Common Complaints

Janelle McAlpine MMRes BA (Human Bioscience) BMid
Registered Midwife

Haemorrhoids

Haemorrhoids (also known as piles) are a swollen, itchy form of varicose veins in the rectum. These get more common as we get older and are caused by a number of factors:

constipation (and the associated straining on the toilet);
pregnancy (due to the weight of the uterus, pressure on the bowels, and action of progesterone);
hereditary factors (as for other varicose veins);
heavy manual labour (particularly without a well toned pelvic floor).

There three different types of haemorrhoids:

Internal haemorrhoids are found inside the rectum. These are not usually painful but can bleed when understrain;
Prolapsed haemorrhoids are more severe and painful. These push through the anus and hang out of the body, particularly after going to the toilet.
External haemorrhoids feel like hard lumps and are like small haemorrhages (bleeds) under the skin.

Haemorrhoids do not appear overnight, and can take years to develop. While not dangerous, they can be painful, uncomfortable and cause bleeding from the rectum. They can be managed (and sometime avoided) by have a diet that includes fibre rich foods and maintaining adequate hydration. Vegetables, fruits, cereals and water will help produce soft bowel motions that are passed easily and regularly.

Doing your pelvic-floor exercises and trying not to strain when you use your bowels can help too.

The rate of haemorrhoids in pregnancy (38-80%) is widely acknowledged to be higher than that of the general population (13-36%) (1)

Urinary Tract Infections

Why do we get UTI’s?

Women are more susceptible than men, with UTI’s most common in women who are sexually active. The reason is that sexual activity can push bacteria into the urethra and infect the system that carries urine out of the body – the kidneys, bladder, and the tubes that connect them. Some women get a bladder infection almost every time they have sex. Women who use a diaphragm for birth control are especially vulnerable. Bladder infections are common and usually not serious if treated promptly. However, if the infection spreads to the kidneys, it can cause more serious illness.

What are the symptoms?

Symptoms of a UTI include:

Pain or burning during urination
The urge to urinate often
Pain in the lower abdomen
Urine that is cloudy or strong-smelling
Pain on either side of the lower back
Fever and chills
Nausea and vomiting

Please see your doctor if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency but does not usually resolve without antibiotics. People with a higher risk of complications include pregnant women, people with diabetes, kidney problems, or a weakened immune system.

About 50% of women will get a urinary tract infection (UTI) at some point in life (2).

Sometimes a UTI can occur without any or all of the usual symptoms. However, a urine test shows the presence of bacteria. In many cases no treatment is needed, but pregnant women are routinely tested and usually treated to avoid a kidney infection.

Many different bacteria live in the intestines and genital area and for the most part this is normal. However, urine and the urinary system are sterile. A UTI is caused when this bacteria is introduced into this system accidentally. In most cases the bacteria travel up the urethra to the bladder, where an infection takes hold.

How is it tested?

The first step in diagnosing a UTI is usually a quick dipstick test called a urinalysis. It looks for bacteria, as well as red and white blood cells. Your doctor may also send urine to a lab for culture to confirm the type of bacteria.

Prescription antibiotics will almost always cure a UTI, however it is important which bacteria responsible for the infection is identified. This is because different types of bacteria respond to different antibiotics. Taking the wrong antibiotics will not only not cure your infection but kill the good bacteria you need in your body and contribute to the growing problems of antibiotic resistance. Your health care provider may recommend drinking lots of water and emptying your bladder frequently to help flush out the bacteria.

Some women are prone to getting recurrent UTIs. If you experience three or more infections a year, please talk to your doctor about how to prevent or minimize these infections. Strategies can include:

Taking a low dose of antibiotics long-term
Taking a single antibiotic dose after sex
Taking antibiotics promptly when symptoms appear.

What about pregnancy?

During pregnancy, there are several factors that increase your risk of getting a UTI. Hormones cause changes in the urinary tract, and the uterus may put pressure on the ureters or bladder or both — making it more difficult for urine to pass from the kidneys to the bladder and out. Untreated UTIs can irritate your uterus and contribute to preterm labor, so be sure to visit your doctor if you suspect you have an infection.

Here are some ways to reduce the risk of you getting a UTI:

Drink plenty of water.
Visit the toilet before and after sex.
Wipe from front to back.
Avoid feminine hygiene sprays.
Take showers instead of baths

Some studies suggest that cranberry juice can prevent, but not treat an infection. This appears to be more effective in young and middle-aged women. Cranberries contain a substance that prevents E. coli bacteria from sticking to the walls of your bladder. Cranberry is also available in capsules or tablets, however people with a history of kidney stones should check with a doctor, first.

Vaginal Discharge

What is discharge about?

The vagina is a self cleaning system, with vaginal discharge serving an function in the health of the female reproductive system. Glands inside the vagina and cervix make a fluid which carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection.

Most of the time, vaginal discharge is normal. The amount, odour and colour changes throughout your cycle so ‘normal’ can encompass a wide variation in the discharge you may notice. For example, around ovulation your discharge becomes thinner in order to assist sperm to make its way to the egg. Breastfeeding and sexual arousal also results in a change in your vaginal discharge. The smell may be different if you are pregnant or your personal hygiene hasn’t been attended to.

I don’t smell right…

However, if the color, smell, or consistency of your discharge is something other than what is normal for you, particularly if you are also experiencing vaginal itching or burning (known as ‘vaginitis’ or inflammation of the vagina) you may have an infection or other condition. Please see your doctor to discuss your concerns. Any change in the vagina’s bacterial balance can affect the smell, color, or texture of your discharge.
These include:

Antibiotic or steroid use
Bacterial vaginosis
Birth control pill
Cervical cancer
Sexually transmitted infections
Diabetes
Douches, scented soaps or lotions, bubble bath
Pelvic infection after surgery
Pelvic inflammatory disease (PID)
Vaginal atrophy, the thinning and drying out of the vaginal walls during menopause
Vaginitis, irritation in or around the vagina
Yeast infections (Thrush)

The doctor will start by asking about your history and symptoms. Some questions they may ask are:

When did the abnormal discharge begin
What color is the discharge?
Is there any smell?
Is there any itching, pain, or burning in or around the vagina?
Do you have more than one sexual partner?

The doctor may take a sample of the discharge or do a Pap test to collect cells from your cervix for further examination.

Bacterial Vaginosis (BV)

Bacterial vaginosis (BV) is a mild infection of the vagina caused by bacterial imbalance. Normally, “good” bacteria keep “bad” bacteria in check as part of the vaginas self maintenance. In women with bacterial vaginosis, the balance has been upset for some reason and the bad bacteria have been multiplying out of control.

Bacterial vaginosis is usually a mild problem and may go away on its own in a few days. However, it’s a good idea to see your doctor and get antibiotic treatment, as if left alone can lead to more serious problems.You are at increased risk of BV if you have multiple sex partners, a new sex partner or douche (rinse out your vagina).

Bacterial vaginosis (BV) is a common condition with up to 30% of women affected at any given time (3)

What are the symptoms?

Many women with bacterial vaginosis do not have any symptoms. BV does not usually cause itching, but it does cause excessive grayish white (or even yellow/green) vaginal discharge, and a fishy odour which may be worse after sex. BV often clears up on its own, but for some women this is not the case and some may get BV recurring. Antibiotics work for some women but not others.
Sometimes women are more susceptible to BV, including during pregnancy. Women with BV during pregnancy have a higher risk of premature laboury or uterine infection after their baby is born than women without BV. BV also increases a woman’s risk of miscarriage. Having BV also increases risk of contracting an STI after exposure or infection after gynaecological surgery. With this in mind your doctor will recommend treatment if you are considering any surgery of this nature.

For some women, the bacteria balance themselves again and BV goes away without treatment. However, when it does not go away even with treatment, bacterial vaginosis is frustrating and irritating. Please see you doctor if you are pregnant or having persistent symptoms.

Candidiasis (Thrush)

What is thrush?

Candida is a fungus that normally lives throughout the body in small numbers. How much of it lives in us is usually controlled by our good bacteria, and the normal balance they maintain. When this balance is upset and organisms grow out of control symptoms occur. Taking antibiotics, high estrogen levels (such as in pregnancy or hormone therapy) can cause this imbalance. So can certain health problems, such as high stress, low immunity, diabetes or HIV. A vaginal yeast infection (thrush) means that too much candida is growing in the vagina. Although thrush can be very uncomfortable, it is not usually serious, and treatment is simple.

How is it treated?

Thrush causes itching, soreness and irritation in and around the vagina and vulva and can be associated with pain or burning when you urinate or have sex. Some women also have a thick, clumpy, white (‘cottage cheese’) discharge that has no odor.

If you have any of the following symptoms of thrush please see your doctor. If you aren’t sure what you have or if this is the first time you have had these symptoms it is a good idea to get a medical review and run some tests. This is especially important if you are pregnant. Your doctor may want to take some swabs (tests) to be sure what you are dealing with. Yeast infections are common during pregnancy, possibly due to the increase in estrogen and the reduced immunity that goes along with it. If you are pregnant, don’t use medicine for a yeast infection without talking to your doctor first.

About 40% of pregnant women will develop thrush at some time during their pregnancy (4)

This feels familiar..

If you have had thrush before and are familiar with the symptoms, so long as you aren’t pregnant you can treat yourself at home with medicines you can buy over the counter. Antifungal creams, vaginal suppositories, or tablets/capsules are available. If your symptoms are mild, you may want to adjust your diet and wait to see if it clears up on its own. Candida thrives in a high sugar environment so reducing your sugar intake can help to limit the severity of the infection.

While what you are experiencing is probably thrush, there are other conditions with symptoms similar to these. These include bacterial vaginosis and sexually transmitted infections (STI’s). Products such as soap, bath oils, spermicidal jelly, or douches can also cause itching and redness of the vulva. If your symptoms are unfamiliar to you please see your doctor for testing and an accurate diagnosis.

Can I prevent it?

The following actions can help prevent a vaginal yeast infection:

Eat a balanced diet rich in fruits, vegetables, whole grains, and nonfat dairy products. So far there is no evidence to suggest eating cultured dairy foods that contain lactobacillus prevent or treat episodes of thrush.
Reduce your processed sugar intake.
Control diabetes.
Avoid unnecessary use of antibiotics. Antibiotics can kill off the good bacteria responsible for controlling the candida in you body.
Maintain high levels of immunity
Keep stress levels under control through life balance and lifestyle choices.

References:

Lamb, K. & Sanders, R. 2015, “Constipation and haemorrhoids: A midwifery perspective for the childbearing continuum”, British Journal of Midwifery, vol. 23, no. 3, pp. 171-177.
Aydin, A., Ahmed, K., Zaman, I., Khan, M.S. & Dasgupta, P. 2015, “Recurrent Urinary Tract Infections in Women”, Obstetrical & Gynecological Survey, vol. 70, no. 10, pp. 621-622.
Marshall, A.O. 2015, “Managing Recurrent Bacterial Vaginosis: Insights for Busy Providers: Managing Recurrent Bacterial Vaginosis”, Sexual Medicine Reviews, vol. 3, no. 2, pp. 88-92.
Duncan, D. 2014, “Recurrent and persistent thrush in pregnancy”, British Journal of Midwifery, vol. 22, no. 11, pp. 782-786.