Perianal abscess and fistula

Picture from Wikimedia Commons

Perianal Abscess and Fistula

The recent article in Straits Times Mind and Body about perianal abscess and fistula

http://yourhealth.asiaone.com/content/relieving-pain-butt

was a good read.

It highlights a very difficult problem many patients face. Firstly, it is a very painful infection in a very private area that you can't even check yourself. Many patients wait until the pain is unbearable before having the courage for a consultation. If the pain is severe, emergency surgery is required to relief the pain and prevent sepsis. Often, the patient has waited so long that the pus has drained spontanously. Unfortunately, that does not solve the problem. About half of these become recurrent even after surgical drainage. The article covered the very many surgical procedures available (none of which is very satisfactory in curing the disease). I would like to share some of the preventive habits adopted by patients which seems to help reduce recurrence.

1. Adopt the WASH regime
   Warm water, sitz bath. Sitting in warm salt water or just using the shower head over the site.
   Analgesics. Paracetamol and/or Ibubrufen to relief pain
   Stool . Ensure regular bowel motion. Probiotics / yogurt may help with this.
   High fibre diet with supplements if necessary.

2. Avoid excessive cleansing. This may irritate the skin further. Try to wash with water instead of using tissue paper after bowel movements.
3. Avoid hot spices. These may survive digestion and cause irritaion of the intestinal mucosa.
4. Treat any other conditions of the anus eg pinworms, piles
5. Sit less. If your work involves sitting for long streatches, take a walk and rest your eyes (and bum) every 45 minutes. Walk over to ask the question instead of using the phone, climb up instead of using the lift etc
6. Regular excercise. About 30 minutes, 5 times a week. If that is not possible, just commit 10 minutes daily before your morning shower for a start. This is essential for regular bowel movement and you get a healthy heart as a bonus.

Most of the patients with perianal abscess require surgery for resolution. Even then, the recurrence rates are 30% to 40%. I think daily care is essential to reduce recurrence.

Dr Mohamed Ghazali

Regular Fasting as a way of life

Regular Fasting as a way of life
Fasting is the act of voluntarily abstaining from food or drink (or both) for a fixed period of time. Most religions advocate fasting firstly to increase piety and secondly as part of  healthy living. Fasting takes various forms, varying from partial day fasts to partial meal fasts. But the overall caloric intake should be reduced. Daily caloric intake requirement varies according to sex and age. But we can assume men need 2000 calories and women need 1500 calories daily. The above diet recommends fasting 2 days a week. Fasting day meals should consist of 2 meals of 300 calories. The rest of the week you can take your usual diet. It is good to separate the 2 fasting days. So Mondays and Thursdays will be good. Incidentally, Mondays and Thursday fasts are followed by many religions including Hinduism, Judaism, traditional Christianity and Islam.

Why do I fast and not lose weight?

Contrary to logic, prolonged fasting actually reduces appetite. But for there to be weight loss, the overall caloric intake needs to be reduced. The fasting day caloric intake needs to be reduced to a total of 600 calories. That's about 1½ murtabak or 4 chappatis. (refer to table below)

Food Name	Serving Portion	Serving Weight (g)	Energy (kcal)	Protein (g)	Fat Total (g)	Carbo- hydrates (g)	Dietary fibre (g)	Choles -terol (mg)	Ca (mg)	Na (mg)
Bhatura	1 piece	120	444	7.9	25	47	2	6	87	579
Bun, chicken curry	1 bun	74	201	6.0	6	30	2	4	20	277
Bun, coconut	1 bun	69	229	5.0	11	27	NA	0	24	160
Bun, dried shrimp	1 bun	66	226	9	10.5	24	2	38	94	432
Bun, kaya	1 bun	68	213	5.8	6	35	1	24	19	126
Bun, red bean	1 bun	84	267	7	7.5	43	3	20	29	142
Bun, sausage	1 bun	77	219	8.6	9	26	1	48	53	404
Bun, tuna	1 bun	68	205	8	9	23	1	39	32	287
Chapati, plain	1 piece	46	144	3.2	5	22	3	0	13	119
Doughnut	1 doughnut	78	304	6.0	16	35	2	16	27	206
Idli	1 piece	61	64	2.8	0	13	2	0	11	228
Murtabak, chicken	1 portion	455	697	32.8	29	76	19	159	177	2248
Murtabak, mutton	1 portion	410	418	28.7	34	76	18	254	247	2653
Naan	1 piece	131	356	10.6	10	57	3	21	57	429
Pow, meat	1 pow	68	206	7.4	8	25	1	13	13	268
Pow, red bean	1 pow	67	204	4.0	6	33	2	2	41	89
Roti jala	1 piece	79	108	3.2	3	17	4	2	19	190
Roti John	1 piece	200	571	20.0	27	61	9	192	71	1596
Roti prata, plain	1 piece	41	122	3.0	4	19	1	1	11	226
Roti prata, with egg	1 portion	117	289	11.7	14	28	2	175	32	364
Thosai, plain	1 piece	91	196	4.1	4	36	1	0	15	534

Key: Ca – Calcium; Na – Sodium; g - grams; kcal - kilocalorie; mg - milligram; tr - trace; NA - Not available

Source: Singapore Food Facts, Ministry of Health, 1999 Most of us make the mistake of overcompensating when we breakfast with high caloric food. If we are selective with the types of food, weight loss is inevitable. The recommended weight loss is ½ to 1 kg a week. Fasting regularly may be a feasible option for sustained weight management. Moreover, it does not involve paying thousands of dollars to a beauty saloon and may in fact save you some money. Dr Mohamed Ghazali

Food Name

Serving
Portion

Serving
Weight
(g)

Energy

(kcal)

Protein

(g)

Fat
Total
(g)

Carbo-
hydrates
(g)

Dietary
fibre
(g)

Choles
-terol
(mg)

Ca

(mg)

Na

(mg)

Bhatura

1 piece

120

444

7.9

25

47

2

6

87

579

Bun, chicken curry

1 bun

74

201

6.0

6

30

2

4

20

277

Bun, coconut

1 bun

69

229

5.0

11

27

NA

0

24

160

Bun, dried shrimp

1 bun

66

226

9

10.5

24

2

38

94

432

Bun, kaya

1 bun

68

213

5.8

6

35

1

24

19

126

Bun, red bean

1 bun

84

267

7

7.5

43

3

20

29

142

Bun, sausage

1 bun

77

219

8.6

9

26

1

48

53

404

Bun, tuna

1 bun

68

205

8

9

23

1

39

32

287

Chapati, plain

1 piece

46

144

3.2

5

22

3

0

13

119

Doughnut

1 doughnut

78

304

6.0

16

35

2

16

27

206

Idli

1 piece

61

64

2.8

0

13

2

0

11

228

Murtabak, chicken

1 portion

455

697

32.8

29

76

19

159

177

2248

Murtabak, mutton

1 portion

410

418

28.7

34

76

18

254

247

2653

Naan

1 piece

131

356

10.6

10

57

3

21

57

429

Pow, meat

1 pow

68

206

7.4

8

25

1

13

13

268

Pow, red bean

1 pow

67

204

4.0

6

33

2

2

41

89

Roti jala

1 piece

79

108

3.2

3

17

4

2

19

190

Roti John

1 piece

200

571

20.0

27

61

9

192

71

1596

Roti prata, plain

1 piece

41

122

3.0

4

19

1

1

11

226

Roti prata, with egg

1 portion

117

289

11.7

14

28

2

175

32

364

Thosai, plain

1 piece

91

196

4.1

4

36

1

0

15

534

Key: Ca – Calcium; Na – Sodium; g - grams; kcal - kilocalorie; mg - milligram;
tr - trace; NA - Not available

Source: Singapore Food Facts, Ministry of Health, 1999

Most of us make the mistake of overcompensating when we breakfast with high caloric food. If we are selective with the types of food, weight loss is inevitable. The recommended weight loss is ½ to 1 kg a week.

Fasting regularly may be a feasible option for sustained weight management. Moreover, it does not involve paying thousands of dollars to a beauty saloon and may in fact save you some money.

Dr Mohamed Ghazali



Welcome to Shifa Clinic & Surgery

Welcome to our archive. This is basically our thoughts about what we see daily. The articles are not meant as advise for any specific condition and does not represent any specific patient. The scenarios are a composite of the various cases that we see and are meant to illustrate the difficulties faced by patients and to serve as a stimulus for further reading on the topic.
Dr Mohamed Ghazali