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Pelvic organ prolapse Overview Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose. This allows one or more of the pelvic organs to drop or press into or out of the vagina. Many women are embarrassed to talk to their doctor about their symptoms or think that their symptoms are normal. But pelvic organ prolapse is treatable. What is pelvic organ prolapse? The pelvic muscles and tissues support the pelvic organs like a hammock. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum, which is part of the bowel. A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or damaged. This causes one or more pelvic organs to drop or press into or out of the vagina. Pelvic organ prolapse is a type of pelvic floor disorder. The most common pelvic floor disorders are: What are the different types of pelvic organ prolapse? The different types of pelvic organ prolapse depend on the pelvic organ affected. The most common types include: Although it is rare, pelvic organ prolapse can also happen after a hysterectomy. Any part of the vaginal wall may drop, causing a bulge into or out of the vagina. Who gets pelvic organ prolapse? Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect one in five women in the United States.1 Pelvic organ prolapse is less common than urinary or fecal incontinence but affects almost 3% of U.S. women.1 Pelvic organ prolapse happens more often in older women and in white and Hispanic women than in younger women or women of other racial and ethnic groups.2,3 Some women develop more than one pelvic floor disorder, such as pelvic organ prolapse with urinary incontinence. What are the symptoms of pelvic organ prolapse? The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex. Other symptoms of pelvic organ prolapse include: Some women say that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your doctor or nurse about your symptoms. What causes pelvic organ prolapse? Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are: How is pelvic organ prolapse diagnosed? Your doctor will talk to you about your symptoms and do a pelvic exam. You may be asked to strain or cough during the exam so your doctor can see whether these actions cause prolapse or urine leakage. Your doctor may also do other tests to see whether you can completely empty your bladder when you go to the bathroom. How is pelvic organ prolapse treated? Treatment for pelvic organ prolapse depends on the type of prolapse you have, your symptoms, your age, other health problems, and whether you are sexually active. Your treatment may include one or more of the following: How can I prevent pelvic organ prolapse? Researchers are studying ways to prevent pelvic organ prolapse. The following steps may reduce your risk of getting a pelvic floor problem: Did we answer your question about pelvic organ prolapse? For more information about pelvic organ prolapse, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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how do you get a prolapse bladder
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Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. When the connections between your pelvic floor muscles and the ligaments weaken, your bladder or other pelvic organs can slip lower than normal and bulge into your vagina. This can happen because of pregnancy, childbirth, being overweight or obese, strain due to heavy lifting or bowel movements, or a chronic cough or bronchitis.
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Anterior prolapse (cystocele) Overview Anterior prolapse, also known as a cystocele (SIS-toe-seel), occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder. Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease. For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions. Symptoms In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include: - A feeling of fullness or pressure in your pelvis and vagina - Increased discomfort when you strain, cough, bear down or lift - A feeling that you haven't completely emptied your bladder after urinating - Repeated bladder infections - Pain or urinary leakage during sexual intercourse - In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down. When to see a doctor A severely prolapsed bladder can be uncomfortable. It can make emptying your bladder difficult and may lead to bladder infections. Make an appointment with your doctor if you have any signs or symptoms that bother you. Causes Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse). Possible causes of anterior prolapse include: - Pregnancy and vaginal childbirth - Being overweight or obese - Repeated heavy lifting - Straining with bowel movements - A chronic cough or bronchitis Risk factors These factors may increase your risk of anterior prolapse: - Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse. - Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen - which helps keep the pelvic floor strong - decreases. - Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support. - Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. - Obesity. Women who are overweight or obese are at higher risk of anterior prolapse. Diagnosis Diagnosis of anterior prolapse may involve: - A pelvic exam. You may be examined while lying down and while standing up. During the exam, your doctor looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. You'll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you'll be asked to contract them, as if you're trying to stop the stream of urine. - Filling out a questionnaire. You may fill out a form that helps your doctor assess the degree of your prolapse and how much it affects your quality of life. Information gathered also helps guide treatment decisions. - Bladder and urine tests. If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection, if it seems that you're retaining more urine in your bladder than is normal after urinating. Treatment Treatment depends on how severe your anterior prolapse is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (uterine prolapse). Mild cases - those with few or no obvious symptoms - typically don't require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles. If self-care measures aren't effective, anterior prolapse treatment might involve: - A supportive device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky. - Estrogen therapy. Your doctor may recommend using estrogen - usually a vaginal cream, pill or ring - especially if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause. When surgery is necessary If you have noticeable, uncomfortable symptoms, anterior prolapse may require surgery. - How it's done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of the pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin. - If you have a prolapsed uterus. For anterior prolapse associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues. If you're thinking about becoming pregnant, your doctor may recommend that you delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of recurrence - which may mean another surgery at some point. Dealing with incontinence If your anterior prolapse is accompanied by stress incontinence - involuntary loss of urine during strenuous activity - your doctor may recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms. Treatment at Mayo Clinic Urologists and urogynecologists at Mayo Clinic provide expert care for female patients of all ages who suffer from problems of the pelvic floor. Mayo physicians are leaders in clinical research that enhances the capability to offer the most advanced treatments available. Many of the urologists across all Mayo Clinic campuses have advanced training and subspecialty certification in female pelvic medicine and reconstructive surgery from the American Board of Urology. Urogynecologists at Mayo Clinic also have advanced training and certification in female urology. Specialty services offered through urology and urogynecology include: - Pelvic organ prolapse with or without incontinence diagnosis and treatment - Urodynamic evaluation - Stress urinary incontinence diagnosis and treatment - Minimally invasive injection therapies - Management of mesh complications - Urge urinary incontinence diagnosis and treatment - Overactive bladder diagnosis and treatment - Botox injections of the urinary tract - Neuromodulation for the urinary tract Lifestyle and home remedies Kegel exercises strengthen your pelvic floor muscles, which support the uterus, bladder and bowel. A strengthened pelvic floor provides better support for your pelvic organs and relief from symptoms associated with anterior prolapse. To perform Kegel exercises, follow these steps: - Tighten (contract) your pelvic floor muscles - the muscles you use to stop urinating. - Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.) - Work up to holding the contraction for 10 seconds at a time. - Do three sets of 10 repetitions of the exercises each day. Ask your health care provider for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time. Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.
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what are symptoms of a nonfunctioning gallbladder
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If your gallbladder is not working normally, common symptoms may include indigestion, bloating, heartburn, gas, nausea, vomiting, and pain after eating, especially in the upper right or middle area of your belly.
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Gallbladder removal - open Cholecystectomy - open Gallbladder - open cholecystectomy Cholecystitis - open cholecystectomy Gallstones - open cholecystectomy Summary Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. Description Surgery is done while you are under general anesthesia so you will be asleep and pain-free. To perform the surgery: The surgeon makes a 5 to 7 inch (12.5 to 17.5 centimeters) cut in the upper right part of your belly, just below your ribs. The area is opened up so the surgeon can view the gallbladder and separate it from the other organs. The surgeon cuts the bile duct and blood vessels that lead to the gallbladder. The gallbladder is gently lifted out and removed from your body. An x-ray called a cholangiogram may be done during your surgery. To do this test, dye is injected into your common bile duct and an x-ray is taken. The dye helps find stones that may be outside your gallbladder. If other stones are found, the surgeon may remove them with a special instrument. The surgery takes about 1 hour. Why the Procedure is Performed You may need this surgery if you have pain or other symptoms from gallstones. You may also need surgery if your gallbladder is not working normally. Common symptoms may include: Indigestion, including bloating, heartburn, and gas Nausea and vomiting Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain) The most common way to remove the gallbladder is by using a medical instrument called a laparoscope (laparoscopic cholecystectomy). Open gallbladder surgery is used when laparoscopic surgery cannot be done safely. In some cases, the surgeon needs to switch to an open surgery if laparoscopic surgery cannot be successfully continued. Other reasons for removing the gallbladder by open surgery: Unexpected bleeding during the laparoscopic operation Obesity Pancreatitis (inflammation in the pancreas) Pregnancy (third trimester) Severe liver problems Past surgeries in the same area of your belly Risks Risks of anesthesia and surgery in general are: Reactions to medicines Breathing problems Bleeding, blood clots Infection Risks of gallbladder surgery are: Damage to the blood vessels that go to the liver Injury to the common bile duct Injury to the small or large intestine Pancreatitis (inflammation of the pancreas) Before the Procedure Your may have the following tests done before surgery: Blood tests (complete blood count, electrolytes, liver and kidney tests) Chest x-ray or electrocardiogram (EKG), for some patients Several x-rays of the gallbladder Ultrasound of the gallbladder Tell your doctor or nurse: If you are or might be pregnant Which drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription During the week before surgery: You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that put you at a higher risk of bleeding during surgery. Ask your doctor which drugs you should still take on the day of your surgery. Prepare your home for any problems you might have getting around after the surgery. You'll be told when to arrive at the hospital. On the day of surgery: Follow instructions about when to stop eating and drinking. Take the drugs your doctor told you to take with a small sip of water. Shower the night before or the morning of your surgery. Arrive at the hospital on time. After the Procedure You may need to stay in the hospital for 3 to 5 days after open gallbladder removal. During that time: You may be asked to breathe into a device called an incentive spirometer. This helps keep your lungs working well so that you do not get pneumonia. The nurse will help you sit up in bed, hang your legs over the side, and then stand up and start to walk. At first, you will receive fluids into your vein through an intravenous (IV) tube. Soon after, you will be asked to start drinking liquids and eating foods. You will be able to shower while you are still in the hospital. You may be asked to wear pressure stockings on your legs to help prevent a blood clot from forming. If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer. Your doctor or nurses will tell you how to care for yourself after you leave the hospital. Outlook (Prognosis) Most people recover quickly and have good results from this procedure. Review Date 9/9/2017 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Anal Fissure I may have a couple anal fissures and looking to speak with someone to get some information and support.
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Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. ... Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. ... Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. ... If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.
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Anal fissure Overview An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Symptoms Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Causes Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Risk factors Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Treatment Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Lifestyle and home remedies Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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Anal Fissure I may have a couple anal fissures and looking to speak with someone to get some information and support.
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Anal fissure: An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). ... Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. ... - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.
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Anal fissure Overview An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Symptoms Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Causes Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Risk factors Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Treatment Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Lifestyle and home remedies Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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congenital diaphragmatic hernia I need to know if CDH can be passed down to future generations. I just learned that this condition most likely caused the death of my first child back in 1971. I was then told it was merely a fluke. I had NO trauma during the full-term pregnancy, and I and my then husband were in very good health. Now my son (from a different husband) and his wife are due to have fraternal twins in 2015. Does the term 'congenital' mean that it could be passed down to another generation? I do not want to alarm my son and his wife. I just would like to inform whatever pediatrician is caring for these babies as to my experience. Unfortunately my son and I are estranged. And I do not know who is their pediatrician. My child's CDH was very severe. I know there are far less severe cases that can go undetected &/or undiagnosed unless there is a reason to suspect such a condition. Please respond to my concerns.
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Isolated congenital diaphragmatic hernia is rarely inherited. In almost all cases, there is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature of a genetic syndrome or chromosomal abnormality, it may cluster in families according to the inheritance pattern for that condition.
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Congenital diaphragmatic hernia congenital diaphragmatic defect Description Congenital diaphragmatic hernia is a defect in the diaphragm. The diaphragm, which is composed of muscle and other fibrous tissue, separates the organs in the abdomen from those in the chest. Abnormal development of the diaphragm before birth leads to defects ranging from a thinned area in the diaphragm to its complete absence. An absent or partially formed diaphragm results in an abnormal opening (hernia) that allows the stomach and intestines to move into the chest cavity and crowd the heart and lungs. This crowding can lead to underdevelopment of the lungs (pulmonary hypoplasia), potentially resulting in life-threatening breathing difficulties that are apparent from birth. In 5 to 10 percent of affected individuals, signs and symptoms of congenital diaphragmatic hernia appear later in life and may include breathing problems or abdominal pain from protrusion of the intestine into the chest cavity. In about 1 percent of cases, congenital diaphragmatic hernia has no symptoms; it may be detected incidentally when medical imaging is done for other reasons. Congenital diaphragmatic hernias are often classified by their position. A Bochdalek hernia is a defect in the side or back of the diaphragm. Between 80 and 90 percent of congenital diaphragmatic hernias are of this type. A Morgnani hernia is a defect involving the front part of the diaphragm. This type of congenital diaphragmatic hernia, which accounts for approximately 2 percent of cases, is less likely to cause severe symptoms at birth. Other types of congenital diaphragmatic hernia, such as those affecting the central region of the diaphragm, or those in which the diaphragm muscle is absent with only a thin membrane in its place, are rare. Frequency Congenital diaphragmatic hernia affects approximately 1 in 2,500 newborns. Causes Congenital diaphragmatic hernia has many different causes. In 10 to 15 percent of affected individuals, the condition appears as a feature of a disorder that affects many body systems, called a syndrome. Donnai-Barrow syndrome, Fryns syndrome, and Pallister-Killian mosaic syndrome are among several syndromes in which congenital diaphragmatic hernia may occur. Some of these syndromes are caused by changes in single genes, and others are caused by chromosomal abnormalities that affect several genes. About 25 percent of individuals with congenital diaphragmatic hernia that is not associated with a known syndrome also have abnormalities of one or more major body systems. Affected body systems can include the heart, brain, skeleton, intestines, genitals, kidneys, or eyes. In these individuals, the multiple abnormalities likely result from a common underlying disruption in development that affects more than one area of the body, but the specific mechanism responsible for this disruption is not clear. Approximately 50 to 60 percent of congenital diaphragmatic hernia cases are isolated, which means that affected individuals have no other major malformations. More than 80 percent of individuals with congenital diaphragmatic hernia have no known genetic syndrome or chromosomal abnormality. In these cases, the cause of the condition is unknown. Researchers are studying changes in several genes involved in the development of the diaphragm as possible causes of congenital diaphragmatic hernia. Some of these genes are transcription factors, which provide instructions for making proteins that help control the activity of particular genes (gene expression). Others provide instructions for making proteins involved in cell structure or the movement (migration) of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of congenital diaphragmatic hernia, but these environmental factors have not been identified. Inheritance Pattern Isolated congenital diaphragmatic hernia is rarely inherited. In almost all cases, there is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature of a genetic syndrome or chromosomal abnormality, it may cluster in families according to the inheritance pattern for that condition. Sources for This Page Bielinska M, Jay PY, Erlich JM, Mannisto S, Urban Z, Heikinheimo M, Wilson DB. Molecular genetics of congenital diaphragmatic defects. Ann Med. 2007;39(4):261-74. Review.
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I have an hernia I would love to take care off it ASAP I was wondering if you guys could help me . Thanks
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The goals of treatment are to relieve symptoms and prevent complications. Treatments may include: - Medicines to control stomach acid - Surgery to repair the hiatal hernia and prevent reflux Other measures to reduce symptoms include: - Avoiding large or heavy meals - Not lying down or bending over right after a meal - Reducing weight and not smoking - Raising the head of the bed 4 to 6 inches (10 to 15 centimeters) If medicines and lifestyle measures do not help control symptoms, you may need surgery.
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Hiatal hernia Hernia - hiatal Summary Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the sheet of muscle that divides the chest from the abdomen. Causes The exact cause of hiatal hernia is unknown. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking. Hiatal hernias are very common. The problem occurs often in people over 50 years. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus. Children with this condition are most often born with it (congenital). It often occurs with gastroesophageal reflux in infants. Symptoms Symptoms may include: Chest pain Heartburn, worse when bending over or lying down Swallowing difficulty A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air, or bile. Exams and Tests Tests that may be used include: Barium swallow x-ray Esophagogastroduodenoscopy (EGD) Treatment The goals of treatment are to relieve symptoms and prevent complications. Treatments may include: Medicines to control stomach acid Surgery to repair the hiatal hernia and prevent reflux Other measures to reduce symptoms include: Avoiding large or heavy meals Not lying down or bending over right after a meal Reducing weight and not smoking Raising the head of the bed 4 to 6 inches (10 to 15 centimeters) If medicines and lifestyle measures do not help control symptoms, you may need surgery. Outlook (Prognosis) Treatment can relieve most symptoms of hiatal hernia. Possible Complications Complications may include: Pulmonary (lung) aspiration Slow bleeding and iron deficiency anemia (due to a large hernia) Strangulation (closing off) of the hernia When to Contact a Medical Professional Call your health care provider if: You have symptoms of a hiatal hernia. You have a hiatal hernia and your symptoms get worse or do not improve with treatment. You develop new symptoms. Prevention Controlling risk factors such as obesity may help prevent hiatal hernia. Review Date 4/24/2017 Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have an hernia I would love to take care off it ASAP I was wondering if you guys could help me . Thanks
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Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for people with serious medical problems. Surgery repairs the weakened abdominal wall tissue (fascia) and closes any holes. Most hernias are closed with stitches and sometimes with mesh patches to plug the hole.
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Hernia Hernia - inguinal Inguinal hernia Direct and indirect hernia Rupture Strangulation Incarceration Summary A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia. Which type of hernia you have depends on where it is: Femoral hernia is a bulge in the upper thigh, just below the groin. This type is more common in women than men. Hiatal hernia occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest. Incisional hernia can occur through a scar if you have had abdominal surgery in the past. Umbilical hernia is a bulge around the belly button. It occurs when the muscle around the belly button does not close completely after birth. Inguinal hernia is a bulge in the groin. It is more common in men. It may go all the way down into the scrotum. Causes Usually, there is no clear cause of a hernia. Sometimes, hernias can occur due to: Heavy lifting Straining while using the toilet Any activity that raises the pressure inside the belly Hernias may be present at birth, but the bulge may not be evident until later in life. Some people have a family history of hernias. Babies and children can get hernias. It happens when there is weakness in the belly wall. Inguinal hernias are common in boys. Some children do not have symptoms until they are adults. Any activity or medical problem that increases pressure on the tissue in the belly wall and muscles may lead to a hernia, including: Long-term (chronic) constipation and pushing hard (straining) to have a bowel movement Chronic coughing or sneezing Cystic fibrosis Enlarged prostate, straining to urinate Extra weight Fluid in the abdomen (ascites) Peritoneal dialysis Poor nutrition Smoking Overexertion Undescended testicles Symptoms There are usually no symptoms. Some people have discomfort or pain. The discomfort may be worse when standing, straining, or lifting heavy objects. In time, the most common complaint is a bump that is sore and growing. When a hernia gets bigger, it may get stuck inside the hole and lose its blood supply. This is called strangulation. This causes pain and swelling at the site of strangulation. Symptoms may include: Nausea and vomiting Not being able to pass gas or have bowel movements When this occurs, surgery is needed right away. Exams and Tests The health care provider can usually see or feel a hernia when you are examined. You may be asked to cough, bend, push, or lift. The hernia may get bigger when you do this. The hernia (bulge) may not be easily seen in infants and children, except when the child is crying or coughing. Ultrasound or CT scan may be done to look for a hernia. If there is a blockage in the bowel, an x-ray of the abdomen will likely be done. Treatment Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for people with serious medical problems. Surgery repairs the weakened abdominal wall tissue (fascia) and closes any holes. Most hernias are closed with stitches and sometimes with mesh patches to plug the hole. An umbilical hernia that does not heal on its own by the time a child is 5 years old will likely be repaired. Outlook (Prognosis) The outcome for most hernias is usually good with treatment. It is rare for a hernia to come back. Incisional hernias are more likely to return. Possible Complications In rare cases, inguinal hernia repair can damage structures involved in the function of a man's testicles. Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area. If a part of the bowel was trapped or strangulated before surgery, bowel perforation or dead bowel may result. When to Contact a Medical Professional Call your provider right away if you have: A painful hernia and the contents cannot be pushed back into the abdomen using gentle pressure Nausea, vomiting, or a fever along with a painful hernia A hernia that becomes red, purple, dark, or discolored Call your provider if you have: Groin pain, swelling, or a bulge. A bulge or swelling in the groin or belly button, or that is associated with a previous surgical cut. Prevention To prevent a hernia: Use proper lifting techniques. Lose weight if you are overweight. Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly. Men should see their provider if they strain with urination. This may be a symptom of an enlarged prostate. Review Date 9/3/2018 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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For adults, surgery is typically recommended to avoid possible complications - especially if the umbilical hernia gets bigger or becomes painful.
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Umbilical hernia Symptoms An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus). If your baby has an umbilical hernia, you may notice the bulge only when he or she cries, coughs or strains. The bulge may disappear when your baby is calm or lies on his or her back. Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort. When to see a doctor If you suspect that your baby has an umbilical hernia, talk with your child's pediatrician. Seek emergency care if your baby has an umbilical hernia and: - Your baby appears to be in pain - Your baby begins to vomit - The bulge becomes tender, swollen or discolored Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications. Causes During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life. In adults, too much abdominal pressure can cause an umbilical hernia. Possible causes in adults include: - Obesity - Multiple pregnancies - Fluid in the abdominal cavity (ascites) - Previous abdominal surgery - Chronic peritoneal dialysis Risk factors Umbilical hernias are most common in infants - especially premature babies and those with low birth weights. Black infants appear to have a slightly increased risk of umbilical hernias. The condition affects boys and girls equally. For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia tends to be more common in women. Diagnosis An umbilical hernia is diagnosed during a physical exam. Sometimes imaging studies - such as an abdominal ultrasound or CT scan - are used to screen for complications. Treatment Most umbilical hernias in babies close on their own by age 1 or 2. Your doctor may even be able to push the bulge back into the abdomen during a physical exam. Don't try this on your own, however. Although some people claim a hernia can be fixed by taping a coin down over the bulge, this "fix" doesn't help and germs may accumulate under the tape, causing infection. For children, surgery is typically reserved for umbilical hernias that: - Are painful - Are bigger than 1.5 centimeters in diameter (slightly larger than a 1/2 inch) - Are large and don't decrease in size over the first two years - Don't disappear by age 4 - Become trapped or block the intestines For adults, surgery is typically recommended to avoid possible complications - especially if the umbilical hernia gets bigger or becomes painful. During surgery, a small incision is made at the base of the bellybutton. The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. In adults, surgeons often use mesh to help strengthen the abdominal wall.
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A diaphragmatic hernia repair is an emergency that requires surgery. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm.
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Diaphragmatic hernia Hernia - diaphragmatic Congenital hernia of the diaphragm (CDH) Summary A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm. The diaphragm is the muscle between the chest and abdomen that helps you breathe. The opening allows part of the organs from the belly to move into the chest cavity near the lungs. Causes A diaphragmatic hernia is a rare defect. It occurs while the baby is developing in the womb. Because the diaphragm is not fully developed, organs, such as the stomach, small intestine, spleen, part of the liver, and the kidney, may take up part of the chest cavity. CDH most often involves only one side of the diaphragm. It is more common on the left side. Often, the lung tissue and blood vessels in the area do not develop normally either. It is not clear if the diaphragmatic hernia causes the underdeveloped lung tissue and blood vessels, or the other way around. 40% of babies with this condition have other problems as well. Having a parent or sibling with the condition increases the risk. Symptoms Severe breathing problems almost always develop shortly after the baby is born. This is due in part to poor movement of the diaphragm muscle and crowding of the lung tissue. Problems with breathing and oxygen levels are often due to underdeveloped lung tissue and blood vessels as well. Other symptoms include: Bluish colored skin due to lack of oxygen Rapid breathing (tachypnea) Fast heart rate (tachycardia) Exams and Tests Fetal ultrasound may show abdominal organs in the chest cavity. The pregnant woman may have a large amount of amniotic fluid. An exam of the infant shows: Irregular chest movements Lack of breath sounds on side with the hernia Bowel sounds that are heard in the chest Abdomen that looks less protuberant than a normal newborn's and feels less full when touched A chest x-ray may show abdominal organs in the chest cavity. Treatment A diaphragmatic hernia repair is an emergency that requires surgery. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm. The infant will need breathing support during the recovery period. Some infants are placed on a heart/lung bypass machine to help deliver enough oxygen to the body. If a diaphragmatic hernia is diagnosed early during pregnancy (before 24 to 28 weeks), fetal surgery may be an option in some situations. Outlook (Prognosis) The outcome of surgery depends on how well the baby's lungs have developed. It also depends on whether there are any other congenital problems. Most often the outlook is good for infants who have a sufficient amount of working lung tissue and have no other problems. Medical advances have made it possible for over half of infants with this condition to survive. The babies survived will often have ongoing challenges with breathing, feeding, and growth. Possible Complications Complications may include: Lung infections Other congenital problems When to Contact a Medical Professional Go to the emergency room or call the local emergency number (such as 911). A diaphragmatic hernia is a surgical emergency. Prevention There is no known prevention. Couples with a family history of this problem may want to seek genetic counseling. Review Date 5/14/2017 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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If your hernia is small and isn't bothering you, your doctor might recommend watchful waiting. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.
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Inguinal hernia Overview An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object. An inguinal hernia isn't necessarily dangerous. It doesn't improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that's painful or enlarging. Inguinal hernia repair is a common surgical procedure. Symptoms Inguinal hernia signs and symptoms include: - A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain - A burning or aching sensation at the bulge - Pain or discomfort in your groin, especially when bending over, coughing or lifting - A heavy or dragging sensation in your groin - Weakness or pressure in your groin - Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum You should be able to gently push the hernia back into your abdomen when you're lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help. Incarcerated hernia If you aren't able to push the hernia in, the contents of the hernia can be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated. Signs and symptoms of a strangulated hernia include: - Nausea, vomiting or both - Fever - Sudden pain that quickly intensifies - A hernia bulge that turns red, purple or dark - Inability to move your bowels or pass gas If any of these signs or symptoms occurs, call your doctor right away. Signs and symptoms in children Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining during a bowel movement. He or she might be irritable and have less appetite than usual. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period. When to see a doctor See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area. Seek immediate medical care if a hernia bulge turns red, purple or dark. Causes Some inguinal hernias have no apparent cause. Others might occur as a result of: - Increased pressure within the abdomen - A pre-existing weak spot in the abdominal wall - A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall - Straining during bowel movements or urination - Strenuous activity - Pregnancy - Chronic coughing or sneezing In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking. Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery. In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone. Risk factors Factors that contribute to developing an inguinal hernia include: - Being male. Men are eight times more likely to develop an inguinal hernia than are women. - Being older. Muscles weaken as you age. - Being white. - Family history. You have a close relative, such as a parent or sibling, who has the condition. - Chronic cough, such as from smoking. - Chronic constipation. Constipation causes straining during bowel movements. - Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen. - Premature birth and low birth weight. - Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you're at higher risk of developing another inguinal hernia. Complications Complications of an inguinal hernia include: - Pressure on surrounding tissues. Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling. - Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas. - Strangulation. An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery. Diagnosis A physical exam is usually all that's needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you'll likely be asked to stand and cough or strain. If the diagnosis isn't readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI. Treatment If your hernia is small and isn't bothering you, your doctor might recommend watchful waiting. In children, the doctor might try applying manual pressure to reduce the bulge before considering surgery. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications. There are two general types of hernia operations - open hernia repair and laparoscopic repair. Open hernia repair In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue. After the surgery, you'll be encouraged to move about as soon as possible, but it might be several weeks before you're able to resume normal activities. Laparoscopy In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh. People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. However, some studies indicate that hernia recurrence is more likely with laparoscopic repair than with open surgery. Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral). Some studies indicate that a laparoscopic repair can increase the risk of complications and of recurrence. Having the procedure performed by a surgeon with extensive experience in laparoscopic hernia repairs can reduce the risks.
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Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. ... Treatments may include: - Medicines to control stomach acid - Surgery to repair the hiatal hernia and prevent reflux Other measures to reduce symptoms include: - Avoiding large or heavy meals - Not lying down or bending over right after a meal - Reducing weight and not smoking - Raising the head of the bed 4 to 6 inches (10 to 15 centimeters) If medicines and lifestyle measures do not help control symptoms, you may need surgery.
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Hiatal hernia Hernia - hiatal Summary Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the sheet of muscle that divides the chest from the abdomen. Causes The exact cause of hiatal hernia is unknown. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking. Hiatal hernias are very common. The problem occurs often in people over 50 years. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus. Children with this condition are most often born with it (congenital). It often occurs with gastroesophageal reflux in infants. Symptoms Symptoms may include: Chest pain Heartburn, worse when bending over or lying down Swallowing difficulty A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air, or bile. Exams and Tests Tests that may be used include: Barium swallow x-ray Esophagogastroduodenoscopy (EGD) Treatment The goals of treatment are to relieve symptoms and prevent complications. Treatments may include: Medicines to control stomach acid Surgery to repair the hiatal hernia and prevent reflux Other measures to reduce symptoms include: Avoiding large or heavy meals Not lying down or bending over right after a meal Reducing weight and not smoking Raising the head of the bed 4 to 6 inches (10 to 15 centimeters) If medicines and lifestyle measures do not help control symptoms, you may need surgery. Outlook (Prognosis) Treatment can relieve most symptoms of hiatal hernia. Possible Complications Complications may include: Pulmonary (lung) aspiration Slow bleeding and iron deficiency anemia (due to a large hernia) Strangulation (closing off) of the hernia When to Contact a Medical Professional Call your health care provider if: You have symptoms of a hiatal hernia. You have a hiatal hernia and your symptoms get worse or do not improve with treatment. You develop new symptoms. Prevention Controlling risk factors such as obesity may help prevent hiatal hernia. Review Date 4/24/2017 Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have a fractured nose i need it fixed. its been broke for 3 years now
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Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary for a broken nose. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries. If you have a minor fracture that hasn't caused your nose to become crooked or otherwise misshapen, you may not need professional medical treatment.
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Broken nose Overview A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose - often the bone over the bridge of your nose. Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in facial trauma. A broken nose can cause pain, along with swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing. Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary for a broken nose. Symptoms Signs and symptoms of a broken nose: - Pain or tenderness, especially when touching your nose - Swelling of your nose and surrounding areas - Bleeding from your nose - Bruising around your nose or eyes - Crooked or misshapen nose - Difficulty breathing through your nose - Discharge of mucus from your nose - Feeling that one or both of your nasal passages are blocked When to see a doctor Seek emergency medical attention if you experience a nose injury accompanied by: - A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness - Difficulty breathing - Bleeding you can't stop - A noticeable change in the shape of your nose that isn't related to swelling, such as a crooked or twisted appearance - Clear, watery fluid draining from your nose Causes Common causes of a broken nose include: - Injury from contact sports, such as football or hockey - Physical altercations - Motor vehicle accidents - Falls A broken nose can even be caused by walking into a fixed object, such as a door or wall, or by rough, wrestling-type play. Risk factors Any activity that increases your risk of a facial injury increases your risk of a broken nose. Such activities may include: - Playing contact sports, such as football and hockey, especially without a helmet that has a face mask - Engaging in a physical fight - Riding a bicycle - Lifting weights, especially if you don't use a spotter - Riding in a motor vehicle, especially without a seat belt Complications Complications or injuries related to a broken nose may include: - Deviated septum. A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum, but surgery is required to correct the condition. - Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. Septal hematoma requires prompt surgical drainage to prevent cartilage damage. - Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries. - Neck injury. Likewise, nose fractures resulting from high-velocity injuries - like those experienced in motor vehicle accidents - may be accompanied by injuries to your neck. If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck. If you suspect a neck injury, see your doctor immediately. Diagnosis Your doctor may press gently on the outside of your nose and its surrounding areas. He or she may look inside your nasal passage to check for obstruction and further signs of broken bones. Your doctor may use anesthetics - either a nasal spray or local injections - to make you more comfortable during the exam. X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries. Treatment If you have a minor fracture that hasn't caused your nose to become crooked or otherwise misshapen, you may not need professional medical treatment. Your doctor may recommend simple self-care measures, such as using ice on the area and taking over-the-counter pain medications. Fixing displacements and breaks Your doctor may be able to realign your nose manually, or you may need surgery. Manual realignment If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them. This needs to be done within 14 days from when the fracture occurred, preferably sooner. During this procedure, your doctor: - Administers medication by injection or nasal spray to ease discomfort - Opens your nostrils with a nasal speculum - Uses special instruments to help realign your broken bones and cartilage Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You'll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose. Surgery Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for manual realignment. In these cases, surgery to realign the bones and reshape your nose may be necessary. If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis. Lifestyle and home remedies If you think you may have broken your nose, take these steps to reduce pain and swelling before seeing your doctor: - Act quickly. When the break first occurs, breathe through your mouth and lean forward to reduce the amount of blood that drains into your throat. - Use ice. Apply ice packs or cold compresses immediately after the injury, and then at least four times a day for the first 24 to 48 hours to reduce swelling. Keep the ice or cold compress on for 10 to 15 minutes at a time. Wrap the ice in a washcloth to prevent frostbite. Try not to apply too much pressure, which can cause additional pain or damage to your nose. - Relieve pain. Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as necessary. - Keep your head up. Elevate your head - especially when sleeping - so as not to worsen swelling and throbbing. - Limit your activities. For the first two weeks after treatment, don't play any sports. Avoid contact sports for at least six weeks after your injury.
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I have a fractured nose i need it fixed. its been broke for 3 years now
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Rhinoplasty is one of the most common plastic surgery procedures. It can be used to: - Reduce or increase the size of the nose - Change the shape of the tip or the nasal bridge - Narrow the opening of the nostrils - Change the angle between the nose and the upper lip - Correct a birth defect or injury -
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Rhinoplasty Cosmetic nose surgery Nose job - rhinoplasty Summary Rhinoplasty is surgery to repair or reshape the nose. Description Rhinoplasty can be performed under local or general anesthesia, depending on the exact procedure and the person's preference. It is performed in a surgeon's office, a hospital, or an outpatient surgery center. Complex procedures may require a short hospital stay. The procedure often takes 1 to 2 hours. It may take longer. With local anesthesia, the nose and the area around it are numbed. You will probably be lightly sedated, but awake during the surgery (relaxed and not feeling pain). General anesthesia allows you to sleep through the operation. The surgery is usually done through a cut (incision) made inside the nostrils. In some cases, the cut is made from outside, around the base of the nose. This type of cut is used to perform work on the tip of the nose or if you need a cartilage graft. If the nose needs to be narrowed, the incision may extend around the nostrils. Small incisions may be made on the side of the nose to break, and reshape the bone. A splint (metal or plastic) may be placed on the outside of the nose. This helps maintain the new shape of the bone when the surgery is finished. Soft plastic splints or nasal packs also may be placed in the nostrils. This helps keep the dividing wall between the air passages (septum) stable. Why the Procedure is Performed Rhinoplasty is one of the most common plastic surgery procedures. It can be used to: Reduce or increase the size of the nose Change the shape of the tip or the nasal bridge Narrow the opening of the nostrils Change the angle between the nose and the upper lip Correct a birth defect or injury Help relieve some breathing problems Nose surgery is considered elective when it is done for cosmetic reasons. In these cases, the purpose is to change the shape of the nose to one that the person finds more desirable. Many surgeons prefer to perform cosmetic nose surgery after the nasal bone has finished growing. This is around age 14 or 15 for girls and a bit later for boys. Risks Risks for anesthesia and surgery in general are: Reactions to medicines, problems breathing Bleeding, infection, or bruising Risks for this procedure include: Loss of support of the nose Contour deformities of the nose Need for further surgery After surgery, tiny blood vessels that have burst may appear as tiny red spots on the skin surface. These are usually minor, but are permanent. There are no visible scars if the rhinoplasty is performed from inside the nose. If the procedure narrows flared nostrils, there may be small scars at the base of the nose that are not often visible. In rare cases, a second procedure is needed to fix a minor deformity. Before the Procedure Your surgeon may give you instructions to follow before your surgery. You may need to: Stop any medicines that thin your blood. Your surgeon will give you a list of these medicines. See your regular health care provider to have some routine tests and make sure it is safe for you to have surgery. To aid with healing, stop smoking 2 to 3 weeks before and after surgery. Arrange to have someone drive you home after surgery. After the Procedure You will usually go home on the same day as your surgery. Right after surgery, your nose and face will be swollen and painful. Headaches are common. The nasal packing is usually removed in 3 to 5 days, after which you will feel more comfortable. The splint may be left in place for 1 to 2 weeks. Outlook (Prognosis) Full recovery takes several weeks. Healing is a slow and gradual process. The tip of the nose may have some swelling and numbness for months. You may not be able to see the final results for up to a year. Review Date 1/10/2017 Updated by: David A. Lickstein, MD, FACS, specializing in cosmetic and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have a fractured nose i need it fixed. its been broke for 3 years now
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Sometimes, surgery may be needed to correct a nose or septum that has been bent out of shape by an injury.
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Nose fracture Fracture of the nose Broken nose Nasal fracture Nasal bone fracture Nasal septal fracture Summary A nose fracture is a break in the bone or cartilage over the bridge, or in the sidewall or septum (structure that divides the nostrils) of the nose. Considerations A fractured nose is the most common fracture of the face. It most often occurs after an injury and often occurs with other fractures of the face. Nose injuries and neck injuries are often seen together. A blow that is forceful enough to injure the nose may be hard enough to injure the neck. Serious nose injuries cause problems that need a health care provider's attention right away. For example, damage to the cartilage can cause a collection of blood to form inside the nose. If this blood is not drained right away, it can cause an abscess or a permanent deformity that blocks the nose. It may lead to tissue death and cause the nose to collapse. For minor nose injuries, the provider may want to see the person within the first week after the injury to see if the nose has moved out of its normal shape. Sometimes, surgery may be needed to correct a nose or septum that has been bent out of shape by an injury. Symptoms Symptoms may include: Blood coming from the nose Bruising around the eyes Difficulty breathing through the nose Misshapen appearance (may not be obvious until the swelling goes down) Pain Swelling The bruised appearance most often disappears after 2 weeks. First Aid If a nose injury happens: Try to stay calm. Breathe through your mouth and lean forward in a sitting position to keep blood from going down the back of your throat. Squeeze the nostrils closed and hold pressure to stop the bleeding. Apply cold compresses to your nose to reduce swelling. If possible, hold the compress so that there isn't too much pressure on the nose. To help relieve pain, try acetaminophen (Tylenol). DO NOT DO NOT try to straighten a broken nose DO NOT move the person if there is reason to suspect a head or neck injury When to Contact a Medical Professional Get medical help right away if: Bleeding will not stop Clear fluid keeps draining from the nose You suspect a blood clot in the septum You suspect a neck or head injury The nose looks deformed or out of its usual shape The person is having difficulty breathing Prevention Wear protective headgear while playing contact sports, or riding bicycles, skateboards, roller skates, or rollerblades. Use seat belts and appropriate car seats when driving. Review Date 8/17/2016 Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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I have been battling Anal fissure for close to two years now and it has refused to heal all these while. Please what do you suggest i do? Thanks
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If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.
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Anal fissure Overview An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Symptoms Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Causes Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Risk factors Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Treatment Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Lifestyle and home remedies Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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I have been battling Anal fissure for close to two years now and it has refused to heal all these while. Please what do you suggest i do? Thanks
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If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.
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Anal fissure Overview An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Symptoms Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Causes Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Risk factors Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Treatment Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Lifestyle and home remedies Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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I have no help its about 4 years now I have ingrown toenail i have a problem of ingrown toenail its about 4 years now I have this problem i need help
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Call your provider if you notice: - Your toenail is not healing -
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Ingrown toenail removal – discharge Onychocryptosis surgery Onychomycosis Unguis incarnates surgery Ingrown toenail removal Toenail Summary You had surgery to remove part or all of your toenail. This was done to relieve pain and discomfort due to an ingrown toenail. Ingrown toenails can occurs when the edge of your toenail grows into the skin of the toe. When You're in the Hospital The health care provider will most often numb your toe with a local anesthesia before the procedure starts. The provider will cut the part of the nail that has grown into the skin of the toe. Either part of the nail or the entire nail will have been removed. The surgery took an hour or less and your provider has covered the wound with a bandage. You can go home the same day. What to Expect at Home You may feel pain once the pain-numbing medicine wears off. Take the pain reliever your provider recommends. You may notice: Some swelling in your foot Light bleeding A yellow-colored discharge from the wound At home you should: Keep your feet raised above the level of your heart to reduce swelling Rest your foot and avoid moving it Keep your wound clean and dry Dressing Change the dressing about 12 to 24 hours after the surgery. Follow your provider's instructions for changing the dressing. Your provider may recommend soaking your foot in warm water before removing the dressing. This helps the bandage not stick to the wound. Change the dressing once or twice a day or as suggested by your provider. Foot Bath Soak your feet 2 to 3 times a day in the bath containing: Epsom salts - to relieve swelling and inflammation Betadine - an antibiotic to help reduce the risk of infection Dry your feet and apply antibiotic ointment your provider has given you. Dress the wound to keep it clean. Activity Try to reduce activity and rest your foot. Avoid bumping your toe or putting a lot of pressure on it. You may want to wear open-toed shoes. If wearing closed shoes, make sure they are not too tight. Wear cotton socks. You may need to do this for about 2 weeks. You can likely resume your normal activities within a week. Getting back to sports may take a little longer. Keep your wound covered both day and night in the first week. You can let your toe remain uncovered at night in the second week. This helps the wound heal. See your provider again in 2 to 3 days or as recommended. Prevention The toenail may grow inward again. To prevent this, follow these tips: Don't wear tight-fitting shoes or high heels Don't trim your nails too short or round the corners Don't pick or tear at the corners of the nails When to Call the Doctor Call your provider if you notice: Your toenail is not healing Fever Pain, even after taking pain-relief medicine Bleeding from the toenail Pus from the toenail Swelling or redness of the toe or foot Regrowth of the nail into the skin of the toe Review Date 12/10/2016 Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have no help its about 4 years now I have ingrown toenail i have a problem of ingrown toenail its about 4 years now I have this problem i need help
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Ingrown toenail removal ? discharge (Summary): You had surgery to remove part or all of your toenail. This was done to relieve pain and discomfort due to an ingrown toenail.
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Ingrown toenail removal – discharge Onychocryptosis surgery Onychomycosis Unguis incarnates surgery Ingrown toenail removal Toenail Summary You had surgery to remove part or all of your toenail. This was done to relieve pain and discomfort due to an ingrown toenail. Ingrown toenails can occurs when the edge of your toenail grows into the skin of the toe. When You're in the Hospital The health care provider will most often numb your toe with a local anesthesia before the procedure starts. The provider will cut the part of the nail that has grown into the skin of the toe. Either part of the nail or the entire nail will have been removed. The surgery took an hour or less and your provider has covered the wound with a bandage. You can go home the same day. What to Expect at Home You may feel pain once the pain-numbing medicine wears off. Take the pain reliever your provider recommends. You may notice: Some swelling in your foot Light bleeding A yellow-colored discharge from the wound At home you should: Keep your feet raised above the level of your heart to reduce swelling Rest your foot and avoid moving it Keep your wound clean and dry Dressing Change the dressing about 12 to 24 hours after the surgery. Follow your provider's instructions for changing the dressing. Your provider may recommend soaking your foot in warm water before removing the dressing. This helps the bandage not stick to the wound. Change the dressing once or twice a day or as suggested by your provider. Foot Bath Soak your feet 2 to 3 times a day in the bath containing: Epsom salts - to relieve swelling and inflammation Betadine - an antibiotic to help reduce the risk of infection Dry your feet and apply antibiotic ointment your provider has given you. Dress the wound to keep it clean. Activity Try to reduce activity and rest your foot. Avoid bumping your toe or putting a lot of pressure on it. You may want to wear open-toed shoes. If wearing closed shoes, make sure they are not too tight. Wear cotton socks. You may need to do this for about 2 weeks. You can likely resume your normal activities within a week. Getting back to sports may take a little longer. Keep your wound covered both day and night in the first week. You can let your toe remain uncovered at night in the second week. This helps the wound heal. See your provider again in 2 to 3 days or as recommended. Prevention The toenail may grow inward again. To prevent this, follow these tips: Don't wear tight-fitting shoes or high heels Don't trim your nails too short or round the corners Don't pick or tear at the corners of the nails When to Call the Doctor Call your provider if you notice: Your toenail is not healing Fever Pain, even after taking pain-relief medicine Bleeding from the toenail Pus from the toenail Swelling or redness of the toe or foot Regrowth of the nail into the skin of the toe Review Date 12/10/2016 Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have no help its about 4 years now I have ingrown toenail i have a problem of ingrown toenail its about 4 years now I have this problem i need help
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If you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see a provider right away. Don't try to treat an ingrown nail at home. Otherwise, to treat an ingrown nail at home: - Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry. - Gently massage over the inflamed skin. - Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic. When trimming your toenails: - Briefly soak your foot in warm water to soften the nails. - Use a clean, sharp trimmer. - Trim toenails straight across the top. Do not taper or round the corners or trim too short. - Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse. Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem. If this doesn't work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist). If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail: - Numbing medicine is first injected into the toe. - The ingrown part of the nail is removed. This procedure is called a partial nail avulsion. - It takes 2 to 4 months for the nail to regrow. If the toe is infected, your doctor may prescribe antibiotics. After the procedure, follow any instructions for helping your nail heal.
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Ingrown toenail Onychocryptosis Unguis incarnates Surgical nail avulsion Matrix excision Ingrown toenail removal Summary An ingrown toenail occurs when the edge of the nail grows into the skin of the toe. Causes An ingrown toenail can result from a number of things. Poorly fitting shoes and toenails that are not properly trimmed are the most common causes. The skin along the edge of a toenail may become red and infected. The great toe is affected most often, but any toenail can become ingrown. An ingrown toenail may occur when extra pressure is placed on your toe. This pressure is caused by shoes that are too tight or fit poorly. If you walk often or play sports, a shoe that is even a little tight can cause this problem. Deformities of the foot or toes can also place extra pressure on the toe. Nails that are not trimmed properly can also cause ingrown toenails: Toenails that are trimmed too short, or if the edges are rounded rather than cut straight across may cause the nail to curl and grow into the skin. Poor eyesight, inability to reach the toes easily, or having thick nails can make it hard to properly trim nails. Picking or tearing at the corners of the nails can also cause an ingrown toenail. Some people are born with nails that are curved and grow into the skin. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail. Symptoms There may be pain, redness and swelling around the nail. Exams and Tests Your health care provider will examine your toenail and ask about your symptoms. Tests or x-rays aren't usually needed. Treatment If you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see a provider right away. Don't try to treat an ingrown nail at home. Otherwise, to treat an ingrown nail at home: Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry. Gently massage over the inflamed skin. Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic. When trimming your toenails: Briefly soak your foot in warm water to soften the nails. Use a clean, sharp trimmer. Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse. Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem. If this doesn't work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist). If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail: Numbing medicine is first injected into the toe. The ingrown part of the nail is removed. This procedure is called a partial nail avulsion. It takes 2 to 4 months for the nail to regrow. If the toe is infected, your doctor may prescribe antibiotics. After the procedure, follow any instructions for helping your nail heal. Outlook (Prognosis) Treatment usually controls the infection and relieves pain. The condition is likely to return if you don't practice good foot care. This condition may become serious in people with diabetes, poor blood circulation, and nerve problems. Possible Complications In severe cases, the infection can spread through the toe and into the bone. When to Contact a Medical Professional Call your provider if you: Are not able to treat an ingrown toenail at home Have severe pain, redness, swelling, or fever Have diabetes, nerve damage in the leg or foot, poor circulation to your foot, or an infection around the nail Prevention Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for playing sports should also have plenty of room, but not be too loose. When trimming your toenails: Briefly soak your foot in warm water to soften the nail. Use a clean, sharp nail trimmer. Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not pick or tear at the nails. Keep your feet clean and dry. People with diabetes should have routine foot exams and nail care. Review Date 4/12/2017 Updated by: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, Subspecialty Foot and Ankle, Camden Bone and Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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I have no help its about 4 years now I have ingrown toenail i have a problem of ingrown toenail its about 4 years now I have this problem i need help
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The toenail may grow inward again. To prevent this, follow these tips: - Don't wear tight-fitting shoes or high heels - Don't trim your nails too short or round the corners - Don't pick or tear at the corners of the nails
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Ingrown toenail removal – discharge Onychocryptosis surgery Onychomycosis Unguis incarnates surgery Ingrown toenail removal Toenail Summary You had surgery to remove part or all of your toenail. This was done to relieve pain and discomfort due to an ingrown toenail. Ingrown toenails can occurs when the edge of your toenail grows into the skin of the toe. When You're in the Hospital The health care provider will most often numb your toe with a local anesthesia before the procedure starts. The provider will cut the part of the nail that has grown into the skin of the toe. Either part of the nail or the entire nail will have been removed. The surgery took an hour or less and your provider has covered the wound with a bandage. You can go home the same day. What to Expect at Home You may feel pain once the pain-numbing medicine wears off. Take the pain reliever your provider recommends. You may notice: Some swelling in your foot Light bleeding A yellow-colored discharge from the wound At home you should: Keep your feet raised above the level of your heart to reduce swelling Rest your foot and avoid moving it Keep your wound clean and dry Dressing Change the dressing about 12 to 24 hours after the surgery. Follow your provider's instructions for changing the dressing. Your provider may recommend soaking your foot in warm water before removing the dressing. This helps the bandage not stick to the wound. Change the dressing once or twice a day or as suggested by your provider. Foot Bath Soak your feet 2 to 3 times a day in the bath containing: Epsom salts - to relieve swelling and inflammation Betadine - an antibiotic to help reduce the risk of infection Dry your feet and apply antibiotic ointment your provider has given you. Dress the wound to keep it clean. Activity Try to reduce activity and rest your foot. Avoid bumping your toe or putting a lot of pressure on it. You may want to wear open-toed shoes. If wearing closed shoes, make sure they are not too tight. Wear cotton socks. You may need to do this for about 2 weeks. You can likely resume your normal activities within a week. Getting back to sports may take a little longer. Keep your wound covered both day and night in the first week. You can let your toe remain uncovered at night in the second week. This helps the wound heal. See your provider again in 2 to 3 days or as recommended. Prevention The toenail may grow inward again. To prevent this, follow these tips: Don't wear tight-fitting shoes or high heels Don't trim your nails too short or round the corners Don't pick or tear at the corners of the nails When to Call the Doctor Call your provider if you notice: Your toenail is not healing Fever Pain, even after taking pain-relief medicine Bleeding from the toenail Pus from the toenail Swelling or redness of the toe or foot Regrowth of the nail into the skin of the toe Review Date 12/10/2016 Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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spina bifida; vertbral fusion;syrinx tethered cord. can u help for treatment of these problem
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Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do. Surgery before birth Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. Research suggests that children with spina bifida who had fetal surgery may have reduced disability and be less likely to need crutches or other walking devices. In addition, fetal surgery may reduce the risk of hydrocephalus. Ask your doctor whether this procedure may be appropriate for you. Surgery after birth Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from more trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord. Depending on the severity of spina bifida and the complications, treatment may include, for example: - Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when they're older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. - Bowel and bladder management.. - Bowel management may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. - Bladder management may include medications, using catheters to empty the bladder, surgery, or a combination. - - Treatment and management of other complications. To help with functioning, special equipment such as bath chairs, commode chairs and standing frames may be needed. Whatever the issue - orthopedic complications, tethered spinal cord, GI issues, skin problems, or others - most spina bifida complications can be treated or at least managed to improve quality of life. Ongoing care Children with spina bifida need close follow-up care and observation. Their primary care doctors follow growth, the need for immunizations and general medical issues. They coordinate your child's medical care. Children with spina bifida also often need treatment and ongoing care from: - Physical medicine and rehabilitation - Neurology - Neurosurgery - Urology - Orthopedics - Physical therapy - Occupational therapy - Special education teachers - Social workers - Dietitians Parents and other caregivers are a key part of the team, learning how to help manage their child's condition and how to encourage and support their child emotionally and socially. Keep in mind that children with spina bifida can go on to college, hold jobs and have families. Special accommodations may be necessary along the way, but encourage your child to be as independent as possible.
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Spina bifida Overview Spina bifida is a birth defect that occurs when the spine and spinal cord don't form properly. It falls under the broader category of neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby's brain and spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the spine. Spina bifida can range from mild to severe, depending on the type of defect, size, location and complications. When early treatment for spina bifida is necessary, it's done surgically, although such treatment doesn't always completely resolve the problem. Types Spina bifida can occur in different forms: spina bifida occulta, meningocele (muh-NING-go-seel) or myelomeningocele (my-uh-lo-muh-NING-go-seel). The severity of spina bifida depends on the type, size, location and complications. "Occulta" means hidden. The mildest form, spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae). Many people who have spina bifida occulta don't even know it, unless the condition is discovered during an imaging test done for unrelated reasons. In a form of spina bifida called meningocele, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae, forming a sac filled with fluid. But this sac doesn't include the spinal cord, so nerve damage is less likely, though later complications are possible. Also known as open spina bifida, myelomeningocele is the most severe form. The spinal canal is open along several vertebrae in the lower or middle back. The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. This makes the baby prone to life-threatening infections. Symptoms Signs and symptoms of spina bifida vary by type and severity. Symptoms can also differ for each person. - Spina bifida occulta. Because the spinal nerves usually aren't involved, typically there are no signs or symptoms. But visible indications can sometimes be seen on the newborn's skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark. - Meningocele. The membranes around the spinal cord push out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn't include the spinal cord. - Myelomeningocele. In this severe form of spina bifida: - The spinal canal remains open along several vertebrae in the lower or middle back. - Both the membranes and the spinal cord or nerves protrude at birth, forming a sac. - Tissues and nerves usually are exposed, though sometimes skin covers the sac. When to see a doctor Typically, meningocele and myelomeningocele are diagnosed before or right after birth, when medical care is available. These children should be followed by a specialized team of doctors throughout their lives and families should be educated on the different complications to watch for. Children with spina bifida occulta typically don't have any symptoms or complications, so usually only routine pediatric care is needed. Causes Doctors aren't certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folate deficiency. Risk factors Spina bifida is more common among whites and Hispanics, and females are affected more often than males. Although doctors and researchers don't know for sure why spina bifida occurs, they have identified some risk factors: - Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a baby. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects. - Family history of neural tube defects. Couples who've had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition. - Some medications. For example, anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, possibly because they interfere with the body's ability to use folate and folic acid. - Diabetes. Women with diabetes who don't control their blood sugar well have a higher risk of having a baby with spina bifida. - Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida. - Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early weeks of pregnancy may increase the risk of spina bifida. Elevating your core body temperature, due to fever or the use of saunas or hot tubs, has been associated with a possible slight increased risk of spina bifida. If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins. If you take medications, tell your doctor. Some medications can be adjusted to diminish the potential risk of spina bifida, if plans are made ahead of time. Complications Spina bifida may cause minimal symptoms or only minor physical disabilities. If the spina bifida is severe, sometimes it leads to more significant physical disabilities. Severity is affected by: - The size and location of the neural tube defect - Whether skin covers the affected area - Which spinal nerves come out of the affected area of the spinal cord This list of possible complications may seem overwhelming, but not all children with spina bifida get all these complications. And these conditions can be treated. - Walking and mobility problems. The nerves that control the leg muscles don't work properly below the area of the spina bifida defect, causing muscle weakness of the legs, sometimes involving paralysis. Whether a child can walk typically depends on where the defect is, its size, and the care received before and after birth. - Orthopedic complications. Children with myelomeningocele can have a variety of problems in the legs and spine because of weak muscles in the legs and back. The types of problems depend on the level of the defect. Possible problems include a curved spine (scoliosis), abnormal growth or dislocation of the hip, bone and joint deformities, muscle contractures and other orthopedic concerns. - Bowel and bladder problems. Nerves that supply the bladder and bowels usually don't work properly when children have myelomeningocele. This is because the nerves that supply the bowel and bladder come from the lowest level of the spinal cord. - Accumulation of fluid in the brain (hydrocephalus). Babies born with myelomeningocele commonly experience accumulation of fluid in the brain, a condition known as hydrocephalus. - Shunt malfunction. Shunts can stop working or become infected. Warning signs may vary. Some of the warning signs of a shunt that isn't working include headaches, vomiting, sleepiness, irritability, swelling or redness along the shunt, confusion, changes in the eyes (fixed downward gaze), trouble feeding, or seizures. - Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-MAY-shun) type II is a common brain abnormality in children with the myelomeningocele form of spina bifida. The brainstem, or lowest part of the brain above the spinal cord, is elongated and positioned lower than usual. This can cause problems with breathing and swallowing. Rarely, compression on this area of the brain occurs and surgery is needed to relieve the pressure. - Infection in the tissues surrounding the brain (meningitis). Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. This potentially life-threatening infection may cause brain injury. - Tethered spinal cord. Tethered spinal cord results when the spinal nerves become bound to the scar where the defect was closed surgically, making the spinal cord less able to grow as the child grows. This progressive tethering can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability. - Sleep-disordered breathing. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnea or other sleep disorders. Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, which warrants treatment to improve health and quality of life. - Skin problems. Children with spina bifida may get wounds on their feet, legs, buttocks or back. They can't feel when they get a blister or sore. Sores or blisters can turn into deep wounds or foot infections that are hard to treat. Children with myelomeningocele have a higher risk of wound problems in casts. - Latex allergy. Children with spina bifida have a higher risk of latex allergy, an allergic reaction to natural rubber or latex products. Latex allergy may cause rash, sneezing, itching, watery eyes and a runny nose. It can also cause anaphylaxis, a potentially life-threatening condition in which swelling of the face and airways can make breathing difficult. So it's best to use latex-free gloves and equipment at delivery time and when caring for a child with spina bifida. - Other complications. More problems may arise as children with spina bifida get older, such as urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disabilities, such as problems paying attention, and difficulty learning reading and math. Diagnosis If you're pregnant, you'll be offered prenatal screening tests to check for spina bifida and other birth defects. The tests aren't perfect. Some mothers who have positive blood tests have normal babies. Even if the results are negative, there's still a small chance that spina bifida is present. Talk to your doctor about prenatal testing, its risks and how you might handle the results. Blood tests Your doctor will most likely check for spina bifida by first performing these tests: - Maternal serum alpha-fetoprotein (MSAFP) test. For the MSAFP test, a sample of the mother's blood is drawn and tested for alpha-fetoprotein (AFP) - a protein produced by the baby. It's normal for a small amount of AFP to cross the placenta and enter the mother's bloodstream. But abnormally high levels of AFP suggest that the baby has a neural tube defect, such as spina bifida, though some spina bifida cases don't produce high levels of AFP. - Test to confirm high AFP levels. Varying levels of AFP can be caused by other factors - including a miscalculation in fetal age or multiple babies - so your doctor may order a follow-up blood test for confirmation. If the results are still high, you'll need further evaluation, including an ultrasound exam. - Other blood tests. Your doctor may perform the MSAFP test with two or three other blood tests. These tests are commonly done with the MSAFP test, but their objective is to screen for other abnormalities, such as trisomy 21 (Down syndrome), not neural tube defects. Ultrasound Many obstetricians rely on ultrasonography to screen for spina bifida. If blood tests indicate high AFP levels, your doctor will suggest an ultrasound exam to help determine why. The most common ultrasound exams bounce high-frequency sound waves off tissues in your body to form images on a video monitor. The information these images provide can help establish whether there's more than one baby and can help confirm gestational age, two factors that can affect AFP levels. An advanced ultrasound also can detect signs of spina bifida, such as an open spine or particular features in your baby's brain that indicate spina bifida. Amniocentesis If a blood test shows high levels of AFP in your blood but the ultrasound is normal, your doctor may offer amniocentesis. During amniocentesis, your doctor uses a needle to remove a sample of fluid from the amniotic sac that surrounds the baby. An analysis of the sample indicates the level of AFP present in the amniotic fluid. A small amount of AFP is normally found in amniotic fluid. However, when an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because the skin surrounding the baby's spine is gone and AFP leaks into the amniotic sac. Discuss the risks of amniocentesis, including a slight risk of loss of the pregnancy, with your doctor. Treatment Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do. Surgery before birth Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. Research suggests that children with spina bifida who had fetal surgery may have reduced disability and be less likely to need crutches or other walking devices. In addition, fetal surgery may reduce the risk of hydrocephalus. Ask your doctor whether this procedure may be appropriate for you. Discuss the risks, such as possible premature delivery and other complications, and potential benefits for you and your baby. It's important to have a comprehensive evaluation to determine whether fetal surgery is feasible. This specialized surgery should only be done at a health care facility that has experienced fetal surgery experts, a multispecialty team approach and neonatal intensive care. Typically the team includes a fetal surgeon, pediatric neurosurgeon, maternal-fetal medicine specialist, fetal cardiologist and neonatologist. Cesarean birth Many babies with myelomeningocele tend to be in a feet-first (breech) position. If your baby is in this position or if your doctor has detected a large cyst or sac, cesarean birth may be a safer way to deliver your baby. Surgery after birth Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Because the spinal cord develops normally in babies with meningocele, these membranes often can be removed by surgery with little or no damage to nerve pathways. Myelomeningocele also requires surgery. Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from more trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord. Treatment for complications In babies with myelomeningocele, irreparable nerve damage has likely already occurred and ongoing care from a multispecialty team of surgeons, physicians and therapists is usually needed. Babies with myelomeningocele may need more surgery for a variety of complications. Treatment for complications - such as weak legs, bladder and bowel problems or hydrocephalus - typically begins soon after birth. Depending on the severity of spina bifida and the complications, treatment may include, for example: - Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when they're older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. - Bowel and bladder management. Routine bowel and bladder evaluations and management plans help reduce the risk of organ damage and illness. Evaluations include X-rays, kidney scans, ultrasounds, blood tests and bladder function studies. These evaluations will be more frequent in the first few years of life, but less often as children grow. - Bowel management may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. - Bladder management may include medications, using catheters to empty the bladder, surgery, or a combination. - For children, a specialist in pediatric urology with experience in evaluating and performing surgery on children with spina bifida is the best choice. - Surgery for hydrocephalus. Most babies with myelomeningocele will need a ventricular shunt - a surgically placed tube that allows fluid in the brain to drain into the abdomen. This tube might be placed just after birth, during the surgery to close the sac on the lower back or later as fluid accumulates. A less invasive procedure, called endoscopic third ventriculostomy, may be used, but candidates must be carefully chosen and meet certain criteria. The surgeon uses a small video camera to see inside the brain and makes a hole in the bottom of or between the ventricles so cerebrospinal fluid can flow out of the brain. - Treatment and management of other complications. To help with functioning, special equipment such as bath chairs, commode chairs and standing frames may be needed. Whatever the issue - orthopedic complications, tethered spinal cord, GI issues, skin problems, or others - most spina bifida complications can be treated or at least managed to improve quality of life. Ongoing care Children with spina bifida need close follow-up care and observation. Their primary care doctors follow growth, the need for immunizations and general medical issues. They coordinate your child's medical care. Children with spina bifida also often need treatment and ongoing care from: - Physical medicine and rehabilitation - Neurology - Neurosurgery - Urology - Orthopedics - Physical therapy - Occupational therapy - Special education teachers - Social workers - Dietitians Parents and other caregivers are a key part of the team, learning how to help manage their child's condition and how to encourage and support their child emotionally and socially. Keep in mind that children with spina bifida can go on to college, hold jobs and have families. Special accommodations may be necessary along the way, but encourage your child to be as independent as possible.
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spina bifida; vertbral fusion;syrinx tethered cord. can u help for treatment of these problem
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Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do. Surgery before birth Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. Research suggests that children with spina bifida who had fetal surgery may have reduced disability and be less likely to need crutches or other walking devices. In addition, fetal surgery may reduce the risk of hydrocephalus. Ask your doctor whether this procedure may be appropriate for you. Surgery after birth Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from more trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord. Depending on the severity of spina bifida and the complications, treatment may include, for example: - Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when they're older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. - Bowel and bladder management.. - Bowel management may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. - Bladder management may include medications, using catheters to empty the bladder, surgery, or a combination. - - Treatment and management of other complications. To help with functioning, special equipment such as bath chairs, commode chairs and standing frames may be needed. Whatever the issue - orthopedic complications, tethered spinal cord, GI issues, skin problems, or others - most spina bifida complications can be treated or at least managed to improve quality of life. Ongoing care Children with spina bifida need close follow-up care and observation. Their primary care doctors follow growth, the need for immunizations and general medical issues. They coordinate your child's medical care. Children with spina bifida also often need treatment and ongoing care from: - Physical medicine and rehabilitation - Neurology - Neurosurgery - Urology - Orthopedics - Physical therapy - Occupational therapy - Special education teachers - Social workers - Dietitians Parents and other caregivers are a key part of the team, learning how to help manage their child's condition and how to encourage and support their child emotionally and socially. Keep in mind that children with spina bifida can go on to college, hold jobs and have families. Special accommodations may be necessary along the way, but encourage your child to be as independent as possible.
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Spina bifida Overview Spina bifida is a birth defect that occurs when the spine and spinal cord don't form properly. It falls under the broader category of neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby's brain and spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the spine. Spina bifida can range from mild to severe, depending on the type of defect, size, location and complications. When early treatment for spina bifida is necessary, it's done surgically, although such treatment doesn't always completely resolve the problem. Types Spina bifida can occur in different forms: spina bifida occulta, meningocele (muh-NING-go-seel) or myelomeningocele (my-uh-lo-muh-NING-go-seel). The severity of spina bifida depends on the type, size, location and complications. "Occulta" means hidden. The mildest form, spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae). Many people who have spina bifida occulta don't even know it, unless the condition is discovered during an imaging test done for unrelated reasons. In a form of spina bifida called meningocele, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae, forming a sac filled with fluid. But this sac doesn't include the spinal cord, so nerve damage is less likely, though later complications are possible. Also known as open spina bifida, myelomeningocele is the most severe form. The spinal canal is open along several vertebrae in the lower or middle back. The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. This makes the baby prone to life-threatening infections. Symptoms Signs and symptoms of spina bifida vary by type and severity. Symptoms can also differ for each person. - Spina bifida occulta. Because the spinal nerves usually aren't involved, typically there are no signs or symptoms. But visible indications can sometimes be seen on the newborn's skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark. - Meningocele. The membranes around the spinal cord push out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn't include the spinal cord. - Myelomeningocele. In this severe form of spina bifida: - The spinal canal remains open along several vertebrae in the lower or middle back. - Both the membranes and the spinal cord or nerves protrude at birth, forming a sac. - Tissues and nerves usually are exposed, though sometimes skin covers the sac. When to see a doctor Typically, meningocele and myelomeningocele are diagnosed before or right after birth, when medical care is available. These children should be followed by a specialized team of doctors throughout their lives and families should be educated on the different complications to watch for. Children with spina bifida occulta typically don't have any symptoms or complications, so usually only routine pediatric care is needed. Causes Doctors aren't certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folate deficiency. Risk factors Spina bifida is more common among whites and Hispanics, and females are affected more often than males. Although doctors and researchers don't know for sure why spina bifida occurs, they have identified some risk factors: - Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a baby. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects. - Family history of neural tube defects. Couples who've had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition. - Some medications. For example, anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, possibly because they interfere with the body's ability to use folate and folic acid. - Diabetes. Women with diabetes who don't control their blood sugar well have a higher risk of having a baby with spina bifida. - Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida. - Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early weeks of pregnancy may increase the risk of spina bifida. Elevating your core body temperature, due to fever or the use of saunas or hot tubs, has been associated with a possible slight increased risk of spina bifida. If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins. If you take medications, tell your doctor. Some medications can be adjusted to diminish the potential risk of spina bifida, if plans are made ahead of time. Complications Spina bifida may cause minimal symptoms or only minor physical disabilities. If the spina bifida is severe, sometimes it leads to more significant physical disabilities. Severity is affected by: - The size and location of the neural tube defect - Whether skin covers the affected area - Which spinal nerves come out of the affected area of the spinal cord This list of possible complications may seem overwhelming, but not all children with spina bifida get all these complications. And these conditions can be treated. - Walking and mobility problems. The nerves that control the leg muscles don't work properly below the area of the spina bifida defect, causing muscle weakness of the legs, sometimes involving paralysis. Whether a child can walk typically depends on where the defect is, its size, and the care received before and after birth. - Orthopedic complications. Children with myelomeningocele can have a variety of problems in the legs and spine because of weak muscles in the legs and back. The types of problems depend on the level of the defect. Possible problems include a curved spine (scoliosis), abnormal growth or dislocation of the hip, bone and joint deformities, muscle contractures and other orthopedic concerns. - Bowel and bladder problems. Nerves that supply the bladder and bowels usually don't work properly when children have myelomeningocele. This is because the nerves that supply the bowel and bladder come from the lowest level of the spinal cord. - Accumulation of fluid in the brain (hydrocephalus). Babies born with myelomeningocele commonly experience accumulation of fluid in the brain, a condition known as hydrocephalus. - Shunt malfunction. Shunts can stop working or become infected. Warning signs may vary. Some of the warning signs of a shunt that isn't working include headaches, vomiting, sleepiness, irritability, swelling or redness along the shunt, confusion, changes in the eyes (fixed downward gaze), trouble feeding, or seizures. - Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-MAY-shun) type II is a common brain abnormality in children with the myelomeningocele form of spina bifida. The brainstem, or lowest part of the brain above the spinal cord, is elongated and positioned lower than usual. This can cause problems with breathing and swallowing. Rarely, compression on this area of the brain occurs and surgery is needed to relieve the pressure. - Infection in the tissues surrounding the brain (meningitis). Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. This potentially life-threatening infection may cause brain injury. - Tethered spinal cord. Tethered spinal cord results when the spinal nerves become bound to the scar where the defect was closed surgically, making the spinal cord less able to grow as the child grows. This progressive tethering can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability. - Sleep-disordered breathing. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnea or other sleep disorders. Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, which warrants treatment to improve health and quality of life. - Skin problems. Children with spina bifida may get wounds on their feet, legs, buttocks or back. They can't feel when they get a blister or sore. Sores or blisters can turn into deep wounds or foot infections that are hard to treat. Children with myelomeningocele have a higher risk of wound problems in casts. - Latex allergy. Children with spina bifida have a higher risk of latex allergy, an allergic reaction to natural rubber or latex products. Latex allergy may cause rash, sneezing, itching, watery eyes and a runny nose. It can also cause anaphylaxis, a potentially life-threatening condition in which swelling of the face and airways can make breathing difficult. So it's best to use latex-free gloves and equipment at delivery time and when caring for a child with spina bifida. - Other complications. More problems may arise as children with spina bifida get older, such as urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disabilities, such as problems paying attention, and difficulty learning reading and math. Diagnosis If you're pregnant, you'll be offered prenatal screening tests to check for spina bifida and other birth defects. The tests aren't perfect. Some mothers who have positive blood tests have normal babies. Even if the results are negative, there's still a small chance that spina bifida is present. Talk to your doctor about prenatal testing, its risks and how you might handle the results. Blood tests Your doctor will most likely check for spina bifida by first performing these tests: - Maternal serum alpha-fetoprotein (MSAFP) test. For the MSAFP test, a sample of the mother's blood is drawn and tested for alpha-fetoprotein (AFP) - a protein produced by the baby. It's normal for a small amount of AFP to cross the placenta and enter the mother's bloodstream. But abnormally high levels of AFP suggest that the baby has a neural tube defect, such as spina bifida, though some spina bifida cases don't produce high levels of AFP. - Test to confirm high AFP levels. Varying levels of AFP can be caused by other factors - including a miscalculation in fetal age or multiple babies - so your doctor may order a follow-up blood test for confirmation. If the results are still high, you'll need further evaluation, including an ultrasound exam. - Other blood tests. Your doctor may perform the MSAFP test with two or three other blood tests. These tests are commonly done with the MSAFP test, but their objective is to screen for other abnormalities, such as trisomy 21 (Down syndrome), not neural tube defects. Ultrasound Many obstetricians rely on ultrasonography to screen for spina bifida. If blood tests indicate high AFP levels, your doctor will suggest an ultrasound exam to help determine why. The most common ultrasound exams bounce high-frequency sound waves off tissues in your body to form images on a video monitor. The information these images provide can help establish whether there's more than one baby and can help confirm gestational age, two factors that can affect AFP levels. An advanced ultrasound also can detect signs of spina bifida, such as an open spine or particular features in your baby's brain that indicate spina bifida. Amniocentesis If a blood test shows high levels of AFP in your blood but the ultrasound is normal, your doctor may offer amniocentesis. During amniocentesis, your doctor uses a needle to remove a sample of fluid from the amniotic sac that surrounds the baby. An analysis of the sample indicates the level of AFP present in the amniotic fluid. A small amount of AFP is normally found in amniotic fluid. However, when an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because the skin surrounding the baby's spine is gone and AFP leaks into the amniotic sac. Discuss the risks of amniocentesis, including a slight risk of loss of the pregnancy, with your doctor. Treatment Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do. Surgery before birth Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. Research suggests that children with spina bifida who had fetal surgery may have reduced disability and be less likely to need crutches or other walking devices. In addition, fetal surgery may reduce the risk of hydrocephalus. Ask your doctor whether this procedure may be appropriate for you. Discuss the risks, such as possible premature delivery and other complications, and potential benefits for you and your baby. It's important to have a comprehensive evaluation to determine whether fetal surgery is feasible. This specialized surgery should only be done at a health care facility that has experienced fetal surgery experts, a multispecialty team approach and neonatal intensive care. Typically the team includes a fetal surgeon, pediatric neurosurgeon, maternal-fetal medicine specialist, fetal cardiologist and neonatologist. Cesarean birth Many babies with myelomeningocele tend to be in a feet-first (breech) position. If your baby is in this position or if your doctor has detected a large cyst or sac, cesarean birth may be a safer way to deliver your baby. Surgery after birth Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Because the spinal cord develops normally in babies with meningocele, these membranes often can be removed by surgery with little or no damage to nerve pathways. Myelomeningocele also requires surgery. Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from more trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord. Treatment for complications In babies with myelomeningocele, irreparable nerve damage has likely already occurred and ongoing care from a multispecialty team of surgeons, physicians and therapists is usually needed. Babies with myelomeningocele may need more surgery for a variety of complications. Treatment for complications - such as weak legs, bladder and bowel problems or hydrocephalus - typically begins soon after birth. Depending on the severity of spina bifida and the complications, treatment may include, for example: - Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when they're older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. - Bowel and bladder management. Routine bowel and bladder evaluations and management plans help reduce the risk of organ damage and illness. Evaluations include X-rays, kidney scans, ultrasounds, blood tests and bladder function studies. These evaluations will be more frequent in the first few years of life, but less often as children grow. - Bowel management may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. - Bladder management may include medications, using catheters to empty the bladder, surgery, or a combination. - For children, a specialist in pediatric urology with experience in evaluating and performing surgery on children with spina bifida is the best choice. - Surgery for hydrocephalus. Most babies with myelomeningocele will need a ventricular shunt - a surgically placed tube that allows fluid in the brain to drain into the abdomen. This tube might be placed just after birth, during the surgery to close the sac on the lower back or later as fluid accumulates. A less invasive procedure, called endoscopic third ventriculostomy, may be used, but candidates must be carefully chosen and meet certain criteria. The surgeon uses a small video camera to see inside the brain and makes a hole in the bottom of or between the ventricles so cerebrospinal fluid can flow out of the brain. - Treatment and management of other complications. To help with functioning, special equipment such as bath chairs, commode chairs and standing frames may be needed. Whatever the issue - orthopedic complications, tethered spinal cord, GI issues, skin problems, or others - most spina bifida complications can be treated or at least managed to improve quality of life. Ongoing care Children with spina bifida need close follow-up care and observation. Their primary care doctors follow growth, the need for immunizations and general medical issues. They coordinate your child's medical care. Children with spina bifida also often need treatment and ongoing care from: - Physical medicine and rehabilitation - Neurology - Neurosurgery - Urology - Orthopedics - Physical therapy - Occupational therapy - Special education teachers - Social workers - Dietitians Parents and other caregivers are a key part of the team, learning how to help manage their child's condition and how to encourage and support their child emotionally and socially. Keep in mind that children with spina bifida can go on to college, hold jobs and have families. Special accommodations may be necessary along the way, but encourage your child to be as independent as possible.
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how do you get a prolapse bladder
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Pelvic organ prolapse: Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose.
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Pelvic organ prolapse Overview Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose. This allows one or more of the pelvic organs to drop or press into or out of the vagina. Many women are embarrassed to talk to their doctor about their symptoms or think that their symptoms are normal. But pelvic organ prolapse is treatable. What is pelvic organ prolapse? The pelvic muscles and tissues support the pelvic organs like a hammock. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum, which is part of the bowel. A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or damaged. This causes one or more pelvic organs to drop or press into or out of the vagina. Pelvic organ prolapse is a type of pelvic floor disorder. The most common pelvic floor disorders are: What are the different types of pelvic organ prolapse? The different types of pelvic organ prolapse depend on the pelvic organ affected. The most common types include: Although it is rare, pelvic organ prolapse can also happen after a hysterectomy. Any part of the vaginal wall may drop, causing a bulge into or out of the vagina. Who gets pelvic organ prolapse? Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect one in five women in the United States.1 Pelvic organ prolapse is less common than urinary or fecal incontinence but affects almost 3% of U.S. women.1 Pelvic organ prolapse happens more often in older women and in white and Hispanic women than in younger women or women of other racial and ethnic groups.2,3 Some women develop more than one pelvic floor disorder, such as pelvic organ prolapse with urinary incontinence. What are the symptoms of pelvic organ prolapse? The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex. Other symptoms of pelvic organ prolapse include: Some women say that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your doctor or nurse about your symptoms. What causes pelvic organ prolapse? Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are: How is pelvic organ prolapse diagnosed? Your doctor will talk to you about your symptoms and do a pelvic exam. You may be asked to strain or cough during the exam so your doctor can see whether these actions cause prolapse or urine leakage. Your doctor may also do other tests to see whether you can completely empty your bladder when you go to the bathroom. How is pelvic organ prolapse treated? Treatment for pelvic organ prolapse depends on the type of prolapse you have, your symptoms, your age, other health problems, and whether you are sexually active. Your treatment may include one or more of the following: How can I prevent pelvic organ prolapse? Researchers are studying ways to prevent pelvic organ prolapse. The following steps may reduce your risk of getting a pelvic floor problem: Did we answer your question about pelvic organ prolapse? For more information about pelvic organ prolapse, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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how do you get a prolapse bladder
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Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse). Possible causes of anterior prolapse include: - Pregnancy and vaginal childbirth - Being overweight or obese - Repeated heavy lifting - Straining with bowel movements - A chronic cough or bronchitis
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Anterior prolapse (cystocele) Overview Anterior prolapse, also known as a cystocele (SIS-toe-seel), occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder. Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease. For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions. Symptoms In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include: - A feeling of fullness or pressure in your pelvis and vagina - Increased discomfort when you strain, cough, bear down or lift - A feeling that you haven't completely emptied your bladder after urinating - Repeated bladder infections - Pain or urinary leakage during sexual intercourse - In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down. When to see a doctor A severely prolapsed bladder can be uncomfortable. It can make emptying your bladder difficult and may lead to bladder infections. Make an appointment with your doctor if you have any signs or symptoms that bother you. Causes Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles. When this happens, your bladder can slip down lower than normal and bulge into your vagina (anterior prolapse). Possible causes of anterior prolapse include: - Pregnancy and vaginal childbirth - Being overweight or obese - Repeated heavy lifting - Straining with bowel movements - A chronic cough or bronchitis Risk factors These factors may increase your risk of anterior prolapse: - Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse. - Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen - which helps keep the pelvic floor strong - decreases. - Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support. - Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. - Obesity. Women who are overweight or obese are at higher risk of anterior prolapse. Diagnosis Diagnosis of anterior prolapse may involve: - A pelvic exam. You may be examined while lying down and while standing up. During the exam, your doctor looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. You'll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you'll be asked to contract them, as if you're trying to stop the stream of urine. - Filling out a questionnaire. You may fill out a form that helps your doctor assess the degree of your prolapse and how much it affects your quality of life. Information gathered also helps guide treatment decisions. - Bladder and urine tests. If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection, if it seems that you're retaining more urine in your bladder than is normal after urinating. Treatment Treatment depends on how severe your anterior prolapse is and whether you have any related conditions, such as a uterus that slips into the vaginal canal (uterine prolapse). Mild cases - those with few or no obvious symptoms - typically don't require treatment. You could opt for a wait-and-see approach, with occasional visits to your doctor to see if your prolapse is worsening, along with self-care measures, such as exercises that strengthen your pelvic floor muscles. If self-care measures aren't effective, anterior prolapse treatment might involve: - A supportive device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky. - Estrogen therapy. Your doctor may recommend using estrogen - usually a vaginal cream, pill or ring - especially if you've already experienced menopause. This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause. When surgery is necessary If you have noticeable, uncomfortable symptoms, anterior prolapse may require surgery. - How it's done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place, removing extra tissue, and tightening the muscles and ligaments of the pelvic floor. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin. - If you have a prolapsed uterus. For anterior prolapse associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues. If you're thinking about becoming pregnant, your doctor may recommend that you delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime. The benefits of surgery can last for many years, but there's some risk of recurrence - which may mean another surgery at some point. Dealing with incontinence If your anterior prolapse is accompanied by stress incontinence - involuntary loss of urine during strenuous activity - your doctor may recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms. Treatment at Mayo Clinic Urologists and urogynecologists at Mayo Clinic provide expert care for female patients of all ages who suffer from problems of the pelvic floor. Mayo physicians are leaders in clinical research that enhances the capability to offer the most advanced treatments available. Many of the urologists across all Mayo Clinic campuses have advanced training and subspecialty certification in female pelvic medicine and reconstructive surgery from the American Board of Urology. Urogynecologists at Mayo Clinic also have advanced training and certification in female urology. Specialty services offered through urology and urogynecology include: - Pelvic organ prolapse with or without incontinence diagnosis and treatment - Urodynamic evaluation - Stress urinary incontinence diagnosis and treatment - Minimally invasive injection therapies - Management of mesh complications - Urge urinary incontinence diagnosis and treatment - Overactive bladder diagnosis and treatment - Botox injections of the urinary tract - Neuromodulation for the urinary tract Lifestyle and home remedies Kegel exercises strengthen your pelvic floor muscles, which support the uterus, bladder and bowel. A strengthened pelvic floor provides better support for your pelvic organs and relief from symptoms associated with anterior prolapse. To perform Kegel exercises, follow these steps: - Tighten (contract) your pelvic floor muscles - the muscles you use to stop urinating. - Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.) - Work up to holding the contraction for 10 seconds at a time. - Do three sets of 10 repetitions of the exercises each day. Ask your health care provider for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time. Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.
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what are symptoms of a nonfunctioning gallbladder
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You may also need surgery if your gallbladder is not working normally. Common symptoms may include: - Indigestion, including bloating, heartburn, and gas - Nausea and vomiting - Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain)
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Gallbladder removal - open Cholecystectomy - open Gallbladder - open cholecystectomy Cholecystitis - open cholecystectomy Gallstones - open cholecystectomy Summary Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. Description Surgery is done while you are under general anesthesia so you will be asleep and pain-free. To perform the surgery: The surgeon makes a 5 to 7 inch (12.5 to 17.5 centimeters) cut in the upper right part of your belly, just below your ribs. The area is opened up so the surgeon can view the gallbladder and separate it from the other organs. The surgeon cuts the bile duct and blood vessels that lead to the gallbladder. The gallbladder is gently lifted out and removed from your body. An x-ray called a cholangiogram may be done during your surgery. To do this test, dye is injected into your common bile duct and an x-ray is taken. The dye helps find stones that may be outside your gallbladder. If other stones are found, the surgeon may remove them with a special instrument. The surgery takes about 1 hour. Why the Procedure is Performed You may need this surgery if you have pain or other symptoms from gallstones. You may also need surgery if your gallbladder is not working normally. Common symptoms may include: Indigestion, including bloating, heartburn, and gas Nausea and vomiting Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain) The most common way to remove the gallbladder is by using a medical instrument called a laparoscope (laparoscopic cholecystectomy). Open gallbladder surgery is used when laparoscopic surgery cannot be done safely. In some cases, the surgeon needs to switch to an open surgery if laparoscopic surgery cannot be successfully continued. Other reasons for removing the gallbladder by open surgery: Unexpected bleeding during the laparoscopic operation Obesity Pancreatitis (inflammation in the pancreas) Pregnancy (third trimester) Severe liver problems Past surgeries in the same area of your belly Risks Risks of anesthesia and surgery in general are: Reactions to medicines Breathing problems Bleeding, blood clots Infection Risks of gallbladder surgery are: Damage to the blood vessels that go to the liver Injury to the common bile duct Injury to the small or large intestine Pancreatitis (inflammation of the pancreas) Before the Procedure Your may have the following tests done before surgery: Blood tests (complete blood count, electrolytes, liver and kidney tests) Chest x-ray or electrocardiogram (EKG), for some patients Several x-rays of the gallbladder Ultrasound of the gallbladder Tell your doctor or nurse: If you are or might be pregnant Which drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription During the week before surgery: You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that put you at a higher risk of bleeding during surgery. Ask your doctor which drugs you should still take on the day of your surgery. Prepare your home for any problems you might have getting around after the surgery. You'll be told when to arrive at the hospital. On the day of surgery: Follow instructions about when to stop eating and drinking. Take the drugs your doctor told you to take with a small sip of water. Shower the night before or the morning of your surgery. Arrive at the hospital on time. After the Procedure You may need to stay in the hospital for 3 to 5 days after open gallbladder removal. During that time: You may be asked to breathe into a device called an incentive spirometer. This helps keep your lungs working well so that you do not get pneumonia. The nurse will help you sit up in bed, hang your legs over the side, and then stand up and start to walk. At first, you will receive fluids into your vein through an intravenous (IV) tube. Soon after, you will be asked to start drinking liquids and eating foods. You will be able to shower while you are still in the hospital. You may be asked to wear pressure stockings on your legs to help prevent a blood clot from forming. If there were problems during your surgery, or if you have bleeding, a lot of pain, or a fever, you may need to stay in the hospital longer. Your doctor or nurses will tell you how to care for yourself after you leave the hospital. Outlook (Prognosis) Most people recover quickly and have good results from this procedure. Review Date 9/9/2017 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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input
| 2
| 2,142
| 5
| 6,428
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Please answer the letter of option truthfully
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instruction
| 0
| 3,468
| 5
| 10,404
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B
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output
| 1
| 3,468
| 5
| 10,405
|
Q:In what situation are closed pouches applied??
A:The patient has a semi-formed or liquid output.;B:The patient has a colostomy.;C:In the immediate post-operative period.;D:The patient has a urostomy.
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input
| 2
| 3,468
| 5
| 10,406
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Please answer the letter of option truthfully
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instruction
| 0
| 3,479
| 5
| 10,437
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C
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output
| 1
| 3,479
| 5
| 10,438
|
Q:Which one of the following represents a IIIrd cranial nerve palsy and is a neurosurgical emergency??
A:Unilateral constricted pupil.;B:Bilateral constricted pupils.;C:Unilateral fixed dilated pupil.;D:Oval shaped pupils.
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input
| 2
| 3,479
| 5
| 10,439
|
Please answer the letter of option truthfully
|
instruction
| 0
| 3,588
| 5
| 10,764
|
A
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output
| 1
| 3,588
| 5
| 10,765
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Q:Where should a stoma be sited??
A:The rectus sheath abdominus.;B:Next to the umbilicus.;C:Within an abdominal crease.;D:In close proximity to the incision site.
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input
| 2
| 3,588
| 5
| 10,766
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Please answer the letter of option truthfully
|
instruction
| 0
| 3,620
| 5
| 10,860
|
D
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output
| 1
| 3,620
| 5
| 10,861
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Q:Which of the following is true about an abdominal mass??
A:A pulsatile mass is always due to an aortic aneurysm;B:An enlarged kidney is dull to percussion;C:A large mass arising out of the pelvis which disappears following urethral catheterization is caused by an ovarian cyst;D:An indentible mass is caused by faecal loading of the colon
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input
| 2
| 3,620
| 5
| 10,862
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Please answer the letter of option truthfully
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instruction
| 0
| 3,685
| 5
| 11,055
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B
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output
| 1
| 3,685
| 5
| 11,056
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Q:What is a tracheostomy??
A:An opening in the anterior wall of the trachea above the cricoid cartilage.;B:An opening in the anterior wall of the trachea below the cricoid cartilage.;C:An opening in the anterior chest wall.;D:An opening in the posterior wall of the trachea below the cricoid cartilage.
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input
| 2
| 3,685
| 5
| 11,057
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Please answer the letter of option truthfully
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instruction
| 0
| 3,701
| 5
| 11,103
|
C
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output
| 1
| 3,701
| 5
| 11,104
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Q:A surgical support can be used for:?
A:prolapsed stomas.;B:high output stomas.;C:herniation around the stoma.;D:retraction of the stoma.
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input
| 2
| 3,701
| 5
| 11,105
|
Please answer the letter of option truthfully
|
instruction
| 0
| 3,724
| 5
| 11,172
|
C
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output
| 1
| 3,724
| 5
| 11,173
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Q:Why might a patient need a tracheostomy??
A:To repair vocal cords after paralysis.;B:To aid swallowing.;C:As an aid to weaning patients from a ventilator.;D:Prior to neck surgery.
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input
| 2
| 3,724
| 5
| 11,174
|
Please answer the letter of option truthfully
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instruction
| 0
| 4,065
| 5
| 12,195
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B
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output
| 1
| 4,065
| 5
| 12,196
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Q:Laryngoscopic examination of the vocal folds after suspected recurrent laryngeal nerve damage usually shows that the vocal fold on the injured side is tensed and in an intermediate position between adduction and abduction. This is because?
A:cricothyroid muscle is still functional but the interarytenoid muscles are fully active.;B:cricothyroid muscle is still functional but the interarytenoids are weak.;C:cricothyroid muscle is paralyzed but the interarytenoids are fully active.;D:cricothyroid muscle is paralyzed but the interarytenoids are weak.
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input
| 2
| 4,065
| 5
| 12,197
|
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