Brief Answer:
Use looz regularly.

Detailed Answer:
Hello my dear patient,
Have gone through your details and i appreciate your cncerns.
As per your query i would say that initially start taking a laxative in optimal dose daily.Lactulose is a very safe laxative and can be used for years without any side effect.

See when you try to pass hard stools it rubs against the soft layer of mucosa of rectum and anal canal this causes the mucosa to wither off hence causing bleeding from the area.So please don't think that taking lacative is going to harm you rather trying to pass hard stools by not using laxatives can cause severe problem.
So start taking looz in a dose of 15 ml once daily at bed time and you can increase the dose to 30 ml or you can decrease it as per the response of your body.
Apart from that drastic change in life style is required to cure constipation. Not exercising enough, not drinking enough water and delaying a bowel movement can worsen constipation symptoms.The most important factor in curing constipation is a natural and simple diet. This should consist of unrefined food such as whole grain cereals, XXXXXXX honey and lentils; green leafy vegetables, like spinach, beans, lettuce, celery, asparagus, carrot. Adding some fat to meals or increasing the size of a meal such as breakfast can help create the urge to defecate. Individuals suffering from constipation should increase the amount of plant foods they consume to get more fiber in their diet. Consume high fiber foods as a part of high biber diet. Grain products: (6-11 servings of grain product in your diet is required daily) whole grain breads, whole wheat, whole grain mixed grain, cracked wheat, buns, muffins. Brown ricewhole wheat pasta or brown rice pastacereals made from whole grain oatmeal ground flax, wheat germ or wheat XXXXXXX in baked goods vegetables: (3-5 servings daily) dark green leafy vegetables contain heigest amounts of fiber e. g Spinach, broccoli, green peas, green beans, turnip greens. Fruits: (2-3 serving of fruits) apples. Oranges, pears, peaches. Berries (strawberries, raspberries, blueberries, and blackberries) dried fruits (dates, prunes apricots legumes, nuts and seeds
Black bean, green beans, peas, kidney bean, lentils, peanut, soy beanWalnuts, peanuts, cashews, sunflower seeds.Constipation can be treated by changing diets.
Take Fybogel husk-Fybogel sachets and Fybogel Hi-Fibre sachets both contain the active ingredient ispaghula husk, which is a type of medicine called a bulk-forming laxative. Ispaghula is a type of fibre. It swells when it comes into contact with fluid in the gut and thus increases the volume of the faeces.It increases the bulk in your stool, an effect that helps to cause movement of the intestines. It also works by increasing the amount of water in the stool, making the stool softer and easier to pass. Psyllium, one type of bulk-forming laxative.
Vitamin c: it maintains the healthy blood vessels and maintain tissue matrix. And increases the body immunity also. Rich source are blackberries, raspberries, broccoli, spinach, guavas, amla, lime melon, orange, papaya, pineapple, tomato.Vitamin e: it is a fat soluble vitamin which maintains healthy cell membrane as well as the prevention of inflammation. It is helpful in healing the inflamed tissue

So try to indroduce all the above mentioned food gradually in your diet and keep taking looz and taper it gradually as per your body response.

Feel free to follow up.

Regards!

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Brief Answer:
follow up.

Detailed Answer:
Hi again,

Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin,In a lay mans language it is breach of external skin and this breach results in direct communication of your anal canal with external enviroment and pathogens.It can be a potential source of infection if left untreated.Its just like a open wound where skin is breached this break in the skin provides a route for the germs to travel from the outside to the inside.Even the pus inside the fistula can spread further leading to formation of multiple tracts and several opening in the skin around the anus. This makes the fistula more complex and further difficult to treat.
Whether a fistula should be managed conservatively or a surgical procedure should be done depends on the intensity of symptoms and tract of fissure.
Tracing path help us to decide that which surgery would be better hence by doing either of two tests mentioned below tract should be traced.

1)CT- Fistulogram is a easy test to find the course of fistula.A radioactive XXXXXXX is injected and Scans are taken by CT machine,Track of fistula can easily be seen in this procedure.
2)MRI is the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the muscles , with high resolution contrast.


Hope i was helpful.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello dear,
All the above mentioned things were an answer to your question.As off now as you are on conservative management no need to do the tests once you want to go for surgery you can go for a MRI.

Please follow all the suggestions i had given earlier to treat hard stools and you would feel; much better in few days.
Yes hard stools if left untreated can cause further tears or hemorrhoids.

Hope i was helpful my dear patient.
I wish you a great life ahead.

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Brief Answer:
follow up.

Detailed Answer:
Hello again dear,
Syrup looz 15-30 ml once daily 15 minutes before going to bed with half cup of water.
Fybogel two table spoon with quarter cup of XXXXXXX warm water once daily before going to bed.


Thanks!

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Brief Answer:
This is called fecal impaction dear.

Detailed Answer:
Hello,
A fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.It is is a large lump of dry, hard stool.Problem with it i that it can't be removed by taking laxatives therefore digital evacuation by using fingers have to be done.

Please feel free to follow up.
Thanks.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello dear,
No a polyp or tumour can't cause the stool to be hard but yes it can cause constipation or bowel obstruction.
It will obstruct the bowel hence very likely it would make it difficult to pass stools daily.However there is no documented proof of type of constipation dear.

No one can perdict the chances.For that patient have to go for a CT abdomen or Colonoscopy.
Investigations are the only way out.

Thanks.

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Brief Answer:
Follow up answer.

Detailed Answer:
The term constipation implies that either the bowel movements happen less frequently or that the stool is tough. If the stool is passed after more than three days then it is generally considered to be too long. The fecal matter becomes harder after not being passed for three days at a stretch leading to fecal impaction.
However in some of the european countries passing stool even once a week is not considered as constipation.

Yes definitely it would. laxatives work by drawing water into your stools to make them larger, softer, and easier to pass. As they liquifies stool(make it soft) if tumor is not too large or completely obstructing in nature;stools would pass.

Thanks.

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Brief Answer:
can be suggestive of irritable bowel.

Detailed Answer:
Hi there,
You are have chronic constipation can be suggestive of Irritable bowel(incomplete) syndrome as your constipation comes in bouts with remission.
Different patients have different presentation in IBS infact same patient at different times may have different presentations.

regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello dear XXXXXXX

Definitely yes poor life style and lack of exercise is one of the most common cause of constipation.
As adviced above as of now colonoscopy is not required as you are willing for medical management however if a noninvasive surgery is planned then colonoscopy would be done.

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Brief Answer:
Follow up suggestions.

Detailed Answer:
Yes you should reduce the dose as said earlier adjust your dose as per response of your body.
Make it 5ml or you can make it even as low s 2.5ml also.

Thanks

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Brief Answer:
Follow up.

Detailed Answer:
Hi there,
Rifagut is an antibiotic and can cause constipation.However this is not very common and secondly if it happens it reverses itself after few days of stopping therapy.
You are on many number of medications and yes they could be responsible for stool hardening.
Take looz daily as required by you.
Don't worry.
Change your diet gradually and things would be better in few weeks.


Regards!

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Brief Answer:
follow up.

Detailed Answer:
Hi there,
Its suggestive gas in ontestones due to fepleted intestinal flora.The intestinal microflora is a complex ecosystem containing over 400 bacterial species. Anaerobes outnumber facultative anaerobes. The flora is sparse in the stomach and upper intestine, but luxuriant in the lower bowel.The intestinal flora is capable of fermenting indigestible carbohydrates (dietary fiber) to short-chain fatty acids such as acetate, propionate, and butyrate. The major source of such fermentable carbohydrate in the human colon is plant cell wall polysaccharides such as pectins, cellulose, and hemicellulose. The acids produced from these fiber substrates by bacteria can be an important energy source for the host.
The gut flora helps to neutralise some of the toxic by-products of digestion, reduce harmful substances (such as toxins and carcinogens), and discourage 'bad' bacteria and yeasts. It also helps to stimulate the digestive process and aid the absorption of nutrients, as well as producing vitamins including B and K.
So any problem with this flora causes symptoms like gastric pain,burping,poor digestion etc.
I would suggest you to take probiotics for few weeks.Probiotics will help to restrore the depleted intestinal flora,Along with probiotics B complex are to be taken.Once the flora is replenished all problems related to digestion will improve.

Take probiotic daily.

Tx

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