A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver. If you are planning to visit one, you most likely have a problem in one or many organs like esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. 

Visit your doctor to understand the severity of your condition and the course of treatment, as it is obvious that during this time you must be suffering from anxiety and you may not ask the questions arising in your mind. That is why you need to prepare in advance for your first visit with a gastroenterologist. Being an active partner in the doctor patient relationship is bound to have its benefits. Here are some handy tips:

1. Come mentally prepared: Don't let the anxiety get to you. If you need some extra help calming down, try yoga or meditation. You can simply go out on a walk alone to help you focus your thoughts. This is just like any other doctor visit. The good part is that you are taking the first step in easing your discomfort and starting treatment, so go with a positive mind.

2. Maintain a diary of symptoms: It is likely that you are experiencing discomfort from past few days or weeks before you finally realize the need to seek out a specialist. Try to remember as much as possible about the symptoms you experienced in a chronological order. Write down any over the counter medicines you've tried or anything unusual that you may have consumed in the past week. 

3. Take stock of your medical history: It is likely that your doctor may want to know about any historic conditions you've suffered that may or may not relate to your present condition. Many ask you to fill out forms during your first time patient registration which includes many minor details about your medical past. List down any allergies, especially food allergies you have. 

4. Take stock of your recent medical tests: Bring your latest blood tests and imaging tests (X-rays, ultrasounds, MRIs, and CT scans) with you for the doctor's visit. If you have a pre-existing condition like diabetes, thyroid or you suffer from other chronic conditions like increased uric acid, carry your most recent medical reports with you. 

5. Make a list of questions for the doctor: In most cases, the first visit is a crucial factor in determining whether you want to continue the course of treatment with a particular doctor. This comes out of your ability to trust the doctor, his knowledge and diagnosis and an overall comfort level that comes with how well he handles your questions. Start by making a list of questions you want to ask about your specific condition and course of treatment and see if you get satisfactory answers. 

6. Brace yourself: If you want to suggest a treatment option, make sure you read up all about it before you tell the doctor.

6 Tips For Your First Visit With A Gastroenterologist

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!

How to Manage Piles at Home and with Medication

Piles or hemorrhoids can be a debilitating disorder of the rectum and anus where passing stool becomes painful. It is the swelling of the veins in the anus and the rectum, which may then be bruised by hard stool passing through it or due to excessive pressure being put on it. This can be a very painful and embarrassing condition for many people to go through.

Remedies for piles at home

There are many remedies that you can try at home to reduce the pain and swelling and even reduce the hemorrhoids themselves over time. Let's look at a few of the options.

Radish for treatment: In this treatment, a radish should be crushed and mixed with appropriate amounts of milk to form a thick paste, which is to be applied on the anus twice daily, and washed off after 15 minutes. This should relieve the symptoms in a few days.

Cumin seeds paste: You can take a tablespoon of cumin seed powder, make it into a paste after adding water and then put it on the affected area. After leaving it for 15 minutes or so, it should be washed away with water. Repeating this twice daily will help with the symptoms and reduce pain.

Diet: Lack of a balanced diet can be problematic for those with piles, and thus, it is recommended that enough roughage such as green leafy vegetables and fruits are included in the diet as well.

Figs: Dried figs are also another great weapon against piles. Soaking some dried figs in warm water overnight and then having them in the morning is known to be good for smooth bowel movements, thus, relieving pressure on the rectal veins.

Some Ayurvedic Medications that May Prove Effective with Piles:

Some of the specific ayurvedic medication that are known to be helpful in treating piles are:

Hareetaki: This is the fruit peel of Harad and if taken with 1 cupful of jaggery, it can reduce the symptoms of constipation as reported by many patients.

Castor oil: Mixing a small teaspoon of castor oil with a glass of milk can also help soften the stool and reduce the stress on the rectal walls.

Nagakesara: This is also an ayurvedic medicine, which is usually prescribed as oral medication three times daily and has proven its effectiveness many times over.

Abhayarishta: 30 ml of this ayurvedic herb is also given to patients after food with equal parts water and has been known to be very effective.

Kasiaditaila: This is an oil, which should be applied externally and it can help reduce the inflammation and itching caused by piles.

10 Best Home Remedies to Treat Piles  - Natural Treatment

Colon polyps are growths that are typically found in the large intestine. Although the causes behind the occurrence of colon polyps are not known, this condition is usually seen to affect adults.
These colon polyps might turn into colon cancer over a period of time; the development of cancer can happen over a number of years.
Colon polyps are usually symptomless; hence it becomes difficult to diagnose the condition. They are commonly found as additional results of screening tests for colon cancers. Screening tests are conducted when there is a suspicion of a disease but it displays no significant symptoms. The symptoms can only be visible if the polyps are enlarged. Typical symptoms include:
Rectal bleeding.
Changes in bowel conditions such as diarrhoea and constipation.
Changes in urination patterns.
Change in appearance of stool.
As the presence of most polyps becomes evident only during colon cancer tests, it is recommended that regular tests for colon cancer be conducted for adults over the age of 50. Some of these tests include:
Colonoscopy: This is highly recommended for detecting colon polyps. A small tube used for viewing is inserted into the colon by the doctor.
Flexible Sigmoidoscopy: It is similar to colonoscopy with the only difference being that the tube is smaller.
Computed Tomographic Colonography (CTC): Also known as virtual colonoscopy, various computer systems and X-rays are used to create a detailed picture of the colon so that the doctor can search for polyps.
The size of the colon polyps helps to identify if the polyp is cancerous or not. Chances of the polyp being cancerous are high if the size of the polyp is higher than 1 cm or 0.4 inches. Hyperplastic polyps (smaller polyps) do not become cancerous and hence, do not need to undergo a colonoscopy. Another form of polyp is the sessile polyp which is usually a flat growth without a stalk and grows on the inner wall of the colon. Similar to other polyps, these polyps can be found and removed using a colonoscopy or a sigmoidoscopy.

Causes and Symptoms of Colonic Polyps

Colorectal surgery: How to be sure you need it?

Colorectal surgery is performed to repair damages that occur in the organs of the anus, rectum, and colon. The damage that takes place in these organs can be the result of problems with lower GI like diverticulitis (a condition wherein pouches known as diverticula in the colon wall become inflamed), cancer and inflammatory bowel disease (a group of intestinal disorders that bring about inflammation of the GI).

Who needs this surgery?

In general, colorectal surgery is an essential treatment option for ulcerative colitis, colorectal cancer, Crohn's disease (an inflammatory bowel disease that gives rise to inflammation of the gastrointestinal tract) as well as certain diverticulitis cases. In such cases, the intestinal tract undergoes major reconstruction.

There are also other bowel problems that may require surgery but not of a serious nature and these are anal fissures, hemorrhoids, bowel incontinence and rectal prolapse. Most of the surgical procedures will aid in repairing tears, get rid of blockages, or make tighter sphincter muscles (muscles that surround openings in the body).

Colorectal surgery is also performed in cases of pelvic floor disorders like rectocele (a condition in which the rectum bulges towards the vagina) and perineal hernia (a hernia that involves the pelvic floor).

At the same time, injury, ischemia or compromised blood supply and obstruction may require the performance of bowel surgery as well. Scar tissue and masses can form within the rectum, clogging the organ and preventing the normal discharge of feces from the body.

Problems like ulcerative colitis (an inflammatory bowel disease that leads to the development of ulcers in the colon as well as inflammation of the area) and diverticulitis can give rise to perforations in the rectum. Surgery is suggested in instances when drugs fail to treat the problem of ulcerative colitis.

Likewise, in the case of recurrent instances of perforations or complications in diverticulitis, surgery may be required to remove the portion of the colon affected.



Colorectal Surgery: How To Be Sure You Really Need it

Piles are uncomfortable and painful. It can also be embarrassing and for this reason, many people delay their treatment. Piles usually affect middle aged people but at times, it can also affect younger men and women. Chronic constipation is one of the most common factors that can trigger piles. This is a condition where the veins near the anal opening in the rectum get inflamed. Any pressure that is put on the rectum puts pressure on these veins which may lead them pain and bleeding.

Luckily this is not a condition you need to live with and it can easily be treated with Ayurveda. Ayurveda approaches the treatment of this disease in multiple ways through dietary and lifestyle changes, medication, exercises and even massage therapy. It has negligible side effects and the potential to greatly improve the quality of your life even if you already have painful piles.

Dietary changes: Preventing constipation can prevent the development of piles. Hence, include plenty of fiber in your daily meals and cut down on starchy food. Adding sesame and mango seeds can also help prevent constipation. Fruits like jambul, papaya and dried figs are natural stool softners and should be eaten regularly.
Lifestyle changes: Along with eating the right food it is also essential to drink plenty of water. This helps the digestive system work smoothly. Avoid sitting in the same position for extended periods of time and only use soft, cushioned seats. Set aside at least an hour every morning for regular exercise such as walking, swimming, cycling or yoga. Certain yoga positions such as the downward facing dog and seated twist can make the process of eliminating waste easier. Scheduling a colon cleanse once in a while can also help treat piles.
Medication: Ayurvedic medication is based on herbs which have negligible side effects. Nagakesara is one such herb that is used to treat piles associated with bleeding. Haritaki and jimikand are two Ayurvedic herbs that can also help regulate your digestive system and treat piles. Abhayarishta is another herb that is often prescribed to treat piles. Kasiaditaila is an Ayurvedic medication that can be applied externally to help shrink piles and manage itching. It can also help relieve pain and bleeding. 
Though they have no major side effects, Ayurvedic medication should never be self-prescribed. Consult a qualified Ayurvedic doctor who will be able to prescribe the right medication in the right dosage for your problem.

How Ayurvedic Remedies Are Good For Piles?

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