Perimenopause is NOT My Friend Episode 9: I Pee When I Sneeze

You know the story about the lobster in the pot — how if you turn the heat up slowly enough, it doesn't realize it's boiling. I think that's what happens to women and our leaky bladders.

Over time, muscles weaken, organs shift, things move around. The bladder starts leaking. We don't know when it starts. We just know it creeps up slowly until the point where we're squeezing our knees shut with every sneeze, avoiding trampolines and jumping jacks, fearing a forceful cough in public, and maybe even an energetic laugh.

For me, it was most noticeable when I sneezed or coughed. But in the last year, I also noticed it on walks with Izzy. She'd tap me on the shoulder — tag, you're it — and take off running. If I started running too quickly, I'd pee. Annoying at best, embarrassing at worst. Sometimes just my underwear. Sometimes through my pants. At home, my family got used to me grumbling under my breath as I waddled to the bedroom to change. Out in the world — well, nothing I could do about it.

The condition is called stress incontinence, different from urge incontinence (the overwhelming need to go when you need to go). Stress incontinence is when urine leaks under physical pressure — a sneeze, a cough, a sprint after your kid.

Most women think we just have to deal with this. It's part of aging. It's embarrassing to talk about. Taboo. Why would anyone want to tell a friend, a family member, or even their doctor that they can't control their bladder?

I did pelvic floor therapy for a few years here in Jordan — which is, it turns out, a somewhat absurd place to pursue pelvic floor therapy, given that it barely exists. As far as I can tell, there are two specialists in the country. I've seen them both. I've also remotely seen my cousin, who owns a pelvic floor therapy clinic in the States. All three were great in their own way and helped me in their own way. None of the work solved the problem. I was still peeing when I sneezed.

Then, through a conversation with a nurse at Carrot Fertility — an instrumental perk we surprisingly still get through my husband's employer — I found out that there is a straightforward surgery for this. 

I immediately booked an appointment with my doctor (who apparently has an IG account with over 10K followers). "It’s called a Transobturator Tape procedure or TOT. I do them often," he said. "Very simple procedure." 

He explained it: a small piece of mesh tape is inserted under the urethra through a small vaginal incision, with the ends passed through tiny incisions in the inner thighs. Over time, the body builds fibrous tissue around it, creating a more permanent support. The problem it's correcting: as the muscles and tissue weaken, the urethra loses support and drops, which allows urine to leak under pressure. The tape holds it in place.

Sign me up, I said. Literally. We made the appointment for the following week.

***

I want to pause here and say something about the Jordanian medical system, because it deserves it. There is an abundance of doctors — over 40K. That means we have about 28 physicians per 10,000 people — which is a lot when the global average is around 16. Many are educated in the US, UK, and Germany which is why Jordan is a medical tourism hub for the region. 

In practice, it’s easy to get appointments and relatively inexpensive. I’ve read that the cost here is about 25% of what it is in the US. I also want to name my privilege: I have great global health coverage through my husband's employer, and I could afford this even if I didn't. That's not nothing. That's actually a lot.

How easy is it to get appointments? When we moved here my husband injured his knee carrying something heavy down the steps to our new apartment. We asked friends where he should go. Abdali, everyone said — indicating Amman’s biggest, nicest, newest, and most expensive hospital. He called the orthopedic clinic to make an appointment.

“Would you like to see the first available doctor or the best doctor?” The scheduler inquired.

“Um, the best?” Ezra replied assuming that might be awhile.

“How is Saturday?” She responded.

***

The following week, my husband dropped me off at the hospital. I went up to a big, spacious, sparkling clean room all to myself with a lovely view of Amman. Pre-op, a couple of hours of waiting, and then I was off to the OR. The procedure itself takes about forty-five minutes and I was back in my room shortly after.

“How’s your mini vacation?” Ezra texted.

“Divine,” I responded, flipping the page on my latest read.

One of the more common side effects of this surgery is temporary difficulty urinating, which in a worst-case scenario means a catheter until things resolve on their own. That didn't happen to me. I drank three liters of fluids, read a book, ate bland hospital food, voided a number of times, and was picked up by my husband and daughter as the sun set over the city.

Two days after the surgery, hay fever season arrived in Amman. That day, I sneezed over a hundred times.

Before this procedure, that would have meant a day of changing underwear, running to the bathroom, squeezing my legs shut every time I felt one coming.

Instead, I didn't brace for a single sneeze. I sneezed walking upstairs. Sneezed walking to the store. Sneezed sitting, lying down, standing, mid-conversation. Only twice did I have any leakage at all. Which is expected — the surgery isn't 100% effective, but it reduces incontinence by around 90%.

For the next week I took it easy, iced my groin, read in bed, watched Virgin River with Izzy, and let The Hubs take care of me. 

A week later, I drove myself to the office for a follow-up. My doctor walked into the room and asked how I was doing.

“Amazing. Life changing. I want to give you a hug,” I said. “But it would be awkward considering I’m naked from the waist down and my feet are in stirrups.”

After the examination we sat in his office and had a long conversation about why women don't get this surgery. I told him: most of the people I mentioned it to didn't even know it existed. Women think they just have to put up with it.

He agreed — he thinks it comes on so gradually that women adapt, and adapt, and adapt, until finally they say khalas (enough in Arabic), I have to do something.

I also told him what I think is underneath the silence: that a woman's femininity is so tangled up in her sexual organs that admitting something is wrong feels like an indictment. A man embarrassed to admit erectile dysfunction. A woman embarrassed to admit — well, what? That her vagina is so "loose" she can't control her bladder? 

Except that's not even scientifically what happens. Your vagina doesn't control your urine. Your urethra and pelvic floor does. But we've been conditioned to believe our vaginas need to be youthful, tight, and certainly not do disgusting things like leak urine. Or go through menopause. So we don't talk about it. We bottle it up, deal with it alone, suffer through.

He looked at me from across his desk and said “With all the studies and medical journals I read on this subject, I have never heard that perspective. And that was really helpful.”

***

I’m glad I speak up about all this. I’m glad I don’t feel embarrassed writing about peeing my pants and posting it on the internet. But it’s okay if you don’t want to talk about it or broadcast it. It makes sense. We’ve created a world that benefits from women burying their issues. Don’t make men uncomfortable. Don’t be needy. Don’t ask for too much. Don’t be too much. Swallow your discomforts. Stay quiet. Stay small. 

If you have a story about your changing body that you want to share, but not publicly, shoot me an email. I’m all ears — very confidential ears.