Coital Urinary Incontinence (Coital UI) is the accidental leaking of urine during sex. It effects roughly 10-25% of women, though it is often unreported due to embarrassment among women.
Urinary leakage can occur during penetration or upon orgasm, and it often leads to reduced sexual desire, inability to orgasm, and can lead to strain on relationships.
The causes of coital UI are still being investigated but Coital UI often affects women who experience leakage during non-sexual exertion activities such as coughing, sneezing, laughing, or exercising, referred to as Stress Urinary Incontinence (SUI).
Stress UI is caused by weakened pelvic floor muscles, or inability of the muscles to contract quickly on exertion. Additionally, the presence of scar tissue in the abdomen or pelvis itself can place high pressure on the bladder.
With penetration this pressure can often be exacerbated either by the penetration itself or by a partner lying on top of the bladder leading to leakage. Another cause of Coital UI is urethral dysfunction wherein the urethral sphincter is unable to close to adequately stop the flow of urine.
Finally, pelvic organ prolapse (POP) can lead to coital UI. POP is the dropping down of the pelvic organs (bladder, uterus, or rectum) lower into the pelvic bowl in a manner that compresses them into the walls of the vagina. It often feels like pressure in the pelvis or a sense that one’s organs are falling out.
In order to determine the root cause of bladder leakage during sex it is often beneficial to visit a urologist for specific testing. Once the root cause is determined often non-invasive treatments can cure Coital UI.
These treatments include pelvic physical therapy by a qualified pelvic specialist, doing Kegels to strengthen the pelvic floor, addressing any scar tissue that may be in the abdomen or pelvic floor from injuries or surgeries using specific and gentle soft tissue mobility techniques.
Kegels are often a highly effective tool to retrain and strengthen the pelvic floor muscles to prevent bladder leakage. A Kegel is a contraction of the pelvic floor muscles, the sling-like muscles that surround and support the bladder, vagina and uterus, and rectum.
Performing pelvic floor strengthening exercises (Kegels) can be helpful in training the muscles to treat bladder leaks, pelvic organ prolapse, low back and hip pain, and to improve sex.
For women, the proper way to do Kegels is to contract the pelvic floor muscles as if you were shutting of the flow of urine. Avoid contracting buttocks or pulling your abdominals in too tightly. The abdominals may gentle tighten but they should not compress strenuously.
Breathing is also important during Kegels. Holding your breath will place pressure on the bladder and pelvic floor, thus making it very difficult to contract the muscles properly. The breathing pattern for this exercise is to inhale and remain relaxed, then exhale as if you were blowing out birthday candles, and simultaneously perform a Kegel.
To practice basic Kegels start by lying on your back with knees bent and feet shoulder width apart. Place your pelvis and low back in neutral alignment: the pelvis should not be rocked up or down, but right in the middle. You may wish to have a pillow under your head.
Avoid holding your breath, movement of the pelvis, or bearing downward as if you were going to pass gas.
Hold the contraction for 5 seconds, then rest for 5 seconds. Repeat 10 times. Do this 7-8 times every day.
Once you have mastered this after a few weeks, you can change the length of time that you hold the contraction, practicing quick and long hold Kegels.