Tag Archives: Constipation

Bowel control

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.

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

Some Health Quaries & Answers

 

Q: My husband and I both have corns on our feet. His corns fell off after he applied corn caps. Mine did not even though I used the same caps. The caps keep falling off instead.

CORNY REMEDY :-

A: If the corn caps worked for your husband, trying the same brand makes sense. For self-treatment to be successful, the foot has to be dry when you apply the caps. Also, do not walk barefoot even in the house. When you have a bath, tie your leg in a plastic bag so that the caps do not get wet. You need to leave them on as long as possible.

Even though the lesions appear similar, in your case the diagnosis may be something else like warts. If they are still present after three months of self-treatment with corn plasters, consult a dermatologist and consider having them surgically removed.

HIS  FACE WAS PARALYZED :-

Q: My uncle was travelling in a car sitting next to the window. After he reached home he found that he could not move the right side of his face, or even close the eye. Is this a stroke?


A: This sounds more like “Bell’s palsy” than a stroke. It is an isolated paralysis of the facial nerve. It is common in persons between 15-60 years of age and in diabetics. It occurs because the facial nerve passes through a narrow bony canal in the ear before its branches enter the facial muscles. Exposure to cold can cause the nerve to swell up. It then becomes compressed. The pressure causes the paralysis. This can also occur as a result of an infection with the Herpes Simplex virus.

Treatment is with antiviral agents, steroids and physiotherapy. Recovery is usually complete.

POTTY TRAINING

Q: My six-year-old son has no control over his bowel movement. His pants and underwear are constantly soiled because part of the motion leaks out. It is not diarrhoea. This happens in school too, and it is becoming a problem.


A: If your son had control of his motion initially and has now lost it, he probably suffers from a condition called “encopresis”. It occurs when the child does not go to the toilet when he feels the urge. This results in chronic constipation. Once the rectum is full of impacted stools, liquid motion from above can leak out of the anus causing this problem.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movement. This means training your son to go to the toilet as soon as the urge to defecate occurs. Also, try to send him to the toilet every day at a fixed time.

The diet should contain dietary fibre in the form of four to five helpings of fruits or vegetables a day.

DARK PATCHES

Q: I developed dark patches on my arms and legs. I went to one of the clinics advertised on television and they diagnosed macular amyloidosis (I don’t know what that is) and advised laser treatment. I am a bit nervous about this.


A: Macular amyloidosis is a skin condition in which itchy lesions appear as flat dusky-brown or greyish spots that may eventually form patches of darkened skin. It is found symmetrically distributed over the upper back between the shoulder blades, on the chest, sometimes on the arms, and rarely on the legs.

The diagnosis has to be made after a biopsy. All dark patches are not macular amyloidosis (yours seem non-itchy) nor do they require expensive treatment like laser therapy. Go to a dermatologist, confirm the diagnosis and then start treatment. Usually anti histamines and topical steroids are tried initially. Do not believe everything said in advertisements on television.

CURE  FOR  PCOS

Q: My daughter has polycystic ovarian syndrome (PCOS). Each time the doctor puts her on tablets, and she is alright for a few months. As soon as the treatment is discontinued, her periods become irregular.


A: PCOS occurs because of an inherited abnormal gene for food metabolism. As a result the sufferer tends to become obese, develop acne and have irregular periods. The gene will always be present. The tendency to manifest the gene can be controlled if —

* Your daughter jogs 40 minutes a day

* She maintains her BMI at 23 (BMI is weight divided by height in metre squared).

Pills or exercise — the choice is hers.

ATTEMPTED  RAPE

Q: A relative tried to rape me during my childhood. Now I have abdominal pain all the time. I think I have an infection.


A: Since you are worried, and with reason, test your blood for VDRL, HIV and HbAg. Also, do an ultrasound of the abdomen and pelvis. If all these are normal, you have nothing to worry about.

Move on with your life and forget the past. Almost 95 per cent women face unwelcome unwanted sexual advances at some time in their life. Take lessons in karate, Kung Fu or some other martial art. It will make you more confident and ensure nothing like that happens again.

Source: The Telegraph ( Kolkata, India)

Enhanced by Zemanta

Hypnotherapy ‘can help’ IBS

Greater use of hypnotherapy to ease the symptoms of irritable bowel syndrome would help sufferers and might save money, says a gastroenterologist.

…………..CLICK & SEE

Dr Roland Valori, editor of Frontline Gastroenterology, said of the first 100 of his patients treated, symptoms improved significantly for nine in 10.

He said that although previous research has shown hypnotherapy is effective for IBS sufferers, it is not widely used.

This may be because doctors simply do not believe it works.

Widely ignored
Irritable bowel syndrome (IBS) is a common gut problem which can cause abdominal pain, bloating, and sometimes diarrhoea or constipation.

Dr Valori, of Gloucestershire Royal Hospital, said the research evidence which shows that hypnotherapy could help sufferers of IBS was first published in the 1980s.

He thinks it has been widely ignored because many doctors find it hard to believe that it does work, or to comprehend how it could work.

“It is pretty clear to me that it has an amazing effect”

Dr Roland Valori, editor of Frontline Gastroenterology
He began referring IBS patients for hypnotherapy in the early 1990s and has found it to be highly effective.

“To be frank, I have never looked back,” he said.

He audited the first 100 cases he referred for hypnotherapy and found that the symptoms stopped completely in four in ten cases with typical IBS.

He says in a further five in 10 cases patients reported feeling more in control of their symptoms and were therefore much less troubled by them.

“It is pretty clear to me that it has an amazing effect,” he said.

“It seems to work particularly well on younger female patients with typical symptoms, and those who have only had IBS for a relatively short time.”

Powerful effect:-

He believes that it could work partly by helping to relax patients.

“Of the relaxation therapies available, hypnotherapy is the most powerful,” he said.

He also says that IBS patients often face difficult situations in their lives, and hypnotherapy can help them respond to these stresses in a less harmful way.

NHS guidelines allow doctors to refer IBS patients for hypnotherapy or other psychological therapies if medication is unsuccessful and the problem persists.

Dr Valori thinks that if hypnotherapy were used more widely it could possibly save the NHS money while improving patient care.

Dr Charlie Murray, Secretary of the British Gastroenterology Society, said: “There is no doubt that hypnotherapy is helpful for some patients, but it depends on the skill and experience of those practising it.

“But the degree to which it is effective is not well defined.

“I would support using it as one therapy, but it is no panacea.”

You may click & see also:-
Hypnosis has ‘real’ brain effect
Children can ‘imagine away’ pain
Soluble fibre ‘effective for IBS’
Frontline Gastroenterology

Source  : BBC News: 18th. March, 2010

Reblog this post [with Zemanta]

Regular Elimination Promotes Optimum Health!

When you can’t properly empty your bowels, you will experience damage to every cell, gland and organ in your body. Even worse, without regular, daily elimination and colon cleansing, your bloodstream and lymph system can become overloaded with toxins, chemicals and rotting waste.

…..

If you continue to be plagued by symptoms such as occasional diarrhea, constipation, irritable bowels, smelly elimination, bloating, excessive and smelly gas, cramping and heartburn… then you may have a clogged and unhealthy excretory system.

In fact, your colon may even be a breeding ground for harmful parasites. According to June Wiles, Ph.D., “Parasites are vermin that steal your food, drink your blood and leave their excrement in your body to be reabsorbed into the bloodstream as nourishment.”

You can also be exposed to parasites if you eat meats such as pork and fish… drink tap water… eat raw fruits and vegetables… take antibiotics… work or live with children… travel out of the country… shake hands with people… or touch door knobs.

To help rid your body of parasites once-and-for-all and restore healthy bowel eliminations for a whistle-clean colon, look for amazing digestive nutrients such as cascara sagrada, senna leaf, black walnut bark and slippery elm bark.

Doctors and nutritionists agree that the best way to prevent sickness and maintain good overall health is through a well-functioning colon that’s free from toxins and waste build-up. A clogged colon can lead to digestion problems, as well as create the perfect breeding ground for parasites… contribute to kidney and heart problems… and even weaken your immune system.

Your colon may be in trouble if you’re experiencing…

*Occasional constipation or diarrhea

*Irritable bowels

*Intensely smelly elimination

*Straining to have a bowel movement

But adding daily fiber to your diet with plenty of water can help you to properly and regularly empty your bowels with a decreased transit time between eating and elimination. Plus, you may have more energy and get relief from bloating and heartburn.

When you experience proper bowel elimination with natural solutions, you’ll be promoting a clean and healthy colon for years to come.

Source:Better Health Research. Feb.8th.2010

Reblog this post [with Zemanta]

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)