‘Prolapse’ means an organ has fallen

DEAR DR. DONOHUE: I recently developed a prolapsed bladder. While I know it is not life-threatening, I want to take care of it ASAP. I am 74 and very active. My gynecologist wants me to do Kegel exercises and be fitted with a pessary. He doesn’t want to do surgery. I would like the surgery while I am healthy enough to recover in a timely manner and get it over with. Please give me your opinion. — B.C.

ANSWER: The meaning of “prolapse” is “a dropping.” The bladder, uterus and rectum can prolapse. It happens mostly to women, and the reason is a weakening of pelvic muscles and ligaments. Age is one explanation. Childbirth is another. It’s a bit unusual to have a patient wanting surgery and the doctor wanting not to do it. Your doctor is a good man. He’s trying to hold off. You might never need an operation. The progression of a prolapse is unpredictable. In the meantime, do the Kegel exercises. Let me explain them for other women with the same problem and for women who lose urine when they cough, laugh or strain to move a heavy object. Women have to know what muscles to contract. They learn this by shutting off urine in midstream or by contracting the muscles they use to prevent the passage of gas. Those muscles should be squeezed tightly 10 consecutive times. The squeeze should be held for two seconds at first. Then increase the hold time to four, six, eight and, finally, 10 seconds. The exercise routine is repeated three to four times a day. It takes a month or two before results are seen. Pessaries come in many shapes. They’re devices inserted into the vagina to prop up a falling organ. You have nothing to lose by putting off an operation and performing the Kegel exercises. You have everything to gain. As I said, you might never need an operation. Be grateful for the doctor you have.

DEAR DR. DONOHUE: Once and for all, my husband and I need to put a disagreement to rest. Can a person with a pacemaker that’s been in for one year vacuum? He is a mason and uses a chipping gun, but he claims he should not vacuum. I am confused. — S.D.

ANSWER: Most household appliances — including vacuum cleaners, microwave ovens, hair dryers and toasters — don’t interfere with the functioning of a pacemaker. Improperly grounded electric appliances held in close contact with the body might be troublesome. Heavy-duty industrial motors that generate a powerful electromagnetic field can disrupt pacemaker function. Unless there is something special about your husband’s pacemaker, a vacuum cleaner should not be a danger to him. To play it safe, check with the doctor’s office. Did he vacuum before he had the pacemaker? Maybe the noise frightens him.

DEAR DR. DONOHUE: I have a two-pronged problem with my right foot. I have a Morton’s neuroma and tarsal tunnel syndrome. Cortisone injections did nothing for either. Both are painful. Is surgery the only answer? — KD.

ANSWER: I addressed Morton’s neuroma quite recently, so it’s a bit soon to repeat. Have you tried a padded shoe insert? Tarsal tunnel syndrome is the foot’s equivalent of the hand’s carpal tunnel syndrome. In the foot’s case, the tibial nerve, located behind the bony bump (medial malleolus) on the big-toe side of the ankle, is trapped in tissue that squeezes it. The result is pain or numbness on the sole of the foot, often centered on the heel bone. Anti-inflammatory drugs like Aleve or Advil can relieve pain and reduce pressure by reducing inflammatory swelling. Heel pads help. Cortisone injections work for many. An orthotic, a specially built insert that keeps your foot from rolling toward the big-toe side upon impact with the ground, takes pressure off the nerve. A podiatrist can fashion one for you and take care of your Morton’s neuroma. If all else fails, surgically freeing the nerve from whatever is compressing it will turn things around.

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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