Urologist: Lend Some Perspective?

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(Note: I’m 39 and have urge incon) I have had a tough time looking for a urologist, and I’m discouraged / anxious. Can you tell me if I’m crazy?

I haven’t seen a urologist in a while, and not while living in this state. Three years ago I reluctantly saw a Doctor. He seemed okay until he learned that I wear protection, aka an actual diaper. He became cold and wrapped things up. It left me discouraged and, because of my anxiety I did not continue care.

Three years later (now) I set up an appointment with a different doc at the same practice. She came into the room looking frazzled and acting irritated. She was miffed that I saw ‘her associate’ and did not continue care. She scolded me for having 300 ml still in my bladder, and was very snippy. I don’t think she liked that I was okay at the moment with diapers. When she left she gruffly said nice meeting you without looking at me.

At this point I’m wondering what to do. I want to go through with care, but am wondering if I the docs are right to be put off?

I scheduled with a different doc for a last attempt. Is there something I’m doing wrong?

 

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It’s tough but common in my experience. I would look for a urologist on your area that lists incontinence or OAB as one of their focus areas. They in my experience tend to be reasonably understanding. They may also be able to help refer you to a primary doc that may be a bit more understanding. Good luck.

 

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Sorry to hear that. I have nothing to say but good things about my urologist but my problem was prostate cancer. I would definitely look for a new doctor.

 

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YOU are perfectly FINE. The doctors you have seen are unprofessional, rude, and by the sounds of it, ignorant of the protocol involved with patients experiencing incontinence. There isn't one single doctor out there that wouldn't use absorbant products themselves if they dealt with bladder control issues. Do they think that you (or any other patient) should go around without protection, even if it is only until another treatment is identified? Diapers are the same as bandages- if you cut your finger, and made an appointment to see them, they would tell you to put a BandAid on it and stop wasting their time. Why is this any different? The medicinal treatments offered to counter incontinence are frequently ineffective, but, as I understand it, always very dangerous. They are known as anti-colinergics, and the implication is a direct and known connection to developing dementia- (possibly Alzheimer's disease, specifically.) If wearing an absorbant product is the best method of treating bladder control problems (and for me it is) then that should be what the medical community recommends, but for some reason, they don't. Good luck. If you are new to this forum, hopefully you will find the support you need to deal with the symptoms (and the issues) pertaining to urge incontinence.

 

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Most GP’s don’t get much experience with urinary problems, especially with men. If you can’t find a good urologist in your area or your insurance requires a referral then just ask your GP to assist you in finding someone in your area. If they are worth their weight, they’ll know a few urologists around your area. Urologists are very common even in small towns. There is one fairly close. GP’s just don’t have a lot of experience with this type of problem. Even some Urologists have a one track mind about how they want to deal with this problem. So make sure you are upfront with them about what your comfortable with and keep an open mind. They are in the business of fixing the problem if they can.
Enjoy your life as best you can. There are a lot of people who are in the same boat with you. And they are willing to help or even console if that’s what you need. This is a difficult issue and we all struggle from time-to-time. This is a great site to get some advice. Thanks for trusting us. We mean we’ll, but we are not professional doctors so seek out good medical advice.

 

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Justaguy,
Like you I’m not that old (early 40’s). I’ve had OAB and bed wetting all my life so I’m accustomed to monitoring my condition. A couple years ago there was a drastic change in symptoms following Covid, and urge incontinence set in. I had my urine checked for kidney damage and infection and all came back clear. I’ve tried bladder retraining and behavioral changes that are recommended, but like Jeff said, I stopped dealing with docs at the prescription level. I figure, as long as nothing is wrong with me otherwise, I’ll go on living life with out much worry beyond changing my protection.

At the end of the day, I didn’t care to deal with docs after finding out everything was healthy in my tract except for the nerve damage post Covid. If I ever notice additional changes to my system, I’ll get them checked out.

I encourage everyone to just enjoy life and not worry too much… if that’s possible this day and age.

 

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Try seeing a Urologist at a reputable hospital, instead of a community practice. The physicians who work out of hospitals tend to be more helpful.

 

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Thanks for the love, folks. It’s hard not to question what is wrong when multiple docs get huffy.

@Jeffswet and @jetskier, good points about the meds. Anticollinergics and Alzheimer’s is a big deal. Long term use is out of the question for me. But I think not an option anyway because my problem is more about retention.

It has taken me 20 years to get my mental health under control with the right medication, and I am not going to mess it up with other scripts. But that frustrates the doctors, it would seem.

I just hope this doctor I’m about to meet is a more accepting person.

 

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I’m in the same boat - I gave up on urologist after co pays and 4 different meds that didn’t work and had side effects - I only need diapers at night - average around 3 or so a week now with mornings waking up with a full diaper - during the day I try to plan on how long being out and if bathrooms are available- yes I had some accidents in public but was able to hide or at least get out before being noticed. This is not going to bring my quality of life down - lot more to worry about to waking up in a diaper wet or dry - I know as I get older things may change - but as long as no major medical issues besides waking up wearing a diaper - I can deal with it wet or dry - bonus no leaks if it happens

 

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@JustAGuy I think seeing a different doctor is the right thing to do. And remember, when they ask you a urine sample, they also want you to entirely empty your bladder.

I hope you are seeing a urologist, and not a primary care physician, for your urinary symptoms. PCPs don’t know much about urology. You need to see a specialist. If they’re rude to you, call it out, they need to hear it!

I’ve taken many psych medicines over the course of my life and my mom works in that field. Taking a bladder medication isn’t going to mess up the benefits you receive from your your psychiatric medication.

Remember: YOU are paying the doctor so YOU are the customer. A doctor is not a god like they seem to think they are; they are just human beings like the rest of us. Unfortunately, they’re often rude. But remind them that you’re the customer paying their salary, demand good service, and you may just get it!

 

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I have urge incontinence, with at least 4 disorders that can cause it.

I have severe BPH, sleep apnea. Small fiber polyneuropathy and have had major surgery for Fournier's gangrene from a diabetes drug(SGLT2 inhibitor)I was taking.
I have no problems with wearing diaper's only the junk diapers that the VA gives me.
I also have very painful back problems but have to get up 4 to 5 times a night
wearing diapers at night means i don't have to get up or even move.
For me it's quality of life.
By the way, I am a long time EMT and know how common wearing diapers is.
One time i was at a urologist appointment and there were 5 of us setting in the waiting room and one of the guys ask how many of us wore diapers and all 5 of us wore diapers

 

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Definitely find a new doctor. One who is a true professional. Check on the Internet for Google (or other) site recommendations. I know they can sometimes be misleading, but you owe it to yourself to find a caring doctor.

 

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I would seek out a Urologist at a different practice.

My Dr. is connected to a hospital, which I didn't realize was a good thing, but maybe as @jwhillyer said above, that is a good thing, so maybe try that.

I had a different Urologist pre-op, then a different one did the Robotic RP, so have stayed with him since vs. going back to my original. The original had better 'bed side manner' and personality, but the surgeon knows more about my exact situation, having done the surgery. He is definitely good and not rude, but you have to pull information from him - he doesn't volunteer usually. As long as I ask, he will explain, so I have been happy with the results, overall.

Both of mine were in the same practice, but attached to two different hospitals in town, as it turns out.

Hope that helps!

+God+bless+

 

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I have had some GREAT Urologists & some terrible ones, just like all facets of medicine. It seems like most of these Urologists picked this specialty because most patients are too embarrassed to speak about their terrible treatment in the hands of people they are reaching out to for help…. A GOD Complex. What other Dr would knowingly not only prescribe, but berate you for not taking drugs that have terrible side effects and are the ONLY class of drugs proven to have a direct cause & effect to dementia & Alzheimer’s disease? Would they prescribe it to their parent or sibling? I doubt it!
My most recent adventure with a new Uro ended with us arguing about the type of catheters I use occasionally now, but for 25+ years I used an indwelling Foley catheter 3 weeks per month while traveling on business. Imagine packing enough diapers for a 3 week trip literally around the world, every month in a different country every 3-4 days?
I even printed a full page document with a somewhat complete incontinence history for 30 years (Car accident at 27) and she never even read it, yet still argued with me like it was my first ever visit to a urologist! After me telling her all of the things I’ve had done to me she admitted there is nothing new to help me. She then went on to order every test imaginable, that I’ve already had too many times, with full knowledge that my spine is collapsing again from L4 to T-9 and is crushing the nerves once again (Similar to Cauda Aquina). In over an hour “EXAMINATION” she never once touched me other than to shake my hand! Needless to say looking for a new Uro again as a just in case something new pops up, but I’ll probably hear about it here first anyway!
Good Luck!Don’t let a few egotistical jerks stop your search for help!

 

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? The medicinal treatments offered to counter incontinence are frequently ineffective, but, as I understand it, always very dangerous. They are known as anti-colinergics, and the implication is a direct and known connection to developing dementia- (possibly Alzheimer's disease, specifically.)

I just want to point out that there are at least a couple of meds that can help with overactive bladder (Myrbetriq and botox) that are not anticholinergic, and have not been linked to dementia.

I agree with others that these doctors are out of line. Nobody deserves to be treated dismissively by their doctor.

 

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No sticking up for urologists but my daughter was a Pediatric ICU that is currently in anesthesia school. She sent me an article about the most stressful occupations since her current and future jobs were both listed. I was surprised to see Urologist was #1 on the list. That’s no excuse to treat a patient badly but just wanted to inform.

 

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As someone who works around doctors all day, sadly many are no smarter than your average Joe. Working in healthcare gives me a huge advantage into finding a good doctor. I go an talk to staff that works in their area. I ask who would they let do surgery on them? I have been in the medical profession for 30 years and sadly I have noticed the competence of the staff has went down dramatically. I work in an ICU. 20-25 years ago I would have let 80-90% of the staff care for me or my family. Sadly now it is probably 20%. When I had my RP in September I had 2 urologists during my case (took 2 hours longer than normal) and asked for certain nurses during my staff. Even with that I had complications (bleeding and clotting) post surgery.

 

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I feel the Covid policies (not Covid itself) put a nail in the already declining healthcare system.

 

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COVID policies are there to keep patients AND staff safe.

@Jimfrompa I agree with you that doctors are getting dumber. I think the way they’re ultra-specialized is a mistake because they don’t see the big, system-wide things going on in a person’s body. Doctors aren’t necessarily any smarter than anyone; they’re just good at understanding Latin and memorizing more words than the rest of us for when they take tests. Doesn’t mean they actually understand what those words mean nor remember them longterm. I saw a doctor at an urgent care clinic last year for severe diaper rash caused by yeast, and she told me she’d never actually seen a yeast infection in-person and had to look up photos on the computer right in front of me!!! She was easily the most stupid doctor I’ve ever met. Fortunately she wasn’t taking care of something serious for me like a broken bone, or COVID. She prescribed me the wrong medications and not enough of them, turning what could have been just a 3-week-long rash into instead a 7-month-long rash that even my dermatologist had a hard time getting to clear. It has never been gone 100% to this day but stays about 95-97% gone.

Another thing that has been a mistake is the way that doctors no longer have phone calls for a group consult about a patient, in part because of the relatively recent HIPAA laws, and in part because they have to see too many clients per day to pay off their gargantuan medical school bills. We’re running out of doctors for that reason alone! Nobody wants to try to pay for med school any more, and I don’t blame them! I think the government should pay for their education immediately, or we’re not going to have doctors left.

@ltapilot Good point, but maybe Myrbetriq hasn’t been around long enough for them to find a connection to dementia yet. My urologist told me Myrbetriq doesn’t work for very many people. It doesn’t work for me. He said Ditropan/Oxybutynin works the most thoroughly and for the most patients. It sort of helped me but mostly not, because of the nature of my diagnosis of Neurogenic Bladder caused by Cauda Equina Syndrome. When your nerves are broken; they’re broken: no medication is going to fix that. I wish.

@Sprung87 All kinds of medications can lead to dementia (memory and cognitive loss), though very few actually cause Alzheimer’s (a separate, full-blown disease which includes symptoms of dementia). Most psychiatric medications can cause dementia, but particularly benzodiazepines like Xanax and Ativan, as well as sleep agents such as Ambien, Lunesta, Restoril, Quviviq, Rozarem, Halcion, Edluar, Sonata, diphenhydramine like in Advil PM and Benadryl, Trazadone, and Gabapentin. Taking melatonin long term comes with dementia risks. Opioids increase the longterm risk of dementia. All epilepsy medications can cause dementia. Proton pump inhibitors, statins, vitamin deficiencies, and cancer treatments cause dementia. Some diabetic medications like Metformin also cause dementia. By no means are bladder medications “the only class of medications that cause dementia,” as you stated. Please don’t spread false information like that. Here is a pretty thorough list of all the medication classes and specific medication names that can cause dementia.

A List of Drugs Linked to Dementia

The list of drugs linked to dementia includes anticholinergics and benzodiazepines, such as antihistamines, antidepressants, and anti-anxiety drugs.

www.aplaceformom.com

 

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So many great comments from different perspectives. All valid.

I am trying not to judge the doctors too harshly, and I do want treatment. But at the moment I would prefer to try and progress with pelvic therapy and other techniques before meds and surgery. In the meantime I will manage with diapers.

I hope this new doctor with understand and respect that.