Colorectal Surgery II
If you have hemorrhoids, you are not alone. Far from it! More than half of adults in America suffer from hemorrhoids. But few people with hemorrhoids ask their doctors for help. This might be because they are embarrassed, because they think the only treatment is painful surgery, or because they want to try home remedies before seeking medical advice. However, it is very important to tell your doctor if you think you may have hemorrhoids. Hemorrhoids detected early can usually be resolved with non-surgical in-office treatment.
Not only can your doctor help you find relief from discomfort, more important, he or she will also determine whether your symptoms are caused by hemorrhoids or by a number of other, potentially serious problems that cause the same or similar symptoms. These include anal fissures and fistulae, polyps, skin tags, pruritus, Crohn’s disease, Irritable Bowel Syndrome (IBS) or cancer.
Hemorrhoids – Overview
Hemorrhoids are swollen veins in the anal canal. These veins normally provide cushioning during bowel movements and may swell after repeated lifting, straining, constipation, passing hard stools, diarrhea, or pregnancy. Hemorrhoids aren’t life-threatening but they can be painful, and if swelling persists the veins may become permanently stretched (“prolapsed”).
Types of Hemorrhoids
There are two kinds of hemorrhoids: internal and external. The dentate line along the circular anus muscle divides the interior nerve canal, which has no nerve endings, from the anal opening and exterior areas, which do have nerve endings. Hemorrhoids that form in the anal canal are thus called internal hemorrhoids, while those outside the anal opening are called external hemorrhoids. External hemorrhoids are typically more uncomfortable at first because there are nerves present in the area where they form. However, internal hemorrhoids often swell beyond the dentate line, causing pain and other problems.
Symptoms of Hemorrhoids
Hemorrhoid symptoms vary in type and severity depending on such factors as a person’s age, anatomy and heredity and duration of the problem. The most common symptoms are bleeding, itching, burning, discomfort during bowel movements, and the feeling of fullness or of a mass in or on the anus.
Treatment for Hemorrhoids
Hemorrhoids should only be treated if they are painful or cause complications. To choose an appropriate treatment, the cause or causes need to be determined. Making changes to diet and fluid intake, toilet habits and exercise can relieve symptoms and prevent recurrence of the problem. Relief can also be found by treating related problems that irritate the hemorrhoid and affected areas (such as diarrhea and constipation).
Beyond this, treatment depends on the type and severity of the hemorrhoid as well as how it has responded to any previous treatment. Hemorrhoids are divided into four grades or stages depending on their history. Grade I and II hemorrhoids are usually treated non-surgically, while Grades III and IV are more likely to require surgical correction.
Hemorrhoid Treatments include:
Rubber Band Ligation (RBL)
An elastic band is wrapped around the hemorrhoid, cutting off blood supply and causing the tissue to die and drop off. External hemorrhoids and early-stage internal hemorrhoids can be treated with RBL.
Infrared Photocoagulation (IPC) or Electrocoagulation
The hemorrhoid is exposed to a warm, painless infrared light or electrical current over a series of treatment sessions.
A sclerosing solution injected into the blood vessels causes the hemorrhoids to shrink.
Surgery is usually reserved for very advanced cases with a large amount of protrusion. The hemorrhoid is removed with a scalpel, cautery device or laser (which causes less pain and shortens recovery time). Local or general anesthesia may be used and hospitalization is usually required, with recovery taking up to two weeks or a month.
This recently introduced procedure involves the insertion of a circular stapler into the rectum that pushes internal and external hemorrhoids and surrounding tissue up into the anal canal and staples them in place, cutting off blood supply.
The anorectal manometry procedure, or ARM, is used to evaluate the muscle tone of the internal and external anal sphincter muscles, the ones that control bowel movements and prevent leakage of stool.
This diagnostic test is commonly used to assess bowel movement issues such as chronic constipation, fecal incontinence or a failure of the muscles to relax during defecation, a condition known as anismus or dyssynergic defecation.
The Anorectal Manometry Procedure
The anorectal manometry procedure involves the use of a flexible tube that contains a small balloon at one end. The end with the balloon is inserted into the rectum and the other end is attached to a machine that measures the pressure of the anal sphincter. The balloon is then slowly and carefully inflated to various sizes. This allows the machine to measure the actions of the anal sphincter muscles and its varying pressure when flexed and relaxed.
The anorectal manometry procedure measures:
- Strength and movement of the anal sphincters
- Sensation of stool in the rectum
- Normality of reflexes that control bowel movements
During the procedure, which normally lasts from 30 to 45 minutes, the patient may be asked to relax or tighten their sphincter muscles. In some cases this test is performed on children as well as adults.
Colon & Rectal Cancer
Colorectal cancer, also known as colon cancer, develops in either the large intestine or the rectum. According to the Centers for Disease Control and Prevention (CDC), colorectal cancer is the second leading cause of cancer deaths in the United States.
Cancer occurs when healthy cells become altered, growing and dividing in a way that keeps the body from functioning normally. Most cases of colorectal cancer begin as small, benign clusters of cells (polyps) on the lining of the colon or rectum. Certain types of polyps, called adenomas, can become malignant.
Treatment of Colorectal Cancer
Depending on the stage of progression of the colorectal cancer, treatment may include one or more of the following:
- Surgical removal of diseased and immediately adjacent tissue
- Radiation therapy
- Targeted or biological therapy
Prevention of Colorectal Cancer
There are many steps that may be taken to lower the risk of developing colorectal cancer. Individuals may decrease their chances of developing this disease by eating a healthy low fat diet, high in fiber and antioxidants, drinking alcohol only in moderation, exercising regularly, maintaining a healthy weight and refraining from smoking.
For individuals at high risk for developing colorectal cancer, medications and surgery may be recommended. Everyone at high risk or 50 years of age and older, and African-Americans 45 years of age and older, should undergo a regularly scheduled colonoscopy, both to screen for cancer and to remove suspicious colorectal polyps at the earliest stage possible.
Anal cancer occurs when cancer cells form within the tissues of the anus. The anal canal or anus is a short tube at the end of large intestine and below the rectum through which stool leaves the body. Anal cancer is a rare condition that may produce symptoms such as bleeding from the anus or rectum or a lump that forms in the area. If anal cancer is diagnosed, depending on the stage of the disease, treatment may include radiation, chemotherapy, or surgery.
Stages of Anal Cancer
If anal cancer is diagnosed, additional diagnostic tests may be used to determine the stage of the cancer. Staging is based on where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. The stages of anal cancer range from stage 0 to stage 4.
In stage 0, abnormal cells are only in the first layer of the lining of the anus and may become cancerous. Stage I is characterized by a tumor that is less than 2 centimeters in size and has not spread to the lymph nodes or other parts of the body. Stage II tumors are larger than 2 centimeters but have not spread beyond the anal canal. Stage III tumors may be any size and the cancer has spread either to lymph nodes near the rectum or to other organs, such as the bladder, urethra or vagina. Stage IV anal cancer has spread to the lymph nodes and to distant parts of the body outside of the pelvis.
Treatment of Anal Cancer
Treatment for anal cancer depends on the stage of the cancer and the patient’s preferences and overall health. This disorder is often treated with a combination of chemotherapy and radiation. When they are combined, these methods enhance the effectiveness of treatment. Surgery may be recommended to treat early-stage small tumors or if a patient cannot have chemotherapy or radiation therapy.
Chemotherapy treatment involves using medication to destroy cancer cells. Chemotherapy medications are injected into a vein or taken orally as pills. The chemicals travel throughout the body, killing rapidly growing cells,such as cancer cells. Chemotherapy can cause troubling side effects such as nausea, vomiting, fatigue, hair loss and increased risk of infection.
Radiation therapy uses high-powered beams such as X-rays, to destroy cancer cells. A radiation machine is used to direct radiation beams to specific areas of the body to target cancer cells. Radiation therapy usually consists of a specific number of treatments given over a set period of time.
Surgery may be performed to remove a small tumor in the anus. During the surgical procedure, a surgeon removes the tumor and a small amount of healthy tissue that surrounds it. Surgery may also be recommended if the cancer remains after initial treatment or if it returns after treatment has been completed.
If the cancer is advanced, a more extensive surgical procedure called abdominoperineal (AP) resection may be performed. During an AP resection, the surgeon removes the anal canal, rectum and a portion of the colon. This procedure, however, results in the patient needing a colostomy bag, to collect waste or feces as it leaves the body.
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