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Anal Abscess/Fistula

What is an anal abscess?

An anal abscess is an infected cavity filled with pus found near the anus or rectum.

What is an anal fistula?

An anal fistula (also called fistula-in-ano) is frequently the result of a previous or current anal abscess, occurring in up to 50% of patients with abscesses. Normal anatomy includes small glands just inside the anus. Occasionally, these glands get clogged and potentially can become infected, leading to an abscess. The fistula is a tunnel that forms under the skin and connects the infected glands to the abscess. A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening. Other situations that can result in a fistula include Crohn’s disease, radiation, trauma and malignancy.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

What is anal cancer?

Cancer describes a set of diseases in which normal cells in the body, through a series of genetic changes, become abnormal and lose the ability to control their growth. As cancers – also known as “malignancies” – grow, they invade the tissues around them (local invasion). They may also spread to other locations in the body via the blood vessels or lymphatic channels where they may implant and grow (metastases).

The anus or anal canal is the passage that connects the rectum, or last part of the large intestine, to the outside of the body. Anal cancer arises from the cells around the anal opening or in the anal canal just inside the anal opening. Anal cancer is often a type of cancer called “squamous cell carcinoma”. Other rare types of cancer may also occur in the anal canal and these require consultation with your physician or surgeon to determine the appropriate evaluation and treatment.

Cells that are becoming malignant or “premalignant”, but have not invaded deeper into the skin, are referred to as “high-grade anal intraepithelial neoplasia” or HGAIN (previously referred to by a number of different terms, including "high grade dysplasia", "carcinoma-in-situ", “anal intra-epithelial neoplasia grade III”, “high-grade squamous intraepithelial lesion”, or "Bowen's disease"). While this condition is likely a precursor to anal cancer, this is not anal cancer and is treated differently than anal cancer. Your physician or colon and rectal surgeon can help clarify the differences.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Anal Fissure

WHAT IS AN ANAL FISSURE?

An anal fissure (fissure-in-ano) is a small, oval shaped tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.

WHAT ARE THE SYMPTOMS OF AN ANAL FISSURE?

The typical symptoms of an anal fissure include severe pain during, and especially after, a bowel movement, lasting from several minutes to a few hours. Patients may also notice bright red blood from the anus that can be seen on the toilet paper or on the stool. Between bowel movements, patients with anal fissures are often relatively symptom-free. Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Anal Pain

What Causes Anal Pain?

People frequently assume that the major source of anal pain is hemorrhoids, in which swollen tissue sticks out of the anus. However, anal pain can result from:

• fissure, created by stool tearing the anus, which is generally an acute, sharp pain. There may be associated muscle spasm, resulting in prolonged pain over hours
• abscess, resulting from a bacterial infection, which may cause fever, night sweats and prolonged, constant pain.
• fungal infection, which may create prolonged pain that is less severe than an abscess.
• tumor, such as cancer, which may produce progressively worsening pain.
• muscle spasm in the pelvis, which can produce a very sharp pain that often resolves quickly.
• fistula, created by an abnormal tunnel between the rectum and the skin, which can be painful, particularly if it gets blocked by stool and an abscess forms in the tunnel behind the blockage.
• anal ulcer, a kind of sore or raw area, which may be painful and can represent an infection.
• rectal STD, such as gonorrhea, Chlamydia or herpes
• skin problem, such as psoriasis or dermatitis, which may cause itching or burning

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Anal Warts

What are anal warts?

Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area. Usually, they do not cause pain or discomfort to afflicted individuals and patients may be unaware that the warts are present. Some patients will experience symptoms, such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.

What causes anal warts?

They are caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact. HPV is considered a sexually transmitted disease (STD). You do not have to have anal intercourse to develop anal warts.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Bowel Incontinence

What is incontinence?

Incontinence is the impaired ability to control gas or stool. Its severity ranges from mild difficulty with gas control to severe loss of control over liquid and formed stools. Incontinence to stool is a common problem, but often it is not discussed due to embarassment.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Colonoscopy

What is colonoscopy?

Colonoscopy is a safe, effective method of examining the full lining of the colon and rectum, using a long, flexible, tubular instrument. It is used to diagnose colon and rectum problems and to perform biopsies and remove colon polyps. Most colonoscopies are done on an outpatient basis with minimal inconvenience and discomfort.

Who should have a colonoscopy?

Colonoscopy is routinely recommended to adults 50 years of age or older as part of a colorectal cancer screening program. Patients with a family history of colon or rectal cancer may have their colonoscopy at age 40. Your physician may also recommend a colonoscopy exam if you have change in bowel habit or bleeding, indicating a possible problem in the colon or rectum.

A colonoscopy may be necessary to:

• Check unexplained abdominal symptoms
• Check inflammatory bowel disease (colitis)
• Verify findings of polyps or tumors located with a barium enema exam
• Examine patients who test positive for blood in the stool
• Monitor patients with a personal or family history of colon polyps or cancer.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Colorectal Cancer

Colorectal cancer is the second most common cancer in the United States, striking 140,000 people annually and causing 60,000 deaths. That’s a staggering figure when you consider the disease is potentially curable if diagnosed in the early stages.

Who is at risk?

Though colorectal cancer may occur at any age, more than 90% of the patients are over age 40, at which point the risk doubles every ten years. In addition to age, other high risk factors include a family history of colorectal cancer and polyps and a personal history of ulcerative colitis, colon polyps or cancer of other organs, especially of the breast or uterus.

How does it start?

It is generally agreed that nearly all colon and rectal cancer begins in benign polyps. These pre-malignant growths occur on the bowel wall and may eventually increase in size and become cancer. Removal of benign polyps is one aspect of preventive medicine that really works!

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Constipation

What is constipation?

Constipation is a symptom that has different meanings to different individuals. Most commonly, it refers to infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool, the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories or laxatives in order to maintain regularity.

For most people, it is normal for bowel ­movements to occur from three times a day to three times a week; other people may go a week or more without experiencing discomfort or harmful effects. Normal bowel habits are affected by diet. The average American diet includes 12 to 15 grams of fiber per day, although 25 to 30 grams of fiber and about 60 to 80 ounces of fluid daily are recommended for proper bowel function. Exercise is also beneficial to proper function of the colon.

About 80 percent of people suffer from ­constipation at some time during their lives, and brief periods of constipation are normal. Constipation may be diagnosed if bowel movements occur fewer than three times ­weekly on an ongoing basis. Widespread beliefs, such as the assumption that everyone should have a movement at least once each day, have led to overuse and abuse of laxatives.

Eating foods high in fiber, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fiber per day recommended for proper bowel function.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Crohn's Disease

What is Crohn's disease?

Crohn's disease is a chronic inflammatory process primarily involving the intestinal tract. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum).

Crohn's disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Diverticular Disease

Diverticulosis of the colon is a common condition that afflicts about 50 percent of Americans by age 60 and nearly all by age 80. Only a small percentage of those with diverticulosis have symptoms, and even fewer will ever require surgery.

What is Diverticulosis/ Diverticulitis?

Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Colorectal Cancer Surgery-Follow Up Evaluation

Why should there be a postoperative follow-up program?

Surgery is the most effective treatment for colorectal cancer. Even when all visible cancer has been removed, it is possible for cancer cells to be present in other areas of the body. These cancer deposits, when very small, are undetectable at the time of surgery, but they can begin to grow at a later time. The chance of recurrence depends on the characteristics of the original cancer and the effectiveness of chemotherapy, if needed, or other follow up treatment. Patients with recurrent cancers - if diagnosed early - may benefit, or be cured, by further surgery or other treatment.

Another good reason for postoperative follow up is to look for new colon or rectal polyps. Approximately one in five patients who has had colon cancer will develop a new polyp at a later time in life. It is important to detect and remove these polyps before they become cancerous.

How long will my follow-up program last?

Most recurrent cancers are detected within the first two years after surgery. Therefore, follow up is most frequent during this period of time. After five years, nearly all cancers that are going to recur will have done so. Follow up after five years is primarily to detect new polyps, and can, therefore, be less frequent but advisable for life.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Hemorrhoids

Did you know...

• Hemorrhoids are one of the most common ailments known.
• More than half the population will develop hemorrhoids, usually after age 30.
• Millions of Americans currently suffer from hemorrhoids.
• The average person suffers in silence for a long period before seeking medical care.
• Today's treatment methods make some types of hemorrhoid removal much less painful.
  

What are hemorrhoids?

Often described as "varicose veins of the anus and rectum", hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: external and internal, which refer to their location.

External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. These are usually painless. However, if a blood clot (thrombosis) develops in an external hemorrhoid, it becomes a painful, hard lump. The external hemorrhoid may bleed if it ruptures.

Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely "prolapsed" - protrudes from the anal opening and cannot be pushed back inside.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Irritable Bowel Syndrome

WHAT IS IRRITABLE BOWEL SYNDROME?

Irritable bowel syndrome (IBS) is a common disorder that may affect over 15 percent of the general population. It is sometimes referred to as spastic colon, spastic colitis, mucous colitis or nervous stomach. IBS should not be confused with other diseases of the bowel such as ulcerative colitis or Crohn's disease. IBS is a functional disorder where the function of the bowels may be abnormal but no structural abnormalities exist.

WHAT ARE THE SYMPTOMS OF IBS?

People with IBS may experience abdominal pain and changes in bowel habits - either diarrhea, constipation, or both at different times. Symptoms associated with IBS include abdominal cramps, fullness or bloating, abnormal stool consistency, passage of mucous, urgency or a feeling of incomplete bowel movements.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Ostomy

WHAT IS AN OSTOMY?

An ostomy is a surgically created opening connecting an internal organ to the surface of the body. Different kinds of ostomies are named for the organ involved. The most common types of ostomies in intestinal surgery are an "ileostomy" (connecting the ileal part of the small intestine to the abdominal wall) and a "colostomy" (connecting the colon, or, large intestine to the abdominal wall).

An ostomy may be temporary or permanent. A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue. A temporary ostomy may also be created to allow inflammation or an operative site to heal without contamination by stool. Temporary ostomies can usually be reversed with minimal or no loss of intestinal function. A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control elimination do not work properly or require removal. The most common causes of these conditions are low rectal cancer and inflammatory bowel disease.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Pilonidal Disease

What is pilonidal disease and what causes it?

Pilonidal disease is a chronic infection of the skin in the region of the buttock crease (Figure 1). The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. The disease is more common in men than women and frequently occurs between puberty and age 40. It is also common in obese people and those with thick, stiff body hair.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Polyps of the Colon and Rectum

Polyps are abnormal growths rising from the lining of the large intestine (colon or rectum) and protruding into the intestinal canal (lumen). Some polyps are flat; others have a stalk.

Polyps are one of the most common conditions affecting the colon and rectum, occurring in 15 to 20 percent of the adult population. Although most polyps are benign, the relationship of certain polyps to cancer is well established.

Polyps can occur throughout the large intestine or rectum, but are more commonly found in the left colon, sigmoid colon, or rectum.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Pruritus Ani

What is Pruritus Ani (proo-rí-tus a-ní)?

Itching around the anal area is called pruritus ani. This condition results in a compelling urge to scratch.

What causes this to happen?

Several factors may be at fault. A common cause is excessive moisture in the anal area. Moisture may be due to perspiration or a small amount of residual stool around the anal area. Pruritis ani may be a symptom of other common anal conditions such as hemorrhoids and anal fissures. The initial condition can be made worse by scratching, vigorous cleansing of the area or overuse of topical treatments.

In some individuals pruritus ani may be caused by eating certain foods, smoking and drinking alcoholic beverages, especially beer and wine. Food items that have been associated with pruritus ani include:

• Coffee, Tea
• Carbonated beverages
• Milk products
• Tomatoes and tomato products such as Ketchup
• Cheese
• Chocolate
• Nuts

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Rectal Prolapse

What is rectal prolapse?

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) becomes stretched out and protrudes out of the anus. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage, resulting in leakage of stool or mucus. While the condition occurs in both sexes, it is much more common in women than men.

Why does it occur?

Several factors may contribute to the development of rectal prolapse. It may come from a lifelong habit of straining to have bowel movements or as a late consequence of the childbirth process. Rarely, there may be a genetic predisposition. It seems to be a part of the aging process in many patients who experience stretching of the ligaments that support the rectum inside the pelvis as well as weakening of the anal sphincter muscle. Sometimes rectal prolapse results from generalized pelvic floor dysfunction, in association with urinary incontinence and pelvic organ prolapse as well. Neurological problems, such as spinal cord transection or spinal cord disease, can also lead to prolapse. In most cases, however, no single cause is identified.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Screening & Surveillance for Colorectal Cancer

What is the risk of colorectal cancer?

Colorectal cancer is the second most common cancer in the United States. The average person's lifetime risk of developing it is about one chance in 20. The risk is increased if there is a family history of colorectal polyps or cancer, and is still higher if there is a personal history of breast, uterine or ovarian cancer. Risk is also higher for people with a history of extensive inflammatory bowel disease, such as ulcerative or Crohn's colitis.

What is screening and surveillance?

Many polyps and cancers of the colon and rectum do not produce symptoms until they become fairly large. Screening involves one or more tests performed to identify whether a person with no symptoms has a disease or condition that may lead to colon or rectal cancer. The goal is to identify the potential for disease or the condition early when it is easier to prevent or cure. Surveillance involves testing people who have previously had colorectal cancer or are at increased risk. Because their chance of having cancer is higher, more extensive or more frequent tests are recommended.

Later in the brochure, the tests and risk groups are defined. Also, your physician can further explain the tests and their value to you.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammation of the lining of the large bowel (colon and rectum). Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss, and fevers. In addition, patients who have had extensive ulcerative colitis for many years are at an increased risk to develop large bowel cancer. The cause of ulcerative colitis remains unknown.

How is ulcerative colitis treated?

Initial treatment of ulcerative colitis is medical, using antibiotics and anti-inflammatory medications such as aminosalicylates. If these fail, prednisone can be used for a short period of time but long-term use can be associated with significant side effects. If prednisone is ineffective or cannot be discontinued, immunomodulators such as 6-mercaptopurine or azathioprine can be used to control active disease that does not merit hospitalization. In order to maintain control of the disease, aminosalicylates or immunomodulators are used on a long-term basis. "Flare-ups" of the disease can often be treated by increasing the dosage of medications or adding new medications. Hospitalization may be necessary to put the bowel to rest and deliver steriods directly into the blood stream.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

Laparoscopic Surgery - What Is It?

What is laparoscopic surgery?

Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.” At each port a tubular instrument known as a trochar is inserted. Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

In certain situations a surgeon may choose to use a special type of port that is large enough to insert a hand. When a hand port is used the surgical technique is called “hand assisted” laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

To continue reading, please visit the American Society of Colon & Rectal Surgeons.

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