Sex Part Two: Answers to the Questions I Had When I Was Newly Injured
Welcome back to this series on sex after spinal cord injury (SCI). I am thrilled that you chose to read part two of this series. As I mentioned in the first part of this series, I will now discuss information on bladder and bowel control.
Bladder and bowel control
As you likely know now, we sometimes lose control of our bladder and bowel muscles after sustaining an SCI. For most of us, this loss of control is permanent, and for some, it is not. Also, some of us experience a lot of bladder or bowel incontinence, and others have minimal experience with bowel or bladder accidents.
However, the reality is that even when you have control over these muscles, sometimes sexual stimulation to your genitals or anus may cause you to urinate or have a bowel movement during sexual penetration. So, when you cannot control these muscles, you may be more likely to have incontinence issues during sex or be unable to grab a catheter fast enough when nature calls while you are getting busy with your partner.
Here are a few tips generated from what I have learned from my own experience and the experience of others:
Bladder
- To reduce the likelihood of urinating during or after sexual intimacy, catheterize shortly before engaging in sexual activity and soon after.
- Catheterizing shortly before ensures your bladder will be empty. In comparison, catheterizing shortly after ensures that you empty the urine that moved from your kidneys to your bladder during genital stimulation before it makes a mess by deciding to try coming out on its own.
- Catheterizing before and after genital stimulation also reduces the chance of experiencing autonomic dysreflexia and pain in your bladder or urethra from urine pressure or incontinence. It also reduces the likelihood of developing a bladder infection because of bladder pressure and incontinence. - If you have a suprapubic catheter, taping it to your lower abdomen will keep the tube out of the way and prevent tugging during sex. - If you have an indwelling catheter, it is essential to clean around it before and after engaging in sexual intimacy involving the genitals. Doing so reduces the risk of infection. Those with female genitalia (vagina) should tape the catheter up onto the stomach to keep the catheter out of the way and prevent tugging. If you
- have male genitalia (penis and scrotum), you should fold the catheter along the side of your erect penis and hold it in place using a condom. That way, you will prevent tugging and keep the catheter out of the way.
- Additionally, many lubricants may harm your catheter, so only water-based lubricants should be used when you have an indwelling catheter.
- Catheterizing shortly before ensures your bladder will be empty. In comparison, catheterizing shortly after ensures that you empty the urine that moved from your kidneys to your bladder during genital stimulation before it makes a mess by deciding to try coming out on its own.
Bowels
- To reduce the likelihood of having bowel incontinence during anal stimulation, it is important to empty your bowels shortly before engaging in sexual intimacy involving butt play.
- It may be best to engage in sexual intimacy involving anal stimulation shortly after your bowel care routine. However, there is no shame in planning ahead and doing some bowel care by yourself or with the help of your caregiver, friend, or partner to make sure your bowels are empty before butt play.
- I would not recommend engaging in butt play shortly after taking your laxative medications, such as Senokot-S. Although, you should not have to worry about incontinence during butt play after taking stool softeners, such as Taro-Docusate Sodium.
- I avoid all butt play because, in my case, anal stimulation is often better at stimulating a bowel movement than a suppository is, and I require stimulation to complete my daily bowel care. If you learn your bowels are like mine in this way, following these tips will likely be more critical.
- Suppose you really enjoy receiving butt play, yet, when you engage, you have difficulty with incontinence. In this case, if the tips mentioned above do not work for you, there is no shame in brainstorming with your doctor or occupational therapist about what else may help you reduce these incontinence issues.
Some advice
- Sliding a pillow or wedge under your pelvis to tilt it upward aids in penetration and keeps the pressure off your bladder and lower bowel. This can reduce the likelihood of incontinence, due to pressure, during sexual intimacy involving penetration.
- If you have incontinence issues, do not want to lay in the mess that lube may create, or want to be cautious, it may be wise to lay a soaker pad or a blue pad (or multiple) before starting to get busy with your partner. That way, you will only need assistance removing the pads you laid down to clean up any mess.
- If incontinence happens when you have not laid down something to protect the bed, and it is difficult for you to get out of bed, you can follow these steps:
- First, you may ask your partner or caregivers to change the bedding by rolling you one way, tucking the sheets under you, and rolling you the other way to remove the bedding. Then repeat the same procedure to put new linen on the bed. If your mattress does not have a protective covering, you may also have your assistant
- If incontinence happens when you have not laid down something to protect the bed, and it is difficult for you to get out of bed, you can follow these steps:
- spray disinfectant and lay a soaker or blue pad on the soiled area of the mattress. Then the mattress can be cleaned thoroughly.
- As someone who has urinated during and after engaging in genital stimulation during sexual intimacy with two of my partners since my injury, I understand that this next tip may be difficult to internalize right away. However, as my fellow injured friends and partners have told me, there is no need to be embarrassed or ashamed if urinary or bowel incontinence happens during sexual intimacy. A moment of incontinence does not decrease your worth as a person. While being upset when it happens is understandable, allowing these incidents to deter you from engaging in sexual intimacy is a disservice to you.
- o If your partner becomes angry or disgusted with you when incontinence happens, then they are not a partner you want in your life. As I mentioned earlier, even people who have complete control over their bladder and bowels may have incontinence during or after sexual intimacy. Sometimes our bodies have a mind of their own, and that is okay. Urine and poop are a natural part of life, and no one should consider either taboo.
Conclusion
Fingers crossed that I answered your questions about how SCIs affect the bowel and bladder during sex. Hopefully, I also provided you with some helpful advice on how to handle these changes to your body due to your SCI.
Please join me for part three of this blog series on sex after SCI, where I will discuss how SCIs impact sex and autonomic dysreflexia!
References
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