Welcome back! If you’re here for the first time, you might want to check out Part One where we talk about incontinence—what it is and why you might experience it. Long story, short: incontinence is peeing when you don’t want to. Why talk about incontinence on a blog about sex? Some women who experience incontinence also worry about peeing during sex (the fancy name for this is “coital incontinence”). This post is going to talk about what treatments might be available to you if you have stress incontinence (that’s leaking urine when you laugh, cough, sneeze, jump, exercise, or when an object like a penis or toy rubs against the urethra). The next post will talk about treatments for urge incontinence (leaking on the way to the bathroom or at the time of orgasm). As a urogynecologist, my goal is to make sure you don’t pee when you don’t want to, including during sex!
Remember: you don’t need to suffer and spend a lot of time buying pads or adult diapers at the drug store. There are options. Let’s break down the treatments for stress incontinence:
Improve the strength in your pelvic floor muscles: The pelvic floor muscles are arranged in a bowl-like shape below your belly. These muscles hold everything up when you’re standing. (For a visual reference, check out this link.) These are the muscles that you squeeze when you have to pee but “hold it” until you can get to the bathroom. You may have heard people talk about a “Kegel,” which is an exercise that can be used to strengthen these pelvic floor muscles when they are weak and loose. Understanding and strengthening these muscles can help prevent stress incontinence. Strengthening these muscles can also have other benefits for your sex life—get to know them well!
One way to find these muscles is to stop your stream when you’re peeing. So, while peeing, try to squeeze your muscles and stop from peeing. If you can do this, you have found your pelvic floor muscles. Congratulations! Great job! This is the first step. You can keep doing this on your own or after your doctor shows you how.
If you can’t find your muscles, or just want to work with a professional to strengthen these muscles, you can see a pelvic floor physical therapist. A pelvic floor physical therapist is like a personal trainer for your pelvic floor. They are trained physical therapists who really understand the pelvic floor muscles. They will work with you to help stop the leaking. When you see a pelvic floor physical therapist, you will probably have a vaginal exam. During the vaginal exam, the therapist will typically put fingers in your vagina to help you know where all of your pelvic floor muscles are located and make sure you know how to work and move the muscles. Yes, the therapist is trained to examine you with fingers in your vagina. This technique may sound weird, but they are trained professionals. They have many tricks and techniques to help build pelvic floor strength. Most pelvic floor physical therapists are women. Many treat women and men (who can also have problems with their pelvic floor muscles!).
Check out these links for more information about pelvic floor physical therapists and how to find the right one near you. You can also ask your doctor or other healthcare professional for names of pelvic floor physical therapists.
For women with weak or loose pelvic floor muscles, strengthening the pelvic floor is an effective first step for many women who experience incontinence. However, if you’ve tried Kegels and a pelvic floor physical therapist and you’re still leaking (even when you’re not having sex), there are other options. Don’t give up!
Consider using a pessary: A pessary is a fancy sounding word that simply refers to a plastic or rubber ring with a knob on one end that sits in your vagina and puts pressure on your urethra. Your urethra is the tube from your bladder to the outside, or where you pee from. The pressure placed on the urethra from the pessary makes it easier to control the flow of urine. Your gynecologist can fit you for a pessary. Then it’s up to you to clean it every 3 months or visit your gynecologist who can remove it and clean it for you. Pessaries from your doctor can be left in or removed for sexual activity—it’s up to you! You can also try a similar device, called Impressa®*, from your drugstore. Impressa requires that you fit yourself, dispose of the device after each use, and you have to remove it for sexual activity involving your vagina. Both types of pessaries are great options.
Surgical options: If pelvic floor exercises (on your own or with a physical therapist) or a pessary aren’t right for you, there are many different surgical options. The type of surgery that’s right for you will depend on your medical history. You can discuss these options with your doctor and/or a doctor who specializes in these issues (a urogynecologist or a urologist). There are two very common surgeries for stress incontinence: “urethral bulking” and “sling” procedures. Follow the links to learn more about these procedures.
Vaginal mesh for prolapse and slings for stress incontinence (made out of a thin mesh) have been in the news a lot in the past few years. You may have seen some commercials about this, and these can be scary! One thing to know is that vaginal mesh for pelvic organ prolapse (when your uterus or the walls of your vagina are falling out) is different from sling mesh for stress incontinence. Vaginal mesh for prolapse repair is no longer available after recently being pulled off the market by the Federal Drug Administration. Mesh slings are much smaller and have been around for 40 years. You can read more about the mesh debate here.
There have not been any studies about how these surgeries affect sexual function. Speaking from clinical experience, however, my patients have not reported any negative affect on their sexual function after having any of these surgeries. In fact, being dry and not smelling of urine often leads to feeling better in general, getting rid of pads, and feeling more confident about sexual activity!
All of the treatments mentioned in this blog are good options. What might be right for you may not work for others. That’s ok.
The most important thing to remember is if you are leaking urine, you are NOT alone and there are things out there to help you. Don’t be embarrassed to talk about it with your doctor – what would a urogynecologist or a urologist do if nobody talked to them about urinary problems? Our whole job is helping people get their continence back.
Have a story about treating your own incontinence? Tweet us @WomanLab_ — we would love to hear about it!
*Note: Names of specific products or places to buy products should not be considered as endorsements. WomanLab does not have funding or sponsorship from these products or places.