Services We Offer Anal Fissure Q & A What Causes an Anal Fissure? 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. What Symptoms Will I Develop From an Anal Fissure? 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. How Is an Anal Fissure Treated? 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. Diverticulitis Q & A What Is Diverticulitis? Diverticula develop when a small area in the wall of your digestive tract protrudes out, forming a tiny pouch or sac. Although diverticula can occur anywhere along your intestine, they typically arise on the lower left side of the large intestine, where the pressure is higher compared with the rest of the colon. Diverticula may be caused by: A low-fiber diet that slows down stool movement, causes constipation, and increases pressure High pressure in the colon worsened by constipation and problems like motility disorders Structural abnormalities such as weakness in the colon wall When diverticula are present, you have a condition called diverticulosis. Most patients with diverticulosis never experience problems or symptoms, but when the pouch becomes infected and inflamed, you have diverticulitis. What Symptoms Might I Develop Due to Diverticulitis? Diverticulitis primarily causes pain, which may be mild to sharp, depending on the severity of the infection. You may also develop a fever, nausea and vomiting, constipation, or possibly diarrhea. Severe cases of diverticulitis can cause a perforated colon, or an opening through the colon wall, which allows an infection to spread into your abdominal cavity. How Is Diverticulitis Treated? A mild case of diverticulitis can be treated at home with dietary restrictions and prescription antibiotics. In moderate cases, you may need to stay in the hospital so you can receive intravenous antibiotics, bowel rest, and close monitoring. The team at California Colorectal Surgeons performs surgery when you have a perforated colon, a fistula develops, the infection doesn’t respond to antibiotics, or you have recurrent diverticulitis. When diverticulitis leads to perforation, your surgeon removes the damaged portion of the colon and installs a temporary colostomy bag. In cases of recurrent diverticulitis, your surgeon can usually reconnect the two ends of the colon. In many cases, your physician at California Colorectal Surgeons repairs diverticulitis with minimally invasive surgery. This type of surgery is done using long, narrow instruments placed through a few very small incisions. An instrument called a laparoscope is inserted through one incision. It holds a camera and lighting to provide a magnified view of the surgical site. Then your surgeon may insert specialized surgical tools through the laparoscope, or use another small incision. Since minimally invasive surgery causes significantly less trauma compared with the single, long incision of open surgery, your benefits include less postoperative pain, a shorter hospital stay, and a quicker recovery. If you develop pain in your lower left abdomen, call California Colorectal Surgeons or book an appointment online. Anal Fistulas Q & A What Causes an Anal Fistula? 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. What Symptoms Might I Develop Due to an Anal Fistula? 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. How Is an Anal Fistula Diagnosed and Treated? 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 FistulaWhen 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 FistulaFistulas 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 FlapUsing 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 PlugYour 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. Hemorrhoids Q & A What Are the Different Types of Hemorrhoids? 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. What Causes Hemorrhoids? 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. What Symptoms Might I Develop if I Have 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. How Are Hemorrhoids Treated? 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. Colon Cancer Q & A Screening for Colorectal Cancer What Causes Colon 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. What Symptoms Will I Develop From Colon Cancer? 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. What Increases My Risk of Colon Cancer? 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. How Can I Prevent 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. How Is Colon Cancer Treated? 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. Rectal Cancer Q & A What Is Rectal Cancer? 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. What Symptoms Might I Develop Due to Rectal Cancer? 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. Am I at Risk for Rectal Cancer? 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. Can I Prevent 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. How Is Rectal Cancer Treated? 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. Colonoscopy Q & A What Is a Colonoscopy? 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. What Should I Know About Colon Cancer? 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. What Should I Expect Before and During a Colonoscopy? 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. Robotic Surgery Q & A Robotic Surgery What Is Minimally Invasive Surgery? Minimally invasive surgery is performed using specially designed instruments that are long and narrow, so they can be inserted through very small incisions. The key instruments for minimally invasive colorectal surgery include a sigmoidoscope (used in the rectum and sigmoid colon), a colonoscope (for the large intestine), and a laparoscope (used for pelvic or abdominal surgery). These scopes are equipped with a tiny video camera and lighting, which give your doctor at California Colorectal Surgeons a magnified view inside your body. Depending on the type of surgery, the instruments may be inserted alongside the scope or through other small incisions. What Are the Benefits of Minimally Invasive Surgery? The small incisions used during minimally invasive surgery cause significantly less trauma compared with the single, long incision made during conventional open surgery. As a result, you gain health benefits such as: Less bleeding during surgery Minimal pain following surgery Quicker recovery Little-to-no scarring Earlier return to normal activities Many minimally invasive procedures may be done on an outpatient basis, so you can go home the same day. If you need to be hospitalized, your stay is shorter compared with open surgery. What Is Robotic Surgery? Robotic surgery is a type of laparoscopic surgery that the team at California Colorectal Surgeons uses for a variety of surgical procedures. However, it’s especially beneficial for pelvic surgery, including treatment of rectal cancer, rectal prolapse, and enterocele repair. Robotic surgery is more accurately called robot-assisted surgery. The robotic arms are completely controlled by your surgeon, who sits at a console, views the surgical site on a monitor, and manipulates the robotic tools. Highly sensitive controls placed on your surgeon’s fingers intuitively translate their hand motions into precise movements made by the robotic arms. As a result, your surgery is more precise and performed with better control because the robotic hands controlling the tools are capable of micro-movements and a range of motion that’s better than human hands. Another benefit of robotic surgery is that its three-dimensional and zoom capabilities provide better visualization than what can be achieved with standard magnification devices. Using robotic surgery to perform colorectal procedures delivers benefits such as: Less injury to nerves in the pelvis that control bladder and sexual function Better clinical outcomes for cancer control Improved sphincter-sparing techniques to avoid a permanent colostomy The robotic arms allow your surgeon to perform delicate surgery in areas that are too small to accommodate a hand. To learn whether you’re a good candidate for robotic surgery, call California Colorectal Surgeons or book an appointment online.