The human body with its multiple organs is a highly complicated structure and one or more organs often malfunction for various reasons. However, for some, no reasons are identified for this problem. One such is irritable bowel syndrome or IBS as it is commonly referred to.

It is a common disorder affecting the large intestine leading to alternate bouts of diarrhea and constipation, abdominal cramps and a feeling of fullness. It is common in people younger than 45 years of age, affects women more than men, and though the exact reason is not known, the following are attributed.

Physical/Physiologic reasons:

1. Signal issues between the brain and intestines: For various or even unknown reasons, the brain may not be able to send the right signal to the stomach to process food, making the stomach to be hyperactive and have an increased sense of pain or sensitivity or discomfort. Neurotransmitters, which are chemicals responsible for sending signals to various organs also could be involved.

2. Hormonal connection: Menstrual periods tend to aggravate symptoms of IBS, while postmenopausal women are largely free of IBS symptoms.

3. Genetics: People with a family history of IBS are more likely to develop IBS too.

4. Aggravating foods: Foods rich in carbohydrates, spicy foods, fatty foods, caffeine and alcohol aggravate IBS symptoms. Ability to absorb sugar could be a cause too.

5. Infections: Some people with IBS have certain bacteria identified in their gut which produces excessive gas and this could lead to altered bowel movements.

6. GI Motility Issues: Alterations in the way the food passes through the stomach can lead to either constipation (slow movement) or diarrhea (quicker movement). There could also be spasms and contractions after eating, especially if the stress levels are high.

7. Psychological issues: Panic disorder, anxiety, depression, and posttraumatic stress disorder are common in IBS patients. It is possible that they are not able to express their psychological stress, it manifests as physical symptoms. Stress increases symptoms of IBS and vice versa.

Management:

1. Manage stress: Meditation, yoga, support groups, medication and even hypnosis in severely stressed people helps control stress, providing great relief in IBS symptoms.

2. Lifestyle changes: Reduce alcohol and smoking

3. Dietary changes: Avoid aggravating foods, increase the amount of fiber if you have diarrhea and space out meals to avoid intestinal overload

4. Herbal remedies: Probiotics, peppermint oil and a variety of herbal medicines are available.

5. Symptomatic medications: Based on presenting symptoms, different medications including antibiotics for infections and motility drugs can be used. Anti anxiety and antidepressants are also prescribed to manage the psychological issues.

In terms of causes, symptoms, or treatment, IBS requires a very individualized approach and your doctor is the right person to discuss this with and decide.

Irritable Bowel Syndrome - Symptoms and Management

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

When an injury happens, the normal tendency of the skin is to repair itself from inside out, until it is completely closed and healed. However, in some cases, due to various reasons, excessively large scars can form. These hypertrophic scars are known as keloids. Here is everything you would like to know about keloids:

Features of keloids:

Benign, fibrous, smooth, hard growths that form over a healed wound
Can be bigger than the original wound
Most commonly found on chest, ear lobes, cheeks, and abdomen
Pregnant women are usually at the risk of developing keloids
Though they do not develop into malignant lesions, they are a cosmetic issue, especially when the visible portions of skin are affected
They are localized, flesh-colored and red in color
They are raised from the surrounding tissue and are prone to repeat injury
It continues to grow with time
Could cause discomfort and irritation when it comes in contact with clothing
Sun exposure or tanning can worsen it and cause tenderness
Common injuries that can lead to keloid formation include burns, surgical incisions, skin piercings, chicken pox scars, tattoos, etc.
Treatment for keloids may not always be effective and need repeat treatments
Treatment options: If the keloid is not in a visible area and does not cause any problem, it is best to leave it untreated and observe for any changes. The following changes could indicate the need for treatment.

Change in color from pale pink to red (indicating inflammation)
Severe increase in pain/tenderness
Sudden increase in size, which could indicate malignancy (keloids are an area where benign growth can turn cancerous)
A biopsy can be done to identify if treatment is necessary. This involves removing a small part of the tissue by injection and sending it for laboratory examination.
Treatment options include both nonsurgical and surgical. Nonsurgical methods are tried first before resorting to surgery.

Steroid injections into the keloid to control growth and inflammation
Moisturization to keep it soft and avoid dryness and cracking and bleeding
Freezing the tissue (cryotherapy) to freeze the growth can help in further increase in the size of the tissue
Laser to remove the tissue, especially if it is small. Alternately, this could be used as a secondary measure after the keloid is excised to prevent further growth
Radiation therapy to shrink the growth
Surgical excision, where the keloid is quite visible or large. This could be followed by radiation or laser to prevent further growth.
Also, in people who are prone to develop keloids, surgical incisions can be treated for a longer time with pressure dressings and silicone pads.

Keloids - Know About Its Treatment!

A stroke may be called a brain attack. It may happen to any person at any time. A stroke occurs when blood supply to the brain is cut off. The brain cells become oxygen deprived due to the stroke and eventually die. Dead brain cells result in brain dysfunction due to which patients lose control over muscle and memory.

Strokes can be mild to life threatening and requires immediate medical attention. Stroke requires advanced care and should be treated by extensively qualified and experienced medical experts. 

Neurosurgery satisfies all the required clauses for treatment of stroke and accounts for being one of the best ways for management of stroke. Renowned hospitals have a dedicated neurosurgical wing and a team of neurological specialists who know how to deal with stroke the best.

Vascular Neurology
This form of neurology focuses on patients who have undergone a stroke or have experienced symptoms of stroke. A multidisciplinary approach is taken for the prevention of recurrent cerebrovascular conditions.

Types of stroke

Ischemic stroke: This kind of stroke occurs when there is a blockage in a blood vessel, which supplies blood to the brain. This form of stroke is the more common. The underlying cause of this stroke is known as atherosclerosis, which is a condition where fatty deposits occur in the walls of the blood vessels and cause blockage in them.
Hemorrhagic stroke: This type of stroke occurs when a blood vessel gets weak and ruptures into the brain. This is caused by two types of weak blood vessels known as aneurysm and arteriovenous malformation.
Transient ischemic attack: This type of stroke is also known as a mini stroke. These attacks occur because of blood clots. The blockage caused is temporary or transient in nature.
Treatment of Ischemic stroke

Tissue Plasminogen Activator: This is one of the best ways to treat ischemic strokes. This medicine is given to the patient intravenously. It dissolves the blood clot and improves blood flow to the area of the brain which is affected. The medicine should be given within three to four hours after stroke symptoms appear.
Endovascular procedure: This is a process by which the blood clot is removed using a catheter, which gets inserted into the area of the blocked blood vessel. It helps in restoring blood flow to that area. 
Treatment of Hemorrhagic stroke

Endovascular procedure: Several endovascular techniques and methods are used so that the weakening of blood vessels is reduced and less bleeding is caused.
Surgical treatment: Different modes of neurosurgery may be undertaken to stop bleeding and for relieving pressure within the skull.

Role of Neurosurgery in Management of Stroke

Alzheimer's disease is a dynamic disease that causes loss of memory and other vital mental functions. To start with, someone with Alzheimer's disease may witness light confusion in the beginning and trouble recalling. In the long run, individuals with the disease may even overlook important individuals in their lives and experience emotional identity changes.

Dementia: Alzheimer s disease is the most widely recognised reason for dementia   a gathering of brain issues that causes the loss of intellectual and social abilities. In Alzheimer's disease, the brain cells deteriorate and die, bringing on an enduring decrease in memory and mental capacity.
Brain Cells: Despite the fact that the reasons for Alzheimer's is not yet completely comprehended, its impact on the brain is clear. Alzheimer's disease harms the brain cells. A mind influenced by Alzheimer's has fewer cells and fewer associations among surviving cells than a solid mind.
Brain Shrinkage: As more brain cells start to die, Alzheimer's prompts critical brain shrinkage. At the point when specialists inspect Alzheimer's brain tissue under the magnifying instrument, they see two sorts of irregularities that are considered to cause Alzheimer s. These are:
Plaque: These clusters of a protein called beta-amyloid may harm and crush brain cells in a few ways, meddling with cell-to-cell functioning. In spite of the fact that a definitive reason for brain cell passing in Alzheimer's is not known, the accumulation of beta-amyloid on the outside of brain cells is a prime reason.
Tangles: Brain cells rely upon an inner support and transport framework to carry the supplements and other fundamental materials through their long extensions. This framework requires the typical structure and working of a protein called tau. In Alzheimer's, strings of tau protein turn into strange tangles inside the brain cells. This may also cause the decrease of brain cells. 
Here are some more causes that can lead to this disease:

Age: Age is a most critical cause in the development of Alzheimer's disease. The probability of building up the condition increases after you reach sixty-five years of age.
Family history: The qualities you acquire from your parents can add to your danger of building up Alzheimer's infection. This may also contribute to the environmental factors which can cause this condition. In some families, a single gene creates Alzheimer s disease and the dangers of the condition being passed on are much higher.
Head injuries: Individuals who have had serious head damage have been observed to be at higher risk of building up Alzheimer's disease.
Cardiovascular diseases: Research demonstrates that few lifestyle components and conditions connected with cardiovascular disease can build the danger of Alzheimer's disease. These include smoking, obesity, diabetes, hypertension and high cholesterol.


Alzheimer's Disease - Reasons That Can Lead To It!

The sciatic nerve is one of the largest nerves in the body. It goes from the lower back all the way down to the base of the leg. When there is a disorder associated with the sciatic nerve, it is known as Sciatica. 

Sciatica, however, does not necessarily need a surgery or a very elaborate procedure to fix the problem. Most commonly, it is treated simply by practicing a number of simple exercises. Here are some of the most common exercises prescribed to treat Sciatica:

1. Reclining Pigeon Pose:
There are three main forms of the pigeon pose. These are sitting, reclining and then forwarding. It is recommended that if you have very recently started your treatment for Sciatica, then certainly you should go for the reclining pose. In this pose, you are supposed to hold your left leg in the air at a right angle to your back. Then, hold your ankle against the knee. Finally, repeat this stretch with the right leg as well.

2. Knee to Opposite Shoulder:
In this stretch, the starting position is on your back side. You have to have your legs out and feet upwards. From this position, try to bring your right leg towards your left shoulder. Hold this for 30 seconds and then release and relax. Repeat this activity three times and repeat the whole procedure with your other leg. Only take your leg as far as it goes.

3. Sitting Spinal Stretch:
At the start of this exercise, sit on the ground with your legs going straight outwards and your feet flexed in the upward direction. Pull your left knee and put it on the outside of your right knee. Finally, place your right elbow on the left knee, so that your body turns to the left. Hold for 30 seconds and then relax. Repeat the procedure with the other knee.

4. Standing Hamstring Stretch:
Put your foot on an elevated surface such that it is above the floor, but not above hip level. Flex your toes forward such that your feet and legs are nearly in a straight line. Bend as far towards the foot as possible. However, do not stretch so far that you feel pain. Finally, repeat this procedure on the other side after release.

Exercises For Sciatica

Don't wait any longer, manage your Sharir Rachana Specialist online with a Lybrate doctor today

Consult for Sharir Rachana Specialist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES