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Our panel of doctors offers suggestions and advice to reader's queries.
I'm a 38-year-old man. After sleeping about six hours, I wake up with extreme pain and stiffness of my back at around 4 a.m. on most days. When I sit or stand or walk for about an hour, the pain subsides.
The rest of the day is problem free. I can bend down or lift weights. My spine X-ray and neurological examinations are normal.
A battery of blood tests was inconclusive except for some cholesterol. Could this be spinal arthritis? (My serum R.A factor is Negative).
Dr. S. Sivamurugan, Orthopaedic Surgeon, replies:
Your complaint is pain and stiffness of the back at night. You should consider changing your mattress to a firmer one and also improve your physical fitness by walking/swimming.
You are unlikely to suffer from spinal arthritis, as all the blood parameters are normal.
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I have been suffering from fistula, fissure, and piles for 10 years. I am 41. I underwent an operation for fistula last year. Now I am taking pilon tablets for piles and fissures. I was affected one by one in the order of fistula, piles, and fissure. I learnt that the fissure and piles may not be cured even if operated upon. Is this right? Is there a cure without surgery? Is there any other treatment available?
Dr. Uma Krishnaswamy, Consultant General Surgeon, replies:
Fistulae cannot be treated by medication and require surgery, which is usually successful as it is in your case. To ensure continuing relief after surgery, one must avoid constipation and straining at stool. Taking a high fibre diet, drinking plenty of water and taking a softening and bulking agent, which your doctor can prescribe helps avoid constipation.
Piles and fissure are curable by surgery, but can be reasonably well managed by the above regime of avoiding constipation. Non-operative measures for fissures involve the use of certain special creams or injections. These may or may not produce lasting relief. Non-operative measures to treat early piles involve: sclerosant injections or rubber banding, which can be done without an anaesthetic as a quick outpatient procedure.
Other expensive options include infrared coagulation and laser coagulation. These are not as popular as the above alternatives. More advanced instances of piles are best treated by surgery.
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