Why do I need to rush for the loo every morning?
I HAVE a sensitive bladder and get sudden urges to go to the loo. Occasionally, I don’t make it in time. It is particularly bad in the mornings. What could be causing this? I am only 62. Andrea Mason, Horley, Surrey.
CleARlY this has been very distressing for you, but be reassured: you are not alone. urinary incontinence — the unintentional passing of urine — affects millions of people.
From what you say in your longer letter, there don’t seem to be any obvious causes. You underwent an operation for prolapse many years ago and are being prescribed mirabegron, a drug that makes the bladder less irritable — both of these treatments should reduce the risk of incontinence.
Furthermore, follow-up hospital visits have shown that ‘everything is where it should be’, and that your pelvic floor muscles are functioning as normal.
Yet you live in constant fear of urinary incontinence. i think there might be more than one thing going on here and suspect the culprit has not yet been identified.
There are two areas that need to be addressed. The first is that being post-menopausal, you must accept that even if the tissues of the urinary tract and vagina are where they should be, they are not as strong, elastic and healthy as they were in your younger years.
This deterioration is known as post-menopausal atrophy and is very common once oestrogen levels fall during the menopause.
So you might see an improvement in bladder function and continence with the use of longterm local oestrogen treatment, a form of hormone replacement therapy (HRT) applied to a specific area such as the skin (in a cream) or vagina (in pessary form).
STudieS have shown local oestrogen treatments can significantly improve incontinence symptoms for as long as patients use them. And unlike larger doses of HRT, the small dose i have described won’t get into the bloodstream, so you won’t face any of the potential side-effects of HRT, such as bloating or breast tenderness.
More importantly, however, i am concerned about the volume of urine you pass each morning. in your letter, you suggest this is more than a litre, which seems excessive.
Are you thirsty and drinking water during the night? Polydipsia (drinking a lot) and polyuria (passing more than three litres of urine per day) are symptoms that can relate to high blood sugar levels — so you may need this to be tested to check for diabetes.
An uncontrolled blood sugar level makes a person thirsty — they guzzle water but then pass lots; it is often the first sign a patient is diabetic. if you have diabetes, it would undoubtedly exacerbate the pre-existing problems of the irritable bladder. Prior to getting tested, try this simple check at home: with a measuring jug, record every sample you pass in a 24-hour period and calculate the total.
if the volume is greater than three litres, you must be investigated further, as there is a high chance this indicates diabetes.
if your blood sugar level check comes back normal, then you should be tested for diabetes insipidus.
This form of diabetes is not about sugar; it actually relates to problems with an anti-diuretic hormone that is secreted from the pituitary gland in the brain and is involved in the regulation of fluid balance in the body. AFTER an operation to remove my spleen due to cancer last year, I was prescribed an antibiotic to take for life. My greatest concern is that this will affect my gut bacteria and immune system and that I may become resistant to antibiotics in general. What are your views on taking antibiotics for life? Lai Fong, by email. THe good news is there’s every chance the major surgery you have undergone, involving removal of part of the pancreas and the whole of your spleen, will result in the cure of your cancer.
One complication, however, as you are aware, is that loss of the spleen carries hazards. The task of this organ is to remove damaged blood cells from the circulation, but also to protect against infection by removing bacteria from the bloodstream.
The risk associated with removal of the spleen is sepsis, a lifethreatening condition which arises when the body’s response to infection goes into overdrive.
This is usually caused by a bacterium called Streptococcus pneumoniae. These organisms are not uncommon, causing tonsillitis, skin infections and pneumonia. Sepsis can follow many of these — in trying to fight the infection, the body attacks its own organs.
The lifetime risk of sepsis after removal of the spleen is about 2 per cent, and this is why you’ve been advised to take the antibiotic erythromycin permanently.
i can understand why you are concerned about the effects a long-term antibiotic may have on your gut microbiome. After all, this vital cohort of organisms has important roles in digestion, immunity and brain function. However, the risk-versus-benefit test falls in the direction of it being safer for you to remain on the antibiotic.
The same applies to the chances of you becoming infected with organisms that are resistant to erythromycin: it will be safer for you to take that small risk rather than accept the hazard of sepsis.
instead, take measures to fortify your gut bacteria and minimise the potential side-effects of an imbalanced microbiome.
EAT a high-fibre diet comprising several types of vegetables and fruits (exceeding the perennial recommendation of ‘five a day’), as these are packed with different types of fibres, both soluble and insoluble, that act as nutrients to the microbiome.
Fermented foods such as live natural yoghurt, sauerkraut and kefir are also of value, as are prebiotics, which are food for the bacteria living in your intestines (these contain oligosaccharides — ask your chemist about these supplements).
Other advice, and i’m trusting you have received this, is that you should have the pneumococcal (or pneumonia) vaccine, repeating the injection every three to five years, as well as the jabs for meningitis and flu.
Your GP can advise on these — as you fall into one of the vulnerable patient groups, you should receive them free.