Sex, Exercise, and Stress Incontinence

Workouts and romance may both trigger 'accidents,' but stress incontinence treatments can bring relief.

From the WebMD Archives

Stress incontinence has an annoying way of showing up at the most inopportune times.

You're jogging along, feeling great -- and then you realize your running shorts are damp with urine. Later that night, during a romantic rendezvous with your partner, a trickle of urine appears again, definitely spoiling the moment.

Lest you think stress incontinence is a problem only of middle-aged or elderly women, think again. Surprisingly, young women actually have more stress incontinence during sex than older women, according to Amy Rosenman, MD, a gynecologist at Santa Monica -- UCLA Medical Center, Santa Monica, Calif., and co-author of The Incontinence Solution.

While only 3% of women over age 65 reported incontinence during sexual activity, 29% of women under age 60 did, Rosenman reports in her book, citing an Israeli study that polled 100 women and was published in the International Urogynecology Journal in 1999. When incontinence occurs during intimate moments, women feel anxious, Rosenman says, even if they are in stable marriages.

The same anxiety can occur, of course, during a workout, where you may end up with an embarrassing wet spot on your pants for the world to see.

Stress Incontinence Due to Weak Pelvic Floor Muscles

The problem, whether the stress incontinence occurs during exercise or sex, has a common denominator, says Beverly Whipple, PhD, RN, professor emerita at Rutgers, The State University of New Jersey, and a sexuality researcher.

"Stress incontinence is related to the strength of the pelvic floor muscles," Whipple says. The weaker those muscles are, the more likely you are to have symptoms of stress incontinence -- leaking urine during physical activity, such as exercise, sex, sneezing, laughing or jumping.

While many women experience minor leakage from time to time, at any age, if it becomes more frequent or interferes with your normal routine, you should tell your doctor. There is an array of very effective treatments for stress incontinence.

If you have had several pregnancies and childbirths, your pelvic muscles and tissues may have gotten stretched and damaged. With age, the muscles can weaken, too, although stress incontinence is not an inevitable part of aging. Excess weight can also weaken pelvic floor muscles and cause stress incontinence.

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Kegels Can Help Stress Incontinence

Strengthening the muscles of the pelvic floor is crucial, experts agree.

One recommended way to do that is through Kegel exercises, according to the American Academy of Family Physicians (AAFP).

First, some anatomy: at the bottom of the pelvis, many muscle layers stretch between your legs, attaching to the pelvic bones at the front, back and sides. If you think of the muscles you would use to stop the flow of urine, those are the ones you will be targeting when doing your Kegels.

The how-to's: Pull in or squeeze the muscles, pretending you are trying to stop urine flow. You should hold that squeeze for about 10 seconds. Follow that by a 10-second rest. How many? Try three to four sets of 10 squeezes a day, recommends the AAFP.

The beauty of Kegels, most experts find, is that they can be done anytime and just about anywhere -- sitting in your car or at your desk or watching television or while talking on the phone. No one will know what you are doing unless you tell them. But to ensure proper form, ask your doctor or nurse to describe to you exactly how to do them correctly.

If you do Kegels correctly and often, you can expect to leak less, Rosenman says.

Typically, bladder control improves after 6 to 12 weeks of daily Kegels, according to the AAFP. But you may notice improvement in stress incontinence after just a few weeks.

Kegels and Vaginal Weights for Stress Incontinence

Another way to prevent stress incontinence is to use vaginal weights. Vaginal weights can help you to isolate the pelvic floor muscles while doing your Kegel exercises. They come in various sizes and are inserted into the vagina using a cone. As you progress, you insert heavier weights.

Vaginal weight kits are sold online and over the counter.

Biofeedback for Stress Incontinence

Biofeedback, as the name implies, uses monitors and "feeds back" information to patients about body processes, including control of the pelvic floor muscles.

In one study of 14 women with stress incontinence, a 12-week program of pelvic floor training with biofeedback gave favorable results, according to a report published in the International Brazilian Journal of Urology. The number of leakage episodes decreased from about eight a day to 2.5 among study participants, the researchers report.

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Self-Help Products for Stress Incontinence

If your stress incontinence is not severe, you may get by with urinary incontinence products such as pads and panty liners. You might want to consider rubberized bed sheets.

Another stress incontinence treatment option is a device called a pessary, which is inserted into the vagina to help elevate the bladder neck and keep urine from leaking.

Medications, Surgery for Stress Incontinence

If your stress incontinence becomes more severe or if it interferes with your lifestyle and kegel exercises and other self-help measures fail, your doctor may suggest medications or surgery.

Medications can help tighten muscles at the bladder neck and urethra, preventing urine from leaking and relieving stress incontinence.

In one operation for stress incontinence, surgical threads are used to help support the bladder neck. In another procedure, called a "sling" operation, the surgeon uses strips of material, either natural or synthetic tissue, to support the bladder neck.

Talking to Your Doctor About Stress Incontinence

Your doctor should routinely ask you about your bladder function to determine if you are having stress incontinence or urge incontinence (also called overactive bladder), Rosenman says.

If your doctor does not ask, Rosenman advocates the straightforward approach. Try something like: "I'm having some problems with my bladder." At that point, if your doctor does not pepper you with questions about how often you experience symptoms, and how long it has been going on, Rosenman suggests asking for a referral to another doctor or to a specialist, such as a urogynecologist. A urogynecologist is a gynecologist who has extra training in urology.

Talking to your partner about stress incontinence is not simple, either, Rosenman acknowledges. But she tells women it may be the most important thing they can do to help their relationship. Communicating well about the problem, she writes in her book, will lead to greater affection and trust. And getting the problem out in the open is often a relief, she says.

In addition to good communication and effective treatments, Rosenman says some simple measures can help women with stress incontinence enjoy a better sex life. Among other tips, she tells them to always empty the bladder before intercourse and to cut back a bit on fluids before intercourse. Don't dehydrate yourself, but don't overdo the fluids, she says. And she encourages experimentation to find positions that are more comfortable, reducing overall anxiety.

In getting more comfortable with talking about stress incontinence, you might also take a cue from two famous Olympic athletes from the U.S. -- speed skater Bonnie Blair and gymnast Mary Lou Retton. In recent years, both have spoken publicly about their experiences with incontinence, raising awareness that the problem exists and, more importantly, that treatments can improve or eliminate the problem.

WebMD Feature Reviewed by Louise Chang, MD on January 17, 2007

Sources

SOURCES: Amy Rosenman, MD, assistant clinical professor of obstetrics and gynecology, University of California Los Angeles David Geffen School of Medicine. Beverly Whipple, PhD, RN, professor emerita, Rutgers: The State University of New Jersey. The American Urogynecologic Society: "Sexuality: Excerpts from The Incontinence Solution." Web MD Feature: "Incontinence: A Woman's Little Secret." American Academy of Family Physicians: "Urinary Incontinence: Kegel Exercises for Your Pelvic Muscles." Medscape: "A Team Approach to Bladder Retraining: A Pilot Study." Halina Zyczynski, MD, associate professor of obstetrics and gynecology, University of Pittsburgh School of Medicine; director, division of urogynecology and reconstructive pelvic surgery, Magee-Womens Hospital, Pittsburgh. Gordon, D. International Urogynecology Journal, August 1999; vol 10: pp. 325-328. Kevin Connolly, president, SRS Medical, Billerica, Mass. Merck Manual Professional: "Urinary Incontinence." Web MD Biography: Bonnie Blair. Web MD Biography: Mary Lou Retton. Neumann P. BMC Women's Health, June 2006; vol 6: p 11. National Institute of Diabetes and Digestive and Kidney Diseases: "Treatments for Urinary Incontinence in Women."

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