Ever Since I Had My Baby

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Ever Since I Had My Baby Page 26

by Roger Goldberg


  THE OTHER COMMON TYPES OF IRRITATION

  Not all that itches, burns, or irritates the vaginal area is yeast. A few other common conditions may also trigger a confusing array of symptoms in that region. Whenever vulvar itching, bleeding, discomfort, or burning becomes a bother, tell your doctor.

  Bacterial vaginosis. “BV,” or gardnerella, occurs when certain bacteria in the vagina multiply. It causes a thin gray discharge and is occasionally responsible for vaginal itching and burning. A fishy odor may increase after intercourse or after washing with certain alkaline soaps. It’s found in 12 to 25 percent of women visiting health clinics, and a recent study found that douching may increase the risk of developing BV. Treatment consists of a prescription medication, either an oral pill or vaginal gel, for five to seven days.

  Trichomonas. “Trich” (sounds like “trick”) is a sexually transmitted organism (actually a protozoan) that causes a yellow-gray odorous vaginal discharge and sometimes painful urination. It can be cured with a single dose of medication or a series of smaller doses over several days. Unlike yeast and BV, trichomonas can be transmitted sexually between partners, so all sexual partners should receive treatment to prevent reinfection.

  Diaper rash. Sometimes it’s not just an issue for the kids. Postreproductive women with any type of incontinence—stress, urge, or mixed—may find that when urine contacts the skin, it can leave the vulva looking red, raw, and angry. This type of chemical rash usually occurs in predictable areas: outside the urethra, across both labia, and often extending onto the groin and inner thighs.

  To treat diaper rash, separate the outer vaginal lips (labia) when urinating, and gently rinse with cold water afterward to keep urine away from the external skin. Avoid the constant use of deodorant pads to allow the skin to breathe and prevent chemical irritation. You can also try a barrier cream. These rather thick, opaque creams are useful for blocking contact between the skin and urine and are intended for use on the outer vulva and groin. Zinc oxide is the least expensive generic alternative. Other barrier ointments have been designed and marketed specifically for incontinence-related irritation (Carlesta, Desitin, Balmex).

  Cosmetic irritants. The vulvar skin can also become irritated by a long list of nice-smelling and beautifully packaged health and hygiene products. Eliminate the source of irritation and you’ll feel better.

  Choose toilet paper, pads, and panty liners that are unscented, colorless, and ideally, hypoallergenic. Avoid bubble baths, scented or colored soaps, perfumed or talcum powders and fabric softeners, and try not to lather up or shampoo while you’re soaking in the tub. Watch out for spermicidal foams, creams and jellies, and condoms or diaphragms made of rubber. Despite the many varieties of powders, perfumes, and feminine hygiene available in the pharmacy aisle, remember one basic rule when it comes to this part of your body: simple is best!

  Also keep in mind that wiping, scrubbing, or scratching will make a contact dermatitis worse. Let the shower stream gently rinse this part of your body; if you lather, do it softly. Pat the area with a towel or unscented tissue, and air-dry as much as possible.

  VULVODYNIA AND VESTIBULITIS

  These disorders with the strange names, also referred to as vulvar syndromes, are far less common than the basic inflammatory conditions, affecting only a very small percentage of women. But those of you who have been diagnosed with one of them can attest to the uncomfortable array of vaginal, pelvic, bladder, and sexual symptoms that they cause, and also to the profound effect they can have on a woman’s quality of life.

  Vulvodynia refers to pain localized around the vulva (outside of the vagina); vestibulitis refers to chronic irritation, tenderness, burning, and rawness around the inner labia, vaginal opening, and urethra. Because the bladder, rectum, pelvic floor, and sexual organs are all supplied by the same power grid of nerves, these vulvar problems can sometimes trigger confusing symptoms nearby.

  Some women notice that their vulvar condition flares after childbirth; others after an episode of cystitis, or after taking medication for a presumed yeast infection, or after starting a new hormone therapy. Some women’s problems will arise with certain foods or beverages, or using certain perfumes or detergents, or wearing certain fabrics. Although some of these vulvar syndromes run in families, it remains a mystery whether any true genetic links exist. Treatments range from modifications in diet and sexual habits to vaginal steroids, estrogen therapy, pain-blocking medications, and local anesthetic injections.

  Tip #2: Control and Prevent Bladder Infections

  Bladder infections are the pits. Almost any woman can vividly describe the signs: burning, strong-smelling or cloudy urine, and the overwhelming constant urge to urinate. Adult women of all ages are prone to cystitis, largely because of a short urethra allowing bacteria relatively easy access into the bladder. But why dwell on this condition in a book focused on your postreproductive body?

  Even if you’ve sworn by your ability to identify bladder infections in the past, it’s common to find that typical cystitis symptoms aren’t so typical anymore. Rather than the burning and bladder pain that tend to accompany bladder infections during your twenties and thirties, symptoms during the decades that follow—such as increased frequency of urination, worsening of incontinence, or just feeling crummy—may provide the tip-off that an episode of cystitis has begun.

  Also, certain features of your postreproductive body may increase your risk for cystitis. Prolapse, for instance, can make hygiene around the urethra more difficult to maintain. Cystoceles can result in an ever-present pool of urine in the bladder, another setup for cystitis. And urogenital atrophy—drying and thinning of tissues around the bladder, urethra, and vagina—introduces yet another risk for infection if you’re postmenopausal or have had your ovaries surgically removed.

  PREVENTION

  Most women experience bladder infections infrequently. With the help of their doctor, they’ll take a course of antibiotics until the infection clears, then forget about their bladder until a problem arises once again. But if infections become more frequent, then you should develop a preventive approach. With the help of a few basic tips, your risk of becoming infected in the first place can be dramatically reduced.

  Empty Regularly

  The simple act of emptying your bladder is an important defense against bladder infections. Staying well hydrated encourages a good flush of urine on a regular basis, leaving bacteria fewer opportunities to cling to the bladder wall and cause infection. Drinking three to four pints of liquid each day, and voiding around every three and a half hours, is a reasonable goal.

  Empty After Sex

  Intercourse is the single most important risk factor leading to bladder infections in women. Up to 75 percent of bladder infections in younger women can be traced back to the bedroom, with more vigorous sexual activity leading to higher infection risks. Sexual activity shifts bacteria (usually E. coli) from their normal location around the anal area to around the urethra and bladder, where they shouldn’t normally be found. Whether an infection will then develop depends, at least in part, on how long these bacteria are allowed to stick around. Urinating shortly after intercourse—a healthy flush, not just a dribble—should be your habit within fifteen to thirty minutes of intercourse. It’s one very simple way to reduce bacterial numbers before they have the opportunity to multiply.

  Keep Clean

  Clean sex. If recurrent infections are a problem, make a habit of showering before intercourse. Avoid irritation of the urethra by altering your positions. Keep well lubricated, and avoid using condoms that leave you feeling raw.

  Wipe right. Wiping the wrong way after urination—from back to front—shifts more bacteria from the anal area into direct contact with the urethra, and it may increase your odds of developing bladder infections. Always wipe from front to back after urination.

  Prolapse and pessaries. Even when they’re fitting right and working well, pessaries can cause a fairly heavy vaginal discharge, which can
make both vaginal and bladder infections more common. Careful hygiene, and periodic removal of the pessary at bedtime, will help to minimize this problem.

  Acidify the Urine

  Following a bladder diet—including cranberry, prune, and other juices discussed in chapter 8—is sometimes all that’s needed to keep the urine acidic and resistant to bacterial growth. If diet isn’t enough, oral supplements can help. Ascorbic acid, or vitamin C, is available in regular and buffered tablets and can help to acidify the urine alongside its other potential health benefits. Methenamine is another urine acidifier that, taken two or three times daily, can help to suppress the germs leading to bladder and kidney infections.

  TREATMENT

  Flush It Early

  Early bladder infections can sometimes be chased away without the help of antibiotics by simply rinsing the bladder clean of bacteria with a good flush. At the earliest sign of infection, try drinking two to three glasses of water at once, followed by a large glass over each of the next three hours. Don’t, however, reach for the cranberry juice. At this stage, you’re treating an infection, not preventing it, and the acid-rich cranberry juice may feel to your irritated bladder lining like salt being rubbed into a wound. It’s a good idea to call your doctor’s office and ask whether a test will be needed, even if your symptoms seem to improve.

  Bladder-Soothing Remedies

  A few tips can be useful for simply relieving your symptoms. Since they don’t actually cure the infection, always call your doctor so that definitive therapy can also be started without delay. Also, if you have a heart or other medical condition, check with your doctor before starting any of these therapies. Because some contain the basic salts of sodium and potassium, they’re not suitable for everyone.

  Baking soda. You already know how this household substance can whiten your teeth and freshen your fridge, but baking soda, or sodium bicarbonate, can also help to relieve bladder burning by reducing its acidity. Mix one teaspoon of baking soda into one of the glasses of water you’re using for the flush.

  Rolaids or TUMS. These can have an antacid effect in the bladder, just like baking soda, producing the same soothing effect.

  Potassium citrate. This is similar to sodium bicarbonate and sometimes better tolerated.

  Aspirins for the bladder. These tablets contain chemicals that soothe the symptoms of cystitis. Although they won’t cure the underlying infection, they’re often prescribed alongside antibiotics for symptom relief.

  Phenazopyridine hydrochloride (Pyridium). A urinary-tract pain reliever that reduces burning, pain, urgency, and frequency.

  Methenamine (Urised). A prescription medication that turns the urine bluish-green. In addition to its mild antibacterial effect, it can also have an antispasmodic soothing effect on an irritated bladder.

  Uristat. Available over the counter for the temporary relief of bladder symptoms. May be useful while you’re waiting to see the doctor or for antibiotics to take effect. Turns the urine reddish-orange.

  Flavoxate (Urispas). An antispasmodic, sometimes handy for symptom relief.

  Antibiotics

  If you develop a full-fledged bladder infection, you’ll probably need a course of antibiotics. Up to 80 percent of typical infections can be treated with a single dose, though a three-to-seven-day course is usually prescribed for assurance. Dozens of antibiotics are available for the treatment of cystitis, and your doctor will need to prescribe the drug of choice based on allergies, previous infections, and whether you’re pregnant or breast-feeding. Your pill will most often come from a short list of favorites.

  Trimethoprim-sulfamethoxazole (Bactrim, Septra). This sulfa drug is available in generic form and is very effective for most bladder infections.

  Nitrofurantoin (Macrodantin, Macrobid). As effective as tri-methoprim but a bit more expensive. Macrobid is a microcrystalline form, more expensive but less likely to cause nausea.

  Quinolones (Ciprofloxacin, Norfloxacin, Ofloxacin, Floxin). Very effective but expensive and often reserved for more stubborn or complicated infections. Should not be used by breastfeeding women.

  Penicillin and cephalosporins. Penicillin and cephalosporins are often chosen during pregnancy because of their long safety record.

  RECURRENT BLADDER INFECTIONS AND PROPHYLACTIC ANTIBIOTIC THERAPY

  Recurrent cystitis is defined by more than three infections during a single year and affects around 15 percent of women at some point in their lives, sometimes despite all of the preventive efforts. This condition can present not only a pattern of very frustrating symptoms but also a risk of kidney damage if left untreated over time. Your doctor may recommend the prophylactic use of antibiotics to prevent recurrent infections from keeping you down.

  This strategy involves keeping a supply of mild oral antibiotic pills at home and taking them before bladder infections occur. Since only low levels of bacteria (rather than a full-blown infection) are being treated, small pediatric doses are usually enough. Prophylactic antibiotics can be taken via either the coital method or the daily method.

  The coital method involves taking a mild antibiotic right before or after intercourse. The idea is to mop up bacteria from the bladder when they’re in greatest number. This method works well if your bladder infections occur predictably after intercourse.

  The daily method entails routinely taking a baby dose of antibiotics each and every day. The daily method is preferred over the coital method if your infections occur unpredictably, unrelated to sexual activity. After six to twelve months of therapy, your doctor will usually decide whether to keep you on the preventive pills for a longer span of time. Some women stay on a daily antibiotic for many years.

  HERBS THAT MAY PREVENT INFECTIONS

  Cranberry extract. As mentioned, a safe and simple way to achieve cranberry-juice protection, without all the fluids and calories.

  Grapefruit-seed extract. Another substance with possible antibacterial effects in the vagina and urinary tract, though one study indicated that chemical preservatives within the extract—rather than the grapefruit itself—might account for this effect.

  Golden seal. A popular herb, claimed to be one of nature’s antibiotics.

  Echinacea. Available in costly drinks and supplements stacked at arm’s reach in the supermarket checkout aisles, echinacea has been claimed to help prevent respiratory infections and urinary tract infections. Despite the fact that it’s perceived as mild and harmless, there is little in the way of science to prove that it works.

  Others. You’ll find a number of herbs mentioned for the relief of bladder and pelvic symptoms. Be careful—not all herbs are alike. Comfrey, for instance, is mentioned as a bladder tonic, but it has been linked to serious liver damage and should not be used. Other herbal remedies may be perfectly harmless and worth a try. Always check with your doctor first.

  KNOW THE LIMITS OF SELF-TREATMENT

  Home remedies can often work beautifully. But they should never be substituted for a prescribed medication without your doctor’s permission. If you suspect that you have frequent bladder infections, remember that there are other conditions—such as bladder stones, tumors, diverticula (small outpouched areas of the urethra or bladder), and inflammation—that can feel just like typical episodes of cystitis. Some of these conditions can become serious if they’re overlooked, especially if you’re pregnant or have diabetes. Rather than relying on your own assumptions, see the doctor so you can both be sure.

  KNOW WHEN NOT TO SELF-TREAT

  Remember, not all antibiotics are safe for pregnancy, breast-feeding, and certain medical conditions. Never take antibiotics without consulting your doctor first. Always notify the doctor when you suspect cystitis that:

  Occurs during pregnancy.

  Is accompanied by a fever or pain in your back or side.

  Isn’t improving with treatment.

  Keeps coming back. Overusing antibiotics can lead not only to vaginal yeast infections but to serious problems with bacterial resist
ance (specific bacterial types that no longer go away with antibiotics) over the long run.

  Tip #3: Evaluate Your Health and Lifestyle

  A number of activities and ailments, conditions and habits, that may at first seem far removed from your lower body can have a definite impact on incontinence and other common postreproductive problems. Before you march onward to the realm of pills, devices, and perhaps even surgery, consider these other factors that might be playing a role.

  WORK AND EXERCISE

  Physical fitness is central to the way virtually every part of your body feels and functions, and these areas of your postreproductive body are no exception. Will certain activities strain your pelvic supports and make incontinence or prolapse more likely to develop over time? If you’re dealing with incontinence, prolapse, or other postreproductive symptoms, what’s the right activity for you? Will high-impact aerobics cause stress incontinence to progress from mild to severe? Should you stop jogging to prevent your small cystocele or mild uterine prolapse from getting worse? Unfortunately, there’s little science to guide our recommendations. One study comparing high-impact and low-impact Olympic athletes found that the degree of physical impact had no obvious influence on the risk of developing stress incontinence. The effects of more moderate recreational stress, such as jogging, aerobics, muscle training, karate, horseback riding, or weight lifting, remain unknown. In the absence of conclusive research, consider a few commonsense tips.

 

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