Have you ever heard about medical trauma? Have you had a Urodynamics procedure? Buckle up. Oh here Ev goes, she’s off on her high horse about patient advocacy. Yes, you are correct. Settle in folks, you’re in for a ride.
Since March, I’ve had to undress and spread my legs to multiple people. People being, health professionals not random strangers. My online dating profile like my bladder is in retention. The intimacy of the procedures still induces a lot of anxiety in me, yes they’ve seen lots of private parts but to you and I, it’s still a very awkward set of affairs. I’m convinced there is a group chat where doctors speak of the female grooming of patients. When you’re living with a bowel or bladder condition you’re expected to be very comfortable with flashing your bits very quickly but that being said clinical staff should have that in mind when conversing with patients especially in procedures like Urodynamics. So, let’s discuss urodynamics and medical trauma; two subjects nobody else speaks about but me but needs to be heard and seen.
“Medical trauma refers to the psychological and emotional distress experienced by individuals due to medical procedures, treatments, diagnoses, or interactions with healthcare providers that are perceived as threatening or harmful. It can result from various factors such as invasive procedures, misdiagnoses, medical errors, or feeling disregarded or disrespected by healthcare professionals.”
Urodynamics out of all the procedures was the one I was dreading, because it’s essentially a simulation of your bladder function. My urological episode means I know what happened but you might be unfamiliar with the procedure so let me give you a brief overview. A urodynamics procedure is a series of tests used to assess how well the bladder, urethra, and sphincter muscles store and release urine. It’s commonly performed to diagnose issues related to urinary incontinence, frequent urination, painful urination, or other urinary tract problems. Before the procedure, I was asked to arrive with a full bladder. This helps in assessing the bladder’s natural capacity and control. A thin catheter is inserted into the bladder through the urethra. Another catheter might be placed in the rectum or vagina to measure abdominal pressure. The bladder is filled with sterile water or saline through the catheter. I was then asked to report sensations of fullness and urgency. The catheters measure pressures in the bladder and abdomen, and the system records these pressures along with bladder volume. I’m then asked to describe any sensations I experience, in my current condition I do not experience these sensations like the normal person. As you can sense, the test is not nice and very invasive so you’d think the health professional overseeing the procedure would have a bedside manner of an angelic person wouldn’t you? Nope, mine was as friendly as Miss Trunchbull’s choky. For comedic purposes, we’ll name him Mr Perfect.
On arrival, I was terrified because I knew I would be leaving the way I was admitted in April. Swollen and full of urine. The consultant then asked the general questions followed by a basic backgrounder; he wanted to know when the retention had begun and if I had, had previous experience with urological problems in my childhood and early teens. The reality is, I’ve never had an overactive bladder so when my urination became less frequent I wasn’t holding NATO like crisis talks with my family. To my surprise, he had an audience of 8 members of staff, four of whom were in and out of the room like this year’s Strictly Come Dancing competitors. In hind sight, I should’ve asked why my urodynamics was being performed like the support act at a sell-out concert, but it didn’t because I was too worried about having a finger up my anus. ‘It’ll only be for a few seconds’ to which I awkwardly said ‘yeah that’s’ what he said too’ – at this point, I’m using the NHS to rehearse a stand-up act. He then, casually dropped in while holding my buttock cheek that a recent MRI showed fibroids but were not a cause for concern. He asked if I was still in school, and I said no I’m nearly 30 and work in PR. Friends and family know I am partial to a chat, and these appointments are no exception but my nerves end with me dropping very awkward one liners in. I expressed my delight in seeing a whole new side of the NHS based on the humility I’d experienced by several on-call urologists. He asked, why I was shocked and I said, have you worked with neurologists? And he said, yeah that’s understandable. I’m learning that my experience with neurologists isn’t an isolated case, and in fact most health colleagues feel identical. The God complex is rife. So, based on that I was at least expecting some personal side of him….
I won’t sugar coat it, but jeez, urodynamics is my least favourite procedure of all. We are all guilty of googling our symptoms and procedures whether helpful or not. In some cases, being open about procedures is vital for the healthcare systems to improve. I point directly to the distress women are put through when they choose to have an IUD/Coil fitted for their contraception or care plans. Without, women speaking about the procedure, we wouldn’t have noted the need for pain relief before, during and after the procedure. Urodynamics was deeply humiliating in all regards from the spectators I had in the VIP section to post procedure when, the consultant used his iPhone’s torch to find my water pipe, despite seconds earlier saying ‘catheterising is so easy’ yep. Wait for it. Post procedure he said and I quote ‘Right, you can’t or you won’t self-catheter? Your bladder has broken and you will need a catheter for the rest of your life. Sorry, no treatment or magic pill. And if I can catheter, why can’t you’. He has two letters before his name and has spent a decade looking up an array of genitalia which would make it easier for him.
As I got off the couch and emptied the 500ml I left without any aftercare. I wasn’t advised of anything, I was almost relived that my insomnia had led me to franticly read urodynamic procedure paperwork. I knew my bladder had been stretched which would leave me swollen and tender for 24 hours maximum. But, when a week had gone by and I was still swollen and in pain I knew something was wrong. Those of you who had read the previous article, know that community care had failed me up until this week, which allowed me to gain access to emergency catheter support. For those under rocks, an emergency catheter team are there to prevent the patient needing to go into hospital; a service which is unpublicised given the 40 hours I have spent in A&E. Throwing my hat into the ring if my PR expertise can be utilised on this matter. I called for a nurse to visit my home who noticed that my water-pipe was not only inflamed but bleeding also. She removed the catheter fitted by Mr Perfect in the hope she could refit and reduce the bleeding. Her fear was that my catheter had bypassed or was blocked due to the fact I was presenting symptoms similar to pre-catheter life. The nurse had 25 years’ experience in catheter management and gave up after three attempts at fitting an indwelling catheter; here I began to balloon up and was in a considerable amount of pain. I looked 9 months pregnant. She advised that I should seek urgent medical assistance admitting that she’d never had to send a patient into emergency care. On arrival, the registrar quickly refitted a new catheter relieving the acute retention
As you’re reading this you must be thinking, Ev that doesn’t sound like a tour of Iraq so I’m not convinced you can class it as trauma. The reality is, I can. And for me, not only have the procedures been pretty grotesque the patient doctor dialogue has fallen short. I am sadly, ineligible for self-catheterising which is the preferred route in managing urinary retention in women because it allows us to continue our everyday.Since April, I have seen 5 on-call urologists all of whom have made feel like I’m not trying hard enough to do the skill. For some women, they’ll pick up the skill quicker than others, I’ve sadly had a series of trials without catheters that have left me being admitted into A&E on every attempt. It’s in writing and in images that my retention has caused a great deal stress onto my kidneys and bladder which poses a risk to life. What has been incredible, that even with the information doctors have continuously said ‘well if you self-catheter’, ‘maybe you should try X’ and ‘but, maybe if you used an alternative brand.’ This dialogue has frustrated me because it has implied I as the patient am the problem not the fact my bladder and urethral sphincter is failing to play ball. If I could, I would. It’s a bit like when I ended a relationship, if a person was capable of change, they would and like my urethra if it could, it would. Simple.
I’d love to hear if you’ve experienced similar or had similar trauma in the medical environment.
