Incontinence Issues - long

I'm still pre-surgical, but have lost 80# on Medifast. I'm not a spring chicken - I'm 56.

At my highest weight, I had some relatively minor stress incontinence issues. Sneezing, coughing, laughing, etc. It wasn't a big problem and a relatively light poise pad did the job.

A year later I'm 80# lighter, but now have urge incontinence as well. I am fine sitting down or lying in bed, but once I realize I need to go pee and stand up ... well.... it's like things inside must shift, as I have much less control than when not standing. I head to the potty as fast as I can, but often don't make it in time. Thank goodness for technology - those thicker Poise pads catch most of it - but I'm wetting my way through at least 3-4 a day.

I do drink about 100 oz of water/crystal lite, 2 diet rockstars and 2 mugs of coffee in a typical day. I take lasix and potassium.

On my last PCP check up in June, I mentioned that this has become a big problem for me. I thought maybe I needed the diuretic cut back since I've lost weight, but my BP is still high. My doc says once I lose more weight it should improve, but I'm doubtful...

Is my age catching up with me? Should I wait it out or seek a second opinion?

Stress incontinence is really common among larger women--I used to have it as well. But it sounds like you might be experiencing OVERFLOW incontinence rather than urge incontinence, or perhaps a combination of the two. Given the volumes of fluid that you are consuming (almost twice the recommended amount), and the fact that caffeine can stimulate even more fluid to be pulled out of your body, AND the addition of Lasix, which as you know will make you pee like a racehorse--you would have to have a bladder of steel NOT to be having issues! Drinking that amount of fluid, even if you are taking a potassium supplement, can also cause your potassium to be depleted.

Incontinence is not just "something that happens" as we get older. My advice is to identify your pubo****ygeal muscles, look up Kegel exercises on the web and begin doing them, decrease the amount of fluid you are drinking by 30-50%, and try to switch to decaf. :)

Also, I recommend that you set up a pee schedule and stick to it. Pee every hour or half-hour at first, whether you have the urge to urinate or not. This will give your bladder and muscles a chance to recover from the constant cycle of overflow and the dam-bursting, break-through kind of thing that's been going on. It will also prevent your bladder from becoming distended and weakened, as well as being kind to your bladder sphincters!

You might be surprised at the amount of control that can return after a few weeks of instituting these changes. Godspeed, Patty!

And here I was thinking I wasn't drinking ENOUGH water!

Thank you for the awesome suggestions. My former PCP had mentioned Kegel exercises, but I had less of a problem then and forgot about it until you mentioned them again.

One reason am I drinking so much is that it takes away the hunger, esp. the Diet Rockstars.  I also have problems with leg cramps at night sometimes, which I was told (somewhere) was from being dehydrated. G2 helps. I thought maybe I was peeing too much potassium out, even with 2 honking big caps each day.

I'll definitely cut back on fluids and try the schedule as well.

Thanks again. These periodic soakings have been a real hassle.

Night-time leg cramps are more likely caused by a magnesium deficiency rather than dehydration. Also, those Rockstar drinks often have caffeine, which IS an appetite suppressant but also stimulates bladder and bowel. Check the backs of the cans--I think they typically have about 200mg of caffeine in each one.

Hunger pangs are a B***H, but rather than drinking so much in fluids, it might be better to chew sugar-free gum, or eat low-calorie foods like salad mix (Dole's Very Veggie is my favorite) with some light dressing on it, or air-popped popcorn, unless you are currently on a liquid diet.

Kudos on the 80 lb. weight loss! It's tough to stick with it, but the rewards, in terms of improved health, are very worth it.

OK, I have a follow up question. I am trying cutting back on my Diet Rockstars today, but I'm thirsty. So far I've had about 24 oz of CL. Last night I did some web searches and found such conflicting info about how much water to have that I'm confused.

About.com has a water calculator. If I plug in my currrent weight, it says

A person who is 370 pounds
and is exercising for 0 minutes ,
is not pregnant,
is not breastfeeding,
does not live at a high altitude,
does not live in a dry climate,
drinks 0 alcoholic drink(s),
when the weather is not very hot or very cold,
and is not sick with fever or diarrhea should have:

185 ounces of water today, or 5.6 liters.
If you eat a healthy diet, about 20 percent of your water may come from the foods you eat. If you eat a healthy diet you can drink 148 ounces of water today, or 4.4 liters.

 

Did I "break" the calculator?

The Mayo Clinic agrees with you - they say 8x8. => 64 oz

Wikipedia says both:

A more flexible guideline is that a normal person should urinate 4 times per day, and the urine should be a light yellow color.

In the US, the reference daily intake (RDI) for water is 3.7 litres per day for human males older than 18, and 2.7 litres for human females older than 18^[15] including water contained in food, beverages, and drinking water.

I think I may be calling my doc for labs anyway. Wonder what he recommends?

I have nothing to offer to this discussion other than I love the research you are doing and I'm sure you'll eventually find out the right amount of fluid to consume. I have had this problem if I wait too long to head to the bathroom after taking my Lasix. I think the kegel exercises will help and also the planned bathroom breaks.

Don't take your Lasix and then head to Texas in a car on Christmas day with a cranky husband and 2 barking small dogs. It's really a terrible idea on so many levels......

I'd like to say CONGRATS on the weight loss too and isn't it amazing the information you can find on the internet?