The urinary incontinence

The urinary incontinence (IU) consists of the involuntary loss of urine.  The it affected has a sudden and imperious need of urinates but is incapable to retain the urine.  The escapes can be produced al to sneeze, to laugh, to carry out some effort or physical exercise.  It supposes a psychic, social, and sanitary problem, since influences in the routine activity of the sick one and reduces its quality of life.  The incontinence is not an illness in itself, but the consequence of an alteration in the phase of filled vesical that is presented in numerous illnesses.  It can be declared to any age and in both sexes.  Nevertheless, is more frequent in the women that in the men.

People that suffer it

Any abnormality that cause an obstruction of the flow of urine (stones in the kidney, anomalous structures. ..) can induce to a urinary infection.  A dilated prostate can also brake the flow of urine, for which increases the risk of infection.

The people submitted to exams by means of pipes or catheters or that need you probe can develop more easily infections originating in said instruments.

The greater they are seen affected by this type of infections with greater frequency, as well as the ones that suffer a decrease of the nervous system, that impedes to control the bladder to will.

On the other hand, any disorder that produce a suppression in the immune system increases the risk to suffer a urinary infection, since this system is the responsible for maintaining to line the pathogenic microorganisms responsible for the infections.

Also they are given in born babies with some deformation of the urinary tract, that often they should be corrected by means of surgery.

Symptoms

- Frequent and urgent Need of urinates.

- Stinging feeling or quemazón in the urethra al urinates.

- Reddening of it return and vaginal itch (in the women).

- Pain al urinates and in the sexual relations.

- Milky, murky Color (thick) or abnormal of the urine.

- Apparition of blood in the urine.

- Fever and chills (the fever can signify that the infection has reached the kidneys).

- Vomitings and queasiness.

- Pain in the side or back (indicates infection in the kidneys).

- Often, the women feel a light pressure above the bone púbico and many men feel an enlargement of the straight one.

- To Be more irritable of the normal thing.

The childlike symptoms, in turn, they can be confused with other inconveniences; besides, they are found before the difficulty of know not to express what passes them.  Nevertheless, if a boy presents a urinary infection he can declare the following indications:  – To Be more irritable of the normal thing.

- Not to eat as does it normally.

- To Have fever for no apparent reason that besides does not have just disappeared.

- Not to be able to be endured the urine.

- To Suffer alterations in its development.

Diagnostic

The tests and analysis that will have to be carried out a patient they will depend on the zone where is presumed that situates the infection and of the symptoms that this suffer.  Some of the most general tests are the following:  – Physical Exam:  The doctor palpates the pelvic and abdominal zone of the patient to detect the places in pain or with reddening.

- Analysis of urine:  With a sample of urine of the patient is examined if this contains some infectious agent (harmful germ).

- Cultivations of urine, vaginal or liquid liquid uretral:  A drop is sown of some of these liquids in a plate with nutrients for bacteria and, after elapsed several hours so that these grow, what type of bacteria is determined is the cause of the infection and what antibiotics can result troops (antibiograma).

- Citoscopia:  It consists of introducing for the urethra a pipe provided of lenses and light to observe directly the state of the urethra and the urinary bladder.

- Abdominal Ultrasound:  It is a painless study of the abdomen that is carried out by means of ultrasonidos that form an image in a monitor.

- Urografía:  It is a x-ray of the kidney, for which one must inject previously a substance that will create a contrast and the kidney will be able to be observed with facility.

Processing

The infections of the urinary apparatus treat with antibiotics, if they are caused by bacteria, or with antiviral (as the aciclovir) if they are caused by virus.  To administer efficiently one and another type of medicine, the medical specialist has the possibility to carry out a test of sensibility or antibiograma, that helps to elect the most effective one against the type of microorganism that is producing the infection.

The most they used antibiotics are the trimetoprim, the amoxicilina and the ampicilina.  Also a class of called medicines quinolonas have been approved in recent years for the processing of the infections of the urinary tract, like they are the ofloxacina, ciprofloxacina and trovafloxina.

Before being initiated the processing with antibiotics, the doctor determines if the patient suffers some inconvenience that can aggravate the infection, like an alteration of the nervous activity, a diabetes or a decrease of the defenses of the agency that can reduce the capacity of this last of fighting the infection.

In patients that suffer infections by Chlamydia or Micoplasma necessary a more long processing is done with tetraciclina or a combination of trimetoprim and sulfametoxazol.  A subsequent analysis helps to confirm that the urinary tract is free of germs.  The patients with infections of serious kidney have to be hospitalized until they can take fluids and medicines by their account.

The doctors think that to drink large aid water quantities to clean the urinary tract of bacteria and that is better to stop smoking (the tobacco is the main cause of the cancer of bladder) and to drink coffee, alcohol and foods with spices while the infection be maintained.

If the infection themselves due to a physical obstruction of the urine (to a stone, for example), can be necessary the surgery to eliminate that that produces the obstruction or to correct a possible physical anomaly as they could be a uterus and a bladder fallen.

The litotricia extracorpórea can disintegrate the stone by means of shock waves produced by means of a called apparatus litotritor.  Also it can be eliminated a stone of the kidney by means of the nefrolitotomía percutánea, that consists of a small incision in the back to create a direct tunnel al kidney by where is introduced a called instrument nefroscopio, that serves for locate and to extract the calculation.

To alleviate the symptoms that produce the infections of the urinary tract (urinary urgency, pain al urinates, spasms. ..) are utilized different types of medicines as the atropina and the fenazopiridina.
Prevention

As first preventive measure, is advisable to drink a large quantity of liquids.  In many cases of urinary infection antibiotic processing can be dispenses with only with taking this precaution.

The infections of sexual broadcast are easily avoidable; the use of condoms is used to being sufficient to impede them.

In turn, the vaccine against the urinary infection has an effect estimulador of the production of antibodies, that accumulate to be defended immediately against the microorganisms, in the event that the infection came to be produced.

In the case of the men, a correct and daily personal hygiene is an important measure to avoid the infections of urinary ways.

For the women, the sprays sanitary and deodorants are normally unnecessary; at times, even they turn out to be damaging.  If a spray for the vaginal hygiene is utilized, not one must direct it never toward the interior of the vagina, since can irritate the vaginal weaving.  If, at any rate, the skin of it return begins to be reddened or to be irritated, one must leave to use it because due to an allergic reaction to some component of the product.

The hygiene of the genital zone should be carried out employing water and a smooth soap once al day, to prevent, among others things, the apparition of urinary infections.  The vagina themselves clean by itself: its walls produce a fluid that drags the dead cells and other microorganisms al exterior.

The vaginal showers are generally little advisable, because they drag the “plug” of mucus that protects the entrance of the cervix of infectious microorganisms.  In spite of this, the doctor at times recommends them.  In that case, the recommendable thing is to maintain somewhat far away the mango of the shower to reduce the pressure of the spurt of entrance; otherwise, the vaginal agencies are dragged toward the uterus (headquarters), where they would be able to cause an infection.

The bacteria and germs that cause the vaginal infection tend to be developed in conditions of heat and humidity.  By this reason is recommendable to utilize knickers of adjusted little cotton (those of naylon cause humidity and heat in the genital area).

Finally, the anal hygiene should be done always toward atrá

Infection of urine in the Pregnancy

The changes that occur in the woman by the embarrassment to level of the urinary system, they favor the development of the urinary infection, complication that puts in risk to the mother and al fetus because relates to the threat of premature birth and other risks as a high arterial pressure.

The pregnant woman should perform in her first control prenatal a general exam of obligatory urine, to detect of early form any data of infection and to give adequate processing.

Urinary infections of repetition

When the picture of the infection persists and is repeated in several occasions, the processing for the woman one must undertake it since a triple focus:  – The adequate processing of the first episode is fundamental to avoid the repetition of the urinary infection.

- One must correct the alterations anatomical or functional capable to perpetuate or to favor the bacteriuria as well as the flattering dietary and sanitary habits of this.

- To Present a preventive processing in function of the urinary infections episodes number of repetition.

¿WHAT IS THE IMPOTENCE?

¿WHAT IS THE IMPOTENCE?

The impotence -whose medical term is that of “erectile dysfunction (DE)” – is the incapacity to achieve or to maintain a sufficient erection for a satisfactory sexual activity.

That of it is a very frequent situation; has been calculated that affects in greater or smaller degree halfway of the men between the 40 and the 70 years.  But is not a theme that treat openly.  Myths and cultural expectations of the male sexuality have impeded many men to seek aid for an inconvenience that is able, in most cases, to be benefited of a medical processing.

Although it can be told with security that every man experiences an erectile dysfunction occasionally, the impotence is defined in medical terms as the incapacity to maintain a sufficient erection for the intercourse in al less 25% of the intents.

HOW A NORMAL ERECTION OCCURS?

When there is not sexual stimulation, the flow of blood inside the penis is very low, what maintains it in flabby or not erect state.  When a man is stimulated sexually, the arteries of the penis relax and they dilate, and the blood flow toward the penis enlarges a lot.  To the extent that the penis is expanded, the veins of the penis -that would have that to return the blood of the penis toward the circulation of return- they are compressed, and the blood cannot leave.  With more blood flow entering and very little leaving, the penis returns each harder and greater time.

You CAUSE DE THE DYSFUNCTION ERECTIL “DE”

Most cases of DE (70-80%) are associates with not psychological and physical alterations.  That of alteration of one can be produces by or several of the three mechanisms responsible for the erection: blockade of the arteries; incapacity of the blood vessels inside the penis to store the blood; or damage in the nerves of the penis or of the area pelviana.  Also they can be responsible for one of other physiological, as low dysfunctions levels of male hormone (testosterone).

Thus, the situations that more often produce impotence are:

* Illnesses that affect to the blood vessels and they restrict the blood flow toward the penis, like the diabetes, the hypertension (high arterial tension), the excess of cholesterol or the heart illnesses.  * “Situations that interrupt the connection between the nervous system and the penis, like the surgery of prostate or wounds traumáticas in the zone.  * “Many medicines (some of them employees to treat the hypertension and the depressions), that produce DE as secondary effect done not desire.  * Nervous Breakdown.  * Habits of risk for DE:  Smoking, alcohol, drugs, stress.

An indicator of the physical impotence, in comparison with the psychological one, is the incapacity to experience or to maintain an erection al to be awoke in the morning.  The impotence that persists more than 3 months and that be not due to an evident stressful event, to drugs, to alcohol or to transitory medical affections that cause DE, indicates the need to receive medical attention by a urologist.

DE and aging:  Many misunderstandings in this theme exist.  As a consequence of the process of aging, is used to there to be a period refractario greater -necessary time for a new erection after an orgasm-.  The age also seems to affect the necessary time to be excited and for the erection and the ejaculation.  All this completely normal changes are considered.  Nevertheless, the sexuality does not have date of expiration.  If that of it is given more in older people, is only because is more probable than they suffering associated illnesses to DE and that use more medicaciones than they altering the erectile function.

DIAGNOSIS DE THE “DE”

1.  Medical history.  It interests to collect present medical problems and prior, medicines that are being taken and antecedents of psychological problems (stress, anxiety, depression).  The doctor will also require sexual antecedents -start of that of, frequency, quality and duration of any erection, etc.- and he will investigate the motivation for the processing and the expectations of the patient.  That of it is logically thing of two, and can be appropriated to interview to the sexual couple

2.  Physical exam.  It includes an exploration of the genital area and a rectal touch (exam of the straight one with a finger put on gloves).  They should be sought evidences of other illnesses -hypertension, diabetes, ateroesclerosis, nervous damage…-

3.  You test of laboratory.  They will be done analysis of blood to measure the levels of testosterone and, if is necessary, those of prolactina for determine if there are problems of the endocrine system.  They can be necessary diverse specific exams to detect that of, like tests of erectile answer after injection of medicines that dilate the blood vessels of the penis, or detection of by means of diverse nocturnal erections devices.

4.  Techniques of radiología diagnostic.  The cavernosometría and cavernosografía of dynamic infusion (DICC) is a test in which an erection with medicines is induced, the capacity of storage of the penis is measured, an ultrasound of the arteries of the penis is done (to measure the arterial pressure of these arteries), and a x-ray of the erect penis is carried out for obtain precise anatomical data.  Only is necessary in some cases of DE.

PROCESSING FOR THE IMPOTENCE

Less than the 10% of the men that suffer from they seek helps medical.  Al to confront that of, is frequent to be demoralized, or to seek miraculous processing.  Innumerable popular remedies exist that should be considered with every caution and skepticism.  At present many very sure and efficient processing exist, although in no magical case.

The modality of the processing comes dictated by the specific problem that causes the impotence.  The first step is to define the cause, if is possible, and then to try the simplest solution and less risked.  In synthesis, the different therapeutic alternatives include an or several of the following.

1) to Change the habits of life that affect to the health of the arteries and veins:  Smoke not, to moderate the consumption of alcohol and of greases, to do something of exercise and to learn to be relaxed.

2) to Change or to reduce the medicines that cause impotence, like some antidepressants, diuretic and betabloqueantes…

3) Psicoterapia and therapy conductual.  Independently of the cause of that of, is recommended for all the psychological therapy form any patients, conductual, sexual or of combination, generally attended by its couple.

4) Therapy transuretral and of injection.  It consists of being injected medicines in the erectile weaving, to relax the smooth muscles of the penis and to permit that can take place the erection.  It is indicated in some cases of DE.  The medicines injected are used to being associations of papaverina-fentolamina, or well alprostadil (prostaglandina E1).  The adverse reactions are generally smaller, but they are able incluír erections prolonged and painful (priapismo).  An alternative to the injections is a device of plastic to apply these medicines through the urethra.  Although surer and less costly than the surgical processing, these therapies have a high rate of abandonments, since the loss of spontaneity causes loses interest in the procedure.

What is the cancer of the lip and the oral cavity?

Cancer of the Lip and the Oral Cavity

The cancer of the lip and the oral cavity is an illness in which cancerous cells are found (harmful) in the weavings of the lip or of the mouth.  The oral cavity includes the front two thirds of the tongue, the upper and lower gums, the interior covering of the cheeks and the lips (the oral mucous membrane), the floor of the mouth under the tongue, the bony upper part of the mouth (the hard palate) and the small area situated behind the wisdom toeeh (the trígono retromolar). 

The cancers of the head and the neck are found with greater frequency in people that have more than 45 years.  The cancer of the lip is more common in the men that in the women and has greater probability to be developed in people of clear skin that have been very exposed al sun.  The cancer of the oral cavity is more common in people that chew tobacco or they smoke pipe. 

You should respond a doctor if has some protuberance in the lip, the mouth or the gums, a sore that not healthy in the mouth, or if he bleeds or feels pain in the mouth.  Another sign of cancer of the mouth or of the gums is the one that the dentures to stop sitting down well.  Often the cancer of the oral cavity and of the lip the dentists they find them al to examine the teeth. 

If you have symptoms, the doctor will examine him the mouth employing a mirror and lights.  The doctor can indicate that x-rays of the mouth do him.  If some abnormal weaving is found, the doctor will have to cut a piece and to observe it with the microscope to determine the presence of cancerous cells.  This procedure is known like biopsy.  To him it will be given you a substance that will sleep him that part of the mouth by a while (a local anesthetic) so that does not sit down pain.  The doctor will also palpate the throat in search of protuberances. 

His possibilities of recovery (forecast) will depend on if the cancer is found in the lips or in the mouth, of if is found only in the lips or the mouth or has been disseminated to other weavings (the phase of the cancer), and of its general state of health. 

The hepatitis

The hepatitis is an inflammatory process of the liver.  Among their multiple causes the viral agents are found that produce hepatitis:  To, B, C, D, G and AND, although can also be unchained for other virus: citomegalovirus (CMV), Epstein Barr (EB), etc., alcohol, infections, medicines and drugs.

DESCRIPTION

It is an infectious illness that affects al liver causing the destruction of small zones of the liver weaving.  According to the cause of the inflammation, there are various types of hepatitis.  The symptoms vary since a light pain having the flu, that is it more common, to a serious liver deficiency.

CONSIDERATIONS Many cases begin with loss of appetite, queasiness, inconvenience, vomitings and fever.  The smokers can come they feel nausea al tobacco.  At times spots they appear and pains in the articulations.  Al tip from 3 to 10 days the urine returns dark and the jaundice appears (yellow coloring of the skin).  In one or two weeks the
jaundice arrives at its higher point and delays in disappearing between 2 and 4 weeks more, period that hard the recovery.

You CAUSE

In most cases, the hepatitis is caused for a virus, although can also be caused for the abuse of alcohol, medicines (especially anesthetics), poison gases, poisons and certainly infections of bacteria, mushrooms or parasitic.

The virus known as hepatitis TO (VHA) is the most frequent one.  It produces a light picture and cures by itself in some weeks without leaving consequences.  It enters for the mouth, grows in the intestines and is expelled with the wastes.  Generally it contracts al to eat food that have been contaminated through the fecal matter, or prepared by someone that itself have not washed the hands.

Another way of quite frequent infection is the consumption of shellfish that stem from water contaminated with black water.

The hepatitis B (VHB).  The type B can be extremely serious and even fatal if themselves not the adequate measures are taken.  Also hepatitis is called sérica, is transmitted for direct contact with blood contaminated (for example, transfusion and punctures) and secreciones seminal (sexual relations).

The analyses of prior blood to the transfusions have reduced the incident of hepatitis sérica, although now is more frequent by the sexual contact, or among addicts, by the use of needles contaminated.

There is a third type called hepatitis that until does little they were known like not-to not-B due to the lack of know-how on them.  Nowadays four of this group are known:

• Hepatitis C (VHC) :  The 90% of the cases associates to transfusions, are very few them related to sexual relations and perinatal broadcast.  It presents a greater tendency to be returned chronicle.
• Hepatitis D (VHD) :  The producing agent of this process requires of the membrane manufactured by the VHB for which he associates to this, that is to say, it pictures are used to reporting in bearers of the VHB.  It is presented mainly among the addicts.
• Hepatitis AND (VHE) :  It presents a broadcast through the water.  Is the cause of epidemics in the India, Asia, Africa and Mexico.  Its process of healing is spontaneous.
• Hepatitis G (VHG) :  It is very frequent in OR. S. TO. creating pictures of viremia that years last.  Does not it generate important liver illnesses.

SIGNS AND SYMPTOMS The main symptoms appeared in the course of a hepatitis are:

• Loss of appetite
• Nausea and vomitings
• Fever, exhaustion and fatigue
• Pains in the articulations
• Spots in the skin
• Dark Urine
• Jaundice (eyes and yellowish skin).

CALLING AL MEDICAL

If it suspects that suffers hapatitis, go immediately al doctor.

The doctor will examine the size and consistency of its liver and he will observe if the spleen is inflamed or sore.  The tests of laboratory will determine the presence of virus in the blood, urine or wastes of the patient and they will identify the type of virus responsible for the
liver inflammation.

PROCESSING

Not a specific processing set against the hepatitis exists, although the rest in bed to the remission of the symptoms is recommended.  The appetite is used to returning after a few days.  The sick one should not consume alcohol neither drugs that itself metabolicen in the
liver, at least during six months.

CARES

Remain in bed and try to maintain a good nutritious state.  A good hygiene can help to control the contagion.  It be washed the hands each time that use the bath and before preparing or to consume food.  The personal utensils and of pertinent table al sick, they should be separated of the remainder and boiled for 15 minutes.  Nevertheless, the sick one does not need to be isolated.

Allergic Skin

Counsels For the Care of the Allergic Skin

The great majority of the people with allergic skin they have the very lean skin, above all in certain zones of the body, besides being very sensitive to a great variety of external stimuli ó internal.  By this reason is necessary that are believed the habit to be taken care of the skin all the life.  The following they are some counsels that will help him in its care; the rigorousness of these measures will depend on the severity and the frequency of the problem, and if is found or not in its active phase.

Avoid to Damage the Skin 1.  Avoid the excess of humidity:  Use short baths, it less frequent than they be permitted it their activities (in children, each 2 to 5 days) using the water it more possible cold.  Avoid the baths prolonged in pools, tubs ó sea.  Dry the skin without carving it.  The towels should not have residues of suavizantes.  2.  Avoid the excess of sweat:  Itself not too much in epoch be sheltered of cold ó heat.  If it does exercise use the clothes more light possible.  Is preferably to be bathed with cold water if sweated too much.  3.  Avoid irritants of the skin:  For the bath use the soaps less alkaline possible (“neuter”), and of preference without perfumes.  In case of active wounds, not the figure, less with soap, only rinse with water.  Replacements of the soap exist ó creams “dermo-cleaning” (Cetaphyl, Avecyde, Aquanyl) for those occasions.

Do not use biological detergents to wash the clothes, use preferably soap of player (any) direct ó melted for its washing machine, with the water it more hot possible, and to rinse it perfectly (at least 2 cycles of rinse in its washing machine).  Try not to use suavizantes of fabric, if uses will require them of 3 cycles to rinse.

The shampoos for hair should be used in form separated of the normal bath if exist active wounds, so that the shampoo drain not on the skin injured.  Try to use the less aggressive for the skin, like those of baby (Baby Magic, Johnson, etc.)  Try to use the smoothest clothes al touch and light possible; the interior clothes of preference of cotton, and with covered elastics by the same fabric.  Avoid rough clothes of nylon, Lycra, acrylán ó wool directly on the skin, above all in the skin already injured.

Due to that is a suffering that is characterized for producing prurito intense (“itch” ó “rasquera”), is very important to bring the clean and always short nails, especially the small children.

Food:

Some natural food exist that contain substances that can produce itch ó that cause him allergy directly in its skin, and that therefore is prudent to avoid always.

The food that more produce reactions are: the citrus (orange and lemon); the Chile; the pepper; the pineapple; the tomato; the strawberry; the chocolate; the shellfish; the nut and the peanuts.  Another group they form it the majority of the food industrialized that they contain chemical conservatives of diverse types (benzoatos, sulphite, citrates, nitritos, etc.) some synthetic colorants and some saborizantes artificial.  All they are capable of inducing more wounds or prurito.  Try to avoid them in the possible thing.

If you already noted that some food natural ó industrialized particularly has produced itch ó wounds, ó has increased them, owe to be considered “allergic” to him, and to avoid it always from there on.

Lubrication of the Skin

The Dermatitis Atópica is characterized for a poor production of grease in the skin, above all in certain zones, by which is done almost always necessary to apply creams ó lubricants with a lot of frequency.  Due to that the baths very hot ó prolonged desgrasan more the skin, them do not we recommend.

After the bath and of the removed of the skin, the use of a cream is suggested suavizante, the one that you prefer and that “fall him well”.  We recommend that have not lanolin, of preference the “cold creams” with less products chemical aggregates, above all without perfumes.  Many options exist.  It will be able to use greasier creams in the winter.  The one that choose, owe to be used at least once al day, after the bath, but generally is necessary to use them several times al day, depending on the degree of dryness of their skin, and the cream that you choose, in spite of the fact that not active wounds in that exist moment.

Medicines

When active wounds of dermatitis exist, like reddening, ronchitas, cracks, ó engrosamiento of the skin, they owe to be used creams with anti-inflammatory medicines of type corticosteroid ó cortisones, -always recetadas by a doctor, of preference specialist-, of the ones that exist a great variety of powers and presentations.  At times they will deserve to be accompanied for antiseptic ó antibiotic local in form separated ó mixed.  In most cases they should be taken besides antihistamínicos, which they remove the allergic reaction and they diminish the prurito immediate.  It is necessary to emphasize that the creams with cortisone indicated and applied in form adapted by a specialist, they are the base of a fast improvement in this type of suffering, for which they do not owe to be stop applying if they are indicated.  If still it has doubts on the type, frequency and time of application of these creams, consult us before suspending them.

It should be understood well that the majority of the people with allergy of the skin have it always very sensitive, and in spite of a good initial evolution, they can be presented easily fallen owed al chronic character of the suffering, since other associated factors to the allergy related to the high sensibility of this exist also type of skin.