Dealing with incontinence during sex
We explore how much can be done for a common issue that many people can’t bring themselves to talk about
Incontinence is known as one of the last taboos—and when anyone leaks in the bedroom, shame and embarrassment are amplified. But sometimes the biggest intimate secrets are the most straightforward to solve.
Globally, more people suffer from bladder dysfunction than hay fever, with older women twice as likely as their male peers to leak urine. It is often written off as something women must just endure, especially if they’ve had babies or are post-menopause, which means they don’t always get the help that’s available.
Decades of hushed conversations about the reality of childbirth and the menopause has meant there isn’t much talk about leaking during sex, or other bedroom problems caused by incontinence.
They cover a large range. Some are embarrassing, like weeing or breaking wind during sex, having to rearrange your vagina as some positions for penetration don’t work, or bed-wetting. Some are painful, like urine burns or infections. Some are practical, like concerns over how much wee continence pads or underwear (disposable or reusable) can hold, or being too tired from frequent night-time loo trips.
The World Federation of Incontinence and Pelvic Problems, a patient body for people with bladder issues, launched practical, evidence-based website Support Incontinence this winter.
It stresses that patients shouldn’t blame themselves or withdraw from their partner. And if they are confident enough, they should try to share their worries. It also gets practical, with tips on using protective sheets, avoiding triggers (such as alcohol and coffee) before sex, and ensuring you’ve popped to the loo before you start.
When I wrote a memoir about my incontinence, several physiotherapists urged me to cover leaking during sex, especially the emotional side. When I leaked, I felt afraid and ashamed, convinced my husband would think I was broken or disgusting.
Sam Evans, a former nurse and co-founder of online sex toy company Jo Divine, tells me I wasn’t alone in not realising I could ask for treatment. “The impact of childbirth upon the body can last for many years”, she says. “I speak to women in their seventies who still struggle to enjoy sexual intimacy or normal pelvic health due to pain and incontinence.”
Urinary incontinence is common, but it isn’t normal and there’s help available. Physiotherapy is effective and there are apps and specialist devices, from strengthening machines and weights to silicon pessaries and tampon-like plugs to prevent fecal leaks. Lifestyle alterations can help too, and there are surgical options. Yet women are often reluctant to say anything.
Stephanie Taylor, founder of Kegel 8, which makes pelvic floor exercising equipment, agrees that women are often prepared to “ignore it” even if it makes them unhappy.
She finds couples react differently: “Some may be very ‘matter of fact’, but others can be devastated, to the point of not wanting to have sex, or ‘let themselves go’ for fear of wetting themselves.”
It is great if you can talk about it, or even embrace the odd leak as part of the fun. And being honest about our bodies is a foundation for healthy sex. But leaving bladder issues untreated can mean they worsen over time, so even if you aren’t embarrassed, it is worth getting leaks checked out.
As these issues often occur as women hit middle-age or later, they can get lost among wider gynae and pelvic issues such as periods, polyps, birth injuries, hormonal changes, menopause symptoms, constipation or prolapses. And some patients worry it is too trivial to raise with medics, especially if incontinence is caused by other medical conditions such as MS, neurological damage or cancer treatments.
Kate Lough, a specialist pelvic physiotherapist and chair of the POGP, a body which focuses on pelvic, obstetric and gynaecological physio, says patients often arrive in clinics for treatment for wider problems. It is critical that physios, doctors and specialist nurses ask about sexual function. And if they don’t, patients should feel empowered to ask what their options are.
In my experience, asking to be referred to a trained nurse or physio is a positive step. And as Sam Evans notes, pelvic floor exercises are “such a simple way to enjoy better orgasms and prevent incontinence!”.
The NHS-approved Squeezy app helps you exercise and find a physio, and lots of UK registered physios and groups like Pelvic Roar share exercises, anatomy info, and resources via Instagram, Twitter and Facebook. Many manufacturers and charities have websites and helplines, to speak to other patients, nurses or physios.
Stephanie Taylor sees other advantages in taking control: “I say to women: it is your pelvic floor—take charge, manage the prolapse, manage and minimise the leaks and get strong. Use it as a learning curve to understand how beautiful the human body is. Getting back into the bedroom is different for many, but a strong couple can work their way around it.”
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