DEAR DR. DONOHUE: I urinate very often, and many times I can’t get to the bathroom in time. It’s very embarrassing and has made me housebound. I have little warning, and when I do, I have to be very quick-acting. Is there treatment for this? I’m 73 years old and live by myself. — R.J.

ANSWER: The name of the problem is “urinary incontinence,” the involuntary loss of urine. Two kinds of incontinence exist. One is stress incontinence. This is urine loss when physically active, like lifting a heavy bag of groceries, moving furniture or any such work requiring straining. It also happens on laughing, coughing or sneezing. In all these instances, pressure within the abdomen forces the urinary bladder to expel urine. I don’t think this is your kind of incontinence.

Your loss of urine sounds more like urge incontinence, also called overactive bladder. Bladder muscles contract suddenly and unexpectedly, and make a person dash to the bathroom to reach the toilet promptly.

Pelvic floor muscle exercises (Kegel exercises) are useful in both kinds of incontinence. To learn how to perform the exercises correctly, stop the flow of urine in midstream. The muscles you contract to do so are the ones you want to exercise. You can do the contractions sitting, standing or lying down. Perform 10 contractions in a row and hold each contraction for three to five seconds. Repeat the exercise three times a day. As time passes, increase the number of contractions to 15, and hold them for 10 seconds. It takes two or more months to obtain results.

The Estring ring is a device inserted into the vagina. It releases a very low dose of estrogen and is left in place for three months. The amount of estrogen is tiny, but still warnings have to be given about the possibility of breast cancer and blood clots.

Medicines tame forceful bladder contractions. Detrol LA, Sanctura, Vesicare, Enablex and Ditropan are the names of some of them. All require a doctor’s prescription.

DEAR DR. DONOHUE: Recently I went to my doctor for a yearly checkup. Blood and urine tests were done. They told me that I had blood in my urine. What’s the cause of that? The doctor told me to have an ultrasound, but I would like to hear from you first. — M.H.

ANSWER: Am I right in thinking you didn’t see the blood, but it was found by examining the urine with a microscope — microscopic hematuria (urine blood)? Its causes are many. The most dangerous cause is cancer somewhere in the urinary tract. More-common causes are kidney stones, urinary tract infections (kidney or bladder), trauma and prostate gland infections and inflammation. Even heavy exercise can cause blood to be found temporarily in the urine.

Your doctor wants you to have an ultrasound so a cause can be identified and treated. If ultrasound doesn’t reveal a cause, a CT scan or inspection of the bladder with a scope are possible next steps. Have the ultrasound done right away.

TO READERS: Urinary tract infections are a problem for both men and women. Female infections greatly outnumber male infections. The booklet on this topic explains them and their treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 1204, 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: Why is it necessary to get off prednisone slowly? — D.D.

ANSWER: High doses of prednisone (one of the cortisone drugs) suppress the adrenal glands’ cortisone production of it. Slow withdrawal gives the adrenal glands a chance to recover their normal synthesis of cortisone.

Given time, the glands do recover.

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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