Digestive System
Flaxseed To Control Your Blood Pressure
A great way to maintain a healthy cardiovascular system is by adding flaxseed to your daily diet. Flaxseed actually contains what is called alphalinolenic acid, which is a fatty acid essential in controlling blood pressure. They have a benefit of helping with digestion; just make sure the flaxseed is crushed for easier consumption and absorption.
A Closer Look at Weight and the Metabolic Syndrome
Many people have never even heard of the metabolic syndrome, also known as Syndrome X. Until recently, most physicians had never heard of the metabolic syndrome either.Yet this condition—a combination of blood lipid abnormalities, high blood pressure, and elevated blood sugar—affects almost one-quarter of the adult population in the United States. The major underlying cause of the metabolic syndrome is obesity, in particular, increased abdominal fat.
Five different conditions make up the metabolic syndrome:
1. High blood triglycerides
2. Low HDL cholesterol
3. High blood pressure
4. Elevated blood sugar
5. Increased waist circumference (greater than 40 inches in men and greater than 35 inches in women)
The metabolic syndrome is rapidly becoming a significant medical problem because it increases so many risk factors for heart disease and diabetes.Weight loss is the only effective treatment for this condition.
Why Metabolism Slows Down
Muscle determines how fast the body’s engine runs and how many calories the body burns over the course of a day. Muscle falls into the “use it or lose it” category—if your muscles are not active, they will shrink. Since we tend to get less active as we get older, our muscles become smaller, and, as a result, our metabolism and calorie burning slow down. Research has shown that the impact of age-related changes in hormones is much smaller than the impact of muscle loss from lack of use.
Even if your weight stays the same as you get older, the amount of fat and muscle on your body will change. This is not the result of aging per se. Because adults become less active as they get older, they’re likely to have more body fat and less lean tissue than in their younger years. A study published in Nutrition found a clear link between activity and body composition. People who were more physically active in their daily lives and through regular exercise had more muscle. The study also found that weight and body fat increased with age.
Any weight gain during adulthood is likely to be body fat because most adults are not active enough to build muscle. Some studies suggest that by age 55, the average person in the United States has added over 37 pounds of fat during his or her adult years!
Here’s the good news. According to the American College of Sports Medicine, as part of a regular physical activity routine, muscle-building strength training can slow down muscle loss and help keep metabolism revved up.
Diagnostic Procedures
If you have symptoms of a digestive disorder, your doctor may need to use one or more of the following diagnostic procedures to examine your gastrointestinal tract and determine the cause of your symptoms. Your digestive tract must be empty before undergoing any of these procedures. For an examination of your esophagus, stomach, or duodenum, you will need to fast (abstain from food and drink) after midnight the night before the procedure. For an examination of your ileum, colon, or rectum, you will need to follow a special liquid diet beginning at least 2 days before the procedure and then fast the night before the procedure. All of these examinations are usually performed on an outpatient basis.
• Gastrointestinal series. A gastrointestinal (GI) series is an examination that is used to diagnose or monitor problems in the digestive tract. An upper GI series examines the esophagus, stomach, and duodenum; a lower GI series examines the colon and rectum. These examinations are used to identify blockages, growths, ulcers, inflammation, and other structural abnormalities. Both procedures use barium sulfate to coat the lining of the digestive tract and provide clear images of the digestive tract on a fluoroscope (a special video monitor) or on X-ray film. For an upper GI series, you drink a barium mixture (a thick, white, chalky liquid called barium meal or barium swallow); for a lower GI series, a barium mixture (called a barium enema) is injected into the colon through the anus and rectum. You may be asked to change positions during the examination as the barium reaches different locations in your digestive tract. Usually you can go home immediately after the procedure and should experience no side effects other than constipation and white or gray stools until the barium is completely out of your system.
• Endoscopy. Endoscopy is a diagnostic examination in which a doctor uses a long, thin, flexible lighted tube called an endoscope to look inside the esophagus, stomach, and duodenum. You will be awake during this procedure, but before the examination begins, your throat will be sprayed with a numbing agent so you do not gag when the endoscope is passed down your throat. You also will receive pain medication and a sedative to help you relax. The endoscope has a precision optical system that works like a video camera, allowing the doctor to see inside each organ as it travels through the digestive tract. The endoscope also can blow air into the digestive tract to inflate it and make it easier to examine. Tiny surgical instruments then can be passed through the endoscope to remove tissue for microscopic examination. This procedure is usually brief—about 20 to 30 minutes—but you will need to lie quietly afterward at the doctor’s office for an additional hour or two until the sedative wears off. You may have a sore throat after the procedure.
• Endoscopic retrograde cholangiopancreatography (ERCP). This diagnostic procedure allows your doctor to examine your liver, gallbladder, bile ducts, and pancreas using an endoscope. In ERCP, the initial steps are the same as those described for endoscopy. However, when the endoscope reaches your duodenum, the doctor injects contrast medium (a type of dye) through the endoscope and into your bile ducts. X rays are taken as soon as the contrast medium is injected. If the doctor sees a gallstone or narrowing of the ducts, he or she can pass tiny surgical instruments through the endoscope to remove the obstruction or widen the duct.
• Colonoscopy. Colonoscopy is a diagnostic examination of the entire length of the large intestine, from the rectum all the way up through the colon to the ileum. Colonoscopy can be used to look for polyps in the colon or to diagnose colon cancer. The procedure is performed with a special type of endoscope called a colonoscope. Before the procedure, you will receive pain medication and a sedative to help you relax. While you lie on your left side, your doctor will insert the colonoscope into your rectum and guide it up through the entire large intestine. As the doctor slowly withdraws the colonoscope, he or she examines your colon directly through the colonoscope or on a video monitor. Air can be blown through the colonoscope to inflate the colon and give the doctor a better view. Instruments can be passed through the colonoscope to take tissue samples or to remove polyps. If there is any blood in the colon, your doctor can use a special instrument or drug to stop the bleeding. Colonoscopy usually takes about 30 to 60 minutes, and you will need to lie quietly for an additional hour or two after the examination. Because of the medication you have been given, you should make arrangements in advance for someone to take you home after the procedure.
• Sigmoidoscopy and proctoscopy. As an alternative to a colonoscopy, your doctor may use a type of endoscope called a sigmoidoscope to examine only the rectum and the sigmoid (lower) colon. Or your doctor may use a type of endoscope called a proctoscope to examine only the anus and rectum. These procedures are similar to colonoscopy, but they examine only a limited portion of the gastrointestinal tract, and each procedure takes only about 10 to 20 minutes.
Other Gastrointestinal Disorders
The following less common disorders of the digestive system affect men far more frequently than women:
• Primary sclerosing cholangitis. Primary sclerosing cholangitis is a rare condition that occurs most often in young men and often is the result of inflammatory bowel disease such as ulcerative colitis. With this disease, the bile ducts (the tubes that carry bile from the liver) inside and outside the liver become narrowed due to inflammation and scarring. This causes bile to accumulate in the liver, which, in turn, damages liver cells. There are no initial symptoms, and the disease is usually detected by chance through a routine blood test for liver function. Symptoms develop between ages 30 and 50 and include fatigue, itching, and jaundice (yellowing of the skin and the whites of the eyes). Specialized tests are needed to confirm the diagnosis. No specific treatment exists for this progressive disease other than treating symptoms; cholestyramine may be prescribed to relieve itching.
• Hemochromatosis. Hemochromatosis is an inherited disease in which the body absorbs and stores too much dietary iron. The excess iron accumulates in the liver, pancreas, heart, testicles, and other organs, where it damages surrounding cells. The disease can result from excessive iron absorption (such as from having frequent blood transfusions) but usually is caused by a genetic error. Hemochromatosis is most common among men of northern European descent. The disease is diagnosed with blood tests to measure levels of iron in the blood and a liver biopsy. Symptoms usually appear during middle age and include weakness, weight loss, joint pain, and abdominal pain. The disease eventually causes changes in skin pigmentation (bronze coloration), liver damage, diabetes, and cardiac arrhythmia as it progresses. Liver failure or liver cancer may result. The disease cannot be cured, but its progression can be slowed through regular removal of blood (phlebotomy), such as by routine blood donation.
Laparoscopic Surgery
A surgeon can examine the abdomen and perform certain surgical procedures using a laparoscope (a viewing tube). The laparoscope is equipped with a precision optical system that sends clear images to a video monitor. Laparoscopic surgery can be used to remove an inflamed appendix or a diseased gallbladder. For laparoscopic surgery, the patient is given general anesthesia, a small incision is made in the abdomen, and the laparoscope is inserted. Other tiny incisions are made around the abdomen through which tiny surgical instruments are inserted through instrument tubes. The surgeon inflates the abdominal cavity with carbon dioxide gas to provide sufficient room in which to examine the tissues and manipulate the surgical instruments. For laparoscopic cholecystectomy, the surgeon uses tiny scissors to cut the cystic artery and the cystic duct and to separate the gallbladder from the liver. He or she then seals off the blood vessels to the gallbladder, draws the gallbladder out through the incision beneath the navel, and stitches up the incisions.
Click to enlarge
The surgeon performs the operation while viewing the inside of the abdomen on the video monitor. Usually the surgery is videotaped at the same time. The diseased tissue is removed through one of the instrument tubes. After surgery the patient will have only a small dressing over the incision. Often he or she can go home later that day and resume normal activities shortly thereafter.
Disorders of the Gallbladder, the Pancreas, and the Liver
The gallbladder has a single, nonessential role in digestion: it stores bile produced by the liver until it is needed in the duodenum to digest fats. Both the pancreas and the liver help regulate metabolism (the chemical processes that take place in the body) and have essential roles in digestion. The pancreas releases hormones and enzymes critical to the breakdown of proteins, carbohydrates, and fats. The liver, one of the most complex organs in the body, performs more than 5,000 life-sustaining functions. It produces, monitors, recycles, and stores a wide range of chemicals that are essential for life. Everything that is absorbed by or injected into the body is filtered through the liver, which removes toxins and other potentially harmful substances from the blood. Unlike other organs, the liver receives blood from two sources: the hepatic artery, which supplies fresh, oxygenated blood, and the portal vein, which brings blood directly from the digestive tract for filtering before it goes on to the heart and the lungs. If the liver does not function properly, the consequences can be life-threatening.
Gallstones
The gallbladder is a small, pear-shaped sac beneath the liver where bile is stored and concentrated. Gallstones can form when an imbalance in its chemical composition causes the bile to harden into solid pieces. If the bile contains too much cholesterol, a tiny particle can gradually grow into a gallstone as more and more material hardens around it. Cholesterol stones are the most common type of gallstone. Another type of gallstone, a pigment stone, is small, dark, and made of bilirubin (the major pigment in bile). There may be one or more gallstones in various sizes, from the size of a grain of sand to the size of a golf ball.
Gallstones
Gallstones are solid lumps,
consisting mostly of cholesterol,
that form in the gallbladder.In
some cases, a small gallstone
passes on its own out of the
gallbladder through the bile duct
and out of the body in stool,
causing no pain.But if a large
stone blocks the cystic duct,
which causes intense pain, both
the duct and the gallbladder are
removed surgically.
The risk of developing gallstones increases with age. Obesity and frequent fasting also are risk factors. People who have diabetes or who take cholesterol lowering drugs also may have an increased risk of developing gallstones.
A gallstone may block the normal flow of bile in the ducts that lead from the liver to the gallbladder and from the gallbladder to the small intestine. A backup of bile in these ducts can cause inflammation of the gallbladder, the ducts themselves, or (rarely) the liver. If a stone gets stuck in the common bile duct, digestive enzymes from the pancreas may flow backward and cause pancreatitis (search pancreatitis for more info). Symptoms of a stone-related blockage include fever, jaundice (yellowing of the skin and the whites of the eyes), nausea or vomiting, and constant, severe pain in the upper right abdomen. Pain also may occur in the chest or the back or between the shoulder blades.
If your doctor suspects that you have gallstones, you probably will undergo an ultrasound examination, in which sound waves are used to create images of the abdominal organs. Blood tests also may be performed. Specialized procedures performed to more closely examine the gallbladder include cholecystogram (in which X rays are taken after a special iodine dye is injected or swallowed) and endoscopic retrograde cholangiopancreatography (ERCP; see “Diagnostic Procedures,” Post).
Surgery to remove the gallbladder is the most common treatment for gallstones that are causing symptoms. (Gallstones that are not causing symptoms usually are discovered by chance during an examination for some other reason and are usually left alone.) The surgery to remove the gallbladder is called a laparoscopic cholecystectomy. After the gallbladder is removed, bile flows directly from the liver to the duodenum. A medication called ursodiol is sometimes used to slowly dissolve small cholesterol stones. The drug is taken by mouth every day for 6 months to 2 years, until the stones are dissolved. However, this treatment does not always dissolve the stones, and it does not prevent their recurrence.
Pancreatitis
The pancreas is a large gland located behind the stomach and close to the duodenum. The disease most commonly associated with the pancreas is diabetes. However, the pancreas can become inflamed when the digestive enzymes it produces become activated and attack its own tissues. This condition is known as pancreatitis.
In acute pancreatitis, the pancreas suddenly becomes inflamed and then returns to normal. Most people experience only one attack, but the condition can recur. Acute pancreatitis usually is caused by alcohol abuse or by gallstones. An attack usually lasts about 48 hours and begins with severe pain in the upper abdomen. The pain may appear suddenly and be severe, or it may worsen gradually, especially after eating. The abdomen may be swollen and tender. The pain is often accompanied by nausea, vomiting, fever, and a rapid heart rate.
These symptoms are often sufficient to diagnose acute pancreatitis, but a blood test to check for high levels of amylase (an enzyme produced by the pancreas) can confirm the diagnosis. The doctor also may recommend a computed tomography (CT) scan or an ultrasound of the abdomen. Unless complications such as bleeding from the pancreas or infection in the abdomen occur, acute pancreatitis usually will clear up on its own. However, most people with acute pancreatitis will need to be hospitalized to receive intravenous fluids and electrolytes to replace those lost through vomiting. Narcotic analgesics such as codeine are prescribed to relieve pain. Future attacks can be prevented by treating the underlying cause.
Chronic pancreatitis is more common in men than in women and usually develops after many years of alcohol abuse. Symptoms are usually the same as those of acute pancreatitis, but the attacks become more frequent as the disease progresses. People with chronic pancreatitis experience pain, weight loss (due to malabsorption of nutrients), and diabetes (due to insufficient production of insulin by the pancreas). Blood tests and other procedures such as ultrasound scanning, CT scanning, or endoscopic retrograde cholangiopancreatography (ERCP; see “Diagnostic Procedures,” Post) can be used to assess the condition of the pancreas. The disease is treated (but not cured) with pain medication, insulin (to control blood sugar levels), and pancreatic enzyme preparations (to correct enzyme deficiencies). In some cases, surgery to remove the pancreas (pancreatectomy) is required to relieve pain. All people with either acute or chronic pancreatitis must stop drinking alcohol.
Cirrhosis
Cirrhosis is a progressive liver disease that results from long-term damage to liver cells. The liver is continuously exposed to potential toxins, including drugs (over-the-counter, prescribed, or illegal) and alcohol—all of which can damage liver cells over time. Eventually the tissue becomes scarred, which blocks the flow of blood through the liver, causing liver failure and portal hypertension (high blood pressure in the veins from the intestines and spleen to the liver). In the United States, cirrhosis is among the leading causes of death. Men are more than twice as likely as women to die of chronic liver disease and cirrhosis.
Heavy alcohol consumption is the most common cause of cirrhosis. Other causes of the disease include viral hepatitis, hemochromatosis (excess iron in the body), Wilson’s disease (excess copper in the body), cystic fibrosis, blocked bile ducts, and adverse drug reactions. Cirrhosis does not always cause symptoms and may be detected during a routine physical examination (the doctor may feel an enlarged liver) or blood test (the test may reveal abnormal liver function). In the early stages of cirrhosis, some people may experience vague symptoms such as fatigue, weakness, exhaustion, loss of appetite, nausea, and weight loss. As the disease progresses, bile pigment builds up in the blood, causing jaundice (yellowing of the skin and the whites of the eyes).
Other common symptoms of cirrhosis include mental confusion due to a buildup of toxins in the brain, and hematemesis (vomiting blood) due to internal bleeding. In men, breast enlargement and hair loss may occur, possibly due to a sex hormone imbalance caused by liver failure. Possible complications of liver failure include ascites (accumulation of fluid in the abdominal cavity), malnutrition, and esophageal varices (enlarged veins in the wall of the esophagus), which can rupture and cause the person to vomit blood. Hepatoma, the most common form of liver cancer, is another possible complication.
The symptoms and signs of cirrhosis and the results of liver function tests (special tests of blood chemistry) are indicators of possible cirrhosis. However, a liver biopsy (removal of a small piece of tissue for microscopic examination) is required to confirm the diagnosis. To exclude rare causes of cirrhosis, special blood tests and cholangiography (X rays of the bile ducts) may be performed. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) may be performed to evaluate the condition of the liver.
There is no cure for cirrhosis, so treatment focuses on slowing the progression of the disease and reducing the risk of complications. People with cirrhosis must not consume alcohol. Ascites may be treated with diuretics (drugs that increase urine production) and by restricting sodium (salt) intake. Portal hypertension may be treated with antihypertensive medication. Esophageal varices may be injected with a sclerosant (an irritant solution) to stop any bleeding. Mental confusion can be treated by reducing the levels of toxins in the bloodstream. This may require reducing the amount of protein in the diet, and taking antibiotics to reduce the number of bacteria in the intestinal tract. In cases of advanced cirrhosis, a liver transplant may be required.
Viral Hepatitis
Hepatitis is a contagious viral infection that causes inflammation of the liver. It is caused by one of the hepatitis viruses, A, B, C, or D. Most people with hepatitis recover on their own without treatment. Some people may experience mild recurrences over months or years. Still others may die of the infection. Hepatitis A and B are the most common types of viral hepatitis; hepatitis B, C, and D are the most dangerous. All donated blood and blood donors are routinely screened for all of the hepatitis viruses.
Many people with hepatitis experience no symptoms, and the disease may be detected during a routine physical examination because the liver feels enlarged or because a blood test shows abnormal liver function. A simple blood test is used to determine whether a person is infected with one of the hepatitis viruses. Some people with hepatitis experience flulike symptoms such as fatigue, slight fever, nausea, vomiting, loss of appetite, weight loss, weakness, mild abdominal pain, muscle and joint aches, and diarrhea. People with chronic hepatitis often experience fatigue, joint aches, skin rashes, or memory loss.
Hepatitis A is spread through poor hygiene practices. It also is spread through contaminated food or water. The infection varies from mild to severe. Once you recover, you are immune to hepatitis A infection for life.
Hepatitis B is the most serious form of the disease. It is spread through unprotected sexual contact and sharing of contaminated needles by intravenous drug users. Many people who are infected with hepatitis B are carriers (they have the virus in their body but do not have symptoms) and can transmit the disease to other people. A woman can pass hepatitis B to her baby during childbirth. Vaccines are available to prevent hepatitis A and B. Your sexual partner should be vaccinated if you have hepatitis B.
Hepatitis C is spread primarily through sharing of contaminated needles by intravenous drug users. Symptoms of hepatitis C are similar to those of hepatitis B. In adults, the course of hepatitis C infection is influenced by several factors. In people who are older, the disease usually has a more rapid development. Many people infected with hepatitis C will develop severe liver disease, such as chronic hepatitis or cirrhosis, within 20 years of acquiring the infection. Rates of such disease are higher in people who are also infected with either hepatitis B or the human immunodeficiency virus (HIV). Even moderate long-term drinking of alcohol is associated with a higher likelihood of cirrhosis or liver cancer in people infected with hepatitis C. Certain forms of hepatitis C are not treatable. Other forms seem to be controlled with the use of antiviral drugs.
Your doctor will recommend that you be tested for hepatitis C if you:
• had a blood transfusion or organ transplant before July 1992
• were treated for clotting problems with a blood product before 1987
• have ever received long-term kidney dialysis
• had frequent ongoing exposure to blood products before 1987. (Recent exposure to blood products is not a risk because all blood products are screened for hepatitis C.)
• are a healthcare worker who was exposed to blood containing the hepatitis C virus
• are an intravenous (IV) drug user or former IV drug user
Hepatitis D usually is spread through sharing intravenous drug needles. It occurs only in conjunction with hepatitis B, and usually causes severe illness. There is no vaccine for hepatitis C or D.
Treatment of hepatitis focuses on controlling symptoms. Most people will recover within several weeks or months. Your doctor will want to know what medications you are taking (both prescription and nonprescription) to make sure they cannot damage your liver. Your doctor will recommend that you rest, eat a well-balanced diet, and avoid alcohol.
Colostomy and Ileostomy
Treatment of Crohn’s disease, ulcerative colitis, polyps, and colorectal cancer sometimes requires removal of all or part of the large intestine. Depending on how much tissue must be removed, the surgeon may need to create a new path for stool to pass from the body. Surgery to create a new opening (called a stoma) through the abdominal wall when the rectum is removed is called a colostomy; if both the rectum and the colon must be removed, the procedure is known as an ileostomy.
The stoma is about the size of a quarter. A pouch is worn over the opening to collect waste and it must be emptied periodically. In some cases the surgeon can create an internal pouch made from a portion of the ileum, which the person periodically empties by inserting a tube through a tiny opening in the abdominal wall.
For some people a colostomy is temporary, and the surgeon performs a second operation to reconnect the healthy sections of the colon after the lower colon and the rectum have healed.
Ileoanal reservoir surgery is an alternative procedure that involves two separate operations. In the first operation, the colon and rectum are removed, and a temporary ileostomy is created. In the second operation, the ileostomy is closed, and part of the ileum is used to create an internal pouch to hold stool. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out. People who have this surgery are able to control their bowel movements, although the bowel movements may be more frequent and may be watery.
Warning Signs of Colorectal Cancer
Colorectal cancer often has no warning signs. Because of this, your doctor will recommend regular screening with fecal occult blood tests (to check for blood in your stool) and colonoscopy (search Diagnostic Procedures post). However, if you experience any of the following symptoms, see your doctor immediately:
• changes in bowel movements—diarrhea or constipation that last for several days, stool that appears narrower than usual, or a feeling that your bowels are not completely empty after a bowel movement
• blood in the stool—red-streaked or black, tarry stools
• abdominal pain—persistent pain, cramps, or tenderness in the lower abdomen
• unexplained weight loss—losing weight without trying to
• fatigue—feeling tired without a specific cause, which may indicate internal bleeding or anemia
Disorders of the Large Intestine and Rectum
When partially digested food reaches the large intestine (colon), the nutrients have already been absorbed by the body. The colon is responsible for absorbing water and pushing out waste matter. The colon’s work is made easier if you eat a healthy diet that includes plenty of fiber from fruits, vegetables, and whole grains. This helps the muscles in your colon push the waste along quickly and efficiently and reduces exposure of the intestinal tissues to carcinogens (cancercausing substances) and other potentially harmful substances.
Ulcerative Colitis
Ulcerative colitis is a type of chronic inflammatory bowel disease. It is similar to Crohn’s disease (Search Post about that for more info), but it affects only the intestinal lining and is almost always restricted to the large intestine. Ulcerative colitis starts at the rectum and spreads upward through the large intestine. The disease causes chronic diarrhea that is usually bloody; as the intestinal lining dies and sloughs off, ulcers form that release mucus, pus, and blood into the colon. Other symptoms include abdominal pain, fatigue, weight loss, loss of appetite, and rectal bleeding. The nonintestinal symptoms that can occur with Crohn’s disease also can occur with ulcerative colitis. People whose ulcerative colitis extends throughout the entire colon are at much greater risk of developing colon cancer than are those whose disease is limited to the rectum and the sigmoid (lower) colon.
Ulcerative colitis develops most frequently between ages 15 and 40. Most people with ulcerative colitis can control their symptoms by making simple dietary changes, such as avoiding raw fruits and vegetables or highly seasoned foods to minimize damage to the sensitive intestinal lining. Treatment for ulcerative colitis is generally the same as it is for Crohn’s disease. Periods of remission (without symptoms) may last weeks, months, or even years. However, in most people, symptoms eventually return. During severe attacks (10 or more bouts of bloody diarrhea per day), a person must be hospitalized to receive intravenous drugs and feeding and to be monitored for perforation of the bowel. For some people, surgical removal of the rectum and all or part of the colon may be necessary.
Irritable Bowel Syndrome
Irritable bowel syndrome is a group of symptoms that includes cramping pain, gas, bloating, and alternating bouts of constipation and diarrhea. Sometimes people with irritable bowel syndrome pass mucus with their bowel movements. Irritable bowel syndrome is also called irritable colon, spastic colon, spastic bowel, mucous colitis, and functional bowel disease. Diagnosis of irritable bowel syndrome is usually made by ruling out other possible causes of the symptoms. Irritable bowel syndrome does not cause permanent damage to the intestines and does not increase the risk of colon cancer.
Stress and diet are the most common triggers for the symptoms of irritable bowel syndrome. Stress probably has a role in irritable bowel syndrome because the nervous system controls the colon and digestion. Contractions of the colon can begin as soon as the person starts eating, and the urge to have a bowel movement may come within 30 to 60 minutes after a meal. High-fat foods (such as red meats and dairy products), caffeine, and alcohol can bring on symptoms. Eating large meals can lead to cramping and diarrhea.
To control irritable bowel syndrome, avoid the foods that cause your symptoms. You also may find relief by eating smaller, more frequent meals and by eating less fat and more fruits, vegetables, and whole grains. Taking fiber supplements also may help. Stress management techniques (search post about that for more info) will help you reduce or control stress. If self-help measures are ineffective, your doctor may prescribe anticholinergic or antispasmodic medication (such as atropine or dicyclomine) to help relieve spasms in the colon.
Diverticular Disease
Diverticula are small bulges or pouches that develop in the colon. These pouches form when the colon strains to move hard stool, and the increased pressure pushes through weak spots in the lining of the colon. This condition may result from eating a diet that is low in fiber. If there are no symptoms or mild symptoms, the condition is called diverticulosis. If the pouches become infected or inflamed—such as when stool or bacteria become trapped inside them—the condition is known as diverticulitis. Diverticular disease occurs mainly in developed countries such as the United States, where people regularly consume low-fiber processed foods.
Diverticulosis usually does not cause symptoms, although some people may experience tenderness or pain in the lower abdomen. Others may have mild cramps, bloating, and alternating bouts of constipation and diarrhea. Eating a well-balanced diet (search post for more info) that is low in fat and high in fiber, taking fiber supplements, and taking antispasmodic medication will relieve the symptoms of diverticulosis and help prevent diverticulitis. If you have no symptoms, you do not need treatment.
The most common symptom of diverticulitis is abdominal pain, especially in the lower left abdomen. The pain may be accompanied by fever, nausea, vomiting, chills, cramping, and constipation. Diverticulitis is usually detected during a diagnostic examination such as a colonoscopy or a gastrointestinal (GI) series (see “Diagnostic Procedures,” Post).
Treatment for diverticulitis includes antibiotics, intravenous fluids, and bed rest. Surgery may be required if an infected diverticulum ruptures and produces an abscess (a pus-filled sac) or causes peritonitis (inflammation of the lining of the abdominal cavity), if a stricture (narrowing) develops in the colon, or if bleeding cannot be controlled. In most cases the affected portion of the colon is removed, and the remaining portions are rejoined. A colostomy also may be required.
Proctitis
Proctitis is inflammation of the lining of the rectum. Symptoms include bleeding, constipation, a feeling of fullness in the rectum, pain in the lower left abdomen or around the anus, and, sometimes, discharge of mucus and pus. Proctitis may occur after certain medical treatments, such as radiation therapy or antibiotic use. Inflammatory bowel disease, sexually transmitted diseases, injury to the rectum, and infection also may cause proctitis.
Diagnosis of proctitis is made by a proctoscopy (see “Diagnostic Procedures,” Post) and a biopsy (removal of a small piece of tissue for microscopic examination). Once the underlying cause of the inflammation has been determined, the doctor will recommend appropriate treatment. If inflammatory bowel disease is the underlying cause, the doctor probably will prescribe corticosteroid medication to relieve the symptoms.
Anal Abscess
An abscess is an infected cavity filled with pus. Abscesses can occur when bacteria penetrate and become trapped in the tissues of the anus or rectum. Anal abscesses that appear close to the tissue surface are very painful. Abscesses in deeper tissues tend to cause more general symptoms of infection such as fever, malaise (a vague feeling of being ill), and tenderness around the abscess. Your doctor will open and drain the abscess. When an anal abscess is drained, a fistula (an abnormal connecting channel between the intestines and the skin in the genital area) may develop spontaneously. Surgery is required to repair a fistula.
Hemorrhoids
Hemorrhoids are swollen (varicose) veins in the lining of the anus and rectum. Hemorrhoids may result from straining during bowel movements. Other possible causes include heredity, aging, and chronic constipation or diarrhea. In general, hemorrhoids can be irritating and painful but are considered normal and do not threaten your health.
Symptoms of hemorrhoids include persistent itching or discomfort around the anus and pain, especially during bowel movements. Hemorrhoids also can bleed. Be sure to tell your doctor if you see blood in your stool, on toilet paper, or in the toilet; bleeding can be a sign of colorectal cancer (search for colorectal cancer for more info).
A doctor can diagnose hemorrhoids by examining the anus and rectum with a gloved finger. To confirm the diagnosis, the doctor probably will perform a visual examination of the inside of the anus and rectum in a procedure called proctoscopy (search for Diagnostic Procedures for more info). In some cases the doctor may perform a colonoscopy (search for Diagnostic Procedures for more info) to examine the colon to rule out cancer and other possible causes of bleeding.
There are a number of steps you can take to relieve symptoms of hemorrhoids: eat a high-fiber diet that includes plenty of fruits, vegetables, and whole grains; drink at least eight 8-ounce glasses of water every day (but avoid alcohol and caffeine, which can irritate hemorrhoids); soak in a bath of plain warm water once or twice a day and cleanse the affected area with mild soap; apply ice packs to the area (to reduce swelling); and apply an over-the-counter hemorrhoidal cream to the affected area for a limited time (be sure to follow package directions). Outpatient procedures to remove hemorrhoids include rubber band ligation, in which rubber bands are placed around the base of a hemorrhoid to cut off its blood supply, causing it to shrink and fall off, and sclerotherapy, in which a chemical solution is injected directly into a hemorrhoid, causing it to shrink. In another procedure, heat is used to seal a hemorrhoid and stop it from bleeding. Some hemorrhoids must be removed surgically.
Appendicitis
The appendix is a small, finger-shaped organ with no known function that projects out from the large intestine. For reasons that are not fully understood, the appendix can become inflamed. Inflammation of the appendix is called appendicitis. Although appendicitis occurs most often in children and young adults, it can occur at any age. Symptoms occur in only about half of all people who have appendicitis, and many of those symptoms occur in other acute abdominal disorders. Because of the high risk of serious and potentially fatal infection associated with appendicitis, you should seek medical help immediately if you experience sudden, severe abdominal pain either with or without any of the following symptoms:
• pain that starts near the navel and moves to the lower right area of the abdomen
• pain that worsens when taking deep breaths, coughing, or sneezing
• pain that worsens when even slight pressure is applied to the area
• nausea or vomiting after the pain begins
• fever after the pain begins
• abdominal swelling
• inability to pass gas
• blood in the stools (they are red-streaked or look black and tarry)
• constipation
To diagnose appendicitis, a doctor examines your abdomen by gently pressing on it and listening through a stethoscope for sounds of normal digestion. (If you have a severe infection, there are no sounds.) Based on your symptoms and the examination, the doctor will admit you to the hospital for surgery to remove your appendix. He or she may perform a procedure called laparoscopy to confirm the diagnosis. If the appendix has not ruptured, the doctor can remove it through the laparoscope (viewing tube). In other cases, he or she may remove the appendix through a larger incision in the abdomen. Both types of surgery are performed in the hospital using general anesthesia. You will be in the hospital for 1 to 3 days, depending on the severity of your condition.
Polyps
Colon Polyp
A polyp is a mushroom-shaped growth of tissue in the
inner lining of the wall of the colon.The most common
type of polyp, called an adenomatous polyp (shown here),
is noncancerous, but it can grow and become cancerous.
A polyp is a growth of tissue in the lining of the wall of the colon. Polyps usually cause no symptoms and often are detected during a routine colonoscopy (search Diagnostic Procedures for more info). Research suggests that a high-fat, low-fiber diet may lead to the development of polyps in the colon. Heredity also may be a factor. A person who develops one polyp is likely to develop more polyps in the future and should be monitored by colonoscopy regularly.
Small, benign (noncancerous) polyps are common in the colon and usually do not cause symptoms or affect your health. However, an adenomatous polyp (the most common type of polyp) is noncancerous but can become cancerous. Therefore your doctor will remove these polyps as soon as they are detected to prevent development of cancer. Small polyps can be removed through a colonoscope, but removal of larger polyps requires general surgery. Left untreated, small polyps will grow. The larger the polyp, the more likely that it is cancerous.
Colorectal Cancer
Cancer of the colon and cancer of the rectum are two of the most common forms of cancer. The term “colorectal cancer” is often used to describe them. Colorectal cancer is the third most common type of cancer among men and also is the third leading cause of cancer death among men. But the rate of cure is high—up to 90 percent—when the disease is detected and treated early.
Nearly all cases of colorectal cancer arise from previously benign (noncancerous) adenomatous polyps. The risk of colorectal cancer increases with age (occurring most often after age 50) and may be higher among people who eat a high-fat, low-fiber diet. People with ulcerative colitis (see ulcerative colitis for more info) are more likely to develop colon cancer. Colorectal cancer can run in families: if you have a parent, sibling, or child who was diagnosed with colon cancer, your risk of developing colon cancer is greater than normal.
A doctor can detect cancers just inside the rectum during a digital rectal examination. Doctors recommend an annual digital rectal examination for all men 40 and older. The most common screening test to detect colon cancer is the fecal occult blood test, which checks for traces of blood in samples of stool. Doctors recommend that all men over age 50 have a fecal occult blood test every year.
A more accurate test, recommended every 5 years, is called a flexible sigmoidoscopy, a visual examination of the lower third of the colon and rectum that uses a probe with a light and a camera attached. The doctor inserts the instrument into the colon and looks through the viewing tube to check for polyps or signs of cancer. A colonoscopy is a similar procedure, but it examines the entire length of the colon. The doctor performing a sigmoidoscopy or colonoscopy may remove tissue for a biopsy during the test.
An alternative to these procedures is a barium enema. During this test, contrast medium (a dye) is inserted through the rectum into the colon, and X rays are taken of the colon to look for abnormalities. If a suspicious area is detected in the colon during a barium enema, the doctor will order a biopsy (microscopic examination of a small piece of tissue that has been removed from the colon) to confirm the diagnosis of cancer.
A tumor in the colon is classified by stages, according to whether it has affected only the top layer of the intestinal lining, penetrated farther down into the lining, involved the surrounding lymph nodes (part of the body’s immune system that fights infection), or spread to other parts of the body.
Treatment for colon cancer depends on how far the cancer has advanced and may include surgery, radiation therapy, chemotherapy (treatment with powerful anticancer drugs), or some combination of these. Surgical removal of the tumor and surrounding colon and lymph tissue is the most common treatment for colon cancer. After the cancerous section of the colon has been removed, the healthy sections are reconnected. In some cases the surgeon may perform a colostomy to provide an outlet for feces. If the tumor is large, you may need to undergo radiation therapy before surgery to help shrink the tumor. Radiation therapy also may be used after surgery to ensure that all the cancerous cells have been killed.
If the surgeon is not sure that all the cancer has been removed, or if the cancer has spread to other parts of your body, you will need to undergo chemotherapy or possibly immunotherapy, in which your body’s immune system is stimulated to destroy cancer cells.
Chemotherapy drugs may be given orally or intravenously. Several different types of drugs may be given simultaneously. You may need to be hospitalized during the first few days of treatment and then continue the treatment on your own at home. Chemotherapy usually is administered in cycles. For example, you may take the drugs for several weeks, stop taking the drugs for several weeks, and then repeat this cycle. Your doctor will explain the risks, advantages, and side effects of these therapies. Some people benefit from participating in a support group, which allows them to share information and experiences with others who are in a similar situation. Ask your doctor to recommend a support group in your area.
