DEAR DR. DONOHUE: I noticed something sticking out of my vagina, so I made an urgent appointment to see my doctor. He said my bladder had dropped, and that ended my conversation with him. Shouldn’t something be done about it? – M.S.

ANSWER:
The bladder, uterus and rectum are close neighbors. They are the “pelvic” organs. Shared ligaments and muscles keep them propped up and in their normal position. Age and having children weaken those supports. So does heredity. Weak support tissues are a family affair, and it’s likely that your mother had a similar problem. All three of those organs, or each one individually, can drop into the vagina. It’s called pelvic organ prolapse. If only the bladder has fallen, the condition is a cystocele (SIS-tuh-seal); if it’s the rectum, a rectocele; if it’s the uterus, it’s uterine prolapse.

Symptoms that arise depend on which organ is most affected. The list includes loss of bladder control, difficulty with bowel movements, pain in the pelvic area and painful intercourse.

Something should be done, especially if you’re having any symptoms. See a gynecologist. If the organs haven’t fallen too far, pelvic floor muscle training can prevent them from falling farther. Those exercises consist in contracting the pelvic muscles, the ones you contract to hold urine or prevent the passage of gas. Ten to 20 10-second contractions of those muscles at least three times a day can shore up sagging muscles and dropping organs. It takes four to six weeks to see improvement. If organs have fallen too far and exercises aren’t the answer, a pessary might be your choice. Pessaries are devices inserted into the vagina to hold up pelvic organs. The ultimate solution to this common problem is surgery. A large number of surgical procedures have been devised, and the doctor can suggest which is best for your particular circumstances.

DEAR DR. DONOHUE: My 3-month-old baby is suffering terribly from prickly heat. I have been dusting her with baby powder, but that doesn’t seem to be helping. What else can I do? – N.P.

ANSWER:
Prickly heat is the result of obstructed sweat ducts. Sweat can’t reach the skin surface. Eventually the sweat ducts burst, and sweat infiltrates the skin and irritates it. The red rash of prickly heat pops up.

Dusting powders aren’t very effective. Cooling the baby is. An air conditioner cures prickly heat in fast order. Even a window air conditioner for the baby’s room would take care of matters. If air conditioning is out of the question, fans help. Frequent cool baths are another way to keep the baby comfortable and free of prickly heat.

DEAR DR. DONOHUE: I am 87. I have lived a full, happy life, and I am getting along well as far as health matters go. Ten years ago I had a quadruple bypass and a replacement of the aortic valve. My heart doctor died of a heart attack. Can you believe that? My new heart doctor wants me to take a stress test. Why? I am doing fine, and I refuse to have surgery again. I am keeping up my house all by myself without any trouble. I have no desire to live another 87 years. Do you think I need this test? – G.F.

ANSWER:
A doctor should order a test to make a diagnosis, to see if an illness is controlled or to make a change in a person’s treatment. Ask your doctor why he or she wants the test.

If the doctor can’t come up with a good reason, then I side with you.

If you tell your doctor exactly what you told me, you make a convincing statement that your wishes are not to upset the apple cart and that you are perfectly satisfied with the way things are. That should mean a great deal to the doctor and should influence recommendations about testing.

DEAR DR. DONOHUE: It appears that I am a prime candidate for a hip fracture. I am white, female, 84, 5 feet 3 inches tall and weigh 100 pounds. My mother sustained a hip fracture at 76. I am quite active and keep up my vitamin D and calcium intake. I don’t smoke. What else can I do? Can you explain why hip fractures are so often the cause of death when other immobilizing injuries and conditions are not? I have several elderly friends who have been wheelchair-bound for years, and they are in good health. What is the difference between hip fracture immobility and years of immobility for other reasons? – F.S.

ANSWER: In the United States, more than 250,000 hips are broken every year, and most of those breaks occur in older people. About one-quarter of people who break their hip die within a year of the break. Death doesn’t come from immobility. Thanks to the skill of orthopedic surgeons, most broken-hip patients are up and moving around a day or so after the operation. Mortality has to do with the age of these people and their related health problems. Many have serious illnesses, like heart, lung or kidney disease.

You do fit the profile for developing osteoporosis. You can ask your doctor for a bone density test to see if you would benefit from osteoporosis medicines. And you should get some daily exercise, like walking.

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.rbmamall.com.


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