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 larger than the size of a pea. Usually, they do not cause pain or discomfort to afflicted individuals. As a result, 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. Anal warts, thought to be caused by the human papilloma virus, can grow larger and spread if not removed.

What causes anal warts?

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

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 40 – 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. If there is a strong family history, hereditary factors would also warrant earlier/aggressive evaluation. 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
• • Monitor patients and family with hereditary cancer syndromes

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, painful spasm, 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. It is recommended to have at least 25 to 30 grams of fiber daily and about 60 to 80 ounces of fluid per daily 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.

What causes constipation?

There may be several, possibly simultaneous, causes for constipation, including inadequate fiber and fluid intake, a sedentary lifestyle, metabolic diseases, and environmental changes. Constipation may be aggravated by travel, pregnancy or change in diet. In some people, it may result from repeatedly ignoring the urge to have a bowel movement. More serious causes of constipation include growths or areas of narrowing in the colon, so it is wise to seek the advice of a colon and rectal surgeon when constipation persists. Individuals with spinal cord injuries frequently experience problems with constipation. Constipation may be a symptom of diabetes. Constipation may also be associated with scleroderma, or disorders of the nervous or endocrine systems, including thyroid disease, multiple sclerosis, or Parkinson’s disease.

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 with symptoms or complications of these pockets. Nearly 50% of Americans will have diverticula by the age of 60, and nearly all by age 80. However, less than 20% will ever have symptoms throughout their lifetime.

What are the symptoms of diverticular disease?

Uncomplicated diverticular disease is usually not associated with symptoms. Symptoms are related to complications of diverticular disease including diverticulitis and bleeding. Diverticular disease is a common cause of significant bleeding from the colon.

What are the symptoms of Diverticulitis?

Diverticulitis – an infection of the diverticula – may cause one or more of the following symptoms:
pain in the abdomen, chills, fever and change in bowel habits. More intense symptoms are associated with serious complications such as perforation (rupture), abscess or fistula formation (an abnormal connection between the colon and another organ or the skin).

What is the cause of diverticular disease?

The cause of diverticulosis and diverticulitis is not precisely known, but it is more common for people with a low fiber diet. It is thought that a low-fiber diet over the years creates increased colon pressure and results in pockets or diverticula.

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, and therefore even without symptoms you should visit both Gastroenterologist and Colorectal Surgeons following the disease.

What are the symptoms of Crohn’s disease?

Because Crohn’s disease can affect any part of the intestine, symptoms may vary greatly from patient to patient. Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating. Not all patients experience all of these symptoms, and some may experience none of them.

Common Crohn’s symptoms include:

• • Cramping – abdominal pain
  • Diarrhea
  • Fever
  • Weight loss
  • Bloating
  • Anal pain or drainage
  • Skin lesions
  • Rectal abscess
  • Fissure
  • Joint pain (Arthritis)

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.

What causes hemorrhoids?

An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge.

Other contributing factors include:

• • Aging
  • Chronic constipation or diarrhea
  • Pregnancy
  • Heredity
  • Straining during bowel movements
  • Faulty bowel function due to overuse of laxatives or enemas
  • Spending long periods of time (e.g., reading) on the toilet
  • Whatever the cause, the tissues supporting the vessels stretch. As a result, the vessels dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened vessels protrude.

What are the symptoms of hemorrhoids?

If you notice any of the following, you could have hemorrhoids:

• • Bleeding during bowel movements
  • Protrusion during bowel movements
  • Itching in the anal area
  • Pain
  • Sensitive lump(s)

What is 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, pain/spasm, 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. The process of defecation (having a bowel movement) requires the coordinated effort of different muscles. The pelvic floor is made up of several muscles that support the rectum like a hammock. When an individual wants to have a bowel movement the pelvic floor muscles are supposed to relax allowing the rectum to empty. While the pelvic floor muscles are relaxing, muscles of the abdomen contract to help push the stool out of the rectum. Individuals with pelvic floor dysfunction have a tendency to contract instead of relax the pelvic floor muscles. When this happens during an attempted bowel movement, these individuals are effectively pushing against an unyielding muscular wall.

How is pelvic floor dysfunction diagnosed?

The diagnosis of pelvic floor disorder starts with a specialized, careful history regarding an individual’s symptoms, medical problems and a history of physical or emotional trauma that may be contributing to their problem. Next the physician examines the patient to identify any physical abnormality. A defecating proctogram is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction. During this study, the patient is given an enema of a thick liquid that can be detected with x-ray. A special x-ray video records the movement of the pelvic floor muscles and the rectum while the individual attempts to empty the liquid from the rectum. Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum. This study will demonstrate if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid. The defecating proctogram is also useful to show if the rectum is folding in on itself (rectal prolapse). Many women have outpouching of the rectum known as a rectocele. Usually a rectocele does not affect the passage of stool. In some instances, however, stool may become trapped in a rectocele causing symptoms of incomplete evacuation. The defecating proctogram helps to identify if liquid is getting trapped in a rectocele when the individual is trying to empty the rectum. Additional studies are often needed, and can be done in the office in a painless fashion. This testing requires specialized training and equipment offered by highly trained Colorectal Surgeons. This allows for diagnosis and care planning that would not otherwise be possible.

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, spasm, or a feeling of incomplete bowel movements

What causes IBS?

The symptoms of IBS seem to occur as a result of abnormal functioning or communication between the nervous system and the muscles of the bowel. This abnormal regulation may cause the bowel to be “irritated” or more sensitive. The muscles in the bowel wall may contract too forcefully or too weakly, too slowly or rapidly at certain times. Although there is no physical obstruction, a patient may perceive cramps or functional blockage.

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.

What are polyps?

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 20 to 40 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.

What are the symptoms of polyps?

Most polyps produce no symptoms and often are found incidentally during endoscopy or x-ray of the bowel. Some polyps, however, can produce bleeding, mucous discharge, alteration in bowel function, or in rare cases, abdominal pain.

What is pilonidal disease and what causes it?

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.

What are the symptoms of pilonidal disease?

Symptoms vary from a small dimple to a large painful mass. Often the area will drain fluid that may be clear, cloudy or bloody. With infection, the area becomes red, tender, and the drainage (pus) will have a foul odor. The infection may also cause fever, malaise, or nausea. There are several common patterns of this disease. Nearly all patients have an episode of an acute abscess (the area is swollen, tender, and may drain pus). After the abscess resolves, either by itself or with medical assistance, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface with one or more small openings or tracts. Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate them. A small number of patients develop recurrent infections and inflammation of these sinus tracts. The chronic disease causes episodes of swelling, pain, and drainage. Surgery is almost always required to resolve this condition.

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 Pruritus Ani 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

Does Pruritus Ani result from lack of cleanliness?

Cleanliness is almost never a factor. However, the natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils.

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 rectal prolapse 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.

Is rectal prolapse the same as hemorrhoids?

Some of the symptoms may be the same: bleeding and/or tissue that protrudes from the rectum. Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while hemorrhoids develop near the anal opening.

What is a rectocele?

A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thinned and weak, and it may balloon out into the vagina when you push down to have a bowel movement. Most rectoceles occur in women where the front wall of the rectum is up against the back wall of the vagina. This area is called the rectovaginal septum and may be a weak area in the female anatomy. Other structures may also push into the vagina. The bladder bulging into the vagina is called a cystocele. The rectum bulging into the vagina is termed a rectocele. And the small intestines pushing down on the vagina from above may form an enterocele. Although uncommon, men may also develop a rectocele. A rectocele may be present without any other abnormalities. In some cases, a rectocele may be part of a more generalized weakness of pelvic support. In that case it may exist along with a cystocele, urethrocele, and enterocele, with uterine or vaginal prolapse, rectal prolapse, and fecal or urinary incontinence.

What can cause a rectocele?

The underlying cause of a rectocele is a weakening of the pelvic support structures and thinning of the rectovaginal septum. Certain factors may increase the risk of a woman developing a rectocele. These include birth trauma such as multiple, difficult or prolonged deliveries, the use of forceps or other assisted methods of delivery, perineal tears, or an episiotomy into the rectum or anal sphincter muscles, and pelvic floor dysfunction/straining. In addition, a history of constipation and straining with bowel movements, or hysterectomy may contribute to the development of a rectocele. Commonly, these problems develop with age but they may occasionally occur in younger women or in those that have not delivered children.

What are the symptoms of a rectocele?

Many women have rectoceles but only a small percentage of women have symptoms related to the rectocele. Symptoms may be primarily vaginal or rectal. Vaginal symptoms include vaginal bulging, the sensation of a mass in the vagina, pain with intercourse or even something hanging out of the vagina that may become irritated. Vaginal bleeding is occasionally seen if the vaginal lining of the rectocele is irritated, but other sources of the bleeding should be checked by your doctor. Rectal symptoms include constipation, particularly difficult evacuation with straining. Often this is associated with bulging in the vagina when straining to have a bowel movement. Some women find that pressing against the lower back wall of the vagina or along the rim of the vagina helps to empty the rectum. At times, there will be a rapid return of the urge to have a bowel movement after leaving the bathroom because stool that was trapped in the rectocele may return to the low rectum after standing up. A general feeling of pelvic pressure or discomfort is often present but this may be due to a variety of problems.

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.

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 (Suggesting a Hereditary Process that must be defined). 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.

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.