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!

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

Piles can be really painful and embarrassing but fairly common at the same time. it should not be taken as a social stigma as with awareness and proper treatment, the condition can be managed and treated well. If overlooked then it may lead to many complications which are difficult to manage.

In Ayurveda, a complete cure to haemorrhoids is possible, so seeking medical attention can be of great help to relieve you from this condition. Piles, also known as Haemorrhoids is a condition in which veins at the lower end of rectum get inflamed and enlarged. When pressure on the rectum and anus increases, it causes added pressure to these veins, resulting in formation of haemorrhoids. They may burst and cause rectal bleeding. Haemorrhoids are most commonly found in middle-aged and old people while also in people who suffer from regular constipation. 

Types of Piles -

Haemorrhoids are of two kinds, internal and external based on their location. Internal haemorrhoids are located in the inner lining of the anal tract. These veins within the rectum are concealed and cannot be felt so they are painless but when ruptured can lead to bleeding. External haemorrhoids are located on the outer surface of the rectum and can be seen, felt and when inflamed become painful. These are the more troubling type of piles. 

Causes and Symptoms of Piles 

Piles are caused mostly by constipation, but other causes may include untreated gastric conditions such as dysentery, sedentary lifestyle, obesity, genetic constitution and weight of increasing uterus during pregnancy. 
If you are experiencing bleeding in anal region during defecation without any pain; you are suffering from 1st stage of Piles. If problem is not treated at this stage; Pile masses start progressing. 
In starting, Pile mass come out during passing stool and go inside by itself (2nd stage). Later on these pile masses need to be reduced manually. If still Piles is not treated; Pile mass comes out again even after manual reduction while coughing, sneezing etc. (3rd stage). While piles may be an embarrassing issue to talk about, it should not be ignored either. It can be easily dealt with simple ways, and in most cases, all it takes is some lifestyle changes to get rid of the problem. 
However, if left untreated, there could lead to severe complications. Some of them have been listed below. 

Bleeding: In patients who have chronic bleeding, it could lead to chronic blood loss. Patient can develop anaemia because of this regular bleeding. 
Mass protruding out from anal opening: If Piles are not treated at 1st stage; it can lead to development of pile mass which protrudes out from anal opening while passing stool and go inside. In later stages; this pile mass come out even on sneezing and coughing. At this stage they are prone to get infected as most of the time Piles are outside the anal opening. 
Hygiene issues: The itching and discharges can lead to the patient having poor hygiene around the anal area. This further can lead to complications like infections. The area around the anus also becomes difficult to clean if the masses are more in number and size. 
Surgical correction may be attempted in severe cases, but this also can lead complications in some people. These include: 
Excessive bleeding which does not stop after the surgery. 
Postsurgical infection 
Anal fistula, which is a connection between the area of piles and the anal canal. 
Damage to sphincter muscles leads to faecal incontinence, which is a loss of control over passing stool.
Ayurveda Treatment of Piles 
Ayurveda has various approaches to the treatment of piles. Piles can be treated by diet, lifestyle, herbal supplements, Ayurvedic medication, and exercise. Ensuring good digestive health helps with piles if constipation is the cause of it. 

Vegetables such as onion, bitter gourd, radish, and turnip are high on roughage and are a must to add to your diet as well. 
Other than the diet you need to introduce specific lifestyle changes such as a colon cleanse every once in a while, and regular exercise. 
Increase water intake, up to 8 glasses per day. 
Keep away from processed foods 
Increase consumption of fruits and vegetables 
Do not sit for more than an hour in one position 
Stick to stool timings and develop good stool habits 
Do not suppress the urge to pass stools for too long and for too often 
So, follow the instructions of your Ayurveda doctor to embark on the road to cure. If these measurements are not successful; kshar karma or Ksharsutra ligation of Pile mass is necessary. In the ligation procedure; Ksharsutra   medicated thread is legated at the root of Pile mass. 

Medicine released from Ksharsutra blocks the blood supply to pile mass and Pile mass sheds off in 7   10 days. Ksharsutra ligation is a para surgical procedure done under local anaesthesia. No hospitalization or bed rest is necessary in Ksharsutra Treatment for Piles. Daily routine activities along with office work can be done during Ksharsutra Treatment. So Piles can be treated completely in all its stages with Ayurvedic treatment. However, this procedure is to be performed only by a surgical specialist of Ayurveda..

Painful Piles - Why You Should Not Ignore Hemorrhoids

5 Foods to eat if you suffer from Piles

Piles, commonly known as hemorrhoid is a condition that leads to pain, discomfort and irritation while passing stool. It is caused due to inflammation of the veins in the lower rectum area. Piles is of two types: internal and external, one can suffer from both simultaneously. The damage in the lower rectum area is a result of aging, chronic constipation, pregnancy, diarrhea and consuming processed food on a daily basis. Piles also lead to bleeding not just while passing the stool but anytime. It is recommended to monitor one's diet and construct a plan that helps to diminish the problem. Here are certain types of foods which can help you deal with Piles better.

Whole grains

People suffering from piles are recommended to include a lot of healthy whole grains into their diet like bran cereal, brown rice, oatmeal, whole wheat pasta. These fiber rich foods soften the stool and help reduce the pain.

Leafy green vegetables

Green vegetables are packed with antioxidants and nutrients that help with digestion. Strengthening the digestive system is important while treating piles. Broccoli, sprouts, carrots, brussels, cabbage, tomato, asparagus, cauliflower, onions, cucumber are some of the vegetables that one should consume while battling piles.

Fruits

Fruits are high in nutrients, fiber, minerals and vitamins that help to regulate the bowel movement. Fruits that can be eaten with their skin on like apples, prunes, raisins, grapes, berries are full of fiber and are very beneficial. The ones that have to be eaten without the skin are good too, for example, papaya, banana, oranges.

Beans

Beans are high in fiber content and should be included in regular meals of a piles patient. Kidney, black, lima, navy beans, black-eyed peas, legumes are some good options.

Water

Although it is not a food, water is an important ingredient when it comes to treating piles. It is advisable to drink at least 6-8 glasses of water daily which helps with the smooth functioning of the bowel movement.

If you would like to consult with me privately, please click on 'Consult'.

5 Foods Items You Should Eat In Piles Problem

Colorectal surgery deals with the disorders of the rectum, anus and colon. Another name of colon is  large intestine . These three body parts form the last stages of the digestive process. When the human waste passes through the colon, its salt and water are extracted before it exits the body as human excreta.

Colorectal disorders

Swelling and inflammation of the veins in the anus (also called as Haemorrhoids)
Anal fissures- unnatural cracks and fissures in the anal area
Fistulas or the unnatural connections between the anus and other anorectal areas
Conditions of constipation
Incontinence in passing of faeces
When the walls of the rectum protrude through the anus- also called as Rectal prolapse
Birth defects such as imperforate anus
Anal cancer- this condition is rare
Colorectal cancer- cancer of colon and rectum
Any injuries to the anus
Removal of any objects inserted into the anus
Bowel habits after colorectal surgery
Many patients report cases of diarrhoea, leakage of stool or gas, urgency to use the toilet and a feeling of insufficient evacuation of faeces. Relax; these conditions are not going to last forever. Your rectum and anus are adjusting to new conditions after this surgery. These organs may take six to twelve months to adjust to new bowel habits.

Is there a need to take a laxative or stool softener?
There is no need to take laxatives after a colorectal surgery. Drink lots of water to make your stool softer and easy to pass. If there is a water deficiency in your body, then it may lead to your faeces becoming hard. In that case, take milk of magnesium, colace etc.

Activities post surgery
You can continue with your normal schedule after this surgical procedure. Carry on running, jogging, exercising, climbing up the stairs etc. even after your surgery. Gastroenterologists recommend that patients should desist from lifting loads weighing more than 10 pounds so that there are no post surgery complications.

Diet after colorectal surgery
Avoid spicy and heavy to digest meals after your surgery. Once the intestines begin working normally, you can continue having your spicy food. Chew your food well to aid its digestion.

Returning to work after colorectal surgery
Most people are back to their work after taking a break of 2-5 days. If the surgery is pretty detailed, you may have to take a break of up to a month. Patients undergoing laparoscopic surgery may have to take a rest of 2- 4 weeks before they report back to work. Take it easy before slipping into your regular schedule. If working hurts after your surgery, don t do it.

Colorectal Surgery - Disorders It Can Treat!

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?

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