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Archive for the ‘health’ Category

 

Philippines is mostly a Catholic country and among our common practices is circumcision. This common practice actually became a tradition which normally happens during the summer vacation when there is an ample time for the boys to heal.

In view of that, I took my youngest child and only son, Daryl, to the nearest clinic on Wednesday, to have him circumcised. And it’s done..

Source: webMD

Circumcision is the surgical removal of the foreskin, the tissue covering the head of the penis. It is an ancient practice that has its origin in religious rites. Today, many parents have their sons circumcised for religious or other reasons.

When is circumcision done?

Circumcision is usually performed on the first or second day after birth. (Among the Jewish population, circumcision is performed on the eighth day.) The procedure becomes more complicated and riskier in older babies, children, and men.

How is circumcision done?

During a circumcision, the foreskin is freed from the head of the penis (glans), and the excess foreskin is clipped off. If done in the newborn period, the procedure takes about five to 10 minutes. Adult circumcision takes about one hour. The circumcision generally heals in five to seven days.

Is circumcision necessary?

The use of circumcision for medical or health reasons is an issue that continues to be debated. Currently, the American Academy of Pediatrics does not recommend routine circumcision for newborn males stating the evidence was not significant enough to prove the operation’s benefit. The procedure may be recommended in older boys and men to treat phimosis (the inability to retract the foreskin) or to treat an infection of the penis.

Parents should talk with their doctor about the benefits and risks of the procedure before making a decision regarding circumcision of a male child. Other factors, such as your culture, religion, and personal preference, will also be involved in your decision.

What are the benefits of circumcision?

There is some evidence that circumcision has health benefits, including:

  • A decreased risk of urinary tract infections.
  • A reduced risk of sexually transmitted diseases in men.
  • Protection against penile cancer and a reduced risk of cervical cancer in female sex partners.
  • Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin).
  • Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location).

Circumcision also makes it easier to keep the end of the penis clean.

Note: Some studies show that good hygiene can help prevent certain problems with the penis, including infections and swelling, even if the penis is not circumcised. In addition, using a condom during sex will help prevent STDs and other infections.

What are the risks of circumcision?

Like any surgical procedure, there are risks associated with circumcision. However, this risk is low. Problems associated with circumcision include:

  • Pain
  • Risk of bleeding and infection at the site of the circumcision
  • Irritation of the glans
  • Increased risk of meatitis (inflammation of the opening of the penis)
  • Risk of injury to the penis

 

I have always loved coffee. Drinking a cup early in the morning is one of my joys in life. However, ever since I was diagnosed as hypertensive, I was ordered to drink it in moderation, better yet, not drink it altogether.

Needless to say I miss it so much, but I’m concerned about my health and I’m scared not to obey the doctor’s order. So, I don’t know how to react about this article on in the internet.

Source: WedMD

Coffee May Combat High Blood Pressure

Chemicals in Coffee Appear to Combat Blood Vessel Aging, Researchers Say
By 
WebMD Health News
Reviewed by Laura J. Martin, MD

Sept.1, 2010 (Stockholm, Sweden) — Older people with high blood pressure who drink one to two cups of coffee a day have more elastic blood vessels than people who drink less or more, Greek researchers report.

As we age, our blood vessels get stiffer, and that’s thought to increase the risk of high blood pressure. The new findings suggest moderate coffee drinking may counteract this process.

Previous research has shown conflicting results as to whether coffee is good or bad for the heart.

The new study involved 485 men and women, aged 65 to 100, who live on a small island called Ikaria, in the Aegean Sea, where more than a third of people live to celebrate their 90th birthday.

“We were aiming to evaluate the secrets of the long-livers of Ikaria,” says study head Christina Chrysohoou, BSc, of the University of Athens.

She presented the findings at the European Society of Cardiology Congress.

Coffee Improves Blood Vessel Elasticity

Participants, all of whom had high blood pressure, underwent imaging scans to measure the stiffness of their blood vessels.

Of the total, 33% of participants drank no coffee or less than one cup of coffee a day, 56% drank one to two cups, and 11% drank three or more cups a day.

People who drank one to two cups of coffee a day had about a 25% greater elasticity in their major blood vessels than people who drank less coffee or none at all.

Their blood vessel elasticity was about five times greater than people who drank three or more cups a day.

The analysis took into account factors that can affect blood vessel aging — age, gender, smoking, education, physical activity, body weight, blood pressure, nutritional habits, and diabetes.

The study also showed that people who drank one to two cups of coffee a day were less likely to have diabetes, high cholesterol, cardiovascular disease, or to be overweight, compared to people who drank more coffee or less coffee, Chrysohoou says.

Nutrients in Coffee Credited for Fighting Blood Vessel Aging

Most of the men and women drank traditional Greek coffee in small, espresso-sized cups.

Greek coffee is considerably stronger, with more caffeine, than espresso, Chrysohoou tells WebMD.

She credits compounds, including flavonoids, magnesium, potassium, niacin, and vitamin E, for combating blood vessel aging by blocking the damaging oxidation process and reducing harmful inflammation. Oxidation reactions can produce free radicals. This, in turn, can start chain reactions that damage cells.

Traditional Greek coffee contains more of these chemicals than most other types of coffee as it is unfiltered and boiled, Chrysohoou says.

“We recommend hypertensive patients drink coffee in moderation, just one to two cups a day, as it seems that it may improve arterial aging,” Chrysohoou says.

One limitation of the study is that participants drank their coffee in cafes with friends or with family at home, in a relaxed atmosphere. Therefore, the psychological benefits of socializing on heart health may help explain the findings.

Expert Skeptical

American Heart Association spokesman Ray Gibbons, MD, tells WebMD that he is skeptical of the results.

“I’m concerned whether this finding could be reproduced,” he says.

Other factors in the Greek lifestyle, such as the heart-healthy Mediterranean diet, could explain the results, Gibbon says.

 

If you happen to live in the Philippines, you know how hot it is right now. It is scalding hot.. It’s as if you’re being boiled alive. For those who have air conditioned houses, well, good for them. But for us, ordinary citizens, well.. we have to keep our bodies cool and hydrated, otherwise.. we’ll drop dead.

So, how do we keep ourselves hydrated?

Source: .org plastics

Water might seem like the new “in” thing. These days, it’s difficult to thumb a supermarket tabloid without spotting at least a few water-bottle-toting celebrities. But in addition to being a favorite accessory of Hollywood A-listers, water is also essential to your health. Water makes up approximately 60 to 70 percent of the human body by weight, so all of us need to stay hydrated to keep our bodies running smoothly.

These simple tips can help make getting enough fluids part of your daily routine:

  • Have something to drink when you first get up in the morning.
  • Carry a plastic water bottle with you during work hours and when you are away from home for long periods of time.
  • Try to drink something before, during and after exercising, especially in hot weather.  Drink water every 15 minutes as you exercise.
  • Remember to drink before you get thirsty.
  • Try to limit caffeinated and sugary beverages.  Caffeine acts as a diuretic and can cause you to lose fluids quickly.  In addition to having extra calories, the fructose, or natural sugars, in fruit juice can slow your body’s ability to absorb fluids.
  • Monitor your fluid intake, factoring in foods. Most of what we eat contains some water, especially fruits and vegetables.  Packing ready-to-eat fruits in sealable plastic bags can be a great way to restore fluids and vitamins during outdoor activities.
  • Keep a glass, cup or plastic bottle of water next to your bed.
  • Learn the signs and symptoms of dehydration.

Remember to drink before you get thirsty and be alert for common signs of dehydration:

  • Dry mouth
  • Excessive thirst
  • Infrequent or dark urination
  • Muscle weakness or cramping
  • Headache
  • Dizziness or lightheadedness
  • Tiredness
  • Sunken eyes
  • Inability to produce tears

 

If you’ve been in the Philippines, you would have an idea how extremely hot the summer season could be. This year is no exception. Just last week, it got so hot we had to keep the fans fixed on us. Still, I felt so hot it seems like my body was going to explode. So, I kept a pitcher of water close and I take a swig every once in a while. I just hope and pray that none of us would get dehydrated this summer.

Source: WebMD

Dehydration is a condition that occurs when the loss of body fluids, mostly water, exceeds the amount that is taken in. With dehydration, more water is moving out of our cells and bodies than what we take in through drinking.

We lose water every day in the form of water vapor in the breath we exhale and in our excreted sweat, urine, and stool. Along with the water, small amounts of salts are also lost.

When we lose too much water, our bodies may become out of balance or dehydrated. Severe dehydration can lead to death.

Causes of Dehydration in Adults

Many conditions may cause rapid and continued fluid losses and lead to dehydration:

  • Fever, heat exposure, and too much exercise
  • Vomiting, diarrhea, and increased urination due to infection
  • Diseases such as diabetes
  • The inability to seek appropriate water and food (as in the case of a disabled person)
  • An impaired ability to drink (for instance, someone in a coma or on a respirator)
  • No access to safe drinking water
  • Significant injuries to skin, such as burns or mouth sores, or severe skin diseases or infections (water is lost through the damaged skin)
Symptoms of Dehydration in Adults

The signs and symptoms of dehydration range from minor to severe and include:

  • Increased thirst
  • Dry mouth and swollen tongue
  • Weakness
  • Dizziness
  • Palpitations (feeling that the heart is jumping or pounding)
  • Confusion
  • Sluggishness fainting
  • Fainting
  • Inability to sweat
  • Decreased urine output

Urine color may indicate dehydration. If urine is concentrated and deeply yellow or amber, you may be dehydrated.

When to Seek Medical Care

Call your doctor if the dehydrated person experiences any of the following:

  • Increased or constant vomiting for more than a day
  • Fever over 101°F
  • Diarrhea for more than 2 days
  • Weight loss
  • Decreased urine production
  • Confusion
  • Weakness

Take the person to the hospital’s emergency department if these situations occur:

  • Fever higher than 103°F
  • Confusion
  • Sluggishness (lethargy)
  • Headache
  • Seizures
  • Difficulty breathing
  • Chest or abdominal pains
  • Fainting
  • No urine in the last 12 hours

 

Last week, my friend in the province sent me a text message. He asked me if I knew anything about Psoriasis. It seems like one of his distant relatives was diagnosed with it. I’ve heard of this diseases but I knew very little, so, I looked it up from the net and here’s what I found

Source: WedMD

Psoriasis (say “suh-RY-uh-sus”) is a long-term (chronic) skin problem that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin.

Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed.

But in psoriasis, new skin cells move rapidly to the surface of the skin in days rather than weeks. They build up and form thick patches called plaques (say “plax”). The patches range in size from small to large. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common in adults. But children and teens can get it too.

Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control.

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin. In some cases, psoriasis runs in families.

People with psoriasis often notice times when their skin gets worse. Things that can cause these flare-ups include a cold and dry climate, infections, stress, dry skin, and taking certain medicines.

Psoriasis isn’t contagious. It can’t be spread by touch from person to person.

Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.

In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis (say “sor-ee-AT-ik ar-THRY-tus”). This arthritis can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails.

Symptoms often disappear (go into remission), even without treatment, and then return (flare up).

A doctor can usually diagnose psoriasis by looking at the patches on your skin, scalp, or nails. Special tests aren’t usually needed.

Most cases of psoriasis are mild, and treatment begins with skin care. This includes keeping your skin moist with creams and lotions. These are often used with other treatments including shampoos, ultraviolet light, and medicines your doctor prescribes.

In some cases, psoriasis can be hard to treat. You may need to try different combinations of treatments to find what works for you. Treatment for psoriasis may continue for a lifetime.

 

I’ve been feeling strange lately. I got hot flashes as if my cheeks are burning. I feel feverish but when I check my temperature, it’s normal. Then, I would suddenly feel weak and very very tired.

Once I was chatting with my sister on Facebook, I mentioned it to her. The following day, she posted an article about Peri-Menopause on my timeline and I have a strange feeling that it’s actually what I’m going through. So, what is Perimenopause?

Source: WebMD

Perimenopause, or menopause transition, is the stage of a woman’s reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen. It usually starts in a woman’s 40s, but can start in a woman’s 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. At this stage, many women experience menopausal symptoms.

How Long Does Perimenopause Last?

The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).

What Are the Signs of Perimenopause?

You may recognize perimenopause when you begin experiencing some or all of the following symptoms:

  • Hot flashes
  • Breast tenderness
  • Worsening of premenstrual syndrome
  • Decreased libido (sex drive)
  • Fatigue
  • Irregular periods
  • Vaginal dryness; discomfort during sex
  • Urine leakage when coughing or sneezing
  • Urinary urgency (a pressing need to urinate more frequently)
  • Mood swings
  • Difficulty sleeping
How Do I know If Changes in My Periods Are Normal Perimenopausal Symptoms or Something to Be Concerned About?

Irregular periods are common and normal during perimenopause. But other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:

  • Your periods are very heavy, or accompanied by blood clots
  • Your periods last several days longer than usual
  • You spot between periods
  • You experience spotting after sex
  • Your periods occur closer together

Potential causes of abnormal bleeding include hormonal imbalances, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.

How Is Perimenopause Diagnosed?

Often your doctor can make the diagnosis of perimenopause based on your symptoms. Blood tests to check hormone levels may also be beneficial, but they may be difficult to evaluate due to erratic fluctuations of hormones during this period. It may be more helpful to have several tests done at different times for comparison.

Can I Get Pregnant If I Am Perimenopausal?

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of birth control until you reach menopause (you have gone 12 months without having your period).

For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a decline in fertility. But, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant.

Are There Treatments That Can Reduce the Symptoms Associated With Perimenopause?

Many women experience relief from hot flashes after taking low-dose birth control pills for a short period of time. Other options that may control hot flashes include the birth control skin patch, vaginal ring, and progesterone injections. Certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.

 

Two weeks ago, my son complained of sore throat. Since he still couldn’t stand Bactidol I made him gargle with warm water with salt. Then, I made him open his mouth so I could look inside and noticed something white. My first reaction was panic. Then, I checked the internet and found out about tonsil stones.

Source: Breath MD

Tonsil stones are another thing that causes halitosis (bad breath). They are formally known as tonsilloliths. They are objects usually made of calcium that grow and develop over time in the crypts and crevasses of the tonsils. They are usually white with a yellow hue in color and some people describe them as white spots in the throat or white spots on the tonsils. Tonsil stones are common in adults and are rare for children and babies. There are few noticeable symptoms of tonsilloliths other than bad breath, but for most of us here at BreathMD that is enough of a reason to find out if we have them and get them out if we do.

What causes tonsil stones

So how do you get tonsil stones? What cause tonsilloliths? Those are very good questions but unfortunately the exact causes are unknown. While tonsils play an important role in trapping harmful bacteria from entering the rest of your body, they also tend to trap food, mucus, dead cells, and other particles. There is a generally accepted notion that tonsil stones are caused by the food, particles, and bacteria that are accumulated on and in the tonsils. These particles are broken down in time by saliva and digestive enzymes and most of what remains is the hard deposits of the particle (usually calcium). The softer parts are broken down and eventually are washed away.

There have also been studies that prove a correlation between patients who have tonsilloliths and patients who suffer from post-nasal drip, which is another cause of bad breath.

Side-effects of tonsil stones

There are various signs and symptoms of tonsil stones. Below is a list of the side-effects of them. Keep in mind that tonsil stones vary greatly in size and that a lot of these symptoms only manifest themselves with patients who suffer from large or rare giant tonsilloliths.

  • Bad breath (halitosis)
  • Pain on swallowing
  • Difficulty swallowing
  • Metallic taste in mouth
  • Coughing fits
  • White Spots on tonsils
  • Ear ache
  • Swollen tonsils
  • Sensation that something is stuck or lodged in the back of the throat

While the side-effects can be unpleasant and uncomfortable, they are rarely life threatening and there has not been any evidence that they negatively affect one’s overall health.

How do you know if you have tonsil stones

If you suffer from the above mentioned symptoms of tonsilloliths you may have them. Keep in mind it is extremely rare to suffer from tonsil stones if you had a tonsillectomy and had your tonsils removed.

You can usually determine if you have tonsil stones through visual inspection. Grab a flashlight and face a mirror. Open your mouth in such a way that you have a clear view of your tonsils. Shine the light on the tonsils and inspect each of them thoroughly for any white spots or white objects on them. Also you may try taking a clean Q-tip and using that to pull back the flap of the tonsils to inspect the cryptic area in the tonsils. If you do not see any white spots or objects you should be good to go. If you do see white objects they might be tonsil stones, debris from a larger tonsil stone, or a tonsil stone in development.

Tonsils stones can also be detected through X-rays and CAT scans and they are often discovered accidentally through these methods.

How to remove tonsil stones

There are various methods used to treat and remove tonsil stones. They are often removed or dislodged unintentionally by coughing or even swallowing. The simplest method of the removal of tonsil stones is take a Q-Tip (people report a bent bobby pin works well) and to gently apply pressure to the white stone until it is dislodged. If that doesn’t work try to apply pressure through different angles and try a back and forth motion. Also if it is hard to reach you might try taking another Q-tip and using that to pull back the flap or part of the tonsil so you have better access. Remember to be very gentle. Your tonsils are very fragile and they might bleed if handled recklessly. A little bleeding is common in removing tonsil stones but do your part and be gentle and take your time to minimize the bleeding and irritation done to your tonsils.

Removal of tonsil stones is also carried out effectively by using an oral irrigator. Ideally the best irrigation tool to use is an oral irrigator that is used to irrigate the lacerations left by the removal of wisdom teeth. Other oral irrigators may be used such as a WaterPik or the SinuPulse Irrigation System but be sure to use the lowest setting at first, and if you feel even the lowest setting would be too powerful on your tonsils, then don’t do it. CAUTION: You may rupture or puncture your tonsil if the water stream is too strong. Be careful and smart. Take your time while irrigating and hopefully that will get rid of your tonsil stones.

If you have tried the above mentioned methods and they did not work, consider seeing a doctor. Doctors may remove tonsil stones by curettage, laser, or even surgery if necessary. If they are really bad and keep recurring, the doctor may suggest tonsillectomy (removal of the tonsils). The doctor will let you know what the best treatment for tonsil stones would be.

Should I get my tonsils removed?

Many people consider getting their tonsils removed if they suffer from recurring tonsil stones and bad breath. It is a hard decision to make and there are many things to consider personally and with your doctor before removing them. The recovery time from a tonsillectomy increases as the patient gets older and many doctors discourage it for adults, whereas many adult patients have had them removed and stated the recovery wasn’t too hard and they are loving life after having them out. Research the topic heavily. If tonsil stones are the only reason you want them out first try removing the tonsil stones and applying the preventive measures in your life that are outlined in the next section. If you just can’t get rid of the tonsil stones and if your tonsils are causing you to have tonsillitis and sickness regularly, it might be best just to rip them out yourself. Just kidding, get a doctor to do a tonsillectomy.

Prevention

While removing tonsil stones is possible, it is important to take measures that stop them from returning and recurring often. We believe that the stones are caused by particles that get trapped in the tonsils, so in order to prevent tonsil stones it is important to clean your tonsils regularly to keep them free of the particles that would eventually break down and cause the tonsilloliths to develop. Here is a list of methods you can apply to prevent tonsil stones.

  • Brush Teeth and Gargle after meals – Brushing your teeth and gargling a germ killing oxygenating solution after meals is an excellent way to ensure that your breath is fresh and your mouth and tonsils are free from food particles that would eventually cause bad breath and tonsil stones. Before brushing after a meal it is a good idea to swish water in your mouth and spit it out until you do not see any more food particles coming out. Then drink a bit of water to wash down any particles in the back of your throat and tonsils. Now brush your teeth and be sure to gargle mouthwash thoroughly. If you do this after each meal it will help your overall oral health and help keep your mouth free of food particles.
  • Irrigate your tonsils regularly – With a gentle oral irrigator wash your tonsils often, at least once a week, to insure there are no particles that have been lodged in them. Try SinuPulse Irrigation Systemto clean your tonsils regularly. You may also use WaterPik with the irrigator tip and on the lowest pressure setting. These irrigators will work best if you use warm water in them.
  • Try Nasal Irrigation – While it is not proven that post-nasal drip is a cause of tonsil stones, it would still be prudent to clean out your nasal passages regularly as well just in case too much mucus drainage in the back of the throat is a cause of tonsil stones. Check out our article on nasal irrigationand also post-nasal drip to discover other methods on how to treat post-nasal drip.
  • Use tonsil sprays and oxygenating mouthwash – Tonsil sprays and oxygenating mouthwash such as TheraBreath Oral Rinse used regularly help to break down the particles faster to hinder the development of tonsil stones. They also help neutralize sulfur-producing bacteria to freshen your breath.
  • Take Oral Probiotics – Although this information is not yet backed up by studies, many people have reported that taking oral probiotics has stopped or hindered the growth of tonsil stones. To learn more read our article on Oral Probiotics.

Keep in mind you will probably not see immediate results. Doing these preventive measures will hinder the growth of future tonsil stones, but do little to remove the tonsil stones you currently have. Try to remove the tonsil stones you currently have and then carry out these preventive measures to try to keep new ones from forming. Overtime you should notice results, but don’t give up after a couple of weeks. It might take months for you to see results.

Also do not neglect other oral health care while trying to get rid of tonsil stones. Read our article on How To Get Rid of Bad Breath for an overview of a basic oral care regimen that will help you have fresh breath.

If you take the protective measures above, hopefully you will be rid of tonsil stones for good and eliminate tonsil stones from your life!

 

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?

Source: Patient.co.uk

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

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.

Toileting routines

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.
Bulk-forming 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.

Stimulant laxatives

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.
Osmotic laxatives

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.

Faecal softeners

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.

Other treatments

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

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.

Source: Patient.co.uk

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.

Epidemiology

  • 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.

Presentation

The incubation period may be as short as seven days and tissue invasion mostly occurs during first four months of infection.

Intestinal amoebiasis
  • 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).
  • Amoeboma:
    • 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.
Hepatic amoebiasis
  • 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.

Differential diagnosis

  • 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.

Investigations

  • 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.

Management

  • 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.

Complications

  • 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.

Prognosis[2]

  • 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.

Prevention

  • 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.[18]

 

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?

Source: Patient.co.uk

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.

Mumps immunisation

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).

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