Many things change in (peri)menopause, none of which are particularly pleasant: hot flashes, night sweats, weight gain, heavy bleeding, insomnia, mood swings, decreased labido, dryness, and urinary incontinence—to name but a few. Most of these changes are silent—which should not be confused with not apparent. Those in the near vicinity are well aware that we are going through something.
I don’t think we should shy away from tough, or embarrassing topics. If we can’t talk about the things we are going through, they will cling to us like static. Invisible, but forcible. Also, I won’t see your face when you read this, so if you are feeling grossed out or afraid…I won’t know. Some people imagine their audience naked—I’ve never figured out how that would be helpful. So instead, I imagine my audience drunk.(Now would be a good time to pause and fix yourself a drink.)
When women hit middle-age, the changes caused by menopause resoundingly crash into those caused by aging—creating a “menopage” in the story of our lives. Middle-age is becoming a less relevant term; age seems to be more a state-of-mind than a numerical expression. The Huffington Post1 revealed that middle-age starts at fifty-three. Moreover, you’ll know you are middle-aged when you enjoy naps, moan when you bend over, get frustrated with technology, spend an inordinate amount of time talking about your joints, and choose comfort over style when it comes to clothing. Apparently I’ve been middle-aged my whole adult life!
At fifty, I feel like I’m making good lifestyle choices. I am healthy, active, engaged, and I appear to have weathered the storm pretty well. However, you know what your mother told you:
It's what's on the inside that counts.
It's what's on the inside that counts.
Never has that been more true. My plumbing ain’t what it used to be; there is leakage into all parts of my life.
The expression—I laughed so hard I peed my pants—is not literal. Actually peeing your pants is never funny.
And yet . . .
Let’s wade into this socially awkward topic—put on your Wellies, it could get wet.
There are many specialists who deal with malfunctioning plumbing. Natural, medical, and manipulative. My doctor recommended pelvic floor physiotherapy. I had just one question for her: WHAT THE HELL ARE YOU TALKING ABOUT? She described, at length, the probing, manipulating, and strengthening possible through physio. I became nauseous and light-headed, and had to lie down. While the doctor monitored my blood pressure, she told me that millions of women had this problem, and that loss of bladder control was a normal function of aging (who is aging, I am in my prime?), and that hormonal changes of peri-menopause could make it worse. (I think I should get another opinion—I am neither aging nor menopausing. And she calls herself a doctor!)
I ignored the problem for another year. But, it became increasingly difficult to play soccer; I dribbled all the way down the field, and not just with my feet. I had to play every game while wearing a pad the size of a small mattress. Oh. My. God.
I booked an appointment for physiotherapy. I had done physio before, so I had an idea about assessment, strength testing, exercises, and the use of props. The therapist came in, and while testing my muscle strength, we talked casually, as if gathered around a coffee table and not my pelvic floor. “Okay, squeeze,” she instructed. “How many children do you have? […] Hold it there. How old are they? [… ] Now cough. Where do they go to school? […] And relax.”
She could find nothing wrong with my muscle strength. She left, and I got dressed. She came back and handed me a brightly coloured plastic egg—the kind that kids get at Easter, the one’s covered in chocolate with surprises inside. The only surprise it held for me was what she wanted me to do with it. “Put it in a condom, and insert it “down below””, she said. “Then run up and down the stairs, or do jumping jacks. If you feel the egg slipping, you need to squeeze your pelvic floor muscles tighter.” I stared at her. Are you kidding me? What am I training for—a “ladies of magic” night show? Other women do box jumps or power squats; I do pull-ups with my pelvic floor.
Physiotherapy didn't work. I read more about stress incontinence. There were other things that made it worse: coffee, alcohol, and chocolate, for example. Things within my control. But, I knew that if I stopped drinking coffee the bladder wouldn’t be the only orifice that became incontinent! I had a family to consider.
My doctor referred me to the Pelvic Floor Clinic. A young nurse named Anna took me to an exam room; I changed into a blue gown, lay down on the exam bed, and positioned a leg into each stirrup. Anna did all of the same strength testing as the physiotherapist, but this time I had a full bladder.
She left the room momentarily, and returned with several plastic bags. “These are pessaries,” she told me and pulled one out of its bag, “They can help with stress incontinence. Would you like to try it?”
I propped myself up on my elbows—a somewhat challenging endeavour, given that my legs were still splayed open. Anna held a baby-doll pink, circular object in her hand. It looked to the untrained eye like a small umbrella canopy, one that could have been used by Bernard to shelter the glamour-mouse Miss Bianca, in “The Rescuers”.
“What exactly is that?” I asked.
“It’s a pessary,” she said again, as if the word defined itself.
“And, what will it do?” I asked.
“When inserted into your vagina, it will push against the urethra whenever you strain, and stop the flow,” she said.
“Oh.” I said feeling a warm flush come over my face. I lay back down. The drop ceiling was classic clinic white. The panels had small pockmarks, as if just recovering from acne; each tile was framed by a polished silver grid that eerily reflected the contents of the room. Anna. Me. The pessary.
“Okay, I’ll try it,” I said.
Anna slipped the device into place, and I sat up. She asked me to jump up and down and cough, legs in a straddle, while standing overtop of a towel. I looked from the towel to the young nurse and wondered, Is this the only job you could get, watching older women with failing sphincters and spurting bladders jump up and down? I grasped the back of my gown and began to jump. It was just like personal training—but not! Up. Down. Cough. Look. Repeat.
I passed the first test. We then went into the hallway. She asked me to mimic the activities that I do in soccer that cause leakage.
“Pardon me.” I said.
“You know, just pretend you’re in a game,” she said.
Let’s review: I had a full bladder; I was naked from the waist down; my gown was wide open at the back; and it was a public hallway. I imagined myself running barefoot down the hallway, sprinkling pee all over the floor like a hose released under pressure, and falling and sliding through my own urine, as if in a horror-house slip-and-slide.
“Okay,” I said—that’s a great idea. I held my gown in my fist and ran, looking more like a fairy in a briar patch, than Beckham across the freshly mowed pitch. I passed that test too.
I was sent to the bathroom to see if I could pee with the pessary in place; everything should work normally when relaxed. I pissed the third test.
Anna sent me back to the room, and instructed me to see if I could find the pessary and pull it out. I closed the door and began the search. Given the confines of the space within which it was installed, I assumed I would just reach in and pull it out. That did not happen. Anna returned. She coached me. “Put one leg up on the bed,” she said. I still could not feel the pessary. I lay back down on the bed. Anna could not remove it either.
“Oh well,” she proclaimed. Oh well? I thought. “You really only need to take it out every three months, so you can simply come back and have it removed and cleaned then.” “What!?” I stammered. Do they have express service? Do I just cruise up to the “secret” door and knock three times? And then when the door slides open, do I lie down on the bed and press the button marked “Pessary Removal”? SERIOUSLY!
I walked out with a silicone dam wedged somewhere between north and south. It reminded me of a time when my roommate, who had just returned from a doctor’s appointment, came skipping into the room, “I’ve got a secret, I’ve got a secret,” she chanted with impish cuteness. She had just been fitted with a diaphragm. Seems to me that her secret was a lot more fun than mine!
That night, I had a soccer game and was keen to see if the device would help to restore me to my former water-tight self. Success! Now I know how a toddler feels—one who goes to bed in a diaper and wakes up dry in the morning. “Look Mommy, I dry!”, she says as she pulls her bottoms down. (I spared my teammates my excitement.)
Stress incontinence had never been a topic at our post-game drinking circle. I had, in fact, contemplated quitting soccer several times because the thought of leaking out, or being injured and taken to the hospital—where they would find out that I had to wear incontinence products—was mortifying. I hoped that with the pessary, I could continue to play—dignity intact.
The fact that I couldn’t remove the pessary caused me a great deal of consternation. Frustrated, a few days after insertion, I said to my husband Ward, “I can’t get this damn thing out! They are probably going to have to cut me open from here to here to remove it”. (belly button to pubic bone—sometimes I can be a bit dramatic)
“Why do you have this thing anyway?” he asked. “Is this because of soccer?”
“YES,” I said.
“I don’t understand why they can’t just put porta-potties on the side lines.”
Staring hard at my doctor-husband, I said, “Do. You. Even. Know. What STRESS INCONTINENCE is?”
“Umm…maybe not,” he said hesitantly.
“I BASICALLY PEE MY PANTS AT EVERY SOCCER GAME! I would need a porta-potty strapped directly to my body, and for some reason they don’t allow women to play soccer with a potty strapped on to their butt!”
Now he stared hard at me, (stuck with a picture in his mind, I’m sure) “Really, you pee your pants?” (He shook his head) “It sucks to be a woman.”
“ARG.” I stormed off.
Later in the week, I enlisted Ward’s help to get the device out. I figured he was familiar with my “equipment”, so surely he could find the pessary and pull it out. This is an activity I would not recommend for new couples—it is not exactly on the list of sexy and romantic encounters, nor could it be considered foreplay. I felt desperate. He was not successful, so I went back to the clinic to have it removed. They managed to find it, wayward and wedged in some other orifice. They pulled it out, and fitted me with a different size, and attached a string to it for easier removal. The pessary never worked for me again.
Instead, I have to chose a pad for every activity that I undertake. Also, I have had to re-define the word activity because as the years have gone by, the incontinence—which follows my fluctuating hormones—has become unpredictable. One day, no leakage at all; and a few days later, I am not able to walk and fart at the same time. So much for multi-tasking. Soccer still provides the most challenge. A full-out burst of speed can create something like an open tap. I do not understand where all the fluid comes from.
After one game, I weighed my pad—I know, gross right? But having studied kidney function in my previous health care life made me really curious. The saturated pad weighed over 300 grams. One millilitre (ml) of fluid weighs one gram. I had peed over a cup during my game. How is that even possible? The normal kidney produces one ml of fluid per minute. Our games last 50 minutes. How could I leak SIX times more than a normal kidney produces? Fucking over-achiever!
Of course I empty my bladder before the game.
Of course I restrict my fluids for a few hours leading up to the game.
It just doesn’t matter.
Every day I need to decide—does my schedule of activities require a piddle pad, or a puddle pad?
By sharing this kind of personal information, we find out that we are not alone in our suffering. Recently, a good friend of mine was supposed to come over for dinner, but she had a horrible cold. I sent her a message on the day of dinner to see how she was feeling. She replied, “I wish I could come. This cough is bad. Just peed my pants. Awesome!”
