THE MONTHLY CYCLE (MENSTRUATION AND PREGNANCY)

As a girl begins to reach womanhood, her breasts begins to enlarge, and hair starts to grow in her pubic area. A year or two later she undergoes a period of rapid growth, after which she begins to menstruate. At first the intervals between menses are irregular because her ovaries are not producing mature sex cells. However, within a year  or so, the time of menstruation becomes irregular.

 A rhythmic pattern are called the 28-day female menstrual cycle, changes in the lining of the uterus (mucosa) and body temperature during a  (more accurately the female sexual cycle) continues throughout the normal reproductive years, and is regulated by rhythmic changes in the female hormones.

The ebb and flow of these hormones causes the changes seen in the sexual organ (ovary, uterus, breasts). While the average cycle is twenty eight days, the interval may vary from as little as twenty days to more than forty days in perfectly normal women.

Stimulated by hormones from the pituitary gland (follicle-stimulating hormone -- FSH, and luteinizing  hormone--LH), a few mature follicles (up to ten) in each ovary respond, but only one ovary releases an ovum (usually alternating each month between ovaries). This process,called ovulation, occurs fourteen days after sexual (menstrual) cycle. Note the abrupt drop in body temperature at the time of ovulation.menses begins,in a woman who has a twenty-eight day cycle.

The cells lining the empty follicle rapidly increase in number and become changed to lutein cells (forming the corpus luteum) which secrete progesterone and estrogen. Under the influence of these hormones, the lining of the uterus, called the endometrium,undergoes considerable change. Blood vessels increase in number, the lining cells multiply rapidly, the endometrium doubles in thickness (becoming 4 to 6 millimeters thick), growing soggy with nutritious secretions known as "uterine milk",and takes on a velvety appearance -- all in readiness to received a fertilize ovum. When conception does not occur, the level of the ovarian hormones (estrogen and progesterone) drops suddenly. Without the encouragement of these hormones the endometrium begins to deteriorate. The underlying blood vessels narrow and soon break apart. The lining cells, denied the blood they need, disintegrate. The unfertilized ovum with much of the mucous membrane is shed, accompanied by the loss of considerable blood. Contractions of the uterus (sometimes causing painful "cramps") aid in expelling this blood and tissue through the vagina. This process is called menstruation.

Typically, five days after menstruation starts  (anywhere from three to seven days is normal), blood flow ceases. A little more than 2 ounces (70 ml) of blood, cells, and tissue fluids are lost.The inside of the uterus is now completely stripped of its lining, and rebuilding of this lining begins again in anticipation of a pregnancy occurring during the next month. The enormous number of white cells present in the menstrual flow protect the uterus from possible infection. 

When conception does occur, the cells of the endometrium initially act as nursemaid to the fertilized egg when its first arrives in the womb (about four days after conception). A secretion called "uterine milk"provides the rapidly growing embryo the food it needs. After three or four days, the ovum implants itself in the lining. Still later, as the demands of the growing embryo increase, the placenta develops. The placenta is an organ which act as a go- between for the mother and fetus. Oxygen and nutrients from the mother's blood pass to the blood of the fetus, while many of the waste formed by the fetus move in the opposite direction. These waste travel through the placenta into the mother's blood, to be expelled by her eliminative organs. Some of the major events in the calendar of a twenty-eight-day menstrual cycle are summarized below. The menstrual flow continues for about five days, following which the rebuilding of the uterine lining begins and continues for eleven or twelve days (proliferative phase). Then,for another eleven to twelve days, the lining cells fill with fluid to nourish the ovum (secretory phrase). Fourteen days after the start of menstruation, ovulation occurs.Twenty-six days from the start, if the ovum is not fertilized, the lining begins to disintegrate, and two days later menstruation commences again.

DISORDERS OF THE URETERS AND BLADDER ( Urinary incontenence)

Urinary incontinence is the inability to hold urine in the bladder or release it as desired. A sudden uncontrollable desire to void is called urge incontinence. Such loss of control commonly occurs during an infection in the bladder (cystitis) or urethra (urethritis). Other causes of incontinence include spinal cord injury, injury during childbirth, an enlarge prostate, and diseases such as Alzheimer's disease, and multiple sclerosis.

  In the case of weakened sphincters and pelvic floor muscles, unexpected vigorous laughing, coughing, and straining (as when lifting something heavy), causes unwilling urine loss called stress incontinence.

What your physician can do. He will treat the underlying infection or disease. He may suggest that you strengthen the weak muscles by trying to hold your urine when the urge to urinate comes. Surgical repair may be necessary in some cases.

DISORDERS OF THE URETERS AND BLADDER (Ureteral stricture).

The right and left ureters carry urine from the right and left kidneys to the urinary bladder.

URETERAL STRICTURE:
 Occasionally a narrowing or stricture occurs in one ureters, interfering with the normal flow of the urine. Narrowing may be the result of damage to the lining from the presence or passing of a kidney stone or from some external pressure as from an enlarging tumor. The  symptom - pain in the lower back which travels to the region of the groin - may vary from a dull ache to almost intolerable pain.

What your physician can do. He may decide to periodically dilate or stretch the narrowing by passing a catheter, using a cystoscope, from the bladder up the ureter. When this method is not feasible, he may remove the kidney and ureter on the affected side, but only if the opposite ureter and kidney are functional.

Kidney Stones (renal calculi)

Kidney stones are masses of solid material, the vast majority of which form and enlarge within the kidney pelvis, while about two percent develop within the tubules of the kidneys. The common stones are composed of calcium oxalate ,uric acid, and cystine-precipitates of chemicals normally held in solution. They occur more frequently in some families and in certain geographic areas.

Certain factors appear to trigger stones formation, including infections of the kidney; obstructions to the flow of urine due to acquired or inherited defects; metabolic/ disorders such as gout (increase in uric acid), hyperthyroidism  (increase in blood calcium levels), and excessive absorption of oxalate;dietary imbalances (diets high in protein increase excretion of calcium, phosphorous, and uric acid); and not drinking enough water.
 Some stones remain in the kidney for long periods without causing symptoms. Usually, however, discomfort ranges from a dull ache in the lower back to extremely severe  colicky pain,which comes and goes in waves. Spasm of the ureter muscles causes the pain. As the stones moves down toward the bladder, the pain shifts to the flank, lower abdomen, and then the groin. As the stone passes into the bladder, the pain is relieved. Injury from the stone may cause blood in the urine.

 The presence and the location of the stone can be determined by means of an X-rays or by X-rays using a dye which is infected into the blood and excreted in the urine (intravenous pyelogram).

What you can do. You should be under the care of your physician. However, you can do a number of things yourself. Drink large quantities of water (enough to produce 4 quarts or four liters of urine per twenty four hours).This may help to flush out a stone, keep it for enlarging, and help prevent the formation of the new stones. A low salt intake, and a diet with 30 to 40 grams of protein per day will not only reduce the workload of the kidneys, but also decrease the excretion of wastes which tend to form stones.

What your physician can do. By periodic examinations he can advice as to whether stones are growing or forming. Should you have high levels of uric acid, he may prescribe medications, together with a chance of diet, to help correct this situation. The problem of a stone which fails to pass or which blocks urine flow require treatment.
 A stone low down in the ureter can be removed through the bladder.

Stones higher up can now be reached using a tube inserted in the side. If not removed the stone can be electrically fragmented and then extracted. Direct surgical removal may be necessary. However, some institutions have an ultrasonic shock wave machine (lithotriptor) which can shatter the stone by directing the shock waves from outside the body.