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?

Every organ is important for the human body to perform its functions normally. Kidneys too are vital and are responsible for removing the excess fluid and toxins from the body. If the kidney is not functioning properly, then the patient is advised to undergo dialysis treatment. In some cases, the patient is advised to undergo a transplant. However, in any case, the patient has to follow a healthy diet, for the treatment and the medicines to work positively.

Suitable diet during dialysis
Most of the patients are not aware of the diet prescribed for dialysis. Though it is always advised to consult a dietician before following any diet for the condition, it is also advisable to gain some knowledge about what the dietician might suggest, so that one is not clueless about the treatment. In a majority of the cases, food containing potassium, phosphorus, low-fat cholesterol, and sodium is included in the diet of these patients. However, these are prescribed in a limited amount and vary from patient to patient.

Sodium: The sodium level of the dialysis patients needs to be controlled; and this can be done by eating food items that have a low sodium content, not more than 2,000 mg. Hence, the quantity of snacks, pudding, and chips are to be reduced in the diet chart.
Potassium: The level of potassium also needs to be kept in check to avoid further deterioration of the kidney. Bread, certain vegetables, and grains contain a high amount of potassium. Moreover, various salt substitutes contain potassium chloride instead of sodium chloride. Large intake of these foods may affect the kidney permanently. Hence, these are majorly excluded from the diet. The patients are advised to include tomatoes and bananas in their diet, though not on a daily basis.
Phosphorus: The patient is advised to avoid foods with high phosphorus. This includes milk and dairy products and grains. However, while on dialysis, meat is important as it gives enough protein despite being high on phosphorus. But, an abundance of meat in the diet may affect adversely. Hence, this is advised, but kept in control.
Cholesterol: To keep cholesterol amount in check during dialysis, the patient needs to cut down on fruits and vegetables and specific fat diets, while eating a sufficient amount of fish.
Protein: High protein food is necessary for a patient with a kidney disease. Meat is an excellent source of protein. Along with that, poultry, fish, and eggs are important, as well. Hence, all this is included in the diet.
Fluids: Dialysis helps in removing the excessive waste fluids from the kidney. But, to keep the body hydrated, the patient is allowed liquid intake, but only up to a certain limit.
It is necessary to maintain a proper diet during dialysis, as it quickens the treatment as well as helps the patient recover quickly.

Undergoing Dialysis - What Should Be Your Diet?

A kidney stone may not be as big as the stones in your garden, but can be quite a pain. Kidney stones are actually mineral crystals that are usually a combination of calcium and phosphates. The size of a kidney stone ranges from the size of a sugar crystal to a ping pong ball. While some kidney stones pass out of the body along with urine, others can block the urethra and become painful. 

In addition to being painful, a kidney stone can cause permanent damage to your kidneys. Since large kidney stones are usually painful, they rarely go undiagnosed. However, if a kidney stone is left untreated, it could cause the kidney to atrophy and lower the functionality of the kidney. Kidney stones that are related to an infection can also lead to chronic urinary tract infections and damage the kidney through scarring and inflammation. This could eventually lead to kidney failure.
 
Not all kidney stones need to be treated with surgery. If the kidney stone is very small, your doctor may prescribe plenty of water and medication to treat the pain. With plenty of water, you should be able to pass the stone in your urine. Ideally, you should take plenty of rest until the stone is passed. 

Larger kidney stones may need you to be hospitalized for treatment. These are:
- extracorporeal shock wave lithotripsy (eswl)
To begin this of treatment, a painkiller is administered. Ultrasonic waves are used to determine the location of the kidney stone. Shock waves are then passed through the kidney stone to break it into smaller pieces, which can then pass out of the body through urine.
- ureteroscopy
This is also called retrograde intrarenal surgery and is performed when the kidney stone is stuck in the ureter. A ureteroscope is passed through the urethra and bladder into the ureter. Laser energy may then be used to break the stone into smaller pieces to unblock the ureter. 
- percutaneous nephrolithotomy (pcnl)
This surgery is performed under general anesthesia. It involves a small incision being made in the back and a nephroscope passed into the kidney through it. Laser or pneumatic energy is then used to break up the stone into smaller pieces and pull them out. 

- open surgery
Open surgery is performed only in the case of an abnormally large stone or abnormal anatomy of the person. An incision is made in the back that allows the doctor to access the kidney and manually remove the stone.

Kidney Stones- Should It Be Removed

Polycystic Ovary Syndrome (PCOS) is a condition, which is born due to an imbalance of hormones within the female body. When this happens, the female body faces anumber of problems as far as her periods or menstrual cycles goes, besides finding it difficult to conceive naturally and easily. Let us find out more about this condition.

PCOS and hormones
To begin with, let us understand what hormones are. These are chemical impulses that send messages to various parts of the brain and rest of the body to signal the release of other kinds of hormones that may be vital for various functions. In PCOS, it is normally seen that the sex hormones are thrown out of balance, due to which the ovaries start producing a small dose of some male hormones. This creates problems as far as ovulation is concerned and also, it gives rise to the growth of facial hair, acne and changes in the overall appearance of the patient. Insulin resistance is another cause that may also trigger PCOS. It is also an inherited issue in many cases.

Symptoms
From irregular periods to an increase in acne and facial hair, there are many symptoms that may point at the existence of this condition. Fertility problems and issues related to normal ovulation are also often seen in women who are suffering from this condition due to the irregular periods. Additionally, depression may be seen in many patients who are suffering from this condition on a chronic basis. Thinning of hair and excess weight gain with difficulty in losing extra pounds may also be indicative of PCOS.

Diagnosis
The diagnosis of PCOS is usually done with the help of a physical examination as well as a blood test that will primarily help in determining the sugar levels and insulin. The doctor will also conduct other hormone tests so as to understand which hormones are not in balance and which ones may be triggering changes in the body. Apart from all this, the doctor will also study the body mass index (BMI) of the patient to find out if there has been a sudden and drastic change on the weight of the patient. During the lab tests, where the blood and urine are examined, the doctor will also seek to rule out any anomalies in the thyroid gland. An ultrasound of the ovaries will also be conducted.

Treatment
Weight loss programs as well as diet tweaks that remove excess dairy and meat may be recommended by the doctor. Further, the doctor may also put the patient on birth control pills so as to bring better balance of hormones. Moreover, moderate exercise will be required for the patient so that the normal production of hormones may be resumed eventually. 

PCOS - How It Can Be Diagnosed?

As we all are aware that waste products in the blood are passed through urine. This filtering process is done by the kidneys as it separates the waste products including minerals and salts, which have to be passed out through urine. Many times, these minerals and salts get stuck in your urinary tract and over a long period, this forms kidney stones. They can vary in size from a ping pong ball to the size of a sugar crystal. They are not noticed till the time they cause a blockage. Sometimes, they cause immense pain if they start breaking or are pushed into the ureters (narrow ducts which lead to the bladder).

Symptoms of kidney stones:
1. Immense pain in the groin, belly and back.
2. Pain while urinating and urination occurring frequently.
3. Blood found in the urine (haematuria).
4. Vomiting and nausea.
5. Feeling extremely restless and not being able to lie still.

Kidney stones can also cause a kidney infection. Signs of kidney infection include:
Kidney stones can also cause infection in the kidneys as they block the passage of urine to the bladder by blocking the ureters. This leads to build up of the waste product which can result in an infection. Some of the symptoms of kidney infections could be:
1. Feeling chilly and shivering on your skin.
2. High temperature of 100.4 F (38C) or more.
3. A feeling of fatigue or weakness.
4. Immense diarrhea
5. Bad smelling and cloudy urine.

Types of Kidney stones:
1. Struvite stones: It contains ammonia and magnesium. It is usually quite large and horn- shaped.
2. Uric acid stones: Brown, smooth and softer than other kinds of kidney stones.
3. Cystine stones: They are yellow and don t look like stones. They usually resemble crystal.
4. Calcium stones: It is composed of calcium.

What causes kidney stones?
Kidney stones can occur due to several factors. It usually forms when urine generally contains crystal substances like uric acid, calcium and oxalate. Your urine might not be able to dilute these substances resulting in the perfect environment for the formation of kidney stones. In case you are showing any of the symptoms mentioned above, you should visit you doctor immediately before the problem can worsen.

Common Symptoms of Kidney Stones

The bladder is a muscular sac that is seated just above the pubic bone. The organ stores urine produced by the kidneys allows us the control the frequency of urination by the expansion and contraction of its muscles. Pain in the bladder is usually caused due to one of three reasons:

Interstitial cystitis: This is a chronic condition which affects more women than men. It makes the bladder inflamed and irritated. The bladder walls turn stiff because of this which makes it difficult for the bladder to expand. Interstitial cystitis may be caused by a defect in the lining of the bladder.

Urinary tract infection: Urinary tract infections can affect a person at any age and may develop in the ureter, urethra, bladder or kidneys. However, it is most commonly seen in the bladder. This infection is caused by bacteria that enter the body through the urinary tract.

Bladder cancer: Cancer that develops in the bladder is known as bladder cancer. Transitional cell carcinoma is the most common type of bladder cancer cell. This begins in the innermost layer of the bladder lining. Pain during urination and discomfort in the lower pelvic region are common symptoms of this disease. Once the cause is diagnosed, antibiotic medication can help treat bladder pain. Along with that, there are a few things you could do at home as well.

Drink plenty of fluids: Ideally, we should drink 8-10 glasses of water a day. Water keeps the body hydrated and helps flush toxins from the body. It also helps dilute the urine. This can make urination less painful as concentrated urine may be acidic and difficult to pass. Water also helps prevent the formation of kidney stones and thus helps the kidneys function optimally.
Urinate frequently: Do not try to control your urine. Holding urine in for extended periods of time allows bacteria to multiply within the body. It is also important to urinate after intercourse as sexual activities can push the bacteria present on the skin deeper into your body. This is important for both men and women.
Dress comfortably: Avoid synthetic, tight fitting underwear and clothes. Instead wear, loose, comfortable clothes that are preferably made out of cotton. These clothes will help keep your skin dry and not allow bacteria to breed.
Pain relievers and heating pads: Sometimes, antibiotics can take a day or two before addressing bladder pain. In such cases, pain relievers can help deal with the discomfort and cramps. Heating pads can also help soothe abdominal and lower back pain that results from bladder infections.

Painful Bladder - What Should You Know About It?

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