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!

Bladder stones, not to be confused with kidney stones, are formed when substances such as calcium oxalate found in urine coalesce into solid lumps and form deposits in the bladder. Though usually small enough to be excreted during urination, sometimes they get trapped in the neck of the bladder. In such cases, as the residues continue to grow larger, they cause extreme pain, infections, and may need surgical attention.

What causes bladder stones?
The most common causes of bladder stones are-

A diet which is high in oxalic acid can cause bladder stones.
Dehydration and a reduced intake of water cause bladder stones.
A protracted use of a urinary catheter, infections of the urinary tract, or an injury that might have impaired bladder function can cause stones to form.
Most often, stones originate somewhere else in the urinary tract and move downwards obstructing the neck of the bladder. There are significant hereditary factors at play here.
Symptoms-

Blood in the urine usually apparent only in the last few drops.
Interruption of the stream of urine and an inability to do so except in certain positions.
Dark-coloured urine.
Diagnosis-

1.Physical Exam
The physician will physically examine to evaluate if the bladder or the rectum are enlarged.

2.Urinalysis
A sample of your urine will be tested for the presence of bacteria, blood and crystallized minerals.

3.CT scan
A CT scan to build a detailed image of the internal organs.

Treatment-

If the size of the bladder stones is small then a simple increase in water and fluid intake should be enough to excrete them out naturally.
If they are too large to flush out from the system naturally, they will either be broken down to smaller sizes using laser ray or similar other energies, or surgically removed.
In order to prevent bladder stones from recurring, here are 5 foolproof methods-

1.Increase the daily fluid intake
A sure-fire way to prevent bladder stones is to increase the amount of water you drink every day. The idea is to reduce the concentration of your urine. A minimum of 2-3 litres of water per day is absolutely necessary.

2.Urinate more often.
If you drink more water throughout the day, you are going to have to urinate more frequently anyway. Do not put it off because you are worried that you will be mocked for having an old lady s bladder.

3.Laxatives.
If you feel like you are constipated, use a laxative. There is no shame in wanting to regulate your bowel movements.

4.Regular Tests.
Get a sample of your urine tested regularly to ensure that your kidneys and bladder are functioning properly and there are no irregularities.

5.Eat fruits.
Get the essential sugar component of your diet from fresh fruits. Say no to saturated sugar and fizzy drinks. Opt for fruits with high water content like melons to add more fluids in your diet.

5 Full-Proof Methods To Prevent Bladder Stones!

Kidney stones are caused when certain minerals of your urine are retained and are not fully released, causing them to amalgamate and form a stone. Passing a kidney stone is one of the most painful experiences you may face physically. Its magnanimity is often compared to childbirth, and those who are suffering from kidney stones dread having this experience. If you are not yet affected by kidney stones and do not want to, read further to know what type of diet you need to follow in order to prevent it.

1. Drink lots of water: On an average, a person must be drinking at least 3 liters of water every day. If you live in a more hot and humid climate, your water intake must be even more than that, so that on an average, 2.5 liters of urine is passed throughout the day, which decreases the chance of unnecessary retention of minerals from the urine and release them more easily from the body.

2. Continue eating foods rich in calcium: It is a common misconception that calcium accelerates the formation of kidney stones. Calcium is digested by the intestine, only excess calcium cannot be digested by the intestine and is sent to the kidney. Continue consuming calcium rich foods unless your doctor prescribes you against it. Make sure your diet includes enough dairy products such as milk, cheeses, etc., or other calcium rich foods, such as oats and broccoli.

3. Limit intake of oxalic acid: Oxalic acid is mostly found in foods obtained from plants. It restricts the absorption of calcium in the intestines and as a result, more calcium is passed into the kidneys; thus, forming calcium oxalate, or oxalate stones. Try to avoid foods, such as rhubarb, Swiss chard, nuts, tea, sweet potatoes, etc.;mainly leguminous plant products.

4. Decrease the ingestion of sodium salts, sugar and meat protein: Salts and sugars, mainly found in packaged foods are used to prevent them from expiring. They increase the release of calcium and oxalates into the blood, which thus increases the chance to develop kidney stones. Meat contains fibers which affect certain nutrients in the kidney, thus aggravating the formation of stones.

5. Increase the consumption of insoluble fibers: Insoluble fibers are those rough fibers which are not soluble in water during the process of digestion. They are found in rice, wheat, barley, etc., and are found to decrease calcium absorption in the kidney. They attach themselves to the calcium and oxalates, which enable them to be released as stool instead of urine.

Kidney Stones and Your Diet

5 reasons you will see blood in urine

The condition in which blood appears in the urine is known as hematuria. The loss of blood in this condition could be gross or microscopic depending on the cause of the condition. There are several causes why blood may appear in the urine. Whatever the cause may be, hematuria is mostly indicative of a serious medical condition.

Here are 5 reasons that cause blood to appear in the urine.

1. Infection

Infections like urethritis, pyelonephritis, cystitis or infection in any other body organ along the urinary tract is one of the most common causes of hematuria. Such bacterial infection in the urethra can also infect the kidneys and the urinary bladder. It results in the urge to urinate frequently and also causes blood to appear in the urine.

2. Kidney stones and bladder stones

Another reason that can cause blood to appear in the urine is the presence of stones in the kidney or bladder. These stones are crystallized minerals that are formed in the kidney or the bladder but fail to pass through the urinary tract. They cause blockage and pain and result in hematuria.

3. An enlarged prostate

An enlarged prostate is a common cause of the appearance of blood in the urine in men who are in their middle ages or older. Enlargement of the prostate gland causes the urethra to be compressed. This prevents the urethra from getting fully emptied while urination.

4. Polycystic kidney disease

PKD is a kidney disorder in which cysts filled with fluid form in the kidneys and impair the kidneys, causing them to fail entirely at times. It is an inherited disease and causes blood to appear in the urine.

In children who are between 6-10 years of age, kidney disorder after streptococcal glomerulonephritis can be a possible cause of hematuria.

5. Cancer

A cancerous kidney, bladder or prostate gland can also cause blood to appear in the urine. It is another major cause of hematuria but usually occurs in older patients.




5 Reasons You Will See Blood in Urine

One of the most common issues with old age in men is the enlarged prostate. Any difficulty with urination (no constant stream, difficulty initiating, or incomplete emptying of the bladder for instance), and the first suspect is an enlarged prostate. These symptoms are followed by a digital rectal exam to check for an enlarged prostate. Once confirmed, the next step is to check for levels of prostate-specific antigen (PSA). If both the exam and the PSA are positive, it could mean prostate cancer. As with any cancer, it is believed that sooner it is diagnosed and the treatment is started, the better.

Historically, the best way to rule out the prostate cancer had been to do a prostate biopsy. This is a minor invasive procedure, wherein biopsies are taken from various regions of the prostate which are known to develop cancer (about 12). A disadvantage of this procedure includes missing out on the front part of the prostate which can also develop cancer. Secondly, it is not a very pleasant experience and given a chance, most men would not want to have it done.

There is good news for these men who would like to avoid prostate biopsies. The first is the multiparametric MRI which uses no x-rays and is considered very safe with extremely accurate results. This MRI exam requires about an hour, and once the images are obtained, the doctor will analyse these images and check for several parameters to assess for prostate cancer. The absence of cancer can be confirmed with up to 90% accuracy, which is far greater than with usual biopsies. If there is a possibility of cancer, then a biopsy can be done to confirm it. 

Also, these images indicate the exact region where cancer likely is, and this guides the doctor to biopsy only where absolutely essential. The chances of false positive and false negative results are reduced drastically. The one disadvantage here is that MRI detected biopsies usually tend to be of a higher grade which requires immediate treatment.

Another way to reduce chances of the biopsy by 30% to 50% is by the 4K test. It helps detect a variety of prostate issues including cancer. It can be used once higher levels of PSA is identified and before going for a biopsy. It combined 4 prostate-specific biomarkers with clinical information to accurately provide men with a risk of developing prostate cancer. It can be used even after negative biopsies to confirm the diagnosis of prostate cancer.

These two measures can drastically reduce the incidence of prostate biopsies, which is neither pleasant for the patient nor very effective for the doctor.

Prostate Biopsies - Ways You Can Avoid It!

A lot of bad things can and do happen when the kidneys fail.  The kidneys are vital for proper bodily functioning because they filter liquid and solid waste products out of the blood and allow vital chemicals (which the body needs for functioning) to flow into the body through the bloodstream.  People can become very sick when the kidneys either fail to perform these functions or fail to perform them properly.  Many people will get chronic kidney disease, therefore, they need to know what the causes and symptoms are in order to treat, and even prevent these diseases from occurring.

People who suddenly experience the following symptoms should see a nephrologist as soon as possible for a medical examination:  blood or protein in the urine, kidney stones, acute kidney injury, kidney infections, and/or pain, and Hepatitis C and kidney disease.  

Blood in the urine can be a sign of kidney problems which can lead to kidney disease.  Additionally, people who urinate frothy or bubbly urine, or have swelling in the hands, face, and feet should see a doctor because this is a sign of protein in the urine.  Protein in the urine can be detected by a urine test.  Kidney stones can be very painful and are problematic.  They are caused by mineral buildup in the kidneys.  Men and white people tend to get kidney stones more, and they can cause blood in the urine, painful urination, sharp lower abdominal or back pain, and nausea and vomiting.

Acute kidney injury occurs when the kidneys stop functioning altogether in a short period of time.  Because this disease can be deadly, those with this disease should get immediate medical help.  Usually, the very sick patients in hospitals get this disease, but it can also be caused by certain medicines, injury, or infections.  This type of kidney disease is easily reversible.  

Symptoms include

Not passing enough urine when urinating
Leg, ankle, or feet swelling
Fatigue
Breathing problems
Confusion
Nausea, and chest pressure or pain. 
Kidney infections tend to be caused by bacteria that have spread from the urinary tract.  Women, because of their anatomy, tend to get kidney infections more than men. 

Symptoms include:

Fever
Vomiting
Back, side or groin pain
Chills
Nausea
Frequent urination
Frequent urges to urinate
Painful or burning urination
Pus or blood in the urine
Cloudy or foul-smelling urine
Kidney pain in the lower back or sides can signify more serious kidney problems.  They can be caused by urinary tract infections, polycystic kidney disease, kidney infections, blood clots, and/or bleeding in the kidneys.  
Hepatitis C is a disease that attacks the liver and can cause kidney disease.  

Symptoms include

Loss of appetite
Nausea
Fever
Fatigue
Vomiting
Dark colored urine
Grey colored stool
Joint pain
Yellow skin and eyes
While kidney diseases are at best unpleasant, and at worst, life-threatening, they can be avoided by drinking lots of water, eating a healthy low salt diet, and watching for any changes in health and urine over time.



What Happens When Kidneys Fail & Signs That Indicate It

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