If you were a renowned urologist...

[cathdiap]

If you were a renowned urologist who had taken the Hippocratic Oath, would you perform surgery to make someone irreversibly incontinent at their request?

Multiple votes are allowed.

I wouldn't do it. It's almost impossible to predict whether that surgery would ultimately improve someone's life. I wouldn't want to risk ruining even one life.

 

[pantyman]

No. Especially in America. Lawsuit waiting to happen. But I would install stents. That way they could try incontinence without it being permanent.

[Guest]

Mainly for self-preservation reasons (ie. legal), I'd personally say no. I also wouldn't feel comfortable intentionally giving another person a disability, especially for something which isn't very well understood. 

That said, I've seen people draw parallels between this and gender-affirming surgeries before. In both cases, some people experience a deep form of body dysphoria which isn't resolved without physical change. If gender-affirming surgery is accepted as medically valid, couldn't the same reasoning be applied to people seeking incontinence surgery? 

Ethically, I think it could only be considered under some very strict conditions: (1) the patient has been thoroughly evaluated by a psychologist to rule out people with fetish-driven motivations; (2) there's evidence that denying surgery would cause greater harm, either in terms of mental health or due to self-harm; and (3) the person has already tried to live out that lifestyle non-surgically for a significant amount of time but still feels it's needed.

[BrownBobby]

17 minutes ago, Paddington said:

Ethically, I think it could only be considered under strict conditions: (1) the patient has been thoroughly evaluated by a psychologist to rule out people with fetish-driven motivations; (2) there's evidence that denying surgery would cause greater harm, either in terms of mental health or due to self-harm; and (3) the person has already tried to live out that lifestyle non-surgically for a significant amount of time but still feels it's a necessity.

 Considering this is the framework that multiple urologists used when working with me…I think you got the right answer here. I won’t fault anyone for not wanting the risk, but dang it’d be nice to have a framework instead of having to hack it together, for a willing surgeon to do an operation with reasonable assurance it’d improve their life and not lead to a lawsuit.

[Guest]

1 hour ago, BrownBobby said:

 I won’t fault anyone for not wanting the risk, but dang it’d be nice to have a framework instead of having to hack it together, for a willing surgeon to do an operation with reasonable assurance it’d improve their life and not lead to a lawsuit.

Yeah, true. If this is something that could genuinely improve someone's life, and if non-surgical options haven't helped, it feels like there should be a safer and more structured way to pursue surgery. I'm assuming there's little to no research or evidence base on incontinence dysphoria (because, well, this is so niche), which makes it very hard to build any kind of medical/legal framework around it though.

One caveat to what I've said is that I don't think this condition is very well understood, so it's possible there could be a way to address it without invasive surgery. That's not to invalidate your personal decision to seek surgery, but I just mean that the possibility of non-surgical (or other less invasive) options working probably shouldn't be ruled out (not that I think you have done this). For instance, maybe the pathway for people with dysphoria could be to gradually lose continence via reverse kegel training, or some other method, in a way which is more reversible and less risky.

[Guest]

This is kind of a tangent (sorry), but if surgeries like these became kosher, I wonder who would bear the healthcare costs, both for the surgery and long-term care/diapers. If we do accept that there is a legitimate healthcare need for the surgery, should tax-payers/insurers pay for what is technically still a self-inflicted disability? 

[Goerge]

I would do the surgery if it improves someones persons life. I know for me double incontinence would improve my life and satisfy the internal nagging I've experienced all my life that I'm not a whole person being continent. When I was younger I contemplated putting myself in serious danger doing DIY induced incontinence and I would of done anything to become double IC similar to people with BIID who have a internal strong desire to be an amputee and then goes to the train tracks to achieve this. I learned to live with this desire and just wear 24/7 and wet and mess at the slightest urge but it's not the same as complete and irreversible incontinence. 

[Goerge]

If I was to perform surgery to make somebody permanently and doubly incontinent I would ask the patient to live as an incontinent person 24/7 for at least a year before I commit to surgery. I think some people want instant gratification without dealing with the consequences of double incontinence. Surgery would be disastrous if one a purge they realise they have live rest of their lives dribbling pee 24/7 and passively messing their nappies without even realising it, in front of friends and family. For the rest of their life. I personally would love this. It dealing with double IC is hard at first until you get used to it and wearing  a nappy 24/7. You learn techniques along the way and it becomes much easier dealing with. Head first into IC would be difficult.

[oznl]

 

No never, too much risk the incontinence will harm the patient

I expect that this is what most practitioners would tell you.

 

Only if I didn't risk lawsuits

I expect that this is what most practitioners would be THINKING.

 

Only if I were paid exorbitant amounts of money. That prevents ill-considered decisions.

What strange place is this you hale from where exorbitant expenditure is an indicator of wise decisions 🤣

Only if I am 100% sure that the unfulfilled incontinence desire is more harmful to the patient

This is the option I voted for since it seems to over-ride the "too much risk" clause of option #1

 

Always. No one would ask for incontinence without a very good reason.

Again, touching faith in the wisdom of humanity 🤣

15 hours ago, Paddington said:

Ethically, I think it could only be considered under some very strict conditions: (1) the patient has been thoroughly evaluated by a psychologist to rule out people with fetish-driven motivations; (2) there's evidence that denying surgery would cause greater harm, either in terms of mental health or due to self-harm; and (3) the person has already tried to live out that lifestyle non-surgically for a significant amount of time but still feels it's needed.

In my book, the principle of bodily autonomy should count for something here but I agree, some kind of evaluation to make sure that this is truly what is wanted.  I would have thought making folk live with a stent for 6 months or more might be a good way of sorting out the signal from the noise.

 

12 hours ago, Paddington said:

This is kind of a tangent (sorry), but if surgeries like these became kosher, I wonder who would bear the healthcare costs, both for the surgery and long-term care/diapers. If we do accept that there is a legitimate healthcare need for the surgery, should tax-payers/insurers pay for what is technically still a self-inflicted disability? 

I guess SRS would be a possible template: in my jurisdiction it is considered similar to cosmetic surgery.  It's totally legal and obtainable but it will cost.

The long term care question is slightly trickier.  I agree that this cohort should not be consuming resources earmarked for disability support but there needs to be some latitude to accomodate the reality that with ageing, many of us will end up in diapers and whatever supports are available to people in those circumstances should not be denied.  I agree that asking the taxpayer to fund your stash of "Little Mermaids" is ethically out of the question.

There's also the thought experiment of where do we stop if we start blocking support entitlements from patients where we consider their needs to be self-inflicted.  Smokers?

I'm not sure I have an answer here but it seems far from black and white.

[BrownBobby]

14 hours ago, Paddington said:

One caveat to what I've said is that I don't think this condition is very well understood, so it's possible there could be a way to address it without invasive surgery. That's not to invalidate your personal decision to seek surgery, but I just mean that the possibility of non-surgical (or other less invasive) options working probably shouldn't be ruled out (not that I think you have done this). For instance, maybe the pathway for people with dysphoria could be to gradually lose continence via reverse kegel training, or some other method, in a way which is more reversible and less risky.

Oh, if you only knew the methods I tried first. I’m probably one of the experts in the field of purposely inducing and developing incontinence with all I exhausted. Ten years of 24/7 diapers. Hypnosis. Behavioral training. Catheters. Physical therapy. Standard mental health therapy. Trauma processing. Prescribed meds. Illegally sourced meds (note: don’t do this one - the ER trip was not fun, and what led to me starting to find urologists seriously.)

This is why this question is especially one that I have trouble with people asking. It’s easy to “armchair diagnose” about what other options there are and conclude it isn’t necessary. But gods, the weight off my shoulders when I sat up a week after my revision surgery and just…wet myself. It was divine. Nothing else even came close to that level of satisfying that maddening compulsion and desire. If the cost of my mental health and satisfaction is a one-way ticket to wet pants for the rest of my life, gods am I glad I paid it.

[cathdiap]

4 hours ago, oznl said:

Only if I am 100% sure that the unfulfilled incontinence desire is more harmful to the patient

 

This is the option I voted for since it seems to over-ride the "too much risk" clause of option #1

Thank you for voting.

The question behind the two options you mentioned is whether a surgeon can ever be 100% sure that the patient knows what it will be like to be irreversibly incontinent and whether it will improve his quality of life overall.

Take me, for example. I know exactly what the surgery's outcome will be and how it will feel. From what I've learned from Reddy and Brownbobby, my stent mimics the absence of sphincter muscles after surgery almost 100%.

What I don't know, however, is how big the impact on my well-being would be if I couldn't reverse the incontinence if I wanted to, or even needed to.

And I wonder who can say that with 100% certainty. Simply because no one knows what the future holds. What if you become homeless, or run out of money for diapers? What if you develop new interests that diapers are very inconvenient for? What if you fall in love with someone who can't accept your incontinence?

[Guest]

1 hour ago, BrownBobby said:

Oh, if you only knew the methods I tried first. I’m probably one of the experts in the field of purposely inducing and developing incontinence with all I exhausted. Ten years of 24/7 diapers. Hypnosis. Behavioral training. Catheters. Physical therapy. Standard mental health therapy. Trauma processing. Prescribed meds. Illegally sourced meds (note: don’t do this one - the ER trip was not fun, and what led to me starting to find urologists seriously.)

This is why this question is especially one that I have trouble with people asking. It’s easy to “armchair diagnose” about what other options there are and conclude it isn’t necessary. But gods, the weight off my shoulders when I sat up a week after my revision surgery and just…wet myself. It was divine. Nothing else even came close to that level of satisfying that maddening compulsion and desire. If the cost of my mental health and satisfaction is a one-way ticket to wet pants for the rest of my life, gods am I glad I paid it.

Fair enough - and thanks for sharing. Glad to hear you're feeling much happier now. 

I've seen some of your posts elsewhere, but I hadn't realised just how much personal experience you had with this. You may be one of the few people who does know enough about this to make that judgemen then.

If I were to revise my earlier post: incontinence dysphoria and other surgical/non-surgical options are areas which I personally don't understand well. So if I were a hypothetical urologist, I think I'd only feel comfortable offering that surgery after seeing more research on its outcomes and other potential treatments. But for someone like yourself, I respect thats been considered already over a long period of time. 

[ozziebee]

I am 30 years post-op transgendered.  The only time I thought I'd made a mistake was two days after the surgery, and only because I was wondering what my family would think when they would, eventually, hear the news.  When they did, they accepted me as me - though even now, my dad weirdly still has issues with calling me "him/he" before correcting himself.  None of the extended family gives a toss what happened way back then, and even if they did, it's their problem to deal with.  For me, water off a ducks back.

I therefore have a level of understanding of the mental, physical, and financial pain one may have with desires to become surgically incontinent, as I feel this is not much different to the desires and draw one has when they seek changing gender.  It's just that gender dysphoria is more recognised, and thus has defined pathways one can follow.  Even back then when being transgendered was very taboo in Australia, well before LGBT became a mainstream thing, and being open about it at work was supported!

There was _still_ a pathway one could follow.

But for the desire to become TPI?  No such pathway exists, without going underground.

Would I do it? 

...

(long pause as I even think about that question now, before I answer)

...

I have to admit, I've struggled with this desire to be incontinent, not because I wax and wane about wearing nappies 24/7 with all that such brings to the table, but purely because my brain says "it's a royal pain to get changed all the time, compared to just putting on knickers and going about one's day, flitter off to the toilet every ow and again when needed, then continue going about one's day".  Completely ignoring the pain in the butt of getting up multiple times at night to go to the toot...

Until one comes home from work, and realises that said knickers are a bit wet, and sometimes a bit feacally smeared, and brain says "wouldn't it be easier if one just wears nappies?"  Not to mention the internal turmoil and struggle one goes through trying to quiet the losing battle of the desire, whilst absolutely recognising that yes, it would more than likely just be easier if one just wears nappies.  

The end result, the answer to the question?  If I had a pathway where I could safely achieve surgical incontinence, I'd likely make enquiries and go down that path. 

So I'd love it if urologists would get on board and build such a pathway.  

 

[Wet Knight]

No, never.

As a lifelong bedwetter who knows the inconvenience, I'd say to the patient "If you have a perfect urinary system, be grateful.  Go home and just wet when YOU want to",

[Bonsai]

In an ideal world, it would be possible to sign a contract that fully protects the surgeon from any possible lawsuit. Then, the only thing that matters is how much you can trust the surgeon, that is, how good is his reputation.

As long as the choice responsability does not fully weight on the patient and the surgeon is forced to run unoavoidable legal risks, then it's better for him to always decline the request for surgery.