Incontinence in the bedroom

Monica wore a sanitary pad every day of the month, even when she was not on her period, because she dripped urine without control. She had been this way for over a year, changing pads three to four times a day.

“Actually most of the time I am dry; it is only that I can never predict when urine will leak so the pad is a safety measure,” she explained. “I am more concerned about my marriage now, that is why I am here.”

Monica had been married to a businessman for 18 years, and they had four children. When she came to the sexology clinic she had not had sex for six months. She had also stopped sharing a bed with her husband and was sleeping on a mattress on the floor while her husband slept in their bed. “I find that very unusual and I am sure it has affected your intimacy,” I blurted out without much reflection.

“Please give me time to explain and you will understand where I am coming from,” Monica said, sounding irritated. It was a reminder that as a sexologist, one has to always be patient and attentive without being judgmental.

Due to her inability to control her flow of urine, Monica had wet her bed twice while having sex. Her husband was irritated and shouted at her. In both instances she had to wash and air the beddings in the night. Her children did not understand what was going on. She was so distressed that she decided to move to the floor. “Now I have no sexual feelings at all otherwise we would have been doing it on my mattress on the floor which has a mackintosh just in case the urine pours out,” Monica explained.

Monica’s case is not unique. Women with incontinence usually develop related sexual dysfunctions. Their self-esteem crashes, making them lose libido. They feel unattractive and this further makes them lose self-confidence. Some women go into depression.

Beyond that, most women with incontinence cannot get aroused. No matter the quality of foreplay, the lady will almost always remain dry. This could be related to her already compromised psychological status. With all these dysfunctions, affected women rarely get orgasm. “I can identify with everything you have said, but how do we sort this issue?” Monica asked.

The solution lies in treating the cause of the urinary leakage. An infection of the urinary system could be the cause. It could also be unusual pressure in the tummy, due to a growth, exerting on the urinary bladder and pushing out urine. Pressure can also result from too much weight gain. Laxity of the pelvic structures is another cause. This may come with age, especially after menopause. Many pregnancies can also cause pelvic organs to be lax.

In other cases the urinary bladder itself has gone out of control and contracts randomly to spill out urine. This could be due to diseases affecting nerves of the bladder.

After examining Monica, I found that she was obese. She also had big uterine fibroids. Further, with a history of four deliveries and no knowledge of pelvic floor exercises, there were high possibilities of laxity of pelvic organs.

I put Monica on weight management, pelvic floor exercises, and avoidance of fluids for at least one hour before sex, as well as routine emptying of the bladder before going to bed. She also had her fibroids removed. She and her husband underwent three months of sex coaching to recreate their intimacy.

“It has been a big undertaking moving me from the mattress back to my marital bed. I am forever grateful,” Monica said on their last day of counseling. She then turned to her husband, kissed him and whispered something in his ear. They both waved at me as they walked out of the consultation room holding hands.