Greetings, Dr. Roach Up until two and a half years ago, I, a 78-year-old lady, had been able to avoid getting a urinary tract infection (UTI). Instead of treating one after the fact, I believed it could be wise to pay attention to the experts’ advice regarding prophylactic measures.
Our urologist advised me to take a probiotic and D-mannose daily, and presto! For two and a half years and counting, there have been no more UTIs. I looked up additional information about D-Mannose online when I was recommending it to a friend and found out that it cleans your bladder. It is pure glucose, though, and if someone has diabetes—like my friend—they should consult their doctor first.
Now that my A1C and glucose labs have just increased (in the prediabetic range), I’m wondering if this is the cause. What are your thoughts? In addition, my primary care physician advised halving the dosage. — B.L.
ANSWER: D-mannose is believed to prevent the onset of a UTI by obstructing the bladder’s bacterial attachment sites. You did appear to benefit from the medication. Unfortunately, there isn’t much proof that it works. In a major research with 600 women who experienced recurrent UTIs, 51% of them continued to get infections while using D-mannose, while 55% of those taking an inert tablet contracted an infection. However, other small studies indicated a benefit.
Despite their similarities, mannose and glucose are not the same. Mannose is largely excreted by the kidneys into the bladder before it can be converted to glucose, so its effect on blood sugar is small in people with healthy kidneys.
The first consideration in a 78-year-old woman with recurrent UTIs is whether there is vulvar atrophy, which can lead to bacteria getting into the bladder. Applying topical estrogen will improve lining health and lower the incidence of UTIs.
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Greetings, Dr. Roach My wife is 51 and has generally struggled with constipation for as long as I ve known her (many decades). A prolonged interval without bowel motions started a few weeks ago. She regularly uses Miralax, fiber bars, other laxatives, and even prune juice, to no effect. She has been giving herself an enema, but again, no results. She feels miserable, and I have encouraged her to go to the emergency room. But she doesn t want to go due to embarrassment.
She occasionally feels a stomachache and had a fever the other day, but it seemed to subside. Her eating has slowed, and there is no significant weight loss or other conditions that seem out of the ordinary. I will try to encourage her to see a doctor, but until then, any advice on what is going on and why this is happening? — W.Q.
ANSWER: I agree that she should see a doctor before attempting further home remedies. There are several medical conditions that can be causing her problem, such as very low thyroid hormone levels. But the most likely cause is irritable bowel syndrome with predominant constipation (IBS-C). Still, a gastroenterologist may want to look for a motility problem in the lower bowel. In addition, if she hasn t had a colonoscopy yet, she should.
If her doctor thinks she has IBS-C, there are additional effective treatments, such as lubiprostone (Amitiza) and linaclotide (Linzess). These would be tried after an evaluation. She should not let embarrassment get in the way of her care. Her doctor will have dealt with many patients with her problem.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions [email protected] send mail to 628 Virginia Dr., Orlando, FL 32803.
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