Dear Doctors: I get frequent UTIs and was shocked you said they are caused by lax hygiene or sexual contact. I am meticulous about hygiene and have no sexual contact. My urologist said it is not the case all the time. This should have been worded differently in your article. Now my friends think I should take better care in cleansing myself. It’s quite frustrating.

Dear Reader: We regret that our discussion of urinary tract infections (UTIs) in a recent column did not include enough context to make clear that they can happen due to multiple causes. As we wrote, most uncomplicated UTIs happen when bacteria enter the urinary tract through common anatomical routes. Often, this is due to accidental transfer from the rectum, or during sexual activity. However, that’s not true for everyone. The focus of the column you are referencing was the growing challenge of antibiotic resistance in treating UTIs. Your letter gives us a chance to take a closer look at other ways UTIs can happen. We hope we can help ease the concerns of other readers like yourself.

When it comes to UTIs, anatomy is destiny. About half of all women will have at least one UTI in their lifetime. Only about 10% of men will have one. Part of the reason is that in women, the urethra is much shorter than it is in men. In men, the urethra is about 20 centimeters long. In women, it’s about 4 centimeters. This is a much shorter distance for bacteria to travel to infect a female bladder. Add in how close the urethra is to the rectum. This increases the risk of bacterial transfer even more, even with good hygiene.

Other factors can play a role in being susceptible to UTIs. One cause is the hormonal changes that occur during perimenopause and menopause. During these phases, the tissues of the urinary tract and the vagina change in ways that are favorable to harmful bacteria. Constipation, diabetes, inability to fully empty the bladder, catheter use, anatomical abnormalities and a weakened immune system can increase chances of getting a UTI. Vaginal and urinary microbiome composition and some spermicidal products can also play a role in UTI risk.

Another risk factor for UTIs brings us back to the topic of the original column, which is antibiotic resistance. This is when bacteria adapt to survive the antibiotics that would normally kill them. It's a widespread problem that makes infections of all types even more difficult to treat and control. With UTIs, there’s an epidemic of recurrent infections due to antibiotic resistance. This is when a drug is unable to completely kill the bacterium at the source of the infection. The surviving microbes then replicate, allowing the infection to persist or recur. Around 20% to 30% of women who have contracted their first UTI go on to experience a bounce-back infection.

The takeaway here is that UTIs reflect underlying biology rather than personal habits. It's a distinction that can lead to improved diagnosis, prevention and treatment.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I am a 67-year-old physically active man. I was taking turmeric three times a day for several weeks to reduce workout-related inflammation. I ended up in the hospital with an abscess and small intestine perforation. I have read excess turmeric may cause this. Please comment.

Dear Reader: Turmeric is a flowering plant in the ginger family. This plant is native to India and has been used as a spice for more than 4,000 years. In addition to lending a sweet, earthy flavor to a wide range of dishes, turmeric contains a number of biologically active compounds. Perhaps best known of these is curcumin. Curcumin has been shown to have anti-inflammatory, antioxidant and possibly antiviral properties. Historically, traditional Chinese, Indian and Thai medicine have used turmeric. More recently, it has become a go-to in alternative medicine in the U.S. Turmeric and curcumin are used for a number of health conditions. They can ease pain and inflammation and reduce stiffness. They can also help with the decreased movement from conditions such as osteoarthritis.

A body of research has found that curcumin can derail some biochemical pathways involved in inflammation. This includes blocking the activity of signaling molecules that contribute to joint pain and swelling. These mechanisms, along with the antioxidant qualities it has, have increased interest in curcumin. It may be an aid in managing the chronic low-grade inflammation and oxidative stress that are biomarkers of metabolic disease.

One problem researchers have bumped into is that, when taken by mouth, curcumin is poorly absorbed by the body. The ability for a substance to be absorbed is known as bioavailability. This is an important aspect of any kind of medication. When someone ingests turmeric, only small amounts of the curcumin it contains can enter the bloodstream. So dietary supplements add certain substances to improve absorption. This can include piperine, which is a black pepper extract, and dietary fat.

Although turmeric and curcumin can be beneficial, it is possible for overuse to cause gastrointestinal side effects. These can include stomach discomfort, indigestion, nausea, loose stools and diarrhea. That said, there is no credible evidence that this would lead to an intestinal perforation or abscess. These are serious conditions that typically arise from infection, obstruction, reduced blood flow or underlying disease. Also, an abscess or an intestinal perforation would take far longer to develop than a few weeks of turmeric use.

When a serious medical event occurs with, or closely follows, a change in routine, like adding a supplement, it is understandable to infer a connection. Based on what we know about turmeric and curcumin and the timing in your case, this connection seems unlikely. They are probably not the direct cause of your intestinal issues. However, because turmeric can affect bleeding risk and interact with certain medications, we urge you to let your medical care providers know you have been using it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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Dear Doctors: At age 51, I was diagnosed with severe rheumatic mitral stenosis. After a second round of tests, treatment was changed from open-heart surgery to balloon valvuloplasty. What can I do to help the results last? Should open-heart surgery be considered instead?

Dear Reader: The heart is a powerful muscle with precisely timed contractions that deliver blood with oxygen to the lungs. It also sends blood and oxygen to vessels and tissues throughout the body. The entrances and exits of the heart’s four chambers seal with thin, flexible leaflets of connective tissue known as valves. Their purpose is to make sure blood flows one way. Valves can have structural problems that affect their function. Stenosis, or narrowing, is one of these problems. In your case, the stenosis is in your mitral valve. This valve separates the left atrium (upper left chamber) of the heart from the left ventricle (lower left chamber). When rheumatic fever causes valve dysfunction, as in your case, it’s called rheumatic mitral stenosis.

This narrowing of the valve impedes the flow of blood into the left ventricle. It forces the heart muscle to work harder and causes pressure to build upstream. This can lead to an enlarged left atrium, heart arrhythmia, high blood pressure in the lungs and heart failure. A decrease in blood flow can cause symptoms such as fatigue, dizziness and fainting. More serious symptoms include systemic fluid buildup known as edema, frequent respiratory infections, coughing up blood and the formation of blood clots, which can cause a stroke.

Treatment depends on the degree of damage to the mitral valve. If it is thin, flexible, with little scarring and minimal backflow of blood, valvuloplasty can be an option. Valvuloplasty is a catheter repair usually done by a cardiologist. They insert a thin tube into the heart through a vein, typically through the groin. Then they insert a tiny balloon through the tube. They inflate the balloon slowly to stretch and expand the mitral valve. If the valve leaflets are too thick or have fused together, the valve may need replacing. This requires open-heart surgery. Rheumatic mitral stenosis often causes this degree of valve damage.

To determine the best path forward, you need to work with a cardiologist. They will review the tests you had and can understand why your recommended treatment may have changed. They’ll likely order additional testing. If imaging tests confirm the mitral valve is in good condition, the minimally invasive catheter repair may be the best approach.

Whichever treatment path you follow, there are a few things you can do to make the repair last as long as possible. Take all prescribed medications exactly as directed, keep blood pressure under control and regularly follow up with your cardiologist. Treat infections such as strep promptly, prevent recurrent infections and maintain good dental hygiene. These steps will all help give your heart the best chance at longevity.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)