DEAR DR. DONOHUE: I have urge incontinence. My family doctor sent me to a woman’s-health doctor, who put me on Vesicare, and I have taken it for four years. In a recent article on incontinence, you didn’t mention this drug. Please do. My husband of 60 years and I live in a continuing-care retirement community, so we have a support system. I am 83. — S.S.

ANSWER: That article was on stress incontinence, the loss of urine that comes when straining to pick up a heavy load or to move heavy furniture or when coughing, laughing or sneezing. It doesn’t respond to medicines as well as does urge incontinence, the loss of urine that comes from sudden, vigorous and involuntary contractions of the bladder muscles. Urge incontinence also goes by the name “overactive bladder.”

Urge incontinence sends the person on frequent and urgent trips to the bathroom in order to avoid an accident. Medicines have an important place in treating this kind of urine loss. They calm the bladder muscles so they aren’t contracting when the bladder is only slightly filled. Vesicare, Enablex, Detrol, Ditropan and Sanctura are examples of medicines that ease the forceful urinary bladder contractions.

In addition to medicines, you can retrain the bladder. When you’re home and near the bathroom and get the urge to urinate, hold off for five minutes or as long as you can. Do this for one full week. On week two, hold off for 10 minutes. Continue in this manner until the length of time between voidings is two or more hours.

It also helps if you stay away from alcohol, carbonated beverages, milk, milk products, honey, sugar and artificial sweeteners.

More-invasive procedures for controlling the bladder are available. One is a device that stimulates the nerve serving the lower urinary tract. It’s called InterStim. You can ask your doctor whether you are a candidate for such a device.

DEAR DR. DONOHUE: My husband, 74, has become so forgetful that I worry about him. I spoke with his doctor, who made arrangements for my husband to be tested. The results said he has MCI. Does that mean he is going to have Alzheimer’s disease? — M.J.

ANSWER: MCI is mild cognitive impairment. The term is used when a person’s memory isn’t as good as it once was but isn’t at the same level of memory loss as a person with Alzheimer’s disease. Some people with MCI have an unaffected memory but are more impaired when it comes to making choices, planning how to get a project done or inhibiting inappropriate impulses.

MCI doesn’t indicate that a person is on a relentless progression to a more serious form of dementia, like Alzheimer’s. It doesn’t usually call for drug treatment. Some patients given the MCI label actually improve in their mental functioning.

The criteria used for labeling a person as having MCI are not precise, and the criteria used are not endorsed by all experts.

DEAR DR. DONOHUE: I started having trouble with constipation. A mild laxative worked, but all of a sudden it stopped working. A colonoscopy was normal. I tried to control it with diet but got no results. A gastro doctor said to take MiraLax every morning. It causes loose stools day and night. Any suggestions? — B.M.

ANSWER: Cut the MiraLax dose to a quarter of what you’re now using and see what the results are. You can up the dose or lower it according to the results you get. Make small changes, not big ones. Or you might want to try an every-other-day dose or every-third-day dose.

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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