Hemochromatosis

Hemochromatosis is a disease in which too much iron builds up in your body. Your body needs iron but too much of it is toxic. If you have hemochromatosis, you absorb more iron than you need. Your body has no natural way to get rid of the extra iron. It stores it in body tissues, especially the liver, heart, and pancreas. The extra iron can damage your organs. Without treatment, it can cause your organs to fail.

There are two types of hemochromatosis. Primary hemochromatosis is an inherited disease. Secondary hemochromatosis is usually the result of something else, such as anemia, thalassemia, liver disease, or blood transfusions.

Many symptoms of hemochromatosis are similar to those of other diseases. Not everyone has symptoms. If you do, you may have joint pain, fatigue, general weakness, weight loss, and stomach pain.

Your doctor will diagnose hemochromatosis based on your medical and family histories, a physical exam, and the results from tests and procedures. Treatments include removing blood (and iron) from your body, medicines, and changes in your diet.

NIH: National Heart, Lung, and Blood Institute

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hernia

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen.

There are several types of hernias, including:

• Inguinal, in the groin. This is the the most common type.
• Umbilical, around the belly button
• Incisional, through a scar
• Hiatal, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
• Congenital diaphragmatic, a birth defect that needs surgery

Hernias are common. They can affect men, women, and children. A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia.

Treatment is usually surgery to repair the opening in the muscle wall. Untreated hernias can cause pain and health problems.

Hiatal Hernia

A hiatal hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Your diaphragm is the thin muscle that separates your chest from your abdomen. Your diaphragm helps keep acid from coming up into your esophagus. When you have a hiatal hernia, it's easier for the acid to come up. This leaking of acid from your stomach into your esophagus is called GERD (gastroesophageal reflux disease). GERD may cause symptoms such as :

• Heartburn
• Problems swallowing
• A dry cough
• Bad breath
• Nausea and/or vomiting
• Breathing problems
• The wearing away of your teeth

Often, the cause of a hiatal hernia is unknown. It may have to do with weakness in the surrounding muscles. Sometimes the cause is an injury or a birth defect. Your risk of getting a hiatal hernia goes up as you age; they are common in people over age 50. You are also at higher risk if you have obesity or smoke.

People usually find out that they have a hiatal hernia when they are getting tests for GERD, heartburn, chest pain, or abdominal pain. The tests may be a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy.

You don't need treatment if your hiatal hernia does not cause any symptoms or problems. If you do have symptoms, some lifestyle changes may help. They include eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight. Your health care provider may recommend antacids or other medicines. If these don't help, you may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

High Blood Pressure in Pregnancy

What is high blood pressure in pregnancy?

Blood pressure is the force of your blood pushing against the walls of your arteries. Your arteries are blood vessels that carry blood from your heart to other parts of your body. High blood pressure, or hypertension, is blood pressure that is higher than normal. Having high blood pressure can put you at risk for other health problems, such as heart disease, heart attack, and stroke.

During pregnancy, high blood pressure can cause problems for you and your baby. To keep you and your baby healthy, it's important to get treatment for high blood pressure before, during, and after pregnancy.

There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. If it becomes severe, it can lead to a preterm birth or your baby having a low birth weight. Some women with gestational hypertension do go on to develop preeclampsia, a more serious type of high blood pressure in pregnancy.
• Chronic hypertension is high blood pressure that starts before the 20th week of pregnancy or before you became pregnant. Some people may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. Preeclampsia also often includes signs of damage to some of your organs, such as your liver or kidneys. The signs may include protein in the urine (pee) and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.
  • If preeclampsia becomes severe enough to affect your brain function and causes seizures or a coma, it is called eclampsia.
  • In rare cases, preeclampsia symptoms may not start until after delivery. This is called postpartum preeclampsia. If this type of preeclampsia becomes more severe and causes a seizure, it is known as postpartum eclampsia.
  • When a person with preeclampsia or eclampsia has damage to the liver and blood cells, it's called HELLP syndrome. It is rare, but very serious.

You are more likely to develop high blood pressure in pregnancy if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are under age 20 or over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of high blood pressure in pregnancy
• Have certain health conditions, such as diabetes or lupus

High blood pressure usually has no symptoms. People usually find out they have high blood pressure when their health care provider measures their blood pressure.

Preeclampsia can cause other symptoms, including:

• Too much protein in your urine (called proteinuria).
• Swelling (edema) in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• A headache that does not go away.
• Vision problems, including blurred vision or seeing spots.
• Pain in your upper right abdomen (belly).
• Trouble breathing.

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output.

If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

High blood pressure in pregnancy can lead to complications such as:

• Placental abruption, where the placenta (the organ that brings oxygen and nutrients to the baby) separates from the uterus (the place where a baby grows during pregnancy)
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• Your baby having a low birth weight
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you

Your provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to order some tests. These may include blood tests and other lab tests, such as a test to look for extra protein in your urine.

If you have high blood pressure, you and your baby will be closely monitored to lower the chance of complications. You may need to:

• Check your blood pressure at home.
• Keep track of how many times you feel the baby kicking each day.
• Adjust your physical activity. Talk to your provider about what level of physical activity is right for you.
• Take medicine to control your blood pressure. Talk to your provider about which medicines are safe for your baby.
• Take aspirin in the second trimester, if you are at risk of preeclampsia and your provider recommends aspirin.
• Visit your provider more often to monitor your condition and your baby's growth rate and heart rate.

If you have eclampsia, HELLP syndrome, or a severe case of preeclampsia, you will most likely need to go to the hospital. Treatment often includes medicines. Your provider may also recommend delivering the baby early. They will make the decision based on:

• How severe the condition is
• The possible risks to you and your baby
• How far along the pregnancy is

The goal is to lower the risks to you while giving your baby as much time as possible to mature before delivery.

The symptoms of preeclampsia can last after delivery, but they usually go away within 6 weeks.