Coital incontinence is a pelvic floor disorder that causes urine to leak spontaneously during sexual activities such as penetration or orgasm. A reported 20-35% of women experience coital urinary incontinence, but it’s believed the actual number is much higher. Due to a misplaced sense of embarrassment, many women refrain from speaking up about the condition and seeking help.
It’s important for all women to understand that issues with the pelvic floor muscles are quite common and they shouldn't feel shame in speaking with their health-care provider or reaching out to others for support. Discussing urinary incontinence is the best way to address any underlying factors that might affect sexual health and receive the correct advice and treatment to manage symptoms.
Understanding Coital Incontinence
Urine leakage often occurs when exercising, laughing, coughing, or sneezing. Coital incontinence occurs due to pressure put on the bladder during sexual acts. An overactive bladder can also influence incontinence problems, as up to 80% of women with OAB also have this type of incontinence.
Causes and Risk Factors
Several factors can cause coital incontinence during sexual activity:
- Penetration during sex can cause urine leakage from the pressure on the bladder and urethra. This is a type of stress incontinence.
- Pelvic organ prolapse leaves the bladder and urethra more susceptible to stress incontinence during penetration.
- Weak pelvic floor muscles cause a loss of sensation around the urethra and vagina, so you might not notice if you leak small amounts of urine during sexual activity.
- During orgasm, you may leak urine due to a relaxed urethra or from involuntary muscle contractions.
Weak pelvic floor muscles are one of the most prevalent reasons behind incontinence. Other physical factors that contribute include changes in hormone levels or childbirth. Women who have psychological factors, such as anxiety, stress, or previous traumatic experiences, are also at greater risk. Further, menopausal women typically have a greater chance of experiencing this type of incontinence due to weak pelvic floor muscles.
Types of Coital Incontinence
There are three main types of coital urinary incontinence:
It’s important to visit your doctor and talk about your symptoms and experiences to diagnose the type of incontinence you have and any factors that may contribute to the condition. Symptoms are often manageable through a variety of treatments.
Symptoms and Impact on Sexual Well-being
All types of incontinence can have an impact on a woman's well-being, but due to the intimate and sensitive nature of the disorder, coital incontinence may have the biggest impact on a woman’s quality of life.
Common Symptoms of Coital Incontinence
Women experience different symptoms with varying degrees of severity. You may feel the urge to urinate during intercourse, or you could leak a small amount of urine during sexual activity. Some women can't fully empty their bladder. Other symptoms include bladder pain, nocturia, reduced urine stream, and stopped urine flow before the bladder is empty.
Emotional and Psychological Impact
Experiencing urine leakage during sex can often lead to feelings of shame, embarrassment, and low self-esteem. Some women may feel unclean and undesirable or experience relationship strain and intimacy concerns.
Seeking Professional Help
Remember you're not alone if you struggle with incontinence. The condition affects many women, especially those over the age of 50. You should feel safe speaking up about your condition and discussing every aspect of your health and well-being with your doctor.
Discussing Coital Incontinence With Health-Care Providers
If you have ongoing issues with incontinence, schedule an appointment with your doctor. Speak up about every detail to give your doctor a clear picture of what's happening, so they can give you a proper diagnosis. You may find it helpful to keep track of your symptoms in a journal. This provides your doctor with accurate information and can make it easier to talk about your symptoms openly.
Physical Examination and Diagnostic Tests
Typically, a physical examination of the pelvis is required for the diagnosis of incontinence. Your doctor may ask you to participate in a stress test, which involves coughing or straining, to determine if you have stress incontinence. A urinalysis is typically done to test your urine for infections and other abnormalities.
Importance of Ruling Out Underlying Medical Conditions
The cause of urine leakage problems may be due to another condition. Your doctor can perform a full physical and run any necessary tests to rule out underlying factors. If you have another medical concern contributing to incontinence, addressing it can help to lessen your symptoms.
Referral to a Specialist if Necessary
Your doctor may refer you to a specialist, such as a urologist or a gynecologist, to better treat your concerns. Always follow up on recommendations to see another health-care provider. You can also seek out another opinion to confirm a prior diagnosis.
Treatment Options
You can treat the symptoms of incontinence through medical means and lifestyle changes. Many women find the most success when combining several methods. Speak with your doctor to determine which strategies are right for you.
Lifestyle Changes and Self-Care Strategies
Pelvic floor exercises, also referred to as Kegels, strengthen the pelvic floor muscles and can help with incontinence. However, keep in mind not everyone can safely do Kegels, so check with your doctor first. You can also reduce the severity of your symptoms by maintaining a healthy weight, since carrying extra pounds can put added stress on your pelvic floor.
Fluid management and timed voiding are other great lifestyle strategies. It’s crucial to stay hydrated by drinking plenty of water throughout the day, but you can avoid drinking a lot in the evening to help with incontinence during sex and at night. Timed voiding is a way to train your bladder to hold fluid for longer periods of time. Set a bathroom schedule to void your bladder and gradually increase the time between trips.
A simple and effective way to manage incontinence is to wear incontinence pads and underwear for added security. Incontinence pads and protective underwear are discreet and comfortable. No one can tell you're wearing them, and you can go about your day without worrying about leaks or accidents.
Medical Interventions
You might be prescribed medications to help treat urge incontinence. Topical estrogen therapy for postmenopausal women is another option for some patients.
Surgery is a possible treatment route for severe cases. It can cure up to 80% of penetration-related incontinence. Anticholinergics, which are medications that block a neurotransmitter called acetylcholine that triggers bladder spasms, are successful in nearly 60% of cases where urine leakage accompanies orgasm.
Psychological Support and Coping Strategies
The emotional and psychological repercussions of dealing with an incontinence issue are often just as overwhelming as managing the physical symptoms, but help is available.
Counseling and Therapy
Professional counseling is an excellent way to address the emotional challenges and self-image concerns that often accompany incontinence problems. Your therapist can lend a sympathetic ear while providing you with techniques for managing anxiety and stress.
Communication and Intimacy in Relationships
Don’t shy away from discussing your symptoms and concerns with your partner. Open dialogue about coital urinary incontinence can be the best way to overcome any problems and strengthen your relationship. Together, you can explore alternative sexual activities and positions that lessen your symptoms and help you feel more confident.
Preventive Measures
Strengthening Pelvic Floor Muscles Before and After Childbirth
With your doctor's guidance, take action to prevent incontinence by including pelvic floor muscle exercises in your daily routine before and after childbirth. This can be a simple way to prevent muscle weakness that can lead to incontinence.
Maintaining a Healthy Lifestyle and Weight
Living a healthy lifestyle supports a healthy weight. Excess pounds can exacerbate incontinence, so take care to manage your weight.
Avoiding Excessive Fluid Intake Before Sexual Activity
A simple way to reduce the chances of experiencing incontinence during sex is to cut down on your intake of liquids beforehand and empty your bladder before sex. It may also help to experiment with different sexual positions to find one that doesn’t put pressure on your bladder.