Introducing our new medical columnist — Dr. K

Regular readers of this space are familiar with the Ask Dr. Gott column. This is the first of a new column: Ask Doctor K by Dr. Anthony Komaroff. Like Dr. Gott, I will respond to reader questions. I hope you will find my comments as helpful as Dr. Gott's were.

I'm a practicing doctor. I see and treat patients, and am a professor at Harvard Medical School. I am also responsible for all of our school's newsletters, special health reports and books about health for the general public.

Why am I writing this column? A patient of mine once surprised me by asking: “You take my medical history, you examine my body, you order tests and prescribe treatments. So what's the most important thing you do for a patient?”

No one had ever asked me that question. I hadn't asked it myself. So I had to think for a minute. Then I told the patient: “The most important thing I do is explain — explain what I think is wrong, and why, and explain what needs to be done, and why.”

I'm writing this column because I believe in the power of information to improve people's health.

In the years since I went to medical school, two hugely important things have occurred. The first is that medical science has progressed much faster than most doctors expected. What once was science fiction is now reality. For example, we can see deep inside your body without touching you. We can determine whether you have a particular genetic defect and treat it.

The second important thing is that scientific studies have revealed how powerful lifestyle changes are in lengthening life and making those added years healthy ones. You've almost surely heard that “eating right” and regular exercise are good for you. That's not news. What might be news is just how good they are for you. Did you know, for example, that specific changes in your diet and regular exercise can reduce your risk of getting the most common kind of diabetes by 70 percent? No medicine yet invented can do that for you. But you can do it for yourself.

You can send questions to me through my website: AskDoctorK.com. You also can mail them to me in care of Universal Uclick, 1130 Walnut St., Kansas City, MO 64106. I won't be able to answer all the questions that are sent to me, but I'll do the best I can.

I can't offer any specific medical advice, of course: Only your doctor knows you well enough to do that. Instead, I want to provide information that you can use to protect your health, and to deal with symptoms and diseases. I also want to tell you about the amazing new discoveries that can help you and your family — new treatments that are available today, or will be soon.

Q. This may seem like an odd question, but can “holding it” when you need to urinate damage your bladder? I sleep on the second floor of my house, but the only bathroom is on the first. Sometimes I just don't feel like getting up! Am I hurting myself?

A. I'd say you're in good company — we've all “held it” before, for whatever reason. Many of my patients ask me the same question you have. I've even had a patient ask if her bladder could actually explode from holding it too long.

The worst that's likely to happen is that you'll become increasingly uncomfortable until you finally give up and empty your bladder. The idea that your bladder can burst from waiting too long is largely a medical myth.

There are rare reports of bladder rupture in heavy alcohol users. Regular, heavy use of alcohol can injure the nerves that sense that a bladder is full and tell it to empty. And, of course, if a person gets really drunk, it can dull the brain: Those nerves from the bladder may be screaming that the bladder is full, but the brain is too dulled to hear it and do something about it. A full bladder is more easily injured than an empty one. Unsteady drunks can fall and injure their bladder.

The bladder is a mighty strong muscle. It is unlikely to rupture just because you hit the snooze button a few extra times. It's much more likely that the urge to go will eventually just take over, and you will urinate whether you want to or not.

But there are potential health consequences of making “holding it” a habit. For example, research has found that women who regularly hold off on urinating when they feel the urge may get more urinary tract infections. Sometimes bacteria get into the bladder. Urinating often eliminates the bacteria. But holding them in the bladder allows them to multiply. They multiply really fast: One bacterium can become millions of bacteria over several hours. So if you are prone to UTIs, urinate as soon as you get the urge.

Bladder problems are common. Because such problems can be embarrassing to talk about, a lot of patients don't tell their doctors about them. If I were your doctor, I would say this: Go when you get the urge, and go even if you don't feel the urge but are about to be unable to go easily (like on a long car trip). If you feel the urge but it's inconvenient to go, don't worry that your bladder will burst.

2011 The President And Fellows Of Harvard College