An anal fissure is a small tear or crack in the lining of the anus which causes sharp pain, bleeding, itching, or burning.

An anal fissure can affect people of all ages, and it s often seen in infants and young children. Constipation is a common problem in this age group and it is a major cause of this problem.

An anal fissure usually isn t a serious condition. In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it s considered chronic, or long term.

Symptoms-

A visible tear in the skin around the anus
A small lump of skin just next to the tear
A sharp pain in the anal area during bowel movements
Streaks of blood on stools or on wiping
Burning or itching around the anus
Causes-

Straining during childbirth
Straining during bowel movements as a result of constipation
Chronic constipation
Diarrhea
Inflammatory bowel disease (IBD)
Overly tight anal sphincter muscles
In rare cases, an anal fissure may develop due to:

Anal cancer which occurs due mostly to ano-receptive sex without barrier protection
HIV infection
Tuberculosis
Syphilis
Herpes
Let s take a closer look at these risk factors.

Anal fissures are common in infants and young kids. Older adults also become prone to anal fissures as the blood flow to the anorectal region decreases.
Women also become prone to these fissures due to straining during childbirth.
The inflammation that occurs in the intestinal lining in people with IBD makes the tissue around the anus more prone to tearing, further causing fissures.
People who frequently experience constipation are at an increased risk for fissures. Also, one can suffer from fissures due to straining and passing large, hard stools. In both these cases, one may experience tears in the anal lining.
Frequent diarrhea can also tear the skin around the anus and so can ano-receptive sex without protection. This can lead to sexually transmitted diseases like genital herpes, HIV/AIDS and infection with HPV virus which causes anal cancer.
Treatment-

Treatment usually helps control anal fissures and the discomfort it causes. Your doctor will prescribe stool softeners and topical pain relievers to stem discomfort. However, if these do not make your anal fissure go away then surgery may be required. And in addition to this, your doctor will also need to look for other underlying causes that can cause anal fissures like for example anal cancer.

Diagnosis

An anal fissure can be diagnosed by simple physical exam. The doctor looks at the area around your anus and follows it up with a rectal exam to confirm the diagnosis.
This can mean the use of an anoscope. In this, the doctor inserts an anoscope into your rectum to be able to see the anal tear.
An anoscope is a thin tube and it allows doctors to inspect the anal canal. An anoscope is also used to diagnose other causes of anal or rectal pain such as hemorrhoids or piles.

How Anal Fissures are Diagnosed?

Gastric bypass is a kind of bariatric surgery, which helps in weight loss. This surgery aims to make changes so that your stomach becomes smaller than it used to be. This limits the amount of food you consume and effectively helps you to reduce weight.

Are you fit for the surgery?

Not everybody can go in for this surgery. Your doctor will recommend this surgery after careful evaluation. These are the parameters based on which your doctor will make a decision-

  Your medical history - If you suffer from sleep apnoea, heart ailments, liver diseases, kidney stones or if you have blood clots then you might have to undergo the surgery.

  Your psychological status - Sometimes obesity is the outcome of certain psychological ailments. A doctor will first ensure that these conditions are addressed before you go under the knife.

How is the surgery performed?

Gastric bypass operation is performed under general anaesthesia so you will be asleep for the entire duration of the surgery and it will be pain-free. The surgery is done laparoscopically. Tiny incisions are made through which scope and fine surgical instruments are introduced into the abdominal cavity. The camera guides the surgeon by providing live images from inside the body. Laparoscopic gastric surgery is advantageous because the wound heals faster and does not leave any marks.

Sometimes your surgeon might opt for an open surgery where she/he makes a large incision to reach the stomach.

There are two major steps to the surgery-

  The aim of the surgery is to make the stomach smaller so the surgeon divides it into two portions with staples. The food that you eat will go into the upper part (the pouch) of the stomach. The reduced upper stomach can hold at the most 28 grams of food so you are forced to eat less than usual. This will help you lose weight.

  The other step is the bypass surgery. After the pouch is created, the surgeon links it to the small intestine through the small hole in the pouch. This way, food will pass directly from the pouch to the small intestine. The surgery takes around 3-4 hours. You will be kept under observation for a couple of days and you will be released from the hospital in a week.

Gastric bypass operation is an effective and simple surgery that can help you reach your weight goals when you have a very high BMI and most other dietary restrictions have not been successful.

Gastric Bypass Surgery - Everything You Should Know!

Achalasia is a serious disorder of the esophagus in which your nerves and muscles fail to work properly. This disorder causes problems in your body such as chest pain, difficulty to swallow food and excessive coughing. 

You will also face problems in breathing in case the food enters in to the lungs. There is a valve in your lower esophageal splinter, which closes the esophagus from your stomach. If you have problems like achalasia then perhaps your lower esophageal splinter fails to open while swallowing food it can lead to accumulation of food in esophagus. In this condition the nerves in your body gets damaged and hence cause health complications.

You are at risk of achalasia when you are middle aged, but it can also occur during childhood. Auto immune disorder often places you at risk for achalasia.

Symptoms of achalasia:
The major symptom of achalasia is dysphagia in which you face problems while swallowing food. You may feel that the food is struck in your esophagus which causes choking and problems when you breathe. There may be other symptoms of achalasia which includes:
1. Loss of weight
2. Heart burn
3. Discomfort or pain while you eat food
4. Chest pain
5. Risk of esophagus cancer

Treatment for achalasia:
Esophageal manometry is a technique your doctor may use, if he suspects achalasia when the symptoms include difficulty while you eat and swallow foods. A tube measures the muscular activity in your stomach and reports about the functioning of your esophagus. Another way to diagnose is through X- ray of the esophagus or endoscopy.

The treatment for achalasia generally starts with oral medications. Sphincter nitrates and calcium blockers often help to relax the muscles. Botox can also help to relax your sphincter and help you swallow food.
Esophagomyotomy also helps to treat achalasia in which your doctor can use an incision to access the sphincter and also alter it to enable better flow into the stomach. It s a generally successful procedure, but sometimes can cause gastro esophageal reflux disease (GERD) which causes heart burn and would require intensive care. Sometimes surgery can also help to give relief but it can also cause acid reflux, respiratory problems, tearing of esophagus along with other serious complications.

Laparoscopic surgery is a simple and effective way of treating this problem .The tight lower esophageal sphincter is released to make way for easy passage of food.The patient recovers in one day and is discharged home following this operation.

Achalasia - Symptoms + Treatment

What are Different Types of Bariatric Surgeries? 

Bariatric Surgery is one of the most popular options for obese people looking for a way to control their weight. To get bariatric surgery, one has to qualify for certain criteria like BMI (Body Mass Index), associated comorbidities like Diabetes, Hypertension, sleep apnea, infertility, hypercholesterolemia etc. There are many kinds of bariatric surgeries or weight loss surgeries, different surgeries work differently in order to give the desired effect, which is why it is important to understand these surgeries thoroughly. 

Weight loss surgeries are divided into different categories like - 

  Restrictive surgeries: Some bariatric surgeries are focused on limiting the amount of food that can be stored in the stomach. This allows a person to eat less than they used to, because of the limited capacity of the stomach. Sleeve gastrectomy, Adjustable gastric banding, Gastric imbrication, Gastric balloon surgery are examples of restrictive procedures. In sleeve gastrectomy, the stomach is divided into two halves first, then one half of the stomach is completely removed. The remaining part of the stomach is formed into a tube-like structure. This tube-like structure cannot hold enough food and restricts excessive food intake. It also limits the secretion of an appetite hormone called Ghrelin which limits the desire of a person to eat. 

  Malabsorptive procedures: In this procedure, a large segment of the small intestine is bypassed i.e the food is not allowed to enter a large segment of the small intestine and hence malabsorption will be there. Duodenal switch is a malabsorbtive surgery. 

To Summarize: The weight loss procedures that suit our Indian population are the Roux en Y gastric bypass and the sleeve gastrectomy. We do not come across any sign of malnutrition in patients who have undergone these procedures. For successful outcomes, vitamin, calcium and protein supplements are required. 

There are certain myths about bariatric surgery --- life will never be normal after the surgery, pregnancy is a problem after this surgery, one will never be able to eat after this surgery, marriage is a problem after this surgery etc. All these are incorrect as one live a better life after the surgery as one has shed the extra kilos, one is cured of existing problems like diabetes, high cholesterol, hypertension, obesity induced infertility and sleep apnea extra. IN FACT, the quality of life is phenomenal after this surgery. CHOICE of surgery depends on the existing BMI, existing associated problems and results of the investigations that are done prior to the surgery. Your surgeon is the best to decide the right procedure for you. As the procedure which your friend has undergone might not be good for you. Choice of procedure and proper follow up are the key points for a successful surgical outcome. 

  Combination of restrictive and Malabsorptive surgeries: In these procedures, the surgery is done on the stomach as well as the small intestine. It involves creating a small stomach pouch which is attached to the small intestine, thus bypassing a small segment of the small intestine to get the desired effect if the person has diabetes associated. The rest of the stomach produces important digestive juices and is also connected to the intestine so that it can transfer these digestive juices in it. As a part of the stomach and few centimetres of the small intestine are bypassed i.e food does not enter this part, the surgery is called the gastric bypass. The Roux en Y gastric bypass and the Mini Gastric bypass surgeries are examples of these combination procedures.

Bariatric Surgeries - Know Forms Of Them!

Ever heard of that phrase  I can taste bile at the back of my mouth ? It is generally used to express disgust. However, in medical parlance,  bile , the English synonym for disgust, plays an important role in the digestive system. It helps in the digestion of fats (breaks the fats down to smaller particles) and contains the waste products of the blood. Bile is secreted from the gallbladder which is a small organ (sac-shaped) present below the liver.

Gallbladder surgery is carried out to treat gallbladder related problems such as gallbladder stones. Presence of gallstones in the gallbladder can hamper bile production. The symptoms that you may experience include feeling unwell and fatigued, the color of the skin turning yellow and an intense tummy ache. The first method of treatment for gallstones is to dissolve them with the help of natural means. However, if this does not work, then gallbladder surgery is done.

Pre-surgery
A pre-surgery assessment is carried out by the doctor a few weeks prior to the surgery. A general health check and blood tests are carried out to determine the procedure of the surgery. Your concerns regarding the surgery are addressed by the doctor; he/she also advises you on how to prepare for your surgery.
Procedure

Gallbladder surgery can be performed in two ways; an open surgery or a laparoscopic surgery. The type of surgery you will undergo will depend on your tests.

Laparoscopic surgery: In this procedure, an incision is made on the belly button (naval region). Following this, two or three other incisions are made on the right side of the stomach. Carbon dioxide is then pumped into the stomach to make the abdomen inflated and a laparoscope is then inserted to see the insides of the abdomen. Through the other incisions, surgical instruments are inserted to remove the gallbladder. Once the removal procedure is completed, the carbon dioxide is pumped out and the incisions are closed.
Open surgery: In an open surgery, a larger incision (as compared to laparoscopic surgery) is made in the abdomen, right below the ribs. The gallbladder is removed using surgical instruments and then the incision is closed.
Post-surgery: In case of laparoscopic surgery, the recovery period is shorter; around two weeks. An open surgery, on the other hand, requires a longer recovery period of 6-8 weeks. You can live a normal life without the gallbladder, as the bile will then directly travel to the digestive system. Mild symptoms of diarrhea and bloating may be experienced. However, they should be temporary and subside within a few days.

Gall Bladder Problems - Which Surgical Procedure Can Help?

Kidney transplantation is a major surgery. In this surgery, doctors will remove your damaged/malfunctioning kidney and replace it with a healthy kidney from a donor. A successful kidney transplantation surgery will greatly increase your life expectancy if doctors have diagnosed you with chronic kidney disease.

However, some kidney transplantation surgeries have a better outcome than others do. This is mainly due to some factors that can affect the chances of success before and after the surgery. Here is a look at what these factors are.

Pre-surgery:

You may not be able to control what happens before the transplantation surgery, but here are some things that can affect your chances of a healthy life:

1. Age of the donor and the recipient: Younger people have healthier bodies and easily recover from surgery. Therefore, to achieve the best results in kidney transplantation surgery, it is important for the kidney donor to be young. Kidneys from a younger donor are likely to be healthier and function better for a longer time. For instance, if donor A is 60 years old and donor B is 30 years old, the outcome of transplant will be better if you receive the kidney from donor B. Similarly, if you are too old, your body may reject the transplanted kidney. However, your body will easily adjust to the transplant if you are young.

2. Living donors are better: If you receive a kidney from a living donor, the surgery is much more likely to be successful. In most cases of living donors, a friend or family member donates the kidney to the patient. Therefore, if you have a friend or relative willing to donate a kidney to you, you should opt for that instead of waiting for a kidney from a dead donor.

Post-surgery:

When you undergo a kidney transplant, you can develop heart diseases. Here are some things that will help you prevent that-

1. Keep blood pressure low

Some medications for your kidney disease can lead to an increase in blood pressure. Therefore, you should consult the doctor and report the elevated blood pressure, so that he/she can change the medicine. Additional medication may be required to keep your blood pressure under check so that you do not develop cardiac conditions.

2. Keep cholesterol levels in check:

To prevent organ rejection after the transplant surgery, doctors prescribe immunosuppressants. These drugs can increase cholesterol levels in the blood, which leads to blood and heart disorders. Therefore, you need to reduce cholesterol intake through diet. Ask your doctor about exercises that you can do to reduce cholesterol build up in the body.

Lastly, maintaining proper body weight is also essential after kidney transplantation surgery. Taking these measures will keep your overall body healthy while keeping heart disease and other problems at bay.

How To Achieve Best Results In Kidney Transplantation?

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