Overactive bladder (OAB) takes its toll on many aspects of your life, including your interpersonal relationships. For many of the estimated 30 million Americans who live with OAB -- especially women -- sex can be excruciatingly painful, not to mention tinged with fear of leakage and/or odor.
OAB is marked by the near constant urge to urinate, which can lead to urinary incontinence or leakage. This occurs because your bladder involuntarily contracts when it isn't full. From medication side effects and neurological conditions to urinary tract infections and pregnancy, the potential causes of OAB in women vary.
Regardless of the cause, “if you are experiencing frequency, urgency, or pain in the bladder area that is exacerbated by sexual relations, it can be a barrier,” says Jennifer Berman, MD, a urologist and sexual health expert at the Berman Women’s Wellness Center in Los Angeles. She is also the author of several books, including For Women Only: A Revolutionary Guide to Reclaiming Your Sex Life.
“Oftentimes, women with OAB worry about urine leakage during sex or orgasm.”
OAB or urinary incontinence can cause physical symptoms as well as fear, anxiety, and shame about sex and intimacy, she says.
But how or when do you tell a new (or even an old partner) that you have OAB? What you can do to minimize your symptoms so they don’t affect your relationships? We’ve got the answers to all your questions about OAB and sex.
Talking About OAB and Sex
Although it can be hard for women to talk about OAB or sex, it may be even harder to talk about OAB and sex.
But “OAB is extremely common and there are treatments,” Berman says. Identifying the cause of your OAB is the first step toward successful treatment. It may be something as simple as changing your current medication regimen to one that doesn’t cause OAB symptoms.
Elizabeth Kavaler, a urologist at Lenox Hill Hospital in NYC, and the author of A Seat on the Aisle, Please! The Essential Guide to Urinary Tract Problems in Women, asks patients about urinary incontinence and sex when taking their history.
If someone is not sexually active because of OAB, she suggests cutting back on fluid and avoiding caffeine and other OAB triggers such as alcohol and chocolate.
Berman adds: “There is a misconception that you have two drink gallons of water a day to flush out your system.”
But you don’t need that much. “Four, 8-oz glasses of water a day is all you need to maintain your health and bodily functions, especially if you are suffering from OAB,” Berman says.
Trying to urinate every two or three hours can also help re-train your bladder, she says.
“About 30% of patients will do well just with behavior changes,” Kavaler says. If these fail, there are nine medications currently available to treat OAB. Other OAB treatments include various surgical procedures, and there has been some success using Botox injections off label to stop bladder contractions.
OAB and Intimacy
Unfortunately, many women with OAB will just avoid sex altogether.
“They think it’s bad for their bladder and that it will make it worse, so they stay away from that whole area,” Kavaler says.
This is a myth. “Unless you have a prolapsed bladder, sex is not dangerous and will not cause your bladder to become damaged,” she says.
Sex is one thing, but intimacy is another, she says. “Intimacy should not change with age or OAB,” she says. “If you feel like you smell from urine, you may feel unsexy,” and avoid sex and intimacy.
Pepper Schwartz, PhD, a sociologist at the University of Washington in Seattle, agrees. “There are a lot of things that go on which long-term partners don’t discuss or don’t discuss the severity of,” she says. OAB may fall into this category.
“Women may feel embarrassed by leakage during sex or orgasm, and even if their partner knows and says ‘it’s OK’, it certainly can stop you from allowing or giving oral sex,” says Schwartz, the author of several books including Prime: Adventures and Advice on Sex, Love, and the Sensual Years.
Hiding something is not good for intimacy, she says. “It has an impact on your own psyche, and you don’t realize that until you do talk about it,” she says.
Put OAB Out There
Once you are open with your partner, you can face the situation together. “If there is urine incontinence during sex or orgasm, you may need a towel,” she says.
She doesn’t advise bringing up OAB and sex fears right before you hit the sheets.
Berman agrees: “It is best to go about it around a conversation about positive things -- not in the bedroom,” she says.
If it’s a new partner, consider this conversation a litmus test. “If the guy is horrified and runs, there are other issues, and it’s important to know that in advance.”