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An anal abscess is an infected cavity filled with pus found near the anus or rectum. 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.
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.
An anal fissure (fissure-in-ano) is a small, oval-shaped tear in the 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.
People frequently assume that the major source of anal pain is hemorrhoids, in which swollen tissue sticks out of the anus
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.
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 embarrassment.
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.
COLON RECTAL CANCER
Colon rectal 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.
COLON RECTAL CANCER SCREENING & SURVEILLANCE
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.
COLON RECTAL SURGERY FOLLOW-UP EVALUATION
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 have 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.
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 the proper function of the colon.
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).
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.
GENETICS & COLON RECTAL CANCER
Genes are the biochemical information that we inherit from each of our parents. They determine our varied physical features and may predispose us to certain diseases. Probably all cancers, especially colon and rectal cancer (CRC), have hereditary genetic factors that potentially increase an individual’s risk for developing these malignancies. In other words, genes are the reason why some diseases such as CRC occur more frequently in certain families. For this reason, when visiting a colon and rectal surgeon, it is important to provide a detailed family history with regard to cancer.
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.
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.
LAPAROSCOPIC SURGERY - WHAT IS IT?
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.
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).
PELVIC FLOOR DYSFUNCTION
For most people, having a bowel movement is a seemingly automatic function. For some individuals, the process of evacuating stool may be difficult. Symptoms of pelvic floor dysfunction include constipation and the sensation of incomplete emptying of the rectum when having a bowel movement. Incomplete emptying may result in the individual feeling the need to attempt a bowel movement several times within a short period of time. Residual stool left in the rectum may slowly seep out of the rectum leading to reports of bowel incontinence.
Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. 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.
POLYPS OF THE COLON & 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.
Itching around the anal area is called pruritus ani. This condition results in a compelling urge to scratch.
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.
A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina. Rectoceles are usually due to thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles. This is a very common defect; however, most women do not have symptoms. There can also be other pelvic organs that bulge into the vagina, leading to similar symptoms as rectocele, including the bladder (i.e., cystocele) and the small intestines (i.e. enterocele).
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.