Having problem with bowel movement. Bowel Problems, Conditions & Symptoms: A Comprehensive Guide
What are the common bowel problems, conditions, and symptoms you may experience? Learn about constipation, diarrhea, IBS, Crohn’s disease, ulcerative colitis, and more. Find the answers to your questions about managing bowel issues.
Understanding Bowel Problems and Conditions
The first and most important point to remember is that everyone with a bowel problem can be helped, and many can be completely cured. If you have been diagnosed with a bowel condition or are experiencing concerning symptoms, this comprehensive guide can provide the information you need.
Identifying Common Bowel Symptoms
Do you find it difficult to have a bowel movement or have a bowel movement less than 3 times a week and have to strain excessively or do not feel completely empty? You may be constipated. Do you pass watery or very loose stools more than 3 times in a day? You may have diarrhea.
Exploring Specific Bowel Conditions
Do you have abdominal pain (in the lower left part of the abdomen) and a change in bowel habits (constipation or diarrhea or alternating between both), with a mild fever and nausea and vomiting? These are symptoms of diverticular disease. If you have diarrhea, weight loss, and abdominal pain, these could be signs of Crohn’s Disease.
Understanding Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome, or IBS, is the name health professionals give to a series of symptoms relating to a disturbance of the large bowel that cannot be explained by any other disease. What are the symptoms of IBS, and how can it be managed?
Recognizing Rectal Prolapse
Rectal prolapse is when part of your rectum or the lining of your rectum protrudes through your anus. What are the common causes and symptoms of rectal prolapse, and how is it diagnosed?
Exploring Diverticulitis
Diverticulitis is an inflammation of one or more diverticulum, which are pockets that form in the smooth wall of the intestine. What causes diverticulitis, and how is it treated?
Coping with Coeliac Disease
Coeliac Disease is a common chronic autoimmune condition that affects around one in every 100 people. The condition is a reaction of the immune system to gluten, which is a protein found in wheat, rye, and barley. What are the symptoms of Coeliac Disease, and how is it managed?
Bowel problems can be challenging to deal with, but it’s important to remember that you are not alone. Many people struggle with various bowel conditions, and there are treatments and support available. If you are experiencing any concerning symptoms, don’t hesitate to seek medical advice. Your doctor can help you identify the underlying issue and develop a plan to manage your condition.
What is Hirschsprung’s Disease, and how does it affect the large bowel? Hirschsprung’s Disease is a rare congenital disorder that affects the large bowel (colon), which causes severe constipation and/or bowel obstruction. This disease affects one in 5,000 babies born. In Hirschsprung’s Disease, the ganglion cells in the bowel are missing, which leads to a lack of muscle relaxation and obstruction of the bowel.
A bowel obstruction can be a serious condition, which can occur in the large or small bowel. A small bowel obstruction commonly occurs where loops of intestine can easily get blocked or twisted. What are the symptoms of a bowel obstruction, and how is it treated?
Short Bowel Syndrome is a rare and complex disease that usually develops after a significant portion of the small bowel and/or colon is removed surgically. This condition can also occasionally happen as a result of a portion of the bowel dying due to lack of blood supply. What are the causes and symptoms of Short Bowel Syndrome, and how is it managed?
Diarrhea can cause frequent and urgent desires to go to the toilet. What are the common causes of diarrhea, and how can it be treated effectively?
Bowel cancer, also called colorectal cancer, includes large bowel cancer (colon cancer) and cancer of the back passage (rectal cancer or cancer of the rectum). What are the symptoms of bowel cancer, and how is it diagnosed and treated?
Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated if they have fewer than three bowel movements per week. What are the causes and symptoms of constipation, and how can it be managed?
Bowel Problems, Conditions & Symptoms
Bowel Category
The first and most important point to remember is that everyone with a bowel problem can be helped and many can be completely cured.
If you have been diagnosed with bowel (faecal) incontinence, IBS, Colitis, Crohns, constipation or other bowel problems you can search the down menus below to find out more information about your specific condition or problem. If you have not been diagnosed by a health professional, the following questions about your symptoms should help you find the information you are looking for.
- Do you find it difficult to have a bowel movement or have a bowel movement less than 3 times a week and have to strain
- Excessively or do not feel completely empty? You may be constipated.
- Do you pass watery or very loose stools more than 3 times in a day? You may have diarrhoea.
- Do you have abdominal pain (in the lower left part of the abdomen) and a change in bowel habits (constipation or diarrhoea or alternating between both), with a mild fever and nausea and vomiting? These are symptoms of diverticular disease.
- If you have diarrhoea, weight loss and abdominal pain, these could be signs of Crohn’s Disease.
- Do you have bloody diarrhoea or diarrhoea containing mucus and the constant urge to go to the toilet even though nothing comes out, with or without abdominal pain? These are symptoms of Ulcerative Colitis.
- Do you leak faeces without being aware of it? This could be bowel or faecal incontinence.
If you experience any of the following symptoms, you must see your GP as soon as possible:
- bleeding from your back passage
- blood in your stools (faeces), which can make them look bright red, dark red, or black
- a change in normal bowel habits lasting three weeks or more
- unexplained weight loss and tiredness
- an unexplained pain or lump in your tummy
Once you have a clearer idea of what your problem may be or if you have been diagnosed you can visit our treatment section to see what your options are for managing your symptoms or condition. Information dealing with the more practical and emotional side of coping with bowel problems can be found by visiting the support section.
How to approach your GP about your bowel problems
It is never too late to get help with your bowel problems. If you would like some advice on how to approach your GP regarding your bowel problem you may find our Advice Sheet helpful. It also includes information on tests that your GP may recommend you have done. To download, please click on this link Bowel Advice Sheet.
Irritable Bowel Syndrome, or IBS, is the name health professionals give to a series of symptoms relating to a disturbance of the large bowel that cannot be explained by any other disease. So what are the Symptoms of IBS? What are the…
Rectal prolapse is when part of your rectum or the lining of your rectum, protrudes through your anus. Find out common causes, symptoms, and details of test and diagnosis.
What is Diverticulitis?
Diverticulitis is an inflammation of one or more diverticulum, which are pockets that form in the smooth wall of the intestine. The reason that diverticulitis develops has not been entirely confirmed, but it is…
Irritable Bowel Syndrome or IBS is a chronic relapsing and often lifelong disorder involving a collection of symptoms, which vary from person to person. This is a guide to what to look out for and how you can better manage IBS.
Coeliac Disease is a common chronic autoimmune condition that affects around one in every 100 people. The condition is a reaction of the immune system to gluten, which is a protein found in wheat, rye and barley. You are more likely to…
Hirschsprung’s Disease is a rare congenital disorder that affects the large bowel (colon), which causes severe constipation and/ or bowel obstruction. This disease affects one in 5,000 babies born. In Hirschsprung’s Disease, the ganglion…
What Is A Bowel Obstruction?
A bowel obstruction can be a serious condition, which can occur in the large or small bowel. A small bowel obstruction commonly occurs where loops of intestine can easily get blocked or twisted. A…
Short Bowel Syndrome is a rare and complex disease which usually develops after a significant portion of small bowel and /or colon is removed surgically. This condition can also occasionally happen as a result of a portion of the bowel…
Diarrhoea can cause frequent and urgent desires to go to the toilet. Learn about what causes this diarrhoea, the symptoms and how to treat it effectively.
Bowel cancer is also called colorectal cancer and includes large bowel cancer (colon cancer) and cancer of the back passage (rectal cancer or cancer of the rectum).
Constipation | Johns Hopkins Medicine
What is constipation?
Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week. However, normal stool elimination may consist of having a bowel movement three times a day or three times a week; it depends on the person.
About 4 million people in the United States have frequent constipation. Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually.
What causes constipation?
Hard, dry stools are the result of the colon absorbing too much water. Normally, as food moves through the colon (also known as the large intestine) the colon absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.
When the colon’s muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. Some of the most common causes of constipation include the following:
Medications
Lack of exercise
Not enough liquids
Not enough fiber in the diet
Irritable bowel syndrome
Ignoring the urge to have a bowel movement
Changes in habits or lifestyle, such as travel, pregnancy, and old age
Problems with intestinal function
Abuse of laxatives
What are the symptoms of constipation?
The following are the most common symptoms of constipation. However, each individual may experience symptoms differently. Symptoms may include:
Difficult and painful bowel movements
Bowel movements fewer than three times a week
Feeling bloated or uncomfortable
Feeling sluggish
Abdominal pain
The symptoms of constipation may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
How is constipation diagnosed?
The tests performed by a doctor will depend on the duration and severity of the constipation, since most persons experience constipation at one time or another. The doctor will also take into account the patient’s age, and whether there is blood in the stool, recent changes in bowel habits, or weight loss.
Diagnosing constipation may include:
Medical history. The doctor will ask for a description of the constipation, including duration of symptoms, frequency of bowel movements, and other information to help determine the cause of the constipation.
Physical examination. A physical examination may also include a digital rectal examination (DRE), in which the doctor inserts a gloved, lubricated finger into the rectum to evaluate the tone of the muscle that closes off the anus. This examination also helps detect tenderness, obstruction, blood, amount and caliber of stool, and if enlargement of the rectum is present.
Other diagnostic tests may include:
Abdominal X-ray
Lower GI (gastrointestinal) series (also called barium enema). A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers which are visible on X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed.
Anorectal function tests. These tests diagnose constipation caused by an abnormal functioning of the anus or rectum.
Treatment for constipation
Specific treatment for constipation will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of this condition
Your opinion or preference
Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms and help prevent the condition. Treatment may include:
Diet modifications. A diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. While adding foods such as beans, whole grains, bran cereals, fresh fruits and vegetables is helpful in adding fiber to the diet. Limiting foods such as ice cream, cheeses, meats, and processed foods, which contain little or no fiber can also be helpful.
Laxatives. Laxatives may be prescribed after diet and lifestyle changes have failed to be effective.
Eliminating or changing medication
Biofeedback. Biofeedback is used to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control release of bowel movements.
Lifestyle changes, such as increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements can be helpful.
What are good fiber sources?
Foods | Moderate fiber | High fiber |
---|---|---|
Bread | Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn | |
Cereal | Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Muslix, granola, oat bran | All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran |
Vegetables | Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado | |
Fruits | Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins | Cooked prunes, dried figs |
Meat substitutes | Peanut butter , nuts | Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix |
What are complications of constipation?
Constipation can cause complications, such as hemorrhoids, which occur by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding.
Sometimes, straining also causes rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening. Constipation may also cause fecal impaction, which occurs mostly in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.
Intestinal constipation: causes, treatment, diet
Every person faced the problem of constipation at least once in his life. If difficulties with bowel movements are observed regularly, then the pathology has acquired a chronic form. In chronic constipation, bowel movements occur less than 3 times a week. At the same time, the chair itself is rare and hard. A constipated person spends more time on the toilet than usual. In the process of defecation, the straining time increases.
Causes of constipation
Intestinal constipation can occur for various reasons.
The first cluster of causes is associated with congenital or acquired pathologies of the large intestine:
- anal fissures
- polyps
- internal and external hemorrhoids
- tumors
- megarectum
- megadolichosigma
- atresia
The second type of causes of constipation include concomitant diseases of the digestive, endocrine and genitourinary systems.
There are also a number of causes of unknown origin, due to which the motility of the rectum and colon is impaired.
Functional constipation can be caused by malnutrition. Eating low in dietary fiber, as well as taking certain medications (diuretics, antidepressants, iron supplements, antacids, anticholinergics) interfere with bowel movements.
A few more causes of chronic constipation:
- wrong way of life
- “knocked down” day and night mode
- lack of physical activity
- low fluid intake (body dehydration)
- “inert” colon syndrome (slow movement of feces)
Special mention should be made of constipation during pregnancy – due to the internal pressure of the fetus, there may be a delay in bowel movement.
Treatment of constipation
People who have problems with bowel movements often ask themselves the question: what to do with constipation? Treatment of constipation, including chronic constipation, is aimed at eliminating the primary pathology that resulted in the problem, as well as changing lifestyle, diet, working conditions, etc.
For the treatment of constipation, a proctologist or gastroenterologist should be consulted. Frequent constipation can be a sign of serious diseases of the stomach and intestines, so we do not recommend self-medication: it would be wiser to make an appointment with a trusted specialist.
Qualified doctors of the Naedine Clinic will conduct a complete examination of the gastrointestinal tract, establish the root cause of the problem and choose the appropriate method of treatment.
Medications are widely used in the treatment of constipation. The type of medication, dose and duration of administration are calculated individually for each patient.
Diet for constipation
Doctor prescribes a special diet for constipation . It is necessary to eat foods rich in fiber daily, for example:
- wheat, oatmeal, pearl barley, buckwheat cereals
- vegetables (carrots, beets, marrows)
- wholemeal bread
- bran
- fruits and berries, including dried fruits (figs, prunes, dates, dried apricots, bananas, non-sour apples)
- vegetable and fruit juices
- fermented milk products (kefir, curdled milk, acidophilus)
- olive, sunflower, linseed, corn oil
Food should be taken 4 times a day. The amount of fluid consumed for constipation should be at least 1.5 liters per day.
The patient must “learn” to go to the toilet to empty his bowels in the morning. With the right treatment regimen, the patient will be able to walk “in a big way” every 1-2 days.
Sign up for a consultation with a proctologist at the Naedine Clinic by phone (8332) 32-7777 or through the online appointment form on our website!
Constipation – symptoms, causes, signs, diagnosis and treatment in “SM-Clinic”
This disease is treated by Gastroenterologist
, Proctologist
- What is constipation?
- Symptoms of constipation
- Causes of constipation
- Diagnosis of constipation in “SM-Clinic”
- Treatment of constipation in SM-Clinic
- Prevention of constipation
- Doctors
Constipation is a short-term or permanent violation of bowel movements, in which it is impossible to completely empty the bowels. Situational constipation, triggered by stress or side effects of drugs, is not a pathology. The criterion for the disease is the absence of stool within 48-72 hours. In this case, the patient may complain of a strong urge to defecate, abdominal pain and general malaise. Strong straining does not lead to relief or is accompanied by the release of hard round stools without complete emptying of the intestine. Possible complications of constipation include anal fissure, intoxication of the body and the formation of hemorrhoids.
Constipation is one of the most common diseases of the gastrointestinal tract. Many doctors call constipation a symptom, however, in the international classification of diseases, this condition is designated as an independent pathology (code K59.0). In most cases, constipation affects the elderly. Treatment of constipation should primarily focus on improving nutrition. If necessary, medical therapy is applied.
Symptoms of constipation
Symptoms of constipation depend on the cause of the condition. The absence of a chair can be observed for three days in a row or occur intermittently. The accumulation of stool in the large intestine is accompanied by increased absorption of fluid, hardening of the stool and the penetration of toxins into the bloodstream. Hard stool damages the intestinal mucosa, and harmful substances adversely affect the patient’s well-being.
Other symptoms and signs:
- Feeling of heaviness in the abdomen;
- Passing stools in the form of hard black or dark brown balls;
- Paroxysmal pain in the abdomen;
- Strong irresolvable urge to defecate;
- Requires constant straining to empty the bowels;
- Passing a lot of mucus along with hard stools;
- Feeling of incomplete emptying of the bowels;
- Bloating
- Lack of appetite;
- Constant belching;
- Weakness and fatigue;
- Sleep disturbance.
Delayed stool adversely affects the intestinal microflora, so patients complain of increased gas formation. A sign of damage to the intestinal mucosa by hard stools may be the release of blood with feces.
Causes of constipation
The activity of the gastrointestinal tract directly depends on the lifestyle of a person. For the formation of normal stools and bowel movements, the intestines need a sufficient amount of fiber. This substance is found in many fruits and vegetables. A monotonous diet can be accompanied by chronic constipation and the formation of hard stools. Other risk factors for constipation include physical inactivity, chronic stress, sleep disturbance, and insufficient water intake. In some cases, constipation occurs even with a healthy lifestyle against the background of a pathological condition.
Other causes:
- Irritable bowel syndrome. This disease is characterized by dysfunction of the intestine. The patient may complain of intermittent constipation followed by diarrhea;
- Intestinal obstruction with the growth of tumors, the penetration of foreign bodies into the organ, parasitic infection, adhesions or other pathological conditions;
- Disturbance of intestinal motility. The movement of feces in the intestines is provided by wave-like contractions of the muscle tissues of the organ. Violation of the rhythm of the intestinal muscles can lead to constipation;
- Diseases of the nervous system. Intestinal functions depend on nervous regulation, therefore, pathologies of the spinal cord and peripheral nerves can cause defecation disorders;
- Unfavorable mental state, accompanied by anxiety and severe stress.
The effectiveness of the treatment of constipation depends on the successful identification of the cause of this condition.
Get advice
If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.
You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:
+7 (495) 292-39-72
Request a call back
Book online
Why SM-Clinic?
1
Treatment is carried out in accordance with clinical guidelines
2
Comprehensive assessment of the nature of the disease and treatment prognosis
3
Modern diagnostic equipment and own laboratory
4
High level of service and balanced pricing policy
Diagnosis of constipation in “SM-Clinic”
With a constant violation of bowel movements, it is necessary to make an appointment with a proctologist. The doctor of our clinic conducts a consultation, during which he asks the patient in detail about complaints and studies the anamnesis. It is important for the doctor to determine how often the patient has stool retention. In addition, the proctologist needs to exclude the presence of intestinal obstruction, which requires urgent treatment. Severe bloating and the absence of gases indicate bowel obstruction. Additional examinations can clarify the diagnosis and identify the cause of constipation.
Applied diagnostic methods in “SM-Clinic”:
- Irrigoscopy is a method of X-ray examination of the colon. The doctor injects a contrast solution into the patient’s intestines using an enema. Then an x-ray examination is performed, during which the specialist sees a change in the shape of the intestine and the extensibility of its walls in real time. Getting several pictures in different positions allows the doctor to clarify the cause of constipation and exclude the presence of intestinal obstruction;
- Endoscopic examination of the large intestine (colonoscopy). The doctor inserts a flexible tube equipped with a camera and a light source into the patient’s rectum. During the study, the specialist studies the features of the contents of the intestine and the state of the mucous membrane of the organ, looking at the monitor. During the procedure, if necessary, a painless sampling of cells of the mucous membrane of the organ is performed for histological examination of the material in the laboratory. To eliminate discomfort, colonoscopy is performed under anesthesia;
- anorectal manometry. The proctologist appoints this study to assess the tone of the muscles of the intestine and the strength of the contraction of the sphincters of the rectum. A flexible tube is inserted into the intestine, after which the specialist fills the balloon at the end of the tube with air. The results of the study make it possible to detect the pathology of the muscles of the organ;
- Study of the defecation process using magnetic resonance imaging (defecography). This is the most highly informative method for diagnosing chronic constipation, allowing the doctor to evaluate the work of the pelvic floor muscles and the defecation process in general. Obtaining a three-dimensional image of the pelvic organs is carried out using a special apparatus. The doctor asks the patient to remove all metal jewelry and lie down on the tomography table. Before the study, a contrast agent is injected into the intestine using an enema. After removing the contrast from the intestine, a second scan is performed with functional tests, such as straining or relaxing the pelvic muscles;
- Blood test. In the treatment room, the nurse takes a small amount of blood from the patient’s vein and sends the material to the laboratory. Based on the results of a blood test, thyroid dysfunction and other causes of constipation are excluded. Own laboratory “SM-Clinic” allows you to conduct this study quickly and get reliable results.
The proctologist himself determines what examinations are necessary for the patient. In most cases, the diagnosis of constipation is limited to a few procedures.
Treatment of constipation in the SM-Clinic
According to the results of the diagnosis, the doctors of our clinic select a treatment plan for constipation. The prescribed therapy eliminates the cause of the pathology and normalizes the activity of the intestine. The gastroenterologist necessarily prescribes a special diet for the patient to restore intestinal motility and form a stool of the correct consistency. If a mechanical obstruction or other dangerous pathology is detected, emergency treatment is carried out.
Methods of constipation treatment in “SM-Clinic”:
- Prescription of drugs containing dietary fiber. The gastroenterologist prescribes the patient metamucil or another agent that normalizes the formation of stool and facilitates defecation;
- The use of drugs that improve intestinal motility. The doctor prescribes a short course of bisacodyl or another agent to the patient;
- The use of osmotic laxatives that eliminate excessive absorption of water by the walls of the intestine. It is lactulose, magnesium hydroxide or magnesium citrate;
- Use of stool softeners. The doctor prescribes docusate sodium or another drug that reduces the absorption of water in the large intestine to the patient;
- Use of enemas and anal suppositories. The proctologist explains how to properly perform bowel lavage at home. The doctor also prescribes suppositories based on glycerin or bisacodyl to facilitate bowel movements.
Our clinic’s proctologists relieve chronic constipation in a patient without long-term use of laxatives that adversely affect bowel function. The main task is to improve nutrition and eliminate negative factors from the daily life of the patient. The doctor controls all stages of treatment and achieves optimal results.
Prevention of constipation
A healthy lifestyle will help a person avoid developing constipation or other bowel problems.
Basic prevention methods:
- Eating enough foods containing dietary fiber and fat;
- Consumption of at least 2 liters of fluid per day;
- moderate physical activity;
- Eliminate stressors.
Our clinic’s gastroenterologists provide consultations to explain disease prevention methods.
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