chatwithketch

Q: Hello Dr, how can I treat hemorrhoids after giving birth?

A: Thanks for writing in and congratulations on your baby! Haemorrhoids are swollen veins in the anal canal. They can be internal, external or both internal and external can co-exist. Internal haemorrhoids occur when veins swell within the rectum and external haemorrhoids are found under the skin around the anus.

These haemorrhoids develop when there is undue pressure in the pelvic and anal area as can occur when people strain to pass faeces (if they have diarrhoea or are constipated), in pregnancy (especially the last 6 months), in obese people, people who eat diets low in fibre and people who practice anal intercourse. When women strain in labour, haemorrhoids can also be made worse.

It is important to consult your doctor to make a proper diagnosis.

In the meantime, limit the discomfort you have by keeping the anal area clean, using wet wipes (non-perfumed) or washing with unscented soap when cleaning up after using the loo, sitting on a bowl of plain warm water for about 15 minutes about twice or three times per day, applying cold compress and not standing or sitting for too long. Some believe sprinkling some powder there helps…it doesn’t! Avoid it J

To prevent this, ensure that your diet has sufficient amounts of fruits and vegetables. Remember that if you take a regular flat plate, half of this should be filled with fruits and vegetables, half of the plate with complex carbohydrates and the last half with proteins.

Limit the time you spend sitting on the toilet seat (read your newspapers elsewhere :D), use the toilet as soon as you feel pressed (that way the fluid in the stool is not absorbed making the stool hard) and then don’t strain when you do go. Drink sufficient quantities of water daily, exercise (to keep everything moving along nicely :D). Use pain relief only under the supervision of your doctor, especially if you’re breastfeeding.

I hope this helps you.

Have a fab weekend, everyone 😀

Q: Hello I would like to know if sitting in warm or hot water in the bath tub can damage the walls of the vagina or the vagina itself.

A: Hi dear, what you describe is a sitz bath and is typically used by women who have had episiotomies. Can it damage the walls of the vagina? No, especially if you follow the tips in this post. My assumption here is that the sitz bath is for an episiotomy.

What’s a sitz bath? This is a warm water bath that helps cleanse the perineum. Just in case you wondered, the perineum is that space between the rectum and the genitals. The right temperature is the one that you can handle without sustaining burns. Putting a few drops of this water on the inner surface of your wrist can help confirm this.
Plain warm water is sufficient but some people add salt to the water which is soothing. Your doctor may also suggest other things he/she may want you to add to the water.

To prepare this, you can either use the plastic sitz bath kit, (a special bowl specifically made for this which fits on your toilet seat so you can sit down easily on it), or your bath tub. Be sure to scrub your plastic sitz bath kit or bathtub, thoroughly, before and after use. If using the bathtub, add sufficient warm water to sit on and then get in. To get the job done properly, you can try hanging your legs out of the tub. Usually, you are encouraged to sit for 10 to 15 minutes on the water. Pat the perineal area dry after you’re done. Do not rub vigorously…remember the area is sore and if you’ve had stitches, it could mess things up 😀 This can be repeated up to 3 to 4 times daily as needed.

To ensure that the episotomy site heals well, use prescribed pain medication, avoid sitting on hard surfaces. Try using a pillow ( a regular or circular one/boppy pillow). Avoid constipation and indeed diarrhea and try placing a pad over the suture area while bearing down to poop. Urinating presents a challenge as pain is experienced during this process. Try using water to rinse off afterwards, preferably using a squirt bottle.

Eat healthy, keep the surgery site as clean as possible and enjoy your time with your baby. This too shall pass. Be sure to let your doctor know if you have concerns.

Have a good night y’all 😀

Q: Hello, Doctor. GOD bless you for the good work that you are doing to help us.
I am your follower from Zambia and really need your help now.
I have two problems.
1. I got circumcised in 2012, and for the past months I have been feeling pain inside my penis just before the head when the penis erects. I have never had sex before, but I usually feel this pain when I get an erection in the morning and when I am aroused. I am scared this could be worse when engaging in sex with my wife when I get married Doctor.
2. My penis bends to the left when it erects, could this cause me any problem to my sexual life when i get married?  
Doctor, I have never opened up to anybody of my conditions, I need your help. Thank you, and GOD bless you.

A: Hi dear, thanks for opening up to me. I hope this post helps you

Typically, after a circumcision, especially in adults, there’s bruising and swelling of the penile area for about 2 to 3 weeks. Urination may also be painful during this period but although there is general discomfort following the procedure, the pain level is not really severe and analgesics can help.

Some tips to help recovery…

• People think wearing loose fitting boxers or underwear is ideal but the opposite is actually recommended. Use underwear that hald the penis in place
• Make sure that your urine is dilute to prevent the burning pain that could happen with acidic urine during urination. How do you do that? Drink a lot of water and put a dab of petroleum jelly to the penile tip to reduce the burning pain
• Apply only those creams that have been prescribed by your doctor to the circumcision site to encourage healing and avoid infections
• Physical activity may be difficult for a couple of weeks; so leave well alone 😀

Erections are typically painful after this procedure and while in recovery. So you don’t really want to have erections at this time. To reduce the chances of nocturnal emissions:

• Try lying on your side when sleeping
• Try drawing your knees up too in a fetal position
• Urinate and ensure your bladder is empty before bedtime

Now, if indeed your circumcision was seven years ago (in 2012), the symptoms you are experiencing may not be associated with the procedure.

Some causes of penile pain include:

• Priapism: Priapism is a condition, in which there is a sustained and oftentimes, painful erection of the penis, continues for hours beyond sexual stimulation or even when there is no sexual stimulation. It is more common in men in their 30s.

There are three types of priapism (ischaemic, non-ischaemic and recurrent) but to understand this, we’ll take a look at the mechanism of erection. An erection occurs in response to stimulation, physical or psychological. As a result of this stimulation, the blood vessels and smooth muscles of the penis relax, allowing increased blood flow to the penis. This is what causes erection. When the stimulation is over, the vessels and smooth muscles constrict causing the blood to flow out of the penis and become flaccid. In priapism, the order of events causing the blood to flow out of the penis is changed such that the blood does not flow out of the penis

In ischaemic priapism, which is the more common type due to inability of blood to leave the penis, there is pain, rigid penile shaft but flaccid glans (penile tip) and the erection lasts more than 4 hours! Causes include blood disorders like sickle cell anaemia and injuries to the penis and/or pelvis, alcohol, cocaine and other illicit drug use, some medications like blood thinners and antidepressants, cancer of the penis etc.

Non-ischaemic priapism is usually due to an injury to the perineum or genitals that results in poor regulation of penile blood flow. It is not usually painful and manifests as erection that lasts for more than 4 hours but the penile shaft is not fully rigid.

In recurrent priapism, situation is similar to ischaemic priapism with erections that are painful, recurrent but ease after 2 to 3 hours. These erections may subsequently progress to become more frequent and more prolonged. It is common in males with sickle cell anaemia

Any sort of priapism should be checked out with a medical doctor (urologist) to determine type, cause and management. Erection lasting more than 4 hours is an emergency and may led to damage of the penis and subsequent erectile dysfunction. Treatment depends on cause and should be started as soon as possible.

Options include aspiration (in which blood is drained out of the penis with a syringe), use of medications to constrict the penile blood vessels, treatment of underlying medical condition like sickle cell anaemia and surgery in some cases. Note of warning, though it sounds very simple to use a syringe to drain out the blood in the penis, you must never attempt it on your own. You must visit a hospital and let a doctor work out the best treatment option(s) for you. Patients who do not get treated early enough and some that went through surgery eventually end up with poor erectile functions despite the successful treatment.

• Balanitis: Skin irritation of the head of the penis, known as balanitis, could present with itching as you described. Causes include:
  Irritation under the foreskin caused by urine
  • Candidiasis
  • Use of shower gels, soaps and other skin irritants
  • Skin conditions like eczema
  • STI
  • Poor hygiene

Your doctor will work with you to determine the cause and treatment is dependent on that.

• Urinary tract infections: In men, UTIs are not so common and would happen more in people who have an enlarged prostate, people who have a poor immune system and people who have kidney and bladder infections. Symptoms include frequent urination, difficulty with urination, pain during urination, fever etc. Involvement if the kidney leads to loin pain in addition to worsening of feelings if illness.
  The doctor will usually send a urine sample to the laboratory to check for bacteria present in the urine and what antibiotic(s) are effective against them. Be sure to take the antibiotics for the prescribed period of time, even if you feel better before you finish the course to prevent backtracking of infection into the kidneys. Drink a lot of water and take analgesics for pain, if needed.In summary, your specific treatment depends on the organism that is found in your urine at the laboratory. Be sure not to prescribe antibiotics for yourself!

For more on urinary tract infections, please click on the link below:
https://chatwithdrketch.com/2014/05/16/daily-health-tips-urinary-tract-infections/

• Sexually transmitted infections like syphilis, gonorrhea and chlamydia, injuries to the penis, penile cancer, phimosis in which the foreskin of the penis is stretched too tight and cannot be pulled away from the head of the penis, can cause penile pain.

Treatment depends on cause and some have been described above. Antibiotics can be used to treat UTIs and some STIs, including chlamydia, gonorrhea, and syphilis. Stretching the foreskin with fingers may make it looser in phimosis. Steroid creams rubbed on the penis can also help. In some cases, surgery is necessary in phimosis and/or cancer. In the latter, radiation treatment or chemotherapy could be included.

So, your first step is to see your doctor for a proper diagnosis and treatment.

As to your second question, it’s quite common for the penis to bend slightly to the left or right when erect. But if you think it curves more than it should and probably causes pain, then please see your doctor.

All the best!

Q: God bless you Doc for your medical contributions and advice. Please I am a mother of one, expecting the second soonest. I gave birth to my first girl through CS because of prolonged labor. Now can I deliver this second baby through vaginal birth without any complications as my Doc has not prescribed CS for me? What are the chances of delivering normally? Thanks ma’am

A: Thanks for your kind words and I’m eagerly waiting for your second with you 😀

Can you deliver vaginally? Yes, you can. Having had one C-section means you can still try for a VBAC (pronounced Vee-Back and means Vaginal Birth After a Caesarian) but a few years back,  once you’d had two C-sections, it meant you could only have subsequent children with the same procedure. That thinking has changed now and so even having had 2 C-sections may not be an automatic sentence to the knife, anymore 😀 However, there are a few factors that influence the decision for or against a VBAC. An important factor is that people who have had a transverse cut C-section (Lower Segment C-Section in which the cut on the abdomen is made from in the lower abdomen running from left to right) are more likely to be successful candidates for VBAC than those with vertical cuts (classical C-section in which there is a longitudinal cut on the abdomen). So, be guided by your doctor and remember that just because your doctor has said it is okay to try for a vaginal birth after a Caesarian Section does not necessarily mean that it will be successful. The woman may very well still end up having a Caesarian Section if a vaginal delivery is tried and it fails.

Generally, there is no specific number of C-sections that a woman is meant to have (especially in centers with significant technological advancement), though about 3 used to be the mark. There are women who have had more than 3 and are alive to tell the story. Having said that, the more the number of sections, the more the risks and complications the woman is exposed to.

Common risks and complications include:
• Weakening of the wall of the uterus wall with risk of uterine rupture!

• Healing after a C-section comes with development of scar tissue which may subsequently cause adhesions as they cause abdominal organs to stick to each other. This may lead to obstruction of the bowel or even block the fallopian tubes, leading to infertility. These adhesions may develop between the uterus and the bladder making it easier to injure the bladder with subsequent C-sections.

• Placental problems may occur in people who have had C-sections as the placenta may be implanted too deeply into the womb or there may be placenta previa. In these instances, removing the placenta presents a challenge and may result in profuse bleeding which requires blood transfusion.

For more on placenta previa, please click on these:
https://chatwithdrketch.com/2015/03/09/daily-health-tips-can-placenta-previa-recur-in-my-pregnancy/

Daily Health Tips: Placenta Previa

Have a good night, y’all 😀

April 2^nd every year is World Autism Awareness Day.

Ever heard of autism? It is major developmental problem that usually appears in early childhood and usually affects a child’s communication and interaction with other people.

These children usually do not respond to their environment or people. They may not respond when they are called, they would resist hugging/cuddling, do not maintain eye contact and generally prefer playing alone. They may not speak properly or speak later than expected, they don’t appear to understand simple instructions and they usually have a sing-song kind of voice. They also usually perform repetitive motions like rocking, may indulge in self-harming activities like head banging and may have the craving for things like chalk or other items not considered food.

Think about how many of these children have been branded witches in our traditional African societies. Think about how many of them have been beaten blue and black by parents who feel they are not smart enough. Think about the laughter and scorn these children go through. Food for thought.

Who is at risk? Autism can affect anyone but boys are more likely to have it, families with one autistic child are likely to have another and it is also thought that perhaps children born to older parents are more at risk.

Regarding treatment, please note that there is no cure, but autistic children can live full and happy lives if this is discovered on time. The focus is on their areas of concern: communication and social interaction. Family therapy sessions focus on equipping families with the skills to take care of these children and interact with them in a way that encourages them to interact socially; educational therapies aimed at providing structured learning programs have also been successful, and usually these involve a team of specialists. Other programs aimed at addressing their communication and behavioural skills help reduce the problems associated with this area of their lives and teach them new skills.

There are no drugs for the treatment of autism but some meds are given to treat the symptoms that arise. For instance, drugs may be given if the child is too hyperactive etc.

There’s a support group for autism in different countries. In Nigeria, the Nigerian Autistic Society could be a useful resource.

Have agood night, y’all 😀

Q: Hello Doc., please help me here? When is the exact time to start to have sex after giving birth??

A: Good question 😀 The honest answer is, as soon as you and your spouse feel up to it. Usually, 6 weeks is advocated at which time the woman would have had a post-natal check.  However, there is really no scientific basis for this and the time a woman feels like intimacy could differ from woman to woman. Some women feel ready earlier and some much later. Bear in mind that there are new issues contending for attention here…namely the new baby who requires a lot of attention, the overwhelming emotion of being in charge of a new life especially for new mothers, the sheer exhaustion after looking after the baby’s needs and sleep deprivation, the pain of vaginal suturing, if the woman had a tear, the dryness of the vagina at this time etc. We could go on and on! So, with all these, it may be difficult to feel really sexy…trust me, I know 😀

So, what’s the way forward? New mums, get as much help as you can so that you don’t feel exhausted every night. Also, rest whenever the baby is taking a nap. Perhaps, timing for intimacy can also be re-scheduled to other times…maybe mornings while the baby is still sleeping etc. Then again, you don’t have to wait for full sexual intercourse to be intimate. You can start off with cuddling and then move on to more adventurous things. Lubrication may also be a great idea to help with vaginal dryness. To help restore muscular tone to the vagina, pelvic floor exercise (Kegel exercises) should be started as soon as possible. The exercise mimics the movements we make when we want to stop the flow of urine. Try holding this for about 10 seconds and then doing about 10 repetitions per set. Try about 4 to 6 sets per day and increase this as you feel ready.

Remember birth control even if you’re breastfeeding exclusively. You don’t want to get pregnant while nursing a baby, right? 😀

I hope this helps 😀

Good night J

It’s about 2 weeks to Easter. Some of you are already planning to cook up a storm. The rest of you may be travelling and catching up with friends and family…this comes with its special brand of stress 😀 But, there’s just something about holidays that make us forget all the good things we’ve been doing, especially in terms of eating healthy and exercising, and go the ‘dark’ way 😀 Some tips to help you get through this holiday season – a mix of having a great time and keeping healthy!

https://www.health.harvard.edu/staying-healthy/3-health-strategies-to-help-you-get-through-the-holidays

Q: Hello Doctor Ketch. I have a problem. I had a depo injection for the first time after a long time of not using it. I had this injection on the 27^th of November and I was to go back on the 17^th of February. At the end of the month of December, I just had a two-day period. After that it stopped. My problem now is that at the end of March I didn’t get my period. I met my husband early March. Does it mean I may be pregnant? I just feel tired though because I never went back for another injection on the 17^th.

A: Taking these injections affect women differently. In the first few months, there is excessive bleeding during periods, followed by a period of lighter periods. This may yet be followed by a period of irregular or no periods especially in women who have taken these injections for up to a year. Irregular periods should be discussed with your doctor to ascertain the cause. It may be due to the drug or due to an infection, which needs to be treated. Prolonged periods can also be treated.

With any of the injections, it might take up to one year (or 2) before the return of periods and fertility. This is really irrespective of whether it is the 2 months’ or 3 months’ injection. And typically, it is a delay not necessarily a case of not being able to conceive again. In the same vein, because the effects of these injections range from 2 months to 3 months, depending on the one taken, then if there were side effects, one would have to bear them for that same period of time.

So, to your question, could you be pregnant? Maybe or maybe not. Run a test and you will know for sure 😀

All the best!

I hope this helps 😀