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

Feeling bloated or acidic after a heavy meal can take away all the satisfaction the taste of food gave you. Indigestion and gas are some of the most common gastrointestinal problems faced by people around the world. In most cases, indigestion is a result of bad food choices and an unhealthy lifestyle. Heartburn is a not a condition of the heart, but a condition of the digestive system and to reduce its frequency, it is very important to drink and eat the right food. All three conditions, gas, heartburn and indigestion, can be relieved at home and do not necessarily require too much medication. Here are 4 easy steps that could help relieve heartburn, gas and indigestion.

The 4 steps to lower heartburn, gas and indigestion
Include More Fiber in the Diet: It is very important for a healthy digestion to include more fiber in the diet. Intake of fiber makes the digestion process simple and helps to push out the waste from the system. The system is detoxified by adding more fiber to your food and it also helps in preventingconditions such as heart disease, diabetes and hemorrhoids. 

Fiber can be added to your food in the form of fruits, cereals, whole grains, nuts, vegetables and plenty of water. It is very important for men to have about 25g of fiber per day.

Eat healthy food: It is very important that you chew your food well for proper functioning of the digestive system. The functioning of the stomach can be improved by eating smaller portions of food. It is best to avoid foods that are difficult to digest and it is also imperative that food must be consumed 1 hour before going to bed. Indigestion can be caused if you lie down immediately after eating food.
Intake of spicy food must be reduced: To reduce the frequency of heartburn it is very important that you reduce the intake of spicy food. It is possible to get relief from heartburn by avoiding spicy foods. Foods rich in probiotics can be supplemented as these help in better digestion.
Exercise regularly: Regular exercise is very essential for the fitness of the body and that includes a healthy digestion. The main benefit of exercising regularly is that it helps to fight stress which is the main cause of digestive problems such as indigestion. The passage of gas in the digestive system can be regulated by taking a walk after your meal. There are many benefits that can be gained by regular exercising such as the prevention of bloating, constipation, gaseous build up and even heartburn. Exercises such as swimming, cycling and yoga will have a positive impact on your digestive system and overall health.

Heartburn, Gas & Indigestion - Quick Steps That Can Help You Recover!

Feeling bloated or acidic after a heavy meal can take away all the satisfaction the taste of food gave you. Indigestion and gas are some of the most common gastrointestinal problems faced by people around the world. In most cases, indigestion is a result of bad food choices and unhealthy lifestyles. Thus they can simply be relieved at home and do not necessarily need medication. Here are 4 easy steps to lower heartburn, gas and indigestion.

1. Add more fiber to your food: Fiber is crucial to healthy digestion. It is easy to digest and help push waste out of the system by adding bulk. In this way, fiber helps detoxify the system as well. It also prevents diabetes, heart disease, hemorrhoids and other diseases. Add fiber to your diet in the form of whole grains, cereals, fruits, vegetables, nuts and plenty of water. Ideally, a woman should have 25gms of fiber a day and men should have 38 grams of fiber a day.

2. Healthy food eating habits: How you eat also makes a difference to your digestion. Instead of eating on the move, eat mindfully. Chew your food carefully to begin the digestive system. Eating smaller portions can also help improve stomach functioning. Avoid fast foods that are difficult to digest. Ensure that you do not eat anything for at least an hour before going to bed. Lying down immediately after a meal is one of the leading causes of indigestion.

3. Probiotics: Gut bacteria is essential for healthy digestion. This bacteria helps maintain a healthy inner ecosystem and help fight harmful viruses, yeast and other such microorganisms. This balance of gut bacteria can be affected by an unhealthy lifestyle like excessive alcohol consumption, smoking, stress and certain prescription drugs. Supplementing your natural probiotic enzymes with food rich in probiotics like yogurt or probiotic supplements can help make your digestion better.

4. Exercise Regularly: Exercise is necessary not only for a fit body but also for healthy digestion. Exercising also helps fight stress that is one of the leading causes of indigestion. Taking a walk after meals can help regulate the passage of food and gases in your digestive system. This prevents bloating and heartburn. Physical activity also helps stimulate your bowels to prevent constipation and prevent gaseous build up. Some forms of exercise you could try are yoga, swimming and cycling. A word of caution; always ensure that there is at least an hour's gap between exercising and your last meal.

Gas & Indigestion - 4 Things That Can Help Ease It!

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

When you have pain in the stomach that is accompanied by nausea and vomiting, chances of you having chronic gastritis are high. This is an issue that specifically affects the stomach and is caused because the lining of the stomach gets inflamed and swollen and in some cases it may get damaged. The deterioration of the lining may be caused because of a bacterial infection and that would have to be treated with specialised medicines and treatment methods.During that time you may feel like there is something wrong with your digestive system and you may need to see a doctor for the constant pain that you have to go through as soon as you eat something.

Getting help
There may be times when you can no longer cope with the pain that may be occurring in your stomach. You may want to go to sleep or just sit still and do nothing; however, you cannot spend your entire life in that manner and you may have to consult an expert to get relief from the problem. One of the first steps in coping with chronic gastritis is to make sure that you make important lifestyle changes, such as eating healthy, choosing the right timings for eating, cutting down on alcohol and smoking and making sure that you choose a well-qualified and experienced doctor for getting the treatment.

Treatment
Apart from lifestyle changes, it is highly essential to follow a medication routine in order to beat the chronic gastritis completely. Doctors may suggest you take the medication according to the severity of the problem, but before that, you may be asked to go through a number of tests to confirm the problem. The tests may range from regular blood tests, stool tests, to endoscopy or even biopsy in some severe cases. After the testes are done, the doctors may be further sure about the the problem and that would be of great help in treating the issue with much more ease and expertise.

While it may be obvious to you that you suffer from chronic gastritis due to the constant pain in the stomach, it is also important to understand that the problem should not be taken lightly and that the right steps of the treatment should be taken in time before the problem gets worse.

Chronic Gastritis - How to Cope with it?

Anal fissure is a condition that is caused when the skin surrounding the anus tears due to excessive strain. Generally, constipation causes the condition, as people have to put a lot of strain during bowel movements. Here is a look at some simple ways to prevent anal fissure.

Natural Ways to Prevent Anal Fissure-
Since the primary cause for anal fissure is constipation, the preventative methods involve reducing constipation.

Increasing fibre content in the diet, with the help of fruits and vegetables can help against constipation.
Staying hydrated and drinking plenty of fluids throughout the day, can also ease stool passage and make it softer.
Avoid straining excessively during bowel movement.
Avoiding spicy foods and chillies in the diet is vital, as such foods can aggravate the difficulty during defecation.
Avoid eating excessive meat and non-vegetarian products.
Drinking buttermilk can also provide relief from the constipation.
Ayurvedic Remedy for Anal Fissure-
Medications for the condition include both oral remedies, which deal with the underlying constipation, as well as topical medicines that can be applied at the site of the problem. Two main Ayurvedic treatment for anal fissure include-

Kshar sutra ligation: In this specialized procedure, a string is attached around the affected region. However, before the string is tied, it is coated in a mixture of healing herbs and natural products. After the string is tied tightly, the benign tissue falls off after 5-10 days. The underlying tissue also gets repaired in a couple of weeks.
Sitz bath: Another easy and effective Ayurvedic remedy for anal fissure is to fill warm water inside a tub. Add a splash of antiseptic liquid in the water and sit inside the tub in such a manner that the anus and buttocks remain submerged in the water. This treatment reduces the pain and discomfort associated with the diseases and keeps the anus hygienic.

Anal Fissure - Ayurvedic Treatment Options For It! 

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