Health Guide

Health Record provides reliable answers to important health questions. Use this site to learn more about detecting, preventing, and treating a variety of medical conditions.

How to Stop Children Bed Wetting

Written by Mystic on Tuesday, July 26, 2011

Bed Wetting

Other names :

Introduction :
Being unaware of passing urine during deep sleep.

Cause :
Normally, urine is retained in the bladder by the contraction of a ring shaped bundle of muscle that surrounds the bladder opening. When you wish to pass urine, this ring of muscle relaxes, and the muscles in the wall of the bladder and around the abdominal cavity, contract to squirt the urine out in a steady stream. Those who are bed wetters, tend to sleep very deeply, and during the deepest phases of this sleep, when all the main muscles of the body are totally relaxed, the sphincter ring muscle that retains the urine in the bladder, also relaxes. Because there is no associated contraction of the muscles in the bladder wall or elsewhere, the urine just dribbles out slowly in the night, not in a hard stream.

Incidence :
Bed wetting is a common problem that may make businessmen dread overnight trips to a conference, cause marriages to break up, stop teenagers from spending the night at a friend's, and drive the mothers of some children to desperation.

Prevention :
Quiet, sensible toilet training at an appropriate age, that rewards success rather than punishing failure, may prevent the problem from developing. Some children are slower at controlling their bladder at night than others, and may be three or four years old before control is obtained.

Investigations :
The first step is to investigate the patient to exclude any cause for bed wetting. Chronic infections, structural abnormalities, and other rarer conditions may cause a weakness or excessive irritability of the bladder. Once these problems have been excluded by urine tests and x-rays, the treatment of a true bed wetter can begin.

Course :
Up to 10% of five year olds still wet the bed, so parents should not become too anxious until the child is past this age. Premature treatment can cause permanent sleep disturbances in a child, but delaying treatment beyond five can lead to the problem becoming a major influence in the child's life. The important thing to remember is that, in most cases, the problem can be controlled by cooperation between doctor, patient and family.

Treatment :
People with this problem are often too embarrassed to see their family doctor about the problem, but it may cause severe disruption to home life and a career. Adults should overcome any false embarrassment, and discuss the matter with their general practitioner to obtain confidential treatment. In children, the simple steps of restricting fluids for three hours before bedtime, taking the child to the toilet during the night, and establishing a reward system, can be tried. Unfortunately, these methods are often unsuccessful, and more specific remedies are required. The best form of treatment is the bed wetting alarm. This consists of a moisture sensitive pad that is placed under the patient, a battery and an alarm. When it becomes wet from the first small dribble of urine, it closes an electrical circuit, and sounds the alarm. The patient is then woken, and can empty the bladder in the toilet before returning to sleep. After a few weeks use, most people learn to waken before the alarm, and the problem is solved, but some patients require an extraordinarily loud alarm to wake them. Another effective form of treatment is the use of a medication (amitriptyline - see Medication Table) every night to alter the type of sleep. The muscles do not relax as much, thus retaining the urine in the bladder, and the patient can sleep quite normally. Over a few weeks, the dosage is slowly lowered, until the medication is stopped completely. Hopefully, the bad sleep habits and bed wetting do not return. The final form of treatment is psychotherapy by a psychiatrist, but this is used in only the most resistant cases.

Diet :
Diet does not appear to be of any benefit.

Complications :
Bed wetters are more likely to develop urinary infections. Social stigmatisation may become a major problem in some sufferers.

Outcome :
The vast majority of patients can control the problem before the teenage years, but in a small number, the problem may persist throughout life.

Related conditions

Asthma : symptoms, trigger factors & management

Written by Mystic on Monday, July 25, 2011

Asthma is a common airways disease affecting 30% of all Australians - one third are adults and two thirds are children.

What is an asthma attack?
An asthma attack happens when the airways (bronchial tubes) in the lungs narrow. In asthma the airways are more sensitive than normal and when exposed to a "trigger" they overreact and become inflamed and narrow due to:

  • Swelling of the airway lining
  • Squeezing or spasm of the airway's muscle walls
  • Increased mucus

Asthma may be indicated by one or more of the following:
  • cough -especially at night
  • wheezing
  • tightness in the chest
  • shortness of breath

Trigger factors
Certain triggers bring on asthma attacks in some people:
  • allergy to house dust mite, pollens, moulds and pets
  • irritants like cigarette smoke, dust or chemical fumes
  • viral infections such as colds or flu
  • vigorous exercise (medication may be needed before exercising)
  • certain medicines such as aspirin and NSAIDS
  • emotional stress or excitement
  • cold air or a sudden temperature change
  • some food additives

Preventers treat airway inflammation. They are the first-line defence and need to be taken every day to prevent attacks. Typical preventers are Becotide, Pulmicort, Intal, Intal Forte, Becloforte, Aldecin, Tilade and Flixotide.Relievers treat airway narrowing. They are rescue medications usually given by inhaler when symptoms occur. These typically include Ventolin, Bricanyl, Berotec, Aldecin, Respolin, Atrovent, Asmol, Respax and Serevent.

Managing asthma
Any asthmatic condition should be referred to your doctor for advice.Your doctor or pharmacist will assist you with a six-step management plan which is aimed at abolishing symptoms, maximising lung function and achieving the best quality of life. The plan will:1. Assess the severity of the asthma2. Achieve the best lung function - ensuring that medications and devices are being used correctly and effectively3. Maintain the best lung function by avoiding trigger factors4. Maintain the best lung function with optimal medication5. Assist with developing a written action plan for management, and handling acute attacks and deterioration.6. Educate and review condition regularly via checkups

Respiratory System and Asthma

Written by Mystic on Sunday, July 24, 2011


Other names :
Wheezy bronchitis.

Introduction :
Asthma is a temporary narrowing of the tubes through which air flows into and out of the lungs.

Types :
Asthma may be spasmodic for no apparent reason (intrinsic), induced by exercise or other known trigger factors (extrinsic), or may be relatively silent and have few symptoms.

Cause :
Asthma is caused by a narrowing of the airways in the lung caused by a spasm in the tiny muscles which surround the air tubes. The problem is further aggravated by the excess production of phlegm in the lungs and swelling of the lung tissue through inflammation. The absolute cause of asthma is unknown, but certain triggers can start an attack in susceptible individuals. The triggers include colds and other viral infections, temperature changes, allergies, exercise, smoke, dust and other irritants. The tendency to develop asthma runs in families along with hay fever and some forms of eczema. If you have a parent with asthma, you have a 15 times greater chance of developing it than the average person.

Incidence :
One of the most common problems dealt with by general practitioners. It affects at least one in ten people in the population to some extent.

Prevention :
Avoiding known trigger factors (eg: foods, fumes, temperature changes), and taking preventative medication on a regular basis.

Investigations :
If asthma is suspected by a doctor, the first step is to perform tests on the lungs to assess their function. This involves blowing into a number of different machines which either draw a graph a doctor can interpret, or give a reading on a gauge. These tests are performed on several occasions at different times of the day before a definite diagnosis of asthma is made. The patient's response to medication is also checked on these machines.

Course :
The narrowing of the airways causes shortness of breath and wheezing. Asthmatics usually find they cannot breathe out easily because as they try to exhale, the lung collapses further, and the small amount of space left in the airways is obliterated. Asthmatic symptoms also include coughing, particularly in children, or a mild tightness and discomfort in the chest. Attacks may build up slowly over many weeks, and the individual may be unaware of the deterioration in his lung function until it is measured. In other cases severe attacks may develop in a matter of seconds after exposure to an irritant.

Treatment :
Asthma cannot be cured, but doctors can control the disease very effectively in the vast majority of patients. The treatment of asthma is a team effort involving the doctor, physiotherapists and other health professionals, as well as the vital cooperation of the patient and his/her parents and family. Many people who have asthma never see a doctor, even though they may be aware of the diagnosis. Although they may feel well, they often do not have their asthma under adequate control. Their quality of life and exercise tolerance could be improved dramatically if a doctor saw them regularly to keep their asthma under review. Once the diagnosis has been established, it is important to identify any trigger substances which might start an attack. This can often be done by the patient on a trial and error basis, but an allergist is usually called upon in severe cases to help in the identification of potential risk factors. The treatment of asthma is divided into two broad categories; prevention of attacks, and treatment of the acute attacks when they occur. Prevention is always better than cure, and all but the mildest of asthmatics should be using one or more of several different types of sprays, inhalers or tablets to prevent attacks (see Medication Table). If one form of prevention does not work, other types should be tried, or combinations used. The best way to treat an attack is by aerosol sprays which take the drug directly into the lungs where it is needed. These can be in the form of pressure pack sprays, inhalers, motor or gas driven nebulisers, or capsules which can be broken and their powder inhaled (see Medication Table). Mixtures and tablets are also available for the treatment of asthma attacks, but they work more slowly and have greater side effects.

Diet :
Any food that triggers attacks should obviously be avoided, but this varies from one patient to another, and there are no general dietary restrictions.

Complications :
Permanent lung damage can result from recurrent attacks of asthma.

Outcome :
Most patients can be adequately controlled, but rarely death from asthma can occur in severe cases. Research into asthma and its control is continuing apace, with the assistance of the Asthma Foundation and other research organisations, and new treatments and control methods are being marketed every year. Asthma is no longer the torture of years past, and the future is looking brighter all the time.

Further information:
The Asthma Foundation is one of the largest and best organised disease related charities in Australia, and can offer a wide range of assistance to patients and their families. Patients with severe asthma should consider wearing a bracelet or necklet with the engraved details of their condition. These are available from the Medic Alert Foundation.

Related conditions
Allergies, Eczema, Hay Fever

I have heard several times said that Ventolin sprays are dangerous, and people should use different things. I have used a Ventolin spray for my asthma for many years without trouble, but now I am worried. Should I stop my Ventolin?

Ventolin, and other similar sprays, were introduced more than twenty five years ago. Over that time they have helped millions of people around the world, and saved the lives of countless asthmatics. Today, these medications remain the principle form of treatment for acute asthma. The side effects are minimal and rare, and they are so safe that they can be purchased from a pharmacy without a prescription, but all asthmatics should have their asthma regularly monitored by a doctor to ensure they are receiving adequate treatment. Prevention is always better than cure, and those who have regular asthma attacks, should be using other medications all the time, in a dose that is sufficient to prevent their asthma. You should not stop your Ventolin, and provided your GP checks your lungs regularly, and you follow his/her advice on further treatment, you have nothing to fear.

I took my son to the doctor with a cough, and she said that he had asthma. I can't believe that this is true. Why would my son develop asthma at the age of 12?

Asthma can develop at any age, but the most common times are at about 2 years, 5 to 7 years of age and at puberty (12 to 14 years). Asthma may be triggered by infections (eg: common colds), allergies, exercise, temperature changes, emotional changes or hormonal changes (different times of the month in women). One of the most common presenting symptoms in children is a persistent dry cough. Once asthma is diagnosed, attacks may occur regularly, seasonally, or very rarely. If regular attacks occur, medication will be given to prevent them. If attacks are infrequent, medication can be used when required. It is very important to receive adequate treatment for asthma, to seek further help if the cough or wheeze continues, and to follow your doctor's instructions carefully. Poorly treated asthma can lead to growth retardation and other long-term problems.

Life Threatening Allergies

Written by Mystic on Friday, July 22, 2011

Introduction :
An allergy is excess sensitivity to a substance that produces a reaction in the body.

Types :
Hay fever, eczema, asthma, itchy eyes and hives may all be caused by an allergy.

Cause :
Allergies may occur on exposure to almost any type of chemical. Animal hair, dust, milk, eggs, pollen, fish, fruit, insect bites, moulds and parasites are just a few of the thousands of possible allergic substances. An allergen is a substance that causes an allergic reaction. When the body first encounters an allergen, the defence mechanisms of the body are triggered, but there is usually no detectable effect. On the second and subsequent occasions of exposure to the allergen, the defence mechanism over reacts, causing effects that may be merely a nuisance, or severe and life threatening, in different areas of the body. Pollens, dusts or chemicals may start the allergic reaction, causing the release of a substance (histamine) from special (mast) cells in the nose, skin, eyes etc. Histamine causes rapid swelling of the tissue, which may secretes copious amounts of watery fluid, and become intensely itchy.

Prevention :
Avoiding foods, chemicals, other substances and situations that are known to trigger the allergy. Antihistamines may be taken on a regular basis if avoidance is not possible.

Investigations :
Tests may be performed to determine whether or not you are allergic to a particular substance, but because there are so many possibilities, you must have some idea of what is causing the problem before the tests are commenced. The tests may take the form of skin pricks with a number of suspected substances, or blood tests that can detect the bodies reaction to an allergen.

Treatment :
The body gradually breaks down the histamine itself, and the reaction disappears, but this process can be speeded up by the use of anti-histamine drugs (see Medication Table) that are taken by mouth or injection to destroy the histamine that is causing the allergy reaction. In some cases, nasal or inhaled sprays (see Medication Table) can prevent the release of the histamine by the cells, and therefore prevent any allergic reaction, but these must be used all the time, as the problem will probably recur if they are ceased. If someone is found to be highly allergic to a specific substance, they can be desensitised so that they do not react as strongly, or sometimes do not react at all. This process is often long and involved, and unfortunately does not always work, but many people have had life threatening and disabling allergies cured or reduced by this procedure. Allergists, who are specially trained doctors, usually undertake allergy desensitisation. The patient has prepared an individualised mixture of the substance to which they are allergic. This mixture is extremely dilute, and the patient is gradually exposed to stronger and stronger concentrations until the body no longer responds to cause an allergic reaction. The desensitising mixture is usually given by a series of small injections at regular intervals over several months.

Diet :
Avoid any foods or drinks that are known to trigger an allergy reaction.

Complications :
Allergies in most people are annoying rather than serious, but in a small number of victims, they may be life threatening. Those who know of a life threatening allergy should always carry adrenaline with them, to be self-injected if they have an attack.

Outcome :
Allergies should not be severe enough to significantly alter your lifestyle if adequately treated by you and your doctor.

Further information:
Allergy Associations exist in several states. People with severe allergies should wear a bracelet or necklet carrying information about the allergy to warn doctors in an emergency. These are available through the Medic Alert Foundation.

Related conditions
Asthma, Conjunctivitis, Eczema, Hay fever.

Does Stress Cause Acne

Written by Mystic on Thursday, July 21, 2011

Other names:
Pimples, zits.

Introduction :
A skin disease causing disfiguring pimples, which usually occurs in teenagers.

Types :
Varies from the very occasional spot, to a severely disfiguring form known as acne vulgaris.

Cause :
Pimples are due to a blockage in the outflow of oil (known as sebum) from the thousands of tiny oil (sebaceous) glands in the skin. This blockage can in turn be caused by dirt (uncommon in our super-clean society), dead skin left behind during the normal regular regeneration of the skin surface, or a thickening and excess production of the oil itself. Once the opening of the oil duct becomes blocked, the gland becomes dilated with the thick oil, then inflamed, and eventually infected. The result is a white head, with the surrounding red area of infection. Eventually this bursts, sometimes leaving a scar. The hormonal changes associated with the transition from childhood to adult life is the major aggravating factor in acne. Hormonal variations later in life can also cause changes to the thickness of oil in the skin, and may worsen or improve acne. Pregnancy, menopause and the oral contraceptive pill may all influence pimples in this way. Stress in the patient, either psychological or disease, may cause pimples to worsen. A simple cold, or the onset of exams may see the number of spots increase dramatically. Pressure from spectacles on the bridge of the nose or tight collars, increases in skin humidity from a fringe of hair or nylon clothing, and excessive use of cosmetics that further block the oil duct openings, can all cause deterioration in a person's acne. If your father or mother had acne, you have a greater risk of developing them. Acne is not infectious.

Incidence :
Usually starts in early teenage years. Acne is generally more severe in teenage males, but starts earlier in females. It may strike later in life too, particularly in women. It affects Caucasians (whites) more than Negroes or Chinese races.

Prevention :
The risk of acne may be reduced by keeping the skin clean, but not by excessive washing or scrubbing.

Course :
Acne can vary from the annual spot, to rarely a severe disease that causes significant disfigurement. Usually settles by late teens, but may persist into mid twenties, and rarely may be lifelong.

Treatment :
Although a cure for acne is not normally possible, medical science can usually control the condition adequately. The steps to follow are :- Gently wash the face with a cloth and non-perfumed non-medicated soap twice a day. Use over the counter chemist preparations that work by drying out the oil in the skin, removing any excess skin flakes, and reducing inflammation. A variety of different prescription creams, lotions and pastes that prevent infection, dry up excess oil and reduce inflammation. Antibiotics (see Medication Table) prescribed by a general practitioner, either short or long term, are successful in controlling more severe acne. Some types of oral contraceptive pill (see Medication Table) and other hormones are very useful in controlling the condition, but only in women. In rare cases, the very potent Roaccutane tablets (see Medication Table) may be prescribed.

Diet :
There is no evidence that diet,stress, vitamins or other herbs have any effect on pimples. A small number of sufferers may find that one particular food causes a fresh crop of spots, but these people usually quickly realise this and avoid the offending substance. There is no truth in the old wives tale that acne is worsened by chocolate.

Complications :
Picking acne spots can cause serious secondary infections. Occasionally secondary infections can develop in acne to cause deeper skin infections that require immediate medical attention with antibiotics.

Outcome :
Usually settles with age and medication, but may cause both skin and psychological scarring.

Medical curiosity :
A century ago, doctors believed that constipation was a cause of acne.

I am 38 years old and my acne is worse than that of my teenage daughter. Why would I get it now?

Acne in adults is unfortunately, far harder to treat than in teenagers. It is due to the same causes though. In simple terms, a change in the hormone levels causes the oil in the glands just under the skin to become thicker, and this blocks up the ducts leading from the oil glands to the surface of the skin. The gland then becomes infected and a pimple develops. Because women have more hormonal problems than men, it is far more common for women to develop adult acne. Changing the hormone levels by using a contraceptive pill (or a different strength of one) often helps the problem. The antibiotics and skin lotions used by teenagers are also helpful.

I had a bad case of acne on my chin. I have been given Clindamycin cream to heal it. Can you tell me what this does to the pimple? Will my acne scars be permanent?

Pimples are infected oil glands in the skin. Clindamycin is an antibiotic that is designed to kill the bacteria that infect the pimples, and therby cure them. If you are finding it successful, then continue the treatment. If your pimples are still bad, you should see your doctor about using other preparations on the skin, and antibiotics or anti-acne drugs by mouth to keep the condition under control. Acne scars are often a deep red colour when the pimple initially subsides, but after a period of months or years, they gradually fade to a pale pink or dead white colour. These scars are unfortunately, permanent, as are scars on any other part of the body. Once you have grown out of your acne, and no further skin infections are occurring, you can see a dermatologist or plastic surgeon to have one of a number of procedures performed, to make the scars less obvious. Dermabrasion, in which the lumps and bumps on your face are reduced, is quite successful if the scarring is widespread.

Identifying Asthma

Written by Mystic on Friday, November 28, 2008

Q: How do I know if I might have asthma?

A: The small airways in your lungs both swell up and become smaller when an asthma attack strikes. This leads to increased mucus production and decreased flow of the air in the lungs. Wheezing, shortness of breath, and coughing result. In mild cases, these symptoms may be mild and infrequent. If your case is moderate or severe, they may come often.

You should ask your doctor whether you may have asthma if you cough after exercise or after exposure to cold winter air. If you commonly have a cough that persists for more than 2 weeks after a common cold, you may have a mild form of asthma. Likewise, you may have asthma if you wheeze or cough after exposure to dust, animal hair, cigarette smoke, or pollen.

If you experience shortness of breath unrelated to extreme exertion, you should contact your doctor. This requires prompt medical evaluation, because there are many serious causes for shortness of breath other than asthma.

Asthma may develop for the first time at any age, even in people in their 60s or 70s. At older ages, however, patients and their physicians must carefully consider the possibility of other explanations for cough, shortness of breath, or wheezing. These include cardiac disease, chronic lung diseases (such as emphysema), anemia, respiratory infection, and cancer.

This information, prepared by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, is not medical advice and should not replace consultation with your doctor. Staff at BIDMC provide Ask an Expert responses to consumers for educational purposes only. Always consult your own doctor about any opinions or recommendations with respect to your symptoms or medical condition.

Statistics and Risk Surrounding Breast Cancer

Written by Mystic on Thursday, November 27, 2008

Q: As each year passes, I seem to know more and more women with breast cancer. What is the chance that I will develop breast cancer myself?

A: Breast cancer is the most common cancer in US women and is greatly feared. However, many women overestimate their risk. One widely quoted statistic--"one in nine"--refers to the cumulative lifetime risk of breast cancer for a woman who lives past the age of 85. The risk of breast cancer for a woman in any given year or decade of her life is much lower than one in nine. The chance a woman will develop breast cancer in the next 10 years is one in 250 for a 30-year-old woman, one in 77 for a 40-year-old woman, one in 43 for a 50-year-old woman, and one in 38 for a 60-year-old woman. Some subgroups of women have higher than average risk. Factors that increase an individual woman's chance of developing breast cancer include older age, previous breast cancer, relatives with breast cancer (especially if mother, sister or daughter is affected, or if cancer was found before menopause), previous breast biopsies (especially if precancerous tissue was found), previous uterine or ovarian cancer, past radiation treatment to the chest, having a first pregnancy after 30, having no children, having an early first period (before age 12), having a late menopause (after age 55), postmenopausal obesity, and moderate alcohol intake. Current birth control pill use raises breast cancer risk slightly. Many (but not all) studies suggest that long-term (more than 5 years) hormone replacement may slightly increase breast cancer risk.