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Hereditary Diffuse Gastric Cancer: What You Need to Know

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HDGC, or Hereditary Diffuse Gastric Cancer, is an inherited condition that increases your risk of stomach cancer. Here’s what you need to know about the condition.

What is Hereditary Diffuse Gastric Cancer?

Hereditary Diffuse Gastric Cancer syndrome is passed down genetically. This condition causes signet-ring shaped cells to grow on the stomach wall. It can spread throughout the stomach, and it does not usually cause a mass. As a result, it is difficult to diagnose early on before symptoms occur with typical testing like an Upper Endoscopy. Later-stage symptoms of HDGC that can indicate the condition include weight loss, loss of appetite, vomiting, nausea, trouble swallowing, and stomach pain.

Only around 1-3% of all stomach cancers are HDGC, so this is a rare condition. It puts you at a higher risk of stomach cancer and lobular breast cancer. In particular, there is a higher risk of diffuse gastric cancer for people with the syndrome. Diffuse gastric cancer is a type of stomach cancer that tends to affect most of the stomach. Somewhere around 20% of stomach cancers are of this type.

Cancer risk for people in families carrying an HDGC gene is high. The risk of developing stomach cancer by age 80 is 67% for men and 83% for women. The lifetime risk for women with HDGC developing lobular breast cancer is around 20-40%.

Diagnosis

People with a family history of HDGC can receive genetic testing to identify gene mutations associated with the condition. There is no single gene mutation that indicates HDGC most of the time. In fact, in families with a strong history of diffuse gastric cancer, the most common gene mutation (CDH1) for this condition only accounts for around 30-50% of cases. In all cases of gastric cancers, CDH1 mutation only cause around 1-3% of cases. So, there are a particular set of circumstances that dictate whether genetic testing should be pursued. Family history has to be taken into account. The guidelines for testing for a CDH1 may include:

  • A diffuse gastric cancer diagnosis before age 35
  • A diagnosis of both diffuse gastric and lobular breast cancer
  • Over two cases of diffuse gastric cancer in a family
  • Multiple cases of diffuse gastric cancer in a family, with one or more diagnoses occurring before age 50

Reducing Cancer Risk

People with an HDGC diagnosis or confirmed CDH1 gene mutation have a few treatment options. Unfortunately, as alluded to earlier, early screening for HDGC is very difficult since the diffuse cancer involved is hard to detect. People with a CDH1 mutation may want to consider getting their stomach removed through a prophylactic total gastrectomy, as this is the only proven way to completely prevent diffuse gastric cancer. This is a significant surgery with long-term side effects, so you should discuss the option thoroughly with your doctor. If you do not want to pursue the surgery, intensive surveillance is another option. This involves an annual EGD (Esophagogastroduodenoscopy) with multiple mucosal biopsies. Additionally, women at risk of HDGC should consider early breast cancer screening starting at age 30. They may also want to consider biannual clinical breast examinations, monthly self-examinations, and frequent breast imaging tests.

Our experienced team at GHP has years of experience screening for and treating conditions including HDGC. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

What is Anorectal Manometry?

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Anorectal Manometry is a procedure that measures the function of anal and rectal muscles. This test helps doctors measure function and pressure in sphincter muscles involved in bowel movements. Here’s what you need to know about the procedure.

When is Anorectal Manometry used?

Anorectal Manometry is used to help evaluate patients with fecal incontinence or constipation. As a type of manometry, it measures the coordination and force of smooth muscles. In particular, it can help evaluate the strength and coordination of sphincter muscles. In short, Doctors use Anorectal Manometry to investigate in cases of abnormal bowel movements. So, if you have difficulty passing stool, struggle with uncontrolled bowels, or experience constipation, your doctor may recommend Anorectal Manometry. Doctors also use Anorectal Manometry to assess anal and rectal muscles pre and post-surgery, investigate functional anorectal pain, and make differential diagnoses regarding anal pain.

Preparing for the Procedure

There are a few preparatory steps you need to take before an Anorectal Manometry. Your doctor will give specific instructions before the procedure. You should not eat or drink anything starting midnight the night before the test. Additionally, your doctor may ask you to take one or two enemas a few hours before the test to empty your bowels. You should also discuss any medications you are taking before the procedure. In particular, you should not take smooth muscle relaxants the day before the procedure.

During the Anorectal Manometry Procedure

Anorectal Manometry does not involve any sedatives. During the procedure, you will lie on your left side with your knees bent. Your doctor will slowly insert a small catheter (tube) through your anal sphincter to your rectum. The catheter has a balloon attached at the end. Once the balloon is in place, your doctor will attach the exposed end of the tube to a machine that inflates the balloon. Your doctor will then measure the muscle coordination and strength in your rectum and anal sphincter. You may be asked to squeeze, push, and relax at various points as they are performing the testing. The machine measures subsequent pressure changes in the balloon. Your doctor may also measure other things like rectal volume, sensation, and muscle reflexes. Once they complete measurements, your doctor will deflate the balloon and remove the catheter and balloon. The procedure takes around 30-45 minutes in total.

After the Procedure

Since no anaesthetic is used during the test, recovery is immediate. You can resume normal activities and diet. Your doctor will discuss their findings with you after the procedure. This can take some time depending on their findings.

Depending on the findings, your doctor may make some recommendations. These may include dietary changes, using certain medication, and muscle strengthening exercise. In some cases, surgery may be required.

Our experienced team at GHP has years of experience performing procedures including Anorectal Manometry. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Chronic Diarrhea: What You Should Know

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Chronic diarrhea can be caused by a variety of things, including infections, GI disorders, food intolerance, and a reaction to medication. Let’s take a closer look at the condition.

Causes and Risk Factors

Diarrhea is chronic when it occurs three or more times per day for more than two weeks. It has several potential causes. Infection is one main cause. This infection can be parasitic, and from parasites like Giardia or Cyclospora. Infection can also be bacterial, from bacteria like Salmonella and E. coli. Some viral infections cause chronic diarrhea too, like some rhinoviruses and rotoviruses.

Outside of infections, there are several other potential causes. Pancreatic disorders like pancreatitis and cystic fibrosis can be a cause. GI diseases like Chrohn’s and IBS can cause diarrhea as well. Intolerance to foods can be at play too- lactose intolerance and fructose malabsorption are two examples. Additionally, some medications like laxatives and antibiotics can cause chronic diarrhea.

Symptoms of Chronic Diarrhea

As previously mentioned, diarrhea becomes chronic if it occurs three or more times per day for two or more weeks. Diarrhea is characterized by loose, watery stools that occur often more frequently than usual. Other symptoms include abdominal pain, abdominal cramps, bloating, nausea, blood or mucus in stool, and a fever. It also dehydrates you over time. If left untreated, this can be very dangerous. You should always see a doctor for chronic diarrhea.

Diagnosis

Chronic diarrhea itself is simple to diagnose, based on the definition outlined above. When you see a doctor for chronic diarrhea, they will work to diagnose the underlying cause. Depending on your symptoms, medical history, medications, the results of a physical exam, and other factors, they will select the appropriate testing measures. Stool samples can be tested to help identify if parasites, bacteria, or viruses are a cause. Your doctor may also want to do a blood test. If initial testing does not reveal a cause, your doctor may order an x-ray or endoscopy.

Chronic Diarrhea Treatment and Prevention

The cause of the condition dictates its treatment. With any case of diarrhea, fluid replacement is key. You should consume fluids and salts to replace those lost through diarrhea, unless otherwise ordered by your doctor. Some fruit juices and soup can be good options here. If liquids are upsetting your stomach, your doctor may recommend an IV to help rehydrate you.

Diarrhea caused by infection can often be treated with antibiotics or other medications. Your doctor will prescribe the proper medication for you depending on your case. If infection isn’t the cause, it will likely take more time to determine the underlying cause and therefore appropriate treatment. Conditions like IBS, Chrohn’s, fructose malabsorption, and Ulcerative Colitis all have their own treatment approaches. Your doctor will work with you to determine the best treatment options depending on the underlying cause.

Preventing chronic diarrhea involves mitigating risk factors for its various causes. To avoid infections that cause diarrhea, always drink safe, clean, properly-treated water. You should also use good food handling techniques, and practice good hand hygiene after using the bathroom and around food. If some foods trigger diarrhea for you, narrow down what they are and avoid them if possible.

Our experienced team at GHP has years of experience treating GI conditions like chronic diarrhea. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Bile Duct Diseases: An Introduction

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Bile ducts are tubes that primarily carry bile from the liver and gallbladder to the small intestine to help digest fats.

Several diseases in the bile ducts can prevent proper bile duct functioning. Read along to find out more.

Bile duct disease

There are several bile duct diseases that can occur. Gallstones are one common issue for bile ducts. These form when deposits of digestive fluid harden in the gallbladder. They can cause inflammation, increasing pressure in the gallbladder and potentially blocking a bile duct. Another common bile duct condition is cholangitis, which is inflammation in the bile duct system. This is often caused by a bacterial infection.

Bile ducts can also have strictures (narrowing). In other cases, they can leak. Cancer can also occur in the bile ducts. Bile duct cancer is rare and aggressive. Additionally, some infants are born with a condition called biliary atresia, in which bile ducts are scarred and blocked. This causes a buildup of bile in the liver and can damage it.

Symptoms of Bile Duct Diseases

Bile duct diseases tend to have some of a group of symptoms. These include abdominal pain, nausea, vomiting, itchy skin, fever, chills, weight loss, loss of appetite, and jaundice. Pain may occur in the upper abdomen and radiate to the back in some cases. Depending on the disease, these symptoms can be at differing levels of severity and present in varied ways. The progression the disease also influences the severity and types of symptoms.

Diagnosis

Doctors diagnose bile duct diseases in a few different ways. Bilirubin blood testing can identify high levels of bilirubin in your bloodstream and can diagnose jaundice. Doctors can perform an Endoscopic Retrograde Cholangiopancreatogram (ERCP) to diagnose diseases. In an ERCP, they can inject contrast dye to help image your bile ducts during an x-ray. They can also perform an Endoscopic Ultrasound (EUS) to examine your bile ducts and make a diagnosis.

Treatment

Treatments vary depending on the type of bile duct disease. ERCP, in addition to helping with diagnosis, can help treat disease. Doctors can pass tools through the endoscope during an ERCP and open blocked ducts, remove or break up gallstones, insert stents, and even remove tumors. Doctors can also help drain bile during an EUS by inserting a stent to help drain into the small intestine or stomach. One other emerging treatment involves using Radiofrequency Ablation for palliative care to treat the symptoms of bile duct cancer. This can be a way to manage pain for long-term cases of cancer.

Surgery may also be necessary in some cases. For example, with patients who have bile duct cancer, surgery can help to remove tumors. If tumors are very large, doctors may need to remove the liver and perform a liver transplant.

Our experienced team at GHP has years of experience treating conditions including bile duct diseases. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Retrograde Cholangiopancreatogram (ERCP): A Brief Overview

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An Endoscopic Retrograde Cholangiopancreatogram (ERCP) is a therapeutic endoscopic procedure that helps diagnose and treat diseases in the liver, gallbladder, pancreas, and bile system. Here’s what you need to know about the procedure. 

When an ERCP is used

There are several reasons your doctor may perform an ERCP. One common reason is to diagnose and treat gallstones that are trapped in the bile duct. They may also perform an ERCP to identify the source of persistent upper right side abdominal pain, to identify a cause of pancreatitis, or to relieve bile duct obstruction caused by tumors. Often, doctors will inject a dye in the bile ducts during an ERCP to assist with X-ray imaging.

Preparing for an ERCP

There are a few important steps to prepare for an ERCP. You will need to discuss any medications you are taking with your doctor. Blood-thinning medications like Coumadin (warfarin), Eliquis (apixaban), Lovenox (enoxaparin), Plavix (clopidogrel), Pradaxa (dabigatran), and Xarelto (rivaroxaban) are especially important to discuss. These can increase the risk of severe bleeding during the procedure, and you should stop taking them before the ERCP. Also, if you use insulin, you may need to adjust timing or dosage on the day of the procedure. Your doctor will also need to know if you have any allergies to medications. Additionally, you will need to fast starting the midnight prior to your procedure. This means avoiding eating from that time until your procedure. 

During the Procedure

Prior to the ERCP procedure, you will go to a pre-op area where nurses will place an IV and take your medical information. You will also speak with an anesthesiologist about the sedation used during the procedure. 

Once you have moved to the procedure room, you will be connected to machines that monitor your vitals during the ERCP. You will be sedated during the procedure. Your doctor will feed the endoscope through your mouth and perform the procedure. The specific techniques and treatments they use will depend on your situation, and include opening blocked ducts and inserting stents. They may also take X-rays during the procedure. Contrast dye is injected through the endoscope to assist in developing X-ray imaging of your bile ducts. In total, the ERCP should take around 30-40 minutes. 

After the Procedure

After the ERCP, you will go to a post-op area to recover from sedation and the procedure and will be monitored for complications. Once you have recovered, your doctor will discuss the results with you, though any biopsies will take a few days to return. You should not operate machinery, drive, or make important decisions for 24 hours after your procedure due to sedative effects. 

It’s common to have a sore throat immediately after the procedure; throat lozenges can help treat soreness. You should follow a clear liquid diet after the ERCP, eventually transitioning to bland foods. 

The procedure has a few uncommon risks. Around 7% of patients experience pancreatitis, an inflamed pancreas. This requires hospitalization to rest the pancreas and manage inflammation. In very rare cases, this can be severe and lead to surgery, organ failure, or death. 

In very rare cases, perforation occurs during the procedure. Most of the time, this can be managed with hospitalization, bed rest, antibiotics, and bowel rest. Rarely, you may need surgery to repair the perforation. 

There is a low risk of bleeding as well, which occurs in around 0.5% of cases. When managed during the procedure, it can be stopped. Delayed bleeding requires patients to return to their doctor for treatment. 

Our experienced team at GHP has years of experience performing ERCPs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Endoscopic Ultrasound: How to Prepare

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An Endoscopic Ultrasound (EUS) is a procedure for assessing and producing images of the digestive system with an endoscope. It is also used as a modality to treat certain gastrointestinal disorders through fine-needle aspiration (FNA). Follow along for an overview of EUS. 

When an Endoscopic Ultrasound is used

An EUS can help doctors determine the source of chest pain, abdominal discomfort, and other symptoms. It can also help them evaluate the extent of disease spread in your digestive tract, and evaluate findings from other diagnostics like MRIs or CT scans. It can help evaluate conditions including Barrett’s Esophagus, Lymphoma, and various cancers. 

There are many different therapeutic procedures that can be performed during an EUS. These include celiac plexus neurolysis (EUS-CPN), pseudocyst drainage, biliary drainage (EUS-BD) and liver biopsy. Each of these treatments has a unique set of steps involved. Below, we will take a look at some general steps and approaches involved with the various diagnostics and treatments performed through an Endoscopic Ultrasound. 

Preparing for an EUS

The way you need to prepare for an EUS depends on the specifics of the procedure and any therapeutic treatments in your case. In general, you often need to fast starting the midnight before the procedure. This helps empty your stomach. You may also need to discuss any medications you are taking with your doctor before the procedure. It is especially important to stop taking any blood-thinning medications leading up to the procedure. These medications can increase the risk of severe bleeding during the Endoscopic Ultrasound. If the EUS is being performed in the rectal area, you may need to undergo a cleansing routine to prepare your bowels. This usually consists of taking a liquid laxative and sticking to a liquid diet for a day before the procedure. 

During the procedure

On the day of your Endoscopic Ultrasound procedure, you will first go to a pre-op area where your medical information will be taken and you will be given an IV. You will also discuss sedation used during the procedure with an anaesthesiologist. 

Depending on the location in your GI tract that doctors will examine or treat, they will advance an endoscope through your mouth or a colonoscope through your anus. You will be on your left side and may be sedated as this happens. Your doctor will advance the scope to the site or sites of interest and then perform any diagnostics or treatments. This can include tissue biopsies, pain-relieving injections, pseudocyst drainage, and bile duct drainage, depending on your situation. Your doctor will be able to see your GI tract through a camera at the end of the scope, and will pass any necessary instruments through the scope to perform the procedure. Most EUS examinations take under an hour, but the exact time will vary depending on what diagnostics or treatments your doctor is administering. 

After an Endoscopic Ultrasound

After your procedure, you will go to a post-op area where you will recover from any sedation and be monitored for side effects of the procedure. Once you are recovered, your doctor will share results with you. Some biopsy results may take longer to return. Given sedation side effects, you should not operate machinery, drive, or make important decisions for 24 hours following the procedure. 

Endoscopic Ultrasounds have a relatively low risk for complications. If you underwent Celiac Plexus Neurolysis to provide pain relief for tumors, you may experience abdominal pain for a few hours and diarrhea for a few days. More rarely, bleeding, infection, and paralysis can occur. If you underwent Pseudocyst Drainage, there is a small risk of bleeding, infection, and pancreatitis. Additionally, in under one percent of cases, perforations occur, requiring surgery to repair. If you underwent Biliary Drainage, there is a 10-20% chance of mild complications associated with bile drainage. These include bleeding, infection, and bile leakage in the abdominal cavity. If you underwent a Liver Biopsy, complications are very rare, and include a small risk of bleeding and infection. In general, if you were sedated during your procedure, there are a few uncommon complications including aspiration, adverse reactions to sedative medication, and complications from lung and heart diseases. 

Our experienced team at GHP has years of experience performing Endoscopic Ultrasounds. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Mucosal Resection (EMR): An Overview

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Endoscopic Mucosal Resection, or EMR, is a therapeutic technique that helps remove precancerous and early stage cancer lesions during an upper endoscopy or colonoscopy. This technique is a less-invasive alternative to surgery. Here’s what you need to know if you are preparing for an EMR.

When is an Endoscopic Mucosal Resection Used?

EMRs are used to remove abnormal tissues in the digestive tract. The procedure can help treat a variety of conditions including Barrett’s Esophagus, colorectal cancer, and colon polyps. This is a less invasive option than surgery for removing abnormal tissues in the digestive tract. While EMRs are often used to treat disease, your doctor may also collect tissue samples during the procedure. They can examine tissue they collect to determine a diagnosis and the scope of disease spread. 

Preparing for an EMR

There are several important steps you need to follow prior to an Endoscopic Mucosal Resection. Your physician will discuss each of these with you leading up to the procedure. First, you may need to stop taking certain medications. These include blood-thinning medications like aspirin, Plavix (clopidogrel), Xarelto (rivaroxaban), Lovenox (enoxaparin), Pradaxa (dabigatran), Coumadin (warfarin), and Eliquis (apixaban). Blood-thinners increase your risk of excessive bleeding during the procedure. Also, if you use insulin, you may need to adjust your dosage and timing before the procedure. Make sure you discuss all medications you use with your doctor. 

Additionally, you will need to follow a clear liquid diet the day before the procedure, and stay hydrated. You will also need to fast beginning the midnight before your procedure. For EMRs performed through a colonoscopy, you will also need to undergo a cleansing routine. This involves taking a liquid laxative the day before your EMR to prepare your bowels. 

During the procedure

EMRs are performed through either an upper endoscopy or a colonoscopy, depending on the location of the diseased tissue. When you arrive for your procedure, you will go to a pre-op area where nurses will take your medical information and place an IV. You will also speak with an anaesthesiologist about the sedation they will use for the procedure. 

You then will go to the procedure room and be connected to monitors that will measure your vitals during the EMR. You’ll be sedated at this point. If the procedure is done through an upper endoscopy, you will be placed on your left side and given a bite block so the endoscope can pass through your mouth safely. If it is done through a colonoscopy, you will also be placed on your left side so the colonoscope can pass through your anus and advanced into the colon. 

Your doctor will be identifying and removing lesions during the EMR. There are several ways to remove lesions. Your doctor may inject a liquid into the submucosal layer under the lesion, which acts as a pillow that lifts the lesion for easy removal. They may also use a suction or a rubber band to help lift the lesion. After the lesion is lifted, it will be captured with a snare and the removal site will be cauterized. The procedure takes around 20 to 60 minutes.  

After the Endoscopic Mucosal Resection

Following your EMR, you will move to a post-op area to recover from sedation and monitor for any complications. Once you have recovered, your doctor will talk to you about the findings and give you post-op recovery instructions. You should not drive or make important decisions for 24 hours following the EMR due to sedative effects. You should follow a clear liquid diet immediately following the procedure, and can later transition to bland foods and a more regular diet. 

Complications from an EMR are uncommon. This includes bleeding, which occurs in 5-10% of cases. Your doctor can usually stop bleeding during the procedure if they recognize it. However, bleeding can become severe if it is delayed and may require follow-up care. In other rare cases (1-2% of the time), perforation of the intestine can occur. This is often managed through antibiotics, bowel rest, and hospitalization. It may require surgery as well. Additionally, some patients have reactions to sedative medication in uncommon cases. Always contact your doctor if you have any severe symptoms like abdominal pain, a fever, or excessive rectal bleeding after the procedure, as they may indicate a severe complication. 

Our experienced team at GHP has years of experience performing EMRs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Single Balloon Enteroscopy: A Closer Look

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Single Balloon Enteroscopy is a procedure that allows doctors to examine the small intestine. Follow along for everything you need to know about the procedure.

When Single Balloon Enteroscopy used

A Single Balloon Enteroscopy is used to examine, diagnose, and treat diseases in both the upper and lower GI tract. The advantage of the procedure is that it gives access to the entire small intestine, which is around 20 feet long on average. Other procedures cannot provide reach to effectively examine or treat the small intestine. The Single Balloon Enteroscopy lets doctors get access and live imaging of parts of the GI tract that are otherwise inaccessible. This is important for examining sources of GI bleeding, taking biopsies, removing polyps or foreign objects, and enlarging strictures.

Preparing for the procedure

There are a few important pre-operative steps you need to take prior to a Single Balloon Enteroscopy. You will need to discuss any medications you are taking with your doctor. Certain blood-thinning medications can pose risks of excessive bleeding during the procedure. Additionally, if you take insulin, you may need to adjust timing and dosage leading up to the procedure.

You will need to adhere to a clear liquid diet the day before the procedure. You will also be asked to refrain from eating starting the midnight before the procedure. In addition to these steps, you will need to use a cleansing routine the day before your procedure. This entails a liquid laxative that clears and prepares your bowels for examination. Your doctor will give clear instructions for all of these important steps leading up to your Single Balloon Enteroscopy.

During Single Balloon Enteroscopy

On the day of your procedure, you will first check in to a pre-op area where nurses will place an IV and take medical information. You will also meet with an anaesthesiologist to discuss sedation during the procedure.

The procedure takes around 60-75 minutes total. Your doctor will use a balloon system consisting of a flexible endoscope with a camera, an overtube, and an attached inflatable balloon at the tip of the overtube. They first insert the endoscope down your throat and into your intestine (you will have a mouthguard to protect your teeth and the endoscope). They will inflate the balloon to anchor the overtube, and then advance the endoscope further into your small intestine. Cyclically, they can then deflate the balloon, advance the overtube, reinflate the balloon, withdraw the overtube to shorten and straighten your small intestine, and advance the endoscope further. This pleats the small intestine over the overtube, shortening the small intestine’s length.

The endoscope is also able to inflate your intestine, rinse it with water, and guide biopsy and cautery instruments. Since you will be sedated, given pain medications, and given a local oral anaesthetic, the procedure is pain-free.

After the procedure

Following the procedure, you will return to a post-op area to recover from sedation. Nurses will monitor you for potential complications. After recovery, your doctor will discuss findings with you, although some results for biopsies and polyp removal can take a few more days to be finalized). You should not drive, make important decisions, or operate machinery for 24 hours after the procedure due to sedative effects.

You may feel bloated for a few hours after the procedure, which is normal. There are few severe complications and risks associated with Single Balloon Enteroscopy. On rare occasions, the procedure can cause perforation, excessive bleeding, and complications from sedation. If you experience excessive rectal bleeding, severe abdominal pain, or a fever, contact your doctor immediately.

Our experienced team at GHP has years of experience performing Single Balloon Enteroscopies We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Hemorrhoids: An Overview

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Hemorrhoids is a term given to a condition in which the veins around the anus or rectum become swollen or inflamed. They can occur inside the rectum or around the anus. Hemorrhoids are extremely common- around 3 in 4 adults will experience hemorrhoids, and about half of all people will have hemorrhoids by age 50. 

Here’s an overview of hemorrhoids. 

Symptoms of Hemorrhoids

The symptoms of hemorrhoids vary based on whether they are internal (inside the rectum) or external (around the anus). External hemorrhoids can cause bleeding, pain, irritation or itching around the anus, and swelling around the anus. Internal hemorrhoids don’t usually cause any pain or discomfort, but they can cause bleeding during bowel movements. Sometimes, these can also push through the anus (prolapse), which can lead to irritation and pain. 

Causes and Risk Factors

The veins around your anus stretch under pressure, and may swell or bulge as a result of too much pressure. As such, anything causing this pressure can cause hemorrhoids. This includes straining during bowel movements, heavy lifting, anal intercourse, having a low-fiber diet, being pregnant, being obese, and sitting on the toilet for long periods of time. 

The risk of developing hemorrhoids increases with age. Tissues supporting veins in the anus and rectum weaken and stretch with age, and can increase risk. Additionally, this same stretching and weakening can happen during pregnancy as baby weight puts pressure around the anus.  

Treatment for Hemorrhoids

Treatment can often take place at home, and for mild cases includes using medications and taking warm baths. Larger or more persistent cases may be cause for seeking further medical attention. Doctors may recommend surgery or banding. Banding is non-invasive and non-surgical. To perform banding, a doctor places a rubber band around a hemorrhoid to cut its blood supply and cause it to wither. This may be recommended for cases with significant persistent bleeding. Typically, two or more cases are required for treatment with banding. 

Prevention

Preventing hemorrhoids involves a few simple lifestyle changes and home remedies. First, eating the proper amount of fiber is important; fiber softens stools and makes them easier to pass, decreasing the likelihood of straining or pressure. Exercise also helps, stimulating bowel function and keeping you regular and less likely to have straining bowel movements. Try not to sit for long periods of time, as it can increase pressure around the anus. Always use the bathroom as soon as possible when you need to defecate as well- waiting can cause build-up and increase strain. Don’t strain during bowel movements either, as this will add pressure around your anus and rectum. All of these simple behavior changes can be incredibly effective prevention measures. 

A warm bath for the buttocks can also help relieve irritation around the anus. A 20 minute warm bath after defecation and a few more baths each day can ease any potential flare-ups. Last, avoiding hard sitting surfaces can prevent hemorrhoids from forming, and also helps ease symptoms of existing ones. 

Our experienced team at GHP has years of experience helping people manage and treat hemorrhoids. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Everything You Should Know About Constipation

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Constipation is a gastrointestinal condition which is generally characterized by three or fewer stools passed in a week. It is very common and affects around 30% of the population. Here’s everything you should know about constipation. 

Symptoms of Constipation

Constipation is defined by a few key symptoms. These symptoms include passing three or fewer stools in a week, having difficulty passing stools, having hard or dry stools, noticing blood in stool, having intense rectal or abdominal pain, and feeling like stool is not completely passed. Mild symptoms often resolve quickly, so they are usually not cause to seek medical attention. However, serious symptoms like blood in stool or needing to manually remove stool are signs that you should seek medical help. 

It’s important to note that not having a bowel movement every day is not necessarily a sign of constipation. Bowel habits fluctuate for everyone based on a variety of factors. However, you should use the described symptoms as a guide to determine if you need medical help. 

Causes and Risk Factors

Constipation most often is caused by stool moving too slowly in the digestive tract. Slow-moving stool is not effectively passed and can become hardened and dried out. Slow-moving stool can happen for a variety of reasons. Blockages from anal fissures, a bowel obstruction, bowel strictures, and certain cancers can lead to constipation. Also, neurological problems can affect nerves that help move stool through the digestive tract. These problems include Parkinson’s disease, Multiple Sclerosis, and spinal cord injuries. Muscular problems can be the root cause too. Weakened pelvis muscles, improperly coordinated pelvic muscles (dyssynergia), and chronically unrelaxed pelvic muscles (anismus) can all prevent proper stool movement. Hormones can play a role sometimes as well. Hormones that help balance fluids may be unbalanced for people who are pregnant, diabetic, or have an underactive thyroid. 

There are a few risk factors for constipation. Older people and women are more likely experience constipation. Dehydration, a low-fiber diet, a sedentary lifestyle, some medications, and mental health conditions including depression and eating disorders are also risk factors. 

Treatments and Prevention

In most cases, constipation can be treated easily. Most of the time, constipation is a disorder of bowel function and not due to other structural issues. In these cases, focusing on softening stool and getting it moving again is the best treatment. You can do this by hydrating more, eating fiber, and getting more exercise. Sometimes, taking a laxative until the constipation passes may be helpful as well. You should consult a doctor for laxative use, especially if your constipation is severe or chronic. 

The same lifestyle changes that can treat constipation are also great ways to prevent it in the first place. Always drink plenty of fluids- six to eight glasses of water per day is a good baseline. However, this varies based on factors including your age, height, weight, sex, and activity level. Avoid consuming too much caffeine, which can cause some dehydration. Eat fiber-rich fruits, vegetables, and whole grains to promote regular bowel movements. You should aim for at least 20 to 35 grams of fiber each day. Regular exercise is another great way to promote bowel movements too. Finally, always use the restroom when you feel the urge. Holding it in can cause fecal matter to accumulate and lead to constipation. 

Our experienced team at GHP has years of experience helping people manage and treat constipation. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.