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COMPLEXITIES OF MANAGEMENT

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Gagamama:


Hi

I note we are, as yet, few so I thought I would post some thoughts:

It would appear (I have sought professional help - at last!") that I have stress incontinence and over-active bladder problems.  The former have been developing slowly over many years but started - so it seemed - after I had a hysterectomy. I put it down to the fact that the other organs in my abdomen shifted about a bit now there was a big empty space and this put pressure on the muscles. Otherwise it was just the usual post childbirth stretching that comes home to roost many years later.
The over-active bit started only with  the menopause and did improve a little bit at first with  HRT, when I was on a high dose. Unfortunately the higher dose HRT triggered more migraines and after a decade I came off it and later went back at a much smaller level.
Not even my gynaecologist is entirely sure about how much of each problem is contributing to the overall one which is very frustrating as it means we have to do a trial and error thing.
We tried the medication (Regurin - Trospium Chloride) but that gave me SUCH a dry mouth I could hardly speak - not ideal for a singer! My Gynae' - who is otherwise quite sensitive for a man - felt it was okay to tell me that he had heard a FEMALE gynae' tell a conference that women have a hobson's choice: wet mouth or wet knickers. Not very helpful or encouraging.
I have some faith that bladder retraining through the measuring and timing  (there's information in the links elsewhere I notice) method may eventually show some improvement, though it does seem obsessive to have a jug in the bathroom and be recording everything: some of my friends think this is counter productive because it makes me more aware of my bladder, obsessing about it and thus creating anxiety. But those friends are lucky enough not to have bladder problems!
If anyone  has any additional thoughts they'll be very welcome.

donjackw:
Hi Gagamama, I was a registered nurse and worked for three years for urologic surgeons.  I get really annoyed when I remember how all they could think of was surgery.  I read your post twice and had a couple thoughts. Yes, bladder re-training makes sense - but seems to me you could just try to lengthen the time between visits without all the measuring.  Just a thought.  Another is Estrace (estradiol) cream to strengthen the urethral opening and all the tissue in that area.  Another is do you have a cystocele (bladder prolapse) as that would be something I do know a lot about - having one myself.  And  one other thought is I use an electrical stimulation unit to stimulate the pelvic floor muscles.  Mine is by Biostim (on internet - one site without prescription I've found) I got my first with a prescription and insurance paid for it, but now much cheaper.  This unit is a neuro-muscular stimulator and a tens unit combined - about the size of a large pack of cigarettes.  It has three pre-programmed modes for incontinence, one for stress, one for urge and I can't remember the other.  Many physical therapists use this modality with their much larger stim machines.

Have you seen a physical therapist who specializes in pelvic floor issues?

Hope any of this helps

One last thought - I'm assuming you don't have Interstitial Cystitis - if so, they have a super website.

Gagamama:
Thanks donjackw for your thoughts.  I left out some things in my post because  the whole history would take too long! I have had a Femetone stimulator for many years now but found that, although it worked, it would only do so if I used it every day. It does have the possibility of quite strong stimulation - or feels like it anyway! Unfortunately that caused me other problems (which I don't want to go into here as it would take forever - trust that neither I nor the continence specialist I saw could see a way around it) so I could only tolerate it about once a week. Not enough to stop the problems from growing -  sadly.
As for the measuring...I'm doing it for now because it really focuses the mind! But if I have to continually re-train, yes I probably will drop the measuring part.
I do intend to ask the gynae at my next visit about an oestrogen cream. I take HRT at moment as I had hysterectomy (endometriosis) some 21 years ago and although kept my cervix showed all the symptoms of early menopause - and have a history of osteoporosis in my family.
Too many other issues getting in the way of simple solutions I fear! hence, eventually considering surgery (TVT) for the stress incontinence though it's a risk because that can apparently over stimulative the over-active bladder bit. In defence of my gynae, he was reluctant to operate if we could sort out something that would work.
Interstitial Cystitis  - haven't a clue. Away to look it up now!

Glades:
Do sympathise with your problem Gagamama, I have similar :(     Mine seem to have been triggered by cystitis and kidney infections.  Have had some stress incontinence since the menopause years but the over active bladder is more recent.  Cystitis and kidney infections were definitely brought on after I stopped taking HRT and gradually 'dried out' down below.   Although have to admit to total ignorance of vaginal atrophy until quite recent times.   I am now using a oestrogen pessaries but to some extent think it's a bit late as the irritable bladder problem seems well established.

Am very dubious of the TVT op which I have been offered, as although it seems pretty good for stress incontinence it does not help over active bladder and may make my risk of cystitis worse.   Am currently using an Athena Pelvic Toner but so far no real progress although still keeping it going on a daily basis.  Haven't tried any of the medications although have read about Duloxetine and Vesicare.   It is such a very intimate problem and can make life so difficult.

Gagamama:
"It is such a very intimate problem and can make life so difficult."

Well said Wensley; I am very lucky indeed to have a couple of friends with whom I feel I can be open but since neither of them are sufferers (I suspect because they happen to be non childbearers!) they tend to give objective comment - which is good - rather than empathetic comment - which would be better!

Those of us who leave it till late - too late? - to investigate the problems formally still I think have to deal with the prevalent "atmosphere" that, since the condition is not life threatening, it is not as urgent in the medical priory list as child cancer, for example. Something we over 50s have to deal with all the time!

Bottom line is, as one of the aforementioned friends pointed out, is this something which occupies your thoughts every day? If it is, then something should be done about it.

I have by the way just gone ahead with the TVT and it is much too soon to say how successful or not it is/will be. Although my gynaecologist offered lots of general opinion about success and the number of people who had difficulties at first, post operatively (common apparently), I am short on real facts. Guess I have to let time tell. Watch this space. Though I would agree that there doesn';t seem to be much point in TVT if one doesn't have actual stress incontinence. By same token, I can't see how strengthening the pelvic muscles will make much difference if irritable bladder and urge incontinence are really a brain signal problem.

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