Organs Shift After Hysterectomy: Best Facts

Mustafa Çelik

Mustafa Çelik

Magnero Content Team
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Organs Shift After Hysterectomy: Best Facts
Organs Shift After Hysterectomy: Best Facts 4

Having a hysterectomy is a big deal, and you might worry about how it affects your body. Many women worry about feeling pain when they pee after surgery. It’s important to talk about this because many women face urinary problems after a hysterectomy.

When you have a hysterectomy, your uterus is removed. This can change the pelvic area. It might cause pelvic pain and make peeing uncomfortable. Knowing what to expect can help ease your worries about this surgery.

Key Takeaways

  • Urinary issues are common after a hysterectomy.
  • Changes in the pelvic area can cause discomfort.
  • Painful urination is a possible side effect.
  • Understanding the causes can help manage the pain.
  • There are tips available to manage discomfort while peeing.

The Normal Urinary Experience After Hysterectomy

Organs Shift After Hysterectomy: Best Facts
Organs Shift After Hysterectomy: Best Facts 5

Knowing what to expect with your urine after a hysterectomy is key. It helps you manage your recovery and spot any issues early. We’ll walk you through what happens right after surgery and in the days that follow. This will help you feel more confident as you recover.

What to Expect in the First 24-48 Hours

Right after a hysterectomy, you might feel like you need to pee a lot but can’t. This is called urinary retention. It happens because of swelling and damage to the area around your bladder during surgery. Knowing this can help you feel less worried.

Your healthcare team will keep a close eye on how much you pee. They might use a catheter to help manage your urine. This is to prevent any problems.

Timeline of Urinary Function Recovery

How fast you get back to normal with your urine can vary. Most women start to feel better within a few days to a week. But, it can take several weeks or even months for your pelvic floor health to fully recover.

It’s important to follow your doctor’s advice on caring for yourself after surgery. If you notice anything off or if your symptoms last too long, tell your doctor. Knowing what to expect can help you spot any issues early.

Distinguishing Normal Discomfort from Complications

Some discomfort is normal after a hysterectomy. But, it’s important to know the difference between normal pain and signs of trouble. Severe pain, trouble peeing, or signs of infection like fever or bad smell are warning signs. You should get medical help right away.

Knowing the difference helps you get help when you need it. This makes your recovery smoother. Your healthcare team is there to support you. Don’t hesitate to reach out if you have any worries.

Common Causes of Painful Urination After Hysterectomy

Painful urination after a hysterectomy can be very uncomfortable. It’s important to know why it happens. Several things can cause this, like problems with catheters or how the body reacts to surgery.

Catheter-Related Discomfort and Trauma

A catheter is often used during and after surgery to help with urine flow. But, it can sometimes cause catheter-related discomfort and harm to the urinary tract. The catheter can irritate the urethra, making it painful to urinate.

Surgical Trauma to Urinary Tract Tissues

The surgery can damage the tissues around the urinary tract. This damage can lead to swelling, inflammation, or bruising. These issues can make urination painful. The severity of the damage depends on the surgery type and how well the body heals.

Inflammation and Healing Processes

After surgery, the body naturally responds with inflammation to heal. While it’s needed, this inflammation can make the urinary tract tissues sensitive. This sensitivity can cause pain or discomfort when urinating. As healing progresses, this inflammation usually goes away, and the pain subsides.

Knowing the reasons behind painful urination after a hysterectomy can help women manage it better. It’s key to talk to a healthcare provider about any ongoing or severe symptoms. This is to check for complications like urinary tract infections (UTIs), which can also cause pain while urinating.

How Organs Shift After Hysterectomy

Organs Shift After Hysterectomy: Best Facts
Organs Shift After Hysterectomy: Best Facts 6

After a hysterectomy, organs in the pelvic area can move and change how they work. This happens because of the changes in the pelvic space. Knowing about these changes helps manage symptoms and keep the pelvic area healthy.

Anatomical Changes in the Pelvic Cavity

The pelvic area is home to many important organs like the bladder, intestines, and reproductive organs. Without the uterus after a hysterectomy, these organs rearrange themselves. The bladder and intestines may move to the space where the uterus was, which can change how they work.

Impact on Bladder Position and Function

The bladder is often affected by these changes. As it moves, it can impact how you urinate. Some people might find it hard to hold their urine or empty their bladder fully. These issues come from the new anatomy and weaker pelvic floor muscles.

Intestinal Repositioning and Effects

The intestines also change their position after a hysterectomy. This can cause problems like constipation or bowel blockages. It’s important for patients to watch their bowel movements and talk to their doctor if they notice big changes.

Understanding the changes in the pelvic area after a hysterectomy helps manage symptoms and improve life quality. Following post-op care and attending follow-up visits is key to addressing any issues or complications.

Urinary Retention: Why You Can’t Pee After Surgery

Women may face urinary retention after a hysterectomy. This means they can’t fully empty their bladder. Knowing why it happens and how to manage it can help ease worries.

Causes of Post-Operative Urinary Retention

Several factors can cause urinary retention after a hysterectomy. Surgical trauma to the pelvic area can swell and bruise the bladder and urethra. This makes it hard to pee. Also, a catheter during surgery can irritate and hurt, making retention worse.

Other reasons include:

  • Anesthesia effects: Anesthesia can temporarily mess with bladder function.
  • Pain medications: Pain meds can slow down bladder and bowel movements.
  • Pelvic floor dysfunction: Surgery can harm nerves controlling the bladder, causing retention.

Signs and Symptoms to Watch For

Knowing the signs of urinary retention is key. This way, you can get help quickly. Look out for:

  1. Difficulty starting urination
  2. Weak or interrupted urine flow
  3. Feeling of incomplete bladder emptying
  4. Frequent urination with little output
  5. Discomfort or pain in the lower abdomen

If you notice these symptoms, tell your doctor right away.

Management Techniques for Urinary Retention

Managing urinary retention requires a few steps to help your bladder work right again. Pelvic floor exercises, like Kegels, can strengthen bladder muscles. Your doctor might also suggest:

  • Catheterization: Using a catheter to drain the bladder.
  • Medications: Drugs to relax bladder muscles and improve flow.
  • Physical therapy: Therapy to fix any pelvic floor issues.

By understanding the causes and using the right treatments, women can manage urinary retention after a hysterectomy.

Different Types of Hysterectomies and Their Impact on Urination

Knowing about the different hysterectomies is key to understanding urinary issues. A hysterectomy removes the uterus and can affect how you urinate. Each type of surgery has its own impact.

Total vs. Partial Hysterectomy Effects

A total hysterectomy removes the whole uterus and cervix. A partial hysterectomy only takes out the top part of the uterus, keeping the cervix. Studies show that how much of the uterus is removed can affect your urine.

Total Hysterectomy: This is the most common type and might increase the risk of urine problems because it requires more cutting.

Partial Hysterectomy: Some research suggests keeping the cervix might lower the risk of urine issues. This could mean fewer problems after surgery.

Abdominal vs. Vaginal vs. Laparoscopic Approaches

The way the surgery is done also affects your urine. There are three main ways: abdominal, vaginal, and laparoscopic hysterectomy.

  • Abdominal Hysterectomy: This traditional surgery has a big cut in the belly. It might lead to more urine problems because it’s more invasive.
  • Vaginal Hysterectomy: Done through the vagina, it’s less invasive. It could mean fewer urine problems and a quicker recovery.
  • Laparoscopic Hysterectomy: This uses small cuts and a laparoscope. It might reduce urine problems and help you heal faster.

Radical Hysterectomy and Urinary Complications

Radical hysterectomy removes the uterus, cervix, part of the vagina, and sometimes more. It’s mainly for cancer. This surgery can really affect how you urinate.

Type of Hysterectomy

Urinary Complications Risk

Recovery Time

Total Hysterectomy

Higher

6-8 weeks

Partial Hysterectomy

Lower

4-6 weeks

Radical Hysterectomy

Significantly Higher

8-12 weeks

It’s important to know these differences to manage your urinary health after surgery. Talking to your doctor about your risks and concerns is vital.

Pelvic Organ Prolapse Following Hysterectomy

Women who have had a hysterectomy need to know about pelvic organ prolapse. This happens when the muscles and tissues that support the pelvic organs weaken. As a result, the organs can drop into the vagina. This can really affect a woman’s life, making it hard to control her bladder.

Types of Prolapse Affecting Urination

There are different types of pelvic organ prolapse that can mess with urination. These include:

  • Vaginal Vault Prolapse: This is when the top of the vagina collapses. It can put pressure on the bladder and urethra.
  • Cystocele: Also known as bladder prolapse, it’s when the bladder bulges into the vagina. This can block urine flow.
  • Urethrocele: This is when the urethra bulges into the vagina. It can cause incontinence and trouble emptying the bladder.

Risk Factors for Developing Prolapse

Some things can make you more likely to get pelvic organ prolapse after a hysterectomy. These include:

  1. How old you were when you had the hysterectomy
  2. Having had other pelvic surgeries or given birth
  3. Weak pelvic floor muscles from aging or other conditions
  4. Chronic coughing or doing a lot of heavy lifting

Knowing these risk factors can help you prevent it and manage symptoms better.

Symptoms and Diagnosis of Pelvic Organ Prolapse

The symptoms of pelvic organ prolapse can differ based on the type and how bad it is. Common signs include:

  • A feeling of heaviness or fullness in the pelvis
  • Seeing a bulge or something sticking out of the vagina
  • Urinary incontinence or trouble peeing
  • Pain or discomfort during sex

To diagnose it, a doctor will do a pelvic exam. They might also do tests like urodynamic studies to check how well you pee.

Urinary Tract Infections After Hysterectomy

Urinary tract infections (UTIs) are common after hysterectomy surgery. Many women worry about this. It’s important to know why UTIs happen, how to spot symptoms, and treatment options.

Why UTIs Are Common Post-Surgery

Several factors increase UTI risk after hysterectomy. The surgery can change how the urinary tract works. This makes it more likely to get infected.

Using a catheter during and after surgery can also introduce bacteria. The healing process brings inflammation, raising infection risk even more.

Recognizing UTI Symptoms After Hysterectomy

Knowing UTI symptoms is key to getting help fast. Look out for:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy or has a strong odor
  • Pelvic pain, specially in women

If you notice these signs, contact your healthcare provider right away for evaluation and treatment.

Treatment and Prevention Strategies

UTIs are usually treated with antibiotics. Your doctor will choose the right medicine for your infection. To prevent UTIs, try:

  • Drinking plenty of water to flush out bacteria
  • Urinating when you feel the need, not holding it
  • Practicing good hygiene, like wiping from front to back
  • Avoiding irritating feminine products

Knowing the risks and taking steps to prevent UTIs can help. If symptoms appear, don’t wait to contact your healthcare provider for help and advice.

Managing Urine Leakage After Hysterectomy

After a hysterectomy, some women face urine leakage. This can be managed with the right strategies and support. Urine leakage, or urinary incontinence, can greatly affect a woman’s life. But, there are many ways to manage it well.

Types of Incontinence Following Surgery

There are several types of urinary incontinence after a hysterectomy. Knowing these types is key to finding the best way to manage it.

  • Stress Incontinence: This happens when movement or pressure on the bladder causes leakage. It’s often due to weak pelvic floor muscles.
  • Urge Incontinence: It’s when you suddenly feel a strong need to urinate, leading to involuntary leakage. This can be caused by an overactive bladder.
  • Mixed Incontinence: This is a mix of stress and urge incontinence. It’s more challenging to manage.

Conservative Management Strategies

Conservative management is often the first treatment for urinary incontinence after hysterectomy. These methods focus on lifestyle changes and non-invasive techniques.

  1. Pelvic Floor Exercises: Doing Kegels can strengthen the pelvic floor muscles. This can improve bladder control.
  2. Dietary Changes: Changing what you drink and avoiding irritants like caffeine and spicy foods can help manage symptoms.
  3. Bladder Training: Increasing the time between bathroom visits can help improve bladder capacity and reduce leakage.

Medical and Surgical Interventions

For some, conservative management may not be enough. Medical or surgical interventions may be needed. These options are considered when incontinence greatly affects quality of life.

Medical treatments might include medications to manage symptoms. Surgical options range from minimally invasive to complex surgeries to fix underlying issues.

Women with urine leakage after hysterectomy should talk to their healthcare provider. They can help find the best management plan for their needs.

Pelvic Floor Health and Rehabilitation

The link between pelvic floor health and urinary function is key after a hysterectomy. Understanding how surgery impacts pelvic floor muscles and urinary function is vital.

Impact on Pelvic Floor Muscles

A hysterectomy can weaken the pelvic floor muscles. These muscles are important for supporting pelvic organs and controlling urine. Research shows surgery can change muscle strength and function, affecting urine control.

Studies have indicated that women may see a drop in muscle strength after surgery. This can lead to incontinence or other urinary problems. But, with the right rehabilitation, strength can be regained, and urine control improved.

Connection to Urinary Function

The pelvic floor muscles are key in controlling urination. Weakening or damage to these muscles can cause incontinence or other urinary issues. Effective pelvic floor rehabilitation is essential for normal urine function.

A study in a respected medical journal found pelvic floor muscle training is very effective for incontinence in women. This highlights the need for pelvic floor exercises in post-hysterectomy care.

Effective Pelvic Floor Exercises

Kegel exercises can boost pelvic floor muscle strength and control urine. To do Kegels right:

  • Find the right muscles by stopping urine flow mid-stream.
  • Contract these muscles for 5-10 seconds, then relax for the same time.
  • Do this 10-15 times, three times a day.

Consistency is key for better pelvic floor strength and urine control. Like any exercise, patience and persistence are necessary.

“Pelvic floor rehabilitation is a vital part of post-hysterectomy care. It helps women regain control over their urine and improves their life quality.”

By focusing on pelvic floor health and rehabilitation, women can actively work on maintaining urinary well-being after a hysterectomy. We suggest talking to a healthcare provider to create a personalized rehabilitation plan.

Bowel Problems After Hysterectomy and Their Impact on Urination

The link between bowel issues and urinary problems after a hysterectomy is complex. While care after a hysterectomy often focuses on the reproductive system, it’s key to consider how it affects other functions like bowel movements and urination.

Constipation and Its Effect on the Urinary System

Constipation is a common issue after a hysterectomy. Straining during bowel movements can put extra pressure on the pelvic floor muscles. These muscles are already stressed from the surgery. This can lead to urinary problems, such as discomfort while urinating and a higher risk of urinary tract infections.

Constipation can also cause bloating and discomfort, making urinary symptoms worse. To help, try changing your diet, staying hydrated, and possibly taking medication. This can ease urinary issues.

Bowel Spasms and Referred Pain

Bowel spasms are another issue after a hysterectomy. These spasms can cause a lot of discomfort and lead to referred pain in the pelvic area. This pain can affect urination, making it hard to urinate normally.

It’s important to treat bowel spasms quickly to avoid affecting urination. Treatment might include medication to relax the bowel muscles and reduce spasms.

Managing Post-Hysterectomy Bowel Issues

Managing bowel issues after a hysterectomy needs a full approach. This includes making dietary changes to avoid constipation, staying hydrated, and possibly using pelvic floor physical therapy. This therapy helps strengthen the muscles around the bowel and urinary tract.

  • Increasing fiber intake to promote regular bowel movements
  • Staying hydrated to soften stool and ease bowel movements
  • Avoiding foods that can cause gas and discomfort
  • Engaging in regular physical activity to stimulate bowel function

By tackling bowel problems effectively, patients can lower their risk of urinary issues after a hysterectomy. This leads to a smoother recovery and better overall health.

Long-Term Urinary Changes After Hysterectomy

It’s important to know how hysterectomy affects urinary health long-term. Women may see changes in their urine function after surgery. Some changes can last forever, while others might go away.

Permanent vs. Temporary Urinary Changes

Urinary changes after hysterectomy can differ from person to person. Some women might have permanent changes like feeling their bladder differently or it not emptying right. Others might see temporary changes that go away a few months after surgery.

Knowing if changes are permanent or temporary helps set expectations. It also guides what treatments might help. The type of surgery, any urinary issues before surgery, and overall health play a big role.

Factors Affecting Long-Term Bladder Function

Several things can affect bladder function long-term after hysterectomy. These include:

  • The surgical approach used for the hysterectomy (abdominal, vaginal, or laparoscopic)
  • The presence of pre-existing pelvic floor disorders
  • Post-operative complications such as infection or adhesions
  • The patient’s age and overall health status

Knowing these factors helps doctors give better advice and care to each patient.

Factor

Impact on Bladder Function

Surgical Approach

The method used can affect the extent of trauma to surrounding tissues, influencing long-term bladder function.

Pre-existing Conditions

Conditions like pelvic organ prolapse or urinary incontinence can be exacerbated or alleviated by hysterectomy.

Post-operative Complications

Infections or adhesions can impact bladder function and overall pelvic health.

Adapting to Your New Normal

Adjusting to urinary changes after hysterectomy needs a few steps. This includes pelvic floor rehabilitation, making lifestyle changes, and sometimes medical treatments. Working with healthcare providers helps women find ways to manage symptoms and keep their pelvic floor healthy.

Understanding urinary changes after hysterectomy and what affects them helps women navigate their recovery. With the right support and treatments, managing symptoms and living well is possible.

Medications That Can Affect Urination After Hysterectomy

It’s important to know how some medications can change how you pee after a hysterectomy. After surgery, doctors give out medicines to help with pain, prevent infections, and help you heal. But, some of these medicines can mess with how you pee.

Pain Medications and Urinary Side Effects

Managing pain is key after a hysterectomy. Opioid medications are often used for pain. They can make it harder to pee by relaxing the bladder muscle and tightening the bladder sphincter.

People taking opioids might find it hard to start peeing or empty their bladder fully. This can lead to urinary tract infections (UTIs) because of urine staying in the bladder too long. Doctors need to watch patients closely and find other ways to manage pain if needed.

Antibiotics and Bladder Irritation

Antibiotics are given after a hysterectomy to stop or treat infections. They are important to prevent problems, but some can irritate the bladder or cause allergic reactions. These can make you pee more often, feel like you have to pee right away, or hurt while peeing.

Antibiotics are meant to kill bad bacteria, but they can upset the balance of good bacteria in the urinary tract. This can cause irritation or infection. It’s important to watch for these side effects and change the treatment if needed.

Managing Medication-Related Urinary Issues

Dealing with urinary problems caused by medicines needs a full plan. We suggest that patients keep a voiding diary to track when they pee, how much, and if it hurts. This helps spot problems early.

Changing medicines or trying different treatments can help with pee problems. For example, using non-opioid pain medicines can lower the chance of pee issues. Also, medicines made to help with pee problems can be an option.

Knowing how medicines after a hysterectomy can affect pee and talking to your doctor can help you manage pee problems during recovery.

Self-Care Strategies for Urinary Comfort

Urinary issues after a hysterectomy can be tough. But, there are ways to feel better. Using these strategies can really help your recovery.

Hydration and Dietary Considerations

Drinking enough water is key for your bladder. It helps get rid of bacteria and lowers UTI risk. Try to drink 8-10 glasses a day, unless your doctor says different.

What you eat matters too. Some foods can bother your bladder. So, cut down on:

  • Caffeine and alcohol
  • Spicy foods
  • Acidic foods like citrus fruits and tomatoes
  • Artificial sweeteners

Eating foods that help your bladder, like cranberries, can also be good.

Positioning for Comfortable Urination

How you sit when you pee can really help. Here are some tips:

  1. Take your time and relax when using the bathroom.
  2. Try to empty your bladder completely to avoid urinary retention.
  3. Experiment with different positions, such as leaning forward or using a toilet stool, to help relax your pelvic muscles.

Double voiding (urinating, waiting a few moments, and then trying to urinate again) can also help empty your bladder fully.

Heat and Cold Therapy for Discomfort

Heat or cold on your pelvic area can help with pain or discomfort. Some like a warm bath or a heating pad. Others prefer cold packs.

Use these therapies safely: Always cover heat or cold with a cloth to avoid burns. Don’t use them for too long.

Adding these self-care steps to your daily life can make you feel better after a hysterectomy. Always talk to your doctor before trying new things, to make sure they’re safe for you.

When to Consult Your Doctor About Urinary Symptoms

After a hysterectomy, it’s important to watch your urinary health closely. Knowing when to see a doctor is key. Some symptoms are common, but others mean you need to see a doctor right away.

Red Flag Symptoms Requiring Immediate Attention

Some symptoms after a hysterectomy need quick medical help. These include:

  • Severe pain while urinating
  • Inability to urinate
  • Blood in the urine
  • Fever with urinary symptoms
  • Severe abdominal pain

If you have any of these, call your doctor fast.

Persistent Issues That Need Evaluation

Some urinary problems might go away by themselves. But if they don’t, you need to see a doctor. Issues like:

  • Frequent urinary tract infections
  • Urinary incontinence that doesn’t get better
  • Hard time starting or stopping urination
  • Always feeling like you need to go

Your doctor can check these and suggest treatments.

Questions to Ask Your Healthcare Provider

When talking to your doctor about urinary symptoms, ask these questions:

  • What could be causing my symptoms?
  • Are there treatments or ways to help?
  • What can I do in the meantime?
  • Are there lifestyle changes that can help?

Having questions ready can help you get the best care.

To understand urinary problems after a hysterectomy better, look at this table:

Symptom

Possible Cause

Recommended Action

Painful urination

Urinary tract infection or surgical trauma

Contact your doctor for evaluation and possible antibiotic treatment

Urinary incontinence

Weakened pelvic floor muscles or nerve damage

Practice pelvic floor exercises or consider physical therapy

Urinary retention

Swelling or nerve damage from surgery

Discuss catheterization or other management options with your doctor

Conclusion

It’s important to know how hysterectomy might affect your urinary health. We’ve talked about how different things can impact your bladder after surgery. This includes the type of hysterectomy, how the surgery was done, and how your body heals.

To have a smooth recovery and good bladder function, be proactive. Focus on strengthening your pelvic floor, keep yourself clean, and drink plenty of water. These steps help a lot with your urinary health.

During your recovery, keep in touch with your doctor. Tell them about any problems or symptoms you have. Working together, you can solve any issues and get the best results for your bladder and overall health after surgery.

FAQ

What are the normal urinary experiences after a hysterectomy?

After a hysterectomy, you might feel some discomfort when you pee. This includes needing to go often but not being able to. This usually happens in the first 24-48 hours.

Why does it hurt to pee after a hysterectomy?

Several reasons can cause pain when you pee after a hysterectomy. These include discomfort from the catheter, damage to the urinary tract, and inflammation.

How do organs shift after a hysterectomy?

After a hysterectomy, organs in your pelvic area might move. This can change bladder function and affect urination.

What is urinary retention, and how is it managed after a hysterectomy?

Urinary retention is a common issue after a hysterectomy. It can be managed with pelvic floor exercises to ease symptoms.

How does the type of hysterectomy affect urinary function?

The type of hysterectomy can impact how you pee. There are differences between total and partial hysterectomies. The surgical approach, like abdominal or vaginal, also matters.

What is pelvic organ prolapse, and how does it affect urination after a hysterectomy?

Pelvic organ prolapse is a common issue after a hysterectomy. It can affect how you pee. There are different types of prolapse, including vaginal vault prolapse.

Why are urinary tract infections common after a hysterectomy?

Urinary tract infections are common after a hysterectomy. This is due to catheter use and changes in the urinary tract anatomy.

How can I manage urine leakage after a hysterectomy?

To manage urine leakage after a hysterectomy, try conservative management first. This includes pelvic floor exercises. If needed, there are medical and surgical options too.

How does a hysterectomy affect pelvic floor health?

A hysterectomy can impact the pelvic floor muscles. It’s important to understand how pelvic floor and urination are connected. This helps with effective pelvic floor exercises.

Can bowel problems after a hysterectomy affect urination?

Yes, bowel problems like constipation and spasms can happen after a hysterectomy. They can affect urination. Managing bowel issues can help with urinary symptoms.

Are long-term urinary changes common after a hysterectomy?

Long-term urinary changes can happen after a hysterectomy. It’s important to know about bladder function changes. This includes understanding permanent versus temporary changes.

Can medications affect urination after a hysterectomy?

Yes, some medications can affect urination after a hysterectomy. This includes pain medications and antibiotics. Knowing their side effects can help manage urinary issues.

What self-care strategies can improve urinary comfort after a hysterectomy?

To improve urinary comfort after a hysterectomy, try self-care strategies. These include staying hydrated, following a certain diet, and using heat or cold therapy. Positioning yourself for comfortable urination also helps.

When should I consult my doctor about urinary symptoms after a hysterectomy?

It’s important to know when to talk to your doctor about urinary symptoms. Look out for red flag symptoms that need immediate attention. Also, if symptoms persist, you should get them checked out.

Reference

National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3016837/

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