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ANAL PAIN
Pain over anal region called anal pain which brings patient to the anorectal surgeon. Anal pain is a common symptoms of anorectal diseases like piles (haemorrhoids), fissure, anal abscess, fistula, anal cancer etc.
What Causes Anal Pain?
  • 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
Where does it hurt?
Anal pain that can be pinpointed to the front or back of the anus at the opening where stool comes through is usually a fissure. Anal pain that is associated with a hard bump the size of a pea in this location can also be due to afissure.
Pain that is associated with a swelling that is deep in the tissue of the skin is usually an abscess. The pain of an abscess usually emerges in days, and may be associated with a painful bump in the skin around the anus.
A firm bump that emerges abruptly at the anal opening and is blue in colour is generally a hemorrhoid that is thrombosed, meaning a clot has formed in the blood vessels. A soft tender spongy mass can also be hemorrhoids.
A painful bump that emerges over months can be a cancer.
Skin pain of the opening or around the opening can often be due to trauma, from a yeast infection or vigorous over-cleansing the anal skin.
When is anal pain serious?
Anal pain that does not resolve with the use of over the counter medications within 24-48 hours should be investigated by Anorectal Surgeon. Anal pain that lasts more than two weeks can be serious. Chronic anal pain that progressively gets more severe is possibly a cancer.
 
What other symptoms should I notice?
  • Is the skin around the anal opening warm or red at the center or on the sides?
  • Is the anal opening swollen?
  • Is the anus moist or dry?
  • If there is a mass, it is blue, red or yellow? Is it soft or hard? Is it painful?
  • If there is an ulcer (raw area), is it flat, red or with raised edges?
  • Is it painful to pass a stool or merely just to sit?
  • Does the pain begin after a bout of diarrhoea and become worse or constant?
  • Is the pain after a constipated stool?
What if there is bleeding and pain?
The most common cause of painful defecation with bleeding is a fissure.
Thrombosed haemorrhoids may also be associated with bleeding.
The most common cause of bleeding with pain regardless of stooling is anal skin infection, such as yeast infection or poor anal care.
Anal itching and burning is often a source of bleeding and pain. This is usually caused by moist drainage from the skin surrounding the anus.
 
What can be done to relieve anal pain?
Maintain a high fiber diet, which can relieve anal pain in the majority of treatable conditions and drinking 8-10 glasses of water daily. Eating foods containing 25-30 grams of fibre daily can improve anal pain in most cases.
Avoid trauma to the area. Do not use soap of any kind on the anus. Do not scrub or scratch the anus. Take sitz bath.
Avoid moisture and creams, including Vaseline®. Applications of dry heat or dry cold can alleviate pain, but moisture will not help any anal condition. Use only medications prescribed by your physician.
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CONSTIPATION
Constipation is a common cause of anorectal diseases like piles (haemorrhoids), fissure, anal abscess, fistula, etc.
 
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;
 
What causes constipation?
  • Inadequate fibre and fluid intake, a sedentary lifestyle, and environmental changes.
  • Constipation may be aggravated by travel, pregnancy or change in diet
  • 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 anorectal surgeon when constipation persists.
  • Individuals with spinal cord injuries frequently experience problems with constipation.
 
Can medication cause constipation?
Yes, many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and ¬aluminum containing antacids can slow the movement of the colon and worsen constipation.
 
When should I see a doctor about constipation?
Any persistent change in bowel habit, increase or decrease in frequency or size of stool or an increased difficulty in evacuating warrants evaluation. Whenever constipation symptoms persist for more than three weeks, you should consult your physician. If blood appears in the stool, consult your physician right away.
 
How is constipation treated?
The vast majority of patients with constipation are successfully treated by adding high fiber foods like bran, shredded wheat, whole grain breads and certain fruits and vegetables to the diet, along with increased fluids.
Your physician may also recommend lifestyle changes.
Fiber supplements may take several weeks, possibly months, to reach full effectiveness, but they are neither harmful nor habit forming,
Other types of laxatives, enemas or suppositories should be used only when recommended and monitored by your colon and rectal surgeon.
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HAEMORRHOIDS
What are hemorrhoids?
Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of haemorrhoids
External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin.
Internal (inside) hemorrhoids develop within the anus beneath the lining.
Internal hemorrhoids are classified by their degree of prolapse, which helps determine management:
Grade One: No prolapse
Grade Two: Prolapse that goes back in on its own
Grade Three: Prolapse that must be pushed back in by the patient
Grade Four: Prolapse that cannot be pushed back in by the patient (often very painful)
 
What causes hemorrhoids?
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 diarrhoea
  • Overeating,
  • Heavy lifting
  • Acid/alkaline imbalance
  • Fatigue liver
  • vitamin B-6 deficiency
  • 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
  • Sitting or standing in one position for long periods of time and lack of exercise can contribute to the development of haemorrhoid.
 
What are the symptoms?
If you notice any of the following, you could have haemorrhoids:
  • Bleeding during bowel movements
  • Protrusion during bowel movements
  • Itching in the anal area
  • Pain
  • Sensitive lump(s)
 
How are haemorrhoids treated?
Mild symptoms can be relieved frequently by increasing the amount of fibre (e.g., fruits, vegetables, breads and cereals) and fluids in the diet.
Eliminating excessive straining reduces the pressure on haemorrhoids and helps prevent them from protruding.
A sitz bath - sitting in plain warm water for about 10 minutes - can also provide some relief .
 
Treatment of 1 st and 2 nd grade Haemorrhoids
Ligation
The rubber band ligation over the internal haemorrhoids through gun is called ligation used in Gd 1 and Gd2 haemorrhoids
Bipolar Coagulation
Bipolar electrotherapy is applied for a directed coagulation effect of the mucous membrane near the haemorrhoid.
Hemorrhoidolysis
Therapeutic galvanic waves applied directly to the hemorrhoid, produces a chemical reaction that shrinks and dissolves hemorrhoidal tissue.
Infrared Photocoagulation
Infrared coagulation (IRC) is another office-base procedure, for Grades 1 and 2 and occasional Grade 3 internal hemorrhoids,
Sclerotherapy
It involves the injection of chemical irritants into the hemorrhoids, resulting in scarring and shrinkage by reducing the blood vessels present in the hemorrhoidal tissues.
Hemorrhoid stapling
this is a technique that uses a special device to internally staple and excise internal hemorrhoidal tissue.
Super Freezing
A cryogenic device uses liquid nitrogen to super freeze the hemorrhoid. This causes the affected tissue to slough off, so that new healthy tissue can grow in its place. This technique is most effective when it is used on external hemorrhoids.
 
Haemorrhoidal artery ligation
Haemorrhoidal artery ligation, is an operation to reduce the flow of blood to the haemorrhoids. It is usually carried out under general anaesthetic and uses a small ultrasound device called a Doppler probe. Ultrasound uses high-frequency sound waves to create an image of part of the inside of the body.
A review of a number of different studies looked at the results of haemorrhoidal artery ligation a year or more after the procedure. It found that about 1 in 10 people experienced:
  • Bleeding
  • Pain when passing stools
  • A prolapsed haemorrhoid (where the haemorrhoid hangs out of the anus)
 
Surgical Treatment
Haemorrhoidectomy
Surgery to remove the haemorrhoids - is the most complete method for removal of internal and external haemorrhoids
Laser Surgery for Haemorrhoids
The unwanted haemorrhoid is vaporized or excised
The result is less discomfort, less medication, and faster healing. A hospital stay is generally not required. The laser is inherently therapeutic, sealing off nerves and tiny blood vessels with an invisible light. By sealing superficial nerve endings patients have a minimum of postoperative discomfort. With the closing of tiny blood vessels, your proctologist is able to operate in a controlled and bloodless environment.
Procedures can often be completed more quickly and with less difficulty for both patient and physician.
 
Atomizing Haemorrhoids
A new technique to remove hemorrhoids is called atomizing. The Atomizer™ is a medical device that was developed with a wave of the Atomizer Wand, the hemorrhoids are simply excised or vaporized one or more cell layers at a time.
The results of atomizing hemorrhoids are similar to that of lasering hemorrhoids, except that there is less bleeding using the Atomizer, and the Atomizer cost less. In both procedures, it is noted that there is less discomfort, less medication, less constipation, less urinary retention, and a hospital stay is generally not required. Complications using the Atomizer are rare, and excellent results are typical
 
Stapled Hemorrhoidopexy (PPH Procedure)
Also known as Procedure for Prolapsed Haemorrhoids (PPH), Stapled Haemorrhoidectomy, and Circumferential Mucosectomy.
PPH is a technique developed in the early 90's that reduces the prolapse of haemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling device. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining haemorrhoidal tissue is stapled. This restores the hemorrhoidal tissue back to its original anatomical position.
 
What are the Risks of PPH?
  1. If too much muscle tissue is drawn into the device, it can result in damage to the rectal wall.
  2. The internal muscles of the sphincter may stretch, resulting in short-term or long-term dysfunction.
  3. As with other surgical treatments for haemorrhoids, cases of pelvic sepsis have been reported following stapled haemorrhoidectomy.
  4. PPH may be unsuccessful in patients with large confluent haemorrhoids.
  5. Persistent pain and fecal urgency after stapled haemorrhoidectomy, although rare, has been reported.
  6. Stapling of hemorrhoids is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery; according to a Canadian study of 537 participants.
 
The Harmonic Scaplel
The Harmonic Scaplel uses ultrasonic technology, the unique energy form that allows both cutting and coagulation of hemorrhoidal tissue at the precise point of application, resulting in minimal lateral thermal tissue damage. Because the Harmonic Scaplel uses ultrasound, there is less smoke than is generated by both lasers and electrosurgical instruments. The Harmonic Scaplel cuts and coagulates by using lower temperatures than those used by electrosurgery or lasers.
The protein coagulum caused by the application of the Harmonic Scaplel is superior at sealing off large bleeding vessels during surgery. It has been my experience that this method is useful on large hemorrhoids that may bleed during surgery, thus minimizing blood loss and reducing the time needed for surgery.
 
Do hemorrhoids lead to cancer?
No. There is no relationship between hemorrhoids and cancer.
OFFICE TREATMENT OF EXTERNAL HEMORRHOIDS
External hemorrhoids, which are not thrombosed, are generally managed symptomatically, with dietary management and topical agents. Only occasionally are they removed surgically.
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ANAL FISSURE
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.
what are the symptoms of an anal fissure?
The typical symptoms of an anal fissure are pain during or after defecation and bleeding. Patients may try to avoid defecation because of the pain.
What causes an anal fissure?
Trauma: anything that can cut or irritate the inner lining of the anus can cause a fissure. A hard, dry bowel movement is typically responsible for a 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.
What can be done if a fissure doesn't heal?
A fissure that fails to respond to treatment should be re-examined. Persistent hard or loose bowel movements, scarring, or spasm of the internal anal sphincter muscle all contribute to delayed healing.
What does surgery involve?
Surgery is a highly effective treatment for a fissure and recurrence rates after surgery are low.
How long does the healing process take after surgery?
Complete healing occurs in a few weeks, although pain often disappears after a few days.
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ANAL ABSCESS
What is an anal abscess?
An anal abscess is an infected cavity filled with pus found near the anus or rectum.
What causes an abscess?
An abscess results from an acute infection of a small gland just inside the anus.
What are the symptoms of an abscess?
An abscess is usually associated with symptoms of pain and swelling around the anus
A patient who feels ill and complains of chills, fever and pain in the rectum or anus
Diagnosis
Diagnosis is by examination, either in an outpatient setting or under anaesthesia The examination can be an anoscopy.
Does an abscess always become a fistula?
No. A fistula develops in about 50 percent of all abscess cases, and there is really no way to predict if this will occur.
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
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FISTULA
What is an anal fistula?
Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.
Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.
What causes a fistula?
After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin.
Symptoms
Pain
Discharge - either bloody or purulent
Pruritus ani - itching
Systemic symptoms if abscess becomes infected
Treatment
There are several options:
Doing nothing - Drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.

Lay-open of fistula-in-ano -
this option involves an operation to cut the fistula open.

Cutting seton - if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton may be used.

Seton stitch - a length of suture material looped through the fistula which keeps it open and allows pus to drain out.

Fistulotomy -
till anorectal ring

Colostomy -
to allow healing

Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally.

Fistula plug involves plugging the fistula with a device made from small intestinal submucosa.

Endorectal advancement flap
is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. Success rates are variable and high recurrence rates.

LIFT Technique -
It is a novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano,



VAAFT Technique:
This technique involves use of an endoscope,
Fistula and Ayurveda
The fact that so many of us from far & vide have gathered here is in itself evidence of the coming back of age of old science of life ayurveda is picking up momentum not only in India, but also in other countries.
Globalization of ayurveda brings with it increased requirement of all types of Ayurvedic preparation and even standardization of this preparation. Availability of standard Ayurvedic drug, even those which are widely used, is a problem at many places even in India where expensive or sparingly used drugs are considered, this problem raises steel higher. Ksharsutra is one such preparation
Treatment of anorectal disease through ayurveda is solely becoming popular in India. People have started realizing that ayurveda has a lot to offer in this field life in many others ksharshutra is undoubtedly the preparation of prime importance in this field. However manufacturing and marketing of ksharshutra has not been given due importance till date and almost all Ayurvedic anorectal physician have to prepare their own ksharsutra which makes it more difficult to work in this filed.
We shall have to accept that there is not a single reference text book of the method of preparation of ksharshutra as it is used today though there are same references indicating use of medicated thread in the management of piles and fistula in Sushruta and Bhavparkasha.
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RECTAL PROLAPSE
What is rectal prolapse?
Rectal prolapse is a condition in which the rectum 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.
Why does it occur?
It may come from a lifelong habit of straining to have bowel movements or as a late consequence of the childbirth process.
How is rectal prolapse diagnosed?
To demonstrate the prolapse, patients may be asked to sit on a commode and "strain" as if having a bowel movement.
How is rectal prolapse treated?
There are many different ways to surgically correct rectal prolapsed
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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. Although most polyps are benign, the relationship of certain polyps to cancer is well established.
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.
How are polyps diagnosed?
Polyps are diagnosed either by looking at the colon lining directly (colonoscopy) or by x-ray study (barium enema).
Do polyps need to be treated?
Since there is no fool-proof way of predicting whether or not a polyp is or will become malignant, total removal of all polyps is advised. The vast majority of polyps can be removed by snaring them with a wire loop passed through the instrument. Small polyps can be destroyed simply by touching them with a coagulating electrical current.
How can I prevent polyps?
Doctors don't know of any one sure way to prevent polyps. But you might be able to lower your risk of getting them if you
• eat a high fiber diet, (i.e. more fruits and vegetables) and less fatty food.
• don't smoke
• avoid alcohol
• exercise every day
• lose weight if you're overweight
Can polyps recur?
Once a polyp is completely removed, its recurrence is very unusual.
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ANAL CANCER
What is anal cancer?
Cancer describes a set of diseases in which normal cells in the body, through a series of genetic changes, lose the ability to control their growth. As cancers 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).
 
Who is at risk?
Anal cancer is commonly associated with the human papilloma virus (HPV). This virus causes warts in and around the anus and on the cervix in women.
Age - Most people with anal cancer are over 50 years old.
Anal sex - Persons who participate in anal sex are at an increased risk.
Smoking - Harmful chemicals from smoking increase the risk of most cancers including anal cancer.
Chronic local inflammation - People with long-standing anal fistulas or open wounds are at a slightly higher risk.
 
What are the symptoms of anal cancer?
  • Bleeding from the rectum or anus
  • The feeling of a lump or mass at the anal opening
  • Pain in the anal area
  • Persistent or recurrent itching
  • Change in bowel habits (having more or fewer bowel movements) or increased straining during a bowel movement
  • Narrowing of the stools
  • Discharge (mucous or pus) from the anus
  • Swollen lymph nodes (glands) in the anal or groin areas.
 
How is anal cancer diagnosed?
An abnormal anal pap smear or the presence of symptoms should lead to examination of the anal canal.
 
How are anal cancers treated?
Surgery – an operation to remove the cancer
Radiation therapy – high-dose x-rays to kill cancer cells, and
Chemotherapy – giving drugs to kill cancer cells.
What happens after treatment for anal cancer?
Follow-up care to assess the results of treatment and to check for recurrence is very important. Most anal carcinomas are effectively treated. In addition, many tumors that recur may be successfully treated if they are caught early. A careful examination by an experienced physician at regular intervals is the most important method of follow-up. Additional studies may be recommended. You should report any symptoms or problems to your doctor right away.
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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.
 
What are the symptoms?
The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea.
 
How is colorectal cancer treated?
Colorectal cancer requires surgery in nearly all cases for complete cure. Radiation and chemotherapy are sometimes used in addition to surgery.
 
Can colon cancer be prevented?
Colon cancer is preventable. The most important step towards preventing colon cancer is getting a screening test.
 
Can hemorrhoids lead to colon cancer?
No, but hemorrhoids may produce symptoms similar to colon polyps or cancer. Should you experience these symptoms, you should have them examined and evaluated by a physician, preferably by a colon and rectal surgeon.
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CROHN'S DISEASE
What is Crohn's disease?
Crohn's disease is a chronic inflammatory process primarily involving the intestinal tract
 
What are the symptoms of Crohn's disease?
Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating. Other symptoms may include anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).
 
What causes Crohn's disease?
The exact cause is not known. However, current theories center on an immunologic (the body's defense system) and/or bacterial cause. Crohn's disease is not contagious, but it does have a slight genetic (inherited) tendency. An x-ray study of the small intestine may be used to diagnose Crohn's disease.
 
How is Crohn's disease treated?
Initial treatment is almost always with medication. There is no "cure" for Crohn's disease, but medical therapy with one or more drugs provides a means to treat early Crohn's disease and relieve its symptoms. The most common drugs prescribed are corticosteroids, such as prednisone and methylprednisolone, and various anti-inflammatory agents.
Not all patients with these or other complications require surgery.
it is important to realize that surgery is eventually required in up to three-fourths of all patients with Crohn's
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IRRITABLE BOWEL SYNDROME (IBS)
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
 
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.
 
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.
 
WHAT ROLE DOES STRESS PLAY IN IBS?
IBS is not caused by stress. It is not a psychological or psychiatric disorder, however emotional stress may contribute to IBS.
 
HOW IS IBS TREATED?
Understanding that IBS is not a serious or life-threatening condition may relieve anxiety and stress, which often contribute to the problem. Stress reduction, use of behavioural therapy, biofeedback, relaxation or pain management techniques can help relieve the symptoms of IBS in some individuals.
Individuals with moderate to severe IBS may benefit from prescribed medication. Medications can help to control the symptoms of IBS but they do not cure the condition. Medications act directly on the intestinal muscles to help the contractions return to normal. Antidepressants in low doses have been shown to be helpful in some with IBS.
 
HOW LONG DOES THE TREATMENT TAKE TO RELIEVE SYMPTOMS?
Relief of IBS Symptoms is often a slow process. It may take six months or more for definite improvement to be appreciated.
Patience is extremely important in dealing with this problem.
 
CAN IBS LEAD TO MORE SERIOUS PROBLEMS?
IBS does not cause cancer, bleeding or inflammatory bowel diseases, such as ulcerative colitis.
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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.
 
When is surgery necessary?
Surgery is indicated for patients who have life-threatening complications of inflammatory bowel diseases, such as massive bleeding, perforation, or infection.
 
What operations are available?
Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus. This operation is called a proctocolectomy
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DIVERTICULAR DISEASE
What is Diverticulosis/ Diverticulitis?
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon.
 
What are the symptoms of diverticular disease?
bleeding from the colon.
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
 
How is diverticular disease treated?
Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressure in the colon and may decrease the risk of complications due to diverticular disease.
Diverticulitis requires different management. Mild cases may be managed with oral antibiotics, dietary restrictions and possibly stool softeners. More severe cases require hospitalization with intravenous antibiotics and dietary restraints. Most acute attacks can be relieved with such methods.
 
When is surgery necessary?
Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there's little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.
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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 embarrassment.
 
What causes incontinence?
There are many causes of incontinence. Injury during childbirth is one of the most common causes.
Anal operations or traumatic injury to the tissue surrounding the anal region
 
Treatment of incontinence may include
  • Dietary changes
  • Constipating medications
  • Muscle strengthening exercises
  • Biofeedback
  • Surgical muscle repair
  • Artificial anal sphincter
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PELVIC FLOOR DYSFUCTION
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 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.
 
How is pelvic floor dysfunction diagnosed?
The diagnosis of pelvic floor disorder starts with a 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.
 
How is pelvic floor dysfunction diagnosed?
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.
 
How is pelvic floor dysfunction treated?
Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback. With biofeedback, a therapist helps to improve a person’s rectal sensation and pelvic floor muscle coordination. There are various effective techniques used in biofeedback. Some therapists train patients by teaching them to expel a small balloon placed in the rectum. Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum (anus) and on the abdominal wall. These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action. This visual feedback helps the individual to understand the muscle movement and aids in improving muscle coordination. Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback.
Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated with a surgical procedure.
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RECTOCELE
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.
 
What can cause a rectocele?
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. In addition, a history of constipation and straining with bowel movements, or hysterectomy may contribute to the development of a rectocele.
 
What are the symptoms of a rectocele?
Many women have rectocele 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.
 
How is a rectocele diagnosed?
an x-ray study called a defecagram. This study shows how large the rectocele is and if it empties with evacuation.
 
What treatment is available for a rectocele?
Rectoceles that are not causing symptoms do not need to be treated. In general, you should avoid constipation by eating a high fiber diet and drinking plenty of fluids.
 
Medical treatment
A bowel management program is the best first step. This includes a diet high in fiber and 6 to 8 glasses of fluids each day. Fiber acts like a sponge
Avoid prolonged straining.
 
Surgical treatment
If symptoms persist even with medical therapy, then surgical repair may be indicated.
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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.
 
What are the symptoms?
Symptoms vary from a small dimple to a large painful mass.
 
How is pilonidal disease treated?
An acute abscess is managed with an incision and drained to release the pus, and reduce the inflammation and pain. This procedure usually can be performed in the office with local anaesthesia. A chronic sinus usually will need to be excised or surgically opened.
 
What care is required after surgery?
If the wound can be closed, it will need to be kept clean and dry until the skin is completely healed. If the wound must be left open, dressings or packing will be needed to help remove secretions and to allow the wound to heal from the bottom up.
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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
  • Tomatoes and tomato products such as Ketchup
  • Milk products
  • 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 can be done to make this itching go away?
1. AVOID MOISTURE in the anal area:
  • Apply either a few wisps of cotton, a 4 x 4 gauze or some cornstarch powder to keep the area dry.
  • Avoid all medicated, perfumed and deodorant powders.
2. AVOID FURTHER TRAUMA to the affected area:
  • Do not use soap of any kind on the anal area.
  • Do not scrub the anal area with anything – even toilet paper.
  • For hygiene, it is best to rinse with warm water and pat the area dry. Use wet toilet paper, baby wipes or a wet washcloth to blot the area clean. Never rub.
  • Try not to scratch the itchy area. Scratching produces more damage, which in turn makes the itching worse. For individuals that experience irresistible itching at night, wearing socks on the hands may be helpful.
3. USE ONLY MEDICATIONS AS DIRECTED BY YOUR PHYSICIAN.
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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 larger than the size of a pea.
 
What causes these 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.
 
Do these warts always need to be removed?
Yes. If they are not removed, the warts usually grow larger and multiply. If left untreated, the warts may lead to an increased risk of cancer in the affected area.
 
What treatments are available?
If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication.
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EXAMINATION OF CANAL, RECTUM AND COLON
Proctoscopy
Proctoscope is funnel like tubular instrument having length of 5 to 10 cms and diameter of 2 cm to 7 cm from one end to other end and that length and diameter is variable for paediatric and general use. Some proctoscopes are having the provision of self illumination. the physician can see bleeding, inflammation, abnormal growths, and ulcers in anal canal with the help of proctoscope.
 
Sigmoidoscopy
A flexible Sigmoidoscopy exam is a short colonoscopy exam, limited to the lower one third of the colon. Sigmoidoscopy enables the physician to look at the sigmoid colon. Physicians may use this procedure to find the cause of diarrhoea, abdominal pain, or constipation. They also use Sigmoidoscopy to look for early signs of cancer in the colon and rectum. With Sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers.
 
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.
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. 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
How is colonoscopy performed?
The colonoscope is inserted into the rectum and is advanced to the portion of the colon where the small intestine joins the colon. During a complete examination of the bowel, your physician will remove polyps or take biopsies as necessary.
 
 
 
 
 
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