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Shhh... I've got an embarrassing problem!

Thursday, February 25, 2010

"What do mean how long until the next rest stop? You just went twenty miles ago!"
I apologized to my husband -- blaming it on the coffee I had brought along in the car, but I was secretly thinking that he wouldn't possibly get it. The man is a virtual camel when it comes to holding his urine!

Every kids little league game we went to, the first thing I did was scout out the Ky-bos -- you know those AWEFUL "portable pottys" that so many recreational parks have. I loathed using them fearing the terrible smell, the germs, the disgusting sight in the unflushable stool. Worst of all was the fear of accidently getting locked in one. I saw it happen to a poor woman at a park once.
One time I sat in the broiling 100 degree sun at a tournament game in a small town, not drinking anything for fear my urinary urgency would kick in and I'd have to use the Ky-bo again. The one that I saw housed a large, hairy, jumpy looking spider the first time I used it!
Little did I know at the time, that the more concentrated your urine is, the more irritating it is to the lining of the bladder and therefore the more urgency you get to use the bathroom.

I was overweight and knew that I needed to exercise, but went to an adult ed evening fitness class once and had to leave early because after one jumping jack I had -- horror of horrors:


At first I thought the dampness of my undies at the end of the day was an accumulation of "fat girl sweat". I was almost in denial until I eventually found myself throwing a box of "mini pads" in the grocery every week along with "fresh wipes" to keep the chronic faint ammonia odor in check.

I finally got up the courage to speak to one of the physicians I work with. After all, I had been a nurse in the women's health field long enough to know the signs and symptoms of urinary incontinence. He sent me to a urologist who diagnosed me with a cysto-urethrocele, uterine prolapse, and rectocele -- all $50 words for my organs had gone South - and not just for the winter! My bladder, uterus, bladder neck, and rectum had all prolapsed. Simply put - female hernias. We tend to think of hernias as only a bulge in a man's groin, but not true. Many women after childbearing and especially as we age and pack on the pounds, develop these hernias.

In my particular case, I had an extensive abdominal surgery to repair all of these defects. The recovery was difficult and involved leaving the hospital with a large catheter in for two weeks and an additional two weeks of self catherizing until I was able to go on my own. This was the mid-ninties and treatment options were limited. Although I had seen a urologist prior to surgery who performed some simple testing on me to determine bladder capacity and visualize my leaking, it was a gynecologist who performed the actual surgery as is customary.

In 1995 a new physician joined our practice right out of residency. Because I had been there so long, I was the nurse who was assigned to all the new physicians who came in so I could "teach them the ropes". This doctor was very interested in female incontinence issues and brought what is known as urodynamic testing into our office. He purchased the equipment and announced that WE would be performing these tests that were once farmed out to urologists -- right there in our office. My first thought was "What do mean WE Kimosabe?" I quickly learned that it was sink or swim. I would learn how to assist with what we called a CMG (cystometrogram) or float on...
At the time I thought that the testing was a pain in the neck. It took significant time to set up the testing equipment and as the doctor performed the test, I had to schedule an hour time slot out of his schedule -- a practically impossible task and women often waited weeks to get in for the test. Then another month to schedule surgery.
In addition to the testing, he brought the latest in innovative surgical repair procedures. Many procedures were now being done vaginally, and with minimal post operative complications. Some were even being done outpatient with the patient being consciously sedated as opposed to general anesthesia -- being "knocked out". My interest was piqued when I saw that the complications that I had experienced were becoming a rarity with the pre-operative testing, selection of the proper treatment options, as well as the newer surgical procedures.
I worked with this particular physician for 13 years as his nurse / sidekick. By this time, most of the physicians in our ever expanding group were on board with doing female incontinence work-ups. I was discovering that with the newly developed medications for urinary urgency, AND with the new trend to advertise prescription medications on television, many women were "coming out of the closet" and talking to their doctors as the commercials advised. Lots of people criticize the drug companies for spending the money on such aggressive marketing tactics, saying it drives up the costs of prescriptions, which ultimately may be true. However, I credit the "gotta go, gotta" commercials for reassuring women that incontinence is a common, valid problem that they don't have to live with because it's a part of being female.
The problem with the use of medications, however, is that many primary care physicians -- the good ol' family doctor -- are prescribing it willy nilly as a first line of therapy, without properly working up the issue. Granted, it is less invasive and if it works, well great. Trouble is the dry mouth and constipating side-effects of the medication aren't worth it if it doesn't solve the problem. Urgency isn't the most common form of incontinence.
While we continued to add new physicians to our group, I asked not be assigned to the new docs. I was finding that I really enjoyed working with the large population of incontinent patients that the physician I had been working with saw. Things began to "click" with just how everything tied together as far as symptoms, diagnosis, and treatment.
About 5 years ago, when I first started losing weight, we bought some new sophisticated equipment for testing and working up female incontinence. Everything was now computerized and we added components to diagnose voiding dysfunctions -- abnormal peeing as well. The testing takes an hour and the other doctors nurses didn't appreciate scheduling or assisting with the process any more than I did at first. I looked like the supreme "suck up" because I was so enthusiastic about the subject and now looked forward to setting up and assisting with the testing.
One day I had a patient who had drove 75 miles into our office for the testing and I was mortified to receive a call from the doctor saying that he was about to get into some emergency surgery and I would need to reschedule his afternoon's worth of patients. I told him that this woman had driven 75 miles and I really didn't feel like I could easily reschedule her. What could I do? Could he come when he was done with surgery and I'd stay late? He thought a moment and said why didn't I just do the test? After all I had seen him perform it hundreds of times.
Yes I could put a catheter in a woman in a coal mine at midnight wearing sunglasses, but there was so much more to the testing. My head was spinning, but for the sake of the patient I agreed to try. I was shaking so badly that first time and it was a crude report to say the least, but it essentially gave the dr. the information he needed to select the best treatment option for the patient. He began suggesting that I test other patients on a regular basis.
The idea of me performing the urodynamic testing caught on quickly and all the other physicians, anxious to free up their own schedules, began asking me to test their patients too. While I was adequate, I never like doing anything half-way. Especially when it comes to the quality of care that a patient deserves. So I formally requested to be sent to training not only in the technical aspects of the testing, but the interpretation of the testing as well. In turn I proposed that a new nurse be hired to work with the doc that spurred my interest in what is known as "urogynecology", and I would perform urodynamics for all the drs. in our group.
They readily agreed and I now perform the testing and generate reports for approximately 300 patients a year. I also work with patients on pelvic floor rehabilitation -- kegel exercises and behavior modification techniques to correct voiding dysfunction. I am hoping to expand into biofeedback as an addition to my pelvic floor therapy. I fit pessaries - a rubber donut shaped device that fits in the vagina to alieviate symptomatic prolapses in woman who are poor surgical candidates. AND I teach self catherization to the occasional patient who warrants it. Rarely post operative patients these days. It's mostly women with neurological disorders like multiple sclerosis, myasthenia gravis, or even common diabetic neuropathy.

I am a member of the Society of Urological Nurses and Associates - SUNA - and fairly well versed in female urinary incontinence if I do say so myself. I am in the process of studying to pass their national certification exam to obtain "official" certification. This is quite an undertaking as it encompasses not only female incontinence and voiding dysfunctions, but males with benign prostate hypertrophy - enlarged prostate issues, sexual dysfunctions, as well as pediatric incontinence issues like bedwetting.

Well dear Spark friends, I've glazed your eyes over enough with my enthusiasm for my profession -- which I fondly refer to as my "Passion for Pee"!

I am going to blog next about the more specifics of different reasons for why people lose urine or feel the urge to urinate constantly. I promise I will use the same "patient friendly" lingo that I use with my patients to put it into terms that are readily understood. I'll cover causes, symptoms, testing, and treatments available.

SOOO -- if the whole subject of wetting your pants or running to the bathroom 24/7 isn't your interest, feel free to skip it.

BUT if you are one of those "closet leakers" - and we aren't talking household pipes -- or you "know somebody" who may have this issue -- you know, a "friend of a friend"....

If you are afraid to exercise. Laugh. Sneeze. Drink the 64 ounces of daily recommended water...

If you feel like your husband or significant other is a camel compared to your number of trips to the bathroom....

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Member Comments About This Blog Post
    Just did an SP search on "incontinence" and your blog was the first hit. It is so thoroughly informative - thank you. I am now going to read Part II.
    3002 days ago

    Comment edited on: 3/29/2010 7:33:45 PM
    Thanks for such an informative blog. My friend had the surgery and hysterectomy a few months ago and took quite a long time to heal. She is much happier now that she no longer has issues.
    3003 days ago
    OK -- so I read these blogs out of order, but am interested in this topic. Usually the kegals do it for me, except when I have a bad cough, and then I flood completely. I can identify with the pads and the wipes. My mom had two bladder suspensions, which were not entirely successful, and now with her stroke she needs to be catheterized once a shift. (Feast or a famine.) It was heartening to hear that there are newer procedures, with less drastic recovery issues that what my mom endured. My first baby was 9 lb 13 oz., and I think that did it for me!! I've been ignoring these symptoms for years, because of what happened to my mom, but I think I'm going to ask my family doc to send me to a urologist at my next annual physical. Thanks for the information, which is something my doctor has never taken time to explain -- both this and the following blog.
    3017 days ago
    Thanks for this blog! My sister had the surgery, along with a hysterectomy, about 4 years ago, and had the difficult recovery you describe. It's nice to know there's a better way if I ever need that. However, she had 2 big babies, and I had none, so maybe I can escape that particular "treat" of getting older.

    Now, if I could only find help for my embarrassing problem -- all my healthy food seems to be giving me gas!
    3021 days ago
    Joanne, THANKS! Not there yet, but do have some early symptoms (jumping jacks at the gym are risky business!) You told me a few weeks ago what you were reading -- now I understand more! God bless you for being so caring for the women who come to your office -- and for being willing to go the extra mile w/ patients and staff!!
    3021 days ago
    You are wonderful! I loved this. I can identify with you in coalmine with the sunglasses.Only ones I have problems with now are the L+D pt's right after delivery.
    You feel about pee the way I feel about skin- love caring for the pt with the abscess, love trying to figure out "gee I wonder what that rash is?" Keep us posted and thank you for taking the time not only to share, but inform!

    3027 days ago
    I am so proud of the nurse that you are! You are the most qualified in that whole office if you ask me, and honey I've had enough kids in that office to know! I can't wait to get into see you and get my work up. I have been wearing a poise pad ever since I pushed the fourth fourteen inch head out and I am not ashamed. Kathy told me to "just loose weight and do kegals". I love her, but it's going to take more than that! emoticon emoticon emoticon
    3032 days ago
    Thanks so much for this blog. I'm looking forward to hearing more!
    3032 days ago
    I wish the technique you describe had been available for my mom. She had to go every hour on the hour and frequently twice in-between. When traveling 50 miles each way from our home to Salt Lake City for shopping, visiting friends & relatives, and for fun, it was only after she started wearing depends that we could make it all the way. I knew every public restroom along the way--we had stopped there at least once a year!!
    I have noticed my control slipping--I'm not the "camel" any longer. Thanks for the info!!!
    3032 days ago
    Wonderfully informative blog. I know who to see if I ever have that problem.
    3033 days ago
    Wow! You have grown so much professionally and perform a wonderful service. Thank you for so much information. -Marsha
    3033 days ago
  • LAURIE5658
    Joanne, THANK YOU THANK YOU THANK YOU!!!! Oh the problems I have!

    3033 days ago
  • JAVAJO47
    Thanks Joanne for this very informative blog. While I don't personally suffer from this issue, I believe it's a topic that SHOULD be discussed more openly. How wonderful that you've committed to advanced certification and knowledge to equip you with the many patients that come in yearly. These medical topics, no matter how embarrassing they may be to a subject, are definitely worth discussing so future generations can openly talk to their professionals without the stigma that is sometimes associated with these types of issues. YOU my friend are an awesome part of that solution. emoticon emoticon

    Jo Ann
    3033 days ago
    I am SO glad I read you blog before heading out with my daughter today for a day of window shopping. I do have a little 'problem' resulting in a very difficult delivery of same daughter 28 years ago this month. But she seems to have some problems as well and she is so young. So we will be discussing your article. I have been telling her about Spark. She is a slender, size 6, individual but I explained that she would meet very interesting women of all walks of life especially those in professions of teaching and health. Thank you VERY much for today's blog.
    3033 days ago
    Very informative blog, we women do have our health problems. So far I have dodged this bullet but it is only a matter of time.

    LOL on those disgusting outdoor potty, believe me, I don't drink a thing during the grand kids games!
    3034 days ago
  • KITTYF54
    thanks, I have some problems, which are much worse when I drink fizzy drinks.

    I've seen the ads but I'm not taking meds for something like this. I have dry mouth anyway from my allergy meds and I'm not making it any worse. LOL I just avoid the sodas. it helps a lot.

    Glad to know more about the subject though. who knows there may come a time when I need that info.
    3034 days ago
    Thanks for the informative blog. You are the perfect person to see for this testing. I'm glad to hear that the doctors you work for had the wisdom to put your abilities and experience to good use. You would be understanding and compassionate for you patients having been there yourself. I'm looking forward to the next installment.
    3034 days ago
    Joanne, another great blog as usual, very useful advice coming from a first hand expert.
    I just started on enablex 15 mg 8 years after prostate removal. They seem to help me much.
    Love to see your enthusiasm and passion.
    Skeeter emoticon
    3034 days ago
    Do the current corrective procedures still require a two-week after surgery catheritiaztion?

    I spoke with my gyn dr & although the surgery seemed simple, the after-cath was a deal-breaker for me.
    3034 days ago
    I am grateful to not be experiencing this problem, but found your reporting so informative. I look forward to learning more! I especially love that we got to know more about you!
    3034 days ago
    Excellent, informative, well written and needed! Looking forward to the next installment!
    3034 days ago
    Thank you for bringing into the open what is such a common problem, particularly for the overweight.
    Hopefully it will give some of them the courage to talk to their doctor and have something done!!
    3034 days ago
  • MRSZIPPY1001
    Joanne is the expert! Having just had the procedure done by the "pee guru" herself, I can honestly say I wasn't nervous or anxious at all and nothing hurt. She explained everything thoroughly as she went along and was very educational...she never stopped talking, (imagine that!) which was the best thing because it kept my mind off of what was really going on and made me feel at ease. The word "catheter" was a scary thought I must admit, but her promise of no pain came true. Well, I would have rather had an hour of "coffee time" and chatting rather than looking at the ceiling tiles for an hour, but all in all, I am glad I had it done and know my problem can be fixed. Taking wash clothes, towels, and extra clothes to work to keep on hand for "accidents" is not a fun way to spend the day. Worse yet, is when you don't know you have leaked on your chair and you get up in front of another co-worker only to be horrified of the big wet spot you didnt realize happened. Ohh, yes and the Febreeze...works wonders on that office chair.

    Well all I can say it that no one should have to go through living like this and there is a solution to the problem along with an easy simple diagnostic test...so don't put it off any longer!

    Keep up the good work Joanne - you are GREAT at what you do and you put your patients at ease along with giving them a wealth of information - shall we call it PEE PASSION 101??! Kimosabe is lucky to have his little Tonto!
    3034 days ago
    Thank you Joann! I can hardly wait for the next installment. I have had this for years and thought it was something I just had to learn to live with. I drink a lot and you know what happens then. However, like another sparker commented, it is lessened by drinking more fluids. I know I need to do the Kegel exercises to see if that would help but I always forget to do them.

    I also went to an aerobics class many years ago and came away with wet pants as well. Quite embarrassing and I never went back. I wear a pad every day, all day just to make sure I don't have an accident. I have laughed too hard at a joke and was unable to have breakfast with my daughter at school because I peed my pants. I sent her flowers and explained later. I have had to leave work because I coughed to hard and buy a new pair of pants because I didn't live close enough to go home to change. I can't laugh deeply because I might have that dreaded accident. I can hardly believe I just shared all of this.

    Three kids later and I thought that was all it was. Thank you!!! I might have to set up an appointment to have a check-up to see if there is something else I can do because this condition can definitely change the way you live your life. I know it has mine.

    God Bless You!!!

    3034 days ago
  • VXWALL1942
    Wow! From patient to testing guru! What an awesome accomplishment. Your passion is evident in your blog. Thanks for much for sharing ... and keeping a bit of humor in something is most frequently a major embarrassmen. From she who has been there...done that!
    3034 days ago
  • _MAOMAO_
    What neat work you do! I got to see a prolapsed uterus once, working on a memory care unit. I knew right away what it was, it was like DUH!

    Don't do jj's often myself - occasionally I feel bouncing where I know I shouldn't. Don't want to help any future prolapse along!
    3034 days ago
    Thanks sincerely for the information. I think I may need to be checked out. My symptoms are not severe; yet include leaking sometimes when sneezing and giggling and getting silly with my husband. I do drink lots of water and I think the problem is less pronounced since I've become more hydrated. Please write more about this.

    3034 days ago
    Vaginal cyctocele grad II, rectocycle...copd/athma....this subject it right up my alley...no pun intended. I don't have the nerve yet for any procedures, but I know getting some of this wt off will help. Thank you for posting such an elaborate and educational blog!
    3034 days ago
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