Female incontinence

Female incontinence

Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.
Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.
Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.
Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine water and wastes removed by the kidneys—in the bladder, a balloon like organ. The bladder connects to the urethra, the tube through which urine leaves the body.
Front view diagram of female urinary tract with labels pointing to kidneys, ureters, pelvic bones, and bladder. An inset shows an enlarged view of the bladder and sphincter muscles with labels pointing to the muscular bladder wall, sphincter muscles, and urethra.
Figure 1.Front view of bladder and sphincter muscles
During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder. Obesity, which is associated with increased abdominal pressure, can worsen incontinence. Fortunately, weight loss can reduce its severity.
What are the types of incontinence?
Stress Incontinence
If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. This type of incontinence is common in women and, in many cases, can be treated.
Childbirth and other events can injure the scaffolding that helps support the bladder in women. Pelvic floor muscles, the vagina, and ligaments support your bladder (see figure 2). If these structures weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the squeezing muscles weaken.
Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.
Urge Incontinence
If you lose urine for no apparent reason after suddenly feeling the need or urge to urinate, you may have urge incontinence. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.
Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower). Certain fluids and medications such as diuretics or emotional states such as anxiety can worsen this condition. Some medical conditions, such as hyperthyroidism and uncontrolled diabetes, can also lead to or worsen urge incontinence.
Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, and injury—including injury that occurs during surgery all can harm bladder nerves or muscles.
Overactive Bladder
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.
Specifically, the symptoms of overactive bladder include
* urinary frequency bothersome urination eight or more times a day or two or more times at night
* urinary urgency the sudden, strong need to urinate immediately
* urge incontinence leakage or gushing of urine that follows a sudden, strong urge
* nocturia awaking at night to urinate
Functional Incontinence
People with medical problems that interfere with thinking, moving, or communicating may have trouble reaching a toilet. A person with Alzheimer’s disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may have a hard time getting to a toilet in time. Functional incontinence is the result of these physical and medical conditions. Conditions such as arthritis often develop with age and account for some of the incontinence of elderly women in nursing homes.
Overflow Incontinence
Overflow incontinence happens when the bladder doesn’t empty properly, causing it to spill over. Your doctor can check for this problem. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.
Other Types of Incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence—and this combination in particular—are sometimes referred to as mixed incontinence. Most women don’t have pure stress or urge incontinence, and many studies show that mixed incontinence is the most common type of urine loss in women.
Transient incontinence is a temporary version of incontinence. Medications, urinary tract infections, mental impairment, and restricted mobility can all trigger transient incontinence. Severe constipation can cause transient incontinence when the impacted stool pushes against the urinary tract and obstructs outflow. A cold can trigger incontinence, which resolves once the coughing spells cease.
The Types of Urinary Incontinence
Stress Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
Urge Leakage of large amounts of urine at unexpected times, including during sleep.
Overactive Bladder Urinary frequency and urgency, with or without urge incontinence.
Functional Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
Overflow Unexpected leakage of small amounts of urine because of a full bladder.
Mixed Usually the occurrence of stress and urge incontinence together.
Transient Leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing).
How is incontinence evaluated?
The first step toward relief is to see a doctor who has experience treating incontinence to learn what type you have. A urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary and associated pelvic problems in women. Family practitioners and internists see patients for all kinds of health conditions. Any of these doctors may be able to help you. In addition, some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.
To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem—including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often you can begin treatment at the first medical visit.
Your doctor may instruct you to keep a diary for a day or more—sometimes up to a week—to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. You can also use the bladder diary to record your fluid intake, episodes of urine leakage, and estimated amounts of leakage.
If your diary and medical history do not define the problem, they will at least suggest which tests you need.
Your doctor will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. This condition is also important to diagnose at the time of an evaluation.
Your doctor may measure your bladder capacity. The doctor may also measure the residual urine for evidence of poorly functioning bladder muscles. To do this, you will urinate into a measuring pan, after which the nurse or doctor will measure any urine remaining in the bladder. Your doctor may also recommend other tests:
* Bladder stress test You cough vigorously as the doctor watches for loss of urine from the urinary opening.
* Urinalysis and urine culture Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
* Ultrasound This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.
* Cystoscopy The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.
* Urodynamics Various techniques measure pressure in the bladder and the flow of urine.
How is incontinence treated?
Behavioral Remedies: Bladder Retraining and Kegel Exercises
By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.
How do you do Kegel exercises?
The first step is to find the right muscles. One way to find them is to imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine sucking or drawing the marble into your vagina.
Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.
Repeat, but don’t overdo it. At first, find a quiet spot to practice—your bathroom or bedroomso you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.
Be patient. Don’t give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.
Some people with nerve damage cannot tell whether they are doing Kegel exercises correctly. If you are not sure, ask your doctor or nurse to examine you while you try to do them. If it turns out that you are not squeezing the right muscles, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both.
Medicines for Overactive Bladder
If you have an overactive bladder, your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency.
Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing. Other side effects include drowsiness, confusion, or memory loss. If you have glaucoma, ask your ophthalmologist if these drugs are safe for you.
Some medicines can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling (edema) or high blood pressure may increase your urine output and contribute to bladder control problems. Talk with your doctor; you may find that taking an alternative to a medicine you already take may solve the problem without adding another prescription.
Scientists are studying other drugs and injections that have not yet received U.S. Food and Drug Administration (FDA) approval for incontinence to see if they are effective treatments for people who were unsuccessful with behavioral therapy or pills.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your body’s functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Neuromodulation
For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients. Neuromodulation is the name of this therapy. The FDA has approved a device called InterStim for this purpose. Your doctor will need to test to determine if this device would be helpful to you. The doctor applies an external stimulator to determine if neuromodulation works in you. If you have a 50 percent reduction in symptoms, a surgeon will implant the device. Although neuromodulation can be effective, it is not for everyone. The therapy is expensive, involving surgery with possible surgical revisions and replacement.
Vaginal Devices for Stress Incontinence
One of the reasons for stress incontinence may be weak pelvic muscles, the muscles that hold the bladder in place and hold urine inside. A pessary is a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.
Injections for Stress Incontinence
A variety of bulking agents, such as collagen and carbon spheres, are available for injection near the urinary sphincter. The doctor injects the bulking agent into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence. After using local anesthesia or sedation, a doctor can inject the material in about half an hour. Over time, the body may slowly eliminate certain bulking agents, so you will need repeat injections. Before you receive an injection, a doctor may perform a skin test to determine whether you could have an allergic reaction to the material. Scientists are testing newer agents, including your own muscle cells, to see if they are effective in treating stress incontinence. Your doctor will discuss which bulking agent may be best for you.
Surgery for Stress Incontinence
In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position. The three main types of surgery are retropubic suspension and two types of sling procedures.
Retropubic suspension uses surgical threads called sutures to support the bladder neck. The most common retropubic suspension procedure is called the Burch procedure. In this operation, the surgeon makes an incision in the abdomen a few inches below the navel and then secures the threads to strong ligaments within the pelvis to support the urethral sphincter. This common procedure is often done at the time of an abdominal procedure such as a hysterectomy.
Sling procedures are performed through a vaginal incision. The traditional sling procedure uses a strip of your own tissue called fascia to cradle the bladder neck. Some slings may consist of natural tissue or man-made material. The surgeon attaches both ends of the sling to the pubic bone or ties them in front of the abdomen just above the pubic bone.
Midurethral slings are newer procedures that you can have on an outpatient basis. These procedures use synthetic mesh materials that the surgeon places midway along the urethra. The two general types of midurethral slings are retropubic slings, such as the transvaginal tapes (TVT), and transobturator slings (TOT). The surgeon makes small incisions behind the pubic bone or just by the sides of the vaginal opening as well as a small incision in the vagina. The surgeon uses specially designed needles to position a synthetic tape under the urethra. The surgeon pulls the ends of the tape through the incisions and adjusts them to provide the right amount of support to the urethra.
If you have pelvic prolapse, your surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy.
Recent women’s health studies performed with the Urinary Incontinence Treatment Network (UITN) compared the suspension and sling procedures and found that, 2 years after surgery, about two-thirds of women with a sling and about half of women with a suspension were cured of stress incontinence. Women with a sling, however, had more urinary tract infections, voiding problems, and urge incontinence than women with a suspension. Overall, 86 percent of women with a sling and 78 percent of women with a suspension said they were satisfied with their results. For more information, please visit www.uitn.net. Women who are interested in joining a study for urinary incontinence can go to www.ClinicalTrials.gov for a list of current studies recruiting patients.
Talk with your doctor about whether surgery will help your condition and what type of surgery is best for you. The procedure you choose may depend on your own preferences or on your surgeon’s experience. Ask what you should expect after the procedure. You may also wish to talk with someone who has recently had the procedure. Surgeons have described more than 200 procedures for stress incontinence, so no single surgery stands out as best.
Catheterization
If you are incontinent because your bladder never empties completely—overflow incontinence—or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use an indwelling—long-term—catheter, you should watch for possible urinary tract infections.
Other Helpful Hints
Many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments, or diapers. This practice is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises.
Points to Remember
* Urinary incontinence is common in women.
* All types of urinary incontinence are treatable.
* Incontinence is treatable at all ages.
* You need not be embarrassed by incontinence.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at finding treatments for urinary disorders, including urinary incontinence. The NIDDK is sponsoring the Urinary Incontinence Treatment Network (UITN), a consortium of urologists and urogynecologists who are evaluating and comparing treatment methods for stress and mixed incontinence in women. The goal of the first study, completed in 2007 , was to learn which treatment methods have the best short- and long-term outcomes for treating stress urinary incontinence in women. Ongoing studies focus on treatments for urge incontinence and minimally invasive treatments for stress incontinence.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development also supports research in the area of pelvic health. The Pelvic Floor Disorders Network (PFDN) was formed in 2001 to do research to improve the care and daily lives of women with pelvic organ prolapse and bladder and bowel control problems.

kegel exercises

kegel exercises

The aim of Kegel exercises is to strengthen pc muscles, specifically those that lie on the pelvis floor. The muscles are engaged during urination, bowel movements, sexual intercourse and, in women, during childbirth.
Age, surgery, childbirth, being overweight and specific medical conditions can cause weakening in the area, leading to urinary and bowel incontinence. In men, weakening of the pelvis can also lead to premature ejaculation. In both sexes, it can cause decreased sexual gratification.
So, Kegel exercises are recommended for a variety of purposes.Recommended that this type of exercise should be the “first line” of a management program to treat stress or urge urinary incontinence.
Stress incontinence is when a person “leaks” urine during laughing, sneezing or coughing. Urge incontinence is when a person feels a sudden urge to “go” and can’t quite make it to the bathroom. These conditions occur in both sexes, but are most common in women after pregnancy, childbirth or caesarean section.
The pc muscles become weakened during natural childbirth, as a result of increased pressure on the area during pregnancy and may also be affected by C-section.
Kegel exercises can also strengthen and tone the vaginal walls following natural childbirth.
A woman simply practices contracting the vagina. In order to feel the contraction, she can use her fingers, specially designed exercisers, balls or foam objects. The goal is to regain the “tightness” of the vagina, which improves sexual performance and gratification.

Urinary infections

Urinary infections

Urinary tract infections are a serious health problem affecting millions of people each year.
Infections of the urinary tract are the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.
*Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999–2000. Vital and Health Statistics. Series 13, No. 157. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; September 2004.

The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a sack-like organ in the lower abdomen. Urine is stored in the bladder and emptied through the urethra.

The average adult passes about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person consumes. The volume formed at night is about half that formed in the daytime.
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What are the causes of UTI?
Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.

In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder infection, called cystitis, results. If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.

Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both partners.

The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.
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Who is at risk?
Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection. An enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection.

A common source of infection is catheters, or tubes, placed in the urethra and bladder. A person who cannot void or who is unconscious or critically ill often needs a catheter that stays in place for a long time. Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life. Bacteria on the catheter can infect the bladder, so hospital staff take special care to keep the catheter clean and remove it as soon as possible.

People with diabetes have a higher risk of a UTI because of changes in the immune system. Any other disorder that suppresses the immune system raises the risk of a urinary infection.

UTIs may occur in infants, both boys and girls, who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery. UTIs are more rare in boys and young men. In adult women, though, the rate of UTIs gradually increases with age. Scientists are not sure why women have more urinary infections than men. One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear.

According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control. Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.
Recurrent Infections

Many women suffer from frequent UTIs. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of the last group, 80 percent will have recurrences.

Usually, the latest infection stems from a strain or type of bacteria that is different from the infection before it, indicating a separate infection. Even when several UTIs in a row are due to E. coli, slight differences in the bacteria indicate distinct infections.

Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract. A recent NIH-funded study found that bacteria formed a protective film on the inner lining of the bladder in mice. If a similar process can be demonstrated in humans, the discovery may lead to new treatments to prevent recurrent UTIs. Another line of research has indicated that women who are "non-secretors" of certain blood group antigens may be more prone to recurrent UTIs because the cells lining the vagina and urethra may allow bacteria to attach more easily. Further research will show whether this association is sound and proves useful in identifying women at high risk for UTIs.
Infections in Pregnancy

Pregnant women seem no more prone to UTIs than other women. However, when a UTI does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine during pregnancy.
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What are the symptoms of UTI?

Not everyone with a UTI has symptoms, but most people get at least some symptoms. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all over—tired, shaky, washed out—and to feel pain even when not urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. Normally, a UTI does not cause fever if it is in the bladder or urethra. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.

In children, symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving. Unlike adults, children are more likely to have fever and no other symptoms. This can happen to both boys and girls. The child should be seen by a doctor if there are any questions about these symptoms, especially a change in the child's urinary pattern.
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How is UTI diagnosed?

To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. Usually, the sample is sent to a laboratory, although some doctors' offices are equipped to do the testing.

In the urinalysis test, the urine is examined for white and red blood cells and bacteria. Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.

Some microbes, like Chlamydia and Mycoplasma, can be detected only with special bacterial cultures. A doctor suspects one of these infections when a person has symptoms of a UTI and pus in the urine, but a standard culture fails to grow any bacteria.

When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor may order some tests to determine if your system is normal. One of these tests is an intravenous pyelogram, which gives x-ray images of the bladder, kidneys, and ureters. An opaque dye visible on x-ray film is injected into a vein, and a series of x rays is taken. The film shows an outline of the urinary tract, revealing even small changes in the structure of the tract.

If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of soundwaves bounced back from internal organs. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra.
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How is UTI treated?

UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).

Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or other disorder. Still, many doctors ask their patients to take antibiotics for a week or two to ensure that the infection has been cured. Single-dose treatment is not recommended for some groups of patients, for example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections. Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A followup urinalysis helps to confirm that the urinary tract is infection-free. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared.

Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment. Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.

Various drugs are available to relieve the pain of a UTI. A heating pad may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. During treatment, it is best to avoid coffee, alcohol, and spicy foods. And one of the best things a smoker can do for his or her bladder is to quit smoking. Smoking is the major known cause of bladder cancer.
Recurrent Infections in Women

Women who have had three UTIs are likely to continue having them. Four out of five such women get another within 18 months of the last UTI. Many women have them even more often. A woman who has frequent recurrences (three or more a year) can ask her doctor about one of the following treatment options:
* Take low doses of an antibiotic such as TMP/SMZ or nitrofurantoin daily for 6 months or longer. If taken at bedtime, the drug remains in the bladder longer and may be more effective. NIH-supported research at the University of Washington has shown this therapy to be effective without causing serious side effects.
* Take a single dose of an antibiotic after sexual intercourse.
* Take a short course (1 or 2 days) of antibiotics when symptoms appear.
Dipsticks that change color when an infection is present are now available without a prescription. The strips detect nitrite, which is formed when bacteria change nitrate in the urine to nitrite. The test can detect about 90 percent of UTIs when used with the first morning urine specimen and may be useful for women who have recurrent infections.
Doctors suggest some additional steps that a woman can take on her own to avoid an infection:
* Drink plenty of water every day.
* Urinate when you feel the need; don't resist the urge to urinate.
* Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
* Take showers instead of tub baths.
* Cleanse the genital area before sexual intercourse.
* Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.
Some doctors suggest drinking cranberry juice.
Infections in Pregnancy

A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. In selecting the best treatments, doctors consider various factors such as the drug's effectiveness, the stage of pregnancy, the mother's health, and potential effects on the fetus.
Complicated Infections
Curing infections that stem from a urinary obstruction or other systemic disorders depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, this group of patients is at risk of kidney damage. Also, such infections tend to arise from a wider range of bacteria, and sometimes from more than one type of bacteria at a time.
Infections in Men
UTIs in men are often a result of an obstruction—for example, a urinary stone or enlarged prostate or from a medical procedure involving a catheter. The first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommend lengthier therapy in men than in women, in part to prevent infections of the prostate gland.

Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in older men are frequently associated with acute bacterial prostatitis, which can have serious consequences if not treated urgently.
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Is there a vaccine to prevent recurrent UTIs?

In the future, scientists may develop a vaccine that can prevent UTIs from coming back. Researchers in different studies have found that children and women who tend to get UTIs repeatedly are likely to lack proteins called immunoglobulins, which fight infection. Children and women who do not get UTIs are more likely to have normal levels of immunoglobulins in their genital and urinary tracts.

Early tests indicate that a vaccine helps patients build up their own natural infection-fighting powers. The dead bacteria in the vaccine do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight against live organisms. Researchers are testing injected and oral vaccines to see which works best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina.

Candida Albicans Treatment

Candida Albicans Treatment

Which Treatment for Candida albicans is right for you? Check out the options below and determine for yourself.
If you are not sure if you have a Candida infection, please look at the Candida albicans symptoms page and take the questionnaire.
There are numerous treatment options available. I opted for the natural Candida cure along with the Candida diet because I dislike pharmaceuticals. The options are listed here and described briefly below. Click on the links for a more detailed description.
* Candida Diet
* Natural Candida Cure
* Candida Albicans Medicine
* Candida Home Treatments
The Candida diet is for you if you scored more than a 6 on the Candida albicans symptoms questionnaire. The diet increases the effectiveness of all of the other Candida treatments. It removes the nutrients that the Candida needs to survive without removing the nutrients you need to survive!!
The natural Candida cure is for you if you scored anything higher than a 6. In most instances it will take from 1 to 3 months to heal yourself with the natural Candida cure. If you have a fingernail fungus or toenail fungus (a form of Candida), it will take up to six months to kill the fungus and another six months for the nail to grow out. The best thing about a natural Candida cure is that it is easy on your body. The main side effect you can expect is a minor die off reaction. A die off reaction makes you feel even sicker for two or three days but quickly clears up.
The Candida albicans medicine page is for you if you scored anything higher than a 10 or if you are not patient enough for a natural Candida cure. In most instances it will take less then 1 month to heal yourself with a Candida albicans medicine. If you have a fingernail fungus or toenail fungus, it will take up to one month to kill the fungus and another six months for the nail to grow out. The main issue with any Candida albicans medicine is that they can be harmful to other parts of the body.
The Candida home treatments are over the counter medications that you can use to cure yeast infections, athletes foot and jock itch discretely in your own home. In most instances the cure will take from 1 day to 3 weeks.
Check out the links and see which treatment for Candida albicans is best for you.

Candida Albicans Symptoms

Candida Albicans Symptoms

Candida is nearly an epidemic in our society and is responsible for many of the chronic illness categories we see so frequently. Candida symptoms are vast and all encompassing and can even incapacitate the individual.
Most people are unaware that it even exists, because most main stream doctors are uneducated about its impact on our health. People suffering from this condition often go from doctor to doctor for years and are usually told they are a hypochondriac or that it is stress or a psychiatric problem, before ever discovering the real culprit.
Candida Albicans is a yeast that occurs naturally in the human body. Normally it lives in harmony with a variety of other microorganisms and actually performs a couple important functions. The problem occurs when something upsets the balance of bacteria in the body and this allows the yeast organism to proliferate and take over all the healthy microorganisms.
It normally resides in the intestinal tract, mouth, throat and genitals, however it can burrow holes in the intestinal tract, enter the blood stream and then make it's way into any organ of the body. To make matters worse it emits over 70 different toxins into the body. Some people may even become allergic to the yeast itself.
Once this hardy organism proliferates in the body, it wrecks havock in many ways and is the insitigator of many common maladies, conditions, syndromes and illnesses in our population.
Some of the most frequent Candida symptoms are:
* abdominal gas
* headaches
* migraines
* excessive fatigue
* cravings for alcohol
* anxiety
* vaginitis
* rectal itching
* cravings for sweets
* inability to think clearly or concentrate
* hyperactivity
* mood swings
* diarrhea
* constipation
* hyperactivity
* itching
* acne
* eczema
* depression
* sinus inflammation
* pre-menstrual syndrome
* dizziness
* poor memory
* persistent cough
* earaches
* low sex drive
* muscle weakness
* irritability
* learning difficulties
* sensitivity to fragrances and/or other chemicals
* cognitive impairment
* thrush
* athlete's foot
* sore throat
* indigestion
* acid reflux
* chronic pain
One of the most well known forms of yeast is the vaginal yeast infection.However, it may play a role in just about any mental health condition or chronic illness you can think of. Yeast overgrowth is considered to be a leading contributor in alcoholism, anxiety disorders, asthma, irritable bowel syndrome, addisons disease, mcs - multiple chemical sensitivites, crohns, autism, cfs - chronic fatigue syndrome, leaky gut syndrome, pms, endometriosis,fms - fibromyalgia syndrome, prostatitis, attention deficit disorder, multiple sclerosis, asthma, food allergies, muscle and joint pain, clinical depression, repeated urinary tract infections, hormonal imbalances, migraines, digestive disturbances, difficult menopause psoriasis, lupus, chronic pain, tourette's, vulvodynia, rheumatoid arthritis and many more.
Men may like to read the Candida symptoms in males section for additional information about some of the unique aspects that apply to them, but be sure to return back here for the majority of material is found here.
The brain is the organ that is most frequently affected by Candida Symptoms, but it also has profound negative effects on these systems:
* digestive
* nervous
* cardiovascular
* respiratory
* reproductive
* urinary
* endocrine
* lymphatic
* musculoskeletal
Candida symptoms can vary from one person to another and often move back and forth between systems within the same individual. One day you may experience symptoms in the musculoskeletal system and the next day it could be the digestive system ,etc.
Reducing Candida Symptoms
There are a variety of causes of candida, but the two leading contributors are a diet high in sugar and refined foods and the overuse of antibiotics.
First and foremost you want to refrain from taking antibiotics unless it is absolutely necessary. Try to find other healthy alternatives to infections etc., but of course there may be times when it can’t be avoided. If you must take an antibiotic for some reason, you should always be sure to take an acidophilus supplement during the course of the treatment. This will help keep healthy bacteria present in your body.
Taking acidophilus on a daily basis is one of the best defenses against yeast overgrowth and it promotes a healthy colon.
The second most important factor in reducing Candida symptoms is to follow a Candida diet. A diet high in sugar is a haven for yeast. It's crucial to eliminate sugars and refined foods to reduce overgrowth. Initially even fruits and high carbohydrate foods may need to be eliminated and then reintroduced to the diet later as you get better. Meat, eggs, vegetables and yogurt are what is best to stick with and small amounts of whole, healthy carbohydrates such as brown rice or potatoes. If you need some ideas on what to eat, you may enjoy the Candida diet recipes page.
Most people with yeast overgrowth are also suffering from nutritional deficiencies and correcting your deficiencies can help you in your battle over Candida symptoms.
Some of the most effective and popular natural health approaches used in the treatment of Candida symptoms include oxygen based products like food grade hydrogen peroxide, caprylic acid, oregono oil, garlic, taheebo tea, grapefruit seed extract and colloidal silver. Prescription medication like Nystatin, Diflucan or Nizoral may be obtained by a physican, but carry a few risks.
It is also essential to keep your home environment healthy and not-toxic. Chemicals weaken the immune system and if the immune system is weak this also allows the yeast to proliferate. So keeping your home chemical free by using non-toxic and natural cleaning supplies, personal care products etc. will help your body stay stronger.
A good holistic Candida cleanse is the most powerful way to relieve symptoms and improve your health.
Many people find the use of a good colon cleanse like enemas to be helpful in eradicating or reducing their symptoms. These can be either plain water, or mixed with nystatin or acidophilus. Good colon health is crucial for reducing yeast overgrowth.
Nystatin is a prescription drug that can be obtained from a physician. It is a non-toxic drug that is not absorbed into the blood stream and is very helpful with yeast in the mouth and gastrointestinal tract. It can also be used as a douche if you are experiencing vaginal itching from yeast.
One very popular treatment product is called Threelac. You may want to read my review and experience with this prodcut before trying it yourself.
There are many different treatment approaches and products on the market today and this can be very confusing. To make things more difficult, not all practitioners treating this condition have a well rounded picture of what's needed for success. It's important that you have a thorough understanding of the complexities of Candida yourself and the most effective way to approach treatment before trying any particular remedy. By randomly choosing products without understanding the true nature of this beast it can actually hinder your progress in eliminating yeast overgrowth. If you're looking for a quick read that will cover all the bases for you and get you on the right path from the very start, you may want to take a look at"Candida Secrets."
During any treatment approach most people experience a temporary worsening of symptoms called
die off. This is a normal part of the healing process, however it can be overwhelming and steps should be taken to minimize the negative effects.
Do You Have Candida?
There are a variety of tests that practitioners use to diagnose yeast overgrowth, that may include stool tests, blood tests, live blood cell tests, etc., but the truth is that none of these tests are really reliable. They may or may not detect an infection of Candidiasis.
The simple most effective way to know if you have a yeast problem is by your symptoms. The very best and most accurate test is the written questionnaire that you can find in Dr. Crook's book called "The Yeast Connection."
Another very effective and affordable test is called the "spit test." Here's how you do it:
As soon as you wake up in the morning before you put anything in your mouth, get a glass of water in a clear glass that you can see through. Don't use tap water.
Collect saliva in your mouth with your tongue and spit it into the glass.
Now keep an eye on your saliva in the glass for the next 15 minutes and observe what it does.
If you see any of the following, then it indicates the presence of yeast colonies:
* Your saliva stays at the top and you see thin strands that look like strings or spider legs extending downward.
* Your saliva floats to the bottom and looks cloudy.
* Your saliva is suspended in mid-air and looks like little specs are floating.
See the picture below for guidance.
Candida is really an insidious, tricky yeast and once you have overgrowth it can be extremely difficult to get under control. It takes a lot of patience, education and persistence. I know this all to well, as I have faced this struggle myself for many years. If you need to talk to someone who understands, you may find my holistic health phone counseling to be helpful. I can give you tips and advice on diet, supplementation, treatment options, coping and adjustment, lifestyle changes or whatever you may want to talk about.
There are several excellent books listed at the bottom of this page to guide you along your way and even if you don’t have a Candida problem these books are excellent pieces of education on the growing incidence of this devastating, yet rarely acknowledged syndrome.
It's also best to find an alternative health doctor who has a complete and thorough understanding of Candida symptoms and its impact on health to guide you if you are just beginning to learn.

Candida Remedies

Candida Remedies

Most people may not have heard of candidiasis and the ones who do know can tell you the symptoms of the disease can easily be mistaken for an upset stomach, an allergic reaction or simple exhaustion.
Unfortunately, if left unattended, candidiasis or infection brought about by the fungus candida albicans can cause serious damage to the body.
The good news is candidiasis, in its early stages, may not necessarily mean a trip to the doctor where you would incur expensive fees and medical bills. For the most part, home remedies have proven quite effective in combating the effects of candidiasis. The key is to administer these remedies early on.
Tea tree oil mouthwash
For oral thush:
Mix a few drops of tea tree oil (approximately 5 to 8 drops) into a glass of either warm or cold water. Gargle the mixture for about a minute. Let the solution touch all the parts of the mouth (throat, palate, cheek lining). Be careful not to swallow the solution. Gargle two times a day (preferably one in the morning and one before sleeping).
For vaginal yeast infection:
Add a few drops of tea tree oil onto a tampon or sterile gauze and apply on to the affected area. Replace every 4 to 6 hours.
Plain yogurt
Make sure it has absolutely no sugar and other ingredients added to it. The yogurt should contain live lactobacillus acidophilus, which are good bacteria that keep candida albicans in check.
For vaginal yeast infection:
Dip tampon in the yogurt and insert into the vagina. Use twice a day until the symptoms clear up and repeat for one more extra day for good measure.
For skin problems (cutaneous candidiasis)
Apply yogurt directly on the affected area. Not only will the yogurt address the fungal infection, but also the yogurt will lend a soothing effect and relieve severe itching and weeping. Let yogurt stand for an hour or so and wash off well. Keep affected area dry. Apply two to three times a day.
Apple cider vinegar
For oral thrush: Mix two (2) teaspoons of apple cider vinegar to one (1) cup cool water. Gargle with solution. Do not swallow. After gargling, dip a cotton swab in undiluted apple cider vinegar and apply directly on to the oral sores. Do not rinse. Allow to stand overnight.
For vaginal yeast infection:
Create a douching solution of one (1) tablespoon of apple cider vinegar and two (2) cups of water. Add one (1) garlic clove and allow the solution to stand for two hours before using for douching.
Changes in diet
Candida seems to thrive on high-sugar diets. So in order to “starve” the fungi, go on a low-to-no sugar diet, using sugar alternatives at best. Continue with this diet for as long as symptoms persist. In addition to the altered diet, make sure you receive sufficient doses of vitamins (A, B-complex, C) as well as minerals (iron and zinc).
This solution works best when the symptoms are becoming systemic, meaning that different parts of the body are affected all at the same time. (For example, in addition to vaginal yeast infection, you have also contracted skin and stomach problems as well.) Diabetics, however, need to consult with a medical professional before undergoing this measure.
Other solutions: Prevention worth a pound of cure
To prevent candida overgrowth, which is the prime cause of the disorders, observe these tips (especially for the women).
Don't douche or clean inside the vagina. Do not use vaginal deodorants or perfumed soaps when washing the external area. You can strip the body of the natural elements that keep the fungus in check. At best, use plain water or a mild, pH-balanced cleanser.
Avoid tight clothes (including underwear), especially ones made of nylon. These prevent proper aeration (breathing) of the skin. It encourages moisture to form in the body, which is prime breeding ground for fungi.
Drink plenty of water to keep the body cool and to flush out toxins (including those produced by the candida fungus) out of your body.
Have a good number of servings of bananas, yogurt, and garlic. These foods have been found to have lots of anti-fungal properties and if part of your regular diet, the chances of avoiding candidiasis are great.
Do not skip meals and avoid keeping your stomach empty for long periods of time. You wreak havoc on a body that function best when working on routine time. Having irregular eating habits have been observed to increase the chances of candida overgrowth.
The key to all of these home remedies are early and quick detection. So in order to administer the right remedy, learn to recognize the symptoms.
However, should you be unsure of the indicators, always consult with a qualified and licensed medical professional. Listen to their advice and pair them with these home remedies. You just may be a step closer to ridding, if not totally avoiding, candidiasis and its nasty effects.

Causes of Urinary Tract Infection

Causes of Urinary Tract Infection

The urinary tract is the body's filtering system for removal of liquid wastes. Because we have a shorter urinary tract, women are especially susceptible to bacteria that may invade the urinary tract and multiply -- resulting in infection known as a urinary tract infection, or UTI.
Although most UTIs are not serious, they can be a painful nuisance. Approximately 50 percent of all women will have at least one UTI in her lifetime with many women having several infections throughout their lifetime. Fortunately, these infections are easily treated with antibiotics. Some women are more prone to repeated infections than others and for them it can be a frustrating battle.
What Causes Urinary Tract Infections?
The most common cause of UTIs are bacteria from the bowel that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra. Once these bacteria enter the urethra, they travel upward, causing infection in the bladder and sometimes other parts of the urinary tract.
Sexual intercourse is a common cause of urinary tract infections because the female anatomy can make women more prone to urinary tract infections. During sexual activity, bacteria in the vaginal area are sometimes massaged into the urethra.
Women who change sexual partners or begin having sexual intercourse more frequently may experience bladder or urinary tract infections more often than women who are celibate or in monogamous relationships. Although it is rare, some women get a urinary tract infection every time they have sex.
Another cause of bladder infections or UTI is waiting too long to urinate. The bladder is a muscle that stretches to hold urine and contracts when the urine is released. Waiting too long past the time you first feel the need to urinate can cause the bladder to stretch beyond its capacity. Over time, this can weaken the bladder muscle. When the bladder is weakened, it may not empty completely and some urine is left in the bladder. This may increase the risk of urinary tract infections or bladder infections.
Other factors that also may increase a woman's risk of developing UTI include pregnancy, having urinary tract infections or bladder infections as a child, menopause, or diabetes.
What Are the Symptoms of Urinary Tract Infections?
Symptoms of UTI or bladder infection are not easy to miss and include a strong urge to urinate that cannot be delayed, which is followed by a sharp pain or burning sensation in the urethra when the urine is released. Most often very little urine is released and the urine that is released may be tinged with blood. The urge to urinate recurs quickly and soreness may occur in the lower abdomen, back, or sides.
This cycle may repeat itself frequently during the day or night--most people urinate about six times a day, when the need to urinate occurs more often a bladder infection should be suspected.
When bacteria enter the ureters and spread to the kidneys, symptoms such as back pain, chills, fever, nausea, and vomiting may occur, as well as the previous symptoms of lower urinary tract infection.
Proper diagnosis is vital since these symptoms also can be caused by other problems such as infections of the vagina or vulva. Only your physician can make the distinction and make a correct diagnosis.
How Is a Diagnosis of UTI Made?
The number of bacteria and white blood cells in a urine sample is the basis for diagnosing urinary tract infections. Urine is examined under a microscope and cultured in a substance that promotes the growth of bacteria. A pelvic exam also may be necessary.
What Is the Treatment for Urinary Tract Infections?
Antibiotics (medications that kill bacteria) are the usual treatment for bladder infections and other urinary tract infections. Seven to ten 10 of antibiotics is usually required, although some infections may require only a single dose of antibiotics.
It's important that all antibiotics are taken as prescribed. Antibiotics should not be discontinued before the full course of antibiotic treatment is complete. Symptoms may disappear soon after beginning antibiotic treatment. However, if antibiotics are stopped early, the infection may still be present and recur.
An additional urine test may be ordered about a week after completing treatment to be sure the infection is cured.
Tips for Preventing Urinary Tract Infections
* The most important tip to prevent urinary tract infections, bladder infections, and kidney infections is to practice good personal hygiene. Always wipe from front to back after a bowel movement or urination, and wash the skin around and between the rectum and vagina daily. Washing before and after sexual intercourse also may decrease a woman's risk of UTI.
* Drinking plenty of fluids (water) each day will help flush bacterium out of the urinary system.
* Emptying the bladder as soon as the urge to urinate occurs also may help decrease the risk of bladder infection or UTI.
* Urinating before and after sex can flush out any bacteria that may enter the urethra during sexual intercourse.
* Vitamin C makes the urine acidic and helps to reduce the number of potentially harmful bacteria in the urinary tract system.
* Wear only panties with a cotton crotch, which allows moisture to escape. Other materials can trap moisture and create a potential breeding ground for bacteria. Avoid thongs.
* Cranberry juice is often said to reduce frequency of bladder infections, though it should not be considered an actual treatment. Cranberry supplements are available over-the-counter and many women find they work when an UTI has occurred; however, a physician's diagnosis is still necessary even if cranberry juice or related herbals reduce pain or symptoms.
* If you experience frequent urinary tract infections changing sexual positions that cause less friction on the urethra may help. Some physicians prescribe an antibiotic to be taken immediately following sex for women who tend to have frequent UTIs.
Things to Remember.
Although urinary tract infections are common and distinctly painful, they usually are easy to treat once properly diagnosed and only last a few days. When treated promptly and properly, UTIs are rarely serious.

Urinary Tract Infections

Urinary Tract Infections

Urinary tract infections (UTIs) affect about 3 percent of children in the United States every year. Throughout childhood, the risk of a UTI is 2 percent for boys and 8 percent for girls. UTIs account for more than 1 million visits to pediatricians’ offices every year. The symptoms are not always obvious to parents, and younger children are usually unable to describe how they feel. Recognizing and treating urinary tract infections is important. Untreated UTIs can lead to serious kidney problems that could threaten the life of your child.
How does the urinary tract normally function?
The kidneys filter and remove waste and water from the blood to produce urine. They get rid of about 1-1/2 to 2 quarts of urine per day in an adult and less in a child, depending on the child's age. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloon-like organ called the bladder (see figure 1). In a child, the bladder can hold about 1 to 1-1/2 ounces of urine for each year of the child's age. So, the bladder of a 4-year-old child may hold about 4 to 6 ounces (less than 1 cup); an 8-year-old can hold 8 to 12 ounces. When the bladder empties, a muscle called the sphincter relaxes and urine flows out of the body through the urethra, a tube at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys (see figure 2) and in front of the vagina in girls (see figure 3)
How does the urinary tract become infected?
Normal urine contains no bacteria (germs). Bacteria may, at times, get into the urinary tract and the urine from the skin around the rectum and genitals by traveling up the urethra into the bladder. When this happens, the bacteria can infect and inflame the bladder and cause swelling and pain in the lower abdomen and side. This bladder infection is called cystitis.
If the bacteria travel up through the ureters to the kidneys, a kidney infection can develop. The infection is usually accompanied by pain and fever. Kidney infections are much more serious than bladder infections.
In some children a urinary tract infection may be a sign of an abnormal urinary tract that may be prone to repeated problems. (See What abnormalities lead to urinary problems?) For this reason, when a child has a urinary infection, additional tests are often recommended. (See What tests may be needed after the infection is gone?) In other cases, children develop urinary tract infections because they are prone to such infections, just as other children are prone to getting coughs, colds, or ear infections. Or a child may happen to be infected by a type of bacteria with a special ability to cause urinary tract infections.
Children who frequently delay a trip to the bathroom are more likely to develop UTIs. Regular urination helps keep the urinary tract sterile by flushing away bacteria. Holding in urine allows bacteria to grow. Keeping the sphincter muscle tight for a long time also makes it more difficult to relax that muscle when it is time to urinate. As a result, the child’s bladder may not empty completely. This dysfunctional voiding can set the stage for a urinary infection.
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What are the signs of urinary tract infection?
A urinary tract infection causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just like the inside of the nose or the throat becomes irritated with a cold. If your child is an infant or only a few years old, the signs of a urinary tract infection may not be clear, since children that young cannot tell you exactly how they feel. Your child may have a high fever, be irritable, or not eat.
On the other hand, sometimes a child may have only a low-grade fever, experience nausea and vomiting, or just not seem healthy. The diaper urine may have an unusual smell. If your child has a high temperature and appears sick for more than a day without signs of a runny nose or other obvious cause for discomfort, he or she may need to be checked for a bladder infection.
An older child with bladder irritation may complain of pain in the abdomen and pelvic area. Your child may urinate often. If the kidney is infected, your child may complain of pain under the side of the rib cage, called the flank, or low back pain. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of urinary tract infection. Your child may have difficulty controlling the urine and may leak urine into clothing or bedsheets. The urine may smell unusual or look cloudy or red.
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How do you find out whether your child has a urinary tract infection?
Only by consulting a health care provider can you find out for certain whether your child has a urinary tract infection.
Some of your child's urine will be collected and examined. The way urine is collected depends on your child’s age. If the child is not yet toilet trained, the health care provider may place a plastic collection bag over your child's genital area. It will be sealed to the skin with an adhesive strip. An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area. A doctor or nurse may need to pass a small tube into the urethra. Urine will drain directly from the bladder into a clean container through this tube, called a catheter. Sometimes the best way to get the urine is by placing a needle directly into the bladder through the skin of the lower abdomen. Getting urine through the tube or needle will ensure that the urine collected is pure.
Some of the urine will be examined under a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. If the bacteria from the sample are hard to see, the health care provider may place the sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the germs have multiplied, they can then be identified and tested to see which medications will provide the most effective treatment. The process of growing bacteria in the laboratory is known as performing a culture and often takes a day or more to complete.
The reliability of the culture depends on how long the urine stands before the culture is started. If you collect your child's urine at home, refrigerate it as soon as it is collected and carry the container to the health care provider or lab in a plastic bag filled with ice.
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How are urinary tract infections treated?
Urinary tract infections are treated with bacteria-fighting drugs called antibiotics. While a urine sample is being examined, the health care provider may begin treatment with a drug that treats the bacteria most likely to be causing the infection. Once culture results are known, the health care provider may decide to switch your child to another antibiotic.
The way the antibiotic is given and the number of days that it must be taken depend in part on the type of infection and how severe it is. When a child is sick or not able to drink fluids, the antibiotic may need to be put directly into the bloodstream through a vein in the arm or hand. Otherwise, the medicine (liquid or pills) may be given by mouth or by shots. The medicine is given for at least 3 to 5 days and possibly for as long as several weeks. The daily treatment schedule recommended depends on the specific drug prescribed: The schedule may call for a single dose each day or up to four doses each day. In some cases, your child will need to take the medicine until further tests are finished.
After a few doses of the antibiotic, your child may appear much better, but often several days may pass before all symptoms are gone. In any case, your child should take the medicine for as long as the doctor recommends. Do not stop medications because the symptoms have gone away. Infections may return, and germs can resist future treatment if the drug is stopped too soon.
Children should drink fluids when they wish. Make sure your child drinks what he or she needs, but do not force your child to drink large amounts of fluid. The health care provider needs to know if the child is not interested in drinking.
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What tests may be needed after the infection is gone?
Once the infection has cleared, additional tests may be recommended to check for abnormalities in the urinary tract. Repeated infections in abnormal urinary tracts may cause kidney damage. The kinds of tests ordered will depend on your child and the type of urinary infection. Because no single test can tell everything about the urinary tract that might be important, more than one of the following tests may be needed:
Kidney and bladder ultrasound. An ultrasound test examines the kidney and bladder using sound waves. This test shows shadows of the kidney and bladder that may point out certain abnormalities. However, this test cannot reveal all important urinary abnormalities. It also cannot measure how well a kidney works.
Voiding cystourethrogram (VCUG). This test examines the urethra and bladder while the bladder fills and empties. A liquid that can be seen on x rays is placed into the bladder through a catheter. The bladder is filled until the child urinates. This test can reveal abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties.
Intravenous pyelogram. This test examines the whole urinary tract. A liquid that can be seen on x rays is injected into a vein. The substance travels into the kidneys and bladder, revealing possible obstructions.
Nuclear scans. These tests use radioactive materials that are usually injected into a vein to show how well the kidneys work, the shape of the kidneys, and whether urine empties from the kidneys in a normal way. Each kind of nuclear scan gives different information about the kidneys and bladder. Nuclear scans expose a child to about the same amount of radiation as a conventional x ray. At times, it can even be less.
Computed tomography (CT) scans and magnetic resonance imaging (MRI). These tests provide 3-D images and cross-sections of the bladder and kidneys. With a typical CT scan or MRI machine, the child lies on a table that slides inside a tunnel where the images are taken. If the child’s infection is complicated or difficult to see in other image tests, a CT scan or MRI can provide clearer, more detailed images to help the doctor understand the problem.
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What abnormalities lead to urinary problems?
Many children who get urinary tract infections have normal kidneys and bladders. But if a child has an abnormality, it should be detected as early as possible to protect the kidneys against damage. Abnormalities that could occur include the following:
Vesicoureteral reflux (VUR). Urine normally flows from the kidneys down the ureters to the bladder in one direction. With VUR, when the bladder fills, the urine may also flow backward from the bladder up the ureters to the kidneys. This abnormality is common in children with urinary infections.
Urinary obstruction. Blockages to urinary flow can occur in many places in the urinary tract. The ureter or urethra may be too narrow or a kidney stone at some point stops the urinary flow from leaving the body. Occasionally, the ureter may join the kidney or bladder at the wrong place and prevent urine from leaving the kidney in the normal way.
Dysfunctional voiding. Some children develop a habit of delaying a trip to the bathroom because they don’t want to leave their play. They may work so hard at keeping the sphincter muscle tight that they forget how to relax it at the right time. These children may be unable to empty the bladder completely. Some children may strain during urination, causing pressure in the bladder that sends urine flowing back up the ureters. Dysfunctional voiding can lead to vesicoureteral reflux, accidental leaking, and UTIs.
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Do urinary tract infections have long-term effects?
Young children are at the greatest risk for kidney damage from urinary tract infections, especially if they have some unknown urinary tract abnormality. Such damage includes kidney scars, poor kidney growth, poor kidney function, high blood pressure, and other problems. For this reason it is important that children with urinary tract infections receive prompt treatment and careful evaluation.
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How can urinary tract infections be prevented?
If your child has a normal urinary tract, you can help him or her avoid UTIs by encouraging regular trips to the bathroom. Make sure your child gets enough to drink if infrequent voiding is a problem. Teach your child proper cleaning techniques after using the bathroom to keep bacteria from entering the urinary tract.
Some abnormalities in the urinary tract correct themselves as the child grows, but some defects may require surgical correction. A common procedure to correct VUR is the reimplantation of the ureters. During this surgery, the doctor repositions the connection between the ureter and the bladder so that urine will not back up into the ureters and kidneys. In recent years, doctors have treated some cases of VUR by injecting collagen, or a similar substance, into the bladder wall, just below the opening where the ureter joins the bladder. This injection creates a kind of valve that keeps urine from flowing back into the ureter. The injection is delivered to the inside of the bladder through a catheter passed through the urethra, so there is no need for a surgical incision.
Points to Remember
* Urinary tract infections affect about 3 percent of children in the United States every year.
* A urinary tract infection in a young child may be a sign of an abnormality in the urinary tract that could lead to repeated problems.
* Symptoms of a urinary infection range from slight burning with urination or unusual smelling urine to severe pain and high fever.
* Untreated urinary infections can lead to serious kidney damage.
* Talk to a doctor if you suspect your child has a urinary tract infection.

Menstrual Disorders

Menstrual Disorders

Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.
However, other women experience a host of physical and/or emotional symptoms just before and during menstruation. From heavy bleeding and missed periods to unmanageable mood swings, these symptoms may disrupt a woman's life in major ways.
Most menstrual cycle problems have straightforward explanations and a range of treatment options exist to relieve your symptoms. If your periods feel overwhelming, discuss your symptoms with your health care professional. Once your symptoms are accurately diagnosed, he or she can help you choose the best treatment to make your menstrual cycle tolerable.
Your menstrual period is part of your menstrual cycle—a series of changes that occur to parts of your body (your ovaries, uterus, vagina and breasts) every 28 days, on average. Some normal menstrual cycles are a bit longer; some are shorter. The first day of your menstrual period is day one of your menstrual cycle. The average menstrual period lasts about five to seven days. A "normal" menstrual period for you may be different from what's "normal" for someone else.
If one or more of the symptoms you experience before or during your period causes a problem, you may have a menstrual cycle "disorder." These include:
* abnormal uterine bleeding (AUB; also called excessive or heavy menstrual bleeding)
* amenorrhea (no menstrual bleeding)
* fibroids: noncancerous uterine tumors
* dysmenorrhea (painful menstrual periods)
* premenstrual syndrome (PMS)
* premenstrual dysphoric disorder (PMDD)
A brief discussion of menstrual disorders follows below.
Abnormal Uterine Bleeding
One in five women bleed so heavily during their periods that they have to put their normal lives on hold just to deal with the heavy blood flow.
Bleeding is considered heavy or abnormal if it interferes with normal activities. Blood loss during a normal menstrual period is about five tablespoons, but if you have AUB, you may bleed as much as 10 to 25 times that amount each month. You may have to change a tampon or pad every hour, for example, instead of three or four times a day.
Heavy menstrual periods can be common at various stages of your life—during your teen years when you first begin to menstruate and in your late 40s or early 50s, as you get closer to menopause.
If you are past menopause and experience any vaginal bleeding, discuss your symptoms with your health care professional right away. Any vaginal bleeding after menopause isn't normal and should be evaluated immediately by a health care professional.
Abnormal uterine bleeding can be caused by:
* hormonal imbalances
* mtructural abnormalities in the uterus
* medical conditions
Many women with excessive menstrual bleeding can blame their condition on hormones. Your body may produce too much or not enough estrogen or progesterone—known as reproductive hormones—necessary to keep your menstrual cycle regular.
For example, many women with abnormal uterine bleeding don't ovulate regularly. Ovulation, when one of the ovaries releases an egg, occurs around day 14 in a normal menstrual cycle. Changes in hormone levels help trigger ovulation.
Certain medical conditions can cause abnormal uterine bleeding. These include:
* thyroid problems
* blood clotting disorders such as Von Willebrand's disease, a mild-to-moderate bleeding disorder
* idiopathic thrombocytopenic purpura (ITP), a bleeding disorder characterized by too few platelets in the blood
* liver or kidney disease
* leukemia
* medications, such as anticoagulant drugs such as Plavix (clopidogrel) or heparin and some synthetic hormones.
Other gynecologic conditions that may be responsible for heavy bleeding include:
* complications from the copper-T IUD
* miscarriage
* ectopic pregnancy, which occurs when a fertilized egg begins to grow outside your uterus, typically in your fallopian tubes
Other causes of excessive bleeding include:
* fibroids (However, fibroids don't always cause excessive bleeding. In fact, about half of all women who have fibroids don't have any symptoms at all.)
* infection
* pre-cancerous conditions
Amenorrhea
You may also have experienced the opposite problem of heavy menstrual bleeding—no menstrual periods at all. This condition, called amenorrhea, or the absence of menstruation, is normal before puberty, after menopause and during pregnancy. If you don't have a monthly period and don't fit into one of these categories, then you need to discuss your condition with your health care professional.
There are two kinds of amenorrhea: primary and secondary.
* Primary amenorrhea is diagnosed if you turn 16 and haven't menstruated. It's usually caused by some problem in your endocrine system, which regulates your hormones. Sometimes this results from low body weight associated with eating disorders, excessive exercise or medications. This medical condition can be caused by a number of other things, such as a problem with your ovaries or an area of your brain called the hypothalamus or genetic abnormalities. Delayed maturing of your pituitary gland is the most common reason, but you should be checked for any other possible reasons.
* Secondary amenorrhea is diagnosed if you had regular periods, but they suddenly stop for three months or longer. It can be caused by problems that affect estrogen levels, including stress, weight loss, exercise or illness.
Additionally, problems affecting the pituitary gland (such as elevated levels of the hormone prolactin) or thyroid (including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea. This condition can also occur if you've had an ovarian cyst or had your ovaries surgically removed.
Menstrual cramps
Most women have experienced menstrual cramps before or during their period at some point in their lives. For some, it's part of the regular monthly routine. But if your cramps are especially painful and persistent, you should consult your health care professional.
Pain from menstrual cramps is caused by uterine contractions, triggered by prostaglandins, hormone-like substances that are produced by the uterine lining cells and circulate in your bloodstream. If you have severe menstrual pain, you might also find you have some diarrhea or an occasional feeling of faintness where you suddenly become pale and sweaty. That's because prostaglandins speed up contractions in your intestines, resulting in diarrhea, and lower your blood pressure by relaxing blood vessels, leading to lightheadedness.
Premenstrual syndrome (PMS)
PMS is a term commonly used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of women experience symptoms severe enough to disrupt their lifestyles. PMS symptoms are more severe and disruptive than the typical mild premenstrual symptoms that as many as 75 percent of all women experience.
There are more than 150 documented symptoms of PMS, the most common of which is depression. Symptoms typically develop about five to seven days before your period and disappear once your period begins or soon after.
Physical symptoms associated with PMS include:
* bloating
* swollen, painful breasts
* fatigue
* constipation
* headaches
* clumsiness
Emotional symptoms associated with PMS include:
* anger
* anxiety or confusion
* mood swings and tension
* crying and depression
* inability to concentrate
PMS appears to be caused by rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It's not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.
PMS differs from other menstrual cycle symptoms because symptoms:
* tend to increase in severity as the cycle progresses
* are relieved when menstrual flow begins or shortly after
* are present for at least three consecutive menstrual cycles
Symptoms of PMS may worsen with age and increase in severity following each pregnancy. If you experience PMS, you may have an increased sensitivity to alcohol at specific times during your cycle. Women with this condition often have a sister or mother who also suffers from PMS, suggesting a genetic component exists for the disorder.
Premenstrual dysphoric disorder (PMDD)
Premenstrual dysphoric disorder is far more severe than the typical PMS. Women who experience PMDD (about 3 to 8 percent of all women) say it significantly interferes with their lives. Experts equate the difference between PMS and PMDD to the difference between a mild tension headache and a migraine.
The most common symptoms of PMDD are heightened irritability, anxiety and mood swings. Women who have a history of major depression, postpartum depression or mood disorders are at higher risk for PMDD than other women. Although some symptoms of PMDD and major depression overlap, they are different:
* PMDD-related symptoms (both emotional and physical) are cyclical. When a woman starts her period, the symptoms subside within a few days.
* Depression-related symptoms, however, are not associated with the menstrual cycle. Without treatment, depressive mood disorders can persist for weeks, months or years.

Libido Problems

Libido Problems

This week I discussed female sexual dysfunction with Robert Taylor Segraves, M.D, Ph.D. and his wife Kathleen Blindt Segraves, Ph. D.
Dr. Robert Taylor Segraves is professor of psychiatry at Case Western Reserve University and chair of the Department of Psychiatry at MetroHealth Medical Center in Cleveland. His major areas of professional interest include pharmacological influences on sexual behavior and pharmacotherapy of affective disorders.
He earned his medical degree from Vanderbilt University and his doctorate degree from the University of London. He completed his residency in psychiatry at the University of Chicago.
Dr. Kathleen Blindt Segraves is associate professor of psychiatry at Case Western Reserve University and director of behavioral medicine service in the department of psychiatry at MetroHealth Medical Center in Cleveland. Her major areas of professional interest include diagnosis and treatment of sexual disorders specializing in female concerns, and cognitive behavioral treatment of relationship issues to augment pharmacotherapy.
She earned her doctorate and masters degrees from the University of Chicago, and completed her undergraduate degree from Illinois Benedictine College.
Q. What are the most commonly seen sexual problems in women?
A. A recent survey (conducted by Laumann and colleagues at the University of Chicago) of American women (ages 18-59) found that the most common sexual problem in women is hypoactive sexual desire disorder (HSDD), more commonly referred to as low sex drive or libido (33.4%), followed by difficulty with orgasm (24.1%). Pain during intercourse--which occurs in 14.4% of women--was the only condition to show a relationship to age -- it decreases as women get older.
HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The definition is vague because the APA acknowledges that there can be significant differences in sexual interest levels among women. According to the survey mentioned above, 37% of women think about sex a few times a month and only 33% think about sex 2-3 times a week or more. Happier women seem to think about sex more often than unhappy women.
Difficulty with orgasm, or female orgasmic disorder, is a persistent delay or absence of orgasm. This definition is also from the APA and it again attempts to allow for individual variation by not giving a specific number or percentage to define a "normal" amount of orgasms. The survey states that 29% of women say they always have orgasms during sex and 40% say they are physically satisfied with their partners.
There are wide variations in sexual functioning, and there is no gold-standard that women should feel they must meet for their sexual functioning to be considered 'normal.' If a woman experiences a sexual problem that troubles her, then it is a problem that needs to be addressed and she should be encouraged to talk to her doctor about it to see how it can be improved.
Q. What causes decreased sexual desire in women?
A.Low sex drive can be caused by a range of factors, which vary from one individual to the next. Fatigue, the daily responsibilities and multiple roles women often assume, and many possible psychological causes can impact a woman's sexual appetite. It is also known that certain health conditions and medications can affect a woman's sexual desire. Depression and anxiety disorders can interfere with sexual desire, but so can some of the drugs used to treat these conditions. Many antidepressants, in particular Selective Serotonin Reuptake Inhibitors, also called SSRIs (e.g.., Prozac, Paxil, Zoloft), have side effects that have a negative impact on women's libidos. Wellbutrin SR is a possible alternative, as it does not seem to cause sexual problems. Serzone, Remeron and Luvox may not cause problems with sexual desire either.
In addition, birth control pills, mood stabilizers, tranquilizers and other medications have been shown to decrease libido. If you notice a drop in your sexual desire around the time you start a new medication, talk to you doctor to see if there is a connection. Do not stop taking any medication without talking to your doctor first.