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What is Prenatal Care? Why it’s Important?

Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers.

Prenatal Care

Prenatal care helps decrease risks during pregnancy and increases the chance of a safe and healthy delivery. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Babies born to mothers who lack prenatal care have triple the chance of being born at a low birth weight. Newborns with low birth weight are five times more likely to die than those whose mothers received prenatal care.

Prenatal care ideally starts at least three months before you begin trying to conceive.

Some healthy habits to follow during this period include:

  • Quit smoking and drinking alcohol
  • Take folic acid supplements daily (400 to 800 micrograms)
  • Talk to your doctor about your medical conditions, dietary supplements, and any over-the-counter or prescription drugs that you take
  • Avoid all contact with toxic substances and chemicals at home or work that could be harmful

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Normal discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Regular checkups are also a great time to learn how to ease any discomfort you may be having, and ask any other questions about your pregnancy and the birth of your future baby.

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Article by

Dr Umalakshi Premnath MD, DM

Consultant, Gastroenterologist

Dr Mehta’s Hospitals, Chetpet

 

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What is Cardiac Marker Test?

Cardiac marker tests identify blood chemicals associated with myocardial infarction (MI), commonly known as a heart attack. The myocardium is the middle layer of the heart wall composed of heart muscle. Infarction is tissue death caused by an interruption in the blood supply to an area.

Purpose

Cardiac markers help physicians to assess acute coronary syndromes and to identify and manage high-risk patients. Creatine kinase-MB (CK-MB), myoglobin, homocysteine, C-reactive protein (CRP), troponin T (cTnT), and troponin I (cTnI) are all used for assessment of the suspected acute myocardial infarction. CK-MB, cTnT, and cTnI may also be used to identify and manage high-risk patients.

Precautions

C-reactive protein results may be affected by the use of oral contraceptives, NSAIDs, steroids, salicylates, and intrauterine devices (IUDs). Homocysteine levels may be affected by smoking, diabetes, and coffee.

These articles contained the following recommendations regarding cardiac marker laboratory testing.

  • Troponin T or I is the preferred cardiac marker.
  • CK-MB is an acceptable alternative, if troponin is not available.
  • Total creatine kinase (CK) is no longer useful & should be discontinued.
  • Troponin should be measured within 6 hours of the onset of symptoms.
  • If the first troponin result is negative, a second sample should be obtained between 6 & 12 hours of symptom onset.
  • Cardiac Marker results should be available within 30 to 60 minutes.
  • An abnormal troponin result should be defined as >99th percentile of a normal population
  • Troponin assay must have a low level of imprecision at the cutoff point (CV<10%).

Based on these recommendations, a group of physicians from Cardiology, Emergency Medicine and Pathology at our hospital decided to implement the following changes in cardiac marker testing.

  • Create a new Cardiac Marker Panel for the Emergency Department that includes CK-MB & Troponin at 0, 3 & 6 hours after admission.
  • Retain the current Acute Cardiac Injury Panel that includes CK-MB & Troponin at 0, 6 & 12 hours for admitted patients.
  • Eliminate total CK from all cardiac panels.
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Back Pain: Types & Treatment

Back pain can affect people of all ages; it may be caused due to a variety of reasons such as injury, improper sitting or sleeping posture, intense physical activity or medical conditions. The human back is composed of multiple complex structures of muscle, tendons, ligament, disc and bones. As people grow older the chances of them developing back pain increases since the human back is the most sensitive part affected by ageing and it is easy to develop degenerative disk disease.

The spine is the human body’s main structural support and it is responsible to bear and balance a lot of other parts of the body. It is necessary for it to remain flexible enough for movement and stable enough for a person to stand upright. The segments of the spine are cushioned with cartilage-like pads called disk and these disks start degenerating due to wear and tear caused by a person’s occupation health condition, age etc.

Any problem in these components can lead to back pain although in some cases it becomes hard to determine the cause of back pain most of these problems are usually believed to be caused due to strain on the back, medical conditions, occupation, poor posture among other reasons.

Back pain problems are classified into two types:

Acute Back Pain

These are generally caused due to some sort of strenuous activity, injury or being in a bad posture for a long time. The time duration this type of back pain lasts for is temporary and may extend up to 6 weeks. This type of aliment is much easier to diagnose and provide treatment.

Chronic Back Pain

This type of back pain is an ongoing problem and last for a longer duration it may last for over 3 months or continue for a lifetime. It is more difficult to diagnose and provide treatment as in some cases the cause for pain may be due to an incurable disease such as cancer and requires long term pain relief treatment.

Most acute back pains get better with a few weeks of treatment at home, however as every person is different the condition may last longer and the pain may become more persistent since back pain is a complex condition.

The following are a few of the common treatment procedures your physician may suggest for back pain problems:

MEDICATION

Over-the-Counter (OTC) Pain Relievers

Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen sodium can help relieve acute back pain problems. The medications will be prescribed by your physician but it is necessary to avoid overdosage as it can cause serious side-effects.

Muscle Relaxants

In cases where OTC drugs are ineffective, the physician might prescribe muscle relaxants to ease the pain. These medications can cause mild dizziness and induce sleep.

Narcotics

The prescription and medication regime is closely monitored by the physician and medicines containing opioids such as oxycodone or hydrocodone are used for treatment. This type of treatment is unsuitable for a longer duration thus it lasts for at most a week.

Topical Pain Relievers

These are external medications and are applied directly over the skin at the site of pain. These include oils, creams, gels, sprays, salves and ointments.

Anti-Depressants

Low doses of anti-depressants such as amitriptyline are sometimes prescribed for patients afflicted with certain types of chronic back pain.

Injections

In cases when oral or topical medication fail to relive the pain the physician may inject an anti-inflammatory medication such as cortisone into the space around the spinal cord to help inflammation around nerve roots and this effect can last up to a few months.

EXERCISE & THERAPY

People with a good diet and fitness regime are less prone to be afflicted with back pain unless they accidentally injure themselves. People with poor health maintenance or diet are more prone to develop diseases related to the back. Thus, physicians often recommend patients to exercise regularly and maintain a healthy diet.

In certain cases, they may also recommend a physiotherapist who can help relieve back pain by using a variety of treatments such as massage, ultrasound, heat, electrical stimulation and muscle-release techniques to ease back muscles and soften tissues.

SURGERY

Surgery is usually the last option available and mostly recommended for patients with structural problems such as those afflicted with:

  • Degenerating spinal condition due to spinal stenosis or narrowing of the spine.
  • Bone spurs usually caused due to arthritis and putting pressure on the spinal cord.
  • Ruptured or bulging disks.
  • Weakened or dysfunction of limbs caused due to nerves in the spine.
  • Spinal infection.
  • Injury to spine and related nerves due to an accident.
  • Tumour in spinal cord etc.

Some of the surgical procedures include:

Fusion

Two vertebrae are splinted together with a bone graft between them using metal plates, screws or cages.

Artificial Disk

An artificial disk is inserted to replace as a cushion between two vertebrae

Diskectomy

Removing a portion of the disk if it happens to irritate or press against a nerve on the spine.

Partial removal of vertebra

Removing a minor section of the vertebra in cases where it is pressing against the spinal cord or nerves

Surgery is a joint decision between you and your physician and often an option to be avoided if possible as it can cause more problems. However, if back pain persists for a few days without any improvement it is recommended you visit the physician.

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Types of Piles and Its Related Surgical Procedures

When one experience discomfort in and around the anal cavity during a bowel movement or when sitting, it could be a symptom of them suffering from piles.

In India piles or haemorrhoids affects over a million per year and one in every ten women suffer from it during pregnancy. Piles can be prevented if proper care is taken in earlier stages without undergoing a surgery however in most cases people find it awkward to discuss it openly even with their physicians. Most patients fail to consult a doctor until they start experiencing rectal bleeding or severe pain. These occur due to swollen and inflamed veins in the rectum that develop due to strained veins in the rectal region caused due to long-term constipation, old age, pregnancy etc. When stool passes this region stretches it causes discomfort, pain and even bleeding. It is important to note that bleeding piles are susceptible to infection thus it’s crucial to visit a physician in the early stages.

Piles can be classified into two types:

Internal:

This type of piles occurs too far inside the rectum and cannot be seen or felt. Since the inside of the rectum cavity has very few pain sensing nerves this type of piles are usually the most neglected type and it is only detected when bleeding starts occurring.

External:

This type of piles appears closer to the anal opening and is most easily seen and felt as this portion of the rectum has a many pain-sensing nerves. Also, this type is more painful as it hurts during defecation.

In most cases, piles can be cleared up without undergoing surgery using early treatment by consulting a doctor. The usual treatment procedure may vary on a case-by-case basis which may include home remedies, dietary changes, tablets and ointments.

Surgery is the last resort and about 10% of piles cases require removal of piles. This procedure is usually recommended when there is no other alternative and the piles start affecting the normal lifestyle. Also in cases where the piles get infected surgery becomes mandatory, this mostly occurs for external piles since it comes in contact with stool. The following are a few scenarios when the doctor may suggest a surgery:

  • Piles causing anaemia due to excessive bleeding.
  • Intense pain when sitting or when defecating.
  • When internal piles get prolapsed and become trapped by the anal muscles.
  • Internal piles bulge out of the rectum and can’t be treated non-invasively.
  • Symptoms of gangrene due to lack of blood supply to the tissue.

Surgical options for treatment of piles include:

Hemorrhoidectomy

The doctor makes small cuts around the anus to remove the piles that have been formed after applying a local or general anaesthesia. This procedure is used for the treatment of external piles and since this region is very sensitive the cuts are stitched and could be tender and painful till it recovers.

Sclerotherapy

The doctor injects medicine into blood vessels or lymph vessels and causes them to shrink. As piles are caused due to swollen or inflamed veins this treatment is valid for curing piles.

Photocoagulation

This procedure is used to treat small and medium-sized haemorrhoids in which the doctor uses a device that creates an intense infrared beam of light and focuses it on the affected region to cut-off blood supply to the haemorrhoid. This way the haemorrhoid is removed and scar tissue is formed on the wall of the anal canal.

Rubber Band Litigation

This is a treatment procedure used for internal piles in which the haemorrhoid is tied off at the base with rubber band and its blood flow is cut-off. An instrument is used to view inside the rectum and place the rubber band at the base. In case the patient finds this procedure painful medicine is injected into the banded haemorrhoids to numb them.

Laser treatment

This is the most preferred procedure by both patients and physicians; it’s working principle similar to photocoagulation in which a beam of light is focused on the affected area to seal off blood vessels and nerves. There is little to no pain involved and the procedure is non-intrusive.

The specific type of surgery will be suggested to you by your physician if you require undergoing one. Thus, if you find it uncomfortable in the rectum region for a longer duration it is advised to consult the physician immediately than shy away from the problem.

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AN INSIGHT INTO PATHOLOGIST

Who is a pathologist? — In routine practice, they are Doctors to Doctors and Physician’s Physician. – involved in diagnosis and assisting in the management of patients. The scenario has changed dramatically over the years with emergence of newer techniques and ancillary studies like molecular pathology, especially in oncology where targeted therapy is the most sought after tool.

Pathologists are now multifaceted with added responsibilities of lab management, financial planning, technology development, and sometimes need to counsel the patients and Doctors as well.

The challenges faced mostly relate to inter lab variations in reports.- the reasons are very many.-sampling technique, methodology adopted, the type of instrument used etc..  There has been a number of studies regarding inter lab comparison and quality management. The biological reference interval and the method adopted are important to assess the validity and authenticity of the report.

For certain investigations like INR, CK etc which have a clinical impact it is advisable to stick to one designated lab as the standardization process are constant to each lab.

The pathologists as a medical fraternity have to balance  confidence and humility  in the diagnostic process.-I quote’   KNOWLEDGE IS PROUD THAT IT KNOWS SO MUCH;  WISDOM IS HUMBLE THAT IT KNOWS NO MORE’— William Cowper.

So let us be wise and knowledgeable.

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Fibroids: What you need to Know

Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Types of Fibroid

There are four types of fibroid:

Intramural: This is the most common type. An intramural fibroid is embedded in the muscular wall of the womb.

Subserosal fibroids: These extend beyond the wall of the womb and grow within the surrounding outer uterine tissue layer. They can develop into pedunculated fibroids, where the fibroid has a stalk and can become quite large.

Submucosal fibroids: This type can push into the cavity of the womb. It is usually found in the muscle beneath the inner lining of the wall.

Cervical fibroids: Cervical fibroids take root in the neck of the womb, known as the cervix.

The classification of a fibroid depends on its location in the womb.

Symptoms

Many women who have fibroids don’t have any symptoms. Around 1 in 3 women with fibroids will experience symptoms.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

  • Heavy menstrual bleeding
  • Menstrual periods lasting more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a doctor

See your doctor if you have:

  • Pelvic pain that doesn’t go away
  • Overly heavy, prolonged or painful periods
  • Spotting or bleeding between periods
  • Difficulty emptying your bladder
  • Unexplained low red blood cell count (anemia)

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

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What is Endoscopy?

Endoscopy is the insertion of a long, thin tube directly into the body to observe an internal organ or tissue in detail. It can also be used to carry out other tasks including imaging and minor surgery.

Endoscopy is a nonsurgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a color TV monitor.

During an upper endoscopy, an endoscope is easily passed through the mouth and throat and into the esophagus, allowing the doctor to view the esophagus, stomach, and upper part of the small intestine.

Types of Endoscopy

Endoscopy is useful for investigating many systems within the human body; these areas include:

  • Gastrointestinal tract: esophagus, stomach, and duodenum (esophagogastroduodenoscopy), small intestine (enteroscopy), large intestine/colon (colonoscopy, sigmoidoscopy), bile duct, rectum (rectoscopy), and anus (anoscopy).
  • Respiratory tract: Nose (rhinoscopy), lower respiratory tract (bronchoscopy).
  • Ear: Otoscopy
  • Urinary tract: Cystoscopy
  • Female reproductive tract (gynoscopy): Cervix (colposcopy), uterus (hysteroscopy), fallopian tubes (falloposcopy).
  • Through a small incision: Abdominal or pelvic cavity (laparoscopy), interior of a joint (arthroscopy), organs of the chest (thoracoscopy and mediastinoscopy).

Why Endoscopy is needed?

Doctors will often recommend endoscopy to evaluate:

  • Stomach pain
  • Ulcers, gastritis, or difficulty swallowing
  • Digestive tract bleeding
  • Changes in bowel habits (chronic constipation or diarrhea)
  • Polyps or growths in the colon

In addition, your doctor may use an endoscope to take a biopsy (removal of tissue) to look for the presence of disease.

Is Endoscopy Safe?

Overall, endoscopy is very safe; however, the procedure does have a few potential complications, which may include:

  • Perforation (tear in the gut wall)
  • Reaction to sedation
  • Infection
  • Bleeding
  • Pancreatitis as a result of ERCP

Procedure

The procedure will depend to some extent on the reason for the endoscopy.

The procedure does not require an overnight stay in the hospital and usually only takes around 1 hour to complete. The doctor will provide instructions about the preparation for the procedure.

For many types of endoscopy, the individual needs to fast for around 12 hours, though this varies based on the type.

For procedures investigating the gut, laxatives may be taken the night before to clear the system.

A doctor will carry out an examination before the endoscopy. It is important to mention all current medications (including supplements) and any previous procedures.

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Difference between Piles, Fistula and Fissure

Piles or Hemorrhoids are the swollen veins in the lower part of the anal canal or anus, these are painless. Fissures are very painful, as they are caused due to the tear or cut in the skin near the anus. The fistula is the small opening develops in the skin around the anus, this opening has pus inside it.

Piles

Piles or Hemorrhoids are the inflammation in the veins of the anal tract. It occurs due to constipation, obesity, pregnancy, sitting in the toilet for a long time, weakening of the rectus muscles, diarrhea and mainly due to lack of fibre diets and liquids, etc.

Piles are of two types, internal or external hemorrhoids. These hemorrhoids are present in everyone’s body, but when it get enlarge, they are considered as abnormal. Internal hemorrhoids are painless as they belong to the nerve fibres of the intestine and so cannot be felt, but the hemorrhoids which get protrude from the anus and bleed during hard stools.

Fissure

The tear or a cut around the anus, which are painful, is known as fissures. It is noticed when passing the stool becomes difficult or constipation occurs, while we try to stretch and gives pressures to the sphincter muscles.

There are two types of fissures, acute and chronic. Acute fissures are easy to treat and heal with time, Chronic fissures are difficult to treat than the acute one and have the chances of reoccurrence. If the fissures do not get heal, one should take the medical help.

Fistula

Anal Fistula is formed especially to the person who has anal abscess earlier; it is a type of opening in the anal area filled with the pus. The small gland in the anus gets infected and causes an abscess.

The symptoms include swelling, pain, redness and irritation around the skin of the anal canal, with the discharge of the pus through the fistula. Diagnosis and treatments are available of this, although antibiotics are also considered as one of the best ways to care fistula.

Key Differences between Piles, Fissures and Fistula

  • The swollen blood vessels in the anal canal, which occurs due to chronic constipation and result in bleeding is called as Piles, while Fissures or Anal Fissures are kind of cracks or tear found in the skin of the anal canal or around the anus, resulting in pain.

 

  • Symptomsof piles are not noticed in the earlier stage as they are painless, but later on, swelling occurs in the anal area and become painful, when they are felt, whereas fissures cause a lot of pain in the anal area, that the sufferer avoids using the toilet, though bleeding is infrequent. The symptoms of fistula are more severe condition than two, as in this, the pus is discharged from the anal area.
  • In all the three cases it is advisable to take liquids and diet with high fibre work best, even they are advised not to exert too much pressure at the time of passing stools, along with that maintaining hygiene habits while using toilets, is the best way of preventing the infections in the anal canal.

Pain, bleeding, constipation, after going toilet or while passing stools can be the symptoms of the disease related to the anal canal. These can be due to the changes in the lifestyle, eating habits which have increased the percentage of such problems drastically. In this article, we discussed the main problems occurring in the anal part and how they distinguished from each other

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Know more about Diabetic Foot Ulcer

Foot ulcers are a common complication of poorly controlled diabetes, forming as a result of skin tissue breaking down and exposing the layers underneath. They’re most common under your big toes and the balls of your feet, and they can affect your feet down to the bones.

All people with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Discuss any foot pain or discomfort with your doctor to ensure it’s not a serious problem, as infected ulcers can result in amputation if neglected.

Diabetic ulcers are most commonly caused by:

  • poor circulation
  • high blood sugar (hyperglycemia)
  • nerve damage
  • irritated or wounded feet

Risk Factors for Diabetic Foot Ulcers

All people with diabetes are at risk for foot ulcers, which can have multiple causes. Some factors can increase the risk of foot ulcers, including:

  • poorly fitted or poor quality shoes
  • poor hygiene (not washing regularly or thoroughly)
  • improper trimming of toenails
  • alcohol consumption
  • eye disease from diabetes
  • heart disease
  • kidney disease
  • obesity
  • tobacco use (inhibits blood circulation)
  • Diabetic foot ulcers are also most common in older men.

 How can you prevent foot ulcers?

Here are some tips to preventing foot ulcers:

Watch your blood sugar. The best way to prevent diabetic foot ulcers is to keep your blood sugar levels under control. Uncontrolled glucose is often behind neuropathy, which causes loss of feeling in the feet and may allow a sore to go unnoticed. Maintaining normal glucose levels will also help any sores on the foot heal faster. This can help keep ulcers from developing.

Pay attention to your feet. Dr. Scott says it’s important to conduct daily foot inspections if you have diabetes. Catching a sore early can go a long way in preventing major problems. Can’t see the bottoms of your feet? Try this: Put a mirror on the floor and hold each foot over it. Or ask a family member to check all areas of your feet regularly.

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What is Constipation?

Constipation occurs when a person has difficulty emptying the large bowel. Home remedies and lifestyle changes can often help resolve it, but sometimes, it may need medical attention.

Constipation can happen for many reasons, such as when stool passes through the colon too slowly. The slower the food moves through the digestive tract, the more water the colon will absorb and the harder the feces will become.

A person who poops fewer than 3 times per week may have constipation.

What Are the Symptoms?

You may have:

  • Few bowel movements
  • Trouble having a bowel movement (straining to go)
  • Hard or small stools
  • A sense that everything didn’t come out
  • Belly bloating

Why Does It Happen?

Some causes of constipation include:

  • Changes to what you eat or your activities
  • Not enough water or fiber in your diet
  • Eating a lot of dairy products
  • Not being active
  • Resisting the urge to poop
  • Stress
  • Overuse of laxatives
  • Some medications (especially strong pain drugs such as narcotics, antidepressants, and iron pills)
  • Antacid medicines that have calcium or aluminum
  • Eating disorders
  • Irritable bowel syndrome
  • Pregnancy
  • Problems with the nerves and muscles in your digestive system
  • Colon cancer
  • Underactive thyroid (called hypothyroidism)

Who is at risk for constipation?

Eating a poor diet and not exercising are major risk factors for constipation. You may also be at greater risk if you’re:

Age 65 or older. Older adults tend to be less physically active, have underlying diseases, and eat poorer diets.

Confined to bed. Those who have certain medical conditions, such as spinal cord injuries, often have difficulty with bowel movements.

A woman or child. Women have more frequent episodes of constipation than men, and children are affected more often than adults.

Pregnant. Hormonal changes and pressure on your intestines from your growing baby can lead to constipation.

How to treat and prevent constipation

Changing your diet and increasing your physical activity level are the easiest and fastest ways to treat and prevent constipation. Try the following techniques as well:

  • Every day, drink water, to hydrate the body.
  • Limit consumption of alcohol and caffeinated drinks, which cause dehydration.
  • Add fiber-rich foods to your diet, such as raw fruits and vegetables, whole grains, beans, prunes, or bran cereal. Your daily intake of fiber should be between 20 and 35 grams.
  • Cut down on low-fiber foods, such as meat, milk, cheese, and processed foods.
  • Aim for about 150 minutes of moderate exercise every week, with a goal of 30 minutes per day at least five times per week. Try walking, swimming, or biking.
  • If you feel the urge to have a bowel movement, don’t delay. The longer you wait, the harder your stool can become.
  • Add fiber supplements to your diet if needed. Just remember to drink plenty of fluids because fluids help fiber work more efficiently.

If you still have trouble with constipation, your doctor may prescribe medications to help.

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