Symptoms often confused with other conditions:
Don't put off haemorrhoids
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Dr. C.K Pathirana |
During previous weeks Healthwise carried a series of articles on
illnesses associated with the anus and the rectum such as anal fissures,
ulcers and rectal cancers. This week we have taken into account a
disease so common in both males and females alike that it is often more
dangerous diseases like rectal cancers are confused with it. Healthwise
spoke to Dr. C.K Pathirana on this week's topic - haemorrhoids, commonly
referred to as piles.
Haemorrhoids is a condition that starts early in life and develops as
the patient gets older. It develops in the lower part of the rectum,
where blood accumulates and forms into sacks to facilitate the smooth
passage of a motion, called anal cushions.
According to Dr. Pathirana, although a motion may seem as simple as
exhaling, many things have to fall into place before circumstances are
just right to have a motion. "The passage has to be air tight,"
explained Dr. Pathirana. And the blood filled cushions have to fill any
gaps.
"The condition has several stages," explained Dr. Pathirana. The
first stage is characterised by bleeding. "When people with constipation
strain to have a motion or if one has several motions a day these anal
cushions tend to enlarge with the accumulation of more and more blood.
The cushions can get traumatised. This leads to bleeding, explained Dr.
Pathirana. This is the first stage of haemorrhoids. Bleeding can occur
before or after a motion.
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Haemorrhoids |
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Banding |
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Closed
Haemorrhoidectomy |
During the second stage these enlarged cushions start to protrude out
of the anus. "One might feel a lump coming out of the anus when
straining" explained Dr. Pathirana. "It goes back into the anal canal by
itself when the process is through."
But in the third stage of the condition the lump will not go back
through the anal canal by itself. "The patient has to manually push it
back in." But because the area concerned is not sensitive it may still
not be painful, only uncomfortable.
In the fourth stage the patient may not even be able to push the lump
in manually. In a matter of days the lump may get bigger and bigger.
This can be extremely painful and Dr. Pathirana advises patients
suffering from such severe pain to seek immediate medical attention.
Symptoms
Until the last stage haemorrhoids is not painful. In addition to
bleeding, patients may experience a mucous discharge - a white, watery
substance - excreting from the back passage. "Patients may also
experience itching" said Dr. Pathirana.
"Bleeding may occur with a spurting action before a motion, stop
while passing stool and bleed again after it is over," explained Dr.
Pathirana. This may be obvious in some patients, but in other cases it
can go unnoticed.
Because of excessive and unchecked bleeding - in which as much as 50
% of haemoglobin level could be lost - patients can become anaemic and
may also display symptoms associated with anaemia such as lethargy,
weakness, tiredness, panting, sleepiness, swelling of ankles, paleness
and bloating of face. "A large number of patients come to us with
symptoms of anaemia, but we find later, the root cause to be
haemorrhoids" explained Dr. Pathirana.
Diagnosis
"Because it is painless and the condition progresses slowly most
patients tend to ignore it until they reach the third or fourth stage"
said Dr. Pathirana. But the real danger in delaying is not the
progression of haemorrhoids, but mistaking a much dangerous and
potentially life threatening disease as being haemorrhoids. "Painless
bleeding can be observed in both chronic cases of inflammatory bowel
disease and rectal cancer," said Dr. Pathirana.
"Physicians usually look for a recent change in bowel movement to
exclude rectal cancer."
Treatment
"If the condition is diagnosed in the initial stages, after a
thorough clinical evaluation injection sclerotherapy is conducted,"
explained Dr. Pathirana. This is a painless procedure which will shrink
the enlarged cushions, that later fall off. Another option available is
'Banding', where the haemorrhoid is sucked into a device and a rubber
band is put around it. "Both these procedures are painless because the
area where haemorrhoids develop is not sensitive. They are Out-Patient
procedures and the patient has to spend only a few hours in the
hospital. The result is the same in both procedures. Haemorrhoids shrink
and fall off."
Surgical intervention
But if the condition still progresses patients have to take their
pick from either open surgery or staple haemorrhoidectomy. "Open surgery
- where the haemorrhoids are surgically removed - is conducted under
general or spinal anaesthesia," explained Dr. Pathirana. Staple
haemorrhoidectomy is more expensive. "In this procedure the haemorrhoids
are stapled using something like a stapling device." Most patients have
to be hospitalised for two days and can get back to their normal routine
in one and half weeks.
Prevention
Regular
exercise facilitates an easier motion and is just as important as having
a balanced diet with a lot of fruits and vegetables that provide fibre.
"If you drink enough water it won't be necessary to strain" explained
Dr. Pathirana.
As in the case of diseases associated with the anus and the rectum
previously discussed in Healthwise it is vital to avoid food and drinks
that cause constipation, such as caffeine, cola drinks and chocolate.
"Do not put off when you develop the urge to have a motion. But avoid
straining."
"If bleeding is noticed, whether there is a lump or not, seek
immediate medical attention" advised Dr. Pathirana. Because most often
symptoms of haemorrhoids are similar to that of other conditions
associated with the anus and rectum.
SP
Into the mind of the child
by K. M. G. W. Abeyratne
Depression, a universally used term, is usually considered to affect
only adults who deal with stresses and strains of everyday life, besides
some unusual incidents. Sometimes it may also be associated with the
physical effects of an illness, or some throbbing emotional arousal
caused by an unexpected episode in one's life.
The developing trends in the mental health field in Sri Lanka are
still underdeveloped. The recognition that children can be depressed
still hasn't gained much impetus in our society. In fact the darker side
of the story is that it does occur in children due to numerous social,
emotional and economic concerns. It is more or less the same syndrome as
in adults but varies its symptom logy with age.
It is very important to understand what depression is in true
psychological terms. The hallmark of depression is an irritable mood.
The
Wikipedia defines it as a 'state of low mood and aversion to an activity
or dysfunction'. Further it can be delineated as an adaptive defence
mechanism.
Children become grouchy, apathetic and withdrawn, lose interest in
books, toys and also associates. Generally children's mood tends to be
more delicate than those of adults. But in a depressed child, there is
more longstanding and incessant mood of sadness, though some
fluctuations from day to day or at different times of the day may occur.
They may like seclusion and some gloomy settings. Self blame and
expression of guilt are common.
A child is often unaware of what is troubling him, and even if he
knows, it is less likely for him to discuss his problems even with his
peers. Usually children are dependents on how adults perceive their
disorderly situations. Although some children verbalise their problems
they don't complain of being depressed. They tend to show their emotions
through behaviour. They act out their feelings. Depression is only
diagnosed when the disturbance is out of proportion to the impetuous
factors and parents feel a constant and pervasive change in the child's
behaviour patterns.
Sometimes it may be too late. It is very important for parents and
teachers to have some knowledge of symptom of childhood depression. Once
they get educated in this concern they can easily identify and hence
seek timely treatment. Parents should be able to distinguish depression
from sadness and unhappiness that can be seen as a result of defeat,
loss or disappointment. Normal grief reactions can also reveal symptoms
like loss of interest, sleep and appetite disturbances, psychomotor
retardation or even agitation, guilt and even suicidal ideation. It
should be clear that if parents and teachers do observe these symptoms
and changes, they should immediately seek professional help rather than
wasting time. This is the work of psychologists and psychiatrists.
According to well-known psychologists, depression appears more
regularly with age. Seven percent of pre-schoolers with one or more
depressive symptoms have been reported.
Depression in schoolchildren can have a seasonal pattern. It can be
seen through the winter and may remit when summer comes. Or during
unbearable hot days until the moderate days comes.
Even newly born children are also subjected to depression due to
numerous environmental and parental factors. Such a child has a
behaviour of whining, weight loss, withdrawals, slowed growth, dazed and
immobile facial expressions. Depressed mothers are also at a risk of
having depressed children.
Even in Sri Lanka we encounter severe symptoms of depression in
orphanages, and infants left alone in hospitals and other places and
even in slums in urban areas. These abandoned children show severe
symptoms including slowed motor responsiveness, expressionless faces,
self stimulating behaviour and consequently high mortality rate.
Depression in toddlers usually involves irritable moods, delayed
development milestones, nightmares and decrease in play activities.
Children in lower grades have symptoms of sadness, motor retardation,
anger, apathy, illness and irritability. Such children play less with
other students and at times verbally express feelings of grief,
worthlessness and even anxiety. Depression normally comes to resemble
more closely to that of adults in school ages. Especially in schools
established in overlooked and heavily populated localities. A child more
often tries to verbalise depressed cognitions. They may have low self
esteem, social withdrawals, moodiness and lack of passion and
motivation. They may show declining performance in sports and academic
affairs marked by poor school grades. As an important counteractive
measure, all teachers have to be well-educated and trained in the field
of child psychology, enabling them to identify the changes of behaviour
blueprints of their students. In addition to this, a guidance and
psychoanalysis/psycho therapy service unit, for a "whole child approach"
comprising of psychiatrists, psychologists, play therapists, social
workers and remedial teachers should be made available at least in every
provincial education department.
Parental and teachers' fears for the adolescent child in today's
laissez-faire society are very often pragmatic. Some teenagers feel that
they are not being allowed the same degree of freedom as their peers.
Twelve to eighteen years is the stress period of a child. They are
subjected to a number of stresses, as results of his/her windy
developmental changes and open society. Early identification of symptoms
of depression, anxiety or any other similar mental chaos at home and in
schools can help, in proper intervention on time.
Depression is not something we can just "snap out of." And it is
caused, as a result of a chemical imbalance of one's brain along with
some other factors. This can be totally cured by a well qualified
doctor. Apart from some basic concepts of child psychology, all teachers
should be given the proficiency of creating a stress-free learning
opportunities and a learning culture in their classrooms and to exploit
various teaching strategies for stress free learning. This is a
compulsion, in case of private and international schools, emerging like
mushrooms all over Sri Lanka where many unrefined persons are chosen for
this noble profession.
As all parents, teachers, even some religious dignitaries and
politicians are in a rat race for monetary and other material gains and
supremacy, our youngsters are somewhat overlooked, neglected and
isolated making room for a visionless vulnerable society.
In Sri Lanka there is an urgent need for public mental health
education. The mental health of the schoolchildren and nature of human
growth should become features of the school curriculum. More detailed
explanations of specific subjects on psychology should be given in
secondary schools and also to parents with liberal use of visual aids
and other sciencetific approaches.
There is also a need for pedagogical specialists, who should be
trained in principles of physical and psychological health.
Comprehensive diploma courses on the content and methods of
psychological health should be started for teachers, principals and even
for senior students including university undergraduates.
Simultaneously, some re-educational programs on community mental
health for needy parents should be initiated and this can be assigned to
both colleges of education and medical/sociology faculties of the
national universities. It is time to take apposite measures as early as
possible before the entire country turns into an asylum of hare-brained
citizens.
The writer is the Director of Studies, Royal Institute, Colombo 5.
World Health Day fell on April 7:
Urbanisation to stay
Virtually all population growth over the next 30 years will be in
urban areas, signalling that urbanisation is here to stay. It is
associated with many health challenges related to water, environment,
violence and injury, noncommunicable diseases (NCDs) and their risk
factors like tobacco use, unhealthy diets, physical inactivity, harmful
use of alcohol as well as the risks associated with disease outbreaks.
Urbanisation is a challenge for several reasons.
The urban poor suffer disproportionately from a wide range of
diseases and other health problems, and include an increased risk for
violence, chronic disease, and for some communicable diseases such as
tuberculosis and HIV/AIDS.
The major drivers, or social determinants, of health in urban
settings are beyond the health sector, including physical
infrastructure, access to social and health services, local governance,
and the distribution of income and educational opportunities.
Urban planning can promote healthy behaviour and safety through
investment in active transport, designing areas to promote physical
activity and passing regulatory controls on tobacco and food safety.
Improving urban living conditions in the areas of housing, water and
sanitation will go a long way to mitigating health risks. Building
inclusive cities that are accessible and age-friendly will benefit all
urban residents.
Such actions do not necessarily require additional funding, but
commitment to redirect resources to priority interventions, thereby
achieving greater efficiency.
WHO
A deadly addiction: junk food
by Susan Brady
While you might not think that cheesecake, ice cream, or candy bars
can be lethal, the cumulative effect of a regular diet of junk food can
cause chronic health problems that contribute to death, particularly
those high in fat and calories.
High-fat,
high-calorie junk foods-those notorious non-nutritive noshes-can be
addictive, and the regular consumption of said unhealthy items is a
contributing factor in the rise in obesity in America, which is also
seeing alarming rates of diabetes, heart disease, and stroke. What is
most surprising out of a new study published in the March 28 issue of
Nature Neuroscience is the posit that eating junk food can be addictive,
just like drugs, smoking, and alcohol.
The study, conducted on rats, suggested that those high-fat,
high-calorie food items can affect your brain in the same way that drugs
like heroin do. These types of food satisfy the pleasure center of the
brain, but will require more and more to retain that pleasurable
feeling. The 40-day Scripps Research Institute study focused on three
groups of rats; one fed regular rat food, a second fed regular food and
junk food for one hour per day, and a third group that was allowed
unlimited junk food for 23 hours every day. That third group became so
addicted to the junk food that they couldn't get enough, consuming more
each day and becoming obese. The eating became compulsive even though an
electric shock was administered every time they did so. The pleasure
obviously outweighed the pain.
While the study was done with extremes, utilising bacon, sausage,
cheesecake, cake frosting and other unhealthy foods available on a
continuing basis 23 hours a day, it did show that there was a change in
the dopamine D2 receptor in the brain. This receptor, when suppressed,
leads to addictive behaviour. The researchers were even able to
artificially suppress the dopamine receptor in rats and came up with the
same results...compulsive overeating. While the majority of the
population is not going sit around and eat bacon and sausage all day
long, it is a reminder that everything should be done in moderation, and
that even food can change the way your brain processes work.
- healthnews.com
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