DEAR DR. DONOHUE: My doctor tells me I have uterine prolapse. The only symptoms I have are an occasional loss of urine and an occasional feeling of heaviness in the pelvis. Neither bothers me. The doctor wants me to have surgery. I don’t want it. Is it always necessary? – K.L.

ANSWER: The uterus sits in the pelvis, a bony, bowl-shaped structure just beneath the abdomen. The uterus is held in place by pelvic ligaments and muscles. Obesity, childbearing, age and chronic coughing weaken those support tissues, and the uterus falls downward. In extreme cases, it can fall through the vagina and protrude out of it. The downward descent of the uterus is prolapse.

Often, the uterus drags with it the urinary bladder and the rectum. Involvement of the bladder can lead to loss of control over the bladder and leakage of urine. Rectal involvement can make bowel movements difficult.

If a woman has no or slight symptoms, then she doesn’t have to rush to surgery.

If the uterus has fallen more, and there are symptoms like constant heaviness and urinary incontinence from time to time, a woman could choose a pessary. It’s a donut-shaped ring that fits over the cervix of the uterus to prop it up. Some women are quite happy with a pessary. For others it’s a troublesome device. It has to be removed every so often to keep vaginal tissues healthy, and sometimes the device just won’t stay in place.

For a uterus that has fallen through the vagina, surgery is the ultimate answer. If a woman is too old or too feeble for major surgery, the doctor can suture the vagina shut so the uterus doesn’t protrude.

DEAR DR. DONOHUE: On several occasions, my wife will say that food she has eaten only an hour ago has “gone right through her.” She states emphatically that undigested food or parts thereof are clearly visible in her stool. Is this normal? How long does it take for food to pass through the digestive system? – H.R.

ANSWER: Ordinarily, the stomach empties 50 percent of its solid food in two hours and 90 percent in four hours. Liquids, on the other hand, pass quickly through the stomach, in a matter of 10 minutes or so.

It takes food one or two hours to traverse the small intestine and 12 to 72 hours to pass through the colon, the large intestine.

About the fastest food makes it through the entire tract is 14 hours; the slowest, 72 hours.

One hour is really fast. Does she have diarrhea? That’s a different story.

If what your wife says is true, I don’t have an explanation for it.

DEAR DR. DONOHUE: On the sweetener I use, there’s a warning that says it should not be used by people with PKU. What is that? Is there a health threat here? – R.N.

ANSWER: PKU is phenylketonuria. It’s an illness where babies are born with a lack of an enzyme that degrades excessive amounts of the amino acid phenylalanine. Amino acids are the basic units of all proteins.

At birth, a baby who doesn’t have the enzyme appears quite normal and healthy. However, over a few months, the high blood levels of phenylalanine interfere with brain development and lead to retardation.

Some phenylalanine gets converted to phenylketone and is passed in the urine, hence the name phenylketonuria.

If the amino acid phenylalanine is removed from the diet, the child progresses normally. If it isn’t, in addition to slowing brain development, PKU can make infants chronically throw up their food and become overactive. They often have a musty odor.

Thanks to mass screening, PKU is almost always discovered soon after birth. The warning on the sweetener label doesn’t apply to you.

DEAR DR. DONOHUE: I wonder if breast-enhancement products – pills and creams – really work. Two friends have tried them with no results. Is there anything to do besides having surgery or wearing padded bras? – T.Y.

ANSWER: I would like to tell you otherwise, but I don’t know of anything other than surgery or padded bras that augments breast size.

DEAR DR. DONOHUE: I take Actonel for osteoporosis. My dentist says it leads to bone resorption. I also take Synthroid. What can I take in place of those two? – E.M.

ANSWER: You must have misunderstood your dentist. Actonel (risedronate) stops bone resorption, and it works well. People with osteoporosis are routinely put on one of the Actonel family of drugs.

Synthroid is thyroid hormone given to correct a sluggish thyroid gland. When it is taken in excess, it can weaken bones.

When taken in the correct dose, it does not do that. A blood test can tell you if you are taking too much or too little. You don’t need to make a change in either of your medicines.

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. Readers may also order health newsletters from www 1/

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