From sleep to eating habits, incontinence can certainly impact a person’s lifestyle. But it’s the anxiety incontinence causes that often plays the biggest role in disrupting someone’s sexual health and physical relationships with their intimate partners.

Fear of a leak during intercourse is a primary reason that people with incontinence begin to avoid physical intimacy. The resulting worry can interfere with their arousal and leave them feeling unattractive. For some, accidents during sex can trigger shame and embarrassment, which over time can lead to anxiety, mood disorders, and even depression.

“If a patient dealing with incontinence does bring up issues with intimacy, that’s usually when the tears come because they feel ashamed or embarrassed,” said Dr. Jannah Thompson, a Michigan urologist who specializes in urogynecology. “It can create conflict in the relationship because either they don’t want their intimate partner finding out, or an accident has happened in an intimate moment, and there’s this conflict and tension there that’s hard to talk about.”

It’s important to understand that those dealing with this problem are not alone. One in 12 Americans live with fecal incontinence. One in six Americans suffer with some type of urinary incontinence, and the majority of them are women. 

Experts say talking about the problem — with a physician and with your intimate partner — is one of the best first steps you can take. Unfortunately, all too often embarrassment prevents many people from seeking help, and they continue to suffer in silence.

Dr. Thompson said some patients who do muster the courage to talk to their primary care physician can get less-than-ideal responses. She’s heard stories of primary care physicians dismissing concerns about leaks as “not that big of an issue” or just “part of aging.”

“As a medical community, we need to take these concerns seriously, we need to be empathetic to them, and we need to understand that there are people with expertise in this area who can help,” said Dr. Thompson, who encourages patients dealing with incontinence to push for a specialist referral. “There’s just so much that’s not taught or explained to primary care physicians about this.”

If some medical professionals don’t handle incontinence conversations appropriately, it’s no wonder some patients are fearful of having similar conversations with their intimate partners.

Opening up the discussion may be uncomfortable, but in the right tone, time and place it can start a productive conversation. Consider broaching the topic with a simple phrase like, “I’d like to talk to you about something personal.”

Dr. Thompson suggests some simple language that could help open the lines of communication with a supportive partner: “I'm dealing with some health issues that are affecting my ability to feel sexy or affecting how I feel about myself. I'm really struggling with this, and I care about you. I want to be intimate with you. But these health issues are impacting that.”

If you suspect your intimate partner is dealing with incontinence, don’t focus the conversation on your desire for physical intimacy. Instead, Dr. Thompson suggests leading with empathy and encouragement. Remind them of your support and that physician care can help treat what is usually a medical problem.

Gender differences may play a role in how men and women think about incontinence and intimacy.

“A man may not care about a leak and may be very supportive, but the woman may still be reluctant because there's anxiety there, and she’s preoccupied thinking about that,” said Dr. Thompson. “The emotional piece of how a woman feels about herself in this situation needs to be taken into account, even if her partner isn't bothered by it.”

There are a variety of ways incontinence can be treated or managed.  Depending on the type of incontinence there may even be a variety of at-home exercises and lifestyle changes that can help regain some measure of control.

While incontinence can be a challenge, it does not have to mean the end of physical intimacy. Talking with your intimate partner can be the first step in relieving some of the mental stress, and talking with a doctor can start the process of treatment options to address its physical cause.

You can learn more about various forms of incontinence and treatments here.

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