Abdominal pain
It is a very common symptom in our daily medical practice. Most people had experienced abdominal pain. abdomen is a large cavity that contains many vital organs, so abdominal pain is one of first symptom when any disease occurs in these organs.
Abdominal pain may be transient and subside over time (as indigestion, constipation, weather changes, muscle tension) and may be an indication of important organic disease that requires medical treatment or even surgical intervention
abdominal pain can be a temporary transient symptom, and it can be chronic, lasting for a long time (several weeks or more).
- severe or mild
- sudden or gradually become worse
- continuous or intermittent
- cramping, stabbing, or pulsating
- Localized in a specific site or spread over all abdomen
- traumatic injury
- abdominal wall hernia
- gastric esophageal reflux
- gastritis
- gastric ulcer
- bowel Inflammation
- Food intolerance
- appendicitis
- Crohn’s disease
- ulcerative colitis
- diverticulitis
- sigmoid torsion
- bowel obstruction
- cholecystitis
- hepatitis
- pancreatitis
- Gastrointestinal tumors
- Urinary tract lesions: stones, infections, tumors…
- Gynecological diseases: ovarian cyst, ectopic pregnancy, endometriosis, pelvic inflammatory disease…
- Diseases of the blood and vessels: aneurysm, vasoconstriction, sickle cell anemia….
Sometimes a lower myocardial infarction causes epigastric pain in the upper abdomen, so no complaint should be ignored.
- clinical history in details
- clinical examination
- laboratory and radiological investigations.
- and may have to do some other investigations such as gastrointestinal endoscopy and diagnostic laparoscopy in specific cases.
Chronic constipation
constipation is infrequent or difficulty in defecation for several weeks or more
any case is considered as constipation if two or more of the following criteria are present:
• Defecation less than 3 times a week
• Feeling obstruction of rectum while defecation
• Straining during defecation
• Passage of solid stool
• incomplete emptying of stool
• Needing help to empty the rectum (pressure on abdomen, use finger to extract stool)
bowel disease:
- anal fissure
- bowel tumor
- tumor in the abdomen may press on the bowel causing constipation
other disease:
- Hormonal:
- Hypothyroidism
- Hyperparathyroidism
- diabetes mellitus
- Neurological:
- Multiple sclerosis
- Parkinson’s disease
- Muscular:
- Weakness in the pelvic muscles
pregnancy
- clinical history that includes all the details of daily diet and lifestyle
- clinical examination
- Other investigations such as:
- laboratory tests to investigate hormonal diseases
- colonoscopy
- measuring the pressures of the anal sphincter
Lifestyle modification:
- 20-30 minutes of workout daily
- A balanced diet: rich in fiber, vegetables and fruits, beans, bran and whole grains
- Drink at least 2 liters of water daily
- Do not ignore the urge to defecate (you can try daily regularly after a certain meal)
- Avoid sitting on toilet seat for a long time
Laxatives:
- Supplements rich in fiber such as cellulose
- Osmotic laxatives such as lactulose
- Stimulant laxatives such as bisacodyl
probiotic is useful in some cases
Lubricant rectal suppositories
enemas
Pelvic floor exercises ( Kegel exercises)
Surgery (total colectomy) can be done to in complicated cases
Ignore constipation may lead to:
- Colitis
- anal hemorrhoids
- anal fissures
- and rectal prolapse.
Rectal bleeding
- It is a blood getting out anus during defecation or even in the normal resting position
- Rectal bleeding is a very important symptom, so you should visit your doctor as soon as you notice the presence of blood on toilet paper or in toilet basin.
- Rectal bleeding is a symptom of many diseases,
- some of which are easy to treat, such as anal hemorrhoids and anal fissures
- and some that may be dangerous, such as colon and rectal cancer
- The color of blood varies according to the source of bleeding
- Red blood indicates a near source of bleeding (rectum, anal canal) as anal fissure
- Dark blood indicates a little further source of bleeding (colon) as ulcerative colitis
- Black blood or tarry stool indicate a distant source of bleeding (stomach, duodenum), as a bleeding peptic ulcer
- Anal hemorrhoids: internal hemorrhoids are most common cause of rectal bleeding
- Anal fissure: bleeding here usually is a few drops of blood at the beginning of the defecation process
- diverticulosis
- Ulcerative colitis
- Crohn’s disease
- peptic ulcer
- Benign and malignant gastrointestinal tract tumors
- Comprehensive clinical examination of the anal canal and rectum using anoscope and proctoscope if needed
- Laboratory tests
- radiological investigations
- stop the bleeding
- keep patient hemodynamically stable
- Hemoglobin monitoring and blood transfusion if necessary (rare cases)
- Treatment of disease-causing rectal bleeding
Anal itching
- is a common, easy-to-treat condition
- most people completely heal from anal itching with proper treatment and self-care measures.
causes of anal itching include:
- Skin diseases:
contact dermatitis
psoriasis
- diabetes
- Hemorrhoids
- anal fistulas
- diarrhea
- thyroid disorders
- Pinworms
- Skin irritation: when changing underwear, soap, or when washing the area aggressively
- clinical examination
- Surgical or dermatological consultation
- Treatment of disease-causing itching:
repair of hemorrhoids
repair of anal fistulas
treatment of skin disease - Lifestyle modification:
washing gently
keeping the area clean and dry
wearing comfortable cotton clothes - may use local creams or oral antihistamine
