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Enlarged Prostate (BPH)

What is the prostate?

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

What is an enlarged prostate (BPH)?

An enlarged prostate is when your prostate gland becomes larger than normal. It's also called benign prostatic hyperplasia or BPH for short. Benign means not cancer. And hyperplasia means too much cell growth. BPH isn't cancer and it doesn't increase your risk of getting prostate cancer.

Usually, the prostate gland continues to grow during adult life. That's why BPH is the most common prostate condition in people over age 50. As the prostate gets bigger, it may press against the bladder and pinch the urethra. This can slow or block the flow of urine out of your bladder.

Over time, the bladder muscle may become weak from trying to pass urine through a narrow urethra. When this happens, your bladder may not empty completely when you urinate. A narrowed urethra and weak bladder cause many of the urinary problems you may have with BPH.

What causes an enlarged prostate (BPH)?

Researchers aren't sure why the prostate keeps growing. Some researchers think changes in hormones with aging may cause the prostate to get bigger.

Who is more likely to develop BPH?

You're more likely to develop BPH if you:

  • Are age 40 or older. The chance of getting BPH increases as you get older.
  • Have family members who have had BPH.
  • Have certain health conditions such as:
    • Obesity.
    • Heart disease and problems with blood circulation.
    • Type 2 diabetes.
    • Erectile dysfunction.
  • Don't get enough physical activity.
What are the symptoms of BPH?

Symptoms of BPH include:

  • Having a frequent or urgent need to urinate
  • Waking up many times to urinate
  • Having problems with urine flow, such as:
    • Trouble starting to urinate
    • A stream that's weak, slow, or stops and starts
    • Dribbling after urination
    • Urinary incontinence
    • Feeling that you can't completely empty your bladder
  • Pain after ejaculation or during urination
  • Urine with an unusual color or smell

It's important to see your health care provider if you have any of these symptoms because they could be from a more serious health problem.

You should get medical help right away if you:

  • Can't urinate at all
  • Have fever and chills with urination that's painful, frequent, and urgent
  • Have blood in your urine
  • Have pain in your lower abdomen (belly) and urinary tract
What other problems can BPH cause?

For most people, BPH doesn't cause other problems. But BPH increases your chance of developing serious conditions, including:

  • Acute urinary retention. With this condition, you suddenly can't urinate at all. This a medical emergency. Acute urinary retention is common in older males and the chance of having it increases with age. It may be triggered by:
    • Taking certain over-the-counter cold or allergy medicines
    • Drinking alcohol
    • Cold temperatures
    • Not moving enough over a long period of time
  • Urinary tract infections (UTIs)
  • Bladder damage and bladder stones
  • Kidney damage
How is BPH diagnosed?

To find out if you have BPH, your provider will:

  • Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
  • Ask about your family health history.
  • Examine you. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to check if your prostate is large, tender, or irregular in any other way.
  • Order medical tests, if needed, such as:
    • Urine tests.
    • A PSA blood test (prostate-specific antigen test).
    • Urodynamic testing to see how well you can hold and release urine.
    • Cystoscopy to look inside your urethra and bladder.
    • Ultrasound pictures of your prostate and urinary tract.
    • A prostate biopsy to diagnose or rule out prostate cancer.
What are the treatments for BPH?

Not everyone needs treatment for BPH. Treatment options depend on how much your symptoms bother you, your health, age, and the size of your prostate:

  • Lifestyle changes may improve mild symptoms. They include:

    • Drinking less before bedtime or going out
    • Avoiding or cutting back on beverages with caffeine and alcohol
    • Bladder training and exercising the muscles that control urine flow
    • Preventing or treating constipation
  • Medicines can help mild to moderate symptoms by:

    • Stopping the prostate from growing
    • Shrinking the prostate
    • Relaxing muscles to improve urine flow

    Sometimes combining 2 types of medicine helps more than taking just one type of medicine.

  • Medical procedures can help improve moderate to severe BPH symptoms when medicines don't help enough. There are several different types of procedures. They all use an instrument inserted into the urethra to either:

    • Widen the urethra
    • Destroy part of the prostate with heat
  • Surgery may be helpful when symptoms are severe, other treatments haven't helped, or you have another problem, such as bladder damage. Different types of surgery are used to:

    • Remove part or all of the prostate
    • Make cuts in the prostate to take pressure off the urethra

    Most BPH surgery is done with tools inserted into the urethra.

Your provider can explain the possible benefits and side effects of your treatment options so you can decide what's best for you.

Can BPH be prevented?

Researchers haven't found ways to prevent BPH. You can take care of your prostate health by:

  • Talking with your provider about your risk for developing an enlarged prostate
  • Getting regular checkups
  • Paying attention to your symptoms so you can get treatment early if you see signs of BPH

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Fatty Liver Disease

What is fatty liver disease?

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

  • Nonalcoholic fatty liver disease (NAFLD)
  • Alcoholic fatty liver disease, also called alcoholic steatohepatitis
What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

  • Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
  • Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.
What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who is at risk for fatty liver disease?

The cause of nonalcoholic fatty liver disease (NAFLD) is unknown. Researchers do know that it is more common in people who:

  • Have type 2 diabetes and prediabetes
  • Have obesity
  • Are middle aged or older (although children can also get it)
  • Are Hispanic, followed by non-Hispanic whites. It is less common in African Americans.
  • Have high levels of fats in the blood, such as cholesterol and triglycerides
  • Have high blood pressure
  • Take certain drugs, such as corticosteroids and some cancer drugs
  • Have certain metabolic disorders, including metabolic syndrome
  • Have rapid weight loss
  • Have certain infections, such as hepatitis C
  • Have been exposed to some toxins

NAFLD affects about 25% of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

How is fatty liver disease diagnosed?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use:

  • Your medical history
  • A physical exam
  • Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as:

  • An enlarged liver
  • Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

  • Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
  • Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
  • Get regular exercise, which can help you lose weight and reduce fat in the liver
  • Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

Heart Diseases

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Heart disease is the leading cause of death in the United States, but there are ways to prevent and manage many types of heart disease.

What are the types of heart disease?

There are many different types of heart disease. Some you may be born with, called congenital heart disease. Other types develop during your lifetime.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to other heart problems:

  • Angina - chest pain from lack of blood flow
  • Heart attacks - when part of the heart muscle dies from loss of blood flow
  • Heart failure - when your heart can't pump enough blood to meet your body's needs
  • Arrhythmia - a problem with the rate or rhythm of your heartbeat

Other types of heart diseases may affect your heart valves or heart muscle (cardiomyopathy).

What causes heart diseases?

The causes of heart disease depend on the type of disease. Some possible causes include lifestyle, genetics, infections, medicines, and other diseases.

Who is more likely to develop heart diseases?

There are many different factors that can make you more likely to develop heart disease. Some of these factors you can change, but others you cannot.

  • Age. Your risk of heart disease goes up as you get older.
  • Sex. Some factors may affect heart disease risk differently in women than in men.
  • Family history and genetics. A family history of early heart disease raises your risk of heart disease. And research has shown that some genes are linked to a higher risk of certain heart diseases.
  • Race/ethnicity. Certain groups have higher risks than others.
  • Lifestyle habits. Over time, unhealthy lifestyle habits can raise your risk heart disease:
    • Eating a diet high in saturated fats, refined carbohydrates, and salt.
    • Not getting enough physical activity.
    • Drinking too much alcohol.
    • Smoking and exposure to secondhand smoke.
    • Too much stress.
  • Having other medical conditions can raise your risk of heart diseases. These conditions include:
    • High blood pressure.
    • High cholesterol levels.
    • Diabetes.
    • Obesity.
    • Autoimmune and inflammatory diseases.
    • Chronic kidney disease.
    • Metabolic syndrome.
What are the symptoms of heart disease?

Your symptoms will depend on the type of heart disease you have. You may not have symptoms at first. In some cases, you may not know you have heart disease until you have a complication such as a heart attack.

How are heart diseases diagnosed?

To find out if you have heart disease, your health care provider will:

  • Ask about your medical history, including your symptoms
  • Ask about your family health history, including relatives who have had heart disease
  • Do a physical exam
  • Likely run heart tests and blood tests

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

What are the treatments for heart disease?

Treatment plans for heart disease depend on the type of heart disease you have, how serious your symptoms are, and what other health conditions you have. Possible treatments may include:

  • Heart-healthy lifestyle changes
  • Medicines
  • Procedures or surgeries
  • Cardiac rehabilitation
Can heart diseases be prevented?

You may be able to lower your risk of certain heart diseases by making heart-healthy lifestyle changes and managing any other medical conditions you have.

NIH: National Heart, Lung, and Blood Institute

Hyperthyroidism

What is hyperthyroidism?

Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid hormones than your body needs.

Your thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that control the way the body uses energy. These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. If not treated, hyperthyroidism can cause serious problems with your heart, bones, muscles, menstrual cycle, and fertility. But there are treatments that can help.

What causes hyperthyroidism?

Hyperthyroidism has several causes. They include:

  • Graves' disease, an autoimmune disorder in which your immune system attacks your thyroid and causes it to make too much hormone. This is the most common cause.
  • Thyroid nodules, which are growths on your thyroid. They are usually benign (not cancer). But they may become overactive and make too much thyroid hormone. Thyroid nodules are more common in older adults.
  • Thyroiditis, inflammation of the thyroid. It causes stored thyroid hormone to leak out of your thyroid gland.
  • Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements. Taking too much of them can cause your thyroid to make too much thyroid hormone.
  • Too much thyroid medicine. This can happen if people who take thyroid hormone medicine for hypothyroidism (underactive thyroid) take too much of it.
Who is at risk for hyperthyroidism?

You are at higher risk for hyperthyroidism if you:

  • Are a woman
  • Are older than age 60
  • Have been pregnant or had a baby within the past 6 months
  • Have had thyroid surgery or a thyroid problem, such as goiter
  • Have a family history of thyroid disease
  • Have pernicious anemia, in which the body cannot make enough healthy red blood cells because it does not have enough vitamin B12
  • Have type 1 diabetes or primary adrenal insufficiency, a hormonal disorder
  • Get too much iodine, from eating large amounts of foods containing iodine or using iodine-containing medicines or supplements
What are the symptoms of hyperthyroidism?

The symptoms of hyperthyroidism can vary from person to person and may include:

  • Nervousness or irritability
  • Fatigue
  • Muscle weakness
  • Trouble tolerating heat
  • Trouble sleeping
  • Tremor, usually in your hands
  • Rapid and irregular heartbeat
  • Frequent bowel movements or diarrhea
  • Weight loss
  • Mood swings
  • Goiter, an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing.

Adults over age 60 may have different symptoms than younger adults. For example, they may lose their appetite or withdraw from other people. Sometimes this can be mistaken for depression or dementia.

What other problems can hyperthyroidism cause?

If hyperthyroidism isn't treated, it can cause some serious health problems, including:

  • An irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart problems
  • An eye disease called Graves' ophthalmopathy. It can cause double vision, light sensitivity, and eye pain. In rare cases, it can lead to vision loss.
  • Thinning bones and osteoporosis
  • Fertility problems in women
  • Complications in pregnancy, such as premature birth, low birth weight, high blood pressure in pregnancy, and miscarriage
How is hyperthyroidism diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, including asking about symptoms
  • A physical exam
  • Thyroid tests, such as
    • TSH, T3, T4, and thyroid antibody blood tests
    • Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.
What are the treatments for hyperthyroidism?

The treatments for hyperthyroidism include medicines, radioiodine therapy, and thyroid surgery:

  • Medicines for hyperthyroidism include
    • Antithyroid medicines, which cause your thyroid to make less thyroid hormone. You probably need to take the medicines for 1 to 2 years. In some cases, you might need to take the medicines for several years. This is the simplest treatment, but it is often not a permanent cure.
    • Beta blocker medicines, which can reduce symptoms such as tremors, rapid heartbeat, and nervousness. They work quickly and can help you feel better until other treatments take effect.
  • Radioiodine therapy is a common and effective treatment for hyperthyroidism. It involves taking radioactive iodine by mouth as a capsule or liquid. This slowly destroys the cells of the thyroid gland that produce thyroid hormone. It does not affect other body tissues. Almost everyone who has radioactive iodine treatment later develops hypothyroidism. This is because the thyroid hormone-producing cells have been destroyed. But hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism.
  • Surgery to remove part or most of the thyroid gland is done in rare cases. It might be an option for people with large goiters or pregnant women who cannot take antithyroid medicines. If you have all of your thyroid removed, you will need to take thyroid medicines for the rest of your life. Some people who have part of their thyroid removed also need to take medicines.

If you have hyperthyroidism, it's important not to get too much iodine. Talk to your health care provider about which foods, supplements, and medicines you need to avoid.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hypothyroidism

What is hypothyroidism?

Hypothyroidism, or underactive thyroid, happens when your thyroid gland doesn't make enough thyroid hormones to meet your body's needs.

Your thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that control the way the body uses energy. These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. Without enough thyroid hormones, many of your body's functions slow down. But there are treatments that can help.

What causes hypothyroidism?

Hypothyroidism has several causes. They include:

  • Hashimoto's disease, an autoimmune disorder where your immune system attacks your thyroid. This is the most common cause.
  • Thyroiditis, inflammation of the thyroid
  • Congenital hypothyroidism, hypothyroidism that is present at birth
  • Surgical removal of part or all of the thyroid
  • Radiation treatment of the thyroid
  • Certain medicines
  • In rare cases, a pituitary disease or too much or too little iodine in your diet
Who is at risk for hypothyroidism?

You are at higher risk for hypothyroidism if you:

  • Are a woman
  • Are older than age 60
  • Have had a thyroid problem before, such as a goiter
  • Have had surgery to correct a thyroid problem
  • Have received radiation treatment to the thyroid, neck, or chest
  • Have a family history of thyroid disease
  • Were pregnant or had a baby in the past 6 months
  • Have Turner syndrome, a genetic disorder that affects females
  • Have pernicious anemia, in which the body cannot make enough healthy red blood cells because it does not have enough vitamin B12
  • Have Sjogren's syndrome, a disease that causes dry eyes and mouth
  • Have type 1 diabetes
  • Have rheumatoid arthritis, an autoimmune disease that affects the joints
  • Have lupus, a chronic autoimmune disease
What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism can vary from person to person and may include:

  • Fatigue
  • Weight gain
  • A puffy face
  • Trouble tolerating cold
  • Joint and muscle pain
  • Constipation
  • Dry skin
  • Dry, thinning hair
  • Decreased sweating
  • Heavy or irregular menstrual periods
  • Fertility problems in women
  • Depression
  • Slowed heart rate
  • Goiter, an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing.

Because hypothyroidism develops slowly, many people don't notice symptoms of the disease for months or even years.

What other problems can hypothyroidism cause?

Hypothyroidism can contribute to high cholesterol. In rare cases, untreated hypothyroidism can cause myxedema coma. This is a condition in which your body's functions slow down to the point that it becomes life-threatening.

During pregnancy, hypothyroidism can cause complications, such as premature birth, high blood pressure in pregnancy, and miscarriage. It can also slow the baby's growth and development.

How is hypothyroidism diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, including asking about your symptoms
  • A physical exam
  • Thyroid tests, such as
    • TSH, T3, T4, and thyroid antibody blood tests
    • Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.
What are the treatments for hypothyroidism?

The treatment for hypothyroidism is medicine to replace the hormone that your own thyroid can no longer make. About 6 to 8 weeks after you start taking the medicine, you will get a blood test to check your thyroid hormone level. Your health care provider will adjust your dose if needed. Each time your dose is adjusted, you'll have another blood test. Once you find the right dose, you will probably get a blood test in 6 months. After that, you will need the test once a year.

If you take your medicine according to the instructions, you usually should be able to control the hypothyroidism. You should never stop taking your medicine without talking with your health care provider first.

If you have Hashimoto's disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Talk to your health care provider about which foods, supplements, and medicines you need to avoid.

Women need more iodine when they are pregnant because the baby gets iodine from the mother's diet. If you are pregnant, talk with your health care provider about how much iodine you need.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

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