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What to do for What I need to know about Gestational Diabetes ? | - Gestational diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. - Gestational diabetes happens when your body can't make enough insulin during pregnancy. Insulin is a hormone made in your pancreas, an organ located behind your stomach. Insulin helps your body use glucose for energy and helps control your blood glucose levels. - You will probably be tested for gestational diabetes between weeks 24 and 28 of your pregnancy. If you have a higher chance of getting gestational diabetes, your doctor may test you for diabetes during your first visit after you become pregnant. - If you have high blood glucose levels because your gestational diabetes is not under control, your baby will also have high blood glucose. - Untreated or uncontrolled gestational diabetes can cause problems for your baby. - Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. - Even if your blood glucose levels return to normal after your pregnancy, your chances of getting diabetesusually type 2 diabeteslater in life are high. Therefore, you should be tested at least every 3 years for diabetes or prediabetes. - You can give your baby a healthy start by breastfeeding. - You can help your child be healthy by showing your child how to make healthy lifestyle choices, including being physically active, limiting screen time in front of the TV or video games, eating a healthy diet, and staying at a healthy weight. | NIDDK | What I need to know about Gestational Diabetes |
What are the symptoms of Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ? | Dermatitis herpetiformis is characterized by small, clustered papules and vesicles that erupt symmetrically on the elbows, knees, buttocks, back, or scalp. The face and groin can also be involved. A burning sensation may precede lesion formation. Lesions are usually scratched off by the time a patient comes in for a physical exam, and the rash may appear as erosions and excoriations.
Patients with DH may also experience dental enamel defects to permanent teeth, which is another manifestation of celiac disease. Less than 20 percent of people with DH have symptoms of celiac disease.3 | NIDDK | Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) |
What causes Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ? | Dermatitis herpetiformis is caused by the deposit of immunoglobulin A (IgA) in the skin, which triggers further immunologic reactions resulting in lesion formation. DH is an external manifestation of an abnormal immune response to gluten, in which IgA antibodies form against the skin antigen epidermal transglutaminase.
Family studies show that 5 percent of first-degree relatives of a person with DH will also have DH. An additional 5 percent of first-degree relatives of a person with DH will have celiac disease.4 Various other autoimmune diseases are associated with DH, the most common being hypothyroidism. | NIDDK | Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) |
How to diagnose Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ? | A skin biopsy is the first step in diagnosing DH. Direct immunofluorescence of clinically normal skin adjacent to a lesion shows granular IgA deposits in the upper dermis. Histology of lesional skin may show microabscesses containing neutrophils and eosinophils. However, histology may reveal only excoriation due to the intense itching that patients experience.
Blood tests for antiendomysial or anti-tissue transglutaminase antibodies may also suggest celiac disease. Blood tests for epidermal transglutaminase antibodies are positive in more than 90 percent of cases.5 All of these tests will become negative with prolonged adherence to a gluten-free diet.
A positive biopsy and serology confirm DH and should be taken as indirect evidence of small bowel damage. A biopsy of the small bowel is usually not needed for DH diagnosis. However, if clinical signs of gastrointestinal disease are evident on examination, further workup may be required.2 Whether or not intestinal damage is evident, a gluten-free diet should be implemented because the rash of DH is gluten sensitive.4 | NIDDK | Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) |
What are the treatments for Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ? | The sulfone dapsone can provide immediate relief of symptoms. For patients who cannot tolerate dapsone, sulfapyridine or sulfamethoxypyridazine may be used, although these medications are less effective than dapsone. A strict gluten-free diet is the only treatment for the underlying disease. Even with a gluten-free diet, medication therapy may need to be continued from a few months to 2 years.
DH can go into remission, which is defined as absence of skin lesions and symptoms of DH for more than 2 years while not taking sulfones or other treatments and not adhering to a gluten-free diet. Cohort studies showing DH remission provide support for reducing sulfone therapy and weaning from a gluten-free diet in patients with well-controlled DH.6 | NIDDK | Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) |
What is (are) Causes of Diabetes ? | Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.
Diabetes is a disorder of metabolismthe way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both.
Insulin is made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.
If beta cells dont produce enough insulin, or the body doesnt respond to the insulin that is present, glucose builds up in the blood instead of being absorbed by cells in the body, leading to prediabetes or diabetes. Prediabetes is a condition in which blood glucose levels or A1C levelswhich reflect average blood glucose levelsare higher than normal but not high enough to be diagnosed as diabetes. In diabetes, the bodys cells are starved of energy despite high blood glucose levels.
Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other complications of diabetes may include increased susceptibility to other diseases, loss of mobility with aging, depression, and pregnancy problems. No one is certain what starts the processes that cause diabetes, but scientists believe genes and environmental factors interact to cause diabetes in most cases.
The two main types of diabetes are type 1 diabetes and type 2 diabetes. A third type, gestational diabetes, develops only during pregnancy. Other types of diabetes are caused by defects in specific genes, diseases of the pancreas, certain drugs or chemicals, infections, and other conditions. Some people show signs of both type 1 and type 2 diabetes. | NIDDK | Causes of Diabetes |
What causes Causes of Diabetes ? | Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the bodys own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time.
Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type 1 diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus.
Latent autoimmune diabetes in adults (LADA) may be a slowly developing kind of type 1 diabetes. Diagnosis usually occurs after age 30. In LADA, as in type 1 diabetes, the bodys immune system destroys the beta cells. At the time of diagnosis, people with LADA may still produce their own insulin, but eventually most will need insulin shots or an insulin pump to control blood glucose levels.
Genetic Susceptibility
Heredity plays an important part in determining who is likely to develop type 1 diabetes. Genes are passed down from biological parent to child. Genes carry instructions for making proteins that are needed for the bodys cells to function. Many genes, as well as interactions among genes, are thought to influence susceptibility to and protection from type 1 diabetes. The key genes may vary in different population groups. Variations in genes that affect more than 1 percent of a population group are called gene variants.
Certain gene variants that carry instructions for making proteins called human leukocyte antigens (HLAs) on white blood cells are linked to the risk of developing type 1 diabetes. The proteins produced by HLA genes help determine whether the immune system recognizes a cell as part of the body or as foreign material. Some combinations of HLA gene variants predict that a person will be at higher risk for type 1 diabetes, while other combinations are protective or have no effect on risk.
While HLA genes are the major risk genes for type 1 diabetes, many additional risk genes or gene regions have been found. Not only can these genes help identify people at risk for type 1 diabetes, but they also provide important clues to help scientists better understand how the disease develops and identify potential targets for therapy and prevention.
Genetic testing can show what types of HLA genes a person carries and can reveal other genes linked to diabetes. However, most genetic testing is done in a research setting and is not yet available to individuals. Scientists are studying how the results of genetic testing can be used to improve type 1 diabetes prevention or treatment.
Autoimmune Destruction of Beta Cells
In type 1 diabetes, white blood cells called T cells attack and destroy beta cells. The process begins well before diabetes symptoms appear and continues after diagnosis. Often, type 1 diabetes is not diagnosed until most beta cells have already been destroyed. At this point, a person needs daily insulin treatment to survive. Finding ways to modify or stop this autoimmune process and preserve beta cell function is a major focus of current scientific research.
Recent research suggests insulin itself may be a key trigger of the immune attack on beta cells. The immune systems of people who are susceptible to developing type 1 diabetes respond to insulin as if it were a foreign substance, or antigen. To combat antigens, the body makes proteins called antibodies. Antibodies to insulin and other proteins produced by beta cells are found in people with type 1 diabetes. Researchers test for these antibodies to help identify people at increased risk of developing the disease. Testing the types and levels of antibodies in the blood can help determine whether a person has type 1 diabetes, LADA, or another type of diabetes.
Environmental Factors
Environmental factors, such as foods, viruses, and toxins, may play a role in the development of type 1 diabetes, but the exact nature of their role has not been determined. Some theories suggest that environmental factors trigger the autoimmune destruction of beta cells in people with a genetic susceptibility to diabetes. Other theories suggest that environmental factors play an ongoing role in diabetes, even after diagnosis.
Viruses and infections. A virus cannot cause diabetes on its own, but people are sometimes diagnosed with type 1 diabetes during or after a viral infection, suggesting a link between the two. Also, the onset of type 1 diabetes occurs more frequently during the winter when viral infections are more common. Viruses possibly associated with type 1 diabetes include coxsackievirus B, cytomegalovirus, adenovirus, rubella, and mumps. Scientists have described several ways these viruses may damage or destroy beta cells or possibly trigger an autoimmune response in susceptible people. For example, anti-islet antibodies have been found in patients with congenital rubella syndrome, and cytomegalovirus has been associated with significant beta cell damage and acute pancreatitisinflammation of the pancreas. Scientists are trying to identify a virus that can cause type 1 diabetes so that a vaccine might be developed to prevent the disease.
Infant feeding practices. Some studies have suggested that dietary factors may raise or lower the risk of developing type 1 diabetes. For example, breastfed infants and infants receiving vitamin D supplements may have a reduced risk of developing type 1 diabetes, while early exposure to cows milk and cereal proteins may increase risk. More research is needed to clarify how infant nutrition affects the risk for type 1 diabetes.
Read more in the Centers for Disease Control and Preventions (CDCs) publication National Diabetes Statistics Report, 2014 at www.cdc.gov for information about research studies related to type 1 diabetes. | NIDDK | Causes of Diabetes |
What causes Causes of Diabetes ? | Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type 2 diabetes may develop gradually and can be subtle; some people with type 2 diabetes remain undiagnosed for years.
Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes.
Genetic Susceptibility
Genes play a significant part in susceptibility to type 2 diabetes. Having certain genes or combinations of genes may increase or decrease a persons risk for developing the disease. The role of genes is suggested by the high rate of type 2 diabetes in families and identical twins and wide variations in diabetes prevalence by ethnicity. Type 2 diabetes occurs more frequently in African Americans, Alaska Natives, American Indians, Hispanics/Latinos, and some Asian Americans, Native Hawaiians, and Pacific Islander Americans than it does in non-Hispanic whites.
Recent studies have combined genetic data from large numbers of people, accelerating the pace of gene discovery. Though scientists have now identified many gene variants that increase susceptibility to type 2 diabetes, the majority have yet to be discovered. The known genes appear to affect insulin production rather than insulin resistance. Researchers are working to identify additional gene variants and to learn how they interact with one another and with environmental factors to cause diabetes.
Studies have shown that variants of the TCF7L2 gene increase susceptibility to type 2 diabetes. For people who inherit two copies of the variants, the risk of developing type 2 diabetes is about 80 percent higher than for those who do not carry the gene variant.1 However, even in those with the variant, diet and physical activity leading to weight loss help delay diabetes, according to the Diabetes Prevention Program (DPP), a major clinical trial involving people at high risk.
Genes can also increase the risk of diabetes by increasing a persons tendency to become overweight or obese. One theory, known as the thrifty gene hypothesis, suggests certain genes increase the efficiency of metabolism to extract energy from food and store the energy for later use. This survival trait was advantageous for populations whose food supplies were scarce or unpredictable and could help keep people alive during famine. In modern times, however, when high-calorie foods are plentiful, such a trait can promote obesity and type 2 diabetes.
Obesity and Physical Inactivity
Physical inactivity and obesity are strongly associated with the development of type 2 diabetes. People who are genetically susceptible to type 2 diabetes are more vulnerable when these risk factors are present.
An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes. Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin resistance and type 2 diabetes but also for heart and blood vessel disease, also called cardiovascular disease (CVD). This excess belly fat produces hormones and other substances that can cause harmful, chronic effects in the body such as damage to blood vessels.
The DPP and other studies show that millions of people can lower their risk for type 2 diabetes by making lifestyle changes and losing weight. The DPP proved that people with prediabetesat high risk of developing type 2 diabetescould sharply lower their risk by losing weight through regular physical activity and a diet low in fat and calories. In 2009, a follow-up study of DPP participantsthe Diabetes Prevention Program Outcomes Study (DPPOS)showed that the benefits of weight loss lasted for at least 10 years after the original study began.2
Read more about the DPP, funded under National Institutes of Health (NIH) clinical trial number NCT00004992, and the DPPOS, funded under NIH clinical trial number NCT00038727 in Diabetes Prevention Program.
Insulin Resistance
Insulin resistance is a common condition in people who are overweight or obese, have excess abdominal fat, and are not physically active. Muscle, fat, and liver cells stop responding properly to insulin, forcing the pancreas to compensate by producing extra insulin. As long as beta cells are able to produce enough insulin, blood glucose levels stay in the normal range. But when insulin production falters because of beta cell dysfunction, glucose levels rise, leading to prediabetes or diabetes.
Abnormal Glucose Production by the Liver
In some people with diabetes, an abnormal increase in glucose production by the liver also contributes to high blood glucose levels. Normally, the pancreas releases the hormone glucagon when blood glucose and insulin levels are low. Glucagon stimulates the liver to produce glucose and release it into the bloodstream. But when blood glucose and insulin levels are high after a meal, glucagon levels drop, and the liver stores excess glucose for later, when it is needed. For reasons not completely understood, in many people with diabetes, glucagon levels stay higher than needed. High glucagon levels cause the liver to produce unneeded glucose, which contributes to high blood glucose levels. Metformin, the most commonly used drug to treat type 2 diabetes, reduces glucose production by the liver.
The Roles of Insulin and Glucagon in Normal Blood Glucose Regulation
A healthy persons body keeps blood glucose levels in a normal range through several complex mechanisms. Insulin and glucagon, two hormones made in the pancreas, help regulate blood glucose levels:
- Insulin, made by beta cells, lowers elevated blood glucose levels. - Glucagon, made by alpha cells, raises low blood glucose levels.
- Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels. - Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen. - Insulin also lowers blood glucose levels by reducing glucose production in the liver.
- Glucagon signals the liver and muscle tissue to break down glycogen into glucose, which enters the bloodstream and raises blood glucose levels. - If the body needs more glucose, glucagon stimulates the liver to make glucose from amino acids.
Metabolic Syndrome
Metabolic syndrome, also called insulin resistance syndrome, refers to a group of conditions common in people with insulin resistance, including
- higher than normal blood glucose levels - increased waist size due to excess abdominal fat - high blood pressure - abnormal levels of cholesterol and triglycerides in the blood
Cell Signaling and Regulation
Cells communicate through a complex network of molecular signaling pathways. For example, on cell surfaces, insulin receptor molecules capture, or bind, insulin molecules circulating in the bloodstream. This interaction between insulin and its receptor prompts the biochemical signals that enable the cells to absorb glucose from the blood and use it for energy.
Problems in cell signaling systems can set off a chain reaction that leads to diabetes or other diseases. Many studies have focused on how insulin signals cells to communicate and regulate action. Researchers have identified proteins and pathways that transmit the insulin signal and have mapped interactions between insulin and body tissues, including the way insulin helps the liver control blood glucose levels. Researchers have also found that key signals also come from fat cells, which produce substances that cause inflammation and insulin resistance.
This work holds the key to combating insulin resistance and diabetes. As scientists learn more about cell signaling systems involved in glucose regulation, they will have more opportunities to develop effective treatments.
Beta Cell Dysfunction
Scientists think beta cell dysfunction is a key contributor to type 2 diabetes. Beta cell impairment can cause inadequate or abnormal patterns of insulin release. Also, beta cells may be damaged by high blood glucose itself, a condition called glucose toxicity.
Scientists have not determined the causes of beta cell dysfunction in most cases. Single gene defects lead to specific forms of diabetes called maturity-onset diabetes of the young (MODY). The genes involved regulate insulin production in the beta cells. Although these forms of diabetes are rare, they provide clues as to how beta cell function may be affected by key regulatory factors. Other gene variants are involved in determining the number and function of beta cells. But these variants account for only a small percentage of type 2 diabetes cases. Malnutrition early in life is also being investigated as a cause of beta cell dysfunction. The metabolic environment of the developing fetus may also create a predisposition for diabetes later in life.
Risk Factors for Type 2 Diabetes
People who develop type 2 diabetes are more likely to have the following characteristics:
- age 45 or older - overweight or obese - physically inactive - parent or sibling with diabetes - family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American - history of giving birth to a baby weighing more than 9 pounds - history of gestational diabetes - high blood pressure140/90 or aboveor being treated for high blood pressure - high-density lipoprotein (HDL), or good, cholesterol below 35 milligrams per deciliter (mg/dL), or a triglyceride level above 250 mg/dL - polycystic ovary syndrome, also called PCOS - prediabetesan A1C level of 5.7 to 6.4 percent; a fasting plasma glucose test result of 100125 mg/dL, called impaired fasting glucose; or a 2-hour oral glucose tolerance test result of 140199, called impaired glucose tolerance - acanthosis nigricans, a condition associated with insulin resistance, characterized by a dark, velvety rash around the neck or armpits - history of CVD
The American Diabetes Association (ADA) recommends that testing to detect prediabetes and type 2 diabetes be considered in adults who are overweight or obese and have one or more additional risk factors for diabetes. In adults without these risk factors, testing should begin at age 45. | NIDDK | Causes of Diabetes |
What causes Causes of Diabetes ? | Insulin Resistance and Beta Cell Dysfunction
Hormones produced by the placenta and other pregnancy-related factors contribute to insulin resistance, which occurs in all women during late pregnancy. Insulin resistance increases the amount of insulin needed to control blood glucose levels. If the pancreas cant produce enough insulin due to beta cell dysfunction, gestational diabetes occurs.
As with type 2 diabetes, excess weight is linked to gestational diabetes. Overweight or obese women are at particularly high risk for gestational diabetes because they start pregnancy with a higher need for insulin due to insulin resistance. Excessive weight gain during pregnancy may also increase risk.
Family History
Having a family history of diabetes is also a risk factor for gestational diabetes, suggesting that genes play a role in its development. Genetics may also explain why the disorder occurs more frequently in African Americans, American Indians, and Hispanics/Latinos. Many gene variants or combinations of variants may increase a womans risk for developing gestational diabetes. Studies have found several gene variants associated with gestational diabetes, but these variants account for only a small fraction of women with gestational diabetes.
Future Risk of Type 2 Diabetes
Because a womans hormones usually return to normal levels soon after giving birth, gestational diabetes disappears in most women after delivery. However, women who have gestational diabetes are more likely to develop gestational diabetes with future pregnancies and develop type 2 diabetes.3 Women with gestational diabetes should be tested for persistent diabetes 6 to 12 weeks after delivery and at least every 3 years thereafter.
Also, exposure to high glucose levels during gestation increases a childs risk for becoming overweight or obese and for developing type 2 diabetes later on. The result may be a cycle of diabetes affecting multiple generations in a family. For both mother and child, maintaining a healthy body weight and being physically active may help prevent type 2 diabetes. | NIDDK | Causes of Diabetes |
What causes Causes of Diabetes ? | Other types of diabetes have a variety of possible causes.
Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action
Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin.
The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes.
Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors.
Other Genetic Diseases
Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes.
The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs.
Damage to or Removal of the Pancreas
Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.
Endocrine Diseases
Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels.
Autoimmune Disorders
Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes.
Medications and Chemical Toxins
Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis.
Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes.
Lipodystrophy
Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. | NIDDK | Causes of Diabetes |
What causes Causes of Diabetes ? | Other types of diabetes have a variety of possible causes.
Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action
Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin.
The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes.
Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors.
Other Genetic Diseases
Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes.
The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs.
Damage to or Removal of the Pancreas
Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.
Endocrine Diseases
Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels.
Autoimmune Disorders
Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes.
Medications and Chemical Toxins
Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis.
Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes.
Lipodystrophy
Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. | NIDDK | Causes of Diabetes |
What to do for Causes of Diabetes ? | - Diabetes is a complex group of diseases with a variety of causes. Scientists believe genes and environmental factors interact to cause diabetes in most cases. - People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both. - Insulin is a hormone made by beta cells in the pancreas. Insulin helps cells throughout the body absorb and use glucose for energy. If the body does not produce enough insulin or cannot use insulin effectively, glucose builds up in the blood instead of being absorbed by cells in the body, and the body is starved of energy. - Prediabetes is a condition in which blood glucose levels or A1C levels are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes can substantially reduce their risk of developing diabetes by losing weight and increasing physical activity. - The two main types of diabetes are type 1 diabetes and type 2 diabetes. Gestational diabetes is a third form of diabetes that develops only during pregnancy. - Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells. - Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. - Scientists believe gestational diabetes is caused by the hormonal changes and metabolic demands of pregnancy together with genetic and environmental factors. Risk factors for gestational diabetes include being overweight and having a family history of diabetes. - Monogenic forms of diabetes are relatively uncommon and are caused by mutations in single genes that limit insulin production, quality, or action in the body. - Other types of diabetes are caused by diseases and injuries that damage the pancreas; certain chemical toxins and medications; infections; and other conditions. | NIDDK | Causes of Diabetes |
What is (are) Your Guide to Diabetes: Type 1 and Type 2 ? | Diabetes is when your blood glucose, also called blood sugar, is too high. Blood glucose is the main type of sugar found in your blood and your main source of energy. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries glucose to all of your bodys cells to use for energy.
Your pancreasan organ, located between your stomach and spine, that helps with digestionreleases a hormone it makes, called insulin, into your blood. Insulin helps your blood carry glucose to all your bodys cells. Sometimes your body doesnt make enough insulin or the insulin doesnt work the way it should. Glucose then stays in your blood and doesnt reach your cells. Your blood glucose levels get too high and can cause diabetes or prediabetes.
Over time, having too much glucose in your blood can cause health problems.
*See the Pronunciation Guide for tips on how to say the the words in bold type. | NIDDK | Your Guide to Diabetes: Type 1 and Type 2 |
What is (are) Your Guide to Diabetes: Type 1 and Type 2 ? | Prediabetes is when the amount of glucose in your blood is above normal yet not high enough to be called diabetes. With prediabetes, your chances of getting type 2 diabetes, heart disease, and stroke are higher. With some weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. You can even return to normal glucose levels, possibly without taking any medicines. | NIDDK | Your Guide to Diabetes: Type 1 and Type 2 |
What are the symptoms of Your Guide to Diabetes: Type 1 and Type 2 ? | The signs and symptoms of diabetes are
- being very thirsty - urinating often - feeling very hungry - feeling very tired - losing weight without trying - sores that heal slowly - dry, itchy skin - feelings of pins and needles in your feet - losing feeling in your feet - blurry eyesight
Some people with diabetes dont have any of these signs or symptoms. The only way to know if you have diabetes is to have your doctor do a blood test. | NIDDK | Your Guide to Diabetes: Type 1 and Type 2 |
What is (are) Urinary Tract Infection In Adults ? | A UTI is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscopeincluding fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the bodys natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis. | NIDDK | Urinary Tract Infection In Adults |
What is (are) Urinary Tract Infection In Adults ? | The urinary tract is the body's drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are a pair of bean-shaped organs, each about the size of a fist and located below the ribs, one on each side of the spine, toward the middle of the back. Every minute, a persons kidneys filter about 3 ounces of blood, removing wastes and extra water. The wastes and extra water make up the 1 to 2 quarts of urine a person produces each day. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder and emptied through the urethra, a tube at the bottom of the bladder.
When the bladder empties, a muscle called the sphincter relaxes and urine flows out of the body through the urethra. The opening of the urethra is at the end of the penis in males and in front of the vagina in females. | NIDDK | Urinary Tract Infection In Adults |
What causes Urinary Tract Infection In Adults ? | Most UTIs are caused by bacteria that live in the bowel. The bacterium Escherichia coli (E. coli) causes the vast majority of UTIs. Microbes called Chlamydia and Mycoplasma can infect the urethra and reproductive system but not the bladder. Chlamydia and Mycoplasma infections may be sexually transmitted and require treatment of sexual partners.
The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up toward the kidneys, and urination washes microbes out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur. Certain bacteria have a strong ability to attach themselves to the lining of the urinary tract. | NIDDK | Urinary Tract Infection In Adults |
How many people are affected by Urinary Tract Infection In Adults ? | Urinary tract infections are the second most common type of infection in the body, accounting for about 8.1 million visits to health care providers each year.1 Women are especially prone to UTIs for anatomical reasons. One factor is that a womans urethra is shorter, allowing bacteria quicker access to the bladder. Also, a womans urethral opening is near sources of bacteria from the anus and vagina. For women, the lifetime risk of having a UTI is greater than 50 percent.2 UTIs in men are not as common as in women but can be serious when they occur. | NIDDK | Urinary Tract Infection In Adults |
Who is at risk for Urinary Tract Infection In Adults? ? | Although everyone has some risk, some people are more prone to getting UTIs than others. People with spinal cord injuries or other nerve damage around the bladder have difficulty emptying their bladder completely, allowing bacteria to grow in the urine that stays in the bladder. Anyone with an abnormality of the urinary tract that obstructs the flow of urinea kidney stone or enlarged prostate, for exampleis at risk for a UTI. People with diabetes or problems with the bodys natural defense system are more likely to get UTIs.
Sexual activity can move microbes from the bowel or vaginal cavity to the urethral opening. If these microbes have special characteristics that allow them to live in the urinary tract, it is harder for the body to remove them quickly enough to prevent infection. Following sexual intercourse, most women have a significant number of bacteria in their urine, but the body normally clears them within 24 hours. However, some forms of birth control increase the risk of UTI. In some women, certain spermicides may irritate the skin, increasing the risk of bacteria invading surrounding tissues. Using a diaphragm may slow urinary flow and allow bacteria to multiply. Condom use is also associated with increased risk of UTIs, possibly because of the increased trauma that occurs to the vagina during sexual activity. Using spermicides with diaphragms and condoms can increase risk even further.
Another common source of infection is catheters, or tubes, placed in the urethra and bladder. Catheters interfere with the bodys ability to clear microbes from the urinary tract. Bacteria travel through or around the catheter and establish a place where they can thrive within the bladder. A person who cannot urinate in the normal way or who is unconscious or critically ill often needs a catheter for more than a few days. The Infectious Diseases Society of America recommends using catheters for the shortest time possible to reduce the risk of a UTI.3
Recurrent Infections
Many women suffer from frequent UTIs. About 20 percent of young women with a first UTI will have a recurrent infection.4 With each UTI, the risk that a woman will continue having recurrent UTIs increases.5 Some women have three or more UTIs a year. However, very few women will have frequent infections throughout their lives. More typically, a woman will have a period of 1 or 2 years with frequent infections, after which recurring infections cease.
Men are less likely than women to have a first UTI. But once a man has a UTI, he is likely to have another because bacteria can hide deep inside prostate tissue. Anyone who has diabetes or a problem that makes it hard to urinate may have repeat infections.
Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract. One NIH-funded study found that bacteria formed a protective film on the inner lining of the bladder in mice.6 If a similar process can be demonstrated in humans, the discovery may lead to new treatments to prevent recurrent UTIs. Another line of research has indicated that women who are nonsecretors of certain blood group antigens may be more prone to recurrent UTIs because the cells lining the vagina and urethra may allow bacteria to attach more easily. A nonsecretor is a person with an A, B, or AB blood type who does not secrete the normal antigens for that blood type in bodily fluids, such as fluids that line the bladder wall.7
Infections during Pregnancy
Pregnant women seem no more prone to UTIs than other women. However, when a UTI does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 4 to 5 percent of pregnant women develop a UTI.8 Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys and cause infection. For this reason, health care providers routinely screen pregnant women for bacteria in the urine during the first 3 months of pregnancy. | NIDDK | Urinary Tract Infection In Adults |
What are the symptoms of Urinary Tract Infection In Adults ? | Symptoms of a UTI vary by age, gender, and whether a catheter is present. Among young women, UTI symptoms typically include a frequent and intense urge to urinate and a painful, burning feeling in the bladder or urethra during urination. The amount of urine may be very small. Older women and men are more likely to be tired, shaky, and weak and have muscle aches and abdominal pain. Urine may look cloudy, dark, or bloody or have a foul smell. In a person with a catheter, the only symptom may be fever that cannot be attributed to any other cause. Normally, UTIs do not cause fever if they are in the bladder. A fever may mean the infection has reached the kidneys or has penetrated the prostate. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, and vomiting. | NIDDK | Urinary Tract Infection In Adults |
How to diagnose Urinary Tract Infection In Adults ? | To find out whether a person has a UTI, the health care provider will ask about urinary symptoms and then test a sample of urine for the presence of bacteria and white blood cells, which are produced by the body to fight infection. Because bacteria can be found in the urine of healthy individuals, a UTI is diagnosed based both on symptoms and a laboratory test. The person will be asked to give a clean catch urine sample by washing the genital area and collecting a midstream sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. Usually, the sample is sent to a laboratory, although some health care providers offices are equipped to do the testing. For people with recurring infections and patients in the hospital, the urine may be cultured. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified. The health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the infection.
If a person has recurrent UTIs, the health care provider may order some additional tests to determine if the persons urinary tract is normal.
Kidney and bladder ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging; anesthesia is not needed. The images can show abnormalities in the kidneys and bladder. However, this test cannot reveal all important urinary abnormalities or measure how well the kidneys work.
Voiding cystourethrogram. This test is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. As the person lies on the x-ray table, a health care provider inserts the tip of a thin, flexible tube called a catheter through the urethra into the bladder. The bladder and urethra are filled with a special dye called contrast medium, to make the structures clearly visible on the x-ray images. The x rays are taken from various angles while the bladder is full of contrast medium. The catheter is then removed and x-ray images are taken during urination. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician. The technician is supervised by a radiologist while the images are taken. The radiologist then interprets the images. Anesthesia is not needed, but light sedation may be used for some people. This test can show abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties.
Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. CT scans can provide clearer, more detailed images to help the health care provider understand the problem.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. An MRI may include an injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the person to lie in a more open space. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed though light sedation may be used for people with a fear of confined spaces. Like CT scans, MRIs can provide clearer, more detailed images.
Radionuclide scan. A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Because the dose of the radioactive chemicals is small, the risk of causing damage to cells is low. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys. Radionuclide scans are performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. Radioactive chemicals injected into the blood can provide information about kidney function. Radioactive chemicals can also be put into the fluids used to fill the bladder and urethra for x ray, MRI, and CT imaging.
Urodynamics. Urodynamic testing is any procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most of these tests are performed in the office of a urologista doctor who specializes in urinary problemsby a urologist, physician assistant, or nurse practitioner. Some procedures may require light sedation to keep a person calm. Most urodynamic tests focus on the bladders ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is having abnormal contractions that cause leakage. A health care provider may order these tests if there is evidence that the person has some kind of nerve damage.
Cystoscopy. Cystoscopy is a procedure that uses a tubelike instrument to look inside the urethra and bladder. Cystoscopy is performed by a doctor in a health care providers office, outpatient facility, or hospital with local anesthesia. However, in some cases, sedation and regional or general anesthesia are needed. Cystoscopy may be used to look for swelling, redness, and other signs of infection. | NIDDK | Urinary Tract Infection In Adults |
What are the treatments for Urinary Tract Infection In Adults ? | Most UTIs are caused by bacteria, which are treated with bacteria-fighting medications called antibiotics or antimicrobials. The choice of medication and length of treatment depend on the patients history and the type of bacteria causing the infection. Some antibiotics may be ruled out if a person has allergies to them. The sensitivity test takes 48 hours to complete and is especially useful in helping the health care provider select the antibiotic most likely to be effective in treating an infection. Longer treatment may be needed if the first antibiotic given is not effective.
When a UTI occurs in a healthy person with a normal, unobstructed urinary tract, the term uncomplicated is used to describe the infection. Most young women who have UTIs have uncomplicated UTIs, which can be cured with 2 or 3 days of treatment. Single-dose treatment is less effective. Longer treatment causes more side effects and is not more effective. A follow-up urinalysis helps to confirm the urinary tract is infection-free. Taking the full course of treatment is important because symptoms may disappear before the infection is fully cleared.
Complicated UTIs occur when a personfor example, a pregnant woman or a transplant patientis weakened by another condition. A UTI is also complicated when the person has a structural or functional abnormality of the urinary tract, such as an obstructive kidney stone or prostate enlargement that squeezes the urethra. Health care providers should assume that men and boys have a complicated UTI until proven otherwise.
Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed medications on their own. Kidney infections may require several weeks of antibiotic treatment. Kidney infections in adults rarely lead to kidney damage or kidney failure unless they go untreated or are associated with urinary tract obstruction.
Bladder infections are generally self-limiting, but antibiotic treatment significantly shortens the duration of symptoms. People usually feel better within a day or two of treatment. Symptoms of kidney and prostate infections last longer. Drinking lots of fluids and urinating frequently will speed healing. If needed, various medications are available to relieve the pain of a UTI. A heating pad on the back or abdomen may also help.
Recurrent Infections in Women
Health care providers may advise women who have recurrent UTIs to try one of the following treatment options:
- Take low doses of the prescribed antibiotic daily for 6 months or longer. If taken at bedtime, the medication remains in the bladder longer and may be more effective. NIH-supported research has shown this therapy to be effective without causing serious side effects. - Take a single dose of an antibiotic after sexual intercourse. - Take a short course2 or 3 daysof an antibiotic when symptoms appear.
To try to prevent an infection, health care providers may suggest women
- drink plenty of water every day - urinate when the need arises and avoid resisting the urge to urinate - urinate after sexual intercourse - switch to a different method of birth control if recurring UTIs are a problem
Infections during Pregnancy
During pregnancy, bacterial infection of the urineeven in the absence of symptomscan pose risks to both the mother and the baby. Some antibiotics are not safe to take during pregnancy. In selecting the best treatments, health care providers consider various factors such as the medications effectiveness, the stage of pregnancy, the mothers health, and potential effects on the fetus.
Complicated Infections
Curing infections that stem from a urinary obstruction or other systemic disorder depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, this group of patients is at risk for kidney damage. Also, such infections tend to arise from a wider range of bacteria and sometimes from more than one type of bacteria at a time.
Infections in Men
Urinary tract infections in men are often the result of an obstructionfor example, a urinary stone or enlarged prostateor are from a catheter used during a medical procedure. The first step in treating such an infection is to identify the infecting organism and the medications to which it is sensitive.
Prostate infectionschronic bacterial prostatitisare harder to cure because antibiotics may be unable to penetrate infected prostate tissue effectively. For this reason, men with bacterial prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in men are frequently associated with acute bacterial prostatitis, which can be life threatening if not treated urgently. | NIDDK | Urinary Tract Infection In Adults |
How to prevent Urinary Tract Infection In Adults ? | Changing some daily habits may help a person prevent recurrent UTIs.
Eating, Diet, and Nutrition
Drinking lots of fluid can help flush bacteria from the system. Water is best. Most people should try for six to eight, 8-ounce glasses a day. Talk with your health care provider if you cant drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.
Urination Habits
A person should urinate often and when the urge arises. Bacteria can grow when urine stays in the bladder too long. Women and men should urinate shortly after sex to flush away bacteria that might have entered the urethra during sex. Drinking a glass of water will also help flush bacteria away.
After using the toilet, women should wipe from front to back. This step is most important after a bowel movement to keep bacteria from getting into the urethra.
Clothing
Cotton underwear and loose-fitting clothes should be worn, so air can keep the area around the urethra dry. Tight-fitting jeans and nylon underwear should be avoided because they can trap moisture and help bacteria grow.
Birth Control
For women, using a diaphragm or spermicide for birth control can lead to UTIs by increasing bacteria growth. A woman who has trouble with UTIs should try switching to a new form of birth control. Unlubricated condoms or spermicidal condoms increase irritation, which may help bacteria grow. Switching to lubricated condoms without spermicide or using a nonspermicidal lubricant may help prevent UTIs. | NIDDK | Urinary Tract Infection In Adults |
What to do for Urinary Tract Infection In Adults ? | - Most urinary tract infections (UTIs) arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the bowel. - Symptoms of a UTI in adults may include the following: - a frequent and intense urge to urinate - a painful, burning feeling in the bladder or urethra during urination - feeling tired, shaky, and weak - muscle aches - abdominal pain - only small amounts of urine passed, despite a strong urge to urinate - cloudy, dark, or bloody urine or urine that has a foul smell - pain in the back or side below the ribs - nausea and vomiting - Fever may indicate a kidney or prostate infection. - Because bacteria can be found in the urine of healthy individuals, a UTI is diagnosed based both on symptoms and a laboratory test. - UTIs are treated with bacteria-fighting medications called antibiotics or antimicrobials. | NIDDK | Urinary Tract Infection In Adults |
What is (are) Pregnancy and Thyroid Disease ? | Thyroid disease is a disorder that affects the thyroid gland. Sometimes the body produces too much or too little thyroid hormone. Thyroid hormones regulate metabolismthe way the body uses energyand affect nearly every organ in the body. Too much thyroid hormone is called hyperthyroidism and can cause many of the bodys functions to speed up. Too little thyroid hormone is called hypothyroidism and can cause many of the bodys functions to slow down.
Thyroid hormone plays a critical role during pregnancy both in the development of a healthy baby and in maintaining the health of the mother.
Women with thyroid problems can have a healthy pregnancy and protect their fetuses health by learning about pregnancys effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications. | NIDDK | Pregnancy and Thyroid Disease |
What is (are) Pregnancy and Thyroid Disease ? | The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe. The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce, store, and release hormones into the bloodstream. The hormones then travel through the body and direct the activity of the bodys cells.
The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.
Thyroid hormone production is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production. | NIDDK | Pregnancy and Thyroid Disease |
What to do for Pregnancy and Thyroid Disease ? | During pregnancy, the body requires higher amounts of some nutrients to support the health of the mother and growing baby. Experts recommend pregnant women maintain a balanced diet and take a prenatal multivitamin and mineral supplement containing iodine to receive most nutrients necessary for thyroid health. More information about diet and nutrition during pregnancy is provided by the National Agricultural Library available at www.choosemyplate.gov/nutritional-needs-during-pregnancy.
Dietary Supplements
Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for a mother during pregnancy. During pregnancy, the baby gets iodine from the mothers diet. Women need more iodine when they are pregnantabout 250 micrograms a day. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Choosing iodized saltsalt supplemented with iodineover plain salt and prenatal vitamins containing iodine will ensure this need is met.
However, people with autoimmune thyroid disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodinesuch as seaweed, dulse, or kelpmay cause or worsen hyperthyroidism and hypothyroidism. More information about iodine is provided by the National Library of Medicine in the fact sheet, Iodine in diet.
To help ensure coordinated and safe care, people should discuss their use of dietary supplements with their health care provider. Tips for talking with health care providers are available at the National Center for Complementary and Integrative Health's Time to Talk campaign. | NIDDK | Pregnancy and Thyroid Disease |
What to do for Pregnancy and Thyroid Disease ? | - Thyroid disease is a disorder that results when the thyroid gland produces more or less thyroid hormone than the body needs. - Pregnancy causes normal changes in thyroid function but can also lead to thyroid disease. - Uncontrolled hyperthyroidism during pregnancy can lead to serious health problems in the mother and the unborn baby. - During pregnancy, mild hyperthyroidism does not require treatment. More severe hyperthyroidism is treated with antithyroid medications, which act by interfering with thyroid hormone production. - Uncontrolled hypothyroidism during pregnancy can lead to serious health problems in the mother and can affect the unborn babys growth and brain development. - Hypothyroidism during pregnancy is treated with synthetic thyroid hormone, thyroxine (T4). - Postpartum thyroiditisinflammation of the thyroid glandcauses a brief period of hyperthyroidism, often followed by hypothyroidism that usually goes away within a year. Sometimes the hypothyroidism is permanent. | NIDDK | Pregnancy and Thyroid Disease |
What is (are) What I need to know about Crohn's Disease ? | Crohn's disease is a disease that causes inflammation,* or swelling, and irritation of any part of the digestive tractalso called the gastrointestinal (GI) tract. The part most commonly affected is the end part of the small intestine, called the ileum.
*See the Pronunciation Guide for tips on how to say the words in bold type.
Crohns disease is one of two main forms of diseases of the GI tract named inflammatory bowel disease (IBD). The other form, called ulcerative colitis, affects the large intestine, which includes the colon and the rectumthe lower end of the large intestine, leading to the anus.
With Crohns disease, chronicor long lastinginflammation may cause scar tissue to form in the lining of the intestine. When scar tissue builds up, the passage can become narrow, causing food and stool to move through the GI tract more slowlywhich can lead to pain, cramps, and diarrhea. | NIDDK | What I need to know about Crohn's Disease |
Who is at risk for What I need to know about Crohn's Disease? ? | Both men and women can get Crohn's disease, and it can run in families. People with Crohns disease may have a blood relative with the disease or another type of IBD. Crohns disease most commonly starts between the ages of 13 and 30. | NIDDK | What I need to know about Crohn's Disease |
What causes What I need to know about Crohn's Disease ? | Researchers are studying the possible causes of Crohns disease. Your bodys natural defense system, called the immune system, protects you from infection by fighting against bacteria, viruses, and other things that can make you sick. Researchers believe that with Crohns disease, the immune system attacks harmless bacteria and viruses. During the attack, white blood cells gather in the intestinal lining. The white blood cells cause chronic inflammation, which leads to ulcers, or sores, and damage to the intestines.
Other factors associated with Crohns disease are
- genesthe traits passed down from your parents - unknown triggers caused by the environment | NIDDK | What I need to know about Crohn's Disease |
What are the symptoms of What I need to know about Crohn's Disease ? | Crohn's disease symptoms can be different for each person. The most common symptoms of Crohns disease are
- abdominal painoften in the lower right area of the abdomen - diarrhea - bleeding in the rectum, which can be seen in a persons underwear, in the toilet, or in a bowel movement; rectal bleeding can be serious and may not stop without medical help - weight loss - fever | NIDDK | What I need to know about Crohn's Disease |
How to diagnose What I need to know about Crohn's Disease ? | A doctor will perform a physical exam and tests to diagnose Crohns disease. During your visit, the doctor will ask about your symptoms and medical history.
The doctor may order blood tests, which involve drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis. Blood tests can show anemia caused by bleeding. Anemia is a condition in which red blood cells are fewer or smaller than normal, which means less oxygen is carried to the bodys cells. Blood tests can also show a high white blood cell count, a sign of chronic inflammation.
You may also be asked for a stool sample. A stool test is commonly used to rule out other causes of GI diseases, such as infections. The doctor will give you a container for catching and storing the stool. The sample is returned to the doctor or a commercial facility and sent to a lab for analysis. A stool sample can also be used to check if you have bleeding or inflammation.
Other tests may be needed to diagnose Crohn's disease. The following tests are all performed at a hospital or outpatient center.
- Colonoscopy. Colonoscopy is the most commonly used test to specifically diagnose Crohns disease. This test is used to look inside your rectum, entire colon, and ileum. The health care provider will give you written bowel prep instructions to follow at home before the test. You may need to follow a clear liquid diet for 1 to 3 days before the test. You will need to take laxatives and enemas the evening before the test, and you will likely have one or more enemas about 2 hours before the test. A laxative is medicine that loosens stool and increases bowel movements. An enema involves flushing water, laxative, or sometimes a mild soap solution into the anus using a special squirt bottle. For the test, you will lie on a table while the doctor inserts a flexible tube into your anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The doctor can see inflammation, ulcers, or bleeding. The doctor may also perform a biopsy. The doctor will look at the tissue with a microscope to confirm the diagnosis of Crohns disease. In most cases, youll be given a light sedative, and possibly pain medicine, to help you relax. You will not feel the biopsy. Cramping or bloating may occur during the first hour after the test. Driving is not permitted for 24 hours after the test to allow the sedative time to wear off. Before the appointment, you should make plans for a ride home. By the next day, you should fully recover and go back to your normal diet. - Flexible sigmoidoscopy. This test is used to look inside the rectum and lower colon. The health care provider will give you written bowel prep instructions to follow at home before the test. You may need to follow a clear liquid diet for 1 to 3 days before the test. You may also need a laxative or enema the night before the test. And youll have one or more enemas about 2 hours before the procedure. For the test, you will lie on a table while the doctor inserts a flexible tube into your anus. You will not need a sedative for the test. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The doctor can see inflammation, ulcers, or bleeding. The doctor may also perform a biopsy by snipping a bit of tissue from the intestinal lining. The doctor will look at the tissue with a microscope to confirm the diagnosis of Crohns disease. You will not feel the biopsy. You can usually go back to your normal diet after the test, though you may have cramping or bloating during the first hour after the test. - Computerized tomography (CT) scan. A CT scan uses x rays and computers to create images of the inside of the body. For the test, you will lie on a table that slides into a tunnel-shaped device where the x rays are taken. The technician may give you a solution to drink and an injection of a special dye through a needle inserted into an arm vein. You will not need a sedative for the test. CT scans can be used to help diagnose Crohn's disease. - Upper GI series (x rays). An upper GI series may be done to look at the small intestine. No eating or drinking is allowed for 8 hours before the procedure. You will not need a sedative for the test. During the procedure, you will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. The barium coats the small intestine, making signs of the disease show up more clearly on x rays. After the test, you may go back to your normal diet, though you may have nausea or bloating for a short time. Traces of barium in the GI tract cause stools to be white or light colored for a few days after the test. - Lower GI series (x rays). A lower GI series may be done to look at the large intestine. The health care provider will give you written bowel prep instructions to follow at home before the test. You will be asked to follow a clear liquid diet for 1 to 3 days before the test. A laxative or enema is usually used the evening before a lower GI series. Enemas are sometimes repeated the morning of the test. For the test, you will lie on a table while the doctor inserts a flexible tube into your anus. You will not need a sedative for the test. The large intestine is filled with barium, making signs of the disease show up more clearly on x rays. After the test, you may go back to your normal diet, though you may have bloating. You also may have some soreness of the anus. Traces of barium in the GI tract cause stools to be white or light colored for a few days after the test. | NIDDK | What I need to know about Crohn's Disease |
What is (are) What I need to know about Crohn's Disease ? | Intestinal blockage can occur in people with Crohns disease when scar tissue blocks the intestinal passage. A narrow intestinal passage is called a stricture. When the passage blocks completely, food and stool stop moving, causing abdominal cramps and vomiting. If you have these symptoms, you should see a health care provider right away.
Ulcers from Crohns disease can cause tunnels to form through the inflamed areas, or even the healthy parts, of the intestine. These tunnels are called fistulas. Fistulas are seen most often in the areas around the rectum and anus. Sometimes a pocket of infection, called an abscess, can form in and around the fistulas. Most fistulas can be treated with medicines, but sometimes surgery is needed.
People with Crohns disease often have anemia, which can be caused by the disease itself or by iron deficiency. Anemia may make a person feel tired.
People with Crohns disease, particularly if they have been treated with steroid medicines, may have weakness of their bonescalled osteoporosis or osteomalacia.
People with Crohns disease may also have arthritis, skin problems, swelling in the eyes or mouth, kidney stones, gallstones, and liver problems. Some people with Crohns disease may have restless legs syndromeextreme leg discomfort the person feels while sitting or lying down. These problems may go away during treatment, but some must be treated with medicines.
People who have Crohns disease may not get enough nutrition, such as protein, vitamins, or calories, because they
- have an upset stomach that keeps them from eating enough calories - may not be able to absorb nutrients in the intestine
Children with Crohns disease may fail to grow normally and may have low height for their age. | NIDDK | What I need to know about Crohn's Disease |
What are the treatments for What I need to know about Crohn's Disease ? | Treatment for Crohns disease depends on
- where the disease is located in the GI tract - what problems you already have from the disease - what past treatments you have had for the disease
The goals of treatment are to
- decrease the inflammation - relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding - correct nutritional problems
Treatment may include
- medicines - surgery - eating, diet, and nutrition
Medicines
One or more of the following medicines may be used to treat Crohns disease:
- Anti-inflammation medicines may be used first to treat your Crohn's disease. These medicines help lower inflammation in the intestine and relieve the pain and diarrhea. Sometimes anti-inflammation medicines cause side effects, so you should talk with your health care provider about what to expect. - Steroids also help lower inflammation. Steroids are similar to natural chemicals in the body. However, steroids are used only for a short time because long-term use can lead to serious side effects. - Immune system suppressors. Azathioprine and 6-mercaptopurine work by keeping your immune system from attacking harmless foreign substances. Immune system suppressors also cause side effects, so you should talk with your health care provider about what to expect. - Biological therapies. Biological therapies are medicines that are given by an injection in the vein, infliximab (Remicade), or an injection in the skin, adalimumab (HUMIRA). Your health care provider may treat you with these medicines if others are not helping to decrease inflammation, or if you have fistulas with abscesses. The goals for using these medicines are to get you better, keep you better, and avoid long-term steroid use. - Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
- Anti-diarrheal medicines and fluid replacements. Diarrhea and abdominal cramps are often relieved when the inflammation improves, but more medicine may be needed. Anti-diarrheal medicines include diphenoxylate, loperamide, and codeine. People with diarrhea should drink plenty of fluids to prevent dehydrationloss of fluids from the body. If diarrhea does not improve, the person should see the doctor promptly for possible treatment with fluids given through a small tube inserted into an arm vein.
Surgery
Some people with Crohns disease need surgery if medicines are no longer working to control blockage, fistulas, abscesses, and bleeding. A surgeon performs the procedure in a hospital, where you will receive medicine to make you sleep during the surgery.
One or more of the following surgeries may be needed:
- Intestinal resection. The surgeon removes the diseased section of intestine and puts the ends of the intestine back together. - Proctocolectomy. Proctocolectomy is surgery to remove the rectum and part or all of the colon. An ileostomy is performed with a proctocolectomy. - Ileostomy. Ileostomy is an operation to create an openingcalled a stomafor the stool to exit the body when the ends of the intestine cannot be put back together. To create a stoma, an end of the intestine is brought out through a small opening made on the lower right part of the abdomen near the beltline. The stoma is about the size of a quarter. An ostomy pouch is worn outside the body over the stoma to collect waste, and it is emptied several times a day. Your health care provider may refer you to an ostomy nursea specialist who cares for people with an ostomy pouch.
Surgery usually does not cure Crohn's disease forever. Sometimes you need to have more than one surgery because the disease returns next to where the intestine was removed. Because Crohns disease can return after surgery, you can talk with your health care provider and other patients to get as much information as possible before having surgery. | NIDDK | What I need to know about Crohn's Disease |
What to do for What I need to know about Crohn's Disease ? | Your health care provider may start you on a special diet, so you get extra nutrition and calories. High-calorie liquid supplements are often used to give you the extra calories and right amount of vitamins and minerals to keep you healthy. During acute phases of the disease, you may need to receive intravenous nutrition to give the intestine a rest.
No foods are known to cause injury or inflammation to the intestine. But foods such as hot spices, alcohol, greasy foods, and milk products may make diarrhea and cramping worse. You should eat a healthy diet and avoid foods that make symptoms worse. Your health care provider may refer you to a dietitian to help you with meal planning. | NIDDK | What I need to know about Crohn's Disease |
What to do for What I need to know about Crohn's Disease ? | - Crohn's disease is a disease that causes inflammation, or swelling, and irritation of any part of the digestive tractalso called the gastrointestinal (GI) tract. - People with Crohns disease may have a blood relative with the disease or another type of inflammatory bowel disease (IBD). - Symptoms of Crohns disease include abdominal pain, diarrhea, bleeding, weight loss, and fever. - A physical exam, blood tests, stool tests, and other tests are needed to diagnose Crohns disease. - Problems of Crohns disease include intestinal blockage, fistulas, abscesses, anemia, and slower growth in children. - Doctors treat Crohns disease with medicines, surgery, diet, and nutrition. - People with Crohns disease should eat a healthy diet and avoid foods that make symptoms worse. - Quitting smoking can help make Crohns disease less severe. Ask your health care provider if you need help quitting smoking. - Support groups may help lower stress for people with Crohns disease. - Most people with Crohns disease are able to work, raise families, and live full lives. - Many women with Crohns disease can become pregnant and have a baby. You should talk with your health care provider before getting pregnant. | NIDDK | What I need to know about Crohn's Disease |
What is (are) Chronic Diarrhea in Children ? | Diarrhea is loose, watery stools. Chronic, or long lasting, diarrhea typically lasts for more than 4 weeks. Children with chronic diarrhea may have loose, watery stools continually, or diarrhea may come and go. Chronic diarrhea may go away without treatment, or it may be a symptom of a chronic disease or disorder. Treating the disease or disorder can relieve chronic diarrhea.
Chronic diarrhea can affect children of any age:
- infantsages 0 to 12 months - toddlersages 1 to 3 years - preschool-age childrenages 3 to 5 years - grade school-age childrenages 5 to 12 years - adolescentsages 12 to 18 years
Diarrhea that lasts only a short time is called acute diarrhea. Acute diarrhea, a common problem, usually lasts a few days and goes away on its own. More information about acute diarrhea is provided in the NIDDK health topics:
- Diarrhea - What I need to know about Diarrhea | NIDDK | Chronic Diarrhea in Children |
What causes Chronic Diarrhea in Children ? | Many diseases and disorders can cause chronic diarrhea in children. Common causes include
- infections - functional gastrointestinal (GI) disorders - food allergies and intolerances - inflammatory bowel disease (IBD)
Infections, food allergies and intolerances, and IBD may cause chronic diarrhea along with malabsorption, meaning the small intestine does not absorb nutrients from food. If children do not absorb enough nutrients from the food they eat, they may become malnourished. Functional GI disorders do not cause malabsorption.
Infections
Infections from viruses, bacteria, or parasites sometimes lead to chronic diarrhea. After an infection, some children have problems digesting carbohydrates, such as lactose, or proteins, such as milk or soy proteins. These problems can cause prolonged diarrheaoften for up to 6 weeksafter an infection. Also, some bacteria and parasite infections that cause diarrhea do not go away quickly without treatment.
More information about infections that cause diarrhea is provided in the NIDDK health topics:
- Viral Gastroenteritis - Foodborne Illnesses
Small intestinal bacterial overgrowth may also cause chronic diarrhea. Normally, few bacteria live in the small intestine, and many bacteria live in the large intestine. Small intestinal bacterial overgrowth is an increase in the number of bacteria or a change in the type of bacteria in the small intestine. These bacteria can cause diarrhea, gas, cramping, and weight loss. Small intestinal bacterial overgrowth is often related to diseases or disorders that damage the digestive system or affect how it works, such as Crohns disease or diabetes. Small intestinal bacterial overgrowth is also more common in people who have had abdominal surgery or who have slow-moving intestines.
Functional Gastrointestinal Disorders
In functional GI disorders, symptoms are caused by changes in how the GI tract works. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusthe opening through which stool leaves the body. The GI tract digests, or breaks down, food and processes solid waste.
Children with a functional GI disorder have frequent symptoms, yet the GI tract does not become damaged. Functional GI disorders are not diseases; they are groups of symptoms that occur together.
Two functional GI disorders that cause chronic diarrhea in children are toddlers diarrhea and irritable bowel syndrome (IBS).
Toddlers diarrhea. Toddlers diarrheaalso called functional diarrhea or chronic nonspecific diarrhea of childhoodis a common cause of chronic diarrhea in toddlers and preschool-age children. Children with this disorder pass three or more loose stools a day and do not have any other symptoms. They typically are growing well and gaining weight, and are healthy.
Toddlers diarrhea develops between the ages of 6 months and 3 years, and it usually goes away on its own by the time children begin grade school. Researchers think a diet with too much sugarsuch as the sugar found in fruit juicerelative to the amount of fat and fiber may cause toddlers diarrhea.
IBS. The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with changes in bowel habits, such as diarrhea. The pain or discomfort of IBS typically gets better with the passage of stool or gas. IBS does not cause symptoms such as weight loss, vomiting, or blood in the stool.
Possible causes include problems with nerves in the intestines, problems with nerve signals between the brain and the intestines, changes in how food moves through the intestines, and hypersensitivity to pain. Psychological problems, such as anxiety and depression, or food sensitivity may also play a role.
IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Health care providers rarely diagnose IBS in younger children because younger children are not able to report symptoms of pain or discomfort. More information is provided in the NIDDK health topics:
- Irritable Bowel Syndrome - Irritable Bowel Syndrome in Children
Food Allergies and Intolerances
Food allergies, celiac disease, lactose intolerance, and dietary fructose intolerance are common causes of chronic diarrhea.
Food allergies. A food allergy is a reaction by the immune system, the bodys natural defense system, to one or more proteins in certain foods. The immune system normally protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances that can cause illness. In food allergies, however, the immune system responds abnormally to certain foods.
Cows milk and soy allergies are the most common food allergies that affect the GI tract in children. Food allergies usually appear in the first year of life. Many children outgrow cows milk and soy allergies by age 3. Allergies to other foods, such as cereal grains, eggs, or seafood, may also affect the GI tract.
Symptoms of food allergies may include diarrhea, vomiting, and weight loss or poor weight gain. Some children have mild symptoms, while others have severe or life-threatening symptoms. For example, some children have severe vomiting and diarrhea that lead to dehydration, which means the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly.
Celiac disease. Celiac disease is an autoimmune disease in which people cannot tolerate gluten. A chronic reaction to gluten damages the lining of their small intestine and prevents absorption of nutrients. Gluten is a protein found in wheat, rye, and barley and in vitamin and nutrient supplements, lip balms, communion wafers, and certain medications.
Children of any age can experience digestive symptoms of celiac disease or have symptoms in other parts of the body. Digestive symptoms can include
- chronic diarrhea - abdominal bloating - stomach pain - gas - vomiting - constipation - pale, foul-smelling, or fatty stool
Malabsorption of nutrients during the years when nutrition is critical to a childs normal growth and development can result in other health problems. These problems may include
- failure to thrive in infants - slowed growth and short stature - weight loss - irritability or mood changes - delayed puberty - dental enamel defects of the permanent teeth - anemia, a condition in which red blood cells are fewer or smaller than normal, which prevents the bodys cells from getting enough oxygen - low levels of important nutrients such as iron and calcium
More information is provided in the NIDDK health topics:
- Celiac Disease - What I need to know about Celiac Disease
Lactose intolerance. Lactose intolerance is a condition in which people have digestive symptomssuch as bloating, gas, and diarrheaafter consuming milk or milk products. Lactose is a sugar found in milk or milk products. Lactase, an enzyme produced by the small intestine, breaks down lactose into two simpler forms of sugar: glucose and galactose. The bloodstream then absorbs these simpler sugars.
Some children have a lactase deficiency, meaning the small intestine produces low levels of lactase and cannot digest much lactose. Lactase deficiency may cause lactose malabsorption. In children with lactose malabsorption, undigested lactose passes to the colon, where bacteria break down the lactose and create fluid and gas.
Not all children with lactase deficiency and lactose malabsorption have digestive symptoms. Experts use the term lactose intolerance when lactase deficiency and lactose malabsorption cause digestive symptoms.
The most common type of lactase deficiency develops over time, beginning after about age 2, when the body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or adulthood.
Infants rarely have lactose intolerance at birth. People sometimes mistake cows milk allergy, which can cause diarrhea in infants, for lactose intolerance. Congenital lactase deficiencyan extremely rare inherited genetic disorder in which the small intestine produces little or no lactase enzyme at birthcan cause lactose intolerance in infants. Premature infants may experience lactose intolerance for a short time after birth. Children of any age may develop temporary lactose intolerance after a viral diarrheal episode or other infection.
More information is provided in the NIDDK health topics:
- Lactose Intolerance - What I need to know about Lactose Intolerance
Dietary fructose intolerance. Dietary fructose intolerance is a condition in which people have digestive symptomssuch as bloating, gas, and diarrheaafter consuming foods that contain fructose. Fructose is a sugar found in fruits, fruit juices, and honey. Fructose is also added to many foods and soft drinks as a sweetener called high fructose corn syrup.
Fructose malabsorption causes dietary fructose intolerance. The small intestine absorbs fructose, and, when a person consumes more fructose than the small intestine can absorb, fructose malabsorption results. Unabsorbed fructose passes to the colon, where bacteria break down the fructose and create fluid and gas.
The amount of fructose that a childs small intestine can absorb varies. The capacity of the small intestine to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.
Another type of fructose intolerance, hereditary fructose intolerance, is not related to fructose malabsorption. Hereditary fructose intolerance is an extremely rare inherited genetic disorder. Children with this disorder lack an enzyme needed to break down fructose. Symptoms of hereditary fructose intolerance may include abdominal pain, vomiting, and diarrhea. This disorder can also damage the liver and kidneys.
Inflammatory Bowel Disease
Inflammatory bowel disease causes irritation and inflammation in the intestines. The two main types of IBD are ulcerative colitis and Crohns disease. These disorders can affect children at any age; however, they commonly begin in the grade school years or in adolescence. The causes of IBD are unknown. Researchers believe they result from an abnormal immune system reaction.
Ulcerative colitis. Ulcerative colitis is a disease that causes inflammation, or swelling, and ulcers in the inner lining of the large intestine. The large intestine includes the colon and the rectumthe lower end of the large intestine leading to the anus. Normally, the large intestine absorbs water from stool and changes it from a liquid to a solid. In ulcerative colitis, the inflammation causes loss of the lining of the large intestine, leading to bleeding, production of pus, diarrhea, and abdominal discomfort.
More information is provided in the NIDDK health topic, Ulcerative Colitis.
Crohns disease. Crohns disease is a disease that causes inflammation and irritation of any part of the GI tract. The end part of the small intestine, called the ileum, is most commonly affected. In Crohns disease, inflammation can extend through the entire wall of the GI tract, leading to possible complications. Swelling can cause pain and can make the intestine empty frequently, resulting in diarrhea.
More information is provided in the NIDDK health topics:
- Crohns Disease - What I need to know about Crohns Disease | NIDDK | Chronic Diarrhea in Children |
What are the symptoms of Chronic Diarrhea in Children ? | Symptoms that accompany chronic diarrhea in children depend on the cause of the diarrhea. Symptoms can include
- cramping - abdominal pain - nausea or vomiting - fever - chills - bloody stools
Children with chronic diarrhea who have malabsorption can experience
- bloating and swelling, also called distention, of the abdomen - changes in appetite - weight loss or poor weight gain
Consult a Health Care Provider A childs parent or caretaker should consult a health care provider if the child - has diarrhea for more than 24 hours - is younger than 6 months old - has received treatment and the diarrhea persists Children with any of the following symptoms should see a health care provider right away: - signs of malabsorptionbloating and swelling of the abdomen, changes in appetite, and weight loss or poor weight gain - severe abdominal or rectal pain - a fever of 102 degrees or higher - stools containing blood or pus More information is provided in the NIDDK health topics: - Diarrhea - What I need to know about Diarrhea | NIDDK | Chronic Diarrhea in Children |
What causes Chronic Diarrhea in Children ? | To determine the cause of chronic diarrhea in children, the health care provider will take a complete medical and family history and conduct a physical exam, and may perform tests.
Medical and family history. Taking a medical and family history is one of the first things a health care provider may do to help determine the cause of chronic diarrhea. He or she will ask for information about symptoms, such as
- how long the child has had diarrhea - the amount of stool passed - the frequency of diarrhea - the appearance of the stool - the presence of other symptoms that accompany diarrhea
The health care provider will ask about the childs diet and may recommend keeping a diary of the childs diet and bowel habits. If the health care provider suspects a food allergy or intolerance, he or she may recommend changing the childs diet to see if symptoms improve.
The health care provider may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as celiac disease and lactose intolerance, run in families.
Physical exam. After taking a medical history, a health care provider will perform a physical exam, which may help determine the cause of chronic diarrhea. During a physical exam, a health care provider usually
- examines a childs body - uses a stethoscope to listen to bodily sounds - taps on specific areas of the childs body
Tests. The health care provider may perform one or more of the following tests:
- Stool test. A stool test is the analysis of a sample of stool. The health care provider will give the parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of blood, bacteria, or parasites or signs of diseases and disorders. The health care provider may also do a rectal exam, sometimes during the physical exam. For a rectal exam, the health care provider inserts a gloved, lubricated finger into the rectum to check for blood in the stool. - Blood test. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The blood test can show signs of certain diseases and disorders that can cause chronic diarrhea in children, including - high levels of white blood cells, which may be a sign of inflammation or infection somewhere in the body - anemia, which may be a sign of bleeding in the GI tract or of malabsorption - the presence of certain antibodiesproteins that react against the bodys own cells or tissueswhich may be a sign of celiac disease - Hydrogen breath test. This test measures the amount of hydrogen in a childs breath. Normally, only a small amount of hydrogen is detectable in the breath. However, bacteria break down sugarssuch as lactose and fructosethat are not digested by the small intestine and produce high levels of hydrogen. In small intestinal bacterial overgrowth, bacteria break down sugars in the small intestine and produce hydrogen. For this test, the child breathes into a balloonlike container that measures hydrogen. Then, the child drinks a lactose-loaded beverage, and the childs breath is analyzed at regular intervals to measure the amount of hydrogen. In most cases, a health care provider performs this test at a hospital, on an outpatient basis. A health care provider may use a hydrogen breath test to check for signs of lactose intolerance, fructose intolerance, or small intestinal bacterial overgrowth. - Upper GI endoscopy. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum, the first part of the small intestine. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A child may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A health care provider will place an intravenous (IV) needle in a vein in the arm if general anesthesia is given. The health care provider may use instruments passed through the endoscope to perform a biopsy or collect fluid. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope. A pathologista doctor who specializes in diagnosing diseasesexamines the tissues in a lab. This test can show problems in the upper GI tract that may cause chronic diarrhea. For example, a biopsy of the small intestine can show signs of celiac disease. A health care provider may use a fluid sample from the small intestine to check for bacteria to diagnose small intestinal bacterial overgrowth. - Flexible sigmoidoscopy or colonoscopy. While these tests are similar, a health care provider uses a colonoscopy to view the rectum and entire colon and a flexible sigmoidoscopy to view just the rectum and lower colon. A gastroenterologist performs these tests at a hospital or an outpatient center. For both tests, the health care provider will give written bowel prep instructions for the child to follow at home. The health care provider may ask that the child follow a clear liquid diet the day before either test. The child may require a laxative for 4 days before either test or only the day before either test. The child may require an enema the day before either test. These medications cause diarrhea, so the child should stay close to a bathroom during the bowel prep. In most cases, light anesthesia, and possibly pain medication, helps the child relax. For either test, the child will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The gastroenterologist may also perform a biopsy by taking a small piece of tissue from the intestinal lining. The child will not feel the biopsy. These tests can show problems in the rectum or colon, such as signs of IBD. Cramping or bloating may occur during the first hour after these tests. The child should recover fully by the next day and be able to return to a normal diet. | NIDDK | Chronic Diarrhea in Children |
What are the treatments for Chronic Diarrhea in Children ? | The treatment for chronic diarrhea will depend on the cause. Some common causes of chronic diarrhea are treated as follows:
- Infections. If a child has prolonged problems digesting certain carbohydrates or proteins after an acute infection, a health care provider may recommend changes in diet. A child may need antibiotics or medications that target parasites to treat infections that do not go away on their own. A health care provider may also prescribe antibiotics to treat small intestinal bacterial overgrowth. - Functional GI disorders. For toddlers diarrhea, treatment is usually not needed. Most children outgrow toddlers diarrhea by the time they start school. In many children, limiting fruit juice intake and increasing the amount of fiber and fat in the diet may improve symptoms of toddlers diarrhea. A health care provider may treat IBS with - changes in diet. - medication. - probioticslive microorganisms, usually bacteria, that are similar to microorganisms normally found in the GI tract. Studies have found that probiotics, specifically Bifidobacteria and certain probiotic combinations, improve symptoms of IBS when taken in large enough amounts. However, researchers are still studying the use of probiotics to treat IBS. - psychological therapy.
To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probiotics.
- Food allergies and intolerances. A health care provider will recommend changes in diet to manage symptoms of food allergies and intolerances. To treat food allergies, the childs parent or caretaker should remove the food that triggers the allergy from the childs diet. For children with celiac disease, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. The childs parent or caretaker can manage the symptoms of lactose intolerance with changes in the childs diet and by using products that contain the lactase enzyme. Most children with lactose intolerance can tolerate some amount of lactose in their diet. The amount of change needed in the diet depends on how much lactose a child can consume without symptoms. For children with dietary fructose intolerance, reducing the amount of fructose in the diet can relieve symptoms. - IBD. A health care provider may use medications, surgery, and changes in diet to treat IBD. | NIDDK | Chronic Diarrhea in Children |
What to do for Chronic Diarrhea in Children ? | A health care provider may recommend changing a childs diet to treat the cause of chronic diarrhea. Making sure that children receive proper nutrition is important for growth and development. A childs parent or caretaker should talk with a health care provider about changing the childs diet to treat chronic diarrhea. | NIDDK | Chronic Diarrhea in Children |
What to do for Chronic Diarrhea in Children ? | - Diarrhea is loose, watery stools. Chronic, or long lasting, diarrhea typically lasts for more than 4 weeks. - Many diseases and disorders can cause chronic diarrhea in children. Common causes include infections, functional gastrointestinal (GI) disorders, food allergies and intolerances, and inflammatory bowel disease (IBD). - Symptoms that accompany chronic diarrhea in children depend on the cause of the diarrhea. Symptoms can include cramping, abdominal pain, nausea or vomiting, fever, chills, or bloody stools. - Children with chronic diarrhea who have malabsorption can experience bloating and swelling of the abdomen, changes in appetite, or weight loss or poor weight gain. - Children with any of the following symptoms should see a health care provider right away: signs of malabsorption, severe abdominal or rectal pain, a fever of 102 degrees or higher, or stools containing blood or pus. - To determine the cause of chronic diarrhea, the health care provider will take a complete medical and family history and conduct a physical exam, and may perform tests. - The treatment for chronic diarrhea will depend on the cause. - A childs parent or caretaker should talk with a health care provider about changing the childs diet to treat chronic diarrhea. | NIDDK | Chronic Diarrhea in Children |
What is (are) Anemia in Chronic Kidney Disease ? | Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. With anemia, red blood cells carry less oxygen to tissues and organsparticularly the heart and brainand those tissues and organs may not function as well as they should. | NIDDK | Anemia in Chronic Kidney Disease |
What is (are) Anemia in Chronic Kidney Disease ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine.
Healthy kidneys produce a hormone called erythropoietin (EPO). A hormone is a chemical produced by the body and released into the blood to help trigger or regulate particular body functions. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. | NIDDK | Anemia in Chronic Kidney Disease |
What causes Anemia in Chronic Kidney Disease ? | When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.
Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:
- iron - vitamin B12 - folic acid
These nutrients are necessary for red blood cells to make hemoglobin, the main oxygen-carrying protein in the red blood cells.
If treatments for kidney-related anemia do not help, the health care provider will look for other causes of anemia, including
- other problems with bone marrow - inflammatory problemssuch as arthritis, lupus, or inflammatory bowel diseasein which the bodys immune system attacks the bodys own cells and organs - chronic infections such as diabetic ulcers - malnutrition | NIDDK | Anemia in Chronic Kidney Disease |
What are the symptoms of Anemia in Chronic Kidney Disease ? | The signs and symptoms of anemia in someone with CKD may include
- weakness - fatigue, or feeling tired - headaches - problems with concentration - paleness - dizziness - difficulty breathing or shortness of breath - chest pain
Anyone having difficulty breathing or with shortness of breath should seek immediate medical care. Anyone who has chest pain should call 911. | NIDDK | Anemia in Chronic Kidney Disease |
What are the complications of Anemia in Chronic Kidney Disease ? | Heart problems are a complication of anemia and may include
- an irregular heartbeat or an unusually fast heartbeat, especially when exercising. - the harmful enlargement of muscles in the heart. - heart failure, which does not mean the heart suddenly stops working. Instead, heart failure is a long-lasting condition in which the heart cant pump enough blood to meet the bodys needs. | NIDDK | Anemia in Chronic Kidney Disease |
How to diagnose Anemia in Chronic Kidney Disease ? | A health care provider diagnoses anemia based on
- a medical history - a physical exam - blood tests
Medical History
Taking a medical history is one of the first things a health care provider may do to diagnose anemia. He or she will usually ask about the patients symptoms.
Physical Exam
A physical exam may help diagnose anemia. During a physical exam, a health care provider usually examines a patients body, including checking for changes in skin color.
Blood Tests
To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. A blood test involves drawing a patients blood at a health care providers office or a commercial facility. A health care provider will carefully monitor the amount of hemoglobin in the patients blood, one of the measurements in a complete blood count.
The Kidney Disease: Improving Global Outcomes Anemia Work Group recommends that health care providers diagnose anemia in males older than age 15 when their hemoglobin falls below 13 grams per deciliter (g/dL) and in females older than 15 when it falls below 12 g/dL.2 If someone has lost at least half of normal kidney function and has low hemoglobin, the cause of anemia may be decreased EPO production.
Two other blood tests help measure iron levels:
- The ferritin level helps assess the amount of iron stored in the body. A ferritin score below 200 nanograms (ng) per liter may mean a person has iron deficiency that requires treatment.2 - The transferrin saturation score indicates how much iron is available to make red blood cells. A transferrin saturation score below 30 percent can also mean low iron levels that require treatment.2
In addition to blood tests, the health care provider may order other tests, such as tests for blood loss in stool, to look for other causes of anemia. | NIDDK | Anemia in Chronic Kidney Disease |
What are the treatments for Anemia in Chronic Kidney Disease ? | Depending on the cause, a health care provider treats anemia with one or more of the following treatments:
Iron
The first step in treating anemia is raising low iron levels. Iron pills may help improve iron and hemoglobin levels. However, for patients on hemodialysis, many studies show pills do not work as well as iron given intravenously.2
Erythropoietin
If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed. Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis.
Studies have shown the use of EPO increases the chance of cardiovascular events, such as heart attack and stroke, in people with CKD. The health care provider will carefully review the medical history of the patient and determine if EPO is the best treatment for the patients anemia. Experts recommend using the lowest dose of EPO that will reduce the need for red blood cell transfusions. Additionally, health care providers should consider the use of EPO only when a patients hemoglobin level is below 10 g/dL. Health care providers should not use EPO to maintain a patients hemoglobin level above 11.5 g/dL.2 Patients who receive EPO should have regular blood tests to monitor their hemoglobin so the health care provider can adjust the EPO dose when the level is too high or too low.2 Health care providers should discuss the benefits and risks of EPO with their patients.
Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. In some people, iron supplements and EPO will improve the symptoms of anemia.
Red Blood Cell Transfusions
If a patients hemoglobin falls too low, a health care provider may prescribe a red blood cell transfusion. Transfusing red blood cells into the patients vein raises the percentage of the patients blood that consists of red blood cells, increasing the amount of oxygen available to the body.
Vitamin B12 and Folic Acid Supplements
A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. Using vitamin supplements can treat low levels of vitamin B12 or folic acid and help treat anemia. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements, with their health care provider.
Read more about vitamin B12 and folic acid on the MedlinePlus website at www.nlm.nih.gov/medlineplus. Read more about complementary and alternative medicine at www.nccam.nih.gov. | NIDDK | Anemia in Chronic Kidney Disease |
What to do for Anemia in Chronic Kidney Disease ? | A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. Some of these foods are high in sodium or phosphorus, which people with CKD should limit in their diet. Before making any dietary changes, people with CKD should talk with their health care provider or with a dietitian who specializes in helping people with kidney disease. A dietitian can help a person plan healthy meals.
Read more about nutrition for people with CKD on the National Kidney Disease Education Program website.
The following chart illustrates some good dietary sources of iron, vitamin B12, and folic acid.
Food Serving Size Iron Vitamin B12 Folic Acid Recommended Daily Value 18 mg 6 mcg 400 mcg 100 percent fortified breakfast cereal cup (1 oz) 18 mg 6 mcg 394 mcg beans, baked 1 cup (8 oz) 8 mg 0 mcg 37 mcg beef, ground 3 oz 2 mg 2 mcg 8 mcg beef liver 3 oz 5 mg 67 mcg 211 mcg clams, fried 4 oz 3 mg 1 mcg 66 mcg spinach, boiled 1 cup (3 oz) 2 mg 0 mcg 115 mcg spinach, fresh 1 cup (1 oz) 1 mg 0 mcg 58 mcg trout 3 oz 0 mg 5 mcg 16 mcg tuna, canned 3 oz 1 mg 1 mcg 2 mcg | NIDDK | Anemia in Chronic Kidney Disease |
What to do for Anemia in Chronic Kidney Disease ? | - Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. - Anemia commonly occurs in people with chronic kidney disease (CKD)the permanent, partial loss of kidney function. Most people who have total loss of kidney function, or kidney failure, have anemia. - When kidneys are diseased or damaged, they do not make enough erythropoietin (EPO). As a result, the bone marrow makes fewer red blood cells, causing anemia. - Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food: - iron - vitamin B12 - folic acid - The first step in treating anemia is raising low iron levels. - If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. - Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. - A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. - A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. | NIDDK | Anemia in Chronic Kidney Disease |
What is (are) Anemia in Chronic Kidney Disease ? | You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
Booklets
- Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Kidney Transplantation - Kidney Failure: Eat Right to Feel Right on Hemodialysis
Fact Sheets
- Kidney Failure: What to Expect - Vascular Access for Hemodialysis - Treatment Methods for Kidney Failure: Hemodialysis - Hemodialysis Dose and Adequacy - Peritoneal Dialysis Dose and Adequacy - Amyloidosis and Kidney Disease - Anemia in Chronic Kidney Disease - Chronic Kidney Disease-Mineral and Bone Disorder - Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you an important member of your health care team.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank: John C. Stivelman, M.D., Emory University School of Medicine; Kerri Cavanaugh, M.D., M.H.S., Vanderbilt University
This information is not copyrighted. The NIDDK encourages people to share this content freely.
July 2014 | NIDDK | Anemia in Chronic Kidney Disease |
What is (are) Vesicoureteral Reflux ? | Vesicoureteral reflux is the abnormal flow of urine from the bladder to the upper urinary tract. The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. Blood flows through the kidneys, and the kidneys filter out wastes and extra water, making urine. The urine travels down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder.
In VUR, urine may flow backrefluxinto one or both ureters and, in some cases, to one or both kidneys. VUR that affects only one ureter and kidney is called unilateral reflux, and VUR that affects both ureters and kidneys is called bilateral reflux. | NIDDK | Vesicoureteral Reflux |
Who is at risk for Vesicoureteral Reflux? ? | Vesicoureteral reflux is more common in infants and young children, but older children and even adults can be affected. About 10 percent of children have VUR.1 Studies estimate that VUR occurs in about 32 percent of siblings of an affected child. This rate may be as low as 7 percent in older siblings and as high as 100 percent in identical twins. These findings indicate that VUR is an inherited condition.2 | NIDDK | Vesicoureteral Reflux |
What is (are) Vesicoureteral Reflux ? | The two types of VUR are primary and secondary. Most cases of VUR are primary and typically affect only one ureter and kidney. With primary VUR, a child is born with a ureter that did not grow long enough during the childs development in the womb. The valve formed by the ureter pressing against the bladder wall does not close properly, so urine refluxes from the bladder to the ureter and eventually to the kidney. This type of VUR can get better or disappear as a child gets older. As a child grows, the ureter gets longer and function of the valve improves.
Secondary VUR occurs when a blockage in the urinary tract causes an increase in pressure and pushes urine back up into the ureters. Children with secondary VUR often have bilateral reflux. VUR caused by a physical defect typically results from an abnormal fold of tissue in the urethra that keeps urine from flowing freely out of the bladder.
VUR is usually classified as grade I through V, with grade I being the least severe and grade V being the most severe. | NIDDK | Vesicoureteral Reflux |
What are the symptoms of Vesicoureteral Reflux ? | In many cases, a child with VUR has no symptoms. When symptoms are present, the most common is a urinary tract infection (UTI). VUR can lead to infection because urine that remains in the childs urinary tract provides a place for bacteria to grow. Studies estimate that 30 percent of children and up to 70 percent of infants with a UTI have VUR.2 | NIDDK | Vesicoureteral Reflux |
What are the complications of Vesicoureteral Reflux ? | When a child with VUR gets a UTI, bacteria can move into the kidney and lead to scarring. Scarring of the kidney can be associated with high blood pressure and kidney failure. However, most children with VUR who get a UTI recover without long-term complications. | NIDDK | Vesicoureteral Reflux |
How to diagnose Vesicoureteral Reflux ? | The most common tests used to diagnose VUR include
- Voiding cystourethrogram (VCUG). VCUG is an x-ray image of the bladder and urethra taken during urination, also called voiding. The bladder and urethra are filled with a special dye, called contrast medium, to make the urethra clearly visible. The x-ray machine captures a video of the contrast medium when the child urinates. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician supervised by a radiologista doctor who specializes in medical imagingwho then interprets the images. Anesthesia is not needed, but sedation may be used for some children. This test can show abnormalities of the inside of the urethra and bladder. - Radionuclide cystogram (RNC). RNC is a type of nuclear scan that involves placing radioactive material into the bladder. A scanner then detects the radioactive material as the child urinates or after the bladder is empty. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed, but sedation may be used for some children. RNC is more sensitive than VCUG but does not provide as much detail of the bladder anatomy. - Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. An abdominal ultrasound can create images of the entire urinary tract, including the kidneys and bladder. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. Ultrasound may be used before VCUG or RNC if the childs family or health care provider wants to avoid exposure to x-ray radiation or radioactive material.
Testing is usually done on
- infants diagnosed during pregnancy with urine blockage affecting the kidneys - children younger than 5 years of age with a UTI - children with a UTI and fever, called febrile UTI, regardless of age - males with a UTI who are not sexually active, regardless of age or fever - children with a family history of VUR, including an affected sibling
More information about urine blockage in infants is provided in the NIDDK health topic, Urine Blockage in Newborns.
VUR is an unlikely cause of UTI in some children, so these tests are not done until other causes of UTI are ruled out for
- children 5 years of age and older with a UTI - children with a UTI but no fever - sexually active males with a UTI | NIDDK | Vesicoureteral Reflux |
How to diagnose Vesicoureteral Reflux ? | Following diagnosis, children with VUR should have a general medical evaluation that includes blood pressure measurement, as high blood pressure is an indicator of kidney damage. If both kidneys are affected, a childs blood should be tested for creatininea waste product of normal muscle breakdown. Healthy kidneys remove creatinine from the blood; when the kidneys are damaged, creatinine builds up in the blood. The urine may be tested for the presence of protein and bacteria. Protein in the urine is another indication of damaged kidneys.
- having to urinate often or suddenly - long periods of time between bathroom visits - daytime wetting - pain in the penis or perineumthe area between the anus and genitals - posturing to prevent wetting - constipationa condition in which a child has fewer than two bowel movements in a week; the bowel movements may be painful - fecal incontinenceinability to hold stool in the colon and rectum, which are parts of the large intestine | NIDDK | Vesicoureteral Reflux |
What are the treatments for Vesicoureteral Reflux ? | The standard treatment for primary VUR has included prompt treatment of UTIs and long-term use of antibiotics to prevent UTIs, also called antimicrobial prophylaxis, until VUR goes away on its own. Antibiotics are bacteria-fighting medications. Surgery has also been used in certain cases.
Several studies have raised questions about long-term use of antibiotics for prevention of UTIs. The studies found little or no effect on prevention of kidney damage. Long-term use may also make the child resistant to the antibiotic, meaning the medication does not work as well, and the child may be sicker longer and may need to take medications that are even stronger.
- children younger than 1 year of age continuous antibiotics should be used if a child has a history of febrile UTI or VUR grade III through V that was identified through screening - children older than 1 year of age with BBDcontinuous antibiotics should be used while BBD is being treated - children older than 1 year of age without BBDcontinuous antibiotics can be used at the discretion of the health care provider but is not automatically recommended; however, UTIs should be promptly treated
Deflux, a gellike liquid containing complex sugars, is an alternative to surgery for treatment of VUR. A small amount of Deflux is injected into the bladder wall near the opening of the ureter. This injection creates a bulge in the tissue that makes it harder for urine to flow back up the ureter. The health care provider uses a special tube to see inside the bladder during the procedure. Deflux injection is an outpatient procedure done under general anesthesia, so the child can go home the same day. | NIDDK | Vesicoureteral Reflux |
What are the treatments for Vesicoureteral Reflux ? | Secondary VUR is treated by removing the blockage causing the reflux. Treatment may involve
- surgery - antibiotics - intermittent catheterizationdraining the bladder by inserting a thin tube, called a catheter, through the urethra to the bladder | NIDDK | Vesicoureteral Reflux |
What to do for Vesicoureteral Reflux ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing VUR. | NIDDK | Vesicoureteral Reflux |
What to do for Vesicoureteral Reflux ? | - Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder to the upper urinary tract. - VUR is more common in infants and young children, but older children and even adults can be affected. About 10 percent of children have VUR. - In many cases, a child with VUR has no symptoms. When symptoms are present, the most common is a urinary tract infection (UTI). - When a child with VUR gets a UTI, bacteria can move into the kidney and lead to scarring. Scarring of the kidney can be associated with high blood pressure and kidney failure. - Voiding cystourethrogram (VCUG), radionuclide cystogram (RNC), and abdominal ultrasound are used to diagnose VUR. - Children with VUR should also be assessed for bladder/bowel dysfunction (BBD). Children who have VUR along with any BBD symptoms are at greater risk of kidney damage due to infection. - The standard treatment for primary VUR has included prompt treatment of UTIs and long-term use of antibiotics to prevent UTIs, also called antimicrobial prophylaxis, until VUR goes away on its own. Surgery has also been used in certain cases. - Secondary VUR is treated by removing the blockage causing the reflux. | NIDDK | Vesicoureteral Reflux |
What is (are) Diabetic Kidney Disease ? | Diabetic kidney disease, also called diabetic nephropathy, is kidney disease caused by diabetes. Even when well controlled, diabetes can lead to chronic kidney disease (CKD) and kidney failure, described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis.
Diabetes affects 25.8 million people of all ages in the United States.1 As many as 40 percent of people who have diabetes are expected to develop CKD.2 Diabetes, the most common cause of kidney failure in the United States, accounts for nearly 44 percent of new cases of kidney failure, as illustrated in Figure 1.3 | NIDDK | Diabetic Kidney Disease |
What is (are) Diabetic Kidney Disease ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine.
When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.
Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine. | NIDDK | Diabetic Kidney Disease |
What is (are) Diabetic Kidney Disease ? | Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.
Diabetes is a disorder of metabolism the way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy.
Insulin is made in the pancreas, an organ located behind the stomach and below the liver. As blood glucose levels rise after a meal, the pancreas is triggered to release insulin. The pancreas contains clusters of cells called pancreatic islets. Beta cells within the pancreatic islets make insulin and release it into the blood.
Diabetes develops when the body doesnt make enough insulin, is not able to use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. The bodys cells are then starved of energy despite high blood glucose levels. | NIDDK | Diabetic Kidney Disease |
What are the symptoms of Diabetic Kidney Disease ? | People with diabetic kidney disease do not have symptoms in the early stages. As kidney disease progresses, a person can develop edema, or swelling. Edema happens when the kidneys cannot get rid of the extra fluid and salt in the body. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms may include
- appetite loss - nausea - vomiting - drowsiness, or feeling tired - trouble concentrating - sleep problems - increased or decreased urination - generalized itching or numbness - dry skin - headaches - weight loss - darkened skin - muscle cramps - shortness of breath - chest pain | NIDDK | Diabetic Kidney Disease |
How to diagnose Diabetic Kidney Disease ? | A health care provider diagnoses diabetic kidney disease based on
- a medical and family history - a physical exam - urine tests - a blood test
Medical and Family History
Taking a medical and family history is one of the first things a health care provider may do to help diagnose diabetic kidney disease. He or she will ask about the symptoms and the patients diabetes history.
Physical Exam
After taking a medical and family history, a health care provider will perform a physical exam. During a physical exam, a health care provider usually
- examines the patients body to check for changes in skin color - taps on specific areas of the patients body, checking for swelling of the feet, ankles, or lower legs
Urine Tests
Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine.
Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The patient collects a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed into the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease.
Blood Test
A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following:
- eGFR of 60 or above is in the normal range - eGFR below 60 may indicate kidney damage - eGFR of 15 or below may indicate kidney failure | NIDDK | Diabetic Kidney Disease |
How to diagnose Diabetic Kidney Disease ? | People with diabetes should get regular screenings for kidney disease. The National Kidney Disease Education Program recommends the following:
- urine albumin-to-creatinine ratio measured at least once a year in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more - eGFR calculated at least once a year in all people with type 1 or type 2 diabetes | NIDDK | Diabetic Kidney Disease |
How to prevent Diabetic Kidney Disease ? | People can prevent or slow the progression of diabetic kidney disease by
- taking medications to control high blood pressure - managing blood glucose levels - making changes in their eating, diet, and nutrition - losing weight if they are overweight or obese - getting regular physical activity
People with diabetes should see a health care provider who will help them learn to manage their diabetes and monitor their diabetes control. Most people with diabetes get care from primary care providers, including internists, family practice doctors, or pediatricians. However, having a team of health care providers can often improve diabetes care. In addition to a primary care provider, the team can include
- an endocrinologista doctor with special training in diabetes - a nephrologista doctor who specializes in treating people who have kidney problems or related conditions - diabetes educators such as a nurse or dietitian - a podiatrista doctor who specializes in foot care - an ophthalmologist or optometrist for eye care - a pharmacist - a dentist - a mental health counselor for emotional support and access to community resources
The team can also include other health care providers and specialists.
Blood Pressure Medications
Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown to slow the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.
People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked.
Managing Blood Glucose Levels
People manage blood glucose levels by
- testing blood glucose throughout the day - following a diet and physical activity plan - taking insulin throughout the day based on food and liquid intake and physical activity
People with diabetes need to talk with their health care team regularly and follow their directions closely. The goal is to keep blood glucose levels within the normal range or within a range set by the persons health care team. More information about diabetes is provided in the NIDDK health topics:
- National Diabetes Statistics Report, 2014 - Diagnosis of Diabetes and Prediabetes
Eating, Diet, and Nutrition
Following a healthy eating plan can help lower blood pressure and control blood sugar. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan
- is low in fat and cholesterol - features fat-free or low-fat milk and dairy products, fish, poultry, and nuts - suggests less red meat, and fewer sweets, added sugars, and sugarcontaining beverages - is rich in nutrients, protein, and fiber
Read more about DASH at www.nhlbi.nih.gov/health/health-topics/topics/dash.
People with diabetic kidney disease may need to limit sodium and salt intake to help reduce edema and lower blood pressure. A dietitian may also recommend a diet low in saturated fat and cholesterol to help control high levels of lipids, or fats, in the blood.
Health care providers may recommend that people with CKD eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet are still being researched. Proteins break down into waste products the kidneys must filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. More information about diabetes and diet is provided in the NIDDK health topics:
- What I need to know about Eating and Diabetes and What I need to know about Carbohydrate Counting and Diabetes - Make the Kidney Connection: Food Tips and Healthy Eating Ideas and Eating Right for Kidney Health: Tips for People with Chronic Kidney Disease.
Weight Loss and Physical Activity
Health care providers recommend that people who are overweight or obese lose weight to improve their bodies ability to use insulin properly and lower their risk for health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. People should aim to keep their BMI lower than 25.4
Experts recommend physical activity as an important part of losing weight, keeping sensitivity to insulin, and treating high blood pressure. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. More information is provided in the NIDDK health topic, What I need to know about Physical Activity and Diabetes. | NIDDK | Diabetic Kidney Disease |
What are the treatments for Diabetic Kidney Disease ? | A health care provider may treat kidney failure due to diabetic kidney disease with dialysis or a kidney transplant. In some cases, people with diabetic kidney disease receive kidney and pancreas transplants.
In most cases, people with diabetic kidney disease start dialysis earlier than people with kidney failure who do not have diabetes. People with diabetic end-stage kidney disease who receive a kidney transplant have a much better survival rate than those people on dialysis, although survival rates for those on dialysis have increasingly improved over time. However, people who receive a kidney transplant and do not have diabetes have a higher survival rate than people with diabetic kidney disease who receive a transplant.5
More information about treatment options for kidney failure is provided in the NIDDK health topics:
- Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Transplantation | NIDDK | Diabetic Kidney Disease |
What are the treatments for Diabetic Kidney Disease ? | People with diabetes should work with their health care team to prevent or manage CKD through the following steps:
- measure A1C levelsa blood test that provides information about a persons average blood glucose levels for the previous 3 months at least twice a year and keep A1C levels below 7 percent - learn about insulin injections, diabetes medications, meal planning, physical activity, and blood glucose monitoring - find out whether protein, salt, or liquid should be limited in the diet - see a registered dietitian to help with meal planning - check blood pressure every visit with a health care provider or at least two to four times a year - learn about possible benefits from taking an ACE inhibitor or an ARB if a person has high blood pressure - measure eGFR at least once a year to check kidney function - get the amount of protein in the urine tested at least once a year to check for kidney damage | NIDDK | Diabetic Kidney Disease |
What to do for Diabetic Kidney Disease ? | - Diabetic kidney disease, also called diabetic nephropathy, is kidney disease caused by diabetes. - People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. - At the onset of diabetes, blood flow into the kidneys increases, which may strain the glomeruli and lessen their ability to filter blood. - Higher levels of blood glucose lead to the buildup of extra material in the glomeruli, which increases the force of the blood moving through the kidneys and creates stress in the glomeruli. - Many people with diabetes can develop high blood pressure, another factor in the development of kidney disease. High blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the entire body. - Diabetic kidney disease takes many years to develop. - People with diabetic kidney disease do not have any symptoms in the early stages. As kidney disease progresses, a person can develop edema, or swelling. Edema happens when the kidneys cannot get rid of the extra fluid and salt in the body. Edema can occur in the legs, feet, or ankles and less often in the hands or face. - Once kidney function decreases further, symptoms may include - appetite loss - nausea - vomiting - drowsiness, or feeling tired - trouble concentrating - sleep problems - increased or decreased urination - generalized itching or numbness - dry skin - headaches - weight loss - darkened skin - muscle cramps - shortness of breath - chest pain - People can prevent or slow the progression of diabetic kidney disease by - taking medication to control high blood pressure - managing blood glucose levels - making changes in their eating, diet, and nutrition - losing weight if they are overweight or obese - getting regular physical activity | NIDDK | Diabetic Kidney Disease |
What is (are) Hemolytic Uremic Syndrome in Children ? | Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. Red blood cells contain hemoglobinan iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.
When the kidneys and glomerulithe tiny units within the kidneys where blood is filteredbecome clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injurythe sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. | NIDDK | Hemolytic Uremic Syndrome in Children |
What is (are) Hemolytic Uremic Syndrome in Children ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. | NIDDK | Hemolytic Uremic Syndrome in Children |
What causes Hemolytic Uremic Syndrome in Children ? | The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. The digestive system is made up of the gastrointestinal, or GI, tracta series of hollow organs joined in a long, twisting tube from the mouth to the anusand other organs that help the body break down and absorb food.
Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. The toxins travel through the bloodstream and can destroy the red blood cells. E.coli O157:H7 can be found in
- undercooked meat, most often ground beef - unpasteurized, or raw, milk - unwashed, contaminated raw fruits and vegetables - contaminated juice - contaminated swimming pools or lakes
Less common causes, sometimes called atypical hemolytic uremic syndrome, can include
- taking certain medications, such as chemotherapy - having other viral or bacterial infections - inheriting a certain type of hemolytic uremicsyndrome that runs in families
More information about foodborne illnesses and the digestive system is provided in the NIDDK health topic, foodborne illnesses. | NIDDK | Hemolytic Uremic Syndrome in Children |
What are the symptoms of Hemolytic Uremic Syndrome in Children ? | A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritisan inflammation of the lining of the stomach, small intestine, and large intestine such as
- vomiting - bloody diarrhea - abdominal pain - fever and chills - headache
As the infection progresses, the toxins released in the intestine begin to destroy red blood cells. When the red blood cells are destroyed, the child may experience the signs and symptoms of anemiaa condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen.
Signs and symptoms of anemia may include
- fatigue, or feeling tired - weakness - fainting - paleness
As the damaged red blood cells clog the glomeruli, the kidneys may become damaged and make less urine. When damaged, the kidneys work harder to remove wastes and extra fluid from the blood, sometimes leading to acute kidney injury.
Other signs and symptoms of hemolytic uremic syndrome may include bruising and seizures.
When hemolytic uremic syndrome causes acute kidney injury, a child may have the following signs and symptoms:
- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face - albuminuriawhen a child's urine has high levels of albumin, the main protein in the blood - decreased urine output - hypoalbuminemiawhen a child's blood has low levels of albumin - blood in the urine
Seek Immediate Care Parents or caretakers should seek immediate care for a child experiencing any urgent symptoms, such as - unusual bleeding - swelling - extreme fatigue - decreased urine output - unexplained bruises | NIDDK | Hemolytic Uremic Syndrome in Children |
How to diagnose Hemolytic Uremic Syndrome in Children ? | A health care provider diagnoses hemolytic uremic syndrome with
- a medical and family history - a physical exam - urine tests - a blood test - a stool test - kidney biopsy
Medical and Family History
Taking a medical and family history is one of the first things a health care provider may do to help diagnose hemolytic uremic syndrome.
Physical Exam
A physical exam may help diagnose hemolytic uremic syndrome. During a physical exam, a health care provider most often
- examines a child's body - taps on specific areas of the child's body
Urine Tests
A health care provider may order the following urine tests to help determine if a child has kidney damage from hemolytic uremic syndrome.
Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or caretaker collects a urine sample in a special container in a health care provider's office or a commercial facility. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the child's urine sample. Patches on the dipstick change color when albumin is present in the urine.
Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.
Blood Test
A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A health care provider will test the blood sample to
- estimate how much blood the kidneys filter eachminute, called the estimated glomerular filtrationrate, or eGFR. The test results help the healthcare provider determine the amount of kidneydamage from hemolytic uremic syndrome. - check red blood cell and platelet levels. - check for liver and kidney function. - assess protein levels in the blood.
Stool Test
A stool test is the analysis of a sample of stool. The health care provider will give the child's parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of E. coli O157:H7.
Kidney Biopsy
Biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The pathologist looks for signs of kidney disease and infection. The test can help diagnose hemolytic uremic syndrome. | NIDDK | Hemolytic Uremic Syndrome in Children |
What are the complications of Hemolytic Uremic Syndrome in Children ? | Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.1
However, children with hemolytic uremic syndrome may have serious and sometimes life-threatening complications, including
- acute kidney injury - high blood pressure - blood-clotting problems that can lead to bleeding - seizures - heart problems - chronic, or long lasting, kidney disease - stroke - coma | NIDDK | Hemolytic Uremic Syndrome in Children |
What are the treatments for Hemolytic Uremic Syndrome in Children ? | A health care provider will treat a child with hemolytic uremic syndrome by addressing
- urgent symptoms and preventing complications - acute kidney injury - chronic kidney disease (CKD)
In most cases, health care providers do not treat children with hemolytic uremic syndrome with antibiotics unless they have infections in other areas of the body. With proper management, most children recover without long-term health problems.2
Treating Urgent Symptoms and Preventing Complications
A health care provider will treat a child's urgent symptoms and try to prevent complications by
- observing the child closely in the hospital - replacing minerals, such as potassium and salt, and fluids through an intravenous (IV) tube - giving the child red blood cells and platelets cells in the blood that help with clottingthrough an IV - giving the child IV nutrition - treating high blood pressure with medications
Treating Acute Kidney Injury
If necessary, a health care provider will treat acute kidney injury with dialysisthe process of filtering wastes and extra fluid from the body with an artificial kidney. The two forms of dialysis are hemodialysis and peritoneal dialysis. Most children with acute kidney injury need dialysis for a short time only.
Treating Chronic Kidney Disease
Some children may sustain significant kidney damage that slowly develops into CKD. Children who develop CKD must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.
In most cases, health care providers treat CKD with a kidney transplant. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a person's body to take over the job of the failing kidney. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children. | NIDDK | Hemolytic Uremic Syndrome in Children |
How to prevent Hemolytic Uremic Syndrome in Children ? | Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by
- avoiding unclean swimming areas - avoiding unpasteurized milk, juice, and cider - cleaning utensils and food surfaces often - cooking meat to an internal temperature of at least 160 F - defrosting meat in the microwave or refrigerator - keeping children out of pools if they have had diarrhea - keeping raw foods separate - washing hands before eating - washing hands well after using the restroom and after changing diapers
When a child is taking medications that may cause hemolytic uremic syndrome, it is important that the parent or caretaker watch for symptoms and report any changes in the child's condition to the health care provider as soon as possible. | NIDDK | Hemolytic Uremic Syndrome in Children |
What to do for Hemolytic Uremic Syndrome in Children ? | At the beginning of the illness, children with hemolytic uremic syndrome may need IV nutrition or supplements to help maintain fluid balance in the body. Some children may need to follow a low-salt diet to help prevent swelling and high blood pressure.
Health care providers will encourage children with hemolytic uremic syndrome to eat when they are hungry. Most children who completely recover and do not have permanent kidney damage can return to their usual diet. | NIDDK | Hemolytic Uremic Syndrome in Children |
What to do for Hemolytic Uremic Syndrome in Children ? | - Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. - The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. - Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. - A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis, an inflammation of the lining of the stomach, small intestine, and large intestine. - Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health. - Some children may sustain significant kidney damage that slowly develops into chronic kidney disease (CKD). - Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by - avoiding unclean swimming areas - avoiding unpasteurized milk, juice, and cider - cleaning utensils and food surfaces often - cooking meat to an internal temperature of at least 160 F - defrosting meat in the microwave or refrigerator - keeping children out of pools if they have had diarrhea - keeping raw foods separate - washing hands before eating - washing hands well after using the restroom and after changing diapers | NIDDK | Hemolytic Uremic Syndrome in Children |
What is (are) Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. The tumors, called gastrinomas, release large amounts of gastrin that cause the stomach to produce large amounts of acid. Normally, the body releases small amounts of gastrin after eating, which triggers the stomach to make gastric acid that helps break down food and liquid in the stomach. The extra acid causes peptic ulcers to form in the duodenum and elsewhere in the upper intestine.
The tumors seen with Zollinger-Ellison syndrome are sometimes cancerous and may spread to other areas of the body. | NIDDK | Zollinger-Ellison Syndrome |
What is (are) Zollinger-Ellison Syndrome ? | The stomach, duodenum, and pancreas are digestive organs that break down food and liquid.
- The stomach stores swallowed food and liquid. The muscle action of the lower part of the stomach mixes the food and liquid with digestive juice. Partially digested food and liquid slowly move into the duodenum and are further broken down. - The duodenum is the first part of the small intestinethe tube-shaped organ between the stomach and the large intestinewhere digestion of the food and liquid continues. - The pancreas is an organ that makes the hormone insulin and enzymes for digestion. A hormone is a natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Insulin helps cells throughout the body remove glucose, also called sugar, from blood and use it for energy. The pancreas is located behind the stomach and close to the duodenum. | NIDDK | Zollinger-Ellison Syndrome |
What causes Zollinger-Ellison Syndrome ? | Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).1 MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum. Symptoms of MEN1 include increased hormone levels in the blood, kidney stones, diabetes, muscle weakness, weakened bones, and fractures.
More information about MEN1 is provided in the NIDDK health topic, Multiple Endocrine Neoplasia Type 1. | NIDDK | Zollinger-Ellison Syndrome |
How many people are affected by Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome is rare and only occurs in about one in every 1 million people.1 Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. A child who has a parent with MEN1 is also at increased risk for Zollinger-Ellison syndrome.2 | NIDDK | Zollinger-Ellison Syndrome |
What are the symptoms of Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. A dull or burning pain felt anywhere between the navel and midchest is the most common symptom of a peptic ulcer. This discomfort usually
- occurs when the stomach is emptybetween meals or during the nightand may be briefly relieved by eating food - lasts for minutes to hours - comes and goes for several days, weeks, or months
Other symptoms include
- diarrhea - bloating - burping - nausea - vomiting - weight loss - poor appetite
Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER), which occurs when stomach contents flow back up into the esophagusa muscular tube that carries food and liquids to the stomach. In addition to nausea and vomiting, reflux symptoms include a painful, burning feeling in the midchest. More information about GER is provided in the NIDDK health topic, Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults. | NIDDK | Zollinger-Ellison Syndrome |
What are the symptoms of Zollinger-Ellison Syndrome ? | A person who has any of the following emergency symptoms should call or see a health care provider right away:
- chest pain - sharp, sudden, persistent, and severe stomach pain - red blood in stool or black stools - red blood in vomit or vomit that looks like coffee grounds
These symptoms could be signs of a serious problem, such as
- internal bleedingwhen gastric acid or a peptic ulcer breaks a blood vessel - perforationwhen a peptic ulcer forms a hole in the duodenal wall - obstructionwhen a peptic ulcer blocks the path of food trying to leave the stomach | NIDDK | Zollinger-Ellison Syndrome |
How to diagnose Zollinger-Ellison Syndrome ? | A health care provider diagnoses Zollinger-Ellison syndrome based on the following:
- medical history - physical exam - signs and symptoms - blood tests - upper gastrointestinal (GI) endoscopy - imaging tests to look for gastrinomas - measurement of stomach acid
Medical History
Taking a medical and family history is one of the first things a health care provider may do to help diagnose Zollinger-Ellison syndrome. The health care provider may ask about family cases of MEN1 in particular.
Physical Exam
A physical exam may help diagnose Zollinger-Ellison syndrome. During a physical exam, a health care provider usually
- examines a persons body - uses a stethoscope to listen to bodily sounds - taps on specific areas of the persons body
Signs and Symptoms
A health care provider may suspect Zollinger-Ellison syndrome if
- diarrhea accompanies peptic ulcer symptoms or if peptic ulcer treatment fails. - a person has peptic ulcers without the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or a bacterial Helicobacter pylori (H. pylori) infection. NSAID use and H. pylori infection may cause peptic ulcers. - a person has severe ulcers that bleed or cause holes in the duodenum or stomach. - a health care provider diagnoses a person or the persons family member with MEN1 or a person has symptoms of MEN1.
Blood Tests
The health care provider may use blood tests to check for an elevated gastrin level. A technician or nurse draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. A health care provider will ask the person to fast for several hours prior to the test and may ask the person to stop acid-reducing medications for a period of time before the test. A gastrin level that is 10 times higher than normal suggests Zollinger-Ellison syndrome.2
A health care provider may also check for an elevated gastrin level after an infusion of secretin. Secretin is a hormone that causes gastrinomas to release more gastrin. A technician or nurse places an intravenous (IV) needle in a vein in the arm to give an infusion of secretin. A health care provider may suspect Zollinger-Ellison syndrome if blood drawn after the infusion shows an elevated gastrin level.
Upper Gastrointestinal Endoscopy
The health care provider uses an upper GI endoscopy to check the esophagus, stomach, and duodenum for ulcers and esophagitisa general term used to describe irritation and swelling of the esophagus. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A technician or nurse inserts an IV needle in a vein in the arm if anesthesia is given.
Imaging Tests
To help find gastrinomas, a health care provider may order one or more of the following imaging tests:
- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. A computer puts the different views together to create a model of the pancreas, stomach, and duodenum. The x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The person does not need anesthesia. CT scans can show tumors and ulcers. - Magnetic resonance imaging (MRI). MRI is a test that takes pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The person does not need anesthesia, though people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the person will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some machines allow the person to lie in a more open space. During an MRI, the person, although usually awake, remains perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images from different angles to create a detailed picture of the upper GI tract. During sequencing, the person will hear loud mechanical knocking and humming noises. - Endoscopic ultrasound. This procedure involves using a special endoscope called an endoechoscope to perform ultrasound of the pancreas. The endoechoscope has a built-in miniature ultrasound probe that bounces safe, painless sound waves off organs to create an image of their structure. A gastroenterologist performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The gastroenterologist carefully feeds the endoechoscope down the esophagus, through the stomach and duodenum, until it is near the pancreas. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A sedative helps the person stay relaxed and comfortable. The images can show gastrinomas in the pancreas. - Angiogram. An angiogram is a special kind of x ray in which an interventional radiologista specially trained radiologistthreads a thin, flexible tube called a catheter through the large arteries, often from the groin, to the artery of interest. The radiologist injects contrast medium through the catheter so the images show up more clearly on the x ray. The interventional radiologist performs the procedure and interprets the images in a hospital or an outpatient center. A person does not need anesthesia, though a light sedative may help reduce a persons anxiety during the procedure. This test can show gastrinomas in the pancreas. - Somatostatin receptor scintigraphy. An x-ray technician performs this test, also called OctreoScan, at a hospital or an outpatient center, and a radiologist interprets the images. A person does not need anesthesia. A radioactive compound called a radiotracer, when injected into the bloodstream, selectively labels tumor cells. The labeled cells light up when scanned with a device called a gamma camera. The test can show gastrinomas in the duodenum, pancreas, and other parts of the body.
Small gastrinomas may be hard to see; therefore, health care providers may order several types of imaging tests to find gastrinomas.
Stomach-acid Measurement
Using a sample of stomach juices for analysis, a health care provider may measure the amount of stomach acid a person produces. During the exam, a health care provider puts in a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. Once the tube is placed, a health care provider takes samples of the stomach acid. High acid levels in the stomach indicate Zollinger-Ellison syndrome. | NIDDK | Zollinger-Ellison Syndrome |
What are the treatments for Zollinger-Ellison Syndrome ? | A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery.
Medications
A class of medications called proton pump inhibitors (PPIs) includes
- esomeprazole (Nexium) - lansoprazole (Prevacid) - pantoprazole (Protonix) - omeprazole (Prilosec or Zegerid) - dexlansoprazole (Dexilant)
PPIs stop the mechanism that pumps acid into the stomach, helping to relieve peptic ulcer pain and promote healing. A health care provider may prescribe people who have Zollinger-Ellison syndrome higher-than-normal doses of PPIs to control the acid production. Studies show that PPIs may increase the risk of hip, wrist, and spine fractures when a person takes them long term or in high doses, so its important for people to discuss risks versus benefits with their health care provider.
Surgery
Surgical removal of gastrinomas is the only cure for Zollinger-Ellison syndrome. Some gastrinomas spread to other parts of the body, especially the liver and bones. Finding and removing all gastrinomas before they spread is often challenging because many of the tumors are small.
Chemotherapy
Health care providers sometimes use chemotherapy drugs to treat gastrinomas that cannot be surgically removed, including
- streptozotocin (Zanosar) - 5-fluorouracil (Adrucil) - doxorubicin (Doxil) | NIDDK | Zollinger-Ellison Syndrome |
What to do for Zollinger-Ellison Syndrome ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Zollinger-Ellison syndrome. | NIDDK | Zollinger-Ellison Syndrome |
What to do for Zollinger-Ellison Syndrome ? | - Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. - Experts do not know the exact cause of Zollinger-Ellison syndrome. - About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1). - Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. - Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. - Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER). - A health care provider diagnoses Zollinger-Ellison syndrome based on the following: - medical history - physical exam - signs and symptoms - blood tests - upper gastrointestinal (GI) endoscopy - imaging tests to look for gastrinomas - measurement of stomach acid - A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery. | NIDDK | Zollinger-Ellison Syndrome |
What is (are) Cystocele ? | A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination, also called voiding, the bladder empties through the urethra, located at the bottom of the bladder. The urethra is the tube that carries urine outside of the body. The vagina is the tube in a womans body that runs beside the urethra and connects the womb, or uterus, to the outside of the body. | NIDDK | Cystocele |
What causes Cystocele ? | A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening. In a cystocele, the bladder tissue remains covered by the vaginal skin. A cystocele may result from damage to the muscles and tissues that hold the pelvic organs up inside the pelvis. A womans pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as
- repetitive straining for bowel movements - constipation - chronic or violent coughing - heavy lifting - being overweight or obese
A womans chances of developing a cystocele increase with age, possibly because of weakening muscles and supportive tissues from aging. Whether menopause increases a womans chances of developing a cystocele is unclear. | NIDDK | Cystocele |
What are the symptoms of Cystocele ? | The symptoms of a cystocele may include
- a vaginal bulge - the feeling that something is falling out of the vagina - the sensation of pelvic heaviness or fullness - difficulty starting a urine stream - a feeling of incomplete urination - frequent or urgent urination
Women who have a cystocele may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. These movements can include coughing, sneezing, laughing, or physical activity, such as walking. Urinary retentionthe inability to empty the bladder completelymay occur with more severe cystoceles if the cystocele creates a kink in the womans urethra and blocks urine flow.
Women with mild cystoceles often do not have any symptoms. | NIDDK | Cystocele |
How to diagnose Cystocele ? | Diagnosing a cystocele requires medical tests and a physical exam of the vagina. Medical tests take place in a health care providers office, an outpatient center, or a hospital. The health care provider will ask about symptoms and medical history. A health care provider uses a grading system to determine the severity of a womans cystocele. A cystocele receives one of three grades depending on how far a womans bladder has dropped into her vagina:
- grade 1mild, when the bladder drops only a short way into the vagina - grade 2moderate, when the bladder drops far enough to reach the opening of the vagina - grade 3most advanced, when the bladder bulges out through the opening of the vagina
If a woman has difficulty emptying her bladder, a health care provider may measure the amount of urine left in the womans bladder after she urinates. The remaining urine is called the postvoid residual. A health care provider can measure postvoid residual with a bladder ultrasound. A bladder ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off the bladder to create an image and show the amount of remaining urine. A specially trained technician performs the procedure, and a radiologista doctor who specializes in medical imaginginterprets the images. A woman does not need anesthesia.
A health care provider can also use a cathetera thin, flexible tubeto measure a womans postvoid residual. The health care provider inserts the catheter through the womans urethra into her bladder to remove and measure the amount of remaining urine after the woman has urinated. A postvoid residual of 100 mL or more is a sign that the woman is not completely emptying her bladder. A woman receives local anesthesia.
A health care provider may use a voiding cystourethrograman x-ray exam of the bladderto diagnose a cystocele as well. A woman gets a voiding cystourethrogram while urinating. The x-ray images show the shape of the womans bladder and let the health care provider see any problems that might block normal urine flow. An x-ray technician performs a voiding cystourethrogram, and a radiologist interprets the images. A woman does not need anesthesia; however, some women may receive sedation. A health care provider may order additional tests to rule out problems in other parts of a womans urinary tract. | NIDDK | Cystocele |