Anal Fissure and Haemorroids

Terms You Should know

Anal Sphincter : Muscles around the anal canal that contract, closing the anus to prevent the expelling of stool. 

Anorectal : Pertaining to the anus and rectum 

Anus : The opening at the end of the large intestine ( rectum) that expels stool. See also large intestine. 

Bowel : The small or large intestine. 

Colon : A portion of the large intestine not including the rectum. 

Colorectal : Pertaining to the colon and rectum. 

Consitpation : The infrequent or difficult passage of hard, dry stools. 

Diarrhoea : Loose or watery and often frequent bowel movements. 

Fibre : A food substance that resists chemical digestion and passes through the system relatively unchanged.

Haemorrhoid : A swollen vein in or around the anus. 

Impaction : Pressed firmly together so as to be immovable, often causing an obstruction. 

Intestines : The portion of the digestive tract that extends from the stomach to the anus. The term intestines includes the small and large intestines. 

Large intestine: A muscular tube that extends from the end of the small intestine ( ileum) to the anus. 

Laxative : A medicine that helps relieve constipation. 

Parianal : The area located around the anus. 

Rectum : The lowest portion of the large intestine. 

Sigmoid colon : The lower part of the large intestine that connects to the rectum. 

Sphincter : A circular band of muscle that acts as a valve. 

Stool : Waste products such as food residue expelled from the body through the rectum and anus. Also referred to as faeces. 

Anal Fissure

An anal fissure is a small tear or cut in the lining of the anus which can cause pain and/or bleeding.

Symptoms, Causes and Diagnosis
Symptoms of Internal and External Haemorrhoids

Malabsorption Syndrome Symptoms Diagnosis and Treatment

Symptoms, Diagnosis and Treatment


The most common symptoms of malabsorption syndrome are diarrhoea, bloating, piles, flatulence, cramping and weight loss. Over time, deficiency of iron, proteins, various vitamins and minerals can occur.

This can lead to degrees of malnutrition and a variety of anaemias, the most common being those of vitamin B 12, folate, and iron deficiency. Vitamin K malabsorption could result in excess bleeding.

Protein depletion can lead to impaired bone formation and osteoporosis, and calcium deficiency can cause weakening and demineralization of the bones, causing a condition called osteomalacia.

Impaired absorption of vitamin A could result in night blindness and dermatitis. Irregular heart rhythms may result from inadequate levels of potassium and other electrolytes.

Children with malabsorption syndrome often exhibit a failure to grow and thrive.

There may also be signs of nutrient, vitamin, and mineral depletion: fissures at the corners of the mouth; fatigue or weakness; dry hair; easy bruising; tingling in fingers or toes; and numbness or burning sensation in legs or feet.


Diagnosis is based on proving the existence of steatorrhoea, that is, the passage of fat > 6 g/24 hr stools. A 72-hour stool collection is required for faecal fat measurement.

Increased faecal fat in the stool indicates malabsorption.
The next step after proving steatorrhoea isw to differentiate between absorptive abnormality and digestive abnormality.

This is done by the D-xylose test. D-xylose is a sugar that does not need to be digested to be absorbed; it is excreted in the urine. Low urinary excretion of D-xylose suggests an absorptive abnormality.

This can be due to bacterial overgrowth, which is confirmed by breath test or due to a diffuse lesion of the jejunum which is confirmed by jujenal biopsy.
Ultrasound, CT Scan, MRI, barium enema, or other rays to identify abnormalities of the gastrointestinal tract and pancreas may also be required.


Fluid and nutrient replacement is essential for any individual with malabsorption syndrome. Consultation with a dietitian to assist with nutritional support and meal planning is helpful.

The patient should be encouraged to eat small, frequent meals throughout the day and avoiding fluids and foods that promote diarrhoea. In some cases, fluid volume excess occurs as a result of diminished protein in the blood.

In such cases fluid intake restriction is advised.
Some patients may require injections of vitamin B12 and oral iron supplements. Supplements of enzymes are required to replace missing intestinal enzymes.

People with cystic fibrosis and chronic pancreatitis require pancreatic supplements. Antispasmodic drugs are used to reduce abdominal cramping and associated diarrhoea. Those with lactose intolerance or glutten enteropathy ( non-tropical sprue) will have to modify their diets to avoid foods that they cannot digest properly.

Risk factors

Malabsorbtion Syndrome risk factors

Risk factors

A fault in the digestive process may result from failure of the body to produce the enzymes needed to digest certain foods. 

Congenital structural defects or diseases of the pancreas, gall bladder, or liver may alter the digestive process. 

Inflammation, infection, injury, or surgical removal of portions of the intestines may also result in absorption problems; reduced length or surface area of the intestines available for fluid and nutrient absorption can result in malabsorption. 

Radiation therapy may injure the mucosal lining of the intestine, resulting in diarrhoea that may not become evident until several years later. 

The use of some antibiotics can also affect the bacteria that normally live in the intestines and affect intestinal function. 

Use of certain drugs, such as mineral oil or other laxatives. 

Causes :

Several disorders can lead to malabsorption syndrome, including cystic fibrosis, chronic pancreatitis, lactose intolerance, and glutten enteropathy ( non-tropical sprue). Celiac Disease ( sprue, glutten-sensitive enteropathy) is a condition where the mucosal lining of the small intestine is damaged by ingestion of gluten. Gluten is a protein found in wheat, rye, barley and oats but not in corn or rice. Maintaining a gluten-free diet restores the damaged mucosal lining to normal and restores normal absorption. On occasion patients may fail to respond to a gluten-free diet. These patients can have refractory sprue or intestinal lymphoma. Prednisone ( steroids) helps in up to 50 per cent of patients with refractory disease.

Crohn’s Disease is an inflammatory or ulcerating condition of the GI tract that may affect the small intestine, resulting in malabsorption syndrome. If treated properly, absorption can be restored ( for more information see Crohn’s disease).

Tropical sprue is a bacterial mediated disease causing a similar picture to that of Celiac Disease. Treatment consists of antibiotics, especially Tetracycline, for up to 6 months.
Whipples disease is a systemic bacterial illness usually affecting middle-aged men and presents with diarrhoea, arthritis, fever, weight loss, swollen lymph nodes and skin pigmentation. It is diagnosed by taking a small bowel biopsy through an endoscope. The treatment is administration of antibiotics for one year or longer.

Lactase deficiency can result in malabsorption. Often, one can have partial lactase deficiency that causes symptoms but not full-blown malabsorption. The treatment is to avoid lactose – containing dairy products ( milk, ice-cream, cheese and so on), and lactase enzymes supplements to aid in digestion.
Parasitic diseases can cause selective malabsorption of lactose or fat. Giardia lamblia is the most common of these parasites and is contracted by ingesting unpurified water. It is treated with drugs like metronidazole or ornidazole.

Other causes of malabsorption can be due to past intestinal surgeries, bacterial overgrowth, AIDS, radiation to the abdomen, diabetes, lymphoma or motility disorders. Malabsoption can occur in those who have had portions of their stomachs removed surgically. The pancreas produce enzymes that help to digest food. Therefore, if a condition exists where enzymes are not being produced it can result in maldigestion or malabsorption. This could include chronic alcoholic pancreatitis, cystic fibrosis, tumours or post surgical states.

Symptoms, Diagnosis and Treatment

Malabsorption Syndrome

Malabsorption Syndrome

Terms You Should Know

Absorption : The process of nutrients passing from the intestines into the blood stream. 

Anus : Opening at the end of the rectum that allows solid waste to be eliminated. 

Anaemia : A decrease in the number of red blood cells in the bloodstream, characterized by pallor, loss of energy, and weakness. 

Atrophy : Wasting away of a tissue or organ, often because of insufficient nutrition. 

Cystic fibrosis : : A hereditary genetic disorder. Thick, sticky secretions from mucus-producing glands cause blockages in the pancreatic ducts and the airways. 

Colon : The large intestine. 

Digestion : The process of breaking down food into its simplest chemical compounds so that it can be absorbed. 

Duodenum : The first portion of the small intestine. It connects the stomach to the small intestine. 

Edema : From the Greek word meaning swelling, an excessive accumulation of fluid in the tissue spaces. Excessive generalized edema may also be referred to as ascites. 

Glutan enteropathy : A hereditary malabsorption disorder caused by sensitivity to gluten, a protein found in wheat, rye, barley, and oats. Also called non-tropical sprue or celiac disease. 

 Ileum:The last portion of the small intestine that connects to the large intestine. 

Immune system : The body's natural defense system that fights against disease.

 Inflammation : A response to tissue injury that causes redness, swelling and pain. 

Jejunum : The middle portion of the small intestine. 

Large intestine : Also known as the colon. 

Rectum : Lowest portion of the colon.

Small intestine : Connects to the stomach and large intestine . It also absorbs nutrients. 

Short bowel syndrome : A condition in which the bowel is not as long as normal, either because of surgery or because of a congenital defect. Because the bowel has less surface area to absorb nutrients, it can result in malabsorption syndrome. 

Steatorrhea: An excessive amount of fat in the stool. 


Malabsorption refers to a clinical condition in which a number of nutrients are not normally absorbed from the intestines. Lipids absorption is almost always affected. At times absorption of single nutrients is selectively affected.

Risk factors
Symptoms, Diagnosis and Treatment