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Is Your Bladder Getting in the Way in the Bedroom?

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The title is a little different, but the theme is the same. This is nearly the same article that I recently published in the April 2009 edition of Perfectify:

Women’s bodies are very resilient, but many women notice changes to their bodies below the belt after major life events. Because women are living healthier and longer lives, the chances of having a problem with your bladder, and how it affects the activities in your life is expected to only become more bothersome over time.

Problems with bladder control are quite common in women of all ages, but starting in the 30s and 40s, many women notice that going to the bathroom or accidental urine loss becomes embarrassing and restricting. Despite being healthy or physical fit, the muscles and connective tissue supporting the bladder, vagina, uterus and rectum can become weak or stretched and declare itself in a variety of ways.

Urinary incontinence (UI) is the involuntary loss of urine in any situation. It can be stress-induced, meaning, urine loss during exercise, running, jumping, laughing coughing and even sex. This is known as Stress Urinary Incontinence (SUI). Very often, the sense of needing to go to the bathroom never goes away and you may feel like you have to know where every bathroom is no matter where you go, otherwise there will be trouble. The constant sense of urge, frequency and leaking before you can even pull your pants down is known as Overactive Bladder (OAB), and can coexist with SUI in many women.

Giving birth is an exciting life-changing event, yet even one vaginal childbirth increases a woman’s risk of bladder and other pelvic floor problems. Having a C-section does not seem to be protective over time. The aging process, menopause, repetitive straining such as with a chronic cough, constipation, obesity, and surgery such as a hysterectomy, are other common predisposing factors. In fact, the lifetime risk for an American woman to need surgery for problems related to pelvic floor weakness is 11%. Urinary incontinence affects 13 million adults in the US, 85% of them being women. Often women with urinary incontinence are reported to be depressed and/or embarrassed about their appearance and odor. Consequently, social interaction with friends and family, activities with the kids, and sexual activity is often avoided.

Sexual complaints are very common in women with pelvic floor weakness. Besides urine leakage with sex (which we’ll explore further below), a dropped bladder (cystocele) also impacts sexuality. Women with urine leakage, in general or during sex, have less libido, have vaginal dryness and irritation, lack of sexual excitement and lack of orgasm. Coital incontinence (urine leakage with sex), is noted to be a big cause of sexual inactivity. Intuitively, a dropped bladder or uterus can cause pelvic pressure and pain with sex and lead to avoiding intimacy as well.
Coital Incontinence (CI) has been reported to occur in 10-24% of sexually active women with pelvic floor weakness yet is probably under-reported. It can occur with a sexual partner or with masturbation. Women will rarely bring it up on their own or even after direct questioning by their family doctor.

There are two types of CI: urine leak with penetration, and urine leak with orgasm. Urine leak with penetration is caused by a weak urethra or bladder sphincter, the same cause of urine leak with exercise or laughing. Urine leak with orgasm is seen in women with severe OAB symptoms. Urine loss from penetration is more common than with orgasm. Leakage can occur even if a woman tries to empty her bladder before becoming intimate. Diagnosing CI should be included in the overall diagnosis and evaluation of any female pelvic health issue, since many often coexist.

An important question to be asked is: Does treating CI or bladder drop help improve a woman’s sexual experience? Many treatments for UI, whether it be from Stress Incontinence or OAB, are available, as well as repairing a dropped bladder or loose vagina. They range from conservative treatments, to medicine, to minimally invasive procedures. Often, pelvic floor muscle retraining, or Kegel exercises, can tone up a weak sphincter, help retrain an OAB, or tighten up the vagina just enough to make sex more pleasurable. They’re easy to perform but must be continuously done. Some common OAB medications have been shown to help orgasm-induced urine leakage. Common side effects of these meds are dry mouth and constipation. Minimally invasive surgery, such as slings, are placed in less than a ½ hour, have high success rates, low complication rates, and relatively short recovery times. These will often treat penetration-induced leakage. Bladder lift and vaginal tightening can be performed to help reduce dropped pelvic organs and reduce a wide vagina opening.

Correcting urinary incontinence has been shown to greatly reduce CI, and as a result, women report improvement in all sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Resolving CI leads to greater self-confidence and greater sexual interest. Bladder lift leads to less vaginal bulge sensation, and less pain with sex.

My goal in treating women with CI and other pelvic health problems is a comprehensive and tailored approach in addressing all potential concerns. The only thing holding you back is the courage to regain those life activities that may have been lost from embarrassment and avoidance.

Dr. Matthew Karlovsky is a urologist that specializes in female pelvic health in Phoenix, Ariz. For more information, visit www.urodoc.net or www.femaleurologyaz.blogspot.com/

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EmpowHER Guest

I hope, in addition to kegels, you consider recommending a more comprehensive physical therapy regimen for strengthening pelvic floor muscles. Kegels are one action of the muscle -- women should also perform pelvic floor elevations (the second action) as well as exercises to strengthen the coordinating muscles (abs, glutes, low back, deep hip rotators, etc.). In the physical therapy world, only do kegels is akin to trying to rehab a knee by only doing quad sets.

Physical therapy won't be the solution for every woman, but it is a good starting point for most. There is a relatively new and growing area within the American Physical Therapy Assocation devoted to Women's Health (http://www.womenshealthapta.org/plp/index.cfm)

You can also find a comprehensive description of the exercises I recommend at www.hab-it.com.

Tasha Mulligan MPT, ATC, CSCS
Creator of the Hab It: Pelvic Floor DVD

May 1, 2009 - 8:36am
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