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Digestive System

divulgacio-imatge

The function of the digestive system is to provide nutrients to all body cells.

To carry out its function, the digestive system first needs to perform a physical and chemical breakdown of the food into its essential components, to proceed to their absorption through the intestine. The last step is to eliminate the debris materials that have no use.

The process of digestion starts when the food enters the mouth and ends when the debris are eliminated in the form of faeces through the anus. During this process, food moves down and mixes with different secretions in the digestive tract thanks to muscular contractions called peristaltic movements that are produced along the digestive tract.

Digestive System

The function of the digestive system is to provide nutrients to all body cells.

To carry out its function, the digestive system first needs to perform a physical and chemical breakdown of the food into its essential components, to proceed to their absorption through the intestine. The last step is to eliminate the debris materials that have no use.

The process of digestion starts when the food enters the mouth and ends when the debris are eliminated in the form of faeces through the anus. During this process, food moves down and mixes with different secretions in the digestive tract thanks to muscular contractions called peristaltic movements that are produced along the digestive tract.

divulgacio-imatge
intestinos

To function correctly, the digestive system needs a digestive tract and other digestive structures relating to it.

The digestive tract is formed by the mouth, pharynge, oesophagus, stomach, thin intestine, appendix, large intestine, rectum and anus.

Digestive structures related to the digetive tract are: salivary glands, páncreas, liver and gallbladder, each of these with a specific function.

Pathologies

What is esophagitis?

Author: Dr. Mª del Carmen Peña Cala

Esophagitis is a lesion of the esophageal mucosa that normally presents with pain and heartburn or swallowing difficulties. It is caused most frequently by reflux from the gastric or intestinal contents that reach the esophagus. Depending on the causal agent, this condition is referred to as peptic, biliar or alkaline esophagitis.

In general, the treatment of non-complicated cases includes weight loss, sleeping on a bed with an elevated head, antiacids, the elimination of factors that increase abdominal pressure and to avoid tobacco and dangerous medications.

Esophagitis can also be of a viral origin, caused by the simple herpes virus. It can also be caused by candida, as certain strains of candida are normally found in the throat and can become pathogenic under certain circumstances (diabetes, antibiotic therapy, etc.) causing, as a results, esophagitis.

Oesophageal tumours

Author: Dr. Mª del Carmen Peña Cala

A tumour is an abnormal bulging of an organ or part of the body.

Benign tumours of the esophagus account for 10% of all oesophageal tumours.

When these tumours are malignant, the patient presents progressive dysphagia (difficult deglutition) and rapid loss weight. Thoracic pain is present when the tumour has spread to perioesophageal tissues, thus, when the disease is discovered, it is usually at a very advanced stage and with a bad prognosis. Survival at 5 years is around 5%, for as long as the tumour has been excised and radiotherapy and/or chemotherapy, or a combination of both, has been administered. In over 60% of patients, the treatment can only be palliative.

Hiatal hernia

Author:Dr. Mª del Carmen Peña Cala

The term “hernia” means the protrusion of an organ or part of such, or other structure, through the wall of the cavity in which it is normally contained.

A hiatal hernia is when part of the stomach is projected through the opening of the diaphragm through which the esophagus goes through.

This facilitates the passage of the gastric content towards the esophagus, causing esophagitis due to reflux in the long run On most occasions, the symptoms get resolved with antiacids and prokinetic drugs (a medication used to accelerate the digestive transit); however, sometimes surgery is required to close the hiatal hernia (Nissen´s procedure).

The symptoms include pain, heartburn, burping, flatulence and reflux.

Gastric and duodenal ulcer

Author:Dr. Mª del Carmen Peña Cala

An ulcer is a lesion of the skin or mucosa surface with loss of substance and it is usually associated with a suppurative process.

What are gastric and duodenal ulcers?


They are very frequent ulcers.

Peptic ulcers consist in the destruction of the mucosa in the area of the stomach , and are commonly known as gastric ulcers.

Duodenal ulcers consist in the destruction of the mucosa in the area of duodenum, and are commonly known as duodenal ulcers.

When ulcers appear, their walls are exposed to the attack of digestive juices and can thus become perforated.

There are several factors that increase the risk of suffering from them: genetic predisposition, tobacco consumption, excessive consumption of coffee and alcohol and the regular use of certain medications such as aspirin and anti-inflammatory drugs, stress and nervous tension.

They are very frequent ulcers.

Often there is chronic blood loss and more seriously, the ulcer can erode a large blood vessel causing heavy bleeding. In such a case, the patient vomits blood, haematemesis, and has deep black, sticky stools, called melenas, because the blood has been partially digested.

The possible perforation of the ulcer poses a serious and grave danger due to the release of potent chemicals and enzymes into the peritoneal cavity.

Stomach cancer

Author:Dr. Mª del Carmen Peña Cala

Cancer is the presence of a malignant tumour.

Its main characteristics are:

1.- Fatal outcome if not treated adequately.

2.- Infiltration of adjacent tissues.

3.- After it has been eliminated, it can reappear in the same place or close by.

4.- Rapid growth with atypical mitosis (abnormal cell divisions).

5.- Inability to reproduce the structure of the tissue on which it is housed.

6.- Production of metastasis in lymph nodes or in distant organs.

Gastric or stomach cancer is one of the most frequent types of cancer in the world. The symptoms in early stages, a time when the cancer is more likely to be cured, are minimal or nul, and thus medical attention is sought when it is too late There are no known causes, although it is believed that diet is to blame and that there might be a slight genetic component.

Diagnosis and collection of biopsy sample for histological typing is performed via fibrogastroscopy. The local study can be completed by means of an echoendoscopy.

The physical and endoscopic exploration is completed with a chest x-ray, liver panel tests, abdominal ultrasound and computerised axial tomobraphy (CAT).

Can it be cured?

At present, surgical removal of the tumour is the only way to combat the illness. A detailed and through search of signs for metastasis at a distance will prevent unnecessary surgery.

Pyloric obstruction

Author:Dr. Mª del Carmen Peña Cala

Obstruction means an interruption in the passage of solid, liquid or gaseous materials into a vessel or body duct.

In the stomach, the only significant obstruction occurs at the level of the pylorus (the pylorus is the sphincter located between the stomach and duodenum). The obstruction can be caused by excessive development of the muscular sphincter, as it occurs in babies (pyloric stenosis), or in adults as a result of scars from ulcers or neoformations in the area.

Pyloric obstruction presents with an enlargement of the gastric body, distension, slow and heavy digestion. The condition can progress to descompensated phases in which food does not reach the duodenum with resulting vomiting.

Intestinal obstruction

Author:Dr. Mª del Carmen Peña Cala

Intestinal obstruction is when the passage of liquids and food through the intestine is impeded.

If the obstruction is total or nearly complete, the liquid and food accumulate behind the obstruction.

A common characteristic of the clinical picture is vomiting that normally occurs fiercely and effortlessly, depending on the type of obstruction.

In a high obstruction, vomiting usually contains sour food and the presence of green bile, and when the obstruction is low, it commonly looks like faeces.

The abdomen is tense, showing distension of the intestine, being especially prominent in obstruction of the colon. No air or faeces are expelled.

Once the abdomen is distended, absorption of nutrients is virtually stopped and the released secretions in the intestine are not absorbed. The patient can become dehydrated very quickly.

At the level of the thin intestine, it can be caused by:

1.- Bands of fibrous tissue called adhesions, that compress the intestine from the outside. This is also known as extrinsic obstruction.

Because part of the intestine can collapse through any of the natural openings of the abdominal wall, becoming obstructed as a result. Such protrusion constitutes the so called “hernia”.

3.- Tumoral pathology. At the level of the large intestine or colon, the most common cause for the obstruction is carcinoma, that could be housed at any point throughout its trajectory.

Constipation

Author: Dr. Mª del Carmen Peña Cala

Constipation means the slow or difficult passage of the intestinal content with infrequent and hard defecation.

It is due to the slow passage of the intestinal content through the colon, where an excessive amount of water is absorbed making the faeces hard and difficult to expel. It is usually symptomatic of an inadequate diet, whilst on other occasions it is due to other pathologies inherent to the colon. However, one should be cautious for the accumulation of faeces exerts pressure and that pressure can lead to a dilation of the veins resulting in painful and uncomfortable haemorrhoids.

If you are prompt to be constipated, we suggest you see your consultant, who will study the cause and will resolve your problem.

Intestinal tumours

Author: Dr. Mª del Carmen Peña Cala

A tumour is an abnormal bulging of an organ or part of the body.

Based on their histology, tumours can be classified as benign or malignant.

The intestine is formed by several layers of tissues, and tumours can originate in any part of these layers.

Within the benign tumour group, polyps are the most common.

Within the malignant tumour group, colon and rectal cancer are the most frequent, in both men and women. These tumours usually have an invasive nature and many of them are diagnosed first due to the complications they present. The treatment of colon cancer is surgical, complemented sometimes with chemotherapy and radiotherapy.

Liver disorders

Author: Dr. Mª del Carmen Peña Cala

The most common liver condition is inflammation or hepatitis, generally caused by a virus.

There are several types of viral hepatitis The most frequent types of hepatitis are:

1.- Hepatitis A, spread by contact with contaminated food. It is not an important condition.

2.- Hepatitis B, spread by contact with infected blood or serum or by sexual contact.

3.- C-virus hepatitis, that is spread via blood.

4.- Hepatitis D, produced by the delta agent that co-infects with the virus of hepatitis B.

5.- Hepatitis E. hepatitis G, other virases such as the CMV (cytomegalovirus) etc.

Hepatitis cases can be severe due to the complications that might arise.

The most feared complication of viral hepatitis is fulminating hepatitis or massive hepatic necrosis (fortunately, it is a rare type of hepatitis). It is more frequently seen in cases of hepatitis B and hepatitis D. Patients usually present with symptoms of encephalopathy (brain damage). The condition can lead to a deep coma.

This type of hepatitis can also progress into cirrosis.

You should follow your doctor’s instructions and recommendations to the letter.

Pancreas Disorders

Author: Dr. Mª del Carmen Peña Cala

The pancreas can be affected by several pathologies such as cancer, endocrine tumours (hormone-related), benign tumours, etc. However, the most frequent condition is inflammation.

The main causes are alcohol and lithiasis or biliary stones, although there could be other causes as well.

What is esophagitis?

Author: Dr. Mª del Carmen Peña Cala

Esophagitis is a lesion of the esophageal mucosa that normally presents with pain and heartburn or swallowing difficulties. It is caused most frequently by reflux from the gastric or intestinal contents that reach the esophagus. Depending on the causal agent, this condition is referred to as peptic, biliar or alkaline esophagitis.

In general, the treatment of non-complicated cases includes weight loss, sleeping on a bed with an elevated head, antiacids, the elimination of factors that increase abdominal pressure and to avoid tobacco and dangerous medications.

Esophagitis can also be of a viral origin, caused by the simple herpes virus. It can also be caused by candida, as certain strains of candida are normally found in the throat and can become pathogenic under certain circumstances (diabetes, antibiotic therapy, etc.) causing, as a results, esophagitis.

Oesophageal tumours

Author: Dr. Mª del Carmen Peña Cala

A tumour is an abnormal bulging of an organ or part of the body.

Benign tumours of the esophagus account for 10% of all oesophageal tumours.

When these tumours are malignant, the patient presents progressive dysphagia (difficult deglutition) and rapid loss weight. Thoracic pain is present when the tumour has spread to perioesophageal tissues, thus, when the disease is discovered, it is usually at a very advanced stage and with a bad prognosis Survival at 5 years is around 5%, for as long as the tumour has been excised and radiotherapy and/or chemotherapy, or a combination of both, has been administered. In over 60% of patients, the treatment can only be palliative.

Hiatal hernia

Author: Dr. Mª del Carmen Peña Cala

The term “hernia” means the protrusion of an organ or part of such, or other structure, through the wall of the cavity in which it is normally contained.

A hiatal hernia is when part of the stomach is projected through the opening of the diaphragm through which the esophagus goes through.

This facilitates the passage of the gastric content towards the esophagus, causing esophagitis due to reflux in the long run. On most occasions, the symptoms get resolved with antiacids and prokinetic drugs (a medication used to accelerate the digestive transit); however, sometimes surgery is required to close the hiatal hernia (Nissen´s procedure).

The symptoms include pain, heartburn, burping, flatulence and reflux.

Gastric and duodenal ulcer

Author: Dr. Mª del Carmen Peña Cala

An ulcer is a lesion of the skin or mucosa surface with loss of substance and it is usually associated with a suppurative process.

What are gastric and duodenal ulcers?


They are very frequent ulcers.

Peptic ulcers consist in the destruction of the mucosa in the area of the stomach , and are commonly known as gastric ulcers.

Duodenal ulcers consist in the destruction of the mucosa in the area of duodenum, and are commonly known as duodenal ulcers.

When ulcers appear, their walls are exposed to the attack of digestive juices and can thus become perforated.

There are several factors that increase the risk of developing them: genetic predisposition, smoking, excessive consumption of coffee and alcohol and regular use of certain medications such as aspirin and anti-inflammatory drugs, stress and nervous tension.

They are very frequent ulcers.

Often there is chronic blood loss and more seriously, the ulcer can erode a large blood vessel causing heavy bleeding. In such a case, the patient vomits blood, haematemesis, and has deep black, sticky stools, called melenas, because the blood has been partially digested.

The possible perforation of the ulcer poses a serious and grave danger due to the release of potent chemicals and enzymes into the peritoneal cavity.

Stomach cancer

Author: Dr. Mª del Carmen Peña Cala

Cancer is the presence of a malignant tumour.

Its main characteristics are:

1.- Fatal outcome if not treated adequately.

2.- IInfiltration of adjacent tissues.

3.- After it has been eliminated, it can reappear in the same place or close by.

4.- Rapid growth with atypical mitosis (abnormal cell divisions).

5.-Inability to reproduce the structure of the tissue on which it is housed.

6.- Production of metastasis in lymph nodes or in distant organs.

Gastric or stomach cancer is one of the most frequent types of cancer in the world. The symptoms in early stages, a time when the cancer is more likely to be cured, are minimal or nul, and thus medical attention is sought when it is too late. There are no known causes, although it is believed that diet is to blame and that there might be a slight genetic component.

Diagnosis and collection of biopsy sample for histological typing is performed via fibrogastroscopy. The local study can be completed by means of an echoendoscopy.

The physical and endoscopic exploration is completed with a chest x-ray, liver panel tests, abdominal ultrasound and computerised axial tomobraphy (CAT).

Can it be cured?

At present, surgical removal of the tumour is the only way to combat the illness. A detailed and through search of signs for metastasis at a distance will prevent unnecessary surgery.

Pyloric obstruction

Author: Dr. Mª del Carmen Peña Cala

Obstruction means an interruption in the passage of solid, liquid or gaseous materials into a vessel or body duct.

In the stomach, the only significant obstruction occurs at the level of the pylorus (the pylorus is the sphincter located between the stomach and duodenum). The obstruction can be caused by excessive development of the muscular sphincter, as it occurs in babies (pyloric stenosis), or in adults as a result of scars from ulcers or neoformations in the area.

Pyloric obstruction presents with an enlargement of the gastric body, distension, slow and heavy digestion. The condition can progress to descompensated phases in which food does not reach the duodenum with resulting vomiting.

Intestinal obstruction

Author: Dr. Mª del Carmen Peña Cala

Intestinal obstruction is when the passage of liquids and food through the intestine is impeded.

If the obstruction is total or nearly complete, the liquid and food accumulate behind the obstruction.

A common characteristic of the clinical picture is vomiting that normally occurs fiercely and effortlessly, depending on the type of obstruction.

In a high obstruction, vomiting usually contains sour food and the presence of green bile, and when the obstruction is low, it commonly looks like faeces.

The abdomen is tense, showing distension of the intestine, being especially prominent in obstruction of the colon. No air or faeces are expelled.

Once the abdomen is distended, absorption of nutrients is virtually stopped and the released secretions in the intestine are not absorbed. The patient can become dehydrated very quickly.

At the level of the thin intestine, it can be caused by:

1.- Bands of fibrous tissue called adhesions, that compress the intestine from the outside. This is also known as extrinsic obstruction.

2.- Because part of the intestine can collapse through any of the natural openings of the abdominal wall, becoming obstructed as a result. Such protrusion constitutes the so called “hernia”.

3.- Tumoral pathology. At the level of the large intestine or colon, the most common cause for the obstruction is carcinoma, that could be housed at any point throughout its trajectory.

Intestinal tumours

Author: Dr. Mª del Carmen Peña Cala

A tumour is an abnormal bulging of an organ or part of the body.

Based on their histology, tumours can be classified as benign or malignant.

The intestine is formed by several layers of tissues, and tumours can originate in any part of these layers.

Within the benign tumour group, polyps are the most common.

Within the malignant tumour group, colon and rectal cancer are the most frequent, in both men and women. These tumours usually have an invasive nature and many of them are diagnosed first due to the complications they present. The treatment of colon cancer is surgical, complemented sometimes with chemotherapy and radiotherapy.

Constipation

Author: Dr. Mª del Carmen Peña Cala

Constipation means the slow or difficult passage of the intestinal content with infrequent and hard defecation.

It is due to the slow passage of the intestinal content through the colon, where an excessive amount of water is absorbed making the faeces hard and difficult to expel. It is usually symptomatic of an inadequate diet, whilst on other occasions it is due to other pathologies inherent to the colon. However, one should be cautious for the accumulation of faeces exerts pressure and that pressure can lead to a dilation of the veins resulting in painful and uncomfortable haemorrhoids.

If you are prompt to be constipated, we suggest you see your consultant, who will study the cause and will resolve your problem.

Liver disorders

Author: Dr. Mª del Carmen Peña Cala

The most common liver condition is inflammation or hepatitis, generally caused by a virus.

There are several types of viral hepatitis. The most frequent types of hepatitis are:

1.- Hepatitis A, spread by contact with contaminated food. It is not an important condition.

2.- Hepatitis B, spread by contact with infected blood or serum or by sexual contact.

3.- C-virus hepatitis, that is spread via blood.

4.- Hepatitis D, produced by the delta agent that co-infects with the virus of hepatitis B.

5.- Hepatitis E. hepatitis G, other virases such as the CMV (cytomegalovirus) etc.

Hepatitis cases can be severe due to the complications that might arise.

The most feared complication of viral hepatitis is fulminating hepatitis or massive hepatic necrosis (fortunately, it is a rare type of hepatitis). It is more frequently seen in cases of hepatitis B and hepatitis D. Patients usually present with symptoms of encephalopathy (brain damage). The condition can lead to a deep coma.

This type of hepatitis can also progress into cirrosis.

You should follow your doctor’s instructions and recommendations to the letter.

Pancreas Disorders

Author: Dr. Mª del Carmen Peña Cala

The pancreas can be affected by several pathologies such as cancer, endocrine tumours (hormone-related), benign tumours, etc. However, the most frequent condition is inflammation.

If it is not treated in time, the effects can be catastrophic due to a possible external release of pancreatic proteases due to the inflammation, thus initiating a self-digestion.

Frequents Questions

Diarrhoea

Diarrhoea is an increase in the normal frequency of defecation or a change of consistency into a more liquid form.

1.- Acute diarrhoea: When its duration is less than 3 weeks in children and adults and less than 4 weeks in nursing infants.

2.- Chronic diarrhoea: When the diarrhoea lasts more than 3 weeks in children and adults and 4 weeks in nursing infants. The evolution can be constant or intermittent.

In the majority of cases, acute diarrhoea is caused by a infectious process or after the administration of antibiotics. It is usually accompanied by other symptoms, such as:

1.- Vomiting

2.- Fever

3.- Headache

4.- Loss of appetite

5.- Muscle pain

6.- Colicky abdominal pain

7.- General malaise

Chronic diarrhoea is hard to diagnose because it can be caused by several factors:

1.- Irritable bowel syndrome is the most frequent cause of chronic diarrhoea. It usually presents in an intermittent manner and its diagnosis is based on exclusion, having to rule out other causes for the diarrhoea.

2.- Intolerance to lactose is also a frequent reason. In our setting, 10 to 15% of the population has partial intolerance to lactose.

3.- Intestinal infections can also cause chronic diarrhoea, especially those caused by parasites.

4.- Intestinal inflammatory disease is on many occasions accompanied by diarrhoea, in conjunction with blood in the stools.

5.- Diseases that cause malabsorption of nutrients are also accompanied by chronic diarrhoea, as it occurs in patients with celiac disease.

6.- Cancer of the colon in certain patients can also be accompanied by chronic diarrhoea.

7.- Microscopic colitis is a disorder of the colon in which despite a normal endoscopy, biopsy detects a considerable inflammation that produces chronic diarrhoea.

8.- Other less frequent causes are diarrhoeas that accompany other endocrine disorders, those due to drugs or food additives, or those caused by intestinal ischemia.

Diarrhoea is diagnosed by means of a blood test, a test of the faeces and, in some patients, after a colonoscopy to take a biopsy sample. Logically, the treatment will be customised depending on diagnosis.

The majority of acute diarrhoeas are autolimited (they are cured by themselves), thus diagnostic studies are only recommended in case there is a high fever, general malaise, tenesmus (constant and inefficient need to defecate), diarrhoea with blood, dehydration, or an episode of over 1 week despite symptomatic treatment. On occasions, the patient will require hospitalisation in cases of severe dehydration, uncontrollable vomiting, old age, underlying severe disease or extreme general malaise.

The treatment will consist mainly in an astringent diet, no milk or derivative milk products, and in some patients, antibiotics might be necessary to control the disease.

Abdominal Pain

The most frequent causes:

• Appendicitis

• Biliary pain

• Acute pancreatitis

• Gastric or duodenal ulcer (with penetration or perforation)

• Intestinal ischemia (lack of blood supply to the intestine)

• Diverticulitis (inflammation of the diverticulae of the colon)

• Digestive spasms

Sometimes, in women, the pain in the abdomen is not caused by the digestive system but by the reproductive system because of:

• Rupture of an ovarian cyst

• Extrauterine pregnancy

Or in both genders by:

• Nephritic colic

Or even by the heart or lungs:

• Acute myocardial infarction

• Pneumonia

The tests needed to establish diagnosis will be based upon what is suspected:

· Blood test

· Ultrasound

· Endoscopy

· Scanner

You should seek medical advice immediately whenever there is acute abdominal pain, especially if intense.

Chronic abdominal pain?

The most frequent causes are:

· Gastric or duodenal ulcer

· Chronic pancreatitis

· Chronic intestinal ischemia (chronic lack of blood supply)

· Tumours inside or outside the digestive system

· Non organic causes: pain with no evident lesion

The tests needed to establish a diagnosis will depend on the type, duration and intensity of the pain.

When a patient experiences chronic abdominal pain, it is advisable to see a doctor. If there is a lesion, it is better to diagnose the condition as soon as possible, and if there is no lesion, there will not be anything to worry about. In any case, treatment will have to be sought to alleviate the patient discomfort.

Digestive gases

1.- Swelling (or distension) of the abdomen.

2.- Excessive burping.

3.- Excessive gases.

We must remember that both burping and gases are normal processes; however, when in normal amount and in the right place.

1.- The digestive gas comes from the gas that we intake with meals and with drinks. Some foods are especially flatulent, such as white beans, chickpeas, cabbage, etc. Some drinks contain gas, such as refreshments, champagne, beer, mineral water, etc.

2.- Part of the total amount of gas is produced by the digestive tract during the reaction of the stomach acids with such substances.

3.- Furthermore, in certain diseases, the intestine is unable to absorb some sugars and an important amount of gas is produced in the intestine. This would be the case of patients with celiac disease or with deficiency to absorb lactose (dairy products), or with a bad sugar absorption.

4.- Nevertheless, the most common cause for the accumulation of intestinal gas is the excessive swallowing of air or medically known as aerofagia Naturally, this swallowing of air goes totally unnoticed by the patient. We all swallow some air when we breathe, when we speak, or when we eat. When we are nervous or when we breathe with our mouth open, we also swallow more than required Smoking, chewing gum, or eating candy dramatically increases the amount of accumulated air.

The gas is not only released through the mouth as burping and as intestinal gas but it is also absorbed (in a large amount) throughout the digestive tract reaching the blood, being transported to the lungs and eliminated through respiration. Sometimes, the gas can be retained, resulting in blotting, because intestinal movements are too slow; which would in turn cause constipation.

Incontinence

It is the repeated loss of voluntary control of anal continence.

Between 3 and 7% of the population suffers from incontinence, although the majority of affected individuals do not seek medical help because they are embarrassed or because of a lack of knowledge of current techniques.

It is more frequent in:

1.- Women.

2.- People over 65.

3.- People with mobility difficulties.

Alterations or loss of strength of the muscles or anal sphincters:

1.- Following anorectal interventions (fissures, fistulas, haemorrhoids).

2.- Multiple or difficulties deliveries.

3.- Trauma.

4.- Pulling of pelvic nerves (constipation).

Decrease of rectal sensibilityl:

1.- Dementia, old age.

2.- Medular lesions.

3.- Cerebrovascular accidents.

4.- Multiple sclerosis.

Decrease of rectal capacity:

1.- Infectious proctitis (inflammation of the rectum).

2.- Actinic proctitis (following radiotherapy).

3.- Intestinal inflammatory disease.

4.-Some rectal tumours.

1.- Detailed patient clinical history.

2.- Physical examination including a rectal palpation.

3.- Psychological support.

4.- Endoanal ultrasound to evaluate if the sphincters are damaged.

5.- Anorectal manometry to assess anorectal function.

Depending on the type and severity of the incontinence, there are several possibilities that can be applied either in combination or separately.

1.- Diet: intake of fibre and mass-forming agents.

2.- Drugs: Loporamide.

3.- Anorectal biofeedback.

4.- Reconstructive surgery or prosthetic surgery.

It is a painless, computer-based technique where patient has to follow a series of body exercises to strengthen the anal sphincters. Later on, the patient can follow these exercises at home.

Blood in Faeces

On most occasions, the patient will observe reddish blood that can appear after the defecation, embedded in the stools, or when the patient is using toilet paper. This type of bleeding is characteristic of anal pathology, as with haemorrhoids or anal fissures. Diagnosis must be confirmed by means of a careful anal exploration that will logically include a rectal digital examination and a rectoscopy. In the case that no diagnosis is established, the possibility of bleeding higher up in the colonic tract should be considered.

With less frequency, the patient can have faeces mixed with blood. This will compel us to explore the upper tract of the colon and will require an anal exploration plus colonoscopy. This technique will allow us to observe other lesions such as polyps of the colon, colon cancer or vascular lesions or intestinal inflammatory disease (such as ulcerous colitis) that can cause a bleeding of this type.

There is the possibility that the patient observes very black, sticky, tar-looking stools, characteristics of bleeding higher up the tract, normally originating in the stomach. This finding will require a gastroscopy to rule out a bleeding ulcer, for instance, a gastric ulcer.

The appearance of the stools will guide us as to the origin of the bleeding. One should not forget that a patient with haemorrhoids can also have a polyp or colon cancer. For this reason, and especially in patients over 50 or with a personal or familial history of polyps or colon cancer, it is advisable to assess the condition of the colon via endoscopy. In younger individuals and with no relevant past history, a simple anal exploration can serve as a diagnostic tool. However, if the bleeding persists, a colonoscopy should be done.

With the above in mind, if a patient sees blood repeatedly in the stools, it would be advisable to seek medical attention immediately.