DEAR DR. DONOHUE: Please tell us how safe the anti-incontinence pills such as Detrol LA are. As an active, healthy lady, 81, I can’t go anywhere because I wet my pants, and often I don’t even know I did. You need to know that I have never been overweight, and have had a prolapsed bladder for four years. — S.K.

ANSWER: Incontinence — loss of bladder control — affects millions of people, with incontinent women outnumbering incontinent men. The two major kinds of incontinence are stress incontinence and urge incontinence.

Stress incontinence occurs when a person lifts a heavy object, moves bulky furniture, coughs, sneezes or laughs. Kegel exercises are helpful for it. While passing urine, deliberately stop the flow. You’ve contracted the muscles that need exercising. Three times a day, while not urinating, contract those same muscles.

In the morning, perform a series of 10 contractions while lying on the floor. Hold each contraction for 10 seconds, relax for one second, and then continue. In the afternoon, while seated, do another series of 10 contractions, but this time hold the contraction for only one second and rest for one second. In the evening, another series of 10 contractions while standing. Hold and relax as you did in the morning. Work up to three sets of 10 contractions each time.

Urge incontinence, also called overactive bladder, is urine loss due to involuntary and forceful contractions of the bladder muscles. It comes on out of the blue. Bladder retraining helps. When you get the urge, hold off emptying your bladder for a few minutes. Each day, increase the time between bathroom visits by a few more minutes, and continue to do this until it’s two or more hours between urinations. Kegel exercises help here, too. Medicines called anticholinergics greatly weaken bladder contractions and do work in preventing involuntary urine loss. Detrol (tolterodine) and Detrol LA (long-acting); Ditropan, which comes as an oral medicine, a skin patch and a gel (Gelnique); Sanctura; Toviaz; and VESIcare provide you with a large menu of choices.

Have you talked to your doctor about doing something for your fallen bladder? It contributes to incontinence. If you’re leery of surgery, you could try a pessary, which is a doughnut-shaped device that props up the bladder and uterus.

DEAR DR. DONOHUE: I get conflicting information from my current and previous doctors. I am a 54-year-old woman and take levothyroxine (thyroid hormone) first thing in the morning with a glass of water. I eat breakfast one hour later. I read the instructions that come with the medicine, and it states that calcium and iron should not be taken within four hours of the medicine. On the ingredients for the cereal, it says that calcium and iron. My former doctor said that foods with these minerals were OK, but my present doctor says no. Who is correct? — C.M

ANSWER: The manufacturer of levothyroxine says not to take calcium and iron within four hours of taking the medicine. The minerals decrease absorption of the medicine. The manufacturer makes no distinction between supplements and food sources of the minerals. I’d wait four hours to take such food.

Or you can settle matters for yourself. If you’ve been taking the minerals as you say and if your thyroid tests are normal, you have proof that breakfast isn’t altering the medicine’s absorption for you.

Answers to many thyroid questions are found in the booklet on that topic. To order a copy, write to: Dr. Donohue — No 401, 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: Are there any proven benefits to the vinegar diet?

I have read that such a diet can clear arterial plaque. — H.M.

ANSWER: I can’t find any proof in medical literature substantiating the claim that vinegar clears arteries of plaque — the buildup of cholesterol, triglycerides and other materials that obstructs the flow of blood through arteries.

I wish I could find such proof. I like the taste of vinegar.

I can’t find any proof that the vinegar diet promotes weight loss, either.

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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