bladder, intercourse will not cause any further damage or issue with the bladder. If you do have to deal with a prolapsed bladder or another more unique female organ issue, discussing the many options for pelvic floor strengthening exercises and learning the best sexual positions for those with pelvic floor issues with your primary care doctor, Urologist, or OB-GYN would be your best bet.
Is it true that some bladder leakage is normal? No, any amount of bladder leakage is not normal. However, incontinence of any level has been directly linked to many medications, surgeries, stress, and more. Many people who deal with a slight leak (especially women after childbirth) think that the small amount that comes out when they sneeze, laugh or cough is something they are stuck with. This is not the case. There are many different things, some very simple, that can be done to ease the bothersome issue.
I’ve heard pelvic exercises are only necessary if I have bladder issues. Is that true? No, there are many reasons that one should do pelvic exercises, specifically Kegel exercises, to help keep the pelvic floor, vaginal walls, and overall pelvic strength up and health on point. Plus, these exercises also help out your sex life and help you to prevent pelvic prolapse.
I was told to pee the instant I felt the urge. Now I’m reading that might have caused my overactive bladder. What should I be doing? Dr. Roger Goldberg states that training your bladder to believe you will empty it the moment you feel a slight urge can lead to further instance of overactive bladder in the mid-life years. He states that urinating normally happens for most once every three to four hours. Of course, sometimes more or less depending on the situations and circumstance (Goldberg).
Since I have this urinary leakage problem, is surgery my best option to make it end? Before any decisions are made, you must meet with your Urologist, or primary care physician for a referral, to get a proper diagnosis. Surgery might be your best option, but without knowing what issues you are facing, there is no way to tell. There are many other treatments available to try before surgical intervention should happen. Always check in to all of your options before making any sort of decision on a major surgery.
Best Sexual Positions for Incontinence and other Pelvic Floor Related Issues
Incontinence: It would be best to avoid the “missionary position,” which is the position where the couple lies face to face with the woman on the bottom or being up on all fours, otherwise known as “doggy style” or “rear entry.”
Instead, try lying on your back and piling two or three pillows underneath your backside. This position raises your pelvis, allowing your body to reposition your bladder, which reduces the extra pressure in the area.
Pelvic Organ Prolapse: With any prolapse, you should avoid any standing position, such as the “Cowgirl,” or “Reverse Cowgirl.” Gravity does not help in this case, and positions attempted should allow and encourage the organs to stay where they are.
By propping a pillow under the lower back, and attempting the more modified missionary position, this will alleviate pressures and allow for organs to remain comfortably in place. Another method would be the kneeling position with rear entry, although not if there are rectal POP present.