Hardcore bullies are manipulators. They are masters at confusing people. But with these masters of manipulation, we must always look at the big picture!
Hardcore bullies will often try to confuse the issue when being confronted with their bullying behavior.
They will blame their victim for the incident that happened between them.
They will bring up small transgressions that the victim may have made and try to make them seem huge. For example, maybe the victim told them to “Shut Up”... The hardcore bully will make this seem like a huge insult to him or her - when in reality the hardcore bully has threatened or cursed at the victim, and the victim was just trying to defend himself or herself.
This Smoke Screen technique is one of the hardcore bullies most successful deflecting attempts because it is easy for people to get caught up in the details of the incident at hand.Hardcore bullies are experts at throwing up the smoke screen.
DON'T ALLOW YOURSELF TO BE "SMOKE SCREENED INTO BELIEVING" A HARDCORE BULLY... BECAUSE THEN YOU WILL BECOME ONE OF THEIR VICTIMS!!!!
Beware of Dr Kruschinski of Endogn and his Patient Advocates!
Friday, April 14, 2006
Dealing with Doctors When You Have Adhesion Related Disorder...
If you are suffering from adhesion-related chronic pain, you need to do whatever it takes in order to receive the kind of care you want/need from doctors. Yes, we have a controversial disorder! Yes, lots of people don't take us seriously! But that's no reason to despair! There are many books and articles that give advice on what to do when seeking the help of a doctor. They usually say things like: * Become an informed medical consumer.* Write down all of the questions you want to ask your doctor.* Make a list of all of your medications. Adhesion related disorder is poorly understood... and debated even among doctors. In fact, many of us have been treated disgracefully by them. Some doctors have gone above and beyond the call of duty to help us; but, unfortunately, there aren't enough of them!!Be sure to have a thorough physical in order to rule out other medical conditions. You don't want to push a doctor into diagnosing you as having adhesion related disorder - while leaving a serious and/or treatable condition undiagnosed.
Tips on how to deal with doctors and the medical system:
1. First, you must do your homework!! It is unfair and unjust that you should have to do this when you are ill; but you will deeply regret it if you don't. Begin by educating yourself thoroughly about your illness. You can't rely on your doctor to know about adhesion related disorder!!
2. Next, you must take your doctor visits quite seriously. It's natural for people, who are very ill, to want to go to the doctor and place all their problems in his/her hands. We all want to say: "Here, make it all better now." Unfortunately, we adhesion-sufferers often can't do this. We may be seeking the help of a doctor, who doesn't specialize in treating adhesion related disorder... a doctor, who doesn't know a whole lot about ARD.
3. No doctor can possibly keep up with all of the new medical information that's coming out!!
4. Doctors are usually overworked and under a lot of stress. The office hours in which you see him/her are not the only hours the doctor is working. Doctors see hospital patients before and after office hours. They spend hours filling out forms for patients, who are seeking disability. Doctors are awakened in the middle of the night with emergency calls.
5. Doctors are very concerned about committing malpractice... and about the good opinion of their colleagues. "First, do no harm" is drummed into doctors from the day they first enter medical school. As a result, they tend to be conservative in their judgements - and are cautious when evaluating new medical information. This can be frustrating for adhesion-sufferers... especially when all of our diagnostic tests are normal or negative for abnormal pathology. But remember, we want our doctors to be careful and conscientious, so we should be willing to cooperate with them.
6. The more work you do for the doctor, the more likely you are to get the care you need. You need to present your medical history and symptoms clearly and concisely. If and when you bring information you've printed out from the Internet about ARD, you need to include the Url (website) so doctors can see your - and their - opinions are backed up by the medical profession.
7. You can't count on doctors being completely free of pre-judgements. It is important to get past whatever preconceptions a doctor may have... and get him/her dealing with your real medical concerns.
8. If you need to seek disability, how your doctor views you and your illness can make a difference!!
9. Beware!!!! There are Doctors out there willing to profit from your pain. They will take advantage of desparate, suffering ARD patients just to make a buck!
Tips on how to deal with doctors and the medical system:
1. First, you must do your homework!! It is unfair and unjust that you should have to do this when you are ill; but you will deeply regret it if you don't. Begin by educating yourself thoroughly about your illness. You can't rely on your doctor to know about adhesion related disorder!!
2. Next, you must take your doctor visits quite seriously. It's natural for people, who are very ill, to want to go to the doctor and place all their problems in his/her hands. We all want to say: "Here, make it all better now." Unfortunately, we adhesion-sufferers often can't do this. We may be seeking the help of a doctor, who doesn't specialize in treating adhesion related disorder... a doctor, who doesn't know a whole lot about ARD.
3. No doctor can possibly keep up with all of the new medical information that's coming out!!
4. Doctors are usually overworked and under a lot of stress. The office hours in which you see him/her are not the only hours the doctor is working. Doctors see hospital patients before and after office hours. They spend hours filling out forms for patients, who are seeking disability. Doctors are awakened in the middle of the night with emergency calls.
5. Doctors are very concerned about committing malpractice... and about the good opinion of their colleagues. "First, do no harm" is drummed into doctors from the day they first enter medical school. As a result, they tend to be conservative in their judgements - and are cautious when evaluating new medical information. This can be frustrating for adhesion-sufferers... especially when all of our diagnostic tests are normal or negative for abnormal pathology. But remember, we want our doctors to be careful and conscientious, so we should be willing to cooperate with them.
6. The more work you do for the doctor, the more likely you are to get the care you need. You need to present your medical history and symptoms clearly and concisely. If and when you bring information you've printed out from the Internet about ARD, you need to include the Url (website) so doctors can see your - and their - opinions are backed up by the medical profession.
7. You can't count on doctors being completely free of pre-judgements. It is important to get past whatever preconceptions a doctor may have... and get him/her dealing with your real medical concerns.
8. If you need to seek disability, how your doctor views you and your illness can make a difference!!
9. Beware!!!! There are Doctors out there willing to profit from your pain. They will take advantage of desparate, suffering ARD patients just to make a buck!
Adhesions Can Cause Pain!!
Adhesions cause pain by binding normally separate organs and tissues together - essentially "tying them down."
The stretching and pulling of everyday movements can irritate the nerves involved. Some adhesions cause pain during intercourse (dyspareunia).
Adhesions cause inflammation.
Erythrocyte Sedimentation Rate (ESR) is a non-specific blood test that will indicate if the patient is experiencing inflammation; however, the ESR cannot indicate the location of the inflammation. Adhesional attachment sites become agitated and inflamed due to the pulling and tugging by the adhesions on the tissues of the attached organs - and this will cause inflammation. Inflammation creates pain and must be taken into consideration by the doctor when treating the ARD sufferer for pain. While pelvic pain can be an obvious symptom of adhesions, there are other serious complications that you should be aware of. Two of the more common complications of adhesions are infertility and bowel obstruction. Adhesions can and do cause disabling pain - and loss of productivity. When you meet with your doctor, be prepared to discuss your symptoms with her/him. Be prepared - become your own best doctor! Adhesion formation - involving the bowel (intestine) - is particularly common following a hysterectomy. Occasionally, these adhesions can cause the bowel to kink and prevent the passage of digested food. A bowel obstruction can occur shortly after surgery - or many years later. Symptoms of bowel obstruction may include pain, nausea, and vomiting. A bowel obstruction is a serious illness that requires immediate medical attention. Even though the overall incidence of bowel obstruction is low, you should be aware of the possibility of its occurrence.
If left untreated, a bowel obstruction can lead to serious complications - even death.
Symptoms of bowel obstruction include: * abdominal pain * nausea * vomiting * diarrhea (early) * constipation (late) * fever. Be sure to talk to your doctor if you have any of these symptoms. If you have been trying unsuccessfully to conceive, you are probably searching for the cause. It’s important to understand that there are many conditions that can cause infertility; and you should talk to your doctor to determine whether your situation requires medical attention. Adhesions that form as a result of certain types of gynecologic surgery - especially tubal surgeries and myomectomies (surgery to remove fibroids) - are a common cause of infertility.
Adhesions can form between the ovaries, fallopian tubes or pelvic walls. These adhesions can block the passage of the ovum (an egg) from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also interfere with sperm transport to the ovum. The good news is that infertility due to pelvic adhesions can be successfully treated in approximately 40% to 60% of women. However, the surgical procedure, adhesiolysis, can often lead to more adhesions. The best way to reduce the chance of adhesions forming and/or reforming is for your surgeon to learn the best interventional techniques used to reduce adhesion formation. The more a surgeon practices these techniques, the more skilled they will become.
The stretching and pulling of everyday movements can irritate the nerves involved. Some adhesions cause pain during intercourse (dyspareunia).
Adhesions cause inflammation.
Erythrocyte Sedimentation Rate (ESR) is a non-specific blood test that will indicate if the patient is experiencing inflammation; however, the ESR cannot indicate the location of the inflammation. Adhesional attachment sites become agitated and inflamed due to the pulling and tugging by the adhesions on the tissues of the attached organs - and this will cause inflammation. Inflammation creates pain and must be taken into consideration by the doctor when treating the ARD sufferer for pain. While pelvic pain can be an obvious symptom of adhesions, there are other serious complications that you should be aware of. Two of the more common complications of adhesions are infertility and bowel obstruction. Adhesions can and do cause disabling pain - and loss of productivity. When you meet with your doctor, be prepared to discuss your symptoms with her/him. Be prepared - become your own best doctor! Adhesion formation - involving the bowel (intestine) - is particularly common following a hysterectomy. Occasionally, these adhesions can cause the bowel to kink and prevent the passage of digested food. A bowel obstruction can occur shortly after surgery - or many years later. Symptoms of bowel obstruction may include pain, nausea, and vomiting. A bowel obstruction is a serious illness that requires immediate medical attention. Even though the overall incidence of bowel obstruction is low, you should be aware of the possibility of its occurrence.
If left untreated, a bowel obstruction can lead to serious complications - even death.
Symptoms of bowel obstruction include: * abdominal pain * nausea * vomiting * diarrhea (early) * constipation (late) * fever. Be sure to talk to your doctor if you have any of these symptoms. If you have been trying unsuccessfully to conceive, you are probably searching for the cause. It’s important to understand that there are many conditions that can cause infertility; and you should talk to your doctor to determine whether your situation requires medical attention. Adhesions that form as a result of certain types of gynecologic surgery - especially tubal surgeries and myomectomies (surgery to remove fibroids) - are a common cause of infertility.
Adhesions can form between the ovaries, fallopian tubes or pelvic walls. These adhesions can block the passage of the ovum (an egg) from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also interfere with sperm transport to the ovum. The good news is that infertility due to pelvic adhesions can be successfully treated in approximately 40% to 60% of women. However, the surgical procedure, adhesiolysis, can often lead to more adhesions. The best way to reduce the chance of adhesions forming and/or reforming is for your surgeon to learn the best interventional techniques used to reduce adhesion formation. The more a surgeon practices these techniques, the more skilled they will become.
Abdominal/Pelvic Pain Can Occur After Surgery...
Post surgical pain can present shortly following a surgery - and usually resolves over the following days and weeks as the patient recovers from that surgery. But some pain may linger for months or years following a surgical procedure. The question is, what is the source of this pain? In some cases, the answer is Adhesions! Adhesions are bands of scar tissue - intra-abdominal and/or pelvic cavity - that bind internal organs together, causing them to stick to each other. The result of these bands of scar tissue can lead to Adhesion Related Disorder (ARD).
Symptoms adhesions can cause are...
Physical disorders such as: * Chronic pain * Infertility * Bowel obstruction * Pain and difficulty having a bowel movement * Gastroesophageal reflux disease (GERD) * Urinary bladder dysfunction * Pain when walking, sitting or laying in certain positions * Loss of nutrients due to poor eating habits or loss of appetiteEmotional disorders such as:* Depression * Thoughts of suicide * HopelessnessLosses such as: * Loss of employment due to lost work days * Loss of family and social life
If you are experiencing pelvic pain, it’s important to see your doctor. Pain in the pelvic or abdominal area can be caused by a variety of conditions, some of which may be serious. Your doctor will be able to perform tests to determine the cause of your pain. Do not assume all pelvic or abdominal pain is caused by adhesions - even if you are post-adhesiolysis. One of the more common non-surgical causes of pelvic pain is endometriosis.It is important to ask for and allow diagnostic tests to rule out other sources of pathology as being the cause of your symptoms.
While some adhesions do cause pain, not all adhesions cause pain and not all pain is caused by adhesions! If all diagnostic tests are normal or negative for abnormal pathology, the one cause of pain your doctor might consider is adhesions - particularly if you have had abdominal or pelvic surgery. Adhesions are commonly associated with pelvic pain. In fact, an estimated 38 percent of women suffering from pelvic pain have adhesions. There are things your doctor can do to reduce the incidence of post-operative adhesions - and maybe even prevent them altogether.
Demand a video or DVD ofthe procedure!
Learn as much as you can about Adhesion Related Disorder - so you will be able to make informed decisions when discussing your symptoms and medical care needs with your doctor. Request all of your operative and pathology reports from Medical Records at the hospital(s), where you have had surgery - and keep a personal file of all of your medical interventions!
Symptoms adhesions can cause are...
Physical disorders such as: * Chronic pain * Infertility * Bowel obstruction * Pain and difficulty having a bowel movement * Gastroesophageal reflux disease (GERD) * Urinary bladder dysfunction * Pain when walking, sitting or laying in certain positions * Loss of nutrients due to poor eating habits or loss of appetiteEmotional disorders such as:* Depression * Thoughts of suicide * HopelessnessLosses such as: * Loss of employment due to lost work days * Loss of family and social life
If you are experiencing pelvic pain, it’s important to see your doctor. Pain in the pelvic or abdominal area can be caused by a variety of conditions, some of which may be serious. Your doctor will be able to perform tests to determine the cause of your pain. Do not assume all pelvic or abdominal pain is caused by adhesions - even if you are post-adhesiolysis. One of the more common non-surgical causes of pelvic pain is endometriosis.It is important to ask for and allow diagnostic tests to rule out other sources of pathology as being the cause of your symptoms.
While some adhesions do cause pain, not all adhesions cause pain and not all pain is caused by adhesions! If all diagnostic tests are normal or negative for abnormal pathology, the one cause of pain your doctor might consider is adhesions - particularly if you have had abdominal or pelvic surgery. Adhesions are commonly associated with pelvic pain. In fact, an estimated 38 percent of women suffering from pelvic pain have adhesions. There are things your doctor can do to reduce the incidence of post-operative adhesions - and maybe even prevent them altogether.
Demand a video or DVD ofthe procedure!
Learn as much as you can about Adhesion Related Disorder - so you will be able to make informed decisions when discussing your symptoms and medical care needs with your doctor. Request all of your operative and pathology reports from Medical Records at the hospital(s), where you have had surgery - and keep a personal file of all of your medical interventions!
Pain... Purpose of Pain... What Worsens Pain... What Blocks Pain
What Is the Purpose of Pain? Pain is your body's alarm system. It tells you that something is wrong. When part of your body is injured or hurt, nerves in that area release chemical signals. Other nerves send these signals to your brain, where they are recognized as pain. Pain often tells you that you need to do something. For example, if you touch a hot stove, pain signals from your brain make you pull your hand away. This type of pain helps protect you. Long-lasting pain, such as arthritis pain, is different. While it tells you that something is wrong, it often isn't as easy to relieve. Managing this type of pain is important, because it can disrupt your life.The Pain Cycle Along with physical changes, such as movement limitations, the emotional ups and downs of your condition can add to your pain. If you feel depressed or stressed due to limited or lost abilities, your pain seems worse. You can get caught in a cycle of pain, limited abilities, lost abilities, stress, and depression that makes everything seem harder to handle.People react differently to pain for several reasons:Physical reasons: The sensitivity of your own nervous system and the severity of your condition determine how your body reacts to pain. These factors determine whether your nerves will send or block pain signals.Emotional and social reasons: Other factors that affect how you react to pain and how much pain you feel include your fears and anxieties about pain, previous experiences with pain, energy level, and the attitude about your condition. The way people around you react to pain also may affect how you personally react to pain.Whatever the reason, many people have discovered that by learning and practicing pain management skills, it is possible to reduce pain.How Does the Body Control Pain?Pain signals are sent through a complex system of nerves in your brain and spinal cord. Your body tries to stop these signals from reaching their destination by creating chemicals that help block pain signals. These chemicals, called endorphins, are morphine-like painkilling substances that decrease the pain sensation.The body produces endorphins in response to different kinds of "controls."These include "natural" controls, such as your own thoughts and emotions. For example: imagine that a father who is driving with his children is hurt in a car accident. The father is so worried about his children that he doesn't feel the pain from his own broken arm. The concern for his children has blocked the pain signal and kept the pain from affecting him.The body also produces endorphins in response to "outside" controls, such as medicine. Morphine is one example of a powerful pain-blocking medicine. Other outside pain control methods - such as exercise, relaxation, massage, and heat and cold treatment - can stimulate the body to either release endorphins or block pain signals in other ways.The following factors can make your pain feel worse:* increased disease activity* stress* excessive physical activity* dwelling on pain* fatigue* anxiety* depressionThe following exercises and techiques can block pain signals: * positive attitude and pleasant thoughts* carefully monitored exercise* relaxation* medication* massage* distraction* pleasing sights* topical lotions* humor* heat and cold treatments If most pain can be eased, why do so many people with pain suffer needlessly?Many of us have beliefs about pain that are simply not true and prevent us from getting the relief we deserve. The truth is: Pain is not something you "just have to live with." Treatments are available to relieve or lessen most pain. If untreated, pain can make other health problems worse, slow recovery, and interfere with healing. Get help right away; and don't let anyone suggest that your pain is simply "in your head."Not all doctors know how to treat pain. Your doctor should give the same attention to your pain as to any other health problems. But many doctors have had little training in pain care. If your doctor is unable to deal with your pain effectively, ask your doctor to consult with a specialist, or consider switching doctors.Pain medications rarely cause addiction. Morphine and similar pain medications, called opioids, can be highly effective for certain conditions. Unless you have a history of substance abuse, there is little risk of addiction when these medications are properly prescribed by a doctor and taken as directed. Physical dependence - which is not to be confused with addiction - occurs in the form of withdrawal symptoms if you stop taking these medications suddenly. This usually is not a problem if you go off your medications gradually.Most side effects from opioid pain medications can be managed. Nausea, drowsiness, itching, and most other side effects, caused by morphine and similar opioid medications, usually last only a few days. Constipation from these medications can usually be managed with laxatives, adequate fluid intake, and attention to diet. Ask your doctor to suggest ways that are best for you.If you act quickly when pain starts, you can often prevent it from getting worse. Take your medications when you first begin to experience pain. If your pain does get worse, talk with your doctor. Your doctor may safely prescribe higher doses or change the prescription. Non-drug therapies such as relaxation training and others can also help give you relief.
Medical News ARDvark Blog ARD related
Lack of research 'patient risk'
Patients are suffering because not enough basic clinical research is being done, a senior doctor warns.
Scientists Suggest Alternative to Cox-2 Drugs
Stomach-safe pain relief without heart risks might be possible, research shows.
Incontinent girls may suffer overactive bladder later
NEW YORK (Reuters Health) - Women who had urinary problems as children are more likely to have overactive bladder as adults, a new study shows.
Half of young US adults lack insurance: survey
WASHINGTON (Reuters) - Half of all young adults in the United States go without health insurance, and more than 15 million Americans were uninsured for four years running, according to a government survey published this week.
Delayed surgery decreases bladder cancer survival
NEW YORK (Reuters Health) - For patients newly diagnosed with bladder cancer, delays of more than 3 months after the initial diagnosis to surgery results in decreased survival, a study shows.
Health Tip: Kick the Habit, for Good
Make a plan to quit smoking
Test Points to Aggressive Cervical Cancer
High tumor glucose uptake means poorer survival, researchers say
Many Researchers Break the Rules: Study
Pressures in and outside lab may be to blame, experts say.
MedImmune Begins Dosing Of Lupus Patients In Phase 1 Clinical Trial
The Corporate Sponsored Creation Of Disease Turns Healthy People Into Patients, Wastes Precious Resources, And Causes Iatrogenic Harm
Wall Street Journal Examines Boston Medical Center Program For Low-Income Children
A Jekyll And Hyde Of Cytokines: IL-25 Both Promotes And Limits Inflammatory Diseases
Patients are suffering because not enough basic clinical research is being done, a senior doctor warns.
Scientists Suggest Alternative to Cox-2 Drugs
Stomach-safe pain relief without heart risks might be possible, research shows.
Incontinent girls may suffer overactive bladder later
NEW YORK (Reuters Health) - Women who had urinary problems as children are more likely to have overactive bladder as adults, a new study shows.
Half of young US adults lack insurance: survey
WASHINGTON (Reuters) - Half of all young adults in the United States go without health insurance, and more than 15 million Americans were uninsured for four years running, according to a government survey published this week.
Delayed surgery decreases bladder cancer survival
NEW YORK (Reuters Health) - For patients newly diagnosed with bladder cancer, delays of more than 3 months after the initial diagnosis to surgery results in decreased survival, a study shows.
Health Tip: Kick the Habit, for Good
Make a plan to quit smoking
Test Points to Aggressive Cervical Cancer
High tumor glucose uptake means poorer survival, researchers say
Many Researchers Break the Rules: Study
Pressures in and outside lab may be to blame, experts say.
MedImmune Begins Dosing Of Lupus Patients In Phase 1 Clinical Trial
The Corporate Sponsored Creation Of Disease Turns Healthy People Into Patients, Wastes Precious Resources, And Causes Iatrogenic Harm
Wall Street Journal Examines Boston Medical Center Program For Low-Income Children
A Jekyll And Hyde Of Cytokines: IL-25 Both Promotes And Limits Inflammatory Diseases
Hemorrhoids
Hemorrhoids
Hemorrhoid surgery - series
Definition:
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.
Alternative Names:
Rectal lump; Piles; Lump in the rectum
Causes, incidence, and risk factors:
This condition is very common, especially during pregnancy and after childbirth. Hemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are sitting.
The most common cause is straining during bowel movements. Hemorrhoids may result from constipation, sitting for long periods of time, and anal infections. In some cases they may be caused by other diseases, such as liver cirrhosis.
Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.
Symptoms:
Symptoms of hemorrhoids include:
Anal itching
Anal ache or pain, especially while sitting
Bright red blood on toilet tissue, stool, or in the toilet bowl
Pain during bowel movements
One or more hard tender lumps near the anus
Signs and tests:
A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:
Stool guaiac (shows the presence of blood)
Sigmoidoscopy
Anoscopy
Treatment:
Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other steps for anal itching include:
Wear cotton undergarments.
Avoid toilet tissue with perfumes or colors.
Try not to scratch the area.
Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.
For cases that don't respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.
Expectations (prognosis):
Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.
Complications:
The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.
Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.
Calling your health care provider:
Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment. You should also be seen if you have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding, especially if you have never bled from hemorrhoids before.
Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.
Prevention:
Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, whole grains. Consider fiber supplements.
References:
Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th Ed. Philadelphia, PA: Saunders; 2002.
Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002.
Rakel P, ed.Textbook of Family Practice. 6th Ed. Philadelphia, PA: Saunders; 2002.
http://pennhealth.com/ency/article/000292.htm
Hemorrhoid surgery - series
Definition:
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.
Alternative Names:
Rectal lump; Piles; Lump in the rectum
Causes, incidence, and risk factors:
This condition is very common, especially during pregnancy and after childbirth. Hemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are sitting.
The most common cause is straining during bowel movements. Hemorrhoids may result from constipation, sitting for long periods of time, and anal infections. In some cases they may be caused by other diseases, such as liver cirrhosis.
Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.
Symptoms:
Symptoms of hemorrhoids include:
Anal itching
Anal ache or pain, especially while sitting
Bright red blood on toilet tissue, stool, or in the toilet bowl
Pain during bowel movements
One or more hard tender lumps near the anus
Signs and tests:
A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:
Stool guaiac (shows the presence of blood)
Sigmoidoscopy
Anoscopy
Treatment:
Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other steps for anal itching include:
Wear cotton undergarments.
Avoid toilet tissue with perfumes or colors.
Try not to scratch the area.
Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.
For cases that don't respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.
Expectations (prognosis):
Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.
Complications:
The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.
Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.
Calling your health care provider:
Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment. You should also be seen if you have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding, especially if you have never bled from hemorrhoids before.
Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.
Prevention:
Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, whole grains. Consider fiber supplements.
References:
Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th Ed. Philadelphia, PA: Saunders; 2002.
Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002.
Rakel P, ed.Textbook of Family Practice. 6th Ed. Philadelphia, PA: Saunders; 2002.
http://pennhealth.com/ency/article/000292.htm
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