Natural Solution to get rid of Hemorrhoids
Considering the number of anatomic structures, there are many disease processes that cause pelvic and rectal pain. In some patients, no actual disease process can be identified. Table 39-2 describes a classification system that provides the clinician with a systematic approach to the diagnosis and management of pelvic pain syndromes. Organic Inflammatory Diseases That Affect the Pelvis and Anorectum
Assessment of cancer-related GI tract sequelae should begin with a thorough history with close attention to symptoms attributable to GI tract pathology, including dysphagia, odynophagia, vomiting, chronic abdominal pain, chronic constipation or diarrhea and hematochezia (Table 12.1).Anorexia,
The majority of patients evaluated for hematochezia that ultimately proves to be hemorrhoidal in origin can be and should be managed with fiber supplementation. Although it is not clearly proved that constipation contributes to hemorrhoidal symptoms, it is certainly reasonable to improve bowel function to reduce hemorrhoidal complaints in the majority of early-stage patients. The remaining nonoperative and operative interventions should be reserved for patients with advanced hemorrhoidal disease and patients who are unresponsive to this simple but effective medical management routine.
Anorectal problems are common in immunocompromised patients, particularly in those who are neutropenic or have AIDS. Symptoms usually include pain, ulceration, discharge, incontinence, bleeding, mass, or tenesmus. Both benign and malignant pathologic processes cause these symptoms. Common communicable anorectal pathogens are similar to those occurring in immunocompetent patients ( Table 35-6 ). Other noncommunicable causes of anal disease include abscess, fistula, perirectal infections, hemorrhoids, fissures, ulcers, and tumors. These lesions are significant problems in the neutropenic patient but may occur in patients with less severe immunocompromise and in patients who are immunocompetent. The work-up for anorectal lesions should include a thorough history, inspection, digital rectal examination, anoscopy, and proctoscopy with biopsy samples because immunocompromised patients are at an increased risk for developing both rectal and anal cancers.
Indeed, the typical patient with hemorrhage from a small bowel source has multiple episodes of hemorrhage, is subjected to numerous diagnostic procedures, and receives a mean of 20 units of packed red blood cells before definitive identification and treatment of the bleeding lesion. This is true despite repeated clinical episodes of obvious gastrointestinal hemorrhage presenting as hematochezia or
Laparoscopy has come a long way since 1901, when George Kelling first performed this procedure to examine the abdominal cavity of a live dog using a Nitze cytoscope.1 ' The credit for Introducing laparoscopy to the United States goes to Bertram M. Bernheim from The Johns Hopkins Medical School.1 ' Calling It organoscopy, Bernheim performed the procedure on two patients using a proctoscope. One had a carcinoma of the pancreas and was a patient of William S. Halsted. Although the initial half of the twentieth century saw only minor advances, the latter half saw rapid progress, especially in the last 20 years. Despite the advances and successes realized by gynecologists, general surgeons were slow to appreciate the importance of laparoscopy. However, success of laparoscopic cholecystectomy led to the application of
The normal route of rectal venous flow is into the internal iliac vein. During pregnancy the fetus may partially occlude the inferior vena cava when the woman is recumbent, increasing venous resistance and diminishing pelvic venous flow into the inferior vena cava. Because the middle rectal veins also communicate with the superior rectal branches of the inferior mesenteric vein, there is the potential for pelvic blood to ascend via the portal circulation. None of the pelvic veins contains valves, which allows blood to take the path of least resistance. Middle rectal veins also communicate with inferior rectal veins these are tributaries of the internal pudendal vein, which drains into the iliac veins before entering the inferior vena cava. Increased blood flow in these vessels, particularly in the last trimester of pregnancy, is a well known cause of hemorrhoids.
The mucilaginous seeds have long been used in native medicine in that country to treat gonorrhoea and menorrhagia Watt, 1893 , to which conditions Chopra, 1958 adds diarrhoea and haemorrhoids. In China Chiang-su, 1982 2 the plant is used as a febrifuge, detoxifier, diuretic, blood cooler, haemostatic, and for the reduction of swellings. It relieves painful swellings, bleeding piles and inflammation of the mammary gland. A decoction taken hot is used to treat tonsillitis, haemorrhage in pulmonary consumption, and sluggish blood developing slight erythema.
Rectal prolapse is a relatively common condition. Appropriate management relies on the accuracy of diagnosis and a rational therapeutic plan. The following definitions should help clarify the various protrusions encountered in the anorectum. Mucosal prolapse is abnormal descent of the rectal mucosa ( Fig. 30-1 ). Complete rectal prolapse or procidentia indicates intussusception of all layers of the rectal wall through the anus (see Fig. 30-1C ). Occult rectal prolapse is incomplete rectal prolapse the prolapse does not protrude though the anus and can be diagnosed reliably only through the use of defecating proctography. Pouch-of-Douglas hernia ( Fig. 30-2 ) originates in the cul-de-sac of Douglas and protrudes through the anterior rectal wall and then out through the anus. The term sigmoidocele has been somewhat confusingly used to describe this type of prolapse. MUCOSAL PROLAPSE HEMORRHOIDS Symptoms and Diagnosis The protruding mass has radiating furrows, which are often associated...
Delay in diagnosis is due to a combination of patient embarrassment and fear, and missed diagnosis. Between one quarter and one third of individuals with malignancy of the anal region have been misdiagnosed with benign pathology such as hemorrhoids, fissure, fistula, eczema, or abscess. A careful history, a thorough examination, and a biopsy of any suspicious lesions should make incorrect diagnosis very unlikely.
Symptoms may include blood or mucus in the faeces changes in bowel habits (diarrhoea, constipation or both), anything abnormal or that lasts for more than two weeks the feeling of needing to go to the toilet even if the bowels have just been emptied pain or discomfort in the abdominal area a lump in the abdomen extreme tiredness, which might be due to bleeding. These symptoms may well be present for other reasons, the most common cause of bleeding being haemorrhoids, for example. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK web site, 2002).
A, With the patient in the lithotomy position, gentle traction is applied on the rectal wall, after which a diluted epinephrine solution may be injected into the outer layer of the prolapsed rectal wall. B, A circular incision is made through the full thickness of the outer layer of the prolapsed segment just proximal to the everted dentate line. C, The rectal prolapse has been completely unfolded. The mesenteric vessels are carefully ligated close to the bowel wall. 1. Ajao, O.G., and Adekunle, O.O. Rectal prolapse in Ibadan, Nigeria. Trop. Doct., 9 117, 1979. 2. Altemeier, W.A., Culberson, W.R., Schowengerdt, C., et al. Nineteen years' experience with the one stage perineal repair of rectal prolapse. Ann. Surg., 173 993, 1971. 3. Biehl, A.G., Ray, J.E., and Gathright, J.B. Repair of rectal prolapse Experience with the Ripstein sling. South. Med. J., 71 923, 1978. 4. Boutsis, C., and Ellis, H. The Ivalon sponge-wrap operation for rectal prolapse. Dis....
Cooper MJ Mackie CR Dhorajiwala J et al Hemorrhage from ileal varices after total proctocolectomy Am J Surg 141178 1981
Hosking, S.W., Smart, H.L., Johnson, A.G., and Triger, D.R. Anorectal varices, haemorrhoids, and portal hypertension. Lancet, 1 349, 1989. 30. Weinshel, E., Chen, W., Falkenstein, D.B., et al. Hemorrhoids or rectal varices Defining the cause of massive rectal hemorrhage in patients with portal hypertension. Gastroenterology, 90 144, 1986.
Symptoms may include blood or mucus in the faeces, changes in bowel habits (diarrhoea constipation or both), anything abnormal or that lasts for more than 2 weeks, the feeling of needing to go to the toilet even if the bowels have just been emptied, pain or discomfort in the abdominal area, a mass in the abdomen or extreme tiredness, which could be the result of anaemia. These symptoms may well be caused by other conditions, e.g. a common cause of bleeding is haemorrhoids. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK website, 2002b).
Bleeding and protrusion are among the most common symptoms of hemorrhoidal disease. However, Mazier reported on a series of 500 patients with complaints of hemorrhoids and found that only one third had any significant hemorrhoidal disease (personal communication). Hemorrhoid bleeding typically results in bright red blood that drops into the toilet or is noted on the toilet. It is generally painless. More vigorous bleeding can occur as the hemorrhoids enlarge. Usually, prompt reduction of the protruding mass will cause this bleeding to abate. Acute thromboses of internal or external hemorrhoids are usually associated with severe pain that occurs with a palpable perianal mass. These patients are generally very uncomfortable, and the diagnosis is immediately obvious on clinical examination. Examination of the patient with hematochezia, although dictated largely by the age of the patient, should include sufficient investigations to rule out a proximal source of bleeding, such as...
Pain syndromes of the pelvic, rectal, and perianal region are referred to by a variety of names levator syndrome, levator spasm, proctalgia fugax, coccygodynia, and chronic idiopathic rectal pain. These terms describe a wastebasket of pain syndromes that are localized to the rectal area. Each of these syndromes may describe a distinct entity or these pain syndromes may overlap. Once organic causes have been excluded, the patient can present a therapeutic challenge. Levator spasm is characterized by episodic pelvic or rectal pain caused by spasm in the levator ani muscles. Symptoms of this syndrome are variable and include complaints of pressure or discomfort and the feeling like sitting on a ball. Left-sided involvement is more common, and the pain occasionally radiates into the gluteal region. The syndrome is more common in women and sometimes occurs after pelvic infections or surgery. The clinical finding in this group of patients is levator sling tenderness on transanal palpation....
In hemodynamically stable patients, the blood loss is less than 20 of blood volume, and brisk hemorrhage has usually stopped. Patients who are hemodynamically stable but continue to pass melena or hematochezia should first undergo emergency colonoscopy. In patients with hemorrhage from a small bowel source, blood is typically found throughout the colon. Identification of active hemorrhage arising from the ileocecal valve conclusively confirms a small bowel source.
Patient preparation consists of 2 Fleet enemas (CB Fleet Co, Inc., Lynchberg, VA) administered 1 hour before the procedure. Normally, no analgesic agent or sedative is required. Patients are preferably examined in the left lateral decubitus position. Patients may also be evaluated in the lithotomy or prone Jackknife positions. When the examination is being performed to stage a rectal cancer, digital rectal examination and proctoscopic examination are performed to determine the location of the tumor, its relationship to the anorectal ring, and to remove residual stool or enema effluent that interfere with optimal ultrasound images. A wide-bore proctoscope (ElectroSurgical Instrument Company, Rochester, NY) is inserted into the rectum to visualize and examine the rectum and area of interest. The ultrasound probe is then introduced through the proctoscope. Proctoscopic evaluation is an extremely important component of the evaluation it is important to advance the proctoscope proximal to...
The causes of fecal incontinence are divided into factors that alter anorectal anatomy (trauma, surgery), overwhelm physiologic control mechanisms (diarrhea, secretory tumors, fecal impaction), or interfere with neurologic function (diabetes, spinal cord injury, pudendal nerve injury). In many cases, a combination of factors leads to incontinence ( Table 31-1 ). For example, incontinence associated with rectal prolapse is due to excessive physical stretching of both the anal sphincter and pudendal nerves. Similarly, diminished sphincter strength associated with aging can unmask a previously well-compensated obstetric sphincter injury. incontinence or complaints of rectal prolapse or anal protrusion.1 1 The patient with rectal prolapse may have a visibly patulous anus or one that gapes with traction. The prolapse itself, with its characteristic concentric folds, can be demonstrated by asking the patient to bear down, optimally while seated on a commode. Rectal mucosal prolapse,...
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