Many women are troubled by haemorrhoids (or piles). This is often worse in the later stages of pregnancy, and during actual labour. These are an extension of the varicose vein problem, and are actually distended veins in the lower part of the bowel. In some women they are very prominent and quite uncomfortable.

Eliminating constipation can often assist in a remarkable manner. Having unprocessed bran, ideally with muesli, for breakfast each day is good and effective therapy. Often, through the application of simple creams such as lanoline, a soothing result can be obtained. Sometimes clothing rubbing against the piles (which may prolapse) can be very uncomfortable, and local applications can reduce this. Sometimes the insertion of suppositories can assist in shrinking them.

But piles are essentially a mechanical problem, and nearly always they rectify themselves automatically when the confinement is over.

Excessive urination

In early pregnancy, the kidneys tend to produce more fluid than usual. This results in the desire to urinate far more often than normal. Indeed, so common is this symptom that it is often regarded as one of the early tell-tale symptoms of pregnancy.

Toward the end of the term, as the foetal head presses on the bladder, frequency is again quite common. This time it is a mechanical cause.

Both types of frequency are non-serious. They do not indicate disease and, apart from the transient nuisance factor, should be ignored.

Women are more prone to urinary-tract infections during pregnancy. This is often accompanied by the passage of unpleasant-smelling urine, aches and pains and possibly an elevated temperature. The fluid may contain blood, or be cloudy. The desire to pass the urine often occurs, and it is often accompanied by a burning sensation, and the desire to micturate again soon after. There is a lack of comfort, even though the bladder has been emptied.

It is important that urinary-tract infections be dealt with adequately, and medication may be necessary. Often a fever and pains over the bladder or in the back may accompany the other symptoms.

Tests may be carried out by the doctor to determine if infections are present. They will also indicate to him the best form of therapy for your particular infection.

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With the advent a few years ago of reliable tests collectively referred to as “immuno-chemical tests,” it is now possible to obtain quick and accurate results. In fact, by using some forms of the test, an answer can be forthcoming in a matter of minutes!

Those that can be read after two minutes are claimed to be 92 per cent reliable. A similar test which occupies about two hours is said to be about 98 per cent accurate. These degrees of accuracy are very high. When teamed in with the patient’s history, the symptoms she describes and the results of the physician’s physical examination, it usually leaves very little doubt in anybody’s mind whether conception has or has not taken place.

Certain precautions are needed when carrying out the pregnancy tests. Ideally, it is a “first” specimen of urine taken during the initial act of urination for the day. The bottle should be clean and free from contamination by drugs or chemicals. (This could possibly give a false reading.) If there is any time-lapse between the time the urine is passed and the time of examination (and a few hours is most likely), the specimen should be refrigerated.

The doctor is seeking to prove the existence in the specimen of urine of a specific hormone called “H.C.G.” This is short for Human Chorionic Gonadotrophin. It is produced by the developing embryo, and actively circulates in the bloodstream. A certain amount is excreted in the urine. If it can be picked up by the use of the test, it is an almost certain guarantee of pregnancy.

However, it takes almost six weeks from the date of the last menstrual period for adequate amounts to be excreted in the urine. Therefore, if the test is carried out before the six-week period, it will most likely yield a negative result, even though the person may be pregnant.

A popular routine is to carry out the H.C.G. test at six weeks. If it indicates negative, and the patient shows many of the other signs of pregnancy, the test is carried out again seven to ten days after. A positive result is then probable, indicating pregnancy has actually occurred.

The doctor will most likely check to see what forms of medication (if any) you are taking. Certain drugs, it seems, can produce incorrect results with the immunochemical test.

The introduction of the simple and accurate immunological pregnancy tests has been a major step forward in the early accurate disgnosis of pregnancy.

New Blood Test for Pregnancy

Since the original urine test for pregnancy was worked out, a quicker and even more reliable one has been developed, and this is now widely used by doctors. In fact, pregnancy can accurately be diagnosed within twenty-four to thirty-six hours of conception. One does not even have to miss a period. It is called the radio immuno assay pregnancy test, or R.I.A. Pregnancy Test for short. Taking a blood sample, a special machine can detect extremely minute traces of H.C.G. circulating in the mother’s blood. It is far more delicate and accurate than the H.C.G. urine tests, and will undoubtedly replace it in due course.

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The rate at which triplets occur is 1 in 90 x 90 pregnancies, and quadruplets 1 in 90 x 90 x 90. This is the rate in Western lands. It is more common in Africa and Asia where a larger hereditary factor apparently plays a part.

There are two types of twins: “Binovular” twins occur when two separate eggs (or ova) are released and fertilized at the same time. Each foetus is a separate entity and is quite distinct from its fellow. “Uni-ovular” twins come from one single egg which has prematurely divided into two separate entities.

Twins are often diagnosed before their birth, but about 20 per cent are not recognized until the moment of delivery. Features which make a patient and the doctor suspect multiple births are mainly the size of the abdomen and womb which are larger than would be expected at any given time.

Sometimes two heads may be felt through the abdominal wall by the doctor’s examining hands. Frequently, the only sure way is by X-ray or ultra-sound examination of the womb. Two separate heads and bodies can be clearly detected in this manner.

Generally, multiple births proceed to term normally. But there is an increased risk of certain complications taking place, so the mother may be requested to attend more frequently for her prenatal examinations. Some cases end in premature labour.

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Even during normal non-pregnant life, women run a greater risk of having reduced stores of iron. Menstruation each month reduces the supply. Although a certain amount of this is made up during the subsequent month, it is very common for the level to be less than normal even early in pregnancy.

For this reason, the doctor usually orders a haemoglobin examination at an early date in pregnancy. The haemoglobin is the red material in the red blood cells, and iron is used in its manufacture. Unless this is present in normal amounts, the body (including the foetus) is unable to gain sufficient supplies of oxygen, and difficulties may be encountered.

With more severe forms of anaemia (as this condition is called), symptoms will appear. Fatigue ‘more than would normally be expected), shortness of breath, a pale complexion and swelling of the tissues (referred to as oedema) may occur.

These are very important symptoms, indicating an immediate need for treatment.

However, the doctor usually has taken the matter in hand well before these symptoms are likely to put in appearance.

Treatment is generally very successful. It is usually given in a form that can be taken orally. Many different forms are available. Some patients are sensitive to some iron salts, and changes are necessary. But usually a certain brand is available that is suitable and can be tolerated satisfactorily.

Sometimes another chemical called folic acid is in short supply, and this may be given in conjunction. It is also needed to keep the blood in good order.

By sticking to a sensible iron-rich eating routine, the risks of anaemia are far less.

An iron-rich diet is usually a vitamin-rich diet as well. If the mother-to-be acquires this naturally, the need for medication is often reduced.

The original blood test carried out at the first consultation is often repeated at the thirty-second and thirty-sixth weeks of pregnancy, for these are critical times when iron utilization is high. Any deficiencies must be brought back to normal as promptly as possible.

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Instead, it settled at some part along the course of the Fallopian tube (sometimes called the oviduct). This odd occurrence seems more common in underdeveloped lands, where about one pregnancy in 150 ends up this way. In Western lands, the incidence is much lower, being about once in every 250 pregnancies.

The tubes are designed as pipes to transport the egg. They are certainly not meant to sustain foetal growth, and it is quite impossible for a pregnancy to continue there for any length of time.

So, symptoms of disaster are inevitable. It is merely a matter of time. Usually this is between the sixth and tenth weeks.

If the egg becomes implanted in the tube at the ovarian end, then a tubal abortion commonly occurs. This may be the least dramatic. The fertilized ovum simply dies, and is spontaneously aborted into the abdominal cavity.

If the egg is located more deeply along the tract of the tube, it increases in size, and gradually burrows into surrounding tissues. Often a major blood-vessel is finally eroded, and a sudden internal haemorrhage occurs. Blood may suddenly spread out into the pelvic cavity, often creating an emergency situation.

If this complication arises suddenly, and there is considerable blood loss, the patient will notice sudden severe pain in the lower abdominal area. Sudden collapse is common, and shock may occur due to the haemorrhaging. There may be some vaginal bleeding.

Urgent admission to hospital and medical attention is essential. With prompt diagnosis and surgical intervention results are usually satisfactory.

The key warning to any woman who appears to be in early pregnancy (one or two missed periods) is to seek prompt attention if there is any sudden onset of low abdominal pain. Call the doctor or get to a hospital.

In recent years, certain procedures have been claimed to increase the risk of tubal pregnancy. The use of the progestogen-only contraceptive pill (the so-called “mini-pill”) had this charge leveled at it at one stage.

Operations aimed at reconstituting the patency of blocked Fallopian tubes were claimed to be followed by an increased risk of ectopics.

One ectopic seems to increase the risk of another if a further pregnancy takes place. (The risk rises to about 10 per cent.) Only about 60 per cent of women who have sustained an ectopic become pregnant again.

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When a baby boy is born he has a fold of skin covering the glans. This is called the foreskin. It is open at the end, just beyond the tip of the glans, so that the opening to the urethra is not covered. The foreskin can be pulled back when the penis is washed, and it moves back to expose the more sensitive skin of the glans when the man has sex. A penis that has a foreskin is said to be uncircumcised.

Some men have been circumcised. That means that their foreskin has been removed. Usually this is done by a doctor, or by a religious elder, when the baby is very young. In some cultures it is done at puberty. Occasionally a man may need to be circumcised later in life for medical reasons.

When a man becomes sexually excited, or ‘turned on’, his penis becomes erect, which means it gets harder and larger. When a man has an erection, it is difficult to tell if he has been circumcised or not because the foreskin pulls back to expose the glans. The penis gets harder and larger because blood flows to spongy tissue in the penis and fills it. The passage from the bladder that carries urine is blocked off so that when he ejaculates, or comes, only semen, which is the fluid containing sperm, is released.

Directly behind the penis is a loose bag of skin called the scrotum. Inside the scrotum are the two testes, or balls, that produce sperm. Sometimes the scrotum hangs loosely, and sometimes it scrunches up tightly close to the body. This generally depends on how the man is built It can also happen because sperm need to be kept at a certain temperature to live, and so when it is hot, the testes may be kept cooler by hanging more loosely away from the body, and when it is cold, they can move up close to keep warmer.

Behind the scrotum, towards the back of the body is an opening, which is the man’s anus. Faeces, or waste from the bowel, comes out here when the man goes to the toilet.

Now let’s look inside the man’s body. This shows the man’s body from the side. Perhaps it would be best to start with sperm production. Look at the testes inside the scrotum. They are about the size of walnuts and are made up of tightly coiled tubes where sperm and hormones are produced from puberty onward. Sperm are really tiny and you can only see them if you use a microscope. You may have heard of testosterone. This is one of the hormones produced in the testes. It is involved in producing male characteristics such as body hair and a deep voice.

Along the back to the top of each testis is the epididymis. The epididymis stores more mature sperm waiting to be fed into the vas deferens when they are needed. The vas deferens is usually just called the vas. One vas leads away from each testis. They are long and narrow and carry sperm to the urethra. The vas loop around the bladder and as they feed into the prostate gland the sperm mix with semen, which is fluid from the seminal glands. The prostate is also where the part of the urethra that is connected to the bladder can be closed off, so that only semen is released when a man ejaculates.

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It is this progressive loss of tone that can turn a mild snorer into a man with a chronic sleep problem. Over a few decades, it can also turn a relatively nice bloke into a grumpy old man. Grumpy because, without even knowing it, he has not had a decent night’s sleep in years.

Until recently, snoring has been largely ignored. It’s been viewed as an innocuous activity which, at worst, irritates the snorer’s sleeping partner. The insidious damage it causes and the resulting ramifications are only now being fully recognized.

Heavy snoring puts tremendous stress on the body. It generates a huge amount of pressure in the throat and can transform sleep from a restful activity into a struggle for oxygen. The development of new technology in the 1970s showed that snoring has the potential to reduce blood oxygen to levels that were previously thought incompatible with human life.

Chronic heavy snorers often have episodes of apnoea when the soft palate and the tongue relax, due to decreased muscle control, and fall back in the throat, effectively blocking the flow of air in and out of the lungs. When this happens the man chokes and the oxygen level in his blood falls dramatically. An automatic reflex usually jerks him into restarting breathing. During such episodes the oxygen level can drop 80 per cent. Repeatedly these men get a fall in oxygen levels equivalent to going up to the top of Mt Everest and back in twenty seconds. Men with chronic sleep apnoea do this hundreds of times a night.

These repeated falls in oxygen have long-term effects on health. Simply having a history of heavy snoring is associated with an eightfold increase in the risk of stroke, double the risk of high blood pressure and an increased risk of heart attack, probably as high as twentyfold. Throat tissue damage can become evident after just five or ten years of snoring. Even in the early stages, the tissue can become so loose that sleeping becomes a night-long battle to breathe. This can happen without the man even being aware of it. All he knows is that he doesn’t feel restored on waking and that during the day he feels sleepy and performs under par.

Men are more prone to snoring than women. Until the age of fifty, about nine men snore to every one woman. After this, the gap begins closing. It is believed that androgens (male hormones) amplify snoring. Men have a lower voice, their throat tissue is floppier, and their larynx vibrates at lower frequencies. At menopause, women’s hormonal balance changes, androgens rise and so does their predisposition for snoring.

Snoring is not inevitable. It is not something men have to resign themselves to. If recognized early it can be stopped. There are several things even an established snorer can do to minimize it. Sleeping on the side rather than the back is recommended. Keeping weight down is crucial. For many men there is a weight threshold above which they will snore. Often a very small amount of extra weight can make a big difference.

Alcohol is a muscle relaxant and relaxes the throat muscles, making snoring all the more likely, so the consumption of alcohol in the last few hours before going to sleep should be avoided. Nasal obstructions, such as allergies or old football injuries, also can lead to snoring and should be treated.

General fitness helps, too, but there are exceptions. Weightlifting or sports which build thick neck muscles can encourage snoring by putting pressure on internal airways. Genetic inheritance is influential as well. Some men are just born with narrow airways and will become snorers. Those with long necks are less predisposed. Giraffes are unlikely to snore, and looking at Nefertiti, it would be a fairly safe guess that she never snored either.

It is when moderate snoring progresses to heavy snoring and incidents of sleep apnoea begin that the activity becomes dangerous. Studies have shown that 25 per cent of middle-aged men (between the ages of forty and sixty) have an average of five apnoeas per hour of sleep. This is regarded as mild apnoea and most men would not know they had it. Men who suffer chronic sleep apnoea may have between 300 and 500 incidents a night. Over time the lack of good sleep begins to show. Signs of personality change emerge, the men feel grumpy and irritable, their short-term memory starts going, and so does their libido.

Treatment for chronic sleep apnoea includes various types of surgery or using a special mask which was developed in the 1980s by Professor Colin Sullivan, respiratory physician at the University of Sydney. This mask has since become the international ‘gold standard’ for treatment. Lasers are also used to operate on the throat to stop snoring.

If you think you suffer from sleep apnoea and need treatment, first see your local doctor. The doctor can then refer you to a respiratory physician who will decide if you need to go to a sleep laboratory.

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