Dear Doctor: I’m 102 years old and a World War II veteran. My problem is that I pass a lot of gas. Several days ago, I had an apple and a small piece of sweet potato, and I stunk up the whole house. I had to open all of the windows and doors. Do you have any suggestions?

Dear Reader: We do have some thoughts on your issue, but first we want to congratulate you on a long life. Our readers often include their age in their letters, and you have surpassed them all by several years.

Internal gas is a fact of life. Whether it’s emitted through the mouth as a burp or through the anus as flatulence, it’s actually a sign the body is functioning properly. Gas can accumulate as a result of air ingested while eating, drinking, speaking or swallowing. It’s also a byproduct of digestion, during which gut bacteria help break down food and emit a range of gases as they work. Most flatulence is made up of carbon dioxide, methane and hydrogen, which are essentially odorless. A small percentage of passed gas includes hydrogen sulfide, which has a powerful odor. Believe it or not, we humans pass gas from one dozen to two dozen times per day.

When excessive gas is accompanied by additional symptoms such as bloating, abdominal pain, loose stool or diarrhea, poor appetite, nausea and unexplained weight loss, it can signify the presence of underlying intestinal issues. These can include irritable bowel syndrome, inflammatory bowel disease, celiac disease, Crohn’s disease or small-intestinal bacterial overgrowth. If you do have these additional symptoms, be sure to let your doctor know.

Another factor in excessive gas is a person’s age. Due to ongoing changes in our bodies as we grow older, our digestive systems become less efficient at processing the food we eat. Some people may even develop lactose or fructose intolerance.

One approach to the problem is to identify the specific food triggers. You can do this by eliminating all suspected foods from your diet, then gradually reintroducing them one by one. Common culprits include high-fiber foods, certain fruits, cruciferous vegetables, beans and items with the artificial sweetener sorbitol. Keep track of symptoms, and you’ll be able to identify not only the specific foods that lead to excess gas, but also the serving size at which it becomes a problem.

You have several options to manage flatulence. Some people swear by probiotic foods and supplements, which can balance the gut. Your health care provider can help you decide if this is an option for you and advise you on specifics. Over-the-counter anti-gas preparations, such as Beano, or those that contain simethicone (Mylanta II, Maalox II) or bismuth (Pepto-Bismol) can reduce gas. Taking Lactaid, an enzyme supplement, helps people who have trouble with milk products.

And take a look at your prescription medications. Blood pressure drugs, narcotics and allergy meds, which can slow digestion and are associated with excess gas. Always check with your doctor before making any changes to medications.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I’m a 75-year-old woman and have been diagnosed with a dropped bladder due to a hysterectomy in my mid-40s. I have discomfort, particularly when I walk a long distance or do heavy lifting; some leakage problems; and frequently have UTIs. What can be done?

Dear Reader: A prolapsed bladder, also known as a fallen bladder, or cystocele, is common after a hysterectomy. It’s due to the drop in estrogen levels that occurs after the uterus and ovaries are removed. Estrogen, the primary female sex hormone, plays an important role in keeping the pelvic tissues toned and strong. Additional causes of the condition can include physical stresses, such as childbirth, frequent straining due to constipation or a chronic cough, heavy lifting and obesity. The decrease in estrogen that accompanies menopause can also contribute to bladder prolapse.

The condition is broken down into four separate stages, from mild to severe, depending on the degree to which the bladder has dropped. Women with a mild case -- Stage 1 -- may not experience any symptoms. When the condition is more advanced, symptoms include the discomfort, stress incontinence and frequent urinary tract infections that you mentioned, as well as lower back pain, difficulty with urination or bowel movements, pain during intercourse and a bulge of tissue from the vagina. In the most advanced cases -- Stage 4 -- the entire bladder protrudes.

Treatment depends on how far the bladder has dropped, as well as variables such as age, medical history, general health and personal preferences. In moderate cases, nonsurgical treatments can help. These include estrogen replacement therapy, which can be administered in a patch, as a pill or in a cream, and is used to strengthen the tissues that support the bladder. Kegel exercises, which are deliberate contractions of the muscles that you use to control urination, strengthen the pelvic floor. Electrical stimulation is used to trigger muscle contractions and build strength and tone, and some women have success with biofeedback.

Another nonsurgical option is a pessary. That’s a rubbery, donutlike device that is inserted into the vagina, much like a diaphragm. The pessary provides physical support. It can ease discomfort and has been shown to help with urinary control. It generally takes just one office visit with a urologist to be measured and fitted with the appropriate device. After that, pessaries require monthly cleaning. Depending on the device, this can be done at home, or it may need to be done in the urologist’s office. Many women do well with a pessary, while others experience discomfort or irritation. Infections are possible, but when a pessary is fitted and cleaned properly, the risk is small.

For severe cases of bladder prolapse, or when the less-invasive methods of managing the condition are not successful, reconstructive surgery may be needed. The goal is to return the bladder to its proper position. Before opting for surgical repair, be sure to learn all about the procedure you will have, as well as the potential risks, benefits and other options available.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I was recently diagnosed with chondrocalcinosis, which is quite painful. I know it’s similar to gout, though it is due to calcium crystals rather than urea. What treatments can help with pain? I don’t want to have a second knee replacement.

Dear Reader: You’re correct that the term chondrocalcinosis refers to a buildup of calcium crystals, specifically calcium pyrophosphate dihydrate crystals, within a joint. Sometimes referred to as pseudogout, it’s most often seen in the knee, but can also affect the elbow, shoulder, wrist and ankle joints. The accumulated crystals in the joint trigger an immune response, which results in inflammation, stiffness, swelling and pain within the joint. Episodes can last anywhere from several days to several months. The condition is often detected via an X-ray, which makes it possible to see the accumulation of calcium deposits. It’s a tricky diagnosis, though, because stiff and aching joints, and additional symptoms such as warmth and redness, are also common to osteoarthritis and rheumatoid arthritis. For a definitive diagnosis, a bit of fluid is removed from an inflamed joint and tested for the presence of calcium pyrophosphate crystals.

Anyone can develop chondrocalcinosis, but the risk rises significantly with advancing age. According to some estimates, it’s found in up to one-fifth of people over the age of 60, and in half of those 90 and older. As with gout, the condition can cause both short- and long-term swelling in the articulated, or movable, joints. Some people have flare-ups in more than one joint, and some also experiences a low-grade fever.

Although a specific cause for chondrocalcinosis hasn’t yet been identified, it is seen more often in people who have high blood levels of calcium (hypercalcemia), of iron (hemochromatosis), or hypomagnesemia, which is too little magnesium. Diet does not appear to play a role in flare-ups.

We’re sorry to say that at this time, there is no known way to dissolve or remove the calcium pyrophosphate crystals within the joint. Instead, the emphasis is on managing the condition. The goal is to ease inflammation and pain and to limit the degenerative tissue damage that the condition can cause. During flare-ups, nonsteroidal anti-inflammatory drugs, or NSAIDs, can ease pain, stiffness and swelling. For people who take blood thinners, or those who have stomach ulcers or poor kidney function, the use of NSAIDs may not be an option. In those cases, an aspiration procedure to remove fluid from the joint, along with an injection of a corticosteroid to manage inflammation, can provide relief. There is evidence that low doses of a medication used for gout, known as colchicine, can be effective in limiting flare-ups.

You mentioned the possibility of a knee replacement. This is a procedure that is sometimes recommended in more serious cases. If your particular case of chondrocalcinosis is severe enough that this has been presented as an option, we recommend that you seek guidance from a rheumatologist. These are physicians who specialize in the diagnosis and treatment of musculoskeletal disease and have an expertise in this painful and sometimes debilitating condition. Your health care provider should be able to provide you with a referral.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)