Flatulence and Bloating Holistic Treatment

Ultimate Flatulence Cure

This guide written by Joseph Arnold now promises to put right peoples problems with flatulence by looking at the problem in an holistic way. Ultimate Flatulence Guide is a program which looks at why people have flatulence, what causes can be avoided and what changes you can make to suddenly see life in a whole new way. In the program, people will discover a list of foods they must avoid in the flatulence treatment process. Besides, the program reveals to users ways to lose weight, and ways to reduce some skin problems. The program is designed to be suitable for those who want to eliminate their flatulence without any medication. Purchasing the program, individuals will get a lot of coaching publications like the Flatulence Cure book, the Natural Organic Remedies And Remedies reserve, the Detoxify Your Body How To Detoxification Fast And Simple Way At Home book, the How To Manage Irritable Intestinal Syndrome reserve, as well as the Acid Reflux Remedies reserve. Read more...

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100% Natural Cure to Flatulence and Stomach Aches. Did you know that Gas Pain is more likely caused by an underlying and even bigger problem? Dear Gas Pain Sufferer, If you're like most people, then you might not think of flatulence as a major problem. Perhaps you even get rid of one by popping a pill. But did you know that even Laxatives, which are known to be the most commonly known cure to flatulence can even worsen the problem? Finally, an all-natural alternative to cure Flatulence is here! This guide will help you cure the causes of not just flatulence but also other problems like: stomach ache abdominal pains indigestion diarrhea

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Acidbase Disorder Common Causes

Splinting, chest burns, tight chest or abdominal dressings) Abdominal distension obesity, ascites, bowel obstruction Disorders of respiratory muscles severe hypokalemia, Amyotrophic lateral sclerosis, Guillain-Barr syndrome, poliomyelitis, myasthenia gravis, drugs (curare, succinylcholine)

Problems with Measurement

While faecal incontinence is commonly defined as a loss of voluntary control of the passage of liquid or stool, it is usual for clinicians to use this term to include incontinence of flatus. The term anal incontinence has also been used to include the uncontrolled passage of flatus and liquid or solid stool. These two definitions can therefore be confusing, and we recommend the continued use of the term faecal incontinence to include the incontinence of flatus as part of a continuum. Some qualification of these definitions with regard to quantity, frequency and impact on quality of life is also required in any assessment of prevalence or incidence rate, particularly if such an assessment is to be useful for planning to meet a community need for assessment and treatment services. Rather than a single disease, faecal incontinence represents a clinical spectrum with diverse manifestations that are closely related to its varied aetiology. This makes classification...

Congenital Risk Factors Anorectal Anomalies

Anorectal anomalies affect 1 3-5,000 newborn babies 11 , most frequently associated with rectourethral fistula in boys and rectovestibular fistula in girls, but which range from low (covered anus) to complex malformations, including persistent cloaca in girls, associated with varying degrees of sacral dysgenesis 12 . The more complex the malformation, the more poorly developed are the levators and external sphincter. Irrespective of adequacy of surgical treatment in terms of anatomical correction, all those born with anorectal anomalies have an abnormal continence mechanism, which in addition to underdeveloped striated musculature includes loss of anal canal sensitivity (and thus faecal continence) and disturbed hindgut motility resulting in a dilated rectum and overflow incontinence 13-15 . Thus, up to 30 of all those born with low defects suffer faecal incontinence, constipation and inability to control flatus, and up to 85 of those with high malformations report social disability...

Sphincteric Risk Factors Obstetric Events

Flatus P primiparous, M multiparous aParity not known in 121 cases bIncludes flatus and faecal incontinence cBreech presentation P primiparous, M multiparous aParity not known in 121 cases bIncludes flatus and faecal incontinence cBreech presentation will be restricted to urgency of defecation or minor incontinence (i.e. flatus or soiling), approximately 1.5-3 of women 1, 2, 4, 5, 97-108 will suffer major or frank stool incontinence. Prevalence rates as high as 10 for major incontinence have been reported by Donnelly et al. 100 , although the continence status of patients prior to delivery was not described in this study, and this therefore likely represents an overestimate with regard to new-onset symptoms. However, given that the prevalence of major faecal incontinence in the community as a whole has been reported as 2-4.3 41, 42 , these data indicate that in the vast majority of women, obstetric trauma is indeed the primary aetiological factor. deliveries showed no difference...

Clinical Description

FDCM DCM is a leading cause of heart failure and arrhythmia. Symptoms of congestive heart failure are dyspnea on exertion, decreased exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, fatigue, edema, and abdominal distension. Chest pain results from limited coronary vessel reserve. Ventricular arrhythmia leads to palpitations, syncope, and sudden cardiac death (SCD). Severe LV dilatation and dysfunction result in thrombo-embolic complications.

Primary Nursing Diagnosis

Patients not undergoing surgery or a procedure need a thorough education. Explain the disease process, the possible complications, and all medications. Teach the patient to avoid high-fat foods, dairy products, and, if the patient is bothered by flatulence, gas-forming foods.

Rectal Compliance and Sensation

Distention of the rectum by stool is associated with several processes that serve to preserve continence, or if circumstances are appropriate, to proceed with defecation. Stool is often transferred into the rectum by colonic high-amplitude propagating contractions, which mostly occur after awakening or after meals 7 . It is likely that rectal contents are periodically sensed by the process of anorectal sampling 8, 9 . This process may be facilitated by transient relaxation of the internal anal sphincter, which allows the movement of stool or flatus from the rectum into the upper anal canal. Here they may come into contact with the specialized sensory end organs, such as the numerous Krause end-bulbs, Golgi-Mazzoni bodies and genital corpuscles, and the relatively sparse Meissner's corpuscles and pacinian corpuscles 10 . Specialized afferent nerves for touch, cold, tension, and friction subserves these organized nerve endings. An intact sampling reflex allows the individual to choose...

Etiology of Fecal Incontinence

Other causes of anatomical disruption include iatrogenic factors such as anorectal surgery for hemorrhoids, fistulae, or fissures and proctitis after radiotherapy for prostate cancer. Postoperative fecal incontinence may affect up to 45 of patients after lateral internal sphincterotomy 6 , 8 , and 1 reported incontinence to flatus, minor fecal soiling, and loss of solid stool, respectively, 5 years later 23 . Incontinence following lateral internal sphincteroto-my does not appear to recover in the long term and appears to be an independent cause of fecal incontinence 24 . Similarly, the risk of fecal incontinence after fistulotomy ranges from 18 to 52 25 . The internal anal sphincter is occasionally and inadvertently damaged during hemorrhoidectomy 26 . The risk of developing fecal incontinence is about 28.3 in patients receiving closed hemorrhoidectomy by Ferguson technique 27 , which is now considered a gold standard for hemorrhoidectomy. Pelvic radiotherapy results in chronic...

Drugs That Alter Metabolism or Nutrient Partitioning

Drug produced an 8-10 body weight loss, compared with a loss of 4-6 in the placebo-treated groups. In all these studies, the combination of orlistat and diet was more effective than placebo plus diet in inducing and maintaining weight loss. More importantly, the use of this drug led to significant improvements in obesity-related risk factors such as blood pressure, glycemic control, and lipid profile. However, there have been concerns related to the gastrointestinal adverse effects, which include abdominal pain, fecal incontinence with oily stools, flatulence, nausea, vomiting, and malabsorption of fat-soluble vitamins. Thus, the drug is contraindicated in chronic malabsorption and cholestasis.

Diet and Patient Education

Patients should be educated to avoid excessive straining at defecation to reduce the risk of pudendal nerve damage. Perianal hygiene must be addressed, including delicate soaps specifically for use in the perianal area, to avoid perianal irritation and pruritus. Only in selected cases should absorbents, diapers, and tampons be recommended. Patients must be educated to reduce or avoid foods that induce loose stools, excessive gastrointestinal transit, or increased intestinal gas production (i.e., milk and derivates, excessive legumes and vegetables, chocolate, tomatoes, caffeine, prunes, grapes, figs).

Rehabilitative Techniques

The aim of sensory retraining is to increase the incontinent patient's ability to perceive the rectal distension induced by feces or flatus (rectal sensation) 20 . Impaired rectal sensation may be a cause of fecal incontinence. Reduced rectal sensation, with a higher than normal rectal distension conscious threshold, allows the stool to enter the anal canal and, due either to the absence or lateness of the external anal sphincter reflex contraction, incontinence may occur 4 . Conversely, an exaggerated rectal sensation, with a lower conscious threshold, may elicit fecal incontinence because it is associated with reduced rectal compliance, repetitive rectal contractions during rectal distention, and longer simultaneous sphincter relaxation 21 .

Genetic Considerations

The signs and symptoms are directly related to the serum calcium level. In some patients, hypercalcemia is discovered upon routine physical examination. Evaluate the patient's neuromuscular status for muscle weakness, hypoflexia, and decreased muscle tone. Observe for signs of confusion. Hypercalcemia slows GI transit time therefore, assess the patient for abdominal distension, hypoactive bowel sounds, and paralytic ileus. Strain the urine for renal calculi. Assess for fluid volume deficit by checking skin turgor and mucous membranes. Auscultate the apical pulse to determine heart irregularities.

Discharge And Home Healthcare Guidelines

I ntestinal obstruction occurs when a blockage obstructs the normal flow of contents through the intestinal tract. Obstruction of the intestine causes the bowel to become vulnerable to ischemia. The intestinal mucosal barrier can be damaged, thus allowing intestinal bacteria to invade the intestinal wall and causing fluid exudation, which leads to hypovolemia and dehydration. About 7 L of fluid per day is secreted into the small intestine and stomach and usually reabsorbed. During obstruction, however, fluid accumulates, causing abdominal distension and pressure on the mucosal wall, which can lead to peritonitis and perforation. Obstructions can be partial or complete. The most common type of intestinal obstruction is one of the small intestine from fibrous adhesions.

Gender Ethnicracial And Life Span Considerations

Intestinal obstructions can occur at any age, in all races and ethnicities, and in both sexes but are more common in patients who have undergone major abdominal surgery or have congenital abnormalities of the bowel. When it occurs in a child, the obstruction is most likely to be an intussusception. Although small bowel obstructions in children are uncommon, the diagnosis should be considered for any child with persistent vomiting, abdominal distension, and abdominal pain

DRG Category 182 Mean LOS 43 days Description Medical Esophagitis

I rritable bowel syndrome (IBS), sometimes called spastic colon, is the most common digestive disorder in the United States. with a prevalence as high as 10 to 20 in the population. It is a poorly understood syndrome of diarrhea, constipation, flatus, and abdominal pain that causes a great deal of stress and embarrassment to its victims. People often suffer with it for years before seeking medical attention.

Meralgia Paresthetica Bernhardt Roth syndrome

The lateral cutaneous nerve is a purely sensory branch arising from the lumbar plexus (L2-L3). It passes obliquely across the iliac muscle, and enters the thigh under the lateral part of the inguinal ligament. It supplies the skin over the anterolateral aspect of the thigh. Meralgia pares-thetica is a condition caused by entrapment of this nerve as it passes through the opening between the inguinal ligament and its attachment 1 - 2 cm medial to the anterior superior iliac spine. Numbness is the earliest and most common symptom. Patients also complain of pain, paresthesias (tingling and burning) and often touch - pain - temperature hyp-esthesia over the anterolateral aspect of the thigh. The condition occurs particularly in obese individuals who wear constricting garments (e.g., belts, tight jeans, corsets and camping gear). Intra-abdominal or intra-pelvic processes may directly impinge on the nerve during its long course the condition can also be due to abdominal distension (as a...

Surgical Results Outcomes of Primary Repair

The demonstrated persistence of defects despite primary repair has implications for future continence 48 . It has therefore been suggested that a col-orectal surgeon preferentially perform repairs for acute obstetric anal sphincter injuries because of their training and experience with sphincter repair in other settings. One paper describes the short-term involvement of a colorectal team in the acute management of third-degree tears 52 . In this study, four women with acute tears that extended to the anal canal or rectum underwent acute repair by a colorec-tal surgeon. The repair involved identification of both the internal and external sphincters, the use of a nerve stimulator to identify the external sphincter, imbrication of the internal sphincter, and overlapping repair of the external sphincter. At the 3-month and 1-year follow-ups, ultrasound showed intact repairs, and only one of the four women had flatus incontinence and occasional seepage. Based on this experience, the...

Anovaginal and Rectovaginal Fistula Repair

Obstetric injury is the most common cause of these fistulas 114 . Injury to the perineum during vaginal delivery and poor healing of primary repair of per-ineal tears are the main causes of the obstetric-induced rectovaginal fistula 115 . A small percentage will heal spontaneously after resolution of acute edema and inflammation, if the fistula is still present, there is usually well-vascularized tissue that permits successful healing following repair 116 . A patient will classically complain of the passage of stool or flatus via the vagina physical exam usually reveals the fistula. However, fistula symptoms may mask or confuse incontinence symptoms. Anal ultrasound and physiologic testing must be performed to evaluate for concomitant sphincter damage, which would require a sphincter repair in addition to surgical treatment of the fistula 117 .

Elective Cesarean after an Anal Sphincter Tear

Although elective cesarean for all births after a third-or fourth-degree perineal laceration has been widely advocated as the method to prevent the occurrence of a new or more severe incontinence, there is very little evidence to support the effectiveness of this prophylactic measure. Elective cesarean has a rather limited protective effect on the anal function. The International Randomized Term Breech Trial found that at 3 months postpartum, only mild flatus incontinence was more prevalent among the planned vaginal delivery than the planned cesarean group (33 58 vs. 20 61, p 0.008) 51 . The prevalence of flatus incontinence (66 616 vs. 59 606, p 0.64), severe flatus incontinence (1 61 vs. 2 58, p 0.481), fecal incontinence (5 619 vs. 9 607, p 0.29), and mild fecal incontinence (2 4 vs. 7 9, p 0.353) were similar between the two groups. The reason for this limited protective effect is that anal incontinence that develops during childbirth occurs primarily during antepartum 52, 53 ....

Is It Safe to Eat Raw Sprouts

Beans do cause flatulence in many persons who eat them. The gassiness is the result of fermentation of the seeds' complex sugars, or oligosaccharides, by bacteria in the large intestine. Persons who eat beans frequently find that they do not develop gas as much. To reduce the flatulence effect, try these strategies The flatulence-producing effect of beans can be further reduced by changing the water several times during soaking and during cooking and by simmering the beans slowly until they are tender.

Childbirth after a Thirddegree Tear

A second Swedish study prospectively followed for 10 years 23 women who had a third-degree perineal laceration 14 . Four women had at least two additional vaginal deliveries, 13 had one subsequent vaginal birth, and six had no additional birth. The only difference among the three groups was that women with two or more additional vaginal deliveries had more severe flatus incontinence, whereas the severity of fecal incontinence was similar. A group of Danish investigators followed 72 women who had a third-degree perineal laceration for 2-4 years. Four (24 ) of the 17 women who had a subsequent vaginal delivery after the anal sphincter tear developed new or more severe flatus incontinence. Eight (15 ) of 55 with no additional birth developed flatus incontinence and nine (16 ) sustained fecal incontinence 38 .

Internal Anal Sphincter

Two British investigators attempted to identify and repair torn internal anal sphincter in 27 cases of third-degree perineal laceration 25 . After an average follow-up of 20 (range 7-34) weeks, only two (7 ) women developed flatus incontinence. Internal anal sphincter repair probably did not contribute to this study outcome, as four (33 ) of the 12 repairs failed and eight (40 ) of the 20 torn internal sphincters were not identified despite the investigators' concerted effort. A group of Norwegian investigators also attempted to identify and repair torn internal anal sphincters among 30 cases of third- and fourth-degree perineal lacerations 26 . These investigators were unable to identify one (6 ) of the 18 torn internal sphincters, and two (12 ) of the 17 repairs failed. After a median follow-up of 34 (range 12-63) months, five patients (17 ) complained of flatus incontinence, and two (7 ) had developed fecal incontinence.

Lateral Internal Anal Sphincterotomy

Several large studies (> 200 patients) have shown that between 23 and 45 of patients will suffer some degree of incontinence in the postoperative period 171,175,176 . In the largest of these studies, by Khubchandani et al. 171 , the reported incidence of flatus incontinence, soiling and solid stool incontinence in 829 patients responding to a postoperative questionnaire was 35 , 22 and 5 , respectively. Others, however, reported a much lower incidence of incontinence (only 1.4 with loss of control of flatus) following tailored surgery, aimed to preserve more sphincter by selecting the height of sphincter to be divided 177 . Long-term studies show that problems with continence may be transient in the majority for example, Mentefl et al. 174 reported a reduction in incontinence from 7.4 in the immediate postoperative period to 2.9 at 12 months. However, several reports show an incidence of 8-18 of any anal incontinence at follow-up ranging from 4.3-5.6 years 172,178,179 . Although for...

Repair of Third and Fourthdegree Perineal Lacerations Introduction

However, this absence of complication was based on the finding that very few patients complained of anal incontinence postpartum. In addition, these early studies did not state whether the investigators ever asked their patients about anal function postpartum or even saw most of these women for follow-up 3,4 . In contrast, more recent studies found that women who sustained a third- or fourth-degree perineal laceration during vaginal delivery often develop anal incontinence (to flatus, liquid, and solid stool) postpartum. Four cohort studies demonstrated that within 12 months postpartum, 17-44 of women who had a third- or fourth-degree perineal laceration were incontinent to flatus and up to 17 had fecal incontinence (Table 1) 7-10 . These rates are significantly higher than in women who delivered during the same time period but did not have an anal sphincter tear. With longer duration of follow-up, the outcome is even worse. After 4-30 years, 38-63 of women with third-or...

Proctological Procedures General Introduction

Fecal Incontinence

Incontinence to flatus may be seen in around one third of patients undergoing sphincterotomy 14, 15 . Other studies have suggested lower rates of incontinence Vafai and Mann 16 reported an incidence of 1 permanent partial incontinence to faeces after closed lateral internal sphincterotomy, and Hoffmann and Goligher 17 reported a 6 rate of flatus incontinence and 1 faecal incontinence. The A similar study from St. Mark's Hospital reported on ten women and five men after lateral sphincteroto-my 22 . Of the women, endoanal ultrasound showed that the entire length of the internal sphincter had been divided in nine, three of whom had flatus incontinence (Fig. 3). The sphincterotomy was only partial in the men. This discrepancy was thought to be related to the shorter anal sphincter in women. Anal fistula surgery represents a compromise between the need to drain sepsis and lay open tracts whilst minimising sphincter muscle division. Incontinence rate estimates after fistula surgery vary...

Suprasphincteric Dysfunction

Rectoanal inhibitory reflex (RAIR) enables rectal contents to come into contact with the epithelium of the upper anal canal, where there is a high concentration of free and organised sensory nerve endings 18 . The mechanism is guaranteed by concomitant rectal contraction and internal anal sphincter (IAS) relaxation. At the same time, there is a reflex external anal sphincter (EAS) contraction that prevents accidents. This sampling mechanism occurs several times per hour 19 and allows an accurate distinction between flatus, liquid and solid faces, and for these reasons it has a role in the fine adjustment of continence, allowing the individual to choose whether to retain or discharge their rectal contents. It is likely that minor degrees of sensory impairment are not by themselves causative of incontinence in patients with otherwise normal anorectal function 20 . However, if the sampling mechanism is defective and sphincter function is poor, the patient may

Multiple Sclerosis Myelopathies and Spinal Cord Injury

The majority of SCI patients, 42-95 , suffer from constipation, and two thirds need to induce defecation by digital stimulation of the anal canal or rectum or to empty their rectum digitally 51, 53, 68 . Patterns of gut dysmotility have been described for different levels and degrees of SCI. Rajendra et al. demonstrated that lesions above T1 result in delayed mouth-to-caecum time, but lesions below this level show normal transit times to the caecum and markedly delayed transit times beyond the ileocaecal valve 69 . Keshavarzian et al. 70 showed a slowed transit throughout the whole colon in patients with spinal cord lesions above the lumbar region, a delay in part due to loss of colonic compliance. The lack of compliance leads to functional obstruction, increased transit times, abdominal distension, bloating, and discomfort 55 . Regarding the frequency of defecation, Yim et al. revealed that patients with UMNB emptied their bowels about three times a week, whereas LMNB patients did so...

Enzymes as Digestive Aids

A number of enzymes are utilized as digestive aids (Table 13.1), and the majority have been derived from animal (pancreatic extract), microbial (e.g., Aspergillus oryzae), and plant (e.g., barley) sources 155 . Amylases are enzymes that catalyze the hydrolysis of a(1-4)-glycosidic linkages of polysaccharides such as starch and glycogen to yield dextrins, oligosaccharides, maltose, and glucose. Amylases are secreted by the pancreas and salivary glands in humans. They are classified according to the manner in which the gly-sosidic bond is hydrolyzed. a-Amylases hydrolyze endo a(1-4) glycosidic linkages, randomly yielding dextrins, oligosaccharides, and monosaccharides (glucose), which are easier to digest 156 . Amylase is administered as a digestive aid to improve digestion of dietary carbohydrate. Cellulase is not produced by humans and is administered as a digestive supplement to alleviate flatulence and to improve overall digestion, especially Invertase is utilized as a digestive aid...

History and Physical Examination

Flank ecchymoses and or abrasions, fractured ribs, abdominal distension or tenderness, and palpable mass. The clinical presentation of renal vein thrombosis depends on the balance achieved between the rapidity and degree of venous occlusion, as well as the development of collateral veins. Thus, patients may be asymptomatic, have no specific symptoms such as nausea or vomiting, or have more specific symptoms such as hematuria or flank pain (Berkovich et al. 2001).

Imaging

Although less useful, plain abdominal films (KUB) include information about the size and position of the kidneys, of the psoas shadow (poor identification may be a manifestation of retroperitoneal hematoma from a ruptured aortic aneurysm), and of intestinal gas distribution (e.g., postoperative ileus) and can aid the search for calculi and organ calcification, free intraabdominal gas, and bone pathology. For more than half a century, the plain abdominal film was the only tool available to detect urolithiasis. However, because of its limited accuracy for the direct detection of stones (Haddad et al. 1992 Levine et al. 1997 Mutgi et al. 1991), it is indicated only in follow-up of conservatively managed urolithiasis, of fragmentation results after lithotripsy (in combination with sonography), and for missed calculi after ureterorenoscopy (Grosse et al. 2005). Its advantages include availability, rapidity, and the ease of image evaluation even by a nonradiologist. Its only secondary...

Beet Root

Prescriptions involving beetroot have been used for fevers since ancient times. One confection for the fevers is included in a 15th century collection of medical recipes, and reads take centaury a handful of the root and of the leaves of the earthbeet a handful of the root of clover a handful of ambrose a handful and make powder of them, then mix honey therewith. And make thereof balls of the greatness of half a walnut. And give the sick each day one of them fasting, and serve him nine days. For this is a good confection for fevers and the mother and for the rising of the heart flatulence (Dawson). That may have worked, especially as nine days may have been enough to see the fever off naturally, but one would have to question the Balkan practice of treating a fever by laying beet leaves on the skin round the

Haemorrhoidectomy

There are essentially four varieties of haemor-rhoidectomy the open technique, now referred to as the Milligan-Morgan operation 220 the closed technique, as popularised by Ferguson 221 the Parks submucosal technique 222 and the more recently introduced stapling method, as originally described by Longo in 1998 223 . Overall, several large series (> 380 patients) have shown that the incidence of severe and persistent postoperative incontinence is rare, ranging from 0.2-1 , irrespective of surgical technique 224-227 . In addition, transient soiling affecting 35-50 of patients may completely resolve by 6 months 228, 229 . However, minor (flatus) and moderate (soiling) incontinence has been reported in the long term in a significant proportion

Clinical Features

A detailed history is required on the initial visit or contact with the patient. A list of important information that should be elicited when taking history is outlined in under the previous heading Etiology of Fecal Incontinence. The temporal relationship between the onset of fecal incontinence and precipitating events should be established. This includes all prior coexisting conditions (diabetes mellitus, etc.), surgeries, spinal injuries, history of physical or sexual abuse, and exposure to radiation. The duration of symptoms should be determined in terms of acute, subacute, or chronic. Incontinence severity is determined by several grading systems. A modified Cleveland Clinic grading system 50 has been validated by investigators at St. Mark's Hospital in the United Kingdom 51 . It provides an objective method of quantifying the degree of incontinence. It can also be used for assessing the efficacy of therapy. The grading system is based on seven parameters that include whether the...

Fevers

HOLLY leaves do seem to have an effect in relieving fevers and catarrh, and were once stated to be equal to Peruvian bark (Dallimore), quinine, in other words. BOX, too, is a febrifuge, still prescribed by herbalists and homeopathic doctors, who treat it as a substitute for quinine in malaria (Palaiseul). Somerset people used to boil the bark of WHITE POPLAR, and drink the infusion for flatulence and fevers (Tongue). A prescription from Alabama is to take the ashes from burnt HICKORY wood, put them in water, and drink it for fever. Make it very weak, as it will eat the stomach (R B Browne).

Evaluation

Nence has been defined, the first variable determining treatment is severity. For patients who are continent to solid stool but have difficulties with control of liquid stool or flatus, aggressive medical therapy consisting of high-fiber diet, fiber supplementation, and antimotility agents may be successful. Perineal muscle strengthening exercises are another conservative option for patients with mild symptoms 37 . Biofeedback therapy is a more formal method of perineal muscle strengthening 87, 88 . A trained therapist monitors the voluntary contraction of the external anal sphincter and guides the patient in more effectively contracting. Patient motivation, commitment, and cooperation is necessary however for the proper patient, this is a good option.

Overlapping Repair

Findings from the Dublin studies were later confirmed by a small randomized controlled trial from the University of New Mexico 30 . The latter study also found that the overlapping method is no more effective in repairing the torn anal sphincter or preserving continence than the end-to-end method. The proportions that had failed repair 4 15 (27 ) vs. 1 11 (9 ), p > 0.10 , had flatus incontinence 4 15 The British study had another interesting finding 32 . More women whose torn anal sphincter was repaired with the overlapping method experienced improvement in their incontinence during the study period 17 27 (63 ) vs. 9 25 (36 ), p 0.01 , whereas more subjects that had end-to-end approximation developed an exacerbation of incontinence 0 27 vs. 4 25 (16 ), p 0.01 . This finding is perplexing, as both repairs have been shown in several studies to have a similar failure rate at 3-4 months postpartum 29, 30, 32 . Although the exacerbation of incontinence may be due to a difference in the...

Sweet Cicely

The whole plant is very attractive to bees, and was often rubbed over the inside of hives to induce swarms to enter (Northcote). In popular medicine it is taken for flatulence and any digestive ailment (Clair), and is a remedy for chest troubles or bronchial colds (Gibson), and is still used to lower blood pressure (Schauenberg & Paris).

Turnip

Turnips seem to have been first grown in the London area in the 16th century, but Norfolk was the first county in which they were extensively cultivated for cattle feed (G M Taylor). Gerard, at the end of that century, was rather disparaging about them the root .is many times eaten raw, especially of the poore people in Wales, but most commonly boiled. The raw root is windy, and engendreth grosse and cold bloud the boiled doth coole lesse . yet it is moist and windy. The Regimen Sanitatis Salernii was equally scathing Turnips cause flatulence and spoil the teeth, stimulate the kidneys, and when ill cooked cause indigestion (Hickey). There seems to have been some doubt early on as to what one should do with them -English travellers in Scotland in the 17th century complained that they got turnips (neeps) as dessert. (The Scots had no fruit but turnips (Graham)).

White Poplar

This one) always lean to the east (Nall). There are a few genuine uses in folk medicine Somerset people used to boil the bark, and drink the infusion for flatulence and fevers (Tongue). Gerard also recommended the bark, but for sciatica or ache in the huckle bones, and for the strangury. The same barke is also reported to make a woman barren if it be drunke with the kidney of a Mule, which thing the leaves also are thought to performe

Clinical Aspects

The incubation period for trichinellosis lasts from 2 to 50 days, depending on the number of infective larvae ingested (a greater number of larvae correspond to a shorter incubation period). 7 The acute stage of trichinellosis corresponds to the phase in which the newborn larvae migrate from the lymphatic vessels and invade the muscle cells. The acute stage can be preceded by loose stools or diarrhea, with flatulence, moderately intense abdominal pain, loss of appetite, and vomiting. 7

Lactase

P-Galactosidase-deficient populations have difficulty in consuming milk and other lactose-containing products, as ingestion of lactose can result in abdominal pain, diarrhea, and flatulence. Intestinal P-galactosidase insufficiency is also thought to be a possible etiology for infantile colic. P-Galactosidase has been widely studied, with incidence of its occurrence reported in animal organs, plants, and microorganisms 168 . Microbial P-galactosidases are most extensively utilized for commercial purposes, owing to their high levels of production and desirable physicochemical properties (e.g., pH and temperature optima) 169 . The principal enzymes exploited commercially are obtained from GRAS-listed yeasts and fungi such as Kluyveromyces lactis and Aspergillus oryzae 170 . The P-galactosidase enzyme derived from Aspergillus oryzae is an extracellular protein. The enzyme has a molecular mass of 105 kDa, is a homodimer, and is glycosylated. The enzyme has a pH optimum of 4.5 and also...

Conclusion

For future epidemiologic studies, a consensus definition of faecal incontinence is recommended that includes any incontinence of flatus, liquid stool or solid stool that impacts on quality of life in adults and children 1 . Any further prevalence studies should ideally be undertaken using anonymous self-administered questionnaires to aid with minimising bias. Widespread use of a standardised questionnaire would assist with achieving consistency and comparability between further studies. An example of a standardised, valid and reliable self-administered questionnaire 23 is included (Appendix). This questionnaire was constructed and validated in New Zealand, and incorporates with permission the Bristol Stool Form Scale 24-26 , Faecal Incontinence Severity Index (with patient weighted scoring) 27 and Faecal Incontinence Quality of Life Index (scored as per Rockwood et al. 28 ).

Anal Dilatation

In prospective studies, minor incontinence (soiling and flatus) rates of 13-27 have been reported immediately following dilatation 189, 192-194 . However, a study by Konsten and Baeten with median follow-up of 17 years in 39 patients who had undergone dilatation and haemorrhoidectomy and 44 patients who had undergone dilatation alone showed a long-term incontinence rate of 52 191 . Comparative studies have shown that anal dilatation is associated with a greater incidence of postintervention incontinence than is sphincterotomy 192, 195,196 .

Fennel

Fennel appears in Anglo-Saxon medical receipts as early as the 11th century, probably owing to the active part Charlemagne took in its diffusion through central Europe (Fluckiger & Hanbury). The faith put in it in earlier times is shown by one of the medical maxims from the Book of Iago ab Dewi (Berdoe) He who sees fennel and gathers it not, is not a man, but a devil. It is said, too, that a certain Comte St Germain became a very rich man by selling a tea that he claimed prolonged life - it was apparently composed of senna and fennel leaves (Thompson. 1897). By the end of the 19th century only the seeds were official in the British Pharmacopeia, and they were used in the form of distilled water, or volatile oil. The chief consumption was then in cattle medicine, and also (the oil) in the manufacture of cordials. But the carminative action had been recognised for a very long time Fennel seed drunke asswageth the paine of the stomacke, and wambling of the same, or desire to vomit,...

Episiotomy

Women who have episiotomies have a higher risk of FI at 3 and 6 months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy triples the risk of FI at 3 months and 6 months post-partum and doubles the risk of flatus incontinence at 3 months and 6 months postpartum. A nonextending episiotomy (second-degree surgical incision) triples the risk of FI and doubles the risk of flatus incontinence postpartum compared with women who have a second-degree spontaneous tear.

Anovulation

Insulin Pump Overweight Women

Anti-oestrogenic effects include thickening of cervical mucus and hot flushes in 10 of women. Other side effects include abdominal distension (2 ), abdominal pain, nausea, vomiting, headache, breast tenderness and reversible hair loss. Clomifene has a mydriatic action that can result in blurred vision and scotomas in 1.5 of women. These changes are reversible. Significant ovarian enlargement

Indigestion

Gypsies use a root and herb infusion of FIELD GENTIAN to relieve indigestion (Vesey-Fitzgerald), and TANSY leaves, chopped up and added to bread dough and cake mixtures, were a popular indigestion remedy in Cambridgeshire (Porter. 1969). In Ireland flatulence used to be cured by taking a tansy leaf decoction with salt added (Egan), and another Irish remedy is the simple expedient of eating CELERY (Maloney). LEMON VERBENA leaves, fresh or dried, are widely used as a tea for indigestion (Macleod), and FENNEL is used in the same way, and has been for a very long time. Fennel seed drunke asswageth the paine of the stomacke, and wambling of the same, or desire to vomit. And breaketh winde .(Gerard). A Middle English rimed medical treatise prescribed wither betony or fennel for the digestion, fennel to be taken in droge after meat. Drogges were a kind of digestive powder for weak stomachs, and were used by Chaucer's 'Doctour' Oil of JUNIPER used to be sold (and is probably still available)...

Chronic Constipation

Both lactulose and sorbitol stimulate intestinal peristalsis by a water-transport mechanism into the bowel. Undesirable side effects are abdominal bloating and flatulence, with subsequent patient discomfort. Glycerin, given as an enema, can obtain rectal emptying. Saline laxatives interfere with bowel osmosis and peristalsis, improving intestinal motili-ty. However, administration to patients with cardiac or renal failure or electrolyte anomalies needs special caution.

Camphor

Camomile tea is a virtual panacea, used for a remarkable number of often unrelated ailments. It is a great standby for an upset stomach (Hawke), or as a laxative (V G Hatfield. 1994). Gypsies in Britain use it for flatulence (Vesey-Fitzgerald), and it is very popular in France (Clair), but even more so in Italy (Thomson. 1976). On Chios, it is drunk for the good of the stomach, which is more or less what Gerard said it is good against coldnesse in the stomack, soure Belchings, voideth winde, and mightily bringeth downe the monethly courses, this last being interesting in view of the German belief that camomile tea is good for women in labour (Thonger). It is listed as a bitter stomachic and tonic (Fluckiger & Hanbury), and as such is recorded in Hampshire as good for clearing the blood (Hampshire FWI), by which a spring tonic is probably meant. And it is also recommended for neuralgia and migraine (Schauenberg & Paris), as well as for a simpler kind of headache (Newman &...

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