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505 Useful link for Diseases and Conditions (Complete)

admin — Tue, 06 Jul 2010 06:50:04 +0000

505 Useful link for Diseases and Conditions (Complete)

Below I summarize Useful links for Diseases and Conditions (Complete).

If you are one of the site owners that I mentioned below, and if you don’t want your site address appear on my blog, Please send your comments to me. Thank you.

Joint Health Supplements | Joint Health Products | Joint Strength
Joint strength should not be ignored. Our joint health supplements are for anyone, from the skier on the slopes every weekend to the casual walker. Our joint health products are for you.
http://www.jointsupplementbenefits.com
Mesothelioma Resource and Info
Mesothelioma resource and info
http://mesothelioma.orp.site11.com
Your Queen Creek Chiropractor
Our office, conveniently located in the center of Queen Creek, AZ provides members of the community with high quality, affordable health care in a comfortable and caring environment. Get the help you deserve for Neck/back pain, auto accident or headaches.
http://www.summithealthchiro.com
Prostate Cancer Surgery
Prostate cancer requires regular checkups to spot, especially in men over forty, so it’s essential to make regular visits to a physician to get prostate exams.
http://prostatecancersupportgroup.com
Ldl And Hdl Cholesterol
What Is Ldl Cholesterol And Hdl Cholesterol? Learn More About Cholesterol Levels On Our Website. We Often Post New Information On Our Website About Cholesterol
http://www.cholesterolbad.com
Acne Cream Treatment
We provide information on acne cream treatment, acne scar natural treatment, laser acne treatments and plenty of other information on acne and skin care treatment.
http://www.acnecreamsite.com/
Psoriatic Arthritis
Information on Arthritisbearthritisfree.com provides you important information on osteo arthritis, psoriatic arthritis, Flomax Arthritis, Rheumatoid Arthritis, arthritis diet, arthritis pain relief.
http://www.bearthritisfree.com
Migraine Information Center
The migraine freedom information center offers useful, practical information to help migraine sufferers win the battle against their migraines 100% naturally. We offer high quality information for all migraine sufferers.
http://www.absolute-migraine-freedom.com
Allergy and Asthma Watch
The latest information on anaphylaxis, food and skin allergies, rhinitis, corticosteroids, and more from the Journal Watch experts.
http://www.jwatch.org/cgi/collection/allergy-asthma
Aids
Resource guide on AIDS and HIV includes medical news, chat, message boards, information and articles, books, and links.
http://www.aidsworldcure.com
Basic Skin Care Secrets
Skin Care talks is a site that related with Skin care tips and techniques to help keep your skin healthy and beautiful.
http://www.skincaretalks.com
The CPAP Shop – Sleep Apnea Equipment
Quality discounted CPAP machines, masks, headgear, filters and tubing and other related Sleep Apnea products. All major manufacturers – Respironics, Resmed, Puritan Bennett, Fisher & Paykel, DeVilbiss, Viasys, Invacare, Medical Industries & Tiara Medical.
http://www.thecpapshop.com
Remedy For Eczema
A site dedicated to finding a remedy for eczema, advice and resources.
http://www.remedyforeczemablog.com
Hemorrhoids Relief
Free information on hemorrhoids relief that you can do at home. Get rid of your hemorrhoids today.
http://www.hemorrhoid-treatment.info
Asbestosis, Pleurisy, Mesothelioma Legal Help
Find how to compensate yourself for asbestos exposure leading to mesothelioma & lung cancer with legal information & attorneys. Learn about diagnosis & treatment and find out about your legal options.
http://www.mesothelioma-advice.org
New Mesothelioma Patient | Home
Information and resources for patients who have been diagnosed with mesothelioma cancer caused by asbestos exposure.
http://www.newmesotheliomapatient.com
Murad.com
Best acne treatments available. Murad acne treatments are clinically proven to help improve your acne.
http://www.murad.com
Vaginal Cancer Information
Vaginal-cancer.com provides informational resource for the patients of Vaginal Cancer. Other people can also take advantage of the site. The site has sections on causes of vaginal cancer, its symptoms, its treatment,
http://www.vaginal-cancer.com/
Uterine Cancer Site
Uterinecancersite.com provides informational resource for the patients of Uterine Cancer. Other people can also take advantage of the site. The site has sections on causes of uterine cancer, its symptoms, its treatment, its different stages,
http://www.uterinecancersite.com/
Fighting Pain
Pain management, for chronic pain, psychogenic pain. Physiology of pain.
http://www.painbusting.com
Thyroid Cancer Information
Thyroidcancersite.com provides informational resource for the patients of Thyroid Cancer. Other people can also take advantage of the site. The site has sections on causes of thyroid cancer, its symptoms, its treatment, its different stages,
http://www.thyroidcancersite.com
Thymoma Cancer
Thymoma-cancer.com provides informational resource for the patients of Thymoma Cancer.
http://www.thymoma-cancer.com/
Prostate Cancer Information
Theprostatecancer.com is an educational resource on Prostate cancer for its patients and other people. The site has detailed information on what is prostate cancer, how it happens, its types and its treatment.
http://www.theprostatecancer.com/
Bladder Cancer Information
Thebladdercancer.com provides excellent information on bladder cancer for patients and others. It has sections on what is bladder cancer, what are its stages, its symptoms and signs. It will also give you the options of its treatment.
http://www.thebladdercancer.com/
HemroidTreatmentNow.com
Complete resource for hemroids information including symptoms and treatment for both internal and external hemroids.
http://www.hemroidtreatmentnow.com
Hyperhidrosis Cure
How to safely prevent underarm sweating for good. There is a natural cure for hyperhidrosis. An ex-sufferer reveals the secrets they don’t want you to know about! Stop sweating and start living.
http://StopMySweat.com/
Libido Enhancers, Male Female Libido Enhancement
The comprehensive guide on men and women health problems. The website covers an extensive section of health supplements and guide on several health issues. It also gives useful advices and tips on dating and relationship.
http://www.howtoselfhelp.org
Local Alcohol Rehabilitation Center
Choosing a alcohol rehabilitation center is one of the most significant decisions to make for you or your loved one.
http://www.alcoholysis.com/
Cancer Patients Donate
Our lovely Graham was diagnosed in April 2007 with a deadly type of leukaemia that affects less than 6 adults a year in Australia and his only chance of survival was a bone marrow transplant.
http://www.adonorforgraham.com/blog/
How To Beat Chronic Urticaria & Angioedema
Copy This Simple Natural Method & Never Suffer With Chronic Urticaria Again
http://www.urticaria-relief.com
What is mesothelioma?
Diagnosis of mesothelioma or asbestosis is immediately followed by either a surgical procedure or chemotherapy. Mesothelioma and asbestosis treatments are expensive. Get help now!
http://www.asbestosismesothelioma.org
Michael Jackson Vitiligo
Michael Jackson has vitiligo and that is the truth, even now you will see brown spots on various parts of Michaels body, at his arms, hands, nose, lips etc. On February 10, 1993, he gave to the world an explanation about his skin disease like that,
http://www.vitiligos.com/people-with-vitiligo/famous-people/
Natural Treatment for Psoriasis
Looking for herbal treatment for Psoriasis, Eczema or Rosacea? We offer Natural and herbal Treatment for Psoriasis. Get a Natural Treatment for Eczema. We provide Baby Eczema Treatment and cure.
http://www.doctors-defense.com
Sinus Dynamics
Providing you with the latest information and treatment regarding sinus or sinusitis infection problems.
http://www.sinusdynamics.com
Ways To Stop Snoring
The article found at this URL explains about the inter-relationship between being over-weight and a person’s propensity to snore. It also outlines the significance of inappropriate lifestyle choices on whether a person snores or not.
http://www.stopmysnoringnow.com
Acneprecautions.com Is Your Guide For Acne Treatments, Causes And All Information About Acne
Learn all about acne, the different types of acne, how it develops, how it affects you, the treatments and medication, the precautions you can take to avoid it.
http://www.acneprecautions.com
Addiction Treatment Drug Rehab
A drug rehab and alcohol rehab center in Scottsdale Arizona that treats various addictions, including co occurring disorders. We believe our treatment program is one of the finest in the world.
http://www.affirmationsrehab.com/
How Long Cocaine is in your System
Find out how long cocaine could be detectable in your body for a drug test.
http://www.howlongdoescocainestayinyoursystem.org
Cure for heart disease
Learn about the cause and treatment for various types of heart diseases. Understand the facts and myths about heart diseases.
http://www.cureforheartdisease.org
Mobility Product Online – Great Value Electric Scooters, Wheel Chairs, Walking Sticks, Commode
Chair Welcome to Mobiliti.co.uk – UK based supplier. Comprehensive range of elderly and disabled Online mobility products. Including motorised scooters, wheel chairs, bathrooms aids, home and daily living aids, orthopaedic support and much more.
http://www.mobiliti.co.uk/
The Merrell Clinic
Sleep clinics specializing in oral appliance therapy for snoring and sleep apnea. Serving patients throughout Alberta and across Canada and the USA.
http://www.merrellclinic.com
Mesothelioma with Type, mesothelioma lawyers, Symptoms, mesothelioma attorney, Causes and Treatment Mesothelioma with Type, mesothelioma lawyers, Symptoms, mesothelioma lawyers, Causes and Treatment
http://www.atledo.com/cancer
Artherosclerosis
Website dedicated to explaining primary pulmonary hypertension, high blood pressure symptoms, causes, investigations and treatment. Ischaemic heart diseases such as hyperlipidemia and artherosclerosis and high blood pressure diet will also be described.
http://www.what-is-hypertension.com
Mesothelioma Information. Are You At Risk?
http://mesotheliomastraight.net/asbestos
Sarasota Interventional Radiology Technologies a Cancer Hospital
Radiation therapy is successful way to treat many kinds of cancer in different part of the body without surgery and stitches and with less pain at affordable cost.
http://www.sivr.net
Great knowledge portal of cancer
The website provides general knowledge of cancer for self-study. There are also information about how to give the treatment to patients, fundamental treatment as well as stories and experience from specialist in this filed.
http://www.cancerdelete.com
Sciatica
A plethora of free sciatica information, including anatomy, causes, symptoms, diagnosis and treatment of sciatic nerve pain, written by an actual recovered patient.
http://www.sciatica-pain.org
Herniated Disc
Comprehensive herniated disc resource written by a recovered disc pain patient. Learn all about disc herniations, degenerative disc disease and treatment options.
http://www.herniated-disc-pain.org
Find Herniated Disc Treatment
Are you looking for herniated disc treatment? Check out this website with complete information on herniated disc.
http://www.herniated-disc-treatment.net
Sleeping Medicine New and Information
Offering Sleeping Medicine News and Information. Zolpidem, Lunesta, Sleep Prescription Information. Sleep better with out Sleeping problems, sleep natural and without addiction to sleep aids.
http://www.sleeping-medicine.com
Tips for Disease Treatments
Offers insightful information to help identify treatments of some diseases and conditions, including rheumatoid arthritis, menopause, high blood pressure, female herpes, diabetes and many others to assist you and your loved ones address various ailments.
http://www.diseasetreatmenttips.com
Chronic Bronchitis – What Exactly Is It?
Chronic Bronchitis Information – Chronic Bronchitis Signs and Symptoms, Treatment Options, and More. Articles, News, Pictures, and Videos related to Chronic Bronchitis.
http://www.chronicbronchitishelp.com
Colon health – About Colon Health.
If you think that you may have a problem with your health You owe it to yourself and your family to read these articles.
http://www.ahealthycolonnow.com/
Intestine Cancer Information
Small-intestine-cancer.com is an informational resource on Intestine cancer. It is useful for patients and the public. The site describes what is Intestine, Intestine Cancer, what are its diagnosis and tests, what is its treatment.
http://small-intestine-cancer.com/
Stomach Cancer
Stomachcancersite.com provides excellent information on stomach cancer for patients and others. It has sections on what is stomach cancer, what are its stages, its symptoms and signs. It also has section about gastric cancer.
http://www.stomachcancersite.com/
Testicular Cancer Information
Testicularcancersite.com provides a detailed resource for Testicular Cancer to the patients and general public. The site has sections on how Testicular Cancer happens, what are its signs and symptoms, what are its stages, what is its treatment.
http://www.testicularcancersite.com/
Diagnosed with mesothelioma
If you are diagnosed with mesothelioma, a deadly cancer caused by asbestos exposure, the experienced mesothelioma attorneys of the Johnson Law Group can help you seek financial compensation. The Johnson Law Group offers free mesothelioma case evaluation…
http://www.nickjohnsonlaw.com
Top Acne Product Reviews
Acne Relief Guide for Top Acne Products and Treatment Reviews. Acne products to make you look and feel better and raise your self esteem.
http://www.acnereliefguide.com
Pinched Nerve Treatment with Neck Traction
Neck traction device relieves the pressure on the neck by stretch the cervical disc. Neck traction is used to treat neck spasm and compressed disc causing neck and shoulder pain.
http://www.chisoftnecktraction.com
Headache Symptoms
What is headache pain? It’s one of the most common complaints and may be frequent for some people. Learn about different types of headaches and migraines.
http://www.headachesymptoms.org
Chronic Back Pain
We provide resources and proven ways to help in preventing and combating all kinds of back pains for all back pain patients…
http://www.backpainclub.com
Symptoms of Diseases
Offering insightful information to help recognize symptoms of diseases, including Attention Deficit Disorder, teenage depression, stages of Herpes, about Alzheimer Symptoms and many others to assist you and your loved ones to spot early warning signs.
http://www.diseasesymptomtips.com
Fungal Skin Infections
Footessentials provide a range of natural alternative products. Essential Oils have many therapopertiproperties; most are anti-bacterial and naturally effective to optimise health and wellbeing without any side effects.
http://www.footessentials.co.uk
Plateltex: Gel for fast lesion recovery
The autologous Platelet-Rich Plasma (PRP) is a blood derivative containing the patient own platelets concentrated up to tenfold the original blood concentration. It is the blood component necessary to prepare the platelet gel.
http://www.plateltex.com
Fungal Skin Infection
Fungal Skin Infections are caused by bacteria called Staphylococcus. These Bacteria live harmlessly on the skin, especially around the mouth and nose.
http://www.improveskinhealth.com
Spinal Stenosis Surgery
If conservative treatments for spinal stenosis have failed you, is it time to consider spinal stenosis surgery?
http://www.stenosis-spinal.com/spinal_stenosis_surgery
Foot pain treatment with docpods orthotic innersoles
Foot aches and pains are often caused by misalignment of the foot and lower limb. This is usually due to over pronation. Docpods orthotics correct lower limb missalignment and help to relieve foot and lower limb pains…
http://www.docpods.com.au
Genital Herpes, Information, Best Natural Treatment
Genital herpes may be easily controlled, eliminated and healed with masterfully combined essential oils. They go to the heart of the problem and eliminates it.
http://www.naturalskinrepair.com/genital-herpes.html
Symptoms of asthma
Asthma is one of the diseases that can be kept in strict control if it is diagnosed early enough. The trouble is that early symptoms of asthma seem to be just fatigue, and is usually interpreted as such.
http://athomeasthmacare.info/
Nasal Spray Addiction: Serious Business
This page examines the possible dangers of becoming addicted to nasal sprays and decongestants.
http://www.nasalspraycraving.com
My Cancer Fund
http://www.mycancerfund.net
Lupus Symptoms and Treatment
Symptoms of lupus concentrates on the difficulty in diagnosing the different types of lupus, the symptoms often present and the treatment of this disease. Symptoms of Lupus also concentrates on the lifestyle changes necessary for living a normal life…
http://www.symptomsoflupus.info
Hair Loss Product Reviews – Hair Loss Product
Read hair loss product reviews for the latest and most popular hair loss treatments and products and find out which ones actually works.
http://www.hairlossproductreviews.net
HELPPNEUMONIA.COM
Find out about pneumonia.
http://www.helppneumonia.com/
Kidney Disease
Kidney disease and other related information.
http://www.helpkidneydisease.com/
Testicular Cancer
Testicular Cancer
http://www.helptesticularcancer.com/
Eczema
Find the solution to your skins needs.
http://www.helpeczema.com/
Ear Ache
Ear Ache help. Find some of the causes and solutions to ear aches.
http://www.helpearache.com/
Treat Cancer
Cancer treatments. Find the right cancer treatment for you.
http://www.helptreatcancer.com/
Ailment Control Articles
There are some easy yet highly valuable tips regarding Ailment Control that can make a world of difference in the condition of a patient.
http://ailmentcontrol.com
The Senior Alliance, Help for Alzheimers, Chronic Pain, Parkinsons Disease and more
An alliance of over 50s working together to find good health information based on sharing our experiences, join us to help yourself and others.
http://www.senioralliance.co.uk
Infertility, Fertility & IVF Clinic for Male & Female: Malpani Infertility Clinic.
Dr Malpani Clinic: Infertility, Fertility & IVF (In Vitro Fertilisation) Clinic for Male & Female in India. Also offers Ovulation Calculator & Ovulation Calendar facilities. India based Infertility & Fertility Clinic offers Information.
http://www.drmalpani.com
How To Get Rid Of Stuff
Learn how to get rid of anything: get rid of stretch marks, sunburn, dandelions, the flu, telemarketers. Our database of articles will help you get rid of anything you need.
http://www.howtogetridofstuff.com
Laser Eye Surgery
Health lasik eye surgery to improve your vision to better than 20/20 Large Description: Lasik eye surgery most advanced FDA approved technology to improve your vision to better than 20/20 lasik eye surgery.
http://www.lalasik.com/
Fibromyalgia
Fibromyalgia information and articles
http://www.fibronews.com
Sun Protection, Sun Protective Clothing.
If I Knew the Benefits That I Know Now Sun protection is a fact of life. It must be done daily in order to prevent or delay skin cancers such as melanoma. Your eyesight might be in danger too.
http://www.sun-protection-and-you.com
Cures and Self Help for Generalized Anxiety Disorder and Depression
Site includes studies into child depression, hierarchy of needs, TV viewing effects and patterns of thinking. Anxiety in education and the workplace, office stress management and confident public speaking are also addressed.
http://www.anxietymadewell.com/
End Your Chronic Low Back Pain For Good?
If you’ve been suffering from chronic pain in your lower back, leg, or neck and shoulders, you know how frustrating it can be to get the help you need to end your pain and suffering.
http://www.arizonabackinstitute.com/
Cancer Assistance Information
Offers insightful information about cancers, symptoms and treatments that include chemotherapy effects, breast cancer signs, brain tumor symptoms, pancreatic cancer symptoms, ovarian cancer warning signs and many others to assist you or your loved ones.
http://www.cancerinfotips.com
Is Steam Good For Acne
Learn how to steam your face correctly so that it can help your acne. Does steaming your face help acne, Yes, if done correctly.
http://www.acnetreatmentspecialist.com/Does-Steaming-Your-Face-Help-Acne.html
Hair Loss, Thinning Hair, Hair Thickener, Hair Baldness, Hair Camouflage, Hair Loss Woman, Hair Bald
We are offering hair care products of hair loss, thinning hair, hair thickener, hair baldness, hair loss woman, hair balding, hair camouflage, hair loss product, hair transplant, hair treatment, hair replacement system, non surgical hair replacement.
http://www.nanogenindia.com/
Your Guide to Obesity
If you’re looking for informations on Obesity, you can find it all here.
http://www.onlineobesityguide.com
Is There A Genital Wart Cure?
Learn what you can do about resolving your genital warts. There are more medical options available than you might think. Find out the real skinny about those irritating warts.
http://www.genital-wart.org
Wellness for Mind, Body and Spirit
A compilation of articles relating to wellness and unwellness. Health as well as diseases are included.
http://www.mesowellness.co.cc
Hemroids treatment
Hemroids.info is an online resource for getting useful information on hemroids, types of hemroids- internal hemroids, external hemroids, bleeding hemroids, hemroids cure, treatment, medicine and more interesting
information on hemroids.
http://www.hemroids.info
Mesothelioma Help
Offering news and stories and help about mesothelioma, it’s causes, symptoms and treatments.The website has a directory of treatment centres both in the UK and USA
http://www.beatmesothelioma.com
Autophagy
Abgent has the most extensive collection Abgent has the most extensive collection of autophagy antibodies.of autophagy antibodies.
http://www.abgent.com/doc/autophagy
Safe, Local, Fast STD Testing – SafeLabCentre.com
SAFE, LOCAL, FAST STD TESTING! Confidential STD Testing Centers For Chlamydia, Gonorrhea, HIV, Herpes, Hepatitis, and Syphilis.
http://safelabcentre.com
Heel Pain Information and Treatment
Information about heel pain, heel spurs and Plantar Fasciitis. Effective, affordable relief with heel pain orthotics and exercises.
http://www.heelpain.net.au
Autism in the UK
Autistic children find it extremely hard to communicate verbally.
http://www.elstreemedical.co.uk
Aids-Drugs-Online AIDS Drugs – Save big by switching to generics AIDS Medicines!
Aids Drugs – Save money on AIDS medicine! We offer only generic medicines like Viraday, Duovir, and Abamune. Come see how much you can save today!
http://www.aids-drugs-online.com/index.php
Acne Scar Natural Treatment
Your Guide On How To Prevent Acne And Reomve Acne Scars – Acne Scar.
http://www.acnescarnaturaltreatment.org
Sleep Advice – Our experts will help you and your family sleep better
Sleep Advice is written by sleep experts to help readers find solutions for sleep, rest and relaxation. Our experts frequently review sleep products and recommend solutions to help you and your family sleep better.
http://sleepadvice.blogspot.com/
What is Diabetes?
Informative web site diabetes mellitus, with information on the various types of diabetes, new on diabetic research and the assorted treatment and medication options commonly used. Website also offers a cookbook of recipes for diabetes.
http://www.informationaboutdiabetes.com
Its All About Cancer
Its all about Cancer, Cancer, Types of Cancer, Causes of Cancer, Symptoms of Cancer, What is Cancer?, Breast Cancer, Causes of Breast Cancer, Types of Breast Cancer, Symptoms of Breast Cancer, What is Breast Cancer?, What is Brain Tumor, cause and …
http://its-all-about-cancer.blogspot.com/
Mesothelioma Orange
All the things you need to know about mesothelioma. Causes, treatments, symptoms, lawsuits, lawyers, attorneys…
http://mesothelioma-orange.blogspot.com
Acne Products Guide
Research many methods of acne treatment and removal, realizing surgical intervention may be of some use, allowing a laser to help remove the first dead layer of skin leaving the healthy and vital skin behind, having many different great opinions on…
http://www.acnecentre.com/
Health The Greatest Gift of God
Important information related to health, healthy lifestyle, healthy food, disaese, treatment, medicine, recent updates, alerts on recent outbreaks.
http://healththegreatestgiftofgod.blogspot.com/
TMJ Treatment – Dr. Martha Cortes – Mnahattan, NY
Dr. Martha Cortes is a dentist in Manhattan, NY and provides a safe and fast way to treat TMJ Disorders and headaches.
http://www.tmjdentistny.com/
Cancer plus about cancer and healthy
http://cancerplus.co.cc
Nutrition and Diabetes
This page within the site talks about eating properly with diabetes. There are tips and many recipe suggestions throughout the site.
http://www.diabetesandrelatedhealthissues.com
Smoking Cessation Lasers
Los Angeles clinic offering therapies including weight loss, sleep apnea, smoking cessation, and insomnia.
http://www.alpsmedicalcenter.com/
Cancer Information, Cancer Facts, Cancer Cure
Facts & information on what causes cancer and how to cure it through lifestyle changes which include diet, exercise and the removal of the factors that have caused it.
http://www.cancerhealed.com
Acne-Natural Cures & Info
A comprehensive Acne information site providing helpful tips and solutions for getting rid of acne.
http://www.debsinc.biz/Acne
Prevention and Management of Diabetes
Learn about diabetes – Causes, symptoms, risks, diagnosis, types and treatment options such as medication, diet, exercise, and other lifestyle changes on diabetescondition.com.
http://www.diabetescondition.com
Prostate Cancer and it’s Dangers
Prostate Cancer is the most common form of cancer in men. It is a complex disease that mainly affects older men and is the second highest cause of death from cancer.
http://www.prostate-cancers.info/
Foot & Ankle Doctor Podiatrist Physician Los Angeles Beverly Hills Thousand Oaks Bunion Surgery
Treatment for bunions, hammertoes, diabetic ulcers, heel pain, toenail fungus, toe problems, foot injuries, ankle pain, foot surgery. Foot Doctor Podiatrist Los Angeles Beverly Hills Thousand Oaks.
http://www.lafootdoc.com
Remedies and Therapies Information
Information, books and remedies on the uses of alternative medicines and therapies, the use of natural herbs, Chinese and Indian medicines, acupuncture, homeopathy, aromatherapy, wellness medicine, diabetic medicine and more.
http://www.altmedtherapy.co.uk
Simple Acne Treatment
http://SmoothMoistSkin.com
Glucose
In this Web Site you can find the best fat burner in the whole Internet, Glocobreak is an innovative, convenient, great tasting and fat-free glucose spray. It can be used as an aid for diets.
http://www.glucobreak.com
The Yeast infection cure center
Yeast infection cure center is a website that shows not only the cure from yeast infection it also shows the prevention from yeast infection. For the treatment of yeast infection you can go both by medical drugs of by natural.
http://www.yeastinfectioncurecenter.com
Type 2 diabetes
Diabetes blog keeps you up-to-date to the latest news on How to Beat Diabetes. Diabetes Blog – provides information on diabetes, symptoms of diabetes, type 1 and type 2 diabetes and more.
http://diabetes-info-site.com/
Generic Drugs by Genericdrugstoday and generic drugs information and drugs at low price.
Buy generic drugs online from generic drugs today for your health related problems, get prescription, drug information, side effects of drugs.
http://www.genericdrugstoday.com
Hemorrhoids Photos and Pictures
Several medical grade photos and pictures of hemorrhoids are presented along with their differentiating description, to allow one to see what a hemorrhoid is and how they can be different according to their type – internal, external or thrombosed.
http://www.hemorrhoidshemroids.co.uk
Treat Hemorrhoids
Find out the best ways to cures hemorrhoids. Hemorrhoid-Cures.com also provides in depth information about all forms of hemorrhoids including external, internal, thrombosed, and prolapsed hemorrhoids.
http://www.hemorrhoid-cures.com
Tips to Sleep Better
Informative site with articles on the common causes of sleepless nights, how to get past them and also highlights the dangers of sleep medicine.
http://www.mysleepingtips.com
Thyroid information
Get hyroid help via new and information at thyroid talk
http://www.thyroidtalk.com
Healthy Tips Magazine – Healthylife99.com : All Information To Care Your Health
Find The Secret To Care Your Heath That You Have Never Known Before.
http://www.healthylife99.com
Procerin | Procerin.name
Procerin – Male pattern baldness happens because of a male hormone called DHT. Procerin is the natural DHT blocker and it is good for your overall health. Procerin offers 90-day money back guarantee.
http://www.procerin.name/
E Treatment For Diabetes Type 2 and All Diseases
Getting rid of diabetes is impossible with allopathy. E Treatment heals effectively not only for diabetes, but also for most other so called incurable diseases.
http://www.new-treatment-for-diabetes-types.com
How To Prevent Head Lice
Learn how to exterminate the The bane of many parents life – the head lice.
http://www.lastheadlice.com
Congenital heart defects blog information of congenital heart defects
http://adamrizky-congenitalheartdefects.blogspot.com
Addiction Treatments, Drug Rehabs Treatment, Substances Available for Addiction
Dedicated to help the addicts and their families to find the right drug related information in detailed.
http://www.addiction-treatments.com/
hernia pictures, hernia repair, hernia news
Learn about the different methods of hernia repair and the road to recovery from hernia patches to hernia surgery alternatives.
http://www.herniasymptoms.org
Arthritis Pain Relief | Arthritis Joint Pain Relief
Arthritis Pain Relief – Knowing what you want for your pain relief is important, so asking the right questions will give you an idea of whether the product is right for you or not. Learn more about Arthritis pain relief.
http://www.arthritispainrelief.in
Procerin Side Effects
Procerin Side Effects – Does Procerin have any side effects? Procerin is a natural hair loss product and it is free of side effects. Procerin offers 90 day money back guarantee.
http://www.procerinsideeffects.com/
Diabetes | Type 2 Diabetes | Type 1 Diabetics
Diabetic Connect is an online community for Diabetics and those caring for Diabetics. The community offers support for anyone living with Diabetes – including Type 1 diabetes, Type 2 diabetes, and gestational diabetes.
http://www.diabeticconnect.com
Automatic Blood Pressure Monitor
Two separate measurements are always taken. The systolic blood pressure is the force exerted on the walls of the blood vessels while the heart is contracting or pushing the blood.
http://bloodpressurekrnls.com/
Arthritis Pain
Arthritis Pain – If you have joint pain from arthritis or sports-based injuries, there is now a supplement available called Synotrex. It is a natural supplement that is made with ingredients and will help for your
Arthritis Pain.
http://www.arthritispain.in
Procerin | Hair Loss
Procerin – The only way to end male pattern baldness, is to block DHT from being produced or to block it from the scalp. Procerin is a DHT blocker, and it is very effective for treating male pattern baldness.
http://www.procerin.in
Skin Disease
Information about Skin disease treatment, skin care, dermatology, various skin infections, fungal infections and disease.
http://www.skin-disease.org/
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http://www.cdadc.com
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http://www.cholesterolcholestrol.com
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Ecstasy Abuse Hurts – Stop the Hurting
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http://www.EcstasyAbuse.net/
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http://www.heart-valve-surgery.com/aortic-stenosis-valve-heart-narrowing.php
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http://simplewebsurf.com/best-time-to-get-pregnant/
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Heart Specialists – Florida Hospital Cardiovascular Institute
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Living with nightmare headaches is hard; learning to manage your pain, interpret your symptoms could change your life! We hope that you will find these articles at nightmare headaches.com useful.
http://www.nightmareheadaches.com
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Infertility Natural Treatments
Free online resource to learn more about male and female infertility natural treatments and find out the real cause of infertility.
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Heart attack Recovery & Heart Disease Prevention
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http://heart-attack-and-heart-disease.com
Picture of Hemorrhoids
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http://www.hemorrhoidshemroids.com
HydroPulse Nasal Irrigation
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http://www.sinusirrigation.org
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Health related message boards offering discussions of numerous health topics including allergies, cancer, diabetes, heart disease, exercise, attention deficit disorder, diet, and nutrition.
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Decrease Cholesterol
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Female Hair Loss
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http://www.belgraviacentre.com
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Welcome to Candida Albicans Infection, your source for candida info.
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The National Kidney Foundation, Inc., a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability…
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http://www.stoprestlesslegsyndrome.com
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http://www.futuretechtoday.com/health/
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Morgellons (also called Morgellons disease or Morgellons syndrome) is a name given in 2002 by biologist Mary Leitao to a condition characterized by a range of cutaneous (skin) symptoms.
http://morgellons-disease.info
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http://www.diabeteshelpkit.info
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http://www.HairSite.com
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Post Nasal Drip
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All About Diabetes
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Child Sleep
Professional infant and child sleep specialist Dana Obleman. I’ve already helped thousands of parents just like you solve their children’s sleep problems, and now I’d like to help you, too!
http://www.sleepsense.net/
Comprehensive Kidney Facts
This site provides comprehensive information about the kidneys including kidney anatomy, kidney functions, kidney diseases, and kidney health. Information is presented in simple easy-to-understand language, with appropriate pictures and diagrams.
http://www.comprehensive-kidney-facts.com/
Information on What is Mesothelioma
A guideline information on mesothilioma, its affects, and how to handle it. Also provides information on the options available after mesothilioma.
http://www.aftermesothelioma.com
Information on What is Hypothyroid?
The author herself is a hypothyroid patients and shares her information. The site gives basic / important information related to hypothyroid, which includes some basic terminology lik t3, t4, tsh etc.
http://www.about-hypothyroid.com
Diabetic Gift Baskets
Resource website for continuing education on diabetes cures and treatments, diets, menus, diabetes awareness bracelets and diabetic supplies. Learn about the different types of diabetes.
http://www.learn-about-diabetes.com/
All About Your Family Health
Maintaining the health of your family is no easy task these days but our approach to family health is based on the knowledge that there is a better way to prevent and protect yourself. Get important info here.
http://www.yourtipsabout.com/
www.allaboutbackpains
Information about how to treat, prevent and causes of back pains.
http://www.allaboutbackpains.com
Spinal Stenosis and Disc Center
A world famous Southern California clinic specializing in the treatment of low back pain problems such as sciatica, spinal stenosis and disc herniation.
http://www.wevegotyourback.org
Stop snoring
There are many remedies to stop snoring, but as snoring can not only cause sleep problems but also health problems you want to find a solution that is proven to work. Medident Sleep Clinic is among some of the best and most trusted sleep clinics.
http://www.sleep.net.au
Acne Treatments | Acne Control | Acne Treatment
The Acne Treatment Control website offers acne sufferers information, help and advice on the prevention, control, medicine options and treatment of acne. The site is also an invaluable resource for the friends and family of acne sufferers.
http://www.acnetreatmentcontrol.com
The Blood Pressure Reduction Guide
The Blood Pressure Reduction Guide All the latest news and research on the high blood pressure – Sign up for our free newsletter and discover natural ways to lower blood pressure safely.
http://www.natural-blood-pressure-reduction.com
Demystify Cancer
This site aims to demystify cancer so that you know more about cancer to help you and your loved ones cope with cancer. It provides cancer guide – on cancer prevention, cancer symptoms, cancer treatment and cancer hope.
http://www.demystifycancer.com/
Say Goodbye To Hemorrhoids, 100% Naturally.
The symptoms, causes, treatment, and prevention of very commonly occurring swollen veins in the rectum. Natural Remedies for Digestive System Diseases, Anorectal Disease, Hemorrhoids. Home Patient Care Management.
http://www.nohemorrhoids.net
Health Directory, Diseases and Conditions, Medical, Beauty & Weight Loss Information
At Sicknessdirectory.com you may obtain health listings by click via our valuable related category containing drug abuse, alcohol treatment, increase health, medicare, health, cancer, HIV/AIDS, insurance, hepatitis, wellness,…
http://www.sicknessdirectory.com/
Sitagliptin Phosphate Drug for Diabetes by Merck – Januvia Metformin
Get the latest and most updated information about Sitagliptin.
http://www.sitagliptin.org.uk
Muscular Dystrophy
Muscular dystrophy treatment, diagnosis, symptoms and causes with detailed articles from professionals.
http://dystrophy.com
Citalopram and bipolar depression
While most people have heard about manic depression, which is also known as bipolar disorder, you may be wondering what is bipolar disorder.
http://www.bipolarsickness.com
Psoriasis Treatment Reviews, Cures & News | PsoriasisToday.com
PsoriasisToday.com – Psoriasis Treatment Reviews, Cures & News.
http://www.psoriasistoday.com
Normal Cholesterol Level
Learn about high cholesterol cure and how you can design your own diet to lower your cholesterol level back to normal.
http://www.highcholesterolcure.net
Social anxiety disorder
Is anxiety crippling your ability to live a normal life? Find what new treatments are available to those suffering from this debilitating disease.
http://www.anxietyinamerica.com
Asthma Cure
Find out the best asthma cure, understand asthma symptoms and the cause of asthma.
http://www.asthmasymptomcure.com
Acid Reflux Relief Explained
Premium resource discussing acid reflux disease symptoms and relief methods. It also covers the cause of acid reflux and other alternative treatment methods.
http://www.acidrefluxexplained.net
Sleep Apnea Symptoms
Offers general information, including symptoms, risks and treatments. Includes lists of professionals and health centers.
http://www.sleep-apnea-explained.com
Depression Information – Online Depression Help
Information about depression its symptoms, causes, types and treatments.
http://www.onlinedepressionhelp.com
Rosacea
Provide information about rosacea, it causes, symptoms and many more things.
http://www.allaboutrosacea.com
Acid Reflux Symptoms
Get the right food plans for acid reflux diet and understand what foods that cause acid reflux symptoms.
http://www.acidrefluxdiets.net
Homeopathic Remedy For Acid Reflux
Free resource on acid reflux remedy, including homeopathic remedy and other natural remedies for acid reflux.
http://www.myacidrefluxremedy.com
Natural Cure For Heartburn
One stop resource on herbal heartburn remedies, learn about the cause for heartburn and natural cure for heartburn.
http://www.herbalheartburnremedies.com
Sleep Apnea Cures
The site is a resource site for sufferers of sleep apnea. We provide information on sleep apnea symptoms and sleep apnea treatments. However, it is always best to consult a Doctor as we are not physicians. Sleep apnea is a chronic disorder that can be…
http://www.mysleepapneacures.com/
Acne Scars Causes, Types, Treatments and Medication – Acne Marks
Offers information on acne scars its causes, types , treatments and medication.
http://www.acnemarks.com/
Best Acne Skin Care Product to Cure Acne Without Side Effects
The best acne skin care Product to cure acne without any side effects.
http://www.acneless.com/
Symptoms Of Cancer
In this cancer resource blog, you will find sign and symptoms of different types of cancer, causes of cancer, and cancer treatments.
http://www.symptomofcancer.com
Health Diseases and Disorders Treatment
Guide to provide information on all common diseases and health conditions with symptoms, causes, diagnosis, and treatment methods as how to overcome them.
http://www.diseasescure.com/
Rare Skin Diseases and Disorders
Get complete cure for various skin diseases and disorders types, problems and common conditions including treatment options for many rare skin disorders and diseases.
http://www.theskindiseases.com/
Drug Rehab – Narconon Arrowhead
Highly successful drug rehab program where 76% of graduates stay drug free. Call 1-800-468-6933.
http://www.stopaddiction.com/
The Anxiety Help
Provides information about anxiety management its symptoms,causes and treatment.
http://www.theanxietyhelp.com
Bird Flu Questions
You do not even need to look very far to find some information on birdflu. No need to look even very much further, past the recent and numerous headlines, WHO (World Health Organization), mainstream media, press, news-releases and warnings etc…
http://www.birdfluquestions.net/
Longwood Chiropractic
Whether you need a comprehensive treatment plan, an adjustment or therapeutic massage, you can expect to receive personalized attention and unsurpassed care.
http://www.lakemarychiropractic.com
FindaChiropodist.co.uk | Find a Chiropodist UK | Find a Podiatrist | Foot Problems
Find a Chiropodist lists over 4500 qualified chiropodists and podiatrists in the UK, all registered with the Health Professions Council. Also offers advice on common foot problems, painful feet and footwear.
http://www.findachiropodist.co.uk
Cholesterol Facts: Helpful Cholesterol Facts To Make Life Easier
Cholesterol Facts: Helpful Cholesterol Facts To Make Life Easier.
http://www.cholesterolfactsonline.com/
Dermatoscopes.com – the advantages of dermatoscopy
Reviewing the advantages of dermatoscope use.
http://www.dermatoscopes.com/advantages-of-a-dermatoscope.shtml
Drug Rehab
Locating drug rehab and alcohol rehab programs anywhere in the U.S.
http://www.drug-rehab-locator.com
Free Symptoms of Diabetes Alert
Our mission is to help improve the quality of diabetes care, increase the understanding of the disease, and motivate people to request for help, change life style and engage in self-care for without patient participation, disease management will be…
http://www.free-symptoms-of-diabetes-alert.com
Colon Cleansing: Natural Health for your intestines
The secret to great health can be described in three words: Cleanse Your Body. Natural Colon Therapy offers free, expert advice on colon cleansing, how to do a colon cleanse, product reviews, and why we need cleansing.
http://naturalcolontherapy.com
Diabetes Mellitus Information and Diabetes Treatment
Diabetes Information and Diabetes Treatment Guide. Diabetes Types, Symptoms, Foods, Diet, Vitamins, Herbs, Exercise, Books and more.
http://www.diabetesmellitus-information.com/
Addiction Rescue
information about addiction its causes, symptoms, types and treatments.
http://www.addictionrescue.com
Diabetics Aid
Information about diabetes its causes,symptoms and treatment.
http://www.diabeticsaid.com
Cancer Information – Real Cancer Information
Information about cancer its causes,symptoms,types and treatments.
http://www.realcancerinfo.com
Acai Berry an extraordinary antioxidant-rich palm fruit
AcaÃ berry has a unique tropical fruit flavor and provides a high level nutritional benefits.The acaÃ berry contains high levels of antioxidants also known as anthocyanins.
http://www.acaiberryjuice.org
Verteran Mesotheliom Cancer
Veterans Helping Veterans provides information Veterans With Mesothelioma, Cancer Information Mesothelioma, Veteran Mesothelioma Cancer,Asbestos Cancer Mesothelioma, Mesothelioma Cancer Treatment, Cancer Health Mesothelioma.
http://www.mesothelioma-veteran.com
Mesothelioma Cancer
Find The Facts About Mesothelioma Cancer, Peritoneal Mesothelioma, Pleural Mesothelioma, Pericardial Mesothelioma, Asbestos Lawyer and Treatment for Mesothelioma.
http://www.peritonealmesotheliomacancer.org
Amazingly Simple Secret of weight loss
Burn Fat, Lose Weight w/out The Gym Let Christopher Be Your Personal Trainer. It’s Time To Toss Those Fat Pants In The Trash Forever.
http://www.thetotalbodytransformation.com/
Women and Pregnancy Care
Your Ultimate source for women health care, providing information on pregnancy, baby care, women health and pragnancy & women complication with symptom and treatment.
http://www.women-health-guide.com/
Health Doctor – Diseases Information
Information on many diseases like heart diseases, respiratory diseases, and many common ailments, showing cause, symptoms, and treatment with explanation as to how to overcome them, without resorting to medicines.
http://www.health-doctor.org/
Metabolism Diet
If you want to improve metabolism as well as increase metabolism and boost metabolism please review our website for more information.
http://www.maximizeyourmetabolism.com/
Essential Tremor – The Essential Facts
Essential Tremor is a condition which causes uncontrollable shaking.
http://www.essentialtremorinfo.com
Lower cholesterol
Cholesterol guru is free online cholesterol web site with best tips to lower your cholesterol in body ,health care and much more.
http://cholesterolguru.com/
Health Problems Articles
Authorative and comprehensive guide to health care, including articles on health problems and health and nutrition related topics.
http://www.health-care-articles.info/
Natural Cure for Genital Warts
Curing Genital Warts Naturally Guides. Includes genital warts symptoms, genital warts pictures, genital herpes etc.
http://www.genitalwartsonline.info
Blood Pressure Manual
Blood pressure manual with complete information on high blood pressure and low blood pressure there symptoms,monitoring ,controling pressure and much more.
http://bloodpressuremanual.com/
What is Sleep Apnea
What is Sleep Apnea. Online guide to symptoms of sleep apnea. Diagnosing and treatment. Informative tips for sleep apnea sufferers and family members.
http://www.sleepapneaanswers.com
Diabetes Diet
Dabetic Diet is the diet for diabetic patients in order to maintain ideal body weight, by providing adequate nutrition along with the normal blood sugar levels in blood. The diet plan is based on height, weight, age, sex and nature of diabetes.
http://diabetesinformationhub.com/DiabetesDiet.php
Online Medical Clinic
Information on diseases and conditions, home remedies, cancer prevention and more related health topics. Information on health topics, including news, discussion and health care services.
http://www.online-medical-clinic.com/
Skin Disorders and Diseases
Get information on skin disorders and skin diseases. Find detailed information on various common skin disorders including its causes, symptoms and effective treatment methods.
http://www.theskindisorders.com/
Diseases Treatment Information
Find treatment methods for treating various health diseases and disorders. There are a number of diseases, some serious, others not so serious, which are either incurable or can be cured only with great difficulty.
http://www.diseasestreatment.com/
Lice Treatment
Nix is the # 1 head lice treatment solution used by professionals. Nix louse prevention & elimination products help you remove headlice safely, effectively, and easily. Run lice, run! Call us at 1-888-542-3546 now.
http://www.nixlice.com/
Diabetes causes
Get latest information on diabetes, its treatment, prevention and cure of diabetes. This site provides the overall detailed knowledge knowledge about diabetes.
http://www.diabetescauses.org/
Arthritis symptoms
Information on arthritis conditions includes symptoms, causes, medications, and treatment. Find arthritis health articles and type of arthritis.
http://www.arthritissymptom.org/
Asthma attack
A blog for asthma information relating to asthma symptoms, asthma treatment, medications, types, asthma in children and adults, causes of asthma attacks.
http://www.asthma-attack.org/
Sweat-Stop stops sweating!
Sweat-Stop is an antiperspirant developed for people who suffer from excessive sweating or… hyperhidrosis.
http://www.sweat-stop.com/en
Diabetes Blog, Diabetes Symptoms, Diabetes Treatment and Diet Care
Latest information, news and tips on diabetes diet care.
http://www.thediabetesblog.net
Understanding Heartburn
Heartburn affects millions of people around the world, but there are cures for heartburn for those that suffer from this condition. To learn more visit Learn About Heartburn for more information.
http://www.learnaboutheartburn.com
Infant eczema
Infants eczema is a resource for factual information about infant eczema, how to deal with infants eczema and what products to use to avoid irritating skin.
http://www.infantseczema.com
Effects of Diabetes
What is diabetes exactly? Diabetes is an incurable metabolic disorder characterized by abnormally high urine production and excessive thirst. Although diabetes is incurable, there are several ways an individual may manage effects of diabetes.
http://www.effectsofdiabetes.com
Diseases & Conditions – A to Z Health Solutions
This guide clearly is intended to provide information on all common diseases and health conditions with symptoms, causes, diagnosis, and treatment methods.
http://www.healthatoz.info/
Skin Disorders Treatment Solution
Skin-Disorders-Guide.com helps you to get complete cure for various skin diseases and disorders types, problems and common conditions including treatment options for your complete skin care.
http://www.skin-disorders-guide.com/
Aids Directory, Treatment and Therapies, Clinics and Practices
Provides the useful service in finding acquired immune deficiency syndrome (AIDS), organization, disease, treatments, medications, sexuality, treatment guidelines, vaccines for patients and more.
http://www.aidsindex.com/
Health Disorders and Health Diseases
Health-Disease.org offer advice on how to maintain a healthy lifestyle from infancy to old age. The aim is to give an overview of common illnesses, consider the symptoms, signs, possible causes, treatment and the likely outcome.
http://www.health-disease.org/
The Cure For Heart Disease
Heart Disease….Will it kill you? Or, Will you cure it. Heart Diseases because of fat content, cholesterol etc..
http://thecureforheartdisease.net
Diabetes Facts
The aim of the site is to inform the user about the diabetes condition. It includes information on the two main types of diabetes and how to identify them. Advice on how to treat diabetes and how to take care of the condition is also provided.
http://www.diabetesdiscussion.net/
Pneumatic Compression Device
Venous ulcers are sores that develop after veins in the legs have been damaged. These ulcers are common, costly to treat, and respond best to early diagnosis and treatment.
http://www.remarxservices.com/
Remove Cellulite
Looking for information on cellulite, its causes and tips to prevent it. Are you one of the 90% of the females who suffer from cellulite aka fat gone wrong and want information to get rid of it.
http://www.combat-cellulite.com
Alcoholism Search Engine
Information on Alcoholism, alcohol abuse, and alcoholism treatment alternatives can be found by using this specialty search engine.,
http://www.Search4Alcoholism.com
Cancer survival
Nasopharyngeal cancer (NPC). I was diagnose with NPC on 17th March 2005 and after going through my treatment; I’m now cancer free since 4th May 2007. Therefore I would like to share with everyone about the experience that I had went through.
http://www.michaelgan.net
Irritable Bowel Syndrome.
Control Irritable Bowel Syndrome by using positive mental attitude. Experts agree this is the best way fowards. Positive thoughts attract positive results.
http://www.healingibs.com
Yeast Infection Symptoms In Man, Woman And Infant
Premium online resource on all you need to know about yeast infection condition.
http://www.yeast-infection-bible.com
Overcoming My Insomnia – knowledge for a restful sleep
Information to overcome insomnia and get a good night sleep. Website provides information on disorders pertaining to insomnia, articles and solutions.
http://www.overcomingmyinsomnia.info/
The Acne Treatment System – Derma Cleanse
Acne can’t be cured, but it can be managed. With our Derma Cleanse System you can treat the acne you have and prevent future acne from forming. Our experts have developed the system to manage your complexion and keep the clear skin you want.
http://dermacleanse.com
Triggers for migraine
Getting to know what triggers migraine and how to identify them. A collection of migraine related resources for the public, volunteers, health professionals & schools.
http://www.migrainewatch.info
Realistic Doctors Excuse Note Sample You Customize for work, school, etc.
Print Your Own Doctor s Excuse Note Now and Learn How to Use Them Without Getting Fired.
http://www.mycaloriescount.com/doctors-excuse-note.html
Acid Reflux Treatment
Resource site for sufferers of acid reflux. Our site will help you whether you are looking for acid reflux treatment or just information on the types of foods that cause acid reflux. We will also provide surfers with the proper diet to avoid acid reflux.
http://www.acidcurereflux.com/
Thick toenail and fingernail fungal infection
A guide to identify symptoms
http://www.treatnailfungus.org/treatment/thicktoenail8.html
Mesothelioma Cancer Tips
Free information and useful tips about mesothelioma cancer. Articles, news, resources and all the information that you need to know about mesothelioma cancer.
http://www.cancer-and-mesothelioma.info
Addiction Treatment and Recovery Resources
Find addiction treatment and drug rehab resources. Addiction treatment and drug rehab professionals, community, and forums available.
http://www.addicted.com
Acne And Rosacea Help
Information on diet, nutrition, and treatments to alleviate acne and rosacea.
http://www.acnetohealth.com
Mesothelioma Cancer Resources Portal
Non-laywer sponsored, hand-picked resources for those facing mesothelioma cancer including support groups, forums, and alternative treatment options.
http://mesotheliomacancerportal.org
Alopecia Areata Information
Alopecia Areata questions and answers. A disorder which causes patches of bald spots to appear on the scalp.
http://www.alopecia-info.org
Thyromine Review
Why your depression is not the end of the world.
http://www.thyromine-reviewed.com
Male Breast Cancer Advice
The breast cancer condition has many symptoms ranging from swelling of the skin to lumps in the breast. It is the aim of the breast cancer advice site to give advice on coping with this condition. Information is available on how the various cancer.
http://www.breastcanceradvice.net
Acne free in 1 night "gauranteed"
Louise Griffin (Naturopath) for the past 8 years has extensively researched powerful techniques for stopping acne and other skin conditions. Acne free in 1 night!
http://www.overnight-acne-cures.com
Acne treatments from zenmed
We specialize in problem skin care products for acne and Rosacea. Discover the difference that quality natural and medicinal ingredients make. Try our acne system today and receive a free product and free shipping. Satisfaction is guaranteed.
http://zenmed.com/
Migraineheadachesymptoms Net
http://www.migraineheadachesymptoms.net
Natural Acne Treatments | ClearPores (Clear Pores)
Top quality improved acne treatments including herbal supplements, based on selectively mixed herbs which reduces sebum, clears pores and deep skin washes to unclog pores and gets rid of acne bacteria.
http://www.wefightacne.com
Acne Treatments | Clear Your Pores
Acne Treatment – Clear Pores, Acnezine, Zenmed, Vilantae – Leaders in natural acne treatments for clear and healthy skin. Get back your confidence and natural beauty!
http://www.clear-your-pores.com
Alopecia Can Be Beaten
Alopecia Can Be Beaten – Treatment , Areata, Totalis, Barbae, Universalis, and Childrens Alopecia. Visit our website and view our case studies, find out more about our products and visit our forum – Calosol.com.
http://www.calosol.com
Living with Arthritis
Free resource site for Rheumatoid Arthritis. Includes information on arthritis symptoms & causes, arthritis treatment, arthritis drugs etc
http://www.living-with-arthritis.biz/
The various ways of lowering high blood pressure
The various ways of lowering high blood pressure.
http://www.reducinghighbloodpressure.net
Diabetes Treatment Tips And Guide
Diabetes treatment and diabetes control is very important in both type 1 and type 2 diabetes mellitus. Diabetes diets, diabetes medications, and tests to diagnose diabetes are discussed. Also get tips on preventing long term health problems of diabetes.
http://www.thediabetesguide.com
Mr Clear s Acne Treatment Reviews and Articles
Mr. Clears complete acne treatment reviews and researched acne articles covering natural products, scarring, medication, surgery, and home remedies.
http://www.mrclear-acne-reviews.com
American Diabetes Services – Diabetic Supplies for Diabetes Testing
American Diabetes Services offers diabetic supplies for diabetes testing. Our diabetic supply company carries glucose meters, diabetic testing strips, and more. Find out if you qualify for free diabetic supplies today! Diabetic medical supplier offers.
http://www.americandiabetes.com
Tips For Insomnia | Fact About Insomnia
The inability to sleep can leave a person feeling unrested, irritable and in some cases unable to think clearly. Visit Tips For Insomnia to learn about insomnia cures and more.
http://www.tipsforinsomnia.com
Avatrol Review
A review of Avatrol and its place in hemorrhoid management.
http://avatrolreview.com
Pain Relief
Power Over Your Pain has stories about people who have overcome pain as well as information about pain support organizations.
http://www.poweroveryourpain.com
Arthritis Cure
If you are looking for information on Arthritis, its symptoms, cure, treatments or diet this site is for you.
http://www.arthritiscure.info
Asthma tips
Find tips and advice to beat your asthma. This site give you full information about asthma like diets, facts cause, Asthma Inhalers etc.
http://www.asthmadoctor.org
Speech Language Pathology Jobs, Products, Speech Therapy Courses
Professional speech pathology resources, including Jobs , discussion areas, message forum, product listings, continuing education courses, and other free resources.
http://Speech-LanguagePathologist.org
Diabetes Type 1
People with diabetes type 1 need insulin in order to stay alive. This disease is often referred to as insulin dependent diabetes. We provide facts on Sugar Diabetes, Diabetes Type 1, Diabetes Type 2, Diabetes Symptoms, Diabetes Supplies and diets…
http://www.sugardiabetes.net
LowerCholesterol30
http://www.lowercholesterol30.com/
Depression Treatment
Find information & help on depression useful for you in treating your depression. Also learn about symptoms, natural treatments to overcome depression.
http://www.treatingdepression.org
Eczemo
provide Information about eczema, its causes, types, treatment and as well as articles about this skin disease.
http://www.eczemo.com
Get Sleep Now
Advice and Information on dealing with the problems of insomnia, sleep apnea and other sleeping disorders. Tips to help you deal with sleep problems in children including how to get your baby to sleep.
http://www.getsleepnow.co.uk
Dust Mites
If you are looking to get great advice for any sort of allergy then it is here for you. We have information on both causes and cures. We have every thing from a food allergy to pet allergies.
http://www.allergyadviceatoz.com
DiaTalk Forums
DiaTalk is an online community of diabetics. Here you can keep up with diabetes news, gain support, and learn from others’ experiences.
http://www.diatalk.org
Get on top of excessive facial blushing.
You can become blushing free. Stop putting up with a blushing problem. It can be beaten. My guide will show you exactly how.
http://www.blushingfree.com
Manage your heartburn and Acid Reflux Symptoms
Everything you need to know about heartburn symptoms, treatment, home remedies, diet and lifestyle List of food that causes heartburn. Getting rid of acid reflux in natural way. Blog about heartburn.
http://www.manageyourheartburn.com
www.stopmusclepain.com
Health education blog for management of nerve related muscle pain. Acute or chronic muscle aches and pains can now be helped with eToims Twitch Method which stimulates trigger points to relax muscle spasms stopping pain.
http://www.stopmusclepain.com
HerbSecret.co.uk, Mother Of Pearl Anti-Scar Cream
Herbsecret. Try the #1 anti-scar cream in the UK! You can also order other skincare products, natural cosmetics and food supplements. We have the most comprehensive information on South American herbs: maca, vilcacora and others.
http://www.herbsecret.co.uk
Mother Of Pearl Anti-Scar Cream
#1 Anti Scar cream for problem-skins according to The Sunday Times. Recommended by British Association of Skin Camouflage.
http://www.anti-scar.co.uk
Dog Allergies, Cat Allergies and More
Your complete allergy resource. Allergy symptoms, diagnosis, types, relief and other info. Shocking info about caffeine allergies.
http://www.my-allergies-relief.com
Cholesterol Information & Knowledgebase – Main
Information and resources about cholesterol and how to deal with high cholesterol.
http://www.yourcholesterolinfo.com
Heart Burn Getaway
Information about heart burn causes, symptoms and treatments.
http://www.heartburngetaway.com/
Breast Cancer Mag
Complete Information about breast cancer and its treatment.
http://www.breastcancermag.com/
Pneumonia Center
Information about diagnosis, symptoms and treatment, and articles about bacterial pneumonia, which is caused by a pathogenic infection of the lungs.
http://www.pneumoniaonline.com
Hypertension – The Hypertension
Hypertension – The Hypertension
http://www.thehypertension.com
Coronary Heart Disease – Coronary Heart Disease
Coronary Heart Disease – Coronary Heart Disease.
http://www.procoronary.com
Aids Care – Aids Care Center
Aids Care – Aids Care Center
http://www.aidscarecenter.com
Cancer – Cancer Center Site
Cancer – Cancer Center Site
http://www.cancerextra.com
Liver Cancer – Liver Cancer Home
Liver Cancer – Liver Cancer Home
http://www.livercancerhome.com
Prostate Cancer
Gives an overview of this Prostate center. Also provides information on current treatment options used in the treatment of the disease.
http://www.bestprostatecancer.com
Hemroids ,Hemroids Treatment I
Hemroids-Information.com- a hemroids article resource providing information on hemroids, bleeding hemroids, external hemroids, internal hemroids, hemroids symptom, causes of hemroids, hemroids surgery and hemroids treatment tips.
http://www.hemroids-information.com/
Quick Hair Loss Treatment
Offers natural hair loss treatment product to permanently cure hair loss without any side-effects.
http://www.quickhairlosstreatment.com
Osteoporosis Information
http://www.osteoporosisguide.org
The Restless Legs Report
http://www.restlesslegsreport.com
Kidney Dialysis Information Centre
Provides plain language information about kidney dialysis, links to related sites, explanations and comparisions of different types of dialysis.
http://www.kidneydialysis.org.uk
Mesothelioma
Mesothelioma Advice
http://www.adviceformesothelioma.com
Acid Reflux Cure
Premium online resource on acid reflux, including causes, symptoms and treatment methods.
http://www.acidrefluxcure.net
Information on Psoriasis – My Psoriasis Guide
Provides information about psoriasis its symptoms and treatment.
http://www.mypsoriasisguide.com/
Strep Throat Infection .com – What is Strep Throat ?
StrepThroatInfection.com is a patient-oriented health resource that provides information on strep throat including symptoms, diagnosis, treatment, causes and other informative articles.
http://www.strepthroatinfection.com/
Multiple Sclerosis Research .com – What is Multiple Sclerosis?
MultipleSclerosisResearch.com is a patient-oriented health resource that provides information on multiple sclerosis including symptoms, diagnosis, treatment, causes and other informative articles.
http://www.multiplesclerosisresearch.com/
Information On Lupus .com – What is Lupus
InformationOnLupus.com is a patient-oriented health resource that provides information on lupus disorder including symptoms, diagnosis, treatment, causes and other informative articles.
http://www.informationonlupus.com
Through Depression .com – Causes, Symptoms, Treatment
ThroughDepression.com is a patient-oriented health resource that provides information on depression including symptoms, diagnosis, treatment, causes and other informative articles.
http://www.throughdepression.com/
Long Term ADHD .com – What is ADHD
LongTermAdhd.com is a patient-oriented health resource that provides information on attention deficit hyperactivity disorder including symptoms, diagnosis, treatment, causes and other informative articles.
http://www.longtermadhd.com/
TheraVitae Heart Failure Treatment with Vescell Stem Cell Transplant Therapy
TheraVitae’s VesCell Adult Stem Cell Therapy is used by Cardiologists and heart surgeons as a coronary artery disease treatment to improve the quality of life of patients suffering from heart failure. VesCell stem cell transplant treatment is autologous…
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Leukoplakia of the Anal Verge with Bleeding Hemorrhoids – A Case Report

admin — Thu, 07 Jan 2010 17:16:05 +0000

Pravin J Gupta
Clinical Head
Nagpur, India

Case Report

On 14^th August 2002, a 46-year- old male, an office clerk, reported with bleeding and prolapse per rectum for since 6 months, however without any complaint of any pain, pruritus or discharge per anus.

Upon anal and intra anal examination a circumferential area of thickening and whitish discoloration of the anal verge, which was extending up to the dentate line, was found. Perianal skin was macerated, excoriated and thickened, suggestive of leukoplakia.

The patient gave no history of previous anal surgery, homosexual contact or exposure to radiation. He had been using various hemorrhoids ointments in and around the anus for the last four months. The test for HIV virus was negative.

The hemorrhoids were ablated using a Ellman radiowave generator [Ellman International Inc., Oceanside, NY, USA] under local anesthesia with the patient in a lithotomy position. A biopsy was taken from the anal verge and the patient was discharged after 2 hours. He was asked to return after 4 weeks.

The microscopic picture of the biopsied anal skin showed pronounced cornification of the anoderm. Acanthosis was prominent, but rete cells were orderly and the basal layer was well defined. The dermis showed profuse chronic inflammation, with lymphocytes, plasma cells and large mononuclear cells in the papillary layer.

At the 4 week follow-up, the patient was asymptomatic, the biopsy wound was healed and the hemorrhoids were not visible. The patient was asked to report each year or earlier if symptoms appeared. At the last follow-up in October 2007, the patient had no specific anal symptoms except occasional Dyschezia. The leukoplakic area remained unchanged.

Discussion

Leukoplakic lesions are most commonly seen in the oral cavity, more frequently in men than in women at that site. They are somewhat less common on the vulva. The bladder, kidney pelvis, ureters, larynx, esophagus, cervix and glans penis are occasionally involved.

Extensions of primary vulvar leukoplakic lesions with involvement of the perineum and perianal skin have been described in literature.

Primary leukoplakia on the anoderm of the anal canal has been occasionally reported. The lesions developed on the so-called “mucosa” or anoderm of the anal canal, with some extension to the adjacent rectal mucosa.

Leukoplakia is considered to be a precancerous dermatosis of mucous membranes analogous to senile keratosis of exposed skin surfaces.

Several patients with carcinoma in situ had a discrete area of leukoplakia in the anal canal or a pigmented plaque of the anus and anal canal.

However, in this case, leukoplakia was absolutely innocuous with no change in the color, texture or extension of the lesion noticed over a period of five years.

The cause of leukoplakia is still controversial. Earlier investigators indicated syphilis as a prominent factor in oral lesions. Deficiencies of vitamin A, hydrochloric acid, vitamin C and estrogens have been mentioned as causative factors in vulvar leukoplakia. Excessive excretion of irritating organic urinary acids has also been considered.

Other investigators consider that prolonged local irritation from any cause, acting on a deficient, aging epithelium is a fundamental cause of this lesion.

The author considers that, probably, continuous use of hemorrhoids cream was the cause of leukoplakia in this patient. A correctly interpreted preliminary biopsy serves as a guide for a proper therapeutic approach.

Follow-up of our case shows little evidence that leukoplakia of the anal canal is premalignant, but patients should be followed carefully, since the natural history of this rare lesion remains unknown.

References

Bender MD, Lechago J. Leukoplakia of the anal canal. Am J Dig Dis. 1976;21:867-72.
Templeton JL, Brennen MD. Anal leukoplakia: management using a staged plastic procedure. J R Coll Surg Edinb. 1991;36:333-4.
Jongen J, Reh M, Bock JU, Rabenhorst G. Perianal precancerous conditions (Bowen disease, Paget disease, Carcinoma in situ, Buschke-Lowenstein tumor) Kongressbd Dtsch Ges Chir Kongr. 2001;118:79-86.
Riedler L. “Bowenoid” leukoplakia in the anal region. Klin Wochenschr. 1988;66:271-3.
Foust RL, Dean PJ, Stoler MH, Moinuddin SM. Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases. Hum Pathol. 1991;22:528-34.
Del Río M, Maturi RH, Maturi HV. Postoperative anus stricture and leukoplakia lesions. Acta Gastroenterol Latinoam. 1987;17:337-42.

Imagem em Medicina – 382 Rev Assoc Med Bras 2009; 55(4): 382-3

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Hemorrhoids – Patient Education Series

admin — Thu, 07 Jan 2010 17:09:25 +0000

What are hemorrhoids?

Hemorrhoids are enlarged veins in the area around the anus. Sometimes called “piles,” hemorrhoids may occur outside the anus and be visible (external hemorrhoids) or may occur inside the rectum (internal hemorrhoids). Sometimes, an internal hemorrhoid may protrude through the rectal opening.

Hemorrhoids can become inflamed and swollen or can develop a localized blood clot. The result is itching, pain or bleeding. These flare-ups can be caused by constipation, straining to have a bowel movement, heavy lifting or pregnancy. In most cases inflammation, swelling or blood clots resolve spontaneously in a few days.

The following suggestions will ease your discomfort and speed recovery. You’ll also find guidelines for preventing hemorrhoidal flare-up.

How do I relieve discomfort?

Avoid straining during a bowel movement
To achieve a soft stool that is easy to pass, increase the amount of fiber in your diet and drink plenty of liquids.
See the list of foods on the bottom of this post. Whole-grain cereals and bran are the richest sources of fiber, but a variety of other foods also contain it.
In addition, your medical provider may prescribe a bulk-type laxative to take once or twice a day until your discomfort is gone.
A bulk laxative draws water into the stool and forms a thick solution to soften and give volume to the stool.
Important : neither a diet with high-fiber content nor a bulk laxative will produce a soft, bulky stool unless you drink plenty of fluids preferably 2 quarts (8 glasses) a day.
Take frequent sitz baths
Soaking for 10 to 15 minutes in a hot bath about 110 degrees Fahrenheit 2 to 3 times a day provides some relief of pain and itching.
Apply compresses soaked in witch hazel
Many people find witch hazel soothing.
Avoid commercial products such as Preparation H or Anusol,
because they are of no additional benefit beyond being a lubricant for easier passing of stool.
Avoid any remedy with the suffix “caine” as these may irritate the anal area.
Hydrocortisone 1% cream can help reduce the local inflammation.
Avoid sitting or standing for long periods.
Lie down frequently until the pain, itching and/or bleeding is gone.

How do I prevent future discomfort?

Eat at regular hours and establish a regular time for bowel movements
Go to the toilet when you have the urge, never delay.
Avoid prolonging time spent on the toilet
Sitting on the toilet for long periods, or straining to produce a stool can aggravate hemorrhoids or produce fissures (cracks in the skin) surrounding the anus.
Clean the anal area after each bowel movement by washing with a warm, soapy cloth or cotton, and then rinsing the area. Avoid using toilet paper. Tucks pads are gentle and a convenient method for wiping.
Eat a diet high in fiber content to achieve soft, bulky stools that do not irritate the rectum or necessitate straining. The list of foods will help you modify your present diet as necessary. Remember to drink plenty of fluids.
Avoid heavy lifting.
Exercise daily to help relieve some of the pressure on the hemorrhoidal veins caused by prolonged standing or sitting.
Schedule 2 to 3 periods of relaxation daily, lying down for 5 to 10 minutes.

Foods to include on a high-fiber diet:

Vegetables :
- Asparagus
- Beans and lentils, all varieties
- Beets
- Broccoli
- Brussel sprouts
- Cabbage
- Carrots*
- Cauliflower*
- Celery*
- Corn
- Cucumber, with skin
- Eggplant
- Endive
- Greens, all varieties
- Kohlrabi
- Lettuce
- Mushrooms
- Okra
- Onions
- Parsnips
- Peas, all varieties
- Peppers*
- Potatoes, all varieties with skin
- Radishes
- Rhubarb
- Sauerkraut
- Spinach*
- Squash
- Tomatoes*
- Turnips
- Watercress
(*eat raw or undercooked)

Bread :
- Buckwheat bread
- Corn bread made with coarse ground meal
- Cracked wheat bread
- 100% Whole wheat
- Rye bread

Cereal :
- All high bran cereals: Kashi Good Friends, Fiber One
- Oat Bran (2 Tbsp daily)
- Brown rice
- Puffed wheat
- Oatmeal
- Shredded wheat
- Whole-grain cereals
- Ground flaxseed

Protein :
- Crunchy peanut butter
- Nuts
- Pumpkin seeds
- Sunflower seeds
- Include for balance, no fiber: Bacon, Ham, Beef, Chicken, Eggs, Fish, Lamb, Pork, Turkey, Veal.

Soups :
- Hearty varieties, such as: vegetable, minestrone, chowder, bean, chili.

Fruit :
- Apples*
- Apricots*
- Bananas
- Berries
- Cantaloupe
- Cherries
- Dried fruits
- Grapefruit
- Oranges
- Peaches*
- Pears*
- Pineapple
- Plums*
- Strawberries
(*eat unpeeled)

Desserts :
- Fruits, (fresh, frozen, canned)
- Fruit whips
- Ices and sherbets

Beverages :
- Fruit juices with pulp
- Include for balance, no fiber: Milk (3 to 4 cups), Water.

Source : Brown University Health Services – www.brown.edu/health

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Botanical Treatments for Hemorrhoids

admin — Thu, 07 Jan 2010 17:01:35 +0000

Botanical Treatments for Hemorrhoids
Kathy Abascal, B.S., J.D., R.H. (A.H.G.) and Eric Yarnell, N.D., R.H. (A.H.G.)

Abstract

Hemorrhoids are a very common condition. Hospitalbased proctoscopy studies show prevalence rates of hemorrhoids in up to 86 percent of patients studied with many in an asymptomatic state.

Botanicals used internally and topically can treat early stages of hemorrhoids effectively and can be used as adjuncts in more advanced stages when surgical treatments may be necessary.

The roles of butcher’s broom (Ruscus aculeatus), horse chestnut (Aesculus hippocastanum), stone root (Collinsonia canadensis), witch hazel (Hammamelis virginiana), arnica (Arnica spp.), oak (Quercus spp.), chamomile (Matricaria recutita), gotu kola (Centella asiatica), calendula(Calendula officinalis), and psyllium (Plantago ovata) in hemorrhoid treatment are discussed.

Introduction

Hemorrhoids are understudied and most likely undertreated. It is estimated that about one half of all Americans have some discomfort from hemorrhoids by the time they are 50 but only a much smaller percentage (approximately 4 percent) seek medical treatment for the condition.

Hospital-based proctoscopy studies show prevalence rates of up to 86 percent with many patients in an asymptomatic state.

Clinical experience suggests that botanical treatments and lifestyle changes can relieve hemorrhoid symptoms in the early stages and can provide significant benefit as adjunct treatment in the later stages of the ailment.

Unfortunately, science has barely begun investigating these fairly ancient treatments. Hemorrhoidal tissues, cushions of tissue within the anal canal that contain blood vessels and supporting tissue made up of muscle and elastic tissue, are present in all individuals.

There are usually three major hemorrhoidal cushions oriented to the right posterior, right anterior, and left lateral positions. There is a rich network of arteries around the anal canal, providing a ready supply of arterial blood to hemorrhoidal blood vessels. It is only when these cushions enlarge causing negative symptoms that “hemorrhoids” in the vernacular sense are present.

Negative symptoms typically include the passage of bright red blood that can occasionally be severe and result in anemia. If the hemorrhoid originates at the top of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the canal, near the anus, it is referred to as an external hemorrhoid.

Internal hemorrhoids are usually painless (because this area of the body lacks pain receptors) but they may bleed when they are irritated and, if large enough, may protrude from the rectum and cause discomfort.

Untreated internal hemorrhoids can lead to prolapse, in which the distended internal hemorrhoids are pushed outside of the anus. If the sphincter spasms, the blood supply to the prolapsed hemorrhoid can be cut off, leading to a strangulated hemorrhoid.

External hemorrhoids occur outside the anal verge. They can be painful, swollen, and irritated. Itching can result from external hemorrhoids although, typically, itching is most commonly caused by skin irritation.

The stages of internal hemorrhoids are shown in Table 1. Obviously, pain, bleeding, and problems with passing stool can be caused by conditions other than hemorrhoids. This article presupposes that such conditions have been ruled out before any treatment for hemorrhoids is undertaken.

The actual cause of hemorrhoids is not known. Genetic predisposition, straining during bowel movements, obesity, a sedentary lifestyle, pressure on the rectal veins caused by poor posture and/or muscle tone, and pregnancy are believed to be causes.

Hemorrhoids are common in patients with spinal-cord injuries. Constipation, chronic diarrhea, poor bathroom habits (such as overzealous cleaning and wiping), postponing bowel movements, and a fiber-poor diet are also considered to be contributing causes. Alcoholic cirrhosis or other causes of portal obstruction can cause severe hemorrhoids.

Internal Botanical Treatments

Botanical treatments for hemorrhoids have been poorly researched. Butcher’s broom and horse chestnut are two herbs that have some scientific validation of benefit in hemorrhoids but have both been better studied in chronic vascular insufficiency (CVI) where they have more substantial evidence of benefit.

Butcher’s Broom

Butcher’s broom is a prickly, small berry producing shrub in the Liliaceae family. Its Latin name (Ruscus) is believed to come from the Anglo Saxon word for holly or box because the plant has a pointed leaf shape similar to holly leaves.

The herb’s common name derives from its use by butchers to clean meat stalls and keep flies away. The whole plant contains steroidal saponins and ruscinogens the compounds deemed to be most active but only the dried rhizomes are used medicinally.

Butcher’s broom is typically administered in capsule form, and is frequently paired with trimethylhesperidin chalcone (a flavonoid complex) and ascorbic acid.* However, the plant is also available as an alcoholic extract and a tea.

There are also numerous topical preparations often combining butcher’s broom with sweet clover (Melilotus spp.). Butcher’s broom has a long history of clinical use as a treatment for hemorrhoids, and its use for treating this condition has been approved by the German Commission E.

In one open-label multicenter study of 124 patients, 69 percent of the patients rated butcher’s broom as having good or excellent efficacy. Seventy-five (75) percent of the treating physicians rated this herb’s efficacy similarly. In addition, 92 percent of the physicians rated butcher’s broom as safe and well-tolerated.

For this study, patients took 6 capsules per day of a product containing 150 mg of butcher’s broom for 3 days and then reduced their dose to 4 capsules per day. Statistically significant improvement in a variety of symptoms (such as pain, local signs, overall severity, etc.) was seen after 7 days of treatment.

While a single study does not prove efficacy, the very favorable observations of treating physicians combined with a long history of clinical use are reasons to recommend that patients consider using butcher’s broom as an internal treatment for hemorrhoids.

Butcher’s broom has been studied for use in pregnancy-related varicosities. Two studies on pregnancy related venous insufficiency both showed improvement in maternal symptoms without any negative effects on the fetus. Two additional European studies, one a multicenter study of 124 patients, showed a similar reduction of symptoms in pregnant women.

These studies do not establish the safety of ruscus in pregnancy conclusively but both animal and human studies indicate that ruscus has a high degree of safety. Based on these studies, we favor butcher’s broom when an internal remedy is needed for treating hemorrhoids in pregnant women (when surgical treatments are often contraindicated).

In most clinical studies using this herb, the researchers gave the subjects 150 mg of butcher’ broom, 3 times per day with meals; the typical alcoholic tincture dose is 30–60 drops (1.5–3.0 mL) 3 times per day.

Table 1. Staging of Internal Hemorrhoids

Stage I
Occasional discomfort and/or bleeding but no obvious external abnormality.

Stage II
Hemorrhoids protrude with defecation but reduce spontaneously.

Stage III
Hemorrhoids protrude and require digital reduction.

Stage IV
Hemorrhoids protrude and cannot be reduced.

Adapted from Anonymous. American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterol 2004;126:1461–1462.

Horse Chestnut

Horse chestnut is a beautiful deciduous tree that produces large chestnut-like seeds that are dried for medicinal use. The seeds contain a complex mixture of triterpene saponins collectively referred to as escins (or as aescins). It also contains flavonoids and tannins.

The German Commission E has approved the use of a standardized horse chestnut extract (containing 16–20 percent anhydrous escin) for treating chronic venous insufficiency (CVI).

Horse chestnut is the most widely prescribed oral remedy for venous edema in Germany. Although widely used in Europe, the herb’s popularity as a remedy in the United State is fairly recent.

There are some 20 clinical trials on horse chestnut and CVI, all of which demonstrated a positive effect. In these studies, the herb’s adverse effects were mild and infrequent and it was found to be as effective as rutoside, another common treatment for CVI in Europe.

There are European publications from the late 1800s and early 1900s reporting that horse chestnut benefits patients who have hemorrhoids but there are no recent studies on the use of the whole botanical medicine for treating hemorrhoids.

One doubleblinded placebo-controlled study on 80 patients suffering from acute symptomatic hemorrhoids showed that 40 mg of aescin administered three times per day, for up to 2 months, reduced symptoms in 81 percent of the subjects (compared to 11 percent in the placebo group) and a notable reduction in bleeding (95 percent versus 62 percent) and swelling (87 percent versus 38 percent) as shown via endoscopic examination.

Symptom reduction typically was reported after 6 days of treatment and improvement in the condition was shown via endoscopy after 2 weeks.

Herbalist Michael Moore, director of the Southwest School of Botanical Medicine, considers horse chestnut to be the preferred remedy for hemorrhoids in individuals who are highly active physically (Michael Moore, personal communication).

High levels of physical activity move more blood to the skeletal muscles, reducing the flow of blood to the gastrointestinal tract.

Mr. Moore says that this can lead to malabsorption, constipation, and hemorrhoids, and he has found horse chestnut combined with increased dietary flavonoids to be particularly helpful in these cases. A typical dose of horse chestnut is 250 mg (corresponding to 100 mg of escin) 2 times per day with meals.

Stone Root Many American herbalists favor stone root, a nonaromatic mint family plant, as a treatment for symptomatic hemorrhoids. The Eclectic physicians found this herb particularly useful in patients with signs of congestion (dark red or purple tissue) and hemorrhoids.

Overweight, physically inactive individuals who eat a diet high in fats and sugars and low in fruits, vegetables, and grains tend to develop this state of congestion. In our experience, stone root will often rapidly resolve hemorrhoid symptoms and we favor its use in these types of individuals.

There is virtually no research on stone root, except for constituent studies showing that it contains flavonoids and saponins. Of course, isolated flavonoids have been shown to be of benefit for patients with hemorrhoids, and both butcher’s broom and horse chestnut also contain flavonoids and saponins.

These data lend some very vague support for the use of stone root. The Eclectics used a fairly low dose of stone root (1–30 drops); presently a typical dose of stone root tincture is 2–4 mL, 3 times per day.

Witch Hazel

Witch hazel also has a long history of use as a hemorrhoid treatment. Witch hazel is a shrub or small tree indigenous to North America. The plant’s yellow flowers appear in the Fall, and the leaves and bark are harvested for medicinal use.

Both the leaves and the bark contain tannins, primarily hamamelitannins, and also contain catechins. The leaves contain more flavonoids than the roots, and both contain a small amount of volatile oil.

Today, many people think of witch hazel primarily as a topical treatment (see below). However, both European and American herbalists typically use witch hazel both as an internal and topical remedy for hemorrhoids.

Thus, both the European Scientific Cooperative on Phytotherapy and France have approved the herb’s combined use for treating hemorrhoids.

Witch hazel is frequently prescribed as a decoction or as an alcohol-preserved decoction. This makes sense as tannins are highly soluble in hot water. Witch hazel extract has produced anti-inflammatory, astringent, and vasoconstrictive properties in pharmacologic studies.

Its astringency is of help for patients with bleeding hemorrhoids, and the Eclectics favored it for such hemorrhoids as well as for any type of passive bleeding. The dose for an infusion is 2–3 g of leaf or bark steeped in 150 mL of boiled water, taken 2–3 times per day between meals. The tincture dose is 2–4 mL, 3 times per day.

Topical Treatments

Topical treatments to assist locally in calming inflammation and for stopping bleeding and swelling are highly useful in hemorrhoid treatment. According to the late Rudolf Fritz Weiss, M.D. (a German phytotherapist and medical doctor), acute hemorrhoidal inflammation is best treated with wet compresses.

In addition, ointments can be applied but he did not consider them to be sufficient if used alone. He recommended that the compresses be cool, below room temperature, but not cold because cold compresses can induce rectal spasming. Dr. Weiss recommended that the wet compresses be applied for at least 1 hour, morning and night, or that a sitz bath be used.

A hemorrhoid ointment should then be applied after each treatment and after every bowel movement. As a practical matter, only a client with severe symptoms is likely to dedicate that amount of time to treatment. Milder cases may be dealt with effectively by a shorter time for compress application and an occasional sitz bath with regular applications of ointment. Suppositories also work well.

Dr. Weiss favored arnica (Arnica spp.) compresses, which he considered to be one of the fastest remedies for acute hemorrhoid inflammation. He recommended using 1–2 teaspoons of arnica tincture per half-liter of water for compresses.

Alternatively, he recommended the use of an oak bark decoction or a chamomile infusion. He typically followed the application of compresses with a witch hazel ointment.

Topical application of witch hazel alone will often suffice to soothe minor symptoms of acute inflammation. No doubt its effectiveness explains why witch hazel remains a common ingredient in over-the-counter hemorrhoidal preparations.

Preparation H® Hemorrhoidal Cooling Gel (Wyeth, Madison, New Jersey) for instance, contains 50 percent witch hazel. It is witch hazel’s tannins that provide many aspects of its healing power, and the clear witch hazel distillate so readily available over the counter is not the medicine of choice because it is almost completely devoid of tannins.

Instead, a more colorful tea or tincture should be used. We tend to prefer combining several herbs in the compresses, sitz baths, or ointments to provide a broader range of actions. Any of the herbs used internally (stone root, butcher’s broom, horse chestnut, and witch hazel) can be combined effectively for topical application.

We also like to include herbs that are noted for their wound-healing properties, such as gotu kola, chamomile, or calendula. If needed, tinctures of these herbs can be worked into a cream base for topical application.

The Broader View of Hemorrhoid Treatment

Addressing hemorrhoids should go beyond simply prescribing the botanicals discussed above. Dietary issues, while beyond the scope of this article, are of great importance. Surprisingly little research has been done on the connection between diet and hemorrhoids given the prevalence of the disorder and the fact that isolated flavonoids have shown substantial benefit in the treatment of hemorrhoids.

Studies on fiber and hemorrhoids have focused on the effect of soluble fiber; adding soluble fiber has shown benefit in hemorrhoid treatment, at least when constipation is an aggravating factor.

As a general rule, we consistently recommend that our clients increase their intake of fruits and vegetables, with an emphasis on foods containing soluble fiber. When constipation is an issue, we often recommend psyllium seed husks. Lifestyle changes that include increasing water intake and exercise to increase muscle tone also help effect a long-term reduction of hemorrhoid symptoms.

As mentioned above, using botanicals both internally and topically will speed healing. Botanicals such as gotu kola or ginkgo (Ginkgo biloba), used to increase peripheral circulation, can act synergistically with herbs used specifically for treating hemorrhoids.

For instance, gotu kola and its isolated triterpenic fraction improve microcirculation, decrease capillary permeability, and reduce symptoms of CVI. The herb also has been shown to increase tensile strength, collagen content, and epithelialization in many types of wounds when used internally or topically.

Dr. Weiss commented that it is important to address adequately the constipation and pain that accompanies many hemorrhoids as well. He typically prescribed a tea that combined laxative, anti-inflammatory, and antispasmodic herbs with a bitter herb to tone the plexus hemorrhoidalis and an astringent to relieve bleeding.

One of his tea formulas is in the box entitled Dr. Rudolf Fritz Weiss’ Hemorrhoid Tea. A comprehensive treatment plan will work effectively on hemorrhoids in the early stages. More complicated or advanced hemorrhoids are likely to require allopathic intervention.

Nonetheless, botanicals as an adjunct to ligation and surgery will be helpful for healing and preventing recurrences.

References

Online document at: www.answers.com/main/ntquery?tname=hemorrhoid Accessed September 2005.
Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterol 2004;126:1463–1473.
Yarnell E. Naturopathic Gastroenterology. Wenatchee, WA: Healing Mountain Publishing, 2000.
Abascal K, Yarnell E. Butcher’s broom: Herb’s potential too often swept under the rug. Alt Comp Ther 2002;8:177–186.
Bennani A, Biadillah MC, Cherkaoui A, et al. Acute attack of hemorrhoids: Efficacy of Cyclo 3 Forte® based on results in 124 cases reported by specialists. Phlebologie 1999;52:89–93.
Berg D. First results with Ruscus extract in the treatment of pregnancy related varicose veins. In: Vanhoutte PM, ed. Return Circulation and Norepinephrine. Paris: John Libbey Eurotext, 1991:55–61.
Baudet JH, Collet D, Aubard Y, Renaudie P. Therapeutic test of Ruscus extract in pregnant women: Evaluation of the fetal tolerance applying the pulse Doppler’s method of the cord. In: Vanhoutte PM, ed. Return Circulation and Norepinephrine. Paris: John Libbey Eurotext, 1991:63–71.
Schroder EA. Phlebodril-Creme in pregnancy-related varicose veins [in German]. Extracta Gynaecologica 1985; 9:151–172.
Leutenegger S, Martinaggi P. Cyclo 3 Fort® and pregnancy [in French]. Gazette Medicale 1988;95:33–36.
Moore M. Herbal Materia Medica. Bisbee, AZ, Southwest School of Botanical Medicine, 2004.
Blumenthal M. The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council, 2003.
Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: The Expanded Commission E Monographs. Newton MA: Integrative Medicine Communications, 2000.
Sirtori CR. Aescin: Pharmacology, pharmacokinetics and therapeutic profile. Pharmacol Res 2001;44:183–193.
Felter HW. The Eclectic Materia Medica. Sandy, OR: Eclectic Medical Publications, 1994.
Stevens JF, Ivancic M, Deinzer ML, Wollenweber E. A novel 2-hydroxyflavanone from Collinsonia canadensis. J Nat Prod 1999;62:392–394.
Joshi BS, Moore KM, Pelletier SW, et al. Saponins from Collinsonia canadensis. J Nat Prod 1992;55:1468–1476.
MacKay D. Hemorrhoids and varicose veins: A review of treatment options. Alt Med Rev 2001;6:126–140.
Weiss RF. Weiss’s Herbal Medicine, classic ed. Stuttgart: Thieme, 2001.
Bruhl W, Schmauz R. Injection sclerotherapy and a bulk laxative in the treatment of bleeding grade 1 hemorrhoids. Coloproctology 2000;22:211–217.
Morgan M, Bone K. Professional review: Horse chestnut [review]. Med Herb 1998;65:1–4
Cesarone MR, Incandela L, De Sanctis MT, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: A clinical prospective randomized trial with a microcirculatory model. Angiology 2001; 52(10[suppl2]):S49–S54.
Cesarone MR, Laurora G, De Sanctis MT, et al. Microcirculatory activity of Centella asiatica in venous insufficiency: A double-blind study [in Italian]. Minerva Cardioangiol 1994;42:299–304.
Bonte F, Dumas M, Chaudagne C, et al. Asiaticoside and madecassoside activity on human fibroblast type I and III collagen secretion [in French]. Ann Pharm Fr 1995;53:38–42.
Maquart FX, Bellon G, Gillery P, et al. Stimulation of collagen synthesis in fibroblast cultures by a triterpene extracted from Centella asiatica. Connect Tissue Res 1990;24:107–120.
Maquart FX, Chastang F, Simeon A, et al. Triterpenes from Centella asiatica stimulate extracellular matrix accumulation in rat experimental wounds. Eur J Dermatol 1999;9:289–296.

Kathy Abascal, B.S., J.D., R.H. (A.H.G.), is executive director of the Botanical Medicine Academy, Vashon, Washington.

Eric Yarnell, N.D., R.H. (A.H.G.), is president of the Botanical Medicine Academy, a specialty board for using medicinal herbs, and is an adjunct faculty member at Bastyr University, Kenmore, Washington.

To order reprints of this article, write to or call: Karen Ballen, ALTERNATIVE & COMPLEMENTARY THERAPIES, Mary Ann Liebert, Inc., 140 Huguenot Street, 3rd Floor, New Rochelle NY 10801, (914) 740-2100.

When to Contact a Physician for Hemorrhoid Symptoms

admin — Tue, 22 Dec 2009 07:00:30 +0000

A variety of problems may be mistaken for hemorrhoids. These include benign tumors called polyps, cancerous tumors, slit-like breaks in the skin (fissures), venereal warts, infection of an anal valve (sphincter), or other infection that leads to abscess.

These problems can produce the same symptoms as hemorrhoids. Therefore, a physician should be contacted when there is any question as to the cause of symptoms.

A physician also should be contacted if hemorrhoidal symptoms are relieved in seven or fewer days with self-care and self-medication, if pain is severe, or if bleeding is noticed. Also consider contacting a physician if any of the following is apparent:

Abscess: painful swelling caused by infection (often produces pus).
Seepage: passing of mucus or fecal material due to inability of the anal sphincter to close completely.
Prolapse with strangulation: an internal hemorrhoid (in rectum) descending through the anal sphincter with blood supply cut off.
Painful defecation: severe or persistent pain occurring with defecation.

Hemorrhoids are composed of masses of blood vessels and other tissues in the area of the anus and rectum. Itching, burning, discomfort, swelling, inflammation, and pain can occur with “piles” the common name for hemorrhoids.

Although these symptoms often can be relieved with self-care and nonprescription medicines, a physician’s advice is needed for some hemorrhoid symptoms and for problems resembling hemorrhoids.

Hemorrhoids are most likely to occur between the ages of 20 to 50, but can appear at other times. Some authorities believe that heredity plays a role in hemorrhoid development. Most experts agree that occupations involving either prolonged sitting or standing can contribute to hemorrhoids, as can a lowfiber diet or a diet with insufficient fluids.

Any activity that increases pressure on the blood vessels in the anorectal area can lead to hemorrhoids (e.g. exertion, constipation, diarrhea, coughing, or sneezing). Pregnancy is a common cause of hemorrhoids and they can be aggravated by labor.

Avoiding circumstances that increase pressure in the blood vessels of the anorectal area could prevent hemorrhoids or reduce the intensity of symptoms. Constipation should be avoided. Consuming a high-fiber diet (vegetables, fruits, and whole grains) and drinking plenty of fluids (several glasses daily) is helpful.

Daily use of a bulk-forming laxative product can add needed fiber to the diet. Try to avoid prolonged sitting or standing and activities that involve excessive exertion and straining.

Keeping the anal area clean can relieve itching and other symptoms. Soap and water are excellent. Commercial wipes (available at pharmacies) are a convenient away from home alternative. Sitz baths (sitting in warm water) can relieve many symptoms.

Several non-prescription products are available for relieving the many symptoms of hemorrhoids. Some authorities recommend ointment-type products (including creams and gels) over suppositories. Pile-pipes are useful to place ointments inside the anorectal opening. A product should be selected based on one’s specific symptoms. Knowledge of various ingredients is a must. Ask your pharmacist to recommend a product that is just right for you.

Itching, burning, and pain: Anesthetics such as benzocaine and pramoxine help relieve these frequently experienced hemorrhoids symptoms. The local anesthetics in some hemorrhoid preparations have not been proven to be effective.

Inflammation: Hydrocortisone cream and ointment in 1% and lesser strength is now available for reducing rectal itching. Such preparations also may relieve some of the inflammation (redness and burning) that often occurs with hemorrhoids.

Swelling: Several hemorrhoid preparations contain vasoconstrictors such as ephedrine, epinephrine, and phenlyephrine. There is some controversy as to whether or not these agents reduce swollen hemorrhoids or provide any special benefit. Although vasoconstrictors may reduce or check bleeding, this symptom requires evaluation by a physician and generally should be treated with non-prescriptive products.

Wound healing: Some hemorrhoid preparations contain a variety of ingredients, which may be promoted as useful in wound healing. These include skin respiratory factor or SRF, a yeast extract, cod liver oil, Peruvian balsam, shark liver oil, vitamin A, and vitamin D. According to an American Pharmaceutical Association publication, there is no evidence that these agents are effective as wound healers.

Miscellaneous ingredients: Most hemorrhoid preparations contain oily materials to protect tissues from fecal materials as well as astringents such as zinc oxide to coagulate protein, reducing irritation and itching. Antiseptics may be included but are of questionable value because of the large number if microorganisms present in the anorectal area.

Mission Statement
The Pat Walker Health Center, University Health Services provides professional and comprehensive medical care, mental health care, health education, and health promotion for a diverse community of students, faculty, and staff.

We, the University Health Services Staff of the Pat Walker Health Center, have a commitment to physical, mental, spiritual, social, and emotional health, the highest standards of quality, and appreciation of the value of each individual.

Through these endeavors we support the educational mission of the University of Arkansas and the growth of each individual.

Pat Walker Health Center – University Health Services
525 N. Garland Avenue, Fayetteville, AR 72701 – (479) 575-4451 – TTY (479) 575-4124
Website: health.uark.edu

Accredited by Accreditation Association for Ambulatory Health Care – A Member of the Division of Student Affairs.

Relief from Common Discomforts of Pregnancy

admin — Tue, 22 Dec 2009 06:57:20 +0000

This article tells you about changes that may occur during your pregnancy. Tips are given for helping with the discomforts that may come with these changes.

REMEMBER: Contact your health care provider if you think you have a health problem or before taking any prescription drugs, over-the-counter medicines, or a home remedy.

Changes in : Skin, Breasts, Mouth, Back, Swelling and Varicose Veins, Hemorrhoids, Vaginal Discharge.

HEMORRHOIDS
Increasing pressure, poor blood flow and straining to pass bowel movements can cause hemorrhoids (enlarged veins of the rectum), which can be painful. If your hemorrhoids bleed, notify your health care provider.

TIPS

Maintain your regular bowel habits and keep the bowel movements soft by drinking plenty of water, juice and milk.
Eat foods like whole grains, raw fruits and vegetables.
Put your feet on a step stool when having a bowel movement. Breathe out while pushing.
Avoid sitting for long periods of time. Sitting on a small inner tube may help if sitting for long periods cannot be avoided.

VAGINAL DISCHARGE
During pregnancy, it may be normal to have a thick white discharge from the vagina. Contact your health care provider if you find that the discharge has changed to bloody, yellow, green, or dark color; is heavy, foamy, or causes burning and itching.

TIPS

Do not use tampons or douche while you are pregnant.
Avoid using minipads unless absolutely necessary. They may cause irritation to the vulva.
Bathe daily. Avoid perfumed soaps and bubble baths.
Wear cotton panties and loose comfortable clothing.

CHANGES IN YOUR SKIN
As the skin stretches on your belly and breasts, you may notice dark or red lines. You may notice darker skin on your face or below your belly button. You may sweat more.

TIPS

These color changes fade and sweating may lessen after the birth of your baby.

CHANGES IN YOUR BREASTS
Your breasts may become larger, firmer, and more tender. They may feel more lumpy. The nipples and the area around the nipples will be darker and the breast veins will look blue. You may also notice sticky drops of breast milk.

TIPS

When you bathe, clean your nipples with warm water only no soaps.
Dry them well.
Wear a good support bra.

CHANGES IN YOUR MOUTH
Your gums may get red and bleed. Your teeth decay more easily while you are pregnant.

TIPS

Brush and floss your teeth gently, at least twice a day.
See your dentist while you are pregnant be sure to tell him you are pregnant.

CHANGES IN YOUR BACK
During pregnancy, the uterus is growing and pulling on your back muscles. This will change how you stand. Your hip joints loosen and may become sore. This may cause a change in the way you walk and in your balance, which can lead to backaches.

TIPS
Your back may ache less if you:

Wear low-heeled shoes.
Stand or sit with a straight back.
Avoid heavy lifting. (If you have to lift something, bend at the knees rather than the waist.)

SWELLING AND VARICOSE VEINS
As your uterus gets bigger, it will cause pressure and slow down the blood return from your legs. Mild swelling is normal due to the increase of fluids in your bloodstream. Swelling that does not go away overnight or happens suddenly is not normal. If this happens, contact your health care provider.

Sometimes the leg veins get larger (varicose veins). This problem may be worse if you have been pregnant before or have a family history of varicose veins.

TIPS

Exercise – take short walks daily.
Change position frequently
Put your feet up and sit with legs uncrossed.
Avoid tight stockings, especially knee high stockings.
Support hose can be helpful if you are on your feet a lot.

DEPARTMENT OF HEALTH
State (SDCL 20-13) and Federal (Title of Civil Rights Act of 1964, the Rehabilitation Act of 1973 as amended, and the Americans With Disabilities Act of 1990) laws require that the S.D. Department of Health provide services to all persons without regard to race, color, creed, religion, sex, disability, ancestry, or national origin. 3,000 copies of this brochure were printed by the South Dakota Department of Health at a cost of $.17 per copy. 6/99 MCH-037.

Procedures for hemorrhoids

admin — Tue, 22 Dec 2009 06:54:38 +0000

Giving you the edge on healthy living, here’s mayo clinic’s medical edge.

You’ve changed your diet, tried sitz baths and medications, but still the itching, burning and bleeding of hemorrhoids is driving you nuts.

Mark Larson, M.D.
“The most common and probably most effective way to treat the hemorrhoidal tissue would be to place small rubber bands over the veins that are dilated and that causes the tissue to shrink. They’re basically strangulated and they fall off.”

It’s a procedure that mayo clinic dr. Mark Larson says can be done right in a physicians office. But sometimes, even this isn’t enough.

Dr. Larson
“Then a consultation with a colorectal or a general surgeon may be required, to actually surgically remove the hemorrhoidal veins.”

But even that is no guarantee that new hemorrhoids won’t appear. So it’s important to address the factors that are causing them in the first place.

For more information, talk to your doctor or visit mayoclinic.org. I’m Vivien Williams.

Hemorrhoids – Reducing the pain and discomfort

admin — Tue, 22 Dec 2009 06:51:49 +0000

What are hemorrhoids?
Hemorrhoids are swollen veins in your rectum or anus. The type of hemorrhoid you have depends on where it occurs.

Internal hemorrhoids involve the veins inside your rectum. You can’t feel pain on the inside of your rectum, so you may not feel pain from an internal hemorrhoid. You may get bleeding or you may feel a fullness in the rectum, like you need to have a bowel movement.

Sometimes, an internal hemorrhoid may stretch down until it bulges outside your anus. This is called a prolapsed hemorrhoid. If this happens, you may feel a pinching sensation or you may just feel a painless lump when you wipe after a bowel movement. A prolapsed hemorrhoid will go back inside your rectum on its own, or you can gently push it back inside.

Prolapsed hemorrhoids can sometimes be itchy or painful. If a blood clot forms, you may feel a very tender lump on the edge of your anus. Your hemorrhoid may crack and bleed. If your hemorrhoid bleeds, you may see bright red blood on the toilet paper when you wipe or in the toilet after a bowel movement.

Hemorrhoids that involve veins outside your anus in your skin are called external hemorrhoids. They may crack and bleed from straining or rubbing. External hemorrhoids can be itchy and painful, especially if a blood clot forms.

What causes hemorrhoids?
One of the main things that can lead to hemorrhoids is straining when you’re trying to have a bowel movement. This may happen if you’re constipated or if you have diarrhea. It may also happen if you sit on the toilet too long. When you sit on the toilet, your anus relaxes. The veins in your anus then fill with blood, which puts pressure on those veins.

Just about everyone has hemorrhoids at some time. But some things may make you more likely to get them. People whose parents had hemorrhoids may be more likely to get them. Pregnant women often get hemorrhoids because of the weight of carrying the baby and also from giving birth. Being very overweight, or standing or lifting too much can make hemorrhoids worse.

Should I see my doctor?
See your doctor if you notice bleeding to make sure the cause is hemorrhoids and not colitis, cancer or some other disease. Your doctor may be able to diagnose hemorrhoids just by examining you. An anoscopy or other test may also be needed. An anoscopy lets your doctor look into your anus with a thin tube like instrument that has a light at the end.

Preventing constipation

Include more fibre in your diet. Fibre helps soften stools. Fresh fruit, leafy vegetables, and whole-grain breads and cereals are good sources of fibre.
Avoid low-fibre foods, such as ice cream, cheese, white bread and meat.
Drink plenty of fluids (except alcohol). Eight glasses of water a day is ideal.
Exercise regularly.
Bulk-forming laxatives may be helpful. Bulkforming laxatives include bran, psyllium (some examples are Metamucil, Fibrepur, Novo-Mucilax, Prodiem [plain]) and others (an example is Fibyrax).
Avoid laxatives for more than occasional use unless they’re bulk-forming.
If you feel the need to have a bowel movement, don’t wait too long to use the bathroom. Your stool will get drier and harder the longer you wait.

What can I do about hemorrhoids?
Hemorrhoids are most often a short-term problem. Constipation is one of the main things that can lead to hemorrhoids. See the box above for some tips on preventing constipation.

In the meantime, you can follow these tips to reduce the pain caused by hemorrhoids. Although you’ll find many hemorrhoid medicines in the store, some haven’t been proven to work. And some may even be harmful if you use them too much. Talk to your family doctor about which products may be helpful for you.

Relieving the pain

Take warm soaks three or four times a day.
Clean your anus after each bowl movement by patting gently with moist toilet paper or moistened pads, such as Tucks or baby wipes. Rinsing in the shower may also be helpful. Pat, don’t wipe, your anus clean.
Use ice packs to relieve swelling.
Acetaminophen (some examples are Panadol, Tylenol), ibuprofen (some examples are Advil, Medipren, Motrin) or aspirin may help relieve pain.
Apply a cream that contains witch hazel to the area or use a numbing ointment. Creams that contain hydrocortisone can be used for itching or pain.
For very painful flare-ups, stay off your feet and in bed for a full day.
Avoid heavy lifting and straining.

Will I need surgery?
Most hemorrhoids heal on their own in a week or two. Hemorrhoids tend to come back unless you do what you can to prevent them. If yours keep causing problems, talk with your doctor about your options.

Internal hemorrhoids can also be destroyed by injection sclerotherapy infrared coagulation (injecting them with chemicals) or by electrocoagulation (burning them). Rubber band ligation can be used to treat internal hemorrhoids.

It involves placing a small rubber band around the base of the hemorrhoid. This stops the flow of blood to the area. The hemorrhoid then withers away. A hemorrhoidectomy (surgical removal of the hemorrhoids) may be needed if internal hemorrhoids are prolapsed or very large.

Painful external hemorrhoids that contain blood clots can be treated by removing the clot in a simple procedure. This works best when it’s done within the first 24 hours after the clot forms and pain starts.

Notes:
This brochure provides a general overview on this topic and may not apply to everyone. To find out if this brochure applies to you and to get more information on this subject, talk to your family doctor.

This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada.

The College of Family Physicians of Canada, one of the nation’s largest medical specialty groups, is committed to promoting and maintaining high standards for family doctors – the doctors who give ongoing, comprehensive care to people of all ages.

This patient education brochure was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Health Notes from Your Family Doctor Hemorrhoids Reducing the pain and discomfort The College of Family Physicians of Canada.

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Hemorrhoid Treatment by Infrared Coagulation (IRC)

admin — Tue, 22 Dec 2009 06:49:20 +0000

It’s True
More than ten million people visit a physician in the U.S. each year with symptoms of hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. New comfortable office treatments have taken the fear out of hemorrhoids. This pamphlet has been prepared to help you understand them.

What Are Hemorrhoids and Who Gets Them?
Hemorrhoids are swelling in the rectum or anal area that may protrude through the anus on straining. They usually contain enlarged veins and are most common in people over the age of 50.

What Are The Symptoms?
Hemorrhoids can often be felt as a swelling in the area of the anus. There may be soreness, bleeding, discharge, or itching.

What Causes Hemorrhoids?
We do not know for sure, but hemorrhoids are often found in people who either sit or stand a lot or who have low fiber diets or poor bowel habits.

Are Hemorrhoids Preventable?
No one knows for sure. Avoid straining or extensive sitting on the toilet. A diet rich in fluids, fruits, vegetables and fiber is desirable. If symptoms develop, see your doctor without delay.

Are There Different Kinds of Hemorrhoids?
Yes. “Internal” hemorrhoids develop inside the anus. The most common symptoms are bleeding during bowel movements or protrusion through the anus upon straining. “External” hemorrhoids develop around the anus and can be very painful, especially if a blood clot develops within them. They can be felt as firm lump or lumps around the anus.

How Are Hemorrhoids Treated?
When treated early, hemorrhoids usually disappear within a week or two. By increasing fiber and fluids in your diet, your stool will soften thereby promoting bowel movements that are more regular. It also helps to eliminate excessive straining and to take warm baths.

Most painful external hemorrhoids will respond to rest and warm sitz baths. Within a week the pain should subside. The firm lump should completely recede within 4-6 weeks. If pain is severe, the physician may decide to make a small incision under anesthesia and remove the clot to provide immediate relief.

What is Rubber Band Ligation?
Internal hemorrhoids can be treated in the doctor’s office by ligation. A small rubber band is placed around the tissue above the hemorrhoid to cut off its blood supply. The hemorrhoid tissue and band slough off a few days later and the sore that is left will heal. This method produces mild discomfort and slight bleeding.

What is Infrared Coagulation?
Infrared Coagulation (IRC) is the most widely used office treatment for hemorrhoids and is preferred over other methods because it is fast, well tolerated by patients, and virtually pain free. A small probe contacts the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. The patient may feel a sensation of heat very briefly, but it is generally not painful. Therefore anesthetic is usually not required.

Are There Any After Effects?
Generally not. Most patients return to a normal lifestyle the same day. There may be slight spot bleeding a few days later. Heavy straining or lifting should be avoided and aspirin should not be taken for a few days.

How Many Visits Are Required?
Many patients have more than one hemorrhoid. Therefore, most physicians recommend two or three visits at twoweek intervals, treating a different portion of the hemorrhoid tissue each visit.

Will The Hemorrhoids Come Back?
Millions of patients have been treated with IRC. Experience tells us that hemorrhoids treated with IRC generally do hot recur. A sensible diet, moderate exercise, and proper bowel habits will also help.

Our team of specialists includes:

Board Certified Physician
Board Certified Nurse Practitioner.

Obtaining an Appointment

You may first be seen by one of our providers
at SCIM and be referred.
You may be referred by another physician.
Self-referral is optional.
Call and set up your appointment today!

“I can’t believe we had our procedure yesterday”

South Carolina Internal Medicine 1 Wellness Boulevard, Suite 200 Irmo, SC 29063 803.749.1111 fax 803.749.0050. Carlotta M. Davis, APRN, CDE

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Health Education, Healthy Living Hemorrhoids (Kaiser Permanente)

admin — Tue, 22 Dec 2009 06:46:20 +0000

Hemorrhoids
Hemorrhoids are enlarged and inflamed veins that may develop either inside or outside the anal canal. These veins can become enlarged and inflamed when we strain to pass hard, compacted stools.

Prolonged sitting or standing, or being overweight or pregnant, can also cause hemorrhoids.

The symptoms of hemorrhoids include:

Bright red streaks of blood on stools or spurting from the anus.
Leakage of mucus from the anus.
Irritation or itching around the anus.

Sometimes an internal hemorrhoid will actually stick out of the anus, and it may have to be pushed back into place with a finger. Although they can cause discomfort, hemorrhoids do not usually cause severe pain unless a blood clot forms in a hemorrhoid.

A clotted hemorrhoid can be extremely painful, but is not dangerous. While itching around the anus can be a symptom of hemorrhoids, anal itching is usually caused by other conditions.

If the anus is not kept clean, itching may result. Any fecal seepage that comes with diarrhea can irritate the skin around the anus. Trying to keep the area too clean by rubbing with dry toilet paper or using excess soap can also injure the skin.

While it is important to keep the skin in the anal area clean, it is also important to be gentle when doing so. Although uncomfortable at times, hemorrhoids rarely pose a serious health problem. They generally last several days and often come back (recur).

Nearly everyone, in fact, has hemorrhoids at some time. There are, however, steps you can take to reduce your discomfort from hemorrhoids and help prevent their recurring.

How to prevent hemorrhoids

Try to keep your stools soft
Be sure to include plenty of water, fresh fruits, vegetables, and whole grains in your diet. Add two tablespoons of bran or a commercial fiber product such as Citrucel or Metamucil to your diet each day.
Avoid using laxatives, because they may cause diarrhea which can irritate hemorrhoids
For information about constipation, check your Kaiser Permanente Healthwise Handbook or search online at kp.org.
Try to exercise every day to promote smooth bowel movements.
Avoid sitting or standing too much
This restricts blood flow around the anus. Take short walks to increase blood flow in your pelvic region.
Go to the bathroom as soon as you have the urge
Try not to strain during bowel movements. Remember to take your time and never hold your breath.
If you are pregnant, try sleeping on your side to relieve the pressure on your pelvic area.
Keep your anal area clean
More importantly, be gentle when cleaning yourself.

Home treatment

Taking warm baths can be soothing and cleansing, especially after a bowel movement.
Try using pre-moistened tissues (baby wipes) or moistened toilet paper instead of dry toilet paper.
Wear cotton underwear and loose clothing.
Relieve itching by using cold compresses on the anus four times a day, ten minutes at a time.
Sitz baths (hot baths with just enough water to cover the anal area) can be soothing, but may worsen itching.
Use medicated suppositories to relieve pain and lubricate the anal canal during a bowel movement.
Ease itching and irritation with zinc oxide, petroleum jelly, or hydrocortisone (1 percent) cream.
Ask your physician before using any product that contains a local anesthetic. These products have the suffix “-caine” in the name of the product or in the name of one of the ingredients. Such products can cause allergic reactions in some people.

Call Kaiser Permanente if:

Any bleeding continues for longer than one week despite home treatment.
Pain is severe or lasts longer than one week after home treatment.
Bleeding occurs for no apparent reason and is not associated with straining to pass stools.
A lump on the anus is increasing in size or becoming more painful and you develop a fever.
Fever accompanies bloody stools.
Stools become more narrow than usual (maybe no wider than a pencil).
Any unusual material or tissue seeps or sticks out of the anus.

Other resources:

Connect to our Web site at kp.org. to access health and drug encyclopedias, interactive programs, health classes, and much more.
Check your Kaiser Permanente Healthwise Handbook.
Contact your Kaiser Permanente Health Education Center or Department for health information programs, and other resources.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional.

If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse any brand names; any similar products may be used.

© 2002, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education.
Adapted from copyrighted material of Healthwise, Incorporated. 915800009 (Revised 8-08) RL 8.0

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Endoscopic hemorrhoidal sclerotherapy using 50% dextrose water a preliminary report

admin — Tue, 22 Dec 2009 06:41:42 +0000

Absract
Injection sclerotherapy has a prominent role in the treatment of bleeding hemorrhoids. The commonly used sclerosants are not available or very expensive in Nigeria. We prospectively evaluated 50% dextrose water, used as a nonallergenic sclerosant, in the treatment of bleeding internal hemorrhoids.

Forty consenting adult patients (median age 50 years [range 35–67]; 22 women) with bleeding hemorrhoids, seen over a 2-year period, were offered injection sclerotherapy with 50% dextrose water.

They were assessed for response, tolerance and complications. The duration of symptoms before presentation was 3 months to 15 years. The bleeding stopped after the injection in all patients. No patient needed a repeat procedure.

No complication was recorded during follow up which ranged from 2 months to 12 months. We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.

Introduction
Bleeding from hemorrhoids is the most common anorectal disease. Historically, injection sclerotherapy has had a prominent role in the treatment of bleeding hemorrhoids.

Some of the sclerosants that have been used include Nbutylcyanoacrylate, ethanolamine oleate, 5% phenol in almond oil, sodium tetradecyl phosphate, and sodium morrhuate.

The injected sclerosant obliterates the hemorrhoid vascularity, inducing inflammation and fibrosis which fixes the hemorrhoids to the surrounding tissue and prevents prolapse. This method has, however, become unpopular because of sclerosant related morbidity which includes anorectal abscess, hepatic abscess, necrotizing fascitis, retroperitoneal sepsis, oleogranuloma (with oil-containing solutions), and pulmonary allergic reaction.

Though rare, some of these complications may be fatal. To reduce the morbidity associated with non-physiological agents, Ponsky et al. used hypertonic saline, and found good response, but no complication, in 19 patients with bleeding hemorrhoids. They concluded that non allergenic sclerosing agents may give better results with less complications.

Another physiological solution that has been used as a sclerosant is 50% dextrose water; this agent has not been used as a sclerosant for hemorrhoids.

Rubber band ligation is presently the most preferred outpatient treatment for hemorrhoids. This method of treatment may not be very useful in patient with active bleeding.

Some of the commonly used sclerosing agents are not easily available in most centers in Nigeria; hence we conducted this study to assess the efficacy of 50% dextrose water in patients with bleeding hemorrhoids.

Methods
The study was conducted at the Endoscopy Unit of our hospital which serves as the referral tertiary hospital to the rural and semi-urban agrarian communities in southwestern Nigeria, which has an estimated population of approximately 7.7 million persons.

Forty consenting consecutive patients (22 women) with bleeding hemorrhoids between January 2006 and May 2008 were recruited. Five patients with bleeding hemorrhoids who chose conservative management and one patient who opted for surgical management were excluded. Patients with significant blood loss before presentation were resuscitated.

The diagnosis of hemorrhoids was confirmed by protoscopy in all patients. Hemorrhoids were classified into four grades using the American classification. Patients above 50 years underwent colonoscopy to rule out additional sources of rectal bleeding. Patients with history of diabetes mellitus or with positive urine-reducing substances were excluded from the study.

Premedication consisted of intramuscular pentazocine (30 mg) and prophylactic antibiotic (combination of ampicillin and cloxacillin 1 g intravenous). Patients were placed in modified left lateral decubitus (Sims’ position).

All injections were done by experienced personnel. Approximately 2–5 mL of 50% dextrose water was injected into the submucosa of each hemorrhoidal bundle, at least 1 cm proximal to the dentate line, using a 20-guage spinal needle.

The injection was deep enough so as not to blanch the mucosa, but not deep enough to injure the underlying muscle. Each patient was observed for 30 minutes before being allowed to go home. Patients were asked to follow up at 1 week, 4 week and 3 months to assess for recurrence or complications.

Intraoperatively, pain assessment was done using a 4-point modified visual analogue scale where grade 1 indicated severe pain requiring conversion to general anesthesia, and grade 4 indicated no pain.

Since bleeding was the chief complaint, relief of bleeding was used as an indicator of success of treatment. The grade of the hemorrhoids, duration of symptoms, the modified visual analogue rating and outcome were recorded. Data were analyzed using SPSS version 11.0 (SPSS Institute, Chicago, IL).

Results
The median age of patients was 50 years (range 35–67 years). The median duration of symptoms before presentation was 1 year (range 3 months to 15 years). Nine (22.5%) patients had grade 1 disease, 15 (37.5%) had grade 2, 11 (27.5%) had grade, and 5 (12.5%) had grade 4 disease.

The procedure lasted for approximately 3 to 5 minutes. All patients tolerated the procedure well. Thirty five patients had grade 3 (mild) discomfort and 5 patients had no discomfort during the procedure. Bleeding stopped after the injection in all patients. No patient needed a repeat procedure.

No complication was recorded during the varying period of follow up which ranged from 2 months to 1 year and the median follow up is 10 months. Eighteen of the 31 patients with grade 2 to 4 hemorrhoids had regression of the anal protrusion.

Discussion
Bleeding is the most common complication of hemorrhoids. Occasionally the bleeding may be large in quantity. Because of the absence of social security and fear of surgery, most Nigerian patients prefer an effective procedure that will not involve the use of anesthesia and that will be inexpensive.

Injection sclerotherapy is a simple, safe and effective method for the treatment of bleeding hemorrhoids. The success rate of the procedure is close to 100%. Problems associated with injection sclerotherapy are due to the sclerosing agent used or incorrect placement.

The most common sclerosing agents used include 5% phenol in almond oil, ethanolamine oleate and sodium tetradecyl phosphate. These agents are expensive and not readily available in our environment.

They are also non physiological, toxic and allergenic. Perianal sepsis has been reported following injection sclerotherapy.

We found an impressive response in our patients after a single injection of 50% dextrose water; the bleeding stopped in all patients and no patient had recurrence of bleeding during follow up. Results obtained in the study may be due to the fact that 50% dextrose water is a physiological solution with mild sclerosing effect. This effect may be progressive over time preventing recurrence of the disease.

In addition, the anal tag associated with the disease regresses after the procedure. This may be due to
the fact that the tone of connective tissues that hold the anal cushion improved after the injection. These findings will need further evaluation in larger population and long-term follow up.

One of the major complications of various treatment modalities of hemorrhoids is pain. Pain could be very severe necessitating use of opoid analgesics. None of our patients needed an analgesic after the procedure. No complication was observed during the procedure.

We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.

References

Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990;98:380–6.
Cataldo PA. Hemorrhoids. Clin Colon Rect Surg 2001;14:203–14.
Kann BR, Whitlow CB. Hemorrhoids: Diagnosis and Management. Tech Gastrointest Endosc 2004;6:6–11.
Thomson WH. Banding and injection of piles. Ann R Coll Surg Engl 2001;83:361–2.
Guy RJ, Seow-Choen F. Septic complications after treatment of haemorrhoids. Br J Surg 2003;90:147–56.
Ponsky JL, Mellinger JD, Simon IB. Endoscopic retrograde hemorrhoidal sclerotherapy using 23.4% saline: a preliminary report. Gastrointest Endosc 1991;37:155–8.
Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993;6:23–33.
Davies RJ. Haemorrhoids. Clin Evid 2006;15:711–24.
Faponle AF, Kuti O. Perception of labour pain by pregnant women in Southwestern Nigeria. Trop J Obstet Gynaecol 2004;21:153–5.
Nisar PJ, Scholefi eld JH. Managing haemorrhoids. BMJ 2003;327:847–51.

Olusegun I. Alatise • Olu A. Arigbabu • Oladejo O. Lawal • Abdulrasheed K. Adesunkanmi •
Augustine E Agbakwuru • Denis A. Ndububa • David O. Akinola • Alatise, et al

Department of Anatomy and Cell Biology, Department of Surgery, Department of Medicine, College of Health Sciences, Obafemi Awolowo University Nigeria.
E-mail: segunalatishe@yahoo.co.uk,
Received: 28 July 2008 /
Revised: 8 November 2008 /
Accepted: 9 December 2008.
© Indian Society of Gastroenterology 2009.
Indian J Gastroenterol 2009: 28(Jan–Feb):31–32.

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American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids (Part 2)

admin — Tue, 22 Dec 2009 06:28:07 +0000

To read the previous post, you can click here.

H. Conclusions
Hemorrhoids are a common condition with symptoms that include bleeding, protrusion, and itching. Because other conditions can lead to identical symptoms, a directed physical examination, including anoscopy and proctosigmoidoscopy, should be performed.

Care depends on the extent of hemorrhoidal disease. First-degree hemorrhoids can be treated with medical management alone or with one of several nonoperative outpatient therapies. Second-degree and relatively small and thirddegree hemorrhoids can be treated with nonoperative therapy.

Surgery is generally reserved for the minority of patients who have large third-degree or fourth-degree hemorrhoids, acutely incarcerated and thrombosed hemorrhoids, hemorrhoids with an extensive and symptomatic external component, or patients who have undergone less aggressive therapy with poor results.

ROBERT D. MADOFF – University of Minnesota – Minneapolis, Minnesota

JAMES W. FLESHMAN – Washington University School of Medicine – St. Louis, Missouri

I. References

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Address requests for reprints to: Chair, Clinical Practice Committee, AGA National Of.ce, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: (301) 654-5920.

The Clinical Practice Committee acknowledges the following individuals whose critiques of this review paper provided valuable guidance to the authors: Jeffrey L. Barnett, M.D., Peter Carne, M.D., Gary R.Lichtenstein, M.D., and John H. Pemberton, M.D.

The authors thank Pamela Barnard, M.S.L.S., for literature search assistance, Mary E. Knatterud, Ph.D., for editorial help, and Alexandra A. Broek for help with preparation of the manuscript.

Abbreviation used in this paper: MPFF, micronized, puri.ed .avonoid fraction.
© 2004 by the American Gastroenterological Association.

Incoming search terms:

Banov L Jr Knoepp LF Jr Erdman LH Alia RT Management of hemorrhoidal disease J S C Med Assoc 1985;81:398–401

American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids (Part 1)

admin — Tue, 22 Dec 2009 06:05:32 +0000

This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice Committee. The paper was approved by the Committee on January 8, 2004, and by the AGA Governing Board on February 13, 2004.

Hemorrhoids are a common condition, but their true prevalence is unknown. Most patients and many physicians tend to attribute any anorectal symptom to hemorrhoids. Furthermore, anal cushions are normal structural components of the anal canal that are present from infancy.

Despite their confusing epidemiology, it is important for gastroenterologists, surgeons, and primary care physicians alike to be able to accurately diagnose hemorrhoids and offer a rational, effective treatment plan.

A. Materials and Methods
We performed a literature search for all English language articles dealing with hemorrhoids published from 1990 to 2002. Databases searched included MEDLINE, PreMEDLINE, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effectiveness, the American College of Physicians Journal Club, and the Cochrane Central Registry of Controlled Trials.

Additional references were obtained from the bibliographies of selected articles. We selected pertinent studies emphasizing randomized controlled trials to formulate this technical review.

B. Etiology and Pathophysiology
Hemorrhoids are found in the subepithelial space of the anal canal. They consist of connective tissue cushions surrounding the direct arteriovenous communications between the terminal branches of the superior rectal arteries and the superior, inferior, and middle rectal veins.

Anal subepithelial smooth muscle arises from the conjoined longitudinal muscle layer, passes through the internal anal sphincter, and inserts into the subepithelial vascular space. There, the smooth muscle suspends and contributes to the bulk of the hemorrhoidal cushions.

The cushions contribute approximately 15%–20% of the resting anal pressure. Perhaps more importantly, they serve as a conformable plug to ensure complete closure of the anal canal. Most people have 3 of these cushions, but cadaver studies have shown that the so-called typical right anterior, right posterior, and left lateral configuration of the cushions occurs only 19% of the time.

Symptoms attributed to hemorrhoids include bleeding, protrusion, itching, and pain. For the most part, external hemorrhoids are asymptomatic unless they become thrombosed, in which case they present as an acutely painful perianal lump. Persisting skin tags after resolution of the thrombosis can lead to problems with hygiene and secondary irritation.

Most hemorrhoidal symptoms arise from enlarged internal hemorrhoids. Abnormal swelling of the anal cushions, stretching of the suspensory muscles, and dilation of the submucosal arteriovenous plexus result in the prolapse of upper anal and lower rectal tissue through the anal canal. This tissue is easily traumatized, leading to bleeding. The blood is typically bright red due to the arterial oxygen tension caused by arteriovenous communications within the anal cushions. Prolapse of the rectal mucosa leads to deposition of mucus on the perianal skin, causing itchiness and discomfort.

The pathogenesis of the enlarged, prolapsing cushions is unknown. Many clinicians believe that inadequate fiber intake, prolonged sitting on the toilet, and chronic straining at stool contribute to the development of symptomatic hemorrhoids, yet rigorous proof of such beliefs is lacking. Other factors have also been proposed, including constipation, diarrhea, pregnancy, and family history.

None of these have been rigorously proven, although 0.2% of pregnant women require urgent hemorrhoidectomy for incarcerated prolapsed hemorrhoids. Multiple studies have shown elevated anal resting pressure in patients with hemorrhoids when compared with controls voluntary contraction pressure is unchanged.

Whether the elevated resting pressure is caused by or due to enlarged hemorrhoids is unknown, but resting tone becomes normal after hemorrhoidectomy. Ultraslow pressure waves are more common in patients with hemorrhoids, but the significance of the waves is uncertain.

C. Epidemiology
The epidemiology of hemorrhoids has been studied using a number of approaches, each of which has shortcomings. Accordingly, the data must be interpreted with caution. Population-based surveys rely on self-reporting of a condition with symptoms that are nonspecific; moreover, a physician observer does not validate these supposed diagnoses.

Hospital discharge data are more reliable in this regard but still remain imperfect; it is likely that most patients with a diagnosis of hemorrhoids at discharge have not in fact undergone a directed anorectal examination. Similar criticism may be leveled at physician visit data; a complete evaluation, including anoscopy, cannot be assumed to have taken place, particularly if the data are from primary care providers.

Hospital-based proctoscopy studies show prevalence rates of up to 86%, even though many of their patients are asymptomatic. Despite these caveats, the community-wide prevalence of hemorrhoids in the United States is reported to be 4.4%, with a peak prevalence occurring between 45 and 65 years of age.

Increased prevalence rates are associated with higher socioeconomic status, but this association may reflect differences in health-seeking behavior rather than true prevalence. Population-based surveys suggest that the prevalence of hemorrhoids decreased in both the United States and United Kingdom during the second half of the 20th century. Hemorrhoids are frequently seen in patients with spinal cord injury.

D. Evaluation and Classification
For many patients, the presence of any anorectal symptom is indicative of hemorrhoids. Physicians should not make the same assumption. Hemorrhoids are, in fact, frequently the cause of common symptoms such as bleeding, a lump, itching, or pain.

However, when hemorrhoids are simply assumed to be the cause, other pathology is too often overlooked. Prolapsing hemorrhoids may cause anal itching, but itching is just as likely to be due to inadequate hygiene, minor incontinence, or perianal dermatitis.

Pain associated with a palpable lump is the hallmark of a thrombosed external hemorrhoid, but anal fissure and perianal abscess are equally common causes of anal pain and, in particular, painful defecation. A precise patient history and a careful physical examination are essential for accurate diagnosis; neither should be omitted when a patient has anorectal symptoms.

Bleeding is the most common presenting symptom of hemorrhoids. The blood is typically bright red and may frequently drip or squirt into the toilet bowl. Darker blood and blood mixed in the stool suggest a more proximal source of bleeding.

However, because physicians predictions are not reliable in the evaluation of hematochezia, exclusive reliance on patients’ descriptions of bleeding is unwise; further investigation is warranted. Current practice guidelines from both the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract advocate a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding.

Complete colonic evaluation by colonoscopy or air-contrast barium enema is indicated when the bleeding is atypical for hemorrhoids, when no source is evident on anorectal examination, or when the patient has significant risk factors for colonic neoplasia. The decision to pursue further evaluation also depends on the patient’s age and general medical condition.

Hemorrhoids alone do not cause a positive result with a stool guaiac test, so fecal occult blood should not be attributed to hemorrhoids until the colon is adequately evaluated. Anemia due to hemorrhoidal disease is rare (0.5 patients/100,000 population) and responds to hemorrhoidectomy.

Because symptoms caused by other conditions are frequently attributed to hemorrhoids, a careful anorectal evaluation is warranted for any patient who reports hemorrhoids. External examination will enable the discovery of pathology such as perianal abscess or anal fistula.

The cardinal symptom of anal fissure is postdefecatory pain, but anal fissure also frequently causes minor rectal bleeding. Anal fissure is best seen with eversion of the anal canal by opposing traction with the thumbs. Any skin tags, thrombosed external hemorrhoids, mixed hemorrhoids, and incarcerated rectal mucosal prolapse will be evident on external examination. Internal hemorrhoids and associated rectal mucosal prolapse are best evaluated through an anoscope with an adequate light source.

Portal hypertension can cause varices of the anal canal. These varices are distinct from hemorrhoids and should not be considered a cause of hemorrhoids. In fact, patients with portal hypertension and varices do not have an increased incidence of hemorrhoids.

Variceal bleeding should not be considered the same as hemorrhoidal bleeding, so standard hemorrhoidal treatments should not be used. Rectal variceal bleeding is best treated by correction of the underlying portal hypertension; transjugular intrahepatic portosystemic shunts have been successfully used in the treatment of refractory bleeding.

If local therapy is necessary, oversewing of the varices rather than attempted excision is the procedure of choice. There are a few case reports of injection sclerotherapy for bleeding rectal varices, but the overall success rate of this approach is unknown.

The evaluation of patients with hemorrhoids should include an assessment of their symptoms. As mentioned previously, the presence, quantity, and frequency of bleeding are important. The presence, timing, and reducibility of prolapsed tissue help to classify the extent of the hemorrhoids and dictate therapeutic options.

The effect of the hemorrhoids on hygiene is a factor when deciding on operative treatment. Anal pain is generally not associated with hemorrhoids unless thrombosis has occurred. Thus, anal pain suggests other pathology and mandates closer investigation.

As many as 20% of patients with hemorrhoids have concomitant anal fissures. New-onset anal pain in the absence of a visible source suggests the possibility of a small intersphincteric abscess.

Hemorrhoids are defined as internal or external according to their position relative to the dentate line. External hemorrhoids become symptomatic only when thrombosed or when skin tags are so large that hygiene is impossible. Thrombosed external hemorrhoids are common. Such patients present with acute-onset anal pain and a palpable perianal lump.

Thrombosed external hemorrhoids occasionally bleed when local pressure causes erosion through the overlying skin. Thrombosed internal hemorrhoids are far less common; typical symptoms include pain, pressure, bleeding, mucus production, and an inability to reduce spontaneously prolapsing tissue.

Symptoms of internal hemorrhoids include bleeding and protrusion. Prolapsed hemorrhoids are a cause of soiling and mucus discharge, and both lead to secondary pruritus ani. Advanced prolapsed hemorrhoids may become incarcerated and strangulated.

Most colorectal surgeons use the grading system published in 1985 by Banov et al. Internal hemorrhoids that bleed but do not prolapse are designated as firstdegree hemorrhoids. Those that prolapse and reduce spontaneously (with or without bleeding) are seconddegree hemorrhoids. Prolapsed hemorrhoids that require reduction are third-degree hemorrhoids.

Prolapsed internal hemorrhoids that cannot be reduced are fourth-degree hemorrhoids; they usually include both internal and external components and are confluent from skin tag to inner anal canal. Acutely thrombosed, incarcerated internal hemorrhoids and incarcerated, thrombosed hemorrhoids involving circumferential rectal mucosal prolapse are also fourth-degree hemorrhoids.

Accurate classification is important for both assessing the reported efficacy of various hemorrhoidal treatments and selecting the optimal treatment for an individual patient. The American Society of Colon and Rectal Surgeons uses the Banov classification in its practice parameters for the treatment of hemorrhoids.

However, a descriptive system is sometimes more useful than one based on symptoms because of the range in severity within each grade. Large third-degree hemorrhoids may only be treatable with excision, for example, if they extend to the dentate line, if chronic prolapse has caused epithelial changes, or if the volume of tissue is simply too large to be managed nonoperatively. Smaller third-degree hemorrhoids, in contrast, may be readily treatable by nonoperative methods.

E. Medical Treatment
Few recent studies concern either the prevention or the medical management of hemorrhoids. The almostuniversal recommendations are to add dietary fiber and to avoid straining at stool. One double-blind, placebo-controlled trial showed that the use of psyllium reduced hemorrhoidal bleeding and painful defecation, but other studies of fiber have shown less impressive or insignificant results.

Because diarrhea exacerbates hemorrhoidal symptoms, controlling it with fiber, antimotility agents, and specific treatment of any underlying cause will likely be of benefit. Over-the-counter topical agents and suppositories have become equally ubiquitous in the empirical treatment of hemorrhoidal symptoms, but data supporting their use are lacking.

Topical analgesics may bring symptomatic relief of local pain and itching. Corticosteroid creams may ameliorate local perianal inflammation, but no data suggest that they actually reduce hemorrhoidal swelling, bleeding, or protrusion. Long-term use of highpotency corticosteroid creams is deleterious and should be avoided. In one prospective series, nitroglycerin ointment relieved pain due to thrombosed external hemorrhoids, presumably by decreasing anal tone.

Several studies have assessed the use of oral micronized, purified flavonoid fraction (MPFF) (Daflon; Servier Laboratories, Neuilly-Sur-Seine, France). Flavonoids increase venous tone, lymphatic drainage, and capillary resistance and normalize capillary permeability.

Two placebo controlled trials showed symptomatic improvement with use of MPFF, but results were inconsistent when MPFF and fiber were combined. Ho et al. reported that a combination of MPFF and fiber led to faster relief of hemorrhoidal bleeding than either fiber and rubber band ligation or fiber alone.

In contrast, Thanapong-sathorn et al. compared fiber with and without MPFF in a double-blind trial and found similar improvement at 14 days. MPFF has not been approved for use in the United States by the Food and Drug Administration.

F. Nonoperative Treatment
Several methods that do not involve surgical excision are available to treat patients with hemorrhoids. These procedures are usually performed in the office setting and do not require anesthesia. Although nonexcisional, they all function as ablative by thrombosis, sclerosis, or necrosis of the mucosal portion of the hemorrhoidal complex.

1. Sclerotherapy
Sclerotherapy is one of the oldest forms of nonoperative treatment; it was first described in 1869 by Morgan in Dublin. It is reserved for first or seconddegree hemorrhoids. A submucosal injection of 5 mL of 5% phenol in oil, 5% quinine and urea, or hypertonic (23.4%) salt solution at the base of the hemorrhoidal complex causes thrombosis of vessels, sclerosis of connective tissue, and shrinkage and fixation of overlying mucosa.

Sclerotherapy requires no anesthesia and takes only minutes to perform through an anoscope. Khoury et al. performed a prospective trial of patients with first or second-degree hemorrhoids who had initially been treated with medical therapy. In that trial, sclerotherapy improved or cured 89.9% of the patients, with no difference between single or multiple injections.

In contrast, Senapati and Nicholls performed a randomized controlled trial and found no difference in bleeding rates at 6 months following sclerotherapy with bulk laxatives or bulk laxatives alone.

Even though sclerotherapy is minimally invasive, it can cause complications. Pain is variably reported in 12%–70% of patients. Impotence, urinary retention, and abscess have also been reported. In one study, hemorrhoidal symptoms recurred in about 30% of patients 4 years after initially successful sclerotherapy.

2. Cryotherapy
Cryotherapy has been advocated as a technique for destroying enlarged internal hemorrhoids. Initial reports were enthusiastic; however, the technique is relatively time consuming, and subsequent reports have shown disappointing results.

Smith et al. performed a trial comparing cryotherapy with closed hemorrhoidectomy on different hemorrhoids in the same patient. The cryotherapy site was associated with prolonged pain, foul-smelling discharge, and a greater need for additional therapy. Cryotherapy is now only rarely used for the treatment of patients with hemorrhoids.

3. Rubber Band Ligation
Rubber band ligation relies on the tight encirclement of redundant mucosa, connective tissue, and blood vessels in the hemorrhoidal complex. The encirclement must be well proximal (at least 2 cm) to the dentate line.

Placement of the band too far distally leads to immediate, usually severe pain due to the presence of somatic sensory nerve afferents that are absent above the anal transition zone. Internal hemorrhoid ligation can be performed in the office setting with one of several commercially available instruments, including devices that use suction to draw the redundant tissue into the applicator to make the procedure a one-person effort.

No anesthesia is required. The resulting scar fixes the connective tissue to the rectal wall and resolves the prolapse. Endoscopic variceal ligators have also been shown to be effective tools for hemorrhoid ligation.

Rubber band ligation is most commonly used for first-, second-, or third-degree hemorrhoids. Some authorities recommend it for fourth-degree hemorrhoids after operative reduction of the incarcerated prolapse.

Up to 3 hemorrhoids can be banded in a single session, although many authorities prefer to limit treatment to 1 or 2 columns at a time. Like the other nonoperative treatments, rubber band ligation does not address the external hemorrhoid component.

Success rates vary, depending on the degree of hemorrhoids treated, length of follow-up, and criteria for success. Wrobleski et al. reported that 80% of their patients improved and 69% were symptom-free at a mean follow-up of 5 years. Steinberg et al. reported 89% patient satisfaction at a similar follow-up interval, but only 44% of their patients were symptom-free.

The recurrence rate may be as high as 68% at 4 or 5 years of follow-up, but symptoms usually respond to repeat ligation; only 10% of such patients require excisional hemorrhoidectomy.

The most common complication of rubber band ligation is pain, which is reported in 5%–60% of treated patients. Pain following the procedure tends to be relatively minor and almost always can be satisfactorily managed with sitz baths and over-the-counter analgesics.

Other complications, such as abscess, urinary retention, band slippage, prolapse and thrombosis of adjacent hemorrhoids, and minor bleeding from the ulcer, occur in 5% of patients.

Severe bleeding occasionally requires intervention when the eschar from the band sloughs, usually 1–2 weeks after treatment. Necrotizing pelvic sepsis is a rare complication of rubber band ligation.

The clinical triad of severe pain, high fever, and urinary retention suggests the diagnosis. Such patients require emergency examination under anesthesia, with radical debridement of all necrotic tissue. The risk of necrotizing pelvic infection is increased in immunocompromised patients, including those with uncontrolled acquired immunodeficiency syndrome, neutropenia, and severe diabetes mellitus.

4. Bipolar Diathermy. Direct-Current, Electrotherapy, and Infrared. Photocoagulation
These techniques all rely on the coagulation, occlusion, and obliteration or sclerosis of the hemorrhoidalvascular pedicle above the level of the anal transition zone. The area of tissue damage sloughs, leaving an ulcer that eventually forms fibrotic tissue at the treatment site.

Bipolar diathermy or cautery is applied in 1-second pulses of 20 W until the underlying tissue coagulates (often _30 seconds). About 12% of patients experience pain, bleeding, fissure, or spasm of the internal sphincter. Multiple applications to the same site are often required, especially for second- and third-degree hemorrhoids (up to 3 per site).

The depth of injury from bipolar cautery is 2.2 mm and does not increase with multiple applications at the same site. Bipolar cautery has been used to treat first-, second-, and thirddegree internal hemorrhoids; success rates (defined by relief of bleeding) range from 88% to 100% in randomized trials. It does not eliminate prolapsing tissue, and up to 20% of patients will require excisional hemorrhoidectomy.

Direct-current electrotherapy requires the prolonged (up to 14 minutes) application of 110-V direct current (up to 15 mA) to the base of the hemorrhoidal complex well above the anal transition zone.

Current and time requirements increase for higher-grade hemorrhoids. Multiple treatments to the same site are required in up to 30% of patients. Even though multiple sites can be treated in one setting with minimal pain, the technique has not been widely accepted because of the lengthy treatment time and the limited control of prolapse in higher-grade hemorrhoids (only a 44% success rate).

However, in several randomized trials using adequate levels of current (16 mA) and prolonged treatment times (10 minutes), bleeding was controlled in 88% of patients with first-, second-, or third-degree hemorrhoids. Complications included pain (33%), ulcer formation (4%), and bleeding (10%).

Infrared photocoagulation focuses infrared radiation from a tungsten-halogen lamp via a polymer probe tip. The probe tip must touch the hemorrhoidal tissue at its base; 0.5- to 2-second pulses of energy are delivered to the area.

Multiple (2– 6) hemorrhoids can be treated at one time. The depth of tissue injury after one treatment is about 2.5 mm, and the penetration increases with subsequent treatment at the same site. According to 2 randomized studies, hemorrhoidal bleeding was successfully controlled in 67%–96% of patients with first- or second-degree hemorrhoids.

Complications, including pain and bleeding, are uncommon. Each method of nonoperative treatment described has its proponents. Randomized controlled trials have compared each method with one or more of the others, yet no single study has compared all 5 (sclerotherapy, rubber band ligation, bipolar diathermy, direct-current electrotherapy, and infrared photocoagulation).

A meta-analysis by Johanson and Rimm examined 5 trials involving 862 patients with first or second-degree hemorrhoids who underwent infrared photocoagulation, sclerotherapy, or rubber band ligation.

Rubber band ligation was more effective than sclerotherapy, and patients treated with rubber band ligation required fewer additional treatments than those treated with sclerotherapy or infrared photocoagulation.

However, rubber band ligation was associated with a significantly higher incidence of pain than the other 2 treatments. Thus, Johanson and Rimm favored infrared photocoagulation as the nonoperative treatment of choice.

MacRae et al. performed a similar meta-analysis covering 23 studies that compared rubber band ligation, infrared photocoagulation, sclerotherapy, hemorrhoidectomy, and manual dilation of the anus for patients with first-, second-, or third-degree hemorrhoids.Like Johanson and Rimm, they found that rubber band ligation was more effective than sclerotherapy, less likely to require additional therapy than either sclerotherapy or infrared photocoagulation, and more likely to cause pain.

Despite these identical findings, MacRae et al. concluded that rubber band ligation was the initial procedure of choice for first-, second-, and third-degree hemorrhoids because of its higher rate of efficacy.

G. Surgical Treatment
Surgical hemorrhoidectomy is the most effective treatment for hemorrhoids overall and for third-degree hemorrhoids in particular. Recurrence following a properly performed hemorrhoidectomy is uncommon.

However, nonoperative techniques are preferred when feasible in the first instance because surgery is associated with more pain and complications.

Hemorrhoidectomy techniques include excising internal and external components in 1–3 quadrants around the anal canal, suturing or banding the internal hemorrhoids and excising the external component, or performing a circular excision of the internal hemorrhoids and prolapsing rectal mucosa proximal to the dentate line.

Anal dilatation has been advocated as a nonexcisional operation for hemorrhoids and this approach has had some acceptance in European centers. However, anal endosonography has shown sphincter injuries associated with anal dilatation and several clinical series have reported high rates of associated incontinence.

Konsten and Baeten reported long-term follow-up (median, 17 years) results of a randomized prospective trial of hemorrhoidectomy versus anal dilatation; 52% of patients who underwent anal dilatation had impaired continence at the time of follow-up.

Furthermore, anal dilatation has a higher failure rate than operative hemorrhoidectomy in prospective randomized trials. Because of the risk of incontinence, most authorities now advocate abandoning this approach to the treatment of patients with hemorrhoids.

Indications for surgical hemorrhoidectomy include hemorrhoids too extensive for nonoperative management, failure of nonoperative management, patient preference, and concomitant conditions (such as fissure or fistula) that require surgery.

About 5%–10% of patients, usually those with third- or fourth-degree hemorrhoids, need surgical hemorrhoidectomy. Surgical hemorrhoidectomy can be performed with either open or closed techniques.

In the Milligan-Morgan hemorrhoidectomy, widely used in the United Kingdom, the internal and external components of each hemorrhoid are excised and the skin is left open in a 3-leaf clover pattern that heals secondarily for 4–8 weeks.

In the Ferguson hemorrhoidectomy, each hemorrhoid component is excised and the wounds are closed primarily. Four randomized trials have studied open versus closed hemorrhoidectomy. Three of these trials showed no difference in postoperative pain. Differences in healing times were not consistent between trials.

One randomized trial showed decreased pain and a more rapid return to work following submucosal (partially closed) versus Milligan-Morgan hemorrhoidectomy. Postoperative pain remains the major drawback of excisional hemorrhoidectomy. Narcotic analgesics are generally required, and recent studies show that most patients do not return to work for 2–4 weeks following surgery.

Several trials have assessed the effect of excision techniques on postoperative pain. Randomized trials have shown no difference in pain scores between diathermy and scissors hemorrhoidectomy, although the oral pain medication requirement was less in the diathermy groups.

Early reports suggested that laser hemorrhoidectomy was associated with decreased postoperative pain, but a randomized trial of the Nd:YAG laser versus cold scalpel excision for closed hemorrhoidectomy did not detect any difference in postoperative pain or analgesic use.

In fact, the trial found that laser hemorrhoidectomy was associated with impaired wound healing and higher cost. Four randomized controlled trials evaluating the ultrasonically activated scalpel showed conflicting results with respect to postoperative pain. Two small randomized trials suggested a possible minor advantage with a bipolar diathermy device (LigaSure; Valleylab, Boulder, CO), but pain scores themselves did not differ significantly.

Other strategies to reduce pain have included limiting the incision, suturing only the vascular pedicle without an incision, using a lateral internal sphincterotomy in conjunction with an external hemorrhoidectomy, administering metronidazole, injecting local anesthetics at the operative site, and using drugs such as anal sphincter relaxants, anxiolytics, parasympathomimetics (to avoid urinary retention), and topical nitroglycerin.

However, each strategy has had limited or mixed results. The complications of hemorrhoidectomy are usually minor but occur with significant frequency. These complications include urinary retention (2%–36%), bleeding (0.03%–6%), anal stenosis (0%–6%), infection (0.5%–5.5%), and incontinence (2%–12%).

Sphincter defects have been documented (by ultrasonography and anal manometry) in up to 12% of patients after hemorrhoidectomy. The use of excessive retraction with extensive dilation of the anal canal is probably responsible for sphincter injury and incontinence.

Lateral internal sphincterotomy has been suggested as an adjunct to hemorrhoid excision, but randomized studies have not confirmed its usefulness. In fact, these studies have actually shown an increase in incontinence.

Emergency hemorrhoidectomy for incarcerated, gangrenous hemorrhoids can be performed safely, with results comparable to those obtained after elective hemorrhoidectomy. A randomized trial of the Milligan-Morgan hemorrhoidectomy versus incision and rubber band ligation for acute strangulated hemorrhoids showed that both techniques can be performed safely; early recovery was slightly improved after incision and ligation.

In 1998, Longo introduced an alternative approach to conventional hemorrhoidectomy by modifying the circular stapling device commonly used for low rectal anastomoses.

Stapled hemorrhoidectomy (also called, among other names, stapled anopexy, prolapsectomy, or circumferential mucosectomy) removes a ring of redundant rectal mucosa above the anal canal and proximal to the hemorrhoids themselves.

The goal is to resuspend the prolapsing hemorrhoidal tissue back within the anal canal as well as to interrupt the arterial inflow that traverses the excised segment. In contrast to conventional hemorrhoidectomy, skin tags and enlarged external hemorrhoids are not removed using the stapled technique.

Eight randomized controlled trials have now studied stapled versus conventional hemorrhoidectomy. All 8 showed decreased pain in the stapled groups, and 6 also showed a more rapid return to normal activities.

Complication, impaired continence, and recurrence rates were comparable between stapled and conventional groups. The disposable stapler adds cost to the operation, but some of this is recouped by shorter operating times and length of stay in countries in which patients are routinely hospitalized.

A systematic review of stapled hemorrhoidectomy concluded that the procedure was as safe as conventional hemorrhoidectomy and was associated with shorter operating time, convalescence, and postoperative disability. Efficacy of the technique compared with conventional hemorrhoidectomy could not be determined due to a paucity of long-term data.

Despite these promising results, several important caveats regarding stapled hemorrhoidectomy remain. One randomized trial was suspended when 5 of 22 patients developed pain and fecal urgency that persisted for up to 15 months, yet no other group has reported similar findings. Several serious complications have been reported after stapled hemorrhoidectomy, including rectal perforation, retroperitoneal sepsis, and pelvic sepsis.

The true incidence of such complications remains unknown, but their common denominator may be excision of full-thickness rectal wall rather than mucosa and submucosa only. Smooth muscle fibers have been detected in a variable percentage of stapled hemorrhoidectomy specimens, although such fibers have also been detected following conventional hemorrhoidectomy.

One histologic study suggested that at least some of those fibers were from the internal anal sphincter rather than the more proximal rectal wall. Of potentially more functional consequence, fragmentation of the internal sphincter was noted in 14% of patients who underwent stapled hemorrhoidectomy using the standard 37-mm anal dilator.

Patients with other diseases in addition to hemorrhoids pose special risks. Infection with human immunodeficiency virus does not contraindicate hemorrhoidectomy, but patients who are severely immunocompromised because of acquired immunodeficiency syndrome are at high risk for complications. Crohn’s disease of the intestine does not seem to contraindicate hemorrhoidectomy; in a Ferguson Clinic series, only 1 of 17 patients developed anal disease (follow-up, 12 years).

However, patients with anorectal Crohn’s disease or Crohn’s proctitis have a substantial risk of local complications that can be severe enough to require proctectomy.

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American College of Gastroenterology – Common Gastrointestinal Problems (A Consumer Health Guide)

admin — Wed, 09 Dec 2009 14:20:22 +0000

American College of Gastroenterology
Digestive Disease Specialists Committed to Quality in Patient Care
Common Gastrointestinal Problems
A Consumer Health Guide

A. Rectal Complaints

The rectum refers to the last four to five inches of the digestive tract. The rectal outlet or opening is called the anal canal, or anus.

There are many troublesome problems that can occur in the rectum. Fortunately, most are treatable when recognized early and properly diagnosed. Rectal symptoms of pain and bleeding should always be thoroughly evaluated by your physician.

Sometimes your doctor may advise you to see a specialist in digestive disorders (called a gastroenterologist) or a surgeon who has received special training in diseases of the colon and rectum (called a colorectal surgeon or proctologist).

A.1. What are hemorrhoids?
Hemorrhoids are veins in the anal canal that become swollen or stretched. Just like varicose veins in the lower legs, hemorrhoids often cause no problems.

A.2. What are the different types of hemorrhoids?
There are two type of hemorrhoids: external and internal. External hemorrhoids are swollen veins that can be seen under the skin outside the anal canal. Usually they look like a small bulge and are the same color as the skin. Internal Hemorrhoids are swollen veins that arise from inside the rectum.

When internal hemorrhoids become large they may prolapse through the anal canal. The most common sign of hemorrhoids are traces of bright red blood on toilet paper or drops of blood into the toilet.

Thrombosed hemorrhoids contain a blood clot and are painful. Burning, discomfort, and itching may result if hemorrhoids become irritated.

A.3. How do hemorrhoids develop?
Hemorrhoids are very common. About half the population have hemorrhoids by age 50 years. Hemorrhoids develop due to increased pressure often caused by straining to have a bowel movement.

Hemorrhoids frequently develop in women during pregnancy when the presence of the fetus causes increased pressure on the rectal area. Chronic constipation or diarrhea may also lead to hemorrhoids as may heredity and aging.

A.4. How are hemorrhoids diagnosed?
As with all conditions involving the anal canal or rectum, diagnosis is made by examining the anus visually and by performing a digital (with a gloved finger) rectal exam. Following this, a lighted instrument is inserted into the anal canal so that the interior of the rectum may be visualized. This lighted tube may be an anoscope (a short tube which can examine the last few inches of the rectum) or a sigmoidoscope (a longer tube which can also examine the lower part of the large intestine).

A.5. How are hemorrhoids treated?

Medical Treatment
Eliminate constipation. Bowel movements should be soft not hard, and should pass without the need to strain. Constipation is usually caused by insufficient bulk in the bowel movement, creating the need to strain to pass it.

Increasing water intake, dietary fiber (see table 1 ) and exercise are often effective remedies. The average American diet is often deficient in fiber, and your doctor may advise you to take fiber supplements.

There are many medicated creams and/or suppositories that can be used to reduce swelling and discomfort of inflamed hemorrhoids, examples include Preparation-H and Anusol. It may also be helpful to sit in a tub of warm water (sometimes called a "sitz bath") several times a day, especially after a bowel movement. Cotton pads soaked in witch hazel may also provide temporary relief.

Surgical Treatment
When hemorrhoids bleed excessively or are very painful, they can be treated. There are several types of treatment:

Sclerotherapy : Injection of a chemical solution into the hemorrhoids causing them to shrink.
Infrared coagulation : a special device used to destroy the internal hemorrhoids.
Banding : a rubber band is placed around the hemorrhoid and causes strangulation followed by scarring
Hemorrhoidectomy : surgical removal of hemorrhoids.

A.6. What is an anal fissure?
This is a fairly common condition in which the lining of the anal canal becomes torn. This generally produces pain or burning, especially with passage of a bowel movement. Bleeding may also occur. A fissure usually occurs with constipation or after forceful passage of a large, hard bowel movement. However, fissures also may occur without straining, since the tissue lining the anal canal is very delicate.

A.7. How is a fissure diagnosed?
When a fissure is present, a digital rectal exam is usually painful. The fissure can be usually be visualized by an external inspection of the anus, or an anoscope can be used to determine the extent of the tear.

A.8. How is a fissure treated?

Warm tub or sitz baths several times a day in plain warm water for about 10 minutes.
Stool softeners to provide a regular soft, formed bowel movement.
Creams and/or suppositories (Preparation-H or Anusol).

Most fissures will heal within several weeks, but surgery may be necessary if symptoms persist. Surgical treatment usually consists of cutting a portion of the muscle in the anal canal (sphincterotomy). This procedure reduces the tension produced by the fissure and allows it to heal. Of course, the best treatment is prevention, and ingestion of a high fiber diet to promote bowel regularity is of utmost importance.

A.9. What is an anal abscess/fistula?
An abscess is a cavity filled with pus. This usually results from a blockage of the anal glands located just inside the anus. A fistula is a connection or tunnel between the anal gland and the buttocks, usually very close to the anal opening. An anal fistula is almost always the result of an anal abscess.

A.10. What are the symptoms of an anal abscess/fistula?
An abscess produces considerable discomfort and swelling just adjacent to the anal opening. Fever may also be present. A fistula produces drainage from the anal canal to the opening of the fistula on the buttocks.

A.11. How is an abscess treated?
Treatment consists of draining the pus. A small opening is made in the skin to allow drainage of pus to occur. In about 50% of individuals, a fistula will form after the abscess has been drained. This usually develops after several weeks, but sometimes occurs several months or even years later.

A.12. How is a fistula treated?
Surgery. Generally the sphincter muscle is cut to open the tunnel, thereby connecting the internal and external openings of the fistula. A groove is formed which then slowly heals and forms scar tissue. During the healing process individuals are given stool softeners to lessen the risk of irritation from passing bowel movements. Sitz baths are also frequently recommended.

A.13. What is pruritus ani?
This refers to itching around the anal area. It is often most troublesome at night or following a bowel movement.

A.14. What causes pruritus ani?
Excessive cleaning or wiping of the anal area is frequently the culprit. Excessive sweating in the area around the anus is another cause. Certain beverages, including alcohol, citrus drinks, and caffeine-containing drinks may aggravate the problem and highly-spiced foods, chocolate, nuts and popcorn may be irritating as well.

Rarely, infections and skin conditions can produce pruritus ani. Poor hygiene is usually not a cause. Unfortunately, when the problem develops, individuals often compound the problem by excessively washing and cleaning the anal area. This leads to a cycle of increased irritation.

B. Important Information for Patients with Chronic Liver Disease and/or Cirrhosis

B.1. Introduction
Patients who suffer from chronic liver disease may develop cirrhosis after years of disease. Cirrhosis of the liver is a serious condition characterized by severe scarring. Not everyone with hepatitis or liver disease develops cirrhosis. If your doctor has told you that you have chronic liver disease and/or cirrhosis, there are important precautions that you should take to prevent further damage to your liver.

B.2. Can I drink alcohol?
No, you should not drink alcohol. Alcohol damages liver cells. A healthy liver is able to replace most liver cells that are injured by alcohol. However, in individuals with cirrhosis, the liver is unable to replace the damaged liver cells. Drinking any alcohol, not just hard liquor, but also beer or wine will speed up the process of liver destruction and may counteract any treatments prescribed by your doctor.

B.3. Is it safe to take acetaminophen (Tylenol)?
It is generally safe to take acetaminophen in the amount specified in the labeling. Acetaminophen is the main ingredient in Tylenol, but it is also found in many non-prescription products for headaches, the flu, sinus problems, arthritis or general aches and pains. In 1993, an FDA Advisory Committee recommended that all over-thecounter pain relievers contain an alcohol warning.

Tylenol and some other pain relievers have included such an alcohol warning on their labeling. But, to date, not all over-the-counter pain relief products have complied with the FDA recommendation.

There have been some reports that chronic heavy alcohol users may be at increased risk of liver toxicity from excessive acetaminophen use. Individuals who have been diagnosed with liver conditions will want to consult with their physician for advice on when and how to take pain relievers and should not exceed recommended doses of acetaminophen or any other pain reliever.

Important Information for Patients with Chronic Liver Disease and/or Cirrhosis especially if they are consuming alcohol. Pay particular attention to products labeled "aspirin-free"; some prescription medications also contain acetaminophen, so be sure to ask your doctor about use of pain relievers.

Some Acetaminophen Containing Medicines :
Tylenol >> 325 mg/tablet
Tylenol Extra Strength >> 500 mg/tablet
Tylenol Adult Liquid >> 500 mg/tablespoon
Tylenol Extended Relief >> 650 mg/tablet
Aspirin Free Excedrin >> 500 mg/tablet
Excedrin Extra-Strength >> 250 mg/tablet
Excedrin P.M.>> 500 mg/tablet
Midrin >> 325 mg/capsule
Actifed Cold & Sinus >> 500 mg/tablet
Sinutab Sinus Allergy >> 500 mg/tablet
Sudafed Cold & Cough >> 500 mg/tablet

B.4. What other medications should I avoid?
You may need to avoid iron supplements. Too much iron can damage liver cells or aggravate liver damage caused by some viruses. Most adults do not need to take iron supplements unless there is a history of obvious blood loss or a known deficiency of iron. Unless your doctor prescribes iron supplements for you, do not take any iron supplements or even multivitamins that contain iron.

B.5. What foods should I avoid?
Sewage runoff can infect edible sea organisms (clams, oysters, crustaceans and fish) with both bacteria and viruses. Contamination of seafood may be undetectable by smell or taste. Clams and oysters are especially susceptible to sewage contamination and should never be eaten raw.

Vibrio vulnificus is a bacteria that is found in contaminated oysters and other seafood. In healthy people, it rarely causes serious infection, but in individuals with cirrhosis it can cause death in 48 to 72 hours.

Hepatitis A is a virus that can be found in clams and oysters. Infection with hepatitis A can cause even healthy persons to become very sick. Individuals with cirrhosis are especially vulnerable to a life-threatening infection caused by this virus.

If you have open sores on your skin, you should avoid exposure to sea water during the warm summer months. Harmful organisms can enter the blood stream through these sores and cause serious infection.

B.6. Are vaccines important?
Yes! Ask your doctor if you would benefit from one or more of the following vaccines:

Hepatitis A Vaccine:
Used to prevent hepatitis A, which can be severe in individuals with cirrhosis. It consists of a series of two injections given six months apart.

Hepatitis B Vaccine:
Used to prevent hepatitis B, another type of viral hepatitis. It consists of a series of three injections. The second and third injections are given one and six months after the initial injection.

Pneumococcal vaccine:
Used to prevent a kind of pneumonia caused by a bacteria called Streptococcus pneumoniae. It consists of only one injection, and should be repeated in five years.

Flu Shot:
Used to prevent influenza, a cause of severe upper respiratory infection and pneumonia. It is a single injection given yearly, usually in the Fall, just prior to the flu season.

B.7. Are there any natural herbs that can heal my liver?
Many causes of cirrhosis do not have any treatment available. For this reason, many individuals resort to the use of "health foods" and "natural herbs or supplements" to improve the liver.

There is no scientific proof that any of these products are of benefit to the liver. Most of them are safe, but liver damage caused by herbal products has been reported.

There are several herbal remedies that are known to cause liver damage. Be sure to tell your doctor before you begin any herbal products so that he or she may better monitor your condition.

B.8. Remember, take care of yourself
Although cirrhosis is a serious condition, you may live many years without problems. Try to eat a well-balanced diet and exercise regularly. The more active you become in taking care of yourself and obtaining regular follow-up with your doctor, the more likely you will be one of the many individuals that do well for many years.

C. Intestinal Gas Problems

Although the mention of intestinal gas problems, such as belching, flatulence, bloating and "gas pains" often elicits some degree of amusement, all of us have gas in our intestinal tract and must expel it in some way.

Some individuals are very sensitive to the effects of gas collections in the stomach and intestinal tract and may develop significant discomfort. If such complaints are troublesome and persistent and do not respond to simple measures, such as change in diet, a visit to your doctor could be helpful.

C.1. Where does the gas that we belch or burp come from?
The gas brought back by belching comes entirely from swallowed air. We all swallow some air when eating food and drinking liquids. Most of the gas mixes with the stomach content and either enters into the small intestine or is belched back.

The air that enters the small intestine is either absorbed or it may continue through to the large intestine and is then passed rectally. Individuals may swallow more air (and thus increase stomach gas) if they have a post-nasal drip, chew gum, have poorly fitting dentures, suck on hard candies or smoke tobacco. Drinking carbonated beverages (soda or beer) or eating rapidly can also increase stomach gas.

C.2. What causes repetitive belching or burping?
Some people have episodes of repeated belching. Since belched gas comes from swallowed air, these individuals are usually unaware that they caused the problem by swallowing air into the esophagus and bringing it back rapidly. Often, the habit can be broken if the person is made aware of the air swallowing behavior.

C.3. What foods cause increased flatus passage?
The food we choose to eat can influence the amount of gas passed rectally. Although most of our food intake is absorbed in the small intestine, some foods, such as cauliflower, broccoli, cabbage, baked beans, and bran are incompletely digested. They are then broken down by bacteria in the large intestine, causing the formation of gas.

A high roughage diet is important to promote bowel regularity, but excessive roughage or fiber may lead to bloating and increased flatulence. When increasing the amount of fiber in your diet, do so gradually, allowing your intestinal tract time to adjust.

Milk sugar (lactose) requires an intestinal enzyme (lactase) for digestion. When individuals lack this enzyme the lactose in milk and other dairy products enters the large intestine where the lactose is broken down by bacteria, producing gas.

Although milk is an excellent source of protein and calcium, many adults experience abdominal bloating, gas and diarrhea after consuming milk sugar.

Persons from Asia and Africa are often extremely intolerant to the smallest quantity of dairy products. Everyone passes some rectal gas, although the volume of gas is different each day. Much of the flatus comes from the nitrogen found in the air one swallows. The remainder of the flatus volume is the result of carbohydrates which are not absorbed in the small intestine and are broken down by bacteria in the large intestine.

Therefore, the amount of flatus represents a combination of swallowed air and poorly absorbed carbohydrates. The unpleasant order of flatus is due to other gases, such as hydrogen sulfide, which is produced by the bacteria.

C.4. How can the volume of flatus be reduced?
In addition to the gas-forming foods cited above, some diet chewing gum and hard candies use sorbitol or fructose as sweeteners. These sugars can lead to excess gas production and should be avoided. Elimination of dairy products or the use of lactase-added milk can be helpful for those with lactase deficiency.

C.5. Where do I feel gas pains?
Individuals with irritable bowel problems (crampy pain and/or bowel irregularity) are often sensitive to excess intestinal gas. A common symptom is generalized abdominal cramping, sometimes relieved by passing flatus.

If the gas accumulates in the right upper abdomen, the pain may radiate up into the right lower chest and could be confused with gallbladder disease. If the gas accumulates in the left upper abdomen, the pain may radiate into the left side of the chest and could mimic heart disease. If gas accumulates in the stomach, the upper abdominal pressure pain could radiate up to the lower chest and raise concern about a heart disorder.

C.6. Is there treatment for gas pains?
Your physician may wish to obtain tests to be confident that recurrent "gas pains" are not the result of some other disorder. If the tests are normal, a diet designed to reduce both air swallowing and the ingestion of gas forming foods would be helpful. Anti-spasmodic medications may relieve crampy discomfort, but these can have side effects on the eyes, plus bladder and bowel function.

C.7. What causes abdominal distension (bloating)?
Many individuals complain of abdominal distension which increases during the day and is most uncomfortable after the evening meal. Often distension is believed to be caused by the build-up of intestinal gas; however, there are other considerations.

The tone of the rectus muscles (the muscles which support the abdominal wall and run along the length of the abdomen on either side of the navel) may be decreased due to the stretching of the abdominal wall in women who have had one or more pregnancies.

If these muscles have become thinned, the abdomen may distend as food (and gas) moves through the intestine. This is most noticed after the evening meal. This explanation for distension (bloating) is most likely if the uncomfortable feeling is absent when the individual is lying down (you don’t need the rectus muscle for a "flat" abdomen when lying down) but is apparent when standing or sitting erect.

There is no effective medical therapy for this type of abdominal bloating but exercise directed toward strengthening the abdominal muscles may be helpful, particularly in younger women.

C.8. When should individuals with gaseous symptoms consult a physician?
Individuals with a long history of occasional gaseousness and abdominal discomfort need not seek medical attention. A change in the location of abdominal pain, significant increase in the frequency or severity of symptoms, or onset of new symptoms in individuals over the age of 40 are some of the reasons to see your doctor.

C.9. What over-the-counter drugs provide relief for gaseous symptoms?
Despite the many commercials and advertiseme medications which reduce gas pains and bloating, very few have any proven scientific value. Simethicone, a common additive to antacid preparations, shows some benefits when being tested in a lab, but many individuals feel little relief.

Several scientific studies have found some benefit from activated charcoal preparations in gassy or flatulent individuals, but other studies have failed to show symptom improvement.

C.10. 10 Steps to Decrease Symptoms of Intestinal Gas

Develop a regular routine of diet, exercise, and rest.
Correct bad habits:
- Chew food thoroughly
- Eat slowly and leisurely in a quiet atmosphere
- Avoid washing solids down with a beverage
- Avoid gulping and sipping liquids
- Avoid drinking out of small mouthed bottles or straws
- Avoid drinking from water fountains
- Avoid carbonated beveragesósodas and beer
- Eliminate pipe, cigar, and cigarette smoking
- Avoid gum chewing and sucking hard candy
- Check dentures for proper fit
- Attempt to be aware of and avoid deep sighing
Do not attempt to induce belching.
Do not overload the stomach at any one meal.
Avoid gaseous vegetables: navy beans, cabbage, brussel sprouts, cauliflower, broccoli, turnips, cucumbers, radishes, onions, melons, and excess raw fruit and vegetables.
Avoid foods with air whipped into themósouffles, sponge cake, milk shakes.
Avoid long-term or frequent intermittent use of medications intended for relief of cold symptomsó cough, nasal congestion, post nasal discharge.
Avoid tight fitting garments, girdles, and belts.
Do not lie down or sit in a slumped position immediately after eating.
Take a leisurely stroll after meals.

D. Food Intolerance

D.1. What is food intolerance?
When ingestion of a particular food or food additive causes unpleasant symptoms, a person is said to be intolerant to that food or additive. Symptoms occur as a result of either poor absorption from the intestine into the bloodstream or less commonly by the release of chemicals within the body occurring as a result of contact of the food / additive with the body.

The most common symptoms are gas, bloating, nausea, diarrhea and abdominal pain. Less common symptoms include shock, welts, fluid retention, rash, wheezing, inflamed sinuses/eyes/nose, vocal cord swelling and, rarely, a migraine headache.

D.2. Which foods commonly cause problems?
Foods containing sugars (lactose, fructose, sorbitol), and gluten are the most common cause of problems. Foods containing monosodium glutamate (MSG), sulfites or histamines cause symptoms in far fewer people.

Sugars
Sugars that are not absorbed in the small intestine pass into the large intestine where bacteria feed on them and produce gas and other breakdown products that can cause symptoms of bloating, gas, diarrhea, nausea and cramps.

Lactose Intolerance
The most common food intolerance by far occurs in people who lack the ability to digest significant amounts of lactose, the predominant sugar in milk. This results from a shortage of the enzyme lactase, which is normally produced by the cells lining the small intestine.

Lactase breaks down milk sugar into simpler forms that can be absorbed into the bloodstream. When there is not enough enzyme to digest the amount of lactose consumed, nausea, cramps, diarrhea, and bloating are common.

Symptoms usually begin 30 minutes to two hours after eating or drinking food containing lactose (e.g. milk, cottage cheese, ice cream, cheese). The severity of the symptoms depends on the amount of lactose an individual can absorb in relation to the amount ingested.

D.3. How do I get lactose intolerance?
For most people, lactose deficiency develops naturally with age as the small intestine lining cells gradually lose the ability to make the enzyme lactase. Most people develo symptoms as adults. Some ethnic and racial groups are more commonly affected.

The condition is least common in persons of northern European descent, whereas 90% of Asian-American and 75% of African-Americans are lactose intolerant.

D.4. How is lactose intolerance diagnosed?
Formal tests for lactose intolerance exist, but most cases can be diagnosed by avoiding lactose containing products and finding significant, if not complete, improvement of symptoms. Milk, dairy products, ice cream, and cheese are the most common lactosecontaining foods.

These should be completely avoided for several weeks to see the effect on symptoms. If the symptoms return after re-challenging the personís digestive system with lactose-containing food after noticing a dramatic reduction in symptoms with avoidance, the diagnosis of lactose intolerance is likely.

D.5. How is lactose intolerance treated?
Avoiding lactose-containing foods, or limiting the amount is effective treatment for most people. Dietary control depends on each personís learning, through trial and error, how much lactose he or she can handle.

For people who develop symptoms from very small amounts of lactose or have trouble limiting their intake of lactosecontaining foods, lactase enzymes are available in both liquid and chewable tablet form for use with either liquid or solid lactose-containing food. Calcium supplementation is recommended for anyone who significantly limits their dietary intake of milk products.

Lactose is hidden in some foods such as whey, curds, milk by-products, dry milk solids, and nonfat dry milk powder. In addition, lactose is used as a base for about 20% of prescription drugs and 6% of over-the-counter medicines.

Individuals with very low tolerance for lactose will need to read all food/medication labels very carefully in order to control their symptoms.

Other Sugars
Fructose is found in many common foods, such as figs, pears, prunes, and grapes. It is also found in corn syrup which is used to sweeten foods, gums, candies and sodas. In people who cannot properly absorb fructose, symptoms similar to lactose intolerance occur.

Sugarless or diet foods, beverages, and even some low calorie gums are sweetened with sugars which are poorly absorbed by most people. If enough of these foods/beverages are ingested, the large load of non-absorbed sugar which reaches the large intestine can again cause symptoms similar to those of lactose intolerance. Sorbitol, mannitol, and xylitol are sugars commonly used in this fashion.

D.6. What is Celiac Disease (sprue)?
People with Celiac Disease have an intolerance to a protein called gluten found in wheat, rye, barley and oats. Eating simple foods like wheat bread will damage the intestines, so food cannot be absorbed normally.

Severe weight loss, bloating, gas, weakness and a change in bowel habits often occur. Celiac Disease is diagnosed by a combination of blood tests, biopsy of the small intestine lining and by improvement in symptoms after removing gluten from the diet.

Treatment consists of removing gluten-containing products from the diet (wheat, rye, barley, and oats). Obvious sources of gluten, such as baked goods, wheat/oat-containing cereals, noodles, and spaghetti are easily avoided.

Unfortunately, wheat is often used in processed food such as ice cream, salad dressing and canned vegetables/soups. It is also found in many brands of instant coffee, ketchup, mustard, candy bars and some over-the-counter medications.

As a result, a successful adherence to a gluten-free diet requires careful label-reading since gluten can be present in many seemingly unlikely places.

Less Common Intolerances
Monosodium glutamate (MSG) sensitivity is the most common problem in this group of less common intolerances.

MSG is used as a flavor enhancer and is popular in Chinese food. This has led to the name "Chinese Restaurant Syndrome" for symptoms of headache, chest tightness, nausea, sweating, burning neck and facial pressure which occur in some people 15 minutes to a few hours after ingesting Chinese food containing MSG.

Histamine containing foods such as cheese, spinach, eggplant, red wine, tuna, mackerel, and yeast can produce symptoms similar to allergic reactions in some people. These symptoms include headache, flushing, rapid heart rate, fainting and wheezing. Foods, medications and cosmetics containing sulfites, tartrazine, benzoates, pargenes, and many dyes have been reported to cause a variety of symptoms.

Asthma-type attacks of wheezing in response to ingestion of sulfites found on sprayed/dipped vegetables and fruits have received the most publicity. Sugar, chocolate, caffeine and various additives have been suggested as agents which worsen migraine headaches, and/or attention deficit hyperactive disorder in some individuals.

Dietary restrictions have been reported as helpful in controlling and improving symptoms in some individuals with these problems.

D.7. What should I eat?
A well balanced, nutritious diet is required to maintain good health and proper weight. Symptoms of abdominal bloating, nausea, diarrhea, gas, cramps, or weight loss may indicate intolerance to food or food additives.

Less common symptoms include shock, rash, hives, generalized swelling, wheezing, inflamed eyes/nose/sinuses, vocal cord swelling, and migraine headache. Should you develop these symptoms, especially if they occur repeatedly, you should see your doctor and ask about the possibility of food sensitivity.

Accurate diagnosis of food intolerance is important to avoid unnecessary diet restrictionó which might lead to poor nutrition, higher food costs, social inconvenience/isolation, and preventing a more serious underlying disease from being left undiagnosed.

E. Abdominal Pain

E.1. Introduction
Have you ever experienced pain in your abdomen? Of course, all of us have experienced a "belly ache" sometime in our lives, but how can you decide when abdominal pain is serious?

Here is a list of common questions your doctor will need to ask about your pain:

What does the pain feel like?
How long does the pain last and when did it first occur?
When does the pain occurs?
Where is the pain located?
What causes the pain?
What relieves the pain?
What other symptoms are associated with the pain?

E.2. What does your pain feel like?
The sensation and interpretation of how pain feels vary from one person to another. There are two predominant types of pain.

Cramping pain is also referred to as colic. It occurs in a repeating cyclic or wave pattern with a build up in intensity followed by a gradual easing in intensity. Gas pain is a common description used to describe cramping pain.

A stretching or squeezing of the intestines will cause this type of pain. It arises from hyperactivity of normal intestinal peristalsis (muscle contractions) and may be due to excess gas, irritation of the intestines from infection or inflammation, blockage, and even stress.

Constant abdominal pain. There may be some variation in the intensity but, overall, this type of pain is distinctively steady. Other descriptions which have been used include "aching, burning, gnawing, hunger, or sharp" pain.

This type of pain can arise from deep inflammation involving any of the abdominal organs and the abdominal cavity. Ulcers, blockage of the gallbladder by stones, and local areas of infection called abscesses can cause this type of pain.

Irritation of the inner lining of the esophagus by gastric acid and irritation of the outside of the intestines and body cavity by leakage of blood, intestinal contents, and bile can also cause this type of pain.

E.3. How long does the pain last?
Pain which lasts for only seconds or a minute usually does not have a specific cause. Many people will experience a rare brief spell of abdominal pain, which is not serious. Pain which lasts for hours or days should be considered potentially serious and medical attention should be obtained.

E.4. When does the pain occur?
Pain may occur spontaneously, at any time. Pain which awakens someone from sleep is regarded as potentially serious. It may occur before or after meals and before or after bowel movements. The "hunger" pain of peptic ulcers may occur just prior to mealtime.

Gallbladder pain may develop after meals as can pain from the pancreas and intestinal obstruction. The irritable bowel syndrome is a common gastrointestinal problem which typically is associated with gaseous or crampy pain after meals along with a sensation of bloating.

Inflammatory diseases of the intestine associated with diarrhea often cause crampy pain before or after bowel movements.

E.5. Where is the pain located?
The place where the pain is initially felt and where it may travel (radiate) is very important in determining the cause of the pain. Pain located in the center of the upper abdomen may arise from the esophagus, stomach, duodenum, liver, pancreas, or bile ducts. Pain from the gallbladder and an inflamed liver will more often be located toward the right side of the upper abdomen.

Gallbladder pain may also radiate through the right shoulder blade. Pain from an ulcer or irritation of the pancreas may radiate through to the back. Pain arising from the small intestine can localize around the belly button.

The abdomen may become swollen or distended with gas when there is blockage of the intestine. Blocked intestines may also be associated with loud grumbling sounds which usually occur at the same time as the crampy waves of pain.

These grumbling sounds may also occur normally and most often between meals. Blockage of the stomach may be due to an ulcer at the very end of the stomach. In addition to the steady pain of an ulcer, the individual may be aware of a sloshing sound of fluid in the blocked stomach. This is most noticeable when lying down and changing positions.

Fever with or without shaking chills can accompany intestinal infections, blockage of the bile ducts, and localized areas of infection called abscesses. The presence of shaking chills suggests serious infection with passage of bacteria into the bloodstream.

A change in the color of the urine and stool may accompany the pain from a blocked bile duct. In this setting, the urine becomes very dark, like strong tea, and the stool becomes light in color. With a prolonged blockage of the bile duct, the eyes and skin will turn yellow which is called jaundice.

Crampy pain accompanied by black or bloody stool is a combination of symptoms indicating severe bleeding which requires prompt attention.

Pain arising from the esophagus may be due to irritation and blockage. Individuals with this type of pain problem will describe difficulty swallowing foods, especially solids. When there is a complete blockage of swallowed food, the individual will have trouble swallowing saliva.

E.6. When should I see a doctor?
If you answer YES to any of the following questions concerning your abdominal pain, you should contact your doctor.

Is your pain steady, severe, or regularly recurring?
Does your pain impair your ability to work or perform your routine activities?
Have you lost weight or your appetite?
Is your pain associated with nausea and vomiting?
Do you experience fever?
Have your bowel habits changed?
Do you experience difficulty in swallowing?
Does your pain awaken you from sleep?
Do you have a previous history of ulcers, gastroesophageal reflux, gallstones, inflammatory bowel disease (ulcerative colitis, Crohnís disease), and intestinal surgery?
Are you taking any medicines that can cause ulcers, such as aspirin or other medications commonly used or prescribed for arthritis or headaches?

Large intestine may localize to either the right, left, or middle of the abdomen below the belly button. Pain developing from inside the pelvis will often be experienced as a pressure-like discomfort in the rectal area. The most common locations of minor pain, often gaslike, are in the middle to upper abdomen and in the lower and left abdomen.

E.7. What causes the pain?
There may be some helpful clues from this observation. Chest pain arising from the esophagus (swallowing tube) may be related to certain foods, solid foods, or extreme temperature of foods (hot or cold).

Meals stimulate the gallbladder to release bile and in the presence of gallstones may induce the pain of a gallbladder attack. Narrowed or blocked areas of the intestine will be worsened after eating solid foods, especially fibrous vegetables.

An excessive intake of certain foods such as beans can cause abdominal cramps. Some individuals are intolerant of certain foods, such as the milk sugar, lactose. For example, after drinking a milk shake or lots of milk, persons intolerant to milk sugar (lactose) may experience excessive gas, cramping, and eventually diarrhea.

E.8. What relieves the pain?
Whether the pain is new or has been recurring for some time, most people will try to relieve it or will notice what makes the pain feel better. Belching is a common maneuver used to relieve upper abdominal discomfort.

The belch is created by swallowing air and immediately expelling it. It is a learned response which can become a habit.

Belching does not provide much, if any, clue to the origins of upper abdominal pain. Flatus, the expulsion of gas from the rectum, may relieve crampy abdominal pains due to distension or stretching of the colon and rectum.

Some individuals naturally have more gas than others which may cause discomfort, create cramps, and be relieved by the passage of flatus. Certain foods, such as beans, can create excess gas and cramping which is relieved by the passage of flatus.

The pain of peptic ulcer disease has been commonly referred to as hunger or gnawing pain which is typically relieved by eating. This pain may awaken a person from sleep. These individuals will often keep antacids, water or crackers on their bed stand to help relieve the night time pain.

More serious pain will cause restlessness, the need to be still, or to assume a certain position. An obstructed organ such as the intestine or gallbladder typically causes restlessness with a need for movement such as rocking or pacing. A perforation or leakage of intestinal contents will cause one to be very still to minimize irritation of the abdominal cavity and outer lining of the intestines.

With inflammation in the lower abdomen, such as appendicitis, the pain may be relieved by lying down with the legs drawn up. Deep inflammation of the upper abdomen, as can occur with inflammation of the pancreas, may feel better by leaning forward or curling up in a ball on one side or the other.

E.9. What other symptoms are associated with the pain?
Severe pain of any kind may be associated with sweating. This is not a specific observation. Nausea and vomiting may be important responses to pain and may indicate a blocked organ such as the stomach, intestine or gallbladder. Nausea and vomiting are common symptoms associated with in-flammation of the pancreas.

For More Information about Digestive Health and GI Conditions
Call the American College of Gastroenterology Hotline at 1-800-978-7666
4900 B South 31st Street
Arlington, VA 22206
or visit their website at http://www.acg.gi.org

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Hemorrhoids Solution – National Digestive Diseases Information Clearinghouse

admin — Wed, 09 Dec 2009 02:37:41 +0000

National Institute of Diabetes and Digestive and Kidney Diseases

NATIONAL INSTITUTES OF HEALTH
U.S. Department of Health and Human Services

What are hemorrhoids?
The term hemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed.

Hemorrhoids may result from straining to move stool. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal intercourse.

Hemorrhoids are either inside the anus internal or under the skin around the anus external.

What are the symptoms of hemorrhoids?
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

How common are hemorrhoids?
Hemorrhoids are common in both men and women. About half of the population has hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus on the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge.

These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

How are hemorrhoids diagnosed?
A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs.

Bleeding may also be a symptom of other digestive diseases, including colorectal cancer. The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon, or sigmoid, with sigmoidoscopy or the entire colon with colonoscopy.

Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

In this free ebook you can see the picture of the External hemorrhoid, Internal hemorrhoid, RECTUM. Illustration reprinted with permission from the American Society of Colon and Rectal Surgeons. Artist: Russell K. Pearl, M.D.

What is the treatment?
Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include :

Tub baths several times a day in plain, warm water for about 10 minutes.
Application of a hemorrhoidal cream or suppository to the affected area for a limited time.

Preventing the recurrence of hemorrhoids will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fiber and fluids in the diet.

Eating the right amount of fiber and drinking six to eight glasses of fluid not alcohol result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding.

Good sources of fiber are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).

In some cases, hemorrhoids must be treated endoscopically or surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.

A number of methods may be used to remove or reduce the size of internal hemorrhoids. These techniques include :

Rubber band ligation
A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
Sclerotherapy
A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
Infrared coagulation
A special device is used to burn hemorrhoidal tissue.
Hemorrhoidectomy
Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.

How are hemorrhoids prevented?
The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs.

Exercise, including walking, and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.

This ebook article come from :

National Digestive Diseases Information Clearinghouse
2 Information Way Bethesda, MD 20892–3570
Phone: 1–800–891–5389
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public.

The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

This fact sheet is also available at www.digestive.niddk.nih.gov. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 07–3021 November 2004.

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Hemorrhoids – Their causes continue to be controversial by ALVIN NEWMAN, MD

admin — Wed, 09 Dec 2009 01:00:54 +0000

“The Lord will strike you with the boils of Egypt, and with hemorrhoids of which you cannot be healed.” Deuteronomy, Chapter 28, verse 27.

Hemorrhoids also called “piles” have been around since our species learned to walk upright. They’re annoying vascular swellings that itch, bleed, prolapse and thrombose. Even though they’re as old as man, there’s little agreement on their nature, pathophysiology and treatment.

In medical school we’re taught that hemorrhoids are varicose veins of the rectum, brought on by conditions that increase abdominal pressure (e.g. pregnancy), raise portal pressure (cirrhosis), or simply by poor washroom habits, such as sitting too long on the toilet and allowing the exertion of downward pressure, forcing the hemorrhoidal tissue to protrude.

But piles aren’t varicose veins at all, e.g. they don’t look or bleed like veins. True varicose veins of the rectum very much resemble their counterparts in the lower extremities or the esophagus.

What’s more, hemorrhoids have been found in stillborns and infants two groups that don’t exhibit any of the factors that supposedly cause them.

The truth is, hemorrhoids aren’t such evil things. They act as vascular cushions and are part of the continence mechanism of the anorectum. When you contemplate their universal prevalence, you realize that they actually cause trouble only occasionally: it’s been estimated that 10% of the adult population suffers at least once in their lifetime from hemorrhoids.

Alvin Newman, MD, FRCPC, FACG, FACP is Adjunct Professor of Medicine at the University of Toronto and Attending Gastroenterologist at Mount Sinai Hospital, Toronto.

A. Diagnosis and staging

Visual inspection will do if they’re prolapsed
Otherwise, use an anoscope
Classification:
• based on whether or not they easily retreat into the anal canal
• independent of bleeding
• stage I can only be seen with an anoscope
• stage II may prolapse with defecation but reduce spontaneously
• stage III will only reduce if the patient pushes them back in
• stage IV permanently prolapsed.

B. Treatment Considerations

Stages I and II seldom merit treatment other than with over-the-counter suppositories, ointments and warm-water sitz baths
Stages III and IV need more serious treatment (see below)
In the case of bleeding hemorrhoids, consider concomitant presence of serious pathology more proximally in the colon
Patients over 50 with rectal bleeding must get a colonoscopy
If considering rubber-band ligation, differentiate between internal (above the dentate line) and external (below the dentate line) hemorrhoids
Never shoot a rubber-band around a skin-covered structure.

C. Pathophysiology

The double nomenclature “hemorrhoids” and “piles” underscores the fact that they may either bleed or become easily identifiable as palpable masses
Hemorrhoids are vascular and fill with blood
Their tumescent state is good for continence
Normally, they disgorge their blood build-up from time to time
In this sense, we are dealing with erectile tissue not unlike the corpus cavernosum of the penis
The difference is that hemorrhoids are surrounded by the internal anal sphincter, which is not under conscious cortical control

D. Bleeding

Frequently caused by straining
Manage by diminishing straining during defecation
• take careful inventory of the patient’s medications and try to eliminate the constipating ones
• many of the most popular analgesic, psychoactive and antiparkinsonian drugs are highly constipating
• there’s evidence from meta-analyses that high-fibre diets may decrease episodes of bleeding

E. Relief from the itch

Itchy hemorrhoids (anal pruritus) are invariably associated with skin irritation
May respond to short-term use of 1% hydrocortisone cream applied 2-3 times daily
Warm sitz baths twice-daily can be highly beneficial and may not only have a soothing effect, but also lower elevated anal sphincter pressure.

Nearly 1,000 years ago, the eminent medieval philosopher / physician Moses Maimonides wrote a treatise on hemorrhoids, suggesting the use of poultices of chicken fat and saffron to relieve symptoms.

In the 21st century, one of the most popular brands of soothing suppositories, Anusol, is made mainly of cocoa butter one could say that the transition from chicken fat to cocoa butter doesn’t exactly represent a giant leap of progress in a millennium.

F. Thrombosis

If the hemorrhoids engorge and the sphincter contracts mightily, the trapped blood will have no easy exit and eventually may thrombose
This is painful in the extreme and is usually treated by an incision and clot-evacuation a technique that provides instant relief
A thrombosed hemorrhoid is the anal equivalent of a priapism, and the treatment is similar to the extreme measures occasionally undertaken in the relief of priapism
Thrombosed hemorrhoids occur more frequently than priapisms because there’s no sphincter around the penis, unless one is using a ring-like sex toy
Stress as well as fissures and other factors may induce sphincter spasm, so thrombosed hemorrhoids may be a functional gastrointestinal disorder
Almost all patients with symptomatic hemorrhoids have increased anal sphincter pressure
Many techniques used in the management of hemorrhoids involve some measure to reduce sphincter pressure.

G. Aggressive treatment

Stage III hemorrhoids
• Rubber band ligation is first-line treatment
• This can be done in the office with acceptably low morbidity and about an 80% success rate
• Infrared coagulation and other tissue destructive techniques are less widely used.
Stage IV hemorrhoids
• Respond only to surgical hemorrhoidectomy
• In parts of Canada, there’s only limited availability of proficient and experienced surgeons willing to perform the operation, as there’s a lack of availability of operating room time
• Improvement of this situation may take a substantial public outcry.

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