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Diagnosis & Treatment

Anorectal Conditions

Hemorrhoids are enlarged bulging blood vessels in and about the anus and lower rectum.

There are two types of hemorrhoids:

  • External (outside) hemorrhoids develop near the anus and are covered by sensitive skin. They are usually painless but if a blood clot (thrombosis) develops, it becomes a painful hard lump.
  • Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. An internal hemorrhoid can cause severe pain if it is completely protrudes from the anal opening and cannot be pushed back inside.

Hemorrhoids are graded to determine treatment options:

  • Grade one: No prolapse
  • Grade two: Prolapse that goes back in on its own
  • Grade three:   Prolapse that must be pushed back in by the patient
  • Grade four:     Prolapse that cannot be pushed back in (often very painful)

Treatment will depend on the severity of your symptoms. Your Colorectal Surgeon will decide the best treatment option for your hemorrhoids. These may include:

  • Rubber band ligation is done by using a tight elastic band placed around the base of the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to fall off.
  • Infrared coagulation is done using a small probe that exposes the hemorrhoid to short bursts of infrared light. This seals off the blood vessel, causing it to shrink.
  • Thrombosed external hemorrhoid is excised as an outpatient. The hemorrhoid is injected with a local anesthetic. A small incision is made and the hemorrhoid is removed.
  • Hemorrhoid stapling is a technique that uses a special device to internally staple and excise the internal hemorrhoid tissue. This treatment is used for internal hemorrhoids only as an outpatient at the hospital.
  • Hemorrhoidectomy is a surgical procedure performed at the hospital using general anesthesia. This procedure removes the hemorrhoids and is the most complete method for removal of internal and external hemorrhoids. It is necessary when clots repeatedly form in external hemorrhoids, ligation fails to treat internal hemorrhoids, the protruding hemorrhoid cannot be reduced, or there is persistent bleeding.

Anal Fissure is a small tear or cut in the skin that lines the anus. Fissures typically cause pain and often bleed. A fissure that fails to respond to treatment may require surgery. Surgery is a highly effective treatment for a fissure and recurrence rates are low.

Sphincterotomy is a small surgery used to cut a portion of the internal anal sphincter muscle. This helps the fissure heal and decreases pain and spasm.

Anal Abscess is an acute infection of a small gland just inside the anus. An anal abscess is treated by making an opening in the skin near the anus to drain the pus from the infected cavity. This can be done in the doctor’s office using a local anesthetic. If the abscess is large or deep, the abscess may require hospitalization and the use of a general anesthetic.

Anal Fistula is almost always the result of a previous abscess. After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the persistence of this tunnel.

Fistulotomy is surgery to cure an anal fistula. A fistulotomy is performed as an outpatient procedure in the hospital and involves opening up the fistula tunnel. Joining the external and internal openings of the tunnel and converting it to a groove will then allow it to heal from the inside out.

Anal Warts (condyloma acuminata) are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. Anal warts are thought to be caused by the human papilloma virus and can grow larger and spread if not removed. Human papilloma virus is transmitted from person to person by direct contact and is considered a sexually transmitted disease.  Anal warts can be treated with a topical medication, by freezing the warts with liquid nitrogen and may also be surgically removed using an anesthetic.

Endoscopy of the colon and rectum

Flexible sigmoidoscopy is a safe, effective means of visually examining the lining of the sigmoid colon and rectum, using a long, flexible, sterilized, tubular instrument.

Colonoscopy is similar to sigmoidoscopy but the lining of the entire length of the colon is examined. Most colonoscopies are done under sedation on an outpatient basis with minimal inconvenience and discomfort.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a common disorder. It is sometimes referred to as spastic colon, spastic colitis, mucous colitis or nervous stomach. IBS should not be confused with other diseases of the bowel such as ulcerative colitis or Chrohn’s disease. IBS can often be managed by dietary changes. Some patients benefit from prescribed medications.

Symptoms of IBS are abdominal bloating, changes in bowel habits – either diarrhea, constipation or both at different times. Other symptoms are abdominal cramps, abnormal stool consistency, passage of mucous, urgency or a feeling of incomplete bowel movements.

Inflammatory Bowel Disease

Crohn’s Disease is a chronic inflammatory process primarily involving the intestinal tract. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum). The exact cause is not known. Crohn’s disease is not contagious. Initial treatment is always with medication. In more advanced or complicated cases of Crohn’s disease, surgery may be recommended. Not all patients with Crohn’s disease require surgery. This decision is best reached through consultation with your colon and rectal surgeon.

Ulcerative colitis is an inflammation of the lining of the large bowel (colon). Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss and fever. Initial treatment of ulcerative colitis is medical, using antibiotic and anti-inflammatory medications.

Surgery is indicated for patients with life threatening complications of inflammatory bowel disease such as bleeding, perforation or infection.

Ileoanal J-Pouch is the newest alternative for the management of ulcerative colitis. Your Colon and Rectal Surgeon is trained in this procedure. The Surgeon removes all of the colon and rectum, but preserves the anal canal. The rectum is replaced with small bowel, which is refashioned to form a small pouch. The pouch acts as a reservoir to help decrease the stool frequency. This maintains a normal route of defecation, but most patients experience five to ten bowel movements per day. This operation all but eliminates the risk of recurrent ulcerative colitis and allows the patient to maintain a normal route of evacuation.

Pruritis Ani is itching around the anal area. A common cause of pruritis ani is excessive moisture in the anal area. Moisture may be due to perspiration or a small amount of residual stool around the anal area. Puritis ani may also be a symptom of hemorrhoids and anal fissures. The initial condition can be made worse by scratching, vigorous cleansing of the area or overuse of topical treatments. A careful examination by a colon and rectal surgeon can help identify the cause for the itching.

Rectal Prolapse is a condition in which the rectum turns itself inside out. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage and may result in leakage of stool or mucus. A videodefecogram may be used to demonstrate the prolapse. Anorectal manometry may also be used to measure the muscle around the rectum. Surgery may be suggested. Your colon and rectal surgeon can help you decide which method will most likely achieve the best result by taking into account many factors such as age, physical condition, extent of prolapse and the results of various tests.

Rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thinned and weak and it may balloon out in the vagina when you push down to have a bowel movement. The underlying cause of a rectocele is a weakening of the pelvic support structures. A rectocele is diagnosed using an x-ray study called a defecagram. This study shows how large the rectocele is and if it empties with evacuation.

Physiological testing (Intestinal and Anorectal) evaluation and management of:

  • Anal incontinence
  • Anorectal pain
  • Constipation
  • DiarrheaRectal prolapse
  • Anal sphincter and pelvic floor

Specialized studies used for diagnosing symptoms related to the colon and rectum:

Videodefecogram is an examination which takes x-ray pictures while the patient is having a bowel movement. This study can also assist the physician in determining whether surgery may be beneficial and which operation is appropriate.

Anorectal manometry is a test that measures whether or not the muscles around the rectum are functioning normally.


Why Central Texas Colorectal and General Surgery?

As a part of Hillcrest Baptist Medical Center, Scott & White Healthcare, Central Texas Colorectal and General Surgery strives to provide excellence in patient care through providing comprehensive Colorectal and General Surgery services in the Central Texas Area.