Medsarticles. Medical Weblog

Most bowel symptoms are not due to the presence of endometriosis on the surface of the bowel itself, but rather are usually related to irritation from implants located on adjacent organs or tissues, such as in the Pouch of Douglas, or due to adhesions from these implants pulling on the bowel.

The range of bowel symptoms varies. The most common include diarrhoea and/or constipation, painful bowel movements, rectal pain, wind pain and abdominal bloating. Other less common bowel symptoms may include lower back pain, pain during rectal examinations, abdominal cramping, rectal bleeding, blood in the stools, urgency to open bowels, nausea and/or vomiting. These symptoms may be present throughout the month but are usually worse during menstruation. Exercise, sexual intercourse and vaginal examinations can also trigger these symptoms.

Research by the Endometriosis Association indicates that bowel symptoms are far more common than is generally acknowledged. In fact, 49% of women in its survey reported that they had experienced bowel pain prior to a diagnosis of endometriosis.

In the unusual cases where endometriosis is located on the bowel, the implants are usually confined to the outer layer of the bowel wall; it is uncommon for endometriosis to be found in the inner layer of the bowel wall. If implants are located on the bowel itself the symptoms experienced may include any of the symptoms mentioned above. In rare circumstances a partial obstruction of the bowel may develop as a consequence of scarring and adhesions from endometrial implants encircling and constricting the bowel.

Bladder symptoms-Implants on the bladder, or on adjacent organs, may cause a range of symptoms including bladder pain, blood in the urine, pain or burning when passing urine and urinary frequency.

Infertility-Infertility is one of the most common symptoms and is thought to affect approximately 30% to 40% of women with endometriosis.

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This is the passage leading from the neck of the uterus, or cervix, to the exterior of the female body, the vulva. It is the passage in which sexual intercourse takes place and through which the menstrual fluid passes each month. During childbirth it forms a part of what is called the ‘birth canal’.

Vaginal health and hygiene are important. Some clear, odourless discharge from the vagina is perfectly normal and is required to keep the vaginal walls moist, clean and slightly acidic. However, when the discharge becomes discoloured and is accompanied by an unpleasant odour and/or itching, it is likely that an infection is present or that the acidity of the vagina has been altered, leading to a proliferation of a yeast fungus known as Candida albicans. This latter condition is quite common and known simply as Candida or thrush. It has a number of causes, including a diet too high in refined sugars and the taking of antibiotics. It is generally treated by increasing the acidity of the vagina to discourage the proliferation of the yeast bug. For natural remedies for Candida, see the separate entries in this book. Other more serious causes of vaginal discharge, itching or pain are venereal diseases such as gonorrhoea.

Dryness of the vagina is a problem which affects most women ocassionally and some women more often. It is a common side effect of menopause, when it results from falling hormone levels in the body. Not only can sex become uncomfortable, but the chances of developing vaginal infections increase during and following menopause. Take Vitamin E internally and apply calendula cream to both soothe and lubricate the vaginal walls. KY jelly is also useful for lubrication. Fortunately, regular sexual intercourse, possibly involving prolonged and gentler foreplay, helps to keep the vagina toned and healthy through the later years of life.

Vaginal prolapse can occur after childbirth but not necessarily immediately afterwards. It occurs when the ligaments supporting the uterus or bladder weaken or lose their tone allowing the uterus to drop down into the vagina. A lump is felt inside the vagina and pressure on the bladder and bowel is often increased. Prolapse the more easily prevented than cured. Women giving birth should do some regular form of exercise to strengthen the muscles of the

pelvic floor and disciplines such as the Alexander Technique are known to improve the posture and prevent muscle conditions such as hernias and prolapse. The widely recognised herb for strengthening the pelvic muscles is raspberry leaf, safely drunk as a tea throughout pregnancy. Poor absorption of mineral salts, particularly calcium fluoride, can cause the tissues to weaken. Take calcium fluoride as a tissue salt and increase your intake of Vitamins E and C.

Women’s vaginas vary in width and length but, generally speaking, any fears a woman has about the size of her vagina adversely affecting the sexual pleasure of either her or her partner are unfounded. Small vaginas swell when properly stimulated to accommodate almost any penis without injury and large vaginas will give as much satisfaction if muscle tone is maintained. Desired sexual positions may vary depending on your anatomy.

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A 50-year-old American woman writes to me as follows:

I first heard about St John’s Wort as a treatment for depression when I was reading about natural remedies for menopausal symptoms. I began taking 300 mg but did not find it all that helpful. This past summer my husband suggested I up the dosage to 600 mg and that was the magic amount for the summer Now that we have turned the clocks back again [at the onset of autumn] I am taking an additional 300 mg in the afternoon, which helps.

I have been in and out of therapy since I was 25. Therapy with the right therapist(s) is helpful, but it is also expensive and time-consuming. My employer has a cap on the number of hours of therapy a person can undergo, and I am getting closer to that cap every week. I am hoping that this next calendar year is my last year of needing therapy. I was not in therapy for several long periods of my life. Often, a tragedy such as a death in the family or major surgery would send me back in.

I prefer natural herbs to drugs wherever I can. I have refused to take Prozac or Lustral. I really don’t want to rely on a drug to control my mood.

Whether or not one agrees with Shirley’s opinions about psychotherapy, herbal remedies or anti-depressant medications, she does seem to embody the trend that Naisbitt mentions in his book. I do believe that she speaks for a very large number of people who are concerned about the cost of mental health care, interested in natural remedies and eager to take their lives into their own hands as much as possible. St John’s Wort provides a solution to all of these concerns. Relatively inexpensive, highly effective, safe and mild in terms of side-effects, it offers millions of people the opportunity to help themselves.

It is, of course, critical to know when self-care has reached its limit and when to seek the help of an expert. Shirley appears to be able to make this distinction. It is an important caveat for others to bear in mind as well.

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Lee and Rinkel originally devised the provocative/neutralizing dose for the diagnosis and treatment of food allergies. It still remained necessary to devise such a test for the inoffice diagnosis and treatment of the chemical-susceptibility problem. This test was a by-product of the alcoholism studies which I made, described in Chapter 10. In the course of those studies, a batch of pure, 100-proof synthetic ethyl alcohol was obtained, derived from a petrochemical, ethylene gas. This type of alcohol, although not approved for drinking, is found in various food products, such as lemon and orange extracts. It is not toxic per se.

When given to chemically susceptible individuals, however, it can provoke reactions similar to those they experienced from environmental chemical exposures. The synthetic alcohol was mixed in graded dilutions. Dilution no. 1 was 1:5 mixture of ethyl alcohol and a salt solution; no. 2 was in a proportion of 1:25 (that is, one-fifth as strong as no. 1); and so forth.

If a patient answered at least two questions positively on the Chemical Questionnaire he was tested with a few drops of dilution no. 2, either by injection intradermally or under the tongue. If he answered three to five questions positively, he was tested with dilution no. 3; greater degrees of susceptibility were treated with even weaker dilutions.

In this way, it was possible to test patients for this perplexing chemical-susceptibility problem in the office and to receive fairly reliable results quickly. Before that, a patient had to move out of his house for a while to get such an answer, whereas today the best tests are performed in the hospital. I published, preliminarily, the results of this test in 1964.4

Using this same synthetic ethyl alcohol as a neutralizing dose, it was possible to relieve the symptoms of some patients for a long period of time. The technique was used especially on those who could not avoid chemical exposure, either because of their jobs, the location of their homes, or for other reasons.

One patient, for example, was a domestic maid who had to travel more than five miles by bus every day, five times a week. Each day she would get a headache on the bus, often before she had even reached her destination. She was provided with a small bottle of ethyl alcohol, at the dilution which had previously been found to suit her. By taking a drop of the solution under her tongue, she was able to relieve her headaches.

Another woman lived on the edge of a golf course. Because of continual pesticide spraying, she was chronically ill. After learning to use a neutralizing dose of the synthetic ethyl alcohol, however, she was not only able to tolerate life in her home, but was even able to play golf on the course without suffering any health problems. Because both ethyl alcohol and the pesticides are ultimately derived from the same substances—petrochemicals—a neutralizing dose made of one substance can have an effect in relieving symptoms caused by another such substance.

This is not meant to imply that such drops are a kind of cure-all for the chemical-susceptibility problem. Unfortunately, they are not. Such treatments are not fully protective, because a person’s intake of chemicals varies greatly with time and place.

In addition to synthetic ethyl alcohol, various other chemical extracts now aid in the treatment of chemically susceptible patients. One of the most ingenious is an extract of automobile fumes which Dr. Harris Hosen of Port Arthur, Texas, prepared for the use of clinical ecologists.5 This is sometimes quite effective in detecting and relieving the effects of smog and the fumes of heavy traffic on susceptible patients.

Basically, however, the most effective “treatment” devised for the chemically susceptible patient is still prevention.

It should be reemphasized that patients with advanced environmentally related illness involving food and chemicals are also often sensitive to pollens, molds, dusts, animal danders, insect emanations, and other inhaled particles. Indeed, the course of environmentally related events often starts with localized allergic manifestations on such a basis. But, as Dr. Mandell has emphasized, pollens, molds, etc., may also be related causally to advanced systemic or generalized effects.6 Since skin testing with extracts of these materials is relatively reliable, this possibility should be evaluated by measuring the degree of skin sensitivity as a basis for providing optimal injection therapy.

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Aging, Sjogren’s Disease (an illness involving dry mouth, dry eyes, and painful joints), certain medications, and radiation treatment over the salivary glands — all result in excessive dryness of the mouth. The mouth-drying effect of certain medicines, understandably, is temporary, but dryness of the mouth due to all of the other causes listed above is permanent. Dryness of the mouth is medically known as xerostomia.

Ordinarily just a nuisance, dryness of the mouth can become dangerous if one has angina pectoris (pain in the chest due to heart disease) and relies upon a tablet of nitroglycerin put under the tongue, where it should quickly dissolve and be absorbed for relief. Also, according to Geriatrics (38#5:16), dryness of the mouth can result in tooth decay if left untreated.

The remedy, of course, is to moisten the mouth by drinking frequently or, better still, by using one of the salivary substitute products, such as Salivart or Xero-Lube, which provide not only water but also certain elements normally present in saliva. Salivary substitute spray products that can be carried in the pocket or in the handbag are now available in most drug stores without prescription.

Now, a correspondent to the New England Journal of Medicine (310:1122) suggests, relief from drug-induced mouth dryness can be even more easily obtained by swallowing tablets of another medication called Bethanechol, which stimulates the salivary flow. A doctor’s prescription is needed for these pills.

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Signs and symptoms

Gumboils can be recognized by their typical appearance. Inflammation or swelling that comes to a point, like a tender pimple, appears where the lip meets the gum at the base of a decayed tooth. The area is sometimes painful. Eventually, the gumboil discharges yellow pus. Usually the associated tooth is obviously injured (fractured or discolored) or has an untreated or recently filled cavity. The tooth may be tender when tapped or may be slightly loose. A gumboil is not usually accompanied by fever.

A gumboil may be confused with a canker sore. However, a canker sore is ulcerated (dug out); it does not protrude like a gumboil.

Home care

Give aspirin or paracetamol for pain. Warm soaks or warm salt water rinses will help the inflammation and promote drainage of the boil. (Use one-half teaspoon of table salt in one-half glass of warm water.) If the associated tooth is about to fall out naturally, a gumboil can be left untreated. The loss of the tooth will allow the pus to drain and the gumboil to heal.

Precautions

• If a young child has a gumboil, consult the dentist.

• Some dentists feel that a gumboil on a baby tooth endangers the permanent tooth that has not yet emerged.

• Premature loss of first-year or second-year molars (or permanent six-year molars) can cause later problems in spacing and positioning of the permanent teeth.

Medical treatment

Your dentist will decide whether to leave the tooth in, pull it, replace it with a space retainer, or save the tooth by performing root-canal work. It’s seldom necessary to give the child antibiotics, or to open and drain the gumboil.

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Many researchers believe that cholesterol itself does not cause heart disease, but rather oxidized cholesterol is to blame. Fats become oxidized when they are exposed to light, oxygen or heat. Because of our typical processed food diets, most people ingest a great deal of oxidized fats.

When unsaturated fatty acids (mostly found in vegetable oil) are refined and processed in their manufacture, much of these fats become oxidized. If we eat food that has been fried or deep fried in these fats, we are consuming a great deal of toxic oxidation products formed in these oils. The intense heat used for frying creates compounds including peroxides, hydroperoxides, ozonides, polymers and hydroperoxyaldehydes. These dangerous compounds inflame and irritate your artery walls, damage cell membranes and impair your immune function. They also have the ability to irritate your liver cells and start the development of fatty liver disease. Whenever you eat food that has been fried in vegetable oil, you will be taking in toxic compounds that create a lot of free radical damage in your body. Extra virgin olive oil and virgin coconut fat are exceptions to this rule.

Oxidized cholesterol is found in foods like processed deli meats, foods containing powdered eggs and powdered milk, and egg yolks if the eggs have been cooked in a way that the yolk is broken and heated to high temperatures, for example frying. Homogenized milk is more likely to contain oxidized cholesterol than un-homogenized milk, because the fat globules are smaller, and thus have a greater surface area. This leaves them more susceptible to damage by light, oxygen and heat.

Fatty acids and cholesterol can be oxidized in our own bodies too. We may eat fresh, unrefined fats, but if our body is lacking antioxidants, these fats can still become damaged. Anything that increases the amount of free radicals in our body makes us more susceptible to fat oxidation; these factors include stress, lack of sleep, exposure to pollution, ultraviolet radiation from the sun and a diet lacking raw vegetables and fruit. If we ingest, or otherwise form oxidized cholesterol in our body, this cholesterol will be incorporated into our lipoproteins; HDL, LDL and others. We know that LDL is the “bad” kind of cholesterol, but when it becomes oxidized it is so much worse. It is believed that oxidized LDL causes much more damaged to artery walls because it is able to stick to the artery walls much more readily. Lecithin helps to protect cholesterol from oxidation; it is found in high amounts in eggs and soy foods.

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The bottom part of the womb, the cervix, changes quite dramatically during the menstrual cycle according to the hormones being produced. Understanding and recognizing these changes is one of the most important ways you can pinpoint the best time to have intercourse in order to conceive.

The mucus-secreting glands (crypts) which line the cervical canal produce mucus continuously but this fluid undergoes important changes during the menstrual cycle. During the first half of the cycle (the follicular phase), the mucus is thick and sticky. It forms a plug over the cervix, which stops semen entering. It also makes the vagina acid, which can kill off sperm within a few hours.

About three to four days before ovulation, as oestrogen levels increase, the mucus becomes clear and stretchy and the amount increases. Surrounded by this fertile mucus, sperm can live for up to seven days.

So it is possible to have intercourse on a Monday and actually conceive on a Friday! This fertile mucus turns the vaginal fluids alkaline, keeping sperm alive. It also provides nourishment for the sperm, in the form of increased amounts of sugar, amino acids, salt and water.

The other intriguing aspect of this fertile mucus is that it forms ’swimming lanes’ (or canals) through which the sperm can pass quickly. It also seems to act as a filter, allowing the healthy sperm to travel forward but effectively trapping the abnormal sperm (there are always some abnormal sperm in semen) and blocking their passage. Once ovulation has taken place and progesterone increases, the mucus again becomes thick and sticky (infertile mucus), protecting the cervix from sperm and also from any foreign bodies.

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A young man, they say, will do anything for sex. A middle-age man will do anything for money. An older man will do anything for respect. But all men will do anything for a good bowel movement.

The problem is that a lot can go wrong between digestion and elimination, irritable bowel syndrome being an all-too-common example. IBS, as it’s affectionately called, isn’t life-threatening and doesn’t lead to harder stuff like colorectal cancer. It isn’t inflammatory and doesn’t permanently damage the bowel. In fact, it’s not really a disease but, rather, a “functional disorder.”

The function it disorders is bowel movement. You can have painful constipation with difficult or infrequent bowel movements. Or you can have equally painful diarrhea with a lot of loose stools and urgent desires to reduce the real estate between your irritable bowel and a toilet. Or you can enjoy both versions. Adding to the pleasure are crampy abdominal pain, gassiness, and bloating.

As bad as IBS sounds (and feels), it’s not nearly as serious as inflammatory bowel disease, or IBD. This is a group of disorders that cause inflammation and ulceration in the small and large intestines. Ulcerative colitis and Crohn’s disease, the two major members of the IBD family, cause symptoms similar to IBS. But they also can offer nasty bonuses – like rectal bleeding, weight loss, fever and anemia.

Doctors aren’t sure what causes IBS or IBD. They do know that unlike IBS, IBD has a genetic element to it; 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease. There’s no cure for either one, though treatment under a doctor’s care can ease the discomfort. So can the following recommendations from the National Institutes of Health.

Assess your food. Milk products, large amounts of alcohol, avocados, and excess fat of any kind can contract your bowel in inconvenient ways. But different folks react to different foods, so the National Institutes of Health recommends that you actually keep a journal of the relationship between what goes in and how it comes out. It’s not exactly the kind of diary material that made Samuel Pepys famous, but it could help you avoid undue distress from IBS.

Don’t overeat. Those seven-course extravaganzas can cause cramping and diarrhea in people with IBS. Try smaller meals more often or just eat smaller portions. And keep the fiber high and the fat low. High-fiber diets mildly distend the colon (the largest section of the bowel, or large intestine), and that helps prevent symptom-starting spasms from developing. You may feel some bloating when you first up the fiber, but that should stop as your body adjusts to the better diet.

Lessen your stress. Another trigger for IBS symptoms is emotional stress, which can also aggravate the symptoms of IBD simply by increasing the number of bowel movements.

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Eating binges may occur either spontaneously or as a result of a breakdown in control. Many patients tell me that just tasting a desired food can start an avalanche of eating. One woman said she made a point of memorizing the locations of all the bakeries in her town, so that she could arrange her routes to avoid accidentally smelling fresh-baked doughnuts and pies.

On the other hand, the bulimic may devote a lot of time to planning her binges.

The food consumed during a binge is often high in calories, sweet, and able to be eaten rapidly-even without being chewed!

However, bulimics will eat almost any food-even salad or “health foods”-during a binge. A typical menu for one patient’s binge might be two pounds of peanut M&M’s, a gallon of ice cream, half a chicken, a package of raw Pillsbury chocolate-chip cookie dough, a microwave pizza, a tub of yogurt, and a box of Pop-Tarts. Studies show that the major difference between binge meals and normal meals is often the quantity of food consumed, not the type.

Patients often look on their bulimia as their “dirty little secret.” Most go to great lengths to keep their bingeing and purging hidden. Often this means arranging circumstances so that the patient is alone when she eats.

Other patients know they must conform to their family’s schedules so as not to attract undue attention. They thus eat a normal meal, but may excuse themselves several times during the meal or immediately afterward to go to the bathroom and throw up. If questioned about their behavior, they’ll blame the problem on a “urinary tract infection” or a “stomach virus.” Although I’ve been in practice for a long time, the sheer ingenuity with which bulimics conceal their behavior never ceases to amaze me.

Interestingly, a binge does not necessarily stop when the food disappears-not as long as pizzas or Chinese food can be ordered by phone and grocery stores stay open twenty-four hours a day. Even the feeling of being full won’t do it, a sign some experts believe means that something is wrong with the way the patient’s brain perceives the feeling of fullness. No, the binge might continue to the point of physical pain, when it’s no longer possible to cram in more food. Sometimes the binge stops only when the patient falls asleep. In some cases a family member might enter the room, or a visitor might come to the door, at which point the patient stops eating.

Self-induced vomiting often marks the end of the binge, the return of control. The “punishment” has fit the “crime.” For some bulimics, however, an empty stomach and the relief of abdominal pain mean that they can then turn around and begin all over again.

Surprisingly, vomiting itself can become habitual. Patients believe (wrongly) that because they are throwing up, they aren’t absorbing any calories. Overeating becomes “okay” since it won’t result in weight gain. They also learn the degree to which they can control vomiting. Some patients learn to trigger vomiting simply by applying a little pressure to the abdomen-an act that gets easier over time. For some patients, merely the sensation of having food in their stomachs can trigger intense urges to vomit. Others, however, need a full stomach in order to vomit, and thus need to eat large amounts before they can purge.

In terms of family background, a significant percentage of parents of bulimic children are obese. Obesity in childhood or during the teen years may predispose a girl to develop bulimia. The incidence of depression is also higher among members of families with a bulimic child than in the population as a whole.

An eating binge can be seen as one kind of impulsive behavior. Many bulimics are unable to control other types of impulses as well. A considerable number have a history of stealing. One patient revealed that she sewed pockets inside her coats so she could shoplift food and other items more easily. Sometimes the stealing is motivated by the high cost of eating food in such quantities; sometimes it just reflects the way the patient interacts with her world. Some bulimics engage in promiscuous sexual behavior, having a large number of partners in short-term relationships. The incidence of alcoholism and abuse of illicit drugs is also higher than in non-bulimic populations.

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