Additional Symptoms and Diseases

Anal Abscess or Fistula

Symptoms: Pain and swelling in the rectum or anus along with fever and chills may be a sign of an anal abscess or fistula.

Diagnosis: Physical examination of the rectal area is necessary to visualize the infected cavity filled with pus (abscess) or the small tunnel (fistula) that forms under the skin to connect an infected anal gland to the skin on the buttocks.

Treatment: An abscess requires a small opening in the skin to drain the pus, which usually can be done in the clinic with a local anesthetic. Larger or deep-seated abscesses, or patients with diabetes or decreased immunity, may require general anesthesia and a short hospital stay. A fistula requires surgery by a colorectal surgical specialist. The procedure may involve cutting a small area of the sphincter muscle and then opening up the fistula tunnel. The external and internal openings of the tunnel are converted to a groove which will allow the fistula to heal. This surgery is usually done on an outpatient basis, although deep or extensive fistula may require a short hospital stay.

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Anal Cancer

Description: Cancer cells may arise around the anal opening or within the anal canal leading to the rectum.

Symptoms: A lump or mass at the anal opening, anal or rectal bleeding, pain in the anal area, persistent itching, change in bowel habits, narrowing of the stools, discharge of mucous or pus from the anus, and swollen lymph nodes in the anal or groin area may be signs of anal cancer.

Diagnosis: Routine digital (finger) exams of the anus and rectum help to diagnose anal cancer early. If cancer is suspected, a biopsy may be done to confirm the diagnosis. Once the cancer diagnosis is confirmed, additional studies will be done to determine the stage and extent of the cancer, which will help guide treatment planning.

Treatment: Combination radiation therapy and chemotherapy is considered the treatment of choice for anal canal cancer. Anal margin (adjacent to the anal opening) cancers are treated by surgical removal. Most anal cancers are treated effectively especially when diagnosed early.

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Anal Warts

Description: Caused by the human papilloma virus, a sexually transmitted disease, anal warts affect the skin around the anus, anal canal (inside), and may also affect the genital area. The warts may appear as tiny blemishes and grow over time to the size of a pea or larger.

Symptoms: Anal warts can cause pain, discomfort, and discharge. Often patients do not know that the warts are present.

Diagnosis: Anal warts are found on physical examination.

Treatment: Surgery or topical ointments can be used to treat the warts, otherwise the warts may grow larger and multiply. If left untreated, anal warts may become cancerous in some cases. Surgery may involve electrical cauterization, laser surgery, or excision, depending on the location and number of warts.

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Bowel Incontinence

Description: The inability to control the passing of gas or stool is called bowel incontinence, and the condition may range from mild to severe. Injury to the anal muscles or nerves may cause bowel incontinence. Injury may occur during childbirth, from infection, or from previous anal surgery, as well as from diseases that affect muscles and nerves, such as multiple sclerosis and diabetes. Even aging may cause bowel incontinence.

Symptoms: Leakage of diarrhea or stool and the inability to control bowel function before reaching the lavatory are signs of bowel incontinence.

Diagnosis: Physical examination of the anal region is required. Other studies may include anal manometry, which involves placing a small catheter into the anus to record sphincter muscle pressure and strength, or a nerve test to determine function. An ultrasound test of the anal muscles is usually required to determine the extent and location of injury.

Treatment: Dietary changes, medications, and home exercises may help mild cases of bowel incontinence. More severe cases may require surgery to repair the anal muscles.

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Crohn's Disease (Inflammatory Bowel Disease)

Description: Inflammatory bowel disease is the term for a group of chronic disorders of the gastrointestinal tract. The intestines become inflamed leading to ulcers or infection. Two of the most common disorders are Crohn's disease and ulcerative colitis. Crohn's disease can involve any portion of the intestinal tract from the mouth to the anus. Ulcerative colitis only involves the colon and rectum.

Symptoms: Inflammatory bowel disease may produce cramps, diarrhea, fever, and fatigue. More serious symptoms may include rectal bleeding, bloody stools, gastrointestinal bleeding, fistulas, liver inflammation, joint pain, clotting problems, and kidney stones.

Diagnosis: Endoscopic examination of the intestines such as sigmoidoscopy or colonoscopy, barium enema study, along with testing of stool for microorganisms is required.

Treatment: Our colorectal surgeons work closely with the gastroenterologists to maximize the patient's quality of life and conserve bowel. Conservative operations such as strictureplasty and limited resections can preserve intestinal length.

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Diverticular Disease

Description: Pockets that develop in the wall of the colon, called diverticula, can become inflamed and cause distress. Diverticulosis is the term for the presence of the colon wall pockets, and diverticulitis is the condition for inflamed pockets.

Symptoms: Diverticulitis may cause abdominal pain, bloating, nausea or vomiting, fever, and a change in bowel habits. Serious complications may include rupture, abscess, or fistula formation.

Diagnosis: X-ray and/or computed tomography (CT) scan of the abdomen may be required for diagnosis. Routine colonoscopies help to identify the diverticulae and exclude other, more serious conditions.

Treatment: Diverticulosis is treated with a high fiber diet. Mild cases of diverticulitis are treated with oral antibiotics. More severe cases require hospitalization for intravenous antibiotics. Surgery is necessary when patients experience recurrent severe symptoms or if severe bleeding occurs during any episode. Surgical treatment involves removal of the diseased part of the colon and reconnection of the colon. Patients should always seek medical advice for diverticulitis pain. Emergency surgery, because of the severity of the infection or rupture, may require a temporary colostomy to avoid additional complications.

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Hemorrhoids

Description: Hemorrhoids are anal tissues containing muscle, connective tissue, and blood vessels that are present at birth in everyone. External hemorrhoids occur near the anus, whereas internal hemorrhoids develop inside the anal canal, within the lining of the anus. Prolapsed hemorrhoids refer to internal hemorrhoid tissue that is enlarged and protrudes through the anal opening (also known as "piles").

Symptoms: Symptoms depend on the type of hemorrhoid. External hemorrhoids can cause no symptoms at all or result in swelling, pain, minor bleeding, or difficulty with anal hygiene. Internal hemorrhoids may also cause no symptoms or result in bleeding, pain, protrusion, mucus discharge, and a feeling of tissue within the anus. Bleeding may occur during defecation, and the blood will be bright red.

Diagnosis: Physical examination is required.

Treatment: Rubber band (ligation) treatment: Only for external hemorrhoids and performed in the office, in this procedure small rubber bands are placed at the base of the hemorrhoids to cut off the blood supply. Over time, the tissue below the bands will die and the hemorrhoids and rubber bands will be eliminated during defecation. Injection or coagulation treatment: For bleeding non-protruding hemorrhoids, this type of treatment works to shrivel up and resolve the hemorrhoids over time. Hemorrhoidectomy: This surgical procedure is done for the most severe cases of hemorrhoids, such as when other treatments fail and blood clots form or bleeding continues. Surgery is an outpatient procedure. Procedure for Prolapse and Hemorrhoids (PPH): This minimally invasive surgery uses a circular stapler device that works to lift up the anal canal tissue to prevent prolapse and reduce blood flow to internal hemorrhoids. The hemorrhoids will shrink usually within a month after the surgery. The PPH procedure helps reduce postoperative pain by avoiding the nerve endings in the anal canal.

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Pilonidal Disease

Description: Skin within the area of the buttock crease can become infected from embedded hairs. The chronic skin infection in this cleft area of the buttocks is called pilonidal disease and occurs most often in patients with thick body hair and in those who are obese.

Symptoms: A small or large abscess filled with fluid may develop, causing pain and infection. The abscess may burst and resolve on its own or require medical attention for drainage. Once the abscess resolves, however, many patients develop a cavity beneath the skin called a pilonidal cyst. This cavity may become re-infected and produce episodes of swelling, pain, and drainage.

Diagnosis: Physical examination is required.

Treatment: Pilonidal disease may require drainage of the abscess in the physician's office or surgery for chronic infection. Surgery may involve removal of the recurrent abscess, opening of the infected skin cavity, and in severe cases closure of the excised wound with skin flaps.

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Polyps of the colon or rectum

Description: Polyps are abnormal growths that arise from the surface of the colon or rectum and protrude into the intestinal canal.

Symptoms: Polyps rarely produce symptoms but sometimes can cause bleeding, mucous discharge, and change in bowel function.

Diagnosis: Polyps may be identified during diagnostic procedures such as colonoscopy or sigmoidoscopy or by Xray study with barium enema.

Treatment: Polyps are treated during colonoscopy by using a wire loop to snare and remove them. Small polyps may be destroyed using a coagulating electrical current. All removed polyps undergo pathologic examination to determine whether the cells are normal, precancerous, or cancerous. Precancerous polyps require regular follow-up colonoscopy. Patients found to have cancerous polyps will undergo additional testing and consultation to discuss a comprehensive treatment plan for cancer care.

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Ulcerative Colitis

Symptoms: Inflammatory bowel disease may produce cramps, diarrhea, fever, and fatigue. More serious symptoms may include rectal bleeding, bloody stools, gastrointestinal bleeding, fistulas, liver inflammation, joint pain, clotting problems, and kidney stones.

Diagnosis: Endoscopic examination of the intestines such as sigmoidoscopy or colonoscopy, barium enema study, along with testing of stool for microorganisms is required.

Treatment: Ulcerative colitis is managed in a multidisciplinary manner using state-of-the-art medications to optimize treatment and life style. Innovative therapies such as the ileoanal reservoir (J-pouch) allow patients to lead a higher quality of life and avoid a permanent ileostomy. Another option for selected patiens is a continent ileostomy or Kouch pouch. Ochsner colorectal surgions are the only surgeons in the gulf South perfoming this surgery.

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