I am leaking urine during sex. What does it mean and what can I do about it?

   AP Photo/Felipe Dana 

It is an embarrassing problem. You are being intimate with your partner and all of a sudden your bladder is emptying your bladder and you cannot make it stop. It is a real medical condition and it is called coital incontinence.

The exact numbers of women who suffer from coital incontinence are unknown as many are reluctant to discuss the problem. However, urinary incontinence (of which coital incontinence is a sub-type) affects 20% of the population. Women who have incontinence during the day are more likely to suffer from coital incontinence.

There are two types of coital incontinence:

• Leaking with penetration. This is the most common type. It is a form of stress incontinence so many women who leak with penetration also leak urine with coughing or sneezing. The cause is weakness of the muscles that support the bladder.

• Leaking with orgasm. This is the result of spasms that cause the bladder to empty. The nerves that are involved in orgasm are some of the same nerves that control bladder function. Some women normally feel symptoms not unlike the need to urinate along with their orgasm; however, it is abnormal if the bladder is actually triggered to empty. Many women with this kind of coital incontinence leak urine during the day, often on their way to the bathroom or with triggers, like getting out keys to open the door.

The first step is to see your doctor. A pelvic exam should be performed to make you’re your do not have a large uterus or a mass in your belly that is pressing on your bladder. Testing to rule out a bladder infection and to make sure you are completely emptying your bladder should be performed. Ruling out other conditions, such as diabetes and multiple sclerosus may also be indicated depending on other symptoms. Special testing performed a urogynecologist (a gynecologist with extra training in bladder problems) may be recommended to further evaluate your bladder function.

First line interventions for both types of coital incontinence are strengthening the pelvic floor muscles (Kegals exercises, known to doctors and therapists as pelvic floor muscle retraining). Women should see a specially trained pelvic floor physical therapist to make sure they are doing these exercises correctly. A device that electrically stimulates the pelvic floor muscles (transvaginal electrical stimulation) may also be helpful in re-educating the muscles. Weight loss if you are overweight and avoiding bladder irritants, such as caffeine and alcohol are also recommended. Emptying your bladder before sex may also help.

If these therapies do not work, medications may help women who leak with orgasm, such as OxyTrol, Ditropan, or Detrol. These drugs reduce bladder spasms. Women who leak on penetration fare better with surgery to support the neck of the bladder. This surgery is typically performed by a urogynecologist.

Do not be embarrassed if you leak urine during sex. It happens, and if your partner cares for you he or she will understand. Talk with your doctor because effective therapy is available.

For more info: the National Association for Continence

Remember, this column does not represent individual medical advice