Anal fissure

                                                Anal fissure 

     An anal fissure is a small tear in the thin, moist tissue mucosa that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. A small tear in the lining of the anus. 

   The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times the fissure can be deep enough to expose the muscle tissue underneath. An anal fissure usually isn't a serious condition. It can affect people of all ages, and it's often seen in infants and young children since constipation is a common problem in these are groups. 

      In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it's considered chronic. 

Symptoms of fissure: 

- A visible tear in the skin around your anus. 

- A skin tag, or small lump of skin, next to the tear

- Pain, sometimes severe, during bowel movements

- Sharp pain in the anal area during bowel movements

- Streaks of blood on stools or on toilet paper after wiping

- Burning or itching in the anal area

- Pain after bowel movements that can last up to several hours

- Bright red blood on the stool or toilet paper after a bowel movement

- A visible crack in the skin around the anus.

Causes:

 Anal fissure most often occurs when passing or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anas. Some other common causes include: 

- Straining during childbirth or bowel movements

- Inflammatory bowel disease (IBD), such as Crohn's disease 

- Decreased blood flow to the anorectal area

- Overly tight or spastic anal sphincter muscles 

Some rare causes: 

- Anal cancer 

- HIV

- Tuberculosis

- Syphilis

- Herpes 

Risk factors:

- Constipation: Straining during bowel movements and passing hard stools increase the risk of tearing. 

- Childbirth: Anal fissures are common in women after they give birth. 

- Age: Anal fissures can occur at any age, but are more common in infants and middle-aged adults. 

- Crohn's disease: This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. 

Diagnosis:

 Medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible, usually, this exam is all that's needed to diagnose an anal fissure. 

 An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear and may have internal or external fleshy growths. 

- Anoscopy: An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus. 

- Flexible sigmoidoscopy: The doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. 

- Colonoscopy: The doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than 50 or you have risk factors for colon cancer, signs, of other conditions, or other symptoms such as abdominal pain or diarrhea. 

Complications:

- Failure to heal: An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment. 

- Recurrence: Once you've experienced an anal fissure, you are prone to having another one. 

- A tear that extends to surrounding muscles: An anal fissure may extend into the ring of muscles that holds your anus closed (internal and sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. 

Prevention: 

 Prevent anal fissure by taking measures to prevent constipation or diarrhea. Eat high fiber foods, drink fluids, and exercise regularly from having to strain during bowel movements. 

- Keeping the anal area dry

- Cleansing the anal area gently with mild soap and warm water

- Treating diarrhea immediately 

- Changing the infant's diapers frequently 

Lifestyle and home remedies: 

Lifestyle changes may help relieve discomfort and promote healing of anal fissure, as well as prevent recurrences.

- Add fiber to diet: Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts, and whole grains. You also can take a fiber supplement, Adding fiber may cause gas and bloating, so increase your intake gradually. 

- Drink adequate fluids: Fluids help prevent constipation. 

- Avoid straining during bowel movements: Straining creates pressure, which can open a healing tear or cause a new tear. 

- If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently, and discuss the problem with your child's doctor. 

If your stomach's been bothering you, our free guide can help you talk with your doctor to get the treatment you need. 

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Blepharospasm (an abnormal contraction of the eyelid muscles)

                                                                      Blepharospasm

        (an abnormal contraction of the eyelid muscles)

     Blepharospasm is an abnormal contraction of the eyelids muscles. It often refers to benign essential blepharospasm(BEB) which is a bilateral condition and a form of focal dystonia leading to episodic closure of the eyelids. The exact cause of blepharospasm is unknown and, by definition, it is not associated with another disease entity or syndrome. 

   Symptoms usually begin as mild and infrequent spasm that progress over time to forceful and frequent contractures of the eyelids. In advanced cases causing functional blindness form inability to temporarily open the eyes. It often refers to benign essential blepharospasm which is a bilateral condition and a form of focal dystonia leading to episodic closure of the eyelids.

Pathophysiology: 

 The mechanism underlying benign essential blepharospasm is not clear. Basal ganglia dysfunction, overactivity of the seventh nerve leading to simultaneous forceful contractions of the eyelid protractors and retractors, ion channelopathy, and sensitization of the trigeminal system by photophobia are some of the proposed mechanisms. 

Causes: 

Stress: Is the body's reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. Stress is a normal part of life. You can experience stress from your environment, your body, and your thoughts. 

Fatigue: Term used to describe an overall feeling of tiredness or lack of energy. It isn't the same as simply feeling drowsy or sleepy. When you're fatigued, you have no motivation and no energy. Being sleepy may be a symptom of fatigue. 

Dry eyes: Common conditions that occur when your tears aren't able to provide adequate lubrication for your eyes. Tears can be inadequate for many reasons. 

Eye strain: This occurs when your eyes get tired from intense use, such as driving a car for extended periods, reading, or working at the computer. If you have any eye discomfort caused by looking at something for a long time, you can call it eye strain. 

Pink eye(conjunctivitis): This is an inflammation or infection of the transparent membrane that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the whites of your eyes to appear reddish or pink. 

Common causes:

 Eye twitching can have causes that aren't due to underlying disease. Examples include muscle twitches, fatigue, sleep deprivation prolonged screen time. 

Others risk factors:

 Variable risk factors for blepharospasm have been reported: 

- Head or facial trauma

- Family history of dystonia or tremor

- Reflex blepharospasm is reportedly triggered by several dry eyes and blepharitis, intraocular inflammation, meningeal irritation, light sensitivity. 

- Stress may exacerbate benign essential blepharospasm

- Medications, such as those used to treat Parkinson's biases have been associated with blepharospasm. 

Signs and symptoms: 

  - A gradual increase in blinking or eye irritation

- Fatigue

- Emotional tension

- Sensitive to bright light

- Facial spasms

- Blurred vision

- Headache 

Diagnosis:

 - Diagnosis of benign essential blepharospasm in clinically and it is a diagnosis of exclusion, having ruled out the presence of associated conditions. The diagnosis of blepharospasm is clinical and is made by careful history taking and physical exam. 

Complication:

 - Complications associated with

- Bruising

- Blepharoptosis

- ectropion

- Epiphora, diplopia

- Lagophthalmos and corneal exposure

Prognosis:

 90% improve symptomatically with injections, although continued injections are necessary. Patients with apraxia opening often do not respond as well to injections. 

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Leiomyoma (FIBROIDS)

                                       Leiomyoma (FIBROIDS)

     A Leiomyoma also has known as fibroids, is a benign smooth muscle tumor that very rarely becomes cancer. They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus. Polycythemia may occur due to increased erythropoietin production as part of a paraneoplastic syndrome. 

     Non-cancerous growths in the uterus that can develop during a woman's childbearing years. The cause of fibroids isn't well understood. Risk factors include a family history of fibroids, obesity, or early onset of puberty. Symptoms include heavy menstrual bleeding, prolonged periods, and pelvic pain. In some cases, there are no symptoms. Treatment includes medication and removal of the fibroid. 

More than 1 million cases per year in India. 

Symptoms: 

 Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size, and the number of fibroids. 

In women who have symptoms, the most common signs and symptoms of uterine fibroids include: 

- Heavy menstrual bleeding

- Menstrual periods lasting more than a week

- Pelvic pressure or pain

- Frequent urination

- Difficulty emptying the bladder

- Constipation

- Backache or leg pains

fibroid can cause acute pain when it outgrows its blood supply. 

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. 

Uterine fibroids are leiomyomata of the uterine smooth muscle. As other leiomyomata, they are benign, but may lead to excessive menstrual bleeding (menorrhagia), often cause anemia and may lead to infertility. 

A rare form of these tumors is uterine lipoleiomyoma- benign tumors consisting of a mixture of adipocytes and smooth muscle cells. Uterine lipoleiomyoma has been observed together with ovarian and other pathologies and some of them may develop into liposarcoma.  

These tumors are monoclonal, and non-random chromosomal abnormalities have been seen in 40% of the tumors. 

See your doctor if you have:

- Pelvic pain that doesn't go away

- Overly heavy, prolonged or painful periods

- Spotting or bleeding between periods 

- Difficulty emptying your bladder

- Unexplained low red blood cell count 

Seek prompt medical care of you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly. 

Causes:

 Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors: 

Genetic changes: Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.

Hormones: Estrogen and progesterone, two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. 

Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production. 

- Other growth factors: Substance that helps the body maintain tissues, such as insulin-like growth factors, may affect fibroid growth. 

- Extracellular matrix(ECM): ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and cause biologic changes in the cells themselves. 

   Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary- they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to normal size. 

Complications: 

 Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anemia). which causes fatigue, from heavy blood loss.

Pregnancy and fibroids: 

 Fibroids usually don't interfere with getting pregnant. However, it's possible that fibroids, especially submucosal fibroids- could cause infertility or pregnancy loss.  

 Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction, and preterm delivery.

Prevention: 

 Although researchers continue to study the causes of fibroids tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment. But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.

Diagnosis: 

 Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids.  

- Ultrasound: If confirmation is needed, your doctor may order an ultrasound. 

- Lab- tests: If you have abnormal menstrual bleeding. These might include a complete blood count (CBC). 

- Magnetic resonance imaging(MRI)

- Hysterosonography

- Hysterosalpingography 

- Hysteroscopy

Surgical procedures: 

- Abdominal myomectomy: multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdomeinal sutgical procedure to remove the fibroids. 

- Hysterectomy: Surgery, the removal of the uterus- remains the only proven permanent solustion for uterine fibroids, but hysterectomy is major surgery. 

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        Hemorrhoids (piles) बवासीर के लक्षण

Lifestyle disease

https://www.youtube.com/watch?v=tzIIa2kRnL8&t=739s

Lifestyle disease due to lack of exercise or sedentary lifestyle some disease is now very common

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Kleptomania: urge to steal

                                                                      Kleptomania

     Kleptomania is the inability to resist the urge to steal items that you generally don't really need and that usually has little value. Kleptomania is a rare but serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated. 

  Frist described in 1816, is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that Kleptomania could be an Obsessive-compulsive spectrum disorder, but also share similarities with addictive and mood disorders. 

  The disorders id frequently under-diagnosed and are regularly associated with other psychiatric disorders, anxiety, and eating disorders, and alcohol and substance abuse. Patients with Kleptomania are typically treated with therapies in other areas due to the comorbid grievances rather than issues directly related to Kleptomania. 

  An impulse control disorder that results in an irresistible urge to steal. The cause of Kleptomania remains unknown but risk factors include a family history of kleptomania or other impulsive control disorders. It occurs more often in women. Kleptomania is a serious disorder that causes an irresistible urge to steal items. Consequences can include job loss, financial penalties, and trouble with the police. No cure exists, but treatment with talk therapy and medication such as antidepressants may help end the cycle of compulsive stealing. 

 Kleptomania is typically diagnosed by a physician or mental health professional. Because kleptomania commonly co-occurs with other conditions such as eating disorders, substance and alcohol abuse, and anxiety disorders, it is often diagnosed when people are referred to a doctor for their comorbid psychiatric symptoms. 

 Kleptomania or compulsive stealing is a common cause of theft that many forget about. This type of stealing is about a psychological compulsive instead of a desire to profit or gain something material or financial, as defined by the diagnostic and statistical manual of mental disorders. 

 Kleptomania is frequently thought of as being a part of OCD. Irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary, and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with Obsessive-compulsive disorder. 

 Kleptomania is a type of impulsive control disorder- a disorder that's characterized by problems with emotional or behavioral self-control. If you have an impulse control disorder, you have difficulty resisting the temptation or drive to perform an act that's excessive or harmful to you or someone else. Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or talk therapy may help to end the cycle of compulsive stealing.  

Symptoms: 

Kleptomania symptoms may include: 

- Inability to resist powerful urges to steal items that you don't need

- Feeling increased tension, anxiety or arousal leading up to the theft

- Feeling pleasure, relief or gratification while stealing

- Feeling terrible guilt, remorse, self-loathing, shame or fear of arrest after the theft

- Return of the urges and a repetition of the kleptomania cycle

Features: 

Kleptomania typically exhibits these features or characteristics: 

- Unlike typical shoplifters, people with kleptomania don't compulsively steal for personal gain, on a date, for revenge or out of rebellion. They steal simply because the urge is so powerful that can't resist it. 

- Episodes of kleptomania generally occur spontaneously, usually without planning and without the help of collaboration from another person.

- Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party. 

- Often, the stolen item has no value to the person with kleptomania and the person can afford to buy them. 

- The stolen items are usually stashed away, never to be used. Items may also be donated, give away to family or friends, or even secretly returned to the place from which they were stolen. 

Diagnosis: 

 When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical evaluation can determine if there may be any medical causes triggering your symptoms. 

Kleptomania is diagnosed based on your signs and symptoms. Because it's a type of impulse control disorder, to help pinpoint a diagnosis 

- Questions about your impulses and how they make you feel. 

- List of situations to ask if these situations trigger tour kleptomania episodes

- Fill out psychological questionnaires or self- assessments. 

- Use the criteria in the diagnostic and statistical of mental disorders(DSM-5), published by the American Psychiatric Association.  

Causes:

 The causes of kleptomania are not known. Several theories suggest that changes in the brain may be at the root of kleptomania. More research is needed t better understand these possible causes, but kleptomania may be linked to: 

- Problems with naturally occurring brain chemicals called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors. 

- Addictive disorders: Stealing may cause the release of dopamine. Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again. 

- The brain's opioid system: Urges are regulated by the brain's opioid system. An imbalance in this system could make it harder to resist urges. 

Risk factors: 

Kleptomania is considered uncommon. However, some people with kleptomania may never seek treatment, or they're simply hailed after repeated thefts, so some cases of kleptomania may never be diagnosed. Kleptomania often beings during the teen years or in young adulthood, but can start in adulthood or later.

- Family history: having a first- degree relative, such as a parent or sibling, with kleptomania, obsessive-compulsive disorder, or an alcohol or other substance use disorder may increase the risk of kleptomania. 

- Having another mental illness: People with kleptomania often have another mental illness, such as bipolar disorder, anxiety disorder, an eating disorder, substance use disorder, or a personality disorder. 

Complications: 

- Left untreated, Kleptomania can result in emotional, family work, legal, and financial problems. For example, you know stealing is wrong but you feel powerless to resist the impulse, so you may be wracked by guilt, self-loathing, and humiliation. Arrested for stealing. 

Other complications: 

- Other impulsive control disorders, such as compulsive gambling or shopping

- Alcohol and substance misuse

- Personality disorders

- Depression

- Anxiety

- Eating disorders

- Bipolar disorder 

- Suicidal thoughts, suicide attempts, and suicide. 

Psychotherapy:

 Form psychotherapy called cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive-behavioral therapy may include these techniques to help you control kleptomania urges: 

- Covert sensitization: in which you picture yourself stealing and facing negative consequences, such as being caught. 

- Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable when you get an urge to steal. 

- Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal. 

Avoiding relapses: 

 It's not unusual to have relapses of Kleptomania. To help avoid replaces, be sure to stick to your treatment plan. If you feel urges to steal, contact your mental health professional, or reach out to a trusted person or support group. 

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