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?

The colon is a part of the digestive system of your body, which extracts the vitamins, nutrients, water and salt from the indigestible food. This helps in getting rid of solid waste from your body. Now, you may wonder why colon cleansing is necessary. It is required when there is some disorder in the normal colon function, such as when the colon absorbs the toxins in place of removing them from your body, you may experience colon problems. These results in syndromes like gaining weight, fatigue, lack of energy, constipation, bloating and many more.

Cleaning the colon in a natural way is one of the earliest processes by which you can get a normal colon. This process is also called autointoxication. There are some ways by which you can go for natural colon cleansing.

One of the easiest and best ways for colon cleansing is drinking plenty of water. Regular intake of water will keep your body hydrated and the body organs functioning. It will also help your body to get rid of various toxins.
Intake of apple juice is yet another process of colon cleansing. Apple juice normalises your bowel movements and keeps your liver fit. It keeps the digestive system functioning as well. One glass of raw apple juice followed by one glass of water half an hour later works best for colon cleansing.
Lemon juice with a high amount of vitamin C is excellent for the digestive system. A glass of warm water mixed with lemon juice and honey keeps your liver, colon and the entire digestive system fit and fine.
Stay away from fried and processed food for a couple of days. It is better if you drink fresh vegetable juice for a number of times in a day. Green and leafy vegetables remove toxins from your body. They have high amount of minerals and enzymes which provides energy to your body.
Yogurt is your best companion when it comes to colon cleansing. It contains some bacteria, which are good for your body and helps accelerate the digestion process. It is one of the best way by which you can cure every stomach and digestion-related problems.

Colon Cleansing - 5 Ways You Can Do it At Home

Severe to moderate pain in the rectum during and after bowel movements is an
indication of anal fissure. If it is accompanied by bright red stool and an itching
sensation around the anus, it is more likely to be fissure than anything else. Fissure
is usually treated with sits bath and enhanced intake of fibrous food. If that does not
heal the problem, the doctor may go for a surgery. However, surgical intervention of
fissures is not always a permanent solution. For permanent solution, patients are
now turning to homeopathy. Yes, homeopathy can address the problem at its root
and gift you a permanent cure.
What Need to Know About Fissure?
  The problem mostly precipitates due to inflammation and dryness of the
mucosal end of the anorectal area.
  Straining during bowel movements and passing hard stools strain the anal
mucosa. That is likely to result in fissure.
  People suffering from chronic diarrhoea are also likely to suffer from this
problem.
  People suffering from some kind of inflammation of the anal area due to
diseases like Crohn&#39;s disease or some kind of inflammatory bowel disease
may also suffer from fissure.
  The patient may feel a lump in the area surrounding the anus.
  He or she may also experience spasms at the end of the rectum.
  Even infants may suffer from this problem.
  Many women suffer from fissure after childbirth.

Homeopathic Treatment of Fissure
  Homeopathy is known to address diseases to their roots.
  In case of fissure, homeopathic medicine can address the problem by
preventing and treating dryness and inflammation of the palpable mucosal
area around the anus. If this area is moist, it can stretch better in response to
straining during bowel movements and thereby prevent tearing.
  Since constipation is one of the main causes of fissure, homeopathic doctors
may prescribe medicines for preventing constipation too.
  However, homeopathic medicine is not a one-size-fits-all remedy. The
medicine depends on the constitution of body. The doctor may try to judge
body constitution of the patient by asking him questions about sleep pattern,
food habit, emotional state, working schedule, etc. The doctor needs to take
all these into consideration to prescribe the most appropriate medicine.

  A homoeopathic doctor first gets a conventional diagnosis. If fissure is
confirmed in the diagnosis, the doctor may launch an all out attack on the
problem so that the problem can be nipped in the bud.
Conclusion
Anal fissure is a painful condition that is mostly precipitated by straining during bowel
movements and passing hard stools. Homeopathy can offer permanent solution to
this problem by preventing constipation on one hand and preventing as well as
treating inflammation and dryness of the anal mucosa on the other hand.

Fissure - An Overview!

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!

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!

If you notice blood in the stool or the toilet bowl, it could be a case of rectal bleeding. There are many reasons why rectal bleeding can occur, the most common one being haemorrhoids. If the rectal bleeding is not significant then it is not a cause for concern. But if you lose a lot of blood then it can be a major problem.

What are the signs?

The most obvious one, in this case, is the presence of blood in your stool. But it's not just the presence of blood that is important here, the colour of the blood is also a very important indicator of what is wrong.

Black colour indicates that you are bleeding from the upper region of the small intestine

A bright red colour is an indication of the blood loss from the lower part of the gastrointestinal tract   rectum or colon

Dark red indicates that the bleeding is taking place at the initial region of the colon

Some other symptoms you may experience are  

Confusion

Pain in the rectum

Stomach cramps

A sensation of dizziness

Causes of rectal bleeding

Causes of rectal bleeding can be divided into mild and serious. 

Mild causes  

Constipation 

Small tears in the anal lining (anal fissures)

Haemorrhoids

Small growths of tissue in the rectum or colon

Serious causes  

Cancer of the colon and anus

Inflammatory bowel disease

An infection of the intestine such as salmonella

How is it treated?

If you lose a lot of blood, then it is a medical emergency. You should rush to the doctor if you experience the following   fainting, intense pain in the stomach, confusion, and rapid breathing.

The doctor will prescribe treatment based on the cause of your rectal bleeding. For example, if the cause is haemorrhoids then warm baths will help soothe the pain. If the haemorrhoids are large then invasive methods such as laser treatments and surgery are prescribed. 

Or if it is constipation then stool softeners are a good option. In addition, you may have to eat a high fibre diet and exercise regularly to normalize your bowel movements. 

Rectal bleeding can be a minor inconvenience or a major problem depending on the cause. So it is best to consult a doctor and seek immediate treatment.

Rectum Bleeding - How To Administer It?

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