Dr Thomas Stuttaford
A: Regardless of your age this is a common, but not at all
simple, problem. There are many different causes of incontinence, including
that occurring during intercourse. Most of these cases are related either to
stress incontinence or to detrusor instability (the destrusor is a muscle in
the bladder that helps to expel urine). Sometimes incontinence during sex
occurs with no other bladder symptoms.
Detrusor instability is the condition that patients refer to as having a weak
or nervous bladder. Whatever they call it, the result is that they suffer
from frequency of urination, both by night and day, and from urgency — they
have to reach the lavatory quickly once they feel the need to pass water and
may have a sudden and uncontrollable loss of urine.
Studies have shown that women who suffer from incontinence are likely to wet
themselves on one in four occasions when they make love. And although they
may try to hide it, in 90 per cent of cases their partner is aware of their
incontinence.
Leaking is more of a problem for those with detrusor instability than stress
incontinence.Stress incontinence is the condition in which women leak when
they cough, laugh or sneeze, or take the type of exercise that is likely to
make them grunt. Lifting heavy weights, straining when changing a car wheel,
serving at tennis and having an orgasm are all examples in which muscular
activity may stimulate a leak.
The older the woman, and the more children she has had, the more likely she is
to suffer some stress incontinence during sex. When a woman has a strong
orgasm all the muscles in her pelvis contract, not only those of the vagina.
Her pelvic floor tightens as do her peri-anal and bladder muscles.
Not all incontinence during intercourse occurs when a woman has an orgasm.
Research carried out in the late 1980s in two large studies indicated that
women are most likely to wet themselves either at the moment of penetration
or at the time of orgasm. Interestingly, those with detrusor instability are
more likely to leak during orgasm; those with stress incontinence during
penetration.
Of the hundreds of women studied, only five had no other obvious urinary tract
symptoms and yet leaked during intercourse — three of them on penetration
and two on orgasm.
A third of women who suffer incontinence avoid sexual intercourse because of
it. Half of these cases — in which women were incontinent but, like you,
continued to have sex — found that it affected their ability to enjoy
intimacy with their partner. Incontinence is irretrievably mixed up in
people’s minds either with old people’s homes or nappies. A young, sexually
active woman is unlikely to want to evoke images of senility or childhood.
Your own partner is understanding and laughs only because he is unable to
find another way of reassuring you.
Women may wet themselves without other symptoms of bladder troubles or of
incontinence. This is thought to be because sexual activities, however
exciting, also can produce considerable emotional stresses and strains.
Cheer up. There is treatment. Ask your doctor about medications such as
Detrusitol XL, Lyrinel XL or Vesicare. They can revolutionise many cases,
and stress incontinence may be also treated surgically or with exercises.
Suzi Godson
A: Make an appointment with your doctor. Female incontinence
is a much more common problem than anyone is prepared to admit. In a group
of seven or eight middle-aged women, the chances are that one will have
experienced a loss of bladder control.
Incontinence can affect anyone at any age (500,000 UK children over the age of
5 can’t control their bladders properly) but it is much more common during
pregnancy, after childbirth and before menopause.
During pregnancy the growing baby squashes the bladder and urethra, sometimes
pushing them out of position completely. Extra weight and pressure can also
weaken the pelvic floor muscles and damage the bladder nerves. Vaginal
delivery and episiotomy (the cut in the muscle that makes it easier for the
baby to come out) can weaken bladder-control muscles and the bigger the baby
the more likely it is that there’ll be problems. (This is not something that
is always made clear to women who are carrying large babies and plan to have
a vaginal delivery.) Bladder control problems don’t necessarily show up
right after childbirth. Some women notice a weakness only in their forties
and, as a woman approaches menopause and oestrogen levels decrease, the
problem is likely to get worse. Oestrogen helps to keep the lining of the
bladder and urethra plump and healthy and, as levels decline, the muscles
that control the bladder weaken.
Because incontinence is embarrassing many women would rather disguise the
problem with sanitary towels and vaginal deodorants than to seek help. It is
often only when a woman is compromised in front of someone else, as you have
been, that she is forced to address an issue that has been nibbling away at
her quality of life for years. As is the case with so many “embarrassing”
personal issues, as soon as she tries to sort it out she realises that she
has been suffering in silence for no reason because the problem is as common
as the solutions are varied.
Severe cases of incontinence may need surgery but whether the problem is major
or minor, sufferers are always advised to strengthen their pelvic floor.
Pelvic-floor exercises involve tightening the muscles around your back
passage, vagina and front passage. The sensation feels a bit like lifting a
platform inside your pelvis and squeezing your muscles around it. You hold
the “lift and squeeze” for as long as you can and then rest for four
seconds, making sure to breathe normally. You repeat the process ten times,
three or four times a day, gradually increasing the time that you can hold
each contraction. Women who are not sure they are working the right muscles
may want to invest in a pelvic toner (www.natural-woman.com). Made in
Britain, the product is designed to combat incontinence and improve sexual
satisfaction. The website gives details of how the toner works and there are
links to other sites with information about surgical treatments.
Improving pelvic tone can take months. In the meantime, remember to pee before
you have sex and try not to get wound up about leaks. Sexual intercourse is
synonymous with the emission of bodily fluids and urine is nothing to be
afraid of. It’s 95 per cent water. It doesn’t leave a stain. And, dare I say
it, for many couples a warm, wet, golden shower is one of the nicest ways to
say I love you.
E-mail your sexual dilemmas to body&soul@thetimes.co.uk or write to
Body&Soul, The Times, 1 Pennington Street, London E98 1TT
