DEAR DR. DONOHUE: I am a veteran. I have a lot of bladder problems. I have to get up six or eight times a night to go to the bathroom. During the day, I’m pretty much OK.

I went to a Veterans Affairs medical facility, and they sent me to a practitioner who gave me a pill and told me I would be OK. I wasn’t. I went to another VA hospital, and the doctor put me on three pills — Detrol LA, Enablex and imipramine — and said there was nothing more he could do. These pills did not help me. Can you tell me what will? — C.E.

ANSWER: Detrol LA (“LA” stands for “long acting”) and Enablex are both used to calm bladder muscles that are contracting too often and too forcefully and that force a person to run to the bathroom or suffer an accident. Imipramine is an antidepressant, but it’s also used to calm an overactive bladder. Why nighttime is worse than daytime has to do with the fact that in older people, nighttime urine production exceeds daytime production.

You are getting no results from three medicines designed to stop the contractions of an overactive bladder. I’d say we are on safe ground assuming you don’t have an overactive bladder. Even though you didn’t mention your age, I presume you are an older man. The chief reason for an older man having to run to the bathroom many times during the night is an enlarged prostate gland. The big gland interferes with complete bladder emptying. The bladder quickly fills after one bathroom trip, and the man has to make another and another and another bathroom visit.

If you haven’t seen a urologist, ask the VA for an appointment to see one. If you have a big gland, as I suspect, medicines exist to shrink it or to counter the effects of its large size. If medicines don’t work, a number of procedures do, some of which can be done right in the doctor’s office. If I’m wrong about this, write back. In the meantime, get to a urologist.

The prostate gland and its problems are discussed in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I was just diagnosed with an inguinal hernia. My internist did not encourage me to have corrective surgery at this time. It is small, and I am asymptomatic. I visited a surgeon who performs such operations laparoscopically and uses polypropylene mesh. I am concerned about chronic pain after the surgery and that my body will react to the mesh, especially years from now. Are absorbable meshes as effective as the meshes in common use today? Can you provide guidelines for me to consider having the surgery now or later? — I.H.

ANSWER: With a small hernia that’s not painful, you don’t have to rush to surgery. You are the one to make the decision. By putting it off, you might never need surgery. By having it now, you correct the problem once and for all. The choice is yours. The surgeon’s input will help you decide the most appropriate time.

Today, almost all surgeons use a mesh, a patch that strengthens the tissues where the operation takes place. The mesh greatly decreases the chance of a hernia recurrence. Polypropylene (a plasticlike material) is the substance most often used as the mesh. Formerly, stainless steel, tantalum gauze, polyvinyl, nylon and Teflon had been used to reinforce a hernia repair, but they were discarded because they were inflexible, degradable, easily infected or because they tended to migrate. Polypropylene has proven to be the most reliable mesh material. It has a long and good track record. Your body won’t reject the mesh. It’s an inert substance. Polypropylene carries a lesser risk of infection. Your chances for pain after you have healed are not great. Absorbable material was popular at one time, but it is not much used now. It appears to be less reliable than polypropylene.

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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