The Physicians’ of Colon and Rectal Surgery Inc specialize in the diagnosis and treatment of diseases of the colon, rectum, and anus. More information on these diseases can be found by clicking on the links below.
- Colorectal Cancer: Colorectal cancer is the second most common cancer in the United States. The most common symptoms are rectal bleeding and changes in bowel habits such as constipation and diarrhea. Unfortunately, many polyps and early cancers fail to produce symptoms. This makes screening for colorectal cancer extremely important as cancers detected early are extremely curable. In addition removal of polyps which are precursors to cancer will help prevent the development of cancer. More Facts about ColoRectal Cancer
- Anal Cancer: Cancer can occur in the anal area. Cancers in this area can be divided into two general types, those arising from the skin and those arising from the rectal lining. Cancer which arise from the skin cells are call squamous cell carcinomas. Cancers which arise from the rectal or colon lining are called adenocarcinomas (please proceed to section on colorectal cancer for further information on adenocarcinoma).Risk factors for anal squamous carcinoma are:Age over 50 Anal sex Smoking Low Immune response Chronic inflammation Previous radiation to the area.Symptoms of anal cancer usually include bleeding and anal pain. Itching and discharge may also be noted. A mass may also be noted in the anal area or in the groin.
- Hemorrhoids: Everyone is born with hemorrhoids. There are 2 types of hemorrhoids, the internal hemorrhoids which tend to cause protrusion and painless bleeding with bowel movements and external hemorrhoids which tend to swell and may be painful. High fiber diets with plenty of water and minimal straining on the toilet are the keys to preventing hemorrhoid difficulties. If you have concerns about hemorrhoids, a limited anorectal exam will be performed during an office visit. No enema preparation is necessary for this type of appointment. The goals of the exam are to: determine which types of hemorrhoids exist, determine if any other process is present, and determine optimal treatment options. Treatment options may include office procedures: excision of a painful thrombosed hemorrhoid, banding of an internal hemorrhoid, infrared coagulation of internal hemorrhoid or injection of a sclerosing agent into internal hemorrhoids (phenol mixed in almond oil-contraindicated if you have a nut allergy). Some options involved general anesthesia to remove part of the bothersome hemorrhoid tissue, operations offered by this group include: standard operative hemorrhoidectomy, stapled hemorrhoidectomy, THD (Transanal Hemorrhoidal Dearterialization) Hemorrhoidopexy.
- Anal Fissure: An anal fissure is a small tear in the skin overlying the anus, it often extending into the anal canal. The tear is typically a result of passing a large, hard stool or related to passing lots of loose stools. This cut causes spasms of the internal anal sphincters which are very painful. The internal anal sphincter is a smooth muscle type, therefore, standard muscle relaxants are not effective in treatment. The classic symptoms of an anal fissure are sharp pain with having a bowel movement which can last for minutes or hours after. There may be bleeding associated with this. Proper diagnosis is important for appropriate therapy. Initial therapy involves increasing fiber and water in the diet, stools softeners and laxatives as needed. Often, a topical medicine designed to slightly relax the tight spasm of the internal anal sphincter is prescribed. If fissures fail to heal with conservative measures, a surgical procedure called a lateral internal sphincterotomy is very effective in treatment. BOTOX injections may also be recommended as part of treatment.
- Anal Abscess/Fistula: One cause of anal pain is an anal abscess or fistula. The pain generally starts as a mild discomfort which then increases to severe pain over the course of a few days. It may be associated with swelling. Individuals may note discharge of pus from the area.What is an anal abscess? This is an infected area filled with pus near the anus or rectum. Most often this results from an infection in an anal gland just inside the anus. Treatment involves draining the pus from the infected cavity. Most often this can be done in the doctor’s office with local anesthetic. Antibiotics alone are usually are not effective in treating these infections.What is a fistula? A fistula is a persistence of the infected tract that can result after someone develops an abscess near the anus or rectum. This is treated by surgery.
- Constipation: When laxatives are not improving constipation, colon and rectal surgeons can help with further evaluation, work up and treatment recommendations. There are two main types of constipation. The most common type is slow transit constipation, meaning the stool moves very slowly through the colon. A colon transit x-ray study may be ordered as part of the work up to help determine if stool is moving normally through the colon. This consists of swallowing sitz marker capsules, each capsule contains 24 tiny “o” rings which are visible on a plain x-ray. One capsule is swallowed for 3 consecutive days (days 1-3) and an x-ray is obtained on day 4 and day 7. The x-rays are reviewed and remaining markers are counted. A normal colon transit test is considered normal if it is less than 68 hours. Prolonged colon transit times indicate slow transit-type constipation and laxatives will be recommended as part of bowel regimen therapy.
A second type of constipation exists which is known by several different names: obstructive defecation, pelvic floor dysfunction, pelvic floor dysynergy or outlet obstruction constipation. This is a phenomenon where the anal sphincter and pelvic floor muscles are not coordinating well, making it very difficult for the pelvic floor and sphincters to relax enough to pass stool. Patients often report a sensation of “incomplete evacuation”and excessive straining on the toilet. The initial screen test for this is anorectal manometry testing, a short test performed in the office to evaluate anorectal pressures during relaxed sphincter state ,during a squeeze to try to prevent a bowel movement, and during a bear down as if trying to have a bowel movement. If there is evidence of pelvic floor dysfunction on manometry, pelvic floor physical therapy with biofeedback may be recommended to help the pelvic floor muscles better coordinate. A dynamic proctogram may be ordered as an additional study to further evaluate the pelvic floor dysfunction and help with treatment recommendations.
- Bowel Incontinence, Fecal Incontinence, Accidental Bowel Leakage: Incontinence is the inability to completely control the bowels. Incontinence may result from injury to the anal muscle or poor muscle strength. Injuries to the anal muscle may occur during childbirth or other anal surgery. Poor muscle strength may be related to age or other medical conditions which affect the muscle or nerves. Evaluation of the situation may require specialized testing of the anal muscles (Anorectal Manometry) and ultrasound. Treatment is directed at the underlying cause and may include surgery, physical therapy, dietary modification or medications. Solesta, a hyaluronic acid gel, can be used as an injection in the anal canal to act as a “speed bump” to help prevent anal leakage/seepage. Sacral Nerve Stimulation is very successfully used to significantly improve bowel control.
- Rectal Prolapse: This is phenomenon where the rectum falls out through the anal sphincters. This is not the same thing as prolapsing hemorrhoids. Evaluation for this often involves sitting on the toilet and asking the patient to strain to try to push the rectum out. If rectal prolapse is diagnosed, initial treatment may involve pelvic floor physical therapy, high fiber diet, minimizing straining. Work up for rectal prolapse may involve colonoscopy, anorectal manometry (office testing of the anal sphincter and pelvic floor muscles) and dynamic proctogram ( an x-ray study designed to demonstrate disorders of the pelvic floor). Treatment may be from the anal side, including: Altemeier/Perineal Proctectomy or Delorme/Rectal Mucosectomy. Treatment may be an abdominal operation, including: (laparoscopic, robotic or open rectopexy with or without removing a segment of the sigmoid colon.
- Anal Warts/Condyloma: Anal warts are lumps or growths caused by infection with human papilloma virus (HPV). The virus is transmitted person to person. You do not have to have anal sex to develop an HPV related problem. Symptoms may include the lumps either outside or inside the anus and may be associated with itching, irritation, bleeding and difficulty cleaning after bowel movements. Treatment is directed at removal of all warts. This can be accomplished by several different methods which might include topical treatment, burning off the warts or surgical removal. We offer High Resolution Anoscopy (HRA) to evaluate the external anal skin and the anal canal under magnification to further evaluate and treat HPV-related diseases include low grade and high grade anal dysplasia. We also offer anal pap smear testing.
- IBD (Inflammatory Bowel Disease) and Crohn’s Disease
- Irritable Bowel Syndrome