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Anal Fissure Q & A

The anal canal is a short tube at the end of your rectum. The canal is surrounded by the sphincter muscles that control the release of stool.

An anal fissure is a small tear in the lining of the anal canal. Fissures are usually caused by trauma to the lining of the canal. Passing hard, dry, or large stools, or having frequent bowel movements can lead to an anal fissure.

Diarrhea that irritates the tissues can also cause a fissure. Less frequently, an anal fissure may be due to inflammatory bowel disease, infections, or tumors.

Anal fissures cause a sharp pain that begins during a bowel movement and may last several minutes to hours. You may also discover bright red blood on the stool or toilet paper.

When the fissure hasn’t healed within six weeks, it’s considered to be a chronic anal fissure. Chronic fissures often develop a small lump or skin tag on your skin near the tear.

Most anal fissures heal on their own, supported by treatments such as:

  • Taking a stool softener
  • Following a high-fiber diet that includes fruits, vegetables, and whole grains
  • Taking daily fiber supplements to reach a total daily fiber intake of 25-30 grams
  • Soaking in warm water two or three times daily for about 10 minutes
  • Avoiding foods that cause constipation (cheese, white rice, white bread, pasta)

Your doctor at California Colorectal Surgeons may also prescribe a topical medication to relax sphincter muscles.

When your fissure doesn’t heal, Botox® may be injected to temporarily relax the muscle. However, surgery is often needed for chronic fissures that don’t respond to medical treatment.

During surgery, your physician at California Colorectal Surgeons removes any scar tissue and cuts a precise portion of the anal sphincter muscle. This stops muscle spasms that pull on the fissure, giving it time to heal.

Anal fissure surgery seldom affects the sphincter muscle’s ability to control bowel movements, although 5-10% of patients may have occasional gas incontinence or minor mucous leakage at night until the muscle heals.

Your pain should go away a few days after surgery, and the muscle and fissure should heal within a few weeks.

Any time you experience anal pain or notice bleeding following a bowel movement, call California Colorectal Surgeons or book an appointment online.

Anal Fistulas Q & A

A fistula is an abnormal connection that forms between two body parts that are usually separated. An anal fistula occurs when a link is created between an infected anal gland and the perianal skin surrounding the anus.

The anal fistula develops when excess pus from the abscessed gland seeps out and creates a small channel that breaks through the delicate skin around the anus.

Although it’s not as common as an infected gland, an anal fistula may also arise due to a complication of Crohn’s disease, anal fissures, or another infection.

If you have an anal fistula, you’ll experience symptoms such as:

  • Red or itchy skin around the anal area
  • Pain and swelling around your anus
  • Drainage of pus from the fistula
  • Fever and chills

Once an anal fistula develops, it can’t be cured with medications like antibiotics. The only treatment is surgery.

Your physician at California Colorectal Surgeons can diagnose an anal fistula with an in-office examination. When you have a complex or deep fistula, you may also undergo imaging studies.

Surgical options for treating an anal fistula include:

Simple Fistula
When your fistula is small and doesn’t involve a large amount of sphincter muscle, your surgeon performs a laser fistulotomy to open the drainage tract. This allows the fistula to heal on its own.

Complex Fistula
Fistulas are complex when they have a long or deep tract, several tracts, or they involve the sphincter muscle. Your physician at California Colorectal Surgeons chooses the surgery that’s best for your condition and that causes the least muscle damage.

Three possible procedures for a complex fistula are:

Endorectal Advancement Flap
Using the rectal wall lining, your surgeon creates a flap, then uses it to close the inside opening of the fistula tract.

Ligation of Intersphincteric Fistula Tract (LIFT)
The fistula tract is sutured closed at its inner and outer openings, and the tract is removed. The LIFT procedure preserves the sphincter muscle.

Anal Fistula Plug
Your surgeon plugs the fistula with a piece of material that fills the length of the tract. Over time, it promotes tissue healing.

If you develop pain around your anus, comprehensive care is available at California Colorectal Surgeons — call or book an appointment online.

Colon Cancer Q & A

Screening for Colorectal Cancer

More than 95% of all colon cancers begin as non-cancerous polyps that grow in the lining of the colon (large intestine). These polyps become cancerous when cellular DNA is damaged and cells in the polyps grow too rapidly, ultimately forming a tumor.

In its early stages, colon cancer doesn’t cause symptoms. You’ll only begin to experience symptoms after the tumor grows or spreads, then you’ll develop:

  • Change in bowel habits such as diarrhea, constipation, change in stool consistency, or narrow stools
  • Feeling your bowel doesn’t empty
  • Blood in your stool (bright red or dark)
  • Abdominal cramps or pain
  • Feeling full or bloated
  • Unexplained weight loss
  • Nausea or vomiting
  • Fatigue

It’s important to know that colon cancer seldom causes pain. If you experience any of the symptoms listed above, don’t wait to feel pain—schedule an appointment with California Colorectal Surgeons.

There are many possible risk factors for colon cancer. Age increases your risk because most colon cancers develop after the age of 40 or 50. Other risk factors include:

  • History of colon polyps
  • A family history of colon cancer
  • Personal history of colon cancer
  • Smoking cigarettes
  • Physical inactivity
  • Being overweight
  • Diet high in red meat and processed meat
  • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)

Heavy alcohol use is also associated with a higher risk of colon cancer.

In addition to changing your lifestyle to lower your risk factors, you can prevent colon cancer with a colonoscopy. During a colonoscopy, your doctor at California Colorectal Surgeons finds and removes polyps before they become cancerous, or when they’re still in an early stage of cancer.

All adults should undergo a colonoscopy around the age of 45 or 50. Your doctor may recommend earlier screening if you’re at high risk for colon cancer.

Colon cancer is treated with surgery. Using minimally invasive techniques such as laparoscopic or robotic surgery, the physicians at California Colorectal Surgeons remove the affected portion of your colon along with its blood supply and associated lymph nodes. Then the two ends of the colon are reconnected to maintain bowel function.

If your cancer is advanced, surgery may be preceded or followed by chemotherapy. Chemotherapy prior to surgery helps to shrink the tumor, while it’s used after surgery to eliminate any remaining cancer cells.

When you need expert treatment for colon cancer, you can depend on the team at California Colorectal Surgeons. To schedule an appointment, call or book a visit online.

Colonoscopy Q & A

A colonoscopy is a procedure to examine, diagnose, and treat the inside of your rectum and colon. Your physician at California Colorectal Surgeons uses a colonoscope, which is a thin, flexible tube that contains lighting and a video camera. As it’s gently guided through your colon, it transmits high-definition images of the colon wall.

As a screening tool, a colonoscopy allows your surgeon to find polyps and colon cancer. A colonoscopy may also be used to determine the cause of symptoms such as rectal bleeding, diarrhea, or constipation.

If problems are identified during a colonoscopy, specialized instruments inserted through the colonoscope are used to remove polyps, take a tissue biopsy, open a blockage, or stop bleeding.

Colon cancer starts as a non-cancerous polyp that grows in the lining of your colon or rectum. Using a colonoscopy to remove polyps at an early stage can prevent colon cancer.

Most people should have a screening colonoscopy at the age of 45 or 50. However, you may need earlier screening if you have a higher risk of colon cancer due to:

  • History of inflammatory bowel disease
  • A family history of colon cancer or polyps
  • Cigarette smoking
  • Low-fiber diet

Being overweight also increases your risk of developing colon cancer.

When you undergo a colonoscopy, your doctor at California Colorectal Surgeons must be able to see the lining of your large intestine. This means that all waste must be thoroughly removed prior to your procedure, so you’ll receive instructions for cleansing your colon.

In addition to following a liquid diet, you’ll need to take a bowel preparation solution. Although it doesn’t taste great, it’s the most important step you can take to ensure a successful colonoscopy.

You’re sedated during your colonoscopy, but the medication is short-acting and you’ll easily wake up. The procedure takes less than a half hour, then you stay in the recovery room for 30-45 minutes.

You’ll be able to eat normally when your procedure is finished, but you should plan to relax the rest of the day. You can get back to your usual activities the next day.

If you need to schedule a colonoscopy, call California Colorectal Surgeons or book an appointment online.

Hemorrhoids Q & A

The area surrounding your anus is served by a network of blood vessels that form vascular cushions. Hemorrhoids develop when veins in these networks become inflamed and swollen. As the veins enlarge, you can develop two types of hemorrhoids:

  • Internal hemorrhoids, which form in the lining of the anus and lower rectum
  • External hemorrhoids, which form under the skin around your anus

Both types of hemorrhoids are quite common in men and women.

The veins around your anus stretch and enlarge under pressure, which may be caused by:

  • Sitting on the toilet for a long time
  • Chronic constipation or diarrhea
  • Frequently lifting heavy objects

Hemorrhoids commonly develop during pregnancy and delivery. Natural age-related changes that weaken the tissues also increase your risk of hemorrhoids.

Bleeding is the most common symptom of internal hemorrhoids. You’ll notice bright red blood on the toilet paper or in the toilet bowl.

Internal hemorrhoids can prolapse when straining or pressure pushes them through the anal opening. When that happens, the hemorrhoids may become painful or cause a mucus discharge.

External hemorrhoids typically cause pain and itching. You may also feel one or more tender lumps near your anus or experience pain when sitting for an extended period.

If you have sudden, severe pain, swelling, or inflammation, it’s a sign that an external hemorrhoid has developed a blood clot.

If your hemorrhoids are mild, eating a high-fiber diet and drinking plenty of fluids may relieve your symptoms. It’s also important to stop straining during bowel movements and to limit the amount of time spent sitting on the toilet, as that increases pressure on the veins.

If conservative treatments fail to provide relief, or the hemorrhoid develops a blood clot, you may need to have the clot or entire hemorrhoid removed.

The experts at California Colorectal Surgeons perform a variety of procedures, from simple, painless office procedures to advanced surgical techniques that treat your hemorrhoid with minimal pain.

In-office procedures include:

  • Infrared coagulation, in which heat from an infrared light shrinks the hemorrhoid
  • Rubber band ligation, in which a rubber band placed on the hemorrhoid blocks blood flow, causing the hemorrhoid to shrink and fall off
  • Sclerotherapy, in which an injected chemical solution shrinks the hemorrhoid

Surgical procedures include:

Traditional Hemorrhoidectomy
This is surgery to remove external and internal hemorrhoids.

Procedure for Prolapsing Hemorrhoids (PPH)
Your doctor uses a stapling device to remove hemorrhoidal tissue and attach remaining tissues back in their normal position.

Transanal Hemorrhoidal Dearterialization (THD)
Also called incision-less hemorrhoid surgery, this minimally invasive procedure uses Doppler ultrasound to locate the blood vessels serving the hemorrhoid, then ties off the vessel, blocking blood flow and shrinking the hemorrhoid.

If you experience bleeding or rectal pain, call California Colorectal Surgeons or book an appointment online.

Pilonidal Disease

Pilonidal disease is a chronic skin infection in the crease of the buttocks near the tailbone. It occurs more commonly in men than women, and symptoms most often occur between puberty and age 40. The cause of pilonidal disease is not completely understood. Hair often grows in the cleft (crease) between the buttocks, and these hairs can traumatize and penetrate the skin at the top of the buttock crease. Friction and pressure from rubbed skin, tight clothing, cycling, or extended periods of sitting can force hair into the skin. The result can be irritation, infections, and the formation of an abscess. Symptoms can vary from mild to severe.

Symptoms include:

Small dimple or pit near the top of the buttocks crease
Irritation
Pain
Pus or blood leaking from an opening in the skin
Swelling or redness
Diagnosis is typically confirmed by a physician's exam of the buttocks area, and treatment depends on the disease pattern. For pilonidal disease without abscess, the primary therapy is keeping the area free of hair. Weekly or bi-weekly topical depilatories or shaving is an option but can be difficult because of the location (unable to see) and deep crease. Hair removal is a more permanent option.

For Pilonidal disease with abscess, the treatment is abscess drainage followed by removal of hair within the abscess cavity. An incision is made that allows the pus to drain, reducing inflammation and pain. This procedure can usually be done in an office-based setting using local anesthesia. Complex or recurring infections are treated surgically through excision or unroofing (opening) the sinuses. Continued hair removal following surgery is important to reduce the risk of recurrence.

Rectal Cancer Q & A

Rectal cancer is like colon cancer in that it most often begins as non-cancerous polyps that develop in the rectal wall, then become cancerous when cells begin to grow abnormally. However, rectal cancer develops in the last 6 inches of the large intestine, which is the rectum.

In most cases, you won’t have any symptoms in the early stages of rectal cancer. As the cancer grows, you may notice a change in your bowel habits, such as constipation or diarrhea. Your stools may be more narrow than normal or contain blood. In later stages of rectal cancer, you may experience pelvic pain and unexplained weight loss.

You’re more likely to develop rectal cancer as you get older, as most cases are diagnosed over the age of 50. Your chances of rectal cancer also increase if you have a family history of rectal cancer, a personal history of inflammatory bowel disease, or polyps that were previously found in your rectum.

Smoking cigarettes, excessive alcohol consumption, physical inactivity, and obesity are also potential risk factors for rectal cancer.

Rectal cancer is preventable when polyps are detected and removed before they become cancerous. All adults at average risk for rectal cancer should undergo screening around the age of 45 to 50 years.

Although stool-based tests screen for the presence of blood, your doctor will need to perform a sigmoidoscopy or colonoscopy to take a biopsy and diagnose the cause of the bleeding.

Alternatively, you can choose to get a sigmoidoscopy or colonoscopy without the stool test so that your doctor at California Colorectal Surgeons can visually examine the rectum and remove polyps.

Rectal cancer must be surgically removed, along with lymph nodes, but the surgery is challenging because the rectum resides deep within the bony pelvis and shares the small space with other organs.

Depending on the stage and location of your cancer, your surgery may be done through the anus or the abdomen. You may also undergo chemotherapy before or after your surgery.

When the team at California Colorectal Surgeons performs rectal cancer surgery, they use minimally invasive techniques and sphincter-saving surgery.

Whether you need an exam and diagnosis of your symptoms, or you know you need rectal cancer surgery, call California Colorectal Surgeons or book an appointment online.