Conditions Treated The Conditions Our Dependable Team Has Treated Benign Polyps There are various types of polyps that can be found in the large bowel. The most common type of colon polyp is the adenoma which is a benign tumor (premalignant) that has the potential to develop into an invasive cancer if left in place and allowed to grow for years. Very rarely, polyps are found that have already developed into small cancers; these are called polyp cancers. Some polyps have begun the transformation to cancer; in this situation, microscopically, the polyp cells more closely resemble a cancer than an adenoma yet there is no invasion beyond the innermost layer of the colon wall. These are given the name dysplastic polyps or “carcinoma in situ”. Colorectal Cancer Colon and rectal cancer is the 2nd or 3rd most common cause of cancer-related death in the United States. In the U.S. about 150,000 new cases are diagnosed each year. The colon and rectum are the 2 parts of the large intestine (or large bowel). The rectum is the last 5 inches of the large bowel that leads to the anus. The colon is about 3 to 4 feet in length and runs from the small intestine to the rectum. The vast majority of colorectal cancers start as benign polyps that develop from the inner lining of the large bowel that is called the mucosa. Although the exact time varies from patient to patient it is thought that, on average, it takes about 5 to 7 years for a polyp to develop into an invasive cancer. Periodic colonoscopy examinations are advised in order to detect and destroy benign polyps before they have the opportunity to develop into a cancer (see colonoscopy section). Colonoscopy is the most common way cancers are diagnosed. Diverticulitis Colonic diverticuli are small pouches or sacs that protrude outwards from the colon wall. Although they can be found in any part of the colon by far and away the most commonly involved segment is the sigmoid colon. It is believed that the great majority of diverticuli are acquired, meaning that they develop during the course of a person’s life. Although no one is certain, most experts believe that diverticuli form as a result of high pressure in the colon that develops when the large bowel contracts. The colon moves stool towards the anus by periodically contracting in a sequential fashion. These contractions temporarily raise the pressure in the colon. In some patients the pressures that develop can be quite high and it is thought that over the course of years the outpouchings slowly develop. Some experts believe the typical low fiber Western diet results in hard dense stools and contributes to the development of diverticuli since the colon must generate higher pressures to move hard stool through the bowel. The rate of diverticulosis in non-vegetarians is almost 3 times higher than in vegetarians. It is estimated that at least 30 % of Americans over the age of 60 and perhaps 60 % of those over 80 have “diverticulosis” which is the name given to patients who have diverticuli in one or more parts of the colon. Inflammatory Bowel Disease Inflammatory bowel disease (IBD) is a term used to describe two intestinal conditions, Crohn’s Disease and Ulcerative Colitis that are characterized by inflammation of the lining of different parts of the gut. What is unique about these 2 diseases is that the intestinal inflammation is not caused by infection, drug reaction, radiation, or a lack of blood supply (which are the most common causes of GI tract inflammation). In patients with IBD no clear cause can be found for the intestinal inflammation. Ulcerative Colitis (UC), with few exceptions, involves only the large bowel (colon and rectum) whereas Crohn’s Disease (CD) may involve both the small and large bowel (and rarely the stomach as well). Colostomy / Ileostomy There are times during colon surgery that it may be necessary for the surgeon to create an ostomy. An ostomy is a surgically created opening, usually in the abdominal wall for the discharge of body wastes. The intestines are “re routed” so that instead of the stool passing through the colon and out the rectum, there is and opening for effluent to pass through the abdominal wall and in to an external pouch. The opening that is seen on the abdominal wall is called a stoma. Rectal Prolapse Rectal prolapse is a condition where the rectum turns itself inside out and protrudes outside of the anus either a short or long distance (up to 6 inches or more). Rectal prolapse usually occurs during bowel movements and although in many patients the prolapse spontaneously returns back into the body after the BM, in advanced cases it may remain outside. If stuck outside, external pressure may need to be applied in order to push it back into the anus. When the prolapsed rectum is outside the body it often causes pain and discomfort and can also make walking and moving difficult. In patients who have had rectal prolapse for a long time the anal sphincter muscles may become weak and this weakness usually results in leakage of stool and gas (fecal/gas incontinence) may develop. Although it can be seen in men, it develops far more often in women. For unclear reasons it can found both in women who have had many children as well as those who have had no children. Patients with rectal prolapse often seek surgical treatment. Anal Fissures An anal fissure is a vertical tear or crack of the anal skin that is usually found either posteriorly (closest to the sacrum) or interiorly (part of the anus adjacent to the vagina or base of the scrotum). The tear is vertically oriented (along the axis of the anus). The most common symptoms are pain with defecation and bleeding during and following BM’s. Patients commonly recall a difficult BM during which they felt a tearing sensation and pain. In many but not all cases anal fissures are associated with hard BM’s or constipation and the need to strain severely. In contrast and far less commonly, fissures may develop in the setting of diarrhea or frequent BM’s. Fissure-related pain often lingers after the BM and, in more severe cases, can last hours. Blood may be seen in the toilet water, on the stool, or on the toilet paper. There are a small percentage of fissure patients who report no symptoms. Anal Fistulas Anorectal abscesses are infections that develop in and around the anus. They usually result in a swelling, constant pain, and sometimes fever. The pain is usually not relieved or made worse by BM. Anorectal abscesses, if left long enough will usually spontaneously drain pus through an opening that develops in the overlying skin. The drainage of pus from the infected cavity lessens or relieves the pain and swelling. In some patients, after spontaneous drainage, the abscess fully resolves without further incident. Sometimes, however, the abscess does not fully empty. In this situation the infection persists and continues to drain either on a daily or intermittent basis. Patients with an abscess that has spontaneously drained but persists need to see a surgeon and undergo an incision and drainage.