Tag Archives: Anus

Bowel control

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Other Names: Bowel incontinence,Fecal incontinence

Description:
Bowel incontinence is the loss of bowel control, leading to an involuntary passage of stool. This can range from occasionally leaking a small amount of stool and passing gas, to completely losing control of bowel movements..CLICK & SEE

You have a bowel control problem if you accidentally pass solid or liquid stool or mucus from your rectum.* Bowel control problems include being unable to hold a bowel movement until you reach a toilet and passing stool into your underwear without being aware of it happening. Stool, also called feces, is solid waste that is passed as a bowel movement and includes undigested food, bacteria, mucus, and dead cells. Mucus is a clear liquid that coats and protects tissues in your digestive system.

Among people over age 65, most surveys find that women experience bowel incontinence more often than men. One to three out of every 1,000 women report a loss of bowel control at least once per month.

To hold stool and maintain continence, the rectum, anus, pelvic muscles, and nervous system must function normally. You must also have the physical and mental ability to recognize and respond to the urge to have a bowel movement.

Ringlike muscles called sphincters close tightly around your anus to hold stool in your rectum until you’re ready to release the stool. Pelvic floor muscles support your rectum and a woman’s vagina and also help with bowel control.

Causes:
Bowel control problems are often caused by a medical issue and can be treated.

*Chronic constipation, causing the muscles of the anus and intestines to stretch and weaken, and leading to diarrhea and stool leakage (see: encopresis)

*Chronic laxative use

*Colectomy or bowel surgery

*Decreased awareness of sensation of rectal fullness

*Emotional problems

*Gynecological, prostate, or rectal surgery

*Injury to the anal muscles due to childbirth (in women)

*Nerve or muscle damage (from trauma, tumor, or radiation)

*Severe diarrhea that overwhelms the ability to control passage of stool

*Severe hemorrhoids or rectal prolapse

*Stress of unfamiliar environment

*A disease or injury that damages your nervous system

*Poor overall health from multiple chronic, or long lasting, illnesses

*A difficult childbirth with injuries to your pelvic floor—the muscles, ligaments, and tissues that support your uterus, vagina, bladder, and rectum

Diagnosis:
To diagnose what is causing your bowel control problem, your doctor will take your medical history, including asking the questions listed in “What do I tell my doctor about my bowel control problem?” Your doctor may refer you to a specialist who will perform a physical exam and may suggest one or more of the following tests:

* anal manometry
* anal ultrasound
* magnetic resonance imaging (MRI)
* defecography
* flexible sigmoidoscopy or colonoscopy
* anal electromyography (EMG)

Anal manometry. Anal manometry uses pressure sensors and a balloon that can be inflated in your rectum to check how sensitive your rectum is and how well it works. Anal manometry also checks the tightness of the muscles around your anus. To prepare for this test, you should use an enema and not eat anything 2 hours before the test. An enema involves flushing water or a laxative into your anus using a special squirt bottle. A laxative is medicine that loosens stool and increases bowel movements. For this test, a thin tube with a balloon on its tip and pressure sensors below the balloon is put into your anus. Once the balloon reaches the rectum and the pressure sensors are in the anus, the tube is slowly pulled out to measure muscle tone and contractions. No sedative is needed for this test, which takes about 30 minutes.

Anal ultrasound. Ultrasound uses a tool, called a transducer, that bounces safe, painless sound waves off your organs to create an image of their structure. An anal ultrasound is specific to the anus and rectum. The procedure is performed in a doctor’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. A sedative is not needed. The images can show the structure of your anal sphincter muscles.

MRI. MRI machines use radio waves and magnets to produce detailed pictures of your internal organs and soft tissues without using x rays. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. A sedative is not needed, though you may be given medicine to help you relax if you have a fear of confined spaces. An MRI may include the injection of special dye, called contrast medium. With most MRI machines, you lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow you to lie in a more open space. MRIs can show problems with your anal sphincter muscles. MRIs can provide more information than anal ultrasound, especially about the external anal sphincter.

Defecography. This x ray of the area around your anus and rectum shows whether you have problems with

* pushing stool out of your body
* the functioning of your anus and rectum
* squeezing and relaxing your rectal muscles

The test can also show changes in the structure of your anus or rectum. To prepare for the test, you perform two enemas. You can’t eat anything for 2 hours before the test. During the test, the doctor fills your rectum with a soft paste that shows up on x rays and feels like stool. You sit on a toilet inside an x-ray machine. The doctor will ask you to first pull in and squeeze your sphincter muscles to prevent leakage and then to strain as if you’re having a bowel movement. The radiologist studies the x rays to look for problems with your rectum, anus, and pelvic floor muscles.

Flexible sigmoidoscopy or colonoscopy. These tests are similar, but a colonoscopy is used to view your rectum and entire colon, while a flexible sigmoidoscopy is used to view just your rectum and lower colon. These tests are performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. For both tests, a doctor will give you written bowel prep instructions to follow at home. You may be asked to follow a clear liquid diet for 1 to 3 days before either test. The night before the test, you may need to take a laxative. One or more enemas may be needed the night before and about 2 hours before the test.

In most cases, you will be given a light sedative, and possibly pain medicine, to help you relax during a flexible sigmoidoscopy. A sedative is used for colonoscopy. For either test, you will lie on a table while the doctor inserts a flexible tube into your anus. A small camera on the tube sends a video image of your bowel lining to a computer screen. The test can show problems in your lower GI tract that may be causing your bowel control problem. The doctor may also perform a biopsy, a procedure that involves taking a piece of tissue from the bowel lining for examination with a microscope. You won’t feel the biopsy. A pathologist—a doctor who specializes in diagnosing diseases—examines the tissue in a lab to confirm the diagnosis.

You may have cramping or bloating during the first hour after these tests. You’re not allowed to drive for 24 hours after a colonoscopy or flexible sigmoidoscopy to allow the sedative time to wear off. Before the test, you should make plans for a ride home. You should recover fully by the next day and be able to go back to your normal diet.

Anal EMG. Anal EMG checks the health of your pelvic floor muscles and the nerves that control your muscles. The doctor inserts a very thin needle wire through your skin into your muscle. The wire on the needle picks up the electrical activity given off by the muscles. The electrical activity is shown as images on a screen or sounds through a speaker. Another type of anal EMG uses stainless steel plates attached to the sides of a plastic plug instead of a needle. The plug is put in your anus to measure the electrical activity of your external anal sphincter and other pelvic floor muscles. The test can show if there is damage to the nerves that control the external sphincter or pelvic floor muscles by measuring the average electrical activity when you

* relax quietly
* squeeze to prevent a bowel movement
* strain to have a bowel movement

Treatment:
Home Care:
Incontinence is not a hopeless situation. Proper treatment can help most people, and can often eliminate the problem.

Treating bowel incontinence should begin by identifying the cause of the incontinence. There are several ways to strengthen the anal and pelvic muscles and promote normal bowel function.

Rutine pelvic floor exercise  may improve the condition.

FECAL IMPACTION:
Fecal impaction is usually caused by chronic constipation. It leads to a mass of stool that partially blocks the large intestine. If constipation or fecal impaction contributes to fecal incontinence, usually laxatives and enemas are of little help. A health care provider may need to insert one or two fingers into the rectum and break the mass into smaller pieces that can pass more easily.

Take measures to prevent further fecal impaction. Add fiber to your diet to help form normal stool. Use other medications your health care provider recommends. In addition, drink enough fluids and get enough exercise to enhance normal stool consistency.

DIET:
Bowel incontinence often occurs because the rectal sphincter is less able to handle large amounts of liquid stool. Often, simply changing the diet may reduce the occurrence of bowel incontinence.

Certain people develop diarrhea after eating dairy foods because they are unable to digest lactose, a sugar found in most dairy products. Some food additives such as nutmeg and sorbitol may cause diarrhea in certain people.

Adding bulk to the diet may thicken loose stool and decrease its amount. Increasing fiber (30 grams daily) from whole-wheat grains and bran adds bulk to the diet. Psyllium-containing products such as Metamucil can also add bulk to the stools.

Formula tube feedings often cause diarrhea and bowel incontinence. For diarrhea or bowel incontinence caused by tube feedings, talk to your health care provider or dietitian. The rate of the feedings may need to be changed, or bulk agents may need to be added to the formula.

Eating, Diet, and Nutrition:
Changes in your diet that may improve your bowel control problem include

*Eating the right amount of fiber. Fiber can help with diarrhea and constipation. Fiber is found in fruits, vegetables, whole grains, and beans. Fiber supplements sold in a pharmacy or health food store are another common source of fiber to treat bowel control problems. The Academy of Nutrition and Dietetics recommends getting 20 to 35 grams of fiber a day for adults and “age plus five” grams for children. A 7-year-old child, for example, should get “7 plus five,” or 12, grams of fiber a day. Fiber should be added to your diet slowly to avoid bloating.

*Getting plenty to drink. Drinking eight 8-ounce glasses of liquid a day may help prevent constipation. Water is a good choice. You should avoid drinks with caffeine, alcohol, milk, or carbonation if they give you diarrhea.

*Kegel exercise  or pelvic floor exercise is very much useful. This exercise
consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the “Kegel muscles”. The exercise needs to be performed multiple times each day, for several minutes at a time, for one to three months, to begin to have an effect.

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MEDICATIONS:
In people with bowel incontinence due to diarrhea, medications such as loperamide (Imodium) may be used to control the diarrhea and improve bowel incontinence.

Other antidiarrheal medications include anti-cholinergic medications (belladonna or atropine), which reduce intestinal secretions and movement of the bowel. Opium derivatives (paregoric or codeine) or diphenoxylate (lomotil), as well as loperamide (Imodium) increase intestinal tone and decrease movement of the bowel.

Other medications used to control bowel incontinence include drugs that reduce water content in the stools (activated charcoal or Kaopectate) or that absorb fluid and add bulk to the stools (Metamucil).

MEDICATION EVALUATION: With your health care provider, review all the medications you take. Certain medications can cause or increase bowel incontinence, especially in older people. These medications include:

*Antacids
*Laxatives

OTHER THERAPIES:
If you often have bowel incontinence, you can use special fecal collection devices to contain the stool and protect your skin from breakdown. These devices consist of a drainable pouch attached to an adhesive wafer. The wafer has a hole cut through the center, which fits over the opening to the anus.

Most people who have bowel incontinence due to a lack of sphincter control, or decreased awareness of the urge to defecate, may benefit from a bowel retraining program and exercise therapies to help restore normal muscle tone.

Special care must be taken to maintain bowel control in people who have a decreased ability to recognize the urge to defecate, or who have impaired mobility that prevents them from independently and safely using the toilet. Such people should be assisted to use the toilet after meals, and promptly helped to the toilet if they have the urge to defecate.

If toileting needs are often unanswered, a pattern of negative reinforcement may develop. In this case people no longer take the correct actions when they feel the urge to have a bowel movement

You may click & See : Toileting safety

SURGERY
People who have bowel incontinence that continues even with medical treatment may benefit from surgery to correct the problem. Several different options exist. The choice of surgery is based on the cause of the bowel incontinence and the person’s general health.

RECTAL SPHINCTER REPAIR
Sphincter repair is performed on people whose anal muscle ring (sphincter) isn’t working well due to injury or aging. The procedure consists of re-attaching the anal muscles to tighten the sphincter and helping the anus close more completely.

GRACILIS MUSCLE TRANSPLANT
In people who have a loss of nerve function in the anal sphincter, gracilis muscle transplants may be performed to restore bowel control. The gracilis muscle is taken from the inner thigh. It is put around the sphincter to provide sphincter muscle tone.

ARTIFICIAL BOWEL SPHINCTER
Some patients may be treated with an artificial bowel sphincter. The artificial sphincter consists of three parts: a cuff that fits around the anus, a pressure-regulating balloon, and a pump that inflates the cuff.

The artificial sphincter is surgically implanted around the rectal sphincter. The cuff remains inflated to maintain continence. You have a bowel movement by deflating the cuff. The cuff will automatically re-inflate in 10 minutes.

FECAL DIVERSION
Sometimes a fecal diversion is performed for people who are not helped by other therapies. The large intestine is attached to an opening in the abdominal wall called a colostomy. Stool passes through this opening to a special bag. You will need to use a colostomy bag to collect the stool most of the time.

Regular Yoga exercise & Meditation under the supervision of an expart  will defenitely help a lot to get rid of the problem.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/bowel-control/Pages/ez.aspx
http://www.nlm.nih.gov/medlineplus/ency/article/003135.htm

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Anal Stenosis


Definition:
Anal stenosis refers to a narrowing of the anal opening, which makes it difficult for stool contents to pass through easily. Symptomatic children tend to be particularly colicky babies, because of the discomfort associated with the stool backing up. The stool may exit under pressure and look almost like a squirt gun. Treatment of this disorder usually involves gentle dilation of the anal opening. This is typically done twice a day. Every week a slightly larger lubricated dilator is passed to stretch the anus until it reaches normal size. In very mild cases, softening the stool may be sufficient until the anus grows sufficiently. Suppositories can make the child comfortable in the short run, but do run the risk of dependence. At around 4 months, apple or even prune juice may help the child to pass stool. Rarely, surgery is needed to insure an opening of adequate caliber. If this is an isolated anomaly, the prognosis is excellent.

You may click to see the picture
Some children are born with no anal opening at all. This is called an imperforate anus. The rectum ends in a blind pouch, about 2 cm inside the perianal skin. Usually the sphincters are well developed. For these children, a colostomy is indicated during the newborn period, but once the final surgery corrects the defect, the prognosis is likewise excellent.

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The most frequent anorectal defect seen in boys is the recto-urethral fistula, or a communication between the rectum and the lower part of the urethra. These children also require a colostomy before the definitive repair period. The long term prognosis for normal urethral and rectal function is good.

Scar formation after perianal fistulae, trauma, severe anal sac disease, or treatment for neoplasia may result in a reduced lumen and particularly a loss of the capacity to dilate with passage of feces. Straining, passage of ribbon-like feces and constipation result.

Symptoms
The restriction of the anal canal prevents the normal expulsion of faeces, resulting in difficulty and pain when trying to open the bowels, and leading to constipation. Babies may also experience pain when trying to open their bowels.

click to see the pictures

Causes and risk factors:
Anal stenosis may be present from birth, when it might be accompanied by malformations of the anal opening. This happens in one in several thousand births.

Sometimes the opening appears further forward than normal. In girls, it’s usually immediately behind or inside the female genitalia. In boys, there may be no obvious opening at all or just a small area of bulging skin or a tiny channel under the skin.

More commonly, stenosis develops as a result of scarring from a tiny fissure, or crack, in the anal canal. This is usually the reason why adults develop anal stenosis, but it can also occur in babies.

Anal stenosis may also develop after surgery to the anus, for example after the removal of piles or haemorrhoidectomy.

Treatment and recovery:
Low-risk treatments:

Laxatives, suppositories and other treatments are used to help loosen motions and lubricate the anal canal, to make it easier to empty the bowels. There’s little risk the person affected will come to any harm from these treatments if they’re used as prescribed and only for a matter of months while the problem settles. (It must be remembered that the risks are considerably less than those that might occur if the affected person becomes very constipated).

One solution to this problem is to simply insert a plastic tube known appropriately as an “anoscope” and relieve the obstruction. ..You may click to see the  picture.

Individuals suffering from anal stenosis aren’t likely to become dependent on the laxatives and suppositories.

However, its also important to make dietary changes (such as plenty of raw fruit and vegetables to provide natural fibre, and plenty of fluid to avoid dehydration) in order to keep the motions soft. Regular exercise also helps keep a regular bowel habit.

Surgical treatments:
In mild cases, gentle and gradual dilation by the regular passage of normal motions may be enough. But quite often surgery is needed, especially in more severe cases. The surgical treatment of anal stenosis depends on the extent of the problem. In most cases all that’s needed is for the anal canal to be stretched. Often this can be done by the doctor in the hospital clinic, without the need for anaesthetic.

If the stenosis is severe, dilation may performed under anaesthesia. More major surgery is only needed if the anal canal needs reconstructing or (in small children with congenital anal stenosis) it needs repositioning or there are other malformations that require surgery.

You may click to see:Recent Colorectal Surgery Articles  :

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

Anal Stenosis and Anorectal Malformations


http://medical-dictionary.thefreedictionary.com/anal+stenosis
http://meded.ucsd.edu/clinicalimg/gu_anal_stenosis.htm
http://www.yourerdoc.com/anal-stenosis/

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Some Health Quaries & Answers

Sensitive to sunlight :-…..CLICK & SEE

Q: I develop blotchy red patches on my arms and face which tingle and burn within 10 minutes of exposure to the sun.

A: Some people are inherently sensitive to sunlight, while others develop the problem as a reaction to medication like tetracyclines, sulpha drugs or even common painkillers and anti histamines. If you are on medication, consult your doctor about changing or stopping it.

In any case, try to avoid exposure to sunlight by leaving early to work and returning after sunset. Use a black umbrella to block the sun’s rays whenever you go out. Wear long sleeved, dark coloured clothing and covered footwear. For the exposed areas like the face, neck and hands, apply a sunscreen with an SF (sun filter) factor of 15 or more.

Prostate surgery :-….CLICK & SEE
Q: I had prostrate surgery two years ago, after which I developed erectile dysfunction. It persists, causing me great anguish.

A: About 80-90 per cent men have erectile dysfunction after prostatectomy. It is usually temporary and one recovers in 12-18 months. A small percentage does have a long-term problem, especially if the surgery is for cancer. That’s because the nerves in the area may have been cut during the operation. Consult the urologist who performed the surgery and discuss your options.

Corns on feet :-…CLICK & SEE
Q: There are two corns on the sole of my foot, which are very painful. What should I do?

A: A corn is actually a thickened area of skin which develops because of uneven pressure. The commonest causes are faulty gait or ill-fitting footwear. But first confirm the diagnosis by consulting a dermatologist. A bony swelling, wart or abscess may appear like a corn to the untrained eye. If the swellings are really corns, you may use corn plasters to remove them. Follow the instructions on the packet. Corn plasters shouldn’t be used if you have diabetes; the corns will recur unless the causative factor is treated.

Burning skin :-
Q: I have lumbar spondylosis. Whenever I sit in the office or watch TV, I feel an uncomfortable burning sensation on the skin along the right side of my abdomen. It disappears upon moving.

A: Sometimes nerves leading to the skin become trapped as they leave the vertebral column. The pressure on the nerve causes it to tingle and burn, producing the uncomfortable sensation you mentioned. The abnormal curvature of your spine owing to the spondylosis is probably responsible. First, try conservative treatment with —

Weight reduction, if obese

Spinal exercises. These can be learnt from a physiotherapist or yoga teacher

• Learning proper postures

• Walking for 40 minutes a day.

Usually there is an improvement in three months which can be sustained if the lifestyle modifications are continued. If there is no improvement and the symptoms are incapacitating, you might need to consider surgery to correct the spinal deformity.

Anal fissure :-….CLICK & SEE
Q: I have had chronic anal fissure for the last six months. Every time I go to the toilet, I experience severe pain. An ayurvedic physician has guaranteed a cure but insists I allow him to perform surgery first.

A: A fissure occurs usually as a result of straining and then passing a hard stool. It is difficult to heal as the pain causes a spasm in the anal sphincter perpetuating the cycle of straining and constipation.

Conservative treatment with a sitz bath (sitting in a basin of hot water), applying a local anaesthetic cream (xylocaine, lignocaine) before and after passing stool, drinking four litres of water a day, eating a high-fibre diet, and using a stool bulking agent like isapgol cures the problem in 90 per cent of cases.

If the difficulty persists, consult a qualified surgeon who can perform an anal dilation or actually cut the anal sphincter. This has to be done carefully as otherwise you may not be able to control your bowel movement. I do not think an ayurvedic physician is licensed or qualified to perform the surgery.

Small big query :-
Q: I am an 18-year-old man and would like to know what type of underwear I should use.

A: You have to make a choice depending on your comfort level. Underwear that is too tight may cause chaffing of the groin area. This can lead to secondary bacterial or fungal infection. It can also raise the temperature of the testicles, which can marginally lower your sperm count. Boxer shorts are most comfortable. But ensure it is made of a natural fibre.

Source: The Telegraph (Kolkata, India)

 

Anoscopy

Definition:
An anoscopy is a procedure that enables a physician to view the anus, anal canal, and lower rectum using a speculum.A tube called an anoscope is used to look at the inside of your anus and rectum. Doctors use anoscopy to diagnose hemorrhoids, anal fissures (tears in the lining of the anus), and some cancers.

CLICK & SEE

How the test is performed:
First, the health care provider performs a digital rectal exam by inserting a lubricated, gloved finger into the rectum to determine if anything will block the insertion of the scope.

He or she then inserts a lubricated metal or plastic anoscope a few inches into the rectum. This enlarges the rectum to allow the health care provider to view the entire anal canal using a light. A specimen for biopsy can be taken if needed. As the scope is slowly removed, the lining of the anal canal is carefully inspected.

How to prepare for the test:
Before the test, you might want to empty your bladder or have a bowel movement to make yourself more comfortable.
You will be asked to defecate to clear your rectum of stool before the procedure. A laxative, enema, or other preparation may be administered to help clear your rectum.

Infants and children:
A child’s age and experience determine which steps are appropriate to help prepare him or her for this procedure. For specific recommendations, refer to the following topics:

*Infant test or procedure preparation (birth to 1 year)
*Toddler test or procedure preparation (1 to 3 years)
*Preschooler test or procedure preparation (3 to 6 years)
*Schoolage test or procedure preparation (6 to 12 years)
*Adolescent test or procedure preparation (12 to 18 years)

What happens when the test is performed?
This test is usually done in a doctor’s office. You need to remove your underwear. Depending on what the doctor prefers, you either lie on your side on top of an examining table, with your knees bent up to your chest, or bend forward over the table. The anoscope is 3 to 4 inches long and the width of an average-to-large bowel movement. The doctor coats the anoscope with a lubricant and then gently pushes it into your anus and rectum. The doctor may ask you to “bear down” or push as if you were going to have a bowel movement, and then relax. This helps the doctor insert the anoscope more easily and identify any bulges along the lining of the rectum.

By shining a light into this tube, your doctor has a clear view of the lining of your lower rectum and anus. When the test is finished, the anoscope then is pulled out slowly.

You will feel pressure during the examination, and the anoscope will make you feel as if you are about to have a bowel movement. Do not be alarmed by this sensation; it is normal. Most patients do not feel pain from anoscopy.

How the test will feel:
There will be some pressure during the procedure, and you may feel the need to defecate. If biopsies are taken, you may feel a pinch.

Risk Factors:
There are no significant risks from anoscopy. Sometimes, especially if you have hemorrhoids, you may have a small amount of bleeding after the anoscope is pulled out.

Must you do anything special after the test is over?
You can return to your normal activities immediately after the test.

How long is it before the result of the test is known?
Your doctor can tell you about your anoscopy exam right away.

You may click to see:->Common Anorectal Conditions:

Resources:
https://www.health.harvard.edu/fhg/diagnostics/anoscopy.shtml
http://www.healthscout.com/ency/1/003890.html

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