By Dr David Delvin

Do YOU have any waterworks problems?

If so, please don't be embarrassed!  These problems are extremely common, and nothing to feel ashamed about.

The two main things you need to know about them are:

*  They generally need sorting out FAST - so don't neglect them:

*  Your doctor is used to dealing with these conditions, every day of the week - so she's not likely to be embarrassed by your story, and she definitely DOESN'T want you to 'suffer in silence'.

Happily, most urinary problems can be helped quite quickly, provided that you go to your GP at an early stage.  Do not delay - and when you do go to your doc, always remember to take a specimen of urine with you, in a very clean container.  If you haven't got anything suitable, your surgery will be happy to give you a sterile glass 'universal container' with a secure screw top.  A good tip is to avoid using any household bottle which might leak your handbag or pocket!

In general a 'first thing in the morning' specimen of urine is best.  Burt really, ANY specimen is better than none at all.  (It's quite often quite difficult for your GP to make a diagnosis if she has no sample of urine to test.)

Now what I'm going to do is simply to list the various common urinary symptoms - and explain what they cold mean.  We'll deal with the ladies first - and then the gents.

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URINARY SYMPTOMS IN WOMEN

PAIN WHILE PASSING WATER  This is the commonest urinary symptom of all - and it can be really unpleasant for the victim.

A woman who has this symptom usually has a urinary INFECTION.  People often refer to the condition as 'cystitis,' which means 'inflammation of the bladder.'

Urinary infections / cystitis generally occur because germs have got into the very short female urinary passage, which is located at the front of the opening of the vagina.  Because this little pipe is so short, it's very easy for the germs to get up into the bladder - and then cause painful urination.

However, in some cases no germ is found in the urine.  In these instances, the pain is often caused by minor bruising around the urinary pipe, caused by sexual activity.  Hence the term 'Honeymoon Cystitis' - though in fact this disorder often occurs in women past the age of 50 - especially when they have just started a new relationship.

TREATMENT:  Most (though not all) urinary infections are easily treated.  Good 'first aid' regimes are available from any chemist.  Your GP will probably begin by giving you a urinary antibiotic, such as trimethoprim.

If by any chance your urinary infection DOESN'T respond well to medication, you should most definitely read one of the excellent cystitis 'self-help' books by Dame Angela Kilmartin.  They're in most public libraries, and they really do give excellent tips about hygiene, pain relief, and avoiding re-infection.

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HAVING TO KEEP 'SPENDING A PENNY':  Having to keep rushing to the loo to pass urine is also (as a rule) a symptom of a urine infection - see above.  Frequently, it's associated with having to get up again and again in the night - only to find that you can only pass tiny amounts.  Very annoying!

BLOOD IN THE URINE:  This too does suggest a urinary infection - see above.  Occasionally it can mean something more serious, so if you get this symptom you really MUST go and see your GP (with a specimen).

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INCONTINENCE OF URINE:  This embarrassing symptom is tremendously common in women, and especially in those over 40.  There are two main types:

*  STRESS INCONTINENCE means 'leaking' when you laugh, cough or sneeze.  It's usually due to weakening of the 'supports' round the bladder - caused by childbirth (especially repeated childbirth).

Pelvic floor exercises - which tighten up the supports - will often help.  But a 'repair' operation may be necessary; thus usually gives good results.

*  URGE INCONTINENCE  This is a type of 'leakage' which is caused by over-sensitivity of the bladder - so that it tends to try and empty itself too soon.  There are ways of overcoming this by 're-training' the bladder.

Also, there is a range of drugs which can help.  They include oxybutinin (Cystrin), tolterodine (Detrusitol), flavoxate (Urispas), propiverine (Detrunorm), and trospium (Regurin).  But please note that all these drugs can have side-effects.

A recent development has been the use of collagen injections around the opening of the bladder.  But this technique is suitable for just a minority of women - and must ONLY be administered by a fully-qualified surgeon who is experienced in the method.  Don't go to any 'cowboy' clinics!

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LEAKAGE OF URINE AT ORGASM  This is a source of embarrassment for a lot of women.  In fact, quite often it turns out that the liquid which out is NOT urine at all - but a special 'sex fluid' believed to be associated with the famous G-spot.  Producing that sexual secretion is NORMAL for quite a few people.

However, if you're sure that it is urine that you are leaking when you climax, it's best to consult a gynaecologist, who will examine you and suggest appropriate measures to take.

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MEN

Men get far fewer urinary problems than women - UNTIL they reach the age of 60-plus, when a lot of chaps start running into problems with their prostates.

So let me just begin by explaining briefly what the prostate gland is.  Please note that many people mistakenly call it 'the PROSTRATE'.  But the word is 'PROSTATE'. 

The prostate is a gland about the size of a horse-chestnut.  If you put a fingertip on the middle of the top edge of your pubic hair, it will be pointing at your prostate.  Just imagine that there's a little 'conker', an inch or two under your finger.

Now imagine that the conker has a small hole through the middle (just like in the game of conkers!)  ALL YOUR URINE HAS TO GO THROUGH THIS HOLE.

So you can see how easily any problem with the prostate cab interfere with the flow of urine.  If the gland gets bigger, that can close off the hole completely - so that you can't 'go' at all.

What's the prostate for?  Its job is to make a substantial contribution to the man's sex fluid.  Bur very fortunately, when prostate enlargement occurs - as it does to some extent in most over-60s - that doesn't generally seem to affect sexual function.

Well, that's the prostate.  Now let's run through the various urinary symptoms which males may get:

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PAIN IN PASSING URINE  In YOUNG men this usually means they've picked up a sexually transmitted infection.  Even in males over 55, such infections have recently been increasing fast - because of today's tendency for retirement-age men to have much more active sex lives.

However, most cases of painful urination in 55-plus males are simply due to ordinary urinary infections - often combined with prostate trouble.  Take a specimen of urine to your doctor and ask him to examine your prostate.  If it's an infection, it'll be easy to treat with pills.

FREQUENCY OF URINATION  This is usually caused by a urinary infection and / or prostate enlargement.  But if you're passing large VOLUMES of urine, you must have a check for diabetes.

BLOOD IN URINE  In men, this is most often caused by urinary tract infection (UTI), but it can have more serious causes - like diseases of the bladder or kidney.  So don't hang around:  see your GP within two or three days.

'DRIBBLING' AND POOR STREAM  These are generally early symptoms of prostate trouble - as is HAVING TO GET UP REPEATEDLY IN THE NIGHT.  See your doctor and have your prostate checked.  And don't be alarmed: the great majority of cases of prostate trouble turn out to be NON-malignant.

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Q.        I'm a divorcee of just over 60, and I've just started a relationship with a lovely new man.  However, this has led to cystitis!  My doctor has been unable to clear it up.  And advice please?

A.        In your age group, part of the problem is the fact that the level of female hormones is not as high as it used to be.  This makes the tissues 'down below' rather vulnerable to infection.  So ask your doctor if she's willing to give you an oestrogen (female hormone) cream to use three times a day for a couple of months.  This should 'perk up' the tissues and (I hope) help you get rid of the problem.

Q.      When I get cystitis (which I do frequently), my doctor takes no interest, and won't even bother to test my urine.  Is this acceptable?

 A.       No, change your doctor.

 Q.       Is it true that it's good to drink cranberry juice if you get cystitis?

 A.      Yes, a lot of women find cranberry juice a soothing initial treatment.  But you should also see your doctor.

Q.       I am an ex-soldier, age 65 - and I am getting symptoms which seem to indicate that my prostate is enlarged.  I haven't been to the doctor yet.  What are the chances that this problem could be cancerous?

 A.     Although prostatic cancer is common, the fact is that the vast  majority of cases of enlargement of the prostate are benign.  Please see your doctor right away.  He'll examine you, do some tests, and (I hope) be able to reassure you.

Q.       I've heard about that 'PSA' test for prostate cancer.  My GP doesn't want to do it for me.  But shouldn't all men get it done regularly?

 A.      No sir.  The PSA test is widely promoted - especially in America - as something that all males over 50 should have.  In fact, it's wildly unreliable and misleading.  Don't bother with it unless a doctor tells you that it's worth doing in your particular case.

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Q.         My husband - age 70 - suddenly started limping last month.  But he's not aware of it.  What's going on?

A.        He may well have had a small stroke.  Anyway, he should get a check-up from his doctor.

Q.        I am 68 and have smoked all my life.  Is there any point in giving up now?

A.       Yes.  You're just moving into the age group where you're most likely to run into trouble with chronic lung disease, heart trouble, or even cancer.  Giving up now could still help you to avoid all that.

Q.        When playing golf, I find that about half way down each of the longer holes, I get a severe pain in my calf.  I ask my playing partners to wait a minute or two, and then it goes off.  What's wrong with me?

A.        I think you may have 'intermittent claudication.'  This is quite a common condition in which the artery that carries blood into the leg becomes 'furred up' and narrowed - this causing pain on walking.  If your doctor agrees with this diagnosis, he'll send you to a vascular (that is, blood vessel) surgeon.  If necessary, the surgeon will operate in order to replace the narrowed artery.

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