COITAL INCONTINENCE (Leaking with Intercourse)

Coital incontinence is defined as urinary incontinence before, during, or after vaginal intercourse. A woman may experience urinary incontinence with penetration (stress urinary incontinence) or with orgasms (detrusor overactivity). A woman may also experience another phenomenon in which she has a small whitish secretion which is attributed to female ejaculation orgasm. This may be a sign of increased arousal; however, it can occur simultaneously with urinary incontinence. If you are unsure about what you may be experiencing, you are encouraged to speak to your urogynecologist for further discussions.

Treatments for coital incontinence are similar to treatment for stress incontinence or urge incontinence. Your physician may initiate treatment with medications or possibly surgery. If you are referred or choose to seek out a pelvic physical therapist, your pelvic floor musculature will be evaluated. Like many other times with urinary incontinence, it may not be because of muscle weakness, but instead of overactive muscles that do not relax properly. Depending on the state of the pelvic floor muscles, it may be necessary to begin a muscle strengthening program in which you are following a stress incontinence protocol. If you are experiencing high tone or overactive pelvic floor muscles, then downtraining initially will be more appropriate.

You may also want to try experimenting with different positions for leakage relief. Positioning yourself on top or side lying may decrease pressure on the abdomen and bladder. If you are lying on your back, try placing a pillow under your buttocks or low back to help place your pelvis in a more neutral position. The tilt of the pelvis may also help decrease the pressure on your bladder by positioning it higher in the pelvic cavity.

Using the Kehel can help if you need strengthening or downtraining. If you need pelvic floor muscle strengthening, performing the assessment, as well as the games will increase your strength. There is also an article on strengthening using the Kehel:

If you need to downtrain the muscles for them to relax completely, you can use the manual mode and/or the massage mode to assist with that. When in the manual mode, the objective is to get the graph line as close to zero as you can and that should indicate that the muscles are relaxing completely. There is an article and video specific to downtraining using the manual mode.

If you are experiencing urgency with orgasm, then sometimes behavioral modification training can help to decrease the urgency. This is also where some medications can be beneficial so speak with your gynecologist or urogynecologist. Also, if you have been trying to self-treat with minimal improvements, you also seek the assistance of a pelvic physical therapist for further assessment.

Elizabeth Bell

Clinical Specialist in Women’s Health

Lola Rosenbaum

Doctor of Physical Therapy

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