Uterine prolapse

Uterine prolapse

Definition:

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Damage to supportive tissues during pregnancy and childbirth, effects of gravity, loss of estrogen, and repeated straining over the years all can weaken your pelvic floor and lead to uterine prolapse.

If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.


Symptoms:

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

• Sensation of heaviness or pulling in your pelvis
• Tissue protruding from your vagina
• Urinary problems, such as urine leakage or urine retention
• Trouble having a bowel movement
• Low back pain
• Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
• Sexual concerns, such as sensing looseness in the tone of your vaginal tissue
• Symptoms that are less bothersome in the morning and worsen as the day goes on

When to see a doctor
Uterine prolapse doesn't require treatment unless it's severe. If your signs and symptoms become bothersome and disrupt your normal activities, make an appointment with your doctor to discuss your options.


Causes:
 Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.


Complications:

Possible complications of uterine prolapse include:

• Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
  
• Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

Treatments and drugs:

If you have mild uterine prolapse, either without symptoms or with symptoms that don't bother you, you probably don't need treatment. However, your pelvic floor may continue to lose tone, making uterine prolapse more severe as time goes on. Check back with your doctor to monitor the extent of your prolapse and review your symptoms.

Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief. Maintaining a healthy weight and avoiding heavy lifting may help reduce pressure on supportive pelvic structures.

For more-severe cases of uterine prolapse, treatment options include:

• Vaginal pessary. This device fits inside your vagina and holds your uterus in place. Used as temporary or permanent treatment, vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for the proper device. You'll also learn how to insert, remove and clean the pessary. You may be able to take the pessary out overnight and reinsert it each day.
  
  But a vaginal pessary may be of little use if you have severe uterine prolapse. Also, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.
  
  
• Surgery. To repair damaged or weakened pelvic floor tissues, doctors often use a vaginal approach to surgery, although sometimes doctors recommend an abdominal surgery. A hysterectomy, which removes your uterus, also may be needed.
  
  As an alternative to vaginal and abdominal surgery, your doctor may recommend minimally invasive (laparoscopic) surgery. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.
  
  In some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs.
  Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each surgery has pros and cons that you'll need to discuss with your surgeon.
  

If you plan to have more children, you might not be a good candidate for surgery to repair uterine prolapse. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, the risks of surgery might outweigh the benefits. In these instances, pessary use may be your best treatment choice for bothersome symptoms.

Talk with your doctor to learn your options, including the benefits and risks.

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Uterine polyps

Uterine polyps

Definition:

Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps).

The sizes of uterine polyps range from a few millimeters — no larger than a sesame seed — to several centimeters — golf ball sized or larger. They attach to the uterine wall by a large base or a thin stalk.

You can have one or many uterine polyps. They usually stay contained within your uterus, but occasionally, they may slip down through the opening of the uterus (cervix) into your vagina. Uterine polyps most commonly occur in women who are going through or have completed menopause (peri- and postmenopausal women), although younger women can get them, too.

Symptoms:

Signs of uterine polyps include:

• Irregular menstrual bleeding — for example, having frequent, unpredictable periods of variable length and heaviness
• Bleeding between menstrual periods
• Excessively heavy menstrual periods
• Vaginal bleeding after menopause
• Infertility

Some women may experience only light bleeding or spotting or may even be symptom-free.
When to see a doctor
Seek medical care if you have:

• Vaginal bleeding after menopause
• Bleeding between menstrual periods
• Irregular menstrual bleeding

Causes:
 Although the exact cause of uterine polyps is unknown, hormonal factors appear to play a role. Uterine polyps are estrogen-sensitive, meaning that they respond to estrogen in the same way that the lining of your uterus does — growing in response to circulating estrogen.


Complications:

Uterine polyps may be associated with infertility. If you have uterine polyps and you experience infertility, removal of the polyps might allow you to become pregnant.

Uterine polyps also may present an increased risk of miscarriage in women who undergo in vitro fertilization (IVF). If you're considering IVF treatment and you have uterine polyps, your doctor may recommend polyp removal before embryo transfer.


Treatments and drugs:

For uterine polyps, your doctor might recommend:

• Watchful waiting. Small polyps without symptoms (asymptomatic) may resolve on their own. Treatment is unnecessary unless you're at risk of uterine cancer.
  
• Medication. Certain hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may shrink a uterine polyp and lessen symptoms. But taking such medications is usually a short-term solution at best — symptoms typically recur once you stop taking the medicine.
  
• Curettage. Your doctor uses a long metal instrument with a loop on the end to scrape the inside walls of your uterus. This may be done to collect a specimen for lab testing or to remove a polyp. Your doctor may perform curettage with the assistance of a hysteroscope, which allows your doctor to view the inside of your uterus before and after the procedure.
  
• Surgical removal. During hysteroscopy, instruments inserted through the hysteroscope — the device your doctor uses to see inside your uterus — make it possible to remove polyps once they're identified. The removed polyp may be sent to a lab for microscopic examination.

If a uterine polyp contains cancerous cells, your doctor will talk with you about the next steps in evaluation and treatment.
Rarely, uterine polyps can recur. If they do, you might need more treatment.

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Uterine fibroids

Uterine fibroids

Definition:

Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding.

Symptoms:

In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Prolonged menstrual periods — seven days or more of menstrual bleeding
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying your bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and cutting off its blood supply.
Fibroid location influences your signs and symptoms:

• Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are thought to be primarily responsible for prolonged, heavy menstrual bleeding and are a problem for women attempting pregnancy.
  
• Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing constipation, or on your spinal nerves, causing backache.

When to see a doctor
See your doctor if you have:

• Pelvic pain that doesn't go away
• Overly heavy or painful periods
• Spotting or bleeding between periods
• Pain with intercourse
• Difficulty emptying your bladder
• Difficulty moving your bowels

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.


Causes:

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue. The growth patterns of uterine fibroids vary — some fibroids may continue to grow slowly; other fibroids may remain the same size or even shrink on their own over time.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:

• Genetic alterations. Many fibroids contain alterations in genes that are different from those in normal uterine muscle cells.
• Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than do normal uterine muscle cells.
• Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Complications:

Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery.

Pregnancy and fibroids
Fibroids usually don't interfere with conception and pregnancy. However, it's possible that fibroids could distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo, and in these cases, doctors often recommend removing these fibroids before attempting pregnancy.

In other cases, treatment for fibroids during pregnancy isn't necessary. A common complication of fibroids during pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers. But if you have fibroids and you've experienced repeated pregnancy losses, your doctor may recommend removing one or more fibroids to improve your chances of carrying a baby to term, especially if no other causes of miscarriage can be found and if your fibroids distort the shape of your uterine cavity.


Treatments and drugs:

There's no single best approach to uterine fibroid treatment. Many treatment options exist.

Watchful waiting
Many women with uterine fibroids experience no signs or symptoms. If that's the case for you, watchful waiting (expectant management) could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause when levels of reproductive hormones drop.

Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:

• Gonadotropin-releasing hormone (GnRH) agonists. Medications called GnRH agonists (Lupron, Synarel, others) treat fibroids by causing your natural estrogen and progesterone levels to decrease, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a GnRH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using GnRH agonists.
  
• Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding and pain caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear.
  
• Androgens. Danazol, a synthetic drug similar to testosterone, may effectively stop menstruation, correct anemia and even shrink fibroid tumors and reduce uterine size. However, this drug is rarely used to treat fibroids. Unpleasant side effects, such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.
  
• Other medications. Oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids.

Hysterectomy
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you also elect to have your ovaries removed, it brings on menopause and the question of whether you'll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.

Myomectomy
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there's a risk of fibroid recurrence.
Myomectomy options include:

• Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
  
• Laparoscopic or robotic myomectomy. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a remote monitor via a small camera attached to one of the instruments. Use of a surgical robot now allows for removal of more fibroids or larger fibroids.
  
• Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained
  inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.

Focused ultrasound surgery
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.

This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off-again fashion, sometimes spanning several hours.

Because it's a newer technology, researchers are learning more about the long-term safety and effectiveness of FUS. Research continues, but so far data collected show that FUS for uterine fibroids is safe and very effective.

Other minimally invasive procedures for fibroids
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

• Myolysis. In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.
  
• Endometrial ablation. This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Endometrial ablation is effective in stopping abnormal bleeding, but doesn't affect fibroids outside the interior lining of the uterus.
  
• Uterine artery embolization. Small particles (embolic agents) injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique, performed by an interventional radiologist, is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include no incision and a shorter recovery time. Complications may occur if the blood supply to your ovaries or other organs is compromised.

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Indigestion

Indigestion

Definition:


Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen. Indigestion is not a disease, but rather a collection of symptoms you experience, including bloating, belching and nausea. Although indigestion is common, how you experience indigestion may differ from other people. Symptoms of indigestion might be felt occasionally or as often as daily.
Fortunately, you may be able to prevent or treat the symptoms of indigestion.

Symptoms:

Most people with indigestion have one or more of the following symptoms:

• Early fullness during a meal. You haven't eaten much of your meal, but you already feel full and may not be able to finish eating.
• Uncomfortable fullness after a meal. Fullness lasts longer than it should.
• Pain in the upper abdomen. You feel a mild to severe pain in the area between the bottom of your breastbone (sternum) and your navel.
• Burning in the upper abdomen. You feel an uncomfortable heat or burning sensation between the bottom of the breastbone and navel.

Less frequent symptoms that may come along with indigestion include:

• Nausea. You feel like you are about to vomit.
• Bloating. Your stomach feels swollen, tight and uncomfortable.

Sometimes people with indigestion also experience heartburn, but heartburn and indigestion are two separate conditions. Heartburn is a pain or burning feeling in the center of your chest that may radiate into your neck or back after or during eating.
When to see a doctor
Mild indigestion is usually nothing to worry about. Consult your doctor if discomfort persists for more than two weeks. Contact your doctor right away if pain is severe or accompanied by:

• Unintentional weight loss or loss of appetite
• Repeated vomiting or vomiting with blood
• Black, tarry stools
• Yellow coloring in the skin and eyes (jaundice)
• Trouble swallowing that gets progressively worse

Seek immediate medical attention if you have:

• Shortness of breath, sweating or chest pain radiating to the jaw, neck or arm
• Chest pain on exertion or with stress

Causes:

There are many possible causes of indigestion. Some are related to lifestyle and what you're eating and drinking. Indigestion can also be caused by other digestive conditions.
Common causes include:

• Overeating
• Eating too quickly
• Fatty or greasy foods
• Spicy foods
• Too much caffeine
• Too much alcohol
• Too much chocolate
• Too many carbonated beverages
• Smoking
• Nervousness
• Emotional trauma
• Medications, including antibiotics, and some pain relievers
• Pancreas inflammation (pancreatitis)
• Peptic ulcers
• Gallstones
• Stomach cancer

When a cause for indigestion can't be found after a thorough evaluation, a person may have functional dyspepsia. Functional dyspepsia is a type of indigestion that occurs because of an impairment in the stomach's ability to accept and digest food and then pass that food to the small intestine.

Complications:

Although indigestion doesn't usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. When indigestion is caused by an underlying condition, that condition could come with complications of its own.

Treatments and drugs:

If lifestyle changes — especially avoiding offending foods — don't help your indigestion, there also are over-the-counter and prescription medications that may help. Most are designed to reduce stomach acid or help move food from the stomach to the small intestine.
Types of indigestion medications include:

• Antacids. Alka-Seltzer, Maalox, Mylanta, Tums, and others are available over-the-counter and work by neutralizing stomach acid. Side effects include diarrhea and constipation. These are often the first medications doctors recommend.

• H-2-receptor antagonists (H2RAs). These medications don't begin working as quickly as antacids do, but they work for a longer period of time. Examples of these drugs include Axid, Tagamet, Pepcid and Zantac, which are available over-the-counter or by prescription. Possible side effects that can occur include headache, nausea, vomiting, constipation, diarrhea, and bruising or bleeding.

• Proton pump inhibitors (PPIs). Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid are most effective for people who also have gastroesophageal reflux disease (GERD). These medications reduce stomach acid more effectively than H2RAs. They're available by prescription, although Prilosec and Prevacid also come in over-the-counter strength. Possible side effects include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation and diarrhea. Long-term use has, rarely, been associated with bone fractures.

• Prokinetics. Medications, such as Reglan, can be helpful if your stomach empties slowly. People taking this prescription medication frequently experience side effects, such as fatigue, sleepiness, depression, anxiety and involuntary muscle spasms.

• Antibiotics. If the bacteria that causes peptic ulcer disease (Helicobacter pylori) is causing your indigestion, your doctor may prescribe an antibiotic.

• Antidepressants. If a thorough evaluation doesn't reveal a cause for your symptoms and the conventional treatments listed above don't work, your doctor may recommend an antidepressant medication. These prescription medications may improve the discomfort from indigestion by decreasing your sensation of pain.

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Angina

Angina

Definition:

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina (an-JI-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.
Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms:

Angina symptoms include:

• Chest pain or discomfort
• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest, or feeling like a heavy weight has been placed on their chest.
The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest pain. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest. If chest pain is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.
Characteristics of stable angina

• Develops when your heart works harder, such as when you exercise or climb stairs
• Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
• Lasts a short time, perhaps five minutes or less
• Disappears sooner if you rest or use your angina medication
• Could feel like indigestion
• Might spread to your arms, back or other areas
• Can be triggered by mental or emotional stress

Characteristics of unstable angina (a medical emergency)

• Occurs even at rest
• Is a change in your usual pattern of angina
• Is unexpected
• Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
• May not disappear with rest or use of angina medication
• Might signal a heart attack

Characteristics of variant angina (Prinzmetal's angina)

• Usually happens when you're resting
• Is often severe
• May be relieved by angina medication

Prinzmetal's angina is rare — only about 2 percent of angina cases are Prinzmetal's angina. This type of angina is caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. For example, a woman may have chest pain that feels like a stabbing, pulsating or sharp form of chest pain rather than the more typical vise-like pressure. Women are also more likely to experience symptoms, such as nausea, shortness of breath or abdominal pain. These differences may lead to delays in seeking treatment.

When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

Causes:

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.
The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow ithout triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

• Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.

• Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by conditions such as severe anemia, especially if you already have narrowed coronary arteries.
  Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.
   
  
• Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily  narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina accounts for about 2 percent of angina cases.

Complications:

The chest pain that can occur with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.
Common symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

Treatments and drugs:


There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.
Lifestyle changes
If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Changes include:

• If you smoke, stop smoking. Avoid exposure to secondhand smoke.
• If you're overweight, talk to your doctor about weight-loss options.
• If you have diabetes make sure that it is well controlled and that you are following an optimal diet and exercise plan.
• Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
• Avoid large meals.
• Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
• Talk to your doctor about starting a safe exercise plan.

Medications
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

• Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.

• Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, which allows more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.

• Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.

• Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.

• Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including narrowing your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.

• Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery are also used to treat angina.

• Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.

• Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.

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Undescended testicle (cryptorchidism)

Undescended testicle (cryptorchidism)

Definition:

Undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging behind the penis (scrotum) prior to the birth of a baby boy. Usually just one testicle is affected, but in some cases both testes may be undescended.

An undescended testicle is more common among baby boys born prematurely or before 37 weeks.
For most boys born with one or two undescended testicles, the problem corrects itself within the first few months of life. If your infant has an undescended testicle that doesn't correct itself, surgery can usually be used to relocate it into the scrotum.

Symptoms:

Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually leave the abdomen, pass through a tube-like passageway in the groin (inguinal canal) and descend into the scrotum.

If your son has an undescended testicle, that process was stopped or delayed in some stage of development. Therefore, you won't see or feel a testicle where you would expect it to be in the scrotum.

When to see a doctor
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn't moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself.

Treating undescended testicle when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer.
Older boys — from infants to pre-adolescent boys — who have normally descended testicles at birth may appear to be "missing" a testicle later. This condition may indicate:

• A retractile testicle, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical examination
• An ascending testicle, or acquired undescended testicle, which has "returned" to the groin and cannot be easily guided by hand into the scrotum

If you notice any changes in your son's genitals or are concerned about his development, talk to your doctor.

Causes:

 The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors may disrupt the hormones, physical changes and nerve activity that influence the development of the testicles.

Complications:


In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Until a boy is 3 or 4 years old, the testicles continue to undergo changes that affect how well they function later.
An undescended testicle isn't in a cooler environment. This might increase the risk of complications later in life. These complications include:

• Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer. Surgically correcting an undescended testicle before age 15 months may decrease, but not eliminate, the risk of future testicular cancer.
• Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who have had an undescended testicle.

Other complications related to the abnormal location of the undescended testicle include:

• Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it may result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion.
• Trauma. If a testicle is located in the groin, it may be damaged from pressure against the pubic bone.
• Inguinal hernia. An undescended testicle may be associated with an inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.

Treatments and drugs:


The goal of treatment is to move the undescended testicle to its proper location in the scrotum. Early treatment may lower the risk of complications of an undescended testicle, such as the risk of infertility and testicular cancer.

Surgery
An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place. This procedure usually requires relatively small incisions and may be performed with laparoscopic devices.

When your son has surgery will depend on a number of factors, such as your son's health and how difficult the procedure might be. Your surgeon will likely recommend doing the surgery after your son is 3 to 6 months old and before he is 15 months old. Early surgical treatment appears to lower the risk of later complications.

In some cases, the testicle may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue.

If your son also has an inguinal hernia associated with the undescended testicle, the hernia is repaired during the surgery.

After surgery, the surgeon will monitor the testicle to see that it continues to develop, function properly and stay in place. Monitoring may include:

• Physical exam
• Ultrasound examination of the scrotum
• Tests of hormone levels

Hormone treatment
Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone could cause the testicle to move to your son's scrotum, but hormone treatment is usually less effective than surgery is. There's some evidence that hormone treatment may contribute to early onset of puberty (precocious puberty).

Other treatments
If your son doesn't have one or both testicles — either missing or didn't survive after surgery — you may consider saline testicular implants for the scrotum that can be implanted during late childhood or adolescence. These implants — testicle-shaped nodules filled with a fluid — result in the "appearance" of two testicles in the scrotum.

If your son doesn't have at least one healthy testicle, your doctor will refer you to a hormone specialist (endocrinologist) to discuss future hormone treatments that would be necessary to bring about puberty and physical

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Hypothyroidism (underactive thyroid)

Hypothyroidism (underactive thyroid)

Definition :

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain important hormones. Women, especially those older than age 60, are more likely to have hypothyroidism.

Hypothyroidism upsets the normal balance of chemical reactions in your body. It seldom causes symptoms in the early stages, but, over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease. The good news is that accurate thyroid function tests are available to diagnose hypothyroidism, and treatment of hypothyroidism with synthetic thyroid hormone is usually simple, safe and effective once you and your doctor find the right dose for you.

Symptoms:

The signs and symptoms of hypothyroidism vary, depending on the severity of the hormone deficiency. But in general, any problems you have tend to develop slowly, often over a number of years.
At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight gain, or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more obvious signs and symptoms. Hypothyroidism signs and symptom may include:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Unexplained weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory

When hypothyroidism isn't treated, signs and symptoms can gradually become more severe. Constant stimulation of your thyroid gland to release more hormones may lead to an enlarged thyroid (goiter). In addition, you may become more forgetful, your thought processes may slow, or you may feel depressed.
Advanced hypothyroidism, known as myxedema, is rare, but when it occurs it can be life-threatening. Signs and symptoms include low blood pressure, decreased breathing, decreased body temperature, unresponsiveness and even coma. In extreme cases, myxedema can be fatal.

Hypothyroidism in infants
Although hypothyroidism most often affects middle-aged and older women, anyone can develop the condition, including infants. Initially, babies born without a thyroid gland or with a gland that doesn't work properly may have few signs and symptoms. When newborns do have problems with hypothyroidism, they may include:

• Yellowing of the skin and whites of the eyes (jaundice). In most cases, this occurs when a baby's liver can't metabolize a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells.
• Frequent choking.
• A large, protruding tongue.
• A puffy appearance to the face.

As the disease progresses, infants are likely to have trouble feeding and may fail to grow and develop normally. They may also have:

• Constipation
• Poor muscle tone
• Excessive sleepiness

When hypothyroidism in infants isn't treated, even mild cases can lead to severe physical and mental retardation.
Hypothyroidism in children and teens
In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults do, but they may also experience:

• Poor growth, resulting in short stature
• Delayed development of permanent teeth
• Delayed puberty
• Poor mental development

When to see a doctor
See your doctor if you're feeling tired for no reason or have any of the other signs or symptoms of hypothyroidism, such as dry skin, a pale, puffy face, constipation or a hoarse voice.
You'll also need to see your doctor for periodic testing of your thyroid function if you've had previous thyroid surgery; treatment with radioactive iodine or anti-thyroid medications; or radiation therapy to your head, neck or upper chest. However, it may take years or even decades before any of these therapies or procedures result in hypothyroidism.

If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause. And if you're receiving hormone therapy for hypothyroidism, schedule follow-up visits as often as your doctor recommends. Initially, it's important to make sure you're receiving the correct dose of medicine. And over time, the dose you need may change.

Causes:

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can be upset. There can be a number of causes, including autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid surgery and certain medications.
Your thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck, just below your Adam's apple.

Hormones produced by the thyroid gland — triiodothyronine (T3) and thyroxine (T4) — have an enormous impact on your health, affecting all aspects of your metabolism.  They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.
Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

• Autoimmune disease. People who develop a particular inflammatory disorder known as Hashimoto's thyroiditis suffer from the most common cause of hypothyroidism. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland. Scientists aren't sure why the body produces antibodies against itself. Some think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. Most likely, autoimmune diseases result from more than one factor. But however it happens, these antibodies affect the thyroid's ability to produce hormones.

• Treatment for hyperthyroidism. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.

• Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you'll need to take thyroid hormone for life.
• Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidisi

• Medications. A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect on your thyroid gland.

Less often, hypothyroidism may result from one of the following:

• Congenital disease. Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland didn't develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth. That's one reason why most states now require newborn thyroid screening.

• Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland.

• Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia — a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.

• Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States. Conversely, taking in too much iodine can cause hypothyroidism. 

Complications:

 Untreated hypothyroidism can lead to a number of health problems:

• Goiter. Constant stimulation of your thyroid to release more hormones may cause the gland to become larger — a condition known as a goiter. Hashimoto thyroiditis is one of the most common causes of a goiter. Although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing.

• Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid. Even subclinical hypothyroidism, a more benign condition than true hypothyroidism, can cause an increase in total cholesterol levels and impair the pumping ability of your heart. Hypothyroidism can also lead to an enlarged heart and heart failure.

• Mental health issues. Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.

• Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body, for example your arms and legs. Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.

• Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by sedatives, infection or other stress on your body. If you have signs or symptoms of myxedema, you need immediate emergency medical treatment.

• Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder — also impair fertility. Treating hypothyroidism with thyroid hormone replacement therapy may not fully restore fertility. Other interventions may be needed, as well.

• Birth defects. Babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems. Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.

Treatments and drugs:

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.
One to two weeks after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every year.

Determining proper dosage may take time
To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after two to three months. Excessive amounts of the hormone can cause side effects, such as:

• Increased appetite
• Insomnia
• Heart palpitations
• Shakiness

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.
Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, the symptoms of hypothyroidism will gradually return.
Proper absorption of levothyroxine
Certain medications, supplements and even some foods may affect your ability to absorb levothyroxine. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or you take other medications, such as:

• Iron supplements
• Cholestyramine
• Aluminum hydroxide, which is found in some antacids
• Calcium supplements

If you have subclinical hypothyroidism, discuss treatment with your doctor. For a relatively mild increase in TSH, you probably won't benefit from thyroid hormone therapy, and treatment could even be harmful. On the other hand, for a higher TSH level, thyroid hormones may improve your cholesterol level, the pumping ability of your heart and your energy level.

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