Have spina bifida — will I pee during sex?

Dear Alice,

I'm 20 years old. I have spina bifida and I can walk perfectly normal but I have incontinence with my bladder. I get a lot of urinary tract infections, too. I've been with my boyfriend for 3 years now. I am kind of worried about having sex with him because I always pee myself. I was wondering what I should do to stop getting these infections so I get be comfortable during sex and not have to think that I will pee on the bed.

Dear Reader,

It is true that people with spina bifida are more prone to urinary tract infections (UTIs) and can also have incontinence. One reason for this is because for people with spina bifida, emptying the bladder completely or knowing when ones bladder is full can be difficult due to a decrease in bladder sensation. This can cause urine to remain in the bladder for too long and creates an environment more hospitable to bacteria. In addition, spina bifida can cause nerve damage that makes it difficult to control the need to pee. You may want to consider the following tips for avoiding UTIs and controlling your bladder as much as possible:

  • Drink at least 8 glasses of water per day. The more water you consume, the more diluted bacteria will be in the bladder.
  • If possible, set up a regular, frequent, urination schedule. Go regularly, even if you don't feel like you have to pee.
  • Try to make sure you are peeing out everything in your bladder every time you go.
  • Monitor your bowels, too. Full bowels can push on your bladder, making it harder to empty fully. After going "number two," try to see if you can pee a little more before leaving the loo. 
  • Always wipe front-to-back, to keep bacteria away from the urethral and vaginal openings.
  • Some doctors will prescribe low-dose antibiotics to be taken regularly as one method of UTI prevention. Check with your healthcare provider to see if she or he thinks this is a good idea.
  • Your partner can also help. He can wash up before getting down (penis, hands, mouth, etc.) to minimize the number of bacteria coming into contact with your urethra.

Specifically in terms of sex, some similar measures may help prevent peeing while in the sack:

  • First, avoid sex if you currently have a UTI — wait until it has cleared up to engage in sexual activity that involves you being penetrated vaginally, which can make a UTI worse.
  • Second, pee right before sex and also immediately after. Peeing before decreases the likelihood of both getting a UTI and peeing in bed, peeing after decreases the likelihood of developing a UTI.
  • Finally, if you do feel an urge to pee during sex, it is okay to stop to get up to pee. In fact, a quick break during sex can be a nice "teaser" for both of you and can make it that much hotter when you resume a few minutes later.

Have you had the chance to talk to your boyfriend about your concerns related to having sex and to possibly peeing during sex? Being able to communicate openly about the possibility of peeing may also decrease your anxiety and make you feel more comfortable overall. Having a towel on the bed as an extra layer and another near by for clean up, in case it does happen, may be a good measure. Also, know that unintentional peeing during sex can happen to anyone. If it does happen, try not to be hard on yourself. If it's possible for the two of you to laugh it off, all the better. Know that if you feel ready to start having sex, you are deserving of a gratifying sex life.

Good luck and here's to hoping that any intimacy you decide to share with your boyfriend is a blast.

Take care,

Last updated Mar 27, 2015
Originally published May 21, 2010

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