Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

What are kidney stones?
The primary function of the kidney is to filter the blood and eliminate the waste products through urine. The waste deposition is sometimes in the form of excessive calcium, uric acid and other undesirable contents. It may cause the urine to get highly saturated. This is when stone like formations take place inside the kidneys. Kidney stones are also termed renal lithiasis or calculi. There are different kinds of kidney stones, which are differentiated based on its varied constituents. Kidney stones cause excruciating pain and uneasiness. Frequent urination, extreme discomfort during urinating and presence of blood in the urine are some of the major signs of kidney stones. The symptoms are not evident if the stones are very small in size.

Causes of kidney stones:

Incorrect calcium intake: High amounts of calcium can lead to high calcium depositions in the kidneys. It is important to keep the calcium intake moderate. Calcium supplements must be checked if you have already included dairy products in your diet.
Abnormal rates of sodium in the body: Sodium, just like calcium, gets deposited in the kidneys.
Excessive animal protein intake: Too much of animal protein intake can make the urine turn acidic, leading to uric acid depositions in the kidneys.
Sugary, aerated drinks: These lead to undesirable waste deposition in the blood stream and eventually in the kidneys.
Inadequate water intake: Not keeping the body well hydrated can cause the urine to turn acidic and increase waste deposition.
Potential risks and complications of kidney stones:

Kidney stones may cause an infection in the kidneys which may eventually spread to the other internal organs and surrounding tissues.
Kidney stones block the ureter and cause severe pain and discomfort that make sitting, standing or any other posture difficult.
Kidney stones rarely cause kidney failures but the severe blockage and infection may cause such detrimental results in the human body.

Kidney Stones - 5 Causes Behind It!

Often, early stages of kidney diseases do not come with specific signs and symptoms and most people will remain unaware of their condition. However, certain symptoms may be perceived that may indicate that a person is suffering from early stages of kidney failure. When you are diagnosed with kidney failure (also known as renal failure) in the initial stages, certain measures can be taken to retard the progression of the renal disease. This can also help reverse the condition and improve the quality of life of the patient. On the basis of a typical cause, the symptoms of kidney failure are grouped into specific categories that are given below. If you notice any of the specified renal failure symptoms, it is recommended to immediately fix up an appointment with your doctor and get your diagnostic tests done. 

Symptoms of Renal Failure from the accumulation of waste products in the body: 

Metallic taste in mouth 
Nausea and vomiting 
Facing difficulty in concentrating 
Loss of appetite 
Aversion towards meat (protein aversion) 
Itching or pruritus 
Symptoms of Renal Failure from the accumulation of fluid in the body: 

Dyspnoea or shortness of breath (this happens due to the accumulation of fluid in the lungs).
Swelling is seen in the feet, hands or face. 
Symptoms of Kidney Failure from damage to the kidneys: 

The amount of urine production changes, though it is not a reliable sign Haematuria or blood in the urine (usually in microscopic quantity). 
Frothiness or foam in the urine (usually happens when protein is present in the urine). 
Symptoms of Kidney Failure due to decreased blood production (anemia): 

Dyspnoea or shortness of breath. 
Fatigue Weakness. 
Confusion If you happen to feel cold all the time. 
The following diagnostic tests will be performed by your doctor in order to determine whether the symptoms are the manifestation of a kidney failure or not: 

Urine analysis - In this test, a sample of your urine is tested to find traces of blood, white blood cells or proteins which may indicate a problem in kidney function. 
Blood Tests - This includes tests for BUN and creatinine in the blood which are usually removed from the blood if the kidneys function properly. 
Actions must be taken when you show signs and symptoms of kidney failure: 

It is common that the symptoms of early renal failure are not always prominent, but if any of the above symptoms are witnessed, it is recommended to met a physician to determine whether they are caused by a kidney disease. You can pen-down the symptoms that you feel are related and bring it to the doctor when you fix up the next appointment. It is essential to know about your disease at the earliest as it will give you time and the ease of taking measures to retard the damage process and will decrease or delay the probability of undergoing dialysis or kidney transplant.

Kidney Failure - What Should You Know About it?

What is Chronic Kidney Disease?

Chronic Kidney Disease (also known as Chronic Renal Failure) is the progressive loss of kidney function occurring over a span of several months to several years and is characterised by the replacement of kidney architecture with interstitial fibrosis.

Chronic kidney disease is classified into five stages on the basis or proteinuria (presence of protein in large amounts in the urine) or Glomerular Filtration Rate (GFR) - 1 being the mildest with no distinct symptoms and 5 being end stage renal failure.

Causes and Risk Factors of Chronic Kidney Disease-

The various reasons (called risk factors) that can increase chances of Chronic Kidney Diseases are:

Diabetes mellitus, hyperlipidemia (excess fat proteins in the blood)
Hypertension

Family history heritable renal disease

Older age, smoking

Autoimmune disease

Past episodes of acute renal disease

The direct causes of Chronic Kidney Diseases are-

Diabetic nephropathy (leading cause)

Hypertensive nephropathy

Glomerulonephritis (swelling of the glomerulus in the kidneys)

Reno-vascular disease (ischemic nephropathy)

Polycystic kidney disease

HIV-associated nephropathy

Transplant allograft failure

Exposure to drugs and toxins

Diet that you must maintain in Chronic Kidney Disease-

It is essential to make dietary as well as lifestyle amends once you are diagnosed with CKD. The main purpose of this diet is to maintain the levels of carbohydrates, fluids and minerals. This is done to prevent the buildup of waste products in the body as the kidneys are unable to fulfil its function properly.

It is recommended to refer a dietician who can make you a diet chart that helps you adhere to your diet.

Here is a list of food items that you may avoid or may consume if you are suffering from Chronic Kidney Disease:

Carbohydrates : Carbohydrates are a good source of energy. If the intake of protein has been restricted, then it is recommended to replace that with carbohydrates as a source of energy. Fruits, vegetables, grains and bread can be consumed as they are rich source of fibres, minerals and various types of vitamins. You can indulge in some hard candies or sweets as well.

Fats: Fats can provide a good amount of calories as well. Ensure that you only stick to healthy fats such as the monounsaturated and polyunsaturated fats that are good for your cardiac health. 

Reduce your phosphorus intake: A diet with no more than 800 mg of phosphorus can help reduce the risk of too much phosphorus building up in your blood.  Limit intake of foods with high levels of phosphate or phosphate additives such as organ meats, whole grain breads, processed foods, cola beverages, cheese, dried beans, liver, peanut butter, dairy products and chocolate. Many beverages and processed foods have these additives. Other high-phosphorus foods to limit include: 

Cheese
Chocolate
Ice cream
Legumes
Milk
Nuts
Seeds
Yogurt
Monitor your potassium levels: Usually, potassium is not restricted in stage 3 CKD unless lab tests show potassium is too high. Your doctor may make medication changes or prescribe a low-potassium diet. Reduce an elevated potassium level by limiting some high-potassium foods and potassium chloride (found in salt substitute and many low-sodium processed foods), such as avocado, bananas, cantaloupe, honeydew, legumes, milk, nuts, potatoes, seeds, tomato products and yogurt. Some high-potassium foods to limit or avoid include: 
Avocado
Bananas
Cantaloupe and honeydew melon
Dried fruit
Legumes
Milk
Nuts and seeds
Oranges and orange juice
Potatoes
Pumpkin and winter squash
Tomato products (juices, sauces, paste)
Yogurt
Proteins: Usually, before undergoing dialysis, it is recommended to adhere to a low-protein intake diet. However when you are undergoing dialysis, it is necessary to consume a certain amount of protein. This detailed information can be obtained from your dietician.
Fluids: In the early stages of CKD, your fluid intake is not monitored. But as the disease progresses, you need to check your intake of fluids as too much fluids may accumulate in your body and create pressure on your kidneys.

Sodium Or Salt Intake: Keeping a check on your salt intake reduces the risks of high blood pressure. Also, having food low on salt can reduce your thirst and prevent fluid retention in your body.

Diet In Chronic Kidney Disease

Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people. There are several types of urinary incontinence, including:

Stress Incontinence  when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh.
Urge Incontinence  when urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards.
Overflow Incontinence (chronic urinary retention)  when you're unable to fully empty your bladder, which causes frequent leaking.
Total Incontinence  when your bladder can't store any urine at all, which causes you to pass urine constantly or have frequent leaking.
It's also possible to have a mixture of both stress and urge urinary incontinence.

What causes urinary incontinence in men?

Urinary incontinence in men results when the brain does not properly signal the bladder, the sphincters do not squeeze strongly enough, or both. The bladder muscle may contract too much or not enough because of a problem with the muscle itself or the nerves controlling the bladder muscle. Damage to the sphincter muscles themselves or the nerves controlling these muscles can result in poor sphincter function. These problems can range from simple to complex.

A man may have factors that increase his chances of developing UI, including

birth defects problems with development of the urinary tract
a history of prostate cancer surgery or radiation treatment for prostate cancer can lead to temporary or permanent UI in men
UI is not a disease. Instead, it can be a symptom of certain conditions or the result of particular events during a man s life. Conditions or events that may increase a man s chance of developing UI include

benign prostatic hyperplasia (BPH) a condition in which the prostate is enlarged yet not cancerous. In men with BPH, the enlarged prostate presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty, leaving some urine in the bladder. The narrowing of the urethra and incomplete emptying of the bladder can lead to UI.
chronic coughing long-lasting coughing increases pressure on the bladder and pelvic floor muscles.
neurological problems men with diseases or conditions that affect the brain and spine may have trouble controlling urination.
physical inactivity decreased activity can increase a man s weight and contribute to muscle weakness.
obesity extra weight can put pressure on the bladder, causing a need to urinate before the bladder is full.
older age bladder muscles can weaken over time, leading to a decrease in the bladder s capacity to store urine.
Treating Urinary Incontinence

Initially, your GP may suggest some simple measures to see if they help improve your symptoms. These may include:

lifestyle changes   such as losing weight and cutting down on caffeine and alcohol
pelvic floor exercises   exercising your pelvic floor muscles by squeezing them, taught by a specialist 
bladder training   where you learn ways to wait longer between needing to urinate and passing urine, guided by a specialist
You may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.
Medication may be recommended if you're still unable to manage your symptoms.
Surgery may also be considered. The specific procedures suitable for you will depend on the type of incontinence you have.
Surgical treatments for stress incontinence, such as tape or sling procedures, are used to reduce pressure on the bladder or strengthen the muscles that control urination.
Operations to treat urge incontinence include enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.

Men Urinary Incontinence Treatment

Urinary incontinence, commonly known as loss of bladder control can really cause embarrassment. The severity of this condition may range from once in a while leaky urine to the sudden and forceful urge to urinate, due to which you end up urinating before reaching the toilet.

Types of urinary incontinence-

Stress incontinence- when you feel the urge to urinate due to sneezing, coughing, laughing or while doing physical exercise
Urge incontinence- when you feel the urge to urinate, suddenly. This may occur during the day and even at night.
Functional incontinence- when you cannot reach the toilet on time because of a physical or mental impairment.
Mixed incontinence- when you involuntarily urinate due to more than one incontinence
Stress incontinence is the most common type in women. The activities which increase your risk, are:

You have had more than one pregnancy and vaginal delivery.
You have pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.
Female urinary stress incontinence is the involuntary release of urine during any physical activity that puts pressure on your bladder. This potentially embarrassing condition differs from general incontinence in that it happens when the body is under immediate physical stress. Activities that can put stress on your bladder include coughing, sneezing, laughing, lifting heavy objects, or bending over. This condition is particular to women, many of whom experience symptoms after muscles have been weakened due to a vaginal childbirth, following menopause, or during pregnancy.

Ensure that you consult a doctor-

If this condition hinders your day to day activities
If the urinary incontinence is the result of a serious underlying problem
Causes of urinary incontinence-

Urinary incontinence may be temporary or permanent. Causes for temporary incontinence are-

Alcohol
Caffeine and caffeinated drinks
Decaffeinated tea or coffee
Spicy and sugary foods
High intake of vitamin b or c
Urinary tract infection (uti)
Constipation
Causes for permanent incontinence are:

Pregnancy
Childbirth
Old age
Menopause
Hysterectomy
Prostate cancer
Enlarged prostate
Neurological disorders
Complications-

Chronic urinary incontinence can lead to certain complications like.

Skin problems- skin rashes and infections can develop around the vaginal area, because of the constant wetness one feels. It may also cause sores.
Urinary tract infections- urinary incontinence can also result in uti
Impact on personal and social life- urinary incontinence can lead to great embarrassment, thus affecting the social and personal life of an individual.
Treatment for female stress urinary incontinence-

There are several types of treatment available. Treatment options include lifestyle changes, medications, nonsurgical treatments, and surgeries.

Lifestyle changes: make regular trips to the restroom to reduce the chance of urine leakage. Drink fewer fluids and avoid activities such as jumping and running.
Medications: medications that reduce bladder contractions.
Nonsurgical treatments: kegel exercises strengthen your pelvic muscles. Done regularly, these exercises can strengthen your muscles, allowing you to control when urine is released from your body.
Surgery:

If other treatments fail, you will have to go for surgical treatment. Types of surgery include:

Injectable therapy, in which collagen is injected into your urethra to reduce incontinence
Tension-free vaginal tape (tvt) surgery, in which mesh is placed around the urethra to give it support
Vaginal sling surgery, in which a sling is placed around the urethra to support it
Anterior or para-vaginal vaginal repair surgery to repair a bladder that is bulging into the vaginal canal
Retropubic suspension surgery to move the bladder and urethra back into their normal positions
Some doctors even try electrical stimulation and medication. When the condition is highly advanced interventional therapies and surgery is recommended.

Some interventional therapies are-

1. Bulking material injections
2. Botulinum toxin type-a
3. Nerve stimulators.

All About Urinary Incontinence

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