General Surgery In women

Haemorrhoids

Haemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially because of repeated straining during bowel movements. They develop when the veins in the rectum or the anus become dilated or enlarged. Swollen haemorrhoids are also called piles.

Haemorrhoids are one of the most common causes of rectal bleeding. They’re rarely dangerous and usually clear up in a couple of weeks. But you should see your doctor to make sure it’s not a more serious condition. He can also remove haemorrhoids that won’t go away or are very painful.

Types, causes and symptoms:

Internal haemorrhoids

Internal haemorrhoids occur inside the rectum, so you can’t usually see or feel them. They don’t generally hurt because you have few pain-sensing nerves there. Bleeding may be the only sign of them.

External haemorrhoids

The most common type, an external haemorrhoids are usually found beneath the skin that surrounds the anus. There are many more pain-sensing nerves there, so they tend to hurt as well as bleed.

Occasionally, repeated strain can push an internal haemorrhoid making bigger and bulging outside the anal sphincter. This is known as a protruding or prolapsed haemorrhoid and can cause pain and irritation. You may be able to see them as moist bumps that are pinker than the surrounding area. They’re more likely to hurt, especially when passing stools.

Thrombosed haemorrhoids

Sometimes blood may pool in an external haemorrhoid and form a clot  or thrombus can occur as a result, causing  severe pain, swelling, inflammation and a hard lump near your anus.

Symptoms

Talk to your doctor or surgeon experience pain, bleed frequently or excessively, from the anus, and if you feel a painful lump in the area.
Common symptoms are:
* Itching around the anus or rectal area

* Pain around the anus

* Lumps near or around the anus which may be sensitive or painful

* Blood in the stool, that you may notice in small amounts

Causes

* Straining during bowel movements
* Chronic constipation
* Chronic diarrhoea
* Obesity
* Pregnancy
* Anal-intercourse
* Low-fiber diet

Haemorrhoids are more likely with aging because the tissues that support the veins in your rectum and anus can weaken and stretch.

Haemorrhoids during pregnancy

Constipation contributes to haemorrhoids during pregnancy, so try and avoid it by: *Adding more fibre-rich foods to your diet
* Drinking plenty or water or other fluids
* Including a daily walk or some exercise or physical activity, daily

Ask your doctor about fibre supplements and stool softeners.

If these suggestions don’t help or your haemorrhoids get worse or begin to bleed, consult your health care provider. For many women, haemorrhoids resolve after delivery. If the haemorrhoids persist, surgical treatment might be recommended.

Pain relief

* Warm water soak. Fill a tub with plain warm water and soak several times a day.

* Avoid sitting for too long. Sitting puts pressure on the veins in affected area. So take frequent breaks from sitting and.try to lie on your side or stand up or walk around.

Talk to your doctor

If these suggestions don’t help or your haemorrhoids get worse or begin to bleed, consult your doctor. The doctor may be able to recommend fibre or stool supplements, or a  haemorrhoid cream.
For many women, haemorrhoids resolve after delivery. If the haemorrhoids persist, surgical treatment might be recommended.

Treatment

Correcting constipation is the best way to treat haemorrhoids and prevent recurrence. Usually the doctor will treat the condition by recommending you have a fibre rich diet. Depending on the severity, stood softeners, creams or fibre supplements may be prescribed.

Surgery

If the haemorrhoids persist, with excessive pain and bleeding, despite medication and diet change, surgical treatment will be recommended.

Haemorrhoidectomy

A haemorrhoidectomy is usually carried out under a general anaesthetic, so you will be unconscious and won’t feel any during the procedure.

A typical haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. Recovery time from the surgery is about a week.  But you may only need to stay at the hospital for 2 days.

Pain killers will be prescribed to manage pain post-surgery.

Hernias

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place.

Most hernias are not immediately life threatening. In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or a medical exam for an unrelated problem.
Depending on its cause, a hernia can develop quickly or over a long period of time. If left untreated, a hernia may grow and become more painful. Often, surgery is required to prevent the likelihood of dangerous complications.

Symptoms

From a painless to very painful tender swollen lump, usually in the abdomen or pelvis.

A reducible hernia

* May appear as a lump in the groin or abdominal area
* Aches but is not tender when touched.
* Sometimes you may feel pain before you notice a lump.
* A lump that increases in size when you stand or when abdominal pressure increase eg., when coughing. It can be pushed back into the abdomen unless it is very large.

An irreduceable or incarcerated hernia

* May be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
* May occur over a long period, without pain
* May lead to strangulation – which happens when blood supply to the tissue in the hernia is cut off
* Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

A strangulated hernia

* This is an irreducible hernia  where the entrapped intestine has its blood supply cut off.
* Pain is persistent, followed by tenderness and sometimes presents symptoms of bowel obstruction like nausea or vomiting
* You may feel ill, with or without a fever
* This indicates the need for immediate surgery

Types of hernia and their symptoms

Each type of hernia is accompanied by specific symptoms as well.

Inguinal Hernia

* Occurs when the intestine or the bladder pushes through a weak spot or tear in the lower abdominal wall, or into the inguinal canal near the groin. They are sometimes called groin hernias.
* Most often these are painful, in some cases they do not cause pain.
* More common in men, in the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles.
* In women, the inguinal canal has a ligament that helps hold the uterus in place.

Symptoms

You may feel a lump on either side of your pubic bone where your groin and thigh meet.
It may or may not be accompanied by pain in the area.

Hiatal hernia

* Occurs when part of your stomach protrudes up through the diaphragm into your chest.
* Most common among those over 50 years
*If a child has the condition, it’s typically caused by a birth defect.

Symptoms

* Acid reflux: when stomach acid moves back into the oesophagus causing a burning sensation

* Chest pain

* Difficulty swallowing

Incisional hernia

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

Umbilical hernia

These occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. Noticeable especially when the child is crying.

It is the only kind that often goes away on its own, by the time the child is 1 year old. If the hernia has not gone by this point, surgery may be used to correct it.

Causes

Hernias are caused by a combination of muscle weakness and strain. Common causes of muscle weakness include:
* Chronic coughing
* Damage due to injury or surgery
* Congenital or developmental: when the abdomen wall fails to close properly in the womb.
* Age
* Pregnancy: as it strains the abdomen
* Constipation: often causes you to strain when having a bowel movement
* Lifting heavy weights
* Ascites or fluid in the abdomen
* Suddenly gaining weight
* Persistent sneezing

Risk factors

The factors that increase your risk of developing a hernia include:
* Personal of family history
* Being overweight
* Chronic cough
* Chronic constipation
* Smoking, which can trigger a cough
* Cystic fibrosis, impairs the function of the lungs causing chronic cough

Treatment options for a hernia

Treatment depends on the size of the hernia and the severity of symptoms. Your doctor may monitor your hernia for possible complications. Treatment options for a hernia include:

Lifestyle changes

Changes in diet often treat Hiatial Hernias. Avoid heavy meals, don’t lie down or bend over after a meal, and ensure your weight in a healthy range. Symptoms can improve by avoiding tomato-based food. Avoiding cigarettes foods that are spicy and cause acid reflux or heartburn also helps.

Surgery

Surgery is needed if the hernia grows larger or causes pain. A hernia is repaired by patching the hole in the abdominal with surgical mesh.

Hernias can be repaired with either open or laparoscopic surgery.

Laparoscopic surgery uses a tiny camera and miniature surgical equipment to repair the hernia with a few small incisions. It is less damaging to the surrounding tissue and needs less recovery time. However, the risk of your hernia reoccurring is higher. Not all hernias are suitable for laparoscopic repair, including those in which a portion of your intestines has moved down into the scrotum.


Open surgery requires a longer recovery process. You may be unable to move around normally for up to six weeks.

Depending on the type of hernia, hospital stay could be about 2 days.