Causes of Unusual Periods

There are a number of possible reasons for sudden and unexplained periods. Most of the time bleeding is not due to periods but is instead termed intermenstrual bleeding. There are cases where some women have their periods more often but this is marked by a shorter menstrual cycle and does not come about suddenly and unexpectedly. Some of the more common causes of sudden and unexplained periods for particular age groups includes :

• Trauma to the vagina or cervix may arise after sexual activity, even a day or two afterwards. It is important to exclude pregnancy as a possible cause as well.
• Implantation bleed also occurs after sexual activity and is a consequence of pregnancy. It can occur anywhere between 6 to 12 days after fertilization.
• Miscarriage or spontaneous abortion where the pregnancy ends due to the death of the fetus. A threatened abortion may also present with bleeding but with proper treatment the pregnancy may still be viable.
• Sexually transmitted infections (STIs) including gonorrhea, syphilis and chlamydia.

The common causes mentioned above are mainly related to pregnancy. In some cases women are not aware of the pregnancy and only discover it when there is abnormal vaginal bleeding. Other causes of sudden or unexpected vaginal bleeding includes :

• Ectopic pregnancy is where the fertilized egg is growing within fallopian tube and not in the uterus. The pregnancy is not viable and emergency medical attention is needed to prevent harm to the mother.
• Intra-uterine device (IUD) may cause occasional spotting.
• Stopping birth control pills.
• Using emergency contraceptives like the “morning after” pill.
• Blood thinners (anticoagulants)
• Psychological stress which can upset the menstrual cycle.
• Abnormal hormonal changes due to medication, illness or any other factor.
• Perimenopause – the stage before menopause marked by irregular menstruation and heavy periods.
• Polyps in the uterus
• Uterine fibroids
• Genital warts
• Cancer of the cervix, uterus or fallopian tube.

Warning Signs

 There are certain instances when sudden and unexplained periods are a sign of a serious and dangerous condition. Immediate medical attention is required in these cases. There are certain warning signs that may also be present which should warrant the need for a trip to the emergency room. This includes :

• Intolerable abdominal and pelvic pain
• Dizziness
• Fainting spells
• Paleness of the skin
• Bluish discoloration of the skin, especially the lips
• Cold and clammy skin
• Profuse vaginal bleeding that cannot be held back even with several sanitary pads.

Normal Female Cycle Terms

There are two major events in the menstrual cycle – ovulation and menstruation.

• Ovulation is the release of an egg cell from the ovaries. It travels down the fallopian tubes and into the uterus. If the egg cell is fertilized by a sperm cell, conception has occurred and a woman is therefore pregnant.
• Menstruation is the discharge of the inner lining of the uterus (endometrium) and unfertilized egg cell a short period after ovulation. Should conception occur, menstruation will cease thereafter until after childbirth. Menstruation is commonly known as the period.
• Menses is the bloody discharge of endometrial remnants and the egg cell during menstruation. It lasts for between 3 to 7 days in most women. It is also known as menstrual bleeding or sometimes referred to as period blood.
• Menarche is the onset of menstruation, or the first period, that signifies puberty in females. From then on a woman is said to be in her fertile or reproductive years although ovulation may not consistently occur in the very early years or with some gynecological problems.

Female Cycle Problems

There are several problems with the menstrual cycle that are identified by specific medical terms.

• Amenorrhea is the absence of menstruation. It is classified as primary amenorrhea if the periods have never started (menarche not reached) by the age of 16years or if a female is showing signs of other sexual characteristics associated with puberty like enlargement of the breasts.
• Anovulation is the term for a menstrual cycle without the release of an egg cell. Menstruation may still occur within this cycle and it is therefore known as an anovulatory cycle.
• Oligomenorrhea is where the menstrual blood (menses) is abnormally light – scanty menses or light period. The term can also be used to describe infrequent menstruation – missed periods. If three or more periods are missed in a row then it is referred to as amenorrhea.
• Menorrhagia is the term for heavy periods where the menstrual blood (menses) is of a larger quantity or there is heavier flow than is considered to be the norm.
• Metrorrhagia is abnormal bleeding in the menstrual cycle also known as intermenstrual bleeding. It arises at a time when menstruation should not be occurring. It can vary from light spotting to bleeding similar to menstruation. Many women are unable to differentiate between the intermenstrual bleed and menstruation and therefore refer to it as periods that are more frequent than normal. However, too frequent menstruation is more correctly known as polymenorrhea.
• Polymenorrhea is very frequent menstruation indicating an abnormally short menstrual cycle. Most women have about 12 to 14 periods a year but with polymenorrhea, the number of periods in a year is substantially more.

The term ‘sensitive breasts‘ is rather subjective – it can be used to refer to discomfort, soreness or pain. In most cases it refers to breast tenderness which is soreness or pain that is felt when firm pressure is applied to the breasts. Although the breasts, and more specifically the nipples, are among the most sensitive parts of the body, breast sensitivity is not an uncommon occurrence. Women frequently experience sensitive breasts just before and during the periods and when pregnant. It is not a cause for concern in these instances and is only a temporary symptom. However, sensitive breasts may sometimes persist and worsen over time which can be a sign of some underlying disease.

Causes of Sensitive Breasts

Sensitivity of the breast that comes and goes, particularly in relation to the menstrual cycle, is normal. It is usually not severe and appears to be related to the fluctuations of the female hormones. This type of recurring pain is known as cyclic breast pain. Another causes of pain caused by hormonal changes is seen in pregnancy. Breast sensitivity with the menstrual cycle and pregnancy is physiological meaning that it is not related to any disease. Other causes of breast pain which often do not follow this cyclic pattern and is related to diseases is known as pathological breast pain or tenderness.

• Breast injury as a result of trauma, excessively tight brassieres and rough handling.
• Breast infection known as mastitis which is mainly seen in breastfeeding women.
• Very large breasts especially when there is poor support with an appropriate brassiere.
• Fibrocystic breast disease where the sensitivity may also be cyclical to some extent.
• Breast cysts which are small collections of fluid in the breast.
• Breast abscess which is a collection of pus in the breast tissue.
• Hormonal medication such as oral contraceptives and hormone replacement therapy (HRT).
• Other drugs such as antidepressants are also known to sometimes cause breast tenderness.

These are the main causes of breast sensitivity. Another possible cause is breast cancer. However, most cases of sensitive breasts is due to one or more of the causes above and not breast cancer, which is a common concern of most women.

Warning Signs

Breast pain on its own is a warning sign of inflammation related to some disease or the other. Sensitive breasts on its own should be investigated by the presence of one or more of the following signs and symptoms signals the need for immediate medical attention.

• Dimpling of the breast
• Skin rash on the breast
• Itchy breasts
• Nipple discharge
• Redness of the breast
• Tender lumps on the breast surface or within the breast tissue
• Nipple deformity

The breasts sit on the chest wall and therefore an injury or disease of the surrounding tissue can also be associated with sensitive breasts. Muscle problems, specifically that of the pectoral muscles, and diseases of the skin over the breasts may therefore present as sensitive breasts. However, it is not the breast tissue itself that is diseased in these cases.

Any women with sensitive breasts who is noticing that the soreness or pain is worsening and has one or more of the symptoms mentioned above should consider these symptoms to be indicative of an underlying problem. It should be reported immediately to a medical professional so that the appropriate investigations can be undertaken as soon as possible.

The size the female breast is mainly due to the fat content within the breast and the milk-producing glands. Genetic factors, age, having children or not and overall body fat content are the main factors that impact on the breast size. These factors cause permanent changes in breast size over  months and years. Sometimes the breast size may fluctuate over a short period of time, like days or weeks, and this can occur for a number of reasons. Although many young girls and women do become quite concerned about these sudden changes in breast size, in most instance it is not a cause for concern.

Causes of Breast Size Change

Hormonal

Hormonal factors are the single most important cause of changes in a woman’s breast size over a short period of time. It can occur with or during  :

• Menstrual cycle
• Puberty
• Pregnancy
• Use of oral contraceptives or hormone replacement therapy
• Menopause
• Gynecological diseases such as polycystic ovarian disease (PCOS)

The female hormones causes enlargement of the milk-producing tissue in the breast and may also contribute to breast swelling by the way of temporary fluid accumulation. Hormones can also increase the fat content within the breast over the long term.

Injury

Trauma to the breast causes inflammation. This increases the permeability of the blood vessels in the breast and fluid leaks out into the tissue spaces. It may be caused by :

• Blow to the breast
• Rough handling
• Tight brassieres
• Surgery to the breast

Inflammation is a temporary process and the swelling is accompanied by pain, redness and heat over the skin. It is typically acute and resolves over a short period of time. Anti-inflammatory drugs are often effective in reducing most of the symptoms of inflammation. Usually only one breast is affected.

Breast Disease

Various breast diseases can present with changes in breast size either through inflammation, loss or gain of fat tissue in the breast, the formation of growths and the accumulation of pus. This can affect one or both breasts. These breast diseases include :

• Fibrocystic breast disease
• Benign breast tumors
• Breast cancer
• Mastitis (breast infection)
• Breast abscess
• Breast cyst
• Galactorrhea

A key feature that needs to be noted is whether the change is in the entire breast or localized to certain parts of the breast.

Is breast size changes a serious problem?

Any change in the breast size or shape has to first be investigated medically before it can be determined whether it is a physiological alteration or due to some pathology (disease). The presence of other symptoms like pain or tenderness, redness, heat, lumps, nipple discharge, changes in nipple appearance and bleeding from the breast are usually indicative of some underlying disease of the breast. However, changes in breast size without other symptoms may not mean it is not due to any disease – it is possible that it is just the first symptom and other symptoms will arise at a later stage. It should be noted though, that the breast size can change with hormonal factors that are in many cases just a normal part of life. Therefore the alteration in breast size may be innocuous and is not a symptoms of any breast disease.

]]> http://www.phaa.com/changes-in-breast-size-different-reasons-and-causes.htm/feed 0 http://www.phaa.com/breast-rash-skin-problems-causes-and-treatment.htm http://www.phaa.com/breast-rash-skin-problems-causes-and-treatment.htm#comments Tue, 14 Feb 2012 13:01:05 +0000 Dr. Chris http://www.phaa.com/?p=799 The breasts in women are prone skin disorders that may cause rashes due to its larger size, temporary structural changes with hormonal influences and daily exposure to irritation from undergarments and clothing. A skin rash is essentially any abnormality of the skin and typically presents with redness, dry, scaling and itchy skin. Sometimes itchy breasts may occur on its own with no rash and this has to be considered separately. Breast rashes may be broadly classified as a rash under the breast and rash on top of the breast near the nipple, or above the breast. The differences in location can be due to specific causes.

Causes of Breast Skin Rash

As with most skin disorders, excessive dryness of the skin is a common cause that is often mistaken for a skin disease. Dryness of the skin is known as xerosis and is largely due to harsh soaps, dry climates and age-related skin changes. It can lead to itching and scaling of the skin and increases the chances of skin infections with repeated scratching. Other causes of a breast rash includes skin diseases that can occur on any part of the body such as :

• Atopic dermatitis which is commonly known as eczema and tends to arise due to allergic factors particularly in a person with a history of allergies from childhood. It may arise or worsen with pregnancy.
• Contact dermatitis is an irritation and inflammation of the skin from exposure to certain substances such as creams, lotions, soaps, some types of fabrics in undergarments and clothing making contact with the breast and even detergents used to wash clothing.
• Submammary candidiasis is a breast fungus that invades the outer layer of the skin. It caused by the Candida species of yeasts and often arises under the breasts within the skin folds that are continuous with the chest. Usually it starts with chaffing of the skin under the breast (intertrigo) which commonly arises with wearing tight fitting bras particularly in women with large breasts.
• Hives (urticaria) is an immune reaction causing patches or lines of raised red skin (weals) that is intensely itchy. It may cause marked swelling of the affected area known as angioedema. The exact cause is unknown but appears to be linked with allergies.
• Breast abscess which is a collection of pus within the breast tissue causing the outer skin to appear raised, red and warm to touch. It is usually painful but even in the absence of pain there is tenderness when pressing over the abscess.
• Mastitis is an infection of the breast tissue more commonly seen in breastfeeding women. The breast appears swollen, red, hot to the touch and painful and the swelling is more generalized than the localized ‘bump’ with an abscess.

Various other diseases of the breast can cause a skin rash which may be oozing and even cause deformities of the breast and nipple. The most notable of these is breast cancer, mammary duct ectasia and Paget’s disease of the breast. Other skin conditions such as seborrheic dermatitis and psoriasis may also affect the breasts but are usually seen elsewhere on the body as well.

Treatment of Breast Rash

Treatment of a breast rash is dependent on the type of rash and causative condition. It may involve a combination of topical applications (cream, lotions, gels and medicated soaps), oral medication (tablets and capsules) and additional therapies such as PUVA light therapy. Therefore treatment measures may differ and it is important to first seek professional advice about the breast skin rash. Some of the general measures to prevent the rash from worsening includes :

• Using loose fitting undergarments and clothing.
• Discontinue any soaps, shampoos or body lotions that may irritate the skin particularly if it is scented.
• Using a suitable hypoallergenic emollient (barrier cream) to protect the affected skin from the environment.
• Avoid scratching as far as possible as this aggravates any condition and can lead to secondary bacterial infections. Keep the nails short and apply thick applications like petroleum jelly at night to avoid abrasion of the skin with unintentional scratching during sleep.
• Always use the treatment prescribed by a doctor. Over-the-counter and prescription medication or applications can be helpful but could mask the condition and worsen it in the long run if it was not specifically prescribed for the condition in question.

]]> http://www.phaa.com/breast-rash-skin-problems-causes-and-treatment.htm/feed 0 http://www.phaa.com/leg-blood-circulation-problems-in-women.htm http://www.phaa.com/leg-blood-circulation-problems-in-women.htm#comments Fri, 03 Feb 2012 23:00:11 +0000 Dr. Chris http://www.phaa.com/?p=793 Circulatory Problems in the Legs

Many of the leg blood circulation problems are common in both men and women. However, in certain conditions, such as during pregnancy, menopause, or as a result of hormone treatment, some of these problems may worsen or the risks increase substantially. For example, hormonal changes during pregnancy and increased blood volume may cause the veins to dilate and become less elastic. In addition, the pressure on the pelvic blood vessels by the baby’s head and the enlarged uterus may compress the veins and produce varicose veins and various blood circulation problems in the legs.

The common symptoms of poor leg circulation are tingling, numbness, pain and leg cramps. If not treated in time, it can lead to serious complications such as gangrene which may even necessitate amputation of the affected leg in extreme cases. Pulmonary embolism is another dreaded complication which is potentially life-threatening. Lifestyle changes and management of the underlying condition may help. Other specific treatments will depend upon the type of circulation problem.

Risk Factors

• Diabetes.
• High blood pressure (hypertension).
• High blood cholesterol.
• Heart disease.
• Stroke.
• Smoking.
• Obesity.
• Prolonged immobilization.
• Standing for long periods.
• Abnormalities in the blood vessels.
• Injury to blood vessels.
• Kidney disease.
• Pregnancy.
• Hormone treatment.
• Certain medication, such as beta blockers.

Types of Blood Circulation Problems in the Leg

Peripheral Vascular Disease

Peripheral vascular disease, also referred to as peripheral arterial disease, may affect women particularly if there is a history of diabetes, hypertension, high blood cholesterol, or heart disease. Smoking also increases the risk. Peripheral arterial disease is a blood circulation problem that commonly affects the legs. Due to hardening of the arteries or arteriosclerosis, the arteries lose their elasticity and also become narrower, thus causing less blood flow to the supplying area. Extreme cold, emotional stress, abnormalities in the blood vessels and injuries to the blood vessels can also lead to blood circulation problems in the legs.

PAD usually results in symptoms such as tingling, numbness, aches and pains, or discomfort in the legs, particularly of the calf muscles. This occurs while walking or during exercise and is usually relieved on rest. The affected leg may look pale and be cold to the touch. As it progresses, PAD may lead to leg pain and cramps at night or non-healing ulcers in the leg. There is a greater chance of a blood clot forming in these affected leg arteries – arterial thrombosis. Sometimes a blood clot forms even when the artery is not blocked more often due to a heart condition known as atrial fibrillation.

Varicose Veins

Varicose veins are dilated veins on the surface of the legs. Varicose veins are usually caused by a condition known as venous insufficiency where the valves in the veins (which normally act as one-way valves allowing blood to flow back to the heart) become incompetent, and blood flows back into the legs. This can cause edema or swelling of the legs and varicose veins. Varicose veins are more common in women than in men. The risk of developing varicose veins increases during pregnancy.

Deep Vein Thrombosis

A single blood clot or multiple blood clots in the leg veins can lead to a condition known as deep vein thrombosis (DVT). This usually occurs due to prolonged immobilization as in long journeys by car or airplane, or after surgery. Women may be especially at risk if they are on birth control pills, are pregnant, or have recently given birth. Postmenopausal women, particularly those on hormone replacement therapy (HRT), are at increased risk.

Pain and edema are the most important symptoms of DVT. The affected leg will be warm to the touch. DVT results in restriction of blood flow from the leg veins to the heart. The most feared complications of DVT is pulmonary embolism which may occur if a clot breaks away into the blood stream and blocks a blood vessel in the lungs.

Hemorrhoids or piles are swollen, painful, and inflamed veins in and around the anus and lower rectum. It is a common condition in both men and women, usually occurring due to straining when passing stool which is common in chronic constipation. Women are prone to develop hemorrhoids, especially during pregnancy and childbirth. The most common symptom is the passage of bright red blood while passing stool or when wiping after a bowel movement.

Causes and Risk Factors of Hemorrhoids

Increased pressure in the veins of the rectum and around the anaus results in swelling of the veins. This causes pain, especially on straining during bowel movements or while sitting. Rupture of the swollen veins may result in bleeding. Straining while passing stool is the most important cause associated with development of piles. This usually results due to constipation. Since constipation is a common symptom during pregnancy, hemorrhoids may develop or get aggravated during this time, especially during the third trimester.

Pressure of the growing uterus on the pelvic veins and inferior vena cava during pregnancy causes a slowing of venous return from lower part of the body, resulting in stagnation of blood in the veins and their subsequent dilation. Increased progesterone levels during pregnancy also contribute to piles formation by causing swelling of the veins due to relaxation of the venous walls. Progesterone also causes slowing down of the intestinal tract, leading to constipation.

Sitting for long periods of time is another common cause of hemorrhoids. Women who have had hemorrhoids before pregnancy are more likely to suffer from them again during pregnancy. Hemorrhoids may be caused during childbirth due to the bearing down efforts or pushing during the second stage of labor. Following childbirth, piles is a common complaint.

Types of Hemorrhoids

Hemorrhoids are of two types. Those situated inside the anus and lower rectum are known as internal hemorrhoids, while those situated under the skin around the anus are known as external hemorrhoids. In some cases, the enlarged internal hemorrhoids pull down the rectal lining and may protrude from the anus. These are known as prolapsing internal hemorrhoids.

Internal hemorrhoids may be graded according to their severity into the following groups

• First degree hemorrhoids have symptoms of bleeding but they do not prolapse.
• Second degree hemorrhoids are those that prolapse and retract on their own. Bleeding may or may not be present.
• Third degree hemorrhoids are those that prolapse but do not retract on their own. They may be pushed back in by a finger.
• Fourth degree hemorrhoids are those that prolapse but cannot be pushed back in. These include thrombosed piles or prolapsed piles.

Symptoms of Hemorrhoids

The passage of varying quantities of bright red blood during or after a bowel movement is the most common symptom of hemorrhoids. This is sometimes accompanied by pain which is also likely while sitting. Anal itching is a common symptom. Hard, painful lumps may be felt near the anus.

Diagnosis of Hemorrhoids

Diagnosis is usually made from the history, followed by a rectal examination. Other tests that may be done are stool guaiac, sigmoidoscopy, and anoscopy.

Treatment of Hemorrhoids

Treatment usually consists of a Sitz bath (sitting in a warm bath for 10 to 15 minutes) and application of corticosteroid creams to reduce pain and swelling or hemorrhoid creams with lidocaine to relieve pain. A high-fiber diet and lifestyle changes can help. Avoiding constipation and use of stool softeners is advisable. Infrared coagulation (heat treatment) or sclerotherapy (injection of a chemical solution within the vein) may help to shrink the piles. When all else fails to control bleeding or pain, surgery may be advised. This includes rubber band ligation or hemorrhoidectomy (surgical removal of hemorrhoids). Stapled hemorrhoidectomy blocks blood flow to the hemorrhoidal tissue.

Not only are cracked heels and soles unsightly to look at, they can cause pain or discomfort in the feet. Bleeding may occur in severe cases. Infection may also occur, particularly if the person is diabetic. Simple measures such as proper foot care, with particular emphasis on keeping the feet well-moisturized, may help to prevent cracked heels and soles of the feet. If not dealt with early, the skin around the heels may become thick and callused with deep fissures in it, which will make healing more difficult.

Causes of Cracked Heels

Dry skin may predispose to development of cracked heels. Callus (dry, thickened skin) formation around the heels may lead to cracked heels. This can be caused by pressure on the heels caused by prolonged standing. Increased pressure on the fat pad under the heel makes it expand sideways which ultimately leads to splitting or cracking of the callus. Obesity may be another predisposing factor. People who go barefoot or those wearing sandals or shoes that are open at the heel are more prone to cracked heels.

Skin conditions such as eczema and psoriasis may cause this problem. Medical conditions such as diabetes and thyroid problems may also predispose to cracked heels. Sweating of the feet for a prolonged period wearing socks or shoes may make the feet soggy, as well as working barefoot in damp or waterlogged conditions. This may cause the heels to crack. Fungal infections can further aggravate the problem.

Symptoms of Cracked Heels

The initial symptom of cracked heels is callus formation around the heel. The skin will be thickened, dry, and hard and small cracks may be seen over it. If neglected at this stage, the cracks will become deeper and can cause pain or discomfort on standing or walking. Bleeding may occur from deep cracks. The cracks may become infected and result in cellulitis in severe cases.

Neuropathic changes in diabetic patients often result in decreased sensation in the feet. In such cases, even severely cracked feet may be ignored due to lack of pain sensation. Such patients are at risk of developing foot ulcers which are often difficult to heal.

Treatment of Cracked Heels

A little care can help to prevent cracked heels. Keeping the heels well-moisturized, especially in the winter months or in dry weather, can not only prevent the formation of calluses and cracked heels, it can heal the condition in the initial stages. Soaking the feet in warm water for 10 to 15 minutes, followed by rubbing gently with a pumice stone can remove the thickened skin. This may be followed by application of a moisturizer to keep the feet soft and smooth. Heel balms containing keratolytic or water-retaining agents may be used, such as urea, salicylic acid, alpha-hydroxy acids, or saccharide isomerate. In case of deep fissures, a liquid, gel, or spray bandage can help to protect the area and allow it to heal, as well as relieve pain.

A podiatrist may be consulted in severe cases that are not amenable to the above measures. Treatment may involve :

• Identifying the cause and treatment of the underlying condition such as diabetes.
• Appropriate antibiotics in case of infection.
• Debridement or removal of the hard skin by cutting it away.
• Strapping the heels with bandage or dressing.
• Use of softening or debriding agents such as urea or salicylic acid.
• Use of heel pads, heel cups, or insoles.
• Special tissue glue that can hold the cracked skin together, thus allowing it to heal.
• Advice regarding appropriate footwear.
• Maintaining proper foot care at home on a regular basis.

Causes of Jock Itch in Women

Jock itch is mainly caused by a certain type of skin fungi known as dermatophytes. The two species that are most likely to be responsible for a groin skin fungus is Trichophyton rubrum and Epidermophyton floccosum. Less often, other Trichophyton species and Candidia (yeasts) may also cause a fungal infection of the skin. Although many people are exposed to these fungi, a skin infection only occurs in some. There are number of known risks but even in the face of these factors, it appears that individual susceptibility which may be genetic or some other as yet unidentified mechanism is a major component of developing fungal infections of the skin.

A fungal infection of the groin is more likely to arise with some underlying skin disease. A common predisposing factor in this regard is intertrigo – chaffing of the skin. This is more common in obese women where the skin folds provide two opposing surfaces for abrasion. Another factor in terms of chaffing is tight underwear which may irritate the skin in the area and make it prone to a fungal infection. Furthermore, the groin area is generally warm and moist as it is covered for most of the day and this provides the ideal conditions for fungi to thrive.

Although jock itch is more common in males, it is likely to arise in any person with one or more of these risk factors apart from those mentioned above :

• Living in a hot and humid climate
• Poorly fitting undergarments – too tight
• Using repeat courses of broad spectrum antibiotics
• Diabetes mellitus
• Immune deficiency
• Excessive sweating
• Poor personal hygiene
• Wearing wet clothes
• Not wiping dry properly after bathing
• Sharing personal items such as towels or underwear with an infected person

Signs and Symptoms of Jock Itch

The most common symptom is an itchy skin rash. It is usually a persistent itch which may ease with scratching but tends to return a short while later. The skin tends be scaling or peeling and while the area is initially red, it gradually becomes darker in color. A person often finds small specks of skin after scratching the area intensely. Sometimes there is musty odor with dampness in the area even without sweating. Burning, pain and heat in the area with a foul smelling discharge may indicate a superimposed bacterial infection.

Treatment of Jock Itch in Women

There are a number of topical and oral medication that can help to eradicate the fungus. Antifungal shampoo should be used in the area at least twice a week and antifungal cream should be applied to the area at least twice a day after bathing. Underwear needs to be changed twice daily and older underwear should be discarded at the start of treatment as it may contain fungal spores which can re-infect the area. The area must be kept dry with thorough wiping after bathing and using an antifungal drying powder if necessary. Oral antifungal drugs are only considered if the infection does not respond to topical applications. A low dose corticosteroid cream may help to relieve itching but long term use should be avoided as it can weaken the skin. Antibiotics are necessary when there is a secondary bacterial infection.

Most women experience some degree of abdominal distention particularly before and during menstruation. It can be a temporary inconvenience for many, although some women will experience recurrent episodes of distention throughout the month irrespective of menstruation. There is often a misconception that this distention, referred to as menstrual bloating, is due to fluid. In fact many women may complain of retaining water in the abdomen and some may even use water pills to counteract the bloating. However, abdominal distention during menstrual periods is unlikely to be caused by fluid retention. It most instances it is actually functional bloating – a condition that occurs by an unknown mechanism apparently in response to hormonal changes. Functional bloating is not related to any underlying disease and will resolve spontaneously with no need for medical attention. Fluid retention in the abdomen, however, is not as innocuous.

Causes of Abdominal Fluid Retention

The organs of the abdomen are lined with a membranous layer known as the visceral peritoneum which is continuous with the parietal peritoneum that lines the inner abdominal wall. Between these two peritoneal layers is a potential space known as the peritoneal cavity. It contains a very small amount of peritoneal fluid that aids with lubrication. Women may find that the amount of peritoneal fluid can increase with changes in the menstrual cycle – this may increase to as much as 20mL. However, it causes no signs and symptoms. In fact for fluid retention to be detectable by diagnostic investigation, it needs to be around 100mL to 200mL. For this fluid retention to be visible, it needs to be above 500mL and for it to cause a massive increase in abdominal girth, the fluid volume needs to exceed 1,000mL.

Fluid retention in the abdominal cavity, or more correctly the peritoneal cavity, is known as ascites. It is a medical condition that needs to be assessed, treated and managed appropriately. Most causes of ascites are related to liver conditions like cirrhosis, hepatitis and other liver diseases including liver cancer. It may also be associated with inflammation of the peritoneal layers (peritonitis), pancreatic, heart, blood and kidney disease and malignancies in the area. Less commonly, ascites may be seen with thyroid dysfunction, systemic lupus erythematosus (SLE), ovarian dysfunction and tuberculosis among other conditions.

Treatment of Ascites

Ascites (fluid retention in the abdomen) needs to be investigated in order to identify the underlying cause. Treatment is then directed at the specific cause. However, some measures such a low sodium diet, diuretics (‘water pills’) and manually withdrawing the fluid (therapeutic paracentesis) may be undertaken to ease the fluid accumulation. These measures are not necessary for menstrual bloating which is usually temporary. Functional bloating is largely due to unknown factors and therefore the appropriate treatment cannot be decided upon. There is some evidence to suggest that functional bloating, which can even vary in severity within hours, may be due to intestinal gas in certain cases. It is less likely to occur or is minimal in a person with firm abdominal muscles, regular but not excessive bowel movements and in a person who is more active. However, this bloating is not significant if temporary before or during the menstrual periods and does not need to be treated.