Urinary incontinence.
It affects almost half of all women at some time in our lives. But most of us are too embarrassed to talk about it.
What other such widespread medical condition would we have the gall to remain silent about? And how long are we willing to compromise our own well-being and quality of life, not to mention those of our sisters, daughters and grand-daughters, because we live silently with our secret shame?
The pee-proof panty industry loves our silence. “You Can Feel Dry. No More Leaks. No More Smell. Try Them Risk Free Today.”
They would have us keep dribbling and leaking and secretly slinking back for more protection.
We can do so much better than this.
Incontinence comes in at least two flavors. The stress-continence variety is most common in relatively younger women. With stress incontinence one can point to a real, physical reason for the leakage: Weakened pelvic floor muscles fail to hold in the urine when one applies pressure, like coughing or sneezing or laughing too hard. And one can strengthen those muscles by doing lots of Kegel exercises.
The second variety, urge incontinence, by contrast, is a sudden intense urge to pee for no apparent reason.
It’s what I had for decades. Talk about embarrassing.
What made my bladder fail me was harder to explain than a cough or a sneeze: The sound of running water. Putting the key in the door of my home. Getting out of my car. Nearing my bathroom. In fact, any cue that reminded me of urination was enough to trigger leakage.
It’s little wonder that I never talked about this condition to anyone. Except my doctor. Once. Many years ago.
“I pee for no reason,” I said, looking down at my lap.
He asked, “What are you doing about it?”
“I wear pads,” I said.
“I’m glad you’ve found a way to deal with it,” he said, clearing his throat and moving on to other issues in my health records.
Since then I have learned that it actually is possible to treat and manage urge incontinence. In many cases it can also be cured, but research suggests that very few people who experience incontinence discuss their condition with a health professional. And when they do, they often face the same vague avoidance that I did.
Have you ever heard of “disease prestige?” The idea of a hierarchy of disease prestige was introduced in the 1940s, and since then a number of researchers have tried to classify medical conditions along it. The higher a disease is on this hierarchy, the more resources and community support are available for its sufferers. The lower it is, the fewer the resources.
High-prestige diseases mostly occur in the upper part of the body. Like heart disease. By contrast, low-prestige diseases tend to occur in the lower part of the body. They are often difficult to diagnose and treat. Many carry shame and stigma, or are thought to be the fault of the person with the ailment. Like urinary incontinence, especially the kind that happens for no apparent reason.
But the truth of the matter is that urination starts with the brain — in the upper part of our bodies. Here’s more or less how it’s supposed to work. The bladder fills up with urine. It stretches until the spinal cord carries a message to the brain, indicating that the bladder is full. When the brain sends the “green light” back to the bladder, urination occurs.
In fact, the medical community has begun to report that urge incontinence may have less to do with weakened muscles and more to do with a faulty connection between our bladder and our brain. Like Pavlov’s dogs, the unconditioned response of the bladder to any cue relating to urination is enough to involuntary empty itself without waiting for the brain’s “green light.”
Dr. Phillip Smith, at UConn Health’s Center for Continence and Voiding Disorders, said it well. “Just how does the brain talk to the bladder, and how can we adjust this communication should it start to fail, in order to help our patients?” he asks. “Current available treatments are not fully addressing our patient’s overarching urinary problems, because it’s not just about the bladder.”
If it’s about a breakdown of communication between our brain and our bladder, then it’s time we stripped urge incontinence of its stigma. It’s time to begin to talk about and to treat it as a high-prestige disease demanding solutions other than shame-based pads and pee-proof panties.
And if the brain ultimately controls all of our organs, including the bladder, then it seems like mind-body therapies should be able to access the subconscious mind and rewire the brain-bladder connection to produce a healthier conditioned or learned response.
It felt like a long shot, but armed with this logic, I consulted a gentle and kind hypnotherapist a few years ago. After a few sessions directed at my unconscious mind, he provided me with a self-hypnosis CD that I listened to each day. After only three weeks of daily self-hypnosis, I experienced a freedom of bladder control I hadn’t known for decades. And now, years later, the results remain in place.
Here’s the point of this blog: We need to talk about this. There are solutions out there. It’s time for so many of us to stop suffering in embarrassed silence.
I would love to hear what you’ve learned that might be useful in furthering our understanding of this debilitating condition.