Coital incontinence: relation to detrusor overactivity and stress incontinence

Abstract

Aims: The aim was to assess functional (demographic, clinical, and urodynamic) and anatomical (described by MRI) abnormalities associated with coital incontinence (CI).

Methods: All consecutive sexually active women with urinary incontinence (UI) were invited. Women were asked if they experience urine leakage during sex; and its timing: during penetration (CIAP) versus during orgasm (CIAO). All women were studied with urodynamics. Pelvic MRI was done for selected group of women. MRI examination was done using 1.5 T superconducting magnet, supine, and during two phases: static and dynamic, using multiplanar T2-weighted turbo spin-echo and single short T2-wighted images.

Results: Ninety women with UI; 60 had CI while 30 had no CI. Prevalence of CI was significantly higher among women with stress incontinence (SUI) (89.4%) compared to those with detrusor overactivity (DOA) (33.3%); P = 0.000. Factors significantly associated with CI were parity, prolapse, and SUI. Among studied MRI variables, no factor was significantly associated with CI. CI showed significant positive correlation with severity of SUI (r = 0.327, P = 0.05) and significant negative correlation with Abdominal leak point pressure (r = -0.362, P = 0.01). Amplitude of unstable detrusor contraction as measured by urodynamics did not correlate with severity of CI.

Conclusions: CI seems to be in the spectrum of SUI and POP. CI is almost invariably a symptom of SUI with urethral sphincter incompetence, even when it occurs during orgasm. Many women with DOA leak during sex; however, the potential role of associated urethral incompetence should be considered.