Dr. Roach

Dr. Keith Roach

DEAR DR ROACH: I am in my early 90s and was diagnosed with “venous insufficiency” in both legs about 20 years ago. Over the years, I have attempted to deal with chronic edema in both ankles and feet by using elevation and compression devices. Of course, these are only temporary measures and only provided a brief period of some relief. I have been tested in the past for deep vein thrombosis and had a thorough heart exam one month ago.
My question to you is, are there any other concerns I should be alert for in my advanced stage, and what testing should I get done? My blood pressure is always close to normal, and my cardiovascular blood work is rated very good. The only medicine I take regularly is for prostate issues. — M.B.
ANSWER: Venous insufficiency is a common diagnosis whose name sounds like it might be very serious. However, it just means that the valves in the veins don’t work as well as they used to, leading to varicose veins (which may or may not be visible) and veins that could leak. Leakage of fluid outside the blood vessels (the blood cells are too big to leak out) causes localized swelling, called edema. Edema fluid is pulled by gravity down to the lowest part of the body, so the feet are the main places where edema is found.
Just being older is enough of a reason to have venous insufficiency. The valves in the veins are delicate structures and often don’t last an entire lifetime. However, some medications are notorious for causing edema. Calcium channel blockers like amlodipine (Norvasc) often do, and a class of prostate medicines, the alpha blockers (such as terazosin), can cause edema, although newer ones are less likely to cause it.
Many of my patients know that liver failure, kidney failure and heart failure can all cause swelling in the feet, but a careful exam and some laboratory testing can usually eliminate these as possibilities. You may not need any more testing.
DEAR DR. ROACH: I am a 78-year-old male. I have no prostate — it has been removed. I suffer from incontinence. I do not want surgery, so could you recommend any over-the-counter medications? — J.S.
ANSWER: Incontinence after prostate removal is common, especially after surgery for prostate cancer. Most men will have some degree of incontinence, although it often gets better in the first one to two years after surgery. Stress incontinence is the most common type. (Stress incontinence is when a person loses urine involuntarily under “stress,” such as a cough or sneeze. Urge incontinence, the other major type, is when you have the urge to go to the bathroom right away, or you will have an accident.)
Over-the-counter medicines are not likely to help stress incontinence after prostate surgery. One effective non-drug therapy is pelvic physical therapy. This strengthens the pelvic floor and needs to be performed by a therapist who has expertise in male incontinence.
Other treatments include an artificial urinary sphincter and pelvic sling surgery, although I can understand why you are anxious about having another surgery. Your regular doctor or urologist can discuss prescription drug treatments, if appropriate.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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