Women's Health: Your Doctor's Examination

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Bladder and Kidneys
Some women, especially those who are sexually active, are prone to urinary tract infections (UTIs). These can be very irritating, as they cause pain, burning, and frequent urination. Urinary tract infections can be prevented by drinking plenty of water and urinating before and after sex; the uncomfortable symptoms can be avoided by drinking cranberry juice or eating cranberries or cranberry products. (Blueberries have also recently been found to provide similar relief.) Urinary tract infections can become serious if they are left untreated, as they can spread into the kidneys. See your doctor if you have pain or burning with urination or cloudy or foul-smelling urine lasting for more than a few days and especially if you have a fever. Thorough treatment of UTIs is with antibiotics.

Another problem among women that can occur after childbirth is stress incontinence, the condition where physical pressure, such as that caused by running and jumping, causes urine to leak out. This is usually due to loosening and stretching of the supporting muscles and ligaments around the bladder and urethra. Stress incontinence improves with Kegel exercises and can be managed by avoiding caffeine or other diuretic foods or products. Fluids can be limited before impact exercise, although this should not be done in hot weather. Wearing an absorbable pad is helpful; occasionally inserting a tampon into the vagina during exercise helps close flow of urine. There are also medications that sometimes help, and in severe cases, surgery can resolve the problem.

Kegel exercises are important for every woman to preserve urogenital health and are especially beneficial during and after pregnancy. These exercises strengthen the muscles that support your bladder and uterus, the same muscles you use to stop the flow of urine. To perform Kegel exercises, contract your internal pelvic muscles as if you are holding back urine. Do this 10–15 times, 5 times a day, increasing the time you hold each contraction to up to 10 seconds.

Managing Incontinence

• Kegel exercises
• Avoid caffeine or diuretics
• Limit fluids before impact activities
• Wear an absorbable pad
• Try inserting a tampon
• Medications
• Surgery

Blood and Lymph
The fluid systems in your body circulate nutrients into your cells and eliminate waste products. Blood is made up of red cells, which carry oxygen; white cells, which carry disease fighters; platelets, which allow clotting; and plasma, the fluid. Lymph is a fluid drainage system in addition to blood that is especially active in eliminating wastes produced by infection.

The most important function of blood is to transport oxygen, without which we cannot live. Oxygen is carried by the iron in the red cells of your blood. If there are not enough red cells, or not enough iron, this is called anemia. Anemia is more common in women, due to menstruation. Signs of anemia include feeling easily cold, tired, and out of breath. Anemia can occur in women who exercise a lot, as the body breaks down the iron and red cells during vigorous exercise. Anemia is diagnosed with a blood test. The best sources of iron are red meats; therefore, vegetarians are at greater risk of having anemia. Do not try to treat anemia by yourself by taking iron supplements; this is not the only answer for anemia, and the dose should be monitored. Consult your doctor if you think you might be anemic.

The lymphatic system does not usually cause problems unless you have an infection, cancer, or lymphedema. During an infection, lymph nodes become swollen and tender. In cases of cancer, they can become hard. If you notice bumps (lymph nodes) that you have not noticed before that are present for longer than one week, see your doctor for an evaluation. Lymphedema is a swelling of one arm or leg that can develop after surgery, such as in the arm after mastectectomy, after injury, or for unknown reasons. Lymphedema should be managed daily with movement exercises to promote circulation. In more severe cases, compressive wraps are used to reduce uncomfortable swelling. Light weight training or exercises such as swimming are helpful, but heavy lifting should be avoided.

Brain and Nerves
Problems with the brain and nerves include weakness, numbness, headaches, vision or hearing problems, and seizures. These problems can be due to a pinched nerve, stroke, or lesion on the spinal cord, nerve, or brain. Neurological diseases such as multiple sclerosis, Parkinson's, meningitis, or viruses can cause other problems. If you have any of the above-mentioned symptoms, see a neurologist and limit exercise until you have been evaluated. The most common neurological problem in active women is headaches. Because there are many causes and treatments, headaches that occur frequently or interfere with your daily or sports activities should be evaluated by a neurologist.

Hormones
Hormones are proteins that have special controlling and signaling functions in the body and maintain the body's delicate metabolic and functional balance. Important hormones include insulin, made by the pancreas; thyroxine and triiodothyronine, made by the thyroid; and estrogen and progesterone, made by the ovaries. Other important hormones are made in the pituitary gland, the hypothalamus, and the adrenal gland. Occasionally, they can be over- or underproduced. Diabetes, a lack of insulin or resistance to insulin's effect in the body, is classified into two types. Type I, juvenile

onset, "insulin dependent," diabetes, starts early in life and is managed with insulin. Type II, adult-onset, "insulin resistant," diabetes is a condition where your body does not respond to insulin and is managed sometimes with diet alone, but often with other medications. Signs you might have diabetes include increased urination, thirst, and hunger; sudden weight loss; fatigue; blurry vision; numbness; and frequent infections of the bladder, vagina, and skin. Diabetes does have genetic risk factors, although its exact causes are not known. Type II diabetes is associated with obesity and lack of exercise. Also, gestational diabetes (in pregnancy) is a strong risk factor for type II diabetes later in life.

Diabetes is a life-long condition, with sometimes life-threatening complications, although strict diet control, a consistent exercise regime, and monitoring of blood sugars can allow a life without the other complications that makes diabetes a life-threatening disease. Exercise plays a vital role in this process, as it helps lower and control blood sugar, increases blood flow, and reduces heart and other risk factors associated with diabetes.

Thyroid hormones control metabolism, temperature, heart rate, and other body systems including fertility and bone metabolism. Many women become hypothyroid, or have low thyroid levels. An overactive thyroid is called Graves' disease. These treatable conditions should be managed by an endocrinologist. Signs you might have thyroid problems include a change in appetite or weight, trouble with tolerating heat or cold, dry skin, brittle fingernails, or a swelling at the base of the neck.