Colorectal

Piles (Haemorrhoids)

What are piles?

Piles (haemorrhoids) are swellings that develop inside and around the back passage (anal canal). There is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged with more blood than usual. The engorged veins and the overlying tissue may then form into one or more swellings (piles).

What are the different types of piles?

Piles can be divided into either internal or external piles. Some people develop internal and external piles at the same time

1. Internal piles are deeper and initially form above a point 2-3 cm inside the back passage (anal canal) in the upper part of the anal canal.
2. External piles start off nearer the surface, below a point 2-3 cm inside the back passage.

What is the cause of piles?

Straining puts pressure on veins in the anus or rectum, causing hemorrhoids. Any sort of straining that increases pressure on your belly or lower extremities can cause anal and rectal veins to become swollen and inflamed. Hemorrhoids may develop due to:

1. Pelvic pressure from weight gain, especially during pregnancy.
2. Pushing hard to have a bowel movement because of constipation.
3. Straining to lift heavy objects or weightlifting.

What are the symptoms of piles (haemorrhoids)?

Signs and symptoms of usually depend on the type of hemorrhoid.

External hemorrhoids

These are under the skin around your anus. Signs and symptoms might include:

1. Itching or irritation in your anal region
2. Pain or discomfort
3. Swelling around your anus
4. Bleeding

Internal hemorrhoids

Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:

1. Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
2. A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.

Thrombosed hemorrhoids

If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:

1. Severe pain
2. Swelling
3. A hard lump near your anus

What is the treatment of piles?

Piles, which are found incidentally and are of a small size without causing any symptoms can be left alone.Depending on the severity, piles are graded from grade 1-4. Generally grade 1 and 2 piles can be managed without any surgery while grade 3 and 4 usually require a surgeons help for treatment

Non-Surgical Treatment

1. Rubber band ligation: A small rubber band placed around the base of a hemorrhoid cuts off blood supply to the vein.n
2. Sclerotherapy: A chemical injected into the swollen vein destroys hemorrhoid tissue.
3. Surgical Treatment : For grade 3 and 4 haemorrhoids some form of haemorrhoid excision is needed.

The various surgical options are

1. Open Surgery for Piles: During an open surgery for piles, hemorrhoidal tissue is removed, but in this procedure the incision is left open. Now a days a very low percentage of patients opt for open procedure unless it is suggested by the surgeon for medical reasons.
2. Stapled haemorrhoidectomy: This is a day care procedure where there is no cut or wound on the outside and the pile mass is removed with a special device called a stapler which is fired deep inside the anus.

How can piles be prevented?

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

1. Eat high-fiber foods: Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
2. Drink plenty of fluids: Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.
3. Consider fiber supplements: Most people don't get enough of the recommended amount of fiber — 20 to 30 grams a day — in their diet. Fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), improve overall symptoms and bleeding from hemorrhoids.
4. Don't strain: Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
5. Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could dry out and be harder to pass.
6. Exercise: Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that might be contributing to your hemorrhoids.
7. Avoid long periods of sitting: Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

Anal Fissure

What is Anal Fissure?

An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.

What are the causes of Anal Fissure?

An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anus. Other common causes include:

1. straining during childbirth or bowel movements
2. inflammatory bowel disease (IBD), such as Crohn’s disease
3. decreased blood flow to the anorectal area
4. overly tight or spastic anal sphincter muscles

In rare cases, an anal fissure may develop due to:

1. anal cancer
2. HIV
3. tuberculosis
4. syphilis
5. herpes

Who is at risk of developing Anal Fissure?

Anal fissures are common during infancy.

Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area.

During and after childbirth, women are at risk for anal fissures due to straining during delivery.

People with Inflammatory bowel disease also have a higher risk for developing anal fissures.

People who frequently experience constipation are at an increased risk for anal fissures

What are the symptoms of Anal Fissure?

An anal fissure may cause one or more of the following symptoms:

1. sharp pain in the anal area during bowel movements
2. streaks of blood on stools or on toilet paper after wiping
3. burning or itching in the anal area
4. a visible tear in the skin around your anus
5. a skin tag, or small lump of skin, next to the tear

How is an Anal Fissure diagnosed?

Usually, an anal fissure can be diagnosed by visual inspection of the anus or by gentle exam with the tip of the finger.

How is an Anal Fissure treated?

1. using over-the-counter stool softeners
2. drinking more fluids
3. taking fiber supplements and eating more fibrous foods, such as raw fruits and vegetables
4. Soaking the anal area in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to help relax the anal muscles
5. applying topical ointment to promote blood flow to the area
6. applying topical pain relievers to the anus to ease discomfort

When does one need surgery for Anal Fissure?

If the anal fissure fails to respond to medical treatment, a surgical procedure called anal sphincterotomy is required. This surgical procedure involves making a small incision in the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal.

How can an anal fissure be prevented?

1. keeping the anal area dry
2. Wipe the area with soft materials, a moistened cloth, or cotton pad. Avoid rough and scented toilet paper.
3. drinking plenty of fluids, eating fibrous foods, and exercising regularly to avoid constipation
4. treating diarrhea immediately

Anal fistula

What is an anal fistula?

An anal fistula is a small channel that develops between the end of the bowel and the skin near your back-passage (anus).

How is an Anal Fistula formed?

An anal fistula is usually caused by an infection near your back passage (anus) that causes a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel (fistula) behind. An anal fistula may also be associated with certain long-term bowel conditions.

What are the causes of anal fistulas?

The leading causes of an anal fistula are clogged anal glands and anal abscesses. Other, much less common, conditions that can cause an anal fistula include:

1. Crohn’s disease (an inflammatory disease of the intestine)
2. Radiation (treatment for cancer)
3. Trauma
4. Sexually transmitted diseases
5. Tuberculosis
6. Diverticulitis (a disease in which small pouches form in the large intestine and become inflamed)
7. Cancer

What are the symptoms of an anal fistula?

The signs and symptoms of an anal fistula include:

1. Frequent anal abscesses
2. Pain and swelling around the anus
3. Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
4. Irritation of the skin around the anus from drainage
5. Pain with bowel movements
6. Bleeding
7. Fever, chills and a general feeling of fatigue

How is an anal fistula diagnosed?

An anal fistula is usually diagnosed by examining the area around the anus to look for an opening (the fistula tract) on the skin. In many cases, there will be drainage from the external opening.

Some fistulas may not be visible on the skin's surface. In this case additional tests may be needed:

1. An anoscopy is a procedure in which a special instrument is used to see inside your anus and rectum.
2. Your physician may also order an ultrasound or MRI of the anal area to get a better view of the fistula tract.
3. Sometimes your surgeon will need to examine you in the operating room (called exam under anesthesia) to diagnose the fistula.

What are the treatments for an anal fistula?

Surgery is almost always necessary to cure an anal fistula. The surgery is performed by a colon and rectal surgeon. The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged.

Fistulas in which there is no or little sphincter muscle involved are treated with a fistulotomy. In this procedure, the skin and muscle over the tunnel are cut open to convert it from a tunnel to an open groove. This allows the fistula tract to heal from the bottom up.

In the case of a more complex fistula, the surgeon may have to place a special drain called a seton, which remains in place for at least 6 weeks. After a seton is placed, a second operation is almost always performed:

1. A fistulotomy, or
2. An advancement flap procedure (the fistula is covered with a flap, or piece of tissue, taken from the rectum, like a trap door), or
3. A lift procedure (the skin above the fistula is opened up, the sphincter muscles are spread, and the fistula is tied off).

Can an anal fistula be prevented?

You can greatly reduce your risk of an anal fistula by avoiding constipation, keeping your stools soft and going to the toilet to open your bowels as soon as you feel the urge to go. To help your bowel work properly and keep your stools soft, it's important to drink lots of fluid and get regular physical exercise.

Pilonidal Sinus

What is Pilonidal Sinus?

A pilonidal sinus is a small hole or tunnel in the skin. It may fill with fluid or pus, causing the formation of a cyst or abscess. It occurs in the cleft at the top of the buttocks. A pilonidal cyst usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor.

A pilonidal sinus is a condition that mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.

What causes Pilonidal Sinus?

The exact cause of pilonidal cysts isn't clear. But most pilonidal cysts appear to be caused by loose hairs that penetrate the skin. Friction and pressure — skin rubbing against skin, tight clothing, bicycling, long periods of sitting or similar factors — force the hair down into skin. Responding to the hair as a foreign substance, the body creates a cyst around the hair.

What are the symptoms of Pilonidal Sinus?

You may not have any noticeable symptoms at first other than a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst (a closed sac filled with fluid) or an abscess (a swollen and inflamed tissue where pus collects).

The signs of an infection include:

1. pain when sitting or standing
2. swelling of the cyst
3. reddened, sore skin around the area
4. pus or blood draining from the abscess, causing a foul odor
5. hair protruding from the lesion
6. formation of more than one sinus tract, or holes in the skin

What are the treatment options for Pilonidal Sinus?

1. Draining the cyst: A small incision (cut) will be made to open and drain fluid from your infected cyst.
2. Injections: Injections (phenol, an acidic chemical compound) can treat and prevent mild and moderate pilonidal cysts.
3. Antibiotics: Antibiotics can treat skin inflammation. However, antibiotics can’t heal pilonidal cysts on their own.

Is surgery required for Pilonidal Sinus?

If you have a chronic pilonidal cyst or it has gotten worse and formed a sinus cavity under your skin, it’s a serious case and you may need surgery to excise (remove) the cyst entirely. Afterward, the surgeon might either leave the wound open for packing (inserting gauze) or close the wound with sutures or a skin flap (skin taken from a healthy part of your body).

Ulcerative Colitis

What is Ulcerative Colitis?

The large intestine (also called the colon) consists of the ascending, transverse, descending and sigmoid colon. The rectum is the last portion of the large intestine. Ulcerative Colitis occurs when the lining of your large intestine (also called the colon), rectum, or both becomes inflamed.

This inflammation produces tiny sores called ulcers on the lining of your colon. It usually begins in the rectum and spreads upward. It can involve your entire colon.

The inflammation causes your bowel to move its contents rapidly and empty frequently. As cells on the surface of the lining of your bowel die, ulcers form. The ulcers may cause bleeding and discharge of mucus and pus.

What is the cause of Ulcerative Colitis?

Researchers believe that UC may be the result of an overactive immune system. However, it’s unclear why some immune systems respond by attacking the large intestines and not others.

Factors that may play a role in who develops UC include:

1. Genes. You may inherit a gene from a parent that increases your chance.
2. Other immune disorders. If you have one type of immune disorder, your chance for developing a second is higher.
3. Environmental factors. Bacteria, viruses, and antigens may trigger your immune system.

What are the symptoms of Ulcerative Colitis?

The seriousness of Ulcerative Colitis symptoms varies among affected people. The symptoms can also change over time.

People diagnosed with Ulcerative Colitis may experience periods of mild symptoms or no symptoms at all. This is called remission. However, symptoms can return and be severe. This is called a flare-up.

Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:

1. Diarrhea or urgent bowel movements.
2. Abdominal (belly) cramping.
3. Tiredness.
4. Nausea.
5. Weight loss.
6. Anemia (reduced number of red blood cells).

Later you may also have:

1. Blood, mucous, or pus in bowel movements.
2. Severe cramping.
3. Fever.
4. Skin rashes.
5. Mouth sores.
6. Joint pain.
7. Red, painful eyes.

How is Ulcerative Colitis diagnosed?

Tests to diagnose UC often include:

1. Stool test. The stool is examined for certain inflammatory markers, blood, bacteria, and parasites.
2. Endoscopy. A flexible tube is used to examine your stomach, esophagus, and small intestine.
3. Colonoscopy. This diagnostic test involves insertion of a long, flexible tube into your rectum to examine the inside of your colon.
4. Biopsy. A surgeon removes a tissue sample from your colon for analysis.
5. CT scan. This is a specialized X-ray of your abdomen and pelvis.

Blood tests are often useful in the diagnosis of UC. A complete blood count looks for signs of anemia (low blood count). Other tests indicate inflammation, such as a high level of C-reactive protein and a high sedimentation rate. Your doctor may also order specialized antibody tests.

What is the treatment for Ulcerative Colitis?

There’s no cure for ulcerative colitis, but treatments can calm the inflammation, help you feel better and get you back to your daily activities. Treatment also depends on the severity and the individual, so treatment depends on each person’s needs. Usually, healthcare providers manage the disease with medications. If your tests reveal infections that are causing problems, your healthcare provider will treat those underlying conditions and see if that helps.

The goal of medication is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Healthcare providers use several types of medications to calm inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It can also relieve your symptoms so you have less pain and less diarrhea. Different types of medications used for the treatment of Ulcerative Colitis include

1. Aminosalicylates like sulfasalazine, mesalamine
2. Corticosteroids
3. Immunomodulators like Azathioprine
4. Biologics like infliximab, Adalizumab, Vedolizumab

Is surgery required for Ulcerative Colitis?

Surgery is an option if medications aren’t working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery (a colectomy) or during a colonoscopy.

sometime during their life.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy — a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch (a bag made from a part of the small intestine) to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening (stoma) in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.

After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. You’ll need to wear the bag at all times to collect waste. With proper care, the pouch doesn’t smell and isn’t noticeable under clothes.

Once you and the ileoanal pouch have healed, your surgeon will discuss taking down the ileostomy.

Your new ileoanal pouch still collects stool. That allows waste to exit your body through your anus as it would normally. Afterward, because you have less space in your large intestine to store poop, you’ll have frequent bowel movements (on average four to eight times a day once your body has adjusted). But you should feel a lot better when you recover from the surgery. The pain and cramping from ulcerative colitis should be gone.

Proctocolectomy and ileostomy

If an ileoanal pouch won’t work for you, your healthcare team might recommend a permanent ileostomy (without an ileoanal pouch). Your surgeon does a proctocolectomy to remove your colon and rectum. The second part of this surgery, done at the same time, is to perform a permanent ileostomy