Once the reality of the positive pregnancy test sets in, dreaming about the yet-to-arrive begins. Curiosity about gender, options for names, ways to manage, shopping ideas, etc., begin to get discussed. And then totally out of the blue the news comes that there is a miscarriage. This is one of the most depressing phases. It is very important for the family to be around and support each other. While the entire family is upset and hurt over the news, the mother needs most care as there is just not emotional but a huge physical component also to the episode. On the other hand, remember that miscarriages are extremely common, and is no indication of a fertility issue.

The first step would be to diagnose and confirm the miscarriage. After that, depending on whether it was complete or incomplete, some medical intervention might be required. In most cases, medications like misoprostol are given to expel the uterine contents. These help by clearing out the contents in about a couple of days' time. In some cases, a D and C might be required if your doctor suspects that medication will not suffice. This also helps identify if there is any issue in the uterus that could have caused the miscarriage.

While the above take care of the physical part, the emotional component also requires cautious management. Needless to say, this is trickier than the earlier one.

Mourn to your heart's content - When you have nursed a life within you and have lost it, it is very normal to cry for its loss. There would be a mix of emotions - shock, denial, confusion, anger, grief, depression, etc. Take some solace from that fact that this is nature's way of removing unhealthy fetuses.

Get someone to talk to - Need not be your husband, but anybody whom you can talk to without having to watch words. A sibling, a good friend, a close relative - your choice. Make sure you don't pick ones who will judge and sympathize with you. More than sympathy, you need someone understanding and knowledgeable.

Socialize more - As you would have kept to yourself post your positive test, use this time to socialize more and meet friends whom you have not regularly been in touch with. Close family members, your children (if you already have), society groups, movie groups, etc., help to a great extent.

Formal medical counseling: If you are not able to cope with your regular circle of family and friends, try seeking professional advice from counseling.

Spirituality - Whether you believe in temple or churches, spend some time there. Involve in some religious activity if you would like, this helps very often.

As much as it is painful and traumatic, it is not very uncommon or unnatural. Get back on your feet, the sooner you do, the better.

Miscarriage - Ways To Recover

Any kind of injury on the surface of the skin is immediately noticed by us, but when something happens to one of our internal organs, it can take a little longer to get to your notice for example, an obstruction in the bile duct. The bile duct is a tubular structure responsible for carrying bile from the liver and gall bladder through the pancreas to the small intestine. This bile helps the digestion process and the absorption of fat.

An obstruction in the bile duct can be triggered by a number of factors. Some of these are:

    Gallstones
    Inflammation of the bile ducts
    Cysts
    Traumatic accidents
    Bile duct or pancreatic tumors
    Hepatitis infections
    Cirrhosis or severe liver damage
    Abnormal narrowing of the bile duct

This can affect anyone, but the people who have a history of gall stones or tumors in the abdomen are at a higher risk of suffering from bile duct obstruction. Chronic pancreatitis, sudden weight loss or obesity can also increase this risk. The symptoms of biliary obstruction include light coloured stool, dark urine, pain in the upper right abdomen, nausea, vomiting and fever. Your doctor will also probably need an X-ray of the bile ducts, blood tests, a hepatobiliary iminodiacetic acid scan and ultrasonograph to confirm a diagnosis before they can start treating you for the same.

If not treated in time, bile duct blockages can lead to a dangerous buildup of bilirubin in the body and trigger a number of life threatening diseases. Treatment for biliary obstruction can be through medication or surgery with surgery being the more preferred mode of treatment. It is aimed at resolving the underlying cause of the obstruction and alleviating the blockage. Treatment for biliary obstruction can be two common forms of treatment include a cholecystectomy and ERCP. The former involves the removal of the gall bladder and is suited to obstructions caused by gallstones. The latter is a procedure to remove small stones from the bile duct or place a stent inside the duct.

There are many ways bile duct obstruction can be prevented which first and foremost includes following a healthy lifestyle. If you are overweight, exercise for at least half an hour a day to regulate your weight and reach a healthy BMI. Decrease your intake of sugar and saturated fats as both these can cause gall stones. Also, increase the amount of fibre in your diet. All the above mentioned tips will certainly help you in preventing bile duct obstruction.

Bile Duct Blockage -  8 Factors Behind it!

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!

What menstrual problems are to women, prostate problems are to men. The prostate is a gland in the lower abdomen that aids in the production of semen. The prostate is walnut sized in a young man, but can get enlarged with age. As it grows bigger, it can cause a number of problems. These are commonly seen after a man celebrates his 50th birthday.

There are three common prostate problems faced by men. Some of the symptoms that can tell if a man has a prostate problem are:

1. Difficulty faced while urinating
2. The urge to urinate frequently at night
3. Constant feeling of a full bladder
4. Pain while urinating
5. Blood in the urine

Prostatitis

This can be defined as inflammation of the prostate gland. In most cases the cause of this inflammation is unknown. However, there are two types of prostatitis; bacterial and nonbacterial. While the former reacts well to antibiotics, the latter is more difficult to control. Symptoms of this disease vary from one person to the next. Some of the factors that could trigger this disease are:

1. Chemical irritants
2. Past bacterial infection
3. Dysfunctional pelvic floor muscles
4. Sexual abuse
5. Chronic anxiety

Enlarged prostate

As mentioned earlier, as men get older, the prostate gland tends to grow in size. This growth is benign, but can block the bladder neck and prostatic urethra. This can cause problems urinating and lead to acute urinary retention. This can be very painful. Inserting a catheter can provide temporary relief and help release stored urine. Chronic retention is much less common and is associated with high bladder pressure and can damage the kidneys.

Prostate cancer

Advancing age and family genetic history are said to be the main triggers of prostate cancer. This type of cancer can remain restricted to the prostate gland in its early stages but may spread to the other glands as the cancer advances. This can also cause the growth of secondary tumors in the bones.

The only way to correctly diagnose a prostate problem is with a thorough physical examination. This includes a digital rectal exam where the doctor will insert a gloved finger into your rectum to check the size of your prostate, a blood test, mid stream urine tests and ultrasounds. In some cases a biopsy of the prostate may also be required. Depending on the diagnosis, your doctor may prescribe antibiotics, surgery, radiotherapy or hormone therapy to manage your prostate.

Are You at Risk of a Prostate Disease?

GERD is a digestive disorder that affects the lower esophageal sphincter, which is the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the backward flow of acids from the stomach into the esophagus. Doctors believe that some people usually suffer due to a condition called hiatal hernia. Pregnant women usually suffer from heartburn or acid indigestion caused by Gastroesophageal Reflux Disease.

The primary goals in the treatment of this disease are relief from symptoms, healing of erosive esophagitis and prevention of complications of esophagitis. The symptoms include heartburn and regurgitation. The setting includes a proton pump inhibitor (PPI). Patients suspected due to GERD with non-cardiac chest pain are recommended to have diagnostic evaluation before institution of therapy. For diagnosing GERD, barium radiographs should not be used.

The other points that must be remembered to diagnose GERD are
1. Endoscopy is recommended only in case of alarming symptoms. Even in typical symptoms, the upper endoscopy is not recommended.
2. For preoperative evaluation, esophageal manometry is recommended, but it has no role in diagnosing GERD.
3. Ambulatory reflux monitoring is a test that can assess association of reflux symptoms.

Management:
The suggested lifestyle modifications for the patients with GERD are

    Weight loss is recommended for patients who are overweight. So, avoid large meals and decrease dietary fat intake.
    Avoid alcohol, chocolate, onions, garlic, acidic foods and peppermint.
    Do not lie down within 3 to 4 hours after meal (recommended for nocturnal GERD patients).
    For symptom relief and to heal erosive esophagitis, a 8-week course of PPIs is the therapy of choice.
    Medications that help in potentiating GERD symptoms, including alpha-adrenergic agonists, nitrates, calcium channel blockers and theophylline should be avoided.
    For patients without diagnostic evaluation, therapy for GERD other than acid suppression, including prokinetic therapy should not be used.
    For patients with partial response to PPI therapy, additional symptom relief can be achieved by increasing the dose twice daily or switching to a different PPI.
    It is recommended to elevate the head of the bed 10 to 20 cm.
    Avoid wearing clothes which are tight around the waist.
    If patients experience heartburn relief, Histamine-receptor antagonists (H2RA) therapy can be used as a maintenance option in patients without erosive disease.

Some surgical options
1. For long-term therapy for patients suffering with GERD, surgical therapy is the best treatment option.
2. In patients who have no evidence of erosive esophagitis, preoperative ambulatory pH monitoring in mandatory.
3. Gastric bypass is the preferred operation for patients who are suffering with obesity and are contemplating surgical therapy for GERD.

Apart from these, there are potential risks that are associated with PPIs such as switching them can be considered in setting of side effects and the therapy can be a risk factor for Clostridium difficile infection.

Management of Gastroesphageal Reflux Disease (GERD)

Menorrhagia is menstrual condition characterized by an abnormal loss of blood or heavy, prolonged bleeding. Although heavy bleeding is not uncommon in premenopausal women, menorrhagia is a severe condition which generally interferes with your daily activities. If your vagina bleeds irregularly or between periods, in addition to such heavy bleeding that at least one pad or tampon gets soaked every few hours, it is highly recommended that you seek medical attention.

Symptoms
Signs and symptoms of menorrhagia include:

    Soaking through more than one tampon or sanitary pad for every few hours
    The need to use double sanitary protection
    Heavy bleeding for weeks on end
    The need to wake up at night to change your sanitary protection
    Restriction of daily activities due to heavy menstrual flow
    Symptoms of fatigue, such as excessive tiredness as well as shortness of breath

Causes
Although the exact causes are unknown, here are a few causes that may be responsible:

    Hormonal imbalance is when there is an hormone imbalance, the endometrium develops in excess and sheds away with menstruation
    In Ovary dysfunction, if your ovaries do not ovulate, your body won't be able to produce the hormone progesterone resulting in a hormonal imbalance which may lead to menorrhagia
    Uterine fibroids are benign tumors which start appearing in your childbearing years
    Polyps are small benign growths found on the uterine lining
    Adenomyosis occurs when your glands from the endometrium becomes embedded in the uterine muscle
    By using Intrauterine device (IUD) menorrhagia may occur as a side-effect
    Pregnancy complications, for instance, an ectopic pregnancy can cause it
    Inherited bleeding disorders, such as von Willebrand disease
    Certain medications like anti-inflammatory drugs
    Other medical conditions, like pelvic inflammatory disease or endometriosis

Treatment
Treatment for menorrhagia depends on a number of factors like the cause and severity of the condition, or your tolerance for specific therapies or medications.
Some drug therapies for menorrhagia include:

    Iron supplements
    Tranexamic acid
    Oral progesterone
    Non steroidal anti-inflammatory drugs
    Oral contraceptives
    Hormonal IUD

If drug therapy is ineffective, other treatment options may include:

    Dilation and curettage
    Focused ultrasound ablation
    Uterine artery embolization
    Endometrial ablation
    Myomectomy
    Endometrial resection
    Hysterectomy

All about Menorrhagia

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