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The physiology of learned incontinence


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There’s a lot of content out there about the “12 month program” and such suggesting that it is possible to learn or acquire incontinence.   There’s also a lot of debate as to whether this learned incontinence is physiological (physically provable) or psychological.

I’ve been experimenting with 24/7 diapering for a few months now.  As this experiment has progressed, I’ve come to realise that I have (for reasons I do not understand) an intense curiosity about learned urinary incontinence (bowel incontinence for me would create overwhelming practical challenges and so I’ve excluded it from consideration).

In my particular case, I have gone out of my way to avoid any appreciable storage or urine in my bladder.  Consequentially, I operate under a regime of very high frequency/very low volume micturition events which is great for maximising diaper yield, but does seem to be precipitating some kinds of physiological change.  Even after only a little over 3 months, although I’m not incontinent, things are “different” down there and it seems physical.

I have no medical qualifications but I’m of at least moderate intelligence and I know how to research so I’ve been trying to learn about what might be going on.

A big challenge is that it is very difficult to map physical sensations from ones lower urinary system back to originating muscles.

One of the early phenomena I have noticed is that I have learned to enter what I call a “drip and dribble” zone.  In this place, I urinate very small amounts every minute or so with no greater conscious effort than a decision to allow this to occur.  For this to occur I need to be undisturbed and stationary.  Sitting at my desk at work is the number 1 place where this happens.  On increasing occasions in this zone, I become aware of one of these dribbles as it happens.  There is no advance warning although if I stand up or concentrate, I will immediately leave this zone.

An associated sensation (or more technically, an absence of sensation) is from urinating itself.  I just get wet.  That’s pretty much all I will feel in this place and there is little or no physical cue between the bladder squeeze and the leak.  A feeling that I used to have when about to pee now sometimes goes missing.

I’ve been trying to understand what is the mechanism behind that kind of effortless progressive diaper dampening is.  Based on reading and trying to interpret sensation, I suspect that I’m looking at detrusor hyperactivity (bladder slightly squeezes every minute or less) with reduced contractibility (there is little urinary pressure or volume) and a relaxed external urinary sphincter (pee drips or dribbles out synchronised to the detrusor contractions without any apparent conscious control).

Interestingly, once I’d reached this point, I started googling around and repeatedly stumbled into “DHIC” incontinence which is described as detrusor hyperactivity coupled with impaired contractibility and that this type of incontinence is extremely common in nursing homes - nobody knows why.  I’m also aware that it is frequently the case that nursing home residents are diapered for their caring institution’s operational convenience rather than clinical need and that nurses often talk about “learned incontinence” in nursing homes (whereby residents simply abandon attempts at continence because there is no point and just use their diapers).  I'm wondering if our community might know the answer to THAT medical mystery.

I’m left wondering if there is indeed a physiological incontinence that can be acquired through practice? 

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Incontinence issues progress over time wether its due to a medical issue or self induced issues, I have been diapered 24/7 for over 4 years now and I cant remember the last time I felt the urge to  pee other then my last test my urologist did where he filled my bladder to full capacity but even then it was just a really mild tingle. I think over time after waring and using diapers 24/7 that our bodies and our subconscious adapt and stop sending the signals that you need to pee as it knows it nolonger needs to as it will use the diaper anyways. 

 I am not sure how much I have helped my incontinence progress after giving up the bathroom run since I rarely made it anyways, so I would say yes its possible on a physiological aspect to incontinence for both medical or self induced. 

 It is interesting how our bodies adapt to and stop reporting signals that are no longer really required when you are protected 24/7 or unfortunately even when you are airing out.

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I do not wear 24/7, but as soon as I get used to wearing diapers my sphincter gets used to it very quickly and my bladder empties itself without doing anything. I think if you relax and wear diapers all the time, you get used to it quickly. But you probably can't get used to complete incontinence.

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Physiological or psychological the effects are the same, and there are physical changes that come with not wanting and not having control which help you move along that path. What you end up with is your body no longer storing urine, but releasing it as it gets produced or something very close to that. Most of continence is simply a learned habit of long-time practice. As such it can also be un-learned or otherwise altered. Incontinence is the more natural state; we all began that way and would have continued had that been possible or more practical. Unless trained to do otherwise the body will choose the most efficient process to maintain life, so once you un-learn continence your body will lose the no-longer-needed processes which allowed retention. No point in it wasting energy so it won't.

All that the body really needs is for the kidneys to produce urine and to have it drain and not build up inside of them- the sphincters, detrussor, and even the bladder itself are unnecessary. The anus could simply be at the end of the intestines without a bowel and it's sphincter and there would be no loss to the body directly; in fact it would be more efficient that way as long as the processed body output didn't create another more adverse effect. All that would become like our tonsils and appendix- body parts which no longer perform a needed function but we've still got anyway. That's where the physiological and psychological meet for those who have desired incontinence: the no-longer-needed parts are still there but now do nothing. And the longer that they do nothing the more they try to maintain that more efficient state of being. Bladder elasticity and muscle tone fade away from disuse, possibly to the point of permanent atrophy where recovery to their former state becomes impossible.

I've always had nerve-related bladder continence problems with my detrussor being spastic in nature and my internal sphincter unreliable for retention. The only path to dryness I had was to consciously and constantly hold my external sphincter closed whenever there might be leakage, and eventually it being continuously overworked wore it out to where it no longer holds for more than 15 seconds no matter how hard I try. My bladder still spasms sometimes but nothing like it used to; now it's a rarity versus being a normal state. I have to consciously will my detrussor into squeezing when I'm using the toilet to save on diapers. My internal sphincter is the same as always- no telling what it's going to do whether holding or releasing but it too seems more relaxed than ever. My bladder has shrunk or lost elasticity to the point that at best I can hold maybe 200mL and that takes much conscious effort on my part plus relies on my extrnal sphincter holding which it might not do. I usually get this in the mornings when I'm drinking coffee and sitting at the computer but it can be an all-day process sometimes; no rhyme or reason for it's erratic behavior that I can find. Maybe 3 or 4 times a year I'll have an unbelievably wet day where I pass at least 2 or 3 gallons of urine even if I've not drank much fluids beforehand. I also have days where I drink huge amounts of fluid but pass almost nothing. No side-effects from any of this; my body is doing what it needs to be doing I guess so I just let it. It knows what it needs to do and it does it without any interference on my part. I can choose to be conscious of the events or to ignore them. Sometimes I enjoy knowing I'm wetting but usually I just discover that I'm wetter than the last time I thought about it. I've consciously chosen to not bother with attempts at continence, my subconscious mind has eventually followed along, and my physical body has followed that with what are probably permanent changes aimed at best body efficiency. I'm happier not having to work at bladder control and I enjoy being wet and the freedom from worry which diapers give me. This is positively the best state of being for me but YMMV- to each theoir own!

Bettypooh

 

 

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  • 2 weeks later...
On 5/3/2019 at 10:13 AM, Rob110 said:

Incontinence issues progress over time wether its due to a medical issue or self induced issues, I have been diapered 24/7 for over 4 years now and I cant remember the last time I felt the urge to  pee other then my last test my urologist did where he filled my bladder to full capacity but even then it was just a really mild tingle. I think over time after waring and using diapers 24/7 that our bodies and our subconscious adapt and stop sending the signals that you need to pee as it knows it nolonger needs to as it will use the diaper anyways. 

 I am not sure how much I have helped my incontinence progress after giving up the bathroom run since I rarely made it anyways, so I would say yes its possible on a physiological aspect to incontinence for both medical or self induced. 

 It is interesting how our bodies adapt to and stop reporting signals that are no longer really required when you are protected 24/7 or unfortunately even when you are airing out.

I rarely feel the need to pee until it is too late.

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Not all residents in nursing homes are diapered, it’s only the ones that either have dementia or who are medically incontinent. Yes I work in a nursing home. 

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I would have to disagree with that statement.  Inmates with mobility difficulties are diapered because the staff can’t respond to their needs fast enough to avoid accidents.  My father had no continence issues before he had to go to a rehab facility after heart surgery. He was diapered on arrival and pretty much ended up using them the entire time he was there. 

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22 hours ago, Newbee said:

Not all residents in nursing homes are diapered, it’s only the ones that either have dementia or who are medically incontinent. Yes I work in a nursing home.  

Not all residents in nursing homes but I've personally seen all residents in ONE nursing home thus treated. An elderly relative got moved to a "high care" dementia facility and was clearly and obviously in nappies when I next saw her, as was every other patient I could see at the place.  They weren't subtle ones and a kind of "nappy cart" did laps of the private rooms with a nurses aide.  I'm certain SOME were IC but it seemed highly unlikely that 100% were on arrival but that seemed to be the default management plan (along with beds with rails to prevent egress). 

21 hours ago, Clr224 said:

I would have to disagree with that statement.  Inmates with mobility difficulties are diapered because the staff can’t respond to their needs fast enough to avoid accidents.  My father had no continence issues before he had to go to a rehab facility after heart surgery. He was diapered on arrival and pretty much ended up using them the entire time he was there. 

Yes.   It really wasn't a bad place in many respects given the limits of a dementia facility but I got the distinct impression they just found it easier to deal with nappy changes than trying to toilet 100 geriatrics with varying mobility but unvarying dementia:  at a purely practical level, they were probably right but would have been tough for some of the less-progressed patients, at least until they got habituated to it.

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All the dementia residents at the nursing home I work do wear nappies but not all the residents in the rest of the facility do but yes most of them do.

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I have read horror stories how caregivers will just let their elderly patients wet their diapers and leave them in it. The family members were not happy about it when they found that out or when an employee there saw it and didn't like how lazy their co workers were. "Oh he has a diaper on, he can just pee in it." I guess this is an example of elder abuse. People are against diapers but yet have no problem making the elderly and the handicapped using them.  Talk about hypocrisy. 

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5 hours ago, Nat said:

I have read horror stories how caregivers will just let their elderly patients wet their diapers and leave them in it. The family members were not happy about it when they found that out or when an employee there saw it and didn't like how lazy their co workers were. "Oh he has a diaper on, he can just pee in it." I guess this is an example of elder abuse. People are against diapers but yet have no problem making the elderly and the handicapped using them.  Talk about hypocrisy. 

The home my mother was in encouraged residents to wear and use nappies.

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We actually covered this in my human physiology course. Like Betty said it's not an either or thing, your muscles and nervous system are programmable this makes evolutionary sense where adaptability = survivability.  This includes the ability to train our urinary sphincter to void or hold as need based on environmental and internal demands.

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3 hours ago, YourFNF said:

We actually covered this in my human physiology course. Like Betty said it's not an either or thing, your muscles and nervous system are programmable this makes evolutionary sense where adaptability = survivability.  This includes the ability to train our urinary sphincter to void or hold as need based on environmental and internal demands.

Yes, kind of.  The point I was trying to make is that I think there is a physiological dimension to “learned” incontinence.  It had been said to me by a few that acquired diaper dependency is 100% psychological but by observing myself carefully, there appear to be early signs of physical change that could, over the course of time, render the psychological dimension to this somewhat secondary.  I suspect that various atrophies would of themselves over time, render the “decision” to use a diaper instead of a toilet somewhat irrelevant as it would have already happened.  In this scenario, the mind leads and the body (eventually) follows, discarding the capacity for control. 

As an observational aside, those early physical changes I can see in my own body look a lot like DHIC (from my lay person's perspective) and I further wondered about any link between the high frequency of DHIC in nursing homes and habitual diaper use.

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  • 2 weeks later...

For what its worth when i became incontinent it started as bedwetting and spontaneous large accidental voids .
My Urologist worked me up and determined it was neurogenic bladder and bowel ,with other things complicating , catheters & diapers was the treatment of choice ,however he did have to warn me , that any control I did have would erode over time , there is no avoiding it ,it will happen sure as the sun rises and sets ,you don't actually plan it ,it does that on its own .If you want it to happen it probably will happen faster ,versus a person who struggles against it and is miserable over it .

I am on a doctor supervised campaign to shrink and atrophy my bladder ,he doesn't want high pressure high volume diaper death voids ,at this point I leak little amounts constantly and if off schedule on cathing or drinking alot ,i will kill a diaper with a flood .
Once my bladder is "incompetent" so its maximum capacity is 50 to 100ML before it cuts loose is his goal(as in 50 to 100 is maximum flood ) basicly not ehough to even need a surge pad ,he doesn't worry about the low pressure constant leaking.

So as our wonderfull moderator said there is no psychological or physiological incontinence difference it's one thing incontinence .

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Ozl,

this might be new for you, but continence (bladder and bowel control) is a learned response and not biological design. As a result, the DHIC that is being referred to occurs due to the body reverting to the autonomic behaviour. In simple terms, the bladder is in a constant state of filling. The internal bladder sphincter muscle, via nerve signals (urine in the bladder), would relax and the external sphincter muscle follow suite. However,  signal is sent from the brain to disrupt this behaviour. As more urine enters the bladder, the signals get stronger to relax sphincters. The 'disruption signal' still can stop this until the bladder becomes distended and forces the sphincters to open. Bowels work in similar way.

In this, the 'disruption signal' is a learnt event. A baby has not learnt this and will void autonomically. ABDLs can suppress / forget this and regress to the infantile process of voiding. Similar occurs to people in diapers 24/7/365.

In relation to nursing homes and the diaper usage, it is a matter of costs / safety and insurance liability. If a frail patient is kept immobile (in a chair / bed etc), the chance of them self injuring is reduced. As a result, the insurance companies do not have to pay out huge costs for hip replacement / fracture surgery. Diapers are cheaper. Secondly, with less mobile patients, the staff to patient ratio can be increased - change them every 3-4 hours (15mins) rather than spend 25-30 mins taking them to the bathroom every hour two = more efficent use of staff time. As a result, placing every patient in diapers increases the profit margin for the operators of nursing homes / care centers, and reduces the staff count.

To answer the question physiological or psychological, it is both. Mentally, one wearing diapers will adapt / forget to control ones sphincters - since they are wearing diapers and will not be using a bathroom. Physically, the bladder and/or bowel will shrink and the body will stop producing vasprossen. Also, the sphincters will be in a constant state of relaxation. 

The result is that the bladder and bowels stop retaining and one will wet and mess as soon as any content enters their bladder / bowels. Since this is the new normal, the person will accept this and not notice if they need to void or if they are wet and/or messy since they will be both almost constantly.

Under the above situation, it is not unusual for the person to mentally regress. There are cases where some patients in nursing homes have learnt dementia either from their treatment at the nursing home or from their treatment by a career (usually a son/daughter) prior to being enrolled in a nursing home.

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11 hours ago, babykeiff said:

Ozl,

this might be new for you, but continence (bladder and bowel control) is a learned response and not biological design. As a result, the DHIC that is being referred to occurs due to the body reverting to the autonomic behaviour. In simple terms, the bladder is in a constant state of filling.

Babykeiff that's actually the line of reason I was following.  My thought bubble (no science behind it at all, just connecting dots on disparate pieces of information) is that DHIC might be pathologising what is effectively a learned (or should that be *unlearned*) behaviour.  If you look at the amount of academic work that's gone into trying to understand the cause of DHIC (primarily, it seems by using urodynamics to map out what the stable looks like after the horse has bolted), that would be ironically amusing.

I've been reading WAY too much urology (along with other stuff to help me actually read urology and get some of it) but I'm acutely aware that I may lack important contextual insight to what I am reading so I don't want anybody to take my pontificating too seriously ?

 

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For medical science to admit that DHIC is caused by the act/omission of nursing care would be the medical field admitting liability to their own actions. This, they do not do. As a result, they publish that nobody knows why DHIC  occurs.

This 'trained incontinence' is well known and avoided by the medical industry. It is one of the reasons that this industry will attempt everything else (external electronic sphincter / leg bags etc) other than diapers for the 4-60+ demographic. Most of the world accept that some people are incontinent, and also accept diapers / pull-ups as a form of protection. The medical industry does not. They are still of the belief that diapers are for babies (birth to 2, at a push, 3) and the elderly (60+), and that everyone else should use a bathroom, including the medically stated incontinent - ie it is a problem that needs to be fixed first.

We in the ABDL world are aware of the situation that suits diapers (constant dribbling / small bladder & bowel / zero retention). In this, we can wear thin diapers/pull-ups and change more often, and thicker diapers overnight.

Pull-ups / thin diapers under clothes can easily be hidden, while bulky diapers / leg bags etc tend to be visible by outline.

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Not all residents in nursing homes are diapered, it’s only the ones that either have dementia or who are medically incontinent. Yes I work in a nursing home. 

In the nursing home do the use Foley catheter??????


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In some homes, usually the ones that do not provide overnight care, indwelling catheter and enema process is used in the morning on all the patients, and same are placed in pull-ups. This is to eliminate the need of the staff to change messy diapers and only have to change wet pull-ups as needed. In over night places, full diapers are used and changed after meals etc. Then, the patients are either kept in bed / strapped in a chair / wheel-chair to remove the mobility.

BTW, in case people here get the wrong opinion... the forced infantalisation of a human being for the gain of another goes totally against everything I stand for. All human beings are born free and equal in dignity and rights. All human beings - not some, not most, but all. No one gets to decide who is entitled to human rights and who is not.

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Foley catheters are used occasionally for managing an acute medical condition that justifies the risk, about 3 years ago it became federal law that since 98% of all hospital related aquirred infection are due to foley ,you better have a damn good reason for using it ,CMS will not reimburse for any medical cost or care hours needed due to staff screw up ,therefor if a foley is used indiscriminately a and there's any problem it creates the nursing home or hospital has to pay for it ,it can't be passed on to customer,patient ,insurance etc.

Very few medical conditions require precise knowledge of a patients input and output ,as an example I had a cardiac arrest and coma in 2013 ,i was foleyed well in the coma but once i came out it and was oriented the nurse wanted to remove it ,i told her "why make extra work for yourself ,i am IC,it will be easier on you to leave it in ,screw the law " even if i was right ,in the eyes of the law that would be wrong .i self cath 4 X's a day ,and can count on 1 hand the number of infections i have had ,in this particular case i got an infection from the foley .

Hospitals and nursing homes may look "clean" but they are filthy petri dishes ,by there very nature . 

 

So they can and will be used as any intervention would be ,but the risks of harm must be weighed against what benefit the patient will achieve ,and how much money the hone or hospital is willing to lose should any adverse result happen . 

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  • 2 weeks later...
On 5/26/2019 at 5:38 AM, Cruiser 03 said:

I am on a doctor supervised campaign to shrink and atrophy my bladder ,

 

What exactly must you do to accomplish this objective.

Willing to share ?

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What exactly must you do to accomplish this objective.
Willing to share ?
I CIC(Clean Intermitent Catheter) 5 X's a day,every 4 hours well awake and immediately before I change into my overnight diaper , i am a mixed bag ,thought I leak all the time mr.bladder is never really empty ,so I have floods as well. My Urologist wants me to have an "incompetent bladder" so that even a full on flood will only be 50-100 ML at max ,because that's how big he wants my tank(bladder) to be as far as urine storage capacity , at that point my bladder is no longer a diaper killer ,I can kill any lesser diapers on the market in one void if I am not emptying via catheter. I use a Coloplas t 16-18 FR Coude hydrophilic catheter ,unless my prostate gets wonky ,and shuts me down ,if so I go to a Coude Indwelling for a couple of weeks ,and dont take it out until the morning he's going to scope me ,he likes some urine in the tank makes scoping easier ,if my prostate is still being an idiot, we go right back to foley ,I do take Flowmax it keeps the prostate down to a "dull roar" (shrinks prostate relaxes bladder neck) .

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  • 2 weeks later...
On 5/5/2019 at 2:16 PM, Bettypooh said:

Physiological or psychological the effects are the same, and there are physical changes that come with not wanting and not having control which help you move along that path. What you end up with is your body no longer storing urine, but releasing it as it gets produced or something very close to that. Most of continence is simply a learned habit of long-time practice. As such it can also be un-learned or otherwise altered. Incontinence is the more natural state; we all began that way and would have continued had that been possible or more practical. Unless trained to do otherwise the body will choose the most efficient process to maintain life, so once you un-learn continence your body will lose the no-longer-needed processes which allowed retention. No point in it wasting energy so it won't.

All that the body really needs is for the kidneys to produce urine and to have it drain and not build up inside of them- the sphincters, detrussor, and even the bladder itself are unnecessary. The anus could simply be at the end of the intestines without a bowel and it's sphincter and there would be no loss to the body directly; in fact it would be more efficient that way as long as the processed body output didn't create another more adverse effect. All that would become like our tonsils and appendix- body parts which no longer perform a needed function but we've still got anyway. That's where the physiological and psychological meet for those who have desired incontinence: the no-longer-needed parts are still there but now do nothing. And the longer that they do nothing the more they try to maintain that more efficient state of being. Bladder elasticity and muscle tone fade away from disuse, possibly to the point of permanent atrophy where recovery to their former state becomes impossible.

I've always had nerve-related bladder continence problems with my detrussor being spastic in nature and my internal sphincter unreliable for retention. The only path to dryness I had was to consciously and constantly hold my external sphincter closed whenever there might be leakage, and eventually it being continuously overworked wore it out to where it no longer holds for more than 15 seconds no matter how hard I try. My bladder still spasms sometimes but nothing like it used to; now it's a rarity versus being a normal state. I have to consciously will my detrussor into squeezing when I'm using the toilet to save on diapers. My internal sphincter is the same as always- no telling what it's going to do whether holding or releasing but it too seems more relaxed than ever. My bladder has shrunk or lost elasticity to the point that at best I can hold maybe 200mL and that takes much conscious effort on my part plus relies on my extrnal sphincter holding which it might not do. I usually get this in the mornings when I'm drinking coffee and sitting at the computer but it can be an all-day process sometimes; no rhyme or reason for it's erratic behavior that I can find. Maybe 3 or 4 times a year I'll have an unbelievably wet day where I pass at least 2 or 3 gallons of urine even if I've not drank much fluids beforehand. I also have days where I drink huge amounts of fluid but pass almost nothing. No side-effects from any of this; my body is doing what it needs to be doing I guess so I just let it. It knows what it needs to do and it does it without any interference on my part. I can choose to be conscious of the events or to ignore them. Sometimes I enjoy knowing I'm wetting but usually I just discover that I'm wetter than the last time I thought about it. I've consciously chosen to not bother with attempts at continence, my subconscious mind has eventually followed along, and my physical body has followed that with what are probably permanent changes aimed at best body efficiency. I'm happier not having to work at bladder control and I enjoy being wet and the freedom from worry which diapers give me. This is positively the best state of being for me but YMMV- to each theoir own!

Bettypooh ive just been diagnosed with urge urinary incontinence and im hoping not losing bowel control because yesterday i was doing dishes and i pooped my pants and today i was getting dressed and farted and had slight leakage and ran to the bathroom just in time before diarrhea came rushing out in one swift stroke

 

 

 

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