Dear Doctor: I am a woman in my early 70s who has been diagnosed with a bladder prolapse. I have no symptoms and was told I don't need surgery until symptoms appear. I have since learned that this condition is quite prevalent among women, but seldom discussed or written about. Should I seek surgery, which could lead to serious complications, even though my case is mild?

Dear Reader: You're correct that your condition -- and thus your worry -- is shared by many women. Before we explore the options, let's begin with an explainer: Bladder prolapse, or a cystocele, is one type of pelvic organ prolapse, which is a protrusion of pelvic organs into the vaginal region. In a cystocele, the front portion of the vaginal wall becomes weak, allowing the bladder to bulge down into the vaginal region.

The prevalence of pelvic organ prolapse is unclear. In 2003, about 200,000 women had surgery for symptomatic prolapse, with the majority of these surgeries due to a cystocele. However, many people go about their lives not even knowing they have a prolapse. A 2008 study described the symptoms of pelvic organ prolapse to 1,961 women over the age of 20 and asked whether they had those symptoms; 2.9 percent answered that they did.

The likelihood of a cystocele or other type of pelvic organ prolapse increases with age. A 2002 study assessed the presence of prolapse in 27,342 women, ages 50 to 79, based on vaginal exams. As you're aware, cystoceles were much more common than people realized. In women with a uterus, the prevalence of a cystocele was 34.3 percent; in those whose uterus had been removed, the prevalence was 32.9 percent.

One major risk factor for a cystocele is having had children. The more children a woman has, the greater the risk of a cystocele. Compared to the risk of women without children, the risk of pelvic organ prolapse is four-fold greater with the first child, eight-fold greater with the second, nine-fold greater with the third and 10-fold greater with the fourth. The theory is that pregnancy and delivery injure the muscles and nerves in the pelvic region, allowing for herniations in the vaginal area. The risk of pelvic organ prolapse also increases with prolonged labor, having a high-birthweight infant and having a first pregnancy before the age of 25.

Another risk factor for cystocele is increasing age. The majority of patients who seek treatment for symptomatic pelvic organ prolapse are in their 60s and 70s. Obesity also increases the risk of cystocele, with obese women having a 47 percent increased risk of prolapse.

Many patients with cystoceles feel the bulge of the bladder into the vaginal region, as if something has dropped into the vaginal area. In addition, women can have increased frequency, urgency and urinary incontinence with cystoceles. All of these symptoms may decrease the desire for sexual intercourse.

Women with urinary symptoms or pelvic discomfort can consider a pessary, a device inserted into the vagina to support the bladder, or surgery to lift the bladder and tighten the pelvic floor ligaments and muscles. But because you're not having any symptoms of cystocele, I wouldn't recommend surgical or medical treatment, which always poses some risk -- even if small.

For now, try pelvic floor muscle training exercises to prevent the cystocele from getting worse. Vaginal estrogen or the osteoporosis medication raloxifene might help as well. Although they haven't been studied extensively for this use, they have the potential to strengthen the vaginal tissues.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm not one for cosmetic surgery nor have I ever had money for such things, but now that I'm 61, I have more than the usual saggy breasts that come with age. Is corrective surgery unwise at my age? If I had thought forward to how the sagging would get progressively worse, I believe I would have tried something at an earlier age.

Dear Reader: It's unclear whether you're considering a breast reduction, a breast lift, breast augmentation or some combination of the three. Each is a major surgery that would, through different approaches, address the issue of sagging breasts. In a breast reduction, fat, tissue and skin are removed to achieve the desired breast size. If the reason for seeking breast reduction surgery is back or neck pain, insurance may cover some or all of the cost. In an augmentation, the size of the breasts is increased with implants made of saline or silicone. While all implants are made to be long-lasting, in reality they have finite life spans. It's possible that sometime in the future, implants may need to be replaced or removed. In a breast lift, underlying tissues are lifted and reshaped, and excess tissue and skin are removed. The specific surgical technique is determined by breast size and shape, the degree of sagging, skin elasticity and nipple position.

In general, people are considered to be candidates for elective surgery if they are in good health, are physically fit, don't smoke and -- this is equally important -- have realistic expectations. When it comes to age, there's a bit of nuance in the findings from various studies. Older age in and of itself is not considered to be a risk factor for physical complications during or after surgery. What matters more are frailty, cognitive impairment and, as we mentioned earlier, smoking. Both frailty and cognitive impairment are associated with being older, so in that regard age can be a factor.

A condition known as post-operative cognitive dysfunction, which we discussed in a previous column, has been linked to surgery and the use of general anesthesia in older individuals. In this condition, short- and long-term memory, mood and consciousness are negatively affected following surgery. Once again, research suggests that risk factors for this include poor physical health, as well as existing problems with memory or cognition.

Elective surgery is a personal decision that, in our opinion, is best made with input from your primary care physician, your surgeon and, if you wish, your closest friends or family members. This will help keep your own wishes and well-being front and center and will keep extraneous (and unhelpful) noise to a minimum.

If you do decide to move forward, start with research. Make a list of potential surgeons and learn about their backgrounds and ratings. Meet with your top candidates so you can ask every question you have. Request before-and-after photos of patients who are willing to speak with you. And check out the American College of Surgeons' program called Strong for Surgery, which focuses on how to prepare yourself physically and mentally for the best outcome.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Could you please reassure my wife about "side effects"? She won't take some of her prescribed medicine because the potential side effects include liver damage, blindness, stroke, heart attack and death. I have tried to explain the legalities of these statements, but only to a deaf ear. (Maybe that's a side effect too!)

Dear Reader: Your wife's worry is understandable. Having prescribed medications for years, I've seen my share of side effects. They episodically occur in nearly every medication I've prescribed and, on occasion, can be severe. Clearly many people feel a distrust toward the pharmaceutical industry and its desire for profits, but those same people should acknowledge the science involved in creating medications to temper and eradicate disease. Yes, I still prescribe medications on a daily basis because, in most cases, their benefits outweigh the risks.

What concerns me is the need for multiple medications, especially for preventable conditions. Compounding that concern is the juxtaposition in advertisements -- for medications to treat preventable conditions as well as for sodas, desserts, sugary cereals, alcohol and fast food. It is almost as if one industry feeds on another.

The sheer number of medications that are available -- for nearly every condition -- and the propensity of patients to want them and doctors to prescribe them increase the likelihood that, overall, side effects will occur. You're right that most of those side effects warned about in commercials (of which there are so very many) don't normally occur. And your wife is also right to worry that they could.

Whatever the reason your wife was prescribed medication, help her to focus on the possible consequences of not taking it. If she has Type 2 diabetes and can't control her blood sugar with her diet, then explain the downside of poorly controlled diabetes: an increased risk of kidney disease, nerve dysfunction, coronary artery disease and a whole lot more. If she has uncontrolled high blood pressure, explain that this increases her risk of stroke, heart attacks, kidney failure and dementia. The consequences of not treating pneumonia, urinary tract infections, depression and kidney dysfunction can lead to a worsening of those conditions.

If your wife has a preventable condition and doesn't want to take drugs, she should concentrate on her physical and emotional well-being. For starters, she needs to take a hard look at the food she is eating, staying away from processed foods and those high in sugar, and limiting those with high amounts of saturated fat. Two, she needs to stay, or become, physically active. And three, she needs to stay mentally active. Well-being means an everyday focus on taking care of oneself while living in a society with so many unhealthy choices.

If your wife has a condition that isn't reversible through lifestyle changes, she should understand that medications can help control her symptoms and the progression of disease -- and that the side effects of blindness, stroke, liver damage, heart attack and death are rare with the vast majority of pharmaceuticals.

She should also understand that our country has systems in place to protect patients. Regulatory watchdogs and the practice of evidence-based medicine help reduce the risk of harmful medications being administered to the public. At times, severe adverse events have caused medications to be pulled from the market.

Nothing will eliminate the risk, but perhaps a consideration of all these factors will help put things in perspective for your wife.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)