DEAR DR. DONOHUE: I have sensations that give me constant distress. They feel like a bladder infection. Sometimes I have similar sensations at the tip of my vagina. I experience urges and pressure that make me feel like I have to get to the bathroom soon or I’ll lose urine. My doctor prescribed the antibiotic Cipro. It didn’t work. Another doctor prescribed nitrofurantoin. It didn’t work. My doctor’s physician’s assistant ordered a urine culture, which showed no infection. She made no mention of where to go from here. Do you have an idea of what’s going on? — P.O.

ANSWER: Your story suggests interstitial cystitis (IN-tur-STISH-ul sis-TIGHT-iss). It primarily but not exclusively strikes women. Their bladders sent out signals to rush to the bathroom time and again, sometimes more than 50 times a day. The bladder is painful, and so is emptying it. Genital pain also might be present. The symptoms are typical of a bladder infection, but antibiotics do this condition no good. One explanation has it that defects in the layer that protects the bladder walls have occurred. They allow urine and its caustic materials to bathe the walls. That creates pain.

Sometimes dietary changes bring relief. Coffee, tea, soft drinks, alcohol, chocolate, tomatoes and tomato products, citrus fruits and spicy foods are the most-implicated foods. Eliminate two of these from your diet for a week’s time and see if there is any improvement. If not, eliminate two others for another week’s trial until you’ve gone through the entire list.

Medicines are the next step in treatment. Tagamet, amitriptyline, antihistamines like Atarax, and Elmiron — an oral medicine specifically designed for interstitial cystitis — are the kinds of medicine used. Pain medicine is essential to treatment. Should these treatments not rid you of pain, a doctor can bathe the bladder with fluids containing lidocaine (a numbing agent) or DMSO.

You need to consult a urologist or a urogynecologist (a specialist in women’s diseases of the urinary tract) for a definite diagnosis. You also should contact the Interstitial Cystitis Association at 800-435-7422 or online at www.ichelp.org. You’ll find that the association provides you with a wealth of information and hope.

DEAR DR. DONOHUE: My nephew, 40, has a history of panic attacks. Lately they have become more frequent. What are they, and where do they come from? How serious are they? I would appreciate any input. — J.S.

ANSWER: Panic attacks are episodes where a person is suddenly stricken with paralyzing fear in a situation that doesn’t call for such a response. The person can be shopping in a store, leisurely walking down a street or engaged in any task that isn’t the least bit fear-provoking. The heart pounds hard and fast. Sweating breaks out. The person might become short of breath and have chest pain. Fear builds to a peak in about 10 minutes, and the afflicted person searches for a way to escape the circumstances he finds himself in. Most likely, the cause is a disturbance in brain chemistry. The brain is flooded with messenger chemicals that ought not to be there. They are the same chemicals that alert us to real danger.

When panic attacks occur frequently, the condition is panic disorder. It can be quite disruptive of a person’s life. Medicines keep people with this disorder calm. Mental health professionals unearth a person’s unfounded thoughts that indicate danger when no danger exists. It is a treatable illness.

DEAR DR. DONOHUE: I use stevia as a sweetener. My daughter says it makes no difference as far as the pancreas is concerned, since it reacts to both sugar substitutes and sugar in the same way. Is this correct? — B.M.

ANSWER: Stevia is a sugar substitute that comes from a South American shrub now grown in many parts of the world. People in the areas where it was first discovered have used it for centuries without ill effects. Two brand names are Truvia and PureVia.

Your daughter is wrong when she says the pancreas releases insulin when stevia is consumed. It does so only when blood sugar rises. Stevia and other substitutes do not raise blood sugar. You should, however, moderate use of this material.

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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