Gastro Intestinal

Gasto Intenstinal: An Overview

All of us have experienced gastro insestinal symptomps like acidity, indigestion, heart burns / GERD, bloating, diarrhoea, gas, stomach pain, cramps, constipation etc. At CALOMS, we provide with best medical, diagnostic, surgical care.

Acid Reflux Treatment Pune

Gastric Reflux:

If you have heartburn or acid reflux or ‘acidity’ twice a week or more —you may have GERD (Gastro Oesophageal Reflux Disease). While medications give symptomatic relief from pain of acid reflux and heartburn, it doesn’t restore the natural anatomy and generally doesn’t stop the disease progression. Acid reflux and heartburn medications just mask the problem usually causing more and more medication to be needed with less relief.

There is no need to continue to suffer with heartburn and acid reflux. At CALOMS we specialise in treating acid reflux disease and GERD(Gastro Oesophageal Reflux Disease) and is one of the best centers in Pune, India to be trained and providing the most recent treatment options for GERD.

At CALOMS we offer the best treatment options including scientifically approved surgical treatment – Nissens Fundoplication for chronic gastro oesophageal reflux disease. Dr Girish Bapat specialises in the laparoscopic treatment and offers most advanced treatment.

Acidity Specialist Doctor in Pune, Acid Reflux Treatment Pune, Mini Gastric Bypass Surgery in Pune, Dr. Girish Bapat.

What Is Gastro Esophageal Reflux Disease (GERD)?

Oesophagus or food pipe carries food from our mouth to our stomach. At the lower end of oesophagus there is a valve which opens to allow the food to pass through. The valve will then close in order to prevent the stomach contents to leak back or reflux into the Oesophagus. Therefore it is supposed to maintain a ‘one way traffic’.

People who are suffering with Gastro Oesophageal reflux disease, GERD or acid reflux disease have problems with this GE valve not closing properly causing acid to reflux or leak into the oesophagus.

Lining of oesophagus is very delicate, when refluxed stomach acid touches the lining of the oesophagus, it causes a burning sensation in the chest or throat called heartburn. This fluid might cause sour taste in the back of the mouth, and this is called acid indigestion (acid reflux). Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Symptoms of Gastro Esophageal Reflux Disease (GERD)?

Though majority of patients with GERD complain of persistent heartburn and/or acid regurgitation, patients may experience symptoms of GERD in a variety of ways. Symptoms of GERD may include:
• Heartburn
• Excessive Burping
• Regurgitation of food
• Chest pain (rule out angina)
• Hoarseness of voice
• Recurrent Sore throat
• Difficulty in swallowing or a feeling like food is stuck in your throat
• Dry Cough
• Bad Breath

Causes of Gastro Oesophageal Reflux Disease:

It’s thought that GERD is caused by a combination of factors, but the most common is the failure of the lower oesophageal sphincter (LOS) – a ring of muscle towards the bottom of the oesophagus which acts like a one way valve. In GERD, this sphincter doesn’t close properly, allowing acid to leak up into the oesophagus.
• Hiatus hernia- hiatus hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
• Alcohol use
• Overweight
• Pregnancy
• Eating fast
• Eating large meals
• Eating late at night, erratic eating habits
• Smoking
• Spicy, oily and junk food
• Aerated drinks – Coke, Limca, Pepsi etc

Complications of Gastro Esophageal Reflux Disease:

Apart from poor quality of life, chronic Gastric Reflux can lead to potentially serious complications:
• Oesophagitis (Inflammation, irritation, or swelling of the esophagus)
• Stricture (Narrowing of the esophagus)
• Barrett’s Oesophagus can potentially become cancer.

Diagnosis:

Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms. Further testing for GERD is usually only required if:
• you have pain when swallowing (odynophagia)
• you have difficulty swallowing (dysphagia)
• your symptoms don’t improve despite taking medication
Further testing aims to confirm or disprove the diagnosis of GERD, while checking for any other possible causes of your symptoms, such as functional dyspepsia (irritation of the stomach or food pipe) or irritable bowel syndrome (IBS).

Endoscopy (Gastroscopy):

Endoscopy demonstrates anatomy and identifies the possible presence and severity of complications of reflux disease (oesophagitis, Barrett oesophagus, strictures (narrowing)). Using the patient’s history and pathologic analysis of biopsy specimens obtained during endoscopy, the diagnosis of GERD can be made. Endoscopy also excludes the presence of other diseases like peptic ulcer and stomach cancer that can present similarly to GERD.

Manometry

Manometry is used to assess how well your lower oesophageal sphincter (LOS) is working, by measuring pressure levels inside the sphincter muscle. Manometry isn’t essential for diagnosing GORD, but it can help exclude conditions with similar symptoms. It can also help ensure that the strength of gullet contractions are adequate if surgery is being considered.

Barium studies:

An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a images of your oesophagus, stomach and upper intestine (duodenum). It also helps to diagnose presence of hiatus hernia.

24 hour- pH studies:

This test is done to monitor the amount of acid in your oesophagus. Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your oesophagus.

Treatment of Gastro- oesophageal reflux disease (GERD).

Treatment of gastroesophageal reflux disease (GERD) involves a stepwise approach. The goals are to control symptoms, to heal oesophagitis, and to prevent recurrent oesophagitis or other complications. The treatment is based on (1) lifestyle modification and (2) control of gastric acid secretion through medical therapy with antacids or PPIs or surgical treatment with corrective antireflux surgery.

Lifestyle modification:

If you have GORD, you may find the following self-care techniques useful:
• If you’re overweight, losing weight may reduce your symptoms, as it will reduce pressure on your stomach.
• Giving up smoking can help, as smoke irritates your digestive system and can make your symptoms worse.
• Eating smaller, more frequent meals, rather than three large meals a day can help. Make sure you have your evening meal three or four hours before bedtime.
• Alcohol, coffee, chocolate, tomatoes, or fatty or spicy food can trigger the symptoms of GORD. If you suspect that any of these make your symptoms worse, remove them from your diet to see whether your symptoms improve.
• Raise the head of your bed by around 20cm (8 inches) by placing a piece of wood or blocks under it. This may improve your symptoms. Don’t use extra pillows, because it may increase pressure on your abdomen.

Medication

A number of different medications can be used to treat GERD. These include:
• over-the-counter medications
• Acid inhibitors (PPIs)
Depending on how your symptoms respond, you may need medication either on a short- or long-term basis.

Over-the-counter medications

A number of over-the-counter medicines (Antacids) can be used to help relieve mild to moderate symptoms of GERD. Antacids neutralise the effects of stomach acid. However, they shouldn’t be taken at the same time as other medicines, because they can stop other medicines being properly absorbed into your body. They may also damage the special coating on some types of tablets. Alginates produce a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid. They work best if taken just after finishing a meal.

Proton-pump inhibitors (PPIs)

If GERD fails to respond to the self-care techniques described above, we may prescribe a course of a PPI for you. PPIs work by reducing the amount of acid produced by your stomach.
Most people tolerate PPIs well, and side effects are uncommon. When side effects do occur, they’re usually mild and may include:
• headaches
• diarrhoea
• nausea
• abdominal pain
• constipation
To minimise any side effects, we will prescribe the lowest possible dose of PPIs that they think will be effective in controlling your symptoms.
In some cases, PPIs may be needed on a long-term basis.

H2-receptor antagonists (H2RA)

If PPIs can’t control your GORD symptoms, another medicine known as a H2RA may be recommended to take in combination with PPIs on a short-term basis (two weeks), or as an alternative to them.
H2RAs block the effects of the chemical histamine, which is used by your body to produce stomach acid. H2RAs therefore help reduce the amount of acid in your stomach.

Surgery

Anti-reflux surgery (Nissens Fundoplication) is an extremely effective treatment for acid reflux disease. Surgery may be required where medical treatment fails to 4 relieve symptoms, or, if the medication satisfactorily relieves the symptoms recur. Anti-reflux surgery is performed via laparoscopic or keyhole surgery. It requires a general anaesthetic and the duration of the procedure is normally approximately one- two hours. A patient will stay in hospital usually for two- three nights after surgery.

Nissen Fudoplication

The hiatus hernia, if present, is firstly replaced into the abdomen. The hole in the diaphragm is tightened up with stitches firstly. The operation involves the wrapping of the floppy upper part of the stomach (fundus) around the weakened lower oesophagus sphincter valve. This causes a much more effective and strong sphincter to prevent acid refluxing from the stomach into the esophagus.
For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Avoid hard food that could get stuck at the site of the surgery, such as toast, chicken or meat.
Common side effects of nissens fundoplication include:
• dysphagia

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How safe is surgery?

Anti-reflux surgery is as safe as most other types of routine surgery such as gallbladder removal or groin hernia repair. Any type of surgery however can involve some potential risks which in this procedure include bleeding, infection, damage to any of the organs in the region such as stomach or oesophagus.
• belching
• bloating
• flatulence
These side effects should resolve over the course of a few months.

 

Anti-reflux surgery (Nissens Fundoplication)

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea and/or constipation. The symptoms vary between individuals and affect some people more severely than others. They tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods. You may find that some of symptoms improve after passing motions. IBS is thought to affect up to one in five people at some point in their life, and it usually first develops when a person is between 20 and 30 years of age. Around twice as many women are affected as men. Only a small number of people with irritable bowel syndrome have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. Others will need medication and counselling.

Irritable Bowel Syndrome (IBS)

Symptoms:

The symptoms of IBS are usually worse after eating and tend to come in episodes. Most people have flare-ups of symptoms that last a few days. After this time, the symptoms usually improve, but may not disappear completely.
In some people, the symptoms seem to be triggered by something they have had to eat or drink. Main symptoms The most common symptoms of IBS are:

  • Abdominal (stomach) pain and cramps, which may be relieved by passing stools
  • A change in your bowel habits – such as diarrhoea, constipation, or sometimes both
  • Bloating and swelling of your stomach
  • Excessive wind or gas
  • Experiencing an urgent need to go to the toilet
  •  A feeling that you have not fully emptied your bowels after going to the toilet.
  • Passing mucus or slime with your stools.

The symptoms of Irritable Bowel Syndrome can have a significant impact on a person’s quality of life and can have a deep psychological impact. As a result, many people with the condition suffer from depression and anxiety.

Irritable Bowel Syndrome (IBS)

Triggering factors:
The exact cause of irritable bowel syndrome (IBS) is unknown, but most experts think that it’s related to problems with digestion and increased sensitivity of the gut. Many causes have been suggested – including inflammation, infections and certain diets – but none have been proven to directly lead to IBS.

Problems with digestion
Your body usually moves food through your digestive system by squeezing and relaxing the muscles of the intestines in a rhythmic way. However, in irritable bowel syndrome it’s thought that this process is altered, resulting in food moving through your digestive system either too quickly or too slowly. If food moves through your digestive system too quickly it causes diarrhoea, because your digestive system does not have enough time to absorb water from the food. If food moves through your digestive system too slowly it causes constipation, as too much water is absorbed, making your stools hard and difficult to pass. It may be that food does not pass through the digestive systems of people with IBS properly because the signals that travel from the brain to the gut are disrupted in some way. Increased gut sensitivity Many sensations in the body come from your digestive system. For example, nerves in your digestive system relay signals to your brain to let you know if you are hungry or full, or if you need to go to the toilet. Some experts think that people with irritable bowel syndrome may be oversensitive to the digestive nerve signals. This means mild indigestion that is barely noticeable in most people becomes distressing abdominal (stomach) pain in those with irritable bowel syndrome .

Psychological factors
There is also some evidence to suggest that psychological factors play an important role in irritable bowel syndrome. Intense emotional states such as stress and anxiety can trigger chemical changes that interfere with the normal workings of the digestive system. This does not just happen in people with irritable bowel syndrome . Many people who have never had irritable bowel syndrome before can have a sudden change in bowel habits when faced with a stressful situation, such as an important exam or job interview. Some people with irritable bowel syndrome have experienced a traumatic event, usually during their childhood, such as abuse, neglect, a serious childhood illness or bereavement. It is possible that these types of difficult experiences in your past may make you more sensitive to stress and the symptoms of pain and discomfort.

IBS triggers
Certain foods and drinks can trigger the symptoms of IBS. Triggers vary from person to person, but common ones include:
• alcohol
• cold drinks
• chocolate, ice creams
• drinks that contain caffeine – such as tea, coffee or cold drinks (coke, pepsi)
• processed snacks – such as crisps and biscuits
• fatty or fried food
Keeping a food diary may be a useful way of identifying possible triggers in your diet. Stress is another common trigger of irritable bowel syndrome symptoms. Therefore, finding ways to manage stressful situations is an important part of treating the condition.

Diagnosis:
A diagnosis of irritable bowel syndrome depends largely on a complete medical history and physical examination. A diagnosis of IBS will then be considered if you have stomach pain or discomfort that is either relieved by passing stools, or is associated with a need to go to the toilet frequently or a change in the consistency of your stools.
This should be accompanied by at least two of the following four symptoms:
• a change in how you pass stools – such as needing to strain, feeling a sense of urgency or feeling you have not emptied your bowels properly
• bloating, hardness or tension in your stomach
• your symptoms get worse after eating
• passing mucus or slime with stools

We may recommend several tests, to rule out infection or problems with your intestine’s ability to take in the nutrients from food (malabsorption). You may undergo a number of tests to rule out other causes such as cancer.

• Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
• Colonoscopy. In some cases, especially if you are age 50 or older or have other signs of a potentially more serious condition, your doctor may perform this diagnostic test in which a small, flexible tube is used to examine the entire length of the colon.
• Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms, especially if you have abdominal pain.
• Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhoea.
• Blood tests. Celiac disease is sensitivity to wheat, barley and rye protein that may cause signs and symptoms like those of irritable bowel syndrome. Blood tests can help rule out this disorder. Children with IBS have a far greater risk of celiac disease than do children who don’t have IBS. If your doctor suspects that you have celiac disease, he or she may perform an upper endoscopy to obtain a biopsy of your small intestine.
• Stool tests. If you have chronic diarrhoea, doctors may want to examine your stool for bacteria or parasites.

Treatment:
The symptoms of irritable bowel syndrome (IBS) can often be managed by changing your diet and lifestyle. In some cases, medication or psychological treatments may also be helpful.

IBS-friendly diet Changing your diet will play an important part in controlling your symptoms of IBS. The diet that works best for you will depend on your symptoms and how you react to different foods. It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. You can then avoid foods that trigger your symptoms. However, it’s important to remember that these foods will not necessarily need to be avoided for life.

Fibre
People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre: soluble fibre (which the body can digest) and insoluble fibre (which the body cannot digest). Foods that contain soluble fibre include:
• oats
• barley
• rye
• fruit – such as bananas and apples
• root vegetables – such as carrots and potatoes

Foods that contain insoluble fibre include:
• wholegrain bread
• bran
• cereals
• nuts and seeds
If you have diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help to avoid the skin, pith and pips from fruit and vegetables.
If you have constipation, increasing the amount of soluble fibre in your diet and the amount of water you drink can help. Dietician at CALOMS may be able to advise on what your recommended fibre intake should be.

Low FODMAP diet If you experience persistent or frequent bloating, a special diet called the low FODMAP diet can be effective. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of carbohydrates that aren’t easily broken down and absorbed by the gut. This means they start to ferment in the gut relatively quickly, and the gases released during this process can lead to bloating. A low FODMAP diet essentially involves restricting your intake of various foods that are high in FODMAPs, such as some fruits and vegetables, animal milk, wheat products and beans. If you want to try the low FODMAP diet, it’s best to do so under the guidance of a professional dietitian, who can ensure your diet is still healthy and balanced.

General eating tips
Your IBS symptoms may also improve by:
• having regular meals and taking your time when eating
• not missing meals or leaving long gaps between eating
• drinking at least 1/2 to 3 litres of water a day.
• restricting your tea and coffee intake to a maximum of two cups a day
• reducing the amount of alcohol and fizzy (e.g. Pepsi, Coke) drinks.
• reducing your intake of resistant starch (starch that resists digestion in the small intestine and reaches the large intestine intact), which is often found in processed or re-cooked foods
• limiting fresh fruit to three portions a day – a suitable portion would be an apple
• if you have diarrhoea, avoiding sorbitol, an artificial sweetener found in sugar-free sweets, including chewing gum and drinks, and in some diabetic and slimming products
• if you have wind (flatulence) and bloating, it may help to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon a day)

Exercise
Many people find that exercise helps to relieve the symptoms of IBS.
Aim to do a minimum of 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.
The exercise should be strenuous enough to increase your heart and breathing rates.

Reducing stress
Reducing your stress levels may also reduce the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:
• relaxation techniques – such as meditation or breathing exercises
• physical activities – such as yoga, pilates or tai chi
• regular exercise – such as walking, running or swimming
If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitive behavioural therapy (CBT).

Probiotics
Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called “friendly bacteria” that can supposedly restore the natural balance of your gut bacteria when it has been disrupted. Some people find taking probiotics regularly helps to relieve the symptoms of IBS. If you want to try a probiotic product, you should take it for at least four weeks to see if your symptoms improve.

A number of different medications can be used to help treat IBS, including:
• antispasmodics – which help reduce abdominal (stomach) pain and cramping
• laxatives – which can help relieve constipation
• antimotility medicines – which can help relieve diarrhoea
• low-dose antidepressants – which were originally designed to treat depression, but can also help reduce stomach pain and cramping independent of any antidepressant effect

These medications are discussed in more detail below. Antispasmodics Antispasmodics work by helping to relax the muscles in your digestive system. Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil. Side effects associated with antispasmodics are rare. However, people taking peppermint oil may have occasional heartburn and irritation on the skin around their bottom. Laxatives Bulk-forming laxatives are usually recommended for people with IBS-related constipation. They make your stools softer, which means they are easier to pass. It’s important to drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative from causing an obstruction in your digestive system.

Antimotility medicines
The antimotility medicine loperamide is usually recommended for IBS-related diarrhoea. Loperamide works by slowing contractions of muscles in the bowel, which slows down the speed at which food passes through your digestive system. This allows more time for your stools to harden and solidify.

Psychological treatments
There are several different types of psychological therapy. They all involve teaching you techniques to help you control your condition better, and there is good evidence to suggest they may help some people with IBS. Psychological treatments that may be offered to people with IBS include:
• psychotherapy – a type of therapy that involves talking to a trained therapist to help you to look deeper into your problems and worries
• cognitive behavioural therapy (CBT) – a type of psychotherapy that involves examining how beliefs and thoughts are linked to behaviour and feelings, and teaches ways to alter your behaviour and way of thinking to help you cope with your situation
• hypnotherapy – where hypnosis is used to change your unconscious mind’s attitude towards your symptoms Complementary therapies
Some people claim therapies such as acupuncture and reflexology can help people with IBS.

Surgery

Anti-reflux surgery (Nissens Fundoplication) is an extremely effective treatment for acid reflux disease. Surgery may be required where medical treatment fails to 4 relieve symptoms, or, if the medication satisfactorily relieves the symptoms recur. Anti-reflux surgery is performed via laparoscopic or keyhole surgery. It requires a general anaesthetic and the duration of the procedure is normally approximately one- two hours. A patient will stay in hospital usually for two- three nights after surgery.

Nissen Fudoplication
The hiatus hernia, if present, is firstly replaced into the abdomen. The hole in the diaphragm is tightened up with stitches firstly. The operation involves the wrapping of the floppy upper part of the stomach (fundus) around the weakened lower oesophagus sphincter valve. This causes a much more effective and strong sphincter to prevent acid refluxing from the stomach into the esophagus.
For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Avoid hard food that could get stuck at the site of the surgery, such as toast, chicken or meat.
Common side effects of nissens fundoplication include:
• dysphagia

How safe is surgery?
Anti-reflux surgery is as safe as most other types of routine surgery such as gallbladder removal or groin hernia repair. Any type of surgery however can involve some potential risks which in this procedure include bleeding, infection, damage to any of the organs in the region such as stomach or oesophagus.
• belching
• bloating
• flatulence
These side effects should resolve over the course of a few months.

 

Anti-reflux surgery (Nissens Fundoplication)

Piles (Haemorroids)

Haemorrhoids, also known as piles, are swellings that contain enlarged blood vessels that are found inside or around the bottom (the rectum and anus).
Most haemorrhoids are mild and sometimes don’t even cause symptoms. When there are symptoms, these usually include:

  •  Bleeding after passing a stool (the blood will be bright red)
  • Itchy bottom
  • A lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
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What causes piles?
The exact cause of haemorrhoids is unclear, although they are associated with increased pressure in the blood vessels in and around your anus. Most cases are thought to be caused by excessive straining on the toilet, due to prolonged constipation, often resulting from a lack of fibre in your diet. Things that can increase your risk of haemorrhoids include:
• being overweight
• being over the age of 45
• pregnancy
• having a family history of haemorrhoids
Preventing and treating piles Haemorrhoid symptoms often settle down after a few days without treatment. Haemorrhoids that occur due to pregnancy usually get better after you give birth. However, making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended. These can include:
• gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, seeds, nuts and oats
• drinking plenty of fluid, particularly water, but avoiding or cutting down on caffeine and alcohol
• not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
• avoiding medication that causes constipation – such as painkillers that contain codeine
• losing weight if you are overweight
• exercising regularly – this can help prevent constipation, reduce your blood pressure and help you lose weight
These measures can also reduce the risk of haemorrhoids returning, or even developing in the first place.
Medication that you apply directly to your back passage (topical treatments) prescribed by your doctor may ease your symptoms and make it easier for you to pass stools.
If your haemorrhoid symptoms are more severe, there are a number of treatment options available.

Symptoms of piles (haemorrhoids)
Most cases of piles (haemorrhoids) are mild, and the symptoms often disappear on their own after a few days.
Some people may not even realise they have haemorrhoids, as they do not experience symptoms.
However, when symptoms do occur they may include:
• bleeding after passing a stool (the blood will be bright red)
• itchiness around your anus (the opening where stools leave the body)
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
• a mucus discharge after passing a stool
• soreness, redness and swelling around your anus
Haemorrhoids are not usually painful, unless their blood supply slows down or is interrupted.

Causes of piles (haemorrhoids)
The exact cause of piles (haemorrhoids) is unclear, but many cases are thought to be linked to increased pressure in blood vessels in and around the anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed.
Who’s at risk
Factors that increase your chance of getting haemorrhoids include:
• being overweight or obese
• persistent constipation, often due to a lack of fibre in your diet
• prolonged diarrhoea
• regularly lifting heavy objects
• a persistent cough or repeated vomiting
• prolonged sitting down
• being pregnant (the haemorrhoids will usually improve after you give birth)
• being over 45 years of age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
• a family history of haemorrhoids, which could mean you’re more likely to get them.

Diagnosing piles (haemorrhoids)
Piles (haemorrhoids) can be easily diagnosed by your doctor. To do so, they will examine your back passage to check for swollen blood vessels.
Rectal examination
Your doctor may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called a digital rectal examination (DRE).
Proctoscopy
In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin hollow tube with a light on the end that is inserted into your anus.

Colonoscopy:
In some cases doctor may advice you Colonoscopy or endoscopy to rule out any other medical conditions like cancer or inflammatory bowel disease.
Types of haemorrhoids
After a rectal examination or proctoscopy, your doctor can determine what type of haemorrhoid you have.
• first degree – small swellings that develop on the inside lining of the anus and are not visible from outside the anus
• second degree – larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again
• third degree – one or more small soft lumps that hang down from the anus and can be pushed back inside (prolapsing and reducible)
• fourth degree – larger lumps that hang down from the anus and cannot be pushed back inside (irreducible)
It’s useful for doctors to know what type and size of haemorrhoid you have, as they can then decide on the best treatment. Read more about treating haemorrhoids.

Treating piles (haemorrhoids)
Piles (haemorrhoids) often go away by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.
Making simple dietary changes and not straining on the toilet are often recommended first.
Dietary changes and self-care
If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular, so that you don’t strain when passing stools.
You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables.
You should also drink plenty of water and avoid caffeine (found in tea, coffee and cola).
Follow the below advice when going to the toilet:
• avoid straining to pass stools, as this may make your haemorrhoids worse
• after passing a stool, use moist toilet paper or baby wipes to clean your bottom, rather than dry toilet paper
• pat the area around your bottom, rather than rubbing it

Medication

Corticosteroid cream
If you have severe inflammation in and around your back passage, your doctor may prescribe corticosteroid cream, which contains steroids.

Painkillers
Common painkilling medication, such as paracetamol, can relieve the pain of haemorrhoids. However, you should avoid codeine painkillers, as they can cause constipation. Products that contain local anaesthetic (painkilling medication) may also be prescribed by your doctor to treat painful haemorrhoids. Laxatives If you are constipated, your doctor may prescribe a laxative. This is a type of medication that can help you empty your bowels.

Non-surgical treatments
If dietary changes and medication don’t help, your doctor may recommend appropriate treatment non-surgical procedures such as banding and sclerotherapy.

Banding
Banding is a procedure that involves placing a very tight elastic band around the base of your haemorrhoids, to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.

Injections (sclerotherapy) A treatment called sclerotherapy may be used as an alternative to banding. During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size.

Surgery for piles (haemorrhoids)
Surgery may be recommended if other treatments for piles (haemorrhoids) have not been successful, or if you have haemorrhoids that are not suitable for non-surgical treatment. There are many different surgical procedures for piles. The main types of operation are described below.

Haemorrhoidectomy
A haemorrhoidectomy is an operation to remove haemorrhoids. It is usually carried out under general anaesthetic orspinal anaesthesia. A conventional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. You will need to take a week or so off work to recover. After having a haemorrhoidectomy, there is around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk. Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO) Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO) is an operation to reduce the blood flow to your haemorrhoids.
It’s usually carried out under general anaesthetic and involves inserting a small device, which has a Doppler ultrasound probe attached, into your anus. This probe produces high-frequency sound waves that allow the surgeon to locate the blood vessels in and around your anal canal. These blood vessels supply blood to the haemorrhoid.

Stapler Heamorroidectomy:
Stapling, also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. It is sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic. This procedure is not carried out as often as it used to, because it has a slightly higher risk of serious complications than the alternative treatments available. However, after stapling, more people experience another prolapsed haemorrhoid compared with having a haemorrhoidectomy. There have also been a very small number of serious complications following the stapling procedure, such as fistula to vagina in women (where a small channel develops between the anal canal and the vagina) or rectal perforation (where a hole develops in the rectum). General risks of haemorrhoid surgery
Although the risk of serious problems is small, complications can occasionally occur after haemorrhoid surgery. These can include:
• bleeding or passing blood clots
• infection, which may lead to a build-up of pus (an abscess).
• urinary retention (difficulty emptying your bladder)
• faecal incontinence (the involuntarily passing of stools)
• anal fistula
• stenosis (narrowing of the anal canal)

Cost of Piles (Haemorroids) Surgery:
Cost depends on lots of factors such as
• Bed category
• Type of Surgery (stapled or haemorroidectomy)
• Choice of hospital etc
• Preexisting medical conditions such as diabetes, angina which may prolong your hospital stay or need critical monitoring.
Following your first meeting with the doctor, we would be able to give you an approximate estimate.

Fissure

What is an anal fissure?

An anal fissure is a tear or a small crack in the skin at lower end of the anus (back passage). The condition is also referred to as Fissure-in-ano. It is probably the result of pressure forced onto the wall of the anal canal either by passage of hard stool or straining with a loose stool.

What are the symptoms?

Pain: The pain is severe on and following bowel action and it can last a few minutes to several hours. The pain is caused by spasm of the anal sphincter (the inner circle of muscle in the anal canal). Because of the pain, patients with this condition fear bowel movement and often try to avoid it. This leads to further constipation with harder stools, which in turn increases the pain.
Bleeding: The tear may result in bleeding during bowel movement.
Skin tag: Sometimes swelling can occur near or around the fissure. This can cause a skin tag to develop (a piece of skin which hangs from surrounding skin). This can have mucus discharge (oozing) which causes excoriation (rubbing of the area around) and itchiness.

What are the Treatments?

Conservative treatment :
• High fibre diet By eating a high fibre diet you should aim to keep your stools soft but bulky.
• Increase fluids Drinking plenty of water (about 2 to 2.5 litres per day) will also help to keep your stools soft.
• Local anaesthetic ointment Sometimes applying local anaesthetic ointment before and after a bowel movement makes passing stools easier with less pain. Your doctor may prescribe you ointment to releive spasm locally and to reduce swelling.

Surgical treatment:
If the above measures have not healed your fissure, surgery might be considered. The operation for anal fissure is called a lateral sphincterotomy and it has a high success rate of curing fissures. 20%) of some change in your ability to control wind from the back passage. You could also experience some soiling (slight incontinence).

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Endoscopy (Gastroscopy/ Colonoscopy)

An endoscopy is a procedure where the inside of your body is examined using an endoscope. Endoscope An endoscope is a long, thin, flexible tube that has a light source and a video camera at one end. Images of the inside of your body are relayed to a television screen. Endoscopes can be inserted into the body through a natural opening, such as the mouth and down the throat, or through the anus (via the bottom).

Types of Endoscope:

Some of the most commonly used types of endoscopes include:

  • Colonoscopes – used to examine your large intestine (colon)
  • Gastroscopes – used to examine your oesophagus and stomach
  • Endoscopic retrograde cholangiopancreatography (ERCP) – used to check for gallstones.

 

GASTROSCOPY:

A gastroscopy is a procedure where a thin, flexible tube called an endoscope is used to look inside the oesophagus (food pipe), stomach and first part of the small intestine (duodenum).

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Why a gastroscopy may be used ?

A Gastroscopy can be used to:

  • Investigate problems such as difficulty swallowing (dysphagia) or persistent abdominal (tummy) pain.
  • Diagnose conditions such as stomach ulcers or gastro-oesophageal reflux disease (GERD).
  • treat conditions such as bleeding ulcers, a blockage in the oesophagus, non-cancerous growths (polyps) or small cancerous tumours The gastroscopy procedure

A gastroscopy often takes less than 15 minutes, although it may take longer if it’s being used to treat a condition. It’s usually carried out as an outpatient procedure. Before the procedure, your throat will be numbed with a local anaesthetic spray. The doctor carrying out the procedure will place the endoscope in the back of your mouth and ask you to swallow the first part of the tube. It will then be guided down your oesophagus and into your stomach.

COLONOSCOPY:

A colonoscopy is a test to view and evaluate the inner lining of your large bowel (colon) and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. The procedure involves the insertion of a narrow and flexible telescopic camera, called a colonoscope, into your anus which allows the doctor to look directly at the lining of your bowel.
This test is normally performed with sedation or an injection of painkillers but you can choose not to have sedation if you wish. Sedation is medication that makes you sleepy but does not put you to sleep.

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