Patient wants to avoid back surgery for disk problem

Q: What causes bulging disks and what can be done to avoid the possibility of surgery?

A: Disks are cushions between each of the 33 vertebrae in the spine. They are formed from a tough outer layer of cartilage that forms over softer cartilage within. Bulging disks extend beyond the space they should ordinarily occupy and are generally that specific outer layer of cartilage that protrudes. Bulging disks don’t ordinarily cause pain unless the bulge herniates into the spinal canal. Bulging disks are generally related to the lumbar spine area and most often occur as a result of the aging process. As a means of identification, a herniated disk often results from injury or trauma to the spine, while a bulging disk occurs gradually over time.

Some activities may actually speed up the development of bulging discs and are best avoided. Patients should use good posture, maintain a healthy weight for their frame and height, bend from the knees when lifting heavy objects, and exercise regularly in an effort to strengthen core muscles. Treatment begins with conservative measures such as rest and restrictions on weight lifting. Heat and ice may be effective. Anti-inflammatory medicines, both over-the-counter and via prescription, plus something for pain may provide a sufficient degree of relief. In the past, this might have been followed by cortisone injections; however, a July 3rd study released in The New England Journal of Medicine disproved the worth of epidurals, which implies this modality will be used much less in the future. Chiropractic manipulation, acupuncture, yoga, physical therapy and spinal decompression may be recommended. In most instances, the symptoms experienced from a bulging disc will diminish or totally disappear with conservative treatment. If they don’t, however, surgery may be recommended. While once considered extensive, expensive, significant, requiring hospitalization and longer recuperation, newer methods such as laser procedures are available and may even be performed on an out patient basis. Talk about advances through research!

What is correct for you will depend on your age, medical conditions, severity of symptoms, and a whole lot more. Because you don’t indicate if you are otherwise physically fit, are free from cardiac issues, diabetes, hypertension and other possible conditions, I cannot begin to guess what will be in store for you. As I indicated, most bulging discs are painless unless they are pressing against a nerve or become herniated or rupture. I surmise you are asking because you are in pain and may have been told surgery is on the horizon. If this is the case, make an appointment with the surgeon who will be performing the surgery for the answers you seek, or as another option, request a second opinion from a tertiary care center. Ask if laser or another procedure is recommended and why. You should never enter into this or any other invasive procedure without knowing what to expect in terms of hospitalization and recuperation. Only then will you know how to proceed. Good luck.

Are petroleum jelly products safe in the nose?

Q: For some time now I’ve used a cotton swab to place a little Vicks Vaporub just inside my nostrils before retiring and I’ve found that it helps to reduce my nasal congestion overnight. Do you see any problem with this use?

A: Nasal congestion a/k/a a stuffy nose is defined as a blockage of the nasal passages, a condition generally resulting from swelling or edema of nasal tissue. The condition may interfere with a person’s ears, hearing, speech, cause mild head pain and discomfort. For older children and adults it is generally an annoyance.

Causes for the condition may be from allergies to a whole host of other conditions , again most of which are relatively harmless. Some of the known allergies include dry air – either from the climate in which a person lives to the heating system in homes. Then there are season allergies such as from hay fever and ragweed, specific medications such as those taken for hypertension,pet dander, spicy foods, tobacco smoke, and stress. The possibilities are limitless.

Initially, it is important to determine why you continue to have a stuffy nose. If someone in the house smokes, that alone may answer the question. If your main source of heat is from a wood stove, that’s another possibility. If you are on specific medications, either research the common potential side effects or consult with the prescribing physician for his or her input. Perhaps you have a deviated septum that should be addressed by a health care professional, or a thyroid condition that has been overlooked.

If your stuffy nose is ongoing, you may unknowingly have nasal polyps – benign growths that can block nasal passages. Some individuals develop polyps without having had any previous nasal problems, yet more frequently polyps may be triggered by allergic rhinitis, chronic sinus infections, asthma, or from a response to NSAIDS (non-steroidal anti-inflammatories) such as aspirin, ibuprofen and others. People with nasal polyps often breathe through the mouth, snore, may have stuffiness and congestion and a diminished sense of smell.

Rhinitis is inflammation of the nasal cavity lining – frequently caused by allergies or environmental factors, infection and even stress. Allergic rhinitis occurs when a person’s immune system reacts to a foreign substance. While the allergen may be harmless in other ways, some individuals react adversely with congestion, headache and more.

The bottom line is that until a person knows what is causing the stuffy nose and need for treatment, the condition will likely continue. So, what can you do on the home front until this occurs? Consider using a humidifier or vaporizer. Drink plenty of fluids. Consider a nasal saline spray to help prevent your nasal passages from drying out. Use warm compresses on your face. Simply wet a wash cloth with warm water, sit back in a chair, and inhale the moist air. Or, fill your bathroom sink with hot water and place a tower over your head and inhale the warm water. Use a neti pot to irrigate your nasal passages. And, continue as you are with a small amount of mentholated salve under your nose to aid in opening your nasal passages.

Controversy has developed with petroleum jelly products being placed in the nose. Labels warn the ointment is for external use only. Petroleum jelly or mineral oil can cause a chronic form of pneumonia when aspirated into the lungs. Over time, the oil components cannot be cleared from the lungs and may cause reduced lung capacity, cough and shortness of breath. Many physicians feel a saline nasal spray is a more appropriate option health wise.

A rule of thumb is that if your condition is ongoing, it should be addressed by your physician or perhaps an otolaryngologist (an ear-nose-and-throat specialist) who can get to the bottom of the problem.

Active senior questions ankle pain

Q: I am a 79-year-old woman presently taking Benicar HCT, Aceon, Synthroid, a baby aspirin, and Lumigan drops. I had a mild stroke in 2002 but otherwise have been in good health and am active. I work out in a gym and am involved in other activities. My only surgery was tonsil removal when I was a child and thyroid cyst removal at the same time. I neither drink alcohol nor smoke. I did smoke for many years but haven’t since 2002.

I had a sudden onset of severe ankle pain with no trauma to cause it. The pain was so severe I had to walk holding onto things. After a day of the pain there was some swelling and redness around the ankle. I remained off my feet as much as I could (I live alone) and on the third day the pain diminished even though there was still some swelling and redness.

Do you have any thoughts as to what the cause of these symptoms could be? I considered thrombosis and gout, had it continued. I would have seen my doctor but the pain is mostly gone so I have not sought medical attention. Should I?

A: In a word, yes. Benicar is an angiotensin II receptor antagonist used to treat high blood pressure and for other purposes, as well. One possible side effect is swelling of the hands or feet, although because yours resolved and was unilateral, the medication is not likely to blame. . Aceon is an ACE inhibitor also used to treat hypertension, and to treat heart attack in those with coronary artery disease. There aren’t side effects from this medication that correlate with those you provide. Synthroid treats hypothyroidism (low thyroid hormone). This drug is generally well-tolerated, yet on rare occasions, it could cause, among other things, a feeling of discomfort and muscle weakness that dissipate on their own. Lumigan drops are used to treat open angle glaucoma. Common side effects may include body aches or pain, fatigue and weakness that again, dissipate on their own once the body adapts to the medication. All in all, it’s unlikely any of your medications are to blame for your ankle pain; however, to be on the safe side, you should take a list of your medications to your prescribing physician for his or her comments as to whether there may be a connection.

On to other possibilities. Common injuries that are spoken of together include sprains and strains. A sprain tears ligaments, while a strain stretches or tears a muscle or tendon. Sprains and strains commonly cause pain and swelling and an inability to move the affected joint. Could you have unknowingly hopped out of bed too quickly and twisted your ankle slightly, causing a mild sprain? This might have caused a ligament to stretch. A strain could have resulted from repetitive movement of a muscle from your workout at the gym or from other activities you perform. A condition known as pseudo gout is a form of arthritis that can cause painful swelling of a joint. While the knee is most commonly affected, the ankle can also bear the brunt of the pain and swelling that may last a few days or longer. Pseudo gout is linked with the presence of calcium crystals in the affected joint. Risk factors that might have a bearing on this condition include having an underactive thyroid, a mineral imbalance, and the aging process. Testing is accomplished through a simple blood test. Gout or pseudo gout could both be possibilities.

You certainly did the right thing by allowing your ankle to rest and improve on its own but the bottom line is that if you were concerned enough to write, you should visit your physician for his or her input – even if the pain has gone away. Your doctor can make an educated decision as to whether lab work, X-rays or other testing is appropriate which may either bring something to light or will allow you to get on with your active life.

Health woman hasn’t seen a doctor in years

Q: I am 49 and have never had health issues, so I have never been to a doctor since I have been an adult. I have never had children, nor any kind of surgery. I am too embarrassed to call to find a general physician but I do see an optometrist and dentist regularly. How do I start? Health insurance is not an issue. I do know that I have high blood pressure and have had it for quite a few years. Thank you.

A: If you read what you just wrote to me, you will understand completely why it is time to select and visit a physician. You take care of your eyes and your teeth – two extremely important parts of the human body – but you have neglected to consider the whole package. I do not know why you feel you have hypertension, unless you have a blood pressure cuff or use one at your local pharmacy that provides such information. And, if you haven’t done anything about your high readings at this time, let’s consider the consequences.

Hypertension (high blood pressure) is a very common health condition. It indicates the force of blood placed against the walls of your arteries is sufficient enough to potentially cause conditions such as heart disease or stroke over time. The condition can develop over years and be present without any symptoms at all. The problem is that even without symptoms, damage to your heart and blood vessels can develop.

Some individuals with hypertension may have an underlying condition to blame such as a thyroid problem, an adrenal gland tumor, kidney disorder, or sleep apnea. Then, too, specific medications such as over-the-counter pain relievers, cold remedies, specific decongestants and some prescription drugs (for others) may be to blame. Risk factors that may increase your chances of developing hypertension include being overweight, leading a sedentary lifestyle, advancing age, consuming too much salt in a daily diet, stress, or having a habit of excessive alcohol intake or smoking. Essentially, the longer your blood pressure is ignored and remains untreated, the greater the potential damage.

A normal blood pressure reading is around 120/80 mm Hg, although the Joint National Committee has raised the treatment range to begin at 150/90 for individuals older than 60. In the general population aged 18 to 60, the recommendation is to maintain a reading of less than 140/90; however, there are instances in which a physician may prefer some patients, because of other medical conditions, have lower readings. Once readings rise above 115/75, a person’s risk of developing cardiovascular disease increases. The first step in this condition is known as pre-hypertension, defined as a systolic (the first number) ranging from 120 to 139 mm Hg, or a diastolic (the second number) ranging from 80 to 89 mm Hg. I do not know what your readings are, so I cannot determine if you carry hypertension as a diagnosis or not.

There are steps that can be taken to attempt to lower your readings. Remove the salt shaker from your kitchen table and do not add salt to your foods while cooking them. Exercise regularly. Maintain a healthy weight. Stop smoking and drink in moderation if appropriate.

The point is, control is a step away and that step is making an appointment with a physician. There is no need for embarrassment. Determine if you have any specific requirements in a physician – young/old, male/female. Speak with a friend regarding a referral or phone your local hospital. Many facilities will match you up with someone that will meet your standards. Then, simply call for an appointment. There’s no need for an explanation. You have simply felt you didn’t need to be seen until now. However, it’s time. Expect a full examination, blood work, probable EKG, and perhaps even a chest X-ray if you are a smoker. Who knows? You may be looking at a clean bill of health without hypertension. Good luck.

Using the internet to shop locally

Q: I was told there is a website I could go on and put in my prescriptions, the amount, the milligrams and everything else it asks for. It will then tell me all the drug stores in my area that have the medication and how much it will cost. Do you know the website?

A: According to a Los Angeles Times article of February 24, 2012, internet start-up GoodRx enables consumers to find the best prices at nearby stores by typing in the drug and a zip code. The brains behind the scene, Scott Marlette, a former Facebook employee, stated he wanted to create a product where people could find the best pharmacy to go to in their own area anywhere across the country at no cost, and avail themselves of the best prices the area has to offer.

For example, a search for Crestor revealed a resident in downtown LA could purchase a one-month supply of 10 mg tablets at nearby CVS outlets for $130.29. And, GoodRx added a bonus by allowing readers to print out discount coupons before going to the store. Kmart offered the same product and quantity for $1523.97.

The database is believed to contain over one million prices at drug stores and mail order pharmacies nationwide for more than 6,000 brand or generic named drug. So, where does the money come from to keep the operation going? In a word – advertising. Another former Facebook employee who according to the website information is serving as GoodRx’s CEO, said the site will be looking to sell ads to marketers, as well as “enhancing listings” for drugstores seeking preferential placement. Hopefully, those who log on will not be drawn to the ads placed and will continue to price shop.

On the positive side, GoodRx will alert users when a prescription should be refilled and will update pricing to let internet users know where the cheapest prices can be found. The company’s founders feel there is clearly a need for greater transparency in health care costs and prescription drugs are an obvious candidate here. Even the well-insured who may not need to comparison shop for drugs will be able to see how wide a price disparity exists, particularly when it comes to generic drugs, and by how much money different chains appear to be profiting from their markups.

Consumer Reports states that shopping on the web is one of the best and fastest ways to compare drug prices and save money. Online pharmacies sell drugs for 35% or more off the regular price and while warning readers to “be careful” suggests using only US websites that have the VIPPS seal. VIPSS stands for Verified Internet Pharmacy Practice Site. They offer the following well-known sites of www.drugstore.com, www.familymeds.com, www.walgreens.com, and www.cvs.com. And www.costo.com.

Consumer Reports also offers those on patient assistance programs, Medicare low income subsidies and those with State drug discount cards appropriate sites for the purchase of cheaper drugs.

This trend is foreign to me, so I’d be very interested in hearing from readers who price shop on line and what their experiences have been. If sufficient information is received, I will print a follow-up and share the stories – good or bad – with readers.

Man wants to restore his vitality

Q: I am an 83-year-old male and have been in good to great health most of my life. About three years ago I was in the hospital for pneumonia. At that time I was diagnosed with COPD. They also discovered I had a thyroid deficiency. This last year I was also diagnosed with a general lack of testosterone.

I live in a rural area and now that summer is here, I again have a lot of normal maintenance to do, somewhat manual labor. I really do not feel old – unless I am standing up. I can tolerate my COPD and my thyroid problem but it seems I have no endurance any more. I have always been a very strong person but if I’m standing or just walking, every few minutes or so I need to stop and immediately sit down. After just a few more minutes, I feel like I might just possibly faint. My blood pressure readings fluctuate quite badly and rarely, if ever, are too high. They range from 133/63 to 79/44.

I feel that my testosterone level is the culprit, or is it the thyroid deficiency? I have tried to talk to my doctor but he is either too busy with other patients or whatever! We just seem to get nowhere and I have put up with this for a year now. Recently we tried some testosterone patches but found I am allergic to them. In his exam room he spends most of our time together just typing away on his computer creating my record. No questions from him, no answers!

I’m not looking to replace my sexual drive but have read a lot of pamphlets about low testosterone levels and want to get my strength back. I feel like I’m not living any more. My head says yes I can but my body says no. I want to really live again.

A: If your doctor has been too busy to address your concerns, it’s time to find another physician. You can ask to have all your records transferred so a new doctor can review your chart to determine what the issues have been in the past and can take aggressive steps to return you to your former level of activity.

I feel you may have a combination of medical concerns that need to be addressed. The first is your blood pressure. According to the numbers you enclosed with your letter, you have relatively low readings more often than not, which could give you a feeling of fainting. It’s likely that when you sit down, your readings rise some and allow you to consider getting up to walk. Medication might be appropriate to keep you on a more level pattern.

Next is your hypothyroidism that may present with symptoms of fatigue, muscle weakness, a slowed heart rate, muscle aches, and more. The problem may have been developing for years so you may have been coping without realizing it. Now it’s time to determine if medication is appropriate to bring your levels back to normal.

You have been diagnosed with COPD, a lung disorder that makes breathing difficult. This diagnosis can limit your normal activities and prevent you from performing even basic activities you once took for granted. The condition develops slowly and can worsen over time. The condition cannot be reversed but treatment is available to help control symptoms such as a lack of energy.

Next is your testosterone level. I wonder why your testosterone level was checked, as it is most uncommon to evaluate without some reason being given. However, the possibilities of therapy appear very exciting. You can increase your muscle mass, improve your energy levels, sharpen your memory, and more. However, one disadvantage may be your age. Testosterone levels decline as a man ages – about 1% each year after the age of 30. Therefore, it must be determined if the reduced levels are a part of the normal aging process or are related to another medical condition. Once that is determined, a physician can make the call as to whether therapy is appropriate in forms other than the patch.

Lastly, is your age. I get the impression that you are a very young 83 with a lot of good years ahead. Unfortunately, over the past three years you have had several medical conditions that have all hit rather rapidly without anything being done to remedy them. Find a good doctor who can look at the big picture instead of his computer screen and restore your quality of life as much as possible. Good luck.

Narcotics cause sleeplessness for this gal

Q: A couple of years ago I read with interest your column about the poor sleep quality of a man who injured his foot and could not sleep. For myself, I have found that the pain medications commonly prescribed following surgery – sometimes long-term – keep me from sleeping more than a few hours at a time. Apparently I don’t tolerate anything with codeine. It makes me restless and doesn’t even help the pain that much. Most doctors prescribe these meds no matter how small the procedure is they perform. Oxycodone or any of its relatives cause more problems for me than they help! I use only Tylenol or Advil. This man may still be taking strong pain relievers long past the time they should have been discontinued. I realize that orthopedic repair is very painful, but finally thought I would tell you of my experiences.

A. And thank you for your comments. Narcotics work by binding to opioid receptors in the brain, spinal cord and other areas of the body. They are intended to lessen pain messages to the brain while reducing the intensity of that pain. And, as you have pointed out so succinctly, they are widely abused drugs that may be prescribed by a physician or other health care professional for the treatment of mild to severe pain – whether taken post surgically or recreationally.

The effects of these drugs may include a reduced heart rate, constipation, sedation, euphoria, an inability to feel pain or at least experience a major reduction in the sense of pain, labored breathing and more. Psychologically, the user will feel relaxed, yet all of the seemingly positive effects are short lived. And, as a user develops a tolerance for drugs in this class, the effects are reduced which generally leads to taking greater quantities for a longer of period of time than is actually necessary in order to achieve the wanted effects. This tolerance can and often leads to physical dependence and addiction to narcotics that may be extremely difficult to defeat and overcome.

The oxycodone you mentioned is one such opioid pain medication that is used to treat moderate to severe pain. It is commonly prescribed by physicians – despite the fact that it may become habit forming, even at regular doses. For this reason, the label will likely state the drug should be taken exactly as prescribed. It should not be shared with another person. It should not be crushed or broken. It should be swallowed whole to avoid potential exposure to a potentially fatal dose. It should not be used if the patient has problems breathing, is an asthmatic, or has an intestinal blockage.

In all fairness to physicians, they prescribe in good faith and expect patients to adhere to the rules. And, it is impossible to consider that every person who takes a similar drug will respond in the same way. Patients are different. Most will follow a doctor’s orders, some will not. Some will experience side effects. Others will not. For you, narcotics cause sleeplessness. For others, they may become relaxed and don’t have the problem. Thank Heaven we are not all the same – all clones in this complex world. How boring it would be! For you, stick with Tylenol or Advil and thank your lucky stars. For others…who knows? By taking drugs longer than they should, they could be in for one rough roller coaster ride.

Will a supplement help rebuild cartilage?

Q: I am a 60 year-old-female in good health and on no prescription medications. I take multi-vitamins, calcium, omega 3 oil, D3, C and an 81 mg aspirin daily. For about 20 years running was my exercise of choice but herniated discs and cervical spinal fusion 20 years ago changed my running to walking. Currently I combine weight training, walking and yoga.

I year ago I had arthroscopic surgery on my knee for a turn meniscus. The MRI showed thinning cartilage and I also experience a little osteoarthritis in my back.

I noticed information for a supplement called SAMe which is supposed to help rebuild cartilage. I am wondering if this is safe and effective. I would appreciate any guidance you might provide regarding this supplement.

A: SAMe is a chemical found naturally within the body and can also be manufactured in a laboratory as a supplement. In fact, it has been recognized as a dietary supplement in our country since 1999. SAMe is used for osteoarthritis, bursitis, tendonitis, liver disease, spinal cord injuries, depression, anxiety, fibromyalgia and other conditions almost too numerous to mention. There is an organization known as the Natural Medicines Comprehensive Database that rates the effectiveness of supplements based on specific scientific evidence which rates this specific product as “likely effective” for osteoarthritis and depression. With regard to the first disorder, it appears to work about as well as aspirin and similar drugs. On the downside, it will take twice as long before improvement is noted. With regard to depression, SAMe might be as effective as some prescription tricyclic antidepressants. The Database goes on to indicate it is “possibly effective” for fibromyalgia, some symptoms of AIDs related nerve problems, and for decreased bile flow from the liver to the gallbladder. The product is likely safe for most individuals. In some, it may cause gas, vomiting, diarrhea, constipation, dry mouth, nervousness, dizziness, headaches, mild insomnia, anorexia

Amino acids are considered the building blocks of the body that make up proteins. Second in line from water, proteins make up the greatest portion of our body weight. Protein substances make up muscles, tendons, organs, glands, hair and nails. Those amino acids that must be obtained through the foods we eat are referred to as essential amino acids, while those manufactured from other sources are referred to as non-essential amino acids. There are nine essential amino acids and nine non-essential amino acids. Studies have shown the best way to get all the essential amino acids is to eat soy, animal protein with meat, eggs and dairy (all in moderation) as the most common sources. When it comes to supplements, they should be thoroughly researched prior to use. Because the body does not store amino acids, it is necessary to replenish them daily.

Lastly and according to the University of Washington Orthopedics and Sports Medicine, vitamins A, C, D and K are good aids for cartilage repair. I recommend you read the back of your daily multi-vitamin bottle to determine the percentage of each vitamin. You may already be getting all you need to restore your thinning cartilage.

Leg edema bothers veteran

Q: I am a World War II veteran with leg edema. My doctor advises me to keep my legs up and to wear spandex socks. I spend a lot of time in my shop building crafts and in the woods looking for unusual wood for lamps. My condition seems to have worsened since I had a heart valve operation. I am also writing a book that requires a lot of sitting.

Do you know of any other remedies for the edema?

A: Hopefully, but first let me congratulate you on staying as active as you are. Walking in the woods alone is commendable and keeping active is good for the mind and body, so my hat is off to you.

Leg edema is the result of fluid retention in the tissues that may be caused by a problem or less than optimal efficiency of the circulatory system, kidneys or the lymphatic system. So you may better understand how the complexities of our bodies actually work, the circulatory system permits blood to circulate throughout the body and transport nutrients, water and oxygen to literally billions of body cells, while simultaneously, carrying waste away. The kidneys are bean-shaped organs that remove waste products of metabolism. They are essential in the urinary system to regulate electrolytes and blood pressure, filter blood, and remove water soluble waste products that divert to the urinary bladder. The lymphatic system is a network of lymph nodes, organs, ducts and vessels that produce and move lymph from tissues to the bloodstream. When bacteria are identified in lymph fluid, the lymph nodes respond by producing more infection-fighting white blood cells – an act that causes the nodes to swell.

Those conditions known to cause the fluid buildup include having heart failure, chronic kidney disease, taking excessive amounts of over-the-counter ibuprofen or naproxen, prescription calcium channel blockers, steroids, and more. Conditions that can contribute to the edema may include having gout, bursitis of the knee, an ACL tendon rupture, osteoarthritis, an inflammatory joint disease such as rheumatoid arthritis, and more.

To begin with, you indicate you had a heart valve operation. This procedure repairs or replaces diseased heart valves. Some replacement valves are comprised of man-made materials such as stainless steel, titanium and carbon alloys. Valves of this type can last a lifetime but require the use of anti-coagulants forever. Those that are made of human or animal tissue are referred to as biologicals. They last up to 15 years but may not require life-long anti-coagulant usage. Lastly, surgeons can use a patient’s pulmonary valve to replace the aortic valve that is damaged. The pulmonary valve is then replaced with an artificial valve and is recommended for those people who do not want to take anti-coagulants.

You don’t specify if you are on any medications such as a calcium channel blocker, NSAIDs or other drugs that might be causing your edema. This is a question that should be presented to your prescribing physician who may be able to make a substitution without compromise to your health. You should reduce your salt intake if appropriate, continue to wear compression socks, elevate your legs above the level of your heart three or four times each day, consider massage and acupuncture, and by all means – keep on moving. The elevation can be accomplished by lying on a couch or bed and elevating your feet and legs by propping them up on pillows. Avoid tobacco products. And, while unproven in scientific studies, some researchers endorse eating a cucumber daily and adding grape seed extract as an antioxidant – both purported to reduce edema. When all else fails, you might consider asking your physician about a water pill (diuretic) such as Lasix that is available by prescription.

Rectal bleed requires investigation

Q: I am a female, 71 years old. I now find that I must wear some type of panty liner because I never know if I will experience rectal bleeding. Some times are just light but others are so heavy I must wear a heavy duty pad and I’m lucky I am at home because I just change the pad every 10 to 15 minutes. I have not had a period for 31 years and have not had a hysterectomy. I do have a prolapsed bladder which doesn’t cause me any pain. Your comments?

A: There are a great number of causes of rectal bleed, ranging from hemorrhoids and anal fissures to cancer of the anus. Such conditions as Crohn’s disease, ischemic colitis, chronic constipation, polyps, rectal prolapse and radiation therapy may also be to blame. The gastrointestinal tract begins at the esophagus, follows to the stomach, small intestine, large intestine (colon), rectum and anus. A bleed can occur in any one or more than one of these areas. It does not represent a disease in itself; however, it is a symptom of an underlying issue that should be addressed and locating the source of the bleed is extremely important. Let’s consider a few of the possibilities.

A hemorrhoid is a swollen blood vessel in the rectum or anus. The hemorrhoid may be internal or external. Symptoms include a lump near the anus that may be painful. If you strain while having a bowel movement, you may damage the surface of a hemorrhoid and cause it to bleed. And, that straining can push an internal hemorrhoid through the anal opening and cause a condition known as a prolapsed hemorrhoid.

An anal fissure is a tear in the lining of the rectum that results from passing hard stool and results in bleeding and pain that is more intense during a bowel movement but which will decrease or dissipate once evacuation is complete.

Colon polyps are small clumps of cells that form on the lining of the colon. While most polyps are benign, others may become malignant over time. Those found in the early stages can be removed without consequence. Symptoms may include rectal bleeding, dark or red stool, abdominal pain and more. Stool that appears discolored may present for several other reasons such as from taking iron supplements or because of eating specific foods. Polyps can form anywhere within the large intestine.

A Meckel’s diverticulum is a bulge in the small intestine. It is generally painless, but when it causes symptoms, it can present with pain and rectal bleeding. While true that diverticulitis is also painful, these are very different entities. A Meckel’s occurs from birth, while diverticulitis is a condition that occurs later in life. When it becomes inflamed, it is painful and while uncommon, it can cause bleeding.

You need to be seen by a health care provider as soon as possible. A part of the examination you have will be to confirm that the blood is not emanating from the vagina. So, begin with your personal physician and from there ask for a referral to a gastroenterologist if appropriate. It is extremely important that the source of your bleed be identified.