Month: February 2022

Haemorrhoids, also called piles, are swollen blood vessels in the lower part of the rectum and anal canal. They vary in size and can be either inside or outside the anus. They are a common phenomenon that can affect anyone at any age. Females are at an increased risk for developing haemorrhoids during pregnancy, especially in the third trimester. It is estimated that up to 50% of pregnant women develop haemorrhoids. Pregnancy haemorrhoids are similar to the ones that develop in other individuals.

What Causes Hemorrhoids During Pregnancy?

Haemorrhoids are caused by the increased pressure in the veins that run through the rectum and anal canal. The enlarging uterus and the growing baby both cause increased pressure to the pelvic area, leading to swelling of the veins.

Another cause of haemorrhoids in pregnancy is constipation that occurs as a result of hormonal changes. The bowel movements slow down during pregnancy which causes constipation, leading to increased straining to pass the hardened stool. Veins of the rectal area swell up due to the extra pressure. Iron supplementation during pregnancy can also cause constipation.

The increased levels of progesterone hormone during pregnancy relax the muscles in the walls of the veins, allowing them to swell more easily. There is also an increase in the total volume of blood during pregnancy that enlarges the veins. Prolonged periods of standing or sitting and straining from carrying the extra weight of the baby can also lead to the development of haemorrhoids.

Pregnant women are also likely to develop haemorrhoids if they have had them previously, which are typically a short-lived problem that goes away after pregnancy.

What Are The Symptoms?

Haemorrhoids in pregnancy usually start at around the 28th week of pregnancy (third trimester) although they can even appear earlier. It can also appear during or even shortly after childbirth.

The most common presentation of haemorrhoids is bleeding during defecation. The bright red blood is not mixed with the stool but rather coated on its outer surface. It can also be noticed during cleansing after bowel movements. Some patients do complain of mild stinging pain and itching after passing stool. Swelling and burning sensation around the anal region or a raised area of skin can also be noticed. If a blood clot develops in the haemorrhoids they become more painful, hard, and inflamed. A severe degree of pain may not always be a result of haemorrhoids but due to anal fissures or infection of the anorectal region.

Haemorrhoids In Pregnancy: How To Treat Them?

Pregnancy haemorrhoids will typically resolve by themselves after childbirth. The symptoms associated with haemorrhoids can be relieved by natural and self-care methods. Seek help from your healthcare provider before starting any natural remedies or if the symptoms of haemorrhoids are persistent. Untreated haemorrhoids worsen with time and can lead to complications.

Read on to learn more about several treatment options to manage and treat haemorrhoids in pregnancy.

Lifestyle modification

Try not to sit or stand for prolonged periods. Brisk walking or a 30-minute exercise can aid bowel movements. You should also avoid standing for long periods of time as it can cause increased downward pressure in the blood vessels of your pelvic region. When feasible, lie down on your side. To improve blood flow, sleep on your left side with your legs tucked towards your chest. You can also do Kegel exercises daily by squeezing and relaxing the muscles in your vaginal and rectal area. This will support your rectum by strengthening the pelvic floor.

Dietary modification

Incorporating more fibre-rich food in the diet increases the bulk of the stool and softens them. This makes bowel movements easier and will reduce the pressure on haemorrhoids. Fresh fruits, vegetables, whole grains cereal, and bread are some examples of high-fibre foods. Drinking plenty of fluids also helps to keep the stool soft. Ask your doctor for safe fibre supplements that can be used in pregnancy.

Sitz bath

Sit in a large bowl or bathtub filled with warm water, with or without added salt, for 20 minutes. This should be done after each bowel movement and an additional 2 to 3 times daily. Gently pat dry the anal area after each sitz bath, as excess moisture can lead to irritation. Do not wipe hard or rub vigorously. Sitz bath can relieve irritation, itching, and spasms of the anal sphincter. You can purchase the tubs or basins for sitz baths at most drug stores and they fit over the toilet seat.

Bowel habits

Pass stool as soon as you feel the urge, if not the stool can lead to increased pressure and straining. Try not to sit in the toilet for prolonged periods as it will cause haemorrhoids to swell up. Elevate your feet with a stool as you sit which allows for easier bowel movements and maintain anal hygiene each time you pass stool. Use baby wipes or a cotton cloth soaked in warm water instead of normal tissue paper. Aloe Vera gel, aqua jelly or petroleum jelly can also be used afterwards.

Medical treatments & procedures

Consult your healthcare provider before taking any medication during pregnancy.
Topical anti-hemorrhoidal agents like anaesthetic creams and steroid creams can be used to provide short-term relief from pain, discomfort, and bleeding.

Anaesthetic creams containing lignocaine can alleviate the pain associated with haemorrhoids while hydrocortisone-pramoxine creams will reduce pain, itching, and inflammation associated with haemorrhoids.

Laxatives, stool softeners, or suppositories that are safe to use in pregnancy can reduce constipation.

Rubber band ligation involves placing a small rubber band at the base of the haemorrhoid which will cut off the blood flow into the area. Haemorrhoids will eventually shrink due to the formation of scar tissue that will prevent recurrence in the area. The session may be repeated few weeks later if symptoms persist.

Surgical treatments

Surgical procedures are reserved for women who have persistent symptoms despite weeks of conservative management. They are not the preferred option but are not uncommon to perform during pregnancy.

Hemorrhoidectomy is a surgical procedure performed under general or spinal anaesthesia. This procedure is only recommended for symptomatic, recurring, or large protruding haemorrhoids. The procedure is associated with several risks like pain, bleeding, infection, recurrence and complications from anaesthesia as well as a longer recovery time.

Stapled hemorrhoidopexy involves pushing the haemorrhoids back into the anal canal and removing and fixing them with the use of staplers. It will treat bleeding or protruding haemorrhoids.

What To Expect After Hemorrhoids Removal In Pregnancy?

The post-surgical effects of haemorrhoid removal are dependent upon the procedure undertaken, how fast you heal, and the timing of your pregnancy. Even the least invasive procedures will require few weeks in recovery. Surgery performed in the third trimester may lead to changes in your birth plan, hence risks, benefits and timing of surgical treatment should be discussed with your surgeon and obstetrician.

Conclusion

Pregnancy haemorrhoid is a common condition that can be treated with home-based treatments and conservative management. Talk to your doctor if they fail to improve after treatment, if they recur or are associated with other complications. You cannot completely prevent the development of haemorrhoids during pregnancy; however, you can take measures to decrease the likelihood of its occurrence and severity. Pregnancy haemorrhoids are mainly caused due to constipation, so avoiding it is the key.

Anal Fissure is a common condition, affecting 1 out of 10 individuals at some point in their lives. They can equally affect both sexes and are more common in children and young adults under the age of 40. Over the years, anal fissure has been a cause of significant distress and frustration to both the patients as well as their doctors. Bleeding from anal fissures is commonly and erroneously attributed to painful haemorrhoids.

Read on to learn about the common causes of anal fissures, how to tell if you have them and what options are available for treatment.

What Is Anal Fissure?

An anal fissure is a small but painful longitudinal tear or defect in the skin lining your anal canal. It is a non-healing tear that can extend into the edge of the anus. Two kinds of anal fissures are commonly encountered, acute and chronic. A short-term or acute anal fissure is a superficial tear in the lining of the anal canal, resembling a paper cut. A long-term or chronic anal fissure does not heal even after eight weeks. At times, the tears are deep enough to expose the underlying muscles.

How Do You Know If You Have Anal Fissure?

An anal fissure may occur if you experience sharp pain while and after defecating. The pain is usually described as a “searing” or “tearing” type of pain. The pain subsides between bowel movements.

You may also notice bleeding or blood spots in bright red on toilet paper or your undergarments.

Symptoms of itching or irritation on the skin around your anal opening may also be present. Some individuals may also notice visible cracks or experience an extra bit of skin (skin tag) at the edge of the anus.

Foul-smelling discharge, discomfort when urinating, frequent urination, or inability to urinate may also be observed.

What Are The Common Causes of Anal Fissure?

Many factors can lead to the development of anal fissures. Some of the more common ones are explained below.

Hard stool

Difficulty in passing hard stools can lead to the development of anal fissures. The hardened stool can be a result of a low fibre diet. An example of such is a diet that lacks fruits and fresh vegetables but is rich in poultry, dairy products, and refined carbohydrates. Fibres from food add bulk to your stool, creating a gel-like consistency of the stool and preventing it from breaking.

Low fibre diets lead to constipation and the formation of small, hard, pebble-like stools that require straining. Hardened stools lead to stretching and subsequent development of tears in the skin of the anal canal. Other factors contributing to the hard stools are not drinking adequate amounts of water and an inactive lifestyle.

Prolonged diarrhoea

Anal fissures can also be caused by repeated bouts of diarrhoea. For severe cases, it can dry out the skin of your anal canal, causing it to crack open.

Pregnancy and childbirth

Anal fissures are common in women after childbirth. Trauma to the anal canal during vaginal delivery can lead to the development of fissures. Pregnant women are also more likely to suffer from constipation.

Other less common causes

• Underlying medical conditions that can damage the anal canal (eg. Inflammatory bowel disease, HIV, Syphilis, Tuberculosis, Anal cancer)
• Overly tight anal sphincters can increase the tension in your anal canal making it more prone to tearing.
• Scars in the anorectal region

How Do You Treat Anal Fissure?

An anal fissure can heal by itself if you take steps to soften your stool. It includes modifying your diet by incorporating fibre-rich foods and plenty of fluid. Avoid straining or prolonged sitting in the toilet. Clean the anorectal area gently and consider using the lubricating gel if the anus is dry and sore. Use baby wipes, moist tissues or bidet spray an alternative to toilet paper. If symptoms persist despite these measures, it’s time for you to see a doctor.

These are the medical and surgical treatment options for anal fissure:

Non-surgical treatment

• Topical Nitroglycerine dilates the blood vessels and promotes blood flow to the fissure. This will promote healing as well as relaxation of the sphincter. The ointment should be applied 2 to 3 times a day around the perianal skin.
• Topical anesthetic creams like lidocaine (Xylocaine) are useful for relieving the pain.
• Botox injection or Botulinum toxin type A injections relax the anal sphincter. This is known as chemical sphincterotomy and will help alleviate the spasms allowing the fissures to heal.
• Topical Calcium channel blockers like 2% nifedipine or diltiazem can reduce the internal anal sphincter pressure.

Surgical treatment

Surgical treatments are second-line therapy if you don’t respond to medical treatments or are unable to tolerate its side effects. Most patients with chronic anal fissures will require surgical treatments. You will be evaluated by a colorectal surgeon for the following:

• Lateral Internal Sphincterotomy

The surgery involves cutting a small portion of your anal sphincter so that the resting anal tone is decreased. This is a routinely performed day surgery under regional or general anaesthesia and can be effective in more than 90% of cases. Pain may be relieved in a week or 2 few and complete symptomatic improvements will be seen 4 to 6 weeks following the surgery. The major concern associated with the procedure is the small risk of faecal incontinence afterwards.

• Other surgical procedures

Advancement flaps is an alternative procedure in patients with a prior history of internal Sphincterotomy or who have poor sphincter functions.

Conclusion

Anal fissures are common conditions that mainly occur in infants and young and middle-aged adults with constipation. These individuals may experience painful defecation and rectal bleeding. It is not a serious condition and most people can practise home-based remedies to relieve uncomfortable symptoms and promote healing.

Medical help must be sought if the problem is persistent or if it recurs. Non-surgical treatments are available and can be effective in most individuals. For some who fail to respond to non-surgical treatment, surgery will be required. A colorectal specialist will evaluate and provide an appropriate treatment for the anal fissure condition.

Colonoscopy is the examination of the rectum, large intestine and distal parts of the small intestine. It is used to detect any abnormalities or changes in the intestine or as part of any therapeutic procedures.

This article will help you prepare for a colonoscopy so that you can undergo the procedure with ease.

What Is Colonoscopy?

Colonoscopy is an outpatient procedure that uses a fibre-optic instrument called a colonoscope. This is a long flexible instrument fitted with a camera that is inserted through the anus. The camera allows the doctor to see the inside of the entire intestine. The procedure is generally performed while you are sedated to minimize the pain and improve the patient’s experience.

Why Is A Colonoscopy Required?

A colonoscopy is performed to evaluate the cause of gastrointestinal symptoms like rectal bleeding, changes in the bowel habit like chronic constipation or diarrhoea, abdominal pain, or any other intestinal problems. The doctor will collect a tissue sample if any abnormalities are found during the procedure.

It is done as part of a screening protocol to prevent colorectal cancer. Individuals aged 50 and above who have an increased risk of colorectal cancer are recommended to go for regular screening, to prevent and detect cancer early. Routine colonoscopy will help detect the suspicious lesions at the initial stages before they can progress to cancer. Colorectal cancer is the most treatable when found early.

Colonoscopy is also done if you have had intestinal polyps before. The doctor can do a follow-up colonoscopy to look for any additional polyps and remove them.

Who Should Undergo Colonoscopy?

According to our national guidelines, screening for colorectal cancer should start at the age of 50 for individuals who do not have any risk factors for colon cancer.

Individuals with higher risks should start screening before age of 50 years old if:

• You or any members of your family have a history of colorectal cancers
• You have genetic syndromes like Familial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colorectal Cancer Syndrome (Lynch Syndrome)
• You have a history of Inflammatory Bowel Disease

The 6 Useful Tips To Prepare For Colonoscopy

Always check your doctor’s instructions to prepare yourself for the colonoscopy. The bowel preparation process is crucial as it affects quality of bowel preparation which has impact on colonoscopy outcomes. Before the colonoscopy, you should receive a set of instructions that you must read carefully and follow closely. Inform your doctor if you drive a car, as the procedure is generally performed while you are sedated so you will feel drowsy afterwards. You might need someone to take you home after the procedure.

Here are some useful tips to help your colonoscopy experience go smoothly and comfortably.

1. Schedule your colonoscopy

Clear your schedule and be at the comfort of your home to start your preparation. Arrange for family members or a sitter to come by, if you have babies or elderly that need care. The colonoscopy can be done in the morning or afternoon. Do discuss with your endoscopist regarding your preferences.

2. Dietary restriction

Changes to the diet should be started 24 hours before the procedure is scheduled. Stick to a liquid diet consisting of water, tea or coffee without creamer, soft drinks and broths. Avoid raw fruits, vegetables, fried food, and solid foods including nuts seeds, popcorn. Other fibre-filled foods that are hard to digest should also be restricted from the diet. Some doctors allow a low residue diet consisting of egg, lean chicken, and pasta. Check with your doctor before making changes to your diet. A low-fibre diet and smaller portions of food are recommended if you plan to get a colonoscopy done in a few days. Drink plenty of water to ensure enough hydration.

3. Preparing your skin

Creams and oils will help prevent and soothe the irritation. You can use petroleum jelly, coconut oil haemorrhoid cream, or diaper rash ointment. You can draw a bath or even use a cold damp cloth to help with the irritation. Medicated wet wipes or adult wet wipes containing vitamin E and Aloe Vera can also soothe the skin as the prep laxative is going to clear your bowels. Using a bidet or shower spray instead of toilet paper would help reduce irritation to the anus.

4. Drinking the colonoscopy prep laxative

Drink the colonoscopy prep laxatives chilled and finish the entire prep drink given to you by your doctor. The bowel preparation solutions are generally bad tasting and can be difficult to swallow. Drink the prep fluid as quickly as possible through a straw, as that can allow you to bypass most of your taste buds while you are drinking. You can even suck a slice of lemon or candy after each glass. Newer studies suggest splitting the prep results in a cleaner bowel. This requires you to drink half of the prep fluid the night before and the rest of it early in the morning.

5. Adjust your medications

Let your doctor know if you are allergic to any medication. If you are taking any medication, you should also inform your medical provider preferably one to two weeks before. These include medications for high blood pressure, diabetes, blood thinners such as aspirin, warfarin, or any health supplements that contain iron. Your doctor may adjust the dose of the medication or ask you to stop the medications temporarily.

6. Personal Preparations

Stay active throughout the prep and wear loose clothing that can be easily taken off. Walking around the house will allow the prep solution to move from your stomach into the intestines, and help with nausea resulting from the prep fluid.

Let your doctor know if you are currently menstruating. Colonoscopy can be performed during menstruation but you might want to wear a tampon for the procedure.

How To Ease Back Into Solid Food, Post Colonoscopy?

Drink and eat food that is gentle to your digestive system. Avoid heavy, fried and fatty food, dairy products, alcoholic beverages, and a high fibre diet. Electrolytes, juice, tea, soups, crackers, white bread, and baked potatoes are a few of the foods recommended post colonoscopy.

What Are The Risks?

Colonoscopy is a commonly performed screening procedure with low risk. However, some complications may occur that include:

• Bleeding
• Adverse reaction to a drug given during the procedure
• Bowel perforation

Call your doctor immediately if you experience:

• Severe abdominal pain, fever, or chills
• Excess or prolonged bleeding

Conclusion

The colon is an integral part of the digestive system. It requires proper care to keep it healthy which includes regular screening such as colonoscopy. When the doctor’s recommendations are followed and done the right way, the preparation is better tolerated and you can expect to go through a smooth and comfortable experience during the Colonoscopy procedure.

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal or bowel disorder featuring recurrent abdominal pain with diarrhoea or constipation. IBS is mainly a disorder of gut motility and function. For people diagnosed with IBS, gut movements are sometimes faster and, at other times, slower. The symptoms of IBS varies, some people have diarrhoea as a predominant symptom, while others have constipation as a predominant symptom. There can be cases of IBS with both diarrhoea and constipation symptoms alternatively.

IBS is a fairly common condition, with prevalence rates of 10-15% worldwide. It has been found that IBS is more common in women than in men. IBS can occur at almost any age, but it typically affects adults of age group 30 to 40 years old.

It’s worth noting that IBS is a different condition from inflammatory bowel disease (IBD) which includes Crohn’s disease and ulcerative colitis. IBS is not a life-threatening condition nor does it produce any serious complications. It does not increase your risk for colon cancer, nor does it cause any structural damage or changes in the colon. Nevertheless, IBS can be distressing and may have a great impact on work and daily life.

Cause & Risk Factors

The underlying cause of IBS is not known clearly. However, multiple factors appear to play a role in causing IBS and act as triggers for the IBS symptoms. Below are some of the well-known triggers or risk factors for IBS.

• Diet: Dairy products, caffeine, artificial sweeteners are more likely to worsen the symptoms in people having IBS.
• Post-infection: IBS symptoms might begin following bacterial infection of the stomach and intestines i.e., gastroenteritis caused by Campylobacter, Salmonella, and Shigella.
• Stress and Psychological factors: It’s a well-known fact that stress and lack of sleep are found to trigger IBS symptoms in many individuals. Also, several research studies suggest IBS is linked to people with depression and anxiety.
• Genetics and environment: Although no single gene mutation has been identified to cause this condition, it could possibly be due to the mutation of many genes. IBS tends to occur in individuals with family history of the condition.

Symptoms

Symptoms tend to come in phases or episodes that can last for days to weeks and may relapse after a certain time. Symptom intensity ranges from mild to severe and differs between individuals, for severe cases, it can even affect their daily lives. The most frequently reported symptom is abdominal pain. Abdominal pain can be localized or generalized, which is instantly relieved with the passing of stool or gas. The stool is not too watery but most often, mucus is present. People who have IBS, generally report to the doctor with the following symptoms:

• Abdominal pain and cramps
• Diarrhoea and/or constipation
• Bloating (or distension)
• Flatulence and gas
• Mucus in stool
• Anxiety and depression

Diagnosis

IBS is diagnosed based on your clinical history, past medical history and with no clinical evidence of other gastrointestinal diseases. It’s worth noting that IBS is diagnosed only if your symptoms are present for more than six months and do not have any other similar conditions. No visible changes are noted on abdominal X-ray, endoscopy or colonoscopy if you have IBS.

Based on clinical features, you might need to undergo some tests for further evaluation and diagnosis: Blood tests, Urinalysis and urine culture, Stool culture, Faecal occult blood test, Abdominal X-ray, Abdominal Ultrasound, Colonoscopy. If test results are normal and not pointing towards other conditions, it is more likely you have IBS.

Other Conditions Similar to IBS

It must be understood that several other conditions do present with similar symptoms. So it is important to elicit a detailed clinical history and rule out other diagnoses. If a person presents with rectal bleeding, significant weight loss or fever along with symptoms of IBS, it can indicate other diseases and should seek medical advice.

Following are the differential diagnosis of IBS:

• Lactose intolerance
• Infectious or Drug-induced diarrhoea
• Celiac disease
• Inflammatory bowel disease (Crohn’s disease and Ulcerative colitis)
• Colorectal cancer

Treatment Options For IBS

There is no known cure for IBS, but it is possible to manage the symptoms through multiple approaches.

Dietary changes

If you have IBS, you might need to be cautious about certain foods you consume in your diet, as certain foods can be the triggers for IBS symptoms. You will also need to follow diet habits.

• Fibre-rich diet: Good sources of fibre include vegetables, green leafy vegetables, fruits, whole grains.
• Hydration: Drinking 1.5 – 2 litres of water per day is essential to maintain hydration and also aids in the digestion and absorption of food in the intestine.
• Adopting Diet that is gluten free or low in fermentable oligosaccharides, disaccharides, monosaccharides and polygols (FODMAP). FODMAPs are found in food such as wheat, onions, some fruits and vegetables, sorbitol and some dairy.

Lifestyle Changes

• Stress management: As we know, stress and lack of sleep can be a trigger for IBS symptoms. Knowing how to handle stressful situations and getting adequate sleep is particularly important in managing this condition.
• Regular exercises: Physical and breathing exercises like yoga will certainly help in reducing stress and maintaining good health.
• Stop smoking and alcohol intake: Smoking and alcohol can actually cause flare-ups in those having IBS. So, one needs to consider stopping smoking and alcohol intake in order to relieve the symptoms.

Medications

• Antispasmodics: Antispasmodics are used to control abdominal pain and spasms. They work by decreasing gut motility.
• Laxatives: Laxatives are particularly beneficial in IBS with constipation. Laxatives work by absorbing fluid and promoting gut movements.
• Antidiarrheal: Loperamide and Diphenoxylate are drugs used to treat chronic diarrhoea symptoms. They work by slowing gut movements.
• Probiotics supplements: Probiotics contain friendly bacteria, which is available in yoghurt or supplements. Taking probiotics for a period of 2-4 weeks provides relief of symptoms. Persons with IBS will more likely benefit from probiotics as they help boost gut health.

Conclusion

Irritable Bowel Syndrome (IBS) is a fairly common digestive disorder that can cause repeated abdominal pain and changes in bowel movements. The symptoms occur intermittently and can be a lifelong problem. IBS can significantly impact your daily life leading to frustration, anxiety, and depression. Since many conditions can mimic the symptoms of IBS it is important to seek help from a healthcare provider. There is no definitive cure for the disorder but your doctor may help find the treatment that works best for you. Dietary modification, probiotics, and medications can improve symptoms and the quality of life. Leading an active and healthy lifestyle is also beneficial.

Inflammatory bowel disease (IBD) is a broader term used to describe two gastrointestinal inflammatory disorders including Crohn’s Disease and Ulcerative Colitis. Crohn’s disease can affect different parts of the digestive tract whereas ulcerative colitis affects only the colon and rectum.

Consultant General Surgeon (Colorectal Surgery), Dr. Sim Hsien Lin answers the top 5 most frequently asked questions about IBD from patients.

Q1: Is IBD a serious condition?

Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory conditions affecting the gastrointestinal tract. IBD may present with symptoms such as abdominal pain, diarrhoea, and blood in stool. This condition usually begins in adulthood, and follows an on-off course, which means symptoms may go into remission but can relapse again.

Based on the severity of disease, people with IBD can have mild, moderate or severe symptoms. IBD is a well-known risk factor for colon cancer, however not all patients with IBD develop colon cancer. Potential severe complications of ulceractive colitis include toxic megacolon, perforation and dehydration. As for Crohn’s disease, severe complications include obstruction, fistulation, malnutrition and perforation.

Q2: What causes IBD?

The exact cause of IBD is unknown. IBD is not caused by infections, nor is it caused by stress or diet. Some of the risk factors commonly associated with IBD are:

Immune response: IBD is considered to be an autoimmune disorder, which means your own immune system attacks the tissues in your gastrointestinal tract resulting in inflammation and injury of the intestine and colon.

Smoking: Studies have found that smokers are at a higher risk of developing Crohn’s disease.

Genetics: If you have someone with IBD in your family, there is a higher likelihood that you will develop IBD yourself.

Q3: What are the symptoms of IBD?

The symptoms and signs of IBD can vary from one person to another, but most patients with IBD present with:

• Episodes of diarrhoea
• Abdominal pain and cramps
• Bloating
• Rectal bleeding
• Weight loss
• Fatigue

Other general non-specific symptoms of IBD include anaemia, fever, and poor appetite. In the long term, IBD can affect your eyes, skin and joints. If you have ulcerative colitis, extraintestinal manifestations may also occur such as:

• Skin rashes (Erythema nodosum, Pyoderma gangrenosum)
• Inflammation of the uvea in the eye (Uveitis)
• Oral ulcers
• Joint pain (Arthritis, Spondylitis)

Q4: Do I need to take any precautions or modify my diet?

IBD symptoms can affect your day to day life. There are a few really important things that you need to consider if you have IBD.

Healthy lifestyle: A balanced diet, regular exercises and stress management are key to improving your overall well-being. If you are a smoker, quitting this habit can improve IBD symptoms and prevent further relapses, especially for Crohn’s disease.

Eating nutritious food: Probiotics found in yoghurt and other supplements have been proven to be beneficial for the gut and intestines. Your diet should be more focused on fruits, vegetables, and whole grains, and eat less fatty foods. Spicy and processed foods are also bad for your gut health and should be avoided.

Q5: Is there a cure for IBD? Do I need to undergo an operation for IBD?

There is no cure for IBD but it can be controlled to a certain extent. Surgery may be needed in severe cases. The main goal of IBD treatment is to prevent further relapses and complications, as well as to achieve remission.

Medications: Various groups of drugs are currently being used for the treatment of IBD.

Anti-inflammatory drugs can help reduce inflammation in the intestine and the colon.

Immuno-suppressants may also be beneficial as it can suppress your immune system and reduce flare-ups.

Biologics are a newer group of medicines that are highly effective in preventing further progression of the disease.

Surgery: If IBD is severe enough or does not respond to medical treatment, surgery may be needed. Surgery for IBD involves removing part of the intestine or complete removal of the colon.

Conclusion

Inflammatory bowel disease (IBD) is a life-long condition. As of yet, there is no cure for IBD, but several treatment options exist that can help control symptoms and prevent flare-ups. It is always best to consult a specialist if you have symptoms of IBD.

Diverticular disease is a common condition found in approximately 50% of individuals above 60 years old. Below, we provide an overview of diverticular disease and diverticulitis, its causes, symptoms, diagnostic modalities, and various treatment options.

What is diverticular disease?

Diverticular disease is a gastrointestinal disorder in which pouches form in the large intestine. These pouches are known as ‘diverticula’.

The large intestine is also known as the colon. It is divided into the following parts:

• Caecum
• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon
• Rectum
• Anal canal

Histologically, from inner to outer layers, the colon has a total of 4 layers:

• Mucosa
• Submucosa
• Muscularis layer
• Serosa

These layers are supplied by an artery called the ‘Vasa recta’.

Diverticular diseases occur when the mucosal and submucosal layers herniate through a potential weakness in the muscular wall of the colon, forming a diverticulum. Diverticula generally are multiple. Each diverticulum is typically 5 to 10 mm in diameter, but at times can exceed 20 mm. Most commonly, the sigmoid colon is affected.

Understanding similar terminologies

Diverticulosis: Presence of pouches in the colon.

Diverticular disease: Clinically significant and symptomatic diverticulosis.

Diverticulitis: Inflammation in the diverticula. May be complicated or uncomplicated.

What are the common causes of diverticular disease?

The various causes of diverticular diseases are:

• Low fibre diet: A low fibre diet is rich in poultry, dairy products, and refined carbohydrates but lacks raw fruits and vegetables
• Constipation
• Straining with bowel movements

All these causes an increase in the colonic pressure which results in bulging in the areas of insertion of the vasa recta, thus, leading to the development of diverticulosis.

If the mouth of the diverticulum becomes blocked with inspissated faeces, it leads to localized inflammation and microbial proliferation in the pouch, resulting in diverticulitis.

In older individuals, the cause of diverticular disease is the neural degradation that occurs with age resulting in uncoordinated contractions, and subsequent increased pressure.

Medicines like nonsteroidal anti-inflammatory drugs, corticosteroids, and opiates; obesity, lack of physical exercise, diets rich in red meat and fat, smoking habits are seen to be the risk factors for the development of diverticular diseases.

How do you know if you have diverticular disease or diverticulitis?

There may be no symptoms and you may only get diagnosed on a screening examination, or you may present with infectious complications, or gastrointestinal bleeding.

In diverticulitis, the common symptoms are:

• Mild, intermittent lower bdominal pain
• Blood in stool
• Fever
• Change in bowel habits
• Bloating
• Nausea and vomiting

In very severe cases, inflammation in the diverticular pouch may progress leading to the formation of pus in the pouch. This condition is known as a diverticular abscess. After the abscess forms, the pus can result in perforation of the wall where the pus or feces leaks into the abdominal space. This is a life-threatening situation and needs prompt management.

In this case, the patient may present with severe abdominal pain with or without altered vital parameters.

How are diverticular disease and diverticulitis diagnosed?

Diverticular disease can be diagnosed through further evaluation. Your doctor may also opt for confirmation via colonoscopy or CT scan of the abdomen.

Colonoscopy is often used for diagnosing diverticular diseases. However, it cannot be done to diagnose diverticulitis due to the risk of perforation.

In some patients, blood tests and stool tests may be done depending on the clinical presentation.

How are diverticular disease and diverticulitis treated?

For patients without symptoms

As most patients do not present with symptoms; they are only diagnosed on a screening colonoscopy test. In this case, lifestyle modification measures need to be followed without any active intervention.

Lifestyle modification measures include:

• Eating food high in dietary fibre like whole grains, fresh fruits, and vegetables, which helps in constipation.
• Drink plenty of fluids so that the stool is soft, moist, and easy to pass.
• Some doctors may recommend probiotics. Probiotics contain ‘good bacteria’ which are normally present in the intestine. This helps to regulate the disbalance in the microbial flora of the colon.
• You can also take a dietary fibre supplement (such as psyllium).
• Increased physical activity

Furthermore, medicine for treatment of constipation might be helpful for patient with severe constipation.

For patients with symptoms

If you present to your doctor with symptoms, management depends on whether the diverticular disease is complicated or uncomplicated. In case of uncomplicated diverticulitis, you are given oral antibiotics for mild symptoms. However, in moderate to severe symptoms, you may need hospitalization for intravenous antibiotics administration.

For patients with complications

In complicated cases, the following may be present:

• An abscess (pus in the pouch)
• Stricture (narrowing of part of the colon)
• Perforation (tear of the intestinal wall)
• Peritonitis (inflammation in the abdominal space that can occur after a perforation)
• Fistula (an abnormal connection between the colon and the bladder, small intestine, vagina, or skin)

In these cases, hospitalisation and treatment with intravenous antibiotics, bowel rest, and surgical consult are necessary. If a diverticular abscess is evident on a CT scan, the patient may have to undergo drainage of the abscess by a needle inserted under CT scan guidance or definitive therapy with surgery.

If there is ongoing inflammation after percutaneous drainage, further surgery may be needed such as resection of the diseased area with or without creation of a colostomy (diversion of feces out through an opening in the skin). The colostomy is generally temporary, and the bowel can be rejoined after 6 to 12 months if the health of the patient permits.

Conclusion

Patients with diverticular disease may not have symptoms but those with diverticulitis present with a spectrum of gastrointestinal symptoms. If diagnosed and treated early, serious sequelae of complications can be avoided. Hence, make sure to visit a specialist if you have the symptoms mentioned above. Above all, eating food rich in dietary fibre and drinking plenty of water is seen to prevent the occurrence of diverticular disease. So, make sure to eat right and adopt a healthy lifestyle.