BRISTOL STOOL SCALE

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DOC HOW DO I KNOW WHETHER MY STOOL IS NORMAL

Actually many people do not know the definition of diarrhea.

They define the word diarrhea as watery stools where in fact the word diarrhea means any stools which are softer or more frequent than normal.

The researchers at the Bristol University have come out with a scale which is called the Bristol Stool Scale.

According to the Bristol Stool Scale, the seven types of stools
are:
1.Type 1: Separate hard lumps like nuts
2.Type 2: Sausage shaped but lumpy
3.Type 3: like a Sausage but with cracks on its surface
4.Type 4: like a Sausage or snake, smooth and soft
5.Type 5: soft blobs with clear cut edges
6.Type 6: Fluffy pieces with ragged edges, a mushy stool
7.Type 7: Watery, no solid pieces. Entirely liquid.

Type 1 and 2 indicate constipation while type 5-7 indicate diarrhea. Type 3 and 4 are considered ideal stools because they are the easiest to pass.

Avoidance of constipation include:

1. Increase in daily fiber intake to at least 15gm (eg. 1 bowl of bran cereal for breakfast),
fruits and vegetables).
Fibre increases the bulk of the stool allowing easy passage of stools through the large
intestine.

2. Drink at least 8 glasses of water a day (2 liters). Water reduces the hardness of stools.

3. Regular exercises at least 2-3 times a day especially after meals. Exercise will enhance
intestinal movement.

4. Allow a distraction free period of 15 min a day for bowel movement. The strongest
intestinal movement occurs after breakfast.

5. Do not ignore or suppress the urge to pass bowel movement. This may impair the
sensation to detect initiation of bowel movement leading to constipation.

Avoidance of  diarrhea include:

1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers

2.washing your hands thoroughly for 20 seconds before eating

3.disinfecting contaminated surfaces such as counter tops and baby changing stations

4.Avoid eating or drinking foods or liquids that might be contaminated

5.Avoid rapid intestinal movement from stress, irritable bowel syndrome

Please read my blogs on constipation and diarrhea

A Simple Guide to Diverticulosis

A Simple Guide to Diverticulosis
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What is Diverticulosis?
---------------------------------------

Diverticulosis is a disorder of the colon or large intestine where there are one or more sac-like pouches(called diverticula) in the walls of the colon.

It is more common in the descending and sigmoid colon.

Who is affected by Diverticulosis?
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Diverticulosis becomes more obvious with age.
50% of people over the age 0f 60 years have Diverticulosis.

What is the Cause of Diverticulosis?
-----------------------------------------------------

The exact cause of Diverticulosis is not known.

It has been suggested that a low-fiber diet is the main cause of diverticular disease.

Diverticulosis is common in developed countries where low-fiber diets are common whereas it is rare in Asia and Africa where people eat high-fiber vegetable diets.

Fiber prevents constipation which can make the muscles strain and increase pressure in the colon.

This increased pressure makes the weak spots in the colon lining to bulge out like pouches and become diverticula.

What are the Symptoms of Diverticulosis?
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Most cases of Diverticulosis have no or little symptoms.

In the more severe cases, the main symptoms of Diverticulosis are:

1.Abdominal pain or cramps-usually over the left side or over the lower abdomen

2.Bloating

3.constipation

The symptoms can range from mild to severe.

How do you make the Diagnosis of Diverticulosis?
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1.A history of abdominal pain especially on the left lower abdomen, bloating and constipation

2.The physical exam consists of
a.palpation of the left abdomen for tenderness or masses
b.digital rectal exam to detect tenderness or blood.

3.stool may be tested for blood

4.blood tests(WBC,ESR,bood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of pouches in the colon

6.Colonoscopy is also done to confirm evidence of diverticulosis and exclude malignant tumours.

What are the complications of Diverticulosis?
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1.Diverticulitis
Diverticulitis occurs when diverticula become infected with bacteria, viruses or become inflamed.
Bacteria are caught in the pouches and develops into diverticulitis suddenly.

The symptoms and signs of diverticulitis are:
1.abdominal pain usually continuous in the lower left abdomen with tenderness

2.fever due to infection,

3.nausea, vomiting,

4.cramping,

5.constipation

6.rectal tenderness

Diverticulitis can lead to:

1.Bleeding,
rare.
Bleeding can be severe caused by a small blood vessel in a diverticulum that weakens and finally bursts.
Surgery may be needed to stop bleeding if bleeding continues.

2.Abscess, Perforation, and Peritonitis
Often a few days of treatment with antibiotics will cure the diverticulitis.
If the infection gets worse, an abscess which is an infected area with pus may form in the colon.

Small abscesses usually clear up with antibiotics.

More severe abscesses may require drainage of the pus using a catheter.

If pus leaks from perforations in the lining of the colon, then it can cause infection in the abdominal cavity and results in peritonitis.

This is an emergency and requires immediate surgery to clean up the pus in the abdominal cavity and removal of the damaged part of the colon.

3.Intestinal Obstruction
The infection of the diverticula can cause scarring of the lining of the colon resulting in partial or total blockage of the large intestine.

If the obstruction blocks the intestine completely, emergency surgery is required to allow faecal matter to pass through.

A temporary colostomy may be necessary.

4.Fistula
occurs as an abnormal connection between two organs or between an organ and the skin.

It results from the damaged tissues coming together and an opening is left between the two tissues.

Usually the bladder, small intestine, vagina, and skin are the organs involved.

The most common fistula occurs between the bladder and the colon especially in men. This can cause a long-lasting infection of the urinary tract.

Surgery may be necessary to remove the fistula as well as the damaged part of the colon.

5.Urinary tract infections occurs frequently due to the fistula and proximity of the bladder to the infected colon.

6.Discarge of faecal material may occur through a fistula between the colon and vagina in some women.

What is the treatment of Diverticulosis?
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Medication:
1.pain medications will relieve any pain symptoms.

2.Antispasmotic mediacation for spams of the colon

3.Antibiotics may be needed in diverticulitis and complications such as urinary infection and peritonitis.

Diet:
1.high-fiber diet

a.whole grain breads and cereals;
b.fruit like apples and peaches;
c.vegetables like carrots, broccoli, spinach, carrots, cabbage, beans.

2.fiber product such as Metamucil once a day.

3.Avoid nuts, popcorn, pumpkin, and sesame seeds or any food which can cause discomfort in the abdomen

Diverticulitis
1.Antibiotics to treat the infection and inflammation,

2.resting the colon by bed rest, nasogastric suction and a liquid diet

3.hospital stay to prevent complications such as abscess.

4.surgery if the attacks are severe or there are complications.
The surgeon resects the affected part of the colon and then joins the remaining sections.

Surgery is also done for complications such as a fistula or intestinal obstruction.

Emergency surgery may be done for a large abscess, perforation, peritonitis, or continued bleeding.

What is the prognosis of Diverticulosis?
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About 1% develop diverticulitis.
70% of patients with acute attacks of diverticulitis can be treated with medical management and have no further attacks

A Simple Guide to Anal fissure

A Simple Guide to Anal fissure
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What is Anal fissure?
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Anal fissure is a superficial linear tear at the edge of the anus.

What are the causes of Anal fissure?
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Anal fissure occur after a tear in the posterior midline of the anus caused by the passage of hard large stools and constipation.

The tear is covered by a sentinel skin tag at the lower end(sentinel pile).

The tear may occur at any age but are more common in young children and pregnant women.

Sometime the tear may occur at the anterior midline of the anus.

What are the symptoms and signs of Anal Fissure?
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Symptoms:

1.Pain during and after passing motions

2.Serous discharge from tear

3.Itch (pruritis ani)

4.blood streak on stools

Signs:

1.sentinel skin tag covering a posterior midline tear of the anus

2.spasm of the anal sphincter

3.perianal infection

What are the investigations required in Anal fissure?
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1.Digital examination of the anus

2.Proctoscopy to exclude piles

3.Sigmoidoscopy may be required in adults.

What is the treatment of Anal fissure?
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1.Stool softener

2.low residue diet

3.Avoid constipation -take more fruits and water

4.Give painkiller if necessary

5.Apply anti-itch cream

6.Use antibiotic cream if there is evidence of perianal infection

A Simple Guide to Appendicitis

A Simple Guide to Appendicitis
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What is Appendicitis?
--------------------------

Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.

What are the causes of Appendicitis?
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Appendicitis may occur after:

1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking

2.inflammatory oedema of the mucosa

3.infection of the intestine(eg. E. coli) spreading to the appendix

What are the symptoms and signs of Appendicitis?
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Symptoms:

1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)

2.nausea and vomiting

3.mild fever

4.often a history of constipation, rarely diarrhea

5. loss of appetite

Signs:

1.tenderness,guarding and rebound pain at McBurney's point

2.Positive Psoas and obturator sign in some cases

3.leucocytosis - mainly polymorphs

4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess

5.rectal examination may show a palpable tender swelling at the right iliac fossa

What are the complications of Appendicitis?
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1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity

2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix

3.Septicemia may result from the bacteria entering the blood.

Death may occur in untreated peritonitis and septicemia.

What is the treatment of Appendicitis?
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All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.

Following surgery, antibiotics are given either intravenously or orally.

What is the prognosis of Appendicitis?
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1.Excellent with appropriate surgical intervention

2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.

3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.

Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.

A Simple Guide to Irritable Bowel Syndrome

A Simple Guide to Irritable Bowel Syndrome
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What is Irritable Bowel Syndrome?
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Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system. It is characterised by abdominal pain/cramps, bloating or gas, diarrhoea and/or constipation. It is also known as spastic colon.

Who is affected by Irritable Bowel Syndrome?
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It occurs in one in five persons and usually between the ages of 20-50.
Women outnumber men by two or three to one.
It can become a chronic condition causing much discomfort and inconvenience to the patient. However, it does not progress to cancer.

What is the Cause of Irritable Bowel Syndrome?
--------------------------------------------------------

The exact cause of IBS is not known.

The muscles of the walls of the intestines in the normal person contract and relax in a co-ordinated rhythm known as peristalsis. This action helps to move food along the intestines during which time absorption takes place.
The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. The contractions are stronger and last longer.
Food is pushed along the intestines at a faster rate, giving rise to abdominal pain, gas and diarrhoea. Sometimes, the opposite occurs. The contractions are weaker causing the passage of food to slow down and constipation results.

Other factors that have been shown to play a part are stress, diet and hormones. These are called triggers.

1.Stress
which may be psychological or physical.
Psychological stresses such as family misunderstanding; bereavement; anxiety; meeting deadlines etc.
Physical stresses such as illnesses, infections, exhaustion etc.

2.Diet
certain foods have been known to cause the onset of symptoms. They include fried or oily food; gas-forming foods e.g.broccoli, beans, cabbage; chocolates; coffee.

3.Hormonal changes
some women experience attacks during or around their menstrual periods.

What are the Symptoms of Irritable Bowel Syndrome?
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The main symptoms of IBS are:
1.Abdominal pain or cramps-usually over the left side or over the lower abdomen
2.Bloating and/or gas
3.Diarrhoea, constipation or alternating diarrhoea and constipation.
4.whitish mucus in the stool

The symptoms can range from mild to severe.
In many cases the symptoms are bearable and go off after a bowel movement.
Women with IBS often have more symptoms during their menstrual periods.

How do you make the Diagnosis of Irritable Bowel Syndrome?
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Because the cause is unknown and there is a lack of specific physical signs, diagnosis is arrived at through a process of elimination .

A colonoscopy is usually done to rule out colon cancer, diverticulosis, polyps.

What is the Treatment of Irritable Bowel Syndrome?
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There is no real cure for Irritable Bowel Syndrome.
Treatment is mainly symptomatic i.e. it is directed towards the relief of symptoms.

Mild symptoms usually go off on their own.
If symptoms are severe, the doctor may prescribe the following:

Anti-spasmodics for the abdominal pain and cramps,
Anti-flatulents to get rid of gas and relief the bloating,
Anti-diarrhoeals to stop diarrhoea,
Antidepressants, even in lower doses than are used for treating depression, can help people with IBS.
Laxatives to relief constipation.

Foods and drinks that may cause or worsen symptoms include:

fatty foods, like french fries
milk products, like cheese or ice cream
chocolate
alcohol
caffeinated drinks, like coffee
carbonated drinks, like soda

Some foods make IBS better.

Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass.
However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.
Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.

Eat small meals for example eating four or five small meals a day.
Large meals can cause cramping and diarrhea in people with IBS.

Stress doesn’t cause IBS, but it can make your symptoms worse.
Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.
Meditation, exercise, hypnosis, and counseling may help.

What can be done to prevent Irritable Bowel Syndrome?
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Prevention is an important part in the total management of this condition.
They consist of stress management and life-style changes.
Stress management
Avoid unnecessary stress
Learn to relax
Exercise regularly

Dietary changes
Avoid oily, spicy food
Avoid gas-forming foods e.g. cabbage, broccoli, beans
Avoid coffee, chocolates, and alcohol
Avoid large meals
Take more fibre