Sunday, April 04, 2010
Dear Spark Friends:
I am veering off my usual health and weight loss topics to bring a concern I have to my table of friends --
I am co-leader of my hometown's team and as such try to read as many blogs as I can from fellow team members to stay in touch. The other day I read an entry from a teacher who wrote about a particular student of hers who had a difficult parent and the gist of her blog was about her resentment over students who are on free and reduced lunches and other entitlement programs.
I am quite certain that this woman was probably venting out of frustration and I left a comment expressing a little of my own opinion. After thinking about it later, though, I regretted leaving it.
I want to make it clear that I didn't regret my opinion one bit, but that I let myself get emotionally sucked into a subject that has nothing to do with motivating and inspiring health and fitness.
So I went back and read over comments that other sparkers had left on her blog and was shocked at the vehemence of some peoples opinions. One particular woman's comment in support of the teacher's feelings seemed especially harsh so I clicked on her page and read the only two blogs she had written at the time.
I was so saddened and disappointed at the judgemental, political extremeness, and almost hateful nature of her blogs!
It isn't the fact that my political leanings differ from hers. I am not an extremist by any means to the right or the left, and I certainly respect the concept of freedom of expression.
However, one of my favorite quotes is:
"Freedom of expression is NOT yelling FIRE! in a crowded theater"
(I am sorry that the author of that quote escapes me for the moment.)
She is entitled to say what she feels like on her own page.
What REALLY bothers me is that when we express ourselves in a judgemental, hateful, vehement manner about any segments of population, we risk alienating people. Now I entirely get the drift that she could care less whether the folks she has chosen to spew her venomous diatribe at feel alienated or not.
I firmly believe that this isn't what Spark People is all about. I am very concerned that a newcomer to SP will stumble across her politically driven blog in seek of weight loss motivation and be completely turned off by the whole website.
For all intents and purposes, Spark People is about motivating, inspiring, encouraging others in the WEIGHT LOSS AND FITNESS EFFORTS.
I have no problem with people blogging about personal issues that are emotionally challenging to them. Our blogs shouldn't be restricted to JUST weight loss and health issues, especially when they ultimately impact our state of health mentally or physically, but I definitely feel they should be presented in a non-judgemental, non-hate mongering manner if they bring in other peoples.
Maybe it's because I am NOT a judgemental person by nature. I read my Bible faithfully, and you know what? I haven't found my name mentioned in it anywhere as an appointed judge. In fact, our good Lord is pretty specific that HE alone has that privilege.
I chose a profession where I get to help all walks of life -- every race, nationality, sexual orientation, religion, and gender. The workings of our bodies really is the great equalizer. We have more in common with everybody else than not when it comes down to it.
I like to think of myself as a kind and gentle and tolerant soul in my "old age". Lol!
While I am by no means wishy-washy or timid in my political leanings, I simply don't feel like Spark People is the venue to express them. There ARE websites out there where you can share all your opinions with like minded folk. Some are monitored by the FBI, I'm sure :)
So when I read her blogs, did I click the little icon to report an inappropriate blog? No. She wasn't profane, sexual, racist, anti-semantic. or anything like that. She was political. She was judgemental and disparaging about a segment of society that through the grace of God I am not in.
So I am coming to MY friends here on SP and asking that you please not encourage these kinds of public blogs by commenting either in agreement or disagreement. By simply commenting, we are acknowledging them and giving them fuel to either continue with them out of our encouragement, or continue them out of vengeance over our dissenting opinion.
Let politics be politics on MSNBC or FOX News. Or on any of the myriad of websites out there dedicated to such.
Let Spark People be Spark People...
Sunday, March 28, 2010
Not too long ago I blogged about being in the doldrums and searching for my motivation. I shared the funny but true story about my husband helping to bring it back. The truth is, I DID spend time reading blogs, re-reading The Spark, and visiting friends pages and I really think it was a culmination of all those efforts that got me mentally back on track.
Now one thing I discovered back when I first started on my weight loss journey is that while making a commitment to yourself is an important first step, carrying on through with it can be quite another story. If only all it took was deciding you really want to be thin, we'd all be thin!
The first thing I did was get back on the scale. You know I ended my affair with the scale a while back and I found that I was using that as an excuse not to get back on it and face the proverbial music. However, there is a difference between sensible weighing in and a daily obsession with it.
Turns out my "little funk" and subsequent foray into the land of cheeseburgers, cheese nachos, and cheesecake cost me SEVEN POUNDS!
I swear, I can never figure out how it can take me seven WEEKS to lose seven pounds, but only TWO weeks to put them back on!
Next thing was to analyze my calories in and calories out. Obviously, cheeseburgers et al are NOT healthy choices. I didn't have to look too far to figure out that what I was eating was wrong. Yes, I understand the whole concept of moderation and not depriving yourself. BUT, I know me. There is no such thing as a few fries. I don't count out 15 tortilla chips and I certainly don't drizzle the cheese sauce - I ladle it on.
Where the analysis came in is WHY was I eating like that. Was it really loss of motivation? Could my determination of the last 5 years go out the window THAT quickly?
I wasn't tracking my intake because when I'm eating all wrong, I don't take the time to look up each and every thing I put in my mouth. It not only is overwhelming, but I'm actually ashamed to see it in black and white.
Working from memory, I went day by day and analyzed where I was when I lost control and what were the circumstances --
One day I forgot my lunch. Left the house with it sitting on my counter. Why? I was rushing because I was running late. Because? I had stayed up late the night before and I was tired and drifted back to sleep for a few minutes. So that meant ordering lunch to be delivered. Did I order wisely? No because most deliveries take a minimum order and that meant asking around the office for volunteers. No problem there except the usuals whom eat out everyday don't exactly eat at healthy places.
One night I got home late from the Y where I work out after work. I was tired, my DH had a cold and had taken a much deserved nap after work and didn't start supper, so we went out to eat and I wanted something fast. Why was I late from the Y? I got out of work late and I chatted with friends after working out. Those things happen.
I decided that I needed to keep a healthy frozen dinner in the freezer at work with my name on it, along with a carton of sugar free applesauce, so if I forget my lunch again, I don't have to order out. Oh and I need to get into bed earlier so I'm not so tired that I can't get right out of bed in the morning.
I also need to keep lean sandwich materials on hand at home and maybe a can of healthier soup or some healthy frozen leftovers so if I'm delayed after the Y, I've got options. If we do end up going out, It can be somewhere like Applebees and DH can order me something off the healthy choices. I'm not even looking at the menu!
Lastly I looked at my exercise. I give myself kudos for being a consistent exerciser. Even when feeling blah about it, I kept going 5-6 days a week. BUT, and this is a big but, I have been in quite a comfortable routine with my exercise. I might read a magazine and ride the bike 30 minutes tops on a low resistance. I might "run". I even convinced myself I was doing "intervals" by running a little, walking a lot. Before Christmas I was running a solid 30 minutes. Granted I was sick most of January and part of February, but instead of working my time back up, I was still taking it easy.
So I decided to turn on the heat a little. Yesterday I ran and I pushed myself. No it wasn't a solid thirty minutes but it was run fifteen, walk five, run ten. Then I went to the bike and did another thirty on a resistance that made me work! Today I rode the bike for 60 minutes on that same resistance. No reading material. I was pumping too hard and sweating too much, so I half way watched TV along with the clock thinking how much longer?!?
Once I was done, my legs felt like jelly but I felt GREAT!
I discovered something. When I exercise like that, it seems that controlling my eating is much easier. First of all, I just wasn't as hungry and secondly after burning all those calories, I wasn't going to eat them right back on!
I've been thinking all day about all of this. Do I want to keep this intensity going just for seven pounds? I look good enough seven pounds heavier. My clothes still fit OK. The answer though, really lies in how I feel. When I eat unhealthy I don't have energy. I feel bloated, gassy, tired, and mentally sluggish. I don't feel like exercising. It gets to be one big vicious cycle!
I picked my goal weight because even though it takes more personal effort to maintain it, I feel SO MUCH BETTER when I make that effort. A pound or two fluctuation doesn't make an appreciable difference, but more then that and I can tell a huge difference.
For right now, the word moderation is not in my vocabulary. I'm the original "if you give me an inch, I'll take a mile" kind of dieter. I'll have to be fairly strict until I'm back to goal. THEN if I can keep challenging myself in my workouts, I can treat myself occasionally with a usually off limits food. But only when I feel in control and CAN be moderate.
So there you have it folks. Next time you feel like you are struggling take some time to do a little self analysis. First get your head back in the game, then analyze what it's going to take to get where you want to be. Break out of those vicious cycles we set up for ourselves.
What's holding YOU back?
Thursday, March 25, 2010
So I opened my newspaper this morning and was greeted with this headline on page 10:
"Daily 1-hour workouts a must for older women to fight flab" and like the rest of the "older women" in the nation said to myself -
To hell with it! Why do I even bother??
When I took journalism 101 at Iowa State, I remember the prof telling us that the average reader seldom reads beyond the first couple of paragraphs of a newspaper article so make 'em good and make your point early. In this particular article, the first couple of paragraphs only compounded the depressing news, stating that "sobering new research spells out just how much exercise women need to keep the flab off as they age -- and it's a lot."
So I decided to go beyond the average reader and actually read the whole article which turned out to be much less depressing. It seems that middle-aged and older women who started at a healthy weight with a BMI of less than 25 who were NOT on calorie cutting diets but consistently got in an hour of moderate activity gained little or no weight, while those without the activity gained an average of 6 pounds.
It's not that I think 6 pounds is so little. I fought for every one of the 70 pounds I lost and I always tell people that out of those 70 pounds, the last ten seemed to be the hardest.
But what I'm afraid is that if I can read that headline and can feel hopeless and think why bother, then the average woman - especially an overweight woman - will REALLY feel discouraged.
They won't go on to read that we are talking 6 pounds and that moderate activity encompasses brisk walking, leisurely bicycling and even golfing. I've cleaned out a closet and felt like I expended more energy than I would have golfing!
It's true that few overweight women get that much exercise --with the notable exception of us Sparkers, right ladies?
The reasearchers said that it's uncertain whether the results would apply to men. With no disrespect to the many men on Spark people, I'd have to hazard a guess that the results most likely wouldn't apply.
My husband announced that he needed to lose a few pounds so he cut out the evening Twinkies and lost 5 pounds! Oh he assured me indignently that it wasn't JUST cutting out the Twinkies. It was adding the Kashi bars he said with a wink and a smile while pointing at the bathroom....
Oh and the study reiterated what we "older women" have known all along: that hormonal changes in menopause also can make women prone to weight gain, especially around the belly.
Well here's a newsflash: so can sex in the younger women who didn't use contraception!
AND we've discovered that even an hour a day of crunches isn't going to totally get rid of THAT belly - even after delivery. Maybe a date with a plastic surgeon or a wardrobe of spanx.
Sigh! No matter how you look at it - women get screwed (pun intended...)
So what's the answer? Give up? Lay down in our recliners in front of the television set munching on a bag of Cheetos. The only exercise we get is getting up to find a tissue to wipe the orange off our fingers?
If I sound like a woman who has been there and done that it's because I HAVE and I DID just that. For years.
The good news is that despite our hormones, our bellies of jelly left after birthing that last 8 pounder, AND -- despite those depressing headlines, with making consistent small changes like eating more vegetables and lean meat, drinking more water, tracking our calories, getting out of that recliner and into the tennis shoes to walk or garden or play bowling on Wi:
WE CAN LOSE WEIGHT AND KEEP IT OFF!
Despite our ovaries running out of gas and joining the ranks of "older women".
How do I know this?
Because I've been there and done that...
Me on the left in red.
Me a year later!
Monday, March 15, 2010
When I was little, I remember my mother always used to sigh dreamily and say "Richard Burton can put his shoes under my bed anytime!"
Being young, and having absolutely no clue about the facts of life, I used to wonder why would Richard Burton put his shoes under a bed instead of in the entryway like the rest of the guests? I even asked my sister who was four years older and she snickered and told me to go ask Mom. Fortunately I wasn't THAT interested at the time and it wasn't until I was somewhat older and happened to think about it that I finally got it and had a chuckle.
Years later when I well into my weight loss journey -- in fact about 20 pounds away from my goal, we had one of those silly female conversations that only women at work on a rare slow day can have. The subject? If you had a "free pass" to make love with any man on earth other than your husband who would it be?
Another nurse in my office thought a moment and shook her head. "Nope girls, sorry to disappoint, but I have to say there is no one other than my husband!"
We all groaned and rolled our eyes until we remembered that she was married to a blue-eyed rugged cowboy type whom we all dubbed "The Marlborough man". He brought her Starbucks every morning just because he loved her.
Ok. My turn. They all turned questioning eyes on me.
Without hesitation I told them it was Antonio Bandaras. Besides being tall, dark, and handsome, he had that incredibly sexy Spanish accent. Why he could just talk in that suave Latino voice and I was in the mood, I told them.
My friend, Terry laughed and said that I must be the only woman in the world who could watch the movie "Shreck" and get turned on when Puss 'N Boots spoke!
Later that night while cuddling with my husband on the couch (secretly thrilled that finally both of us could fit on the couch together), I told him about the conversation. He laughed and told me that if Antonio ever called me and said that he wanted MY body, it was OK. After all it was a once in a lifetime opportunity and because he loved me, he wouldn't stand in the way. Teasingly, I said OK, turnabout is fairplay. If HE had a once in a lifetime opportunity offer, whom would he like it to be? He immediately replied that it was Michelle Pfeiffer. We shook hands on it and I snuggled in closer to him, watching TV.
After a minute he said, "You know I'm not really worried about you and Antonio."
"Oh yeah"? I replied. "Why is that"?
"Because when anyone mentions the word SEX in your presence, you've suddenly got a headache"!
I whacked him with a cushion and of course had to prove him wrong...
It got to be a standing joke between us. For some strange reason, when I needed a boost of motivation to continue on with my weight loss efforts, I used to think about Antonio calling and panicking because I still had X amount of weight to lose! I simply wouldn't feel comfortable standing nude in front of Antonio Bandaras if I was even one pound more than my goal. He was after all, used to seeing Melanie Griffith in the buff and that was SOME competition!
The day I stepped on the scale at the Y and saw that I had reached my goal weight -- 70 pounds lost -- I could hardly wait to get home and tell my husband. I burst through the door proclaiming:
"Guess what? This body is FINALLY Antonio Bandaras ready!!"
That was four years ago and I had all but forgotten about what I jokingly refer to as my "Antonio Bandaras phase". I was in the process of trying to maintain that 70 pound weight loss and finding out that sometimes it was more of a struggle than I had anticipated. I was status quo at work and church now. Old acquaintances were used to my new weight and quit remarking about it long since. New friends had no idea that I even ever used to weigh so much more. Most of the time I managed quite well because so many of the healthy changes that I had made, like regular exercise, were now habits. I really had adopted a new healthy lifestyle. Finding Spark People was a HUGE boost and I continually find motivation and inspiration by logging on and tracking food, fitness, and visiting friends pages.
Lately, however, I hit what I term a "blah" spell. Maybe it has been the gloomy, cloudy, rainy, chilly weather here in Iowa. Days upon days without sunshine. That has meant exercising daily at the YMCA when I used to love walking or running outdoors in the sunshine, breathing in the fresh air!
As I pronounced in my status not too long ago, I spilled tea all over my beloved Macbook laptop and soaked it into ruination. The cost of repairing it will almost be the cost of a whole new laptop. So what did I do? Attack a box of Girl Scout cookies that I had bought from a co-worker "for my husband". Half way through the box reality gripped me and I acknowledged to myself that all those cookies gone weren't going to revive my computer, so I tossed the box into the back of the pantry and went in search of my motivation.
I started in my closet. I looked at all the labels - Small, Size 2, Medium, Size 4, Petite. I had donated all my "fat clothes" so I had nothing to compare the new ones with. The reality of just how many clothes I owned prevented me from the temptation of going out for a little "retail therapy" and buying more.
I dug out old photo albums to look for pictures that would help me see how much I had lost, only to realize that when I was over weight I loathed having my picture taken so I was hard pressed to find even one single picture of my former heavier self.
I pulled out the log of my strength training that I had kept the first year I started exercising and looked over the numbers so I could see how the weights I was lifting had gotten progressively heavier over time.
I reviewed the log of my measurements.
Got onto Spark People and looked over my whole page. Reread my blogs.
I even went to the pages of some of my most motivating friends: DDOORN, BOTZZZ, and others and reread some of THEIR blogs.
Nada, still BLAH. Not in the mood to eat healthy. Don't want to exercise.
I even pulled out the BIG gun. I went to KITT52's page! Gasp! If that woman doesn't inspire you nobody will.
Sadly to say I was still in a funk. I had put on 5 pounds and felt wretched. That was the top of my comfort zone. I lamented to my husband:
"Help! I've lost my mojo and I can't get it back!!"
I don't even know if women have mojos but it sounded appropriate at the time.
Hmm he thought. Did I try...
Yup. No go.
"Sorry Babe", he told me. "Cant help ya" and he disappeared downstairs to watch TV.
A little while later while I was back reading "The Spark" searching for that much needed push -- my cell phone rang. I glanced at it and saw that it was from my husband. That's odd.
I picked it up and quizzically said, "Hello"?
In his best latin lover impression, he breathed into the phone --
"Zhoe-Ahn. Deese eez Antonio Bahn-dah-ross and I want your sexy bodeee!!"
I couldn't help but burst out laughing and I I told him absolutely! Just let me QUICKLY take these five pounds off first.
So the other day when my granddaughter was here and she asked if I would fix us a snack and watch the movie "Shreck" with her.
I told her I'd be happy to fix HER a snack and watch the movie, but Grandma wasn't going to eat because she wasn't hungry.
Friday, March 05, 2010
Estee* was a long time beloved patient of ours. Age 46, she had been a widow since her early 20's and raised a son all on her own. He was now in the armed services and you couldn't find a prouder mother. For years I had teased her that she might meet a new "Mr. Right" and would come in here sporting a big diamond. She'd laugh and say "Girl I am trying"! A devout Christian, her biggest enjoyment in life besides her son, was her church. She told me that if the Lord was going to bring a new man into her life, she would find him at church.
Not long ago she came to see me. Usually she was so upbeat and jovial, with a grin that lit up her whole face. But that day she was barely smiling. I asked her what was wrong and sadly shaking her head, she told me that she couldn't "get happy" at church no more.
"Get happy?" I asked her.
She explained that in her church they would sing as their praise band played and "You just opened yourself up to let that Spirit in and you would raise your hands and dance and shake". Filled with the Spirit -- you were "getting happy"! But lately she found to her terrible embarrassment, that when she danced and shook, she would wet. In her church everybody dressed to the nines in their Sunday best and she had actually ruined a nice dry clean only suit! As a consequence she got less and less active, dancing became swaying. She would use the bathroom right before services started and then pray that the preacher didn't get too wound up and prolong the service. It wasn't just church either. She couldn't lift her little niece without feeling that trickle and had taken to buying pads to wear every day. The last straw came when one of the deacons from her church came to visit her and inquire if everything was OK because he noticed that she wasn't participating as enthusiastically in church as she usually had. She was mortified and mumbled something about being worried about her son even though he wasn't deployed and they prayed together, but silently she prayed that she would just stop leaking. She said she always told her son that you had to "put your feets to your prayers" so she was doing that and it was her fervent prayer that I could help her.
Fortunately, I had a pretty good idea from talking to Estee what her problem was. After the doctor examined her, he referred her to me for testing.
Carolyn* was a retired school teacher and mother of five grown children. She complained of random leaking all day long and even sometimes at night! She couldn't really relate it to any specific activity. She never really felt like she emptied out her bladder when she went to the bathroom because she went frequently and good volumes. She was overweight by about 25 pounds, but upon exam it looked like she had pretty good support from the muscles and ligaments that hold the bladder in place. She was a long time type II diabetic. The first part of my testing, I have the patient urinate on a special commode into a beaker that holds 1000 ml or roughly 64 ounces -- 8+ cups. The average total bladder capacity in a person is between 400-600 ml -- around 4 cups. Most of us would be climbing the walls to find the bathroom if we let ourselves get that full. When I brought Carolyn back to the testing room, she walked and talked normally. She sat down and we spent a few minutes reviewing her questionnaire and 24 hour voiding diary. After I left the room, she used the commode to void and when I came back in I was amazed to see that she had overflowed the beaker! I had a pretty good idea what was going on with Carolyn too.
Jan* was just 37 years old and the mother of two young boys. Both of her boys weighed over 9 pounds at birth. A former smoker, she found herself sneaking a cigarette or two now and then "to help her lose weight" as she was still carrying around about 60 extra pounds after the birth of her last child. She came to me because she felt like her life was ruled by the bathroom. She had to go constantly, and at least once a day she would experience such urgency without warning that she couldn't get to the bathroom fast enough and she would find that urine escaped before she even got her pants pulled down. "It's silly", she told me, "I can just see a sign saying bathroom and I've got to go". The worst was when she'd pick up the boys from after school child care and as soon as she got home she couldn't get her key in the door fast enough to get to the bathroom in time to prevent leaking. She had taken to leaving her back door unlocked - a practice that her husband highly disapproved of. It didn't matter if she used the bathroom right before leaving work. She tried restricting her intake of fluids, having no water all afternoon. Her husband wanted to get a sitter and take her to the movies. Just the two of them like when they were dating, but she feared going because even if she emptied her bladder right before the show started and she drank no soda during the show, she knew she'd have to go at least once during the movie and again right after it ended. It was much easier to watch a movie at home where she could hit the pause button anytime she needed to go. Hmm... I think I know what her issue may be too.
Three women, three different scenarios, but each suffering a decrease in quality of life because of urinary incontinence issues. As I said, I had a fairly good idea from the outset what was causing each woman's symptoms but it isn't just a matter of being able to diagnose from simply interviewing a patient. To me, it's like putting together a big puzzle and when all the pieces fit together and you can treat the patient successfully, it's very gratifying to see an improvement in their lives.
We have a saying in my line of work that "nobody has ever died from urine incontinence". However, occasionally a patient will come close. Like the 70 year old patient that was hurrying to the bathroom when she fell and broke her hip. Surgery was required and two days after surgery she developed a blood clot in her lung which then required an extended hospital stay and she couldn't participate in physical therapy until the clot was dissolved with blood thinners. She ended up leaving the hospital and entering into a skilled care facility. She ultimately ended up in a nursing home, giving up the beloved home she had lived in for over 40 years. She used a walker at first, but eventually had to use a wheelchair. She became depressed and because of medical issues, she was a poor risk for any more surgery and couldn't use medication to suppress her incontinence. She just wore adult incontinence pants -- or diapers as she sadly referred to them.
So you can see that incontinence is not just a "embarrassing little problem" that every female eventually has to endure.
Quite a process takes place when we have to urinate. When you are a kid, you run in the bathroom, pull down your pants, go, jump up and run out and never give it another thought. When you become an adult and start to have "issues", the bathroom takes on a greater precedence. Everywhere you go you scout out the bathrooms in advance -- just in case.
Picture your bladder like a balloon. Like filling a balloon with air, the bladder fills with urine from the kidneys as we eat and drink. As it starts to become full, the pressure inside the bladder increases and that pressure increase sends a signal to the brain that you are going to need a bathroom. So the brain tells you to find the toilet and once you do it sends signals to the nerves that supply the pelvic region (lower abdomen) and control the coordinated process.
A balloon is made entirely of latex. Your bladder is made almost entirely of a muscle called a detrusor muscle. It is designed to contract once you are sitting on the toilet so that there is a force to expel the urine.
The urethra -- the tube that leads from the bladder to the outside of the body is like the tied off part of the balloon. It is designed to be shut tight. Watertight like a frogs behind I always tell my patients. However, when you are on the toilet, and the detrusor muscle that makes up the bladder kicks in and starts to contract, this urethral "sphincter" relaxes and lets the urine flow out.
You can see right now that any number of things can and frequently does go wrong:
First that detrusor muscle can get a mind of it's own and start to contract when you are nowhere near a bathroom. If it's mild and you can distract yourself you may be able to suppress the developing urge, but sometimes it reaches an intensity that you can't and you do what one patient described as "the pee-pee dance" all the way to the bathroom. Many people just can't overcome the urge. This is referred to as urge incontinence or DOA -- detrusor overactivity.
Some people have just the opposite problem. Their detrusor muscle has become lazy for many different reasons. Sometimes it's related to getting poor messages from the brain. People with spinal cord injuries, herniated disks in the back compressing nerves, diabetics with chronic neuropathy (poor nerve conduction) all can suffer from this. When the muscle doesn't contract properly, there is no force to expel the urine. Patients try to push with their abdominal muscles but they never really empty out their bladders appropriately. They walk around as if they were carrying an over full bucket that sloshes over the edge. This is known as overflow incontinence. The risk here is that the muscle will eventually get enlarged and floppy. Big bladders hold big volumes and that increases the pressure in the bladder which can lead to damaged kidneys over time.
The sphincter known as the urethra can have issues of it's own. When a woman's bladder starts to sag, it pulls down the bladder "neck" or the urethra. Normally it is fixed snug like up against the vagina, but when it become unhinged, it becomes mobile. It moves when you cough, sneeze, dance, or lift heavy things. Sometimes just walking will cause it to move. The trouble is that when it moves, it opens a little and urine escapes. This is known as stress urinary incontinence (SUI). Not because it causes you stress, even though it does, but because it takes a "stress maneuver" to make it move and cause subsequent leaking. Sometimes the sphincter itself is compromised and never really is shut tight like that frog's rear. It's like a door that isn't shut all the way, leaving a crack for urine to escape. If the sphincter gets weakened overtime it can lose it's tone and when you sit to urinate, it doesn't gradually relax timed with the detrusor contractions. It flops open and urine runs out. This may happen when you aren't even on the toilet. This has the fancy term "instrinsic sphincter deficiency" or ISD.
That old urethral sphincter may have the opposite problem of being jammed shut tight whether from an obstruction like a polyp, or it's kinked off from a severe prolapse, or there is a stricture from scarring from chronic inflammation or infection. It may not relax appropriately and those folks end up urinating in spurts and trickles. It may also contract rhythmically while trying to empty and that can cause urine to reflux or travel back up into the bladder and they never quite empty out.
The three most common forms of incontinence in order are mixed ( a combination of one or more of the following) stress, urge, ISD, and overflow.
Whatever the cause, all whom are incontinent start to develop some common patterns. They go to the bathroom frequently whether or not they have an urge to go. They want to get the jump on it and feel like if they empty their bladder continually, somehow there won't be enough urine in there to leak. This doesn't work because the kidneys are constantly making urine and there is always going to be a residual left whether large or small that has the potential to leak.
Because a person heads to the bathroom before they have the proper urge, they tend to want to assist the detrusor muscle by pushing out the urine with their abdominal muscles. Even those with strong urges will often push as a method of trying to squeeze out every last drop. What this does over time is contribute to prolapse or worsen an existing prolapse. The bladder might not contract as much as needed over time. Hey if you are willing to do half the work, why shouldn't it just wait on your abdominal assistance? However, abdominal voiding is a very poor way to urinate. If you push hard enough for long enough, you may just push that bladder neck down to where it kinks and then you have to try and lean forward, stretch back, stand, insert your fingers in your vagina JUST TO PEE. So, don't do it -- it's a trick!
People then think if they don't drink much, they won't make much urine and they won't have to go as much. We all know the dangers of dehydration. It's not healthy and besides that it backfires too. The more concentrated your urine is, the more irritating it is to the lining of the bladder and the detrusor muscle will tune up in defense giving you even more urgency.
Because incontinence can be caused by so many different factors and often be a combination of factors, patients come to me to unravel their symptoms and put the puzzle pieces back together. I measure and trace their urine flow pattern. I test the integrity of their urethral sphincter. I fill them with sterile saline and check to see that their nerves are working well and they are feeling proper sensations to go. I see how well they empty and how much they leave behind in the bladder. I check for prolapse and have them perform stress maneuvers so I can see if that urethra is moving. I use electrodes to sense if they are pushing with their abdominal muscles while they urinate. I monitor their detrusor pressures to see if its contracting when it shouldn't be but contracting enough when it should be.
Once I put all the pieces together, I submit my report to the physician who will then prescribe a treatment. Treatments vary according to just what's going on. It might be physical therapy to strengthen the pelvic floor muscles to prevent further prolapse or strengthen the urethral sphincter. It might be surgery to snug everything back up into place tight. It might be behavior modification to relearn poor toileting habits. It might be medication to calm an overactive detrusor muscle. It might be a referral to a urologist. It might even be teaching
them to catheterize themselves if they aren't able to empty due to poor nerve conduction.
It's important to test before treating because when there is a mix of symptoms, you have to sort it out. A patient who urinates frequently because she is sloshing over the edges of her over full bucket due to her poor detrusor contractions wouldn't be a good candidate to snug that urethra up too tight with surgery or give her medication to calm down an already underactive detrusor muscle -- even though she is in the bathroom a lot. She is there because she has trained herself to be there not because her body is telling her it's time to go.
Now you know everything you never wanted to know about urinary incontinence, you may be asking what causes all this? Number one cause in females is childbearing. (Prostate in men) Pregnancy and vaginal delivery wreck havoc on the pelvic floor muscles that hold everything in place. My theory is that you don't pass something the size of a bowling ball through something the size of a golf ball and come out unscathed!
Number two cause is smoking. Yes, smoking. I know smokers feel picked on but the carcinogens in cigarettes that affect the lining of the lungs affect the lining of the bladder the same way. Smokers have a higher incidence of bladder cancer. It also weakens the muscles --The bladder muscles as well as the muscles and ligaments that support the bladder. PLUS - smokers cough more. Plain and simple.
Third leading cause is obesity. Think about it. Put a pound of fat like the kind Oprah famously wheeled out on her show down on something that weighs ounces like a marshmallow. Is it squashed? Uh-huh....
Take an obese smoker that has given birth several times, worked an occupation that doesn't allow for regular bathroom breaks (think nurses, teachers, assembly line workers, telephone operators...) and you have TROUBLE that starts with a capital T that rhymes with P that stands for PEE. (Give me a break -- I'm from Iowa!)
So there you have it -- Urinary Incontinence 101. Now that you've taken the class, see if you can guess the primary causes of the three patients at the beginning. They all ended up revealing mixed patterns, but each one had a primary cause. Come on -- it ought to be easy by now!
If YOU have any of these symptoms, see your physician. Some problems caught early can benefit from the least invasive treatments like physical therapy or behavior modification techniques.
Don't let stop you from seeking treatment and improving the quality of your life!
Whew! After reading this back I realize that It's kinda long. If you've made it this far -- thanks for staying the course!!
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