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Deeper effects of incontinence

Posted Apr 05 2012 6:43pm

It is already difficult enough to talk about incontinence to your doctor, but when this problem starts affecting your sex life… Far from being insignificant, the impact these little leakages have on sexual relations are still rarely brought up in the doctor’s surgery. However, managing incontinence properly will put these sex life woes to bed for good.

Urinary incontinence affects 3 million women

Urinary incontinence affects men and women, young and middle-aged alike, but it is especially common, however, in menopausal women. When hormonal secretion ceases in the body, this has the effect of diminishing the muscle tone of the perineum which, in this way, can encourage leakages to occur. According to data findings, close to 13% of women in the UK suffer from incontinence; but there is a good chance the figure could be underestimated according to specialists. Among men, treatment for cancer of the prostate through radical prostatectomy is a frequent cause of urinary incontinence, affecting 20% of patients operated on according to a study carried out in Sweden.

In an era where self composure and body perfection are valued, urinary incontinence is generally a very negative experience and there are few who talk about it to a doctor of their own accord. According to a study led in 2007 by the INSERM French GPs Sentinelles network of 2,183 women who consulted their GP, more than 60% of women suffering from urinary incontinence had never spoken about it, opting instead just to wear protection (daily for almost half of these women).

From urinary incontinence to coital incontinence

This issue becomes even more taboo when problems with urination are coupled with problems in the bedroom. Up to half of women suffering from urinary incontinence complain of problems with their sex lives, according to a study 2.  which lifted the lid on a taboo that is still deeply entrenched. This brings the number of women for whom this problem has had an effect on sex life to almost 1.5 million. Men are not spared this experience either as a quarter of those suffering from incontinence due to bladder hyperactivity complain of it having an impact on their sex lives and the number increases with age.

While the effects of urinary incontinence on sexuality follow no strict pattern, they are probably very frequent considering that continence and sexuality share not only the same anatomical region, but are both dependent also on the nervous system. In both cases, healthy functioning relies on the localised mechanism, inextricably linked to the body’s central system for the transmission of information. In fact, urinary continence and sexuality often share the same risk factors and, sometimes, malfunctions have the same cause. In this way, in women, the reduction of pelvic muscle tone can contribute to stress urinary incontinence at the same time as a decrease in sexual satisfaction. During the menopause, oestrogen deficiency exacerbates these problems.

Another condition linked to this is a pudental nerve block. This nerve in the pelvis allows the contraction of the perineum and transmits messages of general sensitivity to the central nervous system. Birth or surgery can actually affect the motor and sensory functions, and cause stress urinary incontinence as well as a lack of sensitivity in the vagina and vulva, leading to hypo-orgasmia. Urinary leaks then take place, and more often than you would think, during sexual relations, and this is what is known as coital incontinence. This concerns 60% of women suffering from incontinence.

Effective treatments for incontinence and sexual problems

In certain situations, urinary incontinence points to an underlying sexual problem:  low libido or lack of desire, and long gaps between having sex… In actual fact, incontinence can serve as an excuse to stop sexual relations when they are no longer satisfying. In both cases, telling your doctor about it will allow him or her to suggest an approach that suits your needs and your lifestyle choices.

The management of incontinence problems rests on different approaches, which is it possible to combine together according to the type of incontinence experienced and the impact of the problem on daily life. Perineal reeducation is very often suggested, because of it’s very positive effect on both incontinence and sexuality. A urologist might also suggest behavioural therapy for patients suffering from urge incontinence so they can learn to resist the feeling of urgency. For people who feel their self-esteem is suffering and who adopt strategies to avoid sexual relations, these approaches can be combined with psychotherapy or sex therapy. Medication-based treatments can also be prescribed (more precisely, anticholinergics for bladder hyperactivity), and, in the most severe cases, minimally invasive surgery, involving supporting strips or inflatable balloons, or even periurethral injections can all be considered.

There are questionnaires approved by specialists available and these allow patients to evaluate the impact of urinary incontinence on their quality of life. Do not hesitate to talk about the problem with your doctor.

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