Symp­toms in com­mon can con­fuse

The Weekend Australian - Travel - - Health - LINDA CAL­ABRESI

A few weeks ago you wrote about in­ter­sti­tial cys­ti­tis. I have heard about a con­di­tion called vul­var vestibu­li­tis syn­drome, which sound like it in­volves very sim­i­lar symp­toms. Are they the same? No, they are dif­fer­ent con­di­tions, al­though some symp­toms can be com­mon to both. The most com­mon and char­ac­ter­is­tic fea­tures of in­ter­sti­tial cys­ti­tis are blad­der pain and an of­ten-painful feel­ing that you need to empty your blad­der fre­quently. Women with this con­di­tion can get pain with sex­ual in­ter­course, and pain in the vag­ina, ure­thra or vulva, but that is far less com­mon. Vul­var vestibu­li­tis syn­drome is char­ac­terised by vul­val pain and pain as­so­ci­ated with sex­ual in­ter­course at the point of en­try. While the cause of this syn­drome re­mains un­known, it is gen­er­ally thought to be an in­flam­ma­tory con­di­tion. Some­times it is trig­gered by a Can­dida in­fec­tion also known as thrush. In other cases there is a his­tory of us­ing soaps or other ir­ri­tants on the skin of that area, which could have pre­cip­i­tated the prob­lem. Un­for­tu­nately both con­di­tions can per­sist, and of­ten prove dif­fi­cult to treat. Over the last two years my urine seems to have de­vel­oped a very strong smell. Not all the time — just ev­ery now and then, and it is not as­so­ci­ated with any uri­nary tract in­fec­tions or any uri­nary symp­toms. The start of the prob­lem seemed to have co­in­cided with a new re­la­tion­ship. I am54 and had a hys­terec­tomy 10 years ago. USU­ALLY urine has very lit­tle odour— how­ever, it can be­come more con­cen­trated when you are de­hy­drated, and then there is a stronger smell. Check you are drink­ing suf­fi­cient wa­ter each day and see if the prob­lem re­curs. Hav­ing ex­cluded uri­nary tract in­fec­tion (pre­sum­ably a urine sam­ple was sent to pathol­ogy for test­ing), other pos­si­ble causes of the smelly urine in­clude cer­tain foods, such as as­para­gus, and some med­i­ca­tions in­clud­ing vi­ta­min B6 sup­ple­ments. There are some med­i­cal con­di­tions as well that could be caus­ing the prob­lem, such as di­a­betes or liver dis­ease, but gen­er­ally speak­ing you would nor­mally be hav­ing some other symp­toms as well as strong-smelling urine if one of th­ese was the cause, es­pe­cially af­ter two years. Some­times a smell at­trib­uted to the urine is, in fact, orig­i­nat­ing from a vagi­nal dis­charge. Vagi­nal in­fec­tions such as gard­nerella or tri­chomonas are com­monly as­so­ci­ated with an odour— most of­ten fishy-smelling. Once di­ag­nosed they are very treat­able. I amap­proach­ing 40 and have started tak­ing mul­ti­vi­ta­mins. Are th­ese ben­e­fi­cial? I amgenerally healthy al­though I do take med­i­ca­tion for high blood pres­sure. THERE is plenty of ev­i­dence that sug­gests eat­ing a lot of fruit and veg­eta­bles is as­so­ci­ated with a longer, health­ier life. Such a diet is as­so­ci­ated with a re­duced risk of var­i­ous can­cers and heart dis­ease. Be­cause of this, many peo­ple be­lieve that by tak­ing sup­ple­ments of the vi­ta­mins and min­er­als found in fruits and veg­eta­bles they will re­ceive the same health ben­e­fits. Un­for­tu­nately, how­ever, the ev­i­dence doesn’t gen­er­ally sup­port this. It seems the value of a high fruit and veg­etable in­take is not sim­ply re­lated to par­tic­u­lar vi­ta­mins and min­er­als. Sup­ple­ments do not ap­pear to be an ad­e­quate sub­sti­tute. Also, sup­ple­ment­ing a diet that is not nu­tri­ent-de­fi­cient has not been shown to of­fer any in­creased pro­tec­tion against can­cer or heart dis­ease. Mind you, if your diet is de­fi­cient in cer­tain nu­tri­ents — per­haps the re­sult of a ve­gan diet, or be­cause you have par­tic­u­lar nu­tri­tional re­quire­ments for rea­sons of chronic ill-health — then sup­ple­men­ta­tion is of­ten worth­while. Linda Cal­abresi is a Syd­ney GP and ex­ec­u­tive ed­i­tor of www.6min­utes.com.au, a news ser­vice for Aus­tralian doc­tors. Send your queries to lin­da­cal­abresi@gmail.com

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