Symptoms often confused with other conditions:

Don't put off haemorrhoids

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.

Haemorrhoids

Banding

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