Colorectal surgery is the broad term for surgical procedures performed on the colon, the rectum and the anus. There are various different surgical procedures which fall under colorectal surgery and these are used to treat a vast array of disorders, such as:
1. Anal cancer
2. Colorectal cancer
3. Severe complications related to constipation
4. Anal injuries
5. Inflammatory conditions of the gastrointestinal tract
6. Congenital defects

Procedures
The surgeries under colorectal surgery are performed after diagnostic tests such as proctoscopy, sigmoidoscopy and defecating proctography. The most common diagnostic test is colonoscopy. These help to identify the origin and nature of the problem and decide which surgical procedure is to be followed. The procedures under colorectal surgery are as follows:

Colectomy
This procedure involves removal of a section of the large intestine. This is known as partial colectomy. In extreme cases, such as advanced cancer or severe gastrointestinal infection, the entire colon is removed and this is called total colectomy. Sometimes, the rectum is also taken out along with the colon and this is called proctocolectomy.

Colonic polypectomy
An abnormal growth of tissues in the inner lining of an organ is known as a polyp. Colonic polypectomy is done to eliminate polyps from the colon and rectum before they become malignant. This can be done endoscopically. Surgery is required in case of large polyps.

Strictureplasty
Chronic or repeated bowel inflammation causes scar tissue to accumulate in the large intestine. This results in the narrowing of the colon. Stricturoplasty removes the scar tissue so that proper flow of digestive contents is resumed.

Colostomy or ileostomy
A damaged section of the colon is removed and the shortened intestine is then attached to another opening (stoma) in the anterior wall of the abdomen.

Hemorrhoidectomy
This surgical process is used for swollen hemorrhoids or blood vessels, which form in the anal canal. Hemorrhoidectomy is extremely effective in removing hemorrhoids, but the surgery also involves a number of complications.

Anoplasty
Anoplasty or imperforate anus correction is done to correct birth defects in the rectum and the anus. The structural flaw does not allow the stool to pass properly from the rectum and so it is repaired through surgery.

All About Colorectal Surgery

The first commandment of healthy living is to eat plenty of fresh fruits. However, did you know that some fruits are healthier than others? Fruits do not have any added sugars but many fruits are rich in natural sugar. However, here are 11 fruits which have lowest sugar content.

Limes and lemons: Limes and lemons are known as sour fruits. While they are rich in vitamin C, they do not contain a lot of sugar. Freshly squeezed lime juice and hot water is the perfect drink to curb your appetite and raise metabolism.
Raspberries: Raspberries are rich in fiber but have only a little more than a teaspoon of sugar per cup. This makes them the perfect fruit to start the day with.
Strawberries: Strawberries may taste sweet but a cup of fresh strawberries has only about 7 grams of sugar. However, a cup of strawberries has enough vitamin C to take care of your daily requirements.
Blackberries: A cup of these berries also has minimal sugar. Along with fiber, these fruits are also rich in antioxidants. These berries also help lower the risk of type 2 diabetes, cardiovascular diseases, and other such conditions.
Kiwi: Did you know that kiwis are technically berries? Each kiwi has less than 6 grams of sugar but is very rich in vitamin C.
Grapefruit: A grapefruit is a perfect breakfast. These citrus fruits are rich in fiber and low in sugar. Half a grapefruit contains only 52 calories and minimal sugar. They are also rich in vitamin A, vitamin C, and potassium.
Avocado: Avocados are naturally low in their sugar content. One raw avocado has less than a gram of sugar. However, they are full of vitamin C, vitamin K, folate, and potassium.
Watermelon: Summer would be incomplete without watermelons. Though they taste sweet, watermelons are very low in sugar. A cup of watermelon has less than 10 grams of sugar.
Cantaloupe: Cantaloupes are rich in vitamin A but a cup of this fruit has only about 14 grams of sugar. They are also rich in vitamin B, magnesium and fiber.
Oranges: Eating an orange is the best way to boost our vitamin C levels and keep infections away. One orange typically contains less than 70 calories and 12 grams of sugar.
Peaches: A medium sized peach has less than 13 grams of sugar. This is an example of how taste can be deceptive when it comes to calories.
Given the sugar content in these fruits, it would be a great idea for the diabetics and weight watchers to include them in their diet and have a healthy and hearty meal. If you wish to discuss about any specific problem, you can consult a General Physician.

11 Best Fruits That Are Low In Sugar Content!

Problems of the large intestine are very common and patients should usually consult gastroenterologists for the proper diagnosis and treatment

1. Bleeding per rectum: Bleeding through the anal canal or rectum is usually the most common problem of the patients. It can be due to following reasons: 

A. Piles also known as Hemorrhoids: Hemorrhoids are dilated venous channels of the anal canal. They occur due to long term constipation or chronic cough or due to less fibre intake in the diet. Sigmoidoscopy or proctoscopy is required for diagnosis. Treatment options include medicines and high fibre intake, Injection therapy(Sclerotherapy) for stopping bleeding from piles and Stapler hemorrhoidectomy if the piles are large.

B.  Polyps: Polyps are soft tissue growths seen in the large intestine. They are usually silent but can present with bleeding or anaemia. Polyps usually grow slowly in size and large polyps can turn into cancer of large intestine also known as colorectal carcinoma. Colonoscopy is required for the diagnosis. The gastroenterologists can diagnose the presence of polyps by colonoscopy. Smaller polyps can be removed by polypectomy by gastroenterologists without the need for open surgery. However large polyps or those polyps with suspicion of cancer require surgery.

C. Large intestine Ulcer: They can occur due to early cancer, SRUS, Infections or drugs. They require colonoscopy for the diagnosis. The gastroenterologists usually take Biopsy from the ulcer to know the cause of the ulcer. The mere taking of biopsy does not mean cancer and biopsy samples are seen in the microscope for better diagnosis.

D. Ulcerative Colitis and Crohn s disease: Ulcerative colitis is one form of Inflammatory bowel disease (IBD). The other IBD is known as Crohn s disease. Whereas ulcerative colitis involves only large intestine, Crohn s disease can involve any part of the gastrointestinal tract including small intestine. Ulcerative colitis and Crohn s disease present with Loose stools(diarrhea), bleeding , abdominal pain, weight loss, Anemia and Perianal fissures and  fistula. The diagnosis of IBD is challenging and involves blood tests, CT Scan abdomen, Colonoscopy with biopsy and clinical history. Management includes Medicines which control the inflammation such as Pentasa, Rowasa, Mesacol etc. Severe disease requires additional drugs such as Azathioprine and Anti TNF sich as Infliximab and Adalimumab. Occasional cases require surgery such as those with tight stricture of the intestine, severe dilatation of Large intestine (also known as Toxic megacolon), excessive bleeding, the disease not responding to medical management, or presence of cancer with IBD.

E. Anal fissures: Cut in the anal skin (fissure) causes severe pain in the anal area during passing motions. It is usually due to constipation or straining. It is usually treated by Gastroenterologists initially by medicines and ointments. If the pain continues Surgery is required named as Lateral internal sphincterotomy (LIS).

2. Loose motions or Diarrhea: Excessive passing of liquid motions is known as diarrhea or commonly lose motions. It is usually due to Infections caused by contaminated food and water. It is usually self-limiting. Severe cases with dehydration require admission for IV fluids and antibiotics for the infection. Loose motions for more than 6 to 8 weeks is known as chronic diarrhea. It is evaluated by blood tests and colonoscopy. Usual causes include tuberculosis, celiac disease, ulcerative colitis, microscopic colitis, Malabsorption such as chronic pancreatitis and small bowel bacterial overgrowth.

3. Irritable bowel syndrome (IBS): IBS is very common and at least 20 to 30 percent of Indian patients suffer from it. Symptoms include altered bowel habits such as diarrhoea or constipation, abdominal pain which is usually relieved or increased by defecation. Weight loss or bleeding is not the feature of IBS. Few simple blood tests are required and good medicines are now available for IBS. Few cases may require colonoscopy to rule out alternative causes of the symptoms.

Understanding colonoscopy: Colonoscope is a flexible tube with a camera at its tip to see the inside of the large and small intestine. Bowel preparation is required at least 8 hours before the procedure so that the inside of the large intestine can be seen clearly without the interference of stools.colonoscopy is an OPD based procedure where the patients are discharged the same day. A colonoscopy helps in evaluation symptoms of the large intestine such as loose stools, bleeding and abdominal pain.

In Detail About Colorectal Disorders!

Renal Tubular Acidosis is a medical condition. When the kidney is unable to acidify urine, it leads to the accumulation of acid in the body. Usually, when blood is filtered by the kidney, it passes through the tubules of the nephrons (the functional unit of the kidney).

Before it flows into the bladder from the kidney, the urine undergoes an exchange of salts, acids and other solutes. Renal tubular acidosis results in the formation of excessive amounts of acid because the kidneys cannot drain them. This may happen because the kidneys cannot reabsorb the alkaline bicarbonate ions from the urine in the early segment of the nephron or because of inadequate production of acidic hydrogen ions in the latter half of the nephron.

Renal Tubular Acidosis is simply associated with abnormal urinary acidification. Other functions of the kidneys remain unimpaired.
There are several different types of renal tubular acidosis-

  Distal Renal Tubular Acidosis (RTA)
This is the most fundamental form of RTA. It is characterized when the hydrogen ions are not secreted into the lumen of the nephron by the alpha-intercalated cells of the medullary collective duct of the distal nephron. When this happens the pH of urine cannot be brought down below 5.3. Renal excretion is inhibited and hydrogen ions are not eliminated which leads to academia. At the same time, Potassium ions cannot be absorbed by the cell which leads to hypokalemia. The end result is protein retention and potassium excretion. Distal RTA can lead to the urinary stone formation, calcium deposits in the kidney, rickets and osteomalacia and Sjogren s syndrome.

  Proximal RTA
When proximal tubular cells reabsorb 85% of filtered bicarbonates and 60% of filtered sodium from the urine, then this again leads to academia. The distal intercalated cells, however, function normally and so the academia is not as severe as in case of Distal RTA. The alpha-intercalated cells can acidify urine to a pH of 5.3 or less because they produce hydrogen ions. Proximal RTA is also associated with Fanconi Syndrome which is characterized by aminoaciduria, uricosuria, glucosuria, and tubular proteinuria.

  Combined distal and proximal RTA
Inherited carbonic anhydrase II deficit leads to combined distal and proximal RTA. This is accompanied by osteopetrosis, cerebral calcification, and renal tubular acidosis. Cases of combined distal and proximal RTA are very rare.

How is RTA understood?
The following steps are applied to analyze Renal Tubular Acidosis-
  Determining the anion gap in acidosis. The normal Anion Gap is 8-12 (4-6 mEq/L)
  Separating the renal from the extrarenal causes of normal anion gap acidosis
  Classifying the types of RTA
  If it is distal RTA, further tests will be necessary to support the diagnosis

How is RTA diagnosed?
Three types of tests can reveal if a person is affected by Renal Tubular Acidosis-
  Urine test
  Acid load test
  Physical examination

Treatment of RTA-
Doctors prescribe either or both of the following two types of therapies-

  Alkali therapy- The pH level of urine is restored and electrolytes are balanced
  Vitamin D supplements- If RTA leads to bone deformities or rickets, your doctor will prescribe vitamin supplements to strengthen your bones.

Timely diagnosis can prevent the effects of Renal tubular Acidosis from becoming compounded. With the right medication, a person can lead a healthy normal life.

What Should You Know About Renal Tubular Acidosis?

Do you know not all foods can be consumed on an empty stomach? So, it is imperative that you should be aware of such foods and restructure your breakfast menu accordingly. Here is a list of foods to avoid on an empty stomach. 

Stay away from the following foods when you eat after a considerable gap

Citrus fruits: Citrus fruits contain fruit acids. When these acids enter an empty stomach, they can lead to heartburn. Hence, if eaten after a prolonged period post meal, a person is at risk of gastritis and stomach ulcers.
Soda: Consuming cold soda drinks on an empty stomach may cause damage to the mucosal membrane while reducing blood flow to the stomach. This may lead to a slow digestive process and difficulty in the abdomen.
Spicy foods: Spicy foods are known to cause irritation and damage to the digestive tract, and are especially not recommended for people who suffer from acid reflux issues since very spicy food leads to consequences such as acid reflux in the food pipe.
Cucumber and other green vegetables: Green vegetables and cucumber are rich in amino acids. If consumed on an empty stomach it may very well lead to pain and bitterness in the upper abdomen.
Tomato: Tomato is a fruit containing high levels of tannin. Tannin causes acidity in an empty stomach and leads to consequences and appearance of gastritis if frequently consumed in such a manner.
Fermented milk products: Fermented milk products such as yogurt typically come with loads of health benefits being full of probiotics. But if consumed on an empty stomach it can interfere with the balance of healthy bacteria as the hydrochloric acid produced tends to be destructive.
Sweets: Items such as candy or sweetmeats contain high levels of sugar and cause a sudden and sharp surge of insulin levels in the blood. Over a long period, this has a bad effect on the pancreas.
Products containing yeast: Edible items such as biscuits, puff pastry, vinegar and beverages such as beer and wine contain yeast which can significantly irritate the stomach and cause bloating.
So, be a little conscious and avoid consuming these items on an empty stomach since a little effort goes a long way. In case you have a concern or query you can always consult an expert & get answers to your questions!

Empty Stomach - 8 Food Types That You Must Avoid!

Severe to moderate pain in the rectum during and after bowel movements is an
indication of anal fissure. If it is accompanied by bright red stool and an itching
sensation around the anus, it is more likely to be fissure than anything else. Fissure
is usually treated with sits bath and enhanced intake of fibrous food. If that does not
heal the problem, the doctor may go for a surgery. However, surgical intervention of
fissures is not always a permanent solution. For permanent solution, patients are
now turning to homeopathy. Yes, homeopathy can address the problem at its root
and gift you a permanent cure.
What Need to Know About Fissure?
  The problem mostly precipitates due to inflammation and dryness of the
mucosal end of the anorectal area.
  Straining during bowel movements and passing hard stools strain the anal
mucosa. That is likely to result in fissure.
  People suffering from chronic diarrhoea are also likely to suffer from this
problem.
  People suffering from some kind of inflammation of the anal area due to
diseases like Crohn&#39;s disease or some kind of inflammatory bowel disease
may also suffer from fissure.
  The patient may feel a lump in the area surrounding the anus.
  He or she may also experience spasms at the end of the rectum.
  Even infants may suffer from this problem.
  Many women suffer from fissure after childbirth.

Homeopathic Treatment of Fissure
  Homeopathy is known to address diseases to their roots.
  In case of fissure, homeopathic medicine can address the problem by
preventing and treating dryness and inflammation of the palpable mucosal
area around the anus. If this area is moist, it can stretch better in response to
straining during bowel movements and thereby prevent tearing.
  Since constipation is one of the main causes of fissure, homeopathic doctors
may prescribe medicines for preventing constipation too.
  However, homeopathic medicine is not a one-size-fits-all remedy. The
medicine depends on the constitution of body. The doctor may try to judge
body constitution of the patient by asking him questions about sleep pattern,
food habit, emotional state, working schedule, etc. The doctor needs to take
all these into consideration to prescribe the most appropriate medicine.

  A homoeopathic doctor first gets a conventional diagnosis. If fissure is
confirmed in the diagnosis, the doctor may launch an all out attack on the
problem so that the problem can be nipped in the bud.
Conclusion
Anal fissure is a painful condition that is mostly precipitated by straining during bowel
movements and passing hard stools. Homeopathy can offer permanent solution to
this problem by preventing constipation on one hand and preventing as well as
treating inflammation and dryness of the anal mucosa on the other hand.

Fissure - An Overview!

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