What is incontinence?

Urinary Incontinence (UI) is the unintentional passing of urine. Loss of bladder control is a common condition among women in midlife with reported prevalence ranging from 28% to 47%. Severity ranges from an occasional leak with a cough, laugh or sneeze, to an urgent need to pee that is so sudden (where the person needs a trip to a toilet ASAP). The risk of incontinence increases incrementally from the age of 40 to 60, with prevalence nearly doubled by age 55. Men also experience incontinence, though reported rates (3% to 11%) are much lower than that of women.

Common types of incontinence include stress incontinence (leaking when increased intra-abdominal pressure happens, such as when lifting or during exercise), urgency urinary incontinence (leakage related to a pressing need to pee and irritative bladder symptoms associated with overactive bladder), and mixed incontinence (a combination of stress and urgency UI).

Why does it happen?

Because women experience unique health events such as pregnancy, childbirth and menopause, they are more prone to incontinence. As many as four in 10 women get urinary incontinence during pregnancy. As the baby grows, more pressure is put on the bladder, urethra and pelvic floor muscles. This excess pressure can weaken the pelvic floor leading to leaks or problems passing urine.

Vaginal childbirth too, can decrease pelvic floor muscle strength or damage nerves that control the bladder, rectum and pelvic floor muscles. Movement of the urethra and bladder from their usual position can also cause postpartum bladder control problems.  

Reduced estrogen levels starting around menopause can cause thinning of the lining of the urethra, the tube that passes urine from the bladder out of the body. Vaginal tissue elasticity can also decline at this time, as collagen levels decrease. Additionally, the surrounding pelvic muscles may also weaken due to these age-related hormonal changes, further compromising the ability to control urinary function.

How does it impact sexual health?

Despite incontinence being common during perimenopause and beyond, it is not inevitable and should not be passively accepted if it proves to be bothersome. Incontinence is not just a physical condition but can affect one’s emotional, psychological, social and sexual wellbeing.

One review on the psychosocial impact of urinary incontinence in women cites that up to 23% of women take time off work because of their incontinence! Researchers have observed a strong association between incontinence and increased levels of depression. Between 25-50% of women with urinary incontinence experience sexual dysfunction and poor sexual health. Reports also shows a significant association between urgency UI and lower self-esteem which can influence sexual dysfunction.

The impact of coital incontinence (leakage during sex) on sexual function is multifold. Actual leakage during sex can affect sexual satisfaction. Also, worries about leakage can contribute and are significantly associated with decreased sexual desire and sexual satisfaction. If your head isn’t in the game, chances are you don’t want to play. There is significant data to support that UI is detrimental to sexual function and overall quality of life.

Otherwise healthy individuals with UI perceive their health as suboptimal and sex can be a means to obtaining physical and psychological health benefits. Getting busy in the bedroom has real positive outcomes for one’s health. Studies have shown that sex activates a variety of neurotransmitters that impact not only our brains (better mood, less stress, increased self-esteem) but also several organs in our bodies, helping lower blood pressure, strengthen the immune system and alleviate pain.

Empowering individuals to overcome their incontinence begins with reducing the stigma, addressing its prevalence and providing solutions.

Overcoming Incontinence

Evidence shows that treatment of incontinence improves sexual function. In stress UI, several high level, large trials support the idea that pelvic floor muscle training can significantly decrease urinary related sexual problems, as well as improve sexual physiological response in the areas of desire, arousal, lubrication, orgasm and satisfaction. These improvements may be correlated to increased pelvic muscle strength. One review looking at 2,394 women with UI who underwent pelvic floor training no shorter than six weeks, improved their quality of life – helping physical, mental and social functioning.

Working with a pelvic floor physiotherapist can help to rehabilitate pelvic floor muscles. Speak with your health care provider to get a referral or do a google search to find a practitioner near you. Also, the internet provides a wide array of how-to Kegel exercises to get you started right away.  AOR’s Bladder Manager is a plant-based supplement formulated to help relieve urinary incontinence.  Made with Crateva magna, Equisetum arvense and Lindera aggregata, these ingredients have been clinically proven to reduce symptoms of overactive bladder, urinary frequency, urinary urgency and incontinence.

Using pads or special underwear, wearing dark clothing and limiting fluid intake, are temporary measures. Urinary incontinence is not an inevitable part of aging. It is treatable. If you and your sex life is suffering because unintentional leaks get in the way of you feeling and operating at your best, speak with your healthcare provider to find a solution that works for you.

References

Chu, C.M., Arya, L.A. & Andy, U.U. Impact of urinary incontinence on female sexual health in women during midlife. womens midlife health 1, 6 (2015). https://doi.org/10.1186/s40695-015-0007-6

Lee DM, Tetley J, Pendleton N. Urinary incontinence and sexual health in a population sample of older people. BJU Int. 2018;122(2):300-308. doi:10.1111/bju.14177

Radzimińska A, Strączyńska A, Weber-Rajek M, Styczyńska H, Strojek K, Piekorz Z. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018;13:957-965. Published 2018 May 17. doi:10.2147/CIA.S160057

Dooley Y, Kenton K, Cao G, Luke A, Durazo-Arvizu R, Kramer H, Brubaker L. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol. 2008 Feb;179(2):656-61. doi: 10.1016/j.juro.2007.09.081. Epub 2007 Dec 21. PMID: 18082211.

Waetjen LE, Liao S, Johnson WO, Sampselle CM, Sternfield B, Harlow SD, Gold EB. Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women’s health across the nation. Am J Epidemiol. 2007 Feb 1;165(3):309-18. doi: 10.1093/aje/kwk018. Epub 2006 Nov 28. PMID: 17132698.