KEY POINTS:

• An anal abscess is an infection on or near the anus, which is the opening of the rectum where bowel movements leave the body. The abscess may contain a pocket of pus.
• An anal abscess may be treated with antibiotic medicine and with surgery to open and drain the infected area.
• Follow your healthcare provider’s instructions about when you can return to normal activities and how to take care of yourself at home.

What is an anal abscess?

An anal abscess is caused by an infection on or near the anus, which is the opening of the rectum where bowel movements leave the body. The body forms a pocket of pus surrounding the infection called an abscess. Pus is a thick fluid that usually contains white blood cells, dead tissue, and germs.

What is the cause?

An anal abscess is usually caused by a bacterial infection in the area around the anus. An abscess is a pocket of pus in the deeper layers under the skin. An abscess happens when germs get into tissue below the outer layer of skin. Most of the time an abscess is caused by bacteria, but rarely, it can be caused by a virus or fungus.

Your risk of having an anal abscess may be higher if you have a long-term condition such as Crohn’s disease, ulcerative colitis, or diabetes. It may be higher if you have a sexually transmitted disease or infection (STD or STI).

What are the symptoms?

Symptoms may include

• Redness with soreness near or around the anus
• Swelling or a lump near the anus
• Drainage or pus near the anus
• Pain in the anal or rectal area, especially when having a bowel movement
• Fever

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• An exam of the area around and inside your anus. Your provider will put a lubricated and gloved finger gently into your anus to try to feel a lump. Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2
• Anoscopy, which uses a small, lighted tube put into your anus to examine the anal area
• Ultrasound, which uses sound waves to show pictures of the anal area You may have tests to see if there is a related problem such as an anal fistula. An anal fistula is an abnormal tunnel between the rectum and the outer skin of the anus. A fistula sometimes happens after you have an abscess in the anus or rectum.

How is it treated?

Your provider may prescribe antibiotic medicine. An anal abscess may need to be treated with surgery to open and drain the infected area.

• Small abscesses may be treated in your healthcare provider’s office.
• If the abscess is large, you may need surgery in a hospital or surgery center.
• If you have a condition that makes it hard to heal, such as diabetes or cancer, you may need to stay in the hospital.

How can I take care of myself?

To care for yourself at home after treatment:

• Keep your bowel movements soft by:
• Following your healthcare provider’s instructions for taking stool-softening medicines
• Drinking plenty of water
• After bowel movements, gently wipe the area around the anus with clean, moist pads. This will remove irritating particles and fluid from the anal area.
• Soak in warm baths 2 to 3 times a day to help relieve pain and keep the area clean. Warm baths help bring more blood flow to the area. Blood brings infection-fighting cells and healing nutrients.

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities including sexual activity
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent an anal abscess?

There is no sure way to prevent anal abscesses. You may be able to help prevent them if you:

• Get treatment for any rectal problems, especially infections or pain, right away.Practice safe sex. Have just 1 sexual partner who is not sexually active with anyone else and who will use protection every time you have sex. Use latex or polyurethane condoms the right way during foreplay and every time you have vaginal, oral, or anal sex.
• If you have diabetes, keep your blood glucose (sugar) level under control.
• Follow your healthcare provider’s advice for taking care of any long-term health conditions

KEY POINTS

• Anal cancer is an abnormal growth of cells that forms tumors in the anus. The anus is where your bowel movements leave your body.
• Treatment may include surgery, chemotherapy, or radiation. Often, more than one treatment is used.
• During and after treatment, you will need to have regular follow-up visits with your healthcare provider.

What is anal cancer?

• Anal cancer is an abnormal growth of cells that forms tumors in the anus. The anus is an opening at the lower end of your bowel where your bowel movements leave your body.
• The sooner cancer is found and treated, the better your chances for recovery.
• However, even advanced cancer can usually be treated. Treatment may slow or temporarily stop the growth of the cancer and ease symptoms. Ask your healthcare provider what you can expect with the type of cancer that you have.

What is the cause?

You may have a greater risk of developing anal cancer if you:

• Use tobacco
• Are infected with human papillomavirus (HPV)
• Have anal sex
• Have more than one sexual partner
• Are over 50 years old

What are the symptoms?

At first there are no symptoms. When symptoms do occur, they may include:

• Rectal bleeding or itching
• A lump or growth around the anus
• Pain or a feeling of fullness in the anal area
• Narrowing of bowel movements
• Abnormal discharge from the anus

Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2

What is metastasis?

The spread of cancer cells from one part of the body to other parts is called metastasis. What causes cancer to spread is not known. Cancer cells can:

• Grow into the area around the tumor
• Travel to other parts of the body through the bloodstream or the lymph system.

The lymph system is part of your body’s system for fighting infection. The lymph system consists of lymph nodes that store blood cells (lymphocytes) to fight infection and vessels that carry fluid, nutrients, and wastes between your body and your bloodstream.

New tumors then grow in these other areas. When anal cancer spreads, it most often affects the colon, rectum, and bladder. Sometimes your first symptoms of cancer are in the part of the body where the cancer has spread. The symptoms of cancer that has spread to another part of your body depend on where the tumors are. For example:

• If the cancer has spread to the colon and rectum, you may have diarrhea, constipation, blood, or other changes in your bowel movements.
• If the cancer has spread to the bladder, you may have trouble urinating, pain while urinating, or blood in the urine. How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• Tests of bowel movements to check for blood and infection
• Anoscopy, which uses a small, lighted tube put into your rectum to examine the anal area. A biopsy may be taken to help make a diagnosis. A biopsy is the removal of a small sample of tissue for testing.
• An ultrasound, which uses sound waves to show pictures of the anus and rectum
• Colonoscopy, which uses a flexible, lighted tube put through your rectum to look at the inside of your colon. A similar test called a sigmoidoscopy looks at just the lower part of your colon.

You may need more lab tests and scans to check if the cancer has spread to other parts of your body.

How is it treated?

You and your healthcare provider will discuss possible treatments. You may also talk with a surgeon and a cancer specialist. Some things to think about when making treatment decisions are:

• Your age
• Your overall health
• The stage of the cancer (how advanced the cancer is)
• Whether the cancer has spread to other parts of your body Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3 The usual treatment is surgery to remove the area around the anus that contains the cancer. If a large part of your colon, rectum, and anus is removed, you may need a colostomy. A colostomy is an opening through the skin in your belly that connects tothe healthy end of your colon. After this procedure, bowel movements will empty through the opening and collect in a disposable bag outside your body You must empty or change the bag several times a day. Most people who have a colostomy only need it while they heal after surgery. Other possible treatments are:
• Chemotherapy (anticancer drugs), which uses medicine to kill cancer cells
• Radiation therapy, which uses high-energy X-rays to kill cancer cells and shrink rectal tumors Often, more than one type of treatment is used. During and after treatment, you will need to have regular follow-up visits with your healthcare provider.

Your treatment may also include:

• Preventing infections
• Controlling pain or other symptoms you may have
• Preventing or controlling the side effects from treatments, which may be different for each person based on the treatment you receive
• Helping you manage your life with cancer Ask your healthcare provider about clinical trials that might be available to you.

Clinical trials are research studies to find effective cancer treatments. It’s always your choice whether you take part in one or not.

How can I take care of myself?

If you have been diagnosed with anal cancer:

• Talk about your cancer and treatment options with your healthcare provider. Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider:
• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Eat a variety of healthy foods.
• Stay physically active as advised by your provider.

Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 4

• Get plenty of rest.
• Try to reduce stress and take time for activities that you enjoy. It may help to talk with a counselor about your illness.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexual activity, support groups, and anything else that concerns you.
• If you smoke or use e-cigarettes, try to quit.
• You may be more at risk for serious infections during and after your treatment. Try to stay away from people who may be sick. Avoid crowded places such as shopping malls when you can. Practice good hand washing.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Tell your provider if your treatment causes discomfort. Usually there are ways to help you feel more comfortable.

If you have a colostomy:

• Learn how to take care of your colostomy.
• Learn which foods you should avoid because they cause too much gas or make it hard for you to control your bowels.
• Give yourself time to get used to the changes in your body. You may need to change how you dress to allow room for the colostomy and bag.
• Seek sexual activity counseling for yourself and your partner if you feel you need it.
• You may feel anger, frustration, grief, and embarrassment about the cancer and colostomy. Talk about your feelings. Let members of your care team know what you are thinking.

KEY POINTS

• An anal fissure is a small tear in the skin of the anus. The anus is the opening of the rectum where bowel movements leave the body.
• Most fissures will heal in a few days with at-home treatments such as soaking in a warm tub, using a stool softener or laxative medicine, eating a high-fiber diet, and drinking a lot of liquids.

What is an anal fissure?

An anal fissure is a small tear in the skin of the anus. The anus is the opening of the rectum where bowel movements leave the body. Anal fissures are a fairly common problem.

What is the cause?

A tear may happen when you have:

• Hard, dry bowel movements
• Constipation
• Diarrhea because loose bowel movements or frequent wiping can irritate the anus
• Hemorrhoids
• Anal surgery
• Inflammation of the rectum caused by intestinal problems such as Crohn’s disease
• Some sexually transmitted diseases (STDs)

What are the symptoms?

Symptoms may include:

• Pain during or after bowel movements
• Cramping of the muscle at the opening of the anus caused by irritation of the tear during a bowel movement
• Bright red blood when you have a bowel movement. You may see the blood on the bowel movement, in the toilet water, or on toilet tissue you have used.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you.Tests may include:

• Rectal exam, which your provider does by looking at the skin around the anus and gently putting a lubricated and gloved finger in your rectum
• Anoscopy, which uses a small, lighted tube put into your rectum to look for hemorrhoids or other causes of bleeding Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2 Your healthcare provider may recommend other tests or procedures to learn more about the cause of the fissure or the bleeding.

How is it treated?

Most fissures will heal in a few days with the following at-home treatments:

• Your healthcare provider may recommend a stool softener or laxative.
• Drink enough liquids each day to keep your bowel movements soft and your urine light yellow in color.
• Add more fiber to your diet to soften bowel movements by eating whole-grain bread and cereal, beans, bran muffins, brown rice, and fresh fruit and vegetables.
• For pain, your provider may recommend or prescribe use of pain-relieving cream or ointment, such as hydrocortisone or pramoxine, for a few days. Contact your healthcare provider for advice if you are using nonprescription pain-relieving creams or ointments for more than a few days. These products may cause allergic skin reactions and worsen your problem.
• Soaking in a warm bath 2 or 3 times a day may also help to relieve pain and keep the area clean.
• After bowel movements, gently wipe the area around the anus with clean, moist pads. This will remove irritating particles and fluid from the anal area. For fissures that come back or do not heal, medicines can be put inside the anus to try to relax the muscles around the anus and allow the fissure to heal. If this does not help the fissure heal, you may need surgery.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities, including sexual activity
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent anal fissures?

The best prevention for anal fissures is to keep your bowel movements soft and prevent constipation by:

• Drinking plenty of water
• Eating fresh fruits, vegetables, and whole grains and Staying physically active as advised by your provider.

KEY POINTS

• An anal fistula is an abnormal tunnel between the lower end of your intestine (rectum) and the outer skin of your anus. The anus is the opening where bowel movements come out.
• An anal fistula may be treated with surgery to open and drain the infected area.
• Follow your healthcare provider’s instructions about when you can return to normal activities and how to take care of yourself at home.

What is an anal fistula?

• An anal fistula is an abnormal tunnel between the lower end of your intestine(rectum) and the outer skin of your anus. The anus is the opening of the rectum where bowel movements leave the body.Fistulas usually do not go away without treatment.

What is the cause?

An anal fistula is usually caused by a bacterial infection in the anus. It may happen as a result of:

• Diseases of the intestines such as Crohn’s disease (inflammation of the intestines)
• Injury to your anus such as an anal tear while giving birth through the vagina
• Anal intercourse
• Other diseases or infections

What are the symptoms?

• Itching or irritated skin around your anus
• Watery pus, sometimes mixed with blood, in or around your anus
• Pain in the rectal area, especially when you have a bowel movement
• Leaking of bowel movement and a foul odor

How is it diagnosed?

• An exam of the area around and inside your rectum. Your provider will put a lubricated and gloved finger gently into your rectum to try to see how deep the fistula is and find the opening at the upper end of the fistula tunnel. Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2
• Anoscopy, which uses a small, lighted tube put into your rectum to examine the anal area
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the rectal area and the fistula
• Ultrasound, which uses sound waves to show pictures of the rectal area and the path of the fistula You may have other tests to see if you have an inflammatory disease of the intestine, which may be the cause of the fistula.

How is it treated?

• Small fistulas may be treated in your healthcare provider’s office. In some cases, your provider may be able to use stitches and surgical glue to seal and heal the fistula instead of cutting it open.
• If the fistula is large, you usually need surgery to close the fistula. Before surgery, you will be given medicine to keep you from feeling pain. After surgery, your provider will prescribe stool softeners and rest. Your provider may also prescribe antibiotic medicine and pain medicine. If the fistula is small and easy to treat, you may be better in a few days or weeks. If your fistula is deep or long and harder to treat, it may take more than 1 surgery and a longer time for the fistula to heal completely. If you have a medical problem, such as inflammatory bowel disease, you may keep getting fistulas.

How can I take care of myself?

To care for yourself at home after treatment:

• Do these things to help keep your bowel movements soft:
• Follow your healthcare provider’s instructions for taking stool-softening medicines.
• Drink plenty of water.
• Add more fiber to your diet with whole-grain foods, bran, fruits, and vegetables, unless your healthcare provider tells you to avoid fiber because of a medical condition.
• After bowel movements, gently wipe the area around the anus with clean, moist pads. This will remove irritating particles and fluid from the anal area.
• Soak in warm baths 2 to 3 times a day to help relieve pain and keep the area clean.Warm baths help bring more blood flow to the area. Blood brings infection-fighting cells and healing nutrients.

Follow your healthcare provider’s instructions. Ask your provider:

• How and when you will get your test results
• How long it will take to recover Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3
• If there are activities you should avoid and when you can return normal activities including sexual activity
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent an anal fistula?

KEY POINTS

• Appendicitis is swelling and irritation of the appendix. The appendix is a small, finger-shaped pouch where the large and small intestines join.
• Appendicitis is usually treated with surgery to remove the appendix.
• Ask your provider how to take care of yourself at home, what symptoms or problems you should watch for, and what to do if you have them.

What is appendicitis?

Appendicitis is swelling and irritation of the appendix. The appendix is a small,finger-shaped pouch where the large and small intestines join. Healthcare providers are not sure what the appendix does, but when it is inflamed, it gets swollen and painful and can cause serious problems.It is important to get treatment for appendicitis before the appendix ruptures. A rupture is a break or tear in the appendix. If an infected appendix breaks open, it can cause a life-threatening infection of the belly.Because of the risk of rupture, appendicitis is considered an emergency.

What is the cause?

In most cases, appendicitis is caused by a blockage of the opening of the appendix by a piece of bowel movement. Sometimes it is caused by infection in the digestive tract.

What are the symptoms?

The symptoms can differ from person to person. They may include:

• Pain, usually starting near the bellybutton, then moving to the right lower side of the belly. The pain starts suddenly and worsens quickly, especially when you are moving around.
• Loss of appetite
• Nausea and vomiting
• Constipation or diarrhea
• Trouble passing gas
• Fever, usually not very high
• Swollen, tight, or hard belly

Children under 10 and adults over 50, as well as pregnant women, are less likely to have the usual symptoms of appendicitis. Because of this, they may not get treatment right away, which makes it more likely that the appendix will rupture. They should Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2 be especially careful to report symptoms that could be early signs of appendicitis.Appendicitis is most common between the ages of 10 and 30. If you think you may have appendicitis and are about to see your healthcare provider, do not eat or drink anything before the appointment.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have the following tests:

• Blood tests
• Urine tests
• An ultrasound, which uses sound waves to show pictures of the belly
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the belly
• CT scan, which uses X-rays and a computer to show detailed pictures of the belly
• Exploratory laparotomy: A surgeon will make small cuts in the belly to see if the appendix looks inflamed and should be removed. This is done sometimes after other tests do not give definite results for what is causing the symptoms.If the diagnosis is not clear, you may be watched closely in the emergency room or hospital for 12 to 24 hours to see if surgery is needed. If your provider does not keep you in the hospital and sends you home without surgery, your provider will probably ask you to:
• Not use any pain medicine. Taking pain medicine could make it hard for you to know if the pain gets better or worse.
• Not use any enemas or laxatives. These medicines increase the risk that the appendix will rupture if it is inflamed.
• Not take any antibiotic medicines.
• Take and write down your temperature every 2 to 4 hours.
• Contact your provider if any of your symptoms get worse over the next few hours.

How is it treated?

Appendicitis is usually treated with surgery to remove the appendix. It is important to have surgery quickly before the appendix ruptures. People can live a normal life without an appendix.

You will be given general anesthesia to keep you from feeling pain during the procedure. General anesthesia relaxes your muscles and puts you into a deep sleep. You may have either one cut in the lower right area of the belly or 1 to 3 small cuts if your healthcare provider uses a laparoscope, which is a lighted tube with a camera. If your appendix is removed before it ruptures, you will usually feel much better in a couple of days.

If the appendix has ruptured, infection can spread through your belly, which is dangerous. Your healthcare provider may put a drainage tube in your belly to help Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3 the infection drain. You will stay in the hospital after surgery to receive IV antibiotic medicine and pain medicine and may need more than 1 surgery.

Treatment without surgery includes taking antibiotic medicine to treat the infection.This treatment may be used if you are not well enough for surgery or surgery is not available. Without treatment, appendicitis can be fatal. Close follow-up is important to make sure the infection is getting better and to decide if or when surgery is needed.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. If antibiotic medicine has been prescribed, take all of it according to your provider’s instructions.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

KEY POINTS

• Bile duct stones are hard objects that get stuck in the common bile duct, which is part of your digestive system.
• Usually, bile duct stones need to be removed with surgery. If you have an infection, you may be given an antibiotic medicine before and after the surgery.Ask your healthcare provider how long it will take to recover, and when you can return to normal activities.

What are bile duct stones?

Bile duct stones are hard stone-like objects that get stuck in the common bile duct.The liver, gallbladder, and pancreas are part of your digestive system. The liver makes bile, which helps your body break down the fat in food. Ducts carry bile from the liver to the gallbladder and the small intestines.The gallbladder is a small sac under your liver on your right side that stores bile. Bile helps break down food, especially fatty food. A duct carries bile from the liver and the gall bladder and digestive fluids from the pancreas to the upper part of your small intestines.

What is the cause?

Stones can start in the gallbladder and move into the bile duct or they can start in the bile duct. Long-term problems with gallstones can damage the gallbladder and cause stones to move into the bile duct more easily.Most bile duct stones are made from cholesterol. Cholesterol is a kind of fat used by the body to make hormones and to build and keep cells healthy. If there is too much cholesterol in your bile or if the bile stays in your gallbladder too long, hard pieces can form.Some bile duct stones are made from bilirubin and calcium. Bilirubin is made from the breakdown of old blood cells. If you have a lot of bilirubin in your bile, it can mix with calcium that is naturally in your bile to form gallstones. If you have bacteria in your bile, it can increase the amount of bilirubin that can make gallstones. Bile duct stones happen more often in:

• White, Mexican-American, and Native American people
• Women in their child-bearing years, and women who have had multiple pregnancies
• Both men and women after age 60
• People who are very overweight or who have a large amount of belly fat
• People who have type 2 diabetes, high blood glucose (sugar), high blood pressure, high cholesterol levels, sickle cell disease, cirrhosis, or an infection in the gallbladder or liver
• People who have lost a lot of weight following a diet that is very low in calories and fat
• People who have had a long-term illness and need nutrition through an IV
• People who take medicines such as estrogen, some cholesterol lowering medicines, growth hormone, and others If stones completely block the common bile duct, the flow of bile out of the liver can also be blocked. This causes swelling, irritation, and pain in your liver, your gallbladder, or both. If not treated, you could get a serious infection, or rarely, swelling can cause your gallbladder to burst. Both can be life-threatening.

What are the symptoms?

The symptoms of bile duct stones may come on slowly over time or may happen suddenly. Early symptoms may include:

• Pain in the upper right part of the belly, often starting after a meal with a lot of fat.The pain slowly gets worse, goes away within a few hours, and then comes back after another meal.
• Pain in the upper back between the shoulder blades or in the right shoulder
• Sweating, nausea, and vomiting

Later symptoms may include:

• Severe, steady pain
• Light-colored bowel movements and dark urine
• Itchy skin
• Jaundice, which is a yellowing of the skin and whites of the eyes
• Chills and fever Bile duct stones that block the pancreatic duct can also cause pancreatitis, which is irritation and swelling in the pancreas. The main symptom of pancreatitis is severe pain in the middle of your upper belly. If not treated quickly, pancreatitis can be life-threatening.

How are they diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. The most common test to diagnose bile duct stones is an ultrasound, which uses sound waves to show pictures of your gallbladder and bile ducts. If the ultrasound does not clearly show the gallstones, you may have other tests or scans such as:

• Blood tests
• CT scan, which uses X-rays and a computer to show detailed pictures of your gallbladder and bile duct Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3
• Nuclear scans, which use a tiny amount of radioactive chemical injected into your vein to show how well bile flows from your liver, through your gallbladder, and into your small intestine
• PTHC, which uses contrast dye that is injected through a needle inserted through your liver and X-rays or an MRI to show pictures of the bile ducts
• MRCP (magnetic resonance cholangiopancreatography) is a type of MRI that uses a strong magnetic field and radio waves to show detailed pictures of the ducts that drain fluid from your liver, gallbladder, and pancreas.

How are they treated?

Usually, bile duct stones need to be removed. Usually the stones can be removed using a procedure called ERCP and sphincterotomy. This procedure uses a slim,flexible lighted tube that is put through your mouth. It has a tool to enlarge the bile duct opening into the intestine and remove stones from the common bile duct. It may be followed by surgery to remove the gallbladder if it is the source of the stones. This surgery is called a cholecystectomy.Removal of your gallbladder should cause few, if any, long-term problems because your digestive system can work well without it. You may have looser bowel movements after gallbladder removal. Surgery may be done in one of two ways:

• A laparoscopic surgery to remove the gall bladder (laparoscopic cholecystectomy), part of the duct, and the stones is done using a lighted tube with a camera. The lighted tube is passed into the belly through small cuts in the belly wall. Your provider can put the scope and tools into your belly through the small cuts.
• An open surgery to remove the gall bladder part of the duct, and the stones is done through a large cut in your belly.If you have an infection, you may be given antibiotic medicine before and after the surgery.

How can I take care of myself?

Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent bile duct stones?

• Get your cholesterol levels and weight checked regularly. Lose weight if you are overweight and keep a healthy weight.
• If you are extremely overweight and need to follow a very low-calorie diet for quick weight loss, your healthcare provider may prescribe medicine to help prevent gallstones.
• Eat a diet that is low in saturated fat, trans fat, and cholesterol. Eat healthy foods that are high in fiber such as whole grains, fresh fruits, and vegetables.
• Stay physically active as advised by your provider. Ask for help with a physical activity plan that tells you what kind of activity, and how much, is safe for you. Start slowly to avoid injury.
• Avoid fasting. Long periods of fasting can cause gallstones because the bile stays in the gallbladder too long.

KEY POINTS

• If the number of bowel movements you have stays about the same from day to day, and your bowel movements are soft enough to pass without straining, then you have good bowel habits.
• Bowel habits may change when we change our diet or fluid intake, travel, change our activity level, or change medicines, but persistent changes need to be evaluated.Changes such as constipation, diarrhea, bloody or different colored bowel movements, loss of control, or any other change in your bowel habits that lasts for 2 weeks or more may be a sign of a problem. If you have one or more of these changes and they do not go away, tell your healthcare provider.

What are good bowel habits?

Bowel habits is the term used for how often you have bowel movements. There is no best number of daily or weekly bowel movements. Some people have a bowel movement twice a day and others twice a week. What’s more important than having frequent bowel movements is having regular and soft bowel movements. If the number of bowel movements you have stays about the same from day to day, and your bowel movements are soft enough to pass without straining, then you have good bowel habits.

What causes changes in bowel habits?

Most people have diarrhea or constipation, from time to time. For example, some foods, like nuts and corn, may make your bowel movements loose.You are more likely to have constipation if:

• You don’t eat enough fiber.
• You don’t drink enough liquids.
• You don’t get enough physical activity.
• You overuse some types of laxatives.
• You take medicine that can cause constipation.
• Temporary changes usually are not a sign of a serious medical problem. However, a change in bowel habits that does not go away may be a sign of a problem.

What are signs of a problem?

Symptoms that may signal a problem include:

• Any change in your bowel habits that lasts for 2 weeks or more Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2
• A change in the texture of stools, such as much harder or looser than usual for you
• A change in the color of stools, such as much paler or very dark than usual for you
• Stools that are narrower than before and stay that way for 2 to 4 weeks
• Bowel movements that float and look fatty or greasy
• Bowel movements that are painful or hard to pass
• Stomach cramps, pain, bloating, and no bowel movement for more than 3 or 4 days
• Blood in the stools, on your clothes, or on toilet paper
• If you have one or more of these changes and they do not go away, tell your healthcare provider.

How can I take care of myself?

• Drink plenty of liquids, especially water.
• You may need to increase the amount of fiber in your diet slowly.
• You can increase your fiber by eating 2 cups of fruit, 2 and 1/2 cups of vegetables, and at least 3 servings of whole-grain breads and cereals each day. Drink plenty of liquids throughout the day.
• To prevent gas, increase fiber slowly, adding more fiber every couple of days.If you don’t have that much appetite, try fiber supplement capsules or drinks that contain psyllium, bran, or methylcellulose. There are many brands.
• Try sitting on the toilet at certain times every day. Having a routine helps your brain and body learn when to have a bowel movement. When you have the urge to go to the bathroom, don’t ignore it.
• If you have constipation and want to use a laxative, ask your healthcare provider to suggest the best laxative for you.
• Stay physically active as advised by your provider. For example, walk every day, or if you have joints that hurt, try exercising in a swimming pool instead.
• Some medicines can cause diarrhea or constipation. Ask your healthcare provider to review your medicines.

KEY POINTS

• A large bowel obstruction is a blockage anywhere inside your large intestine. A blockage may stop all food, gas, or fluids from passing through or just make it harder to pass through and out of your body.
• Treatment may include enemas, changes in your diet, or surgery to remove the cause of the blockage. You may need a colostomy to make an opening in your belly and bring the end of the intestine to the outside. Bowel movements will then leave your body through this new opening.
• It may help if you exercise daily, eat a diet high in fiber, and drink plenty of water.
• If you have a health problem that caused the blockage, be sure you know what to do to manage that health problem and help keep from having another blockage.

What is a large bowel obstruction?

A large bowel obstruction is a blockage anywhere inside your large intestine. The large bowel (also called the colon) is the last 5 feet of your intestines. The rectum is the last few inches of the large bowel. The rectum connects with the anus, where your bowel movements come out. A blockage may stop all food, gas, or fluids from passing through or just make it harder to pass through and out of your body. If a blockage is not treated, it can become a life-threatening medical emergency.

What is the cause?

Common causes of a blockage are:

• Tumors or scar tissue that block the intestine
• Diverticulitis, which is swelling and irritation of pouches in the lining of the intestines that may get infected
• A twisting of the intestines
• A hard lump of bowel movement that gets stuck
• Hernia, which is when part of the intestine bulges through a weak area or gap in the muscles in the wall of the belly. The hernia can twist or narrow and block passage of bowel movements.

What are the symptoms?

The first signs of a blockage may be a change in bowel habits, such as little or no gas, or no bowel movements. Other symptoms may include: Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2

• Cramping, swelling, and pain in your belly that comes and goes and becomes more severe
• Nausea or vomiting If your intestine is only partly blocked, you may have diarrhea.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Rectal exam, which your provider does by gently putting a lubricated and gloved finger in your rectum. Your provider may also place his or her other hand on your belly to feel and check the size and shape of your organs.
• X-rays of the belly
• CT scan, which uses X-rays and a computer to show detailed pictures of the intestines
• Colonoscopy, which uses a flexible, lighted tube, put through your rectum to look at the inside of your colon. A similar test called a sigmoidoscopy looks at just the lower one-third of your colon.
• Blood tests
• Urine test
• Test of bowel movements for blood

How is it treated?

Treatment depends on what is causing the blockage.If the blockage is from a hard lump of bowel movement near the anus, your provider may be able to remove it with enemas or by putting a gloved, lubricated finger into your rectum. Your provider may recommend some changes in your diet to prevent future problems.You may need to be treated in the hospital with an IV to give you fluids and medicines. You may also have a tube put through the nose and into the stomach to help drain fluid and gas. Sometimes a tube is put into your rectum to help relieve gas and make you more comfortable.

You may need to have surgery to remove the cause of the blockage. This is more common with complete blockages. A complete blockage is a medical emergency. Part of your intestine may also need to be removed. You may need a colostomy. This means that your healthcare provider will make an opening in your belly and bring the end of the intestine to the outside. Bowel movements will then leave your body through this new opening. It will be collected in a disposable bag. In most cases the colostomy is temporary. This means that you will have a second surgery to rejoin the ends of intestine to each other, and no longer have an opening in the wall of your belly. Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a large bowel obstruction?

Exercise daily and eat a diet high in fiber and low in fat and cholesterol. If you are not used to high-fiber diets, start slowly. Drinking plenty of water helps your intestines to work normally. If you see blood in a bowel movement or have a change in bowel habits, tell your healthcare provider. If you have a health problem that caused the blockage, be sure you know what to do to manage that health problem and help keep you from having another blockage.If you are 50 or older, ask your healthcare provider how often you should have colorectal cancer screening. If you are an African-American, your healthcare provider may recommend a screening colonoscopy at age 45.

KEY POINTS

• Colon or rectal cancer is the growth of abnormal cells in your large intestine.
• Treatment may include surgery to remove the tumor and part of your intestine, chemotherapy, biological therapy, or radiation. Often, more than 1 treatment is used.After successful treatment, you will need to have regular follow-up visits with your healthcare provider.

What is colon or rectal cancer?

Colon or rectal cancer is the growth of abnormal cells in your large intestine, which is also called the large bowel. The colon is the last 5 feet of the bowel. The rectum is the last few inches of the large bowel inside the anus, where your bowel movements come out. Colon cancer is one of the most common types of cancer. Another name for this type of cancer is colorectal cancer.The sooner cancer is found and treated, the better your chances for recovery.However, even advanced cancer can usually be treated. Treatment may slow or temporarily stop the growth of the cancer and ease symptoms. Ask your healthcare provider what you can expect with the type of cancer that you have.

What is the cause?

Most colorectal cancers start from a growth of extra tissue called a polyp on the inside wall of the bowel. Polyps are very common. About half of all people will eventually have a polyp in their large bowel. Less than 1 in 10 polyps turn into cancer. Colorectal cancer grows very slowly, over 10 to 15 years. Colon or rectal cancer usually occurs after age 50, but it can happen at any age.

You may have a greater risk of developing colon cancer if you:

• Have had colorectal cancer in the past
• Have polyps or a bowel disease such as ulcerative colitis or Crohn’s disease
• Have a parent, brother, sister, or child who has had colon cancer or colon polyps
• Have had uterine, ovarian, or breast cancer
• Eat a high-fat and low-fiber diet
• Smoke cigarettes

What are the symptoms?

At first there are no symptoms. When symptoms do occur, they may include:

• Blood in your bowel movements Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 2.
• A change in your bowel movements such as diarrhea, constipation, or bowel movements that are narrower than usual.
• Feeling like your bowels do not empty completely, gas pains or cramps, or a sense of fullness in your belly.
• Feeling tired all the time.
• Weight loss.

What is metastasis?

The spread of cancer cells from one part of the body to other parts is called metastasis. What causes cancer to spread is not known. Cancer cells can:

• Grow into the area around the tumor.
• Travel to other parts of the body through the bloodstream or the lymph system.The lymph system is part of your body’s system for fighting infection. The lymph system consists of lymph nodes that store blood cells (lymphocytes) to fight infection and vessels that carry fluid,nutrients, and wastes between your body and your bloodstream.New tumors then grow in these other areas.When colorectal cancer spreads, it most often affects the lungs and liver. Sometimes your first symptoms of cancer are in the part of the body where the cancer has spread.The symptoms of colon cancer that has spread to another part of your body depend on where the tumors are. For example:
• If the cancer has spread to the lungs, you may have a cough or trouble breathing.
• If the cancer has spread to the liver, you may have yellowish skin, pain, or swelling in your belly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Small samples of your bowel movements will be tested for blood. The test can find blood that you cannot see on your bowel movements. If you have blood in your bowel movements, you may need other tests such as:

• Colonoscopy, which uses a flexible, lighted tube, put through your rectum to look at the inside of your colon. A similar test called a sigmoidoscopy looks at just the lower one-third of your colon.
• Biopsy of the polyp or growth, which may be done during a colonoscopy to take a small sample of tissue for testing
• Barium enema, which means that a chalky liquid that shows up on X-rays is put into your colon through your rectum to see if you have polyps or cancer You may need more lab tests and scans to check if the cancer has spread to other parts of your body.Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3

How is it treated?

You and your healthcare provider will discuss possible treatments. You may also talk with a surgeon and a cancer specialist. Some things to think about when making treatment decisions are:

• Your age.
• Your overall health.
• The stage of the cancer (how advanced the cancer is)
• Whether the cancer has spread to other parts of your body The usual treatment is surgery to remove all or part of the colon or rectum that has cancer.If a large part of your colon or rectum is removed, you may need a colostomy. A colostomy is an opening through the skin in your belly that connects to the healthy end of your colon. After this procedure, bowel movements will empty through the opening and collect in a disposable bag outside your body. You will have to empty or change the bag several times a day. Most people who have a colostomy only need it while they heal after surgery. About 1 in 8 people with rectal cancer will need a permanent colostomy.

Other possible treatments are:

• Chemotherapy (anticancer drugs), which uses medicine to kill cancer cells
• Radiation therapy, which uses high-energy X-rays to kill cancer cells and shrink rectal tumors
• Biological therapy, which uses medicine to help your immune system fight the cancer or targeted medicines that block the growth of the cancer cells Often, more than 1 type of treatment is used. After treatment, you will need to have regular follow-up visits with your healthcare provider.

Your treatment may also include:

• Preventing infections
• Controlling pain or other symptoms you may have
• Preventing or controlling the side effects from treatments, which may be different for each person based on the treatment you receive
• Helping you manage your life with cancer Ask your healthcare provider about clinical trials that might be available to you. Clinical trials are research studies to find effective cancer treatments. It’s always your choice whether you take part in one or not.

How can I take care of myself?

If you have been diagnosed with colorectal cancer:

• Talk about your cancer and treatment options with your healthcare provider.Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 4
• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Eat a variety of healthy foods.
• Stay physically active as advised by your provider.
• Get plenty of rest
• Try to reduce stress and take time for activities that you enjoy. It may help to talk with a counselor about your illness.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexual activity, support groups, and anything else that concerns you.
• If you smoke or use e-cigarettes, try to quit.
• You may be more at risk for serious infections during and after your treatment.Try to stay away from people who may be sick. Avoid crowded places such as shopping malls when you can. Practice good hand washing.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Tell your provider if your treatment causes discomfort. Usually there are ways to help you feel more comfortable.

If you have a colostomy:

• Learn how to take care of your colostomy.
• Learn which foods you should avoid because they cause too much gas or make it hard for you to control your bowels.
• Give yourself time to get used to the changes in your body. You may need to change how you dress to allow room for the colostomy and bag.
• Seek sexual activity counseling for yourself and your partner if you feel you need
• You may feel anger, frustration, grief, and embarrassment about the cancer and colostomy. Talk about your feelings. Let members of your care team know what you are thinking.Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 5.

What are the best ways to find colorectal cancer early?

If you are not at high risk for colorectal cancer but are 50 to 75 years old, there are several ways to check for cancer:

• Have your bowel movements checked for blood once a year.
• Have a sigmoidoscopy exam every 5 years.
• Have a colonoscopy every 10 years.
• A barium enema may be done every 5 years instead of a colonoscopy or sigmoidoscopy. Your healthcare provider may recommend this test instead of a colonoscopy if you have certain conditions, such as a colon that is very twisted. The twists make it hard to pass the scope through the colon.If you have a higher than normal risk for colorectal cancer, ask your healthcare provider when and how often you should be tested for colorectal cancer. You may need to start testing before you are 50.

KEY POINTS

• Fluid buildup in the belly happens when fluid that is normally in your blood vessels and tissues leaks into the belly. Many diseases can cause fluid to buildup in your belly, and the most common is serious liver disease.
• You will be treated for the problem causing the fluid buildup.Treatment may also include medicines,draining the extra fluid, or putting a small tube in the veins near your liver.
• Ask your provider how to take care of yourself at home. Make sure you know what symptoms or problems you should watch for and what to do if you have them.

What is a fluid buildup in the belly?

Fluid buildup in the belly happens when fluid that is normally in your blood vessels and tissues leaks into the belly. This space, also called the abdominal or peritoneal cavity, holds the liver, spleen, pancreas, gallbladder, intestines, and female reproductive organs.Fluid that collects in the belly is called ascites.

What is the cause?

Many diseases can cause fluid to buildup in your belly, and the most common is serious liver disease. Liver disease and scarring can block normal blood flow and increase pressure in the main liver (portal) vein. High pressure in the portal vein causes blood to back up and makes the veins swell. This is called portal hypertension.Fluid leaks out of the veins and collects in your belly and chest. The increased pressure can also cause bleeding of swollen veins in your esophagus.

There are many causes of liver disease, and the most common are:

• Alcohol abuse
• Too much iron in the liver
• Liver infections such as hepatitis B or hepatitis C 

Other diseases can cause fluid to build up in your belly, and the most common are:

• Heart failure
• Kidney failure
• Some types of cancer such as cancer of the ovary or bowel
• Serious infections

What are the symptoms?

Symptoms may include:

• Swelling and pain in the belly area
• Problems taking a deep breath
• Coughing
• Swollen ankles, feet, and legs
• Sudden weight gain caused by extra fluid in the body
• Decreased appetite

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Fluid in the belly usually happens after you have diagnosed with liver disease or another problem, so your healthcare provider may not need to do more tests. If you do have tests they may include:

• Blood tests
• Ultrasound, which uses sound waves to show pictures of the belly
• CT scan, which is a series of X-rays taken from different angles and arranged by a computer to show thin cross sections of parts of the body
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the body
• Chest X-ray

How is it treated?

You will be treated for the problem that is causing the fluid buildup. Treatment may also include:

• Diuretic medicine (water pills) to help control your blood pressure and fluid levels
• Antibiotic medicine if you have an infection caused by bacteria
• Paracentesis, which is a procedure that uses a needle to drain extra fluid out of the belly (abdominal or peritoneal cavity)
• Transjugular intrahepatic portosystemic shunt (TIPS), which is a small tube (shunt) placed in the veins near your liver to help blood flow. This helps the veins shrink back to normal size and can help stop or prevent fluid buildup in your chest and belly. This shunt can also lower the risk of bleeding from swollen veins in your esophagus.
• A liver transplant to treat the liver failure that may be causing the ascites
• Other surgery if needed to treat cancer Talk about your treatment options with your healthcare provider. Make sure you understand your choices.Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3

How can I take care of myself?

 Follow the full course of treatment prescribed by your healthcare provider. 

 Ask your healthcare provider:

• How and when you will get your test results
• If there are activities you should avoid
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Lose weight if you are overweight. Eat a variety of healthy foods.
• Follow a low-salt (low-sodium) diet if it is recommended by your provider.Too much salt makes your body hold in too much water.
• Follow your healthcare provider’s advice about how much liquid you should drink.
• Ask your provider if you should avoid drinking alcohol.
• Weigh yourself every morning after you use the bathroom but before you eat or drink anything. Weighing yourself every day helps you know if extra fluid is building up in your body. Weight gain can let you know about fluid buildup before you start having swelling. Keep track of your weight in a diary or on the calendar. Ask your healthcare provider when you should report a weight gain.
• Stay physically active as advised by your provider.
• Get plenty of rest.

KEY POINTS

• When you have a hernia, part of your intestine (bowel) bulges through a weak area or gap in your muscles. There are several kinds of hernias, based on where in the body they happen.
• Surgery to repair the opening in the muscle wall is the main treatment for a hernia.
• Ask your provider how to take care of yourself at home, if there are activities you should avoid, and when you can return to normal activities.

What is a hernia?

When you have a hernia, all or part of your intestine (bowel) bulges through a weak area or gap in your muscles. There are several kinds of hernias, based on where in the body they happen:

Inguinal or groin hernia. A groin hernia is a hernia in the lower part of your belly, where your legs join the lower part of your body. Another name for groin hernia is inguinal hernia because the bowel bulges into the inguinal canal, a space between layers of muscle in your groin. This is the most common type of hernia.

• Ventral or incisional hernia. This is a hernia that appears in your belly at the site of a previous surgery. This kind of hernia is rare.
• Umbilical hernia. An umbilical hernia is near the bellybutton, which is a naturally weak area. This type of hernia is most common in babies but may happen later in life.
• Epigastric hernia. An epigastric hernia is in the upper belly, between the rib cage and bellybutton. This type of hernia may contain fatty tissue rather than intestines poking through the muscles.
• Femoral hernia. A femoral hernia is just below the groin crease near the femoral vein that carries blood from the leg. It usually the result of pregnancy and childbirth and is rare.
• Hiatal hernia. With a hiatal hernia, part of the stomach pokes through the diaphragm up into your chest, inside of your body. The diaphragm is a muscle between your chest and belly that helps you breathe. This is another common kind of hernia.

What is the cause?

A hernia may be caused by anything that causes the intestines to push against a weak area in your muscles. Some people are born with a weakness in these muscles. A hernia can happen to anyone, but most types are more common in men than women.

It can happen when you:

• Lift heavy objects.
• Cough or sneeze a lot.
• Push too hard when you have a bowel movement.
• Are overweight.
• Are pregnant.
• Men with an enlarged prostate can sometimes get a hernia from pushing too hard to urinate. It may also happen after you have had surgery in your belly.

What are the symptoms?

Symptoms of most types of hernias may include:

• Tugging pain or discomfort in the belly or groin, especially with physical activity • A lump that appears when you lift something or exert yourself • A lump that you can push back in • A burning, aching, or heavy feeling in part of your belly • A swollen or enlarged scrotum in men or boys

If you have a lump that cannot be pushed back, it can mean that part of your intestines is trapped in the gap between the muscles and you need to get medical careright away. A hernia can become a serious problem if your intestines get trapped. Then blood cannot get to that part of your intestines and part of the intestines may die. This can make you very sick. If this happens, you need surgery right away.Many people with a hiatal hernia never have any symptoms. However, in some casesit causes  stomach acid to flow back into the esophagus. The esophagus is the tube that carries food from your throat to your stomach. Symptoms may include burning pain in your chest or throat, a bitter taste in your mouth, a feeling of bloating or fullness inyour stomach, and frequent belching or dry coughing.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include: • An ultrasound, which uses sound waves to show pictures of the organs inside the lower belly. • CT scan, which uses X-rays and a computer to show detailed pictures of the organs inside the belly. • X-rays.

How is it treated?

Surgery to repair the opening in the muscle wall is the main treatment for most types of hernias. Your healthcare provider will close the weak spot. Your provider may sew a piece of mesh over the weak spot and under the skin to make the area stronger. The hernia will not get better on its own without treatment, but it also may not get worse for months or even years. If your hernia is not causing problems, you may choose not to have surgery after talking with your healthcare provider. For groin Adult Advisor 2020.1 © 2018 Change Healthcare LLC and/or one of its subsidiaries 3 hernias, you may need to use a groin support. Ask your healthcare provider what is recommended for you.If you have a hiatal hernia, your provider may recommend medicine to lower the acid in your stomach, losing weight, and quitting smoking. Most often, these changes will control your symptoms.

How can I take care of myself?

• Make sure that you know symptoms to watch for that might mean the hernia has trapped your intestines. This is a medical emergency and you would need surgery right away.
• Follow safe practices when you move heavy things. Learn how to lift and move heavy items safely. Remember to use your legs. Bend at your knees, not at your waist. Ask your healthcare provider how many pounds you can safely lift.
• Ask your provider if you need to wear a groin support.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Avoid constipation by eating foods that are high in fiber, using stool softeners, or drinking a natural stimulant beverage such as prune juice. Drink plenty of water.Use laxatives or enemas only if recommended by your provider.
• If you smoke or use e-cigarettes, try to quit. Smoking may cause coughing, which puts extra pressure on the belly and groin muscles. It’s also important to stop smoking if you need surgery. Stopping 6 weeks or more before surgery can lower your chances of complications from surgery such as pneumonia. Talk to your healthcare provider about ways to quit smoking.
• Take medicine as needed to reduce sneezing and coughing from allergies.Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:
• How and when you will get your test results.
• How long it will take to recover.
• If there are activities you should avoid and when you can return to normal activities.
• How to take care of yourself at home.
• What symptoms or problems you should watch for and what to do if you have them Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.