Ferix

I'm not too concerned whether it will take 6 or 12 months, or more, as long as progress is made. I've waited this long: no need to get impatient now. I'll be concerned if it's been 2 years with no real progress made. I read the notes that my psychiatrist wrote after the appointment. It was interesting to see she's under the assumption I'm seeking to get surgery for both urine and bowel incontinence. I guess that makes sense when she kept repeating that I should find "surgeons", plural and not singular, willing to help with the surgery. I'm not going to seek bowel incontinence surgery but it's surprising it could be easier than I imagined it would be to get an endorsement.

I met with my psychiatrist for a second opinion today! Quick recap: This is my second psychiatrist as I stopped working with my first psychiatrist because she was unwilling to endorse surgery under any circumstances. She started off the visit by letting me know she knew this was a second opinion visit and she had spoken with the other psychiatrist about me. Apparently they work in the same building! She was cool about it though and wanted to hear what I had to say. I told her about my desires to be incontinent and that I've been using diapers to cope. I explained that I believe this is BIID and that the feelings I have are similar to the dysphoria experienced by those who are transgendered. I explain that these desires have been with me all my life and there hasn't been a month in my life where I haven't had access to and used diapers to cope. I explained how the incontinence dysphoria is always with me and I'm constantly reminded of it, especially every time I need to pee--I'm even woken up a couple times a night every night because I have to pee and the dysphoria is there to keep me up. I explained that with age, the desire to become incontinent has only become stronger. It's so strong that it has driven me to wear and use diapers 24/7 as though I'm incontinent for the past 4 years. On top of that, I have been doing exercises to try to weaken my muscles that are responsible for bladder control and disrupt my bladder function so that I lose bladder control. Those exercises, which have been unsuccessful, have mainly been reverse-kegels and performing the crede maneuver regularly (The crede maneuver requires you to press on your lower abdomen right over your bladder rythmically, like your doing CPR to your bladder, until your bladder contracts and you pee uncontrollably). But that's not far enough. I've, for the past decade been using catheters and stents to simulate incontinence. I explained that my stents are home made and I have a decade of experience making them. My stents work like a medical device: The stent holds open the muscles that control the bladder in the same way that a catheter does. It's the reason I know surgery is what I want because the only times I've ever felt like my true self are when I've been truly incontinent with the use of a stent. I explained that I know it is risky to use stents. I have suffered many UTIs from it and I'm not even sure how many; It's not every time I use it but maybe a few times a year for the past decade. I had my doctor treat the first 3 but I was getting worried how they were going to react if I got another and they knew how I was getting the infections. I found online that I could purchase antibiotics without a prescription for pets, even the same drug and dosage I got when my doctor treated my infections. So ever since then, I've been treating my own UTIs whenever I got them. She asked why do I think I go back to them? Is it euphoria? I said no, it's because I really need to feel like myself at all times. I can be successful with my stents and have worn them up to 10 days at a time, though, I usually take it out after a couple days with how uncomfortable they can get. I am trying to live my normal life with it in, even wearing it to my last job where I worked as an EMT doing CPR on patients or wearing it on vacations to Vegas or camping trips with family. My soul aches that I am not incontinent. I strongly believe that these desires are apart of me, that no matter how much therapy and treatments I go through, I will always have these desires and I will always be trying to live like I am incontinent. We could go through years of therapy and I can still see myself turning to stents to make me feel whole because therapy will fall short. I told her how I ended my interaction with the last psychiatrist because I was concerned that I would get tied up into a treatment plan that could take me down a path that doesn't consider surgery; I'd rather not spend any time working with them when I know that there may be other health care professionals that may be willing to help me get surgery. I told her that there are others like me, who have sought the help of a urologist to get surgery and told the truth about their incontinence desires, and after exploring therapy and treatments, actually got surgery to be incontinent (it's true but I'm not going to go into any further detail), so the possibility is out there. I told her I regret how my last interaction with the psychiatrist went. I really felt like I didn't speak to her concerns that she must do no harm and that I may regret my decision later. I told her I really didn't explain to the first psychiatrist how big of a risk I take when I use stents: I thought deeply about it for a good week after the first appointment and it hit me hard to think that if I had told someone from my last job about the stents and pet antibiotics, they'd think I'm crazy. I was a bit shocked to think of seeing it from another perspective because so far, all I've been trying to do was be myself. I told her I was afraid the risk could escalate: maybe I develop an infection resistant to antibiotics; or maybe I have develop an allergy to antibiotics. She asked how does that make me feel. I said I feel like I want to stop. Like I need help. But without surgery being an option and therapy not being enough help, I'm only going to continue to use stents because it's the only way I've been able to match my body image to reality. I told her I've spoken to my doctor and urologist about my desires and they believe me and want to help. I explained that my urologist referred me to a surgeon that is capable of doing the surgery but that visit wont be for another couple months. She said that she would not be able to tell the urologist to do the surgery, and that it would be up to him. She actually said this a few times. I reassured her that I understood that it will be up to me to pitch the case for surgery and to see if they are willing to help. She was concerned that there may be some underlying issues causing these desires and that I really should go to therapy to at least explore the causes and see if there's anything treatable. She said medications might be an option but she didn't indicate that she thought I needed them nor did she prescribe any. She agreed that I have a form of body dysmorphic disorder and if surgery was an option to treat it, then therapy would be the first step to take to get it. She says she's concerned about how surgery would be permanent and that it could cause me harm. But she says she wants me to continue to seek the help of a surgeon and after 6 to 12 months working with a therapist, we can re-evaluate my desires for the surgery and plan the next step if I can find a willing surgeon. To be clear, she did not explicitly say yes she would endorse surgery, but she did not say no either! She said she formerly worked with patients who were getting transplants and it will be likely that the surgeon will have their own ethics review on the surgery and they may have me speak to their psychiatrists before surgery is an option. She said she is going to refer me to a therapist. She says I may need to seek the help of an out of network therapist if I find that the in-network therapist is not willing to help. That about wraps up the conversation! Aside from the first psychiatrist, it really feels like I'm taking the shortest path possible to surgery. It's wild. This whole journey has been an emotional rollercoaster. It's taken a lot to be able to put into words what I live through. I feel good that I was able to get the help of the second psychiatrist, but like I had to show a side of my heart that's hard to see, and that seems to diminish the relief of getting help the help from a psychiatrist. Next step is to wait for a phone call from the therapist to make an appointment. July 12th will be my first visit to the new urologist. Fair warning: Please be respectful and keep your treatment ideas and opinions/judgements to yourself, I simply wont respond to them.

I made an appointment with the urologist that can do the surgery. They are apparently very busy so the soonest I could schedule an appointment is on July 13th. They put me on a list to call if someone cancels, in which case I see the doctor sooner by taking their spot. Regardless, I'm fine with the wait: it gives me a lot of time to think about and practice what I'm going to say.

Just a quick update: I have scheduled an appointment with a new psychiatrist on May 4th (Star Wars Day). Also, today I called up the urologist that can do the surgery. They are still reviewing my referral so it may be another couple days still before they accept it and I can schedule an appointment.

I would do botox if surgery is not an option. I did ask my psychiatrist about that and I spoke of that in a previous post. She would not endorse it. Even with a willing urologist, it would likely still require an endorsement from a psychiatrist. Botox is a second choice as it's not a guarantee it would work to make me permanently incontinent. Does everyone not want to wait and see what actual doctors say? Ask yourself before posting: has Ferix obtained a urologist--and--a psychiatrist? If the answer is no and this is not something you have done yourself, then your medical advice does not apply. From now on I'm going to stop responding to any medical suggestions until I actually have a urologist and psychiatrist.

I have my own supply of antibiotics to self treat my UTIs. I haven't seen a doc about UTIs in years. I doubt you know more about the circumstances of the situation than me so your speculations of doom seems a bit off base. Please continue to enjoy my "exploits" respectfully. Let's allow the time for real doctors figure out what the best treatment for me is.

I have worked for 5 years at the ITA court where they order patients to be to be treated involuntarily so I know that the threshold for involuntary treatment in a hospital is high. They would need to show I am at risk of causing serious harm to myself, others, or that I'm gravely disabled due to a cognitive or organic impairment (like psychosis or dementia). It would be hard for them to argue that I pose a high enough risk over catheter and stent use, especially if I explain that I have 10 years of experience using them and have learned to self treat any UTIs. The usual involuntary commitment for self harm is given to those with problems including: suicidal ideations, self cutting, swallowing razor blades, and things that pose a high risk of serious harm or death. I'm not saying it wouldn't happen but it is extremely unlikely. It would be interesting for sure if I did get involuntarily committed because I know a lot of people at court that I'm on good terms with. For example: The judge invited me to her house for a Christmas party one year, the deputy prosecutor (second to the judge) wrote me a letter of recommendation for a job, the lawyers would regularly buy me lunch, and the court psychiatrist threw a pizza party for me just before I left. It would be like an awkward work reunion.

What a crazy week last week. It was pretty emotionally heavy calling it quits with the first psychiatrist and getting a referral for a second one. It just motivates me more than ever. I left off last week mentioning that my psychiatrist messaged me. This was actually my first psychiatrist asking if I still wanted to do therapy, even though I was not interested in talking with her. I informed her that I had already requested a referral for a second opinion on a psychiatrist. I also thought, maybe there's a chance I can get some insight from her and try one last time to speak to her concerns. To quickly recap: I already told my psychiatrist during my video appointment that my desires were sever, increasing, and has driven me to do things such as living as though I was incontinent for 4 years and using catheters and stents to simulate incontinence. I told her I knew that surgery was permanent and that's what I want. She said she would not endorse surgery, regardless of the circumstance. In my response, I asked her to reconsider. I told her that I was coming for professional help because I was afraid that my desires were going to drive me to do increasingly dangerous things with stents, risking bodily harm, until I made myself incontinent or failed trying. I explained that as a testament to my need to rid myself of these desires, the stents I use are home made. I explained how I researched anatomy and developed my own methods through trail and error and uti after uti (not an exaggeration) until I finally made one that works. I am hoping I can get a "hail marry" from a professional before I try harder than I have before to make myself incontinent. I also said that I am open to therapy and less radical options but I understand that these desires are a part of me, not caused by a life event. I imagine that no amount of therapy can remove the desires, the same desires that drive me to use home made stents, until I'm incontinent. I reiterated that I'd be willing to work with her and any other doctor on a progression of treatments to make sure we exhaust all options. Lastly, once I get surgery it will be an immediate quality of life improvement. The desires will be over, I will no longer have to worry about putting myself at risk with stents, and I can return all of that focus I spend on developing stents and figuring out how to make myself incontinent to living the rest of my life. Being incontinent for the rest of my life may seem like a very long time but the benefits I gain from the surgery greatly outweigh the negatives of a lifetime of despair with incontinence dysphoria. I sent the message but I shouldn't have expected much because she didn't even speak to what I said. She thanked me for letting her know I had a referral for a second opinion and that's all. My referral to the second psychiatrist is pending and should be approved any day. On a good note, my referral to a urologist with the experience to do the surgery went through! I'll be seeing a urologist who does the surgery multiple times a year. I am still working on scheduling the appointment as the hospital hasn't received the approval for referral on their end. I did call and talk with the clinic about it and they said it may take a couple days to process. The receptionist asked what I was wanting to be seen for so I used what my current urologist wrote on the referral, "a consult for continuous leakage of urine". For some reason I must have had slurred speech because she asked me to repeat why I wanted to visit twice, then she asked me to spell it! That felt so akward! I said again but slowly "continuos. leakage. of urine." She suddenly was like, "oh, I could not understand what you were saying! I was trying to type it into google to see if something came up!" I didn't need to spell it after that. Below is my stent for those curious about my stent. The longest I have had it in was for 10 days. I usually don't have it in for more than a day or two because I don't like how it limits mobility and I get scared I'm developing a UTI. It would be so nice if I didn't ever have to use this again to feel like myself.

So, I spent a lot of time thinking about what the psychiatrist said; she actually didn't say much. She said: she works under the heading, "First, do no harm"; and she said I may regret my decision down the road. I don't have any other insight into what she was thinking except what she has told me: She's worried that surgery will harm me because it may be something I regret later. It would be a failure in her duty to allow me to get surgery if in the long run it harms me. If I want to gain the help of a psychiatrist, I have to speak to those concerns. How do I talk to a psychiatrist? I do have knowledge and experience about how to work with a doctor and a psychiatrist. I worked as an EMT for 14 years in Seattle. Many of those years were running 911 calls and talking to doctors and other health care professionals on a daily basis as part of my regular job. On top of that, I spent 5 of those years as a medical contractor working in the King County ITA Court working with psychiatrists and mental health professionals. My job at court was caring for some of the most psychotic patients in the county while they were at court for their hearing. (I also had 2 years working on the "baby" ambulance. It had giant pictures of babies in diapers on the sides. I worked on that ambulance with the NICU transporting critically ill babies) I made a lot of working friendships with doctors and psychiatrists over the years and I know when it comes to business, it's best to be direct and honest. My prime directive for this journey is to be direct and honest about everything. I believe in my argument: I believe that I have a form of BIID which causes incontinence dysphoria. I think my incontinence dysphoria has a lot of similarities to gender dysphoria, so I've been doing research about why transgender surgery is possible. The American Medical Association considers gender transition surgery a medical necessity. Those who get the surgery benefit from decreased gender dysphoria, improved mental health, enhanced self-image and self-esteem, greater comfort with one's body, increased ability to blend into society as a woman, and an enhanced quality of life. Replace gender with incontinence and all of those points could be made for explaining the benefit of having incontinence surgery for treatment of BIID with incontinence dysphoria. This will be an argument that I will need to develop with the goal of addressing a psychiatrist's concern that surgery is not a harm but is a benefit when weighed against the despair that comes with incontinence dysphoria. Onto the next topic: I had my appointment with my doctor today. I told her I need a new psychiatrist. We went over what happened between me and the psychiatrist. I let her know that the psychiatrist will not give the endorsement for incontinence regardless of the circumstance. I told her that the psychiatrist said she believes in her duty to "first, do no harm" and that later down the road, I may regret my decision. I told her I may not have been able to advocate for myself as clearly as I could have and she makes valid points. What I need to do is speak to those points. My doctor agreed. My doctor said that the psychiatrist was probably scared about authorizing surgery: How can she be sure surgery is the proper treatment when it's not something studied. But she also added, "why should it be up to her to deny the surgery?" She said transgender surgery was not something accepted early on so it was harder for patients to find doctors willing to help. She thinks I may have the same problem. My doctor was more than willing to setup another referral to a new psychiatrist. I told her I think there may be a generational gap as well as a cultural gap at play with the first psychiatrist. My first psychiatrist was an older German woman, probably around 50. I told my doctor about my ex's psychiatrist being a trans woman and that I wonder if finding a psychiatrist like that, or at least more culturally and generationally compatible with me, could better help with my wanted outcome. She stated she doesn't have the ability to select psychiatrists like that within the network. She stated that if I found a psychiatrist out of network by name, she could then refer me to that specific psychiatrist. So for now, I'll wait for the referral to go through and then talk with a new psychaitrist. I'll start looking for psychiatrists out of network when I exhaust all my options in network. After my appointment with my doctor I got a message from my psychiatrist! I used it as an opportunity to speak to her concerns about duty to do no harm and later regret. What did I say? How did she respond? I hate to leave things on a cliff hanger but I'm tired, I need a nap, and I'll tell you later.

Well unfortunately I hit a critical road block with my psychiatrist. She had messaged me this week about referring me to therapy, stating, going that option would not get me surgery but would help treat my dysphoria. I responded, saying I am open to trying other options but I also want to continue to pursue a surgical option. She responded by saying I should not pursue surgery and "in down the road I might have regrets" In a longer message, I responded reiterating that I had been wearing and using diapers as though I was incontinent for the past 4 years and that basically my whole life is accepting of that lifestyle; I explained in more than a couple angles that I'm prepared for the lifestyle. I reiterated that I have a urologist willing to help and that there may be other options that I might need an endorsement for, such as getting botox injections if surgery does not pan out. I closed stating, " I have the support of my primary care doctor and my urologist. I hope I can gain yours." She responded by saying neither she nor the therapist will endorse surgery. She said, "for me medical treatment comes under the heading: 'First do no harm'. I know you are certain that you want to be permanently incontinent. But forever might be a long time, and you just might change your mind after a few years or decades." I responded, saying that I had hoped for the opportunity to get a similar workup for those seeking transgender surgery and I'm willing to not get the surgery on merit. I am willing to seek the help from another psychiatrist if need be because I know it's possible. If you really can't see a situation where you would endorse some form of incontinence for me, even through a test of time and sanity with standards similar to that of transgender surgery, that I can't really see working with you. She simply responded, "I understand, but I still hope you reconsider" After I got that message, I scheduled an appointment with my primary care doctor this Thursday. I'll talk to her about a second referral and maybe talk about a strategy to try and convince a hesitant psychiatrist. I will also ask her to find a psychiatrist that specializes with transgender patients. I'm definitely more than disappointed with how that turned out. I think it was important to establish early on if she was willing to make an endorsement or not, when that clearly wasn't an option there's really no point in continuing to work with her and try to convince her otherwise. What was notable was that it felt as though she was hiding the fact that she would not endorse surgery from me. She didn't clearly state she would not endorse surgery on our video appointment and it took me a few messages for her to directly say that she, or the therapist, would not endorse surgery. The journey is not over. I do not give up that easily. I don't regret trying as much as I have. Even though this is a significant setback, I can only keep trying until all options are expended.

I had my second visit with my urologist today! Overall, it went very well. He again made it clear he wanted to help. He checked out my urinary tract and talked about a referral to a specialist. We started off with checking out the inside of my lower urinary tract and bladder with a camera. The camera was like a catheter with a camera on the tip. He showed me my functioning sphincter and even had me squeeze it so we could see it work on the camera. We looked into the bladder and everything inside looked normal. It wasn't terribly uncomfortable and almost felt like nothing compared to the stent play I have experience with. That took a total of 5 minutes. After that was over. he spoke a lot about how doing a sphincterotomy should be done by someone with experience doing them. He said the last one he did was 22 years ago and that whenever he has to do surgery near the sphincter, he avoids the sphincter as it would bleed a lot if cut, so it's been something he's actively avoided working on. He said he has a couple urologists in mind that do sphincterotomies a few times a year, one at the VA and one at a nearby University. He says if I talk to the referred urologist, he doesn't know if they are willing to help. He says he can't recommend surgery, it would be something they would need to decide. He does state he will take good notes and support treatment for me that so that the other urologist would see it in my chart. He said if I got the surgery, it would likely take 30 minutes and I would be able to leave right after. I would have to wear a catheter for a week while it heals. He's not sure if the insurance will cover the surgery. He said he looked up the cost and it could be up to $10k if insurance doesn't cover it. $10k does sound like a lot but it's a roadblock I would be willing to work around; I'll try to do everything I can to not pay that much and hope that insurance covers a good portion of it. I'm really not going to worry about it until I have an actual number for an actual surgery. He says that at this point, the only things holding me back from the surgery is a willing urologist to do the surgery and the endorsement from a psychiatrist, which I'm already working on. He says the endorsement from the psychiatrist would take the longest and compared to transgender surgery patients, they have to wait at least a couple years, so it might take me some time as well. He says the referral to the urologist will take about a week to be approved, at which point I can schedule the appointment. My big worry now is having to convince the new urologist. I will definitely have to make my best pitch and paint the best story I possibly can about myself, incontinence desires, and that the best treatment for me is surgery. I feel like I can make a strong case and it's even stronger now with the support of my primary care doctor, urologist, and that I'm working towards getting the endorsement from my psychiatrist. So far everything has goon super smoothly but it seems like there's potential for a critical roadblock if the new urologist isn't on board with the surgery. It sounds like I have the possibility of asking two if need be but I hope to convince the first urologist on the first try. I'll of course keep you all updated.

I spoke with the psychiatrist today! The visit was by video call. It went well and was fairly unremarkable. I told the psychiatrist everything I've told my urologist and doctor about my incontinent desires and using diapers as though I were incontinent. I told her I was there because I want surgery to become incontinent and that part of my plan is to get the endorsement for that surgery from a psychiatrist. She had a lot of questions about my current mental health, living situation, social interactions, and asked if I had any previous trauma or abuse. She indicated that a lot of the information was standard questions but she was also asking questions establishing a basis for an endorsement; she states that for transgender operations, the goal for a psychiatrist endorsement is to make sure the desire is not driven by psychosis or some other severe mental heath issue. So far I have not indicated any problems. She was also interested about what the plan was that I made with the urologist and what kind of surgery I wanted. I used this as an opportunity to go over what I've been planning on telling the urologist: I want to get a sphincterotomy of both of my urinary sphincters, as much as can be reasonably removed. This is a procedure used for patient's with a neurogenic bladder: Their bladders do not empty causing urine to backup into the kidneys which can cause serious infections. A treatment for this is to remove the sphincters and make them incontinent. That is the surgery I want. I know from my research and from talking with others who have gotten the surgery, that there's a chance the surgery may heal back to normal. I want to make sure that I don't get control back and, as much as possible, have both of my urinary sphincters removed. We changed subjects and she asked if I ever was treated for mental health issues before or if I've spoken to a therapist. I told her no. She stated the next thing she wants me to do is speak to a therapist about what's going on since I've never spoken to one before and getting their endorsement would add to my case for getting the surgery, which may take a while anyways. And that was that... she asked if I had any other questions and I did not. I said that I just want to make sure I come across as serious about this and it's definitely something I want to do, if I could have started this process a long time ago I would have. She seemed to understand and I thanked her for her time. Now I have to wait for a phone call from the therapist's office to set up an appointment. In the mean time, I have my next appointment this Thursday with the urologist.

I'm going to talk to my urologist about this to really get their input because I would prefer to get this done in one surgery. I know an external sphincterotomy would completely remove any control I have over my bladder: the external sphincter is in charge of voluntary control. However, it would still allow for situations that I would retain urine without control since it leaves the internal urinary sphincter in tact. The internal urinary sphincter is controlled involuntarily and can retain urine during sleep or while having an erection. I really don't want to retain any urine at any point, especially while asleep since I wake up every night once or twice a night because of the urge to urinate. I wouldn't mind being incontinent while having an erection, my husband wouldn't mind at all either (he'd probably enjoy it). I'll try to express that I want total urinary incontinence and see what my urologist thinks. I'll explain that I know just getting surgery on the external sphincter leaves a chance that I may have situations where I am still retaining urine. I'll make sure he knows that not only am I okay with having complete loss of control, it's exactly what I want, even if it means cutting both sphincters. Could they do this surgery and only need to cut one sphincter? Do they need to cut both sphincters to get the type of incontinence I want? Are they only willing to cut one and not the other? I can't say what's going to happen until I talk with my urologist about what I want. I'll see what he says: I'm open to any information and insight he may have that I don't. When I suggest surgery options to my urologist, I first want to make sure that I've communicated my goals and make sure he understands my vision of total urinary incontinence. When I'm confident he understands I want no control at any time, we'll talk about options on which sphincter to cut. This may take months before I can even talk to him about the surgery in detail. He still wants to make sure there's a full care team on board with the surgery before the surgery is considered. I can't really say when the conversation will happen but when it does, I'll be certain to share it here.

Did you know that the male anatomy has two urinary sphincters? My next post after the one you quoted goes into further detail.

I can't imagine 3d printing working well. They print in layers causing ridges and lots of places for bacteria to hide and would also make it hard to clean. I have not tried any other heat source. I've only thought of other ways like boiling in water, though I never tried it because I was afraid it would completely deform. I also thought about baking in the oven, which might actually work, but I never took the time to figure it out. One of the reasons why I stuck with the heat gun method is that it was fairly quick when done correctly. Prep takes about 5 minutes and blowing the bumps takes a minute or two tops. Then finishing it and threading the retrieval line was a couple minutes. So it could be done in 10 minutes or less. It was quick to go through several tries and if I messed up early on one stent, I had the option of using the rest of the catheter for practice. I tried silicone but it was too resistant to heat to work with. I also tried other stent designs like ones with bends, but they always slipped out of place. I couldn't really find another material that I had the ability to craft with. I've seen stents made from stainless steel but I don't have the tools to work with steel. The vinyl stent with bumps is probably the best one I've made. It almost "snaps" in place when the bump passes through the internal sphincter muscle and is very secure. It's almost undetectable when sitting or not moving around too much, other than the constant spurts and drips of pee. It does start to get sore with lots of movement but wàlking around the house isn't an issue. I'm done making and using stents for now. In another thread I talk about going for real incontinence so maybe, I hope, I won't ever need to use stents again. *Update: I just tried boiling the stents in water. It doesn't get the stent hot enough to mold.

Thanks for being happy for me. If that's how you feel. I think there's a misunderstanding: I never said I was seeking surgery to become bowel incontinent nor have I discussed that aspect of wanting to be dual incontinent with my doctor. I'd be okay with being bowel incontinent and I'm fine with that happening on its own. Because I'm not seeking to get bowel incontinence surgery, there's no point in speculating about it. Most of what you said is moot and comes off a bit like a positive statement, then doom and gloom, then positive statement, sandwich. Thankfully, what you say is not relevant nor my reality; it would probably cost me 40k in psychiatry fees if I lived in constant fear. I'm going to take this journey one step at a time. I'll share with everyone what happens. The way I see it, these desires are so strong it's worth asking a complete stranger and putting everything out in the open to see if they will help; the worst they can say is no.

What's difficult about the process is that it's hard to make. If you over-heat the vinyl, it melts and the catheter has to be scrapped. There were many stents I got one bump right but messed up on the other or there was some other minor mistake that ruined the whole thing. When I finally made the stent in the right shape, I would then sterilize and insert. Vinyl is so unforgiving to the heat. The window between too cold to form the bumps and too hot it melts is probably less than a second under direct heat from the heat gun. What made it difficult to guage is that it took several seconds under the heat gun for the vinal to reach that perfect goldilocks temperature. There may be another way to form the bumps, I just really haven't tried any others and I'm probably not going to be making anymore if all goes well with my urologist. The size of the catheter is 18 french. I've had no success with heating up 16 french as there's not enough vinyl to support a bump and keep it's shape after it has been heated and blown-up/stretched into the bump shape. It is really tight to pass through the meatus and it took me a few sessions of stretching the meatus with the stent before it could pass through. Once it's all the way in it's almost undetectable at rest. I do feel like it causes a soreness when being active which seems to limit mobility to avoid the sorness.

It's similar to blowing glass and is quite a difficult process. It usually takes me a few tries and mistakes before I make a right one. I use a vinyl straight catheter and a heat gun. I heat up the tube on one end until it's hot enough to pinch off and make an air tight seal. then I tape off the sections of the tube with masking tape and leave only the parts I want the bumps to be bare. So now I have a catheter with the end sealed off and taped. I heat one bare spot carefully with the gun while I spin the stent to evenly distribute the heat, just enough to make the vinyl malleable; Vinyl exposed to the heat gun can melt suddenly so too much heat on one spot will melt the vinyl and ruin the stent. It's a balance of spinning and distance until the stent reaches just the right temp to blow into the open end and inflate the stent. Then I do the same for the other bump. Once the bumps are formed I have to form the ends. I cut the stent at the ends and then heat the vinyl to round the raw edges. To make the end tapered and easy to insert, I stretch out the catheter at the ends of the stent with a heat gun before I cut it. The retrieval line is fishing line poked in trough the tube with a sewing needle. There's a lot of finesse to it that I just can't describe without showing you and not making sense. It's probably not something most people without a bit of crafting skill could pull off; I've literally attempted making 40 of them with 5 being successful.

If you're wondering about my urology visit, that actually happened yesterday by surprise. You can read that above. In short, everything went really well! Both my urologist and my doctor are willing to help. My next step is to get an x-ray on my lower spine to see if there's anything going on that may cause urinary problems. I'm waiting on the referral to go through before I can schedule that but I'll schedule that as soon as the referral appears. After that I will have a video appointment with a psychiatrist on the 30th of this month to talk about what's going on. This will be my first visit with a psychiatrist about the issue. Then on April 1st, I have my next appointment with my urologist where we will meet in person. He's going look inside the lower urinary tract with a camera to check for any signs of injuries or anatomical deformities that may cause problems. He believes that since I don't seem to have any issues with my continence, he won't find anything. Once the procedure's done we'll talk about the path moving forward on how to treat me and work towards incontinence. My urologist seemed very eager to help. He was saying things like "in 17 years I've never had a case like this" and "learn something new everyday" and "It's fascinating, most people want me to bring back their control when they lose it, not take it away" and "I'm very open minded and I don't judge". It's a huge relief that I have such an open-minded urologist: Before the call, I was concerned I would have to talk to multiple urologists until I find one that was willing to help. Everything just seems to be moving surprisingly smoothly. Hopefully things continue to move that way. I'm still very early in this journey so I expect that there's a lot of opportunity for me to hit a roadblock or speed bumps along the way. Whatever happens, I'll keep you guys updated!

Oh hey, I didn't realize I'd be called out in bold font. Probably not the best way to make friends. I mean, yeah, I could be wrong. No biggie. But, I only say that it looks like it could cause incontinence from my experience with stents is because I designed a stent to mimic what the spanner stent is doing. The spanner stent does not interfere with the external sphincter, the muscle in charge of voluntary urinary control. However, it does keep open the internal sphincter, the sphincter in charge of involuntary control. Without the use of the internal sphincter, it would be very hard to hold back any pressure or bladder contraction without training the external sphincter to pick up the slack. I've experienced this with the use of my stent. It's a straight tube with two bumps on either end that ride the internal sphincter like a saddle and rests far enough in it doesn't interfere with the external sphincter. With it in, urine flows in spurts anytime the pressure is too much for the external sphincters to hold. And because I practice keeping as loose down there as much as I can, it pretty much makes me incontinent. So yeah, I agree that the spanner stent does allow the wearer to have control over their external sphincter. But I believe my experiences with stents has shown me that by keeping the internal sphincter open, the spanner stent would likely cause incontinence for anyone not trained to hold their urine while it's in place.

I had seen these discussed on this forum a few years back. I did a bit of my own research to see if I could get one and put it in myself. There's no where you can get one without a doctor putting it in if you live in the US. I even searched international options and there just isn't anywhere that is selling them. It definitely looks like it would cause incontinence based on my experience with stents. *Edit: I further explain why I think this would cause incontinence in my next post below.

Whelp, I had a surprise phone call from my urologist today. He said he had some free time so we went ahead and did the appointment today. I told him everything: I told him about my incontinent desires, life long diaper wearing, my incontinence training, my business selling cloth diapers, and that there are others like me who have gotten help from their urologists. I told him I believe that what I have is a form of BIID and that I experience dysphoria similar to transgender dysphoria. He was an attentive listener and really wanted to understand what I was going through. He said he's been a urologist for 17 years and that he's never had a case like mine. He was also reassuring and said that he wanted to help! He said that he wanted to make sure we go through the proper channels and have a consensus of multiple doctors before we consider surgery as the proper treatment. He said that the type of surgery I was wanting was not something he had done since med-school and said that he was willing to refer me to a university where they have experience in sphincterotomies. One of my concerns was if going to the university would be covered by insurance. He said that with his referral, it would deem it medically necessary and that the insurance would pay. Before we do that though, he wants to collect all the "low hanging fruit". He first wanted to know if I had any pre-existing urinary problems; He asked if I had any problems that might cause issues, like spinal bifida or sciatica, which I said no. He says he wants to run a couple tests: an x-ray to look at my spine and to do a procedure to look inside the lower urinary tract to see if there's any deformity or scarring. He seemed pretty eager to help as he was fascinated about incontinence desires. He said he was going to look up what he can about it after our phone call and do his own research. I did mention to him that I'm open to other options other than surgery, but I really am there for permanent incontinence and hope that we can work together to achieve that goal, surgery or not. The next step is to get my x-ray and I'll have an in person visit with the urologist April 1st to see inside the bladder and to discuss more about the path I need to take to become incontinent. So, I mean, awesome! Looks like the gears are getting into place for this to really happen! If I could swap continence with you I would! I can only imagine how being incontinent, when you don't want to be, can be the worst. I actually want bowel IC too. I have been living as though I am incontinent for the last 4 years. In that time I have never used the toilet, except a couple times when the urge to poo happened in the shower; I just hopped out and took couple steps to the toilet. In my experience, I have found that managing bowel IC is doable. If I anticipate that I will need to mess before I go out for the day, I may take a suppository to encourage a bowel movement before I leave so I wont have one later. That. so far has always worked for me.

Thanks for the insight and I hope the best for your journey! I did end up taking your advice today when I needed to answer some questions on an online form for my upcoming urologist visit. I had to answer why I wanted to be seen: I said, "I experience discomfort with a full bladder and the frequency in which I urinate is distressing." I'll let them know about everything else when I have the visit Friday. I'm doing things a bit out of order to what you are doing. I first saw my primary care doctor about incontinence desires last week. This Friday I'm seeing a urologist. I wont have my first visit with a psychiatrist until March 30th. I have never been to a psychiatrist before so I really don't know what to expect or if they will suggest any medication. I anticipate that if I do get a urologist to help, that they would try other methods to reduce my continence, such as medications targeting muscles that control urination to physical therapy, before they opt for surgery. I'll try anything but I wont be satisfied if the results are anything less than permanent incontinence. If there really is a way for a urologist to help me without surgery and achieve incontinence, then I would be happy with that. I just don't see that happening; if something like becoming incontinent without surgery existed, we'd be talking all about that on these forums and I'm sure there'd be more than 5 of us pursuing it right now.

"I have wanted to wear diapers to the point of giving in, allowing myself to be ruled by my own cognitive distortion, and pushing other people and logic/reason away." Sounds like you don't understand and honestly comes off a bit rude and insensitive. Feel free not to project yourself onto others and please be respectful to those who have different experiences than you. It's odd that you'd come on to an incontinence desire forum to dissuade me from incontinence surgery. It's like going into a transgender forum and telling people not to get sex change surgery because it's hard to be undone. One thing about my conversation with my doctor that I didn't mention: at the end of the call we had a bit of back and forth where I mentioned that I believe I have a form of BIID: body identity integrity disorder. This creates feelings similar to those cause by gender dysphoria. My doctor seemed to really care and understand what was going on. She knew I was serious about what I wanted so I'm really happy she set me up the best way she could by referring me to a psychiatrist and a urologist to help me make this happen. I'm glad I have the help of my doctor who believes me. I didn't think it would ever be possible to have the support of a doctor, let alone my primary doctor. Thanks to everyone who is supporting me, it's really amazing that this could actually happen and I'll be sure to keep you all updated!

Monday, I had my first appointment with my new doctor. This was an appointment I made specifically with her about my mental health and "urine retention". The appointment was on a video call so we got to see each other. It started out as normally as it could be for a video appointment: we greeted each other and I thanked her for taking the time to talk to me. She verified who I was then double checked my meds, history, and allergies. She asked me if I was there to talk about my mental health and urine retention, to which I said yes. She followed that by asking, "what's going on with your mental health, has something happened?" "Not exactly" I replied. "I need help. You see, this issue I have has been going on all my life. For as long as I can remember, I have wanted to be incontinent. I really mean, I am currently continent and I do not want to have control." "These desires to be incontinent are constant and never go away. With time they have only gotten stronger and almost impossible to ignore. To cope with these desires, I wear and use diapers. Wearing diapers has given me some relief to these desires but they never address the core of my problem: I feel like I need to be incontinent." "For all my life, I have turned to diapers to help me cope with my incontinent desires. There probably hasn't been a month in my life where I haven't had access to and used diapers. The older I got, the stronger the desires got and the more I wore diapers." "However, what I was doing was not enough. The call to these desires are so strong, it has driven me to use catheters and stents to achieve temporary incontinence. I know it's highly risky to use catheters and stents, I've actually gotten UTIs from them before and had to get antibiotics from my previous doctor. I never told my previous doctor about the truth of what happened because at the time, I did not believe that it was possible to get help for what I was going through. I was also worried he might take it the wrong way and I wanted to avoid a negative reaction." "I get that using cathers and stents to feel incontinent is extreme; What keeps driving me to use them is because they have allowed me to feel something I have never felt before: to feel like my true self." "In addition to using catheters and stents, I have taken measures to try to untrain my continence. For the last 4 years, I have lived as though I were incontinent and have been wearing diapers full time. To try to lose control, I have spent a lot of time practicing reverse kegals, keeping my pelvic floor muscles relaxed, and never denying an urge. Even with all of this practice, I still feel like I have control and any control I have lost could easily be regained with training." "These desires and diapers have not been bad, in fact, they've brought me a lot of good. Because of diapers, I met my husband, I have a great circle of friends who support me, and I started a business selling cloth diapers that I craft." "Because of my long time involvement in the community and because of my business, I have come into contact with others who have the same desires as me. I have talked to a few people have discussed this problem with their urologist and we're able to get their help. They asked if they could get surgery to become incontinent." "One told me that their urologist was understanding and they were willing to help. They said their urologist was open to a surgical option but they wanted to try physical therapy and meds to try to lose control first. If those measures didn't work, then they would do the surgery. They also spoke with a mental health professional to get an endorsement from them to establish they were mentally sound to get surgery to become incontinent." "They said they did all those things and when that didn't work, they're urologist gave them the surgery they wanted and made them permanently incontinent." "That's what I'm here today for: I need help coping with these desires and I'm done putting myself at risk by using catheters and stents. I'm looking for a permanent solution to my desires and I want to get surgery to become incontinent. I know it's been possible for others to get surgery to become incontinent, one of them was able to get this done in the next state over." "I'm hoping that you can help me by referring me to a urologist that would be open to listening to my problems and helping as well as talking to anyone else, such as a psychiatrist, to establish that I'm mentally sound and clear to get surgery." The whole time My doctor was quiet. She seemed very attentive to what I was saying and then when I was all done she said, "It really sounds like you thought this through and I believe you. I'm not sure if we can convince a urologist to help, especially since surgery would result in a permanent change to remove something that works normal. But if you explain the situation like you did to me, there may be a chance that they'd be willing to help." She continued, "What I can do is refer you to a urologist and a psychiatrist. You can explain to the urologists that you're also seeking help from a psychiatrist and looking to get their endorsement for the surgery so hopefully that can help convince them to be more willing to go with a surgical option." My first thought, " holy crap, that went way better than I thought it would go." I thanked her a ton and that was basically the end of the conversation. Now, my next appointment is Friday, March 5th with a urologist. I'll let you know how that goes.