What do the following have in common?
A) Public speaking in the nude
B) Finding a rattlesnake in your underwear drawer
C) Being held upside down over a cauldron of lava
Answer: Most women would probably say these experiences are less terrifying than telling their partner they’re having bladder leakage during sex.
But bladder leakage can, and does, breach the bedroom door. Medical studies estimate bladder leakage affects more than half of women at some point in their lives. And one study estimated that 6 of 10 women who have bladder leakage experience it during sex.
If you don’t want to talk about bladder leakage during sex, you’re not alone. Most people don’t. But it’s really important to talk about it — at least with your healthcare provider (HCP), said Lauri Romanzi, M.D., a urogynecologist and a member of the HealthyWomen’s Women’s Health Advisory Council. Romanzi wants women to know it’s not a reason to be ashamed, and perhaps most importantly, it can be managed and treated.
Causes of bladder leakage during sex
Bladder leakage is a problem that can develop little by little over time, Romanzi said, and it can happen at penetration or at orgasm. Stress urinary incontinence (SUI), which is when stress on the bladder causes leakage, is the most common type of bladder leakage during sex. “When the urethra is weak,” Romanzi said, “this can cause urine to leak out during penetration. Outside of sex, this can also cause leaks with strenuous physical activity, coughing, sneezing and laughing.”
When bladder leakage is caused by an overactive bladder (OAB), it usually happens during orgasm rather than penetration. (If you’ve ever wondered if female ejaculation during orgasm is urine, it’s not. Female ejaculate is its own liquid, although SUI can cause bladder leakage during orgasm also.)
Treatment for bladder leakage during sex
The first thing women can do to help manage bladder leakage is to strengthen and re-train their pelvic floor muscles. One way to do that is through physical exercises, such as the Kegel technique. You don’t have to do these exercises on your own, and many people do them incorrectly, so getting help from a professional can be a good idea. Romanzi said physical therapists that specialize in pelvic floor therapy (called pelvic floor therapists) can help treat urinary incontinence. In addition to recommending and helping you do pelvic floor exercises, a physical therapist might use biofeedback and electrical stimulation techniques.
General diet changes — eliminating caffeinated or carbonated beverages and fruit juices, as well as alcohol, chocolate, acidic and spicy foods — can help, but every bladder is different. If you’re having bladder leakage, it’s a good idea to keep track of what types of food and drink irritate your bladder and avoid these, especially before bedtime.
A technique called double voiding can also help. This means emptying your bladder, then emptying it again a few minutes later. You can try double voiding before sex to reduce the chances of your bladder leaking during intimacy. Your sex positions can also make a difference if your leakage is caused by pressure on the bladder. Avoid standard missionary position and try putting a pillow underneath your lower back to tilt your organs out of the way.
Medicine might help as well. If your bladder leakage is a result of menopause, Romanzi said that topical estrogen, or estrogen applied inside the vagina, can be helpful. It’s available in creams, tablets and vaginal rings.
For leakage caused by OAB, there are currently several medications approved by the FDA. But some of them can cause side effects such as dry mouth, which can lead to drinking too much and make leakage worse.
If other options are not working, some women may be candidates for more invasive procedures like Botox injections to the bladder or a weekly treatment called percutaneous tibial nerve stimulation (PTNS). PTNS involves delivering electrical stimulation through a needle inserted into a nerve in the ankle, which travels up a nerve in the leg to the nerve that controls the bladder.
In some cases, surgical treatments, such as sacral nerve stimulation among others, can be used.
“[Sacral nerve stimulation involves] a pacemaker-type device that can be implanted for women with severe OAB or urge incontinence that doesn’t respond to other treatments,” Romanzi said. “These deliver electrical pulses from a device inserted in the lower back.”
For women whose leakage is caused by pressure on a weakened urethra, a urethral sling can be surgically inserted. Or, urethral bulking, a similar surgical procedure that injects silicone into the urethra to strengthen it, may be an option as well.
Outside of treatments, you can also manage bladder leakage with pads outside the bedroom. Bladder leakage pads can help to absorb liquid and control odor, which can make you feel less self-conscious when it’s time to be intimate.
The importance of talking about bladder leakage
It might be uncomfortable to bring up bladder leakage, but to get treatment, you have to talk to your HCP first. You might not even have to say the words. Romanzi said many electronic records intake systems now include questionnaires for patients that include bladder control questions. Or, Romanzi suggested, if you can’t bring yourself to bring it up, you can just print out materials that reflect your symptoms and hand them to your HCP.
The best type of provider to see for bladder leakage during sex is a urogynecologist. Your primary care provider or gynecologist can recommend one. Urogynecologists see bladder leakage issues in their practice every day, and have experience discussing topics that patients might not enjoy bringing up. It’s important to find an HCP who not only specializes in women’s bladder problems, but one who also makes you feel comfortable.
Braving the talk and being your own advocate is worth it, Romanzi said. Bladder leakage during sex is known to cause less frequent sexual activity and sex avoidance, but with treatment, you can reclaim your sex life.
Remember: Bladder leakage may have entered your bedroom uninvited, but you can invite it to leave.
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