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: My doctor commented when doing a Pap smear that my womb was prolapsed. He said I shouldn’t worry about it until it caused problems. What causes a prolapse of the womb?
The womb (uterus) is where the baby grows during pregnancy. It therefore has the ability to expand dramatically in size, and is only loosely attached to the rest of the body. The ligaments that support it are stretched during pregnancy and may not return to their original size, allowing the uterus to move around more freely.
The more pregnancies you have, the slacker the ligaments become. With the assistance of gravity, pressure on the abdomen from lifting (eg. the result of pregnancy—children), constipation and lack of fitness it is possible for the womb to slowly slip lower and lower into the pelvis. This causes pressure on the bladder and bowel, leading to problems with these organs. Eventually, the womb may move all the way down the vagina to expose the cervix (opening of the womb). The main symptoms are discomfort and bladder incontinence. Correction is by best performed by surgery, but elderly women may use specially shaped rings that are inserted into the vagina to keep the womb in place.

Question: I have had vaginal infections before that have been treated by Flagyl, and I think I have the same infection again. Can I use the drug Flagyl if I am pregnant?
Flagyl is an excellent antibiotic for treating certain types of bacterial infections that occur deep inside the body. Infections of the woman’s Fallopian tubes and pelvic organs are one example.
No medication should be used between the 6th and 14th week of pregnancy unless it is absolutely essential, as this is the time when the organs and limbs of the baby are developing. Flagyl should NOT be used at this time, and it should only be used during the rest of the pregnancy and during breast feeding if there is no alternative. There is no evidence that Flagyl causes damage to the foetus, but it is known to enter the foetal circulation, so there is a potential for problems. It is better to be safe than sorry!