A Question of Health

WHENEVER I cough or sneeze, I wet myself. This has been diagnosed as "stress incontinence", but I can't understand what this has to do with stress.

Stress incontinence has nothing to do with psychological stress. It is a term for the inability to prevent urine from leaking out of the bladder.

Urine leaks out when you cough or sneeze because the valve that closes off the bladder is faulty. Coughing, sneezing - even laughing - cause an increase in pressure on the bladder; when the outlet valve is weak, urine dribbles out.

Women often develop this symptom after childbirth. You can strengthen the valve by exercising the muscles in the pelvic floor that allow you to cut off the flow of urine in midstream. If this does not work, an operation may be necessary.

A WOMAN in my office has extremely bulgy eyes. Is this caused by a medical problem?"

She is probably suffering from an overactive thyroid gland. This gland is situated in the front of the neck, just below the larynx. When it produces too much of its hormone, thyroxine, it causes weight loss, sweating, tremor and bulging eyes.

An overactive thyroid is much more common in women than in men. Beta- blockers such as propranolol help some symptoms, and other drugs are used to control the overproduction of thyroxine, but the bulginess of the eyes can persist long after the level of thyroid hormone is back to normal. In severe cases, vision can be put at risk.

I HAVE heard of a nasal spray that can be used to treat bed-wetting. Can you explain how it works?

By the age of five, about 80 per cent of children are completely dry at night - but two in 10 still wet the bed. Most of them will become dry at night within the next two years. But this common problem is embarrassing and disruptive.

One new treatment is a nasal spray that reduces the amount of urine that the body produces overnight. This can have a dramatic effect on bed-wetting. It is called desmopressin, and it comes as tablets or a nasal spray. It is available only on prescription, and its use has to be carefully monitored.

CAN DRINKING cranberry juice prevent cystitis?

This popular remedy has been shown to reduce the incidence of cystitis and other urinary infections.

Some researchers believe it fights infection by making the urine more acidic; or that it makes it more difficult for bacteria to stick to the wall of the bladder.

Write to: A Question of Health, `The Independent',

1 Canada Square, Canary Wharf, London E14 5DL; fax 0171-293 2182; or e-mail to health@independent.co.uk

Dr Kavalier regrets he cannot respond personally