• Tummy feels bigger than usual
• Abdominal discomfort or pain
• Rumbling or noises from the tummy
• Belching
• Chest pain

• Swallowing air or drinking aerated beverages
• Gases produced by gut bacteria after digesting carbohydrates through fermentation
• Food intolerances
• Gastrointestinal diseases like carbohydrate malabsorption (fructose or lactose intolerances), small intestinal bacterial overgrowth (imbalances in gut bacteria, overflow of gut bacteria from colon to small intestine)
• Digestive disorders like irritable bowel syndrome, functional dyspepsia
• The build-up of digestive contents in the digestive system due to constipation, bowel blockage, motility disorders or recent weight gain
• Hormonal changes during the menstrual cycle
• Fluid build-up due to ascites caused by liver or kidney disease or heart failure
• Pancreatic dysfunction
• Stomach or gut infections like gastritis or enteritis
• Cancers

• If bloating gets progressively worse
• If bloating persists for over a week
• If it is consistently painful
• If it is accompanied by other illnesses like vomiting, bleeding, diarrhoea, bloody stools, changes in frequency and colour of stools, chest pain, recent weight gain, loss of appetite or fever

• Avoiding overeating and eating smaller portions of food
• Eating slowly to prevent overeating
• Limiting fatty meals that can take more time for digestion
• Avoiding swallowing air by avoiding drinking through a straw, drinking carbonated or aerated beverages, chewing gum and sucking hard sweets or toffees
• Avoiding difficult-to-digest foods like cabbage, cauliflower, apricots, prunes, beans, lentils
• Limiting dairy products, especially those with lactose intolerance
• Limiting fibre-rich whole grains, as sometimes fibre can take time to digest, causing bloating
• Following the low FODMAP diet (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols)

• Abdominal distension due to gas or bloating
• Sudden urge to pass stool
• Loud bowel sounds or abdominal noises
• Excess gas
• Abdominal cramping or pain
• Excess burping
• Diarrhoea or loose stools

• It is the most common variety.
• It is due to decreased lactase production due to increasing age
• It is commonly seen in people of African, Hispanic, and Asian ancestry.

• It happens secondary to other inflammatory conditions of the gut like Crohn’s disease, IBD or IBD.
• It can be temporary and resolves when the primary gut condition is treated.

• It is very rare and occurs when a defective gene is inherited from a parent, causing a complete absence of lactase.
• Babies with this condition can experience diarrhoea as soon as breastmilk or formula is introduced.
• Unfortunately, it is a lifelong condition.

• It generally happens in premature babies, as their digestive system is not fully developed. Lactase production starts after 34 weeks of gestation.
• It resolves as the baby grows up.

• Genetic test: It checks for genetic causes. However, people with secondary lactose intolerance may get false-negative results.
• Lactose tolerance test: This test measures the blood sugar after lactose intake. People with lactose intolerance do not experience any changes in blood sugar levels as their bodies cannot break down lactose.
• Hydrogen breath test: This test measures hydrogen in breath after taking lactose. Higher amounts of hydrogen in the breath suggest digestive problems related to lactose intolerance. The test may indicate other issues too.
• Lactase activity at jejunal brush border: This is an invasive test that requires a biopsy of the jejunal brush border. The jejunum is a part of the small intestine. It is a definitive way to assess lactase activity.
• Stool acidity test: This test measure the stool acid level. It is used for babies and infants who have low stool pH in cases of lactose intolerance.

• Consuming substitutes for dairy products like almonds and soy milk
• Substituting breast milk with formula milk for babies.
• Taking lactase enzyme replacement pills with dose as advised by doctors
• Taking prebiotics and probiotics to help reduce symptoms
• Taking calcium, vitamin D, riboflavin, and protein supplements to compensate for cuts in dairy products

FISSURE ( Anal Fissure / Fissure in Ano)

What is an anal fissure?

An anal fissure is a small tear in the lining of the anus, which causes discomfort, pain, and bleeding during bowel movements. The fissure often uncovers the muscles around the anus, known as the anal sphincter. This uncovering may further lead to spasms of the muscles, pulling the edges of the sphincter more apart.

Anal fissures can occur at any age but are more common in infancy and adulthood. They can be equally common in men and women. If anal fissures last over six weeks, it becomes a chronic condition and may require treatment. 

What causes anal fissures?

Anal fissures most commonly occur because of chronic constipation or frequent loose stool. The other causes of an anal fissure are:

• Strenuous labour or childbirth
• Inflammatory bowel disease
• Anal sex
• Poor blood supply around the anus
• Tight anal sphincter

What are the signs and symptoms of anal fissures?

• Severe sharp, cutting, and burning pain in the anal area during bowel movements
• Passage of bright red blood on the stool or after bowel movements
• Small lump or skin tag around the anus
• Itching in the anal area

How are anal fissures diagnosed?

• A simple examination and evaluation of symptoms help diagnose anal fissures. 
• When the diagnosis is not precise, a colonoscopy test under anaesthesia is advised to rule out other causes like sexually transmitted diseases and cancer.

How are anal fissures treated?

The following approaches are used for fissure treatment:

• Fibre therapy – eating plenty of fibre in the form of wheat bran, oat bran, and whole grains helps not only prevent anal fissures but also in recovery. It modifies stool consistency and fastens healing.
• A warm bath or Sitz bath to help soothe the pain and healing
• Drinking enough water to help improve digestion.
• Sphincter relaxants
• Stool softeners
• Topical pain relievers
• Nitroglycerine or hydrocortisone ointments
• Botox injections into the sphincter to relieve spasms
• Surgery is only advised when other approaches do not help. 
• Laser surgery is the best treatment for fissures as it is a minimally invasive surgery that takes only 15 to 30 minutes. A laser beam is used to remove scar tissue around the anus while a patient is under anaesthesia. Laser treatment for fissures causes less pain and speedy recovery.

Summary

• An anal fissure is a small and painful tear around the anus due to chronic constipation or diarrhoea.
• Adding fibre-rich food and drinking enough water helps in preventing this condition. 
• A doctor’s help is needed when self-management does not help.

How can Bangalore Gastro Centre help you?

Bangalore Gastro Centre Hospital in Bangalore is the top-rated gastro centre in Karnataka. The top gastroenterologists and nutritionists work collaboratively to provide you with the best treatment for fissures. The centre offers endoscopy and colonoscopy tests to diagnose the root cause of fissures. The facility also offers laser treatment for fissures. 

Make an appointment with our best gastro doctors today if you are looking for the best anal fissure treatment in Bangalore.

• If other people in your family have IBD, you may be more likely to develop it yourself as there seems to be a genetic component
• Lifestyle may also play a part, as ulcerative colitis is more common in developed countries such as the UK, USA, Australia
• The incidence of Ulcerative colitis is however increasing steadily in India

• A physical exam to look for abdominal tenderness or paleness caused by anaemia (low blood count)
• A blood test to see if you are anaemic and to assess the amount of inflammation in your body
• Testing a stool sample to rule out an infection, which could cause similar symptoms to ulcerative colitis
• Testing the stool sample to check for inflammation.
• A colonoscopy to examine the colon directly for inflammation
• Lab tests on biopsies taken during colonoscopy, to confirm the presence of ulcerative colitis and help rule out Crohn’s disease
• In some patients, CT scan to check for any serious complications of IBD

• Genetic factors – close relatives suffer from this condition, indicating a role of the genes in its occurrence.
• Germ theory – bacteria or viruses can also be involved. The attack of bacteria or viruses triggers the immune system to evoke gut inflammation.
• Smoking – smokers are affected more than non-smokers.

• Pain at the affected site – It may occur in about 7 in 10 cases. The most common site of the pain is the lower right side of the abdomen. Sometimes Crohn’s disease mimics appendicitis. The pain severity varies from person to person.
• Diarrhoea is the first symptom observed in most cases. It can be mild or severe. The stool contains mucus, pus or blood. Tenesmus (fruitless urge for bowel movement) can be seen.
• Unintentional weight loss is another common symptom.
• Blood in the stool can be observed due to ulcers of the gut lining.
• Anaemia is another consequence due to bleeding.
• A general feeling of unwellness with tiredness, fever, and loss of appetite may be observed.
• Mouth ulcers are not uncommon.
• Anal fissures (painful ‘cracks’ around the anus) may occur. Small wart-like lumps (skin tags) may also appear around the anal area.

• Stricture, which means narrowing the gut, can be seen due to scar tissue formation. Stricture may cause vomiting with pain as it obstructs the passage of food.
• Perforation (a small hole) can form in the gut wall through which the gut’s contents can leak out. It may further cause an abscess or infection inside the abdomen. This condition can be life-threatening.
• Fistulas can also occur. A fistula is an abnormal opening between two parts of the body.
• Crohn’s disease carries a small increased risk of colon cancer.
• Osteoporosis (bones’ thinning) may be seen due to poor absorption of calcium and vitamin D.

• Colonoscopy or gastroscopy, where the gastroenterologist will look inside the colon, ileum, and stomach using a flexible endoscope.
• MRI or CT scan, which may be needed if the diagnosis is in doubt.
• Blood test to assess the level of inflammation within the gut, to assess your general wellbeing, and to check for anaemia and other deficiencies.

• Wait and watch – No treatment is needed when the symptoms are very mild. Some symptoms may settle down on their own.
• Use of steroids (corticosteroids) – to treat any flare-ups. Steroids are discontinued once a flare-up has settled.
• Antibiotics – They are used if infective complications are suspected.
• Immunosuppressant drugs – They are used to suppress the immune system. These drugs have significantly impacted the treatment of Crohn’s disease.
• Aminosalicylate drugs – They are thought to counter inflammation in Crohn’s disease. These are used rarely. These drugs come in different brand names and preparations, such as sachets or suspension, oral tablets or suppositories, and liquid or foam enemas. Depending on the site of the inflammation in the gut, the type of preparation is chosen.
• Surgery- If other treatments do not work. Surgery is also used when there is a complication like chronic fistulas, strictures, and abscesses.
• Dietary treatments – These are elemental diets that involve a liquid diet containing essential proteins and other nutrients. They are beneficial in some cases. They are mainly used in children. The diet can settle down a flare-up in four weeks, and a regular diet is started gradually after that. An elemental diet may be an alternative for people whose medication has not worked well or has caused harmful side effects.
• Supplements – Increased folate supplements and certain drugs are needed if Crohn’s disease happens during pregnancy.

What is constipation?

Every person has a unique pattern of bowel movements, and it is considered normal if the pattern has no deviations. Constipation is a condition when you have difficulty moving the bowels and bowel movements become infrequent, fewer than three in a week. Occasional bouts of constipation are common due to changes in diet. But some people experience chronic constipation for several months. 

What are the signs and symptoms of constipation?

• Dry and hard stools
• Infrequent bowel movements
• Difficulty in passing stools
• A feeling of not having emptied the bowels fully
• Feeling of blockage in the rectum
• Pain while passing stools
• Blood in stools

What causes constipation?

Stools are formed when the colon absorbs water from the remnants of undigested or partially digested food passed into the large intestine. Constipation gives the colon more time to absorb water from the stools, making them dry, hard, and difficult to pass. The common causes of constipation include:

• A low-fibre diet
• Less or no physical activity
• Hormonal disorders of thyroid or parathyroid glands
• Neurological conditions like multiple sclerosis or Parkinson’s disease
• Pregnancy and postpartum
• Use of various medicines like narcotics, antacids, iron supplements, antidepressants, and pain medications
• Ignoring the urge to have a bowel movement
• Dehydration
• Gastrointestinal disorders like irritable bowel syndrome, diverticular disease
• Issues with muscles and nerves in the digestive system
• Eating disorders
• Colon cancer
• Bowel obstruction

What are the tests to diagnose constipation?

• A doctor will ask questions about your medical and bowel movement history and perform a physical examination.
• A doctor may also order routine or specialised tests to determine the cause. The tests may include abdominal X-rays, blood tests, colonoscopy tests, and colonic transit (marker) studies.

How is constipation treated?

Constipation treatment involves lifestyle and dietary changes, medicines, exercises, and in severe cases, surgery.

Self-care:

• Drinking more water
• Avoiding alcohol and caffeine
• Adding fibre to the diet in the form of fresh fruits and vegetables, whole grains, bran cereal, prunes
• Avoiding low-fibre foods like meat, cheese, eggs, refined grains
• Limiting dairy products
• Taking over-the-counter fibre supplements
• Taking over-the-counter stool softeners or laxatives, if needed; however, overuse of laxatives could worsen constipation
• Squatting on the toilet, raising feet or leaning back to make bowel movements easier
• Going to the toilet immediately after feeling the urge

Medicine:

A doctor may review the current medications and change the products which could cause constipation. As a first step in the medical treatment for constipation, a doctor may prescribe other laxatives like:

• Emollients laxatives – wetting agents that facilitate entry of water into the colon and stools to soften them
• Lubricative laxatives – mineral oils that prevent stools from drying out
• Hyperosmolar laxatives – unabsorbable compounds that help retain water in the stools
• Saline laxatives – non-absorbable ions that help increase fluid in the colon
• Stimulant laxatives – medicines that stimulate the movement of gut muscles to push the stools

Exercises:

A doctor may also suggest a biofeedback method as an approach to constipation treatment. They involve various exercises for people with pelvic floor dysfunction. These exercises will help contract and relax muscles during passing stools.

Surgery:

Surgery is rarely performed as a treatment for constipation. It is considered in patients with intestinal disorders like colonic inertia. It involves removing the entire colon except for the rectum, which is joined to the small intestine.

What are the complications of constipation?

Constipation can sometimes lead to other health issues like:

• Haemorrhoids – swollen veins in the rectum
• Anal fissures – tears in the anal lining due to hardened stools
• Diverticulitis – infections in the pouches formed on the colon wall due to trapped stool
• Rectal prolapse – protruding intestines from the anus
• Faecal impaction – a build-up of stool in the rectum and anus
• Damage to pelvic floor muscles due to straining while passing stools
• Stress urinary incontinence – urine leakage from the bladder due to too much muscle straining

Summary:

• Constipation can be managed through diet and lifestyle changes. If the problem persists, your doctor may prescribe medicines, pelvic floor exercises, or switch medications causing constipation. 
• Seek medical care when you see blood in stools, experience severe pain while passing stools, or lose weight unintentionally.

How can Bangalore Gastro Centre help you?

Bangalore Gastro Centre Hospital in HSR Layout, Bangalore, has an excellent team of top gastroenterologists and nutritionists who will work as a team to provide constipation treatment. The centre also offers a colonoscopy test, which can help you diagnose the root cause of chronic constipation. Make an appointment at BGC today if you are looking for constipation treatment in Bengaluru.