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Everyone in the waiting room jolted from the sound of the door opening. A woman with red hair and glasses appeared in the doorway.

"Ms. Finely?” The woman spoke to the group of strangers sitting together. Madison looked up from her phone at Dr. Elion. She nodded then stood up from her chair.

“Yep, that’s me.” Madison acknowledged, locking her phone then placing it in her pocket.

“It’s great to meet you, I’m Dr. Elion.” She greeted. Madison’s eyes shot to the white and brown name plates next to the door.

‘DR. CAROL ELION, UROLOGIST’

She winced in embarrassment. Madison felt the doctor announced to everyone what she was there for. Madison moved quickly through the door threshold, then followed behind Dr. Elion. The two navigated through the hallways. It smelled clean, like an assistant had just vacuumed and sprayed fresh linen scent. Vague water paintings hung on the walls, depicting scenes of warm beaches. Dr. Elion stopped at an open examination room door. She directed Madison into it then followed behind. The door slid shut.

“Well good morning Ms. Finely. I read the report your primary care physician sent me. I got a brief snapshot of your medical history, but if you don’t mind, I’m going to ask some additional questions here to get a better picture of what’s happening.” Dr. Elion said.

“You can call me, Madison. And yes absolutely.” She said, Madison shifted her weight on the plushy examination table. She felt uneasy from the examination room walls.

“Have you or your family ever had a history of bladder issues in the past?” Dr. Elion asked clearly.

“No.” Madison said affirmatively. Dr. Elion looked up from her iPad.

“Nothing? Your grandparents never developed incontinent symptoms?” Dr. Elion followed-up.

“No, absolutely not. Not that I know of at least. I mean I wasn’t too close to my grandparents.” She said.

“Hm, okay…” Dr. Elion said, she added a note to Madison’s records.

“Um, Dr. Elion?” Madison said, feeling suddenly the need to fully explain herself. Dr. Elion looked back up and smiled.

“Yes?” She said sincerely.

“Look, you don’t think there’s anything seriously wrong with me, do you? I’m not an old person that pees themself. I’m thirty-two years old. Nobody around me has these issues. The only logical explanation I can think of is I have a bladder infection, but I wash myself and my apartment religiously.”

"I wouldn't assume so either. Any logical bacterial infection would present symptoms of pain in your Urethra. I'm still going to order blood work on you just to make sure we're not missing anything. Once in a blue moon we find something.” Dr. Elion said. The conversation paused. Madison watched her tap boxes on the screen.

"When did you start noticing these symptoms?" Dr. Elion asked analytically.

"Well what do you mean? Like when did I start feeling different? Or when did I start having accidents?" Madison asked meekly. Although her tone still had an adult composure to it.

"Oh, you're experiencing daytime incidents?" Dr. Elion said concerned. Madison grimaced.

“How many daytime incidents have you had?"

"Well, it's complicated? I haven't had many big full-blown accidents. I’d categorize that as an accident where I have a full bladder, and everything comes out at once. I guess I’ve had…. Three? Sorta three and a half, full bladder accidents. The first one I had was about seven months ago. I was at work and I don’t know, it was just the perfect storm that day. I couldn’t reach the bathroom before a meeting and I ended up wetting myself in front of the CEO.” Dr. Elion stopped writing.

“Wow, that’s horrible. I’m so sorry that happened to you.” Dr. Elion said, her sympathies were accepted.

“It was, I ended up leaving that job because of it. Nobody looked at me the same ever again. I was doing fine for a while but then I had another accident about six weeks ago.” Madison said, pausing for Dr. Elion to catch up in her notes.

“That time I was in my car. I knew it was going to happen too. I drank too much water before leaving the house. I thought I could last the hour and a half car ride, but I mistimed it. It got everywhere in the seat. I had to cancel plans with my friends because of it. I ended up going back home instead.” She said, waiting longer this time for Dr. Elion to ready again.

“But the last time was about three weeks ago. It’s what made me finally call the doctor. I was at my friend’s house playing boardgames. I held out for too long trying to get to the end of the game. I managed to only dribble a little on my way to the bathroom, so they couldn’t tell I was wetting, but I was basically done peeing by the time I got my pants down. It was so embarrassing. That was kind of a wake-up call. I peed maybe, if I had to put a number on it… around a cup? No, not that much. A little less. Well I guess it wasn’t entirely my maximum bladder capacity… That’s certainly more than a cup. I don’t know it was a normal accident amount. I had to wrap a towel around my waist. I told them I had to get something from outside. They knew. They joke about me being the weak bladder girl during parties all the time. I couldn’t stop crying in the car, so I just left.”

“Mm.” Dr. Elion hummed. She checked more boxes and circled portions of her notes. She spoke up.

"Okay I-" Dr. Elion said.

"Dr. Elion look I-" Madison said, they both stopped, not wanting to talk over one another. Dr. Elion broke the awkward silence.

"Call me, Carol." She said, then pointed at Madison for her to continue.

"Sorry, Carol. This sounds like something you can fix right? I'm weirded out by it if I'm being honest. I've never had bladder problems in my entire life. Nobody gets problems like this until they're 80. Do you think it's an infection? Something I could regulate with medicine?" Madison pleaded. Dr. Elion sighed then crossed her arms around her iPad. She leaned back up against the countertop.

"Madison, there are numerous ways one’s bladder can start experiencing incontinent issues during any stage of life. Numerous adults develop some level of incontinence as they age. There is a misconception that the only way young adults develop incontinence is through infection. That only makes up a small percentage of the incontinent population. In fact, the most common is phycological. Incontinence can, and often is, critically linked to neurological and mental conditionings." She said.

"Mental... Conditionings?"

"Yes, you can mentally develop incontinence. Another misconception is the only way to develop neurological issues is via hard impacts or concussions. That’s not the case. We have the strongest influence on our plastic brains. Getting yourself into habits that are detrimental to your bladder control can happen. This starts to blend into the realm of phycological therapy, which I am not qualified to treat you with. However, I have seen patients your age develop incontinence this way.”

“Is… Is that what…. You think I’m doing?” Madison asked. Her heart and hopes sank into darkness. Her mind held onto her every word.

“I’m saying that this could be a possible reason. From what you’ve told me, if it’s just these isolated incidents, then I wouldn’t jump to any conclusions yet. Overall, I’m just concerned with figuring out how to best help your condition. Is there any more problems or incidents you can think of? The more you tell me the better picture I have.” Dr. Elion said, she sounded systematic in her approach.

“Your condition….” Floated in Madison’s head.

“Well um, I guess I do dribble in my pants a lot. My bladder gets full easily, especially if I’m drinking all day. I’ve had to cut down on my coffee and fluid intake in general. If I stretch out my bladder for too long my underwear will get wet from the dribbles. That’s when I know I have to go to the bathroom. I’ve ruined some of my favorite leggings recently with pee stains. I don’t want to have an accident, plus it’s just annoying when your bladder feels full all the time. So, a lot of the time I’ll just go around every half hour, so I don’t have to feel uncomfortable anymore.” Madison confessed.

“So, you’re urinating between fifteen to twenty times a day?” Dr. Elion asked.

“Give or take yeah… Well, and the couple times I go at night.” Madison added. That last part sparked her full attention again.

“Have there been any incidents at night?” Dr. Elion asked, looking straight into her eyes.

Madison felt her cheeks flush a warm deep red. She broke eye contact and instead stared down at where the floor meets the wall. She saw two Blue Tang fish stickers.

“Yes.” She admitted.

“How many have you had?” Dr. Elion asked. Madison felt frustration from having all her recent insecurities laid out and analyzed. She pulled back from being completely descriptive and tried painting her problems in a positive light.

“They’re not that bad. I could control it better at night if I wanted to. I’ve only wet the bed a couple times. All of them I was awake for at some point. Part of it was because I peed in my dream. I have no time to react because I’m already peeing by the time I wake up. It’s frustrating and annoying. The last one I had I was still really sleepy, and I ended up falling back asleep while waiting for it to stop. The first time I wet the bed was about two months ago. I think I did again three days later, but I’ve only had two bed wetting accidents since then. It does make it hard to fall asleep sometimes. I’m nervous about staying dry. I haven’t stayed at any friend’s house lately because of it.” Madison explained, not totally sure if that was too much information. Dr. Elion didn’t appear to react negatively or positively to anything Madison was saying. It was confusing to know what information she needed most.

All this talk about peeing made Madison hyper-focus on the growing levels in her bladder. Her sphincter spiked in pain. It was sudden and caused Madison to perk up from her slouched position. She subconsciously crossed her feet together. Desperation fluttered in her chest. Her toes curled from the intensity. Her mind frantically visualized how this situation could go.

“Should I just go??” She thought, she imagined herself peeing right in front of Dr. Elion. She would be shocked. Or would she? Was it common for her patients to pee themselves on the examination table? It’s certainly happened before. Did she almost expect Madison to do it? For a split second, that made Madison almost consider just going. It would be a good demonstration of her problem.

“No what the hell am I thinking!?” She thought, shaking away those ideas. Instead she decided the best option now was to go to the bathroom. But she didn’t have time to push off the table before Dr. Elion continued.

“I think what we’re going to do is schedule another visit. I’m seeing a huge influx in patients right now because of COVID, but I think we can try to get you in here within the next month. In the meantime, I’ll look at your test results when they come back. If we find anything, I’ll give you a call to start you on a round of antibiotics. Until then I want you to write down and catalog any accidents you have. This will give me a better idea of how frequent you’re urinating, and the overall control of your bladder.” Dr. Elion said, she took a breath and collected herself. Her demeanor grew more serious.

“This is never an easy conversation.” She started. Madison’s felt like she was sinking. She knew what was about to come next. The pain in her bloated bladder only made it feel worse. Like she needed this talk.

“You may want to consider incontinent protection. This doesn’t have to be a twenty-four seven commitment. For now, when you are away from a bathroom for extended periods of time. I would recommend you wear protection to assure yourself.” Dr Elion expressed; she knew how hard it was to say this to someone. Madison took it as well as she could.

“You’re recommending I wear diapers?” Madison said, it didn’t hit her until she said it. Her mind rejected the idea vehemently. “That’s not fair, I thought the whole point of this was, so I didn’t have to wear them! Why can’t we just start medication? Why wait?” Madison said, coming off as desperate. At the surface she tried to convince herself, but deep down she knew. The mountain of evidence she just spilled didn’t help her case.

“I am not saying that you are diaper dependent. Let’s make sure that clear between us. Although, it is undeniable that you are beginning to experience bouts of incontinence in your daily and sleeping life. We need to work together here to figure out what exactly is causing that. Making a knee jerk decision now might actually cause more harm than good down the line.” Dr. Elion said directly to Madison. She was rehearsed in delivering bad news. She collected herself then finished.

“What I will say Ms. Finley.” She said, pausing to make sure Madison looked her in the eyes, “Intense phycological trauma can manifest itself in many ways. You have been through a lot in the past seven months. Make sure that you are dealing with that in a healthy way. It may be discomforting but prolonged releasing of empty or partially full bladders can lead to incontinence. It’s a tough pill to swallow, believe me I know. I don’t think any less of you, this happens to plenty of people. Right now, though, that’s what I think is going on here. Practice holding it while you are in a safe environment like at home. Continue that practice in public, but I suggest protection just in case.” Dr. Elion finished. She understood how hard this was for Madison. It was clear on her face this was a devastating blow. They didn’t exchange words for a few seconds. Madison broke the silence. Another shocking round of pain demanded it.

“Well thank you, Dr. Elion. I really appreciate your time. I’ll certainly do that.” Madison lied. She felt disheveled. She wished there were a window so she could quickly jump out of it.

“I don’t need diapers.” She thought, as Dr. Elion walked over to shake her hand.

“We’ll figure this out, Madison. I’ll do everything I can.” She said optimistically. The sentiment did nothing to quell her crushing forlorn. She just smiled and nodded.

The pressure in her bladder spiked to inches from the point of no return. Madison’s depression was replaced with critical urgency. She stood up from the examination table. Quickly she scuttled to the door. Dr. Elion shot a strange look, normally she was the one who decided when the examination was over.

“Thank you!” Madison said, desperately moving forward. She didn’t wait for a response. She opened the door and slipped through it the moment there was a crack. Her nostrils filled with fresh clean air. She pressed her thighs in between each other. It was the last line of defense she had before an accident. She managed to waddle down the hall back to entrance to the waiting room. With shaky hands she gripped the knob and turned.

“Ermf…” She muttered, feeling suddenly a dribble slip out. Her crotch warmed. Most of the people she waited with were still there. They all looked up at her. Madison felt intense fear and adrenaline sear her decision making. Her eyes flicked to the bathroom across the room.

“I’d rather have an accident in the car than in front of these people.” She thought, making the split second decision. She walked as fast as she could to the exit.

“Wait Ms. Finley! Would you like to set up your next appointment!?” The lady from behind the counter yelled.

“I’ll call you!!!” Madison yelled back. She pushed through the glass door and back outside. The cold air slapped her in the face. It contrasted the warm pee helplessly trickling out of Madison. She felt a line of pee cascade down her inner right thigh, down the calf, and into her shoe. At the same time, another line started rolling down the inside of her left thigh. Quickly, those lines started growing into thick rivers.

“Oooohh oooo!” Madison whined, opening her car door quickly then jumping into her front seat. She couldn’t stop it. There was no use at this point. Her bladder finished releasing the last of it. Madison didn’t even fight it. She let it flow out into her car seat.

“Ugh fucking christ. I piss myself AT the doctors!?!? Did anyone see?” Madison thought. She looked out from her windshield into the waiting room window. Only one old lady stared at her. She had a sad sympathetic look. She knew.

Madison looked back down, the trickle subsided to an end. She whiffed an intense scent of urine. Her mind connected a distant dot.

“This is why my car is starting to smell.” She thought. Her white seat cushion was becoming discolored from her accidents.

“I need to clean the pee stains out of my car seat.” She thought, adding it to the growing list of things she needed to clean her pee out of.

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