Foods to eat if you have Piles

Hemorrhoid No More

Hemorrhoid No More is a 150 page downloadable ebook, with all the secret natural Hemorrhoids cure methods, unique powerful techniques and the step-by step holistic hemorrhoids system discovered in over 14 years of research. This solution was developed by Jessica Wright and is an intelligent, scientific approach that gets hemorrhoids under control and eliminates its related symptoms within a few short weeks (depending on the severity). The Hemorrhoid No More program also teaches you how to prevent Hemorrhoids recurrence. It's a fact- curing Hemorrhoids can never be achieved by tackling one of the many factors responsible for Hemorrhoids. If you've ever tried to cure your Hemorrhoids using a one-dimensional treatment like pills, creams, or suppositories and failed it's probably because you have tackled only one aspect of the disease. Not only will this system teach you the only way to prevent your Hemorrhoids from being formed, you will also learn the only way to really cure Hemorrhoids for good the holistic way. This program contains all the information you'll ever need to eliminate your Hemorrhoids permanently in weeks, without using drugs, without surgery and without any side effects. Read more here...

Hemorrhoid No More Summary

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Contents: 150 Page Ebook
Author: Jessica Wright
Official Website: www.hemorrhoidnomore.com
Price: $37.00

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Hemorrhoid Miracle Cure Hemorrhoids In 48 Hours

The Hemorrhoid Miracle Cure is an eBook packed with insightful information about the cause of hemorrhoids, why traditional treatments dont work, and natural methods that not only alleviate the symptoms for hemorrhoids but keeps them from coming back. The book was written by Holly Hayden who discovered she had hemorrhoids while hiking. After spending hundreds of dollars on over-the-counter and pharmaceutical products that only addressed the symptoms and sometimes caused side effects, Holly finally conducted her own investigation and discovered a series of simple home remedies that eliminated hemorrhoids quickly. The system includes ingredient resources, charts, audio lessons and basically everything you need to cure your hemorrhoids one and for all. I really recommend it and just see the testimonials from users who have triumphed even severe hemorrhoids for good. Read more here...

Hemorrhoid Miracle Cure Hemorrhoids In 48 Hours Summary

Contents: EBook, Audio Lessons
Author: Holly Hayden
Official Website: hemorrhoidmiracle.com
Price: $37.00

Constipation and Hemorrhoids

Nonpharmacologic treatment is the mainstay of constipation and hemorrhoids treatment in pregnant patients. Pregnant women should be counseled to eat a high-fiber diet, drink plenty of fluids, exercise regularly, and avoid prolonged time on the toilet. To relieve hemorrhoids, pregnant women may soak in warm sitz baths and apply ice to the area. Bulk-forming laxatives, such as psyllium and calcium polycarbophil are firstline agents (Table 47-8).18 If these methods fail, stimulant laxatives, such as bisaco-dyl and senna, are acceptable second-line agents for short-term or intermittent use.6,18 During lactation, bulk-forming laxatives and the stimulant laxatives are safe for use.19 Studies are lacking on safe and effective approaches for management of hemorrhoids during pregnancy. Acetaminophen and topical analgesics agents may be used for pain. Surgical resection or banding can also be performed during pregnancy, but it is generally preferable to delay the surgery until after delivery.

Internalexternal Hemorrhoids Clinical Summary

External hemorrhoids result from the dilatation of the venules of the inferior hemorrhoidal plexus below the dentate line. They have a covering of skin, or anoderm, versus internal hemorrhoids, which have a mucosal covering. Hemorrhoids commonly present with an episode of rectal bleeding of bright red blood after defecation. This results from the passage of the fecal mass over the thin-walled venules, causing abrasions and bleeding. Symptoms from external hemorrhoids include swelling, burning, pruritus, and wetness of the anal area. Contributing factors include constipation, family history, pregnancy, portal hypertension, and increased intra-abdominal pressure. Hemorrhoids are commonly found at three anatomic locations right anterior, right posterior, and left lateral positions. A thrombosed external hemorrhoid contains intravascular clots and causes exquisite pain the first 48 hours. Internal hemorrhoids present with painless rectal bleeding or the sensation of prolapse. Other...

Hemorrhoids

Hemorrhoids are submucosal vascular beds located in the anal and rectal canal that assist with defecation and the sensation of anorectal fullness. These vascular beds can occur in insensate areas above the dentate line as internal hemorrhoids or below the dentate line as external hemorrhoids in exquisitely sensitive areas. Hemorrhoid development may result from genetic factors, aging or serial local trauma. One study found that 4.4 of the U.S. population, or 10 million people, complain of hemorrhoid disease (Reese et al., 2009). Internal Hemorrhoids Internal hemorrhoids are classified according to the severity of prolapse. No rectal prolapse occurs with first-degree hemorrhoids, and spontaneously reducible prolapse occurs with second-degree disease. These can be treated with conservative or surgical methods. Third-degree hemorrhoids prolapse and require manual reduction, and fourth-degree hemorrhoids have irreducible prolapse. As the prolapse progresses, surgical treatment becomes a...

What does a TRUS guided prostate biopsy involve

Is in place and completely goes away when the probe is removed. Men who have had prior rectal surgery, who have active hemorrhoids, or who are very anxious and cannot relax the external sphincter muscle may have more discomfort. Once the probe is in a good position, the prostate will be evaluated to make sure that there are no suspicious areas on the ultrasound. Ultrasound looks at tissues by sound waves. The probe emits the sound waves, and the waves hit the prostate and are bounced off the prostate and surrounding tissue. The waves then return to the ultrasound probe, and a picture is developed on the screen. The sound waves do not cause any discomfort. Prostate cancer tends to cause less reflection of the sound waves, a trait referred to as hypoechoic, so the area often looks different in an ultrasound image than the normal prostate tissue. After the prostate has been evaluated, biopsies are obtained. The transrectal ultrasound allows the urologist to visualize the location for the...

Emergency Department Treatment And Disposition

In the case of severe bleeding, fluid resuscitation would need to be instituted and the bleeding vessel located, clamped, and ligated. Treatment for less severe cases includes increased dietary fiber, increased fluid intake, hot sitz baths, bed rest, and nonnarcotic pain medication. Advanced cases may require surgical consultation and treatment. Emergency department treatment of thrombosed external hemorrhoids includes an elliptical excision and extrusion of the clot under local anesthesia. Figure 9.37. External Hemorrhoids. Multiple engorged, thrombosed external hemorrhoids are seen in this patient. (Photo contributor Lawrence B. Stack, MD.)

Animal Models Of Disease

Unlike humans, in the mouse there are two Daf genes, Daf1 and Daf2. The Daf1 gene, like the human DAF gene, encodes GPI-anchored DAF that is ubiquitously expressed, while the Daf2 gene encodes transmembrane anchored DAF that is restricted in its distribution to the testes and spleen (Lin et al., 2001). Consequently for an animal model, the Daf1 gene was targeted. Daf1 knock-out mice (Lin et al., 2001 Miwa, 2001) provide a resource for studying several experimental animal models of disease including experimental autoimmune myasthenia gravis (EAMG), a murine model of systemic lupus erythrematosus (SLE) in MRL lpr mice, acute nephrotoxic serum (NTS)-induced nephritis, and dextran sodium sulfate (DSS)-induced colitis. In EAMG, the binding of anti-acetylcholine receptor (AChR) antibodies to the post-synaptic junction activates the classical pathway, ultimately leading to endplate damage (De Baets et al., 2003). Following anti-AChR mAb administration, as compared with Dafl* + littermates...

Lower Gastrointestinal Bleeding

The combination of an overall higher diagnostic yield and a lower rate of complications makes colonoscopy the preferred choice over angiography as the initial test in most patients with suspected GI bleeding. Colonoscopy may be performed urgently or electively, depending on the patient's hemodynamic status and risk-stratification criteria. Comor-bid risk factors for GI bleeding severity, including advanced age, presence or absence of shock, congestive heart failure (CHF), ischemic heart disease, and stigmata of recent hemorrhage, accurately predict the likelihood of death or rebleeding (Rockall et al., 1996). In patients with LGIB who are hemo-dynamically stable, a clean-out preparation (e.g., GoLytely) should be used before colonoscopy to increase visibility and diagnostic yield. In patients with hematochezia and hemo-dynamic compromise, consideration should be given to a rapidly bleeding upper GI source, the patient should be kept NPO, and a nasogastric tube should be placed. A...

The amygdala and emotional expression

A study on the amnesic patient H.M., whose surgical damage to the medial temporal lobe included removal of the amygdala bilaterally, provides confirmation of the blunting of affective responsiveness in humans with amygdala damage, and offers some further insights into the nature of this disorder. In the clinical setting, H.M. was known not to complain about normally painful conditions including hemorrhoids, and did not produce a normal skin-resistance change to electrical stimulation. He also was noted to rarely mention being hungry even when his meals were delayed, but he otherwise ate in a normal manner when given a meal. These observations were followed up in a systematic study of H.M.'s responsiveness to pain and hunger. In this study H.M's responses to thermal stimulation were compared to those of control subjects and amnesic patients without amygdala damage. H.M. showed a diminished ability to discriminate painful stimulation. Most prominent was his failure to identify any of...

Comparability of different patientreported outcome measures

Similar principles apply to studies in which review authors choose to focus on available data that are presented in dichotomous fashion, or from which review authors can extract dichotomous outcome data with relative ease. For example, investigators studying the impact of flavanoids on symptoms of haemorrhoids found that eligible randomized trials did not consistently use similar symptom measures all but one of 14 trials, however, recorded the proportion of patients either free of symptoms, with symptom improvement, still symptomatic, or worse (Alonso-Coello 2006). In the primary analysis investigators considered outcomes of patients free of symptoms and patients with symptomatic some improvement as equivalent, and pooled each outcome of interest based on the a priori expectation of a similar magnitude and direction of treatment effect.

Fecal Occult Blood Test

As a screening test for colorectal cancer, FOBT has low sensitivity and specificity. Other GI lesions, including hemorrhoids, angiodysplasia, diverticular disease, and upper GI lesions, can lead to increased blood in the stool. Bleeding from colon cancers can be intermittent or undetectable, and other factors can give false-positive or false-negative readings. About 2 to 6 of asymptomatic adults have a positive FOBT test, 10 of whom have cancer and 20 to 30 , adenomas. The rest have upper GI sources of bleeding, non-neoplastic lower GI sources of bleeding (e.g., hemorrhoids), or no identified source of bleeding. The sensitivity of the FOBT in patients with colon cancer is approximately 30 .

History and Geography

Galen of Pergamum listed several causes of dropsy in the first century A.D., including a hardened liver, as well as inadequate blood formation (which he thought occurred in the liver), hemorrhoids, and both amenorrhea and uterine hemorrhage. Virtually all writers on dropsy until the mid-seventeenth century cited the teachings of Hippocrates, Celsus, and Galen. Their ideas were also relayed in the eleventh century by Avicenna of Baghdad, who thought that the tachycardia, palpitations, pulmonary edema, dyspnea, and syncope (fainting or shock, which he postulated was a sign of a weak heart) that accompanied dropsy were related to one another.

What are externalbeam and conformal externalbeam radiation therapies What are the side effects of EBRT

A change in bowel habits is one of the more common side effects of EBRT. Patients may develop diarrhea, abdominal cramping, the feeling of needing to have a bowel movement, rectal pain, and bleeding. Usually, if Rectal pain can be treated with warm sitz baths, hydro-cortisone-containing creams (ProctoFoam HC, Corti-foam), or anti-inflammatory suppositories (Anu-sol, Rowasa).

Portalcaval Anastomoses

VWhen hepatocytes are damaged (e.g., due to disease, alcohol, or drugs), the liver cells are replaced by fibrous tissue, which impedes the flow of blood through the liver (cirrhosis). When the hepatic portal system is blocked, the return of blood from the intestines and spleen through the liver is impeded, resulting in portal hypertension. Therefore, veins that usually flow into the liver are blocked. Consequently, blood pressure in the blocked veins increases, causing them to dilate and gradually reopen previously closed connections with the caval system. Veins in the distal portion of the esophagus begin to enlarge (esophageal varices) veins in the rectum begin to enlarge (internal hemorrhoids) and in chronic cases, the veins of the paraumbilical region enlarge (caput medusa).

Case study 481 GI bleeding

A sigmoidoscopy showed external hemorrhoids and severe hemorrhagic colitis of the sigmoid colon. The patient was admitted and treated with bowel rest, intravenous fluids and antibiotics. Her symptoms resolved within 24 h and she was discharged in 4 days. Further evaluation for other etiologies was unremarkable. A subsequent endoscopy at 6 weeks showed complete resolution and she resumed active running without recurrent symptoms over 24 months. No instances of esophagitis, esophageal ulcers or small bowel ischemia causing bleeding have been observed to date. Exercise-associated mesenteric infarction has been reported 22 . Anorectal disorders, such as hemorrhoids or fissures, may be aggravated by local trauma, are common and may cause bleeding in some runners and cyclists, although the incidence is unknown.

Factors that decrease the quality level of a body of evidence

High probability of publication bias The quality of evidence level may be downgraded if investigators fail to report studies (typically those that show no effect publication bias) or outcomes (typically those that may be harmful or for which no effect was observed selective outcome reporting bias) on the basis of results. Selective reporting of outcomes is assessed at the study level as part of the assessment of risk of bias (see Chapter 8, Section 8.13), so for the studies contributing to the outcome in the 'Summary of findings' table this is addressed by factor 1 above (limitations in the design and implementation). If a large number of studies included in the review do not contribute to an outcome, or if there is evidence of publication bias, the quality of the evidence may be downgraded. Chapter 10 provides a detailed discussion of reporting biases, including publication bias, and how it may be tackled in a Cochrane review. A prototypical situation that may elicit suspicion of...

Treatment and Monitoring

Traveler has a fever or bloody stools, in which case a 3-day regimen is necessary. Alternatives to fluoroquinolones should be used in Asia, where resistance is high among Campylobacter. Azithromycin, as a single adult dose of 1,000 mg, represents an alternative to the fluoroquinolone class.2 The recommended regimen for children is azithromycin 5 to 10 mg kg orally as a single dose. Additionally, the FDA recently approved rifaximin for the treatment of traveler's diarrhea at an adult dose of 200 mg three times daily for 3 days rifaximin is not indicated for use in children under the age of 12 years. Rifaximin is not effective against C. jejuni, and efficacy has not been documented against Salmonella.

Patient Encounter 4

A very pleasant 73-year-old white female with a 48-hour history of hematochezia and hemoptysis presents to the ED. She denies any recent travel, exotic foods, raw foods, or sick contacts. She does note that she ate cold-cut sandwiches at a fundraiser approximately 3 days before her symptoms started. She also noticed that she has three friends who developed bloody diarrhea who also ate at this same fundraiser. She denies any fevers, shakes, chills, cough, sore throat, shortness of breath, chest pain, nausea or vomiting, dysuria, hematuria, edema, or night sweats. On her initial presentation, she had a CT that showed pan-colitis and terminal ileitis. She was started on antibiotic therapy including ciprofloxacin and metronidazole. Fecal leukocytes were negative. A stool culture was sent and was positive for Stx. The final culture result was positive for Escherichia coli O157 H7.

Pinworm Infection Enterobiasis Clinical Summary

Enterobius vermicularis is a threadlike white worm that infects the colon and causes intense pruritus of the perianal region, where the gravid adult female migrates to deposit eggs at night. Female worms measure 8 to 13 mm in length and can be observed moving about the perianal area at night. On rare occasions this nematode can lead to vulvovaginitis. The diagnosis can be made by direct visualization of the nematode by the parents or by using a piece of transparent adhesive tape and touching it to the perianal area upon awakening in the morning. This tape is then applied to a glass slide for microscopic examination under low power to look for eggs. The differential diagnosis includes perianal irritation, cellulitis, fissures, hemorrhoids, and contact dermatitis.

What is prostate cancer screening

Or a firm area in the prostate include prostatitis (prostate infection or inflammation), prostate calculi, an old infarct in the prostate, or abnormalities of the rectum, such as a hemorrhoid. If you have had your rectum removed, then your doctor will rely on the PSA. If the PSA were to rise significantly, then a prostate biopsy would be performed. A transrectal ultrasound biopsy likewise cannot be performed in individuals without a rectum. In this situation, the biopsy is performed transper-ineally, which means through the perineum (the area under the scrotum). Performing biopsies in this way can be more uncomfortable, and they are often performed with some form of anesthesia (general, spinal, or intravenous sedation).

What Practitioners Say It Does

Proponents indicate that qigong lowers heart rate and blood pressure, and improves relaxation potential. Specific qigong exercises aimed at directing the flow of qi to certain areas of the body are used to help prevent tension headaches, constipation, and insomnia. Practitioners describe reports of qigong curing disease, reducing farsightedness and nearsightedness and treating sinus allergies, hemorrhoids, and problems of the prostate (all highly unlikely). Other reports indicate that qigong can lessen the pain of arthritis and migraine headaches and alleviate depression, reduce anxiety, and promote sounder sleep (very probable).

Prolapsed Rectum Clinical Summary

Rectal prolapse occurs when anorectal tissue slides through the anal orifice. Prolapse may be partial, involving only the mucosa (prolapse is < 2 cm), or complete, involving in full thickness extrusion of the rectal wall. Prolapse may result from laxity of the pelvic floor, weak anal sphincters, and or lack of mesorectal fixation. Patients complain of bleeding, mucous discharge, rectal pressure, or a mass. Problems with fecal incontinence, constipation, and rectal ulceration are common as well. Prolapse may be associated with an increased familial incidence, chronic cough, dysentery, or parasitic infection. Other diagnoses to consider include foreign body, tumor, perianal or perirectal abscess, rectal polyp, or engorged external hemorrhoids.

Reducing Your Risk of Colon Cancer

Can a diet rich in fiber actually lower your chance of developing colon cancer Several studies say yes, and it makes perfect sense. Think about it. Insoluble fiber helps move waste material through your intestines more quickly. Therefore, there is less time for suspicious substances to lurk around and possibly damage your colon and rectal area. In addition, fiber may bind with possibly harmful bacteria, transporting it through the intestines and out of your body. While we're down there, it's a perfect time to point out that softer, more regular bowel movements can also prevent constipation and reduce your chance of getting hemorrhoids.

Gastrointestinal System

Maldigestion due to pancreatic enzyme insufficiency is present in about 85 to 90 of CF patients.5 Thick pancreatic secretions and cellular debris obstruct the pancreatic ducts and lead to fibrosis. Volume and concentration of pancreatic enzymes and bicarbonate are reduced, leading to maldigestion of fat and protein and subsequent malabsorption of fat-soluble vitamins (A, D, E, and K). Maldigestion is characterized by abdominal distention, steatorrhea, flatulence, and malnourish-ment despite voracious intake. Maldigestion is progressive and may develop later in a previously pancreatic sufficient patient. Other complications may include gastroesophageal reflux, dysmotility, salivary dysfunction, intussusception, volvulus, atresia, rectal prolapse, and complications related to corrective surgery for meconium ileus.6

Constipation Ready Set No Go

Constipation is a frequent GI complaint, especially among women, children, and those over age 65. Again, we don't talk about it, but it can lead to various maladies, including bad breath, body odor, depression, headaches, hemorrhoids, indigestion, insomnia, gas, and fatigue.

Changing Concepts What Constitutes Heart Disease

Concepts about what constitutes heart disease have changed a great deal in the past century. For example, the corresponding section of a predecessor to this work, August Hirsch's Handbook of Geographical and Historical Pathology (1883-6) is entitled Diseases of the Heart and Vessels, not diseases of the heart, and one of the main topics is hemorrhoids. Anatomic linkage of the heart and vessels into a single unit was common in the nineteenth century, as is shown by such titles as Diseases of the Heart and Aorta and Diseases of the Heart and Great Vessels. Around the end of the nineteenth century, however, the conceptualization of heart disease changed fundamentally. As Christopher Lawrence has pointed out, British physicians started to think about the heart in terms of its functional capacity rather than in terms of its anatomy. This led them to regard cardiac murmurs, such as would be detected by a stethoscope, as less important than physiological measurements of function.

The Abdominal Examination

The anorectal examination is an important component of the abdominal examination that may often be omitted. Although uncomfortable and embarrassing to the patient, it should not be neglected and should be approached with a calm, gentle attitude on the part of the clinician. The examiner should comment on both external and internal components of the anorectal examination, specifically anal sphincter tone presence or absence of hemorrhoids, fissures, fistulas, or masses prostatic abnormality in the male patient and consistency of the stool. Anoscopy should be considered as an adjunct to the anorectal examination when indicated, allowing for direct visualization of the internal anorectal canal. In female patients, the pelvic examination

Neisseria gonorrhoeae

Neisseria gonorrhoeae infection may be asymptomatic in both men and women. The current USPSTF recommendation is for screening women at risk. Men with penile gonorrhea typically present with purulent penile discharge and dys-uria with N. gonorrhoeae infection. Mucopurulent discharge, dysuria, pelvic pain, and dyspareunia are typical symptoms in women. In patients who engage in anal intercourse, anal discharge, rectal pain, and bleeding can be presenting symptoms. Gonococcal pharyngitis is within the differential of exudative pharyngitis in sexually active patients. When symptomatic, throat pain, tonsillar exudates, and anterior cervical adenopathy may be present.

Diseases

Including the twisting stomachache and bloody stools. Besides, this book mentions cold dysentery, dysentery with blue color, hot dysentery with reddish-yellow color, red dysentery with stomachache, and others. The Hyang-yak kugup pang gives a clear-cut definition of tetanus by stating that a spear wound will be fatal if it has caused lockjaw and spasms. Similarly, brief descriptions are given for rabies, stroke, epilepsy, hemorrhoids, prolapsed anus, and diabetes mellitus. The latter is defined as causing much urine, being unrelated to gonorrhea, and resulting in very thin patients. Somewhat obscure is the category of water-swelling diseases. Obviously referring to edemas, this term may include not only primary heart or kidney disease but also edemas of wet beriberi consequently, the symptoms of water-swelling diseases are also listed in this book under the heading of paralysis, this being one of the cardinal symptoms of dry beriberi.

Miscellaneous

Hemorrhoids were clearly distinguished in the text, and were associated with or seen to be aggravated by excessive horseback riding, sitting on hard wooden seats, and friction with clothes or skin. By contrast, because the anatomy and functions of the kidneys were not well known, specific diseases due to disorder of renal function are difficult to spy. Tasting the urine, however, was an important element in diagnosis, and diabetes mellitus appears to have been understood as a disease.

Clinical syndromes

The most prominent manifestation of infection with C. difficile is diarrhea. Although the pathologic lesions, when seen, are those of colitis, bloody stools are rarely present and some infected patients present with profuse watery diarrhea and signs of mild to moderate dehydration suggestive of a noninflammatory diarrheal syndrome. The reason for this overlap in features of noninflammatory and inflammatory (colitis) syndromes may be related to the nature of the C. difficile enterotoxin, toxin A. Unlike the classical enterotoxin, cholera toxin, toxin A causes gross cellular morphologic changes in addition to fluid secretion in vivo (see Chapter 21).293' Although diarrhea may resolve spontaneously in 25 of patients after simple withdrawal of the offending antibiotic,32 the symptoms more commonly become chronic and severe if the etiology is not recognized and specific therapy is not initiated.33 In addition to diarrhea, abdominal pain, ileus, and fever are associated findings in 22 , 21...

Colorectal cancer

Symptoms may include blood or mucus in the faeces, changes in bowel habits (diarrhoea constipation or both), anything abnormal or that lasts for more than 2 weeks, the feeling of needing to go to the toilet even if the bowels have just been emptied, pain or discomfort in the abdominal area, a mass in the abdomen or extreme tiredness, which could be the result of anaemia. These symptoms may well be caused by other conditions, e.g. a common cause of bleeding is haemorrhoids. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK website, 2002b).

The Puerperium

After the first 24 hours, postpartum recovery is rapid. A regular diet after a normal vaginal delivery can be offered as soon as the patient requests food. Full ambulation is encouraged as soon as possible. Showers can be encouraged, but vaginal douching is prohibited during the early postpartum period. Discomfort from an episiotomy can be relieved with hot sitz baths several times a day and analgesia. Drugs may be offered for pain as necessary but should be limited in breastfeeding mothers, because most drugs are secreted in breast milk. Meperidine (Demerol) is not the preferred analgesic for use in breastfeeding women because of the long half-life of its metabolite in infants. Repeated exposure to analgesics, especially meperidine, can result in drug accumulation and toxic effects in young or compromised infants because of their underdeveloped hepatic conjugation. Bladder care is important. Urine retention, bladder over-distention, and catheterization should be avoided if possible....

Anorectal Disease

Bleeding, pain, discharge, or change in bowel habits can indicate active anorectal disease, and all warrant medical evaluation. The patient history and a complete anorectal examination lead to a clear diagnosis in most complaints. Inflamed internal hemorrhoids or rectal polyps typically cause painless rectal bleeding. Painful anal bleeding can result from anal fissures, proctitis, thrombosed external hemorrhoids, or a draining perianal abscess. Palpable chronic masses can indicate an anal skin tag, polyp, or prolapsed rectal mass, and acute masses are usually caused by abscesses or thrombosed hemorrhoids. More than 90 of anorectal complaints can be managed in the primary care physician's office using simple techniques (Pfenninger and Zainea, 2001).

Anoscopy

For a thorough examination, the patient can be placed in a comfortable lateral decubitus position with hips flexed. The examiner may require nonpermeable protective clothing and eyewear. The anal tissues should be examined for tags, hemorrhoids, fissures, dermatitis, condylomata, and masses. A digital rectal examination should precede anoscopy to assess for internal pain or mass.

Bowel Dysfunction

Evacuation problems and other gastrointestinal sequelae such as ileus, gastric ulcers, reflux, di-verticulosis, hemorrhoids, and nausea, loss of appetite, incontinence, hours spent attempting to evacuate the bowel, and impactions. Approximately one in four patients with SCI require a hospitalization for such complications.39

Dyspareunia

Although dyspareunia is a gender-neutral term, men experience dyspareunia much less often with vaginal-penile intercourse than women. Dyspareunia in men is often caused by concurrent medical illness, such as Peyronie's disease or neuropathy, although relationship dynamics and poor sexual technique may also cause sexual discomfort. Anal dyspareunia can occur with the anally receptive or insertive partner and is usually caused by insufficient lubrication or spasm of the anal musculature. Evaluation consists of the history and physical examination. As with most sexual dysfunctions, onset, context, patient perceptions regarding possible causes, and impact on the relationship(s) are important. Physical examination may reveal evidence of neuropathy, urethritis, epididymitis, Peyronie's disease, prostatitis, anal fissures, hemorrhoids, or other pertinent findings. Treatment of dys-pareunia involves correction of underlying physical pathology, counseling regarding sexual technique, and...

Bulk Producers

Laxatives may provide appropriate relief when constipation occurs during the postpartum period, when not breastfeeding, and in immobile patients. Patients who are not constipated but who need to avoid straining (e.g., patients with hemorrhoids, hernia, or myocardial infarction) may benefit from stool softeners or mild laxatives such as polyethylene glycol 3350.

Ways to Take Opioids

While rectal medications are popular among some European cultures, others shun it, as do adolescents, who may be too embarrassed to use them. They also are usually ruled out with diarrhea, hemorrhoids, or a colostomy, or if it's too painful to position the patient to insert a suppository. Usually rectal medications are used just for short periods, especially when doctors want to avoid injections. Vaginal suppositories and even placement of suppositories into colostomies are occasionally considered, and controlled-release rectal formulations of painkillers, although not yet available, are being researched to achieve longer duration of effect.

Anal Canal

V Hemorrhoids are dilated and inflamed venous plexuses within the anorectal canal. Hemorrhoids are classified as internal (superior to the pectineal line) or external (inferior to the pectineal line). Internal hemorrhoids usually are not painful because visceral sensory nerves lack pain receptors. In contrast, external hemorrhoids are usually painful because their innervation is from somatic sensory nerves, which detect pain.

Bowel And Bladder

Neurogenic bowel and bladder dysfunction rank among the most life-limiting problems of people with SCI. No more than 15 regain normal control.25 Fecal incontinence, constipation, and impaction affect most SCI patients until a practical bowel program is attained.67 Digital stimulation with a lubricated and gloved finger in a gentle, circular motion will induce reflex peristalsis in patients with an intact conus medullaris. Glycerine suppositories and contact irritants, stool softeners, colonic stimulants, fiber in the diet, and bulk formers assist bowel evacuation that is timed to the convenience of the patient (see Chapter 8). Incontinence and autonomic dysreflexia can be helped by limiting the ingestion of gas-forming foods like beans, large amounts of dairy products, fruit juices, and berries. Hemorrhoids require immediate treatment.

Perineal Pain

The differential diagnosis of perineal pain associated with primary or metastatic tumor is extensive. Pain of neuropathic origin may occur from invasion of the lumbar spinal cord, spinal roots, sacral plexus, and individual peripheral nerves. Phantom rectal pain has also been described. 11861

Other Diseases

Other health problems frequently mentioned in contemporary literature include beriberi, toothaches, hemorrhoids, ringworm, coughing disease, kidney problems, and food poisoning. In addition to these common ailments, there are two others, which are called senki and shaku. These two terms, used in Japan as early as the tenth century, appear to refer to a host of diseases that cause stomach, intestinal, or back pain. Senki seems to refer to chronic disease, and shaku to more acute problems.

Digestive Disorders

Acute enteritis, in which the symptoms are similar to those of food poisoning and cholera, was treated in the medical texts composed in the later Yi Dynasty. Ascites and meteorism (tympanites) might be indicated in the category that contained diseases in which the abdomen swelled. Disorders of the rectum, such as hemorrhoids and prolapse of the anus, were described in detail, along with methods of treatment and dietary restrictions.

Rectal Bleeding

Rectal bleeding may be manifested by bright red blood, blood mixed with stool, or black, tarry stools. Bright red blood per rectum, also known as hematochezia, can occur from colonic tumors, diverticular disease, or ulcerative colitis. Blood mixed with stool can be the result of ulcerative colitis, diverticular disease, tumors, or hemorrhoids. Ask the patient who describes rectal bleeding the following questions Tenesmus is the painful, continued, and ineffective straining at stool. It is caused by inflammation or a space-occupying lesion such as a tumor at the distal rectum or anus. Hemorrhoidal bleeding is a common cause of hematochezia and streaking of stool with blood.

Evaluation

When obtaining history, besides in-depth questions about urinary complaints and pelvic support problems, patients are questioned in detail about obstructive defecation and fecal incontinence. In our clinic, 23 of patients with severe genuine stress incontinence or pelvic organ prolapse have fecal incontinence, which is in agreement with others (12-15). Many have obstructive defecation associated with rectal prolapse, rectocele, and intussusception (16,17). When there is a history of fecal incontinence or obstructive defecation, we include anal manometry, anal ultrasound, and pudendal nerve terminal motor latency studies to aid in the treatment plan. A basic filling cystometrogram with Valsalva leak point pressure is essential if multichannel urodynamic testing is not available.

Travelers Diarrhea

Enterotoxigenic E. coli is responsible for approximately 30 of travelers' diarrhea. Enteroaggregative E. coli is the second most common bacterial agent and causes 20 of cases. Salmonella, Shigella, and Campylobacter spp. are less often detected but are important causes of dysentery, particularly in Asia and Africa. Dysentery is severe inflammatory diarrhea manifested by fever and bloody stools. Most cases of travelers' diarrhea are self-limited, but chronic postinfectious irritable bowel syndrome may occur in up to 10 of those who experience diarrhea.

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