Bladder Matters

Every now and then, a question from a patient or website visitor tells me that bladder function is interfering with a woman’s sexuality. Maybe their “urge to go” makes them lose focus during an intimate moment, or maybe symptoms are making them feel less than sexy.

In addition to being located in a very neighborly way, the base of the bladder and urethra and the vagina also have the same embryonic origin. They both have estrogen receptors, which means that they’re both affected by changes in hormone levels. And sometimes, I know, when you experience discomfort, it can be a little hard to pinpoint exactly what’s happening where “down there.”

So let’s review a couple of common problems.

Twenty to thirty percent of us will have a bladder infection at some point in our lives. That’s the most common form of urinary tract infection (UTI), which also includes the kidneys and urethra.

A bladder infection is often the result of bacteria that has made its way into the organ, usually from the vagina or anus—again, that neighborliness. (Remember to wipe from front to back.) Symptoms include:

  • Pain or burning during urination
  • Urgent need to urinate immediately
  • Need to urinate extremely frequently
  • Passage of small amounts of urine at a time
  • Pain in the abdomen or lower back
  • Need to get up from sleep to urinate
  • Cloudy, bloody or bad-smelling urine

If you are experiencing any of these symptoms, see your doctor right away. A bladder infection is easily treatable with medication, but you’ll also want to make sure it’s not a sign of something more serious, like vulvovaginal atrophy or kidney problems.

Overactive bladder (OAB) occurs when the muscles of the bladder involuntarily contract, making the urge to urinate more frequent than normal. There’s a dry and wet version: If you can make it to the bathroom in time, that’s dry (or stress incontinence); if you have any leakage, that’s wet (or urge incontinence).

Watch your weight to make OAB less likely to occur; being in the top third of body mass index range increases your risk. You can also take these steps to eliminate or prevent OAB:

  • Do Kegel exercises, which, because of that neighborliness, are good for both urination and sex!
  • Limit your fluid intake before bedtime
  • Go to the bathroom twice before bedtime
  • Avoid caffeine, alcohol, citrus juices, and carbonated beverages
  • Avoid spicy and acidic foods

Other urinary problems, including incontinence, are not uncommon in post-menopausal women and are often a result of declining muscle tone in the pelvic floor—again, that estrogen effect.  Kegel exercises can help keep our organs in place and functioning well; localized estrogen may also be something you want to consider. But if you’re experiencing any kind of bladder issues, be sure to talk with your doctor about it. Just because these conditions are predicted for our age group doesn’t mean you have to put up with them.

Paying attention to your body is the first step to good health, but don’t neglect the second: Seeking help when something’s not right.

Sex and Back Pain: A Work-around Primer

Long, long ago, when humankind first stood up on two feet, some bit of engineering seems to have gone missing. As a result, back pain is practically programmed into the human condition. The lucky ones may experience temporary pain from strained muscles, but for many, back pain can involve severe and constant pain from malfunctioning disks, nerve issues, bone issues, and a host of other maladies.

Unfortunately, nothing saps enjoyment and energy from life like pain. Whether intermittent or chronic, back pain can lay the sufferer, literally, flat on his or her back. Sex, obviously, becomes an early casualty. A 2008 survey found that most people who suffer from back pain have less sex, and they don’t enjoy it much. They say the pain has affected their relationships, but they don’t tend to talk about it either with their partners or their doctors.  (And apparently, their doctors don’t bring up the issue of sex, either.)

There are ways to work around this state of affairs, however, from communicating with your partner and your doctor to experimenting with positions that might make intercourse more comfortable. One doctor even says that sex can actually help ease back pain by “mobilizing ‘stuck’ segments in the spine” and by releasing “feel good” endorphins in the brain. Not to mention returning a sense of intimacy and normalcy to the relationship. So, nurturing a sense of intimacy in your most important relationship is probably worth working on, right?

We’ve beaten this drum before, but communication is critical. First, it’s important to talk to your doctor. Do you have a diagnosis? Do you know what’s causing your back pain? If pain, depression, or fear is affecting your sex life, your doctor may well have some advice, from changing the dosages of your medication to suggesting positions that might alleviate pain.

Second, talk to your partner. Chronic pain is hard to understand if you’re not experiencing it. It feels like the “not now, dear, I have a headache” routine. It feels like rejection or at least avoidance.

If you’ve been avoiding sex, clear the air with your partner. You both need to express how you feel. Are you afraid that sex will hurt your back even more? That you’re somehow “damaged goods”? Does the pain sap your energy? Do you feel depressed? Listen to your partner's fears and frustrations, too. If the conversation is too difficult, maybe you and your partner should discuss it with a therapist. The good news is that, with some courage and experimentation, intimacy and intercourse don’t need to be held hostage to back pain.

Take it slow. Prepare yourself. Take a warm bath to relax muscles. Plan your rendezvous for a time of day when you tend to feel good. Take your pain meds. Set the mood (candles, incense, music). Good sex is as much about the ambience as about acrobatics anyway.

Plan your positions. Depending on the type of back pain you experience, different positions will help ease your pain. Use firm pillows for support under the small of your back, under your neck or head, under your knees—wherever it feels comfortable.

Those with herniated discs tend to feel better when the spine is extended (arched). Use a pillow under your back for the missionary position or have your partner sit on a chair while you straddle. Both these positions tend to keep your back straight or slightly arched.

For those with spinal stenosis, on the other hand, slightly flexing (humping) the back feels better. Keep your knees pulled toward you in the missionary position or drape your legs over your partner’s shoulders. Both positions keep the spine arched.

Try lying on your side. Or lie on the side of the bed with your legs dangling off the side. Just be sure you’re well-supported on a firm surface. Use the pillows wherever you need more support. The rule of thumb is that the partner without the pain should do the work. Take is slow, and if something hurts, stop!

Do kegels. Besides strengthening your pelvic floor muscles, which is good for sex, this exercise also develops your core musculature, which is good for your back.

A highly recommended book specifically dealing with this issue is Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain, by physical therapist Lauren Andrew Hebert.

Q: Will Kegel exercises help me recover from pelvic floor damage from trauma?

It sounds like you could benefit from a really good pelvic floor physical therapist. While many physical therapists have some training with the pelvic floor, there are only a few with that specialty. Find out who that person is in your community and ask for a referral to him or her.

Physical therapists will have tools that help them determine the strength of the muscles, which helps them make an informed plan for properly improving the tone; Kegel exercises are just one tool in that process. Sometimes after a trauma there is muscle spasm; part of the therapy may be training certain muscles to relax.

It's a good approach to see how far you can get with exercise and therapy before you consider reconstructive surgery. Good luck with your continued recovery from your accident!

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