DEAR DOCTOR K: I'm a 45-year-old woman. Now and then, I suddenly feel pain every time I urinate. It lasts for a week or so and then goes away. My doctor said I don't have a urinary infection and didn't prescribe any treatment. What else might be causing my symptoms?
DEAR READER: Several different conditions can cause such symptoms, including a bladder infection, kidney infection, or vaginitis.
DEAR READERS: You are sending me lots of great questions. But even though I write six columns a week, I can't answer them all.
Sometimes my answers prompt you to send additional questions -- and comments. Sometimes your comments take issue with something I've said. Periodically, like today and tomorrow, I'll devote the column to the questions and comments you've sent me.
A list of medications that can cause urinary incontinence.
DEAR DOCTOR K: I'm a man in my late 70s, and I'm having trouble holding my urine. Medicines have helped somewhat, but not completely. My doctor says he's tried every medicine and that I may have to live with my problem to some degree. Is there anything else you can suggest?
DEAR READER: Though you may not guess it from TV ads, losing control of urine -- incontinence -- is not just a woman's problem. Men, particularly older men, can have trouble too. Studies find that one in four men your age experience incontinence at least once a year -- and as many as one in 10 experience it nearly every day.
DEAR DOCTOR K: My doctor did a urine test and says I have hematuria. What is this? And what could have caused it?
DEAR READER: Hematuria is the presence of red blood cells in the urine. It means there is bleeding somewhere in your kidneys, your prostate (if you're a man) or your bladder.
DEAR DOCTOR K: I'm a middle-aged woman scheduled to have surgery next week. My doctor said I'll need an indwelling urinary catheter during and for a few days after my surgery. This sounds worse than the surgery. What will it entail?
DEAR READER: Before describing what it is, I want to explain why it's necessary. When you have general anesthesia, you're unconscious. You can't tell if your bladder is getting full and can't decide to empty it. Even if you have the kind of anesthesia that eliminates pain but leaves you awake, you may not be able to control your bladder. So there needs to be a way to ensure that any urine your kidneys make is eliminated.
DEAR DOCTOR K: I have interstitial cystitis. Medication hasn't helped much. Could dietary changes help?
DEAR READER: In patients with interstitial cystitis (IC), the bladder wall becomes irritated or inflamed, causing pain and painful or frequent urination. Some patients need to urinate as often as 60 times a day. The cause of IC remains a mystery. The symptoms of IC are often similar to those of a bacterial urinary tract infection. However, in IC, there is no bacterial infection and the symptoms do not respond to antibiotics.
DEAR DOCTOR K: I'm a middle-aged woman with urinary incontinence. Is there any way to treat this problem without drugs or surgery?
DEAR READER: I'm glad you asked. Surveys of women across the country indicate that millions have urinary incontinence — the inability to keep from sometimes leaking urine. The reason I'm glad you asked is that those same surveys indicate that more than half the women with this problem never seek care for it. That's a shame, because there is much that can be done to fix it. There are several strategies you can try before considering medications or surgery.
DEAR DOCTOR K: I'm a 42-year-old woman. This year I've had four urinary tract infections. Each cleared up with antibiotics. But now my doctor wants me to take a preventive antibiotic every day. Is this safe?
DEAR READER: Urinary tract infections (UTIs) are surprisingly common in women of all ages. Most UTIs occur in the bladder. As you know from experience, the symptoms include frequent, urgent and painful urination, bloody urine, and pressure or pain in your lower abdomen. Less often, your kidneys may become infected.
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Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of Harvard Health Publications. Learn more »
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