88-520: Hemorrhoids (or haemorrhoids ), also known as piles , are vascular structures in the anal canal . In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed ; the unqualified term hemorrhoid is often used to refer to the disease. The signs and symptoms of hemorrhoids depend on the type present. Internal hemorrhoids often result in painless, bright red rectal bleeding when defecating . External hemorrhoids often result in pain and swelling in
176-719: A spatula mundani . After the advent of the germ theory of disease then the idea of "auto-intoxication" entered popular Western thought in a fresh way. Enema as a scientific medical treatment and colon cleansing as alternative medical treatment became more common in medical practice. Since the 1700s in the West there has been some popular thought that people with constipation have some moral failing with gluttony or laziness . Approximately 3% of children have constipation, with girls and boys being equally affected. With constipation accounting for approximately 5% of general pediatrician visits and 25% of pediatric gastroenterologist visits,
264-404: A benefit on constipation, while potentially causing cardiac arrhythmias and deaths. Enemas can be used to provide a form of mechanical stimulation. A large volume or high enema can be given to cleanse as much of the colon as possible of feces, and the solution administered commonly contains castile soap which irritates the colon's lining resulting in increased urgency to defecate. However,
352-424: A bowel movement so as to avoid pain. The pelvic floor muscles play an important role in helping pass a bowel movement. Injury to those muscles by some of the above risk factors (examples- delivering a large child, lengthy second stage of labor, forceps delivery) can result in constipation. Enemas may be administered during labor and these can also alter bowel movements in the days after giving birth. However, there
440-459: A breaking point similar to that of collagen . Capillary permeability can be increased by the release of certain cytokines , anaphylatoxins , or other mediators (such as leukotrienes, prostaglandins, histamine, bradykinin, etc.) highly influenced by the immune system . The transport mechanisms can be further quantified by the Starling equation . The Starling equation defines the forces across
528-463: A diaphragm and just have an open pore. These types of blood vessels allow red and white blood cells (7.5 μm – 25 μm diameter) and various serum proteins to pass, aided by a discontinuous basal lamina. These capillaries lack pinocytotic vesicles , and therefore use gaps present in cell junctions to permit transfer between endothelial cells, and hence across the membrane. Sinusoids are irregular spaces filled with blood and are mainly found in
616-406: A few weeks to disappear. A skin tag may remain after healing. If hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin, and thus itchiness around the anus. Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following a bowel movement. The blood typically covers the stool (a condition known as hematochezia ),
704-532: A group uncommon with Hirschsprung's disease (HD) being the most common. There are also congenital structural anomalies that can lead to constipation, including anterior displacement of the anus, imperforate anus , strictures, and small left colon syndrome. The diagnosis is typically made based on a person's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small hard pellets (like those excreted by rabbits) qualify as constipation, even if they occur every day. Constipation
792-577: A high-fiber diet and drinking plenty of fluid or by taking fiber supplements and getting sufficient exercise. Spending less time attempting to defecate , avoiding reading while on the toilet, and losing weight for overweight persons and avoiding heavy lifting are also recommended. Conservative treatment typically consists of foods rich in dietary fiber , intake of oral fluids to maintain hydration, nonsteroidal anti-inflammatory drugs , sitz baths , and rest. Increased fiber intake has been shown to improve outcomes and may be achieved by dietary alterations or
880-491: A low enema is generally useful only for stool in the rectum, not in the intestinal tract. Constipation that resists the above measures may require physical intervention such as manual disimpaction (the physical removal of impacted stool using the hands; see fecal impaction ). Regular exercise can help improve chronic constipation. In refractory cases, procedures can be performed to help relieve constipation. Sacral nerve stimulation has been demonstrated to be effective in
968-404: A medical disease, and treatment can be focused on simply relieving the symptoms. The six-week period after pregnancy is called the postpartum stage. During this time, women are at increased risk of being constipated. Multiple studies estimate the prevalence of constipation to be around 25% during the first 3 months. Constipation can cause discomfort for women, as they are still recovering from
SECTION 10
#17328953806331056-433: A minority of cases. Colectomy with ileorectal anastomosis is another intervention performed only in patients known to have a slow colonic transit time and in whom a defecation disorder has either been treated or is not present. Because this is a major operation, side effects can include considerable abdominal pain, small bowel obstruction, and post-surgical infections. Furthermore, it has a very variable rate of success and
1144-434: A network of vessels, a primitive vascular network that vascularises the entire yolk sac , connecting stalk , and chorionic villi . The capillary wall performs an important function by allowing nutrients and waste substances to pass across it. Molecules larger than 3 nm such as albumin and other large proteins pass through transcellular transport carried inside vesicles , a process which requires them to go through
1232-461: A number of important physiologic implications, especially when pathologic processes grossly alter one or more of the variables. According to Starling's equation, the movement of fluid depends on six variables: Disorders of capillary formation as a developmental defect or acquired disorder are a feature in many common and serious disorders. Within a wide range of cellular factors and cytokines, issues with normal genetic expression and bioactivity of
1320-494: A part of normal human anatomy and become a pathological disease only when they experience abnormal changes. There are three main cushions present in the normal anal canal . These are located classically at left lateral, right anterior, and right posterior positions. They are composed of neither arteries nor veins , but blood vessels called sinusoids , connective tissue , and smooth muscle . Sinusoids do not have muscle tissue in their walls, as veins do. This set of blood vessels
1408-811: A result of chronic constipation. Constipation can be caused or exacerbated by a low-fiber diet, low liquid intake, or dieting. Dietary fiber helps to decrease colonic transport time, increases stool bulk but simultaneously softens stool. Therefore, diets low in fiber can lead to primary constipation. Many medications have constipation as a side effect. Some include (but are not limited to) opioids , diuretics , antidepressants , antihistamines , antispasmodics , anticonvulsants , tricyclic antidepressants , antiarrythmics , beta-adrenoceptor antagonists , anti-diarrheals , 5-HT3 receptor antagonists such as ondansetron , and aluminum antacids . Certain calcium channel blockers such as nifedipine and verapamil can cause severe constipation due to dysfunction of motility in
1496-488: A role, including irregular bowel habits ( constipation or diarrhea ), lack of exercise, nutritional factors (low-fiber diets), increased intra-abdominal pressure (prolonged straining, ascites , an intra-abdominal mass, or pregnancy ), genetics, an absence of valves within the hemorrhoidal veins, and aging. Other factors believed to increase risk include obesity , prolonged sitting, a chronic cough , and pelvic floor dysfunction . Squatting while defecating may also increase
1584-419: A semipermeable membrane and allows calculation of the net flux: where: By convention, outward force is defined as positive, and inward force is defined as negative. The solution to the equation is known as the net filtration or net fluid movement ( J v ). If positive, fluid will tend to leave the capillary (filtration). If negative, fluid will tend to enter the capillary (absorption). This equation has
1672-442: A set of symptoms that help standardize the diagnosis of constipation in various age groups. These criteria help physicians to better define constipation in a standardized manner. The causes of constipation can be divided into congenital , primary, and secondary. The most common kind is primary and not life-threatening. It can also be divided by the age group affected such as children and adults. Primary or functional constipation
1760-415: A small cut using a blood lancet , followed by sampling by capillary action on the cut with a test strip or small pipette . It is also used to test for sexually transmitted infections that are present in the blood stream, such as HIV , syphilis , and hepatitis B and C , where a finger is lanced and a small amount of blood is sampled into a test tube . William Harvey did not explicitly predict
1848-460: A small proportion of persons end up needing surgery. The first known mention of this disease is from a 1700 BC Egyptian papyrus , which advises: "Thou shouldest give a recipe, an ointment of great protection; acacia leaves, ground, titurated and cooked together. Smear a strip of fine linen there-with and place in the anus, that he recovers immediately." In 460 BC, the Hippocratic corpus discusses
SECTION 20
#17328953806331936-480: A treatment similar to modern rubber band ligation: "And hemorrhoids in like manner you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind; and when the patient recovers, let him be put on a course of Hellebore ." Hemorrhoids may have been described in the Bible , with earlier English translations using
2024-633: Is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids , anal fissure or fecal impaction . The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day. Constipation has many causes. Common causes include slow movement of stool within
2112-400: Is a small blood vessel , from 5 to 10 micrometres in diameter, and is part of the microcirculation system. Capillaries are microvessels and the smallest blood vessels in the body. They are composed of only the tunica intima (the innermost layer of an artery or vein), consisting of a thin wall of simple squamous endothelial cells . They are the site of the exchange of many substances from
2200-774: Is also common in individuals with muscular and myotonic dystrophy. Systemic diseases that may present with constipation include celiac disease and systemic sclerosis . Constipation has a number of structural (mechanical, morphological, anatomical) causes, namely through creating space-occupying lesions within the colon that stop the passage of stool, such as colorectal cancer , strictures , rectocoles , anal sphincter damage or malformation and post-surgical changes. Extra-intestinal masses such as other malignancies can also lead to constipation from external compression. Constipation also has neurological causes, including anismus , descending perineum syndrome , desmosis and Hirschsprung's disease . In infants, Hirschsprung's disease
2288-677: Is an additional minimally invasive procedure performed by an interventional radiologist . HAE involves the blockage of abnormal blood flow to the rectal (hemorrhoidal) arteries using microcoils and/or microparticles to decrease the size of the hemorrhoids and improve hemorrhoid related symptoms, especially bleeding. HAE is very effective at stopping bleeding related symptom with success rate of approximately 90%. A number of surgical techniques may be used if conservative management and simple procedures fail. All surgical treatments are associated with some degree of complications, including bleeding, infection, anal strictures , and urinary retention , due to
2376-621: Is defined by ongoing symptoms for greater than six months not due to an underlying cause such as medication side effects or an underlying medical condition. It is not associated with abdominal pain, thus distinguishing it from irritable bowel syndrome . It is the most common kind of constipation, and is often multifactorial. In adults, such primary causes include: dietary choices such as insufficient dietary fiber or fluid intake, or behavioral causes such as decreased physical activity . In children, causes can include diets low in fiber and fluids, underlying medical conditions, and reluctance to go to
2464-746: Is difficult to determine how common hemorrhoids are as many people with the condition do not see a healthcare provider. However, symptomatic hemorrhoids are thought to affect at least 50% of the US population at some time during their lives, and around 5% of the population is affected at any given time. Both sexes experience about the same incidence of the condition, with rates peaking between 45 and 65 years. Some studies have found that they are common in people of higher socioeconomic status , however this may reflect differences in healthcare access rather than true prevalence. Long-term outcomes are generally good, though some people may have recurrent symptomatic episodes. Only
2552-676: Is discouraged, as having bowel movements may come to be dependent upon their use. Soluble fiber supplements such as psyllium are generally considered first-line treatment for chronic constipation, compared to insoluble fibers such as wheat bran. Side effects of fiber supplements include bloating, flatulence, diarrhea, and possible malabsorption of iron, calcium, and some medications. However, patients with opiate-induced constipation will likely not benefit from fiber supplements. If laxatives are used, milk of magnesia or polyethylene glycol are recommended as first-line agents due to their low cost and safety. Stimulants should only be used if this
2640-536: Is done manually by a physician and is used to guide which diagnostic tests to order. Functional constipation is common and does not warrant diagnostic testing. Imaging and laboratory tests are typically recommended for those with alarm signs or symptoms. The laboratory tests performed depends on the suspected underlying cause of the constipation. Tests may include CBC ( complete blood count ), thyroid function tests, serum calcium, serum potassium, etc. Abdominal X-rays are generally only performed if bowel obstruction
2728-409: Is excessive or abnormal capillary formation such as cancer and disorders harming eyesight; and medical conditions in which there is reduced capillary formation either for familial or genetic reasons, or as an acquired problem. Capillary blood sampling can be used to test for blood glucose (such as in blood glucose monitoring ), hemoglobin , pH and lactate . It is generally performed by creating
Hemorrhoid - Misplaced Pages Continue
2816-524: Is excessively increased. Increased internal and external anal sphincter pressure may also be involved in hemorrhoid symptoms. Two types of hemorrhoids occur: internals from the superior hemorrhoidal plexus and externals from the inferior hemorrhoidal plexus. The pectinate line divides the two regions. Hemorrhoids are typically diagnosed by physical examination. A visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids. Visual confirmation of internal hemorrhoids, on
2904-494: Is known as the hemorrhoidal plexus . Hemorrhoid cushions are important for continence . They contribute to 15–20% of anal closure pressure at rest and protect the internal and external anal sphincter muscles during the passage of stool. When a person bears down, the intra-abdominal pressure grows, and hemorrhoid cushions increase in size, helping maintain anal closure. Hemorrhoid symptoms are believed to result when these vascular structures slide downwards or when venous pressure
2992-498: Is made by looking at the area. Many people incorrectly refer to any symptom occurring around the anal area as hemorrhoids, and serious causes of the symptoms should not be ruled out. Colonoscopy or sigmoidoscopy is reasonable to confirm the diagnosis and rule out more serious causes. Often, no specific treatment is needed. Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest. Medicated creams may be applied to
3080-454: Is more concerning when there is weight loss or anemia , blood is present in the stool , there is a history of inflammatory bowel disease or colon cancer in a person's family, or it is of new onset in someone who is older. Treatment of constipation depends on the underlying cause and the duration that it has been present. Measures that may help include drinking enough fluids, eating more fiber , consumption of honey and exercise . If this
3168-402: Is not effective, laxatives of the bulk-forming agent , osmotic agent , stool softener , or lubricant type may be recommended. Stimulant laxatives are generally reserved for when other types are not effective. Other treatments may include biofeedback or in rare cases surgery. In the general population rates of constipation are 2–30 percent. Among elderly people living in a care home
3256-430: Is not effective. In cases of chronic constipation, polyethylene glycol appears superior to lactulose . Prokinetics may be used to improve gastrointestinal motility. A number of new agents have shown positive outcomes in chronic constipation; these include prucalopride and lubiprostone . Cisapride is widely available in third world countries, but has been withdrawn in most of the west. It has not been shown to have
3344-672: Is often delayed until after delivery. Evidence does not support the use of traditional Chinese herbal treatment . The use of phlebotonics has been investigated in the treatment of low-grade hemorrhoids, although these drugs are not approved for such use in the United States or Germany. The use of phlebotonics for the treatment of chronic venous diseases is restricted in Spain. A number of office-based procedures may be performed. While generally safe, rare serious side effects such as perianal sepsis may occur. Hemorrhoidal artery embolization (HAE)
3432-457: Is often diagnosed as irritable bowel syndrome (IBS) when no obvious cause is found. Poor dietary habits, previous abdominal surgeries, and certain medical conditions can contribute to constipation. Diseases associated with constipation include hypothyroidism , certain types of cancer , and irritable bowel syndrome . Low fiber intake, inadequate amounts of fluids, poor ambulation or immobility, or medications can contribute to constipation. Once
3520-423: Is on the toilet paper, or drips into the toilet bowl. The stool itself is usually normally coloured. Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus, itchiness , and fecal incontinence . Internal hemorrhoids are usually painful only if they become thrombosed or necrotic . The exact cause of symptomatic hemorrhoids is unknown. A number of factors are believed to play
3608-582: Is present, other potential causes should be considered. Other conditions that produce an anal mass include skin tags , anal warts , rectal prolapse , polyps , and enlarged anal papillae. Anorectal varices due to portal hypertension (blood pressure in the portal venous system ) may present similar to hemorrhoids but are a different condition. Portal hypertension does not increase the risk of hemorrhoids. A number of preventative measures are recommended, including avoiding straining while attempting to defecate, avoiding constipation and diarrhea either by eating
Hemorrhoid - Misplaced Pages Continue
3696-885: Is present, the condition is more likely to be an anal fissure or external hemorrhoid rather than internal hemorrhoid. Internal hemorrhoids originate above the pectinate line. They are covered by columnar epithelium , which lacks pain receptors . They were classified in 1985 into four grades based on the degree of prolapse : External hemorrhoids occur below the dentate (or pectinate) line. They are covered proximally by anoderm and distally by skin, both of which are sensitive to pain and temperature. Many anorectal problems, including fissures , fistulae , abscesses, colorectal cancer , rectal varices , and itching have similar symptoms and may be incorrectly referred to as hemorrhoids. Rectal bleeding may also occur owing to colorectal cancer, colitis including inflammatory bowel disease , diverticular disease , and angiodysplasia . If anemia
3784-421: Is significant stool burden and may reveal abdominal discomfort. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not. Rectal examination also gives information on the consistency of the stool, the presence of hemorrhoids, blood and whether any perineal irregularities are present including skin tags, fissures, anal warts. Physical examination
3872-430: Is suspected, may reveal extensive impacted fecal matter in the colon, and may confirm or rule out other causes of similar symptoms. Colonoscopy may be performed if an abnormality in the colon like a tumor is suspected. Other tests rarely ordered include anorectal manometry , anal sphincter electromyography, and defecography . Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of
3960-428: Is the most common medical disorder associated with constipation. Anismus occurs in a small minority of persons with chronic constipation or obstructed defecation. Spinal cord lesions and neurological disorders such as Parkinson's disease and pelvic floor dysfunction can also lead to constipation. Chagas disease may cause constipation through the destruction of the myenteric plexus . Voluntary withholding of
4048-503: Is traditionally defined as three or fewer bowel movements per week. Other symptoms related to constipation can include bloating, distension , abdominal pain, headaches, a feeling of fatigue and nervous exhaustion, or a sense of incomplete emptying. Although constipation may be a diagnosis, it is typically viewed as a symptom that requires evaluation to discern a cause. Distinguish between acute (days to weeks) or chronic (months to years) onset of constipation because this information changes
4136-480: Is very case dependent. Complications that can arise from constipation include hemorrhoids , anal fissures , rectal prolapse , and fecal impaction. Straining to pass stool may lead to hemorrhoids. In later stages of constipation, the abdomen may become distended, hard and diffusely tender. Severe cases ("fecal impaction" or malignant constipation ) may exhibit symptoms of bowel obstruction (nausea, vomiting , tender abdomen) and encopresis , where soft stool from
4224-701: The American Society of Colon and Rectal Surgeons . Steroid -containing agents should not be used for more than 14 days, as they may cause thinning of the skin. Most agents include a combination of active ingredients. These may include a barrier cream such as petroleum jelly or zinc oxide , an analgesic agent such as lidocaine , and a vasoconstrictor such as epinephrine . Some contain Balsam of Peru to which certain people may be allergic. Flavonoids are of questionable benefit, with potential side effects. Symptoms usually resolve following pregnancy; thus active treatment
4312-523: The differential diagnosis . This in the context of accompanied symptoms helps physicians discover the cause of constipation. People often describe their constipation as bowel movements that are difficult to pass, firm stool with lumpy or hard consistency, and excessive straining during bowel movements. Bloating, abdominal distension , and abdominal pain often accompany constipation. Chronic constipation (symptoms present at least three days per month for more than three months) associated with abdominal discomfort
4400-419: The endocrine glands , intestines , pancreas , and the glomeruli of the kidney . Sinusoidal capillaries or discontinuous capillaries are a special type of open-pore capillary, also known as a sinusoid , that have wider fenestrations that are 30–40 micrometres (μm) in diameter, with wider openings in the endothelium. Fenestrated capillaries have diaphragms that cover the pores whereas sinusoids lack
4488-512: The liver , bone marrow , spleen , and brain circumventricular organs . During early embryonic development , new capillaries are formed through vasculogenesis , the process of blood vessel formation that occurs through a novel production of endothelial cells that then form vascular tubes. The term angiogenesis denotes the formation of new capillaries from pre-existing blood vessels and already-present endothelium which divides. The small capillaries lengthen and interconnect to establish
SECTION 50
#17328953806334576-404: The rectosigmoid colon . Supplements such as calcium and iron supplements can also have constipation as a notable side effect. Metabolic and endocrine problems which may lead to constipation include: pheochromocytoma , hypercalcemia , hypothyroidism , hyperparathyroidism , porphyria , chronic kidney disease , pan-hypopituitarism , diabetes mellitus , and cystic fibrosis . Constipation
4664-793: The Latin word capillaris , meaning "of or resembling hair", with use in English beginning in the mid-17th century. The meaning stems from the tiny, hairlike diameter of a capillary. While capillary is usually used as a noun, the word also is used as an adjective, as in " capillary action ", in which a liquid flows without influence of external forces, such as gravity . Blood flows from the heart through arteries , which branch and narrow into arterioles , and then branch further into capillaries where nutrients and wastes are exchanged. The capillaries then join and widen to become venules , which in turn widen and converge to become veins , which then return blood back to
4752-480: The area of the anus . If bleeding occurs, it is usually darker. Symptoms frequently get better after a few days. A skin tag may remain after the healing of an external hemorrhoid. While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure in the abdomen are believed to be involved. This may include constipation , diarrhea , and sitting on the toilet for long periods. Hemorrhoids are also more common during pregnancy . Diagnosis
4840-706: The area, but their effectiveness is poorly supported by evidence. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Hemorrhoidal artery embolization (HAE) is a safe and effective minimally invasive procedure that can be performed and is typically better tolerated than traditional therapies. Surgery is reserved for those who fail to improve following these measures. Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives. Males and females are both affected with about equal frequency. Hemorrhoids affect people most often between 45 and 65 years of age, and they are more common among
4928-620: The bathroom. In the elderly, common causes have been attributed to insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity , side effects of medications, hypothyroidism , and obstruction by colorectal cancer . Evidence to support these factors however is poor. Secondary causes include side effects of medications such as opiates, endocrine and metabolic disorders such as hypothyroidism , and obstruction such as from colorectal cancer or ovarian cancer . Celiac disease and non-celiac gluten sensitivity may also present with constipation. Cystocele can develop as
5016-497: The blood capillaries open at one end to the arterioles and open at the other end to the venules). This structure permits interstitial fluid to flow into them but not out. Lymph capillaries have a greater internal oncotic pressure than blood capillaries, due to the greater concentration of plasma proteins in the lymph . Blood capillaries are categorized into three types: continuous, fenestrated, and sinusoidal (also known as discontinuous). Continuous capillaries are continuous in
5104-520: The bowel contents and are vital for normal defecation. Deficiencies in PS frequency, amplitude, and extent of propagation are all implicated in severe defecatory dysfunction (SDD). Mechanisms that can normalize these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation. The Rome III Criteria for functional constipation must include two or more of
5192-481: The capillary blood, and sinusoids , a type of open-pore capillary found in the liver , bone marrow , anterior pituitary gland , and brain circumventricular organs . Capillaries and sinusoids are short vessels that directly connect the arterioles and venules at opposite ends of the beds. Metarterioles are found primarily in the mesenteric microcirculation . Lymphatic capillaries are slightly larger in diameter than blood capillaries, and have closed ends (unlike
5280-444: The cells that form the wall. Molecules smaller than 3 nm such as water and gases cross the capillary wall through the space between cells in a process known as paracellular transport . These transport mechanisms allow bidirectional exchange of substances depending on osmotic gradients. Capillaries that form part of the blood–brain barrier only allow for transcellular transport as tight junctions between endothelial cells seal
5368-420: The close proximity of the rectum to the nerves that supply the bladder. Also, a small risk of fecal incontinence occurs, particularly of liquid, with rates reported between 0% and 28%. Mucosal ectropion is another condition which may occur after hemorrhoidectomy (often together with anal stenosis). This is where the anal mucosa becomes everted from the anus, similar to a very mild form of rectal prolapse . It
SECTION 60
#17328953806335456-520: The colon, irritable bowel syndrome , and pelvic floor disorders. Underlying associated diseases include hypothyroidism , diabetes , Parkinson's disease , celiac disease , non-celiac gluten sensitivity , vitamin B 12 deficiency , colon cancer , diverticulitis , and inflammatory bowel disease . Medications associated with constipation include opioids , certain antacids , calcium channel blockers , and anticholinergics . Of those taking opioids about 90% develop constipation. Constipation
5544-441: The consumption of fiber supplements . Evidence for benefits from sitz baths during any point in treatment, however, is lacking. If they are used, they should be limited to 15 minutes at a time. Decreasing time spent on the toilet and not straining is also recommended. While many topical agents and suppositories are available for the treatment of hemorrhoids, little evidence supports their use. As such, they are not recommended by
5632-416: The delivery process especially if they have had a perineal tear or underwent an episiotomy . Risk factors that increase the risk of constipation in this population include: Hemorrhoids are common in pregnancy and also may get exacerbated when constipated. Anything that can cause pain with stooling (hemorrhoids, perineal tear, episiotomy) can lead to constipation because patients may withhold from having
5720-486: The elderly is felt to be due to an increasing number of health problems as humans age and decreased physical activity. Since ancient times different societies have published medical opinions about how health care providers should respond to constipation in patients. In various times and places, doctors have made claims that constipation has all sorts of medical or social causes. Doctors in history have treated constipation in reasonable and unreasonable ways, including use of
5808-487: The endothelial cells that are 60–80 nanometres (nm) in diameter. They are spanned by a diaphragm of radially oriented fibrils that allows small molecules and limited amounts of protein to diffuse. In the renal glomerulus the capillaries are wrapped in podocyte foot processes or pedicels, which have slit pores with a function analogous to the diaphragm of the capillaries. Both of these types of blood vessels have continuous basal laminae and are primarily located in
5896-411: The existence of capillaries, but he saw the need for some sort of connection between the arterial and venous systems. In 1653, he wrote, "...the blood doth enter into every member through the arteries, and does return by the veins, and that the veins are the vessels and ways by which the blood is returned to the heart itself; and that the blood in the members and extremities does pass from the arteries into
5984-454: The following and present for the past three months, with symptoms starting for at least 6 months prior to diagnosis. Constipation is usually easier to prevent than to treat. Following the relief of constipation, maintenance with adequate exercise, fluid intake, and high-fiber diet is recommended. A limited number of cases require urgent medical intervention or will result in severe consequences. The treatment of constipation should focus on
6072-525: The heart through the venae cavae . In the mesentery , metarterioles form an additional stage between arterioles and capillaries. Individual capillaries are part of the capillary bed , an interweaving network of capillaries supplying tissues and organs . The more metabolically active a tissue is, the more capillaries are required to supply nutrients and carry away products of metabolism. There are two types of capillaries: true capillaries, which branch from arterioles and provide exchange between tissue and
6160-475: The increased tendency for high pressure to increase blood flow. In the lungs , special mechanisms have been adapted to meet the needs of increased necessity of blood flow during exercise. When the heart rate increases and more blood must flow through the lungs, capillaries are recruited and are also distended to make room for increased blood flow. This allows blood flow to increase while resistance decreases. Extreme exercise can make capillaries vulnerable, with
6248-561: The now-obsolete spelling " emerods ". Celsus (25 BC – 14 AD) described ligation and excision procedures and discussed the possible complications. Galen advocated severing the connection of the arteries to veins, claiming it reduced both pain and the spread of gangrene. The Susruta Samhita (4th–5th century BC) is similar to the words of Hippocrates, but emphasizes wound cleanliness. In the 13th century, European surgeons such as Lanfranc of Milan , Guy de Chauliac , Henri de Mondeville , and John of Ardene made great progress and development of
6336-403: The other hand, may require anoscopy , insertion of a hollow tube device with a light attached at one end. A digital rectal exam (DRE) can also be performed to detect possible rectal tumors , polyps , an enlarged prostate , or abscesses . This examination may not be possible without appropriate sedation because of pain, although most internal hemorrhoids are not associated with pain. If pain
6424-467: The paracellular space. Capillary beds may control their blood flow via autoregulation . This allows an organ to maintain constant flow despite a change in central blood pressure. This is achieved by myogenic response , and in the kidney by tubuloglomerular feedback . When blood pressure increases, arterioles are stretched and subsequently constrict (a phenomenon known as the Bayliss effect ) to counteract
6512-753: The presence of constipation is identified based on a culmination of the symptoms described above, then the cause of constipation should be figured out. Separating non-life-threatening from serious causes may be partly based on symptoms. For example, colon cancer may be suspected if a person has a family history of colon cancer, fever, weight loss, and rectal bleeding. Other alarming signs and symptoms include family or personal history of inflammatory bowel disease, age of onset over 50, change in stool caliber, nausea, vomiting, and neurological symptoms like weakness, numbness and difficulty urinating. A physical examination should involve at least an abdominal exam and rectal exam. Abdominal exam may reveal an abdominal mass if there
6600-404: The rate of constipation is 50–75 percent. People in the United States spend more than US$ 250 million on medications for constipation a year. Constipation is a symptom, not a disease. Most commonly, constipation is thought of as infrequent bowel movements, usually fewer than 3 stools per week. However, people may have other complaints as well including: The Rome III Criteria are
6688-473: The risk of severe hemorrhoids. Evidence for these associations, however, is poor. Being a receptive partner in anal intercourse has been listed as a cause. During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. The birth of the baby also leads to increased intra-abdominal pressures. Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery. Hemorrhoid cushions are
6776-453: The sense that the endothelial cells provide an uninterrupted lining, and they only allow smaller molecules , such as water and ions , to pass through their intercellular clefts . Lipid-soluble molecules can passively diffuse through the endothelial cell membranes along concentration gradients. Continuous capillaries can be further divided into two subtypes: Fenestrated capillaries have pores known as fenestrae ( Latin for "windows") in
6864-430: The small intestine bypasses the mass of impacted fecal matter in the colon . Constipation is the most common chronic gastrointestinal disorder in adults. Depending on the definition employed, it occurs in 2% to 20% of the population. It is more common in women, the elderly and children. Specifically constipation with no known cause affects females more often affected than males. The reasons it occurs more frequently in
6952-474: The stool is a common cause of constipation. The choice to withhold can be due to factors such as fear of pain, fear of public restrooms, or laziness. When a child holds in the stool a combination of encouragement, fluids , fiber , and laxatives may be useful to overcome the problem. Early intervention with withholding is important as this can lead to anal fissures . A number of diseases present at birth can result in constipation in children . They are as
7040-662: The surgical techniques. In medieval times, hemorrhoids were also known as Saint Fiacre 's curse after a sixth-century saint who developed them following tilling the soil. The first use of the word "hemorrhoid" in English occurs in 1398, derived from the Old French "emorroides", from Latin hæmorrhoida , in turn from the Greek αἱμορροΐς ( haimorrhois ), "liable to discharge blood", from αἷμα ( haima ), "blood" and ῥόος ( rhoos ), "stream, flow, current", itself from ῥέω ( rheo ), "to flow, to stream". Sinusoid (blood vessel) A capillary
7128-440: The surrounding interstitial fluid , and they convey blood from the smallest branches of the arteries ( arterioles ) to those of the veins ( venules ). Other substances which cross capillaries include water, oxygen , carbon dioxide , urea , glucose , uric acid , lactic acid and creatinine . Lymph capillaries connect with larger lymph vessels to drain lymphatic fluid collected in microcirculation. Capillary comes from
7216-507: The symptom carries a significant financial impact upon the healthcare system. While it is difficult to assess an exact age at which constipation most commonly arises, children frequently experience constipation in conjunction with life-changes. Examples include: toilet training, starting or transferring to a new school, and changes in diet. Especially in infants, changes in formula or transitioning from breast milk to formula can cause constipation. The majority of constipation cases are not tied to
7304-443: The two. Bleeding enough to cause anemia is rare, and life-threatening bleeding is even more uncommon. Many people feel embarrassed when facing the problem and often seek medical care only when the case is advanced. If not thrombosed , external hemorrhoids may cause few problems. However, when thrombosed, hemorrhoids may be very painful. Nevertheless, this pain typically resolves in two to three days. The swelling may, however, take
7392-401: The underlying cause if known. The National Institute of Health and Care Excellence (NICE) break constipation in adults into two categories: chronic constipation of unknown cause, and constipation due to opiates. In chronic constipation of unknown cause, the main treatment involves the increased intake of water and fiber (either dietary or as supplements). The routine use of laxatives or enemas
7480-409: The vascular growth and permeability factor vascular endothelial growth factor (VEGF) appear to play a major role in many of the disorders. Cellular factors include reduced number and function of bone-marrow derived endothelial progenitor cells . and reduced ability of those cells to form blood vessels. Major diseases where altering capillary formation could be helpful include conditions where there
7568-441: The veins (either mediately by an anastomosis, or immediately through the porosities of the flesh, or both ways) as before it did in the heart and thorax out of the veins, into the arteries..." Marcello Malpighi was the first to observe directly and correctly describe capillaries, discovering them in a frog's lung 8 years later, in 1661. August Krogh discovered how capillaries provide nutrients to animal tissue. For his work he
7656-403: The wealthy, although this may reflect differences in healthcare access rather than true prevalence. Outcomes are usually good. The first known mention of the disease is from a 1700 BC Egyptian papyrus . In about 40% of people with pathological hemorrhoids, there are no significant symptoms. Internal and external hemorrhoids may present differently; however, many people may have a combination of
7744-467: Was awarded the 1920 Nobel Prize in Physiology or Medicine . His 1922 estimate that total length of capillaries in a human body is as long as 100,000 km, had been widely adopted by textbooks and other secondary sources. This estimate was based on figures he gathered from "an extraordinarily large person". More recent estimates give a number between 9,000 and 19,000 km. Constipation Constipation
#632367