Incontinence and relationships

Relationships
Loving, caring relationships are important for everyone - and many want these to develop into sexual relationships. For everyone these relationships are a source of happiness and sadness, joy and disappointment, anxiety and pleasure, fulfillment and rejection. Relationships are an aspect of life which can be difficult and worrying for everyone. A bladder or bowel control problem is a further complication, but does not mean that intimate relationships are impossible.

Incontinence and you
Incontinence can affect the way you see yourself and this can affect how you feel about entering into a close relationship. You must take control of the way you feel about yourself and the way you think others see you. A separate information sheet is available which contains some ideas for changing the way you feel about yourself and your incontinence.

Incontinence and relationships
If you have a bladder or bowel control problem you may feel that it is impossible for you to have an intimate or sexual relationship. You may have been hiding your problem and are frightened that a close relationship means that your secret will be discovered.

You may be embarrassed that you need to wear pads or a catheter and you may worry about what possible partners will think of that. When people who are incontinent think about relationships they often immediately think ahead to the stage where such a relationship becomes physical and they begin to focus only on the problems their incontinence might cause.

But it is important to remember that sexual activity is not the only important factor in a relationship. You are unlikely to find yourself entering into a physical relationship without in the first place having developed a caring friendship with your partner and a good degree of respect and understanding.

Bearing this in mind, imagine that it is not you who has the continence problem but your desired partner. If trust, friendship and desire has already grown between you, would a partners continence problem cause you to reject them or would you want to support them and help to find a way around the problem so that your relationship can grow?

Be open and honest.
Any healthy relationship is based on honesty and trust. If a relationship is likely to become intimate, you will have to judge when to trust that person with knowledge of your problem - not so early that it sounds like you are presuming to much about the way you think the relationship is going, but not too late either.

Share your worries about your incontinence. Explain the difficulties your incontinence can cause and explain your fears about how this might affect your relationship. You may be embarrassed, but being honest about your problem is the best way to avoid difficulties later and will demonstrate to your partner how much you trust them.

What are you worried about?
Sexual activity is a source of anxiety as well as pleasure for most people. It is normal to worry about what can go wrong. Incontinence is just another complication. A good way to remove some of the worries about how incontinence might affect intimacy and sexual activity is to think ahead about practical problems that might happen and plan how to deal with them.

Before sexual activity...

Personal hygiene - It is a good idea for everyone to make sure that they are clean and fresh before sexual activity. This is the same for someone with a continence problem. Knowing that you are clean and fresh can also help in increasing your confidence: it can reduce concerns that you may have about how your incontinence affects your attractiveness.

Empty your bladder or bowels - This is especially important for someone who is incontinent because it will reduce greatly the risk of having any leakage while intimacy is taking place.

Fluid intake - You should not reduce how much you drink in total, but it may help to cut down on drinking for a few hours before sexual activity takes place.

Pads and bags - If you wear a pad or a catheter or sheath and a leg bag make sure that you are wearing a fresh pad or that the bag has been emptied.

During sexual activity...

Leaks - You may worry about leakages happening during sexual activity. However, if you take the precautions of emptying your bladder and bowel and of not drinking too much beforehand, it is unlikely that any leak will be very serious. And you should remember that sexual activity involves all sorts of other bodily fluids, so a small leak will not cause any problem, if it is noticed at all.

Bed protection - It makes sense to protect the bed in some way. Bed pads, which absorb moisture but have a “stay dry” cover may be the most comfortable.

Catheters - Even if you have to wear a catheter all the time, sexual activity is possible. If your catheter is normally connected to a drainage bag you might consider asking your doctor or nurse for a catheter valve. This is a device which some people use all the time. The valve fits onto the end of the catheter and can be opened or closed like a tap. In this way you can leave the bag off for a while. Remember to ask your doctor or nurse about how to work the valve and how often it needs to be opened to let urine collecting in your bladder to drain away into a suitable receptacle.

If you prefer to leave the catheter connected to a drainage bag, think about what type of bag to use and where this should be placed. It might be best to use a bag with a longer tube, which could be worn on the calf rather than on the thigh, to prevent lying on the bag. Or you might consider connecting the bag to a night drainage bag, again to prevent problems that could be caused by lying directly on the leg bag. For women it may be helpful to tape the catheter forwards and to one side using surgical tape during intercourse, although the best position for it will be established through experience. Remember that the catheter is entering the urethra not the vagina, so it should not affect sexual activity greatly. For men the catheter can be bent back along the penis and held in place by surgical tape ora condom or both. It might be helpful to use a lubricating gel for greater comfort during intercourse. Suprapubic catheters are probably the best option if you are (or intend to be) sexually active. A suprapubic catheter enters the bladder through a small incision made in the abdomen beneath the belly button and so is not in the way at all during intercourse. A separate leaflet is available about suprapubic catheters, or you can ask your doctor or nurse for advice. If you wear a sheath it is best for reasons of hygiene and comfort to remove it before sexual activity and replace it with a new one afterwards, although it is possible to leave it in place.

After sexual activity...

As for everyone, it is a good idea to attend to personal hygiene following sexual activity, although it is a time when it is not easy to remember these things. After a comfortable period of time remember that it might be best to put on a pad, after freshening up. Or you may need to open a catheter valve to empty any urine that has accumulated in your bladder and to reconnect to a leg bag.

In certain circumstances some men may need to consider bladder washouts to prevent their catheter from blocking after ejaculation. This simple procedure can be explained by your doctor or continence nurse.