Understanding and dealing with faecal incontinence

Posted on April 28, 2016 by OIGAdmin

Any form of incontinence, though may not be fatal, can surely rob the life of the affected.

Faecal Incontinence (FI) is basically lack of control over defecation leading to involuntary loss of some or all of the bowel contents. This is a symptom and not a diagnosis. There can be several underlying reasons for FI including recent anorectal surgery, damage during childbirth, weakened sphincter, Irritable Bowel Syndrome (IBS), Chrohn’s disease, just diarrhea or neurological conditions such as Alzheimer’s and dementia. Luckily not too many people suffer from this. It is estimated that just over 2% of the adults suffer from faecal incontinence at some point in time and only 0.5 – 1% of adults experience regular FI.

While potential embarrassment is a major worry, there are more serious health concerns associated with FI over and above the underlying causes of the FI in the first place. As the skin around the anal region has prolonged contact with faecal matter, this can lead to maceration, which is the softening and whitening of the skin due to continues exposure to moisture. Additionally, because of the bacteria that flourish in the faecal matter, Urinary Tract Infections(UTI) become more common. Finally, especially in the case of bedridden people, bed sores (also called pressure ulcers) start forming rather frequently.

Use of adult diapers and their regular change can help mitigate some of the problems. Also regular cleansing and strict maintenance of hygiene can go a long way in reducing the chances of bed sore and related issues.

If you or your loved ones suffer from FI, do approach a Doctor at the earliest.

A note for those family members living with their elder parents or relatives: Many people suffering from FI are too embarrassed to discuss this problem and may be trying to quietly deal with the problems themselves. If you notice frequent and hurried visits to the toilet, reluctance to leave home, frequent washing of clothes, especially undergarments, stains on clothes and bed linen and smells associated with fecal matter, broach the subject with sensitivity and gently get them to allow you to take them to the Doctor.

Varicose veins and stockings

Posted on January 7, 2014 by OIGAdmin

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As we all know, the heart pumps blood through the body. Arteries carry oxygenated blood to all parts of the body and the veins bring the de-oxygenated blood back to the heart.

Veins have one-way valves that ensure that blood keeps moving towards the heart but not in the opposite direction (like the check valves used in plumbing). These valves ensure that blood continues to flow in the right direction irrespective of whether you are standing, sitting, lying down or even standing on your head!

However with age and due to certain health conditions such as obesity and hormonal changes, these values become faulty. This results in pooling or accumulation of blood in certain areas (especially in veins near the skin) causing the veins to be distended and weakened. This is what causes varicose veins to develop (most often in the legs) and they can be mildly to moderately painful.

Symptoms include a dull, heavy aching or burning sensation, fatigue, and mild generalized swelling of the feet and ankles. If you have varicose veins with mild or no symptoms, keeping your legs elevated, doing mild exercises and keeping off caffiene and alcohol can help keep discomfort to the minimum.

If your discomfort is more, you may want to use compression stockings. Compression stockings, as their name implies, apply pressure on your legs and help blood flow better thereby alleviating many of the symptoms of varicose veins.

Compression stockings come in many sizes, lengths, types (with toe open, fully closed, …) and classes. Size is obviously S, M, L, XL, etc. based on the circumference of your leg at the ankle, calf (and thigh possibly). Choose the size based on the table given in the stocking box and not based on how easy it is to put on (if it is easy to wear, it is the wrong size for you).

Length is the length of the stockings and is usually upto below knee(AD), mid-thigh(AF), or groin(AG).

Class represents the level of pressure exerted by the stockings. Class-I stockings apply the least amount of pressure, usually measured in mmHg. Typical class-I stockings apply about 18 mmHg of pressure evenly.

There are also graduated stockings which apply maximum pressure at the bottom and gradually reducing pressure as it goes up the leg.

It is best to consult a doctor so that you can decide which is the right stocking for you.

Actively managing joint pain in elders

Posted on April 10, 2013 by OIGAdmin

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Until a few decades ago, people believed that progressive blindness was an unavoidable consequence of aging. Not anymore. With easy cataract operations and other advances in corrective surgery, vision is no longer such a big problem for most senior citizens.

Similarly, in today’s world, most elders believe non-specific joint pain is inevitable. This, again, need not be true. While many of the underlying reasons for joint pain such as arthritis, diabetes, osteoporosis, loss of muscle, and stiff and brittle tendons and ligaments cannot be completely reversed with medication or surgery, appropriate footwear, seats and cushions, orthopaedic support devices and supplements can help alleviate joint pain to a large extent.

Take for example, one of the most common pain areas – the knee. A lot of strain is put on the knee during the acts of sitting down and getting up – especially in the toilet. A lot of relief can be got by using simple devices such as toilet raisers and appropriately fixed grab bars which can ensure reduced pressure on the knees. Similarly, knee supports and braces can go a long way in reducing pain and deferring knee replacement operations. Also, Collagen peptide supplements have been shown to reduce joint pain especially for people with acute pain.

Another common problem for many people is back pain – especially in the lumbar region. A wide variety of cushions, back support devices, belts and corsets are available that can relieve such chronic pain. In addition, minor adjustments in lifestyle and choice of chairs can lead to perceptible reduction in pain in a short period of time.

Similarly, regular exercise, massage and yoga can help you regain your flexibility and even muscle tone to an extent.

So whether it is your heel or arch of the foot, ankle, knee or hip, coccyx or tailbone, small of the back/lumbar region, upper back or neck, there are easy to use solutions available that can dramatically reduce your pain and improve the quality of your life.

Diabetic Retinopathy

Posted on February 19, 2013 by OIGAdmin

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Diabetes is an emerging global health problem today, with India all set to take on the dubious mantle of “The Diabetic Capital Of The World” due to its huge volume of diabetic patients. Diabetes affects all parts of the body, most importantly the eye. In recent years, the prevalence of diabetic eye disease has been increasing at an alarming rate. Let us address several questions on this burning health problem to get more awareness.

a.)What is diabetic retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in the middle-aged population. It is the affection of the retina (the light sensitive layer of our eyes) due to diabetes. If untreated, it can cause severe vision loss or even blindness. It usually affects both eyes.

b.)What are the symptoms and signs of diabetic retinopathy?
Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

Diabetic retinopathy has four stages:

Mild Nonproliferative Diabetic Retinopathy. At this earliest stage, there are small areas of balloon-like swelling in the retina’s tiny blood vessels called microaneurysms.
Moderate Nonproliferative Diabetic Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
Severe Nonproliferative Diabetic Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply.
Proliferative Diabetic Retinopathy. At this advanced stage, signals are sent by the retina for more nourishment, which trigger the growth of abnormal and fragile new blood vessels. These leak blood causing spots or floaters. This is called vitreous hemorrhage (bleeding in the vitreous: the gel-like substance that fills the center of the eye).

At any of the above stages, fluid can leak into the macula, (the central part of the retina responsible for your vision) causing blurring of vision. This condition is called macular edema.

c.) What is the treatment of Diabetic Retinopathy?

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. This helps in planning treatment.

Laser treatment either in the form of pan retinal photocoagulation (PRP) or focal is usually the treatment of choice for vision threatening diabetic retinopathy. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.

Vitrectomy is another surgery commonly needed for diabetic patients who suffer vitreous hemorrhage, in which the vitreoretinal surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). It is important to always remember that although these treatments have high success rates, they do not cure diabetic retinopathy.

d.)What is the bottom line?

Better control of blood sugar levels, regular retinal evaluations, early detection and timely treatment can prevent vision loss due to Diabetic Retinopathy.

This article is written by Dr.Vasumathy Vedantham MS, DNB,FRCS, Medical Director & Consultant Vitreoretinal Surgeon at Radhatri Nethralaya.