Bladder & Bowel Archive

Ask the doctors

Q. I am 89 years old, and several months ago I was plagued by frequent urinary tract infections. The infections were treated, but is there anything I can do to avoid experiencing this problem again?

A. Urinary tract infections, or UTIs, are common infections that can occur when urine pools in the bladder and bacteria start to grow. These infections can be more common in older women for several reasons, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, or difficulty with emptying the bladder completely. In addition, estrogen helps to maintain a healthy balance of bacteria in the vagina, which can protect against UTIs. But this natural protection may wane when estrogen levels drop after menopause. One of the best ways to prevent UTIs is to stay hydrated by drinking plenty of water. This flushes out potentially harmful bacteria before it can cause a problem. You'll know you are drinking enough if your urine looks clear or light yellow. Some other strategies include fully emptying your bladder when urinating, urinating after sexual intercourse, and wiping from front to back after using the toilet. Also talk to your doctor about replacing estrogen in the vagina with a cream, tablet, or vaginal insert. Your doctor may also want to examine you for pelvic organ prolapse.

Try simple measures first, like using a fiber supplement and treating underlying conditions.

Nobody wants to talk about or even imagine it. But loss of bowel control — known as fecal incontinence — is a problem for millions of adults in the United States, especially women.

"It becomes more common with age. It's socially isolating and takes away your dignity. You live in fear that you have stool in your pants and people can smell it. Some people won't even tell their doctors about it," says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

On call

Q. After I have a bowel movement I sometimes get quite weak and have to lie down until the feeling passes. Why does this happen and is it cause for concern?

A. The sensation you are describing is most likely due to a reflex called a "vasovagal reaction." Here's what I mean.

The most common prostate problem among men over age 50, this condition can cause embarrassing urination issues.

By age 60, half of all men will have an enlarged prostate, a condition also known as benign prostatic hyperplasia, or BPH. By age 85, the proportion reaches 90%.

While BPH does not increase your risk of getting prostate cancer or having sexual problems, it can affect quality of life, specifically by causing annoying and embarrassing urination problems.

Ask the doctors

Q. I was recently diagnosed with a prolapsed bladder. The doctor said it could be due to too much exercise. I've been exercising for more than 40 years and wonder if this is more likely to be age-related. Should people worry about exercise causing this problem?

A. When the bladder drops down from the pelvis and protrudes into the vagina, it's said to be prolapsed. This condition, known as cystocele, is uncomfortable and can also cause urinary problems.

Research we're watching

While cesarean delivery may mean longer recovery time after your baby is born, it may make it less likely that someday you'll need to cross your legs when you cough or sneeze.

A study in the Dec. 18, 2018, issue of JAMA found that women who delivered their first baby by cesarean had half the risk of developing stress urinary incontinence (which causes urine to leak when you cough or sneeze) or overactive bladder, compared with first-time moms who had a spontaneous vaginal birth.

Ask the doctors

 Image: © Stratol/Getty Images

Q. Sometimes I urinate normally, but often I have to wait for the stream to start, or it takes much longer to finish. It may even stop and start, so I have to sit on the toilet much longer than in the past. I do feel that I empty my bladder, but it takes a while. Is this normal?

A. Urinary problems after menopause are common and may be related to age-related hormonal shifts or may have a separate medical cause. For this reason, it's always best to visit your doctor to discuss the problem. Difficulty starting or maintaining a stream of urine may be caused by many factors, including a blockage, an infection, certain medications, or a nerve problem that's affecting your brain's ability to get signals to the bladder, among others. Your doctor will likely recommend tests to search for the underlying cause and to customize your treatment.

News briefs

Older women: Take note of two new screening guidelines. One is for cervical cancer screening. Recommendations from the U.S. Preventive Services Task Force, published online Aug. 21, 2018, by the Journal of the American Medical Association, suggest that many women ages 30 to 65 can now approach cervical cancer screening in several ways: they can get a cervical cytology (Pap) test every three years; a test for human papillomavirus (which causes most cervical cancer cases) every five years; or they can get a combination of both tests every five years. If you're older than 65, the USPSTF recommends against screening unless you haven't had adequate tests before or you're at high risk for cervical cancer. The other screening guidelines are for urinary incontinence. They come from the Women's Preventive Services Initiative and were published online Aug. 14, 2018, by Annals of Internal Medicine. The guidelines recommend that women get screened for incontinence yearly, regardless of age. "I completely agree with brief annual screening for urinary incontinence for women. A simple question can be used to screen for it, such as, 'Do you have any bothersome urinary incontinence or urinary leaking during the day or night?' If the incontinence is treated early, in some cases, it will not progress and the patient will be able to avoid more invasive, costly, risky, or time-consuming treatment options," says Dr. May Wakamatsu, vice chair of gynecology services at Harvard-affiliated Massachusetts General Hospital.

Ask the doctors

 Image: © scibak/Getty Images

Q. I just saw that the FDA issued a warning on vaginal laser procedures. Are these procedures dangerous?

A. More study of these laser procedures is needed to conclusively determine if they're safe and effective for vaginal conditions. If you're considering one of these procedures, have a detailed conversation with your doctor about traditional medical therapies as well as the pros and cons of laser treatments. The FDA issued a warning on July 30 about energy devices (laser therapy).

On call

 Image: © KEMPSKI/Getty Images

Q. What causes urinary tract infections and are men at risk for getting them?

A. Although urinary tract infections (UTIs) are more common in women, men can get them, too. They occur when bacteria build up somewhere along your urinary tract. In men, UTIs can develop in the urethra (the tube that runs from the opening at the tip of the penis to the bladder), the bladder, the prostate, or the kidney.