One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
2. No hospitalization: This can be done either as an outpatient or with minimal one day stay at the hospital
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery.

Know About Laser Prostate Surgery

Kidneys are an important part of the human body. From filtering wastes from the blood to maintaining the blood pressure and red blood cell count in the body, the kidney does it all. Both the kidneys are essential organs and should there be any discomfort in the kidneys, one should consult a medical practitioner as soon as possible. Kidney failure is a common problem in people. This issue manifests itself with certain signs and symptoms. One should listen to these symptoms and act quickly before the condition worsens. Here are some of the signs and symptoms of kidney failure.

Interestingly, in the initial stages, kidney failure portrays no symptoms. It starts developing slowly and steadily causing discomfort in other parts of the body and hindering the working of other organs.

Weakness: If you are suffering from kidney failure, you will start feeling weak. Weakness is however not a symptom which can confirm a kidney failure. Weakness is caused due to many other health issues and thus, you need to verify with other symptoms to be sure of the fact that you are suffering from kidney failure only.

Shortness of Breath: You may start experiencing heavy breathing right after doing some rigorous work. In fact, you might feel shortness of breath or be panting for long moments after climbing just a set of stairs. Shortness of breath is quite common indicating that the body is getting tired after doing work. Such indication, more than once a day, calls for an immediate check up of the body.

Lethargy: While most people, especially the young generation to those in the early thirties jokingly declare themselves as lazy people; lethargy, however, is a symptom of many diseases. Various health issues develop if you feel lethargic of working. Apart from kidney failure, diabetes is also manifested in lethargic body movements. At times, just getting out of the bed in the morning seems very tiring and one continues to lie on the bed even after he/she is fully awake.

Stomach Pain: If you experience pain in the stomach, especially in the sides, then it should be immediately checked by a medical practitioner. Doctors say that kidney failure can bring about stomach pains.

Unusual Urine Discharges: This would include clear urine discharges which indicate that the kidney has stopped filtering the waste products.

Thus, these are some of the most important and common symptoms of kidney failure. If you notice any of these, it is advised to visit a doctor for a check up.

Symptoms of Kidney Failure

Urinary Incontinence is the sudden urine loss that occurs involuntarily in women. Some of the factors which cause urinary incontinence are pregnancy, menopause and childbirth. It should be noted that urinary incontinence by itself is not a disease, but is a symptom of other underlying disorders such as diabetes, infections and other conditions.

Causes of temporary cases of urinary incontinence include:
1. Constipation
2. Urinary tract infections
3. Excess consumption of alcohol and caffeine
4. Consuming carbonated drinks
5. Use of artificial sweeteners
6. High doses of vitamin B and vitamin C
7. Being on sedatives, muscle relaxants, blood pressure and heart medications
8. Eatables which are too spicy, acidic or sugary

However, persistence of incontinence might be due to a more serious condition. Some of the causes are stated below:

Age: The bladder muscles tend to weaken with age. This affects the bladder s urine holding capacity.
Pregnancy: Hormonal changes and increase in weight during pregnancy can cause incontinence.
Menopause: Oestrogen is responsible for the healthy maintenance of the lining of the urethra and bladder. The onset of menopause causes the oestrogen hormone levels to drop. The gradual damage of the bladder tissues causes incontinence.
Childbirth: The bladder control muscles are weakened during normal vaginal delivery, thus leading to incontinence.
Obstruction: Occurrence of tumours in the urinary tract can block the normal flow of urine which can cause incontinence.
Hysterectomy: The same ligaments and muscles support both the bladder as well as the urethra. With removal of the uterus by hysterectomy, the pelvic floor muscles are deteriorated. This leads to urinary incontinence.
Neurological disorders: Conditions such as multiple sclerosis (autoimmune disorder in which the immune system destroys the protective sheath of the nerves), Parkinson s disease (disorder affecting motor functioning of the body), brain tumours, spinal injury or strokes are capable of causing incontinence.

Different forms of urinary incontinence are classified on the basis of their symptoms:

Urge incontinence: Urge or urgency incontinence occurs when there is a leak before the person reaches the toilet.
Stress incontinence: Small amounts of urine leak out during normal physical movements such as sneezing, coughing and exercising. This happens because of the minimum stress exerted on the body, and hence, the name.
Functional incontinence: Sudden leakage of urine occurs due to external deterrents or physical disabilities such as not being able to find a toilet.
Overactive Bladder: This is characterized by frequent and urgent urination.
Overflow incontinence: A full bladder, at times, leads to unexpected leakage.
Transient incontinence: If urine leakage occurs due to temporary situations such as infections, or new medications.

Did You Know - Constipation Can Also be a Sign of Urinary Incontinence

A diseased kidney is one that has lost its ability to carry out the filtration process in a proper manner. This process of filtration usually sends the waste and toxins out of the body in a routine manner. In such cases, a kidney disease manifests which requires a number of treatment measures. Dialysis is something that enters the treatment plan at a later stage as chronic early stage kidney disease can remain in the patient s body for many years. When the kidney function comes down to 15%, then most doctors recommend the start of dialysis which is basically a process that removes the excess waste and fluid from the blood. This can be a process that will leave the patient fatigued and in a mental state that is not exactly stable and positive at all times. It is common to see dialysis patients battling depression due to the chronic nature of the treatment as well as the low chances of recovery.

So, let us find out how dialysis patients can cope with depression.

    Professional Help: Depression is said to be like a common cold when it comes to mental diseases. The state of a person s body can very well affect the balance in his or her mind and lead to depression. Starting from pressing circumstances to hormonal changes as well as chronic ailments, depression can affect people due to a number of reasons. Dialysis patients who are undergoing depression must consult a professional specialist like a psychiatrist who will help the patient understand and cope with the situation with the use of therapy based counselling.
    Medication: The patient can also be given medication that will prevent the build up of unnecessary stress by blocking the production of those hormones that result in a negative state of mind. This medication must be prescribed after speaking the patient s nephrologist about what kind of medication will suit the patient specifically.
    Psychotherapy: Long term psychotherapy is also known as talk therapy that can help the psychiatrist or clinical psychologist in talking the patient through the problems. Besides giving the patient the scope and platform to air out the problems and reach solutions regarding normal day to day functioning despite the troubles, this kind of therapy also aims at equipping the patient with a better perspective and improved attitude.

While going through this kind of therapy and medication, it is important to keep a team of nephrologists and psychiatrists in the loop so that the patient may reach out at any time in order to avail help in the most trying situations. This will give a blanket of security to the patient as well.

3 Ways a Dialysis Patient can Cope with Depression

Kidney stones are caused when certain minerals of your urine are retained and are not fully released, causing them to amalgamate and form a stone. Passing a kidney stone is one of the most painful experiences you may face physically. Its magnanimity is often compared to childbirth, and those who are suffering from kidney stones dread having this experience. If you are not yet affected by kidney stones and do not want to, read further to know what type of diet you need to follow in order to prevent it.

1. Drink lots of water: On an average, a person must be drinking at least 3 liters of water every day. If you live in a more hot and humid climate, your water intake must be even more than that, so that on an average, 2.5 liters of urine is passed throughout the day, which decreases the chance of unnecessary retention of minerals from the urine and release them more easily from the body.

2. Continue eating foods rich in calcium: It is a common misconception that calcium accelerates the formation of kidney stones. Calcium is digested by the intestine, only excess calcium cannot be digested by the intestine and is sent to the kidney. Continue consuming calcium rich foods unless your doctor prescribes you against it. Make sure your diet includes enough dairy products such as milk, cheeses, etc., or other calcium rich foods, such as oats and broccoli.

3. Limit intake of oxalic acid: Oxalic acid is mostly found in foods obtained from plants. It restricts the absorption of calcium in the intestines and as a result, more calcium is passed into the kidneys; thus, forming calcium oxalate, or oxalate stones. Try to avoid foods, such as rhubarb, Swiss chard, nuts, tea, sweet potatoes, etc.;mainly leguminous plant products.

4. Decrease the ingestion of sodium salts, sugar and meat protein: Salts and sugars, mainly found in packaged foods are used to prevent them from expiring. They increase the release of calcium and oxalates into the blood, which thus increases the chance to develop kidney stones. Meat contains fibers which affect certain nutrients in the kidney, thus aggravating the formation of stones.

5. Increase the consumption of insoluble fibers: Insoluble fibers are those rough fibers which are not soluble in water during the process of digestion. They are found in rice, wheat, barley, etc., and are found to decrease calcium absorption in the kidney. They attach themselves to the calcium and oxalates, which enable them to be released as stool instead of urine.

Kidney Stones and Your Diet

Problems of the large intestine are very common and patients should usually consult gastroenterologists for the proper diagnosis and treatment

1. Bleeding per rectum: Bleeding through the anal canal or rectum is usually the most common problem of the patients. It can be due to following reasons: 

A. Piles also known as Hemorrhoids: Hemorrhoids are dilated venous channels of the anal canal. They occur due to long term constipation or chronic cough or due to less fibre intake in the diet. Sigmoidoscopy or proctoscopy is required for diagnosis. Treatment options include medicines and high fibre intake, Injection therapy(Sclerotherapy) for stopping bleeding from piles and Stapler hemorrhoidectomy if the piles are large.

B.  Polyps: Polyps are soft tissue growths seen in the large intestine. They are usually silent but can present with bleeding or anaemia. Polyps usually grow slowly in size and large polyps can turn into cancer of large intestine also known as colorectal carcinoma. Colonoscopy is required for the diagnosis. The gastroenterologists can diagnose the presence of polyps by colonoscopy. Smaller polyps can be removed by polypectomy by gastroenterologists without the need for open surgery. However large polyps or those polyps with suspicion of cancer require surgery.

C. Large intestine Ulcer: They can occur due to early cancer, SRUS, Infections or drugs. They require colonoscopy for the diagnosis. The gastroenterologists usually take Biopsy from the ulcer to know the cause of the ulcer. The mere taking of biopsy does not mean cancer and biopsy samples are seen in the microscope for better diagnosis.

D. Ulcerative Colitis and Crohn s disease: Ulcerative colitis is one form of Inflammatory bowel disease (IBD). The other IBD is known as Crohn s disease. Whereas ulcerative colitis involves only large intestine, Crohn s disease can involve any part of the gastrointestinal tract including small intestine. Ulcerative colitis and Crohn s disease present with Loose stools(diarrhea), bleeding , abdominal pain, weight loss, Anemia and Perianal fissures and  fistula. The diagnosis of IBD is challenging and involves blood tests, CT Scan abdomen, Colonoscopy with biopsy and clinical history. Management includes Medicines which control the inflammation such as Pentasa, Rowasa, Mesacol etc. Severe disease requires additional drugs such as Azathioprine and Anti TNF sich as Infliximab and Adalimumab. Occasional cases require surgery such as those with tight stricture of the intestine, severe dilatation of Large intestine (also known as Toxic megacolon), excessive bleeding, the disease not responding to medical management, or presence of cancer with IBD.

E. Anal fissures: Cut in the anal skin (fissure) causes severe pain in the anal area during passing motions. It is usually due to constipation or straining. It is usually treated by Gastroenterologists initially by medicines and ointments. If the pain continues Surgery is required named as Lateral internal sphincterotomy (LIS).

2. Loose motions or Diarrhea: Excessive passing of liquid motions is known as diarrhea or commonly lose motions. It is usually due to Infections caused by contaminated food and water. It is usually self-limiting. Severe cases with dehydration require admission for IV fluids and antibiotics for the infection. Loose motions for more than 6 to 8 weeks is known as chronic diarrhea. It is evaluated by blood tests and colonoscopy. Usual causes include tuberculosis, celiac disease, ulcerative colitis, microscopic colitis, Malabsorption such as chronic pancreatitis and small bowel bacterial overgrowth.

3. Irritable bowel syndrome (IBS): IBS is very common and at least 20 to 30 percent of Indian patients suffer from it. Symptoms include altered bowel habits such as diarrhoea or constipation, abdominal pain which is usually relieved or increased by defecation. Weight loss or bleeding is not the feature of IBS. Few simple blood tests are required and good medicines are now available for IBS. Few cases may require colonoscopy to rule out alternative causes of the symptoms.

Understanding colonoscopy: Colonoscope is a flexible tube with a camera at its tip to see the inside of the large and small intestine. Bowel preparation is required at least 8 hours before the procedure so that the inside of the large intestine can be seen clearly without the interference of stools.colonoscopy is an OPD based procedure where the patients are discharged the same day. A colonoscopy helps in evaluation symptoms of the large intestine such as loose stools, bleeding and abdominal pain.

In Detail About Colorectal Disorders!

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