John Hutchinson John Hutchinson

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.

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John Hutchinson John Hutchinson

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.

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John Hutchinson John Hutchinson

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.

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John Hutchinson John Hutchinson

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)

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John Hutchinson John Hutchinson

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.

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John Hutchinson John Hutchinson

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

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