Urinary tract infections are common in both men and women

By KEITH ROACH, M.D.

Dear Dr. Roach: I’m a diabetic woman. I keep getting urine infections. I can’t get them cleared up, and I am taking antibiotics every month. Is there anything that can be done? My kidney function is good. — G.D.

Answer: Recurrent urinary infections are common in men and women, especially as they get older, but for different reasons. In men, the issue often is the prostate, which can become enlarged and this makes it difficult for the bladder to empty completely, which allows bacteria to grow. In women, a common issue is vaginal atrophy. Due to lower estrogen levels after menopause, the lining of the urethra (the tube from the bladder that drains the urine) thins, weakening the mechanical barrier and allowing bacteria to enter the bladder.

These aren’t the only reasons. Both men and women can have kidney stones, which can prevent an infection from being cured. However, when I see a woman with multiple infections, I think first of vaginal atrophy. When I see a woman with a single infection that can’t be cured, I think first of kidney stones or other mechanical abnormalities in the urinary system. I can’t tell you how many women I have seen, and how many letters I have received from women like you who were successfully treated once a careful physical exam made the diagnosis. Treatment usually is with estrogen cream.

Dear Dr. Roach:  I am a 79-year-old woman. I had a CT scan recently to check on some lung nodules. They had not changed, but the doctors found a 10 cm retrocardiac hiatal hernia. I am very concerned. My primary-care doctor said not to worry, and that a lot of people have hernias. Should I get a second opinion? — M.M.

Answer: I understand why you are concerned: People hear the word “hernia” and think that surgery will be necessary. However, most hiatal hernias do not require treatment. Let me explain why.

A hernia is a defect in a wall, a hole that can allow the contents from one side of the wall to pass through to the other side. In the case of an abdominal wall hernia, that means that a loop of intestine sometimes can push through the defect; this occasionally leads to severe complications, so these usually are repaired in order to prevent complications.

A sliding hiatal hernia, the most common type, is a literal hole in the diaphragm, the muscle of breathing that separates the chest from the abdomen. The hole is supposed to be there, as the esophagus (which carries the food down) is in the chest but goes through the diaphragmatic hiatus to reach the stomach, which sits high in the abdomen.

In some people, some or all of the stomach can protrude upward through the diaphragm and enter the chest, at which point we use the term “hiatal hernia.” Because the esophagus is behind the heart, all hiatal hernias are retrocardiac (which just means “behind the heart”).

There are two major reasons to contemplate surgery for hiatal hernias. The first is in people with symptoms of reflux disease, especially if it cannot be controlled with usual treatments. The second is when the entire stomach is in the chest, where there is a large likelihood of twisting or bleeding in the stomach. In people in whom, like you, the hiatal hernia was found incidentally while looking for something else, surgery is very rarely needed.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.