Incontinence & Your Sex Life: Everything You Need to Know

We often hear about how important pelvic health is, but there’s one issue many women face that doesn’t always get the attention it deserves — urinary incontinence. And when it comes to sex, the last thing you want to worry about is leakage or discomfort. If you're dealing with incontinence, you’re not alone. Luckily, there are plenty of ways to manage incontinence and stop it from interfering with your sex life.

Let’s explore what urinary incontinence is, its causes, how it can impact intimacy, and practical tips for maintaining a healthy and enjoyable sex life.

What is urinary incontinence?

Urinary incontinence is the involuntary leakage of urine. Basically, it’s when you can’t fully control your bladder. It can range from a small leak when you laugh, sneeze, or have sex, to a more frequent and urgent need to pee that may result in larger leaks. There are a few types of urinary incontinence:

• Stress incontinence: Leakage happens when pressure is put on the bladder, such as during laughing, coughing, exercising, or sex.
• Urge incontinence: This involves a sudden, strong urge to urinate, followed by an involuntary loss of urine. It’s often associated with an overactive bladder.
• Mixed incontinence: A combination of both stress and urge incontinence.

It’s estimated that up to 45% of women experience some form of incontinence, especially after childbirth, during menopause, with weight gain, or with age. While it’s common, it’s certainly not something you have to accept as a permanent inconvenience — there are ways to manage it.

What causes incontinence?

Several factors can contribute to urinary incontinence in women. Some of the most common include:

• Pregnancy and childbirth: During pregnancy, the growing baby puts pressure on your bladder, and the muscles of the pelvic floor (which support the bladder, urethra, and other organs) can become weakened during vaginal childbirth. This weakening can result in stress incontinence.
• Menopause: Estrogen plays a role in keeping pelvic muscles strong, so when estrogen levels drop during menopause, those muscles may weaken, leading to bladder control issues.
• Aging: As we age, muscles naturally lose strength, including those in the pelvic floor. Additionally, the bladder becomes less flexible, making it harder to hold in urine.
• Weight gain: Excess weight can put added pressure on the bladder, leading to stress incontinence.
• Urinary tract infections (UTIs): UTIs can cause temporary incontinence. UTIs irritate the bladder and the urinary tract, leading to symptoms like a frequent and urgent need to pee. This can make it difficult to control the bladder, resulting in involuntary urine leakage, which is a form of incontinence.
• Chronic conditions: Certain health issues, like diabetes and neurological conditions such as multiple sclerosis or Parkinson's, can contribute to bladder problems.

How incontinence can affect your sex life

It’s easy to see how incontinence might create some concerns when it comes to intimacy. The fear of leakage during sex can cause embarrassment, anxiety, or a loss of confidence. You may avoid sex altogether because you’re worried about accidents, or you might not fully enjoy the experience if you’re preoccupied with managing your bladder. 

At least 25% of women with incontinence experience leaks during sex. Meanwhile, a study published in Sexual Medicine revealed that women between the ages of 30 and 70 who experienced incontinence were not only less likely to engage in sexual activity but also had reduced sexual desire. Even though women with incontinence had just as much sex as those without it, they reported feeling less connected to their partners and less satisfied with their sex lives.

Here are some common ways incontinence can affect your sex life:

• Fear of leaking: The most obvious challenge is the fear of urine leakage during sex. especially for women with stress incontinence. Physical movements, especially those that put pressure on your abdomen, can cause small leaks.
• Reduced libido: Anxiety about incontinence can lead to stress and self-consciousness, which in turn may lower your desire for sex.
• Pain or discomfort: In some cases, particularly after childbirth or during menopause, weak pelvic muscles or vaginal dryness (related to lower estrogen levels) can make sex feel uncomfortable, further complicating things.
• Avoidance: Some women choose to avoid sex entirely to sidestep potential embarrassment or discomfort, but this can affect intimacy in relationships. Up to 45% of women with urinary incontinence abstain from sex.

Does sex help reduce incontinence?

Interestingly, sex itself can both help and hinder incontinence — it really depends on the type and cause of incontinence, and the individual. 

During intercourse, especially if the pelvic floor muscles are weak, the pressure on your bladder can cause urine leakage. Certain positions, particularly those that involve thrusting, can intensify this pressure.

On the flip side, reaching orgasm involves the contraction of pelvic muscles, which can actually help strengthen them over time. Regular sexual activity may improve muscle tone in the pelvic area, potentially reducing some of the symptoms of incontinence.

Tips for a healthy sex life if you have incontinence

So, how do you navigate a healthy, enjoyable sex life while managing urinary incontinence? Thankfully, plenty of strategies can help you feel confident and comfortable in the bedroom.

Empty your bladder before sex

This might sound obvious, but making sure you pee before sex can help reduce the risk of leakage. Even better, avoid drinking large amounts of liquid just before sex — especially bladder irritants like caffeine, alcohol, or fizzy drinks. 

Strengthen your pelvic floor

Regular pelvic floor exercises, also known as Kegel exercises, can help improve muscle tone and reduce incontinence symptoms. These exercises involve squeezing and holding the muscles you use to stop the urine flow, and they can be done anytime, anywhere. Research shows that Kegels can significantly reduce both stress and urge incontinence in women — although it’s worth noting that they’re not recommended for those with hypertonic pelvic floor or painful sex. 

If Kegel exercises aren’t enough, consider seeing a pelvic floor physical therapist. These specialists can help you strengthen your pelvic muscles and teach you techniques to improve bladder control. They can also determine whether Kegels are right for you. 

Explore different positions

Some sex positions may put less pressure on your bladder, reducing the risk of leakage. Experiment with positions where you’re on top, as this can give you more control and help relieve pressure on your bladder. Side-lying positions can also be more comfortable for some women.

Talk to your partner

Open communication with your partner is key. Let them know what’s going on and how you feel. You might be surprised by how understanding they are. Plus, knowing that your partner is supportive can ease anxiety and help you feel more relaxed during intimacy.

Put a towel down

If you’re still concerned about leakage, placing a towel underneath you or using special incontinence pads made for sex can help absorb any leaks, allowing you to focus on pleasure instead of worrying. A plastic mattress protector can also help. Remember: sex is meant to messy and wet, a little urine never hurt anyone. 

Address underlying issues

If vaginal dryness or pain during sex is affecting your experience, consider using a lubricant like Vella’s Intimate Elixir or Super Slip & Slide. 

If hormonal changes are contributing to your symptoms, speak to your doctor about options like vaginal estrogen creams or hormone therapy, which can help keep tissues healthy and hydrated and improve urinary symptoms.

Enjoying intimacy without worry

Urinary incontinence doesn’t have to interfere with your sex life. While it may feel embarrassing or frustrating, understanding the causes and implementing strategies to manage it can make a huge difference. From strengthening your pelvic floor muscles to openly communicating with your partner, there are plenty of ways to maintain a fulfilling and enjoyable sex life — without letting incontinence take center stage. Remember, intimacy is about connection and pleasure, and with a few small adjustments, you can continue to enjoy both.