A Question of Health

Why do I keep leaking urine? And how can I avoid getting hay fever during exams?
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Sprung a leak

Sprung a leak

At 48, I like to think of myself as a young grandmother. But recently, while playing with my granddaughter, I was horrified to find that, when I picked her up, I felt a small amount of urine escape. Since then, I have noticed that any sudden exertion can cause this slight leakage. I'm so worried that the leaks might be visible that I've started to wear sanitary liners just in case. I am also concerned that it might be an indication of something seriously wrong "down below". Should I see my doctor?

I doubt that there is something "seriously" wrong, but leaking urine is serious enough to be worthy of some urgent action. You are describing the typical symptoms of stress incontinence. A full bladder is like a balloon full of water, and there is a muscular valve that holds the water in. If the valve isn't strong enough, urine leaks out whenever the balloon is squeezed. Coughing, laughing and picking up grandchildren all put some pressure on the bladder, and this is why your urine is leaking out. This is a very common problem in women, particularly those who have had children. The solution is sometimes relatively simple. You should start with a series of pelvic-floor exercises. The pelvic floor is a sheet of muscles that keeps the bladder neck closed. Exercising these muscles strengthens the bladder valve and helps to keep it closed. To see how to do these exercises, consult the excellent website of the Continence Foundation (www.continence-foundation.org.uk). If the exercises don't solve the problem, there are other ways to help. Surgery is an option, but usually only if everything else fails. There is a national network of continence clinics, and the website will indicate where your nearest clinic is located. There is also a helpline: 0845 0165, Mon-Fri, 9.30am-1pm.

Finals fever

I'm bracing myself for another season of hay fever, but this year, I'm taking my final exams at university and will have to choose between red itchy eyes and falling asleep halfway through an exam from the side-effects of antihistamines. Is there any mega-treatment that will simply turn off hay fever for a couple of weeks?

There is a huge range of hay-fever treatments on the market. Some work for some symptoms and not for others. Some work for some people and not for others. At the top of the list are nose and eye drops, which help itchy eyes and runny noses. Next are 19 oral antihistamines, eight of which are supposed to be "non-sedating", and 11 "sedating". Again, some work well for some people. Then there are steroid nasal sprays, which are particularly good for nose symptoms, but they take a few days to have their maximum effect. If all of this fails, there are two other options. Some patients achieve good results with allergen-specific immunotherapy - a series of injections to desensitise the body so that it doesn't react to the pollens that cause hay fever. This treatment is controversial because it has potentially serious side-effects - it should only be given by a specialist who has full resuscitation facilities, and is not recommended for people with asthma. It also takes months, so it's no good for your exams. The last option, which may be ideal, is a short course of steroid tablets. This is not a "mega-treatment", but is effective and safe. You'll need to persuade your doctor to write a prescription.

Got the hump?

Both of my parents developed hunched backs as they got older, and I fear that I will, too. Is it an inherited condition? And is there anything that can be done to prevent it? I'm now in my mid-40s, and there is no sign of it yet.

"Dowager's hump" is the old-fashioned name for the curvature of the upper spine that leads to a hunched back. One of the main causes for it is osteoporosis. The bones of the spine become thin and brittle and slowly collapse. This forces the spine at the back of the chest to curve forwards. At the same time the spinal bones of the neck and lower back tend to curve backwards, leading to an exaggerated S-shape. The development of osteoporosis is partially determined by genes, but it is possible to try to prevent it with exercise, diet and, sometimes, drugs. Calcium and vitamin D will help. Calcium is present in dairy products, leafy vegetables, dried fruits and tofu. Vitamin D is made in the body when skin is exposed to sunlight. You may want to take supplements if your dietary intake is low. Plenty of exercise will also help, as will not smoking and keeping your alcohol intake down.

Have your say - Readers write

MP from Brighton thinks that not all "identical" tablets have the same effect:

For some people, minute changes in medication as a result of a switch from one branded drug to a "parallel import" or "generic prescribing" can cause problems. People with epilepsy who have been stabilised on one brand of a drug may experience seizures if prescribed another. The charity Epilepsy Action is concerned about the issue and is conducting a survey. Epilepsy Action's helpline is 0808 500 5050, and their website is www.epilepsy.org.uk.

Send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax: 020-7005 2182; or e-mail: health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions

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