Prostate Enlargement

Enlargement of the prostate is a mostly benign enlargement of the male prostate (prostate gland). The medical name for this is benign prostatic hyperplasia (BPH). This is differentiated from malignant prostate enlargement or prostate cancer.

What is the prostate?

The prostate is the prostate gland in men. It surrounds the part of the male urethra that is just in front of the bladder. The prostate secretes a secretion that triggers the mobility of the semen. From around the age of 50, the internal prostate tissue often overgrows, which leads to benign prostate enlargement.


The symptoms of an enlarged prostate are mainly expressed in the form of discomfort when urinating.

The nocturnal urge to urinate

The nocturnal urge to urinate and delayed urination are the first symptoms of prostate enlargement. The urine stream also becomes weaker and only extends to the tip of the shoe. The flow of urine is often interrupted and it takes much longer to empty the bladder. After urination, dribbling occurs. Since the bladder muscles have to do extra work, they are permanently damaged. A so-called bar bladder (trabecular bladder or diverticular bladder) develops.

Incomplete Emptying Of The Bladder

In the further course, complete emptying of the bladder is no longer possible and residual urine builds up in the bladder. The congestion of the urine, in turn, promotes infections of the bladder such as cystitis or urethritis. In addition, the kidneys are damaged in the long run.

Urinary Retention And Complications

If left untreated, an enlarged prostate can cause complete urinary retention, i.e. prevent urination altogether. This is associated not only with pain and urinary incontinence but with significant risks. At this stage of prostate enlargement, the risk of damage to the ureter and kidneys from backwater is particularly high. If not treated immediately, kidney weakness (chronic kidney insufficiency) up to kidney failure (acute kidney insufficiency) can develop.

Another cause of the prostate enlargement symptoms described here is a malignant growth of the prostate gland (prostate cancer).

The cause of prostate enlargement is an age-related change in hormone production. An imbalance between the male (testosterone) and female (estrogen) sex hormones seems to cause the tissue of the prostate to grow.

The prostate symptoms such as the urge to urinate at night are triggered because the enlarged prostate develops increasing pressure on the urethra or directly on the bladder.

Prostate Enlargement


Medical therapy for prostate enlargement is initially carried out with medication. Surgery is necessary in around 20 percent of those affected. In the event of urinary retention, a urinary catheter must be inserted through which the urine can drain.

Drug Treatment Of Prostate Enlargement

In the drug treatment of prostate enlargement, different active ingredients are used for different purposes. So-called alpha blockers relax the muscles in the urogenital tract and can thus make urination easier. Frequently used active substances from this group against prostate complaints are alfuzosin, doxazosin, tamsulosin, and terazosin. However, these only reduce the discomfort. The enlarged prostate itself is not affected.

Warnings About Finasteride

Active ingredients from the group of 5-alpha reductase inhibitors such as finasteride and dutasteride slow down the growth of the prostate. Both active ingredients can have serious side effects. Studies (see study situation) prove erectile dysfunction, loss of libido, and ejaculation problems that sometimes last for years.

The Federal Office for Drugs and Medical Devices warns in a so-called Rote-Hand-Brief (see study situation) that patients should be made aware of the possibility of mood changes including depressive moods, depression, and suicidal thoughts before taking finasteride. The European Medicines Agency has also made it necessary to mention fear as a new side effect of finasteride in the package insert.

Surgical Procedures For Prostate Enlargement

Urogenital surgery knows various surgical procedures for prostate enlargement. Basically, the procedure should always be kept as small as necessary to avoid complications such as incontinence or erectile dysfunction. You can find more information on the surgical techniques in the prostate cancer disease picture.

Self Help

Herbal medicines are enjoying increasing popularity in self-help with prostate enlargement – also thanks to aggressive advertising. It has not been scientifically proven whether over-the-counter drugs for prostate enlargement such as sitosterol, sabal fruits, rye pollen, or nettle root can swell the prostate.

It is known, however, from extracts from pumpkin seeds influence the metabolic processes in the prostate tissue. How and whether this slows down prostate enlargement is not yet known.

All over-the-counter active ingredients are designed to make urination easier and reduce the need to urinate at night. However, the funds are often relatively expensive. Medication prescribed by a doctor, on the other hand, is usually reimbursable. In addition, over-the-counter agents for prostate enlargement sometimes differ extremely in their composition and active ingredient concentration.

The self-treatment of nocturnal urge to urinate does not always make sense for another reason. Persistent urination discomfort can be a symptom of a developing prostate lump. You should therefore be clarified by a doctor. If this does not happen, self-treatment delays early detection and thus increases the risk that prostate cancer can no longer be treated successfully.

More self-help tips

    • Avoid alcohol and cold carbonated drinks and hot spices.
    • Empty the bladder frequently and completely.
    • Do not suppress the urge to urinate so that the bladder does not become overfilled.
    • Make sure you have regular bowel movements so that there is no additional pressure on the bladder and urinary tract.
    • Occasionally take warm Sitz baths.


Specific prevention of prostate enlargement is not known. Still a few tips:

    • Maintain a normal body weight. Because being overweight can adversely affect prostate enlargement.
    • Urologists recommend a balanced, fresh, high-fiber diet as well as regular physical activity and adequate exercise.
    • From the age of 45, you should regularly have an early detection examination of the prostate once a year.
    • If you have any complaints, answer the questions in our self-test on prostate prevention at regular intervals.

Surgery for Urinary Incontinence

Surgery for stress urinary incontinence (leaking that occurs with a cough or sneeze) improves symptoms of another form of incontinence, …Colposuspension (also called Burch colposuspension) is an operation that involves placing sutures (stitches) in the vagina on either side of the urethra (pipe …During a midurethral sling surgery, which is performed in the hospital using spinal or general anesthesia, your surgeon places a synthetic sling under and …Retropubic suspension. This surgery lifts the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area. · Urethral sling. The surgeon What types of surgery does NICE recommend? NICE recommends three types of surgical operation as options for managing stress urinary incontinence if other things …There are two types of indwelling catheters. Indwelling “Foley” catheters are placed in your urethra. Indwelling “suprapubic” catheters go above your pubic bone …Non-mesh continence procedures recommended by NICE are colposuspension (open or laparoscopic) or an AFS. These should be offered to women ..Sling surgery. This surgery involves making deep cuts in the belly to get to the bladder and urethra. The surgeon uses a piece of muscle, ligament, or tendon …There are four main operations used to treat stress incontinence. Mid-urethral sling procedure installs a U-shaped mesh tape under your …Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. Kathleen C. Kobashi, Michael E. Albo, Roger R.To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be …Many treatment options are available, ranging from physiotherapy and bladder retraining techniques, medication, minimally invasive surgery to more extensive …The Burch colposuspension is surgery that involves placing stitches inside the vagina. The stitches attach to supportive ligaments on either side of the urethra to …

Surgery for Urinary Incontinence

Stress urinary incontinence (SUI), the involuntary leakage of urine on effort or exertion, or on sneezing or coughing, affects 4 to 35 percent of women. There are a number of different surgical procedures that can be done to treat urinary incontinence. · The most common surgery for stress incontinence is a sling …Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to …Sling surgery is one minimally invasive treatment option for stress urinary incontinence. Sling surgery is a minimally invasive procedure where a supportive …

Urinary Incontinence

Urinary incontinence or bladder weakness is often associated with a feeling of shame. Many sufferers do not talk about urinary incontinence – not even with their doctor. Without treatment, the causes can often spread over years and increase urinary incontinence. Here, bladder weakness can usually be treated. Here you can read more about the different forms of incontinence and their symptoms, causes, therapy, and self-help.

Urinary incontinence is the inability to consciously control the leakage of urine. Urinary incontinence is also known as bladder weakness. Those affected often develop a false sense of shame and withdraw from social life. Urinary incontinence, however, is a disease and not a “malpractice”. It can occur at any age and there is no reason to be ashamed of it. To counteract the spread and intensification of incontinence, it is important to consult a doctor. He will usually be able to help you!

As the word suggests, urinary incontinence has reduced or lost the ability to control urination. Urinary incontinence usually begins with the unwanted leakage of urine, drop by drop. However, there are different forms of urinary incontinence that can be felt differently.

The Forms Of Bladder Weakness

    • Stress incontinence: As the name suggests, after stress – such as pressure in the abdominal cavity – urine passes involuntarily. This is triggered by lifting heavy objects, but also laughing, coughing, or sneezing. The urine can trickle or come off in a stream. In the past, stress incontinence was also called stress incontinence.
    • Urge incontinence: In this form of incontinence, there is a sudden, very strong urge to urinate, although the bladder is insufficiently filled. Affected people often fail to make it to the toilet and lose urine – sometimes gushingly.
    • Mixed incontinence: Sufferers have symptoms of both stress and urge incontinence.
    • Reflex incontinence: With reflex incontinence, those affected no longer feel a full bladder. Sometimes they can no longer control the emptying of the bladder willingly so that the bladder empties itself repeatedly – but incompletely.
    • Overflow incontinence: In overflow incontinence, a full bladder overflows. So urine keeps trickling out of the filled bladder. In addition, the patients feel a constant urinary urge.
    • Extraurethral incontinence: If the cause of the incontinence lies outside the urinary tract, doctors speak of extraurethral incontinence. Frequently, involuntary urine is lost through the anus or vagina via a fistula.
    • Nocturnal wetting: Nocturnal wetting is normal up to the age of 4 to 5 years. If older children and adolescents or adults regularly wet themselves at night, the medical name is enuresis nocturna. There are many reasons for this. When wetting at night, large amounts of urine are lost during sleep. According to the parents, the bed is “soaking wet” or “swimming”. This can be done daily or with “dry phases”. Those affected and their relatives should confidently contact their doctor if they are wetting at night. You can also find detailed information on urinary incontinence in children under bedwetting.

Urinary Incontinence


The causes of urinary incontinence are extremely diverse. Often there is a combination of causes.

    • Causes in men: Urinary incontinence in men is often due to an enlarged prostate. In these cases, the prostate gland presses on the bladder and at the same time restricts the function of the urethral sphincter.
    • Cause of pregnancy: In pregnant women, as the child grows larger, it often presses on the bladder and thus provokes urinary incontinence. At the same time, the muscles of the pelvic floor are particularly stressed in pregnant women. This can make it difficult to close the urethra. As the birth approaches, the pelvic floor muscles continue to slacken to make the birth easier. This may further promote urinary incontinence. Urinary incontinence usually disappears after delivery.

Overview of common causes of bladder weakness

in women:

    • Relaxation of the pelvic floor muscles due to pregnancy or obesity
    • Menopause hormone deficiency
    • age-related sphincter weakness.

in men:

    • Prostate enlargement.

in the elderly:

    • Bladder sphincter weakness
    • inability to concentrate, for example with dementia or Alzheimer’s disease.


    • Bladder infections
    • Spinal cord or nerve disorders
    • Tumors
    • diabetes
    • multiple sclerosis
    • Result of operations, accidents
    • congenital malformations
    • Obesity and lack of exercise
    • Drugs, such as beta-blockers for high blood pressure and cholinesterase inhibitors for symptoms of Alzheimer’s disease; Water fluids (so-called diuretics) can make urinary incontinence worse.

Any form of uncontrolled leakage of urine should be discussed with your doctor as soon as possible. He can make the diagnosis and start treatment for urinary incontinence with you.

The diagnosis of urinary incontinence includes a detailed discussion of the symptoms as well as various examinations to find the cause of the urinary incontinence. The detection of bacteria in the urine can indicate cystitis or urethritis. An ultrasound examination is used to identify possible organic changes as the cause of urinary incontinence. If these methods are not sufficient, the specialist can measure the bladder pressure or look for noticeable changes in the bladder, urinary tract, or prostate during a uroscopy.

There are various treatment options for treating urinary incontinence, depending on the cause of the symptoms. These include, among other things, drug and surgical treatments.

Drug Treatment Of Urinary Incontinence

Depending on the cause of urinary incontinence, various active ingredients are suitable for drug treatment. In so-called urge incontinence, it makes sense to inhibit the bladder muscles. So-called anticholinergics such as oxybutinin, propiverine, tolterodine or trospium chloride can be used for this purpose. However, these active ingredients are not suitable for all patients, as they often have side effects on the one hand and may not be combined with some medications on the other. An overactive bladder is sometimes inhibited with botulinum toxin (known from wrinkle treatment).

In women with stress incontinence, the antidepressant agent duloxetine works against involuntary urination.

If a hormone deficiency is the cause of urinary incontinence, herbal or chemical estrogens provide relief. Estrogens such as estriol can be used locally as a suppository or ointment in the vagina.

Surgical Treatment Of Urinary Incontinence

Among the surgical procedures against urinary incontinence – depending on the cause – the sling operation or an artificial sphincter for the urethra are the best-tested and most widely used procedures.

    • Loop surgery: In loop surgery, which is used on both men and women, the surgeon places a type of loop around the urethral sphincter. In many cases, this can regain control of urination. The loop operation is usually performed on an outpatient basis with an endoscopic procedure.
    • Artificial sphincter: If the bladder sphincter cannot be sufficiently stabilized by a sling operation or if this operation is not possible, an artificial sphincter can be implanted. A cuff is placed around the urethra, which can be closed or opened from the outside using a pump. In men, the pump is often implanted in the scrotum. Disadvantage of the artificial sphincter: They usually cause a number of complications such as urinary tract infections. In addition, the components of the sphincter have to be changed frequently.
    • Prostate surgery: In men, prostate surgery can help to correct – or unfortunately – cause urinary incontinence. You can read more about this in the prostate enlargement disease picture.

Self-Help With Urinary Incontinence

Self-help with urinary incontinence can make a significant contribution to supporting or even avoiding the success of drug treatment.

    • Pelvic floor training: Whether during pregnancy, due to aging, or hormonally: women in particular benefit from pelvic floor training with urinary incontinence. The simplest form of pelvic floor exercise: interrupt the flow of urine while urinating with muscular tension. You can also do this exercise beyond the toilet. Then just pretend to interrupt a urine stream. The so-called Kegel exercises are a special form of pelvic floor training. Ask your doctor and midwife for instructions. Fitness studios and adult education centers also often offer appropriate courses.
    • Empty the bladder regularly: The bladder can also be trained. This works best if you empty your bladder regularly at specific times. These fixed rhythms quickly become a habit and help to prevent a strong urge to urinate with the risk of unwanted urine leakage. However, this bladder training should only be tried in cooperation with a doctor.
    • Use suitable incontinence materials: Modern incontinence materials are diverse and specially tailored to women and men. They range from ultra-thin but absorbent pads to incontinence briefs or swimwear and condom urinals. It is best to seek advice from a medical supply store or a pharmacy. Incidentally, normal sanitary napkins are not suitable for urinary incontinence.
    • Catheterization: Self-catheterization can help with some forms of urinary incontinence, especially reflex incontinence. The urine is drained from the affected person himself through a thin plastic tube (the catheter). It is best to seek advice from your doctor as to whether this option is an option for you.

Lose Weight And Drink Less

Make sure you have a balanced and fresh diet and, above all, that you drink enough.

    • Under no circumstances should you reduce your fluid intake to counteract an involuntary loss of urine. That would cause more problems than good.
    • Avoid substances that irritate the bladder, such as hot spices and coffee, and foods that cause gas, such as onions, cabbage, and legumes.
    • It makes sense to eat odor-inhibiting foods. These include, above all, cranberries, natural yogurt, spinach, green lettuce, and parsley.
    • Obesity promotes urinary incontinence. Therefore, you would do well to shed excess pounds. You can find suggestions for this here: Weight Loss & Diet


    • You should exercise your pelvic floor, especially after pregnancy.
    • Avoid being excessively overweight.
    • Quit smoking Above all, a smoker’s cough stresses the abdominal cavity due to a permanent increase in pressure and thus stresses the abdominal and pelvic floor muscles, which in turn can lead to incontinence problems. You can get information on how to quit smoking from your family doctor, health center, or your health insurance company.
    • Have check-ups with a urologist and/or gynecologist from the age of 50 at the latest.

Heartburn Medication

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heartburn medication

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Is Heartburn a Sign of Pregnancy

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is heartburn a sign of pregnancy

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Anxiety Disorder In Children

Parents know that young children in particular feel fears very differently than older siblings or adults. Fears require sensitive handling. Here you can read how to approach the topic of children and anxiety in an age-appropriate manner, how to recognize signs of pathological anxiety, and how you can help your child with an anxiety disorder.

Children and fear go together naturally. Because children discover the world. And there is a lot that is new that can sometimes scare children. In addition, children have vivid imaginations. Parents know that you have to occasionally drive a monster out of the closet or keep watch so that burglars don’t disturb the child’s sleep. These are perfectly normal childish fears.

This must be distinguished from anxiety disorders in children, as child psychologists and pediatricians are increasingly diagnosing them. Identifying the signs of such anxiety disorders in children is by no means easy. Children do not always talk about their fears, but rather express them about behavioral problems. One of the reasons for this is that you are usually unable to grasp these fears rationally at all. Their specific fears often remain hidden or only come to light through detours or through certain symptoms.

Often children and adolescents have all-embracing (so-called generalized) anxiety disorders, sometimes the fears are only related to certain situations (before classwork or contact with certain animals). Generalized fear manifests itself, for example, in exaggerated worries about everyday events, extremely exaggerated separation fears (often when going to kindergarten and school), or the fear of being embarrassed in front of others. Often the children try to avoid the fear-inducing situation. As a result, school performance often deteriorates, family life becomes increasingly difficult, friendships diverge and contact with people of the same age is sometimes completely absent.

Anxiety disorders in children are now the most common psychiatric illness in childhood and adolescence. However, there are hardly any exact figures. According to the BELLA study by the Robert Koch Institute (RKI), the proportion of acute anxiety disorders is around 10 percent. The German Society for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy assumes that more than 5 percent of children and adolescents are affected.

Symptoms of Anxiety Disorder In Children

The symptoms of anxiety disorders in children are very diverse. Ultimately, the full range of lively or nervous child behavior can also indicate an anxiety disorder. However, these symptoms do not offer sufficient certainty for a diagnosis. Symptoms of anxiety disorders that are particularly noticeable in children include:

    • waning curiosity
    • Regression (unlearning skills such as language or cleanliness)
    • Wetting and defecating
    • self-chosen isolation
    • Passivity or hyperactivity
    • self-harming behaviour
    • Pulling or pulling hair out (trichotillomania)
    • compulsive behaviors
    • Tremble
    • Shortness of breath

Basically, two changes in behavior are considered to be important alarm signals: when a child falls silent or becomes very aggressive. And to an extent that is atypical for the respective development phase.

Sensitive Children Are More Likely To Suffer From Anxiety Disorders

Boys and girls are equally afraid, only the symptoms are expressed differently. While boys often become violent, girls withdraw into their shells. Many starve until they drop or injure themselves.

Anxiety Disorder In Children

Anxiety disorders occur especially insensitive, shy, and reserved children and adolescents. You can quickly become irritated by changed everyday situations and react rather anxiously to new surroundings. As a rule, children and adolescents with anxiety disorders have very little confidence in each other and have difficulty coping with difficulties that are actually manageable.

Recognize Pathological Anxiety In Children

With anxiety disorders, children show fear in certain situations that seem unfounded to outsiders. Refusal attitudes and symptoms of illness are typical. Some examples:

The child

    • refuses to go to kindergarten or school
    • can’t play outside alone
    • don’t want to fall asleep alone in the evening
    • Don’t stay home alone for a short while during the day
    • don’t want to stay with friends
    • cries and screams or lashes out and clings to the mother (or the person you trust) when saying goodbye • often has headaches and stomach aches
    • suffers from sleep disorders and tiredness, muscle tension, or dizziness.


The causes of anxiety disorders in children are usually to be found in the family environment. Risk factors for the occurrence of anxiety disorders in children are an unfavorable family climate and a low socio-economic status. Social and economic problems already affect children’s health in the first years of life. Material poverty, social decline, conflict-ridden and violent family relationships, as well as a poorly educated environment, increase the risk of developing anxiety disorders and other psychological problems.

However, family misconduct does not always have to be the trigger for anxiety disorders in children. However, the lack of or existing understanding of the plight of a child with fears makes a decisive contribution to whether fear can be overcome or whether it turns into an anxiety disorder over time.

Furthermore, doctors assume a genetic predisposition that is said to increase the risk of an anxiety disorder.

Other causes of anxiety disorders in children and adolescents

An anxiety disorder in children and adolescents is often preceded by certain life experiences. These include in particular:

    • Separation of parents
    • serious illness in one of the parents
    • Death of a loved one, especially a sibling
    • own serious illnesses (such as acute leukemia or a serious accident)
    • Temporary placement in homes or a foster family
    • threatening experiences (environmental disasters, apartment fires, avalanche spills, etc.).


Child behavior changes frequently. And there is not an anxiety disorder behind every anxiety. If, however, you notice particularly severe behavioral problems or a change in behavior in your child for no apparent cause, a consultation with the pediatrician can help. An educational counseling center or a psychologist is also suitable contacts for diagnosing an anxiety disorder in children.


The therapy of anxiety disorders in children belongs in the hands of an experienced psychiatric pediatrician or child therapist. Only they usually have the experience to judge whether therapy for anxiety disorders in children is necessary at all. The course and duration of such therapy depend on the individual needs of the child. When choosing a suitable therapist, you should make sure that the therapist takes your child seriously and that the child feels comfortable there.

Behavioral Therapy As A Remedy For Anxiety

Anxiety in older children and adolescents is usually treated with cognitive-behavioral therapy. To avoid generalization and chronification, it should be started as early as possible. The aim of the therapy is to change behaviors that lead to anxiety-inducing thoughts and thus to reduce anxiety. Certain behavioral exercises, role plays, and relaxation training are suitable for this.

During cognitive-behavioral therapy, the child/adolescent recognizes which thoughts increase his or her fear. Then the truthfulness of the thoughts and the possible probability that the dreaded event will occur are checked. Together with the therapist, new thoughts and strategies have been developed that help to deal better with the fearful situation. There are also other important components of therapy.


As a parent or adult contact person of a child, you can make a significant contribution to preventing anxiety and anxiety disorders in children. Fear arises – even in adults – primarily from the feeling of losing control over a situation. So the best cure for anxiety is to regain control. As a parent, you can support your child and give them security.

Respond Compassionately To Childish Fears

Many parents tend to react too conversationally and rationally to their child’s fears. This corresponds to the adult attitude. But children are not little adults. Thanks to their vivid imagination and lack of life experience, they are sometimes unable to distinguish a real threat from an alleged one. In addition, parental suggestions for solutions are often received with resistance and blockade anyway. Successful fear processing is only possible if children are allowed to participate constructively and if they are challenged, encouraged, and strengthened.

Even if the fears of children often seem harmless to adults, they should always be taken seriously. For the child, the reasons for fears are always very real. The monster under the bed is just as terrifying as the neighbor’s dog.

Overcoming Fear With Imagination

Children in particular have a powerful means of successfully coping with fear: play, magic, and ritual. These very own processing possibilities should be used.

  • Overcoming fears in play: Children actually always play. You play with experiences or roles. After extraordinary experiences that trigger fear, it can very often be solution-oriented repetition games that deal with the traumatic experience. Playing helps to find solutions and supports the child’s processing.

The Power Of The Imagination

Children believe in the power of imagination and in its magic. With the logic of the child, this means that the imagination that creates monsters and robbers can also make them disappear again. Use the power of childish creativity, for example by reading stories and fairy tales to the children or by giving the cuddly toys magical powers.

The magical-fantastic thinking of children (approximately between the ages of 4 and 9) is an age-appropriate form of intelligence with which children are creatively active in order to understand their surroundings, their near and surrounding worlds. Magical thinking represents an attempt at structuring. Many of the developmental tasks at this time are pervaded by fears. With magical-mystical thinking, these fears can be endured better and cope with more productively.


Depression causes the deep-seated feeling of being inescapably trapped in a prison of dark thoughts and weakness. The helplessness experienced is one of the symptoms of depression. In fact, help is almost always possible. The terms depression or depressed are often used in everyday life. Often times they relate to a depressed mood or sadness. A distinction must be made between depression in the sense of an illness. With depression, those affected sit hopelessly and locked in a prison of dark thoughts and physical weakness. An escape appears – this is part of the clinical picture – impossible. In fact, the therapy is often less difficult than assumed. The ideal solution for the treatment of depression is cognitive-behavioral therapy. This is often accompanied by drug therapy.

One of the pitfalls of depression is that it usually doesn’t start suddenly. Rather, many patients experience the disease as a gradual process. If you lose interest in your hobbies or work, withdraw more and more often, hardly make friends anymore, and feel more and more indifferent, you should discuss this with a doctor.

If you have thoughts of suicide, you should see a doctor or therapist immediately. This is often easier when you confide in a family member or a loved one.

According to the Federal Statistical Office, around six million adults between the ages of 18 and 65 will develop depression within a year. Around 12 percent of young people between the ages of 15 and 17 also experience depression. According to this, women are affected about twice as often as men in all age groups. According to the Federal Statistical Office, more than 260,000 Germans go to full inpatient treatment every year. In the past 10 years, the number of sick days due to depression has more than doubled.

In 2018, the number of sick leave due to mental illness fell for the first time in 12 years. The proportion of the total number of 236 days absent per 100 employees is 5.6 percent lower than in the previous year. These are the results of a DAK study with more than 2.5 million employees. Mental illnesses are still the third most common cause of sick leave – behind back pain and colds.

Every 6th employed person now takes antidepressants. According to Professor Dr. Gerd Glaeske, University of Bremen, the number of daily doses has increased sevenfold within 22 years: from 200,000 units in 1991 to more than 1.4 billion units in 2013. This amount is enough to feed 3.7 million people for a whole year Treat antidepressants.

More than 322 million people around the world have depression. According to the World Health Organization (WHO), that is an increase of 18 percent within 10 years.


Depression is an often severe mental illness that is associated with a high rate of suicide. The sadness and listlessness of depression have nothing in common with normal sadness (after a bereavement or a breakup, for example). Depressed people often describe their condition as indifferent, empty, and burned out. Not being able to feel and not being able to grieve depresses the patient and often fills them with fear.

The numbness is usually combined with inhibition of drive. With depression, sufferers often find themselves unable to perform even simple tasks. You can’t get yourself up to anything, have no initiative and no vigor, every activity becomes torture. The mood is often worst in the morning and improves slightly during the day. Often the posture is slack and hunched, the speech soft and monotonous. The symptoms of depression can vary widely. In addition to defensive signs such as sadness or withdrawal, symptoms such as inner feelings of fear, irritability, impotence, sleep disorders or inner restlessness occur.

Depression And Bipolar Disorder

Sometimes the depression alternates with unfounded or exaggerated high spirits (manias). The affected person is overly active, cheerful, and lively. This condition was formerly known as manic depression. The term bipolar disorder is now gaining ground.


In the current research, it is now undisputed that the tendency to depression is hereditary. Children of parents with a history of depression are more than twice as likely to develop depression themselves later than children of healthy parents.

Neurobiologists explain the significantly higher frequency of depression in women, among other things, with the female hormone balance. Women are significantly more susceptible to the onset of depression before menstruation, during pregnancy, or after giving birth. But men can also get depression. In contrast to depression and extreme sadness in women, they often focus on increased irritability, disgruntlement, anger, and aggressiveness up to and including suicidal intentions.


The Tendency To Depression Is Also Learned

According to the assessment of medicine and psychology, learned behavior patterns and ways of thinking play the greatest role in the development of depression. For example, those who are more pessimistic about the world run a higher risk of falling into a downward spiral and thus into a depression. Psychology assumes that such pessimism is largely shaped in childhood and further internalized in the course of life as a familiar point of view.

Depression is favored by stress, fear, and traumatic experiences such as the death of a loved one, job loss, or separation.

Physical Causes Of Depression

In rare cases, depression can also be traced back to a direct physical cause, for example after a stroke or when taking drugs that affect hormone or brain metabolism. Alcohol abuse or addictions can also trigger depression.

Depression From Inflammation

Patients with chronic inflammatory diseases with multiple sclerosis or rheumatism are more often affected by depression. Recently there have been increasing voices that it is not the accompanying circumstances of these diseases, but inflammation that cause depression. Urinary tract infections, ulcerative colitis or periodontal disease could also promote depression.


The therapy of depression belongs in the hands of an experienced doctor or psychologist. Depending on the cause and severity of the depression, the doctor, preferably a specialist in psychiatry or neurology, will first treat the depression with medication. He has the choice between activating and depressant drugs.

The drugs against depression, also called antidepressants, intervene in the unbalanced brain metabolism. In this way, they can reduce the severity or frequency of the depressive phases. The antidepressant effects of these drugs only set in after about two weeks.

Risk Of Suicide From Antidepressants

Drug therapy for depression should be closely monitored. It is by no means uncommon for suicidal thoughts, for example, to be put into practice when an activating drug gives the patient the energy for this act of desperation.

Behavioral Therapy For Depression

In any case, depression should also be treated psychotherapeutically as soon as possible. So-called cognitive behavioral therapy has proven to be particularly successful. The aim of this therapy is to test learned inner convictions using examples, to practice new experiences, and thus to find constructive new thoughts and attitudes.

Self Help

In contrast to depressive moods, depression is a serious illness that can usually not be dealt with on its own. Hence, the best self-help is to acknowledge the fact of depression and seek help. Go to a doctor, counseling center, psychotherapist, or psychologist. Self-help groups or internet forums help to find the way out of depression. Remember: It is a symptom of depression that sufferers do not believe in a cure or a solution. It is all the more important to focus the strength on the beginning of treatment. Help is possible!

Mild symptoms of depression can be relieved with a herbal medicine made from St. John’s wort. However, it takes about two weeks to take effect.

Role Of Family And Friends In Depression

Often it is family, friends or colleagues who first notice the symptoms of depression in another person. As a rule, the disease is already relatively advanced at this point. One of the symptoms of depression is that those affected cannot perceive an illness and very often refuse help. This can make it difficult to deal with people who are suspected of having depression.

If you are looking to help, try following the recommendations below for dealing with people who are depressed.

    • Compassion and comfort confirm depressed people in their misery and are of no help in finding the way out of depression. Let those affected whines without feeling sorry for them.
    • Calls like “Don’t let yourself get down like that” or “Others are doing badly too” increase the pressure and thus the feeling of helplessness. Such well-intentioned appeals usually drive those affected further into social retreat. It is better to act with empathetic questions rather than advice.
    • Hold back with evaluations. Convey the feeling of being there for the sick person. However, do not make yourself an accomplice of the depression by promoting sadness or social withdrawal through special assistance. Try to keep a certain distance from the person concerned.
    • Make the depressed person feel like they can help themselves. Point out information about depression and the good chance of therapy for success.
    • Take suicide threats particularly seriously, even if they are made more often and not carried out. Most people give advance notice of their suicide. A special warning sign is when those affected are sorting out your financial affairs, for example. Do not hesitate to seek professional help if necessary. Better a false alarm than committed suicide.
    • As a relative or friend of a depressed person, you benefit from self-help groups for these groups of people or from psychological counseling.


Depression often follows a prolonged phase of excessive stress, stress, or anxiety. Similarly, avoiding stress and anxiety can help prevent depression.

Another trigger is so-called traumatic experiences such as death or separation. If you feel that you are changing your behavior after a trauma (or you notice this in relatives or friends), you should seek discussion with others or psychological counseling at an early stage.

Basically, the risk of depression decreases with intact social ties, a positive self-image, and a realistic assessment of the environment.

Heartburn (Pyrosis)

Heartburn is the reflux of stomach contents into the esophagus. Heartburn can be harmless, but in the long run, it can also be pathological and indicate reflux disease or cause esophagitis. Read more about the symptoms, causes, therapy, and prevention of heartburn.

Most people are familiar with heartburn (pyrosis) or acid regurgitation (ructus). As a rule, it is uncomfortable – but it also quickly passes and is harmless. Recurring or regular heartburn, on the other hand, should be examined by a doctor. Either the constant reflux of gastric acid into the esophagus is due to the disease and indicates a reflux disease or it injures the esophagus and causes esophagitis (esophagitis). With a few exceptions, heartburn can be treated very well with medication and a change in diet or behavior.

A typical symptom of heartburn is a burning pain in the center of the chest (above the stomach area) that can radiate to the throat, throat, or even face. This often happens after meals (due to overcrowding or acidification of the stomach) or when bending over and changing positions.

Occasionally, stomach acid or digested food gets into the oral cavity with the acidic burping. This leads to an unpleasant burning sensation in the throat and a sour or bitter taste in the mouth. This can cause nausea and, rarely, vomiting.

Heartburn is often accompanied by an unpleasant, sour-smelling bad breath. Heartburn or the pain associated with heartburn are sometimes also perceived as heart pain. In English, heartburn is therefore also called heartburn.

Heartburn Complications

Recurring heartburn puts stress on the esophagus. The result can be inflammation of the esophagus. In turn, esophagitis could increase the risk of esophageal cancer.


Heartburn is caused by acidic stomach contents flowing back into the esophagus (acid regurgitation). The causes of stomach contents getting back into the esophagus can be very different.

Typically, very large meals trigger heartburn once we’ve eaten enough to fill the stomach. Then a slight pressure – for example by moving – is enough to let the stomach contents get into the esophagus.

As the pregnancy progresses, the child puts pressure on the stomach and can cause stomach contents to enter the esophagus. Heartburn can also indicate conditions such as stomach ulcers, duodenal ulcers, or stomach cancer.

Cause Reflux Disease

Heartburn is the main symptom of acid reflux disease. This is a malfunction of the lower esophageal muscle (lower esophageal sphincter) that separates the esophagus from the stomach. As a result, the weakened sphincter muscle can get stomach contents easily into the esophagus.


Other Causes Of Heartburn

The excessive production of stomach acid and the resulting heartburn can have a variety of other causes:

    • excessive consumption of alcohol, coffee, or cigarettes
    • Obesity
    • nervous stomach
    • Diaphragmatic hernia
    • Use of certain medications such as pain relievers and anti-rheumatic drugs (e.g. acetylsalicylic acid, diclofenac, and ibuprofen), cortisone, and chemotherapy drugs
    • Stress or other psychological stress.

Cause In The Duodenum

In the case of heartburn with bitter and bilious belching, the cause is often in the duodenum. Often the intestine is overactive (so-called motility disorder) or the gastric sphincter (also called gastric gatekeeper or pylorus) does not close properly.


The main focus of diagnosing heartburn is finding the cause of the backflow of stomach contents into the esophagus. A frequently used examination method for this is the esophagus and gastroscopy. You will find detailed information on this under gastroscopy.


Inhibiting gastric acid production with medication is usually the essential element of medical treatment for heartburn. Different groups of drugs are used.

    • Antacids are drugs with aluminum or magnesium salts such as aluminum hydroxide or magnesium hydroxide. Other active ingredients are Algedrat, Magaldrat or Simeticon. These drugs bind excess stomach acid for heartburn and also relieve the symptoms of inflammation of the stomach lining (gastritis) or a stomach ulcer. The chewable tablets or sachets of suspension are chewed or swallowed approximately one hour after eating and before going to bed. Sometimes it takes 2 chewable tablets or sachets for the heartburn to go away. Suspensions work faster than chewable tablets because the milky solution quickly lines the stomach lining and protects it from acid. Antacids are also useful during pregnancy.
    • H2 blockers are another group of heartburn medication. So-called H2-receptor blockers such as cimetidine, famotidine and ranitidine inhibit the production of stomach acid. For some time now, various H2-receptor blockers have been available in pharmacies without a prescription.
    • Proton pump inhibitors, such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are another group of drugs that can be used to treat heartburn. For example, the proton pump inhibitors omeprazole, pantoprazole, or esomeprazole are now freely available (see also below: gastric acid blockers involve risks)
    • Prokinetics such as metoclopramide accelerate the intestinal transit and the further transport of food in the intestine. As a result, less acidic food pulp can get into the esophagus.

Recall Of Drugs Containing Ranitidine

Numerous drugs with the active ingredient ranitidine may no longer be used for the time being since September 2019. A current list of the drugs concerned can be found here: Recall ranitidine drugs due to nitrosamine contamination. Ranitidine belongs to the active substance group of H2 antihistamines and is also mainly used in the following clinical pictures:

    • Anaphylactic shock
    • gastritis
    • Diaphragmatic hernia

The European Medicines Agency ordered the EU-wide recall because impurities had been detected at a manufacturer of the active ingredient in India (Saraca Laboratories Limited). According to the Federal Institute for Drugs and Medical Devices (BfArM), this is N-nitrosodimethylamine (NDMA). These nitrosamines are thought to be potentially carcinogenic.

In 2018, NDMA contaminants had already caused numerous recalls for another group of active ingredients, the sartans. The Central Laboratory of German Pharmacists has now examined 38 preparations and declared them not to be contaminated.

Heartburn Surgery

In rare cases, surgery is needed to get rid of heartburn. Reasons for an operation can be, for example, stomach and duodenal ulcers, stomach cancer, or a rupture of the diaphragm.

Self-Help Against Heartburn

To help yourself with heartburn – assuming no other illnesses – you can usually use the above-mentioned over-the-counter medications or sodium hydrogen carbonate (such as baking soda and Bullrich’s salt). However, this only applies if the heartburn occurs occasionally and another disease is excluded as the cause. In the best-case scenario, discuss any medication with your doctor.

Chamomile, yarrow, or liquorice root in the form of teas or drops, like peppermint, caraway, anise or fennel tea, have a digestive and calming effect on the stomach.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report from the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Is Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.


There are few meaningful studies on the effects of behavior change on heartburn. However, many experiences confirm that, for example, avoiding coffee, alcohol, and smoking relieves heartburn or prevents heartburn from developing in the first place. If you have a tendency to heartburn, you should also take note of the following tips:

    • Avoid very spicy or citrus-acid foods and drinks
    • Avoid fatty foods and chocolate if possible
    • eat in an upright position
    • Keep evening meals as small as possible
    • Avoid being overweight
    • no overly tight clothing and constant sitting
    • Do not bend forward after meals
    • Increase the headboard of the bed if you have heartburn at night.

Metabolic Syndrome

Obesity, high blood pressure, lipid metabolism disorders, and an elevated blood sugar level are the main risk factors for cardiovascular diseases and are known as metabolic syndrome and colloquially as the “fatal quartet”.

The metabolic syndrome is not a clinical picture, but rather the summary term for the most important risk factors that lead to cardiovascular diseases. In English, the metabolic syndrome is called “deadly quartet”. This means the sometimes fatal interplay of

    • Overweight (obesity)
    • Fat metabolism disorders with increased triglycerides and low HDL cholesterol (colloquially good cholesterol)
    • High blood pressure (arterial hypertension) and
    • abnormally high blood sugar level (hyperglycemia).

Metabolic Syndrome

In the scientific literature, metabolic syndrome is sometimes also called Reaven syndrome or Syndrome X. The main criteria for metabolic syndrome are:

    • Trunk-dominated overweight (abdominal obesity) with a waist circumference ≥ 94 cm in men and ≥ 80 cm in women (of European origin, Asians have different normal values)
    • Lipid metabolism disorders with increased triglyceride values> 150 mg / dl (> 1.7 mmol / l) and decreased HDL cholesterol concentration: in men <40 mg / dl (<1.05 mmol / l) and in women <50 mg / dl (< 1.25 mmol / l)
    • High blood pressure (arterial hypertension)> 130/85 mmHg
    • Type 2 diabetes or increased fasting blood sugar value of> 100 mg / dl (> 5.6 mmol / l).

There are no exact figures on the frequency of metabolic syndrome in Germany. From various studies on the individual risk factors, however, it can be deduced that in this country around one in four adults sooner or later meets all four criteria. This doubles the risk of a heart attack or stroke. The likelihood of developing diabetes increases even more: Type 2 diabetes is up to 5 times more common in people with metabolic syndrome than in comparable persons of the same age or gender.

Food Allergy

Food allergies are sometimes confused with food intolerances. The main difference: In a food allergy, the immune system fights parts of the food as foreign bodies. More about it as well as symptoms, causes, and therapy of a food allergy. Around 1 to 2 percent of the population suffers from a real food allergy. In these cases, the immune system is allergic to certain foods. An allergy is a bad reaction of the immune system to actually harmless, foreign substances.

A reaction does not appear until the second contact with the triggering substance (allergen) at the earliest. The first time the so-called sensitization takes place, i.e. the immune system forms antibodies against the apparently hostile substance, which it is supposed to fight off. If the body comes into contact with the allergen again, large amounts of these antibodies are reproduced. They fight the substance and an allergic reaction occurs. Defense cells release various highly effective biochemical substances such as histamine, which are then responsible for the classic symptoms.

Common food allergy triggers are:

    • nuts
    • fish
    • wheat
    • Shellfish
    • Different types of fruit and vegetables
    • Eggs


Most adults have pollen-associated food allergies in hay fever (cross allergy). The structure of the allergenic molecules in pollen are similar to some structures in some foods. The immune system, so to speak, confuses the molecule and then reacts with an allergy to different foods.

Food Allergy

The symptoms of the allergy range from skin rashes with itching and wheals to gastrointestinal disorders to shortness of breath or, in the worst case, circulatory failure. The most common cross allergies:

    • Birch, alder, hazelnut – nuts, apples, other stone and pome fruits, potatoes
    • Grasses – tomato, peanut, legumes,
    • Mugwort – celery, spices, carrots

A food allergy must be differentiated from food intolerance. There is no immune reaction here. It is triggered, for example, by foods that contain a lot of histamines. In other forms, there is a lack of enzymes that are supposed to break down certain substances in the body (e.g. lactose intolerance). In addition, some dyes or preservatives in the body can cause a direct release of histamine. The symptoms are mostly similar to those of a real food allergy.


Identifying the triggering allergen can be very difficult, especially due to today’s variety of convenience foods. The simplest test is the so-called prick test. Various test solutions are stabbed into the skin. If there is an allergy, a wheal will form at this point after approx. 20 minutes. In the case of food, it may be necessary not only to use the test solution but to place the food itself on the skin or to scratch a little and then prick the skin in order to obtain a reliable result. If the allergen cannot yet be found, there is the option of a provocation test. This means that the suspicious food is eaten in low doses under medical supervision in order to provoke an allergic reaction. A blood test, in which the antibodies against a suspected allergen can be detected, can also be helpful.


If the allergic reaction is not too strong, drugs that block the histamine in the body (antihistamines) are usually sufficient for therapy. In more severe cases, cortisone is used to suppress the immune response. For patients who have ever had a massive allergic reaction, it is advisable to always have an emergency kit with them, consisting of an antihistamine, cortisone, and an adrenaline supplement, in case a circulatory reaction occurs.

Self Help

The best therapy, of course, is to avoid the offending food. However, some allergens change depending on the preparation, so that, for example, many patients with an apple allergy cannot tolerate the raw apple, but have no problems with the apple in cooked or baked form. Finished products on which the ingredients are not adequately declared can also cause difficulties. It is advisable not to use it.