Gout is a form of arthritis that causes sudden attacks of pain, redness, and tenderness in joints; especially the joint at the base of the big toe.
Gout occurs when your body has extra uric acid; so urate crystals accumulate in joints, causing inflammation and intense pain.
A crisis usually develops during the night because the body is inactive and has a low temperature.
Gout can be treated with medications and changes in diet and lifestyle.
Who is affected by Gout?
-Men are more affected by gout than women because they have higher levels of uric acid in their blood.
-Women are affected after menopause because in this period they reach these uric acid levels.
-People with high blood pressure.
-People with kidney disease.
-People with a family history of gout.
-People with congestive heart failure.
-A person who consumes: a diet high in animal proteins, alcohol, and diuretics.
What causes Gout?
Normally the human body makes uric acid when he breaks down chemicals called purines (substances found in certain food and drinks); the production of uric acid goes through the kidneys and exits the body with urine.
Sometimes the body produces an excessive quantity of uric acid, or the kidneys are not doing a good job to handle the uric acid out of the body, so gout occurs.
What are the symptoms of Gout?
The symptoms of gout always occur suddenly, and often at night (gout attack):
-Intense joint pain especially the large joint of the big toe.
-Inflammation and redness.
-When gout progresses, the patient will not be able to move normally the joints affected.
A gout attack can last a week or two.
Between gout attacks, you may have no symptoms at all.
How often do Gout attacks happen?
Gout attacks can occur frequently or after several years from the last attack.
But if gout isn’t treated, attacks may become more frequent and last longer.
Gout attacks can occur in the same joint or affect different joints.
How to diagnose Gout?
Doctors usually diagnose gout based on the symptoms of the patient and the appearance of the affected joint.
Other tests that help doctors:
-Blood test to measure the amount of uric acid in your blood.
–Aspiration: by using a needle to draw fluid from your affected joint, and the fluid is examined under the microscope.
How is Gout treated?
1-Some medications are used to treat gout symptoms and to prevent future attacks:
-Nonsteroidal anti-inflammatory drugs ( NSAIDs)
2-Medications to prevent gout complications:
-Medications that block uric acid production.
-Medications that help your kidneys to do a good job and remove uric acid from your body.
3-Changes in diet and lifestyle:
Medications are often the most effective way to treat gout attacks, but some changes in your lifestyle are important:
-Choose healthier beverages and foods:
*Avoid malted barley drinks (diuretic that increases the levels of uric acid in the body), fruit juice drinks with high fructose (because fructose stimulates the body to produce uric acid), coffee (caffeine is a diuretic), alcohol.
*You should drink a lot of water because it helps to remove uric acid from your body.
*Avoid foods high in purines: seafood, tuna, red meat, turkey, spinach, liver…
*Avoid foods high in fat and sugars to prevent obesity and diabetes.
*Types of food that might help gout:
Cherries, whole grains, eggs, cucumber, dark chocolate instead of sweets high in sugar, tomatoes, fat free dairy products.
*Exercise regularly and lose weight.
Kidney disease can lead to Gout?
Kidneys are responsible to filter wastes like uric acid (found in your blood) out of your body. But when you have chronic kidney disease, you will have an excessive quantity of uric acid in your blood because the kidneys cannot filter this waste out of the body; so gout occurs.
Gout may lead to kidney stones?
People with gout could be at a higher risk of developing uric acid kidney stones because they have a higher level of uric acid being excreted by the kidneys, and they have more acidic urine, which makes the uric acid more likely to form stones.
Seeing blood in urine should never be ignored; because it can be a sign of a serious medical problem.
It is the most common sign of bladder cancer that is usually painless, the urine color might change to orange, bright red, or brown.
What is hematuria?
Hematuria is the presence of blood cells in the urine. We have two types of hematuria:
-Gross hematuria: when the blood present in the urine is visible to the naked eye.
-Microscopic hematuria: when the blood in your urine can only be seen through a microscope.
Hematuria is just a symptom, so you should visit your doctor who will determine the cause by ordering some tests…When the origin of the blood in your urine is defined, the doctor can start the adequate treatment.
Where blood in urine might come from?
Blood in your urine can come from your kidneys, and from several parts of your urinary tract:
– Medications: the anti-cancer drug cyclophosphamide and penicillin, and anticoagulants can cause urinary bleeding.
What are the symptoms?
Some patients suffer from:
– Frequent, painful, or urgent urination.
– Nausea, vomiting, fever, or pain in the abdomen.
But bloody urine often occurs without other signs or symptoms; so when you see blood in your urine you should directly book an appointment with the doctor.
You should note that urine can also change colors due to food choices.
What are the risk factors of hematuria?
– Age: Many men older than 50 have a high risk of hematuria due to an enlarged prostate gland.
– Patients with existing diseases that are known to cause hematuria.
– Patient who has a family history of kidney disease or kidney stones.
– Certain medications: overuse of pain medications, anticoagulants like Aspirin, and the anti-cancer drug cyclophosphamide and penicillin.
How is hematuria diagnosed?
The doctor’s goal is to find the cause of hematuria by ordering several tests, and a physical exam which includes a discussion of your medical history.
– Urine analysis and urine culture are required.
– Urine cytology: a urine test that can determine the presence of any abnormal cells.
– Imaging tests: an imaging test is required to find the cause of hematuria; your doctor will recommend a CT or MRI scan or an ultrasound exam.
–Cystoscopy: A test that uses a device called a cystoscope to examine the bladder and urethra.
How is hematuria treated?
The treatment of hematuria depends on the cause of blood in urine. The information collected from the medical history, physical exam, urine tests, and imaging tests will be used to determine the best treatment option; for example, when the cause is a UTI, the best treatment is the use of antibiotics.
A cystocele or a prolapsed bladder occurs when ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder are weak; for this reason, the bladder will fall into the vagina.
There are three grades of cystocele:
– Grade 1: The bladder falls only a short way into the vagina.
– Grade 2: The bladder falls to the opening of the vagina.
– Grade 3: The bladder comes out of the opening of the vagina; it’s a severe grade.
Causes and Risk factors
There are several causes and risk factors:
– Pregnancy and childbirth: Women who have had a vaginal delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse; because the pregnancy and the delivery may involve straining the muscles of the floor of the pelvis.
– Age: especially after menopause, when the production of estrogen decreases; so the muscles around the vagina are not strong anymore.
– Family history or genetic factor (some women are born with weak connective tissues).
– Obesity: Women who are obese are at higher risk of anterior prolapse.
– Chronic coughing.
– Lifting heavy objects.
What are the symptoms of a cystocele?
– Seeing something bloating through the vaginal opening.
Prolapsed Bladder can be diagnosed with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing; the doctor may measure the severity of the prolapsed bladder by seeing in which part of the vagina the bladder has fallen.
Other tests and imaging studies may also be done to check the pelvic floor, and confirm the diagnosis of a prolapsed bladder:
– Cystoscopy: a long tube is passed through the urethra to examine the bladder.
– Urodynamics: to measure the capacity of the bladder to hold and release urine.
How to treat the prolapsed bladder?
1- No treatment if the prolapse is:
– Not causing you problems.
– Not blocking your urine flow.
2- Behavior therapy
– Kegel exercises (which help the muscles of the pelvic floor to be strong).
– Pelvic floor physical therapy.
– Pessary: a vaginal support device to hold the bladder in place.
3- Estrogen replacement therapy
4- Weight loss
A moderate or severe prolapsed bladder may require reconstructive surgery to move the bladder into a normal position; and it can be performed through the vagina or the abdomen, under a spinal or general anesthetic.
The surgical treatment is the best therapy for bladder prolapse; but if a woman is planning for a pregnancy, surgery is contraindicated.
The patient usually goes home the day of the surgery, and the recovery time typically takes four to six weeks.
Diagnosis starts with a physical examination to evaluate your general state of health and identify any physical problems that may have consequences on your fertility. The doctor required the presence of the two partners and some tests:
Semen analysis is a routine lab test that helps to determine:
– Sperm volume, concentration, and count per ejaculation.
– PH of the sperm.
– Velocity: how fast your sperm travels.
– Morphology: Size and shape of your sperm.
– Viscosity: liquefaction time of the sperm.
– Motility of the sperm.
– Viability of the sperm.
If the semen test shows low sperm numbers or the total absence of the sperm, it may not mean you are permanently infertile; more testing may be needed.
Your doctor may order a transrectal ultrasound. A probe is inserted in the rectum, and sound waves are delivered to the nearby ejaculatory ducts. This imaging technique can help the doctor to see if some structures such as the ejaculatory duct or seminal vesicles are blocked or present some problems.
If semen analysis shows oligospermia or azoospermia; you may need a testicular biopsy, which can be done with general or local anesthesia. A small cut is made in the scrotum, and a small piece of tissue from each testicle is removed and evaluated under a microscope. The biopsy helps to find the cause of male infertility; and to collect sperm for use in assisted reproduction (such as in vitro fertilization; IVF).
The health care provider may check your hormones to know how well your testicles make sperm; by evaluating the FSH level (FSH is the pituitary hormone that tells the testicles to make sperm).
Can male infertility be treated?
When the diagnosis of male infertility is confirmed, the curative phase begins to increase the couple’s chance of having a child.
Depending on the cause of infertility, treatments may include:
– Hormone therapy to increase the number of sperm, when infertility is caused by high or low levels of certain hormones.
– Treatments for sexual intercourse problems; when certain sexual problems in men cause infertility (premature ejaculation or erectile dysfunction), and in some cases the couple should consult a sexologist.
– Antibiotic treatments if there is an infection.
Surgical treatment :
For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. When there is no sperm in the ejaculation, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
– Assisted reproductive technology (ART): in ART sperm can be obtained through normal ejaculation, surgical extraction, or donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract or used to perform in vitro fertilization or intracytoplasmic sperm injection (ICSI).
In IVF, the egg and sperm (of which there are many) fertilize on their own in the laboratory. In ICSI, the selected sperm is directly injected into the egg.
What about Fertility Preservation?
When you have medical and sexual issues that affect your fertility; freezing your sperm is the best method to preserve your fertility and increase the chance of having a child.
WHO IS A CANDIDATE FOR FERTILITY PRESERVATION?
Fertility preservation is an option when a man:
– Is diagnosed with cancer at a young age.
– Has sexual dysfunctions.
– Expects to have surgery especially a vasectomy.
– Has an autoimmune, hormone, or genetic disorder.
The most common problem is with the production and maturation of sperm. Sperm may:
– Not grow enough.
– Have a strange form.
– Not move the right way.
– We can have oligospermia (low number of sperm) or azoospermia (absence of sperm completely).
Sperm problems can be congenital; but sometimes a toxic lifestyle can reduce sperm count: smoking, drinking alcohol, and taking certain medications.
Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections, or hormonal testosterone disorder.
Damage to the reproductive system can cause low sperm numbers or the total absence of it ; which can cause the obstruction of the tubes that the sperm travel through.
Varicoceles are overinflated veins located in the scrotum; they are more common in infertile men (40 out of 100). They stop the growth of sperm by blocking blood drainage and lead blood to flow back into your scrotum from your belly; the testicles are then too distended and hot to touch for making sperm, which can cause low sperm number.
Retrograde ejaculation is when semen goes into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm; it can be caused by some procedures, medications, or health problems of the nervous system; signs are turbid urine after ejaculation and dry ejaculation.
Sometimes a man’s body makes antibodies that attack his own sperm because of a certain surgery or infection. Antibodies prevent sperm from moving and working normally in order to fertilize the egg.
Sometimes the tubes which sperm travel through can be blocked; some infections and surgeries (such as vasectomy) can cause blockage. Any part of the male reproductive tract can be blocked, which can lead to infertility because the sperm from the testicles can’t leave the body during ejaculation.
A very low pituitary hormone level causes poor sperm growth.
Hereditary disorders such as Klinefelter’s syndrome; in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) cause abnormal development of the male reproductive organs.
Certain medications have side effects on sperm production, function, and delivery. These medications help to treat:
– digestive problems
– high blood pressure
Several factors can increase the risk of male infertility:
– Abusing illegal drugs.
– Drinking alcohol.
– Don’t maintain a healthy weight.
– Being exposed to toxins.
– Overheating the testicles.
– Having a history of undescended testicles.
– Having genetic disorders.
– Having testicular injuries.
– Testicular cancer and treatment.
What are the complications of male infertility?
– Stress and relationship problems.
– Expensive and involved reproductive techniques.
– High risk of testicular and prostate cancer.
Some measures must be taken into consideration to prevent infertility:
When you have these symptoms you should visit your urologist who will:
-Ask about your symptoms and your medical history.
-Do a physical exam for your abdomen, your rectum, and the organs in your pelvis.
-Bladder Diary: The patient should note how many times he goes to the bathroom and when he leaks urine; the bladder diary helps you track: when and how much fluid you drink, when and how much you urinate in 24 hours, how often you have the urgency feeling to urinate, when and how much you leak urine.
-Urine test: Your doctor will require a urine analysis and urine culture to determine if there’s a urine infection.
-Bladder scan: This ultrasound imaging shows how much urine is still in the bladder after you go to the bathroom.
-If there is any doubt about the diagnosis, the urologist required a cystoscopy or urodynamic testing.
Overactive Bladder treatment
Overactive bladder can interrupt your social life, but there are ways to combat the problem.
Natural Treatment for Overactive Bladder
-Bladder training: This type of training helps the patient to control the urge of urinating; he will able to control himself.
-Pelvic floor exercises: Called Kegels exercises; you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination.
Drugs for Overactive Bladder
In the overactive bladder, we have contraction of the muscles in the bladder wall at the wrong time. A group of drugs called anticholinergics help by blocking the nerve signals related to bladder muscle contractions; these medications increase bladder capacity and decrease the urge to urinate.
To relieve dry mouth it is necessary to drink small amounts of water (because large amounts can worsen the symptoms of the overactive bladder) and suck a sugar-free candy; the doctor will recommend eye drops to relieve dry eyes and a diet rich in fiber for constipation.
OnabotulinumtoxinA, also called Botox, is a protein injected in small doses directly into the bladder to relax the muscles. The effect of this protein lasts for 6 months so repeated injections are necessary.
Side effects of Botox injection: urinary tract infections and urinary retention.
Helps to treat an overactive bladder by adjusting nerve messages from the brain to the bladder.
Surgery is required for people with severe symptoms who don’t respond to other treatments.
We have 2 types of surgeries:
-Surgery to increase bladder capacity by using pieces of your bowel to replace a portion of your bladder. This surgery is required only in cases of severe urge incontinence that doesn’t respond to any other treatment.
-Bladder removal: This procedure is the last solution of severe overactive bladder and consists of removing the bladder and surgically constructing a replacement bladder (neobladder) or an opening in the body to attach a bag on the skin to collect urine.
Some TIPS to prevent an overactive bladder
-Maintain a healthy weight.
-Do physical activities and exercises.
-Reduce your consumption of caffeine and alcohol.
-Stop smoking: smoking is irritating to the bladder muscle.
-Treat your chronic conditions, such as diabetes, that might lead to overactive bladder symptoms.
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