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If a problem with the biliary system is suspected by your healthcare provider, an ERCP may be recommended. This endoscopic retrograde cholangiopancreatography is a type of endoscopic imaging test that allows for evaluating the bile ducts and the pancreatic ducts. In general before the procedure, we recommend to not eat anything for eight hours prior to. Blood thinner should be held for an appropriate length of time determined by your endoscopist. Any allergies (especially to contrast) should be reported prior to the procedure date. A small tube with a camera on the end is passed through the mouth, down the throat and into the small intestine while you are under sedation. It is through this small tube that even-smaller instruments are passed to reach the bile duct or pancreatic duct, depending on the issue at hand. Contrast is then injected into the ducts to help visualize your biliary tree or pancreatic duct on X-ray. Primarily, blockages from gall stones, tumors or scar tissue are then able to be found and treated in real time. Following the procedure, you should have your driver bring you home. Anesthesia may take up to 24 hours to wear off. Sore throat, a bloated stomach and nausea may occur immediately after, but is generally mild and wears off quickly.

Anal fissures are small tears in the lining of the anal canal, while hemorrhoids are dilated blood vessels that occur both inside the rectum as well as outside. Internal hemorrhoids typically present with itching, pressure or bleeding, while external hemorrhoids typically present with pain and swelling. Occasionally, internal hemorrhoids can prolapse or push to the outside. This typically occurs with more severe hemorrhoidal disease. Internal and external hemorrhoids can be treated with medication. If this is ineffective, we perform a procedure called hemorrhoidal banding here at GIS to disrupt the blood flow to the hemorrhoid and create a scar tissue in its place. It's extremely effective to manage internal hemorrhoids. If all else fails, hemorrhoids can be managed surgically.

Female patients require a unique approach due to their complicated anatomy and unique experiences (such as pregnancy and child-birth) that affect the pelvic floor. Occasionally, the muscles of the pelvic floor become uncoordinated, leading to symptoms such as constipation, straining or heaviness. Rarely, pelvic organ prolapse can occur if these muscles become too weak. Addressing the issues that arise from pelvic floor dysfunction requires an experienced team, a thorough history and physical exam, and usually multiple diagnostic modalities. All of the information obtained from these studies leads to a custom formulated plan to address your specific issues. This may include medications, pelvic floor physical therapy or a surgical referral if this is felt necessary.

In addition to developing and maintaining a healthy lifestyle with proper diet, exercise and bowel habits, laxatives may still be warranted when suffering from constipation. Over-the-counter options ( such as MiraLAX® or osmotic agents) can be safe and beneficial if used as directed, and work by pulling fluid into the intestine and stool to help the stool be softer and increase the amount of bowel movements. Stool softeners may be helpful in reducing the need to strain when having a bowel movement, such as in cases after surgery or child-birth. Stimulant laxatives make the intestines contract or squeeze and move the stool along. In general when considering a laxative, you should always discuss with your healthcare provider or gastroenterologist who may consider other health concerns that may require caution with certain medications.

While constipation can be a normal experience for most people with certain life events like with travel or changes in your diet, you should speak to your provider about your constipation if any of these following alarm signs are present: if the constipation is lasting more than three weeks, if the symptoms are really bad or disabling, stomach pain whenever you pass stool, changes in the stool caliber like the stool becoming thinner, blood in your stool, black stools, any signs of anemia like low iron in the blood, weakness, fatigue or any weight loss without trying. When you speak with your doctor, be sure to tell them about all medications, including over-the-counter medications you're taking. Your doctor or healthcare provider will decide if tests are needed to find out if the constipation is a symptom of an underlying health problem.