General & Internal Medicine | OMNI Hospitals

Inside an Intensive Care Unit (ICU)

omnihospitals — Tue, 31 Mar 2020 13:24:55 +0000

Since their widespread introduction more than half a century ago, Intensive Care Units (ICUs) have become an integral part of the healthcare system. An Intensive Care Unit (ICU), also known as an Intensive Therapy Unit or Intensive Treatment Unit (ITU) or Critical Care Unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.

Intensive Care Units cater to patients with severe or life-threatening illnesses and injuries, which require constant care, close supervision from life support equipment and medication in order to ensure normal bodily functions. They are staffed by highly trained physicians, nurses and respiratory therapists who specialize in caring for critically ill patients.

Here is an excerpt from a video interview of Dr K V S Murthy, Intensivist at Omni Hospitals, Visakhapatnam on Intensive Care Units.

Q.What is an Intensive Care Unit and what is its importance?

A. An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency.

Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic.

Q.Who is an intensivist?

A. Intensivists admit patients to the Intensive Care Unit. Each patient has a critical care nurse, who manages and monitors the patient.

Q. How does an intensivist-led ICU differ from a traditional ICU?

A. Intensivists are trained to treat patients following a certain protocol and in an evidence-based way, unlike the traditional ICU where there is no set protocol that is followed.

Q. What is the golden hour?

A. Golden hour is the first hour after a serious medical event or injury during which treatment is likely to be the most effective.

Q. What is physical trauma?

A. Physical trauma refers to an injury of sudden onset and severity which requires immediate medical attention. Physical traumatic injuries are the result of a wide variety of blunt, penetrating, and burn mechanisms. They include motor vehicle collisions, sports injuries, falls, natural disasters, and a multitude of other physical injuries which can occur at home, on the street, or at work or school and require immediate care.

Q. How to treat patients experiencing physical trauma?

A. Many trauma management treatment program options are available to the average person. Given the unpredictable and almost random nature of trauma, it just isn’t possible to adopt a one-size-fits-all approach to recovery.

The first, most obvious place to begin with trauma therapies is in the immediate management of the physical effects of the trauma. Physical injuries are first stabilized and then treated in a chain of medical actions that begin in the field with effective emergency care and end with discharge to physical therapy. Obviously, the exact course followed through the recovery process will differ from one patient to the next, but, in general, the central focus will be on preventing further harm, stabilizing the patient’s present condition and moving forward with the repair of the physical damage.

Apart from any equipment or medications used in the course of this process, the techniques of physical therapy — special exercises, massage and practice at using necessary equipment such as prosthetic devices — will be employed to salvage as much of the individual’s prior quality of life as possible.

Q. During an emergency, what is the importance of anaesthesia?

A. There are different types of anaesthesia used for different types of surgery. The reason behind giving general anaesthesia is to keep the person unconscious, without pain, with no sensation or any memory about the surgery.

Patients undergoing emergency surgery have a 10-fold increased risk of adverse events compared to those having planned or elective surgery. The objective of emergency anaesthesia is to allow correction of the surgical pathology with minimum risk to the patient.

Q. Which patients require close monitoring?

A. Patients who require close monitoring are cardiac patients, neuro patients, accident victims and patients experiencing internal organ failures.

Q. What should be done before a consultation?

A. Stabilising a patient before the consultation is very important.

The outreach services of critical care medicine play a pivotal role in improving patient care inwards by providing all logistic support for early recognition of acute life threatening events and treatment interventions to stabilise sick patients who are at the risk of developing life-threatening events.

Q. What are some of the infections contracted in an ICU?

A. There are some common and widespread infections that are contracted in ICUs around the world. While preventive measures can keep them controlled, they are still around.

Ventilator-Associated Pneumonia: This disease usually occurs 48 hours after the mechanical ventilation is given to the patient. This infection has a high mortality rate and can also greatly increase the hospitalization costs.

Bloodstream Infection: Central line-associated bloodstream infection is a very serious infection in the ICU. This usually occurs when germs enter the bloodstream through the central intravenous line. Patients with this infection often have red skin and soreness around the central line. There are tests that can help doctors identify the infection.

Urinary Tract Infections (UTI): Many patients in the ICU are bedridden and because of this they need to be attached to a catheter. Among all the UTIs contracted in hospitals, 75% are catheter-related. Nearly 15-25% of patients in the hospitals receive catheters. There are protocols to ensure that the infection does not spread, but the sheer invasiveness of the device often makes them redundant.

Surgical Site Infections: Surgical site infections, unfortunately, are very common in the ICU. While this does not have a significant mortality rate, it behoves hospitals to be aware of the problem and work towards curtailing it.

Clostridium Difficile Infection: This is a bowel infection common among those that have been given long doses of antibiotics. People who have this infection can exhibit watery diarrhoea three or more times a day, mild abdominal cramping and tenderness.

Q. Can a ventilator cause brain damage?

A. No, a ventilator cannot cause brain damage.

Q. What is the difference between CCU and ICU?

ICU: ICU stands for Intensive Care Unit. The primary intention behind keeping a patient in this room is to provide constant care to those who have a relatively short term, but serious problems like organ failure. The patient and his treatment need to be constantly monitored. Patients are usually intubated for breathing and supply of food.

CCU: CCU stands for Coronary Care Unit, Cardiac Care Unit or Critical Care Unit. It is basically a specialized ICU which is said to be dealing with cardiac patients and is usually staffed by cardiologists. The CCU provides intensive care for the patient who has been admitted because of a heart attack, heart complications or for cardiac surgery. The staff in this unit are trained to care for and monitor patients with various types of heart conditions. While this could be one explanation, another explanation of the CCU is that it takes care of the patients who are comatose or terminally ill, and are not going to be there for a short period of time.

Q. How common is misdiagnosis in an ICU?

A. Not very common.

Q. What is the structure of a healthcare team in an ICU?

A. The ICU team typically comprises physicians or intensivists, clinical pharmacists, respiratory therapists, dieticians, bedside nurses, clinical psychologists, and clinicians-in-training. ICU teams are distinguished from other health care teams in that they are low in temporal stability, which can impede important team dynamics. Furthermore, ICU teams must work in physically and emotionally challenging environments.

Q. What is a step-down unit?

A. The functions of Step-down units vary, but most accommodate patients who need either cardiac monitoring or more frequent nursing attention than allowed in the general ward. Some SDUs perform the long-term mechanical ventilatory treatment and some may even manage low-dose vasoactive drug infusions.

Q. How long can a person live on a ventilator?

A. People can live for years on a ventilator.

Q. Is there a discharge from the ICU directly at OMNI Hospitals?

A. No, patients are not discharged directly from the ICU. They are first shifted to an observation ward.

Q. What are the intensive care facilities available at OMNI Hospitals, Vizag?

A. The ICU at OMNI Hospitals, Vizag is well-staffed and trained, centrally air-conditioned and meticulously checked for hygiene every single hour. There is a nurse for every two beds. The bed-to-bed spacing is plenty and comfortable for all patients. The number of beds is 25; well-equipped with advanced mechanisms and handwash systems.

The consultation and team coordination among all the departments for a critical case in OMNI hospitals are brilliant and hence makes for a seamless experience for a patient.

Weight Loss

Abdullah Saleem — Wed, 19 Feb 2020 06:40:55 +0000

Weight loss has become a major concern among the maximum folks across different parts of the world. There is a gradual increase in health awareness among most people in the current era due to the increase in health issues. Obesity has become a fundamental issue for several people as it causes many health problems like high BP, Diabetes, cardiac attacks and more. In a healthy context, weight loss is nothing but reducing the total body mass or body fat. People who are highly obese usually consider any popular weight loss method. Understand some valid points about weight loss procedures and clear all your doubts from this blog. Here is an excerpt from a video interview with Mrs. M Indira, Dietician at Omni Hospitals, Visakhapatnam on the topic ‘Weight Loss.' Get to know more about the facts and myths about weight loss and obesity. This guide gives us complete information about the procedure to lose weight through the proper diet in a healthy way.

Q. What is the cut-off BMI for considering Obesity in a person?

A. BMI is an acronym for Body Mass Index. It is actually known as the ratio between height and weight. For instance, if a person is 5 feet, he or she should maintain a specific weight. The body mass index tells this particular ratio between height and weight. If the BMI of a person is above 25 then, it is considered overweight. If the person’s BMI is above 30, it is called a medical condition i.e., obesity. Due to obesity, people may confront a lot of health complications.

Q. How many months will it take to lose 10 Kilos of weight?

A. In general, an individual may lose an average of 2 to 4 kilos of weight in a month. It is quite common and advisable for obese people to lose their weight between 2 to 4 kilos in a month but not more than that. It is not advisable for an individual to lose more than 5 kgs in a month.

Q. Explain about the Liquid diet and Weight loss diet?

A. Liquid diets have become popular these days. Following the liquid diet is definitely good provided that it gives an adequate amount of nutrients, proteins and calories to the person. A person should be careful while following a liquid diet through proper balance. The intake of liquid diets should be balanced. If you intake liquids along with the nutrients and fiber then, it becomes very helpful for the individual in the weight loss procedure.

Q. Does losing the weight begins from carbohydrates and water but not from fat?

A. No, it is not true. Mostly, people think that the initial weight loss starts with water and carbohydrates. In fact, the weight that we reduce is from the fat but not from the water and carbohydrates. Fat is actually known as the deposition of excessive calories. Every person may have a specific BMR level. BMR is an acronym for Basal Metabolic Rate. The BMR level is nothing but the energy that is necessary to perform routine tasks on a daily basis. If an individual requires only 2000 kilocalories for performing daily tasks but intaking more than 2000k.cal then, the additional calories will be deposited in the form of fat. That particular fat should be reduced from the body. This process is known as the weight loss. In the process of reducing the fat, only fewer amounts of water and carbohydrates will be diminished from the body. But, it is not completely the water and carbohydrates that we lose from the body during the weight loss procedure.

Q. Is Keto diet good for weight loss?

A. There are both positive and negative points in the Keto diet. Losing weight through keto diet matters a lot. There may be increased risks in some people following the keto diet without proper awareness. The complications may arise due to the accumulation of ketone bodies in the blood. It may eventually result in severe complications like coma and sometimes fatal. Several factors are involved in following this keto diet.

Q. Can aged people lose weight?

A. Yes, people whose age is above 70 years can lose weight. By losing weight, many other complications like Diabetes, Hypothyroidism, Cardiac problems and more will be reduced. Regardless of age, people can try losing their weight. In some cases, walking may not be possible. Such folks can reduce their weight through a limited intake of calories based on their requirement. This way, even-aged people can lose their weight.

Q. Should we avoid sugar completely to stop the weight gain? What if one has a sweet tooth?

A. Most of the people come across this problem. There are three white poisons that should be restricted. Sugar, Salt and Oil are the white poisons. For instance, if your dietary plan is within the normality then, you can intake the required amount. Consider, 60 percent of your total dietary calories should come from carbohydrates. In such a case, you can take a minimum of 5 percent of carbohydrates in the form of sugar on an occasional basis. During a social gathering, parties or family functions, you don’t have to compromise in the consumption of minimal sweets. However, it is very important in the proper selection of sweets. Instead of choosing sweets that are made using totally refined products, it is advisable to choose milk-based sweets, dal-based and other healthy sweets. This sort of sweet selection doesn’t increase the calories as it comprises high-fiber content and adequate proteins.

Q. Is it necessary to be on a very low-calorie diet or starve to lose weight?

A. No, it is not at all necessary to prefer starving all the time or following a low-calorie diet to lose weight. The BMR levels vary from one person to the other. Based on the BMR levels, if you can cut down a minimum of 500k.cal lesser than what you require, you will be able to reduce at least 2 kilos of weight monthly.

Q. Should I stop eating non-veg foods like Fish, Chicken and mutton?

A. No, there is no need to avoid eating non-veg items. In fact, oil and masalas are the major culprits while preparing non-veg dishes. Fish is the best source of Omega-3 fatty acids. Mostly, it is advised to intake fish at least 2 to 3 times a week. It will surely diminish cholesterol levels and acts as a protector against most of the harmful elements. In the case of the non-veg products such as red meat, organ meats like kidney, liver of animals, they are highly rich in cholesterol. Such items should be avoided. The intake of egg white is often advisable as they are rich in protein. The consumption of whole egg along with the yolk is only advisable to take twice a week. People who intake chicken and mutton on a daily basis should be highly conscious.

Q. What kind of diet is good for increasing energy levels?

A. A completely balanced diet is very good for enhancing energy levels. The habitual diet that you have been following right from childhood is very important. From that diet, the dietician should take the individual to a balanced diet by including all the nutrient requirements. There is no necessity to change the diet on a frequent basis. Some of the diets are regional. The diet that you follow should be suitable based on your region.

Q. Should I avoid milk, tea and coffee while following a weight loss diet?

A. There is no need to restrict skimmed milk, skimmed milk powder and others as they are a great source of protein. Curd is another beneficial probiotic product. People can definitely intake all these products. Besides these, it is advisable to intake nuts as they are rich in protein.

Q. What are antioxidants?

A. Antioxidants are the elements that protect our body from free radicals. For instance, if we intake rice then, it indicates we are taking carbohydrates. The consumption of milk indicates protein intake. The intake of oil through foods resembles we are consuming fat. When these proteins, fats and carbohydrates are hydrolyzed, they yield certain free radicals in the body. Some of the free radicals include carbon, hydrogen, oxygen and others. When these free elements move freely in the body, they may be carcinogenic.

Q. How do antioxidants help in weight loss?

A. The antioxidants usually remove the distribution of free radicals in the body. Eventually, the immunity levels in our body will be boosted up. As a result, there are lesser chances of becoming carcinogenic. This way, antioxidants help in losing weight.

Q. Is exercise necessary when we are on a diet?

A. There is a difference between exercise and diet. If you want to lose weight then, it is possible by following a certain diet. If you are willing to remain young even at the age of 80s then, it is considered fitness. Without proper fitness, even a 20 year old person may look like an old person. By doing proper exercise and maintaining fitness, an 80-year-old person may look like a young person. Fitness is all that matters. If you are highly intended to lose your weight then, the diet will help to a greater extent. The combination of diet and exercise are highly essential to losing weight in a healthy way.

Q. Is it required to stop consuming soft drinks?

A. These days, most people are intaking soft drinks on a regular basis. Usually, soft drinks are empty calories. For instance, the intake of 1 teaspoon of sugar indicates we are taking empty calories which is not good for health. In a similar way, the soft drinks are empty calories that shouldn’t be consumed on a regular basis. If you intake such soft drinks frequently, you may increase the intake of empty calories.

Q. Will cutting down junk food help us losing weight?

A. Yes, avoiding junk food will definitely help. Actually, they may not help us in losing weight. The kind of food that you choose when you go out is very important. The consumption of bakery items with trans-fat, empty calories, deep-fried items on a regular basis will surely increase your weight. So, it is advisable to cut down junk food.

Q. What is the role of a counselor in weight loss?

A. Mostly, every individual wants to lose weight. But, the counselor is the person who is capable of showing you the right path during your weight loss journey. A counselor will help you by guiding you in a better way to lose weight. If you are highly willing to lose weight, it is advisable to do it under the guidance of a professional nutritionist.

Q. Does weight loss affect the skin glow?

A. When you are following an improper weight loss diet then, it will surely affect your skin glow. It means if your diet doesn’t comprise adequate proteins, vitamins and minerals, it leads to malnutrition and shows an impact on your skin glow. Make sure that you intake enough fruits, vegetables, protein content in the form of eggs and milk. In such a case, your skin glow will be enhanced even after weight loss.

Q. Will skin become rough after weight loss?

A. In some cases, the skin becomes rough after weight loss only when your diet is deficient in vitamins and minerals. Some of the significant mineral and vitamin deficiencies will make your skin look very dry and rough. If you intake an adequate amount of proteins, minerals and vitamins during weight loss diet, you may not come across such dry skin problems. Generally, when you are on a weight loss diet, ensure that you have lessened the intake of carbohydrates like rice, meat and others. Try to intake more fruits, vegetables, nuts, fluids like curd, buttermilk and more that makes your skin glow and helps in making your skin soft rather than being dry and rough.

Q. What Calorie-free foods can be taken during weight loss?

A. Any kind of healthy salad can be taken during weight loss. One can consume salads that comprise tomato, cucumber, onions, spices like lime, cinnamon powder, groundnuts and more. All these items are very low in calories and are very filling. It is highly better to intake such salads alongside buttermilk while on a weight loss diet.

Q. What are the best snacks to eat on a diet?

A. When you are on a diet, any kind of fruit is the best snack to eat anytime. Among them, banana is slightly rich in calories. However, it is rich in potassium. So, people can eat them as the best snack at any time. Some other snacks with low calories include salads, fruits, buttermilk, nuts, milk and more. If you are feeling hungry, you can consume the aforementioned things. The millets are rich in fiber. Millets can be taken in the form of fluids that are very much filling.

Q. Is fasting helpful in weight loss?

A. In specific regions, fasting is not a problem. Some of them do fasting the whole day just by intaking fluids like fruits, tea, milk and other items made using milk. In the evening i.e., after or before sunset, they can consume light food with a lesser amount of calories. This kind of fasting is good for health. If you don’t eat anything in a day and fill the stomach completely before sleep, it is not a good type of fasting.

Q. What kind of exercise is best for weight loss?

A. There are different types of exercises that help reduce weight. Some of them include jogging, going to the gym, playing sports, swimming, cycling and more. However, it depends on the person's interest. Some of them love cycling and they get immense enjoyment while doing the same. In some people, swimming is the best exercise to shed their weight. Any kind of aerobic exercise will help reduce weight. Instead of doing exercise in closed spaces, it is preferable to perform exercises in an open atmosphere where you get a lot of oxygen to your body. One must choose the best exercise that suits their body. Ensure that you get a lot of oxygen and natural air while doing your preferred exercise.

Q. Is intermittent fasting good for weight loss?

A. Intermittent fasting is good i.e., for about 16 to 24 hours. But, if you do it regularly, it may strain your body which is not a proper way to lose weight.

Q. Is OMAD good for weight loss?

A. OMAD is known as one meal a day. It provides carbohydrates to the body during one particular meal. It is advisable to fill the stomach with some light food [like one glass of milk, a handful of nuts, salad or a fruit] every 2 hours. For instance, you intake one meal in the afternoon. In such a case, you are not supposed to take more simple carbohydrates in the morning and evening. However, you can prefer eating complex carbohydrates such as fruits, vegetables and more.

Q. What is the importance of protein diet?

A. Usually, women still remain active even after performing all the household chores on a daily basis. They eat less amount of food. To reduce their weight, most women cut down their food consumption. Protein is the most important factor. If there is a protein deficiency, it doesn’t lead to weight loss. So, it is necessary to reduce the intake of calories to some extent and increase the intake of protein alongside vitamins and minerals.

Q. Do late-night dinner increase weight?

A. There are some people who work in night shifts. Such people usually eat late at night. Otherwise, people shouldn’t prefer eating late-night. Irrespective of the reason, the people working in the night shift should try to take food in the form of fluids. Such foods include porridges that comprise a lot of fluid, fiber and low carbohydrates.

Q. How does water retention increase weight?

A. It is also related to protein deficiency. When there is a protein deficiency, it leads to fluid accumulation. If you take a routine intake of protein of about 10 percent, it causes protein deficiency. But, if you increase the protein level to more than 15 percent, the fluid accumulation and fat content will eventually reduce. In general, 20 percent of protein intake is ideal. In case, if you are unable to intake that amount then, a minimum of 15 percent should be consumed through the diet.

Q. Is BMI a proper indicator of good weight?

A. BMI helps us in finding out whether a person is weighing according to the height or not. However, there are some other parameters alongside BMI. It includes serum albumin levels. It helps us in finding whether you are properly nourished or not.

Q. What kind of diet is advisable for women with PCOS?

A. In most of the conditions, the intake of protein should be high and the intake of carbohydrates should be less. In the case of PCOD and hypothyroidism, the carbohydrate percent should be cut down. A dietician will be able to help women with PCOS to understand about the intake of carbohydrates percent. Every individual should intake a minimal percent of carbohydrates through food. So, it is always advisable to follow the diet under the guidance of a dietician in the case of women with PCOS.

Q. Is the type of calories or number of calories important?

A. Both of them are important in the case of any individual. For instance, your BMR level is 2000k.cal and you intake 2500k.cal on a daily basis. The additional calories that are not necessary to the body will be converted into the fat and deposited in the Adipose tissue. On the other hand, the type of calories include carbohydrates, fats, proteins and others. The intake of the calories’ type depends on how much extent you take them through the food. So, considering the number of calories and the type of calories is very important.

Q. What is the ideal way to detox the body?

A. Drinking lots of fluids especially water is the best way to detox the body. The intake of water, amount of nuts, fruits, fiber and consumption of vegetables matter a lot in detoxifying the body. Even, sleeping for an adequate amount of time during the night is also essential to detox the body.

Q. Is drinking more water dangerous?

A. Drinking 3 to 4 liters of water on a daily basis is ideal. But, some people drink more than 5 to 6 liters that may create a heavy load on the kidneys.

Q. Are there any risks to overweight women before pregnancy?

A. When the woman has increased body weight, the birth weight of the baby may be high i.e., more than 5 kgs. It is a risk for both the baby and mother during pregnancy. In such a case, the mother may prone to Diabetes Mellitus. On the other hand, the baby may be prone to early Diabetes. So, when you are planning to have a baby, it is advisable to check your BMI and proceed further.

Q. What is the healthy weight?

A. The healthy weight depends on various factors such as the fat percentage, muscle percentage, circumference of the mid-upper arm, BMI [body mass index], BMR levels. When all these parameters are well-balanced, you are said to have a healthy weight. If you are trying to lose weight, you need to look into all the aforementioned parameters. Only then, you can prefer the best weight loss program. Dr M. Indira Clinical Dietician OMNI Hospital, Vizag

Piles, Fistula and Fissures – Symptoms and Treatment Methods

Abdullah Saleem — Wed, 08 Jan 2020 10:16:04 +0000

Piles are one of the most common problems that are usually witnessed in any person. Besides Piles, some of them face severe problems with Fistula and Fissures. Mostly, people with piles fistula and fissures often visit the Surgical Department to get the treatment.

Another term for Piles is Haemorrhoids. Piles are the enlarged veins in the anal canal comprising blood vessels, elastic fibers and tissues. They get enlarged causing severe bleeding and pain to the person. Hemorrhoids are actually painful as they come out of the anal canal.

Here is an excerpt from a video interview with Dr. Raja Prasad, Surgical Gastroenterologist, Omni Hospitals, Kukatpally on Piles, Fistula and Fissures, its causes, symptoms and various treatment options.

Q. What are Piles?

A. Piles are enlarged veins that form in a range of sizes. Piles can either form internal or external. They usually come out of the anal area due to the swollen tissues. This is a very common problem that can happen to any person.

Q. What are the Causes of Piles or Haemorrhoids?

A. Piles are actually caused due to constipation and hard stools. The increased pressure in the lower rectum causes piles in some people. If the patient has constipation and hard stools, they might suffer from Piles. The major cause of Haemorrhoids is pressure on the veins. The other common causes of Haemorrhoids or Piles include:

Constipation
Obesity
Smoking Habits - Lots of Tobacco Usage

Q. What are the Symptoms of Piles?

A. Mostly, the symptoms of piles are not very complicated. Piles can be resolved on their own after some days. However, check some of the symptoms that an individual with piles usually experience.

A person with piles may experience pain while passing a stool.
Bleeding because of Piles is actually painless.
After passing a stool, they may witness a few drops of blood.
Some will notice blood after a bowel movement due to the enlarged piles

People visit a doctor for a medical opinion only when they notice heavy bleeding after passing a stool or painful piles.

Q. What are the types of Piles?

A. There are 4 grades of Piles.

Grade I: At this level, piles may not be visible as they are inside the anus lining.

Grade II: In this grade, the piles are larger and may come out while passing a stool. This grade piles also cause bleeding and the person might notice the blood stuck to the undergarments.

Grade III: In this grade, the patient might experience external hemorrhoids. When the pile mass in the anal canal comes out of the area and forms swelling then, they are called external Haemorrhoids. These piles are mostly symptomless. They can be noticed only when there is a blood clot or when they are swollen in the Haemorrhoid.

Grade IV: This grade of piles shouldn't be overlooked. They definitely require treatment as they are large and pops out of the anal canal. The swollen piles also remain outside of the anus for a long time.

People suffering from Grade III or Grade IV Piles require surgical treatment. However, even in these grades, there is a possibility to treat them through medical management. With medicine, the patients will be free from the pain for a certain period. In the meantime, they can decide about surgical options. In the first two grades of piles, they can be treated with appropriate medicine.

Q. How to Treat Grade I and Grade II Piles?

A. In general, the treatment methods actually depend on the grade of Piles that the person has. To some extent, piles can be treated with medicines depending on the severity of the symptoms. In case, if the symptoms are severe in the patient, they can be treated through surgical methods.

Banding: For the people with grade I and grade II piles, banding is one of the major treatments. The doctor places an elastic band around the base of the pile. As a result, they restrict blood flow. The Haemorrhoid will fall off after some days of treatment. This treatment is helpful for the people with Grade I and Grade II piles.

Sclerotherapy: It is a procedure in which a medicine is injected into the blood vessels to make the hemorrhoid shrink and collapse as the time passes. It is an effective treatment for grade I, II and grade III piles. This eventually causes less bleeding from the piles.

Q. What are the Surgical Options for Grade III and Grade IV Piles?

A. If the piles are Grade III or Grade IV, they definitely require surgical management. The surgical options include Open Haemorrhoidectomy, Stapled Haemorrhoidopexy or True Laser. These are the most common surgical procedures for treating Grade III or Grade IV Haemorrhoids. Some other procedures include Photocoagulation, Argon Plasma and Infrared Coagulation. But, these three are less commonly used surgical procedures.

Stapled Haemorrhoidopexy: It is a surgical procedure that removes the enlarged haemorrhoidal tissue. This procedure has lesser pain compared to the open Haemorrhoidectomy procedure. Moreover, patients who underwent stapled Haemorrhoidopexy procedure will recover faster and lesser pain compared to other surgical procedures.

In the current era, the stapled Haemorrhoidopexy has become a great standard for those who are suffering from Grade III and Grade IV Haemorrhoids. The patients with this grade of piles even have external piles and prolapsed piles. So, this surgical procedure helps in the removal and treatment of all sorts of external and prolapsed Haemorrhoids.

Laser Haemorrhoid Procedure: Instead of insertion and cutting of the mucosa, this procedure uses laser beads for coagulating the Haemorrhoidal tissue. The main benefit of the laser procedure is that it gives lesser pain compared to stapled Haemorrhoidopexy. The patients will recover soon and can get back to their work as early as possible if they undergo laser surgical treatment. The major problem with this procedure is the difficulty in controlling the bleeding problem. The second major problem with laser treatment is the higher cost.

Q. What is Fistula-in-ano?

A. Fistula is actually a tunnel that provides a connection between two cavities or two openings. Fistula-in-ano is sometimes referred to as an Anal Fistula. It is an abnormal connection or a channel between the anal canal and the external skin or perianal skin. Fistula can be treated only through surgical methods and there is no other option for it.

Q. What Causes Fistula?

A. Fistula causes after a patient have perianal abscess or accumulation of pus near the perianal area which leads to rupture of the pus. In some people, it might cause due to the surgical interruption when insertion and drainage are performed. The fistula will be formed and the wound doesn’t heal for several days. The anal canal has a muscle namely external sphincter muscle allows us to voluntarily control our bowel movements. Whenever Fistula connections happen between the perianal area and anal canal, the tract passes through this canal.

If we cut this sphincter then, it turns out to become a problem. As a result of cutting the sphincter, there won’t be any control over the bowel movement. So, patients with Fistula must be evaluated accurately. Before treating the Fistula, the doctors must identify the type of fistula and symptoms through various procedures. Some of them include transrectal ultrasound or MRI Pelvis. With the help of these procedures, it is possible to find out how a tract is going.

Q. Is there a risk of Recurrence in Fistula-in-ano?

A. The recurrence risk of Fistula surgery and the results will depend on the type of a fistula. If it is a simple fistula then, the recurrence risk is very less. But, in the case of complex fistula, the chances of recurrence are very high. The treatment for fistula must be done in a proper way with utmost care in order to prevent the recurrence of fistula. If open surgical procedures are done then, the Haemorrhoids can recur. If we perform Stapled Haemorrhoidopexy surgery, the chances of recurrence are quite less.

Q. What is the surgery for Fistula-in-ano?

A. VAAFT is a popular surgery for treating Anal Fistula. The full form of VAAFT is Video-Assisted Anal Fistula. This surgery is quite similar to laser surgery. During this surgery, the surgeon can view inside the anal fistula tract alongside the internal and external opening and perform coagulation.

Q. What is the Diet to Follow?

A. People must follow a diet that includes high-fiber food such as vegetables and fruits. By the intake of high-fiber food, it prevents constipation problems. As long as constipation and hard stools are prevented, the chances of developing piles or Haemorrhoids can be reduced.

Q. What is a Fissure-in-ano or Anal Fissure?

A. Fissure-in-ano is a simple tear or break caused in the skin near the anal canal. This is also caused due to constipation and hard stool. As a result of the overstretching of anal canal skin, it leads to a skin tear in that region. The skin around the anal canal is very sensitive. Whenever the person with Fissure-in-ano tries to pass the stool, he or she will experience severe pain associated with bleeding. The reason is the skin tends to be teary causing pain to the patient.

Q. What is the Treatment for Fissure-in-ano?

A. Fissure-in-ano is an acute problem for patients suffering from it. Mostly, 50 to 60 percent of people can cure this problem with proper medication. It is also required to take care of the region with simple conservative management. By applying the topical gel, it can soothe the pain and relax the sphincter. This particular treatment is advised to the patients who have fewer symptoms.

In case, if the patient has critical symptoms like severe pain then, they are advised to go for a surgical option. The name of this surgery to treat Fissure-in-ano is Sphincterotomy. In this surgery, the surgeon will cut the internal sphincter and relaxes the anal opening.

Q. How to Get Rid of Fistula or Piles without Surgery?

A. If it is Grade I or Grade II of piles then, it is possible to resolve or recover on its own through proper high-fiber diet with lots of liquids. Make sure that you don't strain much while passing stools. Piles of Haemorrhoids require surgery only if they are bleeding and painful or if they become external Haemorrhoids.

The Grade I and Grade II piles don't need any surgery if they are asymptomatic. But, for Fistula, there is no other medication possible for treating it. People with Fistula must and should undergo surgical treatment as there is no medical management for it.

Another main thing to be mentioned to get rid of Piles, Fistula and Fissures are to follow some proper hygiene while passing stool. Some of them prefer carrying newspapers and mobile phones to washrooms. They sit for a long time and places immense pressure during the bowel movement.

It eventually results in placing immense pressure in the perianal region. Due to such strain, it gives some pain and bleeding near the area. This straining eventually pushes more blood into the Haemorrhoidal veins and results in the enlargement of piles. One must prevent constipation and avoid sitting a long time in washrooms to get rid of Fistula and Piles. The initial sign or symptom of a Fistula is perianal abscess [pus formation].

Q. Is there a recurrence chance of Fissure?

A. Yes, if the patient develops constipation even after curing a Fissure initially, there are recurrence chances of the fissure. They might once again get a tear in the skin near the anal canal and develops a fissure. So, these are some of the vital things that one must remember to avoid constipation and straining at stools.

Q. How to overcome Pain Management in Fistula?

A. People with Fistula might confront a lot of pain when there is a pus formation. Otherwise, there will be just a small amount of pus that can be seen in the patients. By taking painkillers, it is possible to reduce the pain of Fistula in a couple of days. After undergoing Fistula surgery, patients can be treated based on the type of Fistula i.e., low fistula or high fistula. If the wound is large near the perianal region, they might have pain. That pain can be reduced within 2 to 3 weeks. It is not actually possible to overcome Fistula pain all on its own after undergoing surgery. You definitely require medical attention post-surgery.

Q. What tests are done before Fistula or Piles surgery?

A. Before heading to Fistula or Piles surgery, the surgeon will perform Sigmoidoscopy or Colonoscopy tests. This test is performed by placing a camera to view the large intestine. To examine the descending colon and sigmoid colon, these two tests are done. In some cases, Haemorrhoids or piles can be the initial sign of some malignancy like cancer or some ulcerative conditions in the colon.

Dr Raja Prasad

Sr. consultant - Dept. of minimal access and Surgical Gastroenterology

OMNI Hospital, Kukatpally

General Medicine

Fri, 24 Feb 2017 07:40:52 +0000

The department of internal medicine at Omni Hospitals has the best team of top General surgeons and physicians in Hyderabad with vast experience in treating all branches of internal medicine and offer non-surgical primary healthcare services in areas of respiratory diseases, endocrinology, thyroid issues, infections, sudden changes in weight (weight gain or weight loss), and neurology, etc. Our team is well-equipped with knowledge of advanced science and interdisciplinary diagnosis to cater to the needs of out-patient and in-patient services, and emergency care for patients with communicable and non-communicable diseases.

Facilities and Diagnosis

The outpatient department at Omni Hospitals has a team of best General Surgeons and Physicians in Hyderabad who offer preventative and curative healthcare services with specialized medical care.
We offer comprehensive treatment for multisystem problems and undifferentiated infections by employing stringent safety measures and evidence-based approach.
24×7 availability of doctors
Same-day appointments
A network of quality specialists under one roof

The Department of General Medicine at OMNI Hospitals provides primary and secondary medical care for patients above 16 years of age. Our General Surgeons in Hyderabad follow a comprehensive approach to preventive health care with an emphasis on the sustenance of good health achieved through regular physical examinations and screening tests. Our qualified doctors provide initial diagnosis and evaluations for any acute or chronic problems, apart from managing and coordinating all your medical care needs.

Sub Specialities

Allergy
Asthma
Pyrexia
Diarrhoea
Dehydration
Upper respiratory tract infections
Diabetes mellitus
Dengue fever
General weakness
Hypertension

Treatments:

Treatment and management of hypertension
Treatment & management of diabetes
Treatment for high cholesterol
Septic shock
Pesticide poisoning
Drug poisoning
Occupational health assessments
Preoperative assessment and care

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