Archive for the ‘health’ Category
No, I don’t have it right now, but I had it a few years ago and it felt very very uncomfortable. So, I’m being very careful not to have it again. So, what is constipation?
Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful poo (also called faeces, stools or motions). Constipation may be caused by not eating enough fibre, or not drinking enough fluids. It can also be a side-effect of certain medicines, or related to an underlying medical condition. In many cases, the cause is not clear. Laxatives are a group of medicines that can treat constipation. Ideally, laxatives should only be used for short periods of time until symptoms ease.
What is constipation?
Constipation is common. If you are constipated it causes one or more of the following:
- Poo (faeces, stools or motions) becomes hard, and difficult or painful to pass.
- The time between toilet trips increases compared with your usual pattern. (Note: there is a large range of normal bowel habit. Some people normally go to the toilet to pass stools 2-3 times per day. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean that you are constipated.)
- Sometimes, crampy pains occur in the lower part of your tummy (abdomen) You may also feel bloated and feel sick if you have severe constipation.
What are the causes of constipation?
Known causes include the following:
- Not eating enough fibre (roughage) is a common cause. The average person in the UK eats about 12 grams of fibre each day. But, 18 grams per day is recommended by the British Nutrition Foundation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the poo (faeces, stools or motions), and helps your bowels to work well. Foods high in fibre include: fruit, vegetables, cereals and wholemeal bread.
- Not drinking much may make constipation worse. Stools are usually soft and easily passed if you eat enough fibre, and drink enough fluid. However, some people need more fibre and/or fluid than others in order to avoid constipation.
- Some special slimming diets are low in fibre, and may cause constipation.
- Some medicines can cause constipation as a side-effect. Examples are painkillers(particularly those with codeine, such as co-codamol, or very strong painkillers, such as morphine), some antacids, some antidepressants (including amitriptyline) and iron tablets, but there are many others. See the list of possible side-effects on the leaflet that comes with any medicine that you may be taking. Tell a doctor if you suspect a medicine is making you constipated. A change of medication may be possible.
- Various medical conditions can cause constipation. For example, an underactive thyroid, irritable bowel syndrome, some gut disorders, and conditions that cause poor mobility, particularly in the elderly.
- Pregnancy. About 1 in 5 pregnant women will become constipated. It is due to the hormonal changes of pregnancy that slow down the gut movements. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and the bowels being pushed to one side.
Unknown cause (idiopathic)
Some people have a good diet, drink a lot of fluid, do not have a disease or take any medication that can cause constipation, but still become constipated. Their bowels are said to be underactive. This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persists throughout life.
Do I need any tests?
Tests are not usually needed to diagnose constipation, because symptoms are often typical.
However, tests may be advised if you have any of the following:
- If regular constipation is a new symptom, and there is no apparent cause, such as a change in diet, lifestyle, or medication. This is known as a ‘change in bowel habit’ and should be investigated if it lasts for more than about six weeks.
- If symptoms are very severe and not helped with laxative medication.
- If other symptoms develop. More worrying symptoms include passing blood from your bowel; weight loss; bouts of diarrhoea; night-time symptoms; a family history of colon cancer or inflammatory bowel disease (Crohn’s disease or ulcerative colitis); or other unexplained symptoms in addition to constipation.
What can I do to ease and to prevent constipation?
These measures are often grouped together and called lifestyle advice.
Eat foods that contain plenty of fibre
Fibre (roughage) is the part of plant food that is not digested. It stays in your gut and is passed in the poo (faeces, stools or motions). Fibre adds bulk and some softness to the stools. High-fibre foods include the following:
- Wholemeal or whole-wheat bread, biscuits and flour.
- Fruit and vegetables. Aim to eat at least five portions of a variety of fruit and vegetables each day. One portion is: one large fruit such as an apple, pear, banana, orange, or a large slice of melon or pineapple; OR two smaller fruits such as plums, satsumas, etc; OR one cup of small fruits such as grapes, strawberries, raspberries, cherries, etc; OR one tablespoon of dried fruit; OR a normal portion of any vegetable (about two tablespoons); OR one dessert bowl of salad.
- Wholegrain breakfast cereals such as All-Bran®, Bran Flakes®, Weetabix®, Shredded Wheat® and muesli. A simple thing like changing your regular breakfast cereal can make a big difference to the amount of fibre you eat each day.
- Brown rice, and wholemeal spaghetti and other wholemeal pasta.
Although the effects of a high-fibre diet may be seen in a few days, it may take as long as four weeks. You may find that if you eat more fibre (or take fibre supplements – see below), you may have some bloating and wind at first. This is often temporary. As your gut becomes used to extra fibre, the bloating or wind tends to settle over a few weeks. Therefore, if you are not used to a high-fibre diet, it is best to increase the amount of fibre gradually.
Note: have lots to drink when you eat a high-fibre diet or fibre supplements. Drink at least two litres (about 8-10 cups) per day. This is to prevent a blockage of the gut, which is a rare complication of eating a lot of fibre without adequate fluid. See below in the section ‘Bulk-forming laxatives’ for an explanation.
A separate leaflet in this series, called Fibre and Fibre Supplements, gives more details on high-fibre foods.
Have plenty to drink
Aim to drink at least two litres (about 8-10 cups) of fluid per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens the stools. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good. As a start, try just drinking a glass of water 3-4 times a day in addition to what you normally drink.
Sorbitol is a naturally occurring sugar. It is not digested very well and draws water into the gut, which has an effect of softening the stools. In effect, it acts like a natural osmotic laxative (osmotic laxatives are explained later). So, you may wish to include some foods that contain sorbitol in your diet. Fruits (and their juices) that have a high sorbitol content include apples, apricots, gooseberries, grapes (and raisins), peaches, pears, plums, prunes, raspberries and strawberries. The concentration of sorbitol is about 5-10 times higher in dried fruit. Dried or semi-dried fruits make good snacks and are easily packed for transport – for example, in a packed lunch.
Exercise regularly, if possible
Keeping your body active helps to keep your gut moving. It is well known that disabled people, and bed-bound people (even if just temporarily whilst admitted to hospital) are more likely to get constipated.
Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in a backlog of stools which is difficult to pass later. When you go to the toilet, it should be unhurried, with enough time to ensure that you can empty your bowel.
When mobility is limited – for example, in people who are frail or who have dementia – it is important for carers to see that they have sufficient help to get to the toilet at the time they need to go; also, that they have a regular, unhurried toilet routine, with privacy. As a rule, it is best to try going to the toilet first thing in the morning or about 30 minutes after a meal. This is because the movement (propulsion) of stools through the lower bowel is greatest in the mornings and after meals (due to the gastrocolic reflex).
Positioning on the toilet is also important, especially for elderly people with constipation. Western-style toilets actually make things more difficult – squatting is probably the best position in which to pass stools. Putting a small footstool under your feet is a simple way to change your toilet position to aid the passage of stools. Relax, lean forward and rest your elbows on your thighs. You should not strain and hold your breath to pass stools.
What are the treatments for constipation?
Treatment with a laxative is needed only if the lifestyle measures above do not work well. It is still worth persisting with these methods, even if you end up needing to use laxatives.
For short-term uncomplicated constipation, you may even choose to treat yourself (without visiting the GP), by buying laxatives in the pharmacy or supermarket. In short-term constipation, laxatives can be stopped once the poo (faeces, stools or motions) becomes soft and easily passed again. You should probably visit your GP if you are struggling to manage short-term constipation yourself, or if you have longer-term (chronic, or persistent) constipation. All the different types of laxative are available on prescription.
Chronic (persistent) constipation can be more difficult to treat. Laxatives are usually needed for longer periods (sometimes even indefinitely) and they should not be stopped abruptly. Chronic constipation is sometimes complicated by a backlog of hard faeces building up in the bowel (faecal loading) or even partially blocking it (impaction). If loading and impaction occur they need to be treated first, often with much higher doses of laxatives. Then a normal maintenance dose of laxatives is used to keep the bowels moving.
There are four main groups of laxatives that work in different ways:
- Bulk-forming laxatives.
- Stimulant laxatives.
- Osmotic laxatives.
- Faecal (stool) softener laxatives.
Sometimes these are known as fibre supplements. These increase the bulk of your stools in a similar way to fibre. They can have some effect within 12-24 hours but their full effect may take several days to develop.
- Unprocessed bran is a cheap fibre supplement. If you take bran, it is best to build up the amount gradually. Start with two teaspoons a day, and double the amount every five days until you reach about about 1-3 tablespoons per day. You can sprinkle bran on breakfast cereals, or mix it with fruit juices, milk, stews, soups, crumbles, pastries, scones, etc.
- Other fibre supplements include ispaghula (psyllium), methylcellulose, sterculia, wheat dextrin, inulin fibre, and whole linseeds (soaked in water).
There are various branded products that contain these ingredients. Examples are:
- Fibrelief®, Fybogel®, Isogel®, Ispagel® Orange and Regulan® – these all contain ispaghula.
- Celevac® – contains methylcellulose.
- Normacol® and Normacol Plus® – both contain sterculia.
A note of caution: fibre and bulk-forming laxatives partly work by absorbing water (a bit like blotting paper). The combination of bulk-forming laxatives and fluid usually produces soft, bulky stools which should be easy to pass out. When you eat a high-fibre diet or take bulk-forming laxatives:
- You should have plenty to drink. At least two litres per day (8-10 cups). The stools may become dry and difficult to pass if you do not have enough to drink. Very rarely, lots of fibre or bulk-forming laxatives and not enough fluid can cause an obstruction in the gut.
- You may notice an increase in wind (flatulence) and tummy (abdominal) bloating. This is normal and tends to settle down after a few weeks as the gut becomes used to the increase in fibre (or bulk-forming laxative).
Occasionally, bulk-forming laxatives can make symptoms worse if you have very severe constipation. This is because they may cause abdominal bloating and discomfort without doing much to clear a lot of faeces which are stuck further down the gut. See a doctor if you feel that bulk-forming laxatives are making your symptoms worse.
These stimulate the nerves in the large bowel (the colon and rectum, sometimes also called the large intestine). This then causes the muscle in the wall of the large bowel to squeeze harder than usual. This pushes the stools along and out. Their effect is usually within 8-12 hours. A bedtime dose is recommended so you are likely to feel the urge to go to the toilet sometime the following morning. Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and long-term use can lead to a bowel that is less active on its own (without laxatives). This can be thought of as a ‘lazy bowel’.
Stimulant laxatives include bisacodyl, dantron, docusate, glycerol, senna and sodium picosulfate. These medicines can be prescribed on a prescription in the unbranded (generic) form. Commercially branded versions (proprietary brands) contain the same ingredients, but are generally only available for purchase over-the-counter. Examples include:
- Dulcolax® – contains bisacodyl.
- Dioctyl®, Docusol® and Norgalax Micro-enema® – all contain docusate.
- Manevac® and Senokot® – are both brands that contain senna. Senokot® tablets are not available on prescription. Manevac® also contains the bulk-forming laxative ispaghula.
- Dulcolax Perles® – contain sodium picosulfate.
These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). There are two types – lactulose and a group called macrogols (also called polyethylene glycols). Lactulose can be bought over-the-counter as Duphalac®, Lactugal® and Regulose®. Movicol®, Movicol®-Half and Movicol® Paediatric Plain all contain macrogols and are available on prescription.
Lactulose can take up to two days to have any effect so it is not suitable for the rapid relief of constipation. Possible side-effects of lactulose include abdominal pain and bloating. Some people find the taste of lactulose unpleasant. Macrogols act much faster, and can also be used in high doses to clear faecal loading or impaction. Stronger osmotic laxatives (such as magnesium salts and phosphate enemas) can be used to clear the bowel quickly and in situations such as before bowel surgery.
These work by wetting and softening the faeces. The most commonly used is docusate sodium (which also has a weak stimulant action too). Bulk-forming laxatives also have some faecal-softening properties. Arachis (peanut) oil enemas are occasionally used to soften impacted faeces in the rectum (the lowest part of the colon, just before the back passage (anus)).
Liquid paraffin used to be commonly used as a faecal softener. However, it is now not recommended, as it may cause side-effects such as seeping from the anus and irritation of the skin, and it can interfere with the absorption of some vitamins from the gut.
Which laxative should I use and for how long?
The one recommended by your doctor or pharmacist will depend on factors such as your own preference, the symptoms of constipation that you have, possible unwanted effects, your other medical conditions, and cost. However, as a general rule:
- Treatment with a bulk-forming laxative is usually tried first.
- If poo (faeces, stools or motions) remains hard despite using a bulk-forming laxative, then an osmotic laxative tends to be tried, or used in addition to a bulk-forming laxative.
- If stools are soft but you still find them difficult to pass then a stimulant laxative may be added in.
- High doses of the macrogol osmotic laxatives are used to treat faecal loading and impaction – this should be under the supervision and advice of a doctor.
You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day ‘to keep the bowels regular’ or to prevent constipation. This is not advised, especially for laxatives which are not bulk-forming.
Constipation is usually helped by the above treatments. Mostly, laxatives are taken by mouth (orally). In some cases, it is preferable also to treat constipation by giving medication via the back passage (anus).
Suppositories are pellet-shaped laxatives that are inserted into the the lowest part of the colon (the rectum), via the anus. Glycerol suppositories act as a stimulant within the rectum, encouraging the passing of poo (faeces, stools or motions). Sometimes, an enema is needed in severe constipation. An enema is a liquid that is inserted into the rectum and lower colon, via the anus. Enemas can be used to clear out the rectum in severe constipation.
Other treatments may be advised by a specialist for people with severe constipation who have not been helped by the treatments listed above.
Are there any complications of long-term (chronic) constipation?
Short-term constipation or intermittent bouts of constipation are unlikely to cause any long-term problems. Sometimes a split or tear in the anal skin (an anal fissure) can occur with the passage of particularly big or hard poo (faeces, stools or motions). This is very painful, and there may be a small amount of fresh red blood on the toilet paper. Treatment of an anal fissure involves lifestyle measures (mentioned earlier) to keep the stools soft, and perhaps laxatives too, to keep the stools really easy to pass. Local anaesthetic ointment or glyceryl trinitrate (GTN) ointment can be prescribed by your GP to ease the pain and help relax the muscles around the back passage (anus), to help the fissure to heal.
Chronic constipation and long-term use of laxatives can mean that your bowel becomes sluggish and ‘lazy’. This means that the bowel doesn’t work very well on its own, without medication. Constipation then becomes a vicious cycle and even more chronic. Try to avoid getting into this situation in the first place, and consult your GP for advice. Some people with persistent and severe constipation do require regular laxatives.
Severe chronic constipation can result in faecal impaction. This is something that is more likely in the elderly and infirm. Basically, a large mass of hard faeces blocks the rectum. The mass is too big to pass and the rectum is stretched and enlarged, so the muscles within it don’t work so well to push faeces out. Sometimes people with this problem think that they have diarrhoea. This is because liquid faeces, from above the blockage, leak round the big lump of faeces, and out of the anus. This is known as overflow diarrhoea. In this situation, you may also have faecal incontinence – that is, you have no control over this liquid faeces leaking out. Faecal impaction with overflow diarrhoea is likely if you have been getting progressively more constipated, and then get liquid faeces, possibly explosive, and without much control. If a doctor or nurse examines the anus, the hard faeces can often be felt, confirming the diagnosis. The diagram below shows this process:
Natural treatments for constipation
Prunes (dried plums) have long been thought of as effective for constipation. However, up until recently, there had been little scientific proof of this. But, a research trial published in 2011 (cited at the end) lends support to the belief that prunes are good for treating constipation.
In the trial, 40 adults with persistent constipation were studied as to the effect of prunes versus ispaghula (psyllium) – a commonly used treatment for constipation. Briefly, on average, 50 g of prunes (about six prunes) twice daily seemed to be better at easing constipation than 11 g of ispaghula taken twice daily. This is just one small trial, but does seem to confirm many people’s belief that prunes are good for easing constipation.
The Beverley-Travis natural laxative mixture
This recipe (detailed below) was studied in a research trial that involved older people in a care home. A treatment group was compared to a non-treatment group. The conclusion of the study stated that “the Beverley-Travis natural laxative mixture, given at a dosage of 2 tablespoons twice daily, is easy to use, cost-effective, and more effective than daily prescribed laxatives at producing normal bowel movements”. So, it may be worth a try.
- Recipe ingredients – one cup each of: raisins; pitted prunes; figs; dates; currants; prune juice concentrate.
- Directions – combine contents together in grinder or blender to a thickened consistency. Store in refrigerator between uses.
- Dose – two tablespoons twice a day. Increase or decrease dose according to consistency and frequency of bowel movements.
Five years ago, a friend of mine came home from abroad for a week-long vacation. She was a close friend so I filed a leave from work just so we could meet. It was a grand get-together. My friend had a whole pig roasted for us and she had a lot of food prepared. We had the best time of our lives.
Then, we planned another date here in Manila. But.. I wasn’t able to come. I was down with loose bowel movement and fever. After several trips to the toilet, I went to the doctor and my fear was confirmed. I had amoebiasis.
Amoebiasis is caused by the protozoan Entamoeba histolytica. Amoebiasis is often asymptomatic but may cause dysentery and invasive extra-intestinal disease. Entamoeba dispar, another species, has been thought in the past to be non-pathological but in vitro and in vivo experiments suggest it is capable of causing liver damage.
- Humans are the only reservoir, and infection occurs by ingestion of mature cysts in food or water, or on hands contaminated by faeces.
- The cysts of E. histolytica enter the small intestine and release active amoebic parasites (trophozoites), which invade the epithelial cells of the large intestines, causing flask-shaped ulcers. Infection can then spread from the intestines to other organs – eg, the liver, lungs and brain, via the venous system.
- Asymptomatic carriers pass cysts in the faeces and the asymptomatic carriage state can persist indefinitely. E. dispar is the parasite most commonly found in such carriers, Cysts remain viable for up to two months.
- Invasive amoebiasis most often causes an amoebic liver abscess but may affect the lung, heart, brain, urinary tract and skin.
- E. histolytica infects approximately 50 million people worldwide, of which approximately 100,000 die annually.
- It is the third most common cause of death (after schistosomiasis and malaria) from parasitic infections.
- It is very common in South and Central America, West Africa and Southeast Asia. It is rare in temperate climates.
- Increasing prevalence is seen in men who have sex with men who engage in oral-anal sex.
- Travellers and immigrants and residents of institutions are also at risk.
- About 90% of infections are asymptomatic and the remaining 10% produce a spectrum of disease varying from dysentery to amoebic liver abscess.
The incubation period may be as short as seven days and tissue invasion mostly occurs during first four months of infection.
- The most common type of amoebic infection is the asymptomatic passage of cysts, found to be mainly associated with E. dispar infection.
- Symptomatic patients initially have lower abdominal pain and diarrhoea and later develop dysentery (with blood and mucus in stool).
- Amoebic colitis with dysentery: loose stools with fresh blood. The patient is usually generally well with mild or moderate abdominal pain. Symptoms often fluctuate over weeks or even months with the patient becoming debilitated.
- Abdominal tenderness in one or both iliac fossae but may be generalised. There is palpably thickened gut, and low fever. There is abdominal distension in more severely ill patients passing relatively small amounts of stool sometimes.
- Amoebic colitis without dysentery: a change in bowel habit, bloodstained stools, flatulence and colicky pain, tenderness in the right iliac fossa or other places over the colon. This may disappear or progress to dysentery.
- Rectal bleeding: this may occasionally be the only sign, with or without tenesmus (common in children).
- Abdominal mass, which is usually in the right iliac fossa.
- May be painful and tender.
- Fever, altered bowel habit and there may be intermittent dysentery.
- May be symptoms of partial or intermittent bowel obstruction.
- Fulminant colitis: this is more likely in children and in patients taking steroids; high-grade fever, severe abdominal pain, increasing distension of the abdomen with vomiting plus watery diarrhoea. Absent bowel sounds. X-ray may show free peritoneal gas with acute gaseous dilatation of the colon.
- Localised perforation and appendicitis: deep ulcer may cause sudden perforation with peritonitis or may leak causing pericolic abscess or retroperitoneal infection. May also resemble simple appendicitis, often with signs of dysentery.
- There is usually no current, and often no history of, dysentery.
- It usually occurs within eight weeks to one year of infection.
- It presents with sweating and pyrexia, a painful liver or diaphragm, together with weight loss often appearing insidiously, but pain may appear abruptly.
- Fever is typically remitting with a prominent evening rise with brief rigors and profuse sweating.
- Often there is anaemia and dry painful cough.
- There is liver enlargement with localised tenderness in the right hypochondrium, epigastrium and intercostal spaces overlying the liver.
- An epigastric mass from a left-lobe lesion may be found.
- Upward enlargement may cause bulging of the right chest wall with raised upper level of liver dullness on percussion. Reduced breath sounds or crepitations at the right lung base may be heard.
- Abscess may extend into adjacent structures, usually the right chest, peritoneum and pericardium. If it extends into the lung, it produces hepatobronchial fistula with expectoration of brownish, necrotic liver tissue. May also cause peritonitis, pericarditis, brain abscess or genitourinary disease.
- Other causes of infective colitis, ulcerative colitis, colorectal cancer.
- In chronic infection, other possible diagnoses include Crohn’s disease, ileocaecal tuberculosis, diverticulitis, anorectal lymphogranuloma venereum.
- Amoebic liver abscess has to be differentiated from pyogenic abscess which may occur particularly in older patients with underlying bowel disease or after surgery.
- FBC (leukocytosis), raised ESR, abnormal LFTs (raised alkaline phosphatase and transaminases).
- Stool examination:
- Microscopic stool examination for trophozoites should be performed in patients with diarrhoea..Examination of 3 to 6 stool samples and concentration techniques may be required due to low specificity.
- E. histolytica should be differentiated from other Entamoeba spp. The World Health Organization now recommends that intestinal amoebiasis should be diagnosed with specific stool E. histolytica testing (eg, cultures, antigen testing or PCR) rather than examining stool for ova and parasites.
- Serology: antibody testing is positive in nearly 100% of cases of liver abscess, 89-100% of invasive bowel disease and nearly 100% of patients with amoeboma.
- PCR tests (faeces, abscess aspirate or other tissues).
- Barium studies are contra-indicated in acute amoebic colitis because of the risk of perforation.
- Ultrasound, CT and MRI scans of the abdomen can be useful in diagnosing hepatic amoebiasis.
- Ultrasound- or CT-guided liver abscess aspiration.
- Proctoscopy, sigmoidoscopy or colonoscopy: mucosal scrapings for biopsy and E. histolytica testing.
- Abscesses resolve slowly and may increase in size during treatment and so clinical response, rather than repeated scans, is more important in monitoring progress.
- Fluid and electrolyte replacement, gastric suction and blood transfusion may be required.
- Diloxanide furoate is the drug of choice for asymptomatic patients with E. histolyticacysts in the faeces (metronidazole and tinidazole are relatively ineffective).
- Metronidazole is the first choice for treatment of acute invasive amoebic dysentery. Tinidazole is also effective.
- Treatment with metronidazole or tinidazole is followed by a 10-day course of diloxanide furoate to destroy any amoebae in the gut.
- Diloxanide furoate is also given as a 10-day course for chronic infections.
- Amoebic abscesses of the liver:
- Metronidazole and tinidazole are effective for amoebic abscesses of the liver.
- Diloxanide furoate is ineffective against hepatic amoebiasis but a 10-day course should be given at the completion of metronidazole or tinidazole treatment to destroy any amoebae in the gut.
- Surgical drainage of an uncomplicated amoebic liver abscess is unnecessary and should be avoided.
- However, the abscess should be drained if there is a risk that it may rupture or if metronidazole leads to no improvement after 72 hours of treatment.
- Aspiration is largely being replaced by percutaneous catheter drainage.
- In patients unsuitable for percutaneous drainage (elderly, frail, septic shock, multilocular cysts) laparoscopy is the preferred option.
- Laparotomy is usually required for rupture of a liver abscess but can occasionally be managed by ultrasound-guided percutaneous catheter drainage.
- Amoebic colitis may lead to fulminant or necrotising colitis, toxic megacolon, amoeboma or a rectovaginal fistula.
- Amoebic liver abscess: may extend and/or rupture into the abdomen or chest, or disseminate and cause a brain abscess.
- In uncomplicated disease, the mortality rate is less than 1% but is much higher in complicated severe disease – eg, fulminant amoebic colitis, chest involvement or cerebral amoebiasis.
- More severe illness occurs in children (especially neonates), the immunosuppressed, malnourished, pregnancy and postpartum.
- Recurrence is common if amoebae are not completely eradicated.
- The bowel heals rapidly and completely; hepatic abscesses usually disappear within 8 months to 2 years.
- Successful control of amoebiasis depends on prevention of infection through adequate sanitation, safe food and water and good personal hygiene of the population.
- No vaccine is yet available but progress has been made in the identification of possible candidates, the route of application and the understanding of the immune response. It is hoped that this will lead to a vaccine being developed within the next few years.
Last Sunday, my daughter Mika complained of neck pains. Then, that night, she said that the right side of her neck was bigger than the left. My first thought was mumps, but when I touched her forehead to check for fever her temperature was normal. I waited for either other symptoms to appear or the neck pains to subside, but neither happened.
The following day, her neck was still painful but there was still no fever. I didn’t let her go to school fearing that she may spread the virus if it really was mumps.
So, what is mumps?
Mumps is an infection caused by a virus. It mainly affects the salivary glands but sometimes other parts of the body are affected. Mumps normally affects children, but can occur at any age. Mumps is now rare in the UK as children are routinely immunised against mumps.
What is mumps?
Mumps is an infection caused by a type of virus called a paramyxovirus. It is very contagious and spread in saliva, the same way as a cold or flu. This means it can be caught from an infected person coughing, sneezing, etc. It can also be caught from touching infected objects – for example, door handles.
Mumps infection is less common since the introduction of the measles, mumps and rubella (MMR) vaccine in the UK. (See separate leaflet called ‘MMR Immunisation’ for more information.) Mumps infection is now most common in children who have not received the vaccine.
It is very unusual for children under one year to have mumps.
What are the usual symptoms of mumps?
- Swelling and pain of one or both parotid glands are the usual main symptoms. The parotid glands are the main salivary glands. They are just below the ears and you cannot normally see or feel them. The salivary glands make saliva which drains into the mouth.
- The mouth may feel dry.
- Chewing and swallowing may be sore.
- Fever (high temperature), headache, feeling tired and being off food may develop for a few days. These symptoms may occur before you develop swelling of your parotid gland.
- Mild abdominal (tummy) pain may occur.
The swelling of the parotid glands usually lasts for 4-8 days. Mumps is normally a mild illness, but complications sometimes occur. This is why immunisation is important.
There may be no symptoms, or only very minor ones. It is thought that about 3 in 10 people who contract the mumps virus have no symptoms. Rarely, complications alone occur without the usual symptoms occurring first.
The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one episode of mumps.
What are the possible complications of mumps?
The outlook for young children with mumps is very good. Teenagers and adults with mumps are more likely to develop complications, which may include one (or more) of the following:
- The testes (testicles) are sometimes affected. One testis may become inflamed, swollen, and painful for about a week. This is uncommon in young children. However, about 1 in 4 males who get mumps over the age of 12 years will develop a painful swollen testis. Occasionally, both testes are affected. In very rare cases this may cause infertility.
- Brain inflammation (encephalitis or meningitis) is an uncommon complication. It typically causes drowsiness, headache, stiff neck, wanting to keep out of the light and vomiting. Although alarming, meningitis caused by the mumps virus usually clears without any treatment after a few days, without any long-term problems.
- Hearing loss can sometimes occur in people with mumps. This is usually only transient and usually improves with time. Very rarely, mumps can cause permanent deafness.
- Inflammation of the pancreas, heart, and other organs are rare complications.
- If you develop mumps in the first 12 weeks of a pregnancy, it may increase the risk of miscarriage. (However, the mumps virus is not thought to cause malformations or defects in an unborn baby.)
How is mumps diagnosed?
Mumps is most commonly diagnosed by your symptoms and the type of glands that are enlarged in your body. However, some people have a swab taken from their mouth to obtain some saliva. This is sent to the laboratory to confirm the diagnosis.
What is the treatment for mumps?
There is no medicine that kills the mumps virus. For most people, mumps improves over a week with no long-term problems.
Treatment aims to ease symptoms until the body’s immune system clears the virus:
- You do not usually need any treatment if your symptoms are mild.
- Paracetamol or ibuprofen can ease fever and pain.
- Give children lots to drink, particularly if they have a fever. Fruit juice may stimulate the parotid gland to make more saliva, and cause more pain. Water is best if this occurs.
- A warm flannel held against a painful parotid gland can be soothing.
When to seek medical help?
Most children are back to normal within 7-10 days. Seek medical help if you suspect that a complication is developing (described above).
Should people with mumps keep away from others?
Yes. Mumps is very infectious. It takes 14-25 days to develop symptoms after being infected. Affected people are infectious from about six days before, until about five days after, a parotid gland begins to swell.
Children immunised against mumps are unlikely to catch mumps. However, immunisation is not 100% effective. Also, some adults may not be immune and some children may have a poor immune system. So, people with mumps should stay off school, nursery, college or work and avoid other people as much as possible. This is as soon as mumps is suspected and for five days from the onset of parotid gland swelling.
An effective vaccine to prevent mumps is available. It is part of the MMR vaccine. This is routinely offered to all children aged 12-13 months in the UK. A second dose is offered as part of the routine preschool booster programme at between 3 years and four months to 5 years of age.
A previous history of having mumps does not mean that you do not need an MMR vaccine. This is because the diagnosis of mumps is not an easy one to make. For example, someone thought to have had mumps may in fact have had another viral infection. Also, it does not do any harm if you have had mumps in the past and then have the MMR vaccine.
Immunisation gives excellent protection, and so mumps is now rare in the UK. (see leaflet MMR immunisation for more details).
I’ve always had a sharp memory. It’s an asset I’ve always been proud of. It was also the reason I got good grades in school.
But as I age, I began to have problems with the sharp memory I used to have. I know it’s common and that it will get worse in the future. So, I started browsing the net for articles about memory loss and I came across amnesia.
Though there have been movies after movies about amnesia, I haven’t yet met anyone who had it for real. Of all the movies with such theme, 50 First Dates is my favorite, and in that movie, Lucy has anterograde amnesia. And what is it exactly?
Source: Simply Psychology
Anterograde amnesia refers to loss of memory for events after an incident – often such cases are examples of what are known as pure amnesiacs.
Therefore, a person can’t store new information in their short term memory.
Patients with anterograde amnesia quite often show normal memory for events prior to the incident responsible for the memory deficit but have severely impaired ability to recall information about events occurring after the incident.
Whereas with retrograde amnesia there is almost always a gradual restoration of most of the lost information, with anterograde amnesia there is quite often no such recovery and patients are left with a permanent and debilitating condition. The case which led to the discovery of the condition of anterograde amnesia is that of H.M. (Milner et al 1968).
Anterograde amnesia can be caused by a number of potential factors, such as brain surgery, e.g. HM, or alcohol, e.g. Korsakoffs syndrome.
H.M. Case Study of Anterograde Amnesia
H.M. had brain surgery in 1953 when he was 27 yrs. old. The surgery involved removal of part of the brain known as the hippocampus to alleviate the severe symptoms of epilepsy. Although the surgery controlled the epileptic seizures H.M. suffered serious and debilitating memory impairment as a side effect.
His short-term memory was normal but he was completely unable to transfer any new information into his long-term memory. He showed almost no knowledge of current affairs because he forgot any news item as soon as he had read about it; he knew nothing of recent family events including moving house and the death of his father.
Despite being able to remember people he had known long ago he was never able to store information about new people he encountered and they remained forever complete strangers to him.
In many respects H.M. seemed cognitively ‘normal’ as he was able to learn and remember perceptual and motor skills although he needed reminding of what he was able to do.
This case and others illustrate the highly selective nature of the problems of anterograde amnesia following brain damage. There is no general deterioration of memory function but specific deficits in which some abilities such as learning new information are severely impaired whilst others, including language and memory span are quite normal.
Alcohol Induced Amnesia
In 1889 Sergei Korsakoff, a Russian physician described a severe memory disorder due to brain damage. The most obvious symptom of what became known asKorsakoffs syndrome is a severe anterograde amnesia where the patients appears to be unable to form any new memories but can still remember some old ones (i.e. short term memory is impaired).
Korsakoff s syndrome usually, although not always, results from a thiamine (vitamin Bl) deficiency after years of alcohol abuse. Alcoholics often have a poor diet because they get sufficient calories from their alcohol intake, thus their vitamin intake from food is very low.
In addition to the problem of taking in few vitamins alcohol also interferes with the absorption of thiamine in the intestines. Very occasionally Korsakoffs syndrome can also result from infusions of glucose given to people suffering from severe malnutrition.
Many patients go through an acute phase, known as Wernicke’s encephalopathy, during which they suffer from impairments of movement and emotional and cognitive functioning. In the chronic phase that follows the primary symptom is amnesia, primarily anterograde but also retrograde.
The brain damage in Korsakoff syndrome appears to be widespread with loss of nerve cells often occurring in several regions of the brain including the thalamus, cerebellum, cerebral cortex and frontal lobe. Interestingly, patients who have suffered frontal lobe damage due to-injury often encounter the same problem solving difficulties experienced by Korsakoff patients.
Last Tuesday, my daughter, Mika came home not feeling very well. She immediately ate her lunch and slept. When she woke up, she had a slight fever. I gave her paracetamol and let her rest. I didn’t let her go to school the following day and the day after that. On Friday, I panicked when I saw red rashes on her face. I checked her stomach and limbs but I didn’t find any nor did she have any fever.
But since there is an outbreak of measles in Metro Manila, I simply couldn’t take chances, so I took her to the doctor. CBC and Urinalysis were performed. After some while, I was assured that it wasn’t measles but German Measles.
Rubella (German measles) is an infection caused by the rubella virus. Although it most commonly occurs in young children, it can affect anyone. The illness is usually mild. However, rubella in a pregnant woman can cause serious damage to the unborn child. Immunisation has made rubella uncommon in the UK.
What is rubella?
Rubella (German measles) is usually a mild illness. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child or cause a miscarriage. Rubella can lead to damage to the heart, brain, hearing and sight. The baby is likely to be born with a very serious condition called the congenital rubella syndrome.
Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome. Rubella is now a very uncommon infection in the UK as a result of the vaccination programme. However, rubella is still common in many developing countries.
What are the symptoms of rubella?
The majority of people have no symptoms when they are infected with rubella. This is called a subclinical infection. If symptoms do develop, they include the following:
- Swollen glands, usually behind the ears and at the back of the neck. Sometimes glands in other parts of the body swell. The glands gradually go back to normal over a week or so.
- A spotty, pink-red rash develops any time up to seven days after the glands swell. The rash usually starts behind the ears, then spreads to the face and neck and then spreads to the rest of the body. The rash lasts 3-5 days before fading.
- A mild fever, cold, cough and sore throat are common.
- Sore red eyes (conjunctivitis) may develop for a few days.
- Joint pains, like a mild arthritis, may develop for a week or so. This is less common in children, but is quite common in adults with rubella.
- Other symptoms may include fever, tiredness and headache.
Bleeding disorders and brain inflammation (encephalitis) are rare complications.
Note: rubella rarely causes complications in healthy people. The main concern of rubella is that is can cause complications in pregnancy.
Is rubella infectious?
Yes. It is passed on by direct contact and by coughing and sneezing the virus into the air. It takes 2-3 weeks to develop symptoms after being infected. You are infectious from one week before symptoms begin until four days after the rash appears. Therefore, affected children should stay away from school and not mix with others for four days after the rash starts.
Rubella and pregnancy
If you are pregnant and have rubella in the first few months of pregnancy, there is a high chance that the virus will cause severe damage to your developing baby. The virus affects the developing organs and the baby may be born with serious disability – the congenital rubella syndrome.
Complications of congenital rubella syndrome include cataracts, deafness, heart, lung and brain abnormalities.
Having rubella infection in the first three months of pregnancy also increases your risk of having a miscarriage:
- If you are pregnant and come into contact with someone with rubella you should check your rubella status. Your midwife or doctor will normally have a record of this if you do not know. (A blood test is routinely taken early in pregnancy. This checks to see if you are immune and have antibodies in your blood against rubella.) Most women are immune due to previous immunisation and will not develop rubella. No further action is needed if you are known to be immune.
- If you are not immune and come into contact with someone with rubella then blood tests may be advised. These can tell if you are developing rubella before symptoms begin. Further action depends on the results of these tests.
- See a doctor if you are pregnant and develop an illness that you think may be rubella. Rubella is uncommon now due to immunisation. Other viruses can cause rashes similar to rubella. Most viruses do not harm the unborn child. Blood tests can confirm or rule out rubella if it is suspected.
In the unlikely case that you are confirmed to have rubella, then you will be referred to an obstetrician to discuss the possibility of your baby having congenital rubella syndrome. The risk is greater if you are less than 20 weeks pregnant. If you are more than 20 weeks pregnant, then the risk of your unborn baby developing congenital rubella syndrome is very small. No treatment can prevent the development of congenital rubella syndrome.
Note: it is very rare for a pregnant woman to catch rubella in the UK. See separate leaflet called ‘Pregnancy and Rubella’ for more detailed information.
How can you test for immunity to rubella?
Even if you have had a rubella immunisation, or have had rubella infection, there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunisation has worked is to have a blood test. This checks for rubella antibodies.
Because the congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time, you should have a blood test to check that you are protected.
This blood test is offered to all women in the UK who are pregnant and also it may be offered to younger women in routine health checks. However, if you have not had it, you should ask your practice nurse for the blood test. In particular, women who have come to the UK from overseas and have not been immunised are at greatest risk of having a baby with congenital rubella syndrome.
What is the treatment for rubella?
There is no treatment that will kill the virus. Most people with rubella are not very ill, do not need any treatment, and soon make a full recovery. The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one bout of rubella.
- Paracetamol will ease fever or aches and pains. Ibuprofen is an alternative.
- You should give children lots to drink if they have a fever.
- See a doctor if any worrying or unusual symptoms develop.
Immunisation is now offered to all children in the UK as part of the MMR vaccine. Two doses of the vaccine are needed to provide satisfactory protection against rubella.
The first dose is usually given between 12 and 13 months. A second dose is usually given at age 3 years and four months to 5 years, at the same time as the preschool booster of DTaP/IPV(polio) (given as a separate injection). (DTaP stands for diphtheria (D), tetanus (T) and acellular pertussis (aP) (whooping cough). IPV stands for inactivated polio vaccine. Polio is short for poliomyelitis.)
Immunisation gives very good protection and so rubella is now uncommon in the UK. The number of babies born with congenital rubella syndrome has greatly reduced since routine immunisation was introduced.
It is extremely important that all children be immunised against the rubella virus to prevent any complications of rubella occurring.
If you are a woman and are planning to get pregnant, if you are unsure if you are immune then see your practice nurse. A blood test will confirm if you are immune. If you are not immune then you can be immunised before you become pregnant.
This January cold is getting really really uncomfortable. Every time I take my walk in the morning, the wind is icy cold it seems like my lungs are going to freeze. It has also been very difficult to sleep at night. Lately, I’ve been getting worried about hypothermia.
What Is Hypothermia?
Hypothermia is a potentially dangerous drop in body temperature, usually caused by prolonged exposure to cold temperatures. The risk of cold exposure increases as the winter months arrive. But if you’re exposed to cold temperatures on a spring hike or capsized on a summer sail, you can also be at risk of hypothermia.
Normal body temperature averages 98.6 degrees. With hypothermia, core temperature drops below 95 degrees. In severe hypothermia, core body temperature drops to 86 degrees or lower.
What Causes Hypothermia?
The causes of hypothermia include:
Cold exposure. When the balance between the body’s heat production and heat loss tips toward heat loss for a prolonged period, hypothermia can occur. Accidental hypothermia usually happens after cold temperature exposure without enough warm, dry clothing for protection. Mountain climbers on Mount Everest avoid hypothermia by wearing specialized, high-tech gear designed for that windy, icy environment.
However, much milder environments can also lead to hypothermia, depending on a person’s age, body mass, body fat, overall health, and length of time exposed to cold temperatures. A frail, older adult in a 60-degree house after a power outage can develop mild hypothermia overnight. Infants and babies sleeping in cold bedrooms are also at risk.
Other causes. Certain medical conditions such as diabetes and thyroid conditions, some medications, severe trauma, or using drugs or alcohol all increase the risk of hypothermia.
How Does Cold Exposure Cause Hypothermia?
During exposure to cold temperatures, most heat loss — up to 90% — escapes through your skin; the rest, you exhale from your lungs. Heat loss through the skin happens primarily through radiation and speeds up when skin is exposed to wind or moisture. If cold exposure is due to being immersed in cold water, the movement of waves and water can increase heat loss up to 50%.
The hypothalamus, the brain’s temperature-control center, works to raise body temperature by triggering processes that heat and cool the body. During cold temperature exposure, shivering is a protective response to produce heat through muscle activity. In another heat-preserving response — called vasoconstriction –blood vessels temporarily narrow.
Normally, the activity of the heart and liver produce most of your body heat. But as core body temperature cools, these organs produce less heat, in essence causing a protective “shut down” to preserve heat and protect the brain. Low body temperature can slow brain activity, breathing, and heart rate.
Confusion and fatigue can set in, hampering a person’s ability to understand what’s happening and make intelligent choices to get to safety.
What Are the Risk Factors for Hypothermia?
People at increased risk for hypothermia include:
- The elderly, infants, and children without adequate heating, clothing, or food.
- Mentally ill people.
- People who are outdoors for extended periods.
- People in cold weather whose judgment is impaired by alcohol or drugs.
I’m scared. No, I’m actually terrified. Children are dying and it seems like the outbreak of measles in the country is still out of control. I know panicking won’t do any good but I find it difficult to keep still when children from my own kids’ schools are already down with it.
Measles is an infection that mainly affects children, but can occur at any age. It is rare in the UK, due to immunisation. The illness is unpleasant, but most children fully recover. However, some children develop serious complications.
What is measles?
Measles is a highly infectious illness caused by a virus. The virus lives in the mucus of the nose and throat of people with this infection. Physical contact, coughing and sneezing can spread the infection. In addition, infected droplets of mucus can remain active and contagious for around two hours. This means that the virus can live outside the body – for example, on surfaces and door handles.
What are the symptoms of measles?
Once you are infected with the virus, the virus multiples in the back of your throat and in your lungs. It then spreads throughout your body. The following are the most common symptoms of measles:
- A high temperature, sore eyes (conjunctivitis), and a runny nose usually occur first.
- Small white spots usually develop inside the mouth a day or so later. These can persist for several days.
- A harsh dry cough is usual.
- Going off food, tiredness, and aches and pains are usual.
- Diarrhoea and/or vomiting is common.
- A red blotchy rash normally develops about 3-4 days after the first symptoms. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days.
- Children are usually quite unwell and miserable for 3-5 days. After this, the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go.
Most children are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. The immune system makes antibodies during the infection. These fight off the virus and then provide lifelong immunity. It is therefore rare to have more than one bout of measles.
Some people mistake rashes caused by other viruses for measles. Measles is not just a mild red rash that soon goes. The measles virus causes an unpleasant, and sometimes serious, illness. The rash is just one part of this illness.
How is measles diagnosed?
Your doctor will usually be able to diagnose measles from the combination of your symptoms, especially the characteristic rash and the small spots inside your mouth. However, a simple blood or saliva test is usually done to confirm the diagnosis.
What are the possible complications of measles?
Complications are more likely in children with a poor immune system (such as those with leukaemia or HIV), those who are malnourished, children aged under five years and adults. Many malnourished children in the world die when they get measles, usually from a secondary pneumonia. There are still the occasional reports of children in the UK who die from complications of measles. These children have usually not been immunised.
More common complications include:
- Conjunctivitis (eye infection).
- Laryngitis (inflammation of the voice box).
- Ear infection causing earache.
- Infections of the airways, such as bronchitis and croup, which can be common.
Although these are distressing, they are not usually serious.
Less common complications of measles are listed below:
- A febrile convulsion (fit) occurs in about 1 in 200 cases. This can be alarming, but full recovery is usual.
- Brain inflammation (encephalitis) is a rare but very serious complication. It occurs in about 1 in 5,000 cases. It typically causes drowsiness, headache and vomiting which starts about 7-10 days after the onset of the rash. Encephalitis may cause brain damage. Some children die from this complication.
- Hepatitis (liver infection).
- Pneumonia (lung infection) is a serious complication that sometimes develops. Typical symptoms include fast or difficult breathing, chest pains, and generally becoming more ill.
- Squint is more common in children who have had measles. The virus may affect the nerve or muscles to the eye.
A very rare brain disease called subacute sclerosing panencephalitis can develop years later in a very small number of people who have had measles. This can sometimes occur several years after getting measles. This condition can be fatal.
What are the treatments for measles?
There is no specific medicine that kills the measles virus. Treatment aims to ease symptoms until the body’s immune system clears the infection. For most cases, rest and simple measures to reduce a fever are all that are needed for a full recovery. Symptoms will usually disappear within 7-10 days.
The following measures are often useful:
- Children should drink as much as possible to prevent dehydration. Ice lollies are a useful way of giving extra fluid and keeping cool.
- Paracetamol or ibuprofen can be taken to ease fever and aches and pains. You should keep the child cool (but not cold).
- Antibiotics do not kill the measles virus and so are not normally given. They may be prescribed if a complication develops, such as a secondary bacterial ear infection or secondary bacterial pneumonia.
Cough remedies have little benefit on any coughs.
Vitamin A supplements
Vitamin A supplements have been shown to help prevent serious complications arising from a measles infection. Supplements are generally recommended for children living in a country with a high prevalence of a vitamin A deficiency (this is rare in the UK, but common in the developing world). Treatment with vitamin A may be offered to people with measles.
When to see a doctor?
Most children recover. A doctor will normally confirm that the illness is measles. However, you should see a doctor again if symptoms get worse, or if you suspect a complication (see above).
The main serious symptoms to look out for are:
- Dehydration. This may be developing if the child drinks little, passes little urine, has a dry mouth and tongue or becomes drowsy.
- Breathing difficulties.
- Convulsion (fit).
Immunisation is routine in the UK as part of the measles, mumps and rubella (MMR) vaccine. Two doses are usual – the first for children aged between 12 and 13 months and the second usually given at age 3 years and 4 months to 5 years. Immunisation gives excellent protection and so measles is now rare in the UK. However, unfortunately, measles is becoming more common again in children in some areas of the UK. This is due to some children not receiving the MMR vaccine.
Is measles infectious?
Yes – it is very infectious. It is passed on by coughing and sneezing the virus into the air. It takes between 7 and 18 days (most commonly 10-12 days) to develop symptoms after being infected. (This is the incubation period.) You are infectious and can pass it on to others from four days before to four days after the onset of the rash. Therefore, children with measles should not mix with others and should stay off school.
What if I come into contact with someone with measles?
Some people have not been immunised against measles. Also, some people are more prone to complications if they get measles. In particular, people with a poor immune system (for example, those on chemotherapy, or who have HIV, etc), pregnant women and young babies under the age of 12 months. If you or your child come into contact with someone with measles, you should see your doctor as soon as possible. And most importantly, if you or your child are in a group more prone to complications. You may be advised to have a test to check on your immunity to measles. And, if necessary, offered immediate immunisation or a protecting injection of antibody (immunoglobulin). See the guidelines cited at the end from the Health Protection Authority for details.
If you follow my blog regularly, you would notice that I usually post about illnesses, my illnesses. And when I think about it, there are too many for one person. So, I started to consider whether I am hypochondriac or something. So, what is hypochondria?
What is Hypochondria?
If you have a preoccupying fear of having a serious illness you most likely suffer from hypochondria or hypochondriasis. A person with hypochondria continues thinking he is seriously ill despite appropriate medical evaluations and reassurances that his health is fine.
A person with hypochondria will think such normal bodily functions as heart beats, sweating and bowel movements are symptoms of a serious illness or condition.
Even minor abnormalities, such as a runny nose, slightly swollen lymph nodes and a small sore are seen as symptoms of something really serious.
A person with hypochondria may also use vague phrases – he may say he has tired veins or a sore liver.
It is not uncommon for people with hypochondria to focus on one particular organ, such as the lungs, or just one disease, such as cancer. Even after tests come back negative, their anxiety continues to be high and their desire for more physical attention grows.
We are not sure how many people suffer from hypochondria. A sufferer usually sees his primary care physician (General Practitioner), rather a mental health care professional – hence, a diagnosis of hypochondria is often not made. It is estimated that between 0.8% and 8.5% of the US adult population suffers from hypochondria. Approximately the same number of men and women suffer from hypochondria.
A Normal Fear or Hypochondria?
Most of us worry at some time that we may have some minor physical symptom which could be a sign of a serious illness. This is not usually hypochondria. If the preoccupying fear of disease lasts for more than 6 months, the worrier is much more likely to be suffering from hypochondria.
A large proportion of hypochondria suffers also suffer from some psychiatric disorder. Over 60% of hypochondria patients also suffer from major depression, panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder. A sufferer from some psychiatric disorder is thought to also suffer from hypochondria when his preoccupation with illness is not explained by the disorder.
How Long Does Hypochondria Last?
A person with hypochondria may suffer for months, and even years. He may have equally long periods when he does not worry about being ill. Experts say that approximately 30% of hypochondria patients eventually improve significantly. Recovery is more likely among people with a higher
Happy New Year!
Besides our pockets and bank accounts, what aches after the holidays? Well, for me, that would be the stomach. Overeating, I know, is common during the Christmas season, what with all the food. And when we overeat, our tummies tend to ache. And when our tummies ache after eating an enormous amount of food, we assume that we have indigestion or what the medical people call dyspepsia.
So, what is Dyspepsia? Source: Patient.co.uk
Dyspepsia (indigestion) is a term which describes pain and sometimes other symptoms which come from your upper gut (the stomach, oesophagus or duodenum). There are various causes (described below). Treatment depends on the likely cause.
Food passes down the oesophagus (gullet) into the stomach. The stomach makes acid which is not essential, but helps to digest food. Food then passes gradually into the duodenum (the first part of the small intestine).
In the duodenum and the rest of the small intestine, food mixes with enzymes (chemicals). The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food. Digested food is then absorbed into the body from the small intestine.
What is dyspepsia?
Dyspepsia is a term which includes a group of symptoms that come from a problem in your upper gut. The gut (gastrointestinal tract) is the tube that starts at the mouth, and ends at the anus. The upper gut includes the oesophagus, stomach, and duodenum.
Various conditions cause dyspepsia. The main symptom is usually pain or discomfort in the upper abdomen. In addition, other symptoms that may develop include: heartburn (a burning sensation felt in the lower chest area), bloating, belching, quickly feeling full after eating, feeling sick (nausea) or vomiting. Symptoms are often related to eating.
Symptoms tend to occur in bouts which come and go, rather than being present all the time. Most people have a bout of dyspepsia, often called indigestion, from time to time. For example, after a large spicy meal. In most cases it soon goes away and is of little concern. However, some people have frequent bouts of dyspepsia, which affects their quality of life.
What causes dyspepsia?
Most cases of recurring dyspepsia are due to one of the following:
- Non-ulcer dyspepsia. This is sometimes called functional dyspepsia. It means that no known cause can be found for the symptoms. That is, other causes for dyspepsia, such as duodenal or stomach ulcer, acid reflux, inflamed oesophagus (oesophagitis), gastritis, etc, are not the cause. The inside of your gut looks normal (if you have an endoscopy – see below). It is the most common cause of dyspepsia. About 6 in 10 people who have recurring bouts of dyspepsia have non-ulcer dyspepsia. The cause is not clear, although infection with a bacterium (germ) called Helicobacter pylori(commonly just called H. pylori) may account for some cases (see below). See leaflet called ‘Dyspepsia – Non-ulcer (Functional)’ for more detail.
- Duodenal and stomach (gastric) ulcers. An ulcer is where the lining of the gut is damaged and the underlying tissue is exposed. If you could see inside your gut, an ulcer looks like a small, red crater on the inside lining of the gut. These are sometimes called peptic ulcers. See separate leaflets called ‘Duodenal Ulcer’ and ‘Stomach (Gastric) Ulcer’ for more detail.
- Duodenitis and gastritis (inflammation of the duodenum and/or stomach) – which may be mild, or more severe and a precursor to an ulcer.
- Acid reflux, oesophagitis and GORD. Acid reflux is when some acid leaks up (refluxes) into the oesophagus from the stomach. Acid reflux may cause oesophagitis (inflammation of the lining of the oesophagus). The general term gastro-oesophageal reflux disease (GORD) means acid reflux, with or without oesophagitis. See separate leaflet called ‘Acid Reflux and Oesophagitis’ for more detail.
- Hiatus hernia. This is where the top part of the stomach pushes up into the lower chest through a defect in the diaphragm. The diaphragm is a large flat muscle that separates the lungs from the abdomen. It helps us to breathe. A hiatus hernia commonly causes GORD. See separate leaflet called ‘Hiatus Hernia’ for more detail.
- Infection with H. pylori – see below.
- Medication. Some medicines may cause dyspepsia as a side-effect.
- Anti-inflammatory medicines are the most common culprits. These are medicines that many people take for arthritis, muscular pains, sprains, period pains, etc. For example: aspirin, ibuprofen, and diclofenac – but there are others. Anti-inflammatory medicines sometimes affect the lining of the stomach and allow acid to cause inflammation and ulcers.
- Various other medicines sometimes cause dyspepsia, or make dyspepsia worse. They include: digoxin, antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines, bisphosphonates.
(Note: this is not a full list. Check with the leaflet that comes with your medication for a list of possible side-effects.)
H. pylori and dyspepsia
The bacterium (germ) H. pylori can infect the lining of the stomach and duodenum. It is one of the most common infections in the UK. More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life.
Most people with H. pylori have no symptoms and do not know that they are infected. However, H. pylori is the most common cause of duodenal and stomach ulcers. About 3 in 20 people who are infected with H. pylori develop an ulcer. It is also thought to cause some cases of non-ulcer dyspepsia, duodenitis and gastritis. The exact way H. pylori causes problems in some infected people is not totally clear. In some people this bacterium causes inflammation in the lining of the stomach or duodenum. This causes the defence mucus barrier to be disrupted in some way (and in some cases the amount of acid to be increased) which seems to allow the acid to cause inflammation and ulcers. See separate leaflet called ‘Helicobacter Pylori and Stomach Pain’ for more detail.
Other uncommon causes of dyspepsia
Other problems of the upper gut such as stomach cancer and oesophageal cancer can cause dyspepsia when they first develop.
There are separate leaflets which describe the above conditions in more detail. The rest of this leaflet gives an overview of what might happen if you see your doctor about dyspepsia.
What is normally done if you develop dyspepsia?
Your doctor is likely to do an initial assessment by asking you about your symptoms and examining your abdomen. The examination is usually normal if you have one of the common causes of dyspepsia. Your doctor will want to review any medicines that you have taken in case one may be causing the symptoms or making them worse. Following the initial assessment, depending on your circumstances, such as the severity and frequency of symptoms, your doctor may suggest one or more of the following plans of action.
Antacids taken as required
Antacids are alkali liquids or tablets that can neutralise the stomach acid. A dose may give quick relief. There are many brands which you can buy. You can also get some on prescription. If you have mild or infrequent bouts of dyspepsia you may find that antacids used as required are all that you need.
A change or alteration in your current medication
This may be possible if a medicine that your are taking is thought to be causing the symptoms or making them worse.
Test for H. pylori infection and treat if it is present
A test to detect H. pylori is commonly done if you have frequent bouts of dyspepsia. As mentioned, it is the underlying cause of most duodenal and stomach ulcers, and some cases of gastritis, duodenitis and non-ulcer dyspepsia. Various tests can detect H. pylori and your doctor may suggest one:
- A breath test can confirm that you have a current H. pylori infection. A sample of your breath is analysed after you have taken a special drink. Note: prior to this test you should not have taken any antibiotics for at least four weeks. Also, you should not have taken a proton pump inhibitor (PPI) or H2-receptor antagonist (also known as an H2 blocker medicine) for at least two weeks. (These are acid-suppressing medicines – discussed further below.) Also, you should not eat anything for six hours before the test. The reason for these rules is because they can affect the test result.
- An alternative test is the stool antigen test. In this test you give a pea-sized sample of your faeces (stools) which is tested for H. pylori. Note: prior to this test you should not have taken any antibiotics for at least four weeks. Also, you should not have taken a PPI or H2-receptor antagonist medicine for at least two weeks. (These are acid-suppressing medicines.)
- A blood test can detect antibodies to H. pylori. This is sometimes used to confirm that you are, or have been, infected with H. pylori. However, it takes six months or more for this test to become negative once the infection has cleared. So, it is no use to confirm whether treatment has cleared the infection (if this needs to be known). If needed, the breath test or stool antigen test are usually used to check if an infection has cleared following treatment.
- Sometimes a biopsy (small sample) of the lining of the stomach is taken if you have a gastroscopy (endoscopy). The sample can be tested for H. pylori.
If you are found to be infected with H. pylori then treatment may cure the symptoms. Briefly, to clear H. pylori infection you need to take two antibiotics at the same time. In addition, you need to take a medicine to reduce the acid in the stomach. This allows the antibiotics to work well in the stomach. You need to take this combination therapy for a week. It is important to take all the medicines exactly as directed, and to take the full course.
Note: after combination therapy, a test may be advised to check that H. pylori has gone (has been eradicated). This test will usually be a breath test or a stool antigen test (described earlier). If a test is done, it needs to be done at least four weeks after the course of combination therapy has finished. In most cases, the test is negative meaning that the infection has gone. If it has not gone, and you still have symptoms, then a repeat course of combination therapy with a different set of antibiotics may be advised.
Some doctors say that for most situations, this confirmation of eradication test is not necessary if symptoms have gone. The logic is that if symptoms have gone it usually indicates that whatever was causing the dyspepsia has gone. But, some doctors say it is needed to play safe. Your own doctor will advise if you should have this test following treatment to clear H. pylori.
A one-month trial of full-dose medication which reduces stomach acid may be considered – in particular, if:
- Symptoms are more suggestive of acid reflux or oesophagitis. H. pylori does not cause these problems.
- Infection with H. pylori has been ruled out.
- H. pylori has been treated but symptoms persist.
There are two groups of medicines which reduce stomach acid – proton pump inhibitors (PPIs) and H2-receptor antagonists. They work in different ways to block the cells in the stomach lining from making acid. There are several brands in each group. A PPI (such as omeprazole, lansoprazole, pantoprazole, rabeprazole, or esomeprazole) is usually better and is normally tried first.
Reducing acid in the stomach can help in many cases of dyspepsia, whatever the underlying cause. If acid-suppressing medication works, then symptoms should go. If symptoms return at a later date, once the medication is stopped, then further courses may be advised. Many people take acid-suppressing medication as required. That is, waiting for symptoms to develop, and then taking a short course of treatment to clear the symptoms. Some people take them regularly if symptoms occur each day. If this is the situation, you should aim to find the lowest dose of medication that keeps symptoms away.
Further tests are not needed in most cases. One or more of the above options will often sort the problem. Reasons why further tests may be advised include:
- If additional symptoms suggest that your dyspepsia may be caused by a serious disorder such as stomach or oesophageal cancer, or a complication from an ulcer such as bleeding. For example, if you:
- Pass blood with your faeces (blood can turn your faeces black).
- Vomit blood.
- Lose weight unintentionally.
- Feel generally unwell.
- Have difficulty swallowing (dysphagia).
- Vomit persistently.
- Develop anaemia.
- Have an abnormality when you are examined by a doctor, such as a lump in the abdomen.
- If you are aged over 55 and develop persistent or unexplained dyspepsia.
- If the symptoms are not typical and may be coming from outside the gut. For example, to rule out problems of the gallbladder, pancreas, liver, etc.
- If the symptoms are severe and do not respond to treatment.
- If you have a risk factor for stomach cancer such as Barrett’s oesophagus, dysplasia, atrophic gastritis, or had ulcer surgery over 20 years earlier.
Tests advised may include:
- Gastroscopy (endoscopy). In this test a doctor or nurse looks inside your oesophagus, stomach and duodenum. They do this by passing a thin, flexible telescope down your oesophagus. See leaflet called ‘Gastroscopy’ for more detail.
- A blood test to check for anaemia. If you are anaemic, it may be due to a bleeding ulcer, or to a bleeding stomach cancer. You may not notice the bleeding if it is not heavy, as the blood is passed out unnoticed in your faeces (stools).
- Tests of the gallbladder, pancreas, etc, if the cause of the symptoms is not clear.
Treatment depends on what is found or ruled out by the tests.
For all types of dyspepsia, the National Institute for Health and Clinical Excellence (NICE) recommends the following lifestyle changes:
- Make sure you eat regular meals.
- Lose weight if you are obese.
- If you are a smoker, consider giving up.
- Don’t drink too much alcohol.
For dyspepsia which is likely to be due to acid reflux – when heartburn is a major symptom – the following may also be worth considering:
- Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.
- Bedtime. If symptoms recur most nights, the following may help:
- Go to bed with an empty, dry stomach. To do this, don’t eat in the last three hours before bedtime, and don’t drink in the last two hours before bedtime.
- If you are able, try raising the head of the bed by 10-20 cms (for example, with books or bricks under the bed’s legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this, do not use additional pillows, because this may increase abdominal pressure.
As I already said in my other blogs, I only write about what I’m interested in, so, the chances of me going into gadgets, fashion and food, are very very slim. It also means that I wouldn’t be a popular and sought-after blogger, lol!
So, another one of my interests, besides teaching and writing is health. Well, I should be, basically because I’m a sickly person. Ever since I was young, I’ve felt there was always something wrong with me. There was a time I thought they were just psychological, but, no they were true, they were real and I needed to see the doctor to make them right.
With the availability of health information in the internet, I learned to relax a little. You see, when you understand what’s wrong with you, it becomes less scary. And here are some health issues I posted for the year 2013.
- Yeast Infection
- Duodenal Ulcer
- Urinary Incontinence
- Locked Jaw
- Varicose Veins
- Skin Rashes
- Parkinson’s Disease
- Mouth Sores
- Acid Reflux
- Chikungunya Virus
- Swollen Lymph Nodes
- Panic Attack Disorder
- Milk Time
- Onion for Better Health
- Chest Pains
- An Apple a Day
- Crawlers and Stingers
- Skin Asthma
- Heat Stroke
- Type 2 Diabetes
- Blood Chemistry Test
- Blood Pressure Fluctuation
- Alcohol Withdrawal
- Ginger Ale
- Food Poisoning
- Common Cold
I wasn’t afflicted with everything in the list but most actually did. Needless to say it’s very difficult to be sick. It only goes to show that HEALTH, indeed, is WEALTH.
Happy New Year, everyone!!