Trichobezoar: Causes, Symptoms, Treatment and Cost

Trichobezoar is a trichological disorder caused by the accumulation of matted hair in the gastrointestinal tract. It is also known as Rapunzel Syndrome. This condition is most commonly seen in females with a history of trichotillomania (compulsive hair-pulling) or mental health disorders such as depression, anxiety, and obsessive-compulsive disorder (OCD).

They can be classified into four types based on their location in the body:

• Gastric Trichobezoar: This is the most common type and is found in the stomach. It is typically caused by a disorder known as trichotillomania, which is characterised by the obsessive pulling out of one's hair.
• Intestinal Trichobezoar: This type of bezoar is found in the small intestine and can cause obstruction and severe abdominal pain.
• Cecal Trichobezoar: This type of bezoar is found in the cecum, or beginning of the large intestine, and can cause nausea, vomiting, bloating, and abdominal pain.
• Colonic Trichobezoar: This type of bezoar is located in the colon (the large intestine) and can cause obstruction as well as abdominal pain and discomfort due to its size or shape blocking food passage through your intestines

Trichobezoar is most commonly caused by a disorder called trichotillomania, a form of obsessive-compulsive disorder (OCD) characterised by compulsive hair-pulling behaviour.

Other causes include inadequate chewing of food, eating disorders such as anorexia nervosa and bulimia, and stress-related psychological conditions such as anxiety and depression.

In some cases, the ingestion of non-food items such as paper clips or safety pins can also lead to trichobezoars.

Common symptoms of Trichobezoar include:

• Abdominal pain
• Nausea and vomiting
• Change in appetite
• Weight loss
• Bloating or feeling of fullness
• Constipation or diarrhoea
• Anaemia
• Malnutrition

• Maintain good oral hygiene: Brush teeth twice daily and floss regularly to reduce the amount of hairballs that can form in the stomach.
• Limit hair-pulling behaviour: Learn relaxation techniques to help reduce stress and anxiety, which can lead to hair-pulling behaviours.
• Avoid chewing on non-food items: Chewing on objects like straws, pens or other items can increase the risk of swallowing hairs, leading to trichobezoars.
• Limit foods that are difficult to digest: Foods such as corn kernels or nuts should be avoided if they are commonly chewed and swallowed with difficulty.
• Seek medical care if symptoms persist: If you experience abdominal pain, nausea, vomiting or other signs of a trichobezoar, seek medical attention right away for prompt treatment and prevention of further complications.

• Blood tests: Blood tests may be performed to check for signs of infection or other problems caused by trichobezoar such as anaemia or malnutrition.
• Abdominal ultrasound: The ultrasound can detect the location of the bezoar and determine its size. In some cases, an ultrasound may be combined with other imaging tests such as x-ray or CT scan to provide more detailed information about the condition.
• Endoscopy: Endoscopy is a procedure used to examine the digestive tract, and it can be used to diagnose and treat trichobezoars. Endoscopy involves inserting a thin, flexible tube that is equipped with a light and camera at its tip into the patient's stomach or intestines. The photos of the interior of the digestive system may then be seen on a monitor by the attending physician, where they can locate and identify any trichobezoars that may be present.
• CT Scan: The diagnostic imaging procedure known as computed tomography (CT) may produce very detailed pictures of the organs and structures found inside of a patient's body. It is able to identify a wide variety of trichobezoars, which are masses that develop in the stomach and are made up of hair or fibres that cannot be digested.

• Gastrointestinal obstruction: Trichobezoar can cause the blockage of the gastrointestinal tract, leading to abdominal pain, nausea and vomiting.
• Perforation: If left untreated for a long time, the sharp edges of a trichobezoar can cause perforation in the walls of the stomach or intestines.
• Intestinal haemorrhage: As it passes through the digestive tract, trichobezoar may cause bleeding due to tears in the intestinal wall.
• Malnutrition and weight loss: The obstruction caused by trichobezoar reduces nutrient absorption in the gastrointestinal tract which can lead to malnutrition and weight loss.
• Infection: The presence of trichobezoar may also increase risk of infection due to bacterial overgrowth or other factors.

• Drink fresh ginger juice with honey: Take one teaspoon of fresh ginger juice and mix it with one teaspoon of honey. Consume this mixture twice a day for relief from trichobezoar.
• Drink fenugreek seed tea: Boil two teaspoons of fenugreek seeds in a cup of water and strain the liquid. Drink this tea twice daily to get relief from trichobezoar.
• Consume drumstick leaves soup:Boil some drumstick leaves in water and drink the soup 3-4 times a day to help reduce the symptoms associated with trichobezoar.
• Take turmeric powder: For the most effective treatment of trichobezoar, combine one teaspoon of turmeric powder with one glass of warm milk, and consume the mixture each night before going to bed.
• Eat bitter gourd: Eating a few slices of bitter gourd everyday helps in providing relief from trichobezoar symptoms by aiding digestion process as well as removing toxins from the body.

• A diet low in fat and high in fibre should be consumed.
• Consuming foods like fruits, vegetables, whole grains, legumes, and lean proteins is recommended.
• Consume probiotic-rich foods such as yoghourt, kimchi, miso, kefir, and sauerkraut to help maintain a healthy balance of bacteria in the gut.

• Avoid eating any type of hair, including human and animal hair.
• Do not eat hard or indigestible objects such as gum, coins, or buttons.
• Refrain from consuming any type of non-food material like paper, plastic, fabric or string.
• Do not eat large amounts of fibrous vegetables such as celery or corn husks that can become impacted in the digestive system and cause a bezoar to form.
• Limit your consumption of nuts and seeds which can also become stuck in the digestive system and increase the risk of trichobezoar formation.

• Endoscopic Removal: This is the preferred method for removal of Trichobezoar as it can be done without making any incisions into the body. During endoscopic removal, a thin tube with a camera and tools to remove the Trichobezoar is inserted through the mouth or nostril into the stomach.
• Laparotomy: Laparotomy is a surgical procedure that involves making an incision in the abdomen to access and remove the Trichobezoar. This may be recommended if there are complications or if endoscopic removal has failed.
• Enzyme Therapy: Enzyme therapy involves administering enzymes to break down and dissolve the Trichobezoar naturally within the body over time, eliminating the need for surgery altogether in some cases.
• Dietary Modification: A diet low in indigestible fibres and high in easily digestible proteins and carbohydrates is recommended.
• Medications: Medicines can be prescribed to reduce symptoms associated with the Trichobezoar.
• Psychotherapy: Patients suffering from trichotillomania may require psychological therapy to help them cope with their condition and reduce symptoms associated with the disorder.

A person suffering from Trichobezoar should consult a Gastroenterologist for diagnosis and treatment.

• Laxatives: Laxatives can be an effective treatment for trichobezoars. They work by softening and breaking up the mass of hair and stimulating the bowels to move it through the digestive system. Common laxatives used to treat trichobezoars include osmotic laxatives such as polyethylene glycol, stimulant laxatives such as senna, and bulk-forming laxatives such as psyllium husk.
• Antacids: Antacids are a type of drug that can be used to treat trichobezoar because they assist to neutralise the acid produced by the stomach. Antacids work by increasing the pH of the stomach, which reduces acid production. Examples of antacids include calcium carbonate, aluminium hydroxide, and sodium bicarbonate.
• Corticosteroids: Inflammation can be reduced and the immune system can be suppressed using corticosteroids. This may help lessen the quantity of hair that accumulates in the stomach, which in turn may result in less symptoms caused by trichobezoar.
• Proton pump inhibitors: In some cases, PPIs may be used to treat trichobezoar. Treatment with PPIs can help reduce the risk of complications associated with trichobezoar, including blockage or rupture of the stomach wall.

Recovery from a Trichobezoar depends on the severity of the condition, as well as any underlying medical conditions or mental health issues that may be present.

The recovery time following surgery can range from a few days to several weeks depending on the size and complexity of the mass and any additional treatments that may be necessary.

Treatment can improve symptoms and reduce the risk of associated problems, it cannot guarantee permanent resolution of this condition.

While surgical removal can be successful in some cases, it does not guarantee that the condition will not recur or that all hair has been removed from the stomach.

• Monitor the patient’s vital signs, including temperature, heart rate, respiratory rate, and blood pressure.
• Administer antibiotics and antifungal medications as prescribed by the doctor.
• Monitor for signs of infection and other complications, such as abdominal pain or bleeding.
• Change wound dressings regularly and monitor for excessive drainage from the surgical site.
• Encourage the patient to move around and perform light exercise as tolerated to promote healing of the surgical site and reduce risk of infection or complications from bedrest immobility such as deep vein thrombosis or pneumonia.

The cost of Trichobezoar treatment in India varies from case to case and is dependent on several factors.

Generally, the cost of treatment can range from Rs. 10,000 to Rs. 2 lakhs.

The surgery may cost anywhere between Rs 50,000 and Rs 2 lakhs depending upon the complexity of case and other factors such as hospital charges, doctor fees etc.

Post-operative care including medications and other tests may add up to another few thousand rupees depending on individual cases and length of stay in hospital/clinic etc.

• Abdominal pain: Treatments for trichobezoar can cause abdominal pain, as the digestive tract is disturbed during the process.
• Infections: There is a risk of infection when treating trichobezoar, as the treatment may involve breaking open an existing mass or surgically removing it.
• Bleeding: Bleeding may occur due to the disruption of the digestive tract during treatment.
• Intestinal obstruction: Treatment for trichobezoar can lead to intestinal blockage if not properly managed and monitored.
• Nutritional deficiencies: Trichobezoar treatments can lead to nutritional deficiencies due to poor absorption of nutrients from food due to obstruction or disruption of digestive tract function.

If you are suffering from any complications relating to trichobezoar then you should consult a doctor nearby as they can cause complications like gastrointestinal obstruction, perforation, intestinal haemorrhage, etc. in which treatment course can range from a few months to years depending on the severity of the situation.