Medicurio

A wound infection occurs when germs, such as bacteria, grow within the damaged skin of a wound. Symptoms can include increasing pain, swelling, and redness. More severe infections may cause nausea, chills, or fever.

A person may be able to treat minor wound infections at home. However, people with more severe or persistent wound infections should seek medical attention.

An infected wound is a localized defect or excavation of the skin or underlying soft tissue in which pathogenic organisms have invaded into viable tissue surrounding the wound. Infection of the wound triggers the body’s immune response, causing inflammation and tissue damage, as well as slowing the healing process. Many infections will be self-contained and resolve on their own, such as a scratch or infected hair follicle. Other infections, if left untreated, can become more severe and require medical intervention.

The skin is the body’s first line of defense, the surface of which is protected by a thin, acid film produced by the sebaceous glands called the acid mantle. This acid mantle is a dynamic barrier that regulates the skin’s pH and maintains microorganisms called the normal flora that help prevent pathogens from entering the body. Pathogens will often displace some of the normal flora and colonize certain locations, but most of the time this does not lead to infection and does not stimulate an immune response. However, when the skin is broken or if the immune system becomes compromised, any of the microorganisms colonizing the skin or introduced to the wound can cause an infection. The microorganisms likely to infect a wound depend predominantly on what microorganisms are present on the skin, as well as the depth and location of the wound.

Etiology

Most infected wounds are caused by bacterial colonization, originating either from the normal flora on the skin, or bacteria from other parts of the body or the outside environment. The most common infection-causing bacteria is Staphylococcus aureus and other types of staphylococci.

Wound infections are caused by the deposition and multiplication of microorganisms in the surgical site of a susceptible host. There are a number of ways microorganisms can get into wounds.

• Direct contact – transfer from surgical equipment or the hands of the surgeons or nurses
• Airborne dispersal – surrounding air contaminated with micro-organisms that deposit onto the wound
• Self-contamination – physical migration of the patient’s own endogenous flora which is present on the skin, mucous membranes or gastrointestinal tract to the surgical site.

What defines a surgical wound infection?

A surgical wound/site infection is defined by the following criteria. Infection must occur within 30 days of the surgical operation, and at least one of the following must occur:

• Purulent discharge from the surgical site
• Purulent discharge from wound or drain placed in the wound
• Organisms isolated from the aseptically obtained wound culture
• Must be at least one of the signs and symptoms of infection – pain or tenderness, localised swelling, or redness/heat.

Other signs of wound infection include:

• Delayed healing not previously anticipated.
• Discolouration of tissues both within and at the wound margins.
• Abnormal smell coming from the wound site.
• Friable, bleeding granulation tissue despite appropriate care and management.
• Lymphangitis, a red line originating from the wound and leading to swollen tender lymph glands draining the affected area.

Surgical site infections do not include a stitch abscess, episiotomy infection, newborn circumcision scar, or infected thermal burn wound.

Symptoms of Infected Wounds

People can usually safely treat small wounds, such as minor cuts and scratches, at home. With proper care, most small wounds will gradually get better until they fully heal.

If a wound becomes infected, however, it can get worse instead of better. Any pain, redness, and swelling will typically increase in intensity.

Wound infections can also lead to other symptoms, such as:

• warm skin around the wound
• yellow or green discharge coming from the wound
• the wound giving off an unpleasant odor
• red streaks on the skin around the wound
• fever and chills
• aches and pains
• nausea
• vomiting

Risk factors

Cuts, grazes, and other breaks in the skin can become infected when bacteria enter the wound and begin to multiply. The bacteria may come from the surrounding skin, the external environment, or the object that caused the injury.

It is important to clean and protect the wound properly to reduce the risk of infection.

The risk of wound infection is higher if:

• the wound is large, deep, or has a jagged edge
• dirt or foreign particles entered the wound
• the cause of the wound was a bite from an animal or another person
• the cause of the wound was an injury involving a dirty, rusty, or contaminated object

Certain health conditions and environmental factors can also increase the risk of infection. These include:

• diabetes
• poor blood circulation
• a weakened immune system, such as in people living with HIV or those taking immunosuppressant medications
• lack of mobility, for example, in people who spend most of their time in bed
• advancing age — older adults are more at risk of wound infection
• nutrient and vitamin deficiencies

Rarely, incision wounds from surgical procedures can also become infected.

Complications

If a person does not receive treatment for a wound infection, it can spread to other parts of the body, which may lead to serious complications, including:

• Cellulitis is an infection of the deeper layers and tissues of the skin, and it can cause swelling, redness, and pain in the affected area. Other symptoms can include fever, dizziness, and nausea and vomiting.
• Osteomyelitis is a bacterial infection of the bone, and symptoms include pain, redness, and swelling around the infected area. Fatigue and fever are other symptoms that may affect those with osteomyelitis.
• Sepsis is an extreme immune reaction that can sometimes occur when an infection enters the bloodstream. Sepsis can lead to multiple organ failure and is life-threatening. According to the CDCTrusted Source, nearly 270,000 people in the U.S. die each year due to sepsis.
• Necrotizing fasciitis is a rare condition that occurs when a bacterial infection spreads into a tissue called the fascial lining that lies deep beneath the skin. Necrotizing fasciitis is a medical emergency that causes severe skin damage and pain and can spread throughout the body.

When to see a doctor

A person with a wound should seek medical attention if:

• the wound is large, deep, or has jagged edges
• the edges of the wound do not stay together
• symptoms of infection occur, such as fever, increasing pain or redness, or discharge from the wound
• it is not possible to clean the wound properly or remove all debris, such as glass or gravel
• the cause of the wound was a bite or an injury from a dirty, rusty, or contaminated object

Seek urgent medical attention if blood is spurting from the wound or if applying pressure to the wound does not stop the bleeding.

Diagnostic Studies

• Bacterial culture
• Gram stain
• Antimicrobial susceptibility
• Fungal culture
• Blood culture

Treatments & Interventions for Infected Wounds

The following precautions can help minimize the risk of developing infected wounds in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Prompt and proper wound cleansing to reduce bioburden
• Maintaining proper nutrition and hydration

Approaches to treatment can be broken down by whether the infection is systemic or localized just to the wound area. Systemic treatment often will call for oral antibiotics, the specific type determined by microbiological investigation and local infection control protocols.

Localized infections can often be treated with topical antibiotics. Drainage or debridement may be necessary to remove slough and devitalized tissue, as these slow wound healing and can affect the efficiency of topical antibiotics. Antimicbrobial dressings, including those that use silver technology, may be used to help reduce bioburden. Antibiotics, whether topical or systemic, should only be used under the explicit direction of a physician.

How are wound infections prevented?

The goal of wound infection management is to prevent or minimise the risk of infection. The following factors or methods external to the patient are used to prevent infection.

Theatre environment and care of instruments

• Maintain positive pressure ventilation of operating theatre
• Laminar airflow in high-risk areas
• Sterilisation of surgical instruments, sutures etc according to guidelines

Surgical team members educated in aseptic technique

• Staff with infections excluded from duty
• Scrubbing up followed by appropriate sterile attire

Techniques applied to the patient to prevent wound infections include:

• Skin preparation
• Wound cleansing
• Antibiotic prophylaxis
• Good surgical technique.

Antiseptic wound cleansers are adequate for clean wounds or lightly contaminated wounds. Antibiotic prophylaxis may be indicated for clean-contaminated wounds and is usually recommended for contaminated wounds. Antibiotics for dirty wounds are part of the treatment because the infection is already established. When deciding on a prophylactic antibiotic consider the following:

• Use an antibiotic based on likely bacteria to cause infection
• An antibiotic should have good tissue penetration to reach wound involved
• Timing and duration of antibiotic – it is important that therapeutic concentrations are reached at the time of the incision, throughout the surgical procedure and ideally a few hours postoperatively.

Wound infection can complicate illness, cause anxiety, increase patient discomfort and lead to death. It is estimated that surgical wound infections result in an increased length of hospital stay by about 7–10 days. Hence the prevention and management of wound infection have a major impact on both patient health and health economics.

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A skin ulcer is an open wound that develops on the skin as a result of injury, poor circulation, or pressure.

Skin ulcers can take a very long time to heal. If left untreated, they can become infected and cause other medical complications.

These ulcers can form on any area of the skin. Depending on the type, they are especially common on the legs, mouth or lips, hips, and bottom.

A skin ulcer is an open sore caused by poor blood flow.

Good blood flow is necessary for wound healing. But if you have blood circulation problems, minor injuries can’t heal properly. Over time, an injury can turn into a skin ulcer.

If an ulcer becomes infected, it should be treated quickly. Infected sores are serious because the infection can spread throughout the body.

Often, skin ulcers affect the legs. Up to 3 in 1,000 peopleTrusted Source have active leg ulcers. They can also show up on the feet, back, and hips. Skin ulcers are more common in older people.

Your symptoms, treatment, and recovery will depend on the specific cause of your ulcer.

Types of skin ulcer

People can develop the following types of skin ulcer:

Venous skin ulcers

Venous skin ulcers are shallow, open sores that develop in the skin of the lower leg as a result of poor blood circulation.

Damage to the valves inside leg veins prevents blood from returning to the heart. Instead, blood collects in the lower legs, causing them to swell. This swelling puts pressure on the skin, which can cause ulcers.

Arterial (ischemic) skin ulcers

Arterial ulcers occur when the arteries fail to deliver enough oxygen-rich blood to the lower limbs. Without a steady supply of oxygen, the tissues die and an ulcer develops.

Arterial ulcers can form on the outside of the ankle, feet, and toes.

Neuropathic skin ulcers

Neuropathic skin ulcers are a common complication of uncontrolled diabetes. Over time, elevated blood glucose levels can cause nerve damage, which results in a reduced or total loss of feeling in the hands and feet.

This condition is called neuropathy, and it occurs in approximately 60–70 percentTrusted Source of people with diabetes.

Neuropathic skin ulcers develop from smaller wounds, such as blisters or small cuts. A person with diabetes-associated neuropathy might not realize that they have an ulcer until it starts leaking fluid or becomes infected, in which case they may notice a distinct odor.

Bedsores or pressure ulcers

Decubitus ulcers, also called pressure sores or bedsores, occur as a result of constant pressure or friction on the skin.

Skin tissues can withstand a maximum pressure of 30–32 millimeters of mercuryTrusted Source. Any increase in pressure beyond this range can lead to poor circulation, tissue death, and eventually ulcer formation.

If left untreated, decubitus ulcers can cause damage to tendons, ligaments, and muscles tissue.

Buruli ulcer

Buruli ulcer is a medical condition caused by the Mycobacterium ulcerans bacteria. An infection with this bacteria can form large ulcers on the arms and legs.

If left untreated, Buruli ulcer can result in permanent physical damage and disability.

Stasis dermatitis

Stasis dermatitis, or gravitational dermatitis, is a condition that causes inflammation, irritated skin, and ulcers on the legs. It is the result of fluid buildup due to poor circulation.

According to the National Eczema Association, stasis dermatitis is more common in women than men and people over the age of 50.

causes

Skin ulcers happen when there’s a problem with blood circulation. Causes of poor blood flow include:

Diabetes

Diabetes is a disease that causes high blood sugar. Over time, high blood sugar can lead to nerve damage called peripheral neuropathy. You may lose sense of touch in your feet and legs.

Since you can’t feel pain or pressure, you won’t feel injuries on your legs or feet. High blood sugar also slows down wound healing.

If left untreated, injuries can turn into skin ulcers.

Atherosclerosis

Atherosclerosis, or arteriosclerosis, occurs when the arteries become narrow due to fat buildup called plaque.

Normally, the arteries deliver blood throughout the body. But when the arteries narrow, they can’t properly circulate blood.

If part of your body doesn’t get enough blood, the skin tissue breaks down and forms a sore.

You’re more likely to develop atherosclerosis if you have diabetes.

Pressure

If you stay in one position for too long, the constant pressure will squeeze your blood vessels.

This blocks blood flow to skin tissue. Eventually, the skin dies and develops an ulcer.

Venous insufficiency

Venous insufficiency occurs when your veins can’t send blood from your legs to your heart. Blood collects in your leg veins, which leads to swelling.

If the swelling is severe, it can put pressure on your skin and cause ulcers.

Causes of venous insufficiency include varicose veins and blood clots.

symptoms

Skin ulcers look like round, open sores. They range in severity and are usually minor injuries on the skin.

In severe cases, ulcers can become deep wounds that extend through muscle tissue, leaving bones and joints exposed.

The symptoms of skin ulcers include:

• discoloration of the skin
• itching
• scabbing
• swelling of the skin near the ulcer
• dry or flaky skin around the ulcer
• pain or tenderness near the affected area
• clear, bloody, or pus-filled discharge from the ulcer
• a foul odor coming from the area
• hair loss near the ulcer

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diagnosis

A doctor can perform different tests to diagnose your sore. This might include:

• Medical history. This information can help your doctor better understand your symptoms.
• Physical exam. Your doctor will examine the size and depth of your sore, and look for blood, fluid, or pus.
• Blood test. If your ulcer is infected, a blood panel will show how your body is fighting the infection. A blood test can also show underlying problems.
• Tissue or fluid culture. This test can determine what kind of bacteria is causing your infection so your doctor can prescribe the right antibiotics.
• Imaging tests. An X-ray, CT scan, or MRI helps your doctor look at the tissue and bone under the sore.

Complications

If a person does not receive treatment, skin ulcers can progress into chronic wounds or dangerous infections.

Some complications of untreated skin ulcers include:

• cellulitis, a bacterial infection affecting deep layers of skin and soft tissue
• septicemia, or blood poisoning from a bacterial infection
• infections in the bone of joints
• gangrene, which is tissue death as a result of poor blood supply

Risk factors of skin ulcers

You’re more likely to get skin ulcers if you have certain risk factors. These include:

• Pregnancy. During pregnancy, hormonal changes and increased blood volume may cause leg vein problems.
• Cigarette smoking. Tobacco smoke hardens your arteries and disrupts proper blood flow.
• Limited mobility. Being bedridden, paralyzed, or using a wheelchair puts your skin under constant pressure. Leg injuries and arthritis can limit your movement.
• Increasing age. Age is linked to atherosclerosis and venous insufficiency.
• High blood pressure. Hypertension, or high blood pressure, damages the arteries and disrupts blood flow.
• High blood cholesterol. High cholesterol increases narrowing and oxidative stress in the arteries, which disrupts blood flow.
• Obesity. Obesity raises your risk for diabetes, atherosclerosis, and increased pressure in your leg veins.
• History of blood clots. If you’re prone to blood clots, you’re more likely to have blood flow issues.

Skin ulcers treatment

The goal of skin ulcer treatment is to heal the wound, reduce pain, and treat any infection. Your treatment may include:

Dressing

Dressings protect the wound and keep it clean. This promotes healing and prevents infection.

The type of dressing depends on your ulcer and your doctor’s preference. Examples include moist dressings, hydrogels, hydrocolloids, collagen wound dressings, and antimicrobial dressings.

Always follow your doctor’s instructions. They’ll explain how to clean the ulcer and change the dressing.

Antibiotics

If your ulcer is infected, you’ll need antibiotic ointment. If the infection has reached deeper tissue or bone, you’ll receive oral antibiotics.

Your doctor may prescribe antibiotics even if your ulcer isn’t infected. The antibiotics will reduce the risk of infection.

Pain medication

At first, changing the dressing will be painful. A doctor can prescribe medication to control the pain. The ulcer will be less painful as it gets better.

If you can’t feel pain or pressure, you likely won’t need pain medication.

Surgery

Typically, noninfected skin ulcers don’t need surgery.

If other treatments don’t work, or if you have a large sore, you might need a skin graft. This will close the wound and help proper healing.

Surgery may also be done to remove pressure by shaving away bone.

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Appendicitis happens when your appendix becomes inflamed. It can be acute or chronic.

In the United States, appendicitis is the most common cause of abdominal pain resulting in surgery. Over 5 percent of Americans experience it at some point in their lives.

If left untreated, appendicitis can cause your appendix to burst. This can cause bacteria to spill into your abdominal cavity, which can be serious and sometimes fatal.

Read on to learn more about the symptoms, diagnosis, and treatment for appendicitis.

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

Causes

In many cases, the exact cause of appendicitis is unknown. Experts believe it develops when part of the appendix becomes obstructed, or blocked.

Many things can potentially block your appendix, including:

• a buildup of hardened stool
• enlarged lymphoid follicles
• intestinal worms
• traumatic injury
• tumors

When your appendix becomes blocked, bacteria can multiply inside it. This can lead to the formation of pus and swelling, which can cause painful pressure in your abdomen.

Other conditions can also cause abdominal pain. Click here to read about other potential causes of pain in your lower right abdomen.

Symptoms

Signs and symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower abdomen
• Sudden pain that begins around your navel and often shifts to your lower right abdomen
• Pain that worsens if you cough, walk or make other jarring movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the illness progresses
• Constipation or diarrhea
• Abdominal bloating
• Flatulence

The site of your pain may vary, depending on your age and the position of your appendix. When you’re pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

When to see a doctor

Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention

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Complications

Appendicitis can cause serious complications, such as:

• A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
• A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you’re given antibiotics to clear the infection. Once the infection is clear, you’ll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

Diagnosis

Diagnosing appendicitis can be tricky. Symptoms  are often unclear or similar to those of other illnesses, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, kidney stones, intestinal infection, and ovary problems.

These tests can help diagnose appendicitis:

• Examination of your abdomen to look for inflammation
• Urine (pee) test to rule out a urinary tract infection
• Rectal exam
• Blood test to see whether your body is fighting an infection
• CT scans
• Ultrasound

Tests for appendicitis

If your doctor suspects you might have appendicitis, they will perform a physical exam. They will check for tenderness in the lower right part of your abdomen and swelling or rigidity.

Depending on the results of your physical exam, your doctor may order one or more tests to check for signs of appendicitis or rule out other potential causes of your symptoms.

There’s no single test available to diagnose appendicitis. If your doctor can’t identify any other causes of your symptoms, they may diagnose the cause as appendicitis.

Complete blood count

To check for signs of infection, your doctor may order a complete blood count (CBC). To conduct this test, they will collect a sample of your blood and send it to a lab for analysis.

Appendicitis is often accompanied by bacterial infection. An infection in your urinary tract or other abdominal organs may also cause symptoms similar to those of appendicitis.

Urine tests

To rule out urinary tract infection or kidney stones as a potential cause of your symptoms, your doctor may use urinalysis. This is also known as a urine test.

Your doctor will collect a sample of your urine that will be examined in a lab.

Pregnancy test

Ectopic pregnancy can be mistaken for appendicitis. It happens when a fertilized egg implants itself in a fallopian tube, rather than the uterus. This can be a medical emergency.

If your doctor suspects you might have an ectopic pregnancy, they may perform a pregnancy test. To conduct this test, they will collect a sample of your urine or blood. They may also use a transvaginal ultrasound to learn where the fertilized egg has implanted.

Pelvic exam

If you’re female, your symptoms might be caused by pelvic inflammatory disease, an ovarian cyst, or another condition affecting your reproductive organs.

To examine your reproductive organs, your doctor may perform a pelvic exam.

During this exam, they will visually inspect your vagina, vulva, and cervix. They will also manually inspect your uterus and ovaries. They may collect a sample of tissue for testing.

Abdominal imaging tests

To check for inflammation of your appendix, your doctor might order imaging tests of your abdomen. This can also help them identify other potential causes of your symptoms, such as an abdominal abscess or fecal impaction.

Your doctor may order one or more of the following imaging tests:

• abdominal ultrasound
• abdominal X-ray
• abdominal CT scan
• abdominal MRI scan

In some cases, you might need to stop eating food for a period of time before your test. Your doctor can help you learn how to prepare for it.

Chest imaging tests

Pneumonia in the lower right lobe of your lungs can also cause symptoms similar to appendicitis.

If your doctor thinks you might have pneumonia, they will likely order a chest X-ray. They may also order a CT scan to create detailed images of your lungs

Treatment

Appendicitis is almost always treated as an emergency.  Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis.

Generally, if your doctor suspects that you have appendicitis, they will quickly remove it to avoid a rupture. If you have an abscess, you may get two procedures: one to drain the abscess of pus and fluid, and a later one to take out the appendix. But some research shows that treating acute appendicitis with antibiotics may help you avoid surgery.

Depending on your condition, your doctor’s recommended treatment plan for appendicitis may include one or more of the following:

• surgery to remove your appendix
• needle drainage or surgery to drain an abscess
• antibiotics
• pain relievers
• IV fluids
• liquid diet

In rare cases, appendicitis may get better without surgery. But in most cases, you will need surgery to remove your appendix. This is known as an appendectomy.

If you have an abscess that hasn’t ruptured, your doctor may treat the abscess before you undergo surgery. To start, they will give you antibiotics. Then they will use a needle to drain the abscess of pus.

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Surgery for appendicitis

To treat appendicitis, your doctor may use a type of surgery known as appendectomy. During this procedure, they will remove your appendix. If your appendix has burst, they will also clean out your abdominal cavity.

In some cases, your doctor may use laparoscopy to perform minimally invasive surgery. In other cases, they may have to use open surgery to remove your appendix.

Like any surgery, there are some risks associated with appendectomy. However, the risks of appendectomy are smaller than the risks of untreated appendicitis.

Acute appendicitis

Acute appendicitis is a severe and sudden case of appendicitis. The symptoms tend to develop quickly over the course of one to two daysTrusted Source.

It requires immediate medical treatment. If left untreated, it can cause your appendix to rupture. This can be a serious and even fatal complication.

Acute appendicitis is more common than chronic appendicitis.

Chronic appendicitis

Chronic appendicitis is less common than acute appendicitis. In chronic cases of appendicitis, the symptoms may be relatively mild. They may disappear before reappearing again over a period of weeks, months, or even years.

This type of appendicitis can be challenging to diagnose. Sometimes, it’s not diagnosed until it develops into acute appendicitis.

Chronic appendicitis can be dangerous.

Appendicitis in kids

An estimated 70,000 children experience appendicitis every year in the United States. Although it’s most common in people between the ages of 15 and 30 years old, it can develop at any age.

In children and teenagers, appendicitis often causes a stomachache near the navel. This pain may eventually become more severe and move to the lower right side of your child’s abdomen.

Your child may also:

• lose their appetite
• develop a fever
• feel nauseous
• vomit

If your child develops symptoms of appendicitis, contact their doctor right away.

Recovery time for appendicitis

Your recovery time for appendicitis will depend on multiple factors, including:

• your overall health
• whether or not you develop complications from appendicitis or surgery
• the specific type of treatments you receive

If you have laparoscopic surgery to remove your appendix, you may be discharged from the hospital a few hours after you finish surgery or the next day.

If you have open surgery, you will likely need to spend more time in the hospital to recover afterward. Open surgery is more invasive than laparoscopic surgery and typically requires more follow-up care.

Before you leave the hospital, your healthcare provider can help you learn how to care for your incision sites. They may prescribe antibiotics or pain relievers to support your recovery process. They may also advise you to adjust your diet, avoid strenuous activity, or make other changes to your daily habits while you heal.

It may take several weeks for you to fully recover from appendicitis and surgery. If you develop complications, your recovery may take longer.

Appendicitis in pregnancy

Acute appendicitis is the most common non-obstetric emergency requiring surgery during pregnancy. It affects an estimated 0.04 to 0.2 percent of pregnant women.

The symptoms of appendicitis may be mistaken for routine discomfort from pregnancy. Pregnancy may also cause your appendix to shift upward in your abdomen, which can affect the location of appendicitis-related pain. This can make it harder to diagnose.

Treatment options during pregnancy might include one or more of the following:

• surgery to remove your appendix
• needle drainage or surgery to drain an abscess
• antibiotics

Delayed diagnosis and treatment may increase your risk of complications, including miscarriage.

Potential complications of appendicitis

Appendicitis can cause serious complications. For example, it may cause a pocket of pus known as an abscess to form in your appendix. This abscess may leak pus and bacteria into your abdominal cavity.

Appendicitis can also lead to a ruptured appendix. If your appendix ruptures, it can spill fecal matter and bacteria into your abdominal cavity.

If bacteria spill into your abdominal cavity, it can cause the lining of your abdominal cavity to become infected and inflamed. This is known as peritonitis, and it can be very serious, even fatal.

Bacterial infections can also affect other organs in your abdomen. For example, bacteria from a ruptured abscess or appendix may enter your bladder or colon. It may also travel through your bloodstream to other parts of your body.

To prevent or manage these complications, your doctor may prescribe antibiotics, surgery, or other treatments. In some cases, you might develop side effects or complications from treatment. However, the risks associated with antibiotics and surgery tend to be less serious than the potential complications of untreated appendicitis.

Preventing appendicitis

There’s no sure way to prevent appendicitis. But you might be able to lower your risk of developing it by eating a fiber-rich diet. Although more research is needed on the potential role of diet, appendicitis is less common in countries where people eat high-fiber diets.

Foods that are high in fiber include:

• fruits
• vegetables
• lentils, split peas, beans, and other legumes
• oatmeal, brown rice, whole wheat, and other whole grains

Your doctor may also encourage you to take a fiber supplement.

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Perianal abscess is a superficial infection that appears as a tender red lump under the skin near the anus. The infection occurs when bacteria gets trapped in the crypt glands that line the anal canal. The bacteria and fluid (pus) build up and becomes a lump that is red and painful (like a “pimple”). This type of abscess happens most often in male babies under a year of age. It may drain pus on its own and then heal and disappear.

An anal, or rectal, abscess occurs when a cavity in the anus becomes filled with pus. It causes extreme pain, fatigue, rectal discharge, and fever. In some cases, anal abscesses can result in painful anal fistulas. This occurs when the abscess doesn’t heal and breaks open on the surface of the skin. If an anal abscess doesn’t heal, it can cause a lot of pain and may require surgery.

Pathophysiology

Anorectal abscess are though to be caused by plugging of the anal ducts, the ducts that drain the anal glands in the anal wall, helping to ease the passage of faecal matter through mucus secretion.

Blockage of an anal duct results in fluid stasis, which will lead to infection. Common causative organisms include E. coli, Bacteriodes spp., and Enterococcus spp..

The anal glands are located in the intersphincteric space (between the internal and external anal sphincters), therefore infection from the glands here spreads to adjacent areas. Anorectal abscesses are thus categorised by the area (Fig. 1) in which they occur: (1) Perianal* (2) Ischiorectal (3) Intersphincteric (4) Supralevator

causes

A blocked anal gland, a sexually transmitted infection (STI), or an infected anal fissure can cause anal abscesses. Some other risk factors include:

• Crohn’s disease or ulcerative colitis, which are inflammatory bowel diseases that cause the body to attack healthy tissue
• diabetes
• a compromised immune system due to illnesses like HIV or AIDS
• anal sex, which can increase the risk of anal abscesses in both men and women
• use of the medication prednisone or other steroids
• current or recent chemotherapy
• constipation
• diarrhea

Toddlers or children that have a history of anal fissures (tears in the anal sphincter) are also at a higher risk for developing anal abscesses later on. Such anal fissures might occur in children who have a history of constipation.

What is a fistula?

Perianal and perirectal abscesses can be associated with fistula development.  Fistula is a tube-like connection between the space inside the anus (anal canal or rectum) and the skin outside the anus.  Once a fistula forms, bacteria from the intestine becomes trapped and causes the infection to return. Fistula that forms from perianal abscess is superficial. Fistula that forms from perirectal abscess is deep and can track through the different layers of the pelvic floor muscle and anal sphincter muscle complex.

symptoms 

hrobbing and constant pain in the anal area is probably one of the most common and immediately noticeable symptoms of anal abscess. The pain is usually accompanied by swelling in the anal area and greater pain during bowel movements.

Other common signs of an anal abscess include:

• constipation
• rectal discharge or bleeding
• swelling or tenderness of the skin surrounding the anus
• fatigue

Some people may be able to feel a nodule or lump that’s red, swollen, and tender at the rim of the anus. Fever and chills can result from the infection. You may also have rectal bleeding or urinary symptoms such as difficulty urinating.

Anal abscesses may also occur deeper in the rectum, most often in those who have inflammatory bowel diseases. This can result in some pain or discomfort in the abdominal area.

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In toddlers, there typically aren’t many symptoms other than signs of discomfort or pain, which may cause a child to become irritable. A lump or nodule may also be visible or felt around the anal area.

Clinical Features

Anorectal abscesses present with pain in the perianal region, which becomes exacerbated when sat down. Other symptoms include localised swelling, itching, or discharge. Severe abscesses may present with systemic features* such as fever, rigors, general malaise, or features of sepsis.

On examination, there will be a erythematous, fluctuant, tender perianal mass (Fig. 1), which may be discharging pus or have surrounding cellulitis.

Deeper abscesses may not have any obvious external signs, however produce severe tenderness on digital rectal exam, therefore require a further examination under anaesthesia for full assessment.

Complicated, unclear, or chronic disease may require additional imaging, either a CT or MRI scan.

diagnosis

Anal abscesses are most often diagnosed through a physical exam where your doctor checks the area for characteristic nodules. You doctor will also check for pain, redness, and swelling in the anal area.

In some people, there may not be any visible signs of the abscess on the surface of the skin around their anus. You doctor will instead use an instrument called an endoscope to look inside the anal canal and lower rectum. Sometimes the abscess may be deeper than a physical exam can find. Then, you doctor may order an MRI or ultrasound to get a better look.

Further tests may be necessary to make sure Crohn’s disease isn’t a contributing factor. In these cases, a blood test, imaging, and a colonoscopy may be required. During a colonoscopy, your doctor will use a lighted, flexible scope to examine your colon.

treatment

Location and size of the perirectal abscess determines what needs to be done to the treat the infection. When the abscess is small, antibiotics alone are enough to treat the infection.  However, when the abscess is large, in addition to antibiotics, the infection will need to be drained.  Drainage procedure can be done by radiologist who will place a drain (small plastic tube) into the abscess to drain the pus.  The infection can also be drained by the pediatric surgeon in the operating room. 

The type of procedure that is done will depend on the location of the abscess.  Both types of procedure are done with your child under general anesthesia.  After the procedure, your child will be admitted to the hospital for a few days until the infection has resolved.  Sometimes, patients are discharged home with drain in the place, which can be removed in the clinic.  

Perirectal abscess can be associated with fistula. The fistula can be identified on the CT or MRI scan that was used to diagnose the perirectal abscess.  If perirectal abscess or fistula is identified, your child will need to be seen by pediatric gastroenterologist to be evaluated for inflammatory bowel disease. If your child is diagnosed with inflammatory bowel disease, medications will be prescribed to treat the inflammation and allow the fistula to heal.  In some occasions, the fistula stays open and continues to cause abscess formation.  

To prevent future abscess, your child’s pediatric surgeon may recommend an operation to place a Seton (thin rubber band) through the fistula to prevent bacteria and pus from building up.  After this operation, your child can go home the same day or may need to be admitted in the hospital for a few days depending on the extent and how deep the fistula is located.  The Seton can remain in place for few months.

The decision to remove the Seton is determined by your child’s pediatric gastroenterologist and pediatric surgeon.  When the Seton needs to be removed, removal can be done in clinic.  

Management

Patients should be started on antibiotic therapy, as guided by local protocol, and provided with sufficient analgesia.

The main management for anorectal abscesses is with an incision and drainage procedure, which should always be performed under general anaesthetic. These can be left to heal by secondary intention.

Once drained, proctoscopy should be performed to check for the presence of any identifiable fistula-in-ano. If a fistula is identified, the insertion of a seton can be considered by experienced surgeons, however this should only be performed if the tract is clearly identifiable with minimal probing.

Limited data has suggested that use of post-operative antibiotics following drainage of anorectal abscess may lower the risk of fistula formation.

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Anal itching is a common condition. The itch, situated in or around your anus, is often intense and may be accompanied by a strong urge to scratch. You may find anal itching to be embarrassing and uncomfortable.

Also called pruritus ani (proo-RIE-tus A-nie), anal itching has many possible causes, such as skin problems, hemorrhoids, and washing too much or not enough.

If anal itching is persistent, talk with your doctor. With proper treatment and self-care, most people get complete relief from anal itching.

Anal itch, also known as pruritus ani, is an irritating, itchy sensation around the anus (the opening through which stool passes out of the body). Anal itch is a symptom, not an illness, and it can have many different causes. In most cases, a person with anal itch does not have a disease of the anus or rectum. Instead, the itchy sensation is a sign that one or more of the following has irritated the skin in the area:

• Stool on the skin around the anal opening — If the anal area isn’t cleaned properly after a bowel movement, a small amount of stool may be left behind on the skin, causing the area to itch. Less often, watery stools may leak out of the anal opening and cause itching. This sometimes happens in otherwise healthy people whose diets include very large amounts of liquids.
• A diet containing foods or beverages that irritate the anus — A number of foods and drinks can irritate the anus, including spices and spicy foods, coffee (both caffeinated and decaffeinated), tea, cola, milk, alcoholic beverages (especially beer and wine), chocolate, citrus fruits, vitamin C tablets and tomatoes. Once a person eats or drinks something that can irritate the anus, it usually takes 24 to 36 hours before anal itching begins. That’s the time it takes the food to travel through the digestive tract.
• Treatment with antibiotics — Some powerful antibiotics that work against many different bacterial species can trigger anal itch by disturbing the normal ecology of the intestines. These drugs are called broad-spectrum antibiotics, and include tetracyclines and erythromycin (both sold under several brand names).
• A local chemical irritation or skin allergy in the anal area — In sensitive people, chemicals and medications that are applied to the anal area can cause local irritation or allergic reactions. Some major culprits include dyes and perfumes used in toilet paper (especially scented toilet paper), feminine hygiene sprays and other deodorants for the area around the anus or genitals, medicated talcum powders, and medicated skin cleansers and soaps, especially perfumed soaps. Anal itch also can be triggered by over-the-counter medications (suppositories, creams, ointments) intended to treat anal problems.
• Intense cleaning after a bowel movement — Although the anal area should be cleaned after every bowel movement, this cleaning must be gentle. Aggressive rubbing and scrubbing, especially with soaps or other skin cleansers, can irritate the skin and trigger anal itch.

Less often, anal itch is a symptom of some illness or condition that either affects the anal area alone, or involves larger areas of the digestive tract or skin. Some examples include:

• Local diseases and conditions involving lower portions of the digestive tract — These include hemorrhoids, skin tags, rectal fistulas, rectal fissures and, rarely, anorectal cancer.
• Infections and parasites — These include pinworms (especially in children), scabies, pediculosis, condyloma acuminata and skin infections due to Candida or tinea fungi.
• Skin problems — These include psoriasis, eczema and seborrhea. In many cases, these conditions cause symptoms in several different areas of the skin surface, not only around the anus.

Worldwide, anal itch is a very common problem that occurs in up to 45 percent of people at some time during their lives. Men are affected two to four times more often than women. People who are overweight, perspire heavily or routinely wear tight-fitting underwear or hosiery are more likely to get anal itch.

causes

Most anal itching is

• Idiopathic (the majority)
• Hygiene-related

Sometimes the cause of anal itching isn’t identifiable. Possible causes of anal itching include:

• Irritants. Fecal incontinence and long-term (chronic) diarrhea can irritate the skin. Or your skin care routine may include products or behaviors that irritate the skin, such as using harsh soaps or moist wipes and washing too aggressively.
• Infections. These include sexually transmitted infections, pinworms, and yeast infections.
• Skin conditions. Sometimes anal itching is the result of a specific skin condition, such as psoriasis or contact dermatitis.
• Other medical conditions. These include diabetes, thyroid disease, hemorrhoids, anal tumors.

Symptoms

Anal itch is an irritating sensation around the anus that is relieved temporarily by scratching or rubbing. The problem is often worse at night and may interfere with sleep. In most cases, the skin in the area is red.

If anal itch becomes a chronic (long-term) problem, the skin around the anus may become raw and tender from repeated scratching, or it may thicken and become leathery. Repeated scratching also can cause breaks in the anal skin that can lead to painful local infections.

additional symptoms

• The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture.
• At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness, especially during and after bowel movements.
• There also may be small amounts of bleeding.

Diagnosis

To help identify the cause of your anal itch, the doctor may ask you to describe your current diet and medications, your bowel habits, and the way you routinely clean your anal area after a bowel movement. The doctor will review your medical history, including any history of rectal problems (hemorrhoids, fissures or fistulas) or skin problems (psoriasis, eczema or seborrhea). Your doctor’s questions will be followed by a physical examination of your anal area and sometimes, by a digital rectal examination. If you have a history of skin symptoms involving other parts of your body, your doctor will want to examine these skin areas as well.

If your anal itch is due to a local irritation in the anal area, the doctor usually can diagnose the problem based on your history, diet and personal hygiene routine, and the results of your physical examination. Sometimes, the doctor will request a stool sample if he or she suspects a worm or parasite infection. Rarely, your doctor may need to examine the area by inserting a special viewing instrument called an anoscope into your anus. This can help your doctor determine whether the itch is being caused by a problem inside your rectum.

Prevention

In many cases, you can prevent anal itch by taking the following steps:

• Practice good anal hygiene — When possible, gently cleanse the anal area after every bowel movement by using wet toilet paper (unscented and dye-free) or a wet washcloth. Wipe gently or blot the area. Never rub or scrub. If you are in a public toilet, use dry toilet paper temporarily, then finish your cleansing regimen when you return home.
• Use only water to clean the anal area, never soap.
• Avoid using medicated powders, perfumed sprays or deodorants on the anal area.
• Eat a sensible diet that is low in the foods and beverages known to cause anal irritation.
• Wear cotton underwear that is not too tight.
• If you are taking oral antibiotics, eat yogurt to help restore the normal ecology of your colon.

Treatment

In most cases, anal itch can be treated by:

• Thoroughly but gently drying the anal area after every bowel movement, using unscented toilet paper, a clean cloth towel or a hair dryer if necessary.
• Dusting the anal area with nonmedicated talcum powder between bowel movements, or laying a clean square of cotton gauze against the anus to absorb any excess moisture.
• Resisting the urge to scratch, no matter how itchy the area becomes. The itch will pass, or at least decrease in intensity, over a short time, but the more you scratch, the longer it will take for the itching to go away.
• Applying topical remedies such as zinc oxide or hydrocortisone ointment (1 percent) on a regular schedule, or as needed, to help you avoid scratching.
• Wearing soft cotton gloves while in bed if you scratch at night or in your sleep.

Initial self-care for simple itching is directed toward relieving symptoms, like burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area.

• Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel.
• After bowel movements, moist pads (such as baby wipes, flushable moist wipes, and flushable anal cleansing wipes) should be used for cleaning the anus instead of toilet paper.
• If there is constant moisture present in the anus or stool incontinence, it may be necessary to clean the anus with wet wipes between bowel movements.

Many over-the-counter (OTC) products are sold for the treatment of an itchy anus and are available as ointments, creams, gels, suppositories, foams and pads. These products often contain the same drugs used to treat hemorrhoids.

• When used around the anus, ointments, creams, and gels should be applied as a thin covering.
• When applied to the anal canal, these products should be inserted with a finger using finger cots (latex covers for the fingertips) or a “pile pipe.” Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
• Suppositories or foams do not have advantages over ointments, creams, and gels.

Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed in this article.

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Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms typically don’t need treatment.

Gallstone Types

The two main kinds of gallstones are:

• Cholesterol stones. These are usually yellow-green. They’re the most common, making up 80% of gallstones.
• Pigment stones. These are smaller and darker. They’re made of bilirubin..

Causes

It’s not clear what causes gallstones to form. Doctors think gallstones may result when:

• Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
• Your bile contains too much bilirubin. Bilirubin is a chemical that’s produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
• Your gallbladder doesn’t empty correctly. If your gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones

Symptoms

Gallstones can lead to pain in the upper right abdomen. You may start to have gallbladder pain from time to time when you eat foods that are high in fat, such as fried foods. The pain doesn’t usually last more than a few hours.

You may also experience:

• nausea
• vomiting
• dark urine
• clay-colored stools
• stomach pain
• burping
• diarrhea
• indigestion

These symptoms are also known as biliary colic.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder.

According to the American College of Gastroenterology, 80 percent of people have “silent gallstones.” This means they don’t experience pain or have symptoms. In these cases, your doctor may discover the gallstones from X-rays or during abdomen surgery.

diagnosis

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

Ultrasound: An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.

Abdominal CT scan: This imaging test takes pictures of your liver and abdominal region.

Gallbladder radionuclide scan: This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.

Blood tests: Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a procedure that uses a camera and X-rays to look at problems in the bile and pancreatic ducts. It helps your doctor look for gallstones stuck in your bile duct.

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Risk factors-

Many risk factors for gallstones are related to diet, while some factors are uncontrollable. Uncontrollable risk factors are things like age, race, gender, and family history, which can’t be changed.

Lifestyle risk factors	Uncontrollable risk factors	Medical risk factors
being overweight or obese	being female	having cirrhosis
eating a diet that’s high in fat or cholesterol or low in fiber	being of Native American or Mexican-American descent	being pregnant
having rapid weight loss in a short period of time	having a family history of gallstones	taking certain medications for lowering cholesterol
having diabetes mellitus	being 60 years or older	taking medications that have a high estrogen content

While medications can increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

Complications

Complications of gallstones may include:

• Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
• Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.
• Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
• Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

Prevention

You can reduce your risk of gallstones if you:

• Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
• Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
• Eat more high-fiber foods. Include more fiber-rich foods in your diet, such as fruits, vegetables and whole grains.
• Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.

treatment

You don’t need treatment if you don’t have any symptoms. Some small gallstones can pass through your body on their own.

Most people with gallstones have their gallbladders taken out. You can still digest food without it. Your doctor will use one of two procedures.

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. Your doctor passes a narrow tube called a laparoscope into your belly through a small cut. It holds instruments, a light, and a camera. They take out your gallbladder through another small cut. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward.

If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.

If you have another medical condition and your doctor thinks you shouldn’t have surgery, they might give you medication instead. Chenodiol (Chenodol) and ursodiol , Urso 250, Urso Forte) dissolve cholesterol stones. They can cause mild diarrhea.

You may have to take the medicine for years to totally dissolve the stones, and they may come back after you stop taking it.

Surgery

Your doctor may need to perform a laparoscopic gallbladder removal. This is a common surgery that requires general anesthesia. The surgeon will usually make 3 or 4 incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions and carefully remove your gallbladder.

You usually go home on the day of the procedure or the day after if you have no complications.

You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The result is a laxative effect that causes diarrhea. To treat this, eat a diet lower in fats so that you release less bile.

Foods to avoid

To help improve your condition and reduce your risk of gallstones, try these tips:

• Reduce your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.
• Add fiber to your diet to make your bowel movements more solid. Try to add only a serving of fiber at a time to prevent gas that can occur from eating excess fiber.
• Avoid foods and drinks known to cause diarrhea, including caffeinated drinks, high-fat dairy products, and very sweet foods.
• Eat several small meals per day. Smaller meals are easier for the body to digest.
• Drink a sufficient amount of water. This is about 6 to 8 glasses per day.

If you plan to lose weight, do it slowly. Aim to lose no more than two pounds per week. Rapid weight loss may increase your risk of gallstones and other health problems.

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Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

Nearly three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown.

Fortunately, effective options are available to treat hemorrhoids. Many people get relief with home treatments and lifestyle changes.

In many cases, haemorrhoids don’t cause symptoms, and some people don’t even realise they have them. However, when symptoms do occur, they may include:

• bleeding after passing a stool (the blood is usually bright red)
• itchy bottom
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
• a mucus discharge after passing a stool
• soreness, redness and swelling around your anus

Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.

causes

The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation – this is often due to a lack of fibre in a person’s diet. Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.

Other factors that might increase your risk of developing haemorrhoids include:

• being overweight or obese
• age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
• being pregnant – which can place increased pressure on your pelvic blood vessels, causing them to enlarge (read more about common pregnancy problems)
• having a family history of haemorrhoids
• regularly lifting heavy objects
• a persistent cough or repeated vomiting
• sitting down for long periods of time

Types of haemorrhoids

After you’ve had a rectal examination or proctoscopy, your doctor will be able to determine what type of haemorrhoids you have.

Haemorrhoids can develop internally or externally. Internal haemorrhoids develop in the upper two-thirds of your anal canal and external haemorrhoids in the lower third (closest to your anus). The nerves in the lower part can transmit pain messages, while the nerves in the upper part can’t.

Haemorrhoids can be further classified, depending on their size and severity. They can be:

• first degree – small swellings that develop on the inside lining of the anus and aren’t visible from outside the anus
• second degree – larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again
• third degree – one or more small soft lumps that hang down from the anus and can be pushed back inside (prolapsing and reducible)
• fourth degree – larger lumps that hang down from the anus and can’t be pushed back inside (irreducible)

It’s useful for doctors to know what type and size of haemorrhoid you have, as they can then decide on the best treatment

Symptoms

Signs and symptoms of hemorrhoids usually depend on the type of hemorrhoid.

External hemorrhoids

These are under the skin around your anus. Signs and symptoms might include:

• Itching or irritation in your anal region
• Pain or discomfort
• Swelling around your anus
• Bleeding

Internal hemorrhoids

Internal hemorrhoids lie inside the rectum. You usually can’t see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:

• Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
• A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.

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Thrombosed hemorrhoids

If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:

• Severe pain
• Swelling
• Inflammation
• A hard lump near your anus

When to see a doctor

If you have bleeding during bowel movements or you have hemorrhoids that don’t improve after a week of home care, talk to your doctor.

Don’t assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness

Risk factors

As you age, your risk of hemorrhoids increases. That’s because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen when you’re pregnant, because the baby’s weight puts pressure on the anal region.

Complications

Complications of hemorrhoids are rare but include:

• Anemia. Rarely, chronic blood loss from hemorrhoids may cause anemia, in which you don’t have enough healthy red blood cells to carry oxygen to your cells.
• Strangulated hemorrhoid. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be “strangulated,” which can cause extreme pain.
• Blood clot. Occasionally, a clot can form in a hemorrhoid (thrombosed hemorrhoid). Although not dangerous, it can be extremely painful and sometimes needs to be lanced and drained.

Diagnosing haemorrhoids

Your GP can diagnose haemorrhoids (piles) by examining your back passage to check for swollen blood vessels.

Some people with haemorrhoids are reluctant to see their GP. However, there’s no need to be embarrassed – all GPs are used to diagnosing and treating piles.

It’s important to tell your GP about all of your symptoms – for example, tell them if you’ve recently lost a lot of weight, if your bowel movements have changed, or if your stools have become dark or sticky.

Rectal examination

Your GP may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called a digital rectal examination (DRE).

During a DRE, your GP will wear gloves and use lubricant. Using their finger, they’ll feel for any abnormalities in your back passage. A DRE shouldn’t be painful, but you may feel some slight discomfort.

Proctoscopy

In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin hollow tube with a light on the end that’s inserted into your anus.

This allows your doctor to see your entire anal canal (the last section of the large intestine).

GPs are sometimes able to carry out a proctoscopy. However, not all GPs have the correct training or access to the right equipment, so you may need to go to a hospital clinic to have the procedure.

prevent piles

Do

drink lots of fluid and eat plenty of fibre to keep your poo soft

wipe your bottom with damp toilet paper

take paracetamol if piles hurt

take a warm bath to ease itching and pain

use an ice pack wrapped in a towel to ease discomfort

gently push a pile back inside

keep your bottom clean and dry

exercise regularly

cut down on alcohol and caffeine (like tea, coffee and cola) to avoid constipation

Don’t

do not wipe your bottom too hard after you poo

do not ignore the urge to poo

do not push too hard when pooing

do not take painkillers that contain codeine, as they cause constipation

do not take ibuprofen if your piles are bleeding

do not spend more time than you need to on the toilet

treatment

Haemorrhoids (piles) often clear up by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.

Making simple dietary changes and not straining on the toilet are often recommended first.

Creams, ointments and suppositories (which you insert into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canal – the lower third (closest to your anus) or the upper two-thirds. The lower third contain nerves which can transmit pain, while the upper two-thirds do not.

Non-surgical treatments for haemorrhoids in the lower part of the canal are likely to be very painful, because the nerves in this area can detect pain. In these cases, haemorrhoid surgery will usually be recommended.

The various treatments for haemorrhoids are outlined below.

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Dietary changes and self care

If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular, so that you don’t strain when passing stools.

You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables.

You should also drink plenty of water and avoid caffeine (found in tea, coffee and cola).

When going to the toilet, you should:

• avoid straining to pass stools, because it may make your haemorrhoids worse
• use moist toilet paper, rather than dry toilet paper, or baby wipes to clean your bottom after passing a stool
• pat the area around your bottom, rather than rubbing it

Read more about preventing constipation.

Medication

Over-the-counter topical treatments

Various creams, ointments and suppositories (which are inserted into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

These medicines should only be used for five to seven days at a time. If you use them for longer, they may irritate the sensitive skin around your anus. Any medication should be combined with the diet and self-care advice discussed above.

There’s no evidence to suggest that one method is more effective than another. Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it.

Don’t use more than one product at once.

Corticosteroid cream

If you have severe inflammation in and around your back passage, your GP may prescribe corticosteroid cream, which contains steroids.

You shouldn’t use corticosteroid cream for more than a week at a time, because it can make the skin around your anus thinner and the irritation worse.

Painkillers

Common painkilling medication, such as paracetamol, can help relieve the pain of haemorrhoids.

However, if you have excessive bleeding, avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen, because it can make rectal bleeding worse. You should also avoid using codeine painkillers, because they can cause constipation.

Your GP may prescribe products that contain local anaesthetic to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days, because they can make the skin around your back passage more sensitive.

Laxatives

If you’re constipated, your GP may prescribe a laxative. Laxatives are a type of medicine that can help you empty your bowels.

Non-surgical treatments

If dietary changes and medication don’t improve your symptoms, your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.

If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended.

Banding

Banding involves placing a very tight elastic band around the base of your haemorrhoids to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.

Banding is usually a day procedure that doesn’t need an anaesthetic, and most people can get back to their normal activities the next day. You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger, if needed.

You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet. If you notice some mucus discharge within a week of the procedure, it usually means that the haemorrhoids have fallen off.

Directly after the procedure, you may notice blood on the toilet paper after going to the toilet. This is normal, but there shouldn’t be a lot of bleeding. If you pass a lot of bright red blood or blood clots (solid lumps of blood), go to your nearest accident and emergency (A&E) department immediately.

Ulcers (open sores) can occur at the site of the banding, although these usually heal without needing further treatment.

Injections (sclerotherapy)

A treatment called sclerotherapy may be used as an alternative to banding.

During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about 4 to 6 weeks, the haemorrhoid should decrease in size or shrivel up.

After the injection, you should avoid strenuous exercise for the rest of the day. You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.

Electrotherapy

Electrotherapy, also known as electrocoagulation, is another alternative to banding for people with smaller haemorrhoids.

During the procedure, a device called a proctoscope is inserted into the anus to locate the haemorrhoid. An electric current is then passed through a small metal probe that’s placed at the base of the haemorrhoid, above the dentate line. The specialist can control the electric current using controls attached to the probe.

The aim of electrotherapy is to cause the blood supplying the haemorrhoid to coagulate (thicken), which causes the haemorrhoid to shrink. If necessary, more than one haemorrhoid can be treated during each session.

Electrotherapy can either be carried out on outpatient basis using a low electric current, or a higher dose can be given while the person is under a general anaesthetic or spinal anaesthetic.

You may experience some mild pain during or after electrotherapy, but in most cases this doesn’t last long. Rectal bleeding is another possible side effect of the procedure, but this is usually short-lived.  

Electrotherapy is recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids. It can also be used as an alternative to surgery for treating larger haemorrhoids, but there’s less evidence of its effectiveness.

Surgery

Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery.

Surgery is particularly useful for haemorrhoids that have developed below the dentate line because, unlike non-surgical treatments, anaesthetic is used to ensure you don’t feel any pain.

There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.

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A hernia of the abdominal wall is a protrusion of the abdominal contents through an acquired or congenital area of weakness or defect in the wall. Many hernias are asymptomatic, but some become incarcerated or strangulated, causing pain and requiring immediate surgery. Diagnosis is clinical. Treatment is elective surgical repair.

A hernia occurs when an organ protrudes through the wall of muscle that encircles it. There are several different types of hernias that can occur in the abdominal and surrounding areas. These include umbilical hernias, epigastric hernias, incisional hernias, and others. For more information on these specific types of hernias.

Types of Abdominal Wall Hernias

Epigastric Hernia

An epigastric hernia occurs when a weakened area in the abdominal wall allows a bit of fat to push through. Epigastric hernias are typically small. They occur in the middle of the belly, in the area between the belly button and the breastbone.

Some patients develop more than one epigastric hernia at a time. These hernias typically don’t cause symptoms, but you may experience pain in your upper belly.

Treatment of epigastric hernias typically involves surgery, but your doctor will discuss all your options with you in detail.

Incisional Hernia

A hernia that occurs in the area of a previous surgery is known as an incisional hernia. These hernias may occur when the abdominal wall has been weakened by surgery, or when a surgical incision becomes infected, further weakening the area.

Incisional hernias are relatively common because surgical incisions weaken the abdominal area. That weakness makes it easier for a part of the intestine or other tissue to protrude.

Incisional hernias can develop soon after surgery, or they can develop slowly, over months or even years. They typically occur alongside vertical incisions. Incisional hernias tend to be large and rather painful.

Incisional hernias will not heal on their own. Talk to your doctor for more details about your treatment options.

Spigelian Hernia

Spigelian hernias occur throughout the spigelian fascia. Unlike other types of hernias, which develop immediately below layers of fat, spigelian hernias occur in the midst of abdominal muscles. This means that spigelian hernias may not be immediately visible as a bulge or lump. They can go undetected for longer periods of time.

Because spigelian hernias tend to be small, the risk of developing a strangulated hernia is higher.

Spigelian hernias tend to occur more rarely than other types of hernias.

Umbilical Hernia

An umbilical hernia occurs when a weak spot in the belly allows a bit of fat, fluid, or intestine to push through, creating a lump or bulge near the belly button.

Umbilical hernias frequently occur in infants. In most cases, these hernias will heal on their own. Occasionally, however, surgery may be required.

Umbilical hernias also occur in adults, particularly those with health issues that cause increased pressure in the belly. Those issues may include obesity, pregnancy, chronic coughing or constipation, and difficulty urinating.

Because they tend to grow bigger over time, umbilical hernias require treatment. Treatment typically involves surgery, but your doctor will discuss all your options with you in detail. Without treatment, you are at risk of developing a strangulated hernia, which means that blood supply to the tissue has been cut off. Strangulation is life threatening and requires emergency surgery.

Causes 

Abdominal wall hernias can occur in people of any age, including infants. However, the risk of developing a hernia tends to increase as you age. Most abdominal wall hernias are caused by an area of weakness in the abdominal walls. A number of different factors can contribute to the development of that weakness. These factors include:

• Aging
• Chronic coughing
• Collagen vascular disease
• Frequent heavy lifting
• Genetic defects   
• History of previous hernias
• Infection (especially following surgery)
• Injuries to the abdominal area
• Obesity
• Pregnancy
• Straining during bowel movements or urination
• Surgical openings

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Diagnosis

In most cases, your doctor will be able to determine whether you are in fact suffering from a hernia simply by looking and by gently palpating the affected area.

If for some reason a diagnosis isn’t immediately apparent, your doctor may decide to order an imaging test, such as an abdominal ultrasound, CT scan, or MRI. These imaging tests can help to show the hole in the muscle wall, along with the tissue protruding from it.

Prognosis

Congenital umbilical hernias rarely strangulate and are not treated; most resolve spontaneously within several years. Very large defects may be repaired electively after age 2 years.

Umbilical hernias in adults cause cosmetic concerns and can be electively repaired; strangulation and incarceration are unusual but can happen and usually contain omentum rather than intestine.

Treatment

Abdominal wall hernias that have no associated symptoms may not require any treatment at all. Your doctor will discuss your options with you which may include surgery or watchful waiting.

Larger hernias, however, or hernias that are causing pain, may require surgical repair to relieve pain as well as to prevent complications.

There are two types of surgical hernia repair: open and minimally invasive surgery. The type of surgery chosen will depend on the severity and type of hernia you’ve developed, the anticipated recovery time, your past medical and surgical history, and your surgeon’s expertise.

Open Surgery: During this procedure, your surgeon will make a small incision into your groin, and then push the protruding tissue back into your abdomen. Your surgeon will then sew up the weakened area. In some cases, your surgeon will use a mesh  to reinforce that weakened area.

Open surgery can be performed either with general anesthesia or with sedation or local anesthesia.

After your surgery, it might be several weeks before you’re able to fully resume your normal activities. However, it’s still important that you begin moving about again as soon as possible for a healthier recovery.

Minimally Invasive Surgery: Minimally invasive surgery is typically performed under general anesthesia.

During this procedure, your surgeon will make a few small incisions in your abdomen. Your surgeon will then inflate your abdomen, using a special gas, in order to make your internal organs easier to see.

Your surgeon will then insert a small, narrow tube into one of the incisions in your abdomen. This tube has a tiny camera, or laparoscope, at the end of it. That camera serves as a kind of guide for your surgeon, who is then able to insert surgical instruments through the other incisions in your abdomen. Your surgeon will repair the hernia using  and may use mesh.

Patients who are candidates for minimally invasive surgery may experience less scarring and discomfort following surgery than those who undergo open surgery. Patients may also be able to return more quickly to their normal activities.

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A hydrocele is when fluid fills a male’s scrotum, causing it to swell. It is not a major health issue but it can be embarrassing and uncomfortable. Hydroceles are more common in male infants than adults, and there are treatments to solve the problem.

A hydrocele (HI-droe-seel) is a type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle. Hydrocele is common in newborns and usually disappears without treatment by age 1. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

A hydrocele usually isn’t painful or harmful and might not need any treatment. But if you have scrotal swelling, see your doctor to rule out other causes.

Types of hydroceles

The two types of hydroceles are noncommunicating and communicating.

Noncommunicating

A noncommunicating hydrocele occurs when the sac closes, but your body doesn’t absorb the fluid. The remaining fluid is typically absorbed into the body within a year.

Communicating

A communicating hydrocele occurs when the sac surrounding your testicle doesn’t close all the way. This allows fluid to flow in and out.

Causes

Towards the end of pregnancy, a male child’s testicles descend from his abdomen into the scrotum. The scrotum is the sac of skin that holds the testicles once they descend.

During development, each testicle has a naturally occurring sac around it that contains fluid. Normally, this sac closes itself and the body absorbs the fluid inside during the baby’s first year. However, this doesn’t happen for babies with a hydrocele. Babies born prematurely are at a higher risk for hydrocele,

Hydroceles can also form later in life, mostly in men over 40. This usually occurs if the channel through which the testicles descend hadn’t closed all the way and fluid now enters, or the channel reopens. This can cause fluid to move from the abdomen into the scrotum. Hydroceles can also be caused by inflammation or injury in the scrotum or along the channel. The inflammation may be caused by an infection (epididymitis) or another condition.

Baby boys

A hydrocele can develop before birth. Normally, the testicles descend from the developing baby’s abdominal cavity into the scrotum. A sac accompanies each testicle, allowing fluid to surround the testicles. Usually, each sac closes and the fluid is absorbed.

Sometimes, the fluid remains after the sac closes (noncommunicating hydrocele). The fluid is usually absorbed gradually within the first year of life. But occasionally, the sac remains open (communicating hydrocele). The sac can change size or if the scrotal sac is compressed, fluid can flow back into the abdomen. Communicating hydroceles are often associated with inguinal hernia.

Older males

A hydrocele can develop as a result of injury or inflammation within the scrotum. Inflammation might be caused by an infection in the testicle or in the small, coiled tube at the back of each testicle (epididymitis).

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symptoms

Hydroceles usually don’t cause any pain. Usually, the only symptom is a swollen scrotum.

In adult men, there may be a feeling of heaviness in the scrotum. In some cases, the swelling might be worse in the morning than in the evening. It is not usually very painful.

Seek medical treatment if you or your child has sudden or severe pain in their scrotum. This could be the sign of another condition called testicular torsion. Testicular torsion occurs when the testicles become twisted, typically due to an injury or accident. Testicular torsion isn’t common, but it’s a medical emergency because it can lead to blocked blood supply to the testicle and ultimately infertility if untreated. If you think you or child has testicular torsion, go a hospital emergency room right away or call 911. It needs to be evaluated and treated immediately.

Diagnosis

ght passing through. However, if scrotal swelling is due to a solid mass (cancer), then the light will not shine through the scrotum. This test does not provide a definite diagnosis but can be very helpful.

Your doctor may also apply pressure to the abdomen to check for another condition called inguinal hernia; your doctor may also ask you to cough or bear down to check for this. This can occur when part of the small intestine protrudes through the groin due to a weak point in the abdominal wall. While it’s usually not life-threatening, a doctor may recommend surgery to repair it.

They may take a blood or urine sample to test for infections. Less commonly, your doctor may administer an ultrasound to check for hernias, tumors, or any other cause of scrotal swelling.

Risk factors

Most hydroceles are present at birth. At least 5 percent of newborn boys have a hydrocele. Babies who are born prematurely have a higher risk of having a hydrocele.

Risk factors for developing a hydrocele later in life include:

• Injury or inflammation to the scrotum
• Infection, including a sexually transmitted infection (STI)

Complications

A hydrocele typically isn’t dangerous and usually doesn’t affect fertility. But a hydrocele might be associated with an underlying testicular condition that can cause serious complications, including:

• Infection or tumor. Either might reduce sperm production or function.
• Inguinal hernia. The loop of intestine trapped in the abdominal wall can lead to life-threatening complications.

Treatment

A hydrocele usually goes away on its own before a boy’s first birthday. If it doesn’t, or if it gets bigger, their doctor will refer them to a specialist called a urologist. 

If your son has a communicating hydrocele, the pediatrician will usually recommend surgery without waiting for it to go away.

The doctor can remove a hydrocele in a brief operation called a hydrocelectomy.

Your  baby will get medicine to numb their body or to put them under completely. Then, a surgeon makes a cut in their scrotum or lower belly. The surgeon then drains the fluid and sews the sac closed. Once it’s finished, your son can go home the same day.

In the days after surgery, you’ll need to keep the area clean and dry. The doctor and team will show you how to care for your baby as they heal.

After a few days, you may need to take them back to the doctor to make sure they are healing well.

prevented

There is nothing you can do to prevent your baby from getting a hydrocele. For adolescent and adult men, the best protection against a hydrocele is to keep the testicles and scrotum free of injury. For example, if taking part in contact sports, use an athletic cup.

Although hydroceles are usually not a major health issue, you should tell your healthcare provider about any abnormality or swelling in the scrotum. Another disease or condition may be causing or mimicking the abnormality.

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Orchitis (or-KIE-tis) is an inflammation of one or both testicles. Bacterial or viral infections can cause orchitis, or the cause can be unknown. Orchitis is most often the result of a bacterial infection, such as a sexually transmitted infection (STI). In some cases, the mumps virus can cause orchitis.

Bacterial orchitis might be associated with epididymitis — an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. In that case, it’s called epididymo-orchitis.

Orchitis causes pain and can affect fertility. Medication can treat the causes of bacterial orchitis and can ease some signs and symptoms of viral orchitis. But it can take several weeks for scrotal tenderness to disappear.

Acute epididymo-orchitis is a clinical syndrome consisting of pain, swelling and inflammation of the epididymis, with or without inflammation of the testes. The most common route of infection is local extension and is mainly due to infections spreading from the urethra (sexually transmitted infections (STIs)) or from the bladder^[1]. Orchitis (infection limited to the testis) is much less common. Chronic epididymitis refers to epididymal pain and inflammation (usually without scrotal swelling) that lasts for more than six months.

• Epididymitis means inflammation of the epididymis (the structure next to the testicle (testis) that is involved in making sperm).
• Orchitis means inflammation of a testicle.

As the epididymis and testis lie next to each other, it is often difficult to tell if the epididymis, the testis, or both are inflamed. Therefore, the term epididymo-orchitis is often used.

Causes

Orchitis can be caused by a bacterial or viral infection. Sometimes a cause of orchitis can’t be determined.

Bacterial orchitis

Most often, bacterial orchitis is associated with or the result of epididymitis. Epididymitis usually is caused by an infection of the urethra or bladder that spreads to the epididymis.

Often, the cause of the infection is an STI. Other causes of infection can be related to having been born with abnormalities in your urinary tract or having had a catheter or medical instruments inserted into your penis.

Viral orchitis

The mumps virus usually causes viral orchitis. Nearly one-third of males who contract the mumps after puberty develop orchitis, usually four to seven days after onset of the mumps.

Acute Epididymitis

An “acute” case is most often caused by an infection from bacteria. The e-coli bacteria are a common cause for infection.

• In children who haven’t reached puberty, the infection may start in the bladder or kidney. It then spreads to the testis. Some boys get more urinary tract infections, and may get this more often.
• In men, a STD ( sexually transmitted disease) is one of the causes. Mostly from chlamydia, mycoplasma or rarely gonorrhea. These infections start in the urethra. They can then move into the testis. Sometimes there is a discharge of fluid from the urethra.

Sometimes it is caused by something else:

• Enlarged prostate blocking the bladder
• Infection of the prostate gland (“bacterial prostatitis”)
• Partly blocked urethra
• Recent catheter use

Epididymitis is sometimes caused by other things:

• Chemical or inflammatory non-bacterial epididymitis may happen from urine flowing backwards to the epididymis. This is most often from heavy lifting. The urine causes swelling but no infection.
• The drug “Amidarone” can be a cause but this is rare
• An infection from the bloodstream (as with tuberculosis)
• Other unknown causes

In any of these cases, the first sign of a problem is often pain in the back of the testis.

Chronic Epididymitis

A “chronic” case may result after acute epididymitis. It doesn’t seem to go away. It can also happen without acute symptoms or known infection. In this case, the cause is unknown.

Orchitis

Orchitis alone is mostly from a mumps virus (or other virus) infection. “Mumps orchitis” appears in about 1/3 of males who get mumps after puberty. It only occurs in boys that have mumps AFTER puberty. In some cases of mumps, interferon can be given to prevent orchitis. This infection doesn’t spread to the epididymis.

Acute Epididymo-orchitis

Acute epididymo-orchitis is most often from a bacterial infection. It can also be caused by a tuberculous infection of the epididymis, but this is rare. Rarely, it can start in the testis and spread to the epididymis.

Symptoms

Orchitis signs and symptoms usually develop suddenly and can include:

• Swelling in one or both testicles
• Pain ranging from mild to severe
• Fever
• Nausea and vomiting
• General feeling of unwellness (malaise)

The terms “testicle pain” and “groin pain” are sometimes used interchangeably. But groin pain occurs in the fold of skin between the thigh and abdomen — not in the testicle. The causes of groin pain are different from the causes of testicle pain.

When to see a doctor

If you have pain or swelling in your scrotum, especially if the pain occurs suddenly, see your doctor right away.

A number of conditions can cause testicle pain, and some require immediate treatment. One such condition involves twisting of the spermatic cord (testicular torsion), which might cause pain similar to that caused by orchitis. Your doctor can perform tests to determine which condition is causing your pain.

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Epidemiology

• A study of UK general practices during the years 2003-2008 reported a highest incidence of 25/10,000 in 2004-2005. The incidence declined during the latter part of the study.
• Acute epididymitis most commonly occurs in patients aged 15-30 years and patients older than 60 years. In the UK GP study, the incidence declined in younger age groups throughout the study period but that of males aged over 45 years was stable. Prepubertal epididymitis is rare (and testicular torsion is much more common in this age group).
• Mumps orchitis occurs in up to 40% of postpubertal boys with mumps; it is rare in prepubertal boys. An outbreak starting in 2004 and lasting for some three years was seen in England and Wales and was attributed to a reduction in the uptake of measles-mumps-rubella (MMR) vaccine during the early to mid-1990s in children who subsequently matured.
• Prepubertal epididymitis is thought to be more common than was once believed. It is thought to be a postviral infectious phenomenon.

Risk factors

Risk factors for nonsexually transmitted orchitis include:

• Not being immunized against mumps
• Having recurring urinary tract infections
• Having surgery that involves the genitals or urinary tract
• Being born with an abnormality in the urinary tract 

Sexual behaviors that can lead to STIs put you at risk of sexually transmitted orchitis. Those behaviors include having:

• Multiple sexual partners
• Sex with a partner who has an STI
• Sex without a condom
• A personal history of an STI

Complications

Complications of orchitis may include:

• Testicular atrophy. Orchitis can eventually cause the affected testicle to shrink.
• Scrotal abscess. The infected tissue fills with pus.
• Infertility. Occasionally, orchitis can cause infertility or inadequate testosterone production (hypogonadism). But these are less likely if orchitis affects only one testicle.

Prevention

To prevent orchitis:

• Get immunized against mumps, the most common cause of viral orchitis
• Practice safe sex, to help protect against STIs that can cause bacterial orchitis

Treatment

Acute Epididymitis and Acute Epididymo-orchitis

Treatment often starts with a 1-2 week course of antibiotics. Most cases can be treated out of the hospital with pills. The best medicine for you will depend on the type of bacteria found. The most common antibiotics used are:

• Doxycycline
• Ciprofloxacin
• Levofloxacin
• Trimethoprim-sulfamethoxazole

For bad cases of infection, you may need to stay in the hospital for treatment. These are cases with pain that’s hard to control with vomiting, high fever and if you are not getting better with antibiotics given by mouth. Occasionally, for bad cases, narcotics are needed for a few days.

Tuberculosis epididymitis is more serious but is very rare. It is treated with anti-tuberculous drugs. If damage is bad, surgery may be needed to take out the testis and the epididymis (“orchiectomy”).

Epididymitis caused by amidarone is treated by limiting or stopping the drug. Your health care provider will tell you what to do.

For other types of non-infectious epididymitis, there’s no set treatment.

Epididymitis care involves rest for 1 – 2 days with the scrotum raised if possible. The aim is to get the inflamed area above the level of the heart. This helps blood flow, which lowers swelling and pain, and helps with healing. Putting ice on the scrotum now and then can also help. In cases due to infection, it helps to drink fluids.

Anti-inflammatory pills like ibuprofen or naproxen help ease pain. They also ease the swelling that causes the pain. If the pain is severe, a short-term narcotic pain medicine may help but is only used for a short period of time at best in most situations.

Chronic Epididymitis

Chronic epididymitis is mainly treated with drugs and comfort to ease pain. Pain medicine and applying heat are the standard treatments.

If symptoms don’t go away, your health care provider may suggest other pain medicine. Or, recommend a pain management specialist. If all else fails, the epididymis can be surgically removed (“epididymectomy”). The testis can be left in place.

Acute Orchitis

Antibiotics are often the best treatment for bacterial infections. Pain medicine may help reduce symptoms.

There’s no set care for acute mumps orchitis and this will usually resolve in time.

After Treatment

Acute Epididymitis and Acute Epididymo-orchitis

For infectious cases, it takes two to three days to start feeling better. If you don’t, and if the redness doesn’t begin to fade, call your provider. Discomfort can last for weeks to months after the full course of antibiotics is taken in some cases. It can take months for the swelling to ease. Rest with the scrotum raised for a day or two helps speed healing.

Cases of tuberculous epididymitis (without surgery) may need months to heal with medicine. The testis may shrink after treatment.

Amidarone epididymitis simply gets better after cutting the dose or stopping the drug.

Chemical epididymitis heals fully with treatment.

Please follow-up with your health care provider to make sure the problem doesn’t return.

Chronic Epididymitis

Symptoms for chronic epididymitis go away eventually or may come and go. Anti- inflammatory medicine may be needed on and off for a months or years. Symptoms are sometimes better and sometimes worse.

If surgery is done, symptoms ease in most men after a few weeks of healing. If surgery hasn’t helped, your health care provider will try drugs again. In certain cases, he/she may suggest microsurgery to block nerves on the spermatic cord.

Acute Orchitis

Pain often goes away after the acute phase. The testis often shrinks.

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