What do the following have in common?
A) Public speaking naked
B) Finding a rattlesnake in your underwear drawer
C) Being held upside down over a cauldron of lava
Answer: Most women would probably say that these experiences are less scary than telling their partner they have a leaky bladder during sex.
But bladder leakage can, and does, breach the bedroom door. Medical studies estimate that bladder leakage affects more than half of women at some point in their lives. And one study assessed this 6 out 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 very important to talk about it — at least with your health care provider (HCP), said Lauri Romanzi, MD, a urogynecologist and member of the HealthyWomen’s Health Advisory Council. Romanzi wants women to know that it’s nothing to be ashamed of, and perhaps most importantly, it can be treated and treated.
Causes of bladder leakage during sex
Bladder leakage is a problem that can they develop slowly over timesaid Romanzi, and it can happen at penetration or 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 during penetration. Apart from sex, this can also cause leakage with vigorous physical activity, coughing, sneezing and laughing.’
When bladder leakage is caused by overactive bladder (OAB), it usually occurs during orgasm and not during penetration. (If you’ve ever wondered if female ejaculation during orgasm it’s urine, it’s not. Female ejaculation is its own fluid, although SUI can also cause bladder leakage during orgasm.)
Treatment for bladder leakage during sex
The first thing women can do to help manage bladder leakage is to strengthen and retrain their pelvic floor muscles. One way to do this is through physical exercises, such as Kegel technique. You don’t have to do these exercises alone, and many people get them wrongso getting help from a professional might be a good idea. Romanzi said that physical therapists specialize in pelvic floor treatment (called pelvic floor therapists) can help treat urinary incontinence. In addition to suggesting and helping you do pelvic floor exercises, a physical therapist may 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 cyst is different. If you have a leaky bladder, it’s a good idea to keep track of what types of food and drink irritate your bladder and avoid them, especially before bed.
A technique called double emptying may also help. This means emptying your bladder and then emptying it again a few minutes later. You can try double urination before sex to reduce the chances of your bladder leaking during intercourse. Your sex positions can also make a difference if your leakage is caused by bladder pressure. Avoid the typical missionary position and try putting a pillow under your back to tilt your organs out of the way.
Medicine can also help. If your bladder leakage is a result of menopause, Romanzi said topical estrogen, or estrogen applied inside the vagina, may be helpful. Available in creams, tablets and vaginal rings.
For leakage caused by OAB, there are currently several FDA approved drugs. But some of them can cause side effects such as dry mouth, which can lead to excessive alcohol consumption and worsen leakage.
If other options don’t work, some women may be candidates for more invasive procedures like Botox injections into 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 treatmentssuch as sacral nerve stimulation among others, can be used.
“[Sacral nerve stimulation involves] a pacemaker-type device that can be implanted in women with severe OAB or urge incontinence unresponsive to other treatments,” Romanzi said. “These deliver electrical pulses from a device placed on the lower back.”
For women whose leakage is caused by pressure on a weakened urethra, a urethra sling can be inserted surgically. Or, the urethral tumora similar surgical procedure that injects silicone into the urethra to strengthen it may also be an option.
In addition to treatments, you can also manage bladder leakage with pads outside the bedroom. Bladder leakage pads can help absorb fluid and control odor, which can make you feel less self-conscious when it’s time to have sex.
The importance of talking about bladder leakage
Bladder leakage can be uncomfortable to report, but in order to get treatment, you need to talk to your doctor first. You may not even have to say the words. Romanzi said many electronic record capture 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 material that reflects your symptoms and give it to your HC.
The best type of provider for bladder leakage during sex is a urogynecologist. Your primary care provider or gynecologist can recommend one. Urogynecologists see bladder leakage issues in their office every day and are experienced in discussing topics that patients may not enjoy bringing up. It is important to find an HCP who not only specializes in women’s bladder problems, but who will make you feel comfortable.
Dare to speak up and be your own advocate is worth it, Romanzi said. Bladder leakage during sex is known to cause less frequent sexual activity and avoiding sex, but with treatment, you can get your sex life back.
Remember: A leaky bladder may have come uninvited into your bedroom, but you can invite it out.
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