An anorectal abscess is a painful swelling near the anus or in the buttock. The swelling contains pus. 60% anorectal abscesses are superficial and resulting from infection in small anal glands present in between internal and external anal sphincters (intersphincteric space). They are known as a perianal abscess. 30% of anorectal abscesses are deep-seated and results in systemic infection. They are call Ischiorectal abscess. Submucous abscess, pelvirectal abscess and pilonidal abscess developed from versatile cause are comparatively less common. Inadequate and improper management of anorectal abscess may potentially cause complication like fistula formation.


Fast facts on Anorectal abscess-

* Anorectal abscess should be drained at the earliest.
* Conservative medical management almost invariably invites complication like fistula formation.
* Surgical drainage of pus reduces the chance of fistula formation by 50%.


What causes Anorectal abscess?

* Blocked and infected anal glands (cryptoglandular infection).
* Untreated anal fissure that becomes infected.
* Sexually transmitted infections.
* Penetrating injury of the perianal or buttock region.
* Crohn s disease.
* Colon cancer.
* Tuberculosis.



What are the symptoms of Anorectal abscess?

Superficial abscess-

* Constant and throbbing pain that worsens on sitting down.
* Swelling, redness and tenderness of the skin around the anus.
* Discharge of pus.
* Pain is often associated with bowel movement.

Deep abscess-

* All or some of the symptoms of a superficial abscess.
* Fever with chill and rigor.
* General weakness.
* Sometimes fever is the only symptom of the deep abscess.

The anorectal abscess should preferably be explored under general or spinal anesthesia. Medical management often fails and subsequently fistula is formed.

Anorectal Abscess - Know In Detail About It!

A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part of therapy for cancer. You should have a clear understanding of your reason for this surgery.

How is this done?

The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.

There are three ways to remove the uterus:

Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen. 
Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15 20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.
What are the risks of undergoing this procedure?

Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have. 
Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
Infection in the operation site, pelvis or urinary tract.
Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
Things to do before you come to the hospital

It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old

You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.

You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified

At midnight if your procedure is in the morning

At 6 am if your procedure is in the afternoon.

You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.

Please remove all body jewelry.

After your surgery

When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.

Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.

Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.

You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.

If you have pain or nausea, please tell your nurse. Effective pain management is important.

You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.

Recovering at home

What to expect

You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal

You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night

You may feel fatigued

You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer

After the operation, you will no longer have a period

For the majority of women, hysterectomy surgery does not have a negative effect on sexual function

What to avoid

For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.

It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.

Avoid sexual intercourse for six weeks to allow healing to take place.

Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).

It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.

Contact your doctor if you develop any of the following complications:

Your wound becomes red or inflamed, painful.

You have heavy vaginal bleeding heavier than a normal period.

You have offensive vaginal discharge.

You develop a fever i.e. temperature of about 38  C, or you are feeling unwell.

You have pain that is not relieved by simple analgesia.

You are having difficulty passing urine or opening your bowels.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Surgery For Womb Removal - What You Need To Be Aware Of?

6 face washing mistakes that are damaging your skin, everyday!

Face-washing may be a simple everyday task that requires no great effort on your part. But when it?s not done right, it causes significant harm to your skin, each day. The mistakes that you may make while washing your face could lead to issues like irritation, dryness and even wrinkles. Read on to find out how you can avoid making these common errors, and save your skin from blemishes, ageing and lustreless look.

1. Using the wrong cleanser

The use of the wrong cleanser can throw your ph levels out of balance. The optimal ph balance of your skin is 5.5ph. This is the ideal level at which the thin protective layer on the surface of the skin (called acid mantle) can function to keep germs, toxins and bacteria at bay. You should therefore be picking your cleanser based on your skin type as it would come with the right ph balance. 

2. Not cleaning your hands before touching the face

Always clean the germs and dirt of your hands first before moving onto your face. Ignoring this crucial first step can cause you to transfer all the bacteria and dirt of your hands on your face, giving rise to common skin problems such as acne, pimples and blackheads.

3. Using a pre-used washcloth

To avoid the filth from clogging your pores, always clean the washcloth that you use with an antiseptic to keep germs and bacteria at bay. Once you're done washing your face, don't rub the cloth all over your face but pat dry it.

4. Washing face using with hot water

When it comes to the water that you splash on your face, you should always use lukewarm or room temperature water. This is because hot water leaves your skin dry as it washes away the skin's essential oils; and cold water can break the capillaries (fine blood vessels) of your skin. In contrast, mildly lukewarm water will keep your skin hydrated and healthy.

5. Not washing the face twice a day

Just as you shouldn't ignore this important skin care habit that keeps your skin clean, you also shouldn't go overboard with it. Excessive face-washing can hamper the natural oil production of your skin, giving rise to dryness and irritation as a result. Your skin requires the natural oil it produces to keep it smooth and supple. Ideally, you should wash your face twice daily - once in the morning for removing the bacteria and dirt that clogged your pores, and again at night before going to bed.

6. Rushing through the routine

Lastly, don't rush through your cleansing routine. Make sure to properly rinse your face of cleanser completely, otherwise the residues would cause your skin to dry up later on, leading to skin irritation.

It is therefore very important to pay attention to all the little details that make up your face-washing routine. By doing it right, you get to achieve the clear and blemish-free skin that you always wanted.

If you would like to consult with me privately, please click on consult.


6 Face Washing Mistakes that are Damaging Your Skin, Everyday!

Hernia surgery is performed for the correction of a hernia which refers to the bulging of internal organs or tissues through an abnormal opening. It is easy to detect hernia through any pain or discomfort while lifting heavy objects, cough and strain during urination or bowel movements or during prolonged standing or sitting. It can be found in both men and women. The Hernia can be congenital or can be developed over a period of time. If it doesn t get better over time and also does not go away by itself, then surgery becomes the only option.

Types of Surgery
There are two types of surgery for hernia treatment. One is the conventional open method, which requires an incision in the skin directly over the hernia. The other one is the Laparoscopic hernia repair in which surgery is performed using a small telescope known as a laparoscope. In this type of surgery minimal invasions are made and the hernia is repaired with only small incisions adjacent to the hernia. Most hernia operations are performed on an outpatient basis, which means that you can go home the very same day.

Tips for early recovery

    Wear comfortable clothing with expandable waistbands.
    Keep yourself active by moving around as much as you can as it increases circulation, which further speeds up healing.
    Eat a diet rich in fibre, fresh fruits and vegetables.
    Drink lots of water and other fluids to avoid constipation.
    Do not lift any objects even if it is very light as it can bring back pain.
    Do not to pick up things from the floor as it will be difficult to bend.
    Hold a pillow against your stomach while sneezing or coughing to lessen the pain.
    Use stool softener for a few days before and after surgery to help you with your bowel movements.
    Avoid driving till the time you feel any pain and as long as you are taking narcotic pain medicines.
    Band-Aids which cover the incisions should be changed as and when needed.
    Refrain yourself from intercourse as it can be painful.
    Check with your doctor when to take a shower so as not to hurt your incisions, and make sure to gently dry your incisions and replace the Band-Aids after taking a shower.
    Do not consume any alcoholic drinks for at least 24 hours.

The tips mentioned above will definitely provide help to cope up with post surgery blues. However, in case of fever, excessive sweating, difficulty in urinating, bleeding or any prolonged pain consult your doctor immediately.

Hernia Surgery - 13 Tips to Help You Recover from it

Ovarian cysts are fluid-filled sacs in the ovaries, often in multiples, which are very common in women. This is absolutely different condition from polycystic ovaries. Most of them are benign and not indicative of an underlying problem. They produce no specific symptoms and even if detected, can be watched over a period of time. Treatment may be required only if there are serious symptoms or there is higher possibility of cancerous nature of the cyst. Read on to know more. 

Types 

Functional: There are two types in this. The follicular variety is when the egg that is ready for fertilization does not completely shrink and stays for a few more days before it disappears. Another variety, the luteal ovarian cysts are formed when after the release of the egg, there is blood filling up in the corpus luteum. 
Pathological: There are many types here   dermoid, cystadenomas, endometriomas, cancerous cystadenocarcinomas etc. These are worrisome and need to be treated. Both varieties, once identified, should be monitored. The functional variety, though may not cause a problem, can cause infertility and so necessitate treatment. 
Symptoms 

Any ovarian follicle larger than 2 cm can be called as an ovarian cyst. They are usually benign and do not produce any symptoms. However, if they turn pathologic or grow in size, they can cause various symptoms such as: 

Irregular menstruation 
Heavy bleeding 
Intermittent spotting 
Painful and/or frequent urination 
Severe, recurrent abdominal pain 
Infertility 
Abdominal bloating 
Constipation or loose motions 
Nausea, sudden vomiting 
Fever, dizziness, and weakness 
While cysts are often quiet and do not produce any symptoms, they can cause intermittent, nonspecific symptoms like above. If there is a family history of ovarian cancers in mothers, maternal aunt, Sisters, Grandmothers etc then women should have regular Gynaecological checkups to have a check done for ovarian cysts. 

Why go for laparoscopic surgery? 

Laparoscopic surgery is considered to be one of the most effective ways of treating the condition of ovarian cysts. During the surgery, problem causing non-cancerous cyst can be removed without harming the ovaries. In the case of cancer, both ovaries along with uterus etc may have to be removed. This decision is taken by the operating surgeon depending upon age of the patient, characteristics and nature of the cyst and future fertility desires of the patient. 
The patient is given general anesthesia during the surgery. After the surgery, one is suggested to rest for a day and may be permitted to return to normal activities within a day s time. However, one needs to avoid any strenuous activity for almost a week. 
While some cysts can be watched for years, others need treatment. This would be specifically true in cases where the couple is facing infertility issues or if there is a higher possibility of cancerous cysts. Such cysts need urgent intervention and should be monitored by a gynecologist with an experience in oncology. There are few blood tests that are needed to be done to know the nature of the cyst if it is benign or cancerous.

Ovarian Cysts - Ways Laparoscopic Surgery Can Help! 

It is an extremely embarrassing situation to have a bladder leakage. Social life could be altered, with reduced socialising for fear of losing control in the presence of others. Though not discussed frankly, it is an extremely common issue and about 25 million people in the United States suffer from this, with 75% of these being women.

Treatment depends on the type of incontinence, such as stress, urge, overflow, functional, or mixed. It starts with least invasive methods like lifestyle changes moving over to surgical approaches.

Ways to manage it

With trips to the toilet increasing considerably when you have urinary incontinence, simple measures can help manage leakage.

Bladder training: Train your bladder to control the urge for another 10 minutes. This happens by voluntarily contracting the muscles and holding up the urge to go to the toilet. Gradually, it will help increase the frequency of the visit to 4 to 6 hours.
Scheduled toilet trips: Whether or not there is an urge, visit the toilet every 4 to 6 hours.
Double emptying: Even after you have voided, force yourself to void one more time. The residual urine, which is almost always present in the bladder, also gets emptied.
Food/diet modifications: Stress incontinence is worsened by alcohol, spicy foods, acidic foods, and caffeine. Avoiding these can help reduce bladder leakage.
Kegel exercises: The simple repetition of contracting the pelvic floor muscles, holding it in place, and releasing it can do wonders for strengthening the pelvic floor. This can be done anywhere and any time of the day and is very effective for improving bladder control.
Catheters: These can be used if the incontinence is short-lived; the person would need to learn how to safely insert and remove it.
Absorbent pads and medical devices: The absorbent pads are helpful in preventing embarrassment during social situations. On the other hand, medical devices like pessary are inserted into the vagina to support the bladder neck and thereby prevent leakage from the bladder.
Drugs: Anticholinergics/antimuscarinics are useful to control a leaking bladder. Botox injections can help paralyse the overactive bladder muscles and provide a solution. Topical oestrogen may be used in small amounts to improve tone and reduce incontinence. Alpha blockers are also used in some people with good results. There are muscles that relax the bladder and increase the amount of urine it can contain.
Surgery: In the event that all these measures are not useful, surgical correction is possible. Sling procedure where an artificial mesh is used to support the urethra. Bladder neck suspension is where the bladder neck is given support to prevent leakage. If there is a pelvic organ prolapse, that is corrected to rectify the bladder leakage.

 Bladder Leakage - Solutions To Help You Manage It!

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