Definition

By Mayo Clinic Staf

Peritonitis is a bacterial or fungal infection of the peritoneum, a silk-like membrane that

lines your inner abdominal wall and covers the organs within your abdomen. Peritonitis
can result from any rupture (perforation) in your abdomen, or as a complication of other
medical conditions.
Peritonitis requires prompt medical attention to fight the infection and, if necessary, to
treat any underlying medical conditions. Treatment of peritonitis usually involves
antibiotics and, in some cases, surgery. Left untreated, peritonitis can lead to severe,
potentially life-threatening infection throughout your body.
If you're receiving peritoneal dialysis, you can help prevent peritonitis by following good
hygiene before, during and after dialysis.

Symptoms
By Mayo Clinic Staf

Signs and symptoms of peritonitis include:

Abdominal pain or tenderness

Bloating or a feeling of fullness (distention) in your abdomen

Fever

Nausea and vomiting

Loss of appetite

Diarrhea

Low urine output

Thirst

Inability to pass stool or gas

Fatigue

If you're receiving peritoneal dialysis, peritonitis symptoms also include:

Cloudy dialysis fluid

White flecks, strands or clumps (fibrin) in the dialysis fluid

When to see a doctor

Peritonitis can be life-threatening if it's not treated promptly. Contact your doctor
immediately if you have severe pain or tenderness of your abdomen, abdominal
bloating, or a feeling of fullness associated with:

Fever

Nausea and vomiting

Low urine output

Thirst

Inability to pass stool or gas

If you're receiving peritoneal dialysis, contact your health care provider immediately if
your dialysis fluid is cloudy, if it contains white flecks, strands or clumps (fibrin), or if it
has an unusual odor, especially if the area around your tube (catheter) is red or painful.
These may be signs of peritonitis.

Causes
By Mayo Clinic Staf

Infection of the peritoneum can happen for a variety of reasons. In most cases, the
cause is a rupture (perforation) in the abdominal wall. Though it's rare, the condition can
develop without an abdominal rupture. This type of peritonitis is called spontaneous
peritonitis.
Common causes of ruptures that lead to peritonitis include:

Medical procedures, such as peritoneal dialysis. Peritoneal dialysis uses

tubes (catheters) to remove waste products from your blood when your kidneys can

no longer adequately do so. An infection may occur during peritoneal dialysis due to
unclean surroundings, poor hygiene or contaminated equipment. Peritonitis also may
develop as a complication of gastrointestinal surgery, the use of feeding tubes or a
procedure to withdraw fluid out of your abdomen (paracentesis).

A ruptured appendix, stomach ulcer or perforated colon.Any of these

conditions can allow bacteria to get into the peritoneum through a hole in your
gastrointestinal tract.

Pancreatitis. Inflammation of your pancreas (pancreatitis) complicated by

infection may lead to peritonitis if the bacteria spread outside the pancreas.

Diverticulitis. Infection of small, bulging pouches in your digestive tract

(diverticulitis) may cause peritonitis if one of the pouches ruptures, spilling intestinal
waste into your abdomen.

Trauma. Injury or trauma may cause peritonitis by allowing bacteria or chemicals

from other parts of your body to enter the peritoneum.

Peritonitis that develops without an abdominal rupture (spontaneous peritonitis) is

usually a complication of liver disease, such as cirrhosis. Advanced cirrhosis causes a
large amount of fluid buildup in your abdominal cavity (ascites). That fluid buildup is
susceptible to bacterial infection.

Risk factors
By Mayo Clinic Staf

Factors that increase your risk of peritonitis include:

Peritoneal dialysis. Peritonitis is common among people undergoing peritoneal

dialysis therapy.

Other medical conditions. The following medical conditions increase your risk
of developing peritonitis: cirrhosis, appendicitis, Crohn's disease, stomach ulcers,
diverticulitis and pancreatitis.

History of peritonitis. Once you've had peritonitis, your risk of developing it

again is higher than it is for someone who has never had peritonitis.

Complications
By Mayo Clinic Staf

Left untreated, peritonitis can extend beyond your peritoneum, where it may cause:

A bloodstream infection (bacteremia).

An infection throughout your body (sepsis). Sepsis is a rapidly progressing, lifethreatening condition that can cause shock and organ failure.

Tests and diagnosis

By Mayo Clinic Staf

To diagnose peritonitis, your doctor will talk with you about your medical history and
perform a physical exam. When peritonitis is associated with peritoneal dialysis, your
signs and symptoms, particularly cloudy dialysis fluid, may be enough for your doctor to
diagnose the condition.
In cases of peritonitis in which the infection may be a result of other medical conditions
(secondary peritonitis) or in which the infection arises from fluid buildup in your
abdominal cavity (spontaneous peritonitis), your doctor may recommend the following
tests to confirm a diagnosis:

Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of
the fluid in your peritoneum (paracentesis). If you have peritonitis, examination of this
fluid may show an increased white blood cell count, which typically indicates an
infection or inflammation. A culture of the fluid may also reveal the presence of
bacteria.

Blood tests. A sample of your blood may be drawn and sent to a lab to check for
a high white blood cell count. A blood culture also may be performed to determine if
there are bacteria in your blood.

Imaging tests. Your doctor may want to use an X-ray to check for holes or other
perforations in your gastrointestinal tract. Ultrasound may also be used. In some
cases, your doctor may use a computerized tomography (CT) scan instead of an Xray.

The above tests may also be necessary if you're receiving peritoneal dialysis and a
diagnosis of peritonitis is uncertain after a physical exam and an examination of the
dialysis fluid.

Treatments and drugs

By Mayo Clinic Staf

You may need to be hospitalized for peritonitis that's caused by infection from other
medical conditions (secondary peritonitis). Treatment may include:

Antibiotics. You'll likely be given a course of antibiotic medication to fight the

infection and prevent it from spreading. The type and duration of your antibiotic
therapy depend on the severity of your condition and the kind of peritonitis you have.

Surgery. Surgical treatment is often necessary to remove infected tissue, treat

the underlying cause of the infection and prevent the infection from spreading.

Other treatments. Depending on your signs and symptoms, your treatment while
in the hospital may include pain medications, intravenous (IV) fluids, supplemental
oxygen and, in some cases, a blood transfusion.

If you're undergoing peritoneal dialysis

If you have peritonitis, your doctor may recommend that you receive dialysis in another
way for several days while your body heals from the infection. If peritonitis persists or
recurs, you may need to stop having peritoneal dialysis entirely and switch to a diferent
form of dialysis.

Definition
By Mayo Clinic Staf

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the

best care.
Learn more. Request an appointment.

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Hemorrhoids

Hemorrhoids (HEM-uh-roids), also called piles, are swollen and inflamed veins in your
anus and lower rectum. Hemorrhoids may result from straining during bowel movements
or from the increased pressure on these veins during pregnancy, among other causes.
Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may
develop under the skin around the anus (external hemorrhoids).
Hemorrhoids are common ailments. By age 50, about half of adults have had to deal
with the itching, discomfort and bleeding that can signal the presence of hemorrhoids.
Fortunately, many efective options are available to treat hemorrhoids. Most people can
get relief from symptoms by using home treatments and making lifestyle changes.

Symptoms
By Mayo Clinic Staf

Multimedia

Hemorrhoids

Signs and symptoms of hemorrhoids may include:

Painless bleeding during bowel movements you might notice small amounts of
bright red blood on your toilet tissue or in the toilet bowl

Itching or irritation in your anal region

Pain or discomfort

Swelling around your anus

A lump near your anus, which may be sensitive or painful

Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside
the rectum. You usually can't see or feel these hemorrhoids, and they usually don't
cause discomfort.
But straining or irritation when passing stool can damage a hemorrhoid's delicate
surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid
through the anal opening. This is known as a protruding or prolapsed hemorrhoid and
can cause pain and irritation.
External hemorrhoids are under the skin around your anus. When irritated, external
hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid
and form a clot (thrombus), resulting in severe pain, swelling and inflammation.
When to see a doctor
Bleeding during bowel movements is the most common sign of hemorrhoids. But rectal
bleeding can occur with other diseases, including colorectal cancer and anal cancer.
Don't assume that bleeding is coming from hemorrhoids without consulting a doctor.
Your doctor can do a physical examination and perform other tests to diagnose
hemorrhoids and rule out more-serious conditions or diseases. Also consider seeking
medical advice if your hemorrhoids cause pain, bleed frequently or excessively, or don't
improve with home remedies.
If your hemorrhoid symptoms began along with a marked change in bowel habits or if
you're passing black, tarry or maroon stools, blood clots, or blood mixed in with the
stool, consult your doctor immediately. These types of stools can signal more extensive
bleeding elsewhere in your digestive tract.
Seek emergency care if you experience large amounts of rectal bleeding,
lightheadedness, dizziness or faintness.

Causes
By Mayo Clinic Staf

The veins around your anus tend to stretch under pressure and may bulge or swell.
Swollen veins (hemorrhoids) can develop from an increase in pressure in the lower
rectum. Factors that might cause increased pressure include:

Straining during bowel movements

Sitting for long periods of time on the toilet

Chronic diarrhea or constipation

Obesity

Pregnancy

Anal intercourse

Low-fiber diet

Hemorrhoids are more likely as you get older because the tissues that support the veins
in your rectum and anus can weaken and stretch with aging.

Complications
By Mayo Clinic Staf

Complications of hemorrhoids are rare but include:

Anemia. Chronic blood loss from hemorrhoids may cause anemia, in which you
don't have enough healthy red blood cells to carry oxygen to your cells. This may
result in fatigue and weakness.

Strangulated hemorrhoid. If blood supply to an internal hemorrhoid is cut of,

the hemorrhoid may be "strangulated," which can cause extreme pain and lead to
tissue death (gangrene).

Preparing for your appointment

By Mayo Clinic Staf

If you have signs and symptoms of hemorrhoids, make an appointment with your regular
doctor. Depending on your signs and symptoms, your doctor may refer you to one or
more specialists including a doctor with expertise in the digestive system
(gastroenterologist) or a colon and rectal surgeon for evaluation and treatment.
You can help your doctor by being prepared with as much information as possible. Here
are some suggestions to help you get ready for your appointment.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the

appointment, ask if there's anything you need to do in advance.

Write down any symptoms you're experiencing and how long you've noticed
them.

Write down key personal information, including typical bowel habits and diet,
especially your fiber intake.

Make a list of all medications, vitamins or supplements that you're taking.

Write down questions to ask your doctor.

Your time with your doctor is often limited, so preparing a list of questions can help you
make the most of your time together. For hemorrhoids, some questions you might want
to ask your doctor include:

What's the likely cause of my symptoms?

Is my condition likely to be temporary or permanent?

Am I at risk of complications related to this condition?

What treatment approach do you recommend?

If treatments we try first don't work, what will you recommend next?

Am I a candidate for surgery? Why or why not?

Are there any additional self-care steps that might help?

I have other medical problems. How can I manage these along with
hemorrhoids?

In addition to the questions that you've prepared, don't hesitate to ask questions as they
occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may
reserve time to go over points you want to spend more time on. Your doctor may ask:

When did your symptoms first occur?

How uncomfortable are your symptoms?

What are your typical bowel habits?

How much fiber does your diet contain?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

Has anyone in your family ever had hemorrhoids or cancer of the colon, rectum
or anus?
Have you had a change in your bowel habits?
During bowel movements, have you noticed blood on your toilet paper, dripping
into the toilet or mixed into your stools?

What you can do in the meantime

In the time before your appointment, take steps to soften your stools. Eat more highfiber foods, such as fruits, vegetables and whole grains, and consider trying an over-thecounter fiber supplement, such as Metamucil and Citrucel. Drinking six to eight glasses
of water a day also may help soften your stools and relieve your symptoms.

Tests and diagnosis

By Mayo Clinic Staf

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the

best care.
Learn more. Request an appointment.
Your doctor may be able to see if you have external hemorrhoids simply by looking.
Tests and procedures to diagnose internal hemorrhoids may include:

Examination of your anal canal and rectum for abnormalities. During a digital
rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or
she feels for anything unusual, such as growths. The exam can give your doctor an
indication of what further testing might be appropriate.

Visual inspection of your anal canal and rectum. Because internal

hemorrhoids are often too soft to be felt during a rectal examination, your doctor may
also examine the lower portion of your colon and rectum with an anoscope,
proctoscope or sigmoidoscope. These are scopes that allow your doctor to see into
your anus and rectum.

Your doctor may want to do a more extensive examination of your entire colon using
colonoscopy. This might be recommended if:

Your signs and symptoms suggest you might have another digestive system
disease

You have risk factors for colorectal cancer

You're older than age 50 and haven't had a recent colonoscopy

Treatments and drugs

By Mayo Clinic Staf

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the

best care.
Learn more. Request an appointment.

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Rubber band ligation of hemorrhoid

Most of the time, treatment for hemorrhoids involves steps that you can take on your
own, such as lifestyle modifications. But sometimes medications or surgical procedures
are necessary.

Medications
If your hemorrhoids produce only mild discomfort, your doctor may suggest over-thecounter creams, ointments, suppositories or pads. These products contain ingredients,
such as witch hazel or hydrocortisone, that can relieve pain and itching, at least
temporarily.
Don't use an over-the-counter cream or other product for more than a week unless
directed by your doctor. These products can cause side efects, such as skin rash,
inflammation and skin thinning.

Minimally invasive procedures

If a blood clot has formed within an external hemorrhoid, your doctor can remove the
clot with a simple incision, which may provide prompt relief.
For persistent bleeding or painful hemorrhoids, your doctor may recommend another
minimally invasive procedure. These treatments can be done in your doctor's office or
other outpatient setting.

Rubber band ligation. Your doctor places one or two tiny rubber bands around
the base of an internal hemorrhoid to cut of its circulation. The hemorrhoid withers
and falls of within a week. This procedure called rubber band ligation is
efective for many people.
Hemorrhoid banding can be uncomfortable and may cause bleeding, which might
begin two to four days after the procedure but is rarely severe.

Injection (sclerotherapy). In this procedure, your doctor injects a chemical

solution into the hemorrhoid tissue to shrink it. While the injection causes little or no
pain, it may be less efective than rubber band ligation.

Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or

infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden
and shrivel.
While coagulation has few side efects, it's associated with a higher rate of
hemorrhoids coming back (recurrence) than is the rubber band treatment.

Surgical procedures
If other procedures haven't been successful or you have large hemorrhoids, your doctor
may recommend a surgical procedure. Surgery can be performed on an outpatient
basis or you may need to stay in the hospital overnight.

Hemorrhoid removal. During a hemorrhoidectomy, your surgeon removes

excessive tissue that causes bleeding. Various techniques may be used. The
surgery may be done with a local anesthetic combined with sedation, a spinal
anesthetic or a general anesthetic.
Hemorrhoidectomy is the most efective and complete way to treat severe or
recurring hemorrhoids. Complications may include temporary difficulty emptying your
bladder and urinary tract infections associated with this problem.

Most people experience some pain after the procedure. Medications can relieve your
pain. Soaking in a warm bath also may help.

Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or

stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling
generally involves less pain than hemorrhoidectomy and allows an earlier return to
regular activities.
Compared with hemorrhoidectomy, however, stapling has been associated with a
greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes
from the anus. Talk with your doctor about what might be the best option for you.

Lifestyle and home remedies

By Mayo Clinic Staf

You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home
treatments. Often these are the only treatments needed.

Use topical treatments. Apply an over-the-counter hemorrhoid cream or

suppository containing hydrocortisone, or use pads containing witch hazel or a
numbing agent.

Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm
water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet. You
can get one at most drugstores.

Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin
around your anus gently with warm water. Soap isn't necessary and may aggravate
the problem. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair
dryer after bathing.

Don't use dry toilet paper. To help keep the anal area clean after a bowel
movement, use moist towelettes or wet toilet paper that doesn't contain perfume or
alcohol.

Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.
Take oral pain relievers. You can use acetaminophen (Tylenol, others), aspirin
or ibuprofen (Advil, Motrin IB, others) temporarily to help relieve your discomfort.

With these treatments, hemorrhoid symptoms often go away within a week. See your
doctor if you don't get relief in a week, or sooner if you have severe pain or bleeding.

Prevention
By Mayo Clinic Staf

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To
prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so
softens the stool and increases its bulk, which will help you avoid the straining that
can cause hemorrhoids or worsen symptoms from existing hemorrhoids. Add fiber to
your diet slowly to avoid problems with gas.

Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not
alcohol) each day to help keep stools soft.

Consider fiber supplements. Most people don't get enough of the

recommended amount of fiber 25 grams a day for women and 38 grams a day for
men in their diet. Studies have shown that over-the-counter fiber supplements,
such as Metamucil and Citrucel, improve overall symptoms and bleeding from
hemorrhoids. These products help keep stools soft and regular.
If you use fiber supplements, be sure to drink at least eight glasses of water or other
fluids every day. Otherwise, the supplements can cause constipation or make
constipation worse.

Don't strain. Straining and holding your breath when trying to pass a stool
creates greater pressure in the veins in the lower rectum.

Go as soon as you feel the urge. If you wait to pass a bowel movement and the
urge goes away, your stool could become dry and be harder to pass.

Exercise. Stay active to help prevent constipation and to reduce pressure on

veins, which can occur with long periods of standing or sitting. Exercise can also
help you lose excess weight that may be contributing to your hemorrhoids.

Avoid long periods of sitting. Sitting too long, particularly on the toilet, can
increase the pressure on the veins in the anus.