Incontinence is nothing to be ashamed of, but nonetheless makes us embarrassed. Add sex to the mix, and, well, it can leave you feeling awkward and horrified! What can you do to solve it?
There isn’t a one-size-fits-all solution to bladder leaks, but there are several different options you can try. In this week’s edition of Ask the Experts, find out more from our expert, Barbara DePree, MD, in her answers to a reader’s health questions.
Q: My bladder has started leaking during sex, and I’m mortified! My sister told me about a new shot that could help. Is it safe?
A: “What you’re describing is coital incontinence, a common form of stress urinary incontinence that occurs before, during, or after orgasm in more than 60 percent of women, thanks to strain on the bladder or urethra during sex. And your sister is likely talking about an FDA-approved volumizing gel called Bulkamid that is injected by a urologist into the walls of the urethra (the tube that passes urine from the bladder) to plump them, nixing leaking during sex and other activities.
“The procedure is expensive (about $5,000, part of which may be covered by insurance), may need to be done repeatedly, and only lasts for up to seven years, so I suggest talking to your doctor first to figure out what’s going on — especially if you only leak during sex.
“If it happens during orgasm, you may be dealing with overactive bladder, a condition that causes involuntary bladder contractions and can be treated with medication. But if your leaking occurs during penetration, it’s more likely due to stress incontinence and can be treated with regular Kegel exercises, which strengthen the pelvic floor muscles. To do: Squeeze your muscles as if you’re trying to hold in urine for five seconds, then release slowly, doing 10 reps three times daily.”
FIRST tip: You can also ask your gynecologist to write you a prescription for a pelvic floor therapy (PVT) evaluation. You can take the prescription to any therapist you choose (assuming you visit one that takes your insurance). The pelvic floor therapist will perform a full evaluation and determine whether or not you are a good candidate for PVT. During these sessions, the therapist will work with you to strengthen your pelvic floor muscles and may even help you avoid surgery.
“Other strategies that can help: Empty your bladder before sex and try double-voiding to flush lingering urine. To do: Relax and stay seated on the toilet for 15 to 45 seconds after you void. Then complete the following movements: Lean forward, sit up straight, move side to side, stand up and rotate your hips like you’re swinging a Hula-Hoop (in both directions) for 30 seconds, then sit back down.”
Put FIRST to work for you.
Barbara DePree, MD, is a gynecologist in private practice and director of Women’s Midlife Services at Michigan’s Holland Hospital. A Certified Menopause Practitioner, she is the founder of MiddlesexMD.com, an educational resource for women’s sexual health in perimenopause and beyond. To ask her a question, send an email to firstname.lastname@example.org.
This article originally appeared in our print magazine, First For Women.