Anal Fissure Anal Fissure Home Overview An anal fissure is a small tear or crack in the skin around the anus that can cause pain, discomfort, and sometimes bleeding during bowel voiding. Anal fissures can affect people of all ages; however, they are more frequently encountered in individuals who experience chronic constipation. Causes Anal fissures typically occur when the skin around the anus is stretched or torn due to various factors. Common causes include:Constipation: Passing large or hard stools can cause strain, leading to tears in the anal skin.Chronic diarrhoea: Frequent bowel movements can irritate and damage the delicate skin around the anus.Childbirth: Vaginal delivery can cause trauma or stretching to the anal area.Anal intercourse: This can sometimes lead to tearing of the anal skin.Poor blood flow: Reduced circulation to the area, often due to conditions like diabetes or anal trauma, may hinder healing.Infections: Certain infections (e.g., sexually transmitted infections) may result in fissures.Inflammatory bowel disease (IBD): IBD can lead to anal fissures. Symptoms Common symptoms include:Visible tear: A small crack or tear might be visible in the skin around the anus, though it is not always obvious.Pain: The hallmark symptom of anal fissure is sharp or burning pain during or after a bowel movement. The pain may last from minutes to hours.Bleeding: The tear might cause bleeding (bright red blood on toilet paper or in the toilet bowl).Itching or irritation: Affected individuals may feel itchy or an irritating sensation in the area around the anus.Spasms: Some people experience painful muscle spasms in the anal sphincter muscle, which can worsen the pain. Diagnosis Anal fissures are diagnosed based on the following:Physical examination: A simple visual inspection of the anal area is often enough to identify a fissure.Anoscopy or proctoscopy: In some cases, a doctor may use a small instrument (anoscope or proctoscope) to get a closer look at the anal canal.Other tests: If there are concerns about underlying conditions like IBD or infection, blood tests or stool cultures may be performed. Treatment Most anal fissures are acute (short-term) and can heal with conservative treatments, but chronic (long-term) fissures may require more advanced intervention.Conservative (non-surgical) treatment:Increasing the fibre intake: Eating a high-fibre diet helps soften the stool and decreases straining during bowel voiding.Stool softeners: These can be used to make bowel movements easier and less painful.Warm water baths: Soaking the affected area in warm water for 10–15 minutes daily (a few times) can provide pain relief and promote healing.Analgesic creams: These can help manage pain.Medical treatmentsBotox injections: Botulinum toxin (Botox) can be injected into the anal sphincter muscle to relax it and help heal chronic fissures.Topical hydrocortisone or nitroglycerin: These creams can help reduce pain, inflammation, and itching. Further, they promote healing,and relax the anal sphincter to ease muscle spasms.Calcium channel blockers: Topical medications like diltiazem or nifedipine can relax the anal sphincter and reduce spasms, promoting healing.Surgical treatment (for chronic fissures): If conservative treatments fail and the fissure becomes chronic (lasting more than 6-8 weeks), surgical options may be considered:Lateral internal sphincterotomy: In this surgery, a small portion of the anal sphincter is cut to relieve pressure, thereby promoting healing.Fissurectomy: This surgery involves removal of the fissure and surrounding scar tissue.Flap surgery: In rare cases, a tissue flap from nearby areas is used to cover a chronic fissure that is not healing. When to see a doctor Consult a medical professional if you have persistent pain or bleeding during bowel movements. Read more about Anal Fissure Filter Alphabet A
Anal Fistula Anal Fistula Home Overview Anal fistulas are tunnel-like connections between the inner lining of the anus or rectum and the skin surrounding the anus. These abnormal structures typically develop as a result of infection in an anal gland, leading to the formation of an abscess. If the abscess doesn't heal properly, it can form a fistula. Causes Anal abscesses: Infections of the anal glands that become walled off and then drain through an abnormal passage.Inflammatory bowel disease (IBD): IBD Conditions like Crohn's disease or ulcerative colitis can increase the risk of developing anal fistulas.Trauma or injury: A previous injury or surgery in the anal region can lead to fistula formation.Sexually transmitted infections: Some infections, like HIV, may increase susceptibility to anal fistulas.Cancer: In rare cases, rectal or anal cancers can lead to fistula formation. Symptoms The symptoms of anal fistula include:Pain around the anal region, especially when sitting, during bowel voiding, or when passing gas.Persistent drainage of pus, blood, or stool from the opening of the fistula.Irritation or itching around the anus.Fever and chills (in cases where the fistula is associated with an infection).Swelling or redness around the anus, indicating inflammation or infection. Diagnosis Physical examination: This involves investigation of the anal area for visible signs of infection, abscesses, or openings.Anoscopy or proctoscopy: These modalities help look inside the anus and rectum for signs of abnormalities like fistulas.Fistulography: In this imaging test, a contrast dye is injected into the fistula tract, and this is followed by X-ray to visualise the path taken by the dye.MRI or ultrasound: Thes modalities help assess the length and complexity of the fistula, particularly in cases that involve multiple tracks or are difficult to diagnose. Treatment Treatment often involves surgery to drain the abscess and repair the fistula, as conservative methods like antibiotics are generally not effective in healing fistulas. There are several surgical options depending on the fistula's complexity:Fistulotomy: This is most common procedure for treating anal fistulas. In this procedure, the fistula is cut open and allowed to heal from the inside out.Seton placement: For more complex fistulas, a piece of thread (seton) is inserted through the fistula to help drain it and promote healing.Advancement flap procedure: This is often used when the fistula involves a significant amount of tissue and there is concern about damaging the sphincter muscles (which control bowel movements).LIFT procedure (ligation of intersphincteric fistula tract): In LIFT, the fistula tract is closed off to prevent drainage.Fibrin glue or collagen plugs: A less invasive approach may be used to seal the fistula tract. Prevention Maintaining proper anal hygieneAvoiding trauma to the anal areaManaging underlying conditions Read more about Anal Fistula Filter Alphabet A
Multiple Endocrine Neoplasia (MEN) Syndromes Multiple Endocrine Neoplasia (MEN) Syndromes Home Overview MEN syndromes are inherited disorders that cause tumours in multiple endocrine glands. There are several types, including MEN1 and MEN2, each associated with specific tumours such as parathyroid, pituitary, and adrenal tumours. Symptoms Vary depending on the glands affected and can include hormonal imbalances, fatigue, and weight changes. Diagnosis Genetic testingHormone level assessmentsImaging studies Treatment Depends on the tumours present and may include surgery, medications, or other therapies to manage hormone levels and tumour growth.Regular monitoring and early intervention are crucial for managing MEN syndromes. Read more about Multiple Endocrine Neoplasia (MEN) Syndromes Filter Alphabet M
Neuroendocrine Tumours Neuroendocrine Tumours Home Overview Neuroendocrine tumours are tumours that arise from neuroendocrine cells found throughout the body. They can be benign or malignant and often produce hormones. Symptoms FlushingDiarrhoeaAbdominal pain. Diagnosis Blood and urine tests: To measure hormone levels.Imaging studies: To locate the tumour.Biopsy: To confirm the diagnosis. Treatment Depends on the tumour type and location and may include surgery, medications to control hormone production, targeted therapies, or chemotherapy.Regular monitoring is important to manage symptoms and detect any tumour recurrence or progression.Early detection and personalised treatment improve outcomes for patients with neuroendocrine tumours. Read more about Neuroendocrine Tumours Filter Alphabet N
Carcinoid Tumours Carcinoid Tumours Home Overview Carcinoid tumours refer to slow-growing neuroendocrine tumours typically developing in the gastrointestinal tract or lungs. Symptoms Tumours can produce hormones that cause symptoms like flushing, diarrhoea, and wheezing. Diagnosis Blood and urine tests to measure hormone levels, imaging studies like CT or MRI, and biopsy to confirm the tumour type. Treatment Surgery to remove the tumour, medications to manage symptoms, and sometimes radiation or chemotherapy for advanced cases. Regular monitoring is essential to manage symptoms and detect any tumour recurrence. Early diagnosis and treatment of disease enhance outcomes and quality of life for patients with carcinoid tumours. Read more about Carcinoid Tumours Filter Alphabet C
Insulinoma Insulinoma Home Overview Insulinomas are tumours found in the pancreas that produce excessive amounts of insulin, leading to dangerously low levels of blood sugar. The pancreas typically regulates blood sugar by producing insulin, but in the case of insulinomas, the amount produced exceeds the body’s needs. These tumours are rare and usually remain localised, without spreading to other areas. The exact cause of insulinomas is not well understood. Symptoms ConfusionWeaknessSweatingRapid heartbeatBlurred visionWeight gain Diagnosis Typically confirmed through low plasma glucose levels alongside elevated insulin levels Treatment Most insulinomas are benign and can be surgically removed. This procedure is often performed laparoscopically, where the surgeon makes small incisions and uses specialised instruments to excise the tumour. Read more about Insulinoma Filter Alphabet I
Pain Management in Joint-replacement Surgeries Pain Management in Joint-replacement Surgeries Home Overview Pain management is an important part of recovery and rehabilitation after any surgery.Pain management in complex surgeries like joint replacement surgeries is a combined effort between the patient, surgeon, pain management team, and nurses. In such scenarios, pain management should be comprehensive, i.e., pain relief before the surgery, during the surgery, and after the surgery for a substantial amount of time. This strategy allows for early mobilisation, rehabilitation and faster recovery. Pain management before surgery BenefitsReduced postoperative pain: Managing pain before surgery can help reduce the intensity of pain experienced after the procedure. This can lead to smoother recovery.Lower stress levels: Preoperative pain management can help lower stress and anxiety levels, which can positively impact the overall surgical experience and recovery.Improved mobility: Effective pain control can make it easier for patients to move and participate in physical therapy post-surgery, promoting better blood flow and faster healing.Decreased risk of chronic pain: Addressing pain before surgery can reduce the risk of developing chronic pain conditions postoperatively.Optimised pain medication use: By understanding a patient's pain levels and medication needs before surgery, healthcare providers can better tailor postoperative pain management plans, potentially reducing the need for long-term opioid use and its associated risks.Enhanced overall recovery: Proper pain management can lead to fewer complications, shorter hospital stays, and a quicker return to normal activities.TechniquePain medications: Pain management medications must be taken as per instructions of your doctor or by visiting pain management clinic.Pre-surgery physical therapy: Physical therapy prior to surgery reduces stiffness in joints. This helps improve muscle strength and flexibility and range of motion in the post-operative phase as well.Ice packs: Ice packs help reduce pain and swelling. They should be applied for 10 to 15 minutes a few times a day or after physical therapy.Healthy diet: A healthy diet supports tissue healing and helps maintain an appropriate body weight.Deep breathing and relaxation techniques: These help in not only managing pain but also to stay calm and relaxed during surgery. Pain management during surgery Effective pain management during surgery is essential for patient safety, comfort, and optimal recovery.BenefitsImproved surgical outcomes: Effective pain management during surgery can lead to better surgical outcomes by reducing stress responses and improving patient stability.Enhanced patient comfort: Proper pain control ensures that patients remain comfortable during the procedure, which can reduce anxiety and improve overall experience.Reduced post-operative pain: Managing pain effectively during surgery can minimise the intensity of postoperative pain, leading to a smoother recovery.TechniquesAnaesthesia: During surgery, pain is taken care of using anaesthetic medications.Regional anaesthesia: Spinal, epidural, and nerve blocks, which numb a specific area of the body while the patient remains awake, are used to manage pain during surgery. RFH specialises in nerve block anaesthesia which involves injecting target nerves with local anaesthetics—with the help of special catheters placed near the nerve—to ensure that pain is taken care of intraoperatively as well as in the post-operative phase.Multimodal analgesia: This technique combines different types of pain relief methods to target various pain pathways, thereby enhancing overall pain control during surgery and reducing the need for high doses of any single medication.RisksTissue damage: Pain management during surgical procedures might result in tissue stretching or damage, which can cause pain.Inflammatory response: Pain management during surgical procedures might inflammationNerve injury: Accidental damage to nerves during surgery can also occur with nerve blocks and epidurals.What to expect in the recovery room?Monitoring of your vital signs, including blood pressure, blood oxygenation, heart rate, etc.Pain levels are also monitored and in case there is pain or discomfort additional intravenous medications are given.Patient controlled analgesia: Patients are connected to a pump and can select and consume a dose of pain medication(s) by pressing a button. Post-operative pain management Post-operative pain management is essential for enhancing recovery, minimising complications, and improving patient comfort following surgery. The main goal of pain management after any surgery is for the patient to comfortably awaken from anaesthesia and experience an uninterrupted transition to the post-operative period. Effective pain control facilitates early mobilisation, reduces the risk of chronic pain development, and improves overall patient satisfaction.BenefitsEnhanced recovery: Effective pain management can lead to quicker recovery times, allowing patients to mobilise sooner and reducing hospital stays.Improved patient comfort: Proper pain control significantly improves the overall patient experience and satisfaction.Reduced complications: Managing pain effectively can lower the risk of complications such as thromboembolic events and respiratory issues.TechniquesMedications: NSAIDs, acetaminophen, paracetamol, and other non-opioid analgesics are commonly used to manage post-operative pain with fewer side effects.Epidural analgesia: Techniques like epidurals or nerve blocks can provide targeted pain relief, often reducing the need for systemic opioids.in post-operative phase.Adductor canal block: Specialised nerve block which is given during the surgery and catheter inserted near the nerve through which local anaesthetic medications is given at regular intervals in post-operative period.Ice pack and elevation: Helps in reducing swelling and pain.Physical therapy: Gradual supervised gentle movements after surgery helps in earlier mobilization and aids in faster recovery.RisksOpioid-related side effects: These include nausea, vomiting, constipation, respiratory depression, and the risk of addiction.Inadequate pain control: Poorly managed pain can lead to chronic pain conditions and prolonged recovery.Adverse reactions: All pain management techniques carry some risk of adverse reactions, such as allergic responses or complications from regional anaesthesia. Pain management at home following surgery Taking regular pain medications as prescribed by the doctors.Ice packs and elevation.Regular graded physical therapy as per physiotherapist recommendation.Pacing activities.If your pain is preventing you from normal daily activities even after doing all the above, kindly contact or visit your doctor. Read more about Pain Management in Joint-replacement Surgeries Filter Alphabet P