Stress Incontinence or How to Sneeze Without Incident

It's happening again. I'm standing in the middle of the produce section at Raley's and I need to sneeze. For most people this would not be an emergency, but for me a mother and a woman with multiple sclerosis, this is a disaster. I know that when I sneeze, I'm going to leak urine. Maybe this wouldn't be a concern if I had given in to purchasing some of those incontinence pads they sell but I can't bring myself to do it. While I've learned to throw condoms, yeast infection cures, and even personal lubricant onto the conveyor belt without batting an eye or breaking a sweat, I still can't add incontinence pads.

So now the sneeze is coming and I'm looking for a way to lower myself to the ground or cross my legs without notice. I'm also cursing myself for not doing those damn Kegel exercises they tell you about during pregnancy. You know where you squeeze muscles you didn't even know you using something akin to The Force? How do you tighten a muscle you can't see or feel? They tell you to think about stopping urine which is exactly what I'm thinking about right now but I doubt it's going to help.

The sneeze hits me and I, without thought, bend my knees and hunker down in front of my shopping cart. Aidan, my toddler, looks over the edge of his seat at me and an elderly gentleman pauses in assessing the nearby melons to watch. I know he's watching because I'm neurotic enough to check who may have noticed my attempt to dive under the cart. I smile sheepishly and reach out to adjust the boxes of soda I normally stow under there. Remember this trick if you have similar problems with sneezing: Always stuff some items under the cart and then pretend to arrange them when people wonder why your legs have suddenly given out mid-aisle.

But this time, I haven't made it to the soda aisle and there is also no large bundle of toilet paper under there. I'm frantically grasping at air and the man, who may have only casually glanced over at the sudden movement, is now really watching. Slowly disentangling myself from the belly of the basket, I stand back up and attempt to look as if I meant to do that. Whatever "that" was. At least I didn't leak.

"WAHOO!" I grip the handle of the cart and knock my knees together. Aidan is starting to giggle because Mommy always says "sneeze" in an excited voice when she blows. This originally was because my sneezing used to startle him to tears when he was younger. The women of my family do not sneeze with dainty "achoo"s or little squeaks. Usually overwhelmed by our sneezes at the last possible moment, we let out what sounds more like a battle-cry than sneeze. Aidan looks at me expectantly and I mutter "mommy sneeze", while keeping my knees locked. Aidan giggles and I erupt with the third and final sneeze. "WAHOmph!" This time I saw it coming and attempted to bury my face in my shoulder and keep my legs folded over while doing a rather interesting bobbing technique. Surely with all this movement I'm tightening the right dang muscle!

At this point, while leaning over Aidan and the rest of the cart, I begin thinking that it would have been a good idea to wear a panty liner. Many of my girlfriends have suggested I do this, but yet again, my pride, and love of comfort, has caused me to ignore this advice. I mean, come on, the last thing I want to have annoying me throughout my day is a bunched up or roaming panty liner. Don't talk to me about anything "with wings" they always get twisted in some warped fashion about the underwear and then I've got it stuck to my leg while I'm simply trying to pull my panties down!

Besides what are the chances I'm going to sneeze every single day? And if I do sneeze that I'm not going to find a place to quickly sit down and cross my legs? Often Mark finds me on the stairs of our new house, "Oh just taking a rest." He of course knows better and, if he finds me cursing like a sailor and stomping off to the bedroom to change, like any typical man has to acknowledge my plight by quipping "Didn't make it hmm?"

I didn't make it today either and my chances of finding a place to sit down were nil. Unless I'd opted for planting butt in the veggie aisle while sneezing. This surely would have drawn more attention than that of the man who is now coming over to my cart.

"Are you all right?" He asks with a rather embarrassed and perplexed look. I nod and make a rather unladylike snarfing noise because by now my nose is running and it's either snuffle or wipe it on my sleeve which I don't want Aidan seeing. (Because we all know toddlers do exactly what they see and hear and I'd rather he didn't wipe his nose on his sleeve right after cursing like mommy did in the hallway the other day.) "Are you sure?"

Now I've got to wonder why this person has bothered to come over. Do I look ill or demented? Because asking me if I'm sure implies that I just might not be able to determine if I am okay. This leaves me with the option to snap back "what? Don't I look okay?" or do what I did, nod, blush vigorously, and push my cart out of the veggie section at warp speed heading for the restroom.

I spend the next minutes of the shopping trip ensconced in the bathroom, where Aidan tries to peek under every stall, wadding toilet paper into a pad-like formation and shoving it into my pants. I would have made it if it had been a simple sneeze, but nooo I had to have a sneezing attack, and what must have looked like a seizure, in the middle of the leafy greens! To make everything worse, someone actually came over to ask if I was feeling okay! I want to abandon my basket and run home. Instead I return home with a box of panty-liners and consider it insurance against grocery store mishaps.

This entire experience was brought on by what is called stress incontinence. Just saying "stress incontinence" either sounds like you have a problem holding your stress or your stress lacks intelligence. However, stress incontinence has nothing to do with withholding stress and everything to do with the incompetence of the urethral sphincter. Symptoms of this upsetting syndrome are, as described on Medline Plus as "an involuntary loss of urine that occurs during physical activity such as coughing, sneezing, laughing, or exercise." Oh, you mean during life! Stress incontinence is caused by a weakening of the pelvic floor muscles. This condition is often seen in women, who have had multiple pregnancies and vaginal childbirths, and neurologic injury. In my case, having multiple children and multiple sclerosis, a neurological condition in which the nerves do not always send the right message a.k.a. "hold urine", is a double whammy.

How is this condition treated? Well thankfully we all do not have to run around with toilet paper shoved down our pants. There are many options to treating stress incontinence and other bladder dysfunctions that no grocery store clerk need know about. For many Kegel, or pelvic floor, exercises are too little too late. While it is fun to sit on the couch and tell my husband "I'm exercising", they are not always comfortable or feasible for some with MS. (Not all of us have the best level of sensation in those regions, and I'll be the first to admit I'm one of these people.) The options for treating this condition include behavioral changes, and surgery, as well as pelvic floor therapy and medication. Medication is not always the top choice for people looking to treat urinary problems and it does not have to be the final resort.

However in my case treatment was through medication. You've seen those commercials with the woman at the park in the rowboat who suddenly has that urge. You've also seen the commercials of women, well, sneezing in public places. Of course none of them drop to the ground while sneezing, but they all make rather interesting faces. Each of these commercials offers a medication to treat urinary urgency and incontinence. Anticholinergics (eg, oxybutynin, propiverine, solifenacin, tolterodine, trospium) and antispasmodics (eg, flavoxate) may be used to treat urinary frequency, urgency, and incontinence. Often they work wonders as they did for me. Except for the odd side effect of making me extremely thirsty. This meant I drank more water and therefore was going to the bathroom more which seemed a bit redundant. However, there were no accidents! (And no pads, because hey, there are still good days when I prance about in skimpy underwear and pads just ruin the effect!)

Links:
A more in-depth look into urologic health and MS at HealingWell.com