WE ALL HAVE HAEMORROIDS! 


I’m sure someone would say, “No, I don’t”. But the truth is, every healthy individual has haemorroids. These are swellings within the lowest part of the rectum and upper anus which consist of a confluence of blood vessels and connective tissues. They’re always there; even in the unborn child. They only become problematic when they protrude out of the anus (prolapse) or become strangulated, thrombosed or bleed. 

Up to 4% of the general population experience symptoms of pathological haemorroids but almost 70% of them are too embarrassed to seek medical attention. Symptoms can range from mild itching and pain, to severe engorgement, bleeding and infection. Haemorroids can be categorized as internal and external, depending on the level of protrusion. 
What are the causes and risk factors? 
-Prolonged sitting: resulting in obstruction to blood flow 
-Pregnancy and vaginal childbirth: effects of hormones and pressure from the enlarged abdomen. 
-Lack of erect posture
-Chronic constipation: regular straining 
-Prolonged use of stool softeners
-Genetic predisposition 
-Higher socioeconomic status
-Chronic diarrhea
-Colon cancer 
-Other huge intra-abdominal masses
-Chronic liver disease
-Obesity
-Spinal cord injury
-Loss of rectal muscle tone: as occurs in old age
-Previous rectal surgery
-Episiotomy
-Anal intercourse
-Inflammatory bowel disease, including ulcerative colitis, and Crohn disease

Treatment depends on the type and severity. It can be conservative, medical or surgical. 
*Conservative: 

-Avoid constipation: consume at least 25g of fibre daily (obtainable from fruits, vegetables and whole grains), drink lots of water (at least 3 litres daily) 
-Weight loss: regular exercise and low-fat, low-carb diet
-Avoid prolonged sitting on the toilet: for those of you who love reading or texting in the toilet! 
-Avoid prolonged sitting at work: take intermittent short walks
-Improved anorectal hygiene
-Warm bath: treat yourself to a nice soothing time in the bathtub! 

*Medical:
-Stool softeners: to avoid straining during defecation which worsens the symptoms 

-Analgesics: to relieve the pain

-Approved herbal remedies: such as witch hazel (Hamamelis water) 

-Vasodilators: to reduce the spasm and engorgement 

-Local anesthetic ointments and injections: to relieve pain and discomfort  

-Anti-pruritic: to relieve itching (eg. Calamine lotion) 

-Treatment of underlying cause: such as liver disease and portal hypertension

 
*Surgical:

-Only 5-10% of haemorroids will require surgical intervention: severe, recurrent symptoms that are refractory to conservative and medical treatment. 

-There are many options but the ultimate is the removal of the haemorroids (haemorroidectomy) 

-Recurrence rate is very low (less than 5%) compared to medical treatment (10-50%)

-Complications are rare when done by expert surgeons.

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VULVAL ITCHING (PRURITUS VULVAE) 

Vulval itching is quite common and can be very disturbing. Up to 10% of women experience this symptom and need to see a doctor for a persistent itch. If left untreated, it can lead to soreness, ulceration and infection. 

What are the common causes of vulval itch? 
*Infections:

-Candidiasis (yeast infection) 

-threadworm (often due to poor perineal hygiene) 

-genital lice

-scabies 
*Vulval skin diseases 

-lichen sclerosus (a chronic inflammatory disease of the anus and genitals) 

-vulval dermatitis (can be an allergic reaction to soaps, creams or fabrics) 

-lichen planus (a rare cause) 

-vulval psoriasis (well-defined reddish or whitish patches with scaling around the pubic area) 
*Vulval pre-cancerous growth or vulval cancer
*Urinary incontinence (constant soiling and irritation) 
*Systemic conditions (liver failure, kidney failure, diabetes, etc.) 
*Medications (eg. Chloroquine) 
*Hormonal changes (as in pregnancy and menopause) 
*Unknown causes (idiopathic) 
Management basically depends on the cause, but there are general measures that can be taken. 
1. Avoid scratching. It sounds impossible but that’s just the truth. The more you scratch, the more histamine is released into the skin, and the more you feel like scratching! Cut your nails short, resist the urge and avoid the irritants, if known. 
2. Anti-histamines. These are drugs that break the itch-scratch-itch cycle. Opt for sedating ones (such as piriton) at night, so that you can sleep well! 
3. Identify the actual cause and treat appropriately. You may need some invasive tests like high vaginal swab (for microbiological analysis), skin biopsy, skin scrapping and blood analysis. For example, yeast infection can be easily treated with antifungal creams and pessaries. 
4. Practise general vulval and perineal hygiene. Vulval itching is sometimes due to urinary or fecal contamination. 
5. Apply simple, natural, non-perfumed emollients (such as olive oil, shea butter etc.)
6. Use weak steroid creams (sparingly, with physician prescription only) for a short period. This is the best option for chronic itching. 
7. Avoid sexual intercourse until your condition has resolved. Encourage your sexual partner to get treated for STI too (if that is the cause). 

VULVAL CARE 101

Good perineal care tells a lot about your personal hygiene as a woman. It enhances your sexual health, boosts your confidence and improves your general wellbeing. It’s even more important during pregnancy as pathogens in the genital tract can be passed on to the baby during childbirth. The vagina has lots of “friendly bacteria” which help to eliminate harmful microbes. Even though the vagina is self-cleansing, the rest of the external genitalia must be cleaned regularly to avoid upward migration of these pathogens. 

Here are some useful tips… 
*Keep the area clean but avoid using soap. Soaps kill your friendly bacteria (the normal flora) and allow the growth of pathogenic ones

*Clean from front to back to avoid introducing faeces into the vagina.

*Clean the area after urinating, preferably with water; urine is a powerful irritant. 

*Clean the vulva immediately before and after sexual intercourse. This goes a long way in preventing sexually transmitted diseases. 

*Dry out the extra moisture after rinsing: use a clean dry towel, guaze or toilet paper.

*Opt for soap-free shower gels, bath oils, or just plain water.

*Salt baths may help relieve irritation but don’t use routinely. 

*Allow air circulation to avoid sweating. 

*Minimise tight clothing eg. Jeans. 

*Use loose underwear and bed clothes.

*Consider removing underwear at bedtime or whenever the weather is hot. 

*Avoid synthetic underwear, like nylon, and wool. Opt for cotton. 

*Minimise the use of vaginal lubricants, especially perfumed oils. Go for natural oils like olive and almond oils. 

*Avoid douching. 

*Avoid insertion of creams, suppositories and other chemical substances, unless prescribed by a doctor. 

*Avoid indiscriminate use of vaginal tightening creams. Consult a doctor for expert advice. 

Stress as a Lifestyle Disease

Are you interested in hearing more about stress and its health effects?

Stress is not really a disease or a diagnosis in itself. It is generally defined as a feeling of threat to your physical or mental well-being. This feeling is worsened  when you think your normal coping mechanism  is inadequate.  These may present in the form of job stress, relationship conflicts, or even money problems.

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Chronic stress often may be experienced with symptoms of fatigue and low energy, but may also be associated with irritation, sleep disturbances, and feeling depressed or down. The physical symptoms of chronic stress can include headaches, GI upset, and muscle tension, among others.

So what are the effects that stress can have on our bodies?

Chronic stress may give rise to medical conditions such as heart disease, heart attacks, strokes, high blood pressure, depression, and anxiety disorders.

The good news is there are many simple, inexpensive strategies available to choose from. When employed in a regular, consistent way, these strategies significantly moderate the impact of both acute and chronic stress.

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There are no specific laboratory tests for stress. The doctor’s approach will be based on your presenting complaint (which can vary considerably with stress) and the presence of any suspected underlying disorders based on your history and physical examination. Generally, a full blood count to check your blood levels, other investigations to rule out infections will be done. A fasting lipid profile (cholesterol) may be needed and some hormones like the thyroid hormones may be screened.

Inform the doctor of any supplements or herbal preparations that you are using or are considering to use. We doctors frown on some herbal mixtures, but we may just surprise you!

How to deal with Stress

Sleep
Improving poor sleep patterns will have the greatest potential for fatigue reduction. Research has shown that poor sleep lasting one year is associated with a subsequent major depression, an anxiety disorder, and for substance abuse.

Common sleep hygiene recommendations include the following:

  • Avoid evening use of caffeine, alcohol, or tobacco.
  • Establish a regular wind-down period one to two hours before bedtime, in which stimulating activities such as work or exercise are not done.
  • Avoid television late at night.
  •  Regulate noise and temperature extremes in the bedroom when attempting to sleep
  • Stimulus control methods include using the bed only for sleep and sex (no reading or TV in bed) and going to bed only when drowsy. If not asleep in 20 minutes you get up, go to another room, engage in a relaxing non-stimulating activity such as reading or very light housework, and do not attempt to sleep until you’re drowsy again (repeat this pattern as often as necessary). Stimulus control techniques are associated with a 58% reduction in sleep onset time
  • You can keep a sleep diary for the two weeks to help track any subsequent changes to your sleep status. As a way of monitoring progress you can rate your energy levels on a scale from 1 to 10 and record them on a daily basis.

Exercise

Regular aerobic exercise has been shown to have a positive influence on mental health outcomes largely in the area of mood enhancement. Moderate exercise is associated with improving;

  • Immediate mood and energy.
  • Mood and energy boost over weeks.
  • Long-term sleep quality (avoid within three hours of bedtime)

Start small

  • 10- to 20-minute brisk walk at lunch during the week for at least three days a week.
  • The weekends may provide additional opportunity to exercise by being active or playing sports with your children, friends or colleagues.
  • You can use the gym, dance, walk up and down your staircase, just be creative and sweat!

Behavioral methods

Many activities can reduce tension and foster the feeling of calmness. Common activities can include physical activity, listening to music, walking with a friend, reading, or practicing a repetitive leisure activity such as gardening, pottery, or woodwork.

More formal types of calming activities that involve inducing a relaxation response, such as meditation and yoga have been studied and often show an accompanying decrease in heart rate, breathing rate, blood pressure, and a metabolic slowing coupled with feelings of peace and relaxation.

Relaxation techniques are also used to decrease sleep latency. In addition to a regular daytime relaxation practice, it is suggested that the relaxation response technique be used after closing the eyes when attempting to go to sleep at night. There is a significant improvement in sleep onset time if relaxation techniques are practiced and a greater benefit (up to 77% reduction in sleep onset time) if relaxation techniques are combined.

Healthy lifestyle behaviors are protective and negative coping behaviors will likely worsen the long-term effects of stress. The following strategies should be avoided whenever possible:

  • Overuse of alcohol
  • Smoking
  • Frequent use of caffeine
  • Overeating or under-eating
  • Regular or inappropriate use of over-the-counter medications

Alcohol does hasten sleep onset but the toxic effect of ethanol metabolites can disturb normal sleep architecture later in the night. In addition, regular alcohol use can worsen the effects of chronic stress.

Consider limiting coffee to a maximum of two cups a day, as excessive use can be construed as negative coping as well. Although it may assist in reducing fatigue during the day, four to five 8 cups of coffee a day can increase subjective feelings of tension at work and amplify stress effects on blood pressure and heart rate.

Social Support

Social support is frequently under-assessed and under-utilized and they may protect against psychosocial stressors and subsequent adverse impact on health.

Social support may assist by positively influencing an individual’s response to cognitive and emotional states, as well as improving self esteem, self efficacy, and effect. Social support can positively influence health behaviors such as alcohol consumption, exercise, dietary patterns, and illicit drug use. Social disconnection is associated with alcohol consumption, inactivity, and obesity. Social support in general and specifically perceived emotional support, are associated with a reduction in the risk of depression and depressive symptoms following stressful life events.

Social relationships and contacts can also be negative and in turn be perceived as stressful. This is especially true with individuals who have frequent contact that includes conflict in the workplace or family. Negative lifestyle habits can also be influenced by social relationships. A person’s chances of becoming obese increased by 57% if he or she had a friend who became obese; and in marriage, if one spouse became obese, the likelihood that the other spouse would become obese increased by 37%.

So ask yourself

  • Do you have someone who you can really count on to help you feel more relaxed when you are under pressure?
  • Do you have someone who you can count on to be dependable when you need help?

If conflict or negative social relationships are contributing to stress, consider resolving this conflict first.

Weight Management

Weight gain combined with poor diet patterns increases the risk for developing metabolic syndrome. This can worsen stress coping mechanisms drastically. Abdominal obesity (waist circumference greater than 102 cm in men) as well as eating large amount of red meat/pork per day and consuming daily fried foods is associated with an increased risk of developing this metabolic disorder.

Periods of high stress are associated with increased consumption of high fat, low fiber “fast foods”. The number of times eating fast foods may increase by 37% during stressful weeks, and men in particular will increase red meat consumption by 45% during weeks rated as high stress.

A balanced diet and healthy nutrition are one of the most effective steps in weight management, especially when combined with physical activity. Explore taking a healthy lunch to work or alternatively looking for healthier and convenient restaurant choices.  Simple dietary guidelines such as reducing fat content and increasing dietary fiber (fruits and vegetables) have multiple long-term health benefits, and will contribute to maintaining a healthy weight when combined with a regular physical activity program.

Take a vacation

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This option is highly recommended for those who are tensed due to their work schedule and burn out almost on a daily basis in order to meet deadlines and cope with other work pressure. Work related stress accounts for majority of the complaints related to stress and it is because people tends to take their work home that they disrupt the environment that should refresh them in the first place.

Hope you can form strategies to cope with stress now, don’t hesitate to ask us questions or share our pages with loved ones.

Watch out for other articles on lifestyle diseases that will talk about obesity, hypertension and diabetes, chronic back pain and more.

Greater things are yet to come!

 

 

PEPTIC ULCER DISEASE 

Have you ever wondered how the digestive acids and enzymes act on the food we eat, but have no effect on our own digestive tract? Here’s why… Let’s take the stomach for example: one, there is a limit to the amount of gastric acid produced per meal, and two, there is a lining on the stomach which protects it from digesting itself. We can then understand how 1 in 10 adults develop gastric ulcers: either there’s too much acid production or there’s a breach in the integrity of the stomach protective coating, or both. Ulcers also occur in the upper part of the small intestine known as the duodenum (duodenal ulcers). 
Here are the causes and risk factors for PUD:
*Excessive intake of painkillers known as non-steroidal anti-inflammatory drugs (NSAID’s). Examples are aspirin, ibuprofen, piroxicam and diclofenac

*Excessive intake of alcohol

*Smoking, sniffing or chewing of tobacco 

*Infection due to a bacteria (Helicobacter pylori) – present in up to 70% of cases. 

*Severe physiological stress and hormonal changes such as in pregnancy and strenuous physical exertion 

*Severe debilitating diseases such as stroke, liver failure or cancer

*Family history of PUD

*Severe depression or bipolar disorders 

*Tumors of the stomach producing excessive acid

Symptoms of PUD include:
*Burning or gnawing pain in the upper abdomen

*flatulence 

*nausea and vomiting 

*weight loss

*vomiting of frank blood or “coffee grounds” (severe cases) 

*dark tarry stools (severe cases) 

*depression and social withdrawal 
Diagnosis is usually straightforward when the physician interviews and examines the patient. However, with severe and recurrent symptoms, some tests will be done, including endoscopy (a thin tube with a light source, passed through the throat into the digestive tract to visualize and check for any abnormality)
Once the diagnosis is confirmed, treatment can be conservative, medical or surgical. 
*Lifestyle modification: quitting alcohol and tobacco; avoiding triggers such as spices and fizzy drinks; healthy diet; regular exercise; frequent light meals; avoiding late-night meals; stress management and psychotherapy. 
*Medical: combination of acid-reducing drugs, antacid preparations, and antibiotics (to eradicate H. pylori) 
*Surgical: injection of substances to heal the ulcer (via endoscopy), repair of perforated ulcers, etc. 

Erectile Dysfunction

Is it time for a sexual function,
And then there is penile malfunction?
Have you lost your vigour
in such a way you can’t figure?
This is just a hiccup,
it isn’t time to give up

Erectile dysfunction (ED) is a man’s inability to achieve or maintain an erection suitable for satisfactory sex. Normally, when a man is sexually aroused, the penis fills with blood after a series of nerves send signals from the brain. A man that can’t achieve this important feat may be said to be impotent.

Problems with erections tend to become more frequent as a man gets older. Many people associate erectile dysfunction (ED) with older men, but it’s something younger men should take seriously, too. Several medical conditions, habits, psychological factors have been implicated. Listed below are conditions that can cause this problem

  • Diabetes
  • Stroke
  • Spinal cord injury
  • High cholesterol
  • Relationship problems
  • Performance anxiety
  • Past sexual trauma
  • Stress, depression, or anxiety
  • Medication side effects
  • Excessive drug or alcohol use

In clinical practices, the commonest causes are diabetes, hypertensive related diseases and  both of these diseases affect the nerve signals and blood supply to the penis respectively. Also, other common causes include stress and chronic fatigue syndrome, when a man feels exhausted in such a way that can’t be reasonably explained. Symptoms may also include muscle and joint pain, headaches, and trouble concentrating or remembering things. Resting and sleep usually doesn’t help.

Also, several medications have been implicated in making this condition worse. Sexual problems, such as decreased libido, orgasm difficulties, erectile dysfunction in men, and vaginal dryness in women, are common side effects of certain medications. The following list, while not exhaustive, gives the most common types of drugs known to have sexual side effects.

• Anti-anxiety drugs
• Antiepileptic drugs
• Antidepressants
• Antihistamines
• Antipsychotics
• Blood pressure medications, including diuretics (water pills)

How does erectile dysfunction (ED) affect a man’s self-esteem?

Many men associate erections with their identity. Erections are tied to their masculinity and feelings of self-worth. So when erectile dysfunction (ED) occurs, they may lose confidence in themselves and in their abilities to please their partner. Depression and anxiety are common in men with ED and can affect not only the sexual relationship but social and work activities as well. Partner support can also help men with ED-related self-esteem problems.

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sexual dysfunction man

How important are partners in the treatment of erectile dysfunction (ED)?

Studies have shown that treatment for erectile dysfunction (ED) is more effective when the patient has a supportive partner.

How can a partner be supportive? Here are some ideas:

  • Attend doctor’s appointments with the patient. A partner can provide additional insights and may think of questions that the patient overlooks.
  • Help the patient decide on a treatment plan.
  • Communicate. Help the man feel comfortable discussing ED, from the physical aspects to the emotional matters.
  • Be encouraging and upbeat.
  • Understand that overcoming ED takes time. Some men need to try different treatments before they find what works best for them. Patience and a willingness to try other ways of being intimate – aside from intercourse – can take pressure off the man and make him feel like he is still desired.

Working together as a team, both partners can cope more easily with ED treatment and, in turn, strengthen their relationship along with their sex lives.

Preventing (ED)

Men who eat foods high in antioxidants have a lower risk of erectile dysfunction (ED) than those who don’t. Foods like citrus fruits, blueberries, strawberries, apples, pears, cherries, and blackberries. Some teas, coffee, and herbs also have antioxidants in them. Diet should include vegetables, whole grains, and olive oil. Nuts and fish are good additions.

A man’s doctor can help him decide which dietary changes to make. However, men who are having trouble with erections should be sure to mention it. Many factors can contribute to ED and it’s best to have a complete medical checkup.

Here are the risk factors:

Smoking. Research has shown that men who smoke are at higher risk for ED. Often, erection problems are worse for men who smoke heavily and those who have smoked for a long time. Secondhand smoke may also interfere with erections. Smoking can also decrease amounts of nitric oxide, a compound that plays an important role in erections.

Obesity. For some men, obesity is linked to low testosterone, which can interfere with a man’s erections. Obesity also raises a man’s risk for heart disease and diabetes, which are common in men with ED.

High blood pressure (hypertension). High blood pressure is another condition that can cause atherosclerosis and restrict blood flow to the penis.  In addition, some medications used to treat hypertension are associated with ED.

Sedentary lifestyle. Exercise is important for good health on so many levels, including erections. It helps keep blood flowing smoothly throughout the body and to the penis. It also helps a man maintain a healthy weight.

As noted above, these risk factors are modifiable. There are things men can do to reduce their impact. Some actions include:

• Quitting smoking.
• Losing weight.
• Eating healthier food.
• Getting more exercise.

Men and women who suspect that a drug is affecting them sexually should first see their doctor. There are several options to consider: Give the medication more time, change the dosage, change the medication and in some cases, switching to an entirely new medication may help or adding another medication.

Any changes in medication should be made under a doctor’s supervision. Patients should not stop taking their medications as prescribed until they have discussed it with a healthcare provider.

What are some of the treatments for ED?

There are many treatment options available:

  • Oral medications. Phosphodiesterase-5 inhibitors help increase blood flow to the penis.
  • Penile injections. Men can learn to inject medication into the penis. This medication helps blood vessels dilate, allowing more blood for erection.
  • Urethral suppositories. These medications are inserted into the urethra at the tip of the penis.
  • Penile implants. Implants are surgically placed inside the penis and allow a man to get an erection when he wishes. There are several types of implants, from malleable rods that the man raises and lowers himself to inflatable devices controlled with a pump.

Consult a doctor, specifically an Urologist to help you choose the best option.

 

 

 

 

VAGINAL DISCHARGE: KNOW THE NORMAL

Under normal circumstances, the vagina is supposed to be moist; always. This is its way of telling you that, “hey! don’t touch me, I can clean myself”. However, normal vaginal discharge undergoes different changes at different stages of a woman’s life. And yes, even babies and prepubertal girls have this normal moisture. Parents should always pay attention to their children’s body so as to quickly detect any deviation from the norm. 

This writeup is going to focus on the normal, basically. So, if you notice anything outside these, go and see your doctor asap! 
Characteristics of normal vaginal discharge:

Colourless: clear, no debris, sometimes with a tinge of white.

Smooth: no curdiness (like cheese)  

Odourless: once it stinks, it’s abnormal 

Mucoid: sometimes stretchy or “drawing” (like okro)

Non-bloody: unless it’s menses or postpartum bleeding 

Non-itchy: unless you wear a panty for 3 days! 

Non-copious: if you have to use a pad, panty liner, or change your panties often, that’s copious!
Note that some variants can be expected during:

*Pre-ovulation: a bit larger volume, more mucoid, more stretchy.

*Sexual excitement: larger volume, more mucoid, enhances lubrication and pleasure. 

*Pregnancy: Pregnancy is not a disease. The discharge can be more watery and milky (known as leucorrhea of pregnancy). This  can sometimes be confused with breaking of the “bag of water”; see a doctor or midwife if you’re in doubt. 
Abnormal discharge can be due to a wide range of causes and these should be investigated and treated promptly:

*Hormonal medications: contraceptives, HRT, etc. 

*Sexually-Transmitted Infections 

*Pelvic inflammatory diseases 

*Foreign bodies: tissue, cotton wool, guaze, tampons etc. 

*Benign and malignant tumours of the genital tract such as cervical cancer. 

*Atrophic vaginitis: especially postmenopausal