Question: I am only 55, but I am having terrible problems with urinary incontinence. Can you help me with this problem?
Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Urinary incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and mentioned to doctors often only after many visits for other more socially acceptable diseases. Incontinence is usually associated with the old man lying semiconscious in a nursing home bed. But it is far more common in women, and many relatively young women in their thirties or earlier can be victims.
Incontinence is the loss of urine from the bladder at times when such loss is not desirable. It can vary from constant bed-wetting, to the occasional dribble when a woman jumps, coughs or laughs. The most common cause of incontinence is the damage done to the genitals during childbirth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy and damage to the spinal cord in paraplegics and quadriplegics.
The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only 1 to 2 cm long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra and allow the urine to escape. The stretching that occurs during childbirth can cause this critical angle to be lost and the urethra to become a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately this straightened tube can also allow bacteria and infection to enter the bladder more easily and cause the pain and discomfort of cystitis (bladder infection).
Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence. As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth. These can also be done in the early stages of incontinence to help control the bladder function as normally as possible. A patient can start by practising stopping and starting the urinary stream several times whenever they go to the toilet. Physiotherapists can teach the finer details of these exercises.
If the problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted and regularly checked by a doctor.
In intractable cases it may be necessary to insert a semi-permanent catheter (tube) into a woman’s bladder that drains urine into a collecting bag. A woman’s concern about incontinence can become a significant mental problem and a social barrier, and should therefore be treated sooner rather than later.

Question: I have a terribly personal and embarrassing problem. Whenever I try to pass faeces, a lump comes out of my vagina. I can pass a little bit, but no more. As soon as I stand up, the lump goes and I need to go again. Is it cancer?
You probably have a rectocoele, and not cancer.
During childbirth the vaginal canal becomes very stretched. As you age, the tissues supporting the walls of the vagina becomes slack. The combination of these two factors leads to a weakness on the back wall of the vagina and the lower part of the gut (the rectum) can sag (prolapse) into the vagina. When you attempt to pass faeces, the increased pressure in the abdomen pushes the rectum further into the vagina, even to the point where part of the back wall of the vagina is pushed outside as a lump. When this happens, the rectum takes on a very sharp S shape, and this makes it difficult for the faeces to pass down further. You can expel the small amount of faeces just inside the anus, but no further faeces can pass the S to reach the anus.
When you stand up and relax, the lump goes down, the S straightens out, faeces moves down the rectum a bit further, and you want to go to the toilet again. The solution is to have an operation to strengthen the back wall of the vagina and suspend the rectum so that it cannot sag. In the short term, a rubber ring inserted by a doctor into the vagina may prevent the problem.

Question: What is the best treatment for the itch of thrush? I get this terrible infection every few months, and it drives me crazy!
The almost irresistible, but socially unacceptable itch is what drives most patients to the doctor. The treatment of vaginal thrush revolves around vaginal pessaries (tablets), vaginal creams and an oral tablet. These can give rapid relief, and are given in a course that can vary from one to ten days depending on the severity of the infection and the method of treatment used.
You can prevent infections by wearing loose cotton panties, drying the genital area carefully after swimming or showering, avoiding tight clothing, wiping from front to back after going to the toilet and not using tampons when an infection is likely. Even using all these measures, it is a fortunate woman who avoids catching thrush at some time in her life.