mind over bladder

Gotta go? Teach yourself to conquer incontinence.

IT TURNS OUT there's a real name--a medical label--for the annoying thing that happens to me whenever I arrive at my front door. It's called "latchkey syndrome," and it goes like this: As soon as I get my key in my hand, I realize I have to pee immediately. Ignoring my mailbox filled with letters, I tighten my pelvic muscles, throw open the door, and drop my groceries, books, and papers on the hall table. Then, unzipping my pants on the way, I race to the toilet.

I do this every time I get home; it makes no difference whether or not I've recently used the bathroom. Which is why, after a few months, I begin to suspect this is no ordinary medical problem. When my gynecologist assures me that I don't have a urinary-tract infection, prolapsed bladder, or any easily recognizable ailment, I know I've somehow developed a conditioned response: Like Pavlov's dog salivating at the sound of a bell, I need to pee the moment I put my key in the door.

It's a mind-body problem.

Naturally, I'm embarrassed to tell anyone about my experience, even a doctor. This is, by the way, exactly how most people feel when they're incontinent. They don't talk about it with their partners or friends, and they don't discuss it with their physicians. Which is unfortunate, because it keeps 13 million Americans--85 percent of them women-unnecessarily uncomfortable.

My doctor doesn't seem all that shocked by my symptoms. In fact, she seems glad that I've discussed the problem with her. After labeling it for me, she refers me to a specialist.

"You really can take more control of your bladder," Wendy Katzman, a physical therapist and assistant clinical professor at the University of California, San Francisco, assures me. "Approaching your doorway is a common trigger for the sudden, strong desire to urinate that's called urge incontinence. It's different from stress incontinence, where activities like coughing, sneezing, or laughing cause you to leak urine."

Katzman, who works at UCSF's Women's Continence Center (www.ucsf.edu/wcc), tells me that I can retrain my body and strengthen my pelvic muscles by practicing urge suppression techniques, which, when described, sound like something I'd do if I were trying to give birth and quit smoking at the same time.

When I walk into my home, the first step is to sit still and take deep breaths while reminding myself that this is no emergency, that I can, in fact, postpone going to the bathroom. Next, I'm to do Kegel exercises, contracting and releasing my pelvic-floor muscles to strengthen them. Only when the urge to urinate passes should I stand up and walk-calmly-to the bathroom.

I can do all of that. I know how to breathe, and I know how to contract my pelvic floor; I remember doing Kegels when I was pregnant. And I'm old enough to have had real emergencies, so I know the difference between those and what hap pens at my front door.

But when I get home the next day and feel like I'm going to wet my pants, I do not want to breathe or Kegel. I'll try the urge-suppression blah-blah stuff tomorrow, I think, as, bouncing up and down, I try to find the damn door key. Racing to the bathroom, I feel envious of Pavlov's dog, who, I am certain, never had to tell himself, "OK, it's a bell; it's just a silly bell. I don't need to salivate."

On the way home the following afternoon, I plan my attack. I can't have a full bladder, I tell myself, since I used the bathroom 20 minutes ago. I'll look at my mail first, I decide just sit on my couch and do my behavior modification while I read.

I Kegel as I pretend to study the photo on a letter announcing a friend's art show. Breathing deeply, I remind myself that this is not an emergency. Walking into my own house is, in fact, the most normal of everyday activities. And then I reach into my purse, take out a pen, and write a note in my date book about the art show.

I'm so cool, I think, as I stand up and walk-walk!-to the bathroom. For the next few weeks I am pleased with how well this works. As I sit on my couch, focusing on my breathing and my pelvic contractions, using mail as a distraction, the urge to pee really does subside.

There is no mail to distract me on Sundays. But when I come home after a bike ride and sit down in the living room with the newspaper, I'm halfway through the travel section before I realize I've been reading for 20 minutes. "This is amazing!" I announce to my husband. "I don't have to pee."

He is not quite as jubilant as I would like. But then again, I never mentioned the problem to him in the first place.

find an expert
To locate a health practitioner with expertise in treating incontinence contact the National Association for Continence (800-257-3337 or www.nafc.org).



By Wendy Lichtman

Wendy Lichtman is a freelance writer in northern California.

Alternative relief
Simple strategies to help you pacify a problem that plagues millions of women.

1 Keep a diary
Your doctor needs help to properly diagnose incontinence. Keep track of how often you urinate, the events surrounding any leakage, and what and how much you're drinking. Cutting back on coffee and fizzy drinks may help. (Don't stop drinking water; that's dangerous.)

2 Work your pelvics
Kegel exercises--contracting and relaxing those isolated muscles in the floor of your pelvis that control the emptying of the bladder-can curtail incontinence and prevent it from getting worse. Squeeze the muscles for a slow count of three, and then relax for a slow count of three. A set of 10 to 15 three times a day will build strength.

3 Try biofeedback
Not sure if you're doing Kegels correctly? Biofeed back, a mind-body technique that relies on sensors connected to the pelvic floor muscles, may help. Computer graphics and audible tones provide the feedback as you exercise your pelvics, while also allowing a therapist to measure your strength and individualize your workout. A typical regimen is three to four visits over eight weeks. Insurance plans frequently (but not always) pay for it.

4 Suppress the urge
Based on both physical and behavioral therapy, urge suppression helps control the sudden need to urinate typical of urge incontinence. (It's also helpful for curbing stress incontinence.) When you're in situations that trigger leakage, don't run to the bathroom; that teaches your bladder to be overactive. Instead, breathe deeply and distract yourself, which helps signal the bladder to relax.

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