This can be a limiting factor in the use of maintenance metronidazole to suppress chronic pouchitis.Other therapies which have been shown to be effective include probiotics for pouchitis, the application of which usually begins as soon as any antibiotic course is completed so as to re-populate the pouch with beneficial bacteria. The most clinically researched multi-strain probiotic for pouchitis is the De Simone Formulation (formulation name) invented by medical doctor Professor Claudio De Simone. It is currently sold under a variety of brand names globally including Visbiome in the U.S. and Canada, Vivomixx in Europe, and Innovall CU in Germany.Biologics, such as anti-tumor necrosis factor antibodies, may also be useful but the evidence for their use is largely anecdotal. Research
A pilot study on the effect of reducing dietary FODMAP intake on bowel function in people without a colon indicates there might be a relation between pouchitis and FODMAP diets.Alicaforsen (an antisense inhibitor which targets the messenger RNA for the production of human ICAM-1 protein) was evaluated in a Phase 3 clinical trial, which did not meet the co-primary endpoints in the primary analysis (an adaptation of the Mayo Score of improvement in endoscopic remission and bowel frequency). References


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Tears along the long axis of the vagina or the posterior fourchette lacerations are more likely to occur from rape. Lacerations or tears of the hymen are common but are not indicative of consensual or non-consensual intercourse. Treatment of vaginal trauma
Diagnosing and treating vaginal trauma can often be difficult and delayed due to the sensitive and personal nature of these types of injuries; this also may be enhanced if the patient is young in age. The repair of most genital injuries require suture and the bleeding from the area is usually minimal. The bleeding that results from extreme vaginal tears can be copious, leading to hemorrhagic shock, and the patient may need a blood transfusion. Treatment of these lacerations could warrant surgical repair. Vulvar trauma
Vulvar trauma is more common in prepubertal children due to small labial fat pads and more physical activity. Adults are more protected. Though some injuries are serious, most are accidental minor blunt traumas. The most common type of injury is a straddle injury, which can be incurred through normal activities like bicycle riding. Due to the vascularity of the vulva, it may form a large hematoma when injured. The vulva can also be injured through sexual assault. Vulvar trauma can occur concurrently with vaginal trauma, especially if a sharp object is involved. Vaginal trauma
Vaginal trauma can occur when something is inserted into the vagina, for example, a sharp object, causing penetrating trauma. Vaginal trauma can occur as a result as an initial painful sexual experience or sexual abuse.