Gastro-intestinal Care

What is constipation?

Constipation means hard stool, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement.

According to definition of medical science, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week.

The onset of constipation might be Acute or it can be Chronic. There is another condition where the patient is not able to pass even flatus. This condition is known as Obstinate Constipation.

What causes constipation?

Fundamentally, constipation is due to slow passage of digestive foods through any part of the intestine, but it mostly happens due to not passing of digestive contents in the colon.

Among the proximate causes, there are few conventional medications like, calcium-channel blocking drugs, iron supplements; narcotic pain medications might cause the constipation. Other than this few of the persons are having the habit of controlling the bowel motion, not taking the proper diet rich in fibers, taking too much of non-vegetarian foods, sedentary life-style and lack of exercise are the most important causes. Few persons are taking too much of un-necessary laxatives that is also another cause of constipation; in this case there is a situation happens which is known as colonic inertia where the nerves or muscles of the colon do not work normally.

Few pathological conditions, like hypo-thyroidism, diabetes mellitus, scleroderma, spinal cord disorder, multiple sclerosis, may also cause constipation.

What happens when un-treated or mal-treated:

Constipation is most of the time a subjective phenomenon, its feelings depends from individual to individual. Some persons do not have any problem even that particular person does not defecate for 2-3 days or someone have irritation and anxious if he does not clear his bowels for 1 day only. Gradually this condition might turn up to irritable bowel syndrome (IBS). The patients have in-effectual urging for stool always, but does not have anything comes out. Chronic constipation or hard stool might lead to piles or fissure due to constant straining. But the problem related to the acute constipation always associated with some underlying factor that has to be ruled out as quickly as possible and to be promptly taken care of.

Modern-day conventional treatment for chronic constipation is very much limited. Apart from different types of laxatives (lubricant laxatives, emollient laxatives, hyper-osmolar laxatives etc), they hardly have any sort of permanent solution for this problem. On the secondary effect of these laxatives, the condition becomes more complicated.

What are piles [HAEMORRHOIDS]?

Piles are swollen veins and muscle around your anus and in the anal canal and rectum. Piles arise from increased pressure of internal or external veins around the anal canal and
these veins may become engorged and more wider than usual and these wider engorged veins and the over lying tissue may form swelling called piles .
almost 75 % of all adults suffer from piles at some stage in lfe .

Piles are classified into two general categories :

Internal piles : can not be seen of felt …they are usually painless and can bleed when irritated such as assage of hard stool

Internal piles can be classified into grades 1 to 4 according to their severity and size:

• Grade 1 are small swellings on the inside lining of the anal canal. They cannot be seen or felt from outside the anus.
• Grade 2 are larger. They may be partly pushed out from the anus when you go to the toilet, but quickly move back inside again.
• Grade 3 hang out from the anus when you go to the toilet. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
• Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

External piles : They are visible o the outer surface of the anus .and they are painful as lower part of anal canal has lots of pain nerves. They usually do not bleed.

Causes of piles [haemorrhoids ]

• Chronic constipation
• Obesity
• Sedative life style.
• Pregnancy
• Family history of piles
• Diarrhea lasting for long time .
• Frequently lifting heavy objects
• Long periods of sitting .
• Ageing –when you get old yor are more prone to get piles as anal muscles get weak in old age .

Symptoms of piles :

• You can feel a lump or swelling aroud your anus.
• Soreness and pain after passing stool.
• Bleeding while passing stool you can notice blood on toilet pan , or aroud stool.
• A feeling of unsatisfactory stool .
• Itching and soreness around the anus .
• large piles can cause mucus discharge some pain and irriatation.

Complications of piles :

• Uclcer formation in external piles
• In severe cases pile can get strangulated due to twisting which is very painful.
• Thrombosed piles –blood clot formation within the pile with severe pain.

DOS AND DONTS OF PILES :

• Eat plenty of fibre rich food such as fruits, veges, whole grain cereal, beans.
• Drink plenty of fluids try to reduce caffeeniated drinks .
• Follow healthy and active life style…exercise regulary.
• Sit in warm water for at least 10 minutes .
• Maintain healthy weight.
• Avoid excess alchol.

What is IRRITABLE BOWEL SYNDROME [IBS]?

IBS is a common and long term functional disorder of digestive system that affects the large intestine [colon]. Functional disorder means there is problem with the body functions but there is no abnormality in the bowel tissue.
IBS commonly causes abdominal pain, cramping, bloating, diarrhea and constipation, without any apparent cause.
It affects people of all ages and both sexes. It generally develops in young adults when a person is around 20 to 30 years of age.

Causes of Irritable bowel syndrome:

The cause of IBS is unknown ; but after long years of researches, the scientists have come to the conclusion that the cause of this disorder is abnormality in the intestinal muscular contraction ; sometimes contractions might be too strong to cause gas , bloating and diarrhea sometimes contraction are too weak that they cause hard stool or constipation.

Triggering factors:

• Food: Many people have food sensitivity, which can lead to symptoms of IBS these food can be chocolate, dairy product, spices, fat, beans, cabbage, carbonated drinks, and alcohol.
• Stress: Most of the people with IBS symptoms are worse during increased bouts of stress.
• Hormones: In many women experience that IBS symptoms are worse during menstrual period.
• Infections: Sometimes other illness like gastroenteritis can trigger the IBS.
• Genetics and heredity: Researches had shown that IBS runs in families and there are more chances of IBS in an individual who have IBS in parents or close relatives.
• Certain medications: Some people have aggravation of IBS symptoms after taking antibiotics or steroids.

Symptoms of IBS:

Symptoms and signs may vary from person to person. In some persons symptoms are very minor and tolerable but at the same time some people suffer more severely than others.

1. Abdominal pain and cramps in the lower abdomen; and pain is relieved by defecation.
2. Change in the bowel habits such as constipation followed by diarrhea and sometimes both.
3. Patients frequently complaints of gas formation, bloating, and abdominal distention after having their meal.
4. There would always be a sensation of incomplete evacuation and unsatisfactory feeling after defecation.
5. Occasionally there would be some urgency to go to the toilet .
6. Sometimes the patient may pass mucus in the stool.

Complications of IBS:

This is not a life threatening disorder. The person with IBS can have depression, anxiety, distress, and change in quality of life. The person with severe constipation can have anal fissure.

Long standing diarrhea patients can have weight loss, vitamin deficiencies and severe dehydration.

DO’S AND DON’TS OF IBS:

• Avoid the food that triggers the symptoms. Such as processed food, pasta, pastry, bread.
• Try to avoid the food that over stimulate gut like large meals or high fat food .
• Try eating smaller meals more often throughout the day.
• Never skip your breakfast.
• Slow down; never eat food in hurry chew food properly.
• Take more fiber rich diet, fresh fruits and vegetables in your meals.
• Do not eat food late at night.
• Exercise regularly such as walking, cycling, and swimming.
• Drink plenty of water.
• If you lead a hectic lifestyle, try yoga and long walk and take enough sleep.
• Limit intake of alcohol, and caffeine.

What is chronic acidity [gastro esophageal-reflux]?

Chronic acidity or gastro-esophageal reflux disease … is chronic digestive disorder

This occurs when stomach content flows back into your food pipe [esophagus].

Since Stomach content are acidic in nature this irritates the lining of food pipe which causes heartburn and pain etc.
Many people experience this from time to time when these sign and symptoms occur at least twice in week or interfere with daily life you may be diagnosed with chronic acidity or GERD.

Most of the people can manage the acidity with lifestyle changes but some people may need proper treatment.
In normal digestion the lower esophageal sphincter [LES] opens to allow food to pass into the stomach and closes to prevent food and acidic juices from flowing back into the esophagus Acidity or GERD occurs when LES is weak.

Cause of chronic acidity:

There are multiple causes for chronic acidity or GERD :

• Obesity
• Bulging of top of stomach into the diaphragm [ hiatus hernia]
• Pregnancy and asthma
• Smoking
• Functional abnormality of LES or connective tissue disorder such as scleroderma.
• Certain food and beverages like chocolates, peppermint, fried or fatty food, coffee, and alcohol may trigger heat burn.
• Life style – eating dinner before sleep is also responsible to cause acidity.
• Constant stress may also trigger symptoms of GERD.
• Beta blockers and ca channel blockers for high blood pressure.

Symptoms of chronic acidity [GERD] :

• Heart burn or burning pain in the chest after meals and can stay for couple of hours sometimes spreading to your throat. This is most common symptom of acidity.
• Strong feeling that food is stuck behind the breast bone.
• Bloating of abdomen after having meals.
• Nausea after eating.
• Bringing food back in mouth or throat esp. in sleep.
• Coughing or wheezing.
• Burping and Hiccups.
• Difficulty in swallowing.
• Bad breath.
• Chronic sore throat.

Complications of chronic acidity [GERD]:

Over periods of time chronic inflammations in your esophagus can lead to complications such as:

such as narrowing[ strictures ] of esophagus ; ulcers of esophagus and long term chronic acidity may cause precancerous changes in esophagus.
Long standing acidity may also lead to asthma and cough.

DOS AND DONTS OF CHRONIC ACIDITY:

• Always follow a healthy life style and healthy eating habits which include fibers such as fresh fruits and vegetables, oats, in your diet.
• Avoid fried- spicy and fatty food.
• Always take your meals 2-3 hour prior to your bed time.
• Avoid two heavy meals and break this into small meals.
• Elevate your bed by few inches.
• Try to maintain a healthy weight.
• Drink plenty of water and liquids such as coconut water.
• Avoid sleeping immediately after meals.
• Always maintain a healthy weight and include exercise in your daily routine .

What is peptic ulcer disease?

Peptic ulcers are painful open raw area or ulcers in the lining of stomach or first part of small intestine [duodenum].

Peptic ulcer is more common in males than females.

Peptic ulcers are often chronic in nature.

Cause of peptic ulcers:

• Most of the ulcers are caused by infection an infection with bacteria called helicobacter pylori [H. PYLORI].
• Frequent usage of painkillers [NSAID] such as aspirin, ibuprofen even safety coated medicines can cause ulcers.
• Excessive drinking of alcohol, smoking and chewing tobacco.
• Genetic predisposition –children are three times more prone to get peptic ulcer if parents have the similar disease.
• Spicy food may aggravate the condition.
• Long standing stress, grief, targets, anxieties can also predispose individual to ulcers.
• Serious illness in lungs, kidney or liver.

Symptoms of peptic ulcer:

Following are the most common symptoms of peptic ulcer:

• Burning pain [hunger pain] in the middle or upper stomach between meals or at night
• Bloating of abdomen after meal
• Heart burn
• Water brash
• Burping
• Nausea or vomiting
• Vomiting of blood
• Black stool

Complications of peptic ulcer:

Though ulcers often heal on their own but if ignored ulcers can lead to serious health problems like

• Gastro intestinal bleeding
• Perforation- a hole through the stomach wall.
• Gastric outlet obstruction from swelling or scarring that blocks the passageway from stomach to intestine.

DO’S OF PEPTIC ULCER:

• Eat small meals at regular interval.
• Eat healthy food fiber rich diet such as oats, fresh fruits vegetables, nuts dried beans eggs .
• Eat low fat dairy products and fat free diet… healthy fat includes olive oil .
• Eat slowly and chew properly.
• Finish meal 3-4 hour before bed time.
• Drink lots of water.

DON’TS OF PEPTIC ULCER:

• Avoid spicy, fatty and fried food.
• Don’t use alcohol and tobacco.
• Try not to use painkillers frequently.
• Cut down tea, coffee, caffeine containing beverages.
• Avoid sour food such as orange …grape fruit juice and tamarind.