Periodontal/Gum Periodontal/Gum DiseaseDisease• Periodontal/gum diseases are serious Periodontal/gum diseases are serious

infections that, left untreated, can lead to infections that, left untreated, can lead to tooth loss tooth loss

• The word The word periodontalperiodontal literally means literally means "around the tooth“"around the tooth“

• Periodontal disease is a chronic bacterial Periodontal disease is a chronic bacterial infection that affects the gums and bones infection that affects the gums and bones supporting the teeth supporting the teeth

• Periodontal disease can affect one tooth or Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in many teeth. It begins when the bacteria in plaque causes the gums to become inflamedplaque causes the gums to become inflamed

Do you have gum Do you have gum disease???disease???• Do you ever have pain in your mouth? Do you ever have pain in your mouth?

• Do your gums ever bleed when you brush Do your gums ever bleed when you brush your teeth or when you eat hard food? your teeth or when you eat hard food?

• Have you noticed any spaces developing Have you noticed any spaces developing between your teeth? between your teeth?

• Do your gums ever feel swollen or tender? Do your gums ever feel swollen or tender? • Have you noticed that your gums are Have you noticed that your gums are

receding (pulling back from your teeth) or receding (pulling back from your teeth) or your teeth appear longer than before? your teeth appear longer than before?

• Do you have persistent bad breath? Do you have persistent bad breath? • Have you noticed pus between your teeth Have you noticed pus between your teeth

and gums? and gums? • Have you noticed any change in the way your Have you noticed any change in the way your

teeth fit together when you bite? teeth fit together when you bite? • Do you ever develop sores in your mouth?Do you ever develop sores in your mouth?

How to look after your How to look after your teethteeth

How to BrushHow to BrushPlace your toothbrush next Place your toothbrush next to the teeth so that it rests to the teeth so that it rests on the gums forming a 45-on the gums forming a 45-degree angle against the degree angle against the gums. gums.

Move the toothbrush from the Move the toothbrush from the gums towards the edge of teeth gums towards the edge of teeth to move the dental plaque away to move the dental plaque away from the gum line. from the gum line.

After After brushing, brushing, one by one one by one tooth, all the tooth, all the outer teeth outer teeth surfaces do surfaces do the same for the same for the inner the inner surfaces.  surfaces. 

Brush the chewing Brush the chewing surfaces of the surfaces of the teeth with teeth with horizontal moves. horizontal moves.

How to FlossHow to Floss

Human Torso ModelHuman Torso Model

*Please refer to your handout of the human digestive system

Human Digestive Human Digestive SystemSystem

Alimentary CanalAlimentary Canal ++ Associated GlandsAssociated Glands

Alimentary Canal and Associated Alimentary Canal and Associated GlandsGlands

• MouthMouth• PharynxPharynx• OesophagusOesophagus• StomachStomach• Small IntestineSmall Intestine• Large IntestineLarge Intestine• AnusAnus

• Salivary GlandsSalivary Glands• Gastric GlandsGastric Glands• PancreasPancreas• LiverLiver• Intestinal Intestinal

GlandsGlands

DigestionDigestion

DigestionDigestion

• Digestion is the process of breaking down Digestion is the process of breaking down large, complex substances into smaller, large, complex substances into smaller, simpler molecules for absorptionsimpler molecules for absorption

• Carbohydrates ->Carbohydrates -> glucose/fructose/galactoseglucose/fructose/galactose

Proteins ->Proteins -> amino acidsamino acids

Fats ->Fats -> fatty acids and glycerolfatty acids and glycerol• Vitamins, minerals and water can be Vitamins, minerals and water can be

absorbed directly without digestionabsorbed directly without digestion

Mechanical Digestion vs. Chemical Mechanical Digestion vs. Chemical DigestionDigestion

• Mechanical processMechanical process• Chewing of teethChewing of teeth• Churning of stomachChurning of stomach• Food is changed Food is changed

physically but physically but not chemically not chemically

• Increase surface Increase surface area of food area of food substancessubstances

• Chemical processChemical process• Involves action of Involves action of

digestive digestive enzymes secreted enzymes secreted from glandsfrom glands

• Different types of Different types of enzymes break enzymes break down different down different food typesfood types

ProteaseProtease

Breaks down Breaks down proteinprotein moleculesmolecules

A A proteinprotein molecule is made molecule is made of many different of many different aminoamino acidsacids

Amino acidsAmino acids

CarbohydrasCarbohydrasee

A A starchstarch molecule is molecule is made of many made of many glucoseglucose moleculesmolecules

GlucoseGlucose

Breaks down Breaks down carbohydratecarbohydrate

moleculesmolecules

LipaseLipase

GlycerolGlycerol

Fatty Fatty acidsacids

Breaks down Breaks down fatfat moleculesmolecules

A A fatfat molecule is molecule is made up of made up of fattyfatty acidsacids and and glycerolglycerol moleculesmolecules

Example of Carbohydrase: Example of Carbohydrase: AmylaseAmylase

• In saliva and pancreatic juiceIn saliva and pancreatic juice• Helps break down starch into Helps break down starch into

simple sugars in mouth and in simple sugars in mouth and in small intestinesmall intestine

Example of Protease: Example of Protease: PepsinPepsin

• In gastric juiceIn gastric juice• Helps break down proteins into Helps break down proteins into

amino acids in stomachamino acids in stomach

Example: Example: LipaseLipase

• In pancreatic juiceIn pancreatic juice• Helps break down oil droplets into Helps break down oil droplets into

fatty acids and glycerol in small fatty acids and glycerol in small intestineintestine

SalivaSaliva

• The taste, smell and sight of food can The taste, smell and sight of food can stimulate salivary glands to secrete stimulate salivary glands to secrete saliva into the mouth via salivary ductssaliva into the mouth via salivary ducts

• Saliva – contains water, mucus and Saliva – contains water, mucus and salivary amylase. Slightly alkalinesalivary amylase. Slightly alkaline

• Water – moistens and softens foodWater – moistens and softens food Mucus – lubricate food for swallowingMucus – lubricate food for swallowing Salivary amylase – starch -> maltoseSalivary amylase – starch -> maltose

SwallowingSwallowing1)1) Food is chewed and mixed with salivaFood is chewed and mixed with saliva2)2) Tongue rolls the food into a Tongue rolls the food into a bolusbolus3)3) Food is swallowed down the oesophagus through Food is swallowed down the oesophagus through

the the pharynxpharynx4)4) Tongue moves upwards and backwards to prevent Tongue moves upwards and backwards to prevent

food from entering the food from entering the trachea/nasaltrachea/nasal cavitycavity5)5) TheThe soft palate soft palate moves up to block the nasal cavity moves up to block the nasal cavity6)6) The The larynxlarynx moves upwards to so that the moves upwards to so that the glottis glottis

(the opening to the larynx) is covered by the (the opening to the larynx) is covered by the epiglottisepiglottis to prevent food from entering the to prevent food from entering the tracheatrachea

Movement of Food Along the Movement of Food Along the Alimentary CanalAlimentary Canal

• Inner surface of alimentary canal is Inner surface of alimentary canal is lined with one to several layers of lined with one to several layers of cells – cells – epitheliumepithelium

• Some epithelial cells produce Some epithelial cells produce mucusmucus, which acts as a , which acts as a lubricantlubricant

PeristalsisPeristalsis

The small intestine has two muscle The small intestine has two muscle layers that work together in peristalsis layers that work together in peristalsis and segmentationand segmentation

PeristalsisPeristalsis

The inner circular muscles contract, The inner circular muscles contract, tightening the tube and pushing the food tightening the tube and pushing the food forward in the intestineforward in the intestine

PeristalsisPeristalsis

When the circular muscles relax, the outer When the circular muscles relax, the outer longitudinal muscles contract, and the longitudinal muscles contract, and the intestinal tube is shortenedintestinal tube is shortened

PeristalsisPeristalsis

As the circular and longitudinal As the circular and longitudinal muscles tighten and relax, the muscles tighten and relax, the food moves forward food moves forward

StomachStomach

• a muscular, elastic, pear-shaped bag, lying a muscular, elastic, pear-shaped bag, lying crosswise in the abdominal cavitycrosswise in the abdominal cavity

• food enters the stomach from the food enters the stomach from the esophagus. The connection between the esophagus. The connection between the stomach and the esophagus is called the stomach and the esophagus is called the cardiac sphinctercardiac sphincter

• The other end of the stomach empties into The other end of the stomach empties into the duodenum, the first section of the the duodenum, the first section of the small intestine. The small intestine. The pyloric sphincterpyloric sphincter separates the stomach from the duodenumseparates the stomach from the duodenum

Sphincter ClosedSphincter Closed

Sphincter OpenedSphincter Opened

Functions of StomachFunctions of Stomach

• StorageStorage• Mechanical digestion – turns food Mechanical digestion – turns food

into into chymechyme• Chemical digestion Chemical digestion

• The lining of the stomach The lining of the stomach contains deep collections of contains deep collections of cells organized into cells organized into gastric gastric glandsglands

• The openings of the gastric The openings of the gastric glands into the surface of glands into the surface of the stomach are called the stomach are called gastric pitsgastric pits

• The The mucous cellsmucous cells in the in the gastric pits secrete gastric pits secrete mucusmucus

• In the deeper part of the In the deeper part of the gland, the gland, the parietal cellsparietal cells secrete secrete hydrochloric acidhydrochloric acid

• The The chief cellschief cells secrete secrete pepsinogenpepsinogen (an inactive (an inactive form of the protein-form of the protein-digesting enzyme digesting enzyme pepsinpepsin))

RenninRennin• In young children, the gastric juice also In young children, the gastric juice also

contains a type of protease called contains a type of protease called renninrennin• Rennin Rennin coagulatescoagulates milk – allow the milk – allow the

proteins to stay in stomach longer for proteins to stay in stomach longer for digestiondigestion

* Rennin can be used to curdle milk to * Rennin can be used to curdle milk to make cheese!make cheese!

Ulcer/Peptic UlcerUlcer/Peptic Ulcer

• A small erosion in the gastrointestinal A small erosion in the gastrointestinal tract tract

• A weakening of the mucus coating – A weakening of the mucus coating – acid erodes the wall of the GI tractacid erodes the wall of the GI tract

• Stomach – gastric ulcerStomach – gastric ulcer• Small intestine – duodenal ulcerSmall intestine – duodenal ulcer• Main cause – bacterial infectionMain cause – bacterial infection• Can be treated with antibioticsCan be treated with antibiotics

Small IntestineSmall Intestine

The small intestine is divided into 3 The small intestine is divided into 3 sections:sections:

• DuodenumDuodenum• JejunumJejunum• IleumIleum

* In the small intestine, both digestion * In the small intestine, both digestion and absorption occurand absorption occur

BileBile

• Bile is a Bile is a dark greendark green fluid containing: fluid containing:

1) bile salts1) bile salts

2) sodium hydrogen carbonate2) sodium hydrogen carbonate

3) bile pigments3) bile pigments• Bile does NOT contain digestive Bile does NOT contain digestive

enzymesenzymes• Made by the liverMade by the liver• Stored in the gall bladderStored in the gall bladder

• The gall The gall bladder bladder contracts to contracts to release bile release bile into the into the duodenum duodenum via the via the bile bile ductduct

• Stimulated Stimulated by the by the arrival of arrival of chyme in the chyme in the duodenumduodenum

BileBile

1) 1) Bile saltsBile salts – – EMULSIFICATIONEMULSIFICATION- Bile salts break up (emulsify) lipids into small Bile salts break up (emulsify) lipids into small

oil dropletsoil droplets- This allows enzymes to have a larger surface This allows enzymes to have a larger surface

area to break down the fat moleculesarea to break down the fat molecules

Lipids Small Lipids Small oil dropletsoil droplets

Bile salts (emulsification)Bile salts (emulsification)

BileBile2) 2) Sodium Hydrogen CarbonateSodium Hydrogen Carbonate – –

NEUTRALIZATIONNEUTRALIZATION- It neutralizes stomach acid to provide It neutralizes stomach acid to provide

the necessary alkaline condition (pH 8) the necessary alkaline condition (pH 8) for the pancreatic and intestinal for the pancreatic and intestinal enzymes to workenzymes to work

The pH Scale

1 2 3 4 5 61 2 3 4 5 6 77 8 9 10 11 12 13 148 9 10 11 12 13 14AcidicAcidic AlkalineAlkaline

NeutrNeutralalMore acidicMore acidic More basicMore basic

The Need for Different pH The Need for Different pH LevelsLevels

• The stomach releasesThe stomach releases hydrochloric hydrochloric acidacid to provide an acidic condition to provide an acidic condition (pH1 - 2) for (pH1 - 2) for stomach proteasesstomach proteases (e.g. (e.g. pepsin) to work. Acid also kills germs pepsin) to work. Acid also kills germs

• The activity of The activity of salivary amylasesalivary amylase is is stopped in the stomach since it stopped in the stomach since it cannot work in acidic conditions. cannot work in acidic conditions. Pancreatic amylasePancreatic amylase also requires an also requires an alkaline condition to workalkaline condition to work

The Need for Different pH The Need for Different pH LevelsLevels

3) 3) The gall bladder releases The gall bladder releases bile bile into the small intestine to provide into the small intestine to provide an alkaline condition (pH 8) for an alkaline condition (pH 8) for the the pancreatic and intestinal pancreatic and intestinal enzymesenzymes to work to work

BileBile3) 3) Bile pigmentsBile pigments- Waste products formed from the Waste products formed from the

breakdown of old red blood cells in the breakdown of old red blood cells in the liverliver

Investigation #1:Investigation #1: Investigating the Investigating the

effect of bile effect of bile salts on oilsalts on oil

PancreasPancreas

• A yellowish organ found beneath A yellowish organ found beneath the stomach and is connected to the stomach and is connected to the small intestine at the the small intestine at the duodenumduodenum

• Produces pancreatic juice that Produces pancreatic juice that flows into the duodenum through flows into the duodenum through the the pancreaticpancreatic ductduct

PancreasPancreas Pancreatic juice contains 3 types of digestive Pancreatic juice contains 3 types of digestive

enzymes:enzymes:• Tryptase Tryptase • AmylaseAmylase• LipaseLipase

*Pancreas also produces the hormones glucagon *Pancreas also produces the hormones glucagon

and insulin to regulate the level of blood glucoseand insulin to regulate the level of blood glucose

Intestinal JuiceIntestinal Juice

• Alkaline solution containing Alkaline solution containing digestive enzymes, hormones, digestive enzymes, hormones, mucus, neutralizing substances, etc.mucus, neutralizing substances, etc.

• Secreted by intestinal glands in the Secreted by intestinal glands in the wall of the duodenumwall of the duodenum

• e.g. carbohydrases catalyze the e.g. carbohydrases catalyze the breakdown of double sugars into breakdown of double sugars into simple sugarssimple sugars

CarbohydraseCarbohydrase

• MaltaseMaltase: : MaltoseMaltose -> -> GlucoseGlucose + + GlucoseGlucose

2) Sucrase2) Sucrase: : SucroseSucrose - -> > GlucoseGlucose + + FructoseFructose

3) Lactase3) Lactase: : LactoseLactose - -> > GlucoseGlucose + + GalactoseGalactose

Lactose IntoleranceLactose Intolerance• Inability to digest Inability to digest

significant amount of significant amount of lactose, the predominant lactose, the predominant sugar of milk, due to a sugar of milk, due to a shortage of the enzyme shortage of the enzyme lactaselactase

• Common symptoms Common symptoms include nausea, cramps, include nausea, cramps, bloating, gas, and bloating, gas, and diarrhoea diarrhoea

• The undigested lactose will The undigested lactose will serve as food for bacteria serve as food for bacteria found in the large intestinefound in the large intestine

Digestion in IleumDigestion in Ileum

• Completion of digestionCompletion of digestion• Food is churned by peristaltic Food is churned by peristaltic

movement and is mixed with movement and is mixed with digestive juicesdigestive juices

• Food becomes watery fluid called Food becomes watery fluid called chylechyle

• Food is now present in simplest Food is now present in simplest formform

AbsorptionAbsorption

AbsorptionAbsorption

• Absorption is the uptake of simple and Absorption is the uptake of simple and small food molecules from the small food molecules from the alimentary canal into the blood streamalimentary canal into the blood stream

• Food molecules can be absorbed into Food molecules can be absorbed into blood by diffusion or active transportblood by diffusion or active transport

• Absorption occurs in the stomach, the Absorption occurs in the stomach, the small intestine and the large intestinesmall intestine and the large intestine

Absorption in StomachAbsorption in Stomach Food substances that are absorbed Food substances that are absorbed

in the in the

stomach:stomach:• Water Water • MineralsMinerals• AlcoholAlcohol• Simple sugarsSimple sugars• Water-soluble vitaminsWater-soluble vitamins

Absorption in Small Absorption in Small IntestineIntestine• Most of the digested food is absorbed in Most of the digested food is absorbed in

the small intestinethe small intestine• The inner lining of the small intestine is The inner lining of the small intestine is

folded to provide a large surface areafolded to provide a large surface area• The inner surface of the small intestine The inner surface of the small intestine

is made up of a large number of finger-is made up of a large number of finger-like projections called like projections called villivilli (singular: (singular: villusvillus))

• Peristalsis in the small intestine allows Peristalsis in the small intestine allows the digested food to come into contact the digested food to come into contact with the villi for absorptionwith the villi for absorption

Structure of VilliStructure of Villi

• Epithelium lining Epithelium lining • Blood capillaries (transportation of Blood capillaries (transportation of

simple sugars, amino acids and simple sugars, amino acids and minerals)minerals)

• Lacteal (lymph vessel)Lacteal (lymph vessel)

LactealLacteal

• fatty acids and glycerol recombine in fatty acids and glycerol recombine in the epithelium of the villus to form fat the epithelium of the villus to form fat which then enters the lacteal as fine which then enters the lacteal as fine fat dropletsfat droplets

• the lymphatic system converges with the lymphatic system converges with the circulatory system at a duct the circulatory system at a duct located in the neck arealocated in the neck area

They They take uptake up the the absorbed food and absorbed food and transporttransport them away them away

4. 4. Each villus contains Each villus contains a dense network of a dense network of blood capillariesblood capillaries

This allows the food to This allows the food to cross cross the membrane rapidlythe membrane rapidly

3. 3. The wall of villi is The wall of villi is thin thin (one-cell thick)(one-cell thick)

These villi can These villi can increase the total increase the total surface areasurface area for for absorptionabsorption

2. 2. Its inner surface is Its inner surface is covered with covered with numerous finger-like numerous finger-like projections called projections called villivilli

Food can Food can stay long enoughstay long enough for absorption to occurfor absorption to occur

1. 1. It is It is very longvery long (6 m) (6 m)

AdaptationAdaptationFeatureFeature

Absorption in Large Absorption in Large IntestineIntestine

• Much of the remaining water and Much of the remaining water and minerals is absorbed in the colonminerals is absorbed in the colon

• The appendix, which has no known The appendix, which has no known functions, is joined to the caecumfunctions, is joined to the caecum

• AppendicitisAppendicitis – food materials – food materials trapped in the appendix causing trapped in the appendix causing bacterial infection bacterial infection

Caecum in HerbivoresCaecum in Herbivores• Do not have Do not have

digestive enzymes digestive enzymes to break down to break down cellulosecellulose

• Rely on bacteria Rely on bacteria residing in the long residing in the long caecum to provide caecum to provide the enzyme the enzyme cellulasecellulase

• Cellulose -> GlucoseCellulose -> Glucose

Investigation #2:Investigation #2:

A Model GutA Model Gut

• What does the content inside the What does the content inside the dialysis tubing represent?dialysis tubing represent?

• What does the dialysis tubing What does the dialysis tubing represent?represent?

• What does the water in the What does the water in the beaker/boiling tube represent?beaker/boiling tube represent?

AssimilationAssimilation

AssimilationAssimilation

• the process by which absorbed food the process by which absorbed food molecules in the blood are transported molecules in the blood are transported to cells for the use of growth, tissue to cells for the use of growth, tissue repair and other metabolic activities. repair and other metabolic activities. The actual destiny of each food The actual destiny of each food molecule depends not only on its type molecule depends not only on its type but also on the body requirements at but also on the body requirements at that time (e.g. use immediately or put that time (e.g. use immediately or put into storage)into storage)

LiverLiver

• Largest organ of the bodyLargest organ of the body• Reddish brown in colorReddish brown in color• Lies on the right side of the abdominal Lies on the right side of the abdominal

cavity beneath the diaphragm cavity beneath the diaphragm • Blood is carried to the liver via two large Blood is carried to the liver via two large

vessels called the vessels called the hepatic arteryhepatic artery and the and the hepatic portal veinhepatic portal vein

• After processing in the liver, blood After processing in the liver, blood leaves the liver through the leaves the liver through the hepatic veinhepatic vein

Functions of LiverFunctions of Liver

• Carbohydrate metabolismCarbohydrate metabolism - the liver - the liver converts excess glucose into converts excess glucose into glycogen as a temporary way of glycogen as a temporary way of storing the glucose. Glycogen can storing the glucose. Glycogen can also be converted back to glucose also be converted back to glucose when neededwhen needed

• Fat metabolismFat metabolism - the liver converts - the liver converts excess protein and carbohydrate into excess protein and carbohydrate into fat. Excess glycogen is stored as fat fat. Excess glycogen is stored as fat for long term storagefor long term storage

Functions of LiverFunctions of Liver

3) 3) Protein metabolismProtein metabolism – the liver can – the liver can synthesize new proteins/ amino synthesize new proteins/ amino acids and deaminate excess amino acids and deaminate excess amino acidsacids

DeaminationDeamination• Amino group Amino group

(~NH(~NH22) removed ) removed • AmmoniaAmmonia (NH (NH33) )

produced (toxic)produced (toxic)• Ammonia Ammonia

converted to converted to ureaurea – – excreted in urineexcreted in urine

• Carbon skeleton – Carbon skeleton – converted to converted to carbohydratescarbohydrates

Functions of LiverFunctions of Liver3) 3) Protein metabolismProtein metabolism – the liver can – the liver can

synthesize new proteins/amino acids synthesize new proteins/amino acids and deaminate excess amino acidsand deaminate excess amino acids

4) Vitamin storage4) Vitamin storage - the liver stores - the liver stores mainly vitamins A, D and Bmainly vitamins A, D and B1212

5) Iron storage5) Iron storage - the liver stores iron - the liver stores iron which is obtained from the breakdown which is obtained from the breakdown of red blood cells. The iron salts can of red blood cells. The iron salts can be used in the formation of new RBCbe used in the formation of new RBC

Functions of LiverFunctions of Liver

6) 6) Bile productionBile production – emulsification and – emulsification and neutralizationneutralization

7) Drug/Alcohol metabolism7) Drug/Alcohol metabolism – the liver – the liver changes the drug into an excretable changes the drug into an excretable and harmless form (detoxification) and harmless form (detoxification)

8) Disposal of bacteria8) Disposal of bacteria - The liver - The liver filters many bacteria, viruses, and filters many bacteria, viruses, and other microorganisms from the blood other microorganisms from the blood

EgestionEgestion

EgestionEgestion

• FaecesFaeces – semi-solid, greenish brown – semi-solid, greenish brown mass containing undigested and mass containing undigested and unabsorbed food substances. Also unabsorbed food substances. Also contains bile pigment (hence the color contains bile pigment (hence the color of faeces), dead RBC, cells from of faeces), dead RBC, cells from intestinal wall, bacteria, etc.intestinal wall, bacteria, etc.

• Temporarily stored in rectumTemporarily stored in rectum• Anal sphincterAnal sphincter – relaxes to allow a – relaxes to allow a

person to defaecateperson to defaecate

Constipation and Constipation and DiarrhoeaDiarrhoea

• Peristalsis too slowPeristalsis too slow• Too much water Too much water

absorbedabsorbed• Some common causes Some common causes

include lack of fibre in include lack of fibre in diet, not enough liquids, diet, not enough liquids, lack of exercise, etc.lack of exercise, etc.

• Lead to dry, hard faecesLead to dry, hard faeces• Difficulty in defaecationDifficulty in defaecation• May damage wall of May damage wall of

rectum and cause rectum and cause bleeding or form bleeding or form pilespiles

• Peristalsis too fastPeristalsis too fast• Too little water Too little water

absorbedabsorbed• Some common causes Some common causes

include bacterial / viral / include bacterial / viral / parasitic infections, parasitic infections, food intolerance, etc.food intolerance, etc.

• Lead to loose, watery Lead to loose, watery stoolsstools

• More frequent egestionMore frequent egestion• May cause dehydrationMay cause dehydration

HaemorrhoidsHaemorrhoids• Also referred to as Also referred to as pilespiles• Haemorrhoids are enlarged veins just Haemorrhoids are enlarged veins just

under the surface tissue of the rectum under the surface tissue of the rectum or the anusor the anus

• Haemorrhoids in the rectum are called Haemorrhoids in the rectum are called internal haemorrhoidsinternal haemorrhoids; those that ; those that occur around the anus are called occur around the anus are called externalexternal haemorrhoidshaemorrhoids

• May cause bleeding, pain, itching and May cause bleeding, pain, itching and a sense of pressure a sense of pressure

HaemorrhoidsHaemorrhoids Increased pressure in the veins around the Increased pressure in the veins around the

anus is thought to be the cause of anus is thought to be the cause of haemorrhoids:haemorrhoids:

• straining to pass a bowel motion because straining to pass a bowel motion because of hard, dry stools (as in constipation)of hard, dry stools (as in constipation)

• diarrhoeadiarrhoea• heavy liftingheavy lifting• being very overweight being very overweight • sitting or standing for long periodssitting or standing for long periods• pregnancypregnancy