Mayo Clinic Q & A

DEAR MAYO CLINIC: What causes fecal incontinence? Can it be treated? ANSWER: Fecal incontinence, or leakage of stool from the rectum, can range from occasional leakage while passing gas to a complete loss of bowel control. An estimated 8 percent of the general population and 15 percent of people age 70 and older are affected. Although fecal incontinence is more common in middle-aged and older adults, it isn’t an inevitable part of aging. It’s often the result of another treatable medical issue or can be a warning sign of a more serious problem. Your rectum and anus are at the end of your large intestine. Normally, the muscles and nerves in and around these two structures sense the presence of waste, allow storage in the rectum, and then move and eliminate stool. Changes in the function of this complex system can interfere with normal stool elimination.

DEAR MAYO CLINIC: Is it true that some children are more susceptible to getting cavities than others? My 11-year-old has never had a cavity, but my 6-year-old already has needed four fillings. What’s the best way to prevent cavities in kids? At what age should they start flossing? ANSWER: Some people may be more prone to tooth decay than others, even within the same family. To give your children the best protection against cavities, teach them the importance of dental health by showing them how to care for their teeth. That includes daily flossing from a very young age. It is important for parents to have good oral hygiene, too. Make sure you and your children see a dentist regularly. Tooth decay happens when areas in the hard surface of your teeth become damaged and develop holes, or cavities. If left untreated, the holes get bigger and can eventually lead to pain, infection and tooth loss. A combination of factors can trigger tooth decay, including bacteria in the mouth, teeth not being cleaned well, and eating or drinking lots of sugary foods and beverages.

DEAR MAYO CLINIC: Is it true that people with rheumatoid arthritis have a higher risk of heart disease? How are the two conditions related? Is there a way to lower the risk? ANSWER: Studies have shown that if you have rheumatoid arthritis, your risk of developing heart disease is two to three times higher than people who do not have the disorder. Although the exact connection between the two conditions is unclear, a number of factors seem to play into the increased heart disease risk. Regular check-ups, tests to check for heart problems, lifestyle changes and being able to recognize symptoms of heart disease can all help manage the risk. Rheumatoid arthritis is an inflammatory disease that causes swelling. It often affects the small joints in the hands and feet and causes joint tenderness, pain and stiffness. But the disorder can go beyond the joints, too, and that is part of the connection to heart disease.

DEAR MAYO CLINIC: I am 40 years old. After having a period that lasted nearly two months, I had tests done that showed a small, hyperechoic lesion within the endometrium. What exactly does this mean? My primary care doctor suggested a hysterectomy as treatment. Are there other ways to treat this condition? ANSWER: Thank you very much for your important question. This can be a source of much confusion and concern, so I hope I can help you with that. The endometrium is the layer of cells that make up the lining of your uterus. It is not uncommon for small lesions to form within that lining. When that happens, the lesion may trigger abnormal uterine bleeding similar to the kind you are experiencing. In some cases, lesions in the endometrium can signal a larger problem, such as cancer. But in many situations, they are not cancerous and pose no serious health risks. The term “hyperechoic” is used to describe how the tissue looks during an ultrasound exam. This is a rather nonspecific term meaning that during the test the tissue reflected back an unusually large number of ultrasound echoes.

DEAR MAYO CLINIC: I am considering having LASIK surgery, but have a friend who had the procedure done many years ago and is now experiencing regression in her vision and has to wear glasses again. Is this typical? What are the risks of LASIK surgery? ANSWER: It is not typical for a person’s vision to regress after LASIK. Although the procedure may lead to some side effects and complications, they are uncommon. A thorough evaluation before surgery often can help avoid many of the potential problems that can happen after LASIK. LASIK stands for laser-assisted in-situ keratomileusis. It is a type of refractive surgery — surgery that changes the shape of the transparent tissue, called the cornea, at the front of your eye. The surgery corrects vision problems such as nearsightedness, farsightedness and astigmatism, reducing or eliminating the need for eyeglasses or contact lenses.

DEAR MAYO CLINIC: My mother, 67, was recently diagnosed with peripheral artery disease. She has been having leg pain and other symptoms for many months. She was prescribed medication but her doctor said she may need surgery. What would that involve? Are there any other treatment choices? ANSWER: In people who have peripheral artery disease, narrowed arteries limit blood flow to the arms and legs. When the limbs do not get enough blood, it can trigger a variety of symptoms. The most common include leg pain when walking, leg cramps after doing an activity, leg numbness and leg weakness. If left untreated, pain and other symptoms may get worse over time. Treatment for peripheral artery disease usually includes lifestyle changes and medication. For many people, those two therapies are all they need to effectively manage the disease. If they are not enough, though, a procedure to open blocked arteries (angioplasty) may be recommended. Surgery to bypass a blocked or narrowed artery can be another useful treatment option for some cases of peripheral artery disease. Lifestyle changes often can help ease symptoms and slow the disease’s progress. Smoking is one of the biggest risk factors for peripheral artery disease. Smoking frequently leads to artery narrowing and damage. It also can make the disease get worse more quickly. If your mother smokes, quitting is one of the most important steps she can take to combat peripheral artery disease.

DEAR MAYO CLINIC: My daughter, 31, was recently diagnosed with rheumatoid arthritis. Do doctors know what causes the disease, especially at a young age? Will she need to be on medication for the rest of her life? ANSWER: The precise cause of rheumatoid arthritis, or RA, remains unclear. However, both genetic and environmental factors appear to play a role in raising a person’s RA risk. Because we do not know the exact cause, we do not have a cure for RA. Most people with this disease do need long-term treatment. Rheumatoid arthritis is a kind of disease known as an autoimmune disorder. These disorders happen when your immune system mistakenly attacks your body’s own tissues. In RA, the immune system attacks the lining of the membranes that surround your joints, called the synovium. That causes inflammation. The inflammation, in turn, thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

DEAR MAYO CLINIC: Why do children need so many vaccines in their first two years of life? Isn’t it okay and even safer to wait until they are a bit older to give them the recommended vaccinations? ANSWER: The current childhood vaccination schedule has been studied extensively. It is safe. It is also highly effective at preventing a variety of serious diseases. To offer the best protection against those diseases, I strongly urge you to have your child vaccinated on time, according to the recommended schedule. Babies need multiple vaccines because infectious diseases can cause serious health problems in infants. For a short time after they are born, antibodies from their mothers help protect newborns from many diseases. But that immunity begins to fade quickly, with some immunity lasting only about one month after birth. The vaccination schedule that is recommended now has been studied and found safe and effective against the diseases babies face at the time they are getting the vaccines. A delayed schedule is a delay in protection against some diseases that are very serious, and in many cases life-threatening.

DEAR MAYO CLINIC: What is the typical treatment and recovery time for a herniated disk? At what point should surgery be considered? ANSWER: In many cases, pain and other symptoms caused by a herniated disk resolve with time and self-care measures. When medical treatment is required, therapy that doesn’t involve surgery often is all that’s needed to effectively treat herniated disk symptoms. However, if your symptoms significantly limit your day-to-day activities, if you have nerve damage due to a herniated disk, or if your symptoms cannot be controlled with other treatment, then spine surgery may be necessary. Your spinal disks are the cushions between the individual bones, called vertebrae, that make up your spine. The disks have a soft center within a tougher exterior. A herniated disk happens when some of the center pushes out through a crack in the outer portion of the disk. A herniated disk may irritate or compress a nearby spinal nerve root. The result can be back pain, along with pain, numbness or weakness in an arm or leg.

DEAR MAYO CLINIC: How effective is surgery to treat scoliosis in adults? What does the surgery involve? ANSWER: Fortunately for most adults who have scoliosis, the condition can be successfully managed without surgery. For some who suffer from an overly tilted or arthritic spine, though, surgery can be very effective at relieving symptoms. The surgery is a complex procedure and can include removing some spinal joints and connecting two or more of the bones in the spine together to properly balance the spine and improve quality of life. Scoliosis is a three-dimensional change in the normal shape of the spine that leads to excessive sideways or forward curves. It most often develops in children during the growth spurt just before puberty. But some adults can suffer from scoliosis, too.

DEAR MAYO CLINIC: My mother-in-law has had insomnia ever since her husband died (just over one year ago). She regularly takes over-the-counter sleep aids, but I am concerned she is also depressed. Is it true that the two conditions are related? Should I encourage her to see a therapist? ANSWER: Insomnia can be a reflection of ongoing distress, and it is often associated with episodes of clinical depression following a period of grieving. But it is possible that your mother-in-law’s insomnia and the loss of her husband are not connected. It would be a good idea for her to make an appointment to see her primary care physician. That physician can assess your mother-in-law’s medical condition and, if needed, provide a referral to a mental health professional. Insomnia is generally defined as the inability to fall asleep, stay asleep or both, despite the opportunity for adequate sleep. Occasional insomnia is a nuisance, but it usually does not present significant health concerns. When insomnia persists, however, it can become a clinical problem.

DEAR MAYO CLINIC: My daughter, who is in her early 20s, was diagnosed with narcolepsy nine months ago. Her primary care doctor prescribed stimulants, but they make her very jittery and don’t eliminate all of her symptoms. Is this the only treatment available? Should she see a specialist? ANSWER: The sleep disorder narcolepsy is a lifelong condition often treated with potent medications. Because of that, it is essential that anyone suspected of having narcolepsy be carefully evaluated by a sleep medicine specialist to arrive at a diagnosis. I recommend your daughter seek testing with such a specialist. If her diagnosis of narcolepsy is confirmed, the sleep medicine specialist can work with her to create a treatment plan that best fits her needs. Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. About 70 percent of people with narcolepsy also experience a symptom known as cataplexy — sudden muscle weakness that follows a positive emotional reaction, especially laughter.