DEAR DR. DONOHUE: I have had hemorrhoids for years. They have gotten so bad that I’ve decided to do something about them. I asked about infrared coagulation or laser surgery as alternatives to standard surgery. One doctor cautioned me to put off doing anything because of the possibility of ending up with permanent leakage of stool. I am so scared of stool leakage that I don’t know where to turn. How about the staple procedure? There are so many choices and I have so little guidance that I need your help. – P.W.

Hemorrhoids are rectal varicose veins. Their location, size and any associated symptoms dictate the best procedure for getting rid of them.

The staple procedure is one popular in Europe and gaining in popularity here as more doctors master the technique. A small device inserted into the rectum removes a circular swath of rectal lining and the underlying hemorrhoids. Then the device staples the cut edges together. The operation takes about 20 minutes, and healing is quite rapid.

Lasers, infrared light and electric current have been and still are used to obliterate the dilated veins. All have something that can be said in their favor.

Wrapping rubber bands at the base of the hemorrhoids cuts off their blood supply, and they wither and fall off within several days or weeks.

Fecal incontinence is a possibility with any of the above procedures. However, it rarely happens. The most common cause of women having fecal incontinence is the toll childbirth takes on rectal support and function. I don’t hear any women refusing to have children because of the possibility of fecal incontinence later in life. You should not drag your feet about correcting your hemorrhoids because of the remote chance of suffering loss of rectal control.

You live in a state blessed with many fine medical schools and famous hospitals. Call the surgery department of one of those institutions for the name of a surgeon who performs one of these procedures.

DEAR DR. DONOHUE: About three years ago my bladder started to protrude through my vagina. Some doctors recommend surgery, but others don’t. Should I go for surgery or not? – G.H.

When the supporting tissue that holds the bladder in place gives way, the bladder sinks and can sometimes protrude through the vaginal opening. Such a displaced bladder is a cystocele (SIS-toe-seal).

Cystoceles can cause a loss of urine control, an increase in the number of times a woman must visit the bathroom, an inability to completely empty the bladder and a painful irritation of the exposed bladder.

Kegel exercises can sometimes strengthen the bladder’s support and make surgery unnecessary. The exercises consist of stopping the urine flow in midstream to learn what muscles to contract. When a woman gains that knowledge, she can perform Kegel exercises throughout the day regardless of where she is. The degree to which your bladder has fallen makes Kegel exercises unlikely to be helpful.

Pessaries – doughnut-shaped plastic or silicone devices of many varieties – can be fitted snugly around the uterine cervix to hold pelvic organs in place. Again, with the condition you describe, a pessary is not the best solution.

The one to make the decision about surgery is you. If you have any of the unpleasant symptoms associated with a fallen bladder, then a date with a surgeon is my recommendation.

DEAR DR. DONOHUE: I saw your article about constipation. I am a victim of it. I contacted my druggist and a health-food clerk, but no one had heard of miller’s bran. Please tell me where to get it. – E.G.

I vow not to use “miller’s” in a discussion of bran for the rest of my life. It creates confusion.

Bran is the outer cover of grains. In our desire to eat refined foods, grains are milled to remove the bran. Millers do that job.

Forget the “miller” reference. Ask for bran. Every health-food store I have ever been in has a more-than-generous supply of it.

DEAR DR. DONOHUE: What makes mineral water mineral water? Does it have any health benefits? – R.C.

Minerals make mineral water mineral water. It has a high content of calcium, magnesium, potassium and sodium.

For centuries, people have bathed in mineral water as a cure for arthritis. It is also bottled for drinking. I can’t vouch for any claim that it has salubrious effects.

I am sure readers will let me know, and I’ll pass the information on to you.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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