Oesophageal Candidiasis
Candida Oesophagitis is the most common type of non-peptic inflammation of the gullet. Oesophageal candidiasis is a thrush infection of the gullet or oesophagus and is associated with numerous medical conditions or use of medications.
Candida Oesophagitis is the most common type of non-peptic inflammation of the gullet. Oesophageal candidiasis is a thrush infection of the gullet or oesophagus and is associated with numerous medical conditions or use of medications. The most common symptom it causes is difficulty swallowing or pain on swallowing and sometimes pain behind the breastbone. It is important to diagnose and treat because of the other associations. The best way to diagnose the condition is by endoscopy with biopsies.
The infection usually occurs in patients receiving either a course of antibiotics or whose immune system is suppressed by therapy for other medical conditions such as steroids. Asthmatic patients who use inhaled steroids are also at risk for this infection as are patients with HIV infection. Diabetics are also at risk and those who have obstruction to the gullet or other forms of malignancy. Patients with malnutrition are also at risk. The gullet infection may be accompanied by infection of the mouth.
At endoscopy, white plaques on a red background are seen which can progress to ulceration and more invasive diseases. Diagnosis is confirmed by a biopsy with those specimens being sent to the laboratory for confirmation.
Therapy is aimed at treating the yeast infection as well as excluding other conditions that may be associated with it. The usual treatment is Nysyatin as a first line. Amphotericin lozenges may also be prescribed. For severe and invasive cases other anti-fungal therapy such as Ketoconzole or Fluconazole may be prescribed. Patients taking antacid therapy should receive Fluconazole as it does not require acid in the stomach for absorption.
Your doctor may suggest a blood test looking for diabetes or HIV infection if that is clinically appropriate and may even investigate your immune system further if recurrent problems with this infection become evident.
Pelvic Floor Exercises
The floor of the pelvis is made up of layers of muscles and other tissues. These layers stretch like a hammock from the tailbone at the back to the pubic bone in front. A woman’s pelvic floor supports the bladder, the womb (uterus) and the bowel.
The floor of the pelvis is made up of layers of muscles and other tissues. These layers stretch like a hammock from the tailbone at the back to the pubic bone in front. A woman’s pelvic floor supports the bladder, the womb (uterus) and the bowel. The urethra (front passage), the vagina (birth canal) and the rectum (back passage) pass through the pelvic floor muscles. The pelvic muscles play an important role in bladder and bowel control and sexual sensation.
Reasons why the pelvic floor muscles may weaken include:
Pregnancy and childbirth in women
Continual straining to empty your bowels (constipation)
Persistent heavy lifting
A chronic cough (such as smokers cough, chronic bronchitis and asthma)
Being overweight
Changes in hormone levels at menopause
Lack of general fitness
It is important for women of all ages to maintain pelvic floor strength. Women with stress incontinence, that is, those who regularly lose urine when coughing, sneezing or exercising should benefit from these exercises. For pregnant women these exercises help the body to cope with the increasing weight of the baby. Healthy, fit muscles prenatally will recover more readily after the birth.
As women grow older it is important to keep the pelvic floor muscles strong because during and after menopause the muscles change and may weaken. A pelvic floor exercise routine helps to minimise the effects of menopause on pelvic support and bladder control. Pelvic floor exercise may also be useful in conjunction with a bladder training program aimed at improving bladder control in people who experience the urgent need to pass urine frequently (urge incontinence).
How to contract the pelvic floor muscles
The first thing to do is correctly identify the muscles that need to be exercised.
Sit or lay down comfortably with the muscles of your thighs, buttocks and abdomen relaxed
Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks.
When you are passing urine, try to stop the flow mid-stream then restart it. Only do this to learn which muscles are the correct ones to use and then do it no more than once a week to check your progress as this may interfere with normal bladder emptying.
If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles or are unable to even slow the stream of urine as described above, you should seek professional help to get your pelvic floor muscles working correctly. Even women with very weak pelvic floor muscles can be taught these exercises by a physiotherapist or continence advisor with experience in this area.
Good results take time. In order to build up your pelvic floor muscles to their maximum strength, you will need to work hard at these exercises. The best results are achieved by seeking help from a physiotherapist or continence advisor who will design an individual exercise program especially suited to your muscles.
There are many health professionals qualified to assist you with bladder control problems. You may seek assistance from your doctor who may offer treatment directly or refer you to a specialist or to a qualified continence advisor. You may also seek help and obtain information directly from the following sources:
Continence Foundation of Australia helpline 1800 330 066
Continence services and clinics
Continence nurse advisors
Local community health centres
Local doctors
Domiciliary nursing services
Independent living centres
Australian Physiotherapy Association
All text (only) herein is the intellectual property of Dr Melissa White. Update July 2014.
Proctitis
Proctitis is defined as an inflammation of the anus and the lining of the rectum, affecting only the last six inches of the rectum.
Proctitis is defined as an inflammation of the anus and the lining of the rectum, affecting only the last six inches of the rectum. Symptoms include:
Ineffectual straining to empty the bowels
Diarrhoea
Rectal bleeding
Involuntary spasms
Cramping during bowel movements
Left side abdominal pain
Passage of mucus through the rectum
Anorectal pain
A common symptom is a continual urge to have a bowel movement. The rectum could feel full or have constipation. Another is tenderness and mild irritation in the rectum and anal region. A serious symptom is pus and blood in the stool accompanied by cramps and pain during bowel movements. If there is severe bleeding, anaemia can also be caused showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails and shortness of breath.
Proctitis is commonly caused by auto-immune diseases of the colon (such as Crohn’s disease and Ulcerative Colitis), harmful physical agents, chemicals, foreign objects placed in the rectum, trauma to the anorectal area and sexually transmitted infections. It may also occur independently (Idiopathic Proctitis). More rare causes include damage by irradiation (e.g. cervical and prostate cancer radiation therapy) or a sexually transmitted infection such as lympogranuloma venereum and herpes Proctitis. Proctitis is also linked to stress.
Sexually transmitted Proctitis
Gonorrhoea (Gonococcal Proctitis)
The most common cause is strongly associated with anal intercourse. Symptoms include soreness, itching, bloody or pus-like discharge or diarrhoea. Other rectal problems that may be present are anal warts, anal tears, fistulas and haemorrhoids.
Chlamydia (Chlamydia Proctitis)
This accounts for approximately 20% of cases. People may show no symptoms, mild symptoms or severe symptoms. Mild symptoms include rectal pain with bowel movements, anal discharge and cramping. With severe cases people may have discharge containing blood or pus, severe rectal pain and diarrhoea. Some people suffer from rectal strictures; a narrowing of the rectal passageway. The narrowing of the passageway may cause constipation, straining and thin stools.
Herpes Simplex Virus 1 and 2 (Herpes Proctitis)
Symptoms may include multiple vesicles that rupture to form ulcers, tenesmus, rectal pain, discharge and haemotochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.
Syphilis (Syphilis Proctitis)
The symptoms are similar to other causes of infectious Proctitis including rectal pain, discharge and spasms during bowel movements. Some people have no symptoms. Syphilis occurs in three stages. The primary stage; one painless sore less than an inch across with raised borders found at the site of sexual contact, and during acute stages of infection the lymph nodes in the groin become diseased, firm and rubbery. In the secondary stage, wart-like growths resembling cauliflower are produced around the anus and rectum. The third stage occurs late in the course of syphilis and affects mostly the heart and nervous system.
Treatment
By looking inside the rectum with a proctoscope or a sigmoidoscope, Dr White can diagnose Proctitis. A biopsy is taken, in which Dr White scrapes a tiny piece of tissue from the rectum and is then sent for testing. The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient suffers from Crohn’s disease or Ulcerative Colitis, a colonoscopy or barium enema x-rays are used to examine the rest of the colon.
Treatment for Proctitis varies depending on severity and the cause. For example, Dr White may prescribe antibiotics for Proctitis caused by bacterial infection. If the Proctitis is caused by Crohn’s disease or Ulcerative Colitis, Dr White may prescribe different drugs in enema or suppository form or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications.
The Low FODMAP Approach to Diet
A Summary of FODMAP Food Sources
F - Fermentable
O - Oligosaccharides > Fructans Galactans
D - Disaccharides > Lactose
M - Monosaccharides > Fructose
A - and
P - Polyols
Patients who may benefit from following a Low FODMAP Diet are:
People that have abnormal GIT fructose/fructans/galactans handling and absorption.
30 % of Irritable Bowel Syndrome patients may benefit.
40 % of recovered Coeliac Disease patients may benefit.
There is no accurate test for this at this stage on the Sunshine Coast. There is a fructose breath test only. There is no breath test for fructans, galactans or polyols.
What can patients do?
Try a Low FODMAP Approach to Diet. The aim is to decrease dietary small chain fermentable carbohydrates and to decrease fermentation and bloating.
Initially, it is best to AVOID these foods for two months to see if you respond. All patients should at least avoid fructose and galactans. In the long term you may be able to just limit these foods. Some patients benefit from a clinical review and dietary discussion with Dr White for specific advice.
This is NOT a gluten free diet. Gluten is NOT the issue.
Summary of FODMAP Food Sources
-
AVOID these foods containing excess FRUCTOSE. Limit concentrated fruit sources, such as large serves of fruit at one sitting (Dried Fruit, Wine, Fruit Juice):
Apple
Pear
Mango
Watermelon
Clingstone Peaches
Sugar snap peas
Broad beans
Nashi Pears
Dried Fruits
Tinned fruit – in natural juice
Honey
High fructose corn syrup
Wine (sweet, rose, cider)
Rum
Cider vinegar/Molasses
BBQ Sauce/Ketchup/Chutneys
LIMIT these foods to the amount stated in the brackets ( ):
Asparagus (1)
Artichoke (1/4 cup)
Cherries (2)
Boysenberries (4)
Figs (2)
-
FRUITS
AVOID these:
Watermelon
Peaches (white)
Nectarines
Dates
Persimmon
Tamarillo
LIMIT these to the amounts shown in brackets ( ):
Grapefruit (½)
Pomegranate (½)
Rambutan (2)
Figs (2)
VEGETABLES
AVOID these:
Onion family (white and brown)
Spring onion (white part)
Leeks
Spanish shallots
Garlic
Onion and garlic salt/powders
Squash
LIMIT these to the amounts shown in brackets ( ):
Broccoli (up to 1/4 cup)
Cabbage (up to ½ cup)
Beetroot (up to 4 slices)
Artichoke (up to ¼ cup)
Fennel (up to ½ cup)
Green beans (up to 6)
Asparagus (up to 2)
Snow peas (up to 6)
Sweet corn (up to ½ cob)
Brussel sprouts (up to ½ cup
BREADS / CEREALS
AVOID these:
Wheat (in large amounts), eg: bread, pastas
Couscous
Rye bread (in large amounts )
Muesli/Fruit bars
LIMIT
Crackers (up to 3) and Biscuits (up to 3)
Barley
Chia seeds
Wheat bran
-
LEGUMES
AVOID these:
Chick Peas / hummus
Baked beans
Savoy cabbage
Soy beans/soy milk
Split peas
Haricot beans
Okra
Kidney beans
Lima/Berlotti beans
Custard Apples
LIMIT these to the amounts shown in brackets ( ):
Lentils (up to ¼ cup)
Peas (up to ¼ cup)
Green Beans (up to 6)
OTHER
AVOID these:
Inulin (a fibre in some dairy products including probiotics)
Cashews
Pistachios
Tahini and Tzatziki
Dandelion tea
Ecco, Caro
Chicory
Soy Milk
Whey powder
LIMIT
Almonds to < 10
-
Avoid/Limit foods containing lactose ONLY if you are lactose intolerant. You can be tested for this by having an endoscopy with biopsies or a breath test.
AVOID these:
Cow’s milk – regular and low fat
Goats Milk / Sheep’s Milk
Ice Cream – regular and low fat
Butter Milk
Yoghurt – regular and low fat
Mascarpone/Ricotta
Custard Haloumi
Cream – including sour cream
A2 Milk
Condensed Milk
Processed cheese
Most people can tolerate 1/3 cup milk per day for coffee/tea/cooking.
LIMIT
Cottage Cheese (< 4 tablespoons)
-
SORBITOL
AVOID these:
Apples
Pears
Apricots
Broccoli
Nectarines
Clingstone Peaches
Peaches/Plums
Prunes
Blackberries
Pomegranate
LIMIT these to the amounts shown in brackets ( ):
Avocado (½)
Cherries (up to 2)
Lychees (up to 4)
MANNITOL
AVOID these:
Mushrooms
Cauliflower
Watermelon
Coconut Cream
Isomalt/Xylitol
Guava
Any diet products (eg: mayonnaise, sauces)
LIMIT these to the amounts shown in brackets ( ):
Snow peas (4)
Celery (½ stalk)
Sweet Potato (½ cup)
Coconut Milk (½ cup)
Ulcerative Colitis
Inflammatory Bowel Disease (IBD) is a medical term that describes a group of conditions in which the intestines become inflamed (red and swollen). Two major types of IBD are Crohn’s disease and Ulcerative Colitis.
Inflammatory Bowel Disease (IBD) is a medical term that describes a group of conditions in which the intestines become inflamed (red and swollen). Two major types of IBD are Crohn’s disease and Ulcerative Colitis.
Ulcerative Colitis affects the large intestine (colon) whereas Crohn’s disease can occur in any part of the intestines. No one knows for certain yet what causes IBD but it is believed to be a combination of genetic, environmental and immunological factors. Exposure to environmental triggers – possibly but not necessarily viruses, bacteria and/or proteins or a combination of such triggers prompts the immune system to switch on its normal defence mechanism (inflammation) against a foreign substance. In most people, this immune response gradually winds down once the foreign substance is destroyed. In some people (possibly those with a genetic susceptibility to IBD), the immune system fails to react to the usual ‘switch off’ signals so the inflammation continues unchecked. Prolonged inflammation eventually damages the walls of the gastrointestinal tract and causes the symptoms of IBD.
The ways in which IBD affects a person with the condition is highly variable. It depends on where the disease is located in the gastrointestinal tract and how severe the inflammation is within the affected area. Symptoms of IBD may range from mild to severe but tend to include the following:
Abdominal cramps and pains
Frequent, watery diarrhoea (may be bloody)
Severe urgency to have a bowel movement
Fever during active stages of disease
Loss of appetite and weight loss
Tiredness and fatigue
Anaemia (due to blood loss)
A small percentage of people with IBD may also experience problems outside the gastrointestinal tract including joint pain, skin conditions, eye inflammation, liver disorders and thinning of the bones (osteoporosis). Although IBD is a chronic (ongoing) condition, symptoms may come and go depending on the presence and degree of inflammation in the gastrointestinal tract. When inflammation is severe, the disease is considered to be in an active stage. When inflammation is less (or absent), symptoms may disappear altogether and the disease is considered to be in remission. For most people with IBD, the usual course of disease involves periods of remission interspersed with occasional flare-ups.
IBD cannot be cured as yet but it can be managed effectively, especially with the use of medications to control the abnormal inflammatory response. Controlling inflammation allows the intestinal tissues to heal and relieves the symptoms of abdominal pain and diarrhoea. Types of medications most commonly used to manage IBD include aminosalicylates, corticosteroids, immunomodulators, biological agents and antibiotics.
In ulcerative colitis, inflammation occurs on the lining (mucosa) of the large intestine or colon. The inflammation is usually located in the rectum and lower colon but may involve other parts of the colon and sometimes even the entire colon. Tiny open sores or ulcers form on the surface of the lining and these may bleed. The inflamed lining also produces a larger than normal amount of intestinal lubricant or mucus which sometimes contain pus. Inflammation in the colon reduces its ability to reabsorb fluid from the faeces which causes diarrhoea. Inflammation in the rectum can lead to a sense of urgency to a bowel movement.
Long term management with small doses of medication are the aim of treatment to achieve remission. It is believed that this reduces your risk of bowel cancer. Long term care by Dr White or your gastroenterologist is essential. Eventually, reviews are yearly.
What you CAN eat on a Low FODMAP Diet
Are you on a Low FODMAP diet?
Here is a list of foods YOU CAN EAT:
FRUITS:
Banana
Strawberry
Grapes
Orange/Mandarin
Pineapple
Kiwi Fruit
Passionfruit
Paw Paw
Lime/Lemon
Cranberries/Blueberries/Raspberries/Loganberries
Rhubarb
Star anise
Tangelo
Dragon fruit
And you are allowed a small amount of these (up to)
Grapefruit (½)
Cherries (3)
Lychees (4)
Rambutan (3)
Boysenberry (4)
Dried banana chips (10)
VEGETABLES
Potato
Pumpkin (Jap)
Tomato
Zucchini
Carrot
Cucumber
Capsicum
Iceberg lettuce
Cabbage/Spinach
Eggplant/Parsnip
Olives
Spring onions – green part
Choko/Kale
Radicchio/Radish
Choy sum/Bok Choy
Alfalfa/Silver beet/pickles
Bamboo shoots Bean shoots/sprouts
Endive
Squash
Witlof
Okra
Water chestnuts
Taro
Turnip
And you are allowed a small amount of these (up to)
Broccoli (½ cup)
Sweet Potato (½ cup)
Butternut Pumpkin (1/4 cup)
Avocado (1/3)
Celery (½ stick)
Green beans (6)
Artichoke (1/4)
Beetroot (4 slices)
Peas (½ cup)
Snow peas (10)
Fennel (½ cup)
Corn (½ cob)
GRAINS/SEEDS/NUTS
Oats
Psyllium
100% Spelt bread/Sourdough
Gluten Free bread/pasta/flour
Buckwheat
Rice - noodles/puffed/cakes
Cornflour/Corn flakes/Corn biscuits
Muesli – wheat free, fruit free
Quinoa/Polenta
Tapioca
Millet/Sorghum
Arrowroot flour
Nuts (< 1 handful) – peanut/pecan/hazelnut/macadamia/walnut
Seeds – sesame/sunflower
DAIRY
Hard cheese
Camembert/Brie/Feta
Lactose free milk
Yoghurt low fat/Ice-cream low fat
Almond milk
Rice milk
Soy milk (only if made from soy protein NOT whole soy beans)
Oat milk
OTHER FOODS
Normal table sugar
Meat/Chicken/Fish
Eggs
Olive oil (including garlic infused)
Herbs – Basil/Dill/Coriander/Chilli/Ginger/Lemongrass/Chives/Cumin/ Cinnamon/Mint/Marjoram/Oregano/Parsley/Rosemary/Thyme
Vinegar/Balsamic
Tofu/Tempeh
Soy sauce/Hoisin Sauce/Oyster Sauce
Vegemite/Peanut Butter
Pickles/Mustard
Golden syrup/Treacle
Turmeric/Wasabi/Seaweed
Dry coconut (1/4 cup)
Asafoetida powder (onion-like powder)
Pretzels (½ cup)
Potato crisps
Quorn mince