How to Stop Incontinence From Sabotaging Your Sex Life

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It's bad enough worrying 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 sabotaging 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 or orgasm.

But don't despair: Here's a seven-step plan for coping with incontinence and getting your sex life back on track.

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.

More Ways to Stop Incontinence From Sabotaging Your Sex Life

3. Experiment with new sex positions.

Now this one your partner should have no trouble getting on board with. Here are some options to try:

  • Rear entry. When he stands or kneels behind you, it puts less pressure on the bladder and urethra.

  • Side entry. Another position that prevents his weight from being on your abdomen and relieves pressure.

  • Woman on top. When you're on top, it's easier to control the depth of penetration and to work those deep pelvic muscles you'll want to strengthen.

4. 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.

More Ways to Stop Incontinence From Sabotaging Your Sex Life

5. 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.

6. 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.

7. 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. Some of the most popular are Detrol, Enablex, Sanctura, Ditropan, Toviaz, Vesicare, and generics containing the active ingredient oxybutynin.

In recent years, timed release once-a-day versions of these drugs have become popular. But if incontinence during sex and exercise is your primary concern, ask your doctor whether it's more effective to take an older, multidose formula. Some women say taking one dose of a multiple-dose drug just prior to sex works better than one dose a day.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

9 months, said...

I,am 8yrs older than my wife and had incontinence for 15yrs due to being a diabetic and prostate problems. I must wear diaper 24/7 and when we go somewhere must pack diapers and bed pads this plays on the mind especially sine I,am the only confined to diapers feel like let her down.

over 1 year, said...

I no longer find my incontinent 34 year old husband sexually attractive . he finally agreed to wear diapers during the day and night . which is great cause no more embarrassing accidents in public or my friends houses. and a dry bed yay. but he has to wear tab diapers and I have to diaper him when he wets even have to carry his diapers in my purse whenever we leave. I just can't see him as a sexual partner I love him always will. won't leave him but our roles have changed.

almost 3 years, said...

My wife 75 and I am 84 has incontinence problems, mainly from wearing pads all day her vulva is so irritated that she refuses my touching her vulva in foreplay leave alone my penis entering is too painful. Consequently we have had to abstain from having intercourse for several years. Is there some kind of treatment to relieve my wife when having intercourse? Thank you for your private advice on this problem. I have discussed it with our Primary doctor but have not had help. The doctors seem to write it off as AGE problems.

about 3 years, said...

4 word solution: get into GOLDEN SHOWERS!!

about 4 years, said...

Why do you assume it's a woman with the problem? I was looking for information on male incontinence as the result of surgery and back issues! It seems men have to stay in the closet and not talk about this....and this kind of answer promotes that. Sorry - but perhaps you could revisit your answer and not fall in to the trap so many do that this is a woman's problem. It's not. Also, many men have problems with this after prostate problems, which we are barely talking about now compared to women's issues. How about helping the men to feel more comfortable with this, and giving their partners a little help?

almost 5 years, said...

At 85 with gal at 70 I feel lucky. Vacuum system works well. I've been on depressants and perform better now without them. Sex at 85 is very possible men!

almost 5 years, said...

I am a man, but I get no satisfaction from seeing anybody wet themselves. It is a great shame that these articles seemed to be aimed at women, because men have incontinent issues, I suffer from nocturnal enuresis at night and a leaking bladder during the day, but I wear a nappy pad during the night and pull up pants during the day, and I always wear a pair of pvc pants over them to stop any embarrassing leaks. My sex life is just about working, with me going off to the toilet, half way our love making, still no problems as I am 68 years old and my good wife is 70 years old. My wife isnt incontinent like me, I think you are talking about people that dress up as babies or cross dressers etc. they are into all that weir stuff.

about 6 years, said...

this may be aimed at older women with incontinence issues but there is a need to point out that some women ejaculate which may feel like pee but it is not. I am disappointed that this article does not even mention this. It makes some women that can do this, feel that they have a problem when in fact it is not a problem and most guys enjoy it. If you want to know more just google female ejaculation.

about 6 years, said...

Kind of a lopsided article, seems to assume the issue only affects women.

over 6 years, said...

I have heard some men like us to lose control and wet our pants or jeans? True or false?? Why would some men be turned on by this?