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Diarrhoea

Diarrhoea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal. When the intestines push stools through the bowel before the water in the stool can be reabsorbed, diarrhea occurs. It can also occur when inflammation of the bowel lining causes excess fluid to leak into the stool. Abdominal cramps, nausea, vomiting, or a fever may occur along with the diarrhoea.

Diarrhoea is one of the most commonly occurring health problems affecting all ages. Most adults will have 4 episodes of diarrhea each year. Diarrhea that comes on suddenly may last up to 14 days.

 

Diarrhoea has many causes.

  • Diarrhoea is often caused by stomach flu (gastroenteritis) or food poisoning. Diarrhea is your body's way of quickly clearing viruses, bacteria, or toxins from the digestive tract. Since most cases of diarrhea are viral, they will clear up in a few days with good home treatment. E. coli is a common bacteria that causes diarrhea. E. coli infection is related to improper food preparation.

  • Drinking untreated water or unpasteurized dairy products can cause viral, bacterial, or parasitic infections, such as Giardia lamblia. Giardia lamblia parasite can cause diarrhea that develops 1 to 4 weeks later. These infections can also occur when you use untreated water to brush your teeth, wash your dishes or vegetables, or make ice for drinks.

  • Many prescription and nonprescription medicines can cause diarrhea.

    • Antibiotics may cause mild diarrhea that usually clears up without treatment. A more serious type of diarrhea caused by the bacteria Clostridium difficile (sometimes called C-diff) may occur while taking an antibiotic or shortly after finishing the antibiotic.

    • Laxatives, such as Correctol, Dulcolax, Ex-Lax, or Feen-a-Mint, may cause diarrhea.

  • Using too much of products that contain sorbitol (such as chewing gum) or fructose can cause diarrhea.

  • Some people get diarrhea while traveling (traveler's diarrhea).

  • For some people, emotional stress, irritable bowel syndrome, anxiety, or food digestion problems (such as lactose intolerance) cause diarrhea.

  • Repeated episodes of diarrhea may be caused by inflammatory bowel disease.

  • Diarrhea may also be caused by malabsorption problems and certain types of cancer.

  • Diarrhea may develop after stomach, bowel, or gallbladder surgery, or after bariatric surgery for obesity.

Many times the exact cause of diarrhoea is difficult to determine. Almost everyone has an occasional bout of diarrhea. Although diarrhea is annoying, most cases are not serious and will clear up with home treatment.

Review the Emergencies and Check Your Symptoms sections to determine if and when you should see your doctor.

High Blood Pressure (Hypertension)

Illustration of the cardiovascular system

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.

Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80."

  • The systolic number shows how hard the blood pushes when the heart is pumping.

  • The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.

Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.

What causes high blood pressure?

In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.

Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.

Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.

Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. Malignant high blood pressure (hypertensive crisis), which is blood pressure that rises very fast, can also cause these symptoms. Malignant high blood pressure is a medical emergency.

How is high blood pressure diagnosed?

Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.

How is it treated?

Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.

You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.

  • If you have prehypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.

  • If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.

  • If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.

Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.

It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don't take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.

What can you do to prevent high blood pressure?

There are six lifestyle changes you can make to help prevent high blood pressure:

  • Lose extra weight.

  • Eat less salt.

  • Exercise.

  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women and lighter-weight men.

  • Get 3,500 mg of potassium in your diet every day. Fresh, unprocessed whole foods have the most potassium. These foods include meat, fish, nonfat and low-fat dairy products, and many fruits and vegetables.

  • Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.

HEADACHE OR MIGRAN
 
five-headaches-profile-illu
The type of pain you are experiencingdetermines the treatment you need. (ISTOCKPHOTO/HEALTH)

It's critical to identify which type of headache you suffer from—tension, cluster, sinus, rebound, or migraine—so that the correct treatment can be prescribed. In one 2004 study, 80% of patients with a recent history of self-described or doctor-diagnosed sinus headache—but none of the signs of sinus infection—actually met the criteria for migraine. And two-thirds of those patients expressed dissatisfaction with the medications they were using to treat their headaches. Here's a cheat sheet to help you put a name to your pain.


Tension headaches
Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they are not usually accompanied by nausea and vomiting, and they rarely stop someone from continuing their regular activities. Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat tension headaches, which experts believe may be caused by contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals.

Cluster headaches
Cluster headaches, which affect men more often than women, are recurring headaches that occur in groups or cycles. The headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face. During an attack, sufferers are often restless and unable to get comfortable and not likely to lay down the way someone with a migraine usually does. The cause of cluster headaches is unknown, but they may have some genetic component. There is no cure, but medications can reduce the frequency and duration of attacks.

Sinus headaches
When a sinus becomes inflamed, usually through an infection, it can cause pain. It usually comes with a fever, and can—if necessary—be diagnosed by MRI or CT scan (which can both detect changes in fluid levels), or by the presence of pus viewed through a fiber-optic scope. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound headaches
Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.

"Most of the patients we see in a headache center with daily headache have medication-overuse, or rebound, headaches," says Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.

"They are on a merry-go-round and they can't get off," says Dr. Tepper. "They keep taking more medicine, they keep having more headaches, and so the patient becomes more and more desperate. That's when they end up coming to headache specialists to kind of reset the whole system."

One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that the headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.

Migraine headaches
Migraine headaches come from a neurological disorder that can run in families and are defined by certain criteria.

  • At least five previous episodes of headaches

  • Lasting between four hours and 72 hours

  • Having at least two out of four of these features: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity

  • Having at least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound

An oncoming migraine attack may, for some, be foreshadowed by an aura, which can include visual distortions (such as wavy lines or blind spots) or numbness of a hand. It's estimated, though, that only 15% to 20% of migraineurs experience this. 

What's Happening During a Migraine:-
Why do some people suffer from the agonizing head pain of
migraines—and the nausea and sensitivity to light that can accompany them—while others don't? The answer, at the biochemical level, is complicated, but probably boils down to this: Migraine sufferers' brains are simply more sensitive to outside stimuli than are other people's brains.

Migraines used to be blamed on blood vessels in the brain dilating, or opening up. The newer thinking is that the expansion of blood vessels is the result of some other event, not the cause. The cause may in part be the excitation of a nerve responsible for sensation in the face.

"It's called the trigeminal nerve," explains Larry Newman, MD, director of the Headache Institute at St. Luke's-Roosevelt Hospital Center in New York City.

When the trigeminal nerve is stimulated, it causes the release of a variety of neurotransmitters (among them serotonin, which is also associated with mood change). These in turn cause the blood vessels that surround the brain to expand and inflame.

 

"Those blood vessels are attached to nerve fibers which transmit the pulsations from the blood vessels back into the brain, where you then perceive it as pain," says Dr. Newman.

"This is a system that we all have," says Michael Cutrer, MD, a neurologist at the Mayo Clinic in Rochester, Minn. "But in people who have migraine, it is a system vulnerable to being repeatedly activated when there's no good reason. Like a car alarm going off too often, instead of being a protective mechanism like it was built to be, it becomes a system that begins to interfere with your ability to function normally in your life."

Although some people experience a pre-attack
aura, a typical migraine occurs in two steps.

  • The trigeminal nerve is activated
    When the trigeminal nerve gets excited the most common first symptom is pain around the eye and temple. If that pain is treated quickly with migraine medications like triptans, inflammation can be reduced, and a sufferer can shut down the migraine relatively quickly. (Triptans act as an extra supply of serotonin to help narrow the blood vessels and block the transmission of pain to the nerves).

  • The central nervous system is triggered
    Left untreated another mechanism will trigger in the central nervous system itself. At this point that pain mechanism becomes very difficult to turn off. Medications at this stage are less likely to work. It's as if the pain has become independent of the original source at the trigeminal nerve.

A recipe for prolonged suffering
"Once it goes beyond a certain point, cutting off the source is no longer sufficient because the pain of the headache reverberates in the central nervous system," says Dr. Cutrer. "A different set of neurons has now become irritable and activated—and getting them back to normalcy is not easy. They can continue to be reactivated and reactivated and the headache becomes harder to treat."

That's the dreaded migraine phase that can go on for hours or days.

At that point, everything in your head can hurt: you can't wear earrings, you have to take off your glasses, you don't want to lie that side of your head on the pillow. Yes, even your hair hurts.

Because of the importance of catching migraines in the early phase, doctors advise patients to monitor
triggers and symptoms to prevent excitation of the trigeminal nerve and, if that fails, to get the jump on treatment to calm it down. Triggers missed and medication delayed are a recipe for prolonged suffering. 

Skin Cancer, Nonmelanoma

Is this topic for you?

This topic is about nonmelanoma skin cancer, including basal cell cancer and squamous cell cancer. For information about melanoma skin cancer, see the topic Skin Cancer, Melanoma.

What is nonmelanoma skin cancer?

Skin cancer is the abnormal growth of cells in the skin. It is the most common type of cancer. It is almost always cured when it is found early and treated. So it is important to see your doctor if you have changes in your skin.

Most skin cancers are the nonmelanoma type. There are two main types of nonmelanoma skin cancer:

  • Basal cell carcinomaClick here to see an illustration.. Most nonmelanoma cancers are this type. It can damage deeper tissues, such as muscles and bones. It almost never spreads to other parts of the body.

  • Squamous cell carcinomaClick here to see an illustration.. This type is less common. It often starts in skin that has been injured or diseased. It sometimes spreads to other parts of the body.

What causes it?

Nonmelanoma skin cancer is usually caused by too much sun. Using tanning beds or sunlamps too much can also cause it.

How is nonmelanoma skin cancer diagnosed?

Skin cancer usually appears as a growth that changes in color, shape, or size. This can be a sore that does not heal or a change in a wart or a mole. These changes usually happen in areas that get the most sun—your head, neck, back, chest, or shoulders. The most common place for skin cancer is your nose.

Your doctor will use a biopsy to find out if you have skin cancer. This means taking a sample of the growth and sending it to a lab to see if it contains cancer cells.

What increases my risk for nonmelanoma skin cancer?

If you have light skin that sunburns easily, you are more likely to get skin cancer.

Your risk is higher if you are male or if you are over 40. Your risk is higher if others in your family have had it or if you have had it before.

You may also be more likely to get it if you have been exposed often to strong X-rays, to certain chemicals (such as arsenic, coal tar, and creosote), or to radioactive substances (such as radium).

How is it treated?

Your doctor will want to remove all of the cancer. There are several ways to do this. The most common way is to numb your skin so that it does not hurt, then cut out the cancer. You will be awake while this is done.

This surgery almost always cures nonmelanoma skin cancer.

After your treatment, you will need regular checkups, because having skin cancer once means you are more likely to get it again.

Can nonmelanoma skin cancer be prevented?

You can prevent it by being careful in the sun. Stay out of the sun at midday, when the sun’s rays are strongest. Wear sunscreen or other sun protection. Do not use tanning booths or sunlamps.

Frequently Asked Questions

 

Learning about skin cancer:

Being diagnosed:

Getting treatment:

Living with skin cancer:

 

 

                       
                       Acne Vulgaris

 

Illustration of the skin in cross-section

What is acne vulgaris?

Acne vulgaris, or acne, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or, it can be bigger, solid, red lumps that are painful (cysts).

Most young people get at least mild acne. It usually gets better after the teen years. But many adult women do have acne in the days before their menstrual periods.

How you feel about your acne may not be related to how bad it is. Some people with severe acne are not bothered by it. Others are embarrassed or upset even though they have only a few pimples.

The good news is that there are many good treatments that can help you get acne under control.

What causes acne?

Acne starts when oil and dead skin cells clog the skin's pores. If germs get into the pores, the result can be swelling, redness, and pus. See a picture of how pimples formClick here to see an illustration..

For most people, acne starts during the teen years. This is because hormone changes make the skin more oily after puberty starts.

You do not get acne from eating chocolate or greasy foods. But you can make it worse by using oily skin products that clog your pores.

Acne can run in families. If one of your parents had severe acne, you are more likely to have it.

What are the symptoms?

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.

How is acne treated?

To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.

If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says.

It can take time to get acne under control. Keep using the same treatment for 6 to 8 weeks. You may even notice that it gets worse before it gets better. If your skin is not better after 8 weeks, try another product.

If your pimples are really bothering you or are scarring your skin, see your doctor. A prescription gel or cream for your skin may be all you need. Your doctor may also order antibiotic pills. A mix of treatments may work best. If you are female, taking certain birth control pills may help.

If you have acne cysts, talk to your doctor about stronger medicine. Isotretinoin (such as Accutane) works very well, but it can cause birth defects. And using Accutane may be associated with depression. Let your doctor know if you have had depression before taking this medicine. And if you are female, you must protect against pregnancy by using two forms of birth control. Even one dose of this medicine can cause birth defects if a woman takes it while she is pregnant. You cannot take isotretinoin if you are breast-feeding.

What can be done about acne scars?

There are skin treatments that can help acne scars look better and feel smoother. Ask your doctor about them. The best treatment for you depends on how severe the scarring is. You can have scar tissue removed or have a shot of collagen. Collagen smoothes a pitted scar by plumping up the skin underneath. You may get the best results with a combination of treatments.

Frequently Asked Questions

 

Learning about acne:

Being diagnosed:

Getting treatment:

Living with acne:

 

Vaginal Yeast Infections

 

 


Is this topic for you?

Other problems (like bacterial vaginosis and trichomoniasis) can cause vaginal symptoms that may seem like a yeast infection. If you need help determining which problem you have, see the Check Your Symptoms section of the topic Vaginal Problems.

What is a vaginal yeast infection?

A vaginal yeast infection means that too many yeast cells are growing in the vaginaClick here to see an illustration.. These infections are very common. Although they can bother you a lot, they are not usually serious. And treatment is simple.

What causes a vaginal yeast infection?

Most yeast infections are caused by a type of yeast called Candida albicans.

A healthy vagina has many bacteria and a small number of yeast cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms—like the yeast—under control.

When something happens to change the balance of these organisms, yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes this imbalance. The high estrogen levels caused by pregnancy or hormone replacement therapy can also cause it. So can certain health problems, like diabetes or HIV infection.

What are the symptoms?

A yeast infection causes itching or soreness in the vagina and sometimes causes pain or burning when you urinate or have sex. Some women also have a white discharge that looks a little like cottage cheese and has no odor.

These symptoms are more likely to occur during the week before your menstrual period.

How is a vaginal yeast infection diagnosed?

It’s easy to guess wrong about a vaginal infection. See your doctor if you aren't sure what you have or if this is the first time you have had these symptoms. Also see your doctor if you are pregnant. Your doctor may want to do a vaginal exam.

How is it treated?

If you have had a yeast infection before and can recognize the symptoms, and you aren't pregnant, you can treat yourself at home with medicines you can buy without a prescription. You can use an antifungal cream or suppository that you put into your vagina or antifungal tablets that you swallow.

If your symptoms are mild, you may want to wait to see if they clear up on their own.

Yeast infections are common during pregnancy. If you are pregnant, don't use medicine for a yeast infection without talking to your doctor first.

If you use a cream or suppository to treat the infection, don't depend on a condom or diaphragm for birth control. The oil in some medicines weakens latex, the material often used to make these devices.

Many women have infections that come back. If you have more than four yeast infections in a year, see your doctor. He or she may do a test to make sure that your symptoms are being caused by a yeast infection and not some other problem, such as diabetes.

Can vaginal yeast infections be prevented?

You can prevent yeast infections by making sure that your genital area stays as dry as possible and can “breathe.” For example:

  • Wear cotton, not nylon, underwear, and avoid tight-fitting pants and panty hose.

  • Change out of a wet swimsuit right away.

  • Avoid douches and feminine sprays, scented toilet paper, and deodorant tampons.

Frequently Asked Questions

Learning about vaginal yeast infections:

Being diagnosed:

Getting treatment:

Ongoing concerns:

 

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