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Doctor's Consultation  by Dr. Iain Corness

 

Is rectal bleeding just a passing thing?

Rectal bleeding is something most people don’t discuss at parties. This may be a bad plan, actually, because you should not ignore rectal bleeding. You see, not every case of rectal bleeding is from a pile (hemorrhoid) that will settle.
A friend had some rectal bleeding recently, and did not ignore it. Fortunately the cause was found with a colonoscopy (the black snake), and the condition was amenable to surgery and he is now over it. But it could have been the other way round. Never ignore rectal bleeding.
The rectum is the last portion of the large bowel that ends just before the anus. Bleeding from this area can be a herald sign of a mild or life-threatening importance, which is why all episodes of rectal bleeding must be investigated.
Depending upon the cause of the bleeding, and how high up in the gastro-intestinal tract, it may be seen as black, tarry stools, maroon stools; bright red blood on or in the stool, blood on the toilet tissue, or blood staining the water in the toilet bowl bright red. Treatment can range from relief of symptoms and let Mother Nature do the rest, to antibiotics, blood transfusion, or even surgery. It all depends on the cause.
There are many potential causes, including hemorrhoids (piles) which are swollen rectal veins in the anal and rectal area. They can cause burning, painful discomfort, as well as bleeding. External hemorrhoids are small swellings that are easy to see and quite painful, however internal hemorrhoids are usually painless. A feeling of incomplete emptying may be noted with bowel movements. Treatment focuses on relieving these symptoms with the use of stool bulking agents and softeners, and if necessary, removal of the bleeding piles.
Rectal fissure is another. This is a tear in the lining of the rectum caused by the passage of hard stools, which can lead to mild rectal bleeding of bright red blood. Exposed nerves and vessels result in moderate to severe pain.
Diverticulosis, those little pockets on the bowel wall, can also bleed. The stools are dark red or maroon. Pain is usually absent but surgery is required in up to 25 percent of these patients.
Bloody diarrhea is often seen in bacterial dysentery, which we have all had to a greater or lesser degree. Responsible organisms include Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and Clostridium difficile. A most unsavory bunch of bugs! The treatment depends upon the organism, but generally intravenous fluid and electrolyte replacement and an anti-spasmodic and broad spectrum antibiotic will bring this under control.
Another common cause of rectal bleeding is Inflammatory Bowel Disease especially in young adults - typically those younger than 50 years of age. Bleeding occurs in small to moderate amounts of bright red blood in the rectum, usually mixed in with stool and mucus. Associated symptoms include fever and abdominal cramps. This condition generally settles with steroids.
Of course, the one that everyone worries about is bowel cancer. We lump these together under the general heading of Tumors and Polyps. Polyps bulge out from the lining of the colon. Bleeding occurs when large polyps develop. They can be hereditary, and are usually harmless, but some types can be pre-cancerous.
Both benign and malignant tumors are frequently found in the colon and rectum. Those people older than 50 years are most affected; however, tumors can be found in younger people. It should also be noted that less than 20 percent of people with tumor or polyps will have rectal bleeding. However, when bleeding does occur, it is usually slow, chronic, and minimal. Diagnosis requires careful evaluation with colonoscopy.
Rectal bleeding from a traumatic cause is always a critical concern. Rectal damage from a gunshot wound or foreign body insertion can result in extensive infection or rapid and fatal blood loss.
And yes, there’s more! A common source of bleeding is hemorrhage from the stomach or duodenum. This can occur after someone has swallowed a foreign body that causes injury to the stomach lining or bleeding stomach ulcers.
The list does go on, but these conditions are rare; however, the message is that rectal bleeding must always be investigated. Never ignore rectal bleeding!


Digital Lifestyle makes for worry lines? Botox may be the answer?

Some interesting information coming out of the UK, where it is claimed that Botox use has increased in an increasingly younger age group. No longer is Botox the province of the middle-aged matrons, it is claimed. And the reason is put down to squinting at computer and other LCD screens.

Medical experts at Court House Clinics in the UK believe the number of women in their 20’s seeking Botox treatments is in part due to the rise of daily computer use and smart phone technology.

They base some of this on the sales of smart phones. They state the analytics company IDC has reported smart phone shipments of 144.9 million in Q1 of 2012 compared to 101.7 million units in Q1 in 2011. These figures, they say, along with societal pressure to look eternally young has led to a massive increase in the number of young women seeking Botox treatment. The increase being touted is 410 percent!

Dr Patrick Bowler - Medical Director Court House Clinics, says, “We have to accept that our lifestyles are changing as fast as the technology boom is altering our lives. Look around and we see people immersed in their mobiles. Also most people now work with computer screens.

When you look at people using these devices they are concentrating hard. The natural reaction of the face when concentrating is the “frown” or screwing up of the eyes. If you over use any part of your face lines will develop. This can be seen with, for example, smokers where the lip area becomes more lined and creased. The new generation of young women are spending more time on these devices with the resultant consequences. Women are now more aware that they can help prevent these lines deepening with the use of treatments like Botox. It’s not about age, it’s about treating the individual and what is happening to their face and there has been a noted increase in younger women troubled by static frown lines in the last five years.” Constantly peering down at a small screen such as the ones found on an iPhone, Blackberry or other handheld device has caused more facial wrinkles to appear in young women, he says.

Dr Bowler’s theory is one supported by Dr Sebagh of the US who amongst other things has been responsible for treating celebrities like Cindy Crawford for wrinkles. “The phenomenon of increased facial wrinkles can be seen on anyone who has and regularly checks a Blackberry or iPhone,” said Dr Sebagh last year.

So what exactly is Botox? It is a prescription-only medical product that contains tiny amounts of highly purified botulinum toxin protein refined from the bacterium, Clostridium botulinum. Botox has a unique, protected molecular structure that stabilizes the core toxin from degradation. When injected at FDA-approved and labeled doses into a specific muscle or gland, the Botox neurotoxin diffuses locally to produce a safe and effective result by producing a localized and temporary reduction in the overacting muscle or gland, usually lasting up to approximately three to ten months depending on the indication and on the individual patient.

However, it should not be thought that Botox is purely for people with wrinkles. According to the manufacturer Allergan, “Patients should receive their treatments in an appropriate medical setting from people who are well trained. We heavily discourage - we even mandate - that our sales people don’t go to places like spas. We will supply to anyone who can establish their credentials as a medical professional. If it’s someone new, we make sure they have a valid license through a state medical society.”

Non-cosmetic use of Botox includes bladder treatment, for example. Researchers at the University of Pittsburgh have found that injections of the Botulinum toxin can help treat people who suffer from an overactive bladder. The patients suffered from a variety of conditions, including multiple sclerosis, spinal cord injury and stroke. Professor Michael Chancellor, an expert in urology and gynecology at the University of Pittsburgh, said, “Bladder dysfunction affects a staggering number of people worldwide. The use of Botox injections can offer many of these patients a safe, but temporary, solution to this embarrassing problem.”


HEADLINES [click on headline to view story]

Is rectal bleeding just a passing thing?

Digital Lifestyle makes for worry lines? Botox may be the answer?