Colorectal Conditions Treated

Colon and Rectal Cancers

The colon and rectum are parts of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body.

The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last six inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Colon cancer is cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Rectal Cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum.

Most of these cancers evolve from benign growths called adenomatous polyps. Most tumors of the intestine do not produce symptoms during the early stages. As they develop and become more advanced certain symptoms may develop. Blood may appear in the stool either as visible to the naked eye or as microscopic or "occult" usually picked up by a laboratory test. When tumors grow large enough they can partially block the lower intestine causing a change in the caliber of the stools. They may also cause a rectal fullness not relieved with a bowel movement.

It is estimated that 4,590 people in New Jersey are diagnosed each year with colorectal cancers, and that 1,580 die annual of the disease. Ninety percent of colorectal cancers occur in people over age 50. The risk for colon cancer appears to be far higher in industrialized nations than less developed countries. People who have a first-degree relative (sibling or parent) who developed colorectal cancer before age 50 have a significantly higher life-time risk (about 25 percent) than people who do not have a family history or did not develop colorectal cancer until after age 60.

Screening tests for colon cancer are extremely important for detecting the premalignant form of cancer, i.e. polyps as well as early stages of colon cancers which may be removed completely for cure.

The Digital Rectal Exam is used to detect tumors in the lower portion of the rectum as well as the prostate.

Fecal occult testing - blood in bowel movements is not always visible to the naked eye. There are tests using color changes to detect if occult blood is present. Other more advanced methods to visualize the colon include Sigmoidoscopy, Colonoscopy or Double Contrast Barium Enema.

A sigmoidoscope is a flexible tube containing a camera and a light at the end. It can only view the rectum and the lower left portion of the colon while a colonoscopy allows for visualization of the entire colon and in some cased the very terminal portion of the small intestine. A barium enema is a radiologic procedure that is strictly diagnostic for assessing the colon and rectum for polyps or tumors.

Screening should start at age 50 in those who have no symptoms and no family history of colon cancer. An annual digital rectal exam and fecal occult blood test should start at this age along with a screening sigmoidoscopy or colonoscopy.

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Anal Abcess

This condition is defined as any collection of pus in the perianal or rectal area. The cause is typically from a blockage of one of the anal glands that are part of the normal anal anatomy. They may also be caused by an infected anal fissure, sexually transmitted infections or inflammatory bowel disease such as Crohn's disease. Most abscesses occur in an area that is accessible for drainage. However, they may be found higher in the rectum from a source in the pelvis. The abscess often appears as a swollen, red, tender lump at the edge of the anus or in the surrounding perianal region. There may be discharge of pus from the rectum. The patient may have an associated fever. The typical complaint is a deep, dull ache often feeling like increasing pressure in the rectum.

A rectal exam will usually suffice to make the diagnosis of an anorectal abscess. Sometimes a proctosigmoidoscopy may be performed to visualize the mucosal lining of the rectum.

The most definitive treatment involves an incision and drainage of the purulent fluid from the abscess cavity. This can often be performed in an outpatient setting under a local anesthetic. If the cavity is noted to be very deep and not within easy reach from the peri anal area, surgeryin an operative room setting may be indicated.

Warmer, sitz baths may assist in increasing the drainage from the abscess and assist with pain relief.

The outcome is good following surgery although one out of three patients undergoing an incision and drainage may develop a fistula tract to the drainage site.

Call your doctor if you should develop fever, chills or other symptoms following treatment of an anorectal abscess.

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Anal Fissure

An anal fissure is a small tear in the skin of the anal canal, which often causes pain and bleeding. A fissure is most often caused by a hard bowel movement but can also occur after diarrhea and inflammation of the anorectal area.

Fissures can heal without specific treatment and may improve with the use of stool softners, fiber supplements and warm water baths or sitz baths. The longer a fissure is present the less likely it is to heal without treatment. Associated sphincter muscle spasm or tightness makes healing less likely.

Specific treatment of anal fissures may include the use of topical medicated creams, dilute nitroglycerin ointment, injection of Botox or surgery.

Surgery may consist of a small operation to remove the fissure and divide a small portion of the anal sphincter to reduce spasm and promote healing. Cutting this muscle rarely interferes with bowel control and can usually be performed in the office.

Complete healing after treatment usually occurs in a few weeks although the pain often disappears in a few days.

Anal fissures do not lead to colon cancer but symptoms of pain and bleeding need to be carefully evaluated since serious conditions other than fissure can cause similar symptoms.
Anal fissures do not lead to colon cancer but symptoms of pain and bleeding need to be carefully evaluated since serious conditions other than fissure can cause similar symptoms.

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Anal Fistula

An anal fistula is a passage that develops between the anus and the skin. Most fistulas are the result of an abscess or infection that spreads to the skin. Fistulas are typical of Crohn’s disease.

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Anal or Rectal Bleeding

There are many causes of anal or rectal bleeding some of which are quite serious. Causes of rectal bleeding include hemorrhoids, anal fissure, colitis, or proctitis, colon and rectal cancer or polyps, diverticulosis, abnormal blood vessels, infections and other disorders of the intestinal tract.

In all cases of bleeding, medical attention should be sought and the patient should be examined.

Investigation of bleeding may include a visual examination with a proctosocope, flexible sigmoidoscope or colonoscopy. Other tests may include a Barium Enema, Upper Endoscopy, Angiogram or Cat Scan.

As there are many causes of rectal bleeding there are many ways ot treat it. Most importantly all cases of rectal bleeding should be evaluated by a physician. It is wrong to assume that bleeding is benign and will go away. Many patients with colorectal cancer or precancerous polyps have delayed treatment by assuming that their bleeding was caused by hemorrhoids.

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Crohn’s Disease

Crohn’s disease is an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn’s disease is an inflammatory bowel disease, the general name for diseases that cause swelling in the intestines. Because the symptoms of Crohn’s disease are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis, it can be difficult to diagnose. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine. In Crohn’s disease, all layers of the intestine may be involved, and normal healthy bowel can be found between sections of diseased bowel.

Crohn’s disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but it is more often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohn’s disease, and African Americans are at decreased risk for developing Crohn’s disease.

Crohn’s disease may also be called ileitis or enteritis.

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Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.

When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.

Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. It can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn’s disease. Crohn’s disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach.

Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.

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Diverticulosis of the colon is a common condition affecting approximately 50 percent of Americans by age 60. Very few people with diverticulosis have any symptoms and few will ever require surgery.

Diverticula are out-pouching of the colon wall and occur most commonly in the sigmoid or left side of the colon. Diverticulitis is the inflammation, perforation or surrounding infection of the diverticulum.

Symptoms of diverticulitis include abdominal pair or cramping, a change in bowel habits, and occasionally fever. Diverticulosis can also cause severe rectal bleeding in a small percentage of patients.

How is diverticulosis treated? Mild symptoms of diverticulosis are usually treated by diet and occasionally medications. Increased fiber in the diet is usually recommended to help reduce pressure in the colon. Diverticulitis can be mild or complicated and usually requires antibiotics and may require hospitalization. Surgery to remove the area of diverticulitis may be necessary to treat recurrent or severe attacks of diverticulitis that do not respond to medication.

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Fecal Incontinence

Fecal incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you get to a toilet. Or stool may leak from the rectum unexpectedly, sometimes while passing gas.

More than 5.5 million Americans have fecal incontinence. It affects people of all ages—children and adults. Fecal incontinence is more common in women and older adults, but it is not a normal part of aging.

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Hemorrhoids are enlarged veins of the anus and rectum. There are two types of hemorrhoids based on their location: internal hemorrhoids and external hemorrhoids. Internal hemorrhoids occur in the anus and rectum. Painless bleeding and protrusion are the most common symptoms. External hemorrhoids develop outside the anus where they are noticeable and are covered with sensitive skin. Blood clots can form within external hemorrhoids causing pain, swelling and bleeding if they rupture.

Hemorrhoidal veins are present in everyone, but symptomatic hemorrhoids may be caused by various factors including pregnancy, chronic constipation, diarrhea, straining during bowel movements, overuse of laxatives or enemas, heredity, aging, or spending a long time on the toilet.

Common hemorrhoidal symptoms include bleeding, itching, protrusion, pain and sensitive lumps, these symptoms can be treated in various ways. Minor symptoms may respond well to conservative dietary changes and topical treatments.

Symptoms caused by internal hemorrhoids can often be relieved by quick, effective and relatively painless office procedures such as rubber band ligation, injection or infra-red photocoagulation.

Surgery to remove hemorrhoids (hemorrhoidectomy) is often not necessary in many patients, but can be the best method of treatment for permanent removal of symptomatic internal and external hemorrhoids. Hemorrhoidectomy is most often performed under a local anesthetic, as an outpatient without the need for hospitalization.

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A colon polyp is a growth on the surface of the colon, also called the large intestine. Sometimes, a person can have more than one colon polyp. Colon polyps can be raised or flat. The large intestine is the long, hollow tube at the end of your digestive tract. The large intestine absorbs water from stool and changes it from a liquid to a solid. Stool is the waste that passes through the rectum and anus as a bowel movement.
Some colon polyps are benign, which means they are not cancer. But some types of polyps may already be cancer or can become cancer. Flat polyps can be smaller and harder to see and are more likely to be cancer than raised polyps. Polyps can usually be removed during colonoscopy—the test used to check for colon polyps.

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Rectum Prolapse (Rectocele)

A rectocele occurs when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina. An enterocele (small bowel prolapse) occurs when the small bowel presses against and moves the upper wall of the vagina. Rectoceles and enteroceles develop if the lower pelvic muscles become damaged by labor, childbirth, or a previous pelvic surgery or when the muscles are weakened by aging.

Surgical repair of rectoceles and enteroceles is used to manage symptoms such as movement of the intestine that pushes against the wall of the vagina, low back pain, and painful intercourse.

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