My husband has difficulty passing urine. Help!

Dear Doc,

My husband has been having problems with passing urine, and he was told his prostate is bigger than usual. What would cause the prostate to be enlarged? Is there treatment for it?JoanDear Joan,

The prostate is an organ that is part of the male reproductive system. It is a gland that produces part of the seminal fluid (semen) that carries the sperms. It is located just below the urinary bladder, and it surrounds the tube that carries urine out from the bladder (the urethra). When the prostate is enlarged, it may put pressure on the urethra and make it difficult for urine to come out.

In most men, the prostate gland enlarges as they grow older, especially after the age of 45, and some of them experience urinary symptoms because of this enlargement. There is no definite known cause for it. Persons who have close family members with an enlarged prostate and persons with testicular abnormalities may be at a higher risk. 

This enlargement is known as benign prostate enlargement or hypertrophy (BPE or BPH) because it is non-cancerous. To differentiate between BPE and prostate cancer, several tests can be done, including taking a biopsy.

An enlarged prostate can cause urinary symptoms including having a feeling of incomplete emptying of the bladder; passing urine frequently; waking up at night more frequently to pass urine; having a weak urine stream; having dribbling of urine for some time after you are done passing urine; urinary incontinence; feeling like you have to pass urine urgently; needing to force out the urine; discomfort or pain when passing urine, and rarely, having blood in urine. 

The blockage in urine flow can also lead to complications like frequent urine infections; hydronephrosis and hydroureters (swelling of the kidneys and ureters because of accumulation of urine within them) and even kidney failure.

It is advisable for your husband to be followed up by a specialist (urologist) for evaluation and relevant tests. Depending on the severity of the symptoms and preference, medications may be prescribed to manage the symptoms, or surgical treatment may be done. In case he is on any other medications that may be affecting the urinary system, then these may be stopped or adjusted.

As part of self-care, he can have scheduled times when he goes to the toilet, and he should also go to the toilet as soon as he feels the urge. Alcohol and caffeine can increase the need to pass urine and should be avoided. Kegel’s exercises may also be beneficial in strengthening his pelvic muscles.

Dear Doc,

What would be causing recurrent ringworms in a seven-year-old boy? I have tried deworming him, but it doesn’t seem to work.
Molly

Dear Molly,
Ringworms are caused by a fungal infection affecting the skin, hair follicles or hair shafts of the scalp, the eyebrows or the eyelashes. The infection results in itchy patches that may be dry and scaly or that may be red and swollen, and there may also be hair loss or hair breakage. There may also be swollen lymph nodes and a low grade fever.

Ringworms can affect anyone, but they more commonly affect children between the age of three and 14 years, and those with weak immune systems. They spread easily from contact with infected people or animals, and also from contact with surfaces, things or soil that has the fungus. The infection is more common in tropical environments like ours, and spreads more easily where there is overcrowding, or sharing of items (such as towels, combs or hats), or if there is poor hygiene. Persons who sweat a lot also have a higher risk of getting a fungal infection.

Ringworms are diagnosed from examination and from analysis of a skin sample to identify the fungal infection. The infection is treated by taking antifungal oral medication for several weeks. Additionally, there are shampoos and creams that may be prescribed to stop the spread of the infection and to relieve some of the symptoms, though they need to accompany the oral medication. Other persons around the child also need to be examined for the infection and treated, so that the child does not get re-infected. Beddings, towels and any shared items should be cleaned thoroughly, and hand hygiene should be observed after coming into contact with pets.

Deworming does not treat ringworms; it eliminates worms from the gastrointestinal tract. 

Dear Doc,
I have noticed that my daughter has an increased appetite and has been eating a lot in the past few weeks. What could be causing this? She is eight. 
Concerned parent

Dear Concerned parent,

A child who is growing can have a high appetite. The appetite may increase if she is having a growth spurt, or if her activity level has increased. The appetite may also increase when the weather is cooler, or just because food is more readily available, for example because of being home during the school holidays. Children may also eat more due to changes in their emotional state such as a result of anxiety, stress, excitement, boredom or depression. Rarely, the increased appetite is a symptom of an underlying disease like diabetes, thyroid disease, or some brain disorders; or a side effect of a medication.

Since you are concerned about her appetite, it is advisable for you to keep a food diary to identify if there is a pattern to when she eats more (for instance when it is a sports day at school) or if there are specific foods she eats more of. You can also make and stick to a menu at home that provides adequate and varied meals, and healthy snacks in between mealtimes. Also, have a discussion with her about the concerns, and together create rules and look for alternatives for feeding behaviour that can be changed such as eating when bored.

She can also have a medical check-up to check on her overall health, get nutritional counseling and also evaluate for and treat any underlying conditions.

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