Chapter 26 – [February 27, 2002]
Before her first visit to the specialist around the first of February, the nearly six foot tall seventh grader had been instructed to arrive with a full bladder about a half hour before her scheduled appointment which was at 4:30pm, after school. The medical assistant at the front desk had asked Jordan and her mom to fill out a questionnaire on her medical history – the form had two full pages with detailed inquiries and check boxes for her most intimate of urinary functions and accidents. As Sally had asked questions (out loud) in the lobby for which she hadn’t already known the answers, Jordan sank deeper into her chair. She didn’t want to be reminded of her bedwetting, the UTI and bladder infection, nor her ongoing issues with diaper rash.
Once in the examination room, Jordan had been asked to remove her clothes below the waist and had been given a sheet to wrap around her like a towel after a shower. The urologist, Dr. Roots (No joke? Jordan had thought), had pushed down firmly on the teenagers’ lower abdomen, right on her full bladder. It had been painful and during the process she had been terrified she was about to spring a leak right there on the table.
After that, the doctor had asked Jordan to sit on a weird chair thing with a toilet seat on top and what looked like a clear juice pitcher sitting on the floor underneath. A funnel that appeared to be something like what her dad kept in the garage (except rigged up with all kinds of wires) linked the seat and the pitcher. Dr. Roots had said the test was called a ‘uroflometry’ and she had been instructed to pee normally until finished. Luckily, her gown mostly covered her as she sat.
After that had been completed, with Jordan lying back on the exam table, the doctor then scanned her bladder with an ultrasound device to discover if she had any pee left over. As it had turned out, she appeared to have normal levels remaining.
However, the overall volume of pee she produced after feeling so urgent was relatively low according to the doctor. This, he said, potentially indicated a problem that could explain her bedwetting. He wanted to do additional testing at a second appointment even though her urinary problems were relatively minor in the grand scheme of urinary ailments. In the meantime, the doctor had asked both Sally and Jordan to monitor the girl’s fluid intake and to journal all her urinating both day and night.
With my schedule and Jordan’s increasing inability to take care of herself, fat chance that’s gonna happen! Sally had thought to herself as she nodded brightly to the doctor’s instructions.
Jordan’s second appointment occurred on a Wednesday after school later in the month. Once again, the instructions had been to arrive at Dr. Root’s office with a full bladder and once again, Jordan was required to don the same getup: clothed top with a sheet wrapping around her naked legs and midsection.
I’m sure glad my period hasn’t come yet this month – it’s due any day. She thought to herself as she was getting her clothes off in the room.
Sitting on the paper covered exam table, Jordan’s urge to pee this time was very strong and she hoped the doctor wouldn’t palpate her bladder.
“Ok Jordan, today we’re going to do a set of procedures known as “urodynamics”. They’re used to test how well your bladder is functioning. The first part is similar to the test we did the last time you were in the office. Remember our fancy chair we had you sit on last time?” The doctor said.
Jordan gave a slight nod and looked back to her mother, standing cross-armed behind her.
“Well that’s what we’re gonna start with today – hop down and take a seat.” Dr. Roots continued.
“You can keep that sheet wrapped around yourself as best you can. Just keep it out of the way!” The middle-aged female nurse jumped in, offering instructions.
Jordan shuffled over to the still crazy looking contraption and sat down, almost immediately spraying urine into the electronic funnel pitcher. Very rapidly, the urge passed and her stream decreased to nil.
The nurse took note of the volume in the pitcher. Placing a weird looking blue absorbent pad on the exam table and patting it she said, “Ok, please hop back up on the table Jordan.”
Much more comfortable (physically speaking), Jordan gathered her sheet around her and obeyed. When the nurse slid the stirrups out from the examination table and extended the footrests, the girl’s heart sank.
Oh no! Not again! I’m gonna get poked and prodded down there again? I should’ve known. She fretted to herself with a look of disappointment and fear on her face.
Noticing the girl’s apparent stress, the nurse tried to encourage her. “This shouldn’t hurt Jordan. Have you ever had a catheter before?”
An actual full-blown look of shock swept over her face as (still without saying a word) she thought, A Catheter? What the hell is that? How am I supposed to know if I’ve had one of those? I’d rather not have had anything done to me down there except maybe a diaper covering it up once in a while.
Sally, not offering an answer left room for her daughter to respond.
“…um…I’m not sure…I don’t think so…” Jordan finally said hesitantly.
“Ok, well it might be a little uncomfortable, but it shouldn’t hurt. First, I’m going to place a little anesthetic on the skin around your urethra. This will help numb the area. Then, I’ll very very slowly insert the catheter into your urethra – all the way up into your bladder. The catheter has more anesthetic on it so you shouldn’t feel pain but you will know it’s there. Ok?”
“Ok” Jordan said sounding dejected but in agreement.
“Would you please put your feet in these rests and scoot down closer to the end?”
Jordan obeyed, exposing her bare legs and privates to the open air.
The process had felt not exactly painful, certainly novel, and entirely mortifying.
This is unbelievable. Am I really lying on a table with a tube coming out my pee hole? This can’t be happening. She thought to herself. What would Alex say?
The catheter didn’t seem to do much once it was in; its tube running out and into the same pitcher under the chair contraption. The nurse took careful note of any output before attaching the tube to some other piece of equipment Jordan couldn’t see. The nurse then quickly placed a series of sticky sensors (reminiscent of the ones from her sleep study but only smaller) on her butt, inner thighs, and stomach. She then flopped the sheet back down over Jordan’s knees, returning her a tiny bit of modesty.
“Ok Jordan,” the doctor’s voice now boomed from behind her left shoulder, “well just as we had suspected from before, you appear to be retaining very little urine after you’ve peed so that’s a very good sign. The rest of this test will determine what you feel at different points of bladder fullness and emptiness.”
Jordan nodded, tubes coming out every witch way, in a state of shock.
Over the course of the next 30 minutes or so, her bladder was filled very slowly and she was asked various questions or to do different movements. At several points, the liquid leaked out all over her butt and on the blue pad feeling almost like she was peeing herself right there in the doctor’s office! It had been terrible.
Finally, at the end of the process, the doctor returned with his findings.
“Well Jordan, It appears that your muscles and nerves are all working properly. However, your brain seems to be trigged that your bladder is full when it’s not nearly at its real actual potential capacity. So it tells your bladder to empty at the incorrect time – far too early. Your primary issue appears to be a type of low bladder volume. You should be able to either outgrow this or compensate for it through some retraining or medications.” He let that sink in for a moment.
“Ok,” Jordan said thinking, Well Jeez doc! So this whole thing was a waste of time then? Why the heck did I have to come here and get a tube poked in every orifice if all I need to do is yoga or something to get better?
She looked annoyed and glanced back at her mom who appeared to be thinking a similar thing.
“So what exercises can she do that might help then – specifically with regards to the bedwetting doctor?”
“Well, one that might be the most helpful is something we call “bladder volume training…”
As he explained how Jordan was to do her best to wait 3 or 4 or even 5 hours between bathroom breaks, building up bladder pressure until just under breaking point, the nurse worked quickly to remove the probes and catheter from Jordan. The idea was that if she could stretch it out during the day when she could consciously control her urine, then she could teach her brain that it was capable of the increased capacity. At night – it wouldn’t trigger to release so many times when it filled up at such low volumes.
Jordan was sitting up now covered with her sheet as he continued, “The second thing is for you to do your very best to keep track of how often you pee, when you pee, and how much you pee—”
Sally interrupted him feeling stressed by all the instructions. “Listen doc, I think it’s reasonable to try this bladder stretching thing and I imagine it can help her but she’s in seventh grade! Doing some kind of detailed journal just ain’t gonna happen with our lives. It’s just too chaotic right now.”
Jordan felt a little shocked by her mom’s sense of anxiety but also somewhat relieved, I’m glad somebody said it.
Dr. Roots was a little taken aback but he nodded politely and said, “Ok. Now what about some medication to slow down the bladder contractions just a bit? It might help with this retraining and help her build up some more control?”
Turning to Jordan, Sally asked, “What do you think Jordie? Doctor are there side effects?”
“Well – people often experience painful urination, back pain, sometimes pain in their bladder, and sometimes have difficulty urinating. There are some less common side effects like headaches and loss of appetite or a cough. But it’s true that for many people, the side effects out weigh the benefits.”
Jordan thought for a moment and said, “I think I’ll try just the exercises for a while.”
“Ok sounds good. Lets’ get you scheduled for a follow-up in a few months alright?”
Both ladies nodded, Jordan feeling uncomfortable with just how comfortable she was becoming with being naked under a sheet in a doctor’s room.
“One more thing,” the doctor continued, “In truth, bladder capacity isn’t typically someone is just born with or a bodily defect. It is more of a learned condition like bicep size or muscle strength in another area of the bod. Meaning, if we don’t use our bladders to their full capacity for a long time, they’ll kind of quit working to their full potential. Make sense?”
Jordan nodded.
“It sounds as though your OB/GYN has dug through pretty thoroughly on other potential causes and I’m pretty confident in saying that you really don’t have a significant urological or neurological issue here. I mean, we could do an MRI or something but I just think it’s unnecessary. The most likely thing that happened, in my opinion, is that you originally had some kind of psychological event and the wetting was a kind of PTSD coping mechanism to it. The more you’ve wet, the less toned your bladder has become, and it’s been a self-fulfilling prophecy of sorts.”
Jordan looked up at her mom and Sally looked back at her daughter.
“Perhaps you should considered seeing a psychological therapist in addition to the exercises to deal with the underlying cause.” He tried to make the suggestion with as much tact as he could muster. “Go ahead and get cleaned up and you can put your clothes back on.”
“Ok.” Jordan said, the only one to respond as the doctor turned to clean up his supplies. He left the room and the nurse went through the reverse process of removing all the equipment from Jordan before she was able to get dressed again. Just before she and her mom exited the room however, the doctor returned with his nurse apparently with a new set of questions.
“I meant to ask you about this the last time you were here. I was so focused on your nighttime incontinence that I forgot to ask. I saw in the charts that Dr. Yepp faxed over that Jordan ended up in the emergency room last month for a bladder infection? Has anything reoccurred with that since? Are you still experiencing any symptoms Jordan?”
“No it seems to be ok now. It was pretty bad though.” Jordan said wanting for the doctor to just go and let her get up and put clothes on.
“Jordan, often these infections are caused in women by sexual activity. I’d like to ask you some questions about that. Is it ok if your mom is here for that?”
Jordan felt awkward about the whole line of thought and about the weird invitation to kick her mom out. She of course hadn’t been sexually active – she hardly knew anything at all about the sexual bits she possessed.
“O…ok…she can st…stay though…”
“Jordan have you been sexually active with anyone? Male or female?”
She turned beet red. “No.” she replied a little incredulously.
“Well you need to know that it’s very important for women to keep clean down there, especially after sexual contact. Many women make it a point to urinate after every time they have intercourse in order to flush all the bacteria from that region. Because the female urethra is so short, it’s very easy for infections to happen so it’s important to develop healthy habits like this early or else you’ll end up with an abnormally high number of infections.”
“Um…no…I mean yes…I mean…she can stay…and no, I’m not…sexually active…” Jordan was still red and starting to feel a little defensive.
Sally cringed as the doctor spoke so frankly about sex. She wasn’t even sure if she’d talked with Jordan herself that frankly yet, which made her feel ashamed given that the girl was thirteen-years-old and carried all the signs of womanhood.
She decided to interject, “Well, Dr. Yepp seemed to think that it was probably the diapers that were the most likely contributor of the infection. He said to just be sure to keep clean and for me to check her during the night to make sure she doesn’t sit in a wet one for a long period of time.”
The girl under the sheet lying in a puddle of saline felt her heart thump hard in her chest as her mom brought up the “D” word. She had hoped it wouldn’t surface in front of these people because she had gathered from Dr. Yepp that doctors don’t seem to think of diapers with as much fondness as she did.
Dr. Roots did an almost imperceptible double take to Jordan and then back to Sally. He glanced down at the notes and flipped through the pages before speaking. “Hmm. Well, I can’t say it’s profoundly unusual for an older child to wear some kind of absorbent device to bed. But like Dr. Yepp apparently has said himself, we certainly don’t recommend it as a long-term treatment option. And did you infer that they’re full-blown diapers? And you’re putting them on her? I don’t want to be rude Mrs. Reynolds, but why? She’s thirteen! There are several products on the market today designed for older teens that are user friendly that she could easily handle herself.”
The two began to speak as if Jordan wasn’t sitting right there in the room.
“Those other products don’t work doctor. They leak. It kind of defeats the purpose of wearing them in the first place if all the pee just comes right out!”
MOOOM! Jordan pleaded with her eyes. Shut the hell up! This is mortifying! I can’t believe you’re telling him all that!
Sally continued, “We have a system figured out in our house that works adequately for us and we’re both comfortable with it. Diapers are a part of that. Perhaps your income can afford replacing destroyed mattresses on a monthly basis? Mine can’t! She needs help with the proper fit so they don’t leak.” Sally was ready to go to battle – allowing the stress from her divorce and all the other things from her life come to the surface there in that conversation.
Jordan cringed again, wishing she could crawl into a corner (after getting clothed) and die.
The doctor just stared at her in wonder before finally speaking. “Ok. Ok. Ok. Sorry, Mrs. Reynolds. No offense Intended. I just…” He decided to drop just how unusual her case seemed given the choice of treatment they had chosen and how defensive Sally seemed about it.
“You were trying to say…About the UTI?” Sally asked maternally.
“Well. UTIs are caused by bacteria usually starting in the urethra and then traveling to the bladder – sometimes to the kidney. Like I said, in girls and women, the urethra is real short so you all get UTIs relatively easily. Having old urine in a diaper right up next to your body for a long time (all night long for example) is a recipe for a UTI in and of itself.” He looked at Sally trying to allow that to sink in.
“Now, I see that she’s still got some of what I guess I diaper rash left and I saw that in her charts as well.” Then choosing to frame it in ways he was most comfortable with, “If she goes and smears a bunch of cream on or around the urethral opening without cleaning everything very very well beforehand, she’s inevitably gonna force some bacteria in there. My hunch is that if she practiced a little better cleanliness habits, the UTI issue would decline, regardless of the topical product you apply.”
The two ladies remained silent.
“My recommendation, if you insist on continuing with the diapers, is more showers, more baths, and more wiping (from front to back).” Still looking at Jordan who looked like a deer caught in the headlights, “Keep your genital area very clean and you won’t get UTIs – at least not very many. There’s probably a certain level of inevitability to it but you can’t help that as long as you’re in diapers.”
The two nodded silently and the doctor gave each of them a greeting before opening the door to them to leave. Jordan couldn’t bolt for the exit quickly enough.
Why was that guy so upset that mom helps me with my diapers? Jordan thought all of a sudden afraid. It feels like the more people who find out about them, the more likely it is that they’re gonna get taken away from me someday.