Monday, March 25, 2013

Incontinence in Women

As a young girl and then a young woman, I heard a lot of things about being pregnant and having babies.  I was pregnant for our daughter in 1988 when I was 28 years old.  That was the year I discovered that there were a lot of things that no one ever told me.  Oh, women joke about having to pee often, but they don’t really tell you all the gory details.

I was pregnant again the following year, but miscarried at about 12 weeks.  And then pregnant again about a year after that, and again miscarried at about 14 weeks.  In each of those pregnancies, I was already wearing maternity clothes by the time I miscarried… meaning I was big in the belly area.  And even though I was no longer pregnant after the miscarriage, my body felt pregnant.  My uterus was all “dusted and cleaned” out, but it was still enlarged, putting additional pressure on a full bladder, so all the frequent need to urinate that comes with pregnancy for months was an experience I had to go through to some extent during those times.

My fourth and final pregnancy was in 1994, when our son was born.  Sam was a big baby, and during the final weeks of pregnancy, I believe he kept his feet on my bladder 24-7.  I peed often.  No, really.  I peed OFTEN.

Peeing often affects the size of your bladder.  Who knew?... But even if you have never experienced a pregnancy, we are still taught as young children that when you have that urge to pee, quick! hurry! run and go pee!  Good girl!  GOOD girl!

The size of your bladder has an impact on incontinence.   As adult women, we actually can train our bladders to be smaller or larger.  The more often we give into the urge to pee, that is, if we pee frequently, the smaller we train our bladder to be.

And those Kegel exercises we learn about are not really explained very well.  I heard about those, of course, long before pregnancies.  Probably covered in several articles in Cosmopolitan.  Keep that area tight, women, and your man/men will appreciate it and so will you!   A tight tata will give you a more intense orgasm!  And who doesn’t want that?!

Forget that!  The most important aspect of exercising “that area,” aka your pelvic floor, is to prevent incontinence later in life.  Seriously, if you’re in your 20’s, pay heed – you will care about this all too soon!   Much more than you will care about more intense orgasms.  Not that you won’t care about that… just not as much as caring about being able not to piss yourself.

And those Kegel exercises are usually explained by telling you to stop urination mid-stream, and then work those muscles.  Ever hear a woman in the stall next to you peeing like she’s turning a faucet on, then off, then on, then off… Kegel! 

As years went by, I found myself doing what so many, many women do:
1)  Squeezing legs together for sneezing or coughing
2)  Leaking a little (or a lot) with a great bout of laughter
3)  Staying away from trampolines and horseback riding
4)  Etc etc etc
5)  and oh yeah, wearing panty protection 24-7

And then I hit the perfect storm for incontinence when I was 48 years old.  In mid-January 2008, I had a neck surgery to repair my C6 vertebrae to remove a piece of it that was broken off and pressing into my spinal cord.  As a result, my C5, C6 and C7 are fused with steel rods and brackets.  The morning after that surgery, I felt supreme relief.  But then, I got an infection and ended up with a second surgery a couple of weeks later on the same site to remove a big pocket of puss.  Then under anesthetic a third time to have a PIC line inserted, and I took antibiotics for 3 months.

During that time, I was taking pain medications – Vicodin, Valium and Flexeril, and I think Darvocet was in there, too.  I spent a lot of time on our sofa, because that ended up being the spot I could find some comfort laying down.  The antibiotics made me so ill that between that and the physical pain emanating from my neck, I pretty much lived on that sofa for weeks and weeks.  At age 48, that was my first major experience with incontinence.  One day, instead of taking Vicodin, I decided to switch it up and take Darvocet.  My prescription for Vicodin was for me to take 2 pills, so I took 2 Darvocet without thinking, but I should have taken only 1 pill.  I was zonked out for over 12 hours.  I remember feeling my body sink very, very deeply into the sofa.  Then I woke up on a very cold, wet sofa cushion.  Holy crap.  My husband, Kevin, had tried to wake me and was actually to the point of being excessively worried when I finally decided to return to the land of the living.  And then he took such good care of me, helping me to get off the sofa, out of my soaking wet nightgown and into the shower.  He took the cover off the sofa cushion, washed the cover and tried to wash the piss out of the cushion.  He dried my tears, took a cushion from the love seat and put it on the sofa for me.  And major kudos to Flexsteel, the brand of our sofa and loveseat –  because our sofa has a lifetime warranty on the cushions, and Flexsteel didn’t even care that I ruined the cushion by pissing on it!  When I called them to order a new cushion, they sent me one free – didn’t even charge me postage!

When I eventually returned to sleeping in our bed on a regular basis, I learned something else new… when you get out of your bed, you don’t really even think about it.  Likely you sit up and swing your feet to the floor in a smooth motion, and probably most people reading this sentence right now are trying to think to themselves, “How is it exactly that I do get out of bed?  Hmmm…” 

What I learned was that after my neck surgery I could no longer just “get out of bed.”  Instead of rising up and swing my feet to the floor, I had to roll almost over onto my stomach and push myself up.  So every morning, with that full morning bladder and not yet fully awake, I would try to get out of bed the usual way by a 48-year force of habit, which would send screaming red hot pokers of pain from my neck through my entire body.  And then I would pee, a little or not so little depending on the day and the level of pain.  Oh, good times.

That was the year that my body went to hell in a handbasket, including my bladder and pelvic floor muscles.  I was going to physical therapy for my neck, and then I found myself going to physical therapy for incontinence. 

And I bless that physical therapist for her fine teaching skills, amazing, wonderful bedside manner and empathy.

Here’s what I learned and want to pass on to every woman I can.  And if you’re in your 20’s reading this and think this doesn’t apply to you, baby, think again.  You’ll be 40 all too soon.

First, train your bladder to be larger. 

On your first morning pee, make sure you empty your bladder as much as you can.  And isn’t that a wonderful feeling?  My 4th favorite feeling.

Also, try waiting as long as possible between urinations throughout your day, and again, take time to fully empty your bladder.  This is to train your bladder to be as large as possible.  Size does matter, ladies.  And helps you to sleep through the night without having to get up and go pee when you should be deep into REM sleep.

After your morning starts, you’ve had coffee or whatever, you should try not peeing more than every 4 or 5 hours throughout your day and evening.  Obviously if your schedule is to pee every hour, you’re going to have to build yourself up to a longer length of time between urinations.  And in the evening, wait until just prior to bed to pee. 

Do NOT start and stop your pee stream.  This actually can do more to cause incontinence than to prevent it!

Exercise your pelvic floor muscles often.  You can do this almost anytime – driving in your car, sitting in a chair, even walking with your grocery cart.  But here’s the catch:

These exercises should start at your sphincter muscle, i.e., your butthole, yes, your butthole. 

Tighten that anal opening and then take that tightening all the way up to your urinary tract opening, i.e., your pee hole.  You should be able to tighten that whole area without feeling the movement on the outside of your hip or butt.  These are your pelvic floor muscles; it’s not just about your dainty little lady parts… it has to include your asshole.  Hear me and listen.

Exercises include tightening in 3 steps, start with your butthole and tighten and hold, count of 5, move forward a bit and tighten and hold count of 5, and then move forward to your pee hole, tighten and hold count of 5, release, count of 5 and start again, doing at least 5 reps.  Another exercise is to tighten the entire area all together, count of 5, release, count of 5, 10, 15, etc, and again 5 reps.

So that’s the secret I learned: train your bladder to be as large as possible and exercise your pelvic floor muscles correctly and often.

Pass it on.

Caveat:  If you’re really having trouble with incontinence, tell your doctor and get to a physical therapist, preferably a woman PT who has been trained for incontinence.  The physical therapy was slightly uncomfortable/disconcerting for me initially – I had to pull my pants down so she could stick these sensors on my butt for a machine to measure the muscle movement, and of course, talking out loud about your butthole to anyone is a rather unique conversation… but it’s worth it.  So worth it.