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Normal continence (control of feces / bowel) involves the coordinated interaction between multiple different nerve pathways and the pelvic and perineal musculature. Many other factors, like systemic disease, emotional effect, bowel motility, stool consistency, evacuation efficiency, pelvic floor stability, and sphincter integrity, play a role in normal regulation of the anal sphincter. Failure at any level may result in an impaired ability to control gas or stool (especially if the motion is liquid). The bleeding prolapsed hemorrhoid can also cause incontinenece. Following investigations are needed for the identifying the cause;
1) Endoanal ultrasound,
4) Anorectal manometry
5) Anorectal electrophysiology testing
The treatment entails;
1) Biofeedback; Pelvic floor exercises with biofeedback are beneficial when combined with the addition of dietary modifications. Biofeedback educates regarding pelvic floor coordination, recognition of sensory thresholds, and conditioning of the pelvic musculature, and it helps develop improved pelvic floor habits.
2) Dietary modification: a food diary may be useful to detect offensive items, such as citrus or spicy foods, caffeine, and alcohol, that may be associated with incontinence. Avoiding these may decrease the irritant load to the rectum.
3) Medications; The two most commonly used drugs are loperamide and diphenoxylate with atropine. Loperamide is currently the treatment of choice because it not only thickens the stool but also has been shown to increase anal sphincter tone and improve continence mechanisms.
4) Anal sphincteroplasty; it is a surgical procedure and is done when the above medical treatment fails and if the injury of the sphincter of anus is demonstrated.
The treatment of hemorrhoids is by warm sitz bath, avoiding straining, keeping the stools soft and local application of the ointment like proctosedyl or Preparation-H. Following is the detailed advisory;
1) Avoid constipation if you have, by not postponing the urge to defecate;
2) Eat a balanced, high-fiber diet; Increased dietary fiber of 25-30 grams / day. High fiber cereal can help reach this goal quickly.
3) Drink plenty of water and liquids (about 2 liters a day)
4) Regular exercise; this helps in relieving constipation, if any.
5) Avoid excessive pressure and straining during defecation. Don't sit for extended periods, limit this time as much as possible.
6) Avoid irritant foods, chillies and hot herbs and substances.
7) Warm sitz baths; this is universally soothing for pain and may help decrease the hemorrhoid size. This is done thrice a day for couple of days and then twice a day (15 minutes each time).
8) Local ointments applied in anal canal which contain xylocaine and vasconstrictors (OTC product).
The hemorrhoids should respond to these measure in 3-4 days. If they do not completely resolve in a week or 10 days, it would be time to seek a personal examination by a physician.
If these measures do not help you may try the non surgical / mild invasive procedures;
1) Rubber band ligation
2) Bipolar, infrared, and laser coagulation
5) Laser hemorrhoidectomy
6) Doppler-guided hemorrhoidal artery ligation
7) Anal streching or Lord's stretching.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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