Experiencing UI in the grocery store: One mom-to-be’s story

My second pregnancy was much like my first — morning sickness was a constant and unwelcome companion, my hair was shinier than it’s ever been, and I was bone-tired. By the time weird cravings kicked in at the four-month mark (strawberry-flavored milk and fresh oranges, please!), I felt like a pregnancy symptom veteran. I thought I’d experienced the full spectrum of things pregnancy had to offer.

pregnant woman holding petaled flowers

But I was wrong! There was one pregnancy symptom I hadn’t yet encountered: urinary incontinence (UI).

One rainy Saturday I went to the grocery store to buy some pasta for dinner. Right there, next to the fettuccine and tomato sauce, the new pregnancy symptom introduced itself: I sneezed and peed right there in the store.

It wasn’t a huge volume of liquid—no trickle down my legs, just wet knickers (and flushed, embarrassed cheeks). I abandoned my shopping mission and fled the scene. I needed to change my underwear and process what just happened.

After a close inspection of my underwear when I got home, I concluded that, yes, I had indeed just peed myself in a grocery store. “That was awful and weird,” I thought. “I mustn’t have realized how badly I need to go.”

To my dismay, however, and like so many pregnant women do, I soon discovered it wasn’t a freak accident caused by an overly full bladder. It was my new normal. As my pregnancy progressed and my belly grew, sneezing and belly laughing became problematic (at best). Much to the disappointment of my eldest daughter, trampoline jumping was no longer an activity we could do together. I also found that picking her up felt high-risk at times.

I knew bodies changed significantly during pregnancy. I had experienced this directly the first time around — breasts and feet grow, veins (that you didn’t know you had) surface, your skin breaks out and changes color in particular places, even your vulva looks different. But UI? It just hadn’t been on my radar until this point. I could deal with the other symptoms, but I found something particularly unsettling about UI; it felt like a full loss of control.

Each time I experienced UI, I would be overwhelmed by the feeling that my body wasn’t my own. Irritated and frustrated, it was the first time I’d felt strong negative emotions toward my own body since I was a teenager. Such a negative headspace isn’t somewhere a 35-year-old expectant mother wants to revisit.

As I moved into my third trimester, I employed a simple and relatively common approach to UI management: complete denial. I didn’t discuss it with anyone and tried to convince myself it wasn’t an issue. Unfortunately, denial doesn’t work well when the thing you’re denying keeps showing up (or leaking out).

Frustration and irritation shifted into disconnection and restlessness. I felt disconnected from both myself and the people around me. The more I kept it to myself, the more difficult it became to share my concerns. My restlessness was underpinned by a low level of anxiety; I longed for my pre-pregnancy body (and my pre-pregnancy pelvic floor control).

At seven months pregnant, I signed up for a yoga pregnancy class. It was a beautiful class full of women in full bloom. We stretched, and we laughed. We sat in a circle and shared stories about bodies, birth, and babies. We uncovered parallel experiences and secret fears.

One night our facilitator opened our session with the question “What surprised you most about this pregnancy?” When it was my turn to speak, my experience of peeing myself in the grocery store rushed back. I hesitated momentarily, reliving the embarrassment.

As I shared my tale, my cheeks burned again, and I shed some silent tears. They weren’t so much about that first UI experience but were connected to everything that followed. The sense of loss of control, the frustration, and disconnection surfaced. Talking about it was uncomfortable and freeing at the same time.

As I sat with these women, I realized there was no judgment, just understanding and a slew of similar experiences. Over half of the women in the room had a UI story to share. In that circle, I discovered that UI isn’t something you need to hide or ignore. It’s a reality for many women. A frank conversation with the right people saw me change up my UI strategy (to something considerably more effective than total denial). It also saw the beginning of me unraveling the body issues that had emerged from my UI experience.

I wouldn’t describe my UI experience as negative or bad. I learned something about the female experience. I learned about bodies (their vulnerabilities and their reliance). I also came to value connection and conversation with other women in a different way; I don’t mean having conversations with our close friends but recognizing the collective female experience and having open conversations with women I encounter. I now do this readily.

Who knew peeing in a grocery store would have such a profound and positive impact?

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Jade egg as a UI treatment

My body has changed. Two pregnancies and births caused parts of me to stretch, grow, and shift. Other bits changed color. There are also amazing new things my body can do like provide sustenance and comfort for tiny humans. Most changes I felt OK about, but one left me feeling frustrated and irritated: urinary incontinence (UI). I found the right remedy for my UI symptoms in an unexpected place: a jade egg. Although jade egg practices have received public criticism by some well-regarded obstetricians, I weighed all the facts I could find and gave it a go. The results were surprising.

For me, experiencing UI symptoms felt like a loss of control (on multiple levels!). It would creep up on me in unexpected places. A sneeze in a grocery store was suddenly an unwelcome and dangerous event, and for some time trampolining with my eldest child was not an option. Of all the impacts pregnancy and birth had on my body, this was the one that affected my confidence and at times my day-to-day activities.

Ultimately UI caused a sense of disconnectedness to creep into my world. My body didn’t feel like my own and I felt stuck.

I took myself to the family doctor. The consult was less than fruitful: “It’s a common problem. Here’s a medical fact sheet. What you need to do is identify muscles around your bladder opening; just start and stop your urine stream. You could also try to tighten the muscles in your back passage. If you think about the end of a bowel movement, it will help.”

I’d never really considered my bladder opening before, and I didn’t want what to talk about my urine stream. I also felt uncertain about my “back passage.” So I left (both the appointment and later the medical practice).

Despite the confusing (and mildly alarming) instructions, in the weeks that followed I tried to do pelvic floor exercises each day. It helped a bit, but I was still ill prepared for trampolining or a sneeze attack. My newfound frustration with my body didn’t improve either.

Just as I was starting to feel desperate, I connected with some other women through yoga who’d experienced the same symptoms. They listened and I felt understood and reassured. My doctor had been knowledgeable about pelvic mechanics but didn’t grasp the emotional impact of UI.

The message of my yoga acquaintances was similar to the instruction of my doctor. I think the main difference was that the language was kinder. We talked about “pelvic wellness,” patience, acceptance, and gentle repetition. There was no mention of anyone’s back passage.

One valuable idea I picked up from this group was ritualizing pelvic exercises like you would a morning yoga practice. They suggested I choose a couple of regular moments in the rhythm of my day and make time for it. From these women, I also came to understand I needed to play a longer game. My UI symptoms weren’t going to disappear overnight; I needed a strategy based on gentle persistence.

My yoga friends also had another tool in their pelvic wellness repertoire: the jade egg. Jade egg practices are a Taoist tradition. The basis of the practice centers on using the egg while performing pelvic exercises to build vaginal strength.

It makes sense; Dr. Kegel (that is indeed his real name), the originator of the Kegel exercise, intended that women practice pelvic floor exercises with a particular device called a perineometer inserted in their vaginas. Next-generation perineometer-type devices are available today and continue to work on the principles of building strength through resistance and sensory feedback. It’s kind of like using a dumbbell to build muscle strength except you need to put the dumbbell somewhere very personal.

Like perineometers, jade eggs are inserted into your vagina and then used to perform pelvic floor exercises. Practitioners often recommend beginners do this for 15-20 minutes in one session.

A jade egg is a highly polished egg-shaped stone, with nephrite jade being the traditional choice of material. From a safety perspective, nephrite jade is a good choice because it’s both extremely tough and inert. The stone’s weight also plays a role in the egg’s effectiveness (in terms of building strength). The physical size of jade eggs varies, but a common size is around an inch and a half long.

Using a jade egg to build pelvic strength is pleasant and sensual. It feels like a positive and nurturing practice instead of sticking a medical device up your vagina.

However, the recent criticism of jade eggs isn’t surprising. There are large numbers of people calling themselves “experts” (who are just jade egg retailers) sharing volumes of misinformation and pseudoscience. I learned that you need to be discerning when researching effective technique and hygiene and only buy from a reputable supplier (a good approach when selecting any item that will end up in the most intimate part of your body).

I’ve found a regular jade egg practice to be hugely beneficial. It’s been surprisingly effective in restoring both strength and sensitivity. The practice has also helped erode the feeling of disconnect that snuck into my consciousness.

I believe our bodies are our biographies. Our experiences change us and sometimes leave visible marks behind (like scars from childhood or stretch marks from pregnancy). Sometimes the body’s changes (like UI) aren’t highly visible but are keenly felt. These changes can feel unwanted and overwhelming when we don’t know how to navigate them. Compassionate understanding and proactive self-care can go a long way in helping us adjust and move forward.

UI gave me a lesson in patience and gentle persistence. It also led me to a nurturing body practice that has imparted far-reaching benefits — not a bad takeaway from something that initially seemed like an awful and unwanted change.

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Botox for overactive bladder

In 2017, more than 7 million people had Botox injected into their faces to smooth their skin and help prevent wrinkles. By now, Botox is essentially a household term tossed around in conversations about aging and standards of beauty. But in addition to providing a seeming fountain of youth, the neurotoxin has a surprising number of other uses, from mitigating migraines, helping with uncontrollable blinking, and yes, even aiding in bladder control.

Botox is an increasingly popular solution for overactive bladder—a condition in which you have strong, often uncontrollable urges to pee throughout the day, pee more than eight times a day, and often wake up during the night to go to the bathroom. In short, overactive bladder means the bladder contracts too often, causing those urges or leaks. And several studies have found that Botox helps decrease overactive bladder symptoms just as well or better than anticholinergic drugs, which block signals from the brain for the bladder to contract.

How does Botox work for an overactive bladder?

Botox is a brand name for a poison released by the bacteria Clostridium botulinum, which causes botulism, a severe type of food poisoning that can cause paralysis. But scientists were able to take this seemingly destructive bacterium and isolate its neurotoxin in small doses to realize that its paralyzing factors can also be used for good. Essentially, when applied in small, diluted doses by a licensed professional, Botox blocks nerve receptors receiving signals from the brain. So, for example, when the brain sends a signal to a muscle to contract, if the receptor’s blocked by Botox, the muscle doesn’t move. That’s how wrinkles are smoothed in the face, and that’s how Botox works for overactive bladder.

Botox interacts with the overactive bladder by blocking the brain’s signals for the bladder to contract. This leads to fewer urges, fewer leaks, and fewer trips to the bathroom at night. While Botox might not cure overactive bladder completely, it can certainly help lessen the symptoms.

How is Botox administered for an overactive bladder?

The Botox procedure is quick and relatively simple when you’re being treated for an overactive bladder. You’re given an antibiotic to help prevent a UTI resulting from the procedure, and you’re given a numbing agent for the bladder. Then, a cystoscope is inserted through the urethra into the bladder, and Botox is injected in several places inside the bladder. The injection process only takes about 10 minutes. Then, the doctor will ask you to wait in the office for about half an hour, to ensure that you can pee normally after the procedure. Most patients can.

Though you may have some burning the first few times you go to the bathroom, there’s no recovery downtime.

Does Botox really help an overactive bladder?

One study found that 9 in 10 patients saw their leaky episodes cut down by more than half, and around 50 percent of patients saw their UI completely end. Another study found a consistent drop in UI episodes, and bladder stability for more than a year for more than a third of patients. Quality of life also improved, as patients had more control over their lives, weren’t planning their days around bathroom breaks, and had higher self-esteem. Women see results as soon as two weeks after the injections.

Botox isn’t permanent—which can be a good thing (if it doesn’t work for you) or a not-so-great thing (because if it does work, you have to have continuous treatments). One course of Botox injections for overactive bladder lasts about six months, at which point the procedure must be repeated.

What are the side effects of Botox for overactive bladder?

Though most women don’t see any side effects after getting bladder Botox, some do. The most common side effect of Botox for overactive bladder is a UTI, which, according to Botox’s materials, about 18 percent of patients experience. Painful or difficult urination is also possible, as is an inability to fully empty the bladder—which can occur from the bladder now not being able to contract enough and is resolved by using a disposable catheter. But less than 10 percent of patients experience these side effects. Another study found that UTIs are three times higher in women who receive Botox for overactive bladder than those who received placebos, and the need for a catheter was four times higher.

One woman who received Botox injections for overactive bladder had difficulty urinating afterwards and had to carry small catheters around with her to use the restroom. But even with this inconvenience, she considered Botox a game-changer, , because it let her feel dry and confident when she went out—a far cry from strict control over what she ate, where she went, and what she wore before she got the Botox.

“It was a huge relief. Now I can’t go to the toilet if I tried. I must still use a catheter of course, but at last I feel clean and relaxed when we go out. What a life changer Botox has turned out to be for me,” she said.

Who can get Botox to treat an overactive bladder?

Botox is only recommended to help your overactive bladder if neither self-management (such as pads, bladder training, or lifestyle changes) nor oral medications work for you.

In addition, Botox only helps with urge incontinence—it won’t do much for stress incontinence, which occurs when weakened pelvic floor muscles don’t clamp down around the urethra, causing unexpected leakage. So make sure you know the difference between the two, and as always, talk to a doctor about your UI and possible treatment options. Botox also isn’t recommended if you have a UTI.

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The duomo embarrassment

On a solo trip to Italy, I had all the makings of a dream evening in Florence: comfortable flats, pistachio gelato, and a seat in front of the Duomo, lit up against the dark night sky. Inside my purse were a folded map of the city, my dog-eared guidebook, plenty of euros, and a ticket for the local city bus. The stars were glowing, and a few feet away an elderly man with a basket of sunflowers began to sing “La Vie En Rose.” I felt inspired, confident, bold … and then like I urgently needed to pee.

It took me about seven seconds to calculate how long it would take me to get back to my Airbnb if I sprinted, which would be too long. In my mind, I quickly ran through the nearby places with bathrooms, all of which displayed a “Restroom not for public use” sign. Before I could Google “How do you say ‘complete freaking emergency’ in Italian?” it became more of a damage control situation. I felt the warm sensation spread across the seat of my pants, quickly turning into a chilly puddle. Defeated, I tied my denim jacket around my waist, threw away the rest of my gelato, and walked back to my room. The perfect Italian night was over.

At first, I chalked it up to too many espressos and not enough public restrooms in the city of Florence, but the desperate urges continued over the next three days as I toured the city. After nearly knocking over a young girl patiently waiting her turn, I barely made it to the restroom at a local cafe. At the Accademia Gallery, I had to do the whole legs-squeezed-together-and-biting-my-bottom-lip routine while looking at Michelangelo’s “Prisoners.” I, too, felt like a prisoner.

I knew that I couldn’t continue to fool myself. There just weren’t enough clean pants left in my suitcase. Plus, I’d always been such a big proponent of listening to my heart, so why was my bladder suddenly the one calling all of the shots?

I had not wanted to address the big wet elephant in the room for fear that it would limit me, that people would judge me as I bought pantyliners, and that perhaps a doctor would even tell me I shouldn’t travel any longer. But it was the lack of addressing it that actually limited me. I was allowing my urge incontinence to dictate how I spent my days, where I stopped for lunch, and how long I was able to gaze at Italian Renaissance masterpieces.

My time in Florence forced me to own the condition instead of letting the condition own me. While there, I took to Google for a quick self-diagnosis. Turns out that about 24% of women between the ages of 18 and 44 experience some sort of incontinence. I made sure to see my doctor when I arrived home, who assured me that my diagnosis would not keep me from seeing the world. Of course, I haven’t stopped traveling. Instead, I’ve implemented a new self-care routine that involves a hydrating face mask, completing at least three sets of 10 Kegel exercises every day, and adhering to a strict policy of not cursing at my weak pelvic floor muscles. Now, wherever I go, I make sure to always have a guidebook handy, plus a pair of leak-proof underwear and a few spare pantyliners. What other people think of that? None of my business.

The Duomo Embarrassment, as I’ve come to call it, empowered me to self-advocate. The result? More time looking at beautiful art and architecture and less time looking for a bathroom.

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One woman introduced UI to her family via laughter

I sat in the gymnasium with all the other sixth-grade girls. I was looking longingly at the rope attached to the vaulted ceiling. Today this rope would go unclimbed, as my teacher silently started the projector meant to usher us into adulthood.

“Mom,” the outdated teen in the video said to her outdated mother, “Would it be okay if I took a shower? I have that ‘not so fresh’ feeling.…” As if it were carefully scripted, this actress mother had the perfect response full of compassion and instruction as she ushered her daughter into this new stage of womanhood.

I remember the horror I felt at learning of the inevitable betrayal my athletic body was about to inflict upon me. I took the “Soon you will be a woman” pamphlet home and crumpled it up, defying the change.

My mother was not at all like the woman in the video. She must have forgotten all her lines. She never said a word about “the change.” Whether this was because she knew her tomboy daughter would not welcome this news or because of some generational taboo, these topics were somehow just not discussed.

But change I did, and as the years flew by, I began to have kids of my own with whom I speak more openly. I knew what it was like to be left to my own devices—an overactive imagination and a committee of my prepubescent peers—to learn about the facts of life. I was determined to arm my children with knowledge. Nothing is taboo or shrouded in secrecy. In other words, I made the opposite “mistake” with my teens and OVERshared.

This is how it came to pass that while taking care of my 87-year-old mother, I had no qualms about asking my 13-year-old son to go to the store and exchange the size-4 urinary incontinence pads (“grandma diapers”) for the size-5 long pads. I was puzzled that despite my insistence, my good-natured son absolutely refused to do this task.

As I reflected later, it occurred to me that I never would have asked him to get my tampons, but somehow this seemed so natural. I theorized why this difference existed; unlike the mysterious world of monthly menses, I did not feel the slightest bit modest about urinary incontinence. I had often spoken with friends about “the curse,” but when it came to the topic of urinary incontinence, this was frequently mentioned in the context of laughing too hard to hold it or discussed in a circle of new moms, all of whom were cradling the evidence that whatever inconvenience came along with childbirth was more than worth it. But I suspect there was another reason this topic was easier for me to accept openly.

By the time I experienced urge incontinence in my forties, my mother had gotten pretty good at the mothering gig. In fact, one day out of the blue, she looked me in the eyes and told me about UI.

“Women of a certain age, especially if they have had babies, leak sometimes. But it’s okay because they make special pads of varying sizes to use so that you don’t have to worry about being uncomfortable or smelly.” The earnestness of her mommy talk touched me deeply. She is, despite her reticence in my teens, a very nurturing mother, and our communication has only deepened with the passage of time. As I am now someone who relies on incontinence pads daily, it feels more like a fact of life with a practical solution and less like an unwelcome change. Having the gift of a mother who is still actively parenting me well into my mid-life is one of my greatest blessings. I can always count on her to gently guide me through the changes of menopause and soften the blow when life throws me a curveball.

That is why her behavior shocked me one night as my son and I watched Golden Girls with her as she reclined in her bed, dozing off. I had absentmindedly set a cup of hot tea on the arm of my La-Z-Boy and it spilled in my lap.

I jumped up and yelled. This startled her from her sleepy state so she scolded me for the outcry. I ran to the kitchen, grabbed the ice tray and banged it on the counter, praying for relief. Again she scolded me.

“MOM! I got tea on my lap! Hot tea all over my lap!”

I was astonished to hear her GIGGLE, and like any self-respecting mature woman with burns on her thighs, I stomped off to my bedroom and sulked. (But not before exchanging a “WHAT THE HECK?! Can you believe how insensitive she is?” look with my well-trained, supportive teen!)

Moments later my son burst into my room laughing so hard he could not catch his breath.

“MOM!!! Grandma just said, ‘You see, women of a certain age cannot always control their bladder and sometimes they just let go RIGHT NOW!’ Mom, she thought you said you had PEE in your lap!”

I love that, just as it was for me, the topic of urinary incontinence has been introduced to my son with laughter! I love imagining that this is the memory my son will have as he unashamedly goes to the store for his future wife who is carrying my grandchild. And if that little one is a girl, I know just what I am going to say when she becomes a “woman of a certain age.”

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