WHERE THERE IS NO DOCTOR THE URINARY SYSTEM AND THE GENITALS
Item
- Title
- WHERE THERE IS NO DOCTOR THE URINARY SYSTEM AND THE GENITALS
- extracted text
-
COMMUNITY HEALTH CELL
47/1. 'First Fleer) St. Marks Read,
D-85
Bangalore -
001,
CHAPTER
The Urinary System
and the Genitals
This is a reprint from
\^/here There Is No Doctor
(Ind ian ada ptat ion)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
CHAPTER
18
The Urinary System
and the Genitals
The urinary system or tract serves the body by removing waste material from
the blood and getting rid of it in the form of urine:
\
/The bladder is a bag that stores the
The kidneys^
/
\
/ urine. As it fills, it stretches and gets
filter the
X. f
»7
/ bigger.
blood and
pA “
form the
| /k.
The urine tube or
\ ZT
/
urine.
\ fl H V
M y/j
urinary canal
)
\
\
(urethra) carries
/ 7 ) \
The ureters
j
urine out through
j
As
I
are tubes
1
®
1
the penis in men or
)
that carry
1
T
/
to a small opening-—I
Y
/
urine to
\
A
1
between the lips of '
the bladder.
\
the vagina in women.
The genitals are the sex organs.
The man:
bladder
sperm tube
urine canal
The prostate gland makes the
liquid that carries the sperm.
penis ormale sex
organ
scrotum or—
sac that holds
the testicles
The testicles make the
sperm, or microscopic
cells with tails, that
join with the egg of a
woman and make her
pregnant.
278
PROBLEMS OF THE URINARY TRACT
There are many different disorders of the urinary tract. They are not always
easy to tell apart. Some are not serious, while others can be very dangerous. A
dangerous illness may begin with only mild symptoms. It is often difficult to
identify these disorders correctly by simply using a book like this one. Special
knowledge and tests may be needed. When .possible, seek advice from a health
worker.
Common problems with urinating include:
1.
Urinary tract infections that are not spread by sexual contact.
2.
Kidney stones.
3.
Prostate trouble (difficulty passing urine caused by an enlarged gland; most
common in older men).
4.
Gonorrhea (difficulty or pain in passing urine; an infectious disease, spread
by sexual contact).
Urinary Tract Infections that Are Not Spread by Sexual Contact
Signs:
Sometimes fever and chills
or headache.
Sometimes pain
in the side.
Sometimes there is
pain in the lower
back (kidneys).
Painful urinationand need to
urinate very
often.
Sometimes the pain
seems to go down
the legs.
Urine may be
cloudy or
reddish
(bloody).
In serious cases
(kidney disease)
the feet and face
may swell.
Many women suffer from minor urinary infections. In men they are much less
common. Sometimes the only symptoms are painful urination and the need to
urinate often. Other common signs are blood in the urine and pain in the lower
279
belly. Pain in the mid or lower back, often spreading around the sides below the
ribs, with fever, indicates a more serious f
Treatment:
♦ Drink a lot of water. Many minor
urinary infectionscan be cured by
simply drinking a lot of water,
without the need for medicine.
(But if the person cannot
urinate or has swelling of the hands
and face, he should not drink much
water.)
♦ If the person does not get better by drinking a lot of water, or if he has a fever, he
should take pills of a sulfonamide (p. 402). sulfisoxazole with potassium hydroxide (p.402)
or methenamine mandelate (p.403), or trimethaprim with phenazopyridine
hydrochloride (p.403). If these do not help, have tetracycline. Pay careful attention to
dosage and precautions. To, completely control the infections, it may be necessary
to take the medicines for 10 days or more. It is very important to continue to drink a
lot of water when taking these medicine, specially with the sulfonamides.
♦ If the person does not get better quickly, seek medical help.
Kidney or Bladder Stones:
Signs:
• The first sign is often sharp or severe pain in the lower back, the side, or the
lower belly, or in the base of the penis in men.
• Sometimes the urinary tube is blocked so the person has difficulty passing
urine—or cannot pass any Or drops of blood may come out when the person
begins to urinate.
• There may be a urinary infection at the same time.
Treatment:
♦ The same as for the urinary infections described above.
♦ Also give aspirin or another painkiller and an antispasmodic like Baralgan
(seep. 416).
♦ Try to urinate while lying down. This sometimes allows a stone in the bladder
to roll back and free the opening to the urinary tube.
♦ In severe cases get medical help. Sometimes surgery is needed.
Enlarged Prostate Gland:
This condition is most common in older men. It is caused by a swelling of the
prostate gland, which is between the bladder-and the urinary tube (urethra).
• The person has difficulty in passing urine and sometimes in having a bowel
movement. The urine may only dribble or drip or become blocked
280
completely. Sometimes the man is not able to urinate for days.
• If he has a fever, this is a sign that infection is also present.
• the person passes urine more often, especially at night.
• pain in the lower abdomen.
Treatment for an enlarged prostate:
♦ If the person cannot urinate, he should try
sitting in a tub of hot water, like this:
If this does not work, a catheter may be
needed (p.284).
♦ If he has a fever, use an antibiotic such as
ampicillin (p. 399) or tetracycline (p.400).
♦ Get medical help. Serious or chronic cases
may require surgery.
Note: It is important to distinguish between
prostate trouble and gonorrhea, which can also
make it hard to pass urine. In older men it is more likely to be an enlarged
prostate. Also, if a person, with gonorrhea, strains, he can pass urine. But a
person with an enlarged prostate gland cannot pass urine if he strains. However
a younger man—especially one who has had sexual contact with an infected
person (within the last few days or weeks)-probably has gonorrhea.
DISEASES SPREAD BY SEXUAL CONTACT
(VENEREAL DISEASES)
Gonorrhea (clap, VD, the drip):
This is a disease usually spread by sexual contact (a venereal disease).
In the man:
• Pain with urination.
• Drops of pus from the penis.
• Difficulty urinating (some
times he cannot pass any urine
at all).
• Fever (sometimes).
After months or years:
• Hard, tender swelling in one
knee or other joint, or many
other problems.
In the woman:
• At first, there are often no symptoms
(she may feel a little pain when
urinating or have a slight vaginal
discharge).
• If a pregnant woman with gonorrhea
is not treated before giving birth, the
infection may get in the baby's eyes
and make him blind (see p.266).
After months or years:
• Pain in the lower belly (pelvic
281
inflammatory disease, p.287).
• Menstrual problems.
• She may become sterile.
• Other problems.
In a man, the first signs of gonorrhea begin 2 to 5 days (or up to 3 weeks or
more) after sexual contact with an infected person. In a woman, years may pass
before any signs show up. But even though she does not show any signs, she can
give the disease to someone else, starting a few days after she becomes infected.
Treatment of gonorrhea:
♦ Inject procaine penicillin; Put half the dose in each buttock (see p. 399).
It is important to use procaine penicillin and not crystalline penicillin. If
you can get probenecid, give 1 gm. half an hour before you inject the
penicillin. If you do not have penicillin (or if it does not seem to work),
use tetracycline (o. 400;.
♦ If the person cannot urinate, he should try doing so while sitting in a tub of
hot water (see p. 280). If he still cannot urinate, the bladder should be
drained using a catheter (see p. 284). Get medical help.
♦ If a man has had sex with his wife after being exposed to gonorrhea, she
should be treated also. Even if the wife shows no signs of the disease, she
probably has it. If she is not treated at the same time, she will give the
disease right back to her husband again.
♦ The eyes of all babies should be protected from gonorrhea and possible
blindness by using 1 percent silver nitrate drops at birth (see p. 414).
♦ Everyone who has had sex with a person known to have gonorrhea should
also be treated, especially wives of men who are infected.
CAUTION: A person with gonorrhea may also have syphilis, without knowing it.
Sometimes it is best to go ahead and give the full treatment for syphilis, because
the gonorrhea treatment may prevent the first syphilis symptoms, but may not
cure the disease.
For prevention of gonorrhea and other venereal disease, see p. 283.
Syphilis:
Syphilis is a common and dangerous disease that is spread from person to
person through sexual contact.
Signs:
• The first sign is usually a sore, called a chancre. It
appears 2 to 5 weeks after sexual contact with a
person who has syphilis The chancre may look like a
pimple, a blister, or an open sore. It usually appears
in the genital area of the man or woman (or less
commonly on the lips, fingers, anus, or mouth). .This
sore is full of germs, which are easily passed on to
,ff
\r
—
] i'\ - HQ
COMMUNITY HEALTH
f
282
another person. The sore is usually painless, and if it is inside the vagina, a
woman may not know she has it —but she can easily infect other persons.
• The sore only lasts a few days and then goes away by itself without
treatment. But the disease continues spreading though the body.
• Weeks or months later, there may be sore throat, mild fever, mouth sores, or
swollen joints. Or any of these signs may appear on the skin:
a painful rash or ‘pimples’
all over the body
ring-shaped welts
(like hives)
an itchy rash on the
hands or feet
All of these signs usually go away by themselves, and then the person often
thinks he is well—but the disease continues. Without adequate treatment, syphilis
can invade any part of the body, causing heart disease, paralysis, insanity, and
many other problems.
CAUTION: If any strange rash or skin condition shows up days or weeks after a
pimple or sore appears on the genitals, it may be syphilis. If unsure, get medical
advice.
Treatment for syphilis:
♦ Inject procaine penicillin,(see p. 399). To cure syphilis completely, it is
very important to give the full treatment. Persons who are allergic to
penicillin or who do not get better with it can take tetracycline,
♦ Injection PAM (see p398) is effective if a person has both syphilis and
gonorrhea.
♦ If there is any chance that someone has syphilis, he should immediately see
a health worker. Special blood tests may be needed. If tests cannot be made,
the person should be treated for syphilis in any case.
♦ Everyone who has had sexual contact with a person known to have syphilis
should also be treated, especially husbands or wives of those known to be
infected.
CAUTION: Do not take home remedies, or medicines from local or untrained healers
for syphilis. These medicines do no good. The signs of syphilis often go away on
their own. Butthegermsdonot die. Without proper treatment, the disease will come
back in a more serious form.
To prevent syphilis, see the next page.
283
Bubos: Bursting Lymph Nodes in the Groin
(Lymphogranuloma Venereum)
Signs:
• In a man: Large, dark lumps in the groin that
open to drain pus, scar up, and open again.
• In a woman: Lymph nodes similar to those in
the man. Or painful, oozing sores in the anus.
Treatment:
♦ See a health worker.
• Give adults tetracycline, (see p. 400)
♦ Avoid all sexual contact until the sores are completely healed.
How to prevent spreading venereal disease to other people:
1.
Get treatment right away: It is very important that all persons infected with
this kind of illness get treatment at once so that they do not infect other people.
Do not have sex with anyone until 3 days after treatment is finished.
Note: In case of syphilis, regular check up by a health worker is necessary for at
least two years after all the signs of the disease have gone.
2.
Tell other people if they need treatment: When a person finds out that he or
she has any form of venereal disease (VD), he should tell everyone with whom he
has had sex, so that they can get treatment, too. A man is especially obligated to
tell women he has slept with, because without knowing that she has it a woman
can pass the disease on to other people, her babies may become blind, and in time
she may become sterile or very ill herself.
3.
A man and his woman should both take treatment together. If one of them does
not take treatment, he or she can pass the disease back to the other person.
4.
Be careful with whom you have sex: Someone who has sex with many
different persons is more likely to catch these diseases. Brothels or whorehouses
are especially dangerous. Do not go to them! Do not be tempted when you go to
the cities. Use of condoms helps (but does not always) prevent VD.
5.
Always wash genitals after having sex. A man should use condoms during sex
This may help (but does not always) prevent VD.
6 Help others: Insist that friends who may have VD get treatment at once, and
that they avoid all sexual contact until they are cured.
284
HOW AND WHEN
TO USE A CATHETER
(A RUBBER TUBE TO DRAIN URINE FROM THE BLADDER)
When and when not to use a catheter:
■ Never use a catheter unless it is absolutely necessary and it is impossible to
get medical help in time. Even careful use of a catheter sometimes causes
dangerous infection or damages the urinary canal.
■ If any urine is coming out at all, do not use the catheter.
» If the person cannot urinate, first have him try to urinate while sitting in a
tub of warm water (p. 280). Begin the recommended medicine (for
gonorrhea or prostate trouble) at once.
■ If the person has a very full, painful bladder and cannot urinate, or if he
begins to show signs of poisoning from urine, then and only then use a
catheter.
Signs of urine poisoning (uremia):
• The breath smells like urine.
• The feet and face swell.
• Vomiting , distress, confusion.
Note: People who have suffered from difficulty urinating, enlarged prostate, or
kidney stones should buy a catheter and keep it handy in case of emergency.
HOW TO USE A CATHETER
1. Boil the catheter for 15
minutes.
2. Wash the penis and the whole
area around it well with soap
and warm water.
4. Cover the area around the
penis with a very clean cloth,
sterilized if possible.
5. Wash your hands with
alcohol. (If you have sterile
gloves, use them.)
3. Wash your hands with
boiled water and soap.
6. Lubricate the catheter with
antibiotic ointment or a sterile
lubricant.
286
7. Insert the catheter
little by little, very
carefully.
BE VERY CAREFUL THAT
THE CATHETER NEVER
TOUCHES ANYTHING BUT THE
OPENING OF THE PENIS AND
YOUR HANDS.
If the catheter does not go in easily, roll
it gently between your fingers and move
the penis, but never force the catheter. It
is very easy to injure the urinary canal
and cause serious problems. When urine
starts to come out, do not try to push the
catheter in any more.
Keep the penis in
this position so
that the urine
canal is not bent.
Important:
If the person shows signs of urine poisoning, do not let the urine come out all
at once: instead, let it out very slowly, little by little over an hour or 2
Women sometimes have trouble urinating after giving birth and need a catheter
put in. The method is similar, but the woman's urinary tube is much shorter.
PROBLEMS OF WOMEN
Vaginal Discharge
(a mucus or pus-like stuff that comes from the vagina):
All women normally have a small amount of vaginal discharge, which is clear,
milky, or slightly yellow. If there is no itching or bad smell, there is probably no
problem.
But many women, especially during pregnancy, suffer from a discharge often
with itching in the vagina. This discharge may be caused by various infections.
Most of them are bothersome, but not dangerous.
1 A thin and foamy, greenish-yellow or whitish, foul-smelling discharge with
itching. This is probably an infection of Trichomonas. It burns to urinate. Some
times the genitals hurt or are swollen.
Treatment:
♦ 11 is very important to keep the genitals clean.
286
The woman should douche 1 to 3 times a day until she gets better. If there
is no vinegar, use lemon juice in water.
♦ In serious cases use vaginal inserts that contain metronidazole or other
medication (SVC Pessaries) for Trichomonas (see p. 409). In very serious cases take
metronidazole by mouth. Take 200 mg. 3 times a day for 10 days. For precautions
and instructions, (see p,407)
Important:
It is likely that the husband of a woman with Trichomonas has the infection too.
though he does not feel anything. (Some men with Trichomonas have a burning
feeling when urinating). If the woman gets a severe infection again after she has
been treated, both she and her husband should take the same treatment, starting on
the same day. Only take metronidazole by mouth if the infection is very severe. The
husband should use condoms during sex.
2. White discharge that looks like cottage cheese or buttermilk, and smells like
mold, mildew, or baking bread. This could be a yeast infection (moniliasis, 'thrush').
Itching may be severe. The lips of the vagina often look bright red and hurt. It
burns to urinate. Thrush is especially common in pregnant women or in those
who are sick, diabetic (p.149) or have been taking antibiotics, or birth control pills.
Treatment:
Get urine checked for diabetes (P.149)
Douche with vinegar-water or dilute gentian violet, 2 parts gentian
violet to 100 parts water (2 teaspoons to a half liter). Or use nystatin vaginal
tablets or any other vaginal inserts for moniliasis. For dosage and instructions see
page 408. Putting yogurt in the vagina is said to be a useful home remedy to help
control yeast infections.
WARNING: Never use antibiotics against this kind of infection. Antibiotics make
yeast infections worse.
287
3.
Thick, milky discharge with a rancid smell. This could be an infection caused
by a bacteria called hemophilus. Special tests may be needed to tell this from a
trichomonas infection. Douche with vinegar-water. Also use a vaginal
tablet (insert) of sulfathiazole twice a day for 2 weeks (see p.408).
4.
Watery, brown, or gray discharge, streaked with blood; bad smell. These are
signs of more serious infections, or possibly cancer (p. 326). If there is fever, use
an antibiotic (ampicillin if possible-see p. 399). Get medical help right away.
Important: If any discharge lasts a long time, or does not get better with
treatment, see a health worker.
How a Woman Can Avoid Many Infections:
1.
Keep the genital area clean. When you bathe, wash well with mild soap.
2.
Urinate after sexual contact. This helps prevent urinary infections (but will
not prevent pregnancy).
3.
Be sure to clean yourself carefully after each bowel movement.
Pain or Discomfort
in the Lower Central Part of a Woman's Belly
This can come from many different causes, which
are discussed in different parts of this book. The
following list, which includes a few key questions,
will help you know where to look.
Possible causes of pain in the lower belly are:
1.
Menstrual discomfort (p. 291). Is it worst
shortly before or during the period?
2.
A bladder infection (p. 279). One of the most
common low mid-belly pains. Is urination very
frequent or painful?
3.
A yeast infection (p. 286) or Trichomonas
(p. 286). These sometimes get into the womb or
tubes to the ovaries. Is there a vaginal discharge?
What is it like?
4.
Pelvic inflammatory disease. This is often a late
stage of gonorrhea (p. 280). It may be acute with
symptoms similar to those of peritonitis or
288
appendicitis (p.108), or chronic, with continual or
intermittent pain or discomfort in the lower belly,
often with periods of chills and fevers.
5.
Problems that are related to a lump or mass in the lower part of the belly.
These are discussed briefly on page 326 and include ovarian cyst, ectopic
pregnancy (when the baby begins to develop outside the womb), and cancer.
6.
An infection or other problem of the gut or rectum (p. 198). Is the pain
related to eating oi co bowel movements?
Some of the above problems are not serious. Others are dangerous. They are
not always easy to tell apart. Special tests or examinations may be needed.
If you are unsure what is causing the pain,
or if it does not get better soon,
seek medical help.
MEN AND WOMEN WHO ARE NOT ABLE
TO HAVE CHILDREN (INFERTILITY)
Sometimes a man and woman try to have children but the woman does not
become pregnant. Either the man or woman may be infertile (unable to bring
about pregnancy). Often nothing can be done to make the person fertile, but
sometimes something can be done, depending on the cause
COMMON CAUSES OF INFERTILITY:
1.
Sterility. The person's body is such that he or she can never have children.
Some men and women are born sterile.
2.
Weaknesses or a nutritional lack. In some women severe anemia, poor
nutrition, or lack of iodine may lower the chance of becoming pregnant. Or it
may cause the unformed baby (embryo) to die, perhaps before the mother even
knows she is pregnant (see Miscarriage,p. 327).
A woman who is not able to become pregnant, or has had only miscarriages,
should get enough nutritious food, use iodized salt, and if she is severely anemic.
take iron pills (p. 424). These may increase her chance of becoming pregnant
and having a healthy baby.
3.
Chronic infection, especially pelvic inflammatory disease (see Gonorrhea,
p.287) is a common cause of infertility in women. Treatment may help—if the
disease has not gone too far. Prevention and early treatment of gonorrhea mean
fewer sterile women.
4.
Men are sometimes unable to make their women pregnant because they have
fewer sperms than is normal. It may help for the man to wait, without having sex,
289
for several days before his woman enters her 'fertile days' each month midway
between her last menstrual period and the next (see Rhythm Method and
Mucus Method, p. 339 and340). This way he will give her his full amount of
sperm when they have sex together on days when she is able to become pregnant.
Warning: Hormones and other medicines commonly given to men or women who
cannot have babies almost never do any good, especially in men. Home remedies
and magic cures are not likely to help either. Be careful not to waste your money
for things that will not help.
If you are a woman and are not able to have a baby, there are still many
possibilities for leading'a happy and worthwhile life:
» Perhaps you can arrange to care for or adopt
children who are orphans or need a home. Many
couples come to love such children just as if they
I xk.
were their own.
I
° Perhaps you can become a health worker or help
E&j
your community in other ways. The love you would
rG'
O.
give to your children, you can give to others, and all
IT?
nG
will benefit.
(J (x
JJ
° You may live in a village where people look with
shame on a woman who cannot have children.
Perhaps you ana others can form a group to help those who have special needs and
to show that having babies is not the only thing that makes a woman worthwhile
(Sg
^8^
/fea
WJ?|
The book Where There Is No Doctor is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
SafdarjungDevelopment Area
New Delhi 110016
Rs. 2.00
>
*
- Media
61.pdf
Export
Position: 83 (9 views)