DEAR DR. DONOHUE: I have to run to the bathroom all day long. If I don’t make it in time, I have an accident. This has made me so nervous that I have given up on all thoughts of a social life. It’s ruining my life. If we go to a restaurant, I must have a table near the restrooms, or I won’t sit down. What can be done? I’ll try anything. – P.G.

ANSWER:
Your condition is an overactive bladder. Sudden, inappropriate and forceful contractions of the bladder wall muscles make it imperative for you to rush to the bathroom or you lose control of urine. Such bladder muscle contractions shouldn’t occur until the bladder is full or nearly full. For some reason, your bladder reacts violently when it’s only partially full. Conditions like a bladder infection can be a cause. Often, however, muscle contractions take place without any cause ever being found. You have to see a doctor who can look for things that are easily treated, like an infection.

If no cause is discovered, then you can reprogram your bladder to not react like this when it’s only partially filled. For two days, time the intervals between bathroom visits. Add 5 minutes to the shortest interval and hold off on urinating for that time interval for a week. On week two, increase the interval by 15 minutes. Keep this up for a month, and then increase the interval by half an hour. Every two weeks, add another half hour to the interval between bathroom visits. When you reach three hours, you can stop.

You also can ask your doctor for prescription medicines that quiet bladder muscles. Detrol, Sanctura, Vesicare and Enablex are names of some of these medicines.

Another technique involves injecting the bladder muscles with Botox. Botox weakens the force of bladder muscle contractions and allows you to hold urine for more-normal intervals.

In extreme circumstances, a gynecologic urologist can advise you if a battery-operated device attached to the bladder is something you could consider. It stops frequent, unwanted and unneeded bladder contractions.

DEAR DR. DONOHUE: My biggest health problem, if you can call it a health problem, is getting to sleep at night. I lie in bed for what seems an eternity before I fall asleep. A friend told me she had the same problem and cured it with melatonin. I’d like to try it if it’s safe. Is it? I am 76 years old and would like a few years of good sleep. – T.R.

ANSWER:
Melatonin is a hormone secreted by the pineal gland, a small gland attached to the brain. It conditions the body to adapt to day-night cycles. Melatonin secretion is 10 times greater at night, with peak secretion occurring between 11 p.m. and 3 a.m.

Evidence suggests that this hormone shortens the time it takes to fall asleep and lengthens the time spent in uninterrupted sleep. Melatonin production wanes with age, and its lack could explain your sleep problems.

It also has been used for shift workers to get their brains and bodies conditioned to new sleep-wake cycles, and travelers sometimes take it to prevent jet lag.

Melatonin isn’t sold as a drug, so it’s not closely supervised. Serious side effects haven’t been reported. A safe starting dose is 0.2 mg to 0.3 mg.

DEAR DR. DONOHUE: What causes hangnails? I have a crop of them. I know this isn’t a pressing medical question, but what can you recommend to prevent them? – L.B.

ANSWER:
Hangnails form when the skin dries. Dry skin at the borders of the nails cracks to form a hangnail. Prevention comes from the daily use of moisturizers.

Even though it’s tempting to pull a hangnail off, don’t. Cut it with small, sharp scissors.

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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