Monday, March 29, 2010

Men gotta stand

kw: observations, physiology

This is for men who are getting to "a certain age".

I had a bit of an unpleasant experience late last year, and it took some thinking to reason it out. My regular physician, after a "digital exam", was worried about my prostate—it has always been oversize—and sent me for an ultrasound and an exam by a urologist. The urologist repeated the ultrasound exam, while adding a dynamic voiding test (catching the urine in a beaker on a recording scale). Both ultrasound exams showed that I was not completely voiding. Thus a half-year saga began.

First he wanted to do a cystoscopy, to see if my bladder showed signs that it was suffering overpressure. This happens when the prostate gets tight and the muscular bladder has to squeeze harder to drive urine out. As any muscle, exercise makes it stronger, and this is visible. The cystoscopy showed no such signs. Then he thought that perhaps my bladder was too weak. With some arm-twisting, he persuaded me to undergo a "urodynamics" test. He gave me a date a few months in the future, for no reason I could fathom.

I used the time well. I decided that if I indeed had a weak bladder, perhaps I could strengthen it. (Feel free to stop reading whenever you've had enough) I remembered that I had, for both ultrasound tests, sat to urinate. I had been sitting to void ever since I'd had cancer surgery in 2000, initially because of fatigue due to chemotherapy, later because I'd become slow to empty, and didn't like standing at a urinal for long periods. But I read that the bladder is tipped in an unfavorable way when a man sits "on the throne". I decided to re-learn to "stand and deliver".

Surprisingly, it wasn't much of a problem. My changed attitude soon removed my anxiety about how much time I might be standing there, and that actually sped things up. Then, by waiting longer before "going", I had the chance to consciously push and void as fast as possible, hoping this would strengthen the bladder walls.

It seems to have worked. The Urodynamics test required two catheters, one to the bladder, and one in the rectum to measure muscular pressures and myoelectrical signals. The attendant recorded my verbal reports of various feelings of fullness and urgency as a machine slowly forced water into the bladder. Once we reached the point of "Enough, already!", I was allowed to stand, push out the catheter and void into a recording beaker.

Afterward, the doctor was puzzled. He said I'd emptied my bladder completely. He could not at that point justify further testing or other interventions. That's good, because he had earlier been speaking of some rather drastic-sounding procedures. He set up an appointment for a year later, to "check on things." I plan to break that one. I'll decide when I think I have a problem. Maybe I'll check back with him in five or ten years.

This is one more case of having to be my own diagnostician. While I'd thought for a long time that I was doing right by sitting to void, I found by experience that the geometry of the bladder makes it harder to get that last couple of ounces out that way. Once again, I stand and deliver, as I had not done for a decade.

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