Balancing the desires to have MtF bottom surgery and to become incontinent.

[PokenerdMike]

To get the question out of the way, I'm wondering if a trans person (male to female), with bottom surgery, could realistically become incontinent.

To state the obvious, of course, after her surgery she could voluntarily lose control using the methods outlined here. And in a perfect world, no one would judge that.

Unfortunately, in the world we live in, would her plumbing be too closely monitored to become incontinent? If she started to lose control would doctors become suspicious?

I'm genuinely asking, because I don't know if doctors notice things like that at all. Or if they'd write it off as an unintended consequence of the surgery.

I'm asking because I think I'm trans. I'm pretty sure I'm trans. But I'm only just starting to accept it. I haven't worked everything out yet, but I'm pretty confident that I would want to have bottom surgery. That's a strong desire I've had for a while.

I've also had a strong desire to eventually become incontinent. I've always had an interest in diapers, and even as far back as middle school I had read the 12 month diaper training program at least a dozen times. (I'm 23 now) I remember because I had tried to print it off on my family computer. Then I chickened out and threw it in the shredder in the middle of the night. That was back when the guide would appear as a pdf in a simple google search.

Is it possible to have both? Surgery and incontinence? What would the logistics of that be? Would there be any consequences? Would doctors raise their brows with suspicion? Alternatively, can the surgery be performed on an incontinent person? Which should I do first?

Truth be told, I don't even know if there is an answer. This is such a small group within a small group, I'm sure only a handful of people have ever really questioned it. Hopefully you're here now.

[kasarberang]

So I am not trans, but I deal with doctors a lot.

I can't possibly see doctors doing anything in response to you being incontinent. You could probably do either one first and it wouldn't be a problem.

I can't imagine a doctor denying someone transition surgery because they were incontinent or responding negatively if someone became incontinent after transition surgery.

They may ask you some questions but in the end there's nothing of meaning they can do, especially if the surgery is already been performed. They can't reverse the surgery and they legally can't force you to do anything you don't want to do.

 

The only possibility I could see being an issue is if you went incontinent before the surgery, but that's simply because some places are very hard to get transitional surgery done where as others are easier. For example here in California I think you'd have a very hard time finding someone who would deny you that if you wanted it, but in someplace like Texas you might have a significantly more difficult time.

So the safest bet would probably be to do the surgery first, simply cause the doctors can't do anything about it at that point, after the surgery is done they can't make you do anything that you do not consent to.

 

I hope this was of some help to you.

[Elfy]

My wife is trans and post-op for a few years now.

After the surgery and a scheduled check-up a few months later there isn't any extra inspections or anything in that area. My wife had that one follow-up was told everything had healed properly and that she was cleared for sex and then that was it. She maintains the phone number for the hospital if any emergencies happen but by this point everything is healed and it has been years without a single issue. So if the thing holding you back is worry that your genitals will be examined constantly I can assure you that once you have left the hospital they won't be

I don't know if it's just my wife's experience or not but she has had a few UTIs since the surgery. People with female genetalia are more susceptable to them so it's probably just that rather than anything worrisome. The doctors haven't been concerned when she has seen them.

As far as I know incontinence is no barrier to having the surgery and vice versa so you could achieve your goals either way round. There is a small risk of incontinence because of the surgery but I believe it is very, very unlikely.

This is all experience in the UK btw. Things may be different elsewhere.

[PokenerdMike]

Thank you Kasarberang, that's a comforting perspective. 

 

21 hours ago, Elfy said:

My wife is trans and post-op for a few years now.

After the surgery and a scheduled check-up a few months later there isn't any extra inspections or anything in that area. My wife had that one follow-up was told everything had healed properly and that she was cleared for sex and then that was it. She maintains the phone number for the hospital if any emergencies happen but by this point everything is healed and it has been years without a single issue. So if the thing holding you back is worry that your genitals will be examined constantly I can assure you that once you have left the hospital they won't be

I don't know if it's just my wife's experience or not but she has had a few UTIs since the surgery. People with female genetalia are more susceptable to them so it's probably just that rather than anything worrisome. The doctors haven't been concerned when she has seen them.

As far as I know incontinence is no barrier to having the surgery and vice versa so you could achieve your goals either way round. There is a small risk of incontinence because of the surgery but I believe it is very, very unlikely.

This is all experience in the UK btw. Things may be different elsewhere.

I'd be worried that they'd be more concerned than usual if I started to inexplicably become incontinent. I fear that might provoke further research into the cause of my incontinence. That extra scrutiny might make it difficult to not only claim ignorance to how I'm losing control, but also make it difficult to to request diapers. My understanding is that diapers an unconventional solution. I'd imagine the extra scrutiny combined with me wanting to wear diapers would start to look suspicious in their eyes.

[lord.bill]

One thing I find a little confusing about this post is how the fear of scrutiny would "make it difficult to request diapers." Would you be looking for insurance coverage or something? I don't know why you would need to have a doctor approve you to wear diapers. I think that in many (a large minority) of cases of incontinence there is no definite cause found, though this would apply more to older people. There could be numerous issues with muscles or nerves that would be difficult to determine. I doubt doctors would do a major investigation unless you wanted one (they might refer you to a urologist, but you don't actually need to take that referral.) Even if they did run a bunch of tests, if they couldn't find anything I can't see a situation where they'd decide you must be faking it (maybe if you were suing someone for damages?) Unless you would somehow have a tangible monetary benefit from being diagnosed as incontinent, there'd be so reason to assume that its something you would want to fake. You could actually tell your doctor it's a choice, some people on here have done that. There are numerous threads on peoples' experiences with their doctors.

That being said, having bottom surgery would probably erase any suspicion they had. Bottom surgery differently has the potential to damage nerves related to urinary sensation and control. I know one trans woman whose control was impacted by surgery. I've heard that incontinence can happen, but I don't know much it's frequency or details because it's a bit taboo to talk about permanent complications particularly around continence, and most of the trans people I interact with are young and transmasculine.

I'm relatively certain that being incontinent would not impact your ability to get surgery. I'm sure the surgeons have seen it before, and I don't see how it would change the mechanics of the surgery,

Though this would be less relevant after surgery, a common testosterone blocker taken along with estrogen when testes are still present (spironolactone) is a diuretic so that could be used to explain problems with control.

It's worth considering what time frame you are thinking of for becoming incontinent. It sounds like you are just realizing you're trans. Good for you! However, many people are unaware of the process to actually get to surgery. Maybe you've looked into it already. Generally all insurances (if you insurance covers it) and most surgeons will require 12 months of continous hormone therapy and 12 months of continous "real life experience" (social transition.) Beginning hormones may be more or less difficult depending on your area of the country, and there's often a long wait time for surgeries. This means that surgery is likely years away. If you want to be incontinent sooner than that, you should keep that in mind.

There's actually an oddly high prevalence of trans women in the ABDL community, if that means anything to you.

TL;DR I don't know why you would request diapers from your doctor or why your doctor would be suspicious of your motives. Having bottom surgery would provide a potential, if rare, reason for incontinence. Being incontinent shouldn't prevent you from getting surgery.

 

[BlakeJordan]

The only thing I can think of that you may want to consider is hair removal for the surgical site. As this can often take a year or more and is typically required for the penile inversion technique, it might be worth getting that out of the way.

This typically involves electrolysis and/or laser hair removal. It is necessary with the penile inversion technique to reduce/eliminate hairs within the vaginal walls. Some surgeons offer follicle scraping instead of the above hair removal methods.

It’s also generally less of a risk/concern when any number of the non penile inversion techniques are used. Though currently the availability of surgeons in the US that offer these is somewhat limited as are long term outcomes.

[PokenerdMike]

On 7/19/2020 at 1:36 AM, lord.bill said:

One thing I find a little confusing about this post is how the fear of scrutiny would "make it difficult to request diapers." Would you be looking for insurance coverage or something?

@lord.bill

I wouldn't be looking for insurance coverage, I'm just trying to think long term I guess. Everyone has to visit a doctor eventually, and everyone has to visit the hospital eventually. Eventually they're going to find out, so for that reason I would want to be medically diagnosed as incontinent.

That way if they ever question me about it, I can say "I sought treatment 'X' number of years ago, we tried X, Y and Z with little luck. They speculate that it could be caused Y, it's not known yet though. For my own comfort I choose to wear protection, and I've adjusted to that pretty well."

I want a history, I guess, so I can say that I at least tried to prevent it. 

What scares me is the stories of other people who have gone to their doctors about this. My understanding is that they can be very meticulous to begin with. They'll send you to a urologist, try to diagnose you with a number of things, put you on medication and be stumped when that medication fails. People have also made it sound like they're very reluctant to recomend diapers. If I come out of the gate swinging, saying that I want to wear diapers, they'll be very suspicious of my motives. Nobody wants to wear diapers after all. 

In regards to surgery, I don't think urinary incontinence is a common symptom of SRS. I could be wrong though, but I think the doctor who performs my surgery would be very interested to learn about my sudden incontinence. It could reflect badly on them, so I'm fearful that they'll take extra steps to diagnose my incontinence and prevent it.

A portion of my lip went numb after I had my wisdom teeth removed, and I had appointments for months after the fact with the person who removed them. I was the only patient of his that this had happened to I guess, and he took an interest. I'd imagine it would be a similar, perhaps more rigorous process with the surgeon who performed my surgery.

@BlakeJordan

Thank you for the advice. I was kind of aware of that, though not %100. Thank you for breaking that down for me.