Hemorrhoids are rectal veins that become swollen and dilated because of increased pressure upon them, usually due to straining during a bowel movement. About half of the population have hemorrhoids by age 50. They are also common in women during and immediately after pregnancy because of increased pressure in the abdomen. Diarrhea may also cause them to flare up.
Although hemorrhoids may be irritating, they are usually not life-threatening. In many cases, hemorrhoids can be managed with lifestyle changes such as increasing your daily intake of fiber and drinking more water.
Symptoms of external hemorrhoids include:
Signs and Symptoms
- Bright red blood from your rectum
- A discharge of mucus
- Rectal fullness or discomfort
- Rectal pain, especially if they become thrombosed (that means their blood supply is cut off) or prolapsed (protrude through the anus)
In advanced cases, surgical treatment may be required to improve symptoms. There are several techniques; your doctor will help you determine the best option.
Excisional Hemorrhoidectomy: This surgical procedure is done in the operating room under general anesthesia. It is usually reserved for large external hemorrhoids and large internal hemorrhoids that do not respond to ligation or sclerotherapy. During the procedure, the hemorrhoid and the vascular tissue that supplies it with blood are cut and removed from the anus. Although effective, it is a painful operation. Possible complications include bleeding, fecal impaction (stool that will not pass through the anus), and urinary retention.
Signs and Symptoms of Colon Disease:
Symptoms may include diarrhea, constipation, abdominal cramps, nausea, fever, chills, weakness, or loss of appetite and/or weight loss, or bleeding.
There may be no symptoms. This is why colorectal screening is essential.
History and physical exam will include questions about you and your family’s complete medical history.
Other tests may include:
- Blood tests
- Digital rectal exam
- Abdominal X-ray
- Abdominal ultrasound
- CT scan
- Electrocardiogram (ECG)
A colon resection is surgery to remove part of your colon. During a colon resection, the surgeon removes (resects) the affected piece of colon and then sews the two new ends together in an anastomosis. The repair is designed to maintain your colon’s normal tube-like shape, so you can regain your normal bowel movements. This is known as a colectomy. A colectomy is a surgical procedure to remove all or part of your colon. Your colon, also called your large intestine, is a long tube-like organ at the end of your digestive tract. Colectomy may be necessary to treat or prevent diseases and conditions that affect your colon.
Surgical Procedures-There are various types of colectomy operations:
- Total colectomy involves removing the entire colon.
- Partial colectomy involves removing part of the colon and may also be called subtotal colectomy.
- Hemicolectomy involves removing the right (ascending) or left (descending) portion of the colon.
- Sigmoidectomy is the removal of the lower part of the colon which is connected to the rectum.
- Low anterior resection is the removal of the upper part of the rectum.
- Segmental resection is the removal of only a short piece of colon.
- Proctocolectomy involves removing both the colon and rectum.
Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:
- Bleeding that can’t be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon.
- Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.
- Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed.
- Crohn’s disease. If medications aren’t helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.
- Ulcerative colitis. Your doctor may recommend total colectomy if medications aren’t helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.
- Diverticulitis. Your doctor may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications of diverticulitis.
- Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome.
You’ll discuss your treatment options with your surgeon. In some situations, you may have a choice between various types of colectomy operations, and you and your physician can discuss the benefits and risks of each.
Colon surgery may be performed in two ways:
- Open colectomy. Open surgery involves making a longer incision in your abdomen to access your colon. Your surgeon uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon.
- Laparoscopic colectomy. Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Your surgeon passes a tiny video camera through one incision and special surgical tools through the other incisions. The surgeon watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows the surgeon to operate on the colon outside of your body. Once repairs are made to the colon, the surgeon reinserts the colon through the incision.
The type of operation you undergo depends on your situation and your surgeon’s expertise. Laparoscopic colectomy may reduce the pain and recovery time after surgery, but not everyone is a candidate for this procedure. Also, in some situations your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy.
Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste. Options may include:
- Rejoining the remaining portions of your colon. The surgeon may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before.
- Connecting your intestine to an opening created in your abdomen. The surgeon may attach your colon (colostomy) or small intestine (ileostomy) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary.
- Connecting your small intestine to your anus. After removing both the colon and the rectum (proctocolectomy), the surgeon may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day.
Information from www.mayoclinic.org
What is an anal fissure?
An anal fissure is a small tear or cut in the skin that lines the anus. Fissures typically cause pain and often bleed. Fissures are quite common, but are often confused with other causes of pain and bleeding, such as hemorrhoids. A sentinel pile or tag often develops which can also be confused with a hemorrhoid.
Signs and Symptoms
- Pain, sometimes severe, during bowel movements
- Pain after bowel movements that can last up to several hours
- Bright red blood on the stool or toilet paper after a bowel movement
- Itching or irritation around the anus
- A visible crack in the skin around the anus
- A small lump or skin tag on the skin near the anal fissure
How can a fissure be treated?
Often treating one’s constipation or diarrhea can cure a fissure. An acute fissure is typically managed with non-operative treatments and over 90% will heal without surgery. A high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids help relieve constipation, promote soft bowel movements, and aide in the healing process. Increased dietary fiber may also help to improve diarrhea. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles, which can also help healing. Occasionally, special medications may be recommended. A chronic fissure may require additional treatment.
What does surgery involve?
Surgery is a highly effective treatment for a fissure and recurrence rates after surgery are low. Surgery usually consists of a small operation called a fissurectomy which is removing scar tissue to allow the healthy tissue to heal.
ANAL ABSCESS & ANAL FISTULA
What is an anal abscess?
An anal abscess is an infected cavity filled with pus found near the anus or rectum. An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions – colitis or other inflammation of the intestine, for example – can sometimes make these infections more likely.
What is an anal fistula?
An anal fistula (also commonly called fistula-in-ano) is frequently the result of a previous or current anal abscess. This occurs in up to 50% of patients with abscesses. Normal anatomy includes small glands just inside the anus. The fistula is the tunnel that forms under the skin and connects the clogged infected glands to an 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.
Signs and Symptoms
Anorectal pain, swelling, perianal cellulitis (redness of the skin) and fever are the most common symptoms of an abscess. Occasionally, rectal bleeding or urinary symptoms, such as trouble initiating a urinary stream or painful urination, may be present.
Patients with fistulas commonly have history of a previously drained anal abscess. Anorectal pain, drainage from the perianal skin, irritation of the perianal skin, and sometimes rectal bleeding, can be presenting symptoms of a fistula-in-ano.
How is an abscess treated?
An abscess is treated by making an opening in the skin near the anus to drain the pus from the infected cavity and thereby relieve the pressure. Often, this can be done in the doctor’s office using a local anesthetic. A large or deep abscess may require hospitalization and the assistance of an anesthesiologist. Hospitalization may also be necessary for patients prone to more serious infections, such as diabetics or people with decreased immunity. Up to 50% of the time after an abscess has been drained, a tunnel (fistula) may persist, connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening. If the opening on the skin heals when a fistula is present, a recurrent abscess may develop. Until the fistula is eliminated, many patients will have recurring cycles of pain, swelling and drainage, with intervening periods of apparent healing.
What about treatment for a fistula?
Currently, there is no medical treatment available for this problem and surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter muscle), a fistulotomy may be performed. This procedure involves un-roofing the tract, thereby connecting the internal opening within the anal canal to the external opening and creating a groove that will heal from the inside out.
The surgery may be performed at the same time as drainage of an abscess, although sometimes the fistula doesn’t appear until weeks or years after the initial drainage. Fistulotomy is a long-standing treatment with a high success rate (92-97%).