GI Disorders

- Diverticulosis
- Hemorrhoids
- Constipation

- Irritable Bowel Syndrome

What is Diverticulosis?
Diverticulosis is a condition of the lower GI tract. Strictly defined, diverticular disease is the term used to describe out-pouchings in the lower part of the large intestine associated with symptoms. Common symptoms include altered bowel movements, abdominal discomfort or pain. Acute diverticulitis occurs when an out-pouching becomes acutely inflamed and irritated. This results in significant discomfort and generalized symptoms of infection, including fever. Diverticulosis, on the other hand, is a term used to describe the out-pouchings that occur in the lower colon that are not attributed to any symptoms. These out-pouchings are occasionally seen and described during colonoscopy.

Diverticular disease commonly results in repeated episodes of discomfort, despite attempts at treatment. A significant number of people will have a recurrent episode of diverticulitis within one year of their initial attack. Unfortunately, the process of repeated inflammation may lead to chronic complications such as bleeding, infection, and obstruction.

What causes Diverticulosis?
The incidence of diverticulosis increases with age, with 5-10% of people affected by the age of 50. It is, unfortunately, related to the high fat, low fiber diets commonly consumed in developed countries. Anywhere between 10-25% of people will exhibit symptoms related to diverticular disease in their lifetimes. It is unclear why some people develop symptoms, while others do not.

How is Diverticulosis treated?
Treatment of diverticular disease is multi-faceted. Fiber supplementation has been advocated to reduce the complications and symptoms of diverticular disease. Use of a common prescription laxative, lactulose, has been advocated to reduce symptoms in patients experiencing symptoms related to diverticular disease. Bulk fiber laxatives, such as Citrucel may help the digestive system work more efficiently, thereby reducing strain on the colon.

After an acute episode, physicians will often recommend examinations of the colon via colonoscopy or barium enema.

Carefully monitoring diet intake with a ‘food diary’ will allow patients the opportunity to pinpoint certain foods and/or situations that predispose them to diverticular disease flare-ups.

For a person with repeated episodes of pain and bleeding that is not helped with medical means, surgery is sometimes an option. Removal of the affected portion of colon has been an effective treatment option.

For a person with acute diverticulitis, immediate medical attention is often necessary. Evaluating for obstruction or other complications is paramount. Admission to the hospital is sometimes necessary for intravenous antibiotics and fluids. Consideration of surgery may be necessary.

What Causes Hemorrhoids?
Hemorrhoids can occur at any age and are common causes of discomfort and aggravation. Approximately 50% of women will have experienced hemorrhoids by age 50. A variety of conditions can increase the risk of a woman developing hemorrhoids. Prior childbearing, chronic constipation with straining during bowel movements, prolonged sitting at work and the aging process can increase the risk of this common disorder. Fortunately, there are effective treatments available to soothe the irritation and lessen the discomfort. Other anal conditions including anal itching and anal-rectal fissures are very common during the perimenopause and menopause transition. This page will describe hemorrhoids and the other prevalent anal conditions. Evaluation and treatment strategy options will be discussed.

What is a Hemorrhoid?
A hemorrhoid is swelling and dilation of the veins around the anal region, often complicated by inflammation, thrombosis and bleeding.. There are two types of hemorrhoids: external and internal. A demarcation in the anal canal (called the dentate line) separates the anal canal from rectum. Internal hemorrhoids occur above the dentate line and are generally painless. They can be a source of bleeding or protrude outside of the anal opening if enlarged and inflamed. They can also cause a sense of incomplete emptying at the time of a bowel movement. Conversely, external hemorrhoids occur below the dentate line and can be exquisitely painful. Thrombosis occurs if a dilated vein forms a blood clot A thrombosed external hemorrhoid is felt as a hard, painful lump near the anal opening. These can occasionally become ulcerated and result in bleeding.

The accompanying graphic depicts common anal / rectal conditions. It is a side view representation of the rectum and anus.

• Number 1: External Hemorrhoid
• Number 2: Anal Fissure
• Number 3: Pruritus Ani
• Number 4: Internal Hemorrhoid
• Number 5: Dentate Line
• Number 6: Rectum

The bleeding from internal hemorrhoids often follows a bowel movement and is noted to be bright red blood covering the stool or on toilet tissue and underwear. Pain from internal hemorrhoids generally occur only with protrusion of the vein during a bowel movement. Thrombosed external hemorrhoids are often irritated and can be a source of itching and discomfort with wiping. Significant heavy bleeding causing anemia is unusual.

How is a Hemorrhoid diagnosed?
The diagnosis of a hemorrhoid can be made only after a thorough evaluation. Although hemorrhoids are often associated with bleeding, one should not assume that rectal bleeding is caused by hemorrhoids until other serious conditions are excluded. The rectum and anus are closely inspected to look and feel for dilated hemorrhoid veins. A rectal exam is generally done to feel for internal hemorrhoids and other anal and/or rectal abnormalities. Occasionally, further evaluation with a scope to look into the anus (anoscope) or large intestine (colonoscope or sigmoidoscope) is done to exclude other causes of bleeding from the rectum.

How can a Hemorrhoid be preventatived?
Prevention of hemorrhoids revolves around normal bowel movements. Avoiding the straining associated with constipation is very important. Stool softeners and food or supplements that add bulk to your stool are often used. Bulk forming agents include bran and other whole grains, fiber supplements, fruits and vegetables. Proper hydration to keep stool soft is important, therefore increasing water intake is beneficial.

How is a Hemorrhoid treated?
Once a hemorrhoid is diagnosed, strategies for treatment and to prevent future hemorrhoids are employed. When an inflamed, thrombosed hemorrhoid is diagnosed measures used to soothe the inflammation are employed.

Warm soaks ( sitz baths) several times a day can significantly reduce the pain, especially after a painful bowel movement. Topical anesthetics can also be used to reduce the pain of a thrombosed hemorrhoid. Anti-inflammatory topical treatments (such as proctoFoam® HC (hydrocortisone acetate 1% and pramoxine hydrochloride 1%) and proctoCream® HC 2.5% (hydrocortisone acetate 2.5%) can soothe the irritation and pain. Hydrocortisone is a commonly used anti-inflammatory agent and is found in a number of medications. Astringent compresses can also be used for soothing purposes.
Bulk fiber laxatives, such as Citrucel are often recommended to reduce strain on the rectal area. Fiber may create softer larger stools, reducing straining and helping sensitive tissue heal faster, naturally.

If hemorrhoids are recurrent, severely painful or associated with frequent bleeding then surgical options may be pursued. Sclerotherapy involves injecting the hemorrhoid with medication to reduce the bleeding. Banding of internal hemorrhoids with special rubber bands can be done in certain cases. Lastly, surgically excising the hemorrhoids (hemorrhoidectomy) can be done under anesthesia.

What other medical conditions are related to Hemorrhoids?
Pruritus ani refers to itching and burning around the anus. Improper hygiene or irritating soaps or detergents may be the cause. Other causes include skin infections and allergic reactions. Certain foods may aggravate this condition. Caffeine, spicy foods, citrate containing foods, and acidic foods have all been implicated. In menopause, thinning of the vagina and skin regions around the vagina and anus, acondition, called urogenital atrophy, may be a source of itching and burning. Another common condition associated with itching in the female genital region in is lichen sclerosis. Associated with thinning and scarring of the genital skin region, this condition is often associated with extreme itching and burning.

The treatment for all causes of Pruritus ani revolves around proper hygiene. Avoiding overzealous cleansing is appropriate. Gentle cleansing of the area with a mild, fragrance free soap or water, followed by thorough drying is important. Use of a drying powder, like cornstarch, may also be of benefit. Monitoring the diet will also allow the elimination of foods or food groups that aggravate the itching and burning. Medical treatment revolves around the use of an anti-inflammatory agent, such as hydrocortisone. The use of estrogen containing creams may also be prescribed to alleviate the itching and irritation from urogenital atrophy.

Anal fissures can occur after passing a hard or large stool. Fissures are small tears in the anal canal. This condition is associated with pain at the time of a bowel movement. The pain is often described as a cutting or tearing discomfort. They can be associated with bleeding and discharge. This condition will often resolve spontaneously. The use of stool softeners and/or bulk fiber laxatives (link to store, Citrucel) can help reduce strain on the rectal area and may reduce the incidence of fissures. Treatment revolves around reducing the pain from these fissures with anti-inflammatory agents and local anesthetics.

Constipation:
Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others.

At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through it, the colon absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.

The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly.

Common Causes of Constipation

• Not enough fiber in diet
• Not enough liquids
• Lack of exercise
• Medications
• Irritable bowel syndrome
• Changes in life or routine such as pregnancy, older age, and travel
• Abuse of laxatives
• Ignoring the urge to have a bowel movement
• Specific diseases such as multiple sclerosis and lupus
• Problems with the colon and rectum
• Problems with intestinal function (Chronic idiopathic constipation).

Not Enough Fiber in the Diet.
The most common cause of constipation is a diet low in the fiber found in vegetables, fruits, and whole grains and high in the fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods are less likely to become constipated.

Fiber--soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

On average, Americans eat about 5 to 20 grams of fiber daily, short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods in which the natural fiber is removed.
A low-fiber diet also plays a key role in constipation among older adults. They often lack interest in eating and may choose fast foods low in fiber. In addition, loss of teeth may force older people to eat soft foods that are processed and low in fiber.

Not Enough Liquids
Liquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8-ounce glasses. Other liquids, like coffee and soft drinks, that contain caffeine seem to have a dehydrating effect.

Lack of Exercise
Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.

Medications
Pain medications (especially narcotics), antacids that contain aluminum, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants for epilepsy can slow passage of bowel movements.

Irritable Bowel Syndrome (IBS)
Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but there is no specific cause or anything unusual that the doctor can see in the colon.

Changes in Life or Routine
During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.

Abuse of Laxatives
Myths about constipation have led to a serious abuse of laxatives. This is common among older adults who are preoccupied with having a daily bowel movement.

Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

Ignoring the Urge to Have a Bowel Movement
People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.

Specific Diseases
Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus. Figure 3 lists the diseases that cause constipation.

Irritable Bowel Syndrome 

 (Copied from http://www.niddk.nih.gov/health/digest/pubs/irrbowel/irrbowel.htm , a non-copyrighted text) 

Irritable bowel syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both. Sometimes the person with IBS has a crampy urge to move the bowels but cannot do so.

Through the years, IBS has been called by many names--colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Most of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine (colon). IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

The cause of IBS is not known, and as yet there is no cure. Doctors call it a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Often IBS is just a mild annoyance, but for some people it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances. Most people with IBS, however, are able to control their symptoms through medications prescribed by their physicians, diet, and stress management.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.