Colorectal Disorders

Colon cancer may not make its victims sick until it is well advanced. For this reason, most colon cancers are not detected early and many people die unnecessarily.

An estimated 152,000 Americans will develop colon cancer each year, with 57,000 dying from this preventable disease.

Early detection is the best way to prevent colon cancer deaths. Colon cancers begin as polyps, which grow slowly from the size of a pinhead to that of a lemon. Cancer can develop when these polyps reach the size of a blueberry.

Symptoms and risk factors play a major role in the early detection of colon cancer problems. If you have any of the risk factors or symptoms, you need to see a physician.

Risk Factors

Symptoms

Colon cancer is the second leading cause of cancer deaths. However, according to the American Cancer society, when colorectal cancer is detected in its early stages, up to 88% of these cases can be treated successfully. When cancer is detected after it has spread to other parts of the body, less than 7% may be treated successfully. Early detection saves lives.

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Colon Cancer Prevention

Examine Your Family Tree

This is one time when climbing a tree and going out on a limb is not dangerous. In fact it could save your life. Investigating your family tree for all history of illness is important with cancer it's critical. Multiple research studies have shown that a person has a higher risk of cancer when an immediate family member has had cancer. Once armed with this information, a person should begin a regular routine of doctor visits and tests.

Susie, one of our patients, never knew about the threat of colon cancer in her family until her father was diagnosed with a cancerous colon polyp. The polyp was removed without surgery and today he is cancer free. Shortly after her father's diagnosis, doctors discovered her brother had a colon polyp that could have eventually turned into cancer. His polyp was removed and was found to be benign. He lost only one day of work. Susie traced back in her family tree and found an aunt and uncle who also developed cancer. Alerted to a high family history risk, Susie was motivated to take action in getting herself tested for colon cancer on a regular basis.

Many people are afraid of having a colonoscopy (a procedure that can discover abnormalities in the colon), but Susie adds that the testing and procedures are painless. If she had just one chance to tell others about colon problems, she would say: Do something now! Don't wait! Don't be afraid! Most people don't want to think about colon cancer happening to them, but they need to be educated on the risk factors. Susie's father and brother didn't think it would ever happen to them, but it did. Susie had her first colonoscopy two years ago and was given a clean bill of health. Now she continues to follow the schedule of regular testing as our physicians suggests. Susie can give herself a pat on the back for investigating her family tree and taking action in preventing cancer from entering her life. So, go ahead and go out on a limb a quick check of your family tree could save your life.

American Cancer Society Guidelines

The American Cancer Society recommends that men and women at average risk begin regular screening for colorectal cancer at age 50.  You and your doctor should discuss one of the following three options:

Our physicians advise:

Those patients with a family history of colon cancer of polyps, a personal history of breast, uterine or ovarian cancer, or a personal history of inflammatory bowel disease are at greater risk for colorectal cancer and therefore should have periodic colonoscopy.

To Win = Early Detection

THE FACTS

Colorectal cancer, or cancer of the colon or rectum, is the second-leading cause of cancer-related deaths in the United States, claiming over 56,000 lives each year.  An estimated 131,000 men and women will be diagnosed with colorectal cancer this year alone.

Who is at Risk?

Both men and women are at risk for developing colorectal cancer.  The disease is most common among people aged 50 and older and the risk increases with age.  A family history of colorectal cancer or colorectal polyps also increases the risk of developing colorectal cancer.

Prevention

Colorectal cancer is a leading cause of cancer death in the United States.  Although screening for this disease could save thousands of lives each year, these screening procedures are not used nearly as much as they should be.  When detected early and treated promptly, cancers of the colon and rectum are among the most curable.

These early detection tests also aid physicians in the identification of polyps, which give rise to colorectal cancer.  Therefore, early detection tests can actually prevent colorectal cancer form ever occurring because precancerous polyps can be removed.

Neglecting Rectal Bleeding?

Problems.  Some resolve themselves, other require much time and attention.  When it comes to rectal bleeding, ignoring the problem won't make it go away.  Any amount of blood loss form the rectum is not normal and is usually a symptom of a far greater problem.

Rectal bleeding can appear in a couple of ways' either as blood in , or on the stool, which can be hard to detect with the naked eye; or as droplets of blood in the toilet bowl or on the toilet paper.

Any lesion in the digestive tract may produce bleeding.  The most common cause of rectal bleeding is hemorrhoids.  IN particular, internal hemorrhoids often cause the passage of bright, red blood seen on the outside of the stool and not usually mixed with it.

Unfortunately, about half of the American population suffers from hemorrhoids at some time in their life.  Because hemorrhoids can appear simultaneously with a variety of anorectal disorders, other possible causes of bleeding must be ruled out before deciding on hemorrhoids as the sole diagnosis.

Why?  Rectal bleeding is one of the few symptoms of colorectal cancer.  Cancers of the colon and rectum can grow for years before symptoms become apparent.  If there is blood loss, it is often hidden in the stool, making it difficult to detect.  for this reason, annual stool blood tests are recommended for anyone over 40 with out symptoms.  These tests are done in the privacy of the home and can detect hidden blood in the stool.

More importantly, Colon& Rectal Care recommends colonoscopic or sigmoidoscopic examinations for those over 50 and for anyone, no matter what the age, with symptoms or high risk factors that include:  unexplained weight loss, change in bowel habits, previous cancer, and rectal bleeding.  We also recommend these exams at the age of 40 for anyone with a family history of colon cancer.  These tests are vital to finding not only the cause of rectal bleeding but also polyps - an early sign of cancer.

Diabetics Face Increased Risk of Colorectal Cancer:
Presented at ACG

Colorectal cancer occurs significantly more frequently in people with diabetes than in healthy people, according to investigators who presented their findings here at the 70th annual meeting of the American College of Gastroenterology (ACG).

"Because we had seen an indication in smaller studies that people with diabetes faced a higher risk [of colorectal cancer], we wanted to see whether this was true," said principal investigator Donald Garrow, MD, MS, Clinical Instructor of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States.

"We used 7 years' worth of data from a large national database, and our findings confirmed this concern," Dr. Garrow said during his presentation on November 1st.

A further rationale for the study was based on several in vitro studies, which had shown that hyperinsulinemia and hyperglycemia promote the growth of colorectal cancer, and that both insulin and insulin-like growth factor-1 (IGF-1) receptors are found in these tumors. And high levels of circulating IGF-1 have been linked to both certain benign polyps and to cancer, he added.

The investigators obtained the responses to the National Health Interview Survey (NHIS) of 226,953 subjects who participated during 1997 to 2003. Among these subjects, 5.9% (n = 13,399) reported a history of diabetes.

The analysis controlled for factors that are associated with both diabetes and colorectal cancer, including obesity, race, and smoking status, as well as age and gender.

Subjects with diabetes were 1.4 times more likely to develop colorectal cancer than non-diabetics. The rate of colorectal cancer among those with diabetes was 1.39% and 0.47% among those without diabetes (P < .001). The odds ratio (OR) for colorectal cancer in diabetics was 1.39 (confidence interval [CI] = 1.15-1.67).

The OR for people who were older than 50 years was 13.9 (CI = 10.66-18.14), a predictable finding, Dr.Garrow said. However, the OR for white respondents was 1.29 (CI = 1.29-1.58). Obese respondents had an OR of 0.79 (CI = 0.66-0.93), while former smokers and users of alcohol had increased risks, with ORs of 1.43 (CI=1.22-1.69) and 1.10 (CI=0.90-1.34), respectively.

Current guidelines recommend that colorectal cancer screening start at the age of 50 years old in diabetics. However, Dr. Garrow said that if future studies corroborate the findings from this study, it may be necessary to recommend that diabetics receive more aggressive screening.

If you would like to read more about colon and rectal health care try these links.

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Hemorrhoids are enlarged, dilated blood vessels that occur in the anal canal and under the skin around the anal opening.

Hemorrhoids can occur at any age, and are believed to be the most common medical problem experienced by people in the Western Hemisphere. Hemorrhoids frequently affect pregnant women and people with sedentary occupations. Other potential causes include constipation, heavy lifting, stress, lifestyle, and obesity. No one is immune. There are two basic types of hemorrhoids:

External hemorrhoids
External hemorrhoids occur below the anorectal line and around the anal opening. They are swollen veins covered by sensitive skin. When an external hemorrhoid forms a blood clot (thrombus) it can appear blue in color and cause severe pain, itching, and inflammation.

Internal hemorrhoids
Internal hemorrhoids usually remain inside the anal canal and are generally not felt or seen unless they protrude through the anus to the outside. Symptoms may include pain, bleeding, itching, and a feeling of fullness after a bowel movement. Internal hemorrhoids can protrude during a bowel movement and may recede spontaneously.

Treatment protocols are varied and can include:

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Commonly known as IBS, Irritable Bowel Syndrome affects an estimated 22 million people, two-thirds of whom are women. It is a chronic, functional disorder of the colon, but should not be confused with Inflammatory Bowel Disease, which causes severe inflammation of the colon lining.

Physicians consider IBS a functional disorder because there is no sign of disease when the colon is examined by x-ray or other diagnostic methods.

IBS causes a variety of symptoms including lower abdominal pain, gas, bloating, constipation or diarrhea, or alternating constipation and diarrhea.

IBS can cause a great deal of discomfort, however, with proper medical attention, most people with IBS can keep their symptoms under control.

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Inflammatory Bowel Disease (IBD) is the name for a group of disorders in which various parts of the intestinal tract become inflamed. the cause of these diseases is not known. Various terms are used to describe a particular patient's condition, including: colitis, proctitis, enteritis, and ileitis. Most often, physicians divide IBD into two groups: ulcerative colitis and Crohn's Disease.

The most common symptoms of IBD are diarrhea and abdominal pain. Both ulcerative colitis and Crohn's Disease can cause rectal bleeding, however, Crohn's Disease patients experience rectal bleeding less often. In either disease, inflammation, fever, and bleeding may be serious and persistent, leading to weight loss and anemia. Proper medical treatment is crucial in IBD patients to prevent complications such as perforation of the colon and peritonitis.

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Diverticular diseases are caused by a lack of dietary fiber and roughage which in turn can cause constipation and pressure. When the pressure inside the colon builds up, the intestinal wall bulges out at weak points. Pouches (diverticula) develop at these weak points in the intestine. In diverticulosis, the protrusions of the colon are present, but not inflamed.

When the protrusions of the colon are inflamed and painful, the condition is known as diverticulitis. This is much more serious and can cause pain in the lower abdomen (usually the left side), nausea, vomiting, distention, and rectal bleeding. Absence of bowel movements, diarrhea, and sometimes fever are also symptoms of diverticulitis. The disease can cause either intense or moderate pain that is usually constant and can last for several days. Proper medical treatment is imperative for diverticulitis.

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Constipation

Constipation is a multi-factorial problem that affects millions of people and at least 5% of the population by some estimates. It can be quite debilitating even causing missed work or social activities. Constipation is defined as

Of primary importance when evaluating constipation is a review of diet, medications, and water intake. The most important initial treatment for constipation is adequate water intake and high fiber diet. This includes eight glasses of water per day and 30 grams of fiber each day. Many can be helped with these simple measures.

At the outset, our physicians are interested in determining the cause of your constipation. Thus, the work-up for constipation includes several tests performed in the Anorectal Physiology Laboratory at our Shadeland office. The laboratory tests include anorectal manometry (measuring pressures, sensation and appropriate reflexes in the rectum), EMG (muscle strength and coordination), Pudendal nerve studies and anorectal ultrasound.

You may require radiographic (x-ray) analysis of your colon, which may include a proctogram, colonic transit study (measurement of the motility of the colon) and a barium enema (colon x-rays). Other treatment options include biofeedback (an exercise program to improve muscle coordination) and certain medications (laxatives, stool softeners). A colonoscopy may be necessary to make sure there is no problem in the colon causing constipation.

Rarely, patients may require surgery to cure constipation. These surgeries include repairing the rectum if it is protruding, creating an opening with the appendix or removal of a portion of the colon. Medical options are always attempted before considering surgical treatment. Overall, 80% of our patients improve their quality of life without surgery.

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Fecal Incontinence

Fecal incontinence is defined as the loss of sphincter control or the inability to defer defecation to a socially acceptable place. It affects up to 8% of the population with two-thirds of the patients being female and below the age of 65. It is the second common cause of adult institutionalization and costs $400,000 per year in adult diapers.

Continence (having bowel control) is a coordinated action between multiple factors. These factors include the consistency of the stool, the strength of the anal muscles, rectal sensation, reflexes and appropriate nerve conduction. Incontinence can result from a disruption to any of these processes. Common causes include obstetrical injury, previous anorectal surgery, chronic rectal prolapse, neuropathy and several other diseases.

What is the treatment for incontinence?
Evaluation includes a careful history and physical examination. In addition, anorectal manometry (measurement of pressures and sensation in the rectum) EMG (muscle strength and coordination), ultrasound (cross-sectional images of the anal muscles) and several additional tests are extremely helpful in determining the causes and best treatment options for one’s incontinence. These tests are available at our Anorectal Physiology Lab located at our Shadeland office. Often an evaluation of the colon is necessary to exclude associated anorectal colonic disorders.

Medical treatment includes increasing daily fiber and water intake, and the use of biofeedback therapy (exercise program to improve sensation and strength measurement of one’s rectum and anus). Patients may improve their continence by 70% with the use of these conservative measures. Some may be helped with surgical procedures such as Sphincteroplasty (bringing the sphincter muscles back together), nerve stimulation or even an artificial sphincter. On very rare occasions, an ostomy may be necessary. Overall, 80% of patients can be helped with this problem with various therapeutic measures with significant improvement in their quality of life.

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What are anal fissures?

Anal fissures are tears or cracks at the margin of the anus, between the inside and outside of the rectum, over the muscle that controls bowel movements. Fissures can be one of the most painful conditions in the anorectal area. Because of the location of fissures, they tend to become aggravated during and after bowel movements.  For most people, the pain ends after a few minutes.  For others, it can persist for hours. You may also notice small amounts of blood and discharge from anal fissures.

Frequently, anal fissures are caused by constipation or diarrhea. Some fissures result from increased anal sphincter muscle tone. Fissures can occur in combination with other anorectal problems such as hemorrhoids and fistulas.  Large, multiple or atypically located anal fissures may indicate other problems such as Crohn’s disease (a chronic inflammation of the colon) or other inflammatory problems.  Certain anal and rectal cancers can produce symptoms similar to a fissure.  Thus, careful examination is necessary before concluding the problem is from a fissure and not a cancer.

Treatment

If treated early, most fissures heal within a few weeks. Many superficial anal fissures are healed by office treatments used in combination with stool softeners, a high-fiber diet, sitz baths, laxatives and medicated suppositories.  An in-office treatment called curettage and cauterization, which involves application of chemicals over the fissure to stimulate healing, may be done.  These treatments are given every three to four weeks as needed.  Our physicians generally recommend office medical care before surgery.

Controlling constipation is important to both preventing and healing fissures.  A diet high in fiber should be continued even after the symptoms of fissure are gone. Adding a bulk laxative (psyllium products) to the diet may prevent recurrence.  For maximum benefit from psyllium products, drink several glasses of water a day.

Laxative preparations containing mineral oil are not advised because of the difficulty in cleansing the area following defecation. Decreasing abnormal anal sphincter tone with various topical medications (Nifedipine) also helps many patients with anal fissures.

Do Fissures recur?

Some fissures heal only to recur later. When fissures are treated early, a greater success rate is noted. Repeated recurrences may lead to scarring and narrowing of the anal canal. Scarring may damage the anal sphincter. Surgery may be necessary if the fissure fails to heal after office management or when an acute deep fissure is associated with pain, infection or narrowed anal canal.  Occasionally, an infection can appear over the top of the fissure, making surgery necessary.  About 30 percent of patients with anal fissures require surgical treatment, which can usually be done on an outpatient basis.

It is important to see our physicians when symptoms first develop.  When diagnosed early, fissures can be cured without surgery.  Early treatment avoids complications such as anal canal scarring, narrowing and infections.

Surgery options

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What is pruritus ani (anorectal itching)?

Anorectal itching may be constant or may flare-up occasionally. Itching may be especially bothersome at night. Because of scratching and rubbing, the skin around the rectum may become inflamed, leathery, and red or white in color. In some people, the skin may appear normal but will still continue to itch.  

Causes and treatments

One common cause of anorectal itching is diet. Certain foods and beverages such as chocolate, tomatoes, peppers, spices, shellfish, coffee, tea, cola, wine and beer tend to cause itching for some people. 

Treatment begins by eliminating caffeine, tomatoes, spicy foods, and alcoholic beverages from your diet. Each week you will gradually add one of these foods or beverages to your diet to see which substances are causing your anorectal itching. Those that bother you should be avoided to prevent the itching from recurring.

Another cause of itching may be hygiene. Overzealous cleansing and the use of some over-the-counter medications can dry out the skin, causing it to itch. Likewise, inadequate cleansing can expose the skin to fecal material and cause skin irritation. Symptoms improve for most patients if cleansing and dietary changes are followed for two weeks. 

Sometimes the cause of this itching can be difficult to pinpoint. Possible causes also include stress, pinworms, lice, fungus, yeasts, or allergies to drugs such as antibiotics. Pruritus ani is also associated with certain system disorders such as diabetes, inflammatory bowel disease, and uremia. Pruritus ani can be a self-perpetuating disease: scratching causes further irritation, which causes the itching to increase. Pruritus ani may also result from internal hemorrhoids and decreased anal sphincter tone. 

What can I do to help avoid pruritus?

1. Initially, avoid the following items in the list below.  (If you have also been diagnosed with a fissure, avoidance of these items may not be as helpful in your case.)  When the problem resolves, you may add these items back one at a time, starting with that which is most important to you.  In this way, you may identify the causative agent, if it is a food product driving the problem.  There also seems to be a relationship to the quantity of these foods that a patient consumes.  Often patients can tolerate small amounts easily, but after a certain amount, the problem resurfaces:

   1. Coffee

   2. Cola

   3. Chocolate

   4. Tea (hot or iced)

   5. Citrus fruits (lemon, lime, orange, orange juice)

   6. Tomatoes

   7. Mustards

   8. Tomato sauces (pizza, etcetera)

   9. Spicy foods

   10. Milk or dairy products (possible lactose intolerance even if you have no history of that diagnosis or prior problems with milk products)

2. Try Calmoseptine ointment (over the counter).  Apply once or twice per day.

3. Keep the area dry.  Moisture contributes to the problem.

4. No use of commercial toilet paper and be careful of fancy toilet paper with perfumes in it which can be quite irritating to the anus.

5. Use witch hazel pads to wipe after bowel movements.  (Tucks is a common brand, but you may use the store brand which works just as well and costs half the price, usually.)

6. Avoid excessive scratching or cleaning of the area and don’t scrub with soaps that can harm the area.

7. Place a cotton pad in the area to help maintain dryness until the symptoms resolve.

8. Other agents that your physician may try, depending on your exam, symptoms, and medical history include doxepin, bactroban, or in some cases, for a short time interval, clobetasol.

9. Be sure to return in 4 weeks to be sure there are no other problems and that your condition has resolved.  If not, there are some serious conditions such as anal cancers that can present early with itching and may require biopsies to be sure you don’t have that problem if you are not responding to the above recommendations.

When can I stop monitoring my diet and daily living routine?

As the condition improves, gradually reduce the strict regimen described here, but remember to keep the area clean and dry and avoid damaging the skin by rubbing it or applying medication. If pruritus recurs, start the routine again until the irritation is controlled.

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What is hemorrhoid Band Ligation?

Hemorrhoid rubber-band ligation is a nearly pain-free method of removing internal hemorrhoids. Ligation means “tied off.” During the 10 minute procedure, tiny rubber bands are applied to the hemorrhoids to cut off their blood supply. Because internal hemorrhoids cause little or no pain, they can be ligated with little discomfort to the patient.  The absence of blood to the hemorrhoids will cause them to fall off in seven to 10 days. 

What should I expect after the ligation?

You may feel a dull ache or slight pressure for a day or two after treatment. This usually starts soon after the rubber bands are in place. To ease this ache, take Tylenol or Extra Strength Tylenol tablets. Avoid aspirin, aspirin-containing products, and Ibuprofen. If Tylenol does not relieve the ache, please phone our office.  

You may eat your normal diet, however we recommend that you increase your fiber intake and include a fiber supplement such as Metamucil or Citrucel. Take one teaspoon per day and drink at least six glasses of water per day to keep your stools large and soft. 

You may drive a car and perform your normal activities during the banding period. 

You may notice a small amount of bleeding when the hemorrhoids fall off. This is normal. If you experience severe bleeding, chills, or an inability to urinate (a possible sign of infection), call the office immediately. If bleeding or protrusion of the hemorrhoids persists for more than two weeks, please phone the nurse at 317-841-8090. After hours, call 317-631-3466.

We will schedule a follow-up visit with you approximately two weeks after your ligation.  It may take more than one treatment to remove all of your hemorrhoids.

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What is the Anorectal Physiology Lab?

The “Anorectal Physiology Lab” at Colon and Rectal Care was created to provide a valuable service to the patients of Indianapolis. The tests offered provide our physicians with important information regarding the function and anatomy of your anus and rectum. Each of the tests listed below typically take between 5-15 minutes each. A detailed description of each test is listed below with attention to why the test is done, how it is done and what information is obtained from each test.

Transrectal/Transanal Ultrasound
Ultrasound uses “sonic waves” to visualize anatomy. These tests are helpful in evaluating incontinence, rectal pain and rectal tumors. For anorectal and transrectal ultrasound, a rigid scope is inserted gently into the rectum. The ultrasound probe, with a deflated balloon on the end, is inserted through the scope. The balloon is then inflated and cross sectional images of the rectum are taken. This test helps to evaluate complex fistulas and rectal masses. It can help determine appropriate medical and/or surgical treatment. Transanal ultrasound also involves the placement of the ultrasound into your rectum, with a cap attached. Images of the anal muscles are taken. This test used to study rectal pain, simple anal fistulas and incontinence to determine if the muscles are intact.

Manometry
Manometry is useful in evaluation of anal incontinence, constipation, fistula, fissures, pruritis, and prolapse. It involves the placement of plastic catheter with a small balloon on the end into the anus approximately 6”. Water is instilled through the catheter and you will be asked to squeeze and push your anal muscles at various times. This test determines the pressures in your anus and rectum. Following this, we will inflate the balloon, which measures the rectal sensation. Abnormalities in sensation, pressures or physiologic reflexes can lead to incontinence, pruritis or constipation.

Surface EMG
EMG is the abbreviation for Electromyography, which measures the muscle activity of the anal canal. It is a useful examination to evaluate incontinence, constipation and rectal pain. The test involves the placement of “EKG” type leads around the anus. We then ask you to squeeze and push at different times. This test determines the strength and coordination of the pelvic muscles.

Pudendal Nerve Terminal Motor Latency
Pudendal Nerve Terminal Motor Latency (PNTML) measures the “delay” between an electrical impulse and muscle contraction. It assesses the appropriate functioning of the pudendal nerves and is useful in incontinence, constipation and prolapse. The test involves the placement of a gloved finger in the anus. On the glove is a stimulating electrode. Several electrical impulses are delivered and the nerve function is determined. On rare occasions you may feel the impulse for a few seconds, and any discomfort is very mild.

Concentric Needle EMG
Needle EMG (electromyography) is used in anal incontinence and measures the muscle activity of the external anal sphincter. More importantly, it determines abnormal nerve regeneration. It involves the placement of a “tiny” needle into the anal muscles. There is a bee sting feeling when the needle is first placed, but this quickly disappears. This test is used very selectively for those patients with complex incontinence.

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What do I need to know about Diarrhea?

Diarrhea is a common problem that everyone suffers from occasionally. Fortunately, it is usually a limited episode that resolves quickly. The word diarrhea means different things to different people. Some people who have bowel movements every three days think they have diarrhea if they begin having a bowel movement everyday whereas daily movements are normal for many others. Thus diarrhea needs to be compared to what is normal for each individual. Typically, diarrhea is thought to be loose, unformed or watery stools that come more often than normal. It is often accompanied by abdominal cramps and less warning when it is time to go.

What causes diarrhea?
The onset of diarrhea can be related to a viral illness, and usually goes away in a few days. Another common cause is irritable bowel syndrome, which is usually accompanied by constipation alternating with the diarrhea. Bacterial infections like food poisoning can also cause diarrhea, which can be accompanied by rectal bleeding. Other causes of diarrhea include inflammatory diseases of the colon such as: Ulcerative Colitis or Crohn's disease. Lactose intolerance, which makes a person unable to digest milk products, can also cause diarrhea.

I have diarrhea, what can I do?
During a short episode of diarrhea, simply drinking fluids and rest may be enough. Fluids should be limited to water, fruit juices, non-caffeinated beverages and salt containing liquids such as broth and sport drinks like Gatorade or All Sport. Avoid all caffeinated beverages. If you have a history of irritable bowel syndrome make sure to get enough fiber and water in your diet. Take medications only as directed. If the diarrhea persists, over the counter medicines such as Imodium AD should not be used without the advice of your doctor, because they can make the problem worse.

Diarrhea can cause serious problems such as: