Polyps of the Colon and Rectum

Polyps are abnormal growths rising from the lining of the large intestine (colon) 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 15-20 percent of the adult population. Although most polyps are benign, the relationship of certain polyps to cancer is well established.

What are the symptons 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 of 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).

There are three types of colorectal endoscopies: (1) rigid sigmoidoscopy, (2) flexible sigmoidoscopy and (3) colonoscopy. Rigid sigmoidoscopy permits examination of the lower six to eight inches of the large intestine. In flexible sigmoidoscopy, the lower one-fourth to one-third of the colon is examined. Neither rigid nor flexible sigmoidoscopy requires medication and can be performed in the doctor’s office.

Colonoscopy uses a longer flexible instrument and usually permits inspection of the entire colon. Bowel preparation is required, and sedation is often used.

The colon can also be indirectly examined using the barium enema x-ray technique. This examination uses a barium solution to coat the colon lining. X-rays are taken, and unsuspected polyps are frequently found.

Although checking the stool for microscopic blood is an important test for colon and rectal disorders, a negative test does NOT rule out the presence of polyps. The discovery of one polyp necessitates a complete colon inspection, since at least 30 percent of these patients will have additional polyps.

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.

Most colon examinations using the flexible colonoscope, including polyp removal, can be performed on an outpatient basis with minimal discomfort. Large polyps may require more than one treatment for complete removal. Some polyps cannot be removed by instruments because of their size or position, surgery is then required.

Can polyps recur?

Once a polyp is completely removed, its recurrence is very unusual. However, the same factors that caused the polyp to form are still present. New polyps will develop in at least 30 percent of people who have previously had polyps. Patients should have regular exams by a physician specially trained to treat diseases of the colon and rectum.

Diverticular Disease

Diverticular disease of the colon is a common condition that afflicts about 50% of American by age 60 and nearly all by age 80. Only a small percentage of those with diverticula of the colon have symptoms, and even fewer will ever require surgery.

What is diverticulitis?

Diverticula are pockets or pouches that develop through weaknesses in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulitis describes perforation or inflammation of the diverticulum.

What are the symptoms?

The major symptoms of diverticular disease are abdominal pain (usually in the lower left abdomen), diarrhea, cramps, alteration of bowel habits and, occasionally, severe rectal bleeding. These symptoms occur in a small percentage of patients with diverticulosis and are sometimes difficult to distinguish from other intestinal disorders such as irritable bowel syndrome.

Diverticulitis – an inflammation or infection of a diverticulum – may cause one or more of the following symptoms: pain, chills, fever, and change in bowel habits. Severe cases of diverticulitis may be complicated by infections of the abdomen, drainage tracts to the bladder or vagina, or bursting of the colon requiring emergency operation.

What is the cause of diverticular disease?

Indications are that a low-fiber diet over many years creates increased colon pressure and results in the development of diverticula.

How is diverticular disease treated?

Mild symptoms of diverticular disease are usually treated by diet and occasionally medications to help control pain, cramps, and changes in bowel habits. Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) and sometimes restricting certain foods reduces pressure in the colon so that complications are less likely to arise.

Diverticulitis requires more intense management. Mild cases may be managed without hospitalization, but this is a decision best made by your physician. Treatment usually consists of oral antibiotics, dietary restrictions, and possible stool softeners. Severe cases require hospitalization with intravenous antibiotics and strict dietary restraints. Most acute attacks can be relieved with such methods.

When is surgery necessary?

Surgery is indicated for recurrent episodes, complications, or severe attacks when there is little or no response to medication.

In surgery, usually part of the colon – commonly the left or sigmoid colon – is removed and the colon is reconnected or “anastomosed” to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in 1 – 3 weeks.

Who performs this type of surgery?

Colon and rectal surgeons are experts in the surgical and nonsurgical treatment of colon and rectal problems. They have completed advanced training in the treatment of colon and rectal problems in addition to full training in general surgery. Colon and rectal surgeons treat benign and malignant conditions, perform routine screening examinations and treat problems surgically when necessary.

Hemorrhoids

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. If a blood clot develops in one of them, a painful swelling may occur. The external hemorrhoid feels like a hard, sensitive lump. It bleeds only 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
• Faulty bowel function due to overuse of laxatives or enemas, straining during bowel movements
• Spending long periods of time (e.g. reading) on the toilet.
  

Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened veins protrude.

What are the symptoms?

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)
  

Do hemorrhoids lead to cancer?

No. There is no relationship between hemorrhoids and cancer. However, the symptoms of hemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other disease of the digestive system. Therefore, it is important that all symptoms are investigated by a physician specially trained in treating diseases of the colon and rectum. Do not rely on over-the-counter medications or other self-treatments. See a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed.

How are hemorrhoids treated?

Mild symptoms can be relived frequently by increasing the amount of fiber (e.g., fruits, vegetables, bread and cereals) and fluids in the diet. Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding. A sitz bath – sitting in pain warm water for about 10 minutes – can also provide some relief.

With these measures, the pain and swelling of most symptomatic hemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks. In cases of severe, persistent pain, your physician may elect to remove the hemorrhoid containing the clot with a small incision. Performed under local anesthesia as an outpatient, this procedure generally provides relief.

Severe hemorrhoids may require special treatment, much of which can be performed on an outpatient basis.

Ligation – The rubberband treatment – works effectively on internal hemorrhoids that protrude with bowel movements. A small rubberband is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding.

Injection and Coagulation can also be used on bleeding hemorrhoids that do not protrude.
Both methods are relatively painless and cause the hemorrhoid to shrivel up.

Hemorrhoidectomy – surgery to remove the hemorrhoids – is the best method for the permanent removal of hemorrhoids. It is necessary when (1) clots repeatedly form in external hemorrhoids; (2) ligation fails to treat internal hemorrhoids; (3) the protruding hemorrhoid cannot be reduced; or (4) there is persistent bleeding. A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia and may, depending upon circumstances, require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful.

Other treatment include cryotherapy, BICAP coagulation and direct current. Cryotherapy, popular 20 years ago, consists of freezing hemorrhoidal tissue. It is not recommended for hemorrhoids because it is very painful. BICAP and direct current are methods that shrink the hemorrhoid. None of these treatments have gained widespread acceptance.