Ask the doctor - leaking urine

Click here to return to the main Ask the doctor page

I’m only 36 but have noticed some leakage when I laugh or sneeze. Is it OK to use a panty liner every day or will this trigger thrush, which I’m also prone to?

Urinary leakage affects millions of women. Often it’s related to changes caused by pregnancy but can affect anyone with slight weakness of muscles supporting the bladder. Panty liners are fine for daily use and may even reduce the risk of thrush as you can change them regularly to keep fresh and dry. But rather than using liners designed for everyday discharge, use a liner designed to lock away moisture from urinary leakage such as Tena Lights (£1.99 from supermarkets and pharmacies; request a sample from www.lightsbytena.co.uk). These will keep you dry and prevent odour Pelvic-floor exercises can also help – ask your practice nurse or visit www.patient.co.uk for information on how to do these.
Dr Sarah Brewer, Prima (Oct 11)
Read: how to tighten your pelvic floor

I suffer frm stress incontinence, and it doesn’t seem to have got better with pelvic floor exercises. Is there anything else I can try?

Stress incontinence – where you leak small amounts of urine when you cough, sneeze, laugh, run, jump and so on – is very common. It’s caused by weakness of the pelvic floor. Women who’ve had children are more likely to be affected (for obvious reasons!) but it also gets more common after the menopause. Pelvic floor exercises can make a huge difference, but only if you do them properly and regularly. If you’re not absolutely sure you’ve been exercising the right muscles, have a chat with your GP. The options include referral to a continence clinic, where a team including nurses and physiotherapists can assess the problem and help you with exercises. Since the start of this year, you can also get a device on NHS prescription. Called the Pelvic Toner, it helps you to check you’re exercising the right muscles. As your muscles get stronger, you can adjust it to make the muscles work harder
Dr Sarah Jarvis, Good Housekeeping (May 11)

I've had lots of investigations for bacterial urinary infections. The nurse suggested I try cranberry extracts. Do they work? What’s the best dose?

Cranberry extracts do seem to be effective in preventing urinary infections. When the results of ten studies, involving over 1000 people, were analysed, those taking cranberry extracts for a year had significantly fewer recurrences than those taking dummy tablets. Research also suggests that cranberry extracts are as effective as low-dose antibiotics (trimethoprim). Either drink cranberry juice (200ml to 300ml of 25 per cent juice daily), or take a high-dose cranberry extract tablet, widely available in health-food stores and pharmacies. Please note: If you think you have a urinary tract infection, seek medical advice – especially during pregnancy.
Dr Sarah Brewer, Prima (Sept 10) 

I've had stress incontinence for years, but I also have arthritis and can't exercise much. It's now so bad, I've started to avoid going out. What will help?

Stress incontinence is caused by weakness of the muscles of your pelvic floor. Pregnancy and childbirth (for obvious reasons!) put a lot of pressure on your pelvic floor, as does being overweight. In addition, the muscles tend to get weaker after the menopause, and at least one in five women over 40 have some degree of stress incontinence. Many GPs like me think this may be a gross underestimation, because many women suffer but are too embarrassed to admit to it. Exercises to strengthen your pelvic floor are the mainstay of treatment, and can be very successful, but you have to stick with them. Many areas now have specialist clinics that can help with support and physiotherapy. One prescription medicine developed as an anti-depressant - duloxetine - has also been found to help in up to 60% of women.

Dr Sarah Jarvis, Good Housekeeping (Jun 10) 

Bed wetting advice

My six-year-old son has been dry at night for a year, but in the past few weeks he has started wetting the bed again several times a week. I've heard that boys are much more likely to wet the bed than girls, so is this just a phase?

Bedwetting is remarkably common - about one in six five-year-olds and one in 15 eight-year-olds still wet the bed regularly. Boys are slightly more prone to this problem than girls, and it also runs strongly in families. If one parent used to wet the bed, there's a 40% chance their child will; if both parents did, the chances increase to 70%. In most cases, there is nothing physically wrong - although I always recommend seeing a GP if your child is aged over five, just to rule out medical causes such as a urine infection or diabetes. Medically, bedwetting is divided into two types: ‘primary' (if your child has never been reliably dry) and ‘secondary' (if your child has been dry for at least six months but then starts wetting the bed again). Medical problems or stress - from bullying, school or home problems, for example - are much more likely factors in secondary bedwetting, so you should always get it checked out by your GP.

Dr Sarah Jarvis, Good Housekeeping (Jan 10)

Kidney concerns

I've discovered that my father, whom I didn't know, died of kidney disease. How will I know if I have inherited his kidney problems?

Kidney conditions can be hereditary, but they often aren't. If there is a history in your family, it's wise to monitor yourself. Kidney infections will cause fever, pain and urinary problems, but other forms of kidney disease have few, if any, symptoms until the damage is quite advanced. Doctors screen for kidney problems by analysing urine for the presence of protein, traces of blood and cell clumps. A blood test to check levels of chemicals (urea and salts) in your blood also provides an accurate picture of how well your kidneys are working. There is an excellent kidney disease self-assessment questionnaire on the NHS Choices website, which asks about your medical health past and present, any medications and your family medical history to assess whether you need to see your GP for a kidney function test. You can find the kidney questionnaire, and other health assessment checks, by visiting nhs.uk and clicking on ‘Tools' in the menu bar in the top-right corner.

Dr Sarah Brewer, Prima (Oct 09)

Do supplements cause kidney stones?

I get sharp pains in my abdomen, which are caused by kidney stones. I keep colds at bay by taking lots of supplements, but are they to blame for my stones?

Calcium, high doses of vitamin C and vitamin D supplements can make people more prone to kidney stones. Although they don't often cause problems and pass painlessly out with your urine, kidney stones may get stuck in the ureter, which can be very painful. So drink plenty of water and they'll usually pass within a day.

In some cases they get stuck and may need to be removed by ureteroscopy, where a telescope is passed up through the bladder and the stones are broken up by laser. Extracorporeal shock wave lithotripsy may also treat them. About 50 per cent of people who have a kidney stone will develop another in the next 10 years. To reduce your risk, cut down on your supplements, and if you have calcium oxalate stones, limit foods that are high in oxalates, such as tea, spinach, chocolate and asparagus.

Dr Louise Selby, SHE (Apr 09)

I leak when I sneeze

I've had three children and now, when I cough or sneeze, I get some leakage. I am doing pelvic floor exercises but it's getting worse. What can I do?

You're experiencing the common problem of stress incontinence. It is more prevalent in women who have had children, as the pelvic floor muscles have been stretched and weakened by the extra weight when they were pregnant. Keep doing your pelvic floor exercises, but make sure you're doing them correctly and aim for about five minutes at least three times a day, preferably 6-10 times a day. Visit patient.co.uk for clear information on how to do them. Vaginal cones (£24.95 for two AcquaFlex cones from stressnomore.co.uk) can also help and you might benefit from a visit to a physiotherapist.

Some people also find that the medication duloxetine is helpful - your GP can prescribe it at a dose of 40mg twice a day. There's also minor surgery in the form of a new technique called tension-free vaginal tape (TVT). It makes a sling around the urethra, giving it support and keeping the bladder closed. It can be done under local anaesthetic, unlike the traditional operation colposuspension (where the top of your vagina is lifted and the surgeon uses stitches to tie it behind the pubic bone), and recovery is quicker.

Dr Louise Selby, SHE (Feb 09)

How can I stop the pain of cystitis?

I get cystitis a couple of times a year. It always settles with antibiotics, but I still go through agony for a day or two before the pills start to work. How can I relieve the symptoms in the meantime?

Cystitis, or inflammation of the bladder, affects at least half of women and is usually caused by germs that live naturally on the skin around your urethra - the tube urine comes out of when you pass water. Because a woman's urethra is much shorter than a man's, it's very easy for germs to pass up it into the bladder. There they can multiply, causing inflammation of the delicate bladder lining. This causes the symptoms of cystitis - needing to pass water more often, burning when you do and sometimes low tummy pain. Making your urine less acid will relieve symptoms while the antibiotics take effect. We used to recommend drinking a teaspoon of bicarbonate of soda dissolved in water - it tastes disgusting, but it does work! These days, treatments from your pharmacist such as Cymalon are just as effective and taste a great deal more pleasant. Drinking lots of fluid and a hot water bottle on your lower tummy will also help.

Dr Sarah Jarvis, Good Housekeeping (Feb 09)

Preventing kidney stones

I was recently admitted to hospital in agony and was diagnosed with a kidney stone. Eventually it passed on its own but I never want to go through that pain again. What can I do to prevent it?

Kidney stones are extremely common. About one in 20 women in the UK will develop a kidney stone at some stage in their life. No-one knows why some people get them but the stones result from tiny crystals in the urine clumping together and blocking the tube that runs from the kidney to the bladder. Most stones are small and pass through the system naturally in a day or so.

To prevent new stones forming, the most important thing is to drink plenty of water. I would recommend two to three litres a day. This keeps the urine diluted and prevents a build-up of the chemicals that can cause kidney stones.

If you do get a recurrence, it would be useful to ask your doctor to analyse the chemical composition of the kidney stone and check the levels of calcium and uric acid in your blood. This would enable the doctor to give you advice on how to alter your diet. For instance, if you had a calcium-based stone – the type which accounts for 80 per cent of stones – it would be advisable to limit your intake of oxalates. These are naturally occurring chemicals that combine with calcium and can lead to kidney stones. Oxalates are found in meat, chicken, fish such as anchovies and herring, asparagus, berries, chocolate, spinach and rhubarb. Strangely enough, your actual calcium intake has little to do with whether you develop the condition.
To find out more about kidney stones contact patient.co.uk

Dr Louise Selby, SHE

Urinary incontinence

Where can I get information about treatment for urinary incontinence? My GP says he can refer me to the hospital, but I’d like to know what my options are before I go ahead.

Urinary incontinence is an incredibly common problem, affecting one in three women at some stage in their lives. Treatment depends on several factors, including your age, whether you've completed your family, whether you have ‘urge' or ‘stress' incontinence and so on. Most areas now have a specialist incontinence nurse adviser, who will be able to give you advice on the right way to do pelvic floor exercises. If they're done correctly, two-thirds of women improve so much they need no further treatment. Have a chat with your GP or practice nurse about being referred.

Dr Sarah Jarvis, Good Housekeeping

Stress incontinence

I had my first baby six months ago, and ever since I’ve suffered from stress incontinence when I sneeze or run. Almost worse, though, my vagina feels really loose when my husband and I make love. Are the two connected?

Yes, these symptoms are almost certainly connected and, although it might sound strange, this is actually good news because you can use the same treatment for both problems. When you deliver, the muscles and supportive structures of your pelvic floor take a lot of strain and - unless you're really obsessional about your pelvic floor exercises - stress incontinence can be a real problem. It affects around one in three women at some point in their lives but, fortunately, it's never too late to do something about it. First of all, make an appointment to see your GP, to rule out other causes and to ask about the options. Your doctor may be able to refer you to a specialist physiotherapist, who can give you exercises to practise. Electrical stimulation and vaginal cones of gradually increasing weight can also be very effective.

Dr Sarah Jarvis, Good Housekeeping

Urine infections

I’ve had blood in my urine twice in the past 18 months. Both times I felt generally unwell and had a burning sensation when I went to the loo. My GP told me the blood was due to an infection and that I don’t need to worry. But it happened again last week and, although antibiotics cleared it up, I keep thinking it could be something more sinister.

I'm delighted to be able to reassure you. If your doctor has confirmed that you had a urine infection and it settled down with antibiotics, there's no need to worry. Urine infections cause inflammation of the lining of your bladder, which then often bleeds. If you pass blood without pain, though, or if a urine sample shows blood but no evidence of infection, you would need further investigations.

Dr Sarah Jarvis, Good Housekeeping

Will cranberry juice help?

I frequently get cystitis, and one of my friends swears by cranberry juice. Can it really make a difference?

Yes, your friend is right. It sounds like an old wives’ tale, but actually has a strong scientific basis. Women are more likely than men to suffer from cystitis – more than three out of five women will get it at some point – and at least one in three women who get cystitis will have another attack in the next 12 months. This recurrent cystitis is most common in women in their 20s and those over 55, but there’s increasing evidence that drinking cranberry juice can help women who suffer from frequent bouts. This may be due to one of the ingredients in the juice that stops bugs from sticking to the lining of the bladder, making it easier for your body to flush them out. Whatever the reason, it’s well worth drinking a couple of glasses of cranberry juice a day. A variety with at least a 25% concentration of fruit is best, and there are low-sugar versions available if you’re watching your weight.

Dr Sarah Jarvis, Good Housekeeping

Easing cystitis

I suffer from frequent bouts of cystitis. Are there any alternative treatments apart from cranberry juice, which I’ve never found to be particularly helpful?

Cystitis is extremely common – over two million women in the UK suffer from it every year. Antibiotics will usually clear it up, but many women, like you, have recurring bouts and want a drug-free alternative.

It’s vital to drink plenty of fluids and limit your intake of tea, coffee and alcohol, which are dehydrating and can increase the acidity of urine. Bacteria love warm, airless conditions, so wear loose cotton clothing and cut down on sugar in your diet, as sugar encourages the growth of bacteria. Avoid perfumed toiletries too and pass urine as soon as you feel the need. If an attack starts, take a powder such as Canesten Oasis (available nationwide), which makes urine less acidic. For more advice, contact the Cystitis and Overactive Bladder Foundation (cobfoundation.org; 01908 569169).

Dr Louise Selby, SHE

Click here to return to the main Ask the doctor page

The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit netdoctor.co.uk