Urinary incontinence can be stopped

Mary was distressed when she came to the sexology clinic. She entered the consultation room and even before taking her seat, pronounced that she was in serious trouble and that she was about to lose her marriage. I ushered her into a seat.

“I am pouring stuff during sex that makes the beddings wet and leaves my bedroom ponging the whole day!” she exclaimed. She said the incident had happened three times after which she opted to keep off sex. It was going on six months and she and her husband had not had been intimate since. “He was disgusted and pushed me away and now he is threatening to get another woman,” Mary said tearfully. She had all the signs of depression arising from these bedroom troubles.

A 35 year old, Mary had two children. Both deliveries were normal vaginal ones. The last delivery had been six months prior to her visit to the clinic. Following delivery, she noted that whenever she lifted anything heavy she would leak urine. Urine also occasionally leaked when she coughed. She initially assumed that the leakage was because her genitals were yet to fully heal following delivery.

Things however worsened when Mary resumed sex. Initially she thought the fluid was excessive lubrication but soon realised that it was urine. Her beddings started smelling and she had to wash and air them and the mattress.

I examined Mary and my conclusion was that she had stress incontinence. Any pressure to her tummy – either from carrying a heavy load or coughing or exerting during sex made urine leak. Stress incontinence is due to a weak urinary sphincter. The sphincter is what automatically closes to stop urine from leaking whenever pressure is exerted on the tummy.

There are many causes of stress incontinence. Many cases occur in older age when the muscles of the pelvis become weak. Obesity is also a known cause. The fatty tummy exerts pressure on the pelvis, pushing the sphincter to open at wrong times. Laxity of the pelvic muscles following pregnancy and delivery is also a known cause.

“So you mean my muscles are weak because of pregnancy and delivery?” Mary interrupted. “Will I ever be normal if that is the case?” I nodded reassuringly.

I advised Mary to make a habit of passing urine before sex. She was also to avoid drinking water for at least one hour before sex. I put her on physiotherapy for the pelvis, and pelvic muscle exercises while at home. I also asked her to bring her husband along to be given information on what she was suffering from and to be part of the counseling to resolve the on-going relationship conflict.

“So you are saying that it will take some weeks before Mary regains proper urinary control and that if this fails we may have to consider surgery. Why can’t you just do the surgery right away?” Mary’s husband asked when he came to the clinic. He seemed to be in a hurry to have Mary back to health.

I however reassured Mary that most cases of the related stress incontinence recover with adequate pelvic floor exercises and physiotherapy, and it is important to be patient and give the exercises a chance. Mary was quite disciplined in following up my instructions and after six weeks of exercises, she had no urine leakage on lifting weights or coughing. I gave them the greenlight to go ahead and try sex.

A few days after the six weeks, Mary popped into the clinic to see me. She walked into the consultation room, opened her handbag and removed a bottle of what looked like an expensive brand of wine.

“This is just to appreciate your support and to say thank you for saving my marriage,” she shook my hand and quickly rushed out of the door.