I once had a swim coach who demanded so little from our team that we lost every meet. Luckily my vagina coach is holding me to a higher standard; she believes in self-discipline.
“Just resist the urge to go,” Judith Florendo says after I confess to caving in to a 3 am compulsion to pee. “Stay in bed. Do a few Kegels, count backward and try to go back to sleep.”
Florendo is a pelvic floor physical therapist in Chicago. She used to rehab knees and shoulders. Now she retrains vaginas, treating women whose lives are disrupted by bladder-control problems. There are two common varieties: leakage triggered by a rise in intra-abdominal pressure, such as with sneezing or heavy lifting, and leakage due to an overactive bladder. In the latter version, the bladder triggers sudden or too-frequent urges to urinate. If it contracts so forcefully that you spurt before reaching the toilet, you have urge incontinence.
About two thirds of women with sneeze-induced leakage, known as stress incontinence, also have urge issues, placing them in the “mixed” incontinence category. That’s me. I spurt urine when I sneeze or hoist a heavy box or when I bounce with my six-year-old twins in the magic megacastle at the “inflatable family-fun center.” The seepage is annoying, but what’s ruining my life is my urge to pee in the middle of the night. I might be able to go back to sleep after being awakened by my bladder, but then my two boys each weigh in (“Mom, my orca whale fell off my bed. Get it now.” “Mom, my nostril has too much crust”). The result: totally fractured sleep, which makes me foggy all day and, according to my husband, Paul, “meaner than that maid who was on Downton Abbey.” Incidentally, Paul sleeps with earplugs and so is privy to none of the midnight madness.
Until recently I accepted my un-cooperative bladder as a minor nuisance. But between the mounting sleep loss and unpleasant episodes at the inflatable family-fun center, I began to wonder, Could I reget my bladder to chill? I was aware of the usual treatments: Kegel exercises, which I doubted were effective enough to solve either of my problems, and bladder-relaxing medication, which seemed like overkill; I prefer to avoid drugs unless I’m dealing with pain or disease.
In researching options, I found the Women’s Health Foundation, a nonprofit that specializes in women’s pelvic health programming, and was given contact details for a phone call with Florendo.
Into the Void
When we first speak, Florendo sugarcoats nothing. “Your nights could definitely get worse,” she warns, noting she has several patients who make three sleep-interrupting trips to the toilet each evening. “Long after your kids have stopped waking you up, you’ll still have this habit. Break it now.”
Interesting: I’d considered my urge problem a condition, not a mere habit. But urogynecologists I later consulted all agreed that behavioral changes can help control the urges.
To get a handle on my case, Florendo instructs me to maintain a three-day voiding diary, noting how often I urinate, how urgently I need to go and how many seconds it takes my bladder to empty. My log shows I typically pee nine or 10 times in a 24-hour period—normal is six to eight—and many of my voids last mere seconds, a sign that my bladder is jumping the gun.
The diary also reveals that my bladder can hold more than I’ve led myself to believe. When I’m on mom duty, blending smoothies and adjudicating disputes, I often go three hours without peeing. But when I work at my desk, with a glass of water at hand and a bathroom nearby, I barely last 90 minutes.
Florendo’s conclusion: “Your brain is in control, not your bladder.”
To resolve both my sneeze problem and my overnight urges, Florendo says, I must (a) urinate only when I really, really need to and (b) strengthen my pelvic floor muscles with those dreaded Kegels. Yes, they will help, she says.