The Difficulty:
Nighttime is not my friend. Sleep is not something I look forward to because it is always a venture into the unknown; into the new difficulties in my life; into one of the side effects of bladder surgery. Because I never know, when I go to sleep, whether I will wake up dry or wake up soaked or something in between. For many months after surgery I was plagued with night sweats and I would go through many changes of tee shirts (and blankets, sheets, and pillows) nearly every night. Those eventually stopped and I could finally concentrate on the problem of controlling my new bladder while sleeping. Or at least tuning in to the signals and waking up in time. There seems to be a couple different things going on here:
- Drainage; controlling and/or sensing leakage (for want of a better word). A few drops here and there, now and then, that the pad can absorb and keep up with for a long time. I have gotten much better at this over the past year. I noticed one night that as I was settling in to bed I was relaxing (down there) in preparation to sleep - compared to how I felt during the day. I decided to try contracting those muscles and holding that feeling until I went to sleep. This seems to have helped a lot - a surprise to me.
- Flow; often - early in the morning, and after about 8 hours of sleep, I would wake up suddenly to the sensation of a strong flow. Often this would overwhelm the pad and warm my leg or whatever was down stream. And by the time I could muster enough consciousness to shut things down, well, let's just say it was usually too late. Which leads me, finally, to The Wave.
My surgeon took a lot of pride in the fact that he performs nerve sparing surgery. Most of what he talks about in this regard is sparing the nerves that passed next to the prostate and on down to the penis to control the erection process (he's a young guy and still believes that sex is important). I have come to believe that he was also able to spare the nerves that feed the piece of intestine that he moved and reformed into the neo-bladder. I think you'd have to.
The surgeon has told me that the new bladder doesn't have muscles like the original bladder that contracted and pushed the urine out when I took a pee. Based on my experiences with this neo-bladder I have come to the conclusion that there are, in fact, muscles in the neo-bladder walls that are capable of contracting and emptying the bladder very effectively. The problem is that these are not voluntary muscles, they are not very strong, and I have no control over when they do their work (more or less).
Evidence the fact that I can sit down to pee and work as hard as I can to empty the bladder - all the tricks I have been taught and have learned. When I think I'm finished there are times when, in the process of pushing, etc. I discover that I also need to take a dump. NOW - once I initiate this process and almost immediately, I get a strong flow of urine. So, I've learned that if I really want to clear out the bladder all I need do is take a dump. What's going on here? It could be that in the process of moving this bowel through the lower colon (which passes next to the bladder) I am squeezing the 'bag' - so to speak - in a way that I cannot do either with my diaphragm muscles or through manual external massage.
But an alternative hypothesis has come to mind based on this and other evidence. I believe these muscles are used in the intestine to move digestive materials through the intestine using peristaltic contractions. The Neo-bladder has retained these muscles and the nerves that control them and the net effect is similar to the 'wave' that the fans do at a football game.
Cheerleaders run - in front of one section and then the next - waiving their hands up in the air to get the fans in each section in turn, to stand and cheer and then sit back down while the next section stands and cheers. And so on, as the wave moves around the stadium.
My surgeon removed one of these sections and made it the neo-bladder and in the process kept the nerves intact so the relocated section still 'thinks' its in it's original place in the 'stadium'. So as the peristaltic contraction moves down the intestines and that 'cheerleader' gets to where that relocated section used to be, the neo-bladder contracts (stands up and cheers) as if it were still in it's original place in the intestinal system.
And so (the test)?
I can imagine that when we are sleeping our body functions shut down along with our minds ( a concept I became very familiar with after my surgery). When we are fully rested our body begins to wake up and the functions fire up again so the body is prepared for whatever the mind decides to ask it to do when it gets around to waking up. So when my intestines wake up, they begin moving things around again and since my neo-bladder still thinks it's intestine, it takes it's turn when the wave passes.
The solution here seems to be to tune my mind to wake up when my body wakes up. This involves both sensing the fact and then (the hard part) acting on it. When my body wakes up it's time for me to get out of bed because if I'm up and moving then I can easily control the wave when it hits. Otherwise I will snooze (like I've done all these years) and then it becomes too late.
This seems to work - as long as I don't mess with things. As long as I don't stay up and get over tired. As long as I don't party too much or eat too much before bedtime. As long as I don't drink anything when I wake up at night (don't know for sure if this makes a difference) but I drink a lot of water in the daytime to make up for it - gotta keep the new system well flushed out. And as long as if I wake up and it's close to morning, I get up.
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