Hemorrhoids

Hemorrhoids or piles are caused when the veins around the anus or lower rectum get swollen and inflamed. Hemorrhoids are painful but surely not dangerous or life threatening. Hemorrhoids are very common among pregnant women. The pressure of the fetus on the abdomen and hormonal changes affect the blood vessels and force them to enlarge. These vessels experience severe pressure during childbirth thereby making hemorrhoid a common occurrence in women.

Causes for hemorrhoids

• Straining too much to pass stools
  
• Sitting for too long
  
• Chronic constipation
  
• Pregnancy
  
• Childbirth
  
• Obesity
  
• Cigarette smoking
  
• Excessive coughing
  
• Aging
  
• Diarrhea
  
• Anal intercourse
  
• Hypertension
  
• Lifting heavy weight
  
  

Types of hemorrhoids

Internal hemorrhoids: Veins that get swollen inside the anal canal are referred to as internal hemorrhoids. Internal hemorrhoids are not very painful as there are no pain receptors in this area. Most people who have internal hemorrhoids are not even aware. Internal hemorrhoids can bleed when they are irritated.

External hemorrhoids: Veins that get swollen near the opening of the anus are termed as external hemorrhoids. These hemorrhoids are at times painful and cause swelling and irritation.

Anal fissure: A thin tear in the anal area is an anal fissure. This hemorrhoid is itchy, painful and bleeds while passing stools.

Prolapsed hemorrhoids: These hemorrhoids are a type of internal hemorrhoid and they stretch down until they protrude outside the anus. This type of hemorrhoid can be painful.

Thrombosed hemorrhoids: A blood clot forms inside the external hemorrhoid thus causing thrombosed hemorrhoid. This type of hemorrhoid is very painful and can be felt as a stiff but tender mass in the anal area.

Typical symptoms of hemorrhoids include rectal pain and itching. There might bleeding during bowel movements. Increase fiber and fluid intake to avoid constipation. Use ice packs for relief. Use hemorrhoidal cream. Tub or sitz baths can provide relief. Exercise regularly and wear loose undergarments.

Common techniques followed in removal of hemorrhoids

Hemorrhoidectomy: At times severe internal or external hemorrhoids may require removal by surgery; this procedure is known as hemorrhoidectomy.

Sclerotherapy: A chemical solution is injected around the blood vessel so as to shrink the hemorrhoid.

Rubber band ligation: A rubber band is positioned inside the rectum around the bottom of the hemorrhoid. The band helps in cutting off blood circulation thereby forcing the hemorrhoid to wither away after a few days.

Infrared coagulation: A special device is used to burn hemorrhoidal tissue.

Laser coagulation: This is a new technique - electric current is applied to remove the hemorrhoids.

Spinal Anesthesia

Spinal anesthesia is administered through injection to anaesthetize or numb the lower part of the body before performing surgery on the patient. Spinal anesthesia is a type of regional anesthesia and will block the pain below the site of the injection. This kind of anesthesia is injected into the spine of the lower back through a long needle. The medicine is directly administered into the fluids surrounding the spine. This is normally given between L3 - L4. Unlike general anesthesia, here the patient is awake and conscious during the procedure.

Surgeries performed under spinal anesthesia

Spinal anesthesia suits simple surgical procedures involving short duration. It is a single shot and hence medicine is given only once and no catheter is placed for further medication. Once the medicine is administered, spinal anesthesia starts working instantly. As soon as the shot is given, patient will begin to experience a hot feeling in the lower part of the body and subsequently the area becomes numb. Spinal anesthesia is appropriate for the surgeries performed below the umbilicus like:

• Vaginal repair or vaginal hysterectomies
  
• Hernia operation
  
• Piles
  
• Varicose veins
  
• Orthopaedic surgeries on the legs, pelvis
  
• Prostate removal
  
• Operation on genitals
  
• Surgery for trauma on lower limbs
  

Spinal anesthesia procedure

Firstly, patient will be positioned appropriately. The patient will be made to sit on the edge of the operating table keeping the stool under the legs for support or the patient will be made to lie down on one side, knees tucked up to the chest. Once positioned, the lower back will be cleaned with antiseptic lotion. Small dose of local anesthesia will be given at the site where the spinal will be administered so that patient does not feel the piercing pain. The anesthetist administers the spinal injection and will remain in the operation theatre throughout to check the progress and the effect of anesthesia.

Spinal anesthesia complications

Spinal anesthesia is less risky when compared to general anesthesia. Patient can return to normalcy in no time and also there are less chances of developing chest and lung infections and other respiratory disorders. However, spinal anesthesia may give rise to few side effects like:

• Headache
  
• Itching on the body
  
• Low blood pressure
  

These conditions are quite manageable and treatable and will wane off within few hours after the procedure. Neurological injury is an extremely rare complication that may be caused by spinal anaesthesia.

Anemia

Anemia stands for 'without blood' in Greek; When the number of red blood cells (RBC) falls below normal, Anemia is a resultant condition. Hemoglobin is an important constituent of RBC. Hemoglobin usually occurs in the range of 12 and 18 g/dL (grams per deciliter of blood). If the hemoglobin levels show a decrease, anemic conditions set in. Consequently, the various organs and tissues of the body do not receive adequate oxygen on account of the diminished oxygen carrying capacity of the blood. This impairs their normal functioning. Usually women have smaller stores of iron than men. Besides, they also lose blood during menstruation making them primary targets for anemia.

World Health Organization (WHO) defines anemia as a hemoglobin level lower than 13 g/dL in men and lower than 12 g/dL in women. It is essential to be familiar with the typical symptoms of anemia. Often anemia is misdiagnosed and left untreated. An anemic person is likely to feel extremely tired and weak. This is accompanied with dizziness and breathlessness. A person suffering from anemia tends to appear pale and experience feelings of depression. In some cases, anemia can lead to heart ailments too.

Causes of Anemia

• Serious disease or infection such as hookworm infection, bleeding piles, esophageal var ices and peptic ulcers.
  
• Hemorrhagic - Excessive blood loss due to surgery, menstruation or injury.
  
• Genetic defects lead to sickle cell anemia, Thalassemia anemia and aplastic anemia.
  
• Hemolytic - Excessive intravascular blood destruction where red blood cells are destroyed prematurely.
  

Types of Anemia

Iron deficiency Anemia - Nearly 20% adult women tend to suffer from this form of anemia. Loss of blood due to menstruation is not compensated with an iron-rich diet. Pregnancy and breast feeding can also deplete iron stores. Iron deficiency anemia is also noticed during growth spurts or internal bleeding.

Aplastic anemia - When the bone marrow does not produce sufficient quantities of blood cells, aplastic anemia is noticed. Childhood cancers such as leukemia are often responsible for this form of anemia. Other possible causes of aplastic anemia are radiation, cancer or antiseizure medications and chronic diseases such as thyroid or kidney malfunction. Treatment for aplastic anemia involves blood transfusions and bone marrow transplant. This is done to replace malfunctioning cells with healthy ones.

Vitamin deficiency anemia - Low levels of folic acid lead to faulty absorption of iron. Anemia caused due to folic acid deficiency is called Megaloblastic anemia. Pregnancy doubles the body requirements of folic acid and it is imperative that pregnant women take folic acid supplements. Good dietary sources of folate are fresh fruits, green leafy vegetables, cruciferous vegetables, liver and kidney, dairy products and whole grain cereals. Vegetables should be eaten raw or lightly cooked.Folic acid anemia is also a common problem faced by alcoholics. Vitamin B-12 deficiency can lead to a condition of Pernicious anemia. Diseases such as thyroid malfunction or diabetes mellitus can affect the body's ability to absorb vitamin B-12. This vitamin is vital in the production of hemoglobin.

Vitamin C Deficiency Anemia is a rare form of Anemia that is the result of small red cells owing to prolonged dietary deficiency of the Vitamin C.

Sideroblastic Anemia: In this anemia, the body has sufficient iron but it fails to incorporate it into hemoglobin.

Hemolytic Anemia results from high rate of destruction of Red Blood Cells (RBC) at a rate faster than the rate bone marrow can replenish them.

Thalassemia anemia - Thalassemia or Cooleys Disease is a hereditary disorder found predominantly in people of South East Asian, Greek and Italian racial groups. This form of anemia is seen in differing degrees as Thalassemia encompasses a group of related disorders that affect the human body in similar ways. The most common occurrences of Thalassemia are alpha and beta thalassemia. Alpha thalassemia occurs when there are defects in the genes that produce alpha globin, while beta thalassemia occurs when there are defects in the genes that produce beta globin. The severity of the disorder depends on how many genes are affected and the specific mutations involved. Thalassemia anemia is characterized by symptoms like jaundice, enlarged spleen, shortness of breath and facial bone deformities.
Thalassemia is a group of inherited blood disorders that affect the production of hemoglobin, a protein in red blood cells that carries oxygen throughout the body. The disorder is caused by mutations in the genes that control the production of hemoglobin. Thalassemia anemia occurs when a person has fewer red blood cells than normal, or the red blood cells are smaller and do not contain enough hemoglobin. This can lead to a range of symptoms, including fatigue, weakness, pale skin, jaundice, and an enlarged spleen.

Treatment for thalassemia anemia may involve blood transfusions, iron chelation therapy to remove excess iron from the body, and bone marrow transplant in severe cases. With appropriate treatment and management, many people with thalassemia can lead healthy and productive lives.

Diagnosing Anemia

A complete blood count test will test for hemoglobin levels and display an anemic condition. But often anemia is a symptom whose cause lies deeper. The cause and type of anemia will determine the treatment that is needed. A stool test will help in detecting occult blood. Hemoglobin electrophoresis is a blood test that helps identify abnormal hemoglobins. Diagnosing thalassemia or sickle cell anemia becomes possible with this test.

Treating Anemia

Deficiency can be treated with supplements of iron, Vitamin B-12 and Vitamin C. Partaking an iron-rich diet can be beneficial for those suffering from nutritional deficiency anemia. Seafood, nuts, whole grains and dried fruits such as raisins, prunes and apricots are rich in iron. Ensure adequate consumption of Vitamin C as it aids and stimulates iron absorption. Try and combine citrus foods with iron-rich foods - add tomatoes to a turkey sandwich or chopped strawberries with iron-fortified breakfast cereals.