Q: I am a 36-year-old woman and have had several bladder infections in the last year or so. Each time the symptoms started (burning, frequent urination of small amounts and sometimes some blood in the toilet bowl), within a few days, I’ve been seen either by my doctor or a nearby urgent care office, where I was given a five-day prescription for an antibiotic. That worked well within about 48 hours.

When I emailed you about this several months ago, you asked about new foods, beverages, underclothing and whether I was sexually active. The answers to all of those questions was “no.”

I followed your instructions about not waiting to empty my bladder when the urge occurs, wearing cotton underwear to keep the area dry, using a separate face towel to dry the area after showering, not dressing until the area was thoroughly air-dried and careful wiping from front to back following urination. However, I have still had a recurrence of the symptoms and had to seek treatment. Is there anything else that could be contributing to these infections or medication, other than antibiotics, that might help?

A: There is! In our email interactions, I began to suspect that something else was causing excess moisture in that area, causing germs to migrate from the anal area toward the front, and questioned you more closely about potentially risky activities.

You indicated that, in the interest of staying in shape, you have a gym membership, where you run on the treadmill and ride an exercycle quite vigorously, most of the time for at least a half-hour. Because of your busy schedule, you use the gym in the early morning, on your way to work, and generally do not have time to shower before heading to work.

These activities are causing an unusual amount of movement in that area, combined with the accumulation of moisture from sweat, which doesn’t get a chance to completely dry before you then go to work. You then spend much of the day sitting at a desk. Altering your schedule by accessing the gym in the late evening has allowed you to nearly immediately go home, shower and completely dry the area. This change seems to have prevented any further such infections.

If you continue these precautions but develop any further infections, I recommend you discuss with your physician taking an old medication — methenamine hippurate. It is not an antibiotic, but instead is a urinary antiseptic. It kills germs by being converted to formaldehyde in the urine, which prevents germ growth without the risk of developing antibiotic resistance. Methenamine interacts with a number of other medications and has several side effects, hence the recommendation to discuss it with your personal physician. He or she will be most familiar with the details of your health and can better advise you whether this over-thecounter medication will help you.

To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website, familydoctor. org, where you can search for your topic of interest.

I want to thank Maggie S. for this question. If you have a topic you would like to hear more about, please message me at paulmdake@ gmail.com.

Dr. Paul Dake, a Newberry native, is a retired family physician. He lives in Pinconning, Michigan.