Ulcerative Colitis is a chronic inflammatory disease that affects the lining of the intestine and the rectum. It is located just above the anus. Patients suffering from ulcerative colitis tend to have small ulcers in their rectum and the colon. These eventually flare up leading to diarrhea, bloody stools, anemia and abdominal pain. The inflammation starts from the rectum and eventually, spreads to the colon. Ulcerative Colitis tends to flare up and remit in an alternate phase. The remission can last from few weeks to few years.

Methods adopted to diagnose Ulcerative Colitis-
Ulcerative Colitis is very similar to an inflammatory bowel disease known as Crohn s disease. The only differentiating factor is the fact that, ulcerative colitis affects the colon whereas, Crohn s disease affects the digestive system and the small intestine. A doctor might prescribe certain tests such as the colonoscopy, blood tests, CT scan, pill camera, stool sample tests etc.

Why is surgery necessary to treat Ulcerative Colitis?
An estimated 40 percent of all Ulcerative Colitis patients need to undergo surgery to recover completely. The reason surgery becomes necessary to treat ulcerative colitis are the following:

Drug therapy and medication become ineffective.
Without undergoing surgery, the condition might increase the risk of developing cancer.
The colon has the risk of getting ruptured if surgery is not performed on time.
There could be excessive bleeding.
Toxic megacolon might set in.
Types of surgery available to treat Ulcerative Colitis
A procedure where the entire colon is removed is known as the colectomy. In case both the colons are removed, the procedure is termed as proctocolectomy. In this procedure, an external pouch needed to be attached to the stoma that collects the stools. There is another method known as pouch surgery. 

Pelvic pouch or ileal pouch is also termed as IPAA. This procedure doesn t involve permanent stoma. In this procedure, both the colon and the rectum are eradicated from the body. The small intestine is then used to form a J-shaped pouch, that serves as the new rectum. The pouch is then connected to the anus. The whole procedure is done via two surgeries.

What are the surgical complications of this procedure?

There could be an excessive bowel movement.
There are instances where an inflammation of the pouch is observed. This condition is known as pouchitis.
There could be a situation of intestinal blockage from adhesion due to surgery.
There could be pouch failure that can happen inside within 5 few years. This is observed in 4 out of 100 patients who are treated. In this case, the patient should go for a permanent ileectomy.

Ulcerative Colitis - What You Need To Know?

As soon as one is released from hospital after going through an abdominal surgery, the patient must make a checklist and an early recovery strategy before leaving home. Do follow the following tips and recover soon.

    Do make prior arrangements for a safe and comfortable journey back to home. Ensure that you have made transportation arrangements to go home safely. Use your own car or book any cab or take any friend s help. Place a cushion over your abdomen to keep it safe from jerks.
    Do go for post-surgery checkup. Book an appointment with your surgeon post-surgery. This would ensure that surgery did not cause any side-effect.
    Understand the schedule for taking medicines. Usually the patients are given painkillers. If you think you are not getting relief from it then ask your surgeon to prescribe you an alternative. Patients are likely to suffer from constipation post an abdominal surgery. If that happens, intake more fibrous food, fluids and indulge in light physical activities. Patients can also ask for cheaper alternative medicines.
    Check for certain signs and symptoms and take adequate steps:
        Take adequate sleep. There are chances that you may feel dizzy and fatigue, therefore one must observe change in sleep patterns. Have patience. Things will become normal in due course of time.
        You will also be subjected to little pain from the incision. Take your medicines as directed in order to get an early relief from pain.
        Draining of yellow color liquid from the incision in little quantities post the surgery is normal. If the drainage continues even after 7 to 14 days with redness around incision, it is a clear symptom of infection. Consult your surgeon immediately for the cure.
        Removal of urinary catheter from the bladder may cause minor difficulties during urination. Situation will become normal in few days. If discomfort persists, consult your surgeon.
    Identify the following dangerous symptoms and call your doctor right away.
        Persistent vomiting or nausea
        Incapability to digest food or fluids
        Swelling in leg
        Abnormal body temperature
        Infection at the surgical site
    Maintain a healthy and supervised lifestyle post surgery.
        It will take few days to return to your normal routine life. So have patience until then.
        Go for morning and evening walks. Avoid heavy exercises as such activities may cause physical strain.
    Take care of your surgical incision
        Surgical incision should be regularly cleaned or washed gently. Try to keep the surgical site dry until the stitches are removed.
        After 5-7 days of surgery, the stitches would be removed by the surgeon. Avoid putting ointment on the stitches until then. It will take few weeks for the scars to fade.

Under proper care and supervision, the patient will soon recover post an abdominal surgery and will be able to get their life back on track.

Tips to Recover from an Abdominal Surgery

Types of abdominal and pelvic surgical incision

At the time of a surgical procedure, while making an incision a doctor has to take care of a number of factors before making an incision. Considering a number of factors, different types of incisions have come into fore, such as 

Midline Incision: It s the commonest incision and is done along the linea alba (fibrous structure running through the mid of the abdomen). These are preferred, especially in diagnostic laparotomy as it permits a wide access to the abdomen.
Pfannenstiel Incision: It is transverse in nature, extending from the umbilicus to the pubic-symphysis. It is generally employed for abdominal hysterectomy of benign nature and caesarean section.
Chevron Incision: It is an incision under the rib-cage and is done on the abdomen. It starts from beneath the ribs on the right abdomen and extends till the other mid axillary line. Thus, the entire abdominal width is incised for proper reach into the liver. The incision can be up to 2 feet.
Kustner Incision: It is transverse in nature and extends from the symphysis pubis till the iliac spine (anterior). This type of incision takes time to perform. A Pfannenstiel incision offers more exposure than a Kustner incision.
Lanz Incision: It is a variation of the more common mcburney-incision (also known as Gridiron s incision). It is generally used for open appendectomies. There are quite a few variations for this type of an incision.
Gridiron s incision: It is done for appendectomies. It is an oblique short incision which is done in the lower right quadrant in the abdomen.
Kocher s Incision: It is oblique in nature, extending from the abdominal upper right quadrant and is generally used for performing an open cholecystectomy. Gallbladder, biliary tract and certain liver operations can be suited for a Kocher s incision. This however is different from the same named incision used for the thyroid gland surgery.
Cherney Incision: It is transverse in nature. It allows a great range of exposure for the pelvic sidewall. It is less painful than a midline incision. It allows for the greatest pelvic exposure and hence is a widely preferred and practiced incision.

8 Types Abdominal and Pelvic Surgical Incisions

Abdominal pain can be triggered by a number of factors. Sometimes, it's mild enough to be overlooked while at others, the pain can be debilitating. Most abdominal problems start with the same symptoms and hence the cause of this pain can be a little difficult to pin point. In many cases, the location of the pain can help understand the factors that are triggering it.

Generalized pain can be simply be triggered by indigestion. On the other hand, it could also be a symptom of a number of illnesses like irritable bowel syndrome, appendicitis, viral gastroenteritis and intestinal obstructions etc. However, the former are more common. This type of pain resolves itself without medical intervention.

In other cases, abdominal pain can be localized to the upper or lower abdomen on the right or left side or in the centre of the abdomen. This sort of pain is usually sporadic and comes and goes with great intensity. In most cases, this sort of pain is a symptom of a serious problem and should not be ignored. One of the most common examples of localized abdominal pain is the pain caused by appendicitis in its later stages. Severe pain that is located just above the centre of the belly button could be a sign of pancreatitis. A burning sensation and severe cramps in the center of the stomach could point towards stomach ulcers that could cause perforations if left untreated. Other causes for this type of pain include endometriosis, ovarian cysts, angina, kidney infections and a spleen infection.

Mild stomach pain whether localized or general can be relieved using home remedies and does not often require medication. However, if the pain is severe or if it comes on suddenly, you must immediately consult a doctor. Another reason to consult a doctor is if the pain persists for more than 24 hours. If the pain is accompanied by black or bloody stools or vomiting and nausea, do not ignore it. Black stools are often an indicator of the presence of blood in the digestive tract. Abdominal pain that worsens with movement or is tender to touch is also something that should be shown to a doctor. Other reasons to consult a doctor are abdominal pain with persistent vomiting following meals and unexplained weight loss and a loss of appetite.

The bottom line is, that when it comes to abdominal pain, it's better to consult a doctor and be told that there's nothing to worry about rather than self medicate and wait for it to worsen.

Abdominal Pain & When To Consult A Doctor

The abdomen houses multiple organs and pain in the abdomen could indicate a problem with any of these organs. From a medical point of view, the abdomen and associated pain can be divided into nine areas or quadrants the right, middle and left sideways and the upper, middle, and lower quadrants from top to bottom. The doctor would usually ask the patient to point to the area of the problem for instance, right lower quadrant or upper left quadrant.

With a mental mapping of the organ in each of these quadrants, the diagnosis is arrived at, with confirmation by imaging if required. Some of the most common causes for lower abdominal pain are listed below, and the kidneys are important organs in this area.

Lower left abdominal pain is caused because of the problems in the large intestine, small intestine, spleen, left kidney, ureter, ovaries, fallopian tube, urinary bladder and their associated structures.
Some of the common issues in this area could be menstrual cramps, urinary tract infections (UTIs), left kidney stones, uterine disorders, intestinal obstruction, ectopic pregnancy, constipation, colon cancers, pelvic inflammatory disorder, Crohn s disease, inguinal hernia, and a ruptured spleen.
Lower right abdominal pain can be due to appendicitis, right inguinal hernia, UTI, right kidney stones, colon cancer, menstrual cramps, uterine disorders, intestinal obstruction, ectopic pregnancy, pelvic inflammatory disorders, diverticulitis, Crohn s disease, endometriosis, and lymph node inflammation.
As is evident from this list, many of these are related to the urinary tract and kidneys. Whether it is the kidneys per se, the urinary bladder, the ureters, or the associated nerves and blood vessels, UTIs are very common. And if one of these organs is affected, then the chance of the infection spreading to the surrounding organs is very high. There is a constant flow of urine through these structures, and so the infection can pass through easily.
A person who has had kidney problems would have very characteristic symptoms. The pain would be in the lower back, on either side of the spine, depending on which side is affected. While the pain experienced due to kidney stones is acute and can be stabbing in nature, the UTI would appear in bouts. The associated symptoms should always be kept in mind when identifying and treating kidney problems.
There could be nausea, diarrhoea, blood in the urine, fever, profuse sweating and severe fever, which could help in discovering the problem.
These should not be ignored and diagnosis should be confirmed with blood tests and imaging including X-rays and CT scans. The treatment would depend on the condition, and early identification of the problem leads to better prognosis and a simpler treatment.

Lower Abdomen Pain - Can It Be A Sign Of Kidney Problem?

In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.

This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.

The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.

Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of  gate  that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.

Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the  gates  of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels.

Ways to Treat Chronic Functional Abdominal Pain!

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