Q: I’m worried that my weak bowels and bladder will be a problem, make that a huge turn-off, with a new sexual partner now that I have a disability. Is this going to be a major problem for me in my sex life?
A: It’s easy to imagine that reduced bowel and bladder control will always make a "mess" of a sexual relationship, but there are a number of things you can do to manage the issue. First and foremost you need to maintain a regular bowel and bladder program. Make sure you drink enough, keep catheters clean, and empty yourself as fully as possible, to reduce the likelihood of bladder infection. Fever, spasticity, or painful urination will certainly take the thrill out of your sex life.
Likewise for your bowels. Use your diet to avoid the extremes of constipation or loose, soft stool by eating proper levels of roughage and fibre. Constipation keeps toxins in your body longer that are meant to be eliminated with your stool, and being too loose, will dehydrate you because there is more water in the stool. A salad, a bran muffin, or a few pitted prunes now and then is not such a tough thing to work into your diet. These practices will support your general health while reducing the chance of accidents during sex.
Now for the obvious. Empty your bladder and clear your bowels sufficiently before sex. You might reduce your fluid intake beforehand, but take care not to abstain so much that you increase the risk of an infection. Your body and your bladder and your kidneys need fluids, so if you’re going to ease off on fluids in the evening prior to intimacy, then you might want to really flush yourself out well earlier in the day with lots of water. Consider getting into the more strenuous activities (those movements which put pressure on your bladder, for instance) earlier in your lovemaking.
Yes, I know, making a plan for sex doesn’t exactly foster the spontaneity that is its nature, and yes, the more "aggressive stuff" tends to naturally come later, but you do have some choices that can make a difference. This question depends on your particular disability and its effects on your body. Some people have "frozen" bladders that are unlikely to empty accidentally unless it becomes quite full, or some people experience spasticity which might lead to a sudden reflex urination. You need to know your own body and its responses, and if you’re just entering into sexuality with a recent disability, this is part of what you’ll be observing and learning along the way.
When you know how your body works and responds, you can take it into account as you develop your style of sexuality in relationship to your disability. Perhaps you’re more concerned about the presence of a catheter. Users of an indwelling catheter can cap the end and do without a leg bag for a period of time. Perhaps you can tape the catheter to your leg so it won’t get pulled in the course of your movements or contact with your partner. Take great care here. If you’re unable to sense pressure on the bulb in your bladder, you could risk a serious internal injury.
Some men have found that they can leave a catheter in place, and cover it with a prophylactic condom during intercourse. Again, you have to take great care that it is not being pulled out from the urethra. For women, given that the urethral opening is apart from the vagina, intercourse is often still workable with a catheter in place. Will your partner be repelled by your bowel and bladder issues? If you fail to show them that you understand how your body works, and that you have strategies for handling it, they are more likely to be uncomfortable. They’ll mirror your attitude, whatever it is. This is yet another test of the nature of the relationship you are having. If someone is just out for casual sex, or has other motives that aren’t about accepting and supporting you for who you are, they’re less likely to accommodate how bowel and bladder issues influence your sexuality.
In other words, if they are turned off by it, or unwilling to learn what your body is about, they might not be a good choice for a partner. A true partner, who cares about you, that you have sensual chemistry with, who wants to please you, is going to be accepting about this. There are even people out there who kind of enjoy a little warm wetness. The occasional accident is inevitable. You might just have to be the one who sleeps on the wet spot, that’s all. So keep a towel or a hair dryer handy.