Bladder health may be far from the most riveting of conversations, but trust me, a bladder that behaves itself will make your life a whole lot more enjoyable, and that includes your sex life, as well.
As we discussed in the last post, bladder misbehavior in the form of incontinence and urinary tract infections (UTIs) is a common female complaint, and it tends to become more common and more troublesome as we age. This is because decreasing estrogen affects genital tissue and muscles in unhelpful ways.
You don’t need to check out adult diapers just yet, however. Not only are treatment options available, depending on the type of incontinence you have, but you can develop some common-sense bladder health habits that will tune up that tired organ and may even roll back some of the age-related changes.
Despite your attention to good bladder health, you may still experience bothersome levels of incontinence and UTIs. The next step is to talk with your doctor. Studies show that most women avoid this conversation because, well, it’s embarrassing. Let me assure you that we’ve heard it all, and incontinence is an incredibly common female issue. This isn’t something you should endure. Treatments are available, and they do work.
Depending on the type of incontinence you have, (urge and stress incontinence are the two major sub-types), treatment options could be very simple. With bladder training, for example, you set a timer and wait for increasingly longer periods before urinating to “retrain” the bladder (and yourself). This method coupled with Kegel exercises can cut urge incontinence problems in half, according to the National Institutes of Health.
There are a number of medications, including some new ones, that are very effective in treating urge incontinence. Your health care provider can help you weigh the options.
Since stress incontinence is more commonly caused by wear and tear on the pelvic floor (by childbirth, for example) as well as by normal aging and hormonal loss, medications are less effective in treating it. Topical estrogen, however, is a good option for rejuvenating tissue in the entire genital area, urethra included. It isn’t absorbed systemically, so it’s a good option for those who want to avoid extra hormonal exposure
A common and minimally invasive surgical procedure involves inserting a tiny mesh sling to support the urethra. This procedure is effective in over 85 percent of cases.
For most of us, some level of incontinence is an annoying fact of life. But it shouldn’t compromise our quality of life or cause undue embarrassment or anxiety. If you find this to be the case, it’s time for a talk with your doctor.
And what, you ask, does my bladder have to do with sex?
Good question, but here’s the thing: When you think about it, all our sexual bits are tucked in a very tight space with all the “other” bits we use for elimination. They all cohabit the same anatomical real estate and pass through the same muscular sling (pelvic floor). If you question the wisdom of our anatomy, pity the poor hyena, who copulates, urinates, and gives birth—with great difficulty—through the same tube.
Since all those organs are clustered in one anatomical region, they are also all sensitive to any change of flora or pH balance or hormones that might happen in that space. In fact, what we now refer to as the genitourinary symptoms of menopause (GSM) is an umbrella term for the hormonal changes which affect the whole enchilada—pelvic floor, bladder, vagina, and all the associated tubes and musculature. (The bowels aren’t included, but they can also be affected by age and hormonal change.)
So, as vaginal tissue becomes more fragile due to loss of estrogen during menopause, so does the labia and the urethra (the tube from the bladder through which we urinate). Specifically with regard to the bladder, GSM exacerbates two extremely common female complaints: urinary incontinence and urinary tract infections (UTIs).
If you’ve had kids—and maybe if you haven’t—you’ve probably experienced the nearly ubiquitous stress incontinence of the cough-sneeze-pee variety. A second type of incontinence is overactive bladder (OAB) or urge incontinence. This is when you feel the need to pee suddenly, frequently, and urgently. In both cases, small—and sometimes large—leakages may occur.
Both conditions can either commence or worsen with menopause, and either can cause you to urinate a little or a lot during sex, usually with penetration or orgasm, when all the nerves in the area are stimulated.
Which could really dampen the mood.
Research on the effect of incontinence on sex is scarce, and honestly, that effect would seem pretty intuitive. Studies that have been conducted indicate that incontinence has a negative effect on sex (duh!)—and on life in general. The embarrassment and anxiety of constantly having to worry about peeing your pants certainly puts the kibosh on quality of life—and that embarrassment doesn’t stop at the bedroom door.
In one small study, every woman with OAB syndrome all expressed anxiety over its effect on their sex life, whether or not they were actually incontinent during sex (coital incontinence). Just the worry about whether they would pee during an orgasm was enough to create a psychological barrier to sex. The worse their condition, the greater the negative impact on sex.
“Overactive bladder with or without incontinence negatively affects women's sexual health, reducing sexual desire and ability to achieve orgasm,” the study concluded.
Urinary tract infections (UTIs) are the second sucker-punch to libido that accompany and can increase with age and menopause. Again, it’s all part of a syndrome in which loss of hormones makes our genitourinary tissue more fragile and prone to breakdown and, thus, infection. Our female anatomy—short urethra in a warm, moist location near our other orifices—creates an inviting greenhouse for bacterial growth. Ironically, even sex can cause a UTI because it invites the migration of bacteria from one spot to another.
But take heart! As with most things menopausal, prevention techniques and treatment options are available. There are ways to mitigate the effects of GSM on the bladder and ways to prevent them. Not perfectly. Not always. But neither do you have to soldier on alone and in silence. That’s the kind of awareness that Bladder Health Month is all about.