What We Offer
FLMSA cares for patients with conditions affecting the Colon, Rectum, and Anus as well as Pelvic Floor disorders. Because we are specialists, we are sensitive to the fact that these private parts of the body may be difficult to talk bout. However, we encourage you to share your concerns, because there is no reason for problems in these areas to go untreated.
Fort Lauderdale Medical Surgical Associates, offer a full continuum of colon and rectal care including preventive care (colonoscopy screening), diagnosis, treatment, and follow-up for conditions including:
Check Out Our Glossary
Anorectal disorders are a group of medical disorders that occur at the junction of the anal canal and the rectum. Our surgeons are specially trained in diagnosing and treating a wide range of disorders of the rectum including diarrhea, hemorrhoids, abscesses, fistula, fissures, anal itching, warts, and rectal prolapse.
What is accidental bowel leakage (ABL)?
Accidental bowel leakage of stool means the inability to control the passage of stool or gas. Some people have mild trouble holding gas; while others have severe trouble holding stool. Incontinence is a miserable problem that many people have trouble talking about. People are frequently embarrassed and afraid there is no help. However, treatment is available. Colorectal surgeons are specially trained physicians who frequently care for this problem.
How common is this problem?
One study showed that over 2% of the population suffers from accidental bowel leakage. More than 30% of nursing home patients are incontinent. It affects women more than men, and it becomes more common as people age and their sphincter muscles lose tone.
What causes accidental bowel leakage?
Normal control of the passage of stool depends on many factors. A problem in any of the following areas can contribute to a lack of control. One factor is the time it takes for stool to pass through the bowel. If stool moves through the bowel too quickly, a person may not have a warning and may have an accident. This happens most commonly to people with irritable bowel syndrome or inflammation of the bowel (colitis). The consistency of the stool is difficult for anyone to control. Anything that causes diarrhea, such as infection, inflammation, and food intolerance, can lead to incontinence.
Normally, the rectum will stretch to hold stool or gas entering it, giving the person time to make it to the bathroom. If the rectum is full of stool or abnormal growth, it may not expand further to hold additional stool. If this happens, loose stool may leak out. To prevent leakage one must be able to tell that stool or gas is present in the rectum. People with neurological problems, such as a stroke, may have abnormal sensations in the rectum. They will not be able to sense that gas or stool has entered into the rectum and therefore have no warning to go to the bathroom.
The sphincter muscle, a circle of muscle around the anus (rectal opening), keeps the anus closed. It needs to function properly in several ways for adequate control. It needs to hold the anus closed at rest and squeeze to tighten the anus when stool or gas enters the rectum. As people age, the muscle gradually loses strength. The sphincter muscle can also be injured during childbirth or during rectal surgery. If an injury is recognized and repaired, the muscle usually heals properly. If it does not, there may be a gap in the circle of the muscle so it is unable to close correctly. For some people, this gap is small and only becomes a problem when the muscle weakens with age. Two nerves stimulate the sphincter muscle. If the nerves are injured, the sphincter muscle may become weak. The nerves may be injured through stretching during pregnancy or childbirth or from excessive straining to move one’s bowels. Rectal prolapse, the tissue that repeatedly comes out through the anus, can also stretch or injure the nerve. In these situations, the muscle is intact but does not work properly, resulting in incontinence.
What tests are available?
First, the doctor will ask questions about your symptoms, bowel habits, and other medical problems. You will then be examined with particular attention paid to the sphincter muscle, rectum, and lower colon. At this point, the doctor may know the cause of the incontinence. If not, you may need to have some additional tests at our Pelvic Floor Center. For one of those tests (manometry), a catheter is placed into the anus to record pressures as patients tighten and relax the sphincter muscle. Another test may also be done to test for proper nerve function. An ultrasound probe inserted into the anus can provide a picture of the muscles, which would show any area of injury. You may need an x-ray to check for rectal prolapse.
How is accidental bowel leakage treated?
If present, the underlying problems are corrected. If a medical illness, such as inflammation of the bowel, infection, or irritable bowel syndrome, is causing the accidental bowel leakage, medication may be prescribed.
Diarrhea and constipation are treated with dietary changes, usually emphasizing a high-fiber diet. If incontinence continues despite these changes, the treatment depends on the cause.
Accidental bowel leakage caused by injury to the sphincter muscles may require surgery. The muscles and nerves will be tested before surgery to help predict the success of the surgery. If the muscle is intact but functions poorly, dietary changes may help.
Biofeedback or pelvic floor muscle training may also be recommended. This program teaches people to consciously identify and exercise their pelvic floor muscles.
New methods of replacing the sphincter muscle are currently being investigated and hold promise for the future. Finally, for patients with severe incontinence, a colostomy greatly improves their lifestyle.
If the underlying cause of accidental bowel leakage can not be completely corrected, measures can be taken to make the problem more manageable. Regular bowel movements help to keep the rectum empty, which decreases the chance of accidental leakage. A high-fiber diet and/or fiber supplements will usually improve constipation. Fiber also helps people with diarrhea by absorbing the water and making the stool more formed. The doctor may also recommend medication to control diarrhea.
Many people are concerned about leaving home because of accidental bowel leakage. Enemas or rectal irrigation can be used to empty the rectum and reduce the chance of leakage. Many patients find these useful prior to leaving home.
For people with accidental bowel leakage, one troubling aspect is the painful skin irritation that may occur. There are many methods for preventing or improving skin irritation, and the details should be discussed with your doctor. After cleansing, the skin should be gently dried. The general principle is to keep the skin as dry as possible. Many people use a hairdryer. A protective barrier cream is applied lightly and the skin is covered with the rolled cotton gauze. This should be done if one needs to wear a protective pad or garment. Many people find that carrying a kit with the necessary supplies reduces their anxiety about episodes that may occur away from home.
What is an anal fissure?
An anal fissure is a split or tears in the lining of the anal canal (rectal opening).
When does a fissure occur?
A fissure most commonly occurs after an episode of constipation, but it can happen after an attack of diarrhea. A fissure begins on the surface and usually heals rapidly on its own. Sometimes fissures may deepen to reach the underlying sphincter muscle (the muscle around the anal canal). It is not completely understood why some fissures heal and others do not. One major factor is persistent constipation or diarrhea, which can prevent healing. In addition, each time stool passes, the muscle goes into spasm, tightening the anal canal. If the sphincter muscle does not relax and the anal canal remains too tight, the fissure opens again with each bowel movement. Rarely, a fissure can be caused by Crohn’s disease or an infection. Treatment for the underlying disease usually relieves the fissure. Fissures very rarely become infected and they do not become cancerous.
What are the symptoms?
RECTAL PAIN: People often describe it as burning or tearing pain with a bowel movement. The pain may last for minutes or persist for hours after a bowel movement. The pain that lasts after a bowel movement is caused by the spasm in the sphincter muscle. Some people avoid having a bowel movement because of the pain.
RECTAL BLEEDING: It is usually small amounts of bright, red blood that can be seen on the toilet paper or in the toilet water.
SWELLING: Swelling at the outer end of the fissure can result in a skin tag. It may be noticed when cleaning the rectal area.
ITCHING: Discharge may result as the fissure alternately heals and reopens, causing itching.
How is a fissure treated?
Most superficial fissures heal without treatment, but some become chronic and cause ongoing discomfort. The first step is to correct constipation or diarrhea and treat any underlying disease. A high-fiber diet or dietary bulk agent with plenty of fluids is recommended. A topical anesthetic ointment may help relieve the pain. The spasm may also be relieved by sitting in a warm bath several times a day. These measures usually result in healing. If they do not, or the symptoms return, surgery may be required. Your doctor will discuss this with you.
What can I do to prevent another fissure?
If constipation is a problem, eat foods high in fiber. Drink 8 to 10 glasses of fluid that do not contain caffeine or alcohol. Your doctor may recommend a commercially available natural fiber product to increase your fiber intake.
If symptoms do recur, take warm baths. This will help to reduce the spasm and lessen the pain.
If your doctor recommends an ointment, apply it directly to the painful area.
What are anal warts?
Anal warts, also known as condyloma, are growths found on the skin around the anus (rectal opening) or in the lower rectum.
What causes anal warts?
Anal warts are caused by the human papillomavirus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. There are many types of human papillomavirus; some cause warts on the hands and feet and others cause genital and anal warts. The same type of warts may occur on the penis, scrotum, vagina, or labia. The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time, the virus remains in the tissues but is inactive.
What are the symptoms of anal warts?
Many patients with anal warts have no symptoms. Some patients may notice small growths in the anal area. Others have minor complaints of itching, occasional bleeding, or moisture in the anal canal.
How are anal warts diagnosed?
Diagnosis is made by the doctor, who inspects skin around the anus and checks the anal canal with an anoscope (a short instrument inserted into the anus).
How are anal warts treated?
There are several ways anal warts can be treated, depending on the location, number, and size of warts. If the warts are small, they can be treated with podophyllin or bichloracetic acid, which are solutions applied directly to warts intended to cause sloughing of the wart. This is an office procedure that takes just a few minutes. Occasionally, an ointment will be prescribed that is applied by the patient at home. This supplements the treatment provided in the office. Another form of treatment is cauterization. If the area contains numerous warts, the doctor may choose to remove them surgically. This is done as a same-day procedure in a hospital or surgery center.
Will a single treatment cure anal warts?
A single treatment will not cure anal warts in most cases. Close follow-up is critical because the virus may continue to be present and cause new anal warts to form. Even after there are no visible warts, the virus may remain in the tissue. Small warts that reappear are easily treated in the office. Follow-up visits are necessary even after there are no visible warts. Visits may be necessary for several months. There is a possibility of serious problems if the warts are left untreated. Rarely, these warts can become cancerous, so it is important to keep the follow-up appointments the doctor suggests.
How can the spread of anal warts be prevented?
There are several ways to prevent this virus from spreading:
What is diarrhea?
Diarrhea is a common problem that we all suffer from occasionally. Fortunately, it is usually a limited episode that resolves quickly. When it doesn’t, there can be cause for concern. The word diarrhea means different things to different people. Some patients who regularly experience bowel movements every three days think they have diarrhea if they begin going every day. Complaints of diarrhea should be compared to what is normal for each individual patient. Typically, diarrhea is thought to be loose, unformed, or watery stools that come more often than normal. It is often accompanied by abdominal cramps, and less warning when it is time to go.
What causes diarrhea?
As was already mentioned, most of us will get diarrhea occasionally. Most of the time it is related to a viral illness and will go away in a few days. Bacterial infections like food poisoning can also cause diarrhea which can be accompanied by rectal bleeding. This is a more serious situation, and you should call your doctor. Other more serious causes of diarrhea include inflammatory diseases like ulcerative colitis and Crohn’s disease, or diverticulitis. More common causes include irritable bowel syndrome, which is usually accompanied by constipation alternating with diarrhea. Another common cause is lactose intolerance, which makes a person unable to digest milk products.
What can I do?
During a minor episode of diarrhea, simply forcing fluids and rest is enough. Fluids should be limited to water, fruit juices, non-caffeinated beverages, and salt-containing liquids such as broth and sports drinks like Gatorade or All Sport. Avoid all caffeinated beverages. Those people with a history of irritable bowel syndrome should make sure they are getting enough fiber and water in their diet. They should also make sure they are using any medicines their doctor has given them according to the prescription. If diarrhea persists, over-the-counter medicines like Immodium A-D should not be used without the advice of your doctor. If a serious condition exists, the use of those medicines can actually make the problem worse.
Are there warning signs?
Things to watch for during an episode of diarrhea include:
If a person cannot drink enough to keep up with the fluid lost through bowel movements, they need to be in the hospital. If any of these warning signs occur, please call your doctor right away.
An anal fissure is a split or tears in the lining of the anal canal (rectal opening).
When does a fissure occur?
A fissure most commonly occurs after an episode of constipation, but it can happen after an attack of diarrhea. A fissure begins on the surface and usually heals rapidly on its own. Sometimes fissures may deepen to reach the underlying sphincter muscle (the muscle around the anal canal). It is not completely understood why some fissures heal and others do not. One major factor is persistent constipation or diarrhea, which can prevent healing. In addition, each time stool passes, the muscle goes into spasm, tightening the anal canal. If the sphincter muscle does not relax and the anal canal remains too tight, the fissure opens again with each bowel movement. Rarely, a fissure can be caused by Crohn’s disease or an infection. Treatment for the underlying disease usually relieves the fissure. Fissures very rarely become infected and they do not become cancerous.
What are the symptoms?
RECTAL PAIN: People often describe it as burning or tearing pain with a bowel movement. The pain may last for minutes or persist for hours after a bowel movement. The pain that lasts after a bowel movement is caused by the spasm in the sphincter muscle. Some people avoid having a bowel movement because of the pain.
RECTAL BLEEDING: It is usually small amounts of bright, red blood that can be seen on the toilet paper or in the toilet water.
SWELLING: Swelling at the outer end of the fissure can result in a skin tag. It may be noticed when cleaning the rectal area.
ITCHING: Discharge may result as the fissure alternately heals and reopens, causing itching.
How is a fissure treated?
Most superficial fissures heal without treatment, but some become chronic and cause ongoing discomfort. The first step is to correct constipation or diarrhea and treat any underlying disease. A high-fiber diet or dietary bulk agent with plenty of fluids is recommended. A topical anesthetic ointment may help relieve the pain. The spasm may also be relieved by sitting in a warm bath several times a day. These measures usually result in healing. If they do not, or the symptoms return, surgery may be required. Your doctor will discuss this with you.
What can I do to prevent another fissure?
If constipation is a problem, eat foods high in fiber. Drink 8 to 10 glasses of fluid that do not contain caffeine or alcohol. Your doctor may recommend a commercially available natural fiber product to increase your fiber intake.
If symptoms do recur, take warm baths. This will help to reduce the spasm and lessen the pain.
If your doctor recommends an ointment, apply it directly to the painful area.
What is a thrombosed external hemorrhoid?
A thrombosed external hemorrhoid is hemorrhoid with multiple blood clots that can be seen and felt under the skin around your anus. It is usually moderately to severely painful. These hemorrhoids often occur with chronic constipation, diarrhea, or pregnancy, but they can also appear on their own.
How is a thrombosed external hemorrhoid treated?
Today the doctor cut off the skin over the clot and removed the clotted hemorrhoid. You have had a partial hemorrhoidectomy. The wound was either left open or closed with an absorbable suture. If an absorbable suture was used, this stitch will fall out on its own. The doctor put a dressing over the wound to soak up any blood or discharge.
What can I expect after treatment?
Symptoms and Care You will have pain after the local anesthetic wears off. It may be moderately strong. You may take acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to relieve the pain. Do not take aspirin or products containing aspirin for at least seven days as they promote bleeding. Occasionally, your doctor may need to prescribe something else in addition to relieve the pain. Topical anesthetic ointments available over the counter, such as Xylocaine® and Analpram®, may also help with the pain. A small amount of bleeding is normal. Leave the dressing in place for approximately 12 hours; then take your first sitz bath. If the dressing is difficult or painful to remove, do it after soaking in the bath. If the wound is still bleeding, cover it with a pad or gauze. It takes two to four weeks for the wound to heal. Don’t worry if some discomfort, bleeding, discharge, pus, or itching occurs during this time; it is part of the normal healing process. Anal hygiene is important. Wash or sit in the tub after bowel movements or at least twice a day. You may have been asked to return to the office in 7 to 14 days for a wound check. Your doctor will let you know if this is necessary and if you need further treatment or tests.
Diet It is important to keep your bowel movements soft and regular. Eat foods high in fiber and drink plenty of water (8 to 10 glasses a day). If you are constipated, take a fiber supplement (for example, Metamucil® or Konsyl-D®). Prune juice or small doses of milk of magnesia may also be used.
Activity Avoid strenuous activity for the rest of the day. Tomorrow you can go back to your normal activities.
What if I need a refill on pain medication?
If you need a refill for pain medication, you must call your doctor during normal business hours. Our policy is that we do not refill pain medication prescriptions after hours or on weekends because your chart is not available. The doctor on call is not allowed to refill your prescription.
What should I be concerned about after my treatment?
If any of the following problems occur, please call our office and speak with a nurse who will help you with your problem or have the doctor call you.
Excessive pain unrelieved by your pain medication
Increasing pain several days after treatment
Fever or chills
Difficulty urinating
Severe bleeding that won’t stop with direct pressure using Kleenex or gauze
Constipation (no bowel movement for three days)
Diarrhea (more than three watery bowel movements within 24 hours)
Nausea and vomiting
If your doctor is unavailable, the on-call doctor is available 24 hours a day, every day of the year. After hours, call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort, and expense.
What is a pilonidal cyst?
A pilonidal cyst is a cavity underneath the skin over the tailbone. Pilonidal literally means “nest of hair” because the cavity is often found to contain hair. Research indicates that it is an acquired disease resulting from the impaction of debris and hair into the midline hair follicles which rupture, spreading infection beneath the skin. This condition is not hereditary.
What are the symptoms?
Some people have no symptoms, therefore no treatment is necessary. Occasionally, pus accumulates in the cyst, causing pain and swelling in the tailbone area to form (abscess). When this occurs, a patient will experience fever and sometimes acute pain and swelling in the tailbone area. Other people may develop low-grade infections with milder, recurring episodes of pain and swelling.
Who is affected?
This problem is more common in young adults and teenagers. This condition is rare in patients over 40 years of age. It is three times more common in men than women.
How is a pilonidal cyst treated?
Patients with an acute abscess can generally be treated in the doctor’s office. The doctor uses local anesthesia to numb the area. An incision is made to allow for drainage of pus. This immediately relieves pressure and decreases pain. Daily cleansing of the area in the bathtub or shower is important to keep hair and other debris out of the wound. The patient should return for follow-up until the wound is healed. Healing occurs rapidly, and wounds are usually completely closed in three weeks. For patients with repeated episodes of continuing infection, surgery may be required. This is done as an outpatient procedure at a hospital. In most cases, the cyst is opened, cleaned, and allowed to heal from the inside out. Stitches are often used, but they will dissolve in one to two weeks. After surgery, it is important to keep gauze in the wound to keep the skin edges separated until the wound fills in from the bottom. The patient typically returns to the office for follow-up visits until the wound is healed. In some instances, a more complex procedure is necessary. Wound hygiene is the single most important part of caring for pilonidal disease. Careful cleansing and dressing of the wound will prevent infection or premature closure of the skin, both of which can lead to recurrent problems.
Will a pilonidal cyst recur?
After surgery, approximately 10 percent of patients will develop another cyst. To help prevent the development of another cyst, keep the area free from hair with a depilatory (hair removal) cream or by shaving the area. If hair is allowed to grow back, recurrence is much higher.
Who should have a colonoscopy?
The doctor may recommend a colonoscopy to:
Screen the colon at age 50 or earlier if there is a family history of colon cancer.
Examine and possibly remove polyps or tumors located by a barium enema exam.
Monitor patients with a past history of colon polyps or cancer, or with a strong family history of colon cancer.
Examine patients who test positive for blood in the stool.
Check inflammatory bowel disease (colitis).
Check unexplained abdominal symptoms or changes in bowel habits.
Identify the cause of unexplained bleeding.
What is a colonoscopy?
A colonoscopy is a procedure that allows the doctor to visually examine the entire lining of the colon and rectum using a colonoscope (a long flexible tube about the thickness of a finger). The colonoscope is inserted into the rectum and gradually advanced through the colon. The doctor is able to carefully examine the lining of the rectum and diagnose colon and rectal problems, perform biopsies, and remove polyps.
How is a colonoscopy performed?
A colonoscopy is done in an outpatient setting. Patients take an oral preparation to cleanse the bowel the day before the procedure. The colonoscope is inserted into the rectum and gradually advanced through the colon. The doctor may inject medicine to relax the patient and help ease any discomfort. Colonoscopies are done under sedation, not anesthesia. The entire procedure usually takes less than an hour. The patient usually may resume normal activities the following day.
When is a biopsy done?
If the doctor sees an area in the bowel that needs further evaluation, a biopsy forceps can be passed through the colonoscope to take a sample of tissue (biopsy). This sample will be sent to the hospital lab. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.
What is a polypectomy?
Polypectomy is the removal of a polyp. During the course of the examination, a polyp may be found. Polyps are abnormal growths of tissue that vary in size from a tiny dot to several inches. If the doctor feels that removal of the polyp is indicated, a wire loop, or snare, will be passed through the colonoscope and the polyp removed from the intestinal wall using an electrical current. If additional polyps are detected, they may be removed as well. Polyp removal is not painful.
What are the risks of a colonoscopy?
Colonoscopy and polypectomy are associated with very low risk when performed by doctors with special training and experience doing these endoscopic procedures. One possible complication is perforation, which is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Perforation will usually necessitate hospitalization and often surgery. Another complication is bleeding that may occur from the site of biopsy or polyp removal. It is usually minor and stops on its own. Rarely, hospitalization and surgery are necessary. A third complication is localized irritation of the vein in your hand that may occur at the site of medication injection. A tender lump could develop and may remain for several weeks to several months. Elevation of the arm and hand on several pillows and the local application of heat speeds recovery.
What is the benefit of having a colonoscopy?
The doctor can perform a biopsy and remove polyps during the procedure before they turn into cancer. Screening tests can also find colorectal cancer early when the chance of being cured is good.
What do I need to know before scheduling my colonoscopy?
Prior To Your Appointment
Let your Primary Care or Referring Doctor know if:
You are on anti-coagulants (blood thinners) or aspirin-containing products.
You have been told to take antibiotics prior to dental visits or diagnostic tests.
You have bleeding tendencies.
You are diabetic.
You have special diet requirements.
You have any heart or kidney problems.
Please contact the doctor who ordered these medications for you, for any changes that may be required before your procedure. You must make arrangements for someone to drive you home after the procedure. A companion must accompany you because you will be given medication to help you relax. You will not be allowed to drive, take a taxi or bus alone after the procedure. It is recommended that you have a responsible adult with you for 12 hours following your procedure. Even though you may not feel tired, your judgment may be impaired and your reflexes may be slower. Your driver may be asked to sign paperwork in order to discharge you from the facility. You will be on a clear liquid diet and drinking laxatives the day prior to your colonoscopy. Please keep this in mind to arrange your work/activity schedule, since you will need to be close to a restroom when you start your laxative preparation.
What is Inflammatory Bowel Disease?
Inflammatory bowel disease is the name given to several similar disorders of the intestine. The primary problem is that the lining of the intestine is inflamed and irritated, and easily damaged.
What are the symptoms?
The symptoms may include diarrhea, with or without blood, and abdominal cramping. These symptoms may evolve slowly over several weeks, or they may begin suddenly.
What is the cause?
The cause remains unknown, though it does not appear to be an infection with any known bacteria or virus. The underlying problem seems to involve an allergic reaction in which some cells in the body make antibodies to attack other cells in the body.
HPV infection, abnormal anal Pap smear, anal dysplasia, and anal cancer
Abnormal anal pap smears, anal dysplasia, and anal cancer are all caused by the human papillomavirus (HPV).
What is human papilloma virus (HPV)?
HPV is a common virus that can be transmitted sexually. There are over 100 types of HPV. Most everyone is exposed to the virus at one point in their lives; most people “clear” the virus, but some people may harbor the virus chronically. HPV infection may present differently: some HPV types cause warts while other HPV types cause anal and cervical cancer.
Risk factors for HPV: men and women are equally susceptible to HPV infection.
Treating HIV with antiretroviral therapy may reduce the risk of getting anal dysplasia
What is anal dysplasia?
Anal dysplasia is a pre-cancerous condition that occurs when the cells of the lining of the anal canal undergo abnormal changes. The anal canal is the last few inches of the intestine. Anal dysplasia may progress from low-grade (low risk) changes to high-grade (high risk) changes before it turns into cancer.
What causes anal cancer?
90% of anal cancers are caused by the human papillomavirus (HPV). The oncogenic (cancer-causing) HPV types are responsible for the transformation of the anal canal cells from normal to pre-cancerous to cancerous. Anal cancer may develop slowly over a period of years. Anal cancer may occur inside the anal canal where the anus meets the rectum: it is usually not visible in that position. Or it may develop in the skin just outside of the anal canal opening. In such cases, the person may be aware of a visible or palpable, often painful growth.
What are the symptoms of anal cancer?
Sometimes there are no specific symptoms of anal cancer until it is quite advanced. As mentioned above, there may or may not be a visible or palpable growth. People may also have anal pain, bleeding, and discomfort.
These same symptoms can be caused by other benign conditions, like hemorrhoids or anal fissures. This is one of the reasons you should be seen and examined when you have those symptoms, so the correct diagnosis is made. At a minimum, you should have the following examinations:
Diagnosis of anal dysplasia
The diagnosis of anal dysplasia may be made by performing an anal pap smear. Just like a cervical Pap smear, cells are collected from a swab inserted into the anus. Those cells are then examined by a pathologist looking for pre-cancerous or dysplastic changes. Male/female patients with any of the following risk factors should have an anal pap smear:
What is a perianal abscess?
A perianal abscess is an infection in a mucus-secreting gland in the anal canal around your anus.
What is a perianal fistula?
A perianal fistula, almost always the result of a previous abscess, is a small passage connecting the anal gland from which the abscess arose to the skin where the abscess was drained.
What causes an abscess?
An abscess is formed when a small gland just inside the anus becomes infected from bacteria or stool trapped in the gland. You did nothing to cause this infection. Certain conditions — constipation, diarrhea, colitis, or other inflammation of the intestine, for example — may make these infections more likely.
What causes a fistula?
After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.
What are the symptoms of an abscess or fistula?
Perianal abscesses are generally manifested by intense anal pain and swelling. Fever is possible. Drainage of the abscess, either on its own or with an incision, relieves the pain and pressure. Fistulas are associated with drainage of blood, pus, or mucus, but they are generally not painful.
Does an abscess always become a fistula?
No. A fistula develops in up to 50 percent of all abscess cases. There is no way to predict if this will occur. If drainage persists for two to three months, the diagnosis of the perianal fistula is made.
How is an abscess treated?
An abscess is treated by draining the pus through an opening made in the skin near the anus. Often this can be done in the doctor’s office using a local anesthetic. A large or deep abscess may require drainage in the operating room. Hospitalization may be necessary for patients susceptible to more serious infections, such as diabetics or people with decreased immunity.
How is a fistula treated?
Surgery is generally necessary to treat a perianal fistula. This usually involves cutting a small portion of the anal sphincter muscle to open the passage, joining the external and internal opening, and converting the passage into a groove that will then heal from the inside out. Most fistula surgery can be performed on an outpatient basis. If the fistula involves too much sphincter muscle, a two-stage procedure or more complicated repair may be necessary.
What can I expect after fistula surgery?
Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain medication. The amount of time lost from work or school is usually minimal. There will be no limitation on activity. Soak the affected area in warm water three or four times a day. Stool softeners may also be recommended. You may need to wear a gauze pad or mini pad to prevent the drainage from soiling your clothes. Bowel movements will not affect healing.
Will an abscess or fistula recur?
If proper healing occurs, the problem usually will not return. If your bowels are otherwise normal, you are probably not at higher risk for developing another.
What is pruritis ani?
Pruritus ani is a bothersome and sometimes intense itching or burning sensation of the skin around the anus (rectal opening). It is most noticeable at night or after a bowel movement. The most common complaint is an irresistible urge to scratch. Some people will note occasional bleeding when wiping after a bowel movement. This is a common problem that affects up to 5% of the population. It affects men and women equally and may occur at any age.
How is pruritis ani diagnosed?
It is diagnosed by an examination of the skin around the anal area. The appearance of the skin will vary, depending on the severity and the length of time the condition has been present. It may start with redness of the skin and can progress to thickening of the skin. It may also lead to cracks and open sores which may result in small amounts of blood on the toilet tissue. Sometimes a biopsy (a small piece of skin removed for microscopic examination) is necessary.
What causes pruritis ani?
There are many causes of pruritus ani but most fall into four categories:
How is it treated?
Treatment of pruritus ani is directed at the care of the skin and determination of the underlying cause. After gently cleansing the skin and patting it, it is important to make sure the skin is dry. Some people use a hairdryer. Apply the ointment recommended by your doctor. Place a wisp of rolled cotton between the cheeks to absorb moisture.
What can I do to speed healing and help prevent pruritis ani?
DO NOT:
DO:
Constipation can be an uncomfortable experience and one that may have concerned you for some time. The following information can help answer your questions about constipation and help you understand your doctor’s choice of treatment.
What is constipation?
Constipation may mean different things to different individuals. Most commonly, it refers to the passage of too few bowel movements per week. It may also describe having hard, dry stools that are difficult to pass, a decrease in the size of the stool, or needing to strain to have a bowel movement. Some individuals describe a sense of not emptying their bowel completely or the need for enemas, suppositories, or laxatives in order to have a bowel movement.
The definition of normal frequency of having a bowel movement ranges from 3 times a day to 3 times a week. Chances are you know what is regular for you–and therefore what is irregular for you also.
What causes constipation?
In trying to understand why you sometimes experience constipation, remember that your body’s needs are unique. From time to time these needs change, sometimes as a result of diet and exercise. In turn, your body responds with certain symptoms, including constipation. Common causes of occasional constipation include:
If you are constipated frequently and making the following recommended changes does not help, it is wise to schedule an appointment with a Colon and Rectal Surgeon. More serious causes of constipation include narrowing of the colon or growths in the colon. Constipation may be associated with some medical conditions such as diabetes, Parkinson’s disease, thyroid disease, multiple sclerosis, or spinal cord injuries.
Sometimes constipation is caused by problems with the function of the pelvic floor muscles. The muscles may not relax appropriately when trying to pass stool, making it difficult and sometimes painful to have a bowel movement. Biofeedback therapy may be helpful in retraining these muscles to allow for easier passage of stool.
What can I do about constipation?
Help yourself maintain regularity by adding some of these simple steps to your daily routine:
Gradually add high-fiber foods to your diet, including • fruit (not peel ed when appropriate) • dried fruits (apricots, prunes, raisins, and dates) • raw vegetables • bran cereals • whole-grain breads.
Drink 8 to 10 glasses of decaffeinated fluid each day (caffeine intake can contribute to dehydration and cause the constipation problem to become worse).
Follow a regular exercise program. Walking is good for the heart and body, and abdominal exercises help improve intestinal muscle tone. Ask your doctor about a program that would be right for you.
Respond to the urge to have a bowel movement. When you feel the urge, relax and let your body take the time it needs. If you ignore the urge, you could prolong the problem.
If one is recommended by your doctor, take a high-fiber supplement to help you stay regular.
Use laxatives only as your doctor recommends.
Should I take a laxative?
Your doctor may prescribe a laxative for you. There are many types of laxatives, each one having benefits and drawbacks for certain patients.
Bulk-forming agents are not digested but absorb liquid in the intestine and then swell to form a soft, bulky mass that stimulates a bowel movement. Because bulk agents mimic the body’s own actions, they are said to work naturally. They may lead to increased gas and can take up to three days to have an effect.
Stool softeners do not cause a bowel movement but ease the difficult passage often associated with hard dry stool. They can work in one or two days but may take up to five days.
Stimulant laxatives encourage bowel movements through the action of the intestinal wall. They increase the muscle contractions in the intestine that lead to having a bowel movement. Stimulant laxatives are a popular type of laxative for self-treatment. While all stimulant laxatives work basically the same way, some are more likely to cause cramping or irritation and rarely, nausea and vomiting. These types of laxatives should not be taken for prolonged periods of time.
Hyperosmotic laxatives work by drawing water into the bowel from surrounding tissues. This softens the stool and sends the bowel the message to empty. Too much water can be drawn in, though, resulting in loose bowel movements and upsetting the body’s balance of fluids. There are three types of hyperosmotic laxatives taken by mouth–saline, lactulose, and polymer types.
Enemas fill the colon with fluid, which softens the stool and stimulates bowel movement.
With so many products available, it is not easy to know which is best for you. Follow your doctor’s recommendation.
It is always a good idea to look for natural ways to meet your body’s needs and avoid long-term use of medication. Excessive use of stimulant laxatives can actually cause constipation and dependence upon laxatives because the colon loses its normal tone and the ability to contract. Bulk-forming agents are safe to take for a long time. They are essentially a supplement to fiber in your diet.
What is an abscess?
You have either a perianal abscess, an infection that began in a mucus-secreting gland in the anal canal around your anus, or a pilonidal abscess, an infection in a hair follicle trapped under the skin overlying the tailbone. In either case, you did nothing to cause the infection, and you could have done nothing to prevent its development.
How is an abscess treated?
Drainage is the recommended treatment. First, the doctor injects a local anesthetic around the abscess to allow the drainage to be as painless as possible. An incision is made into the abscess to drain the pus. A portion of skin and fat is removed to allow drainage while your body heals the abscess. A gauze dressing is then applied. In addition to drainage, antibiotics are sometimes given to diabetics, patients with artificial heart valves or joints, or those who have decreased immunities.
What should I know after my abscess has been treated?
Symptoms and Care You will have some pain after the local anesthetic wears off. It may be moderately strong. Your doctor may prescribe something for you. Do not take aspirin or products containing aspirin for at least seven days as they promote bleeding. You may take acetaminophen (Tylenol®) or ibuprofen. It takes a minimum of two to four weeks for the wound to heal. Don’t worry if some bleeding, discharge, pus, or itching occurs during this time; it is part of the normal healing process. You may apply gauze, cotton dressings, or mini pads to the wound as needed. Anal hygiene is important. Take a bath or shower at least twice a day. (A hand-held sprayer is helpful if you are taking a shower.) You have been asked to return to the office in 7 to 14 days for a check-up. Most patients with perianal abscesses will not need further drainage, but some will develop a fistula, a drainage tract from the anal canal to the skin, and surgery may be necessary. Pilonidal abscesses may recur, possibly requiring further surgery.
Diet It is important to keep your bowel movements soft and regular. Eat foods high in fiber and drink plenty of water (6-8 glasses a day). If you are constipated, take a fiber supplement such as Metamucil®, Konsyl-D®, Citrucel®, Effersyllium®, or Hydrocil®. Prune juice or small doses of milk of magnesia may also be used.
Activity Avoid strenuous activity for the rest of the day. Tomorrow you may go back to your normal activities.
What if I need a refill on my pain medication?
If you need a refill for pain medication, you must call your doctor during normal business hours. Our policy is that we do not refill pain medication prescriptions after hours or on weekends because your chart is not available. The doctor on call is not allowed to refill your prescription.
What should I be concerned about after my treatment?
If any of the following problems occur, please call our office and speak with a nurse who will help you with your problem, or have the doctor call you.
Excessive pain unrelieved by your pain medication
Increasing pain several days after treatment
Fever or chills
Difficulty urinating
Severe bleeding that won’t stop with direct pressure using Kleenex or gauze
Constipation (no bowel movement for three days)
Diarrhea (more than three watery bowel movements within 24 hours)
Nausea or vomiting
If your own doctor is unavailable, the doctor on call is available 24 hours a day, every day of the year. After hours, call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort, and expense.
What is a perianal fistula?
A perianal fistula, almost always the result of a previous abscess, is a small passage connecting the anal gland from which the abscess arose to the skin where the abscess was drained.
What is a perianal abscess?
A perianal abscess is an infection in a mucus-secreting gland in the anal canal around your anus.
What causes an abscess?
An abscess is formed when a small gland just inside the anus becomes infected from bacteria or stool trapped in the gland. You did nothing to cause this infection. Certain conditions – constipation, diarrhea, colitis, or other inflammation of the intestine, for example, may make these infections more likely.
What causes a fistula?
After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.
What are the symptoms of an abscess or a fistula?
Perianal abscesses are generally manifested by intense anal pain and swelling. Fever is possible. Drainage of the abscess, either on its own or with an incision, relieves the pain and pressure. Fistulas are associated with drainage of blood, pus, or mucus, but they are generally not painful.
Does an abscess always become a fistula?
No. A fistula develops in up to 50 percent of all abscess cases. There is no way to predict if this will occur. If drainage persists for two to three months, the diagnosis of the perianal fistula is made.
How is an abscess treated?
An abscess is treated by draining the pus through an opening made in the skin near the anus. Often this can be done in the doctor’s office using a local anesthetic. A large or deep abscess may require drainage in the operating room. Hospitalization may be necessary for patients susceptible to more serious infections, such as diabetics or people with decreased immunity.
How is a fistula treated?
Surgery is generally necessary to treat a perianal fistula. This usually involves cutting a small portion of the anal sphincter muscle to open the passage, joining the external and internal opening, and converting the passage into a groove that will then heal from the inside out. Most fistula surgery can be performed on an outpatient basis. If the fistula involves too much sphincter muscle, a two-stage procedure or more complicated repair may be necessary.
What can I expect after fistula surgery?
Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain pills. The amount of time lost from work or school is usually minimal. There will be no limitation on activity. Soak the affected area in warm water three or four times a day. Stool softeners may also be recommended. You may need to wear a gauze pad or mini pad to prevent the drainage from soiling your clothes. Bowel movements will not affect healing.
Will an abscess or fistula recur?
If proper healing occurs, the problem usually will not return. If your bowels are otherwise normal, you are probably not at higher risk for developing another abscess.
What are internal hemorrhoids?
A hemorrhoid is a cushion of blood vessels in the lining of the anal canal. All people have hemorrhoids; we are all born with hemorrhoids. Not everyone, however, has hemorrhoid-causing symptoms. When these hemorrhoids become enlarged, you may have painless rectal bleeding. Swelling of hemorrhoids may cause them to prolapse (slide-out) during a bowel movement.
How are internal hemorrhoids treated?
Your physician will determine if your hemorrhoids require one of the following treatments:
Barron ligatures (rubber bands) – A rubber band is put around hemorrhoid, causing it to wither and fall off over a 5 to 10-day period.
Injection of hemorrhoids – A liquid is injected into hemorrhoid, stopping the bleeding and preventing it from protruding.
These treatments are only used for internal hemorrhoids. They would be extremely painful if used for external hemorrhoids.
What can I expect after internal hemorrhoid treatment?
Symptoms You may feel mild to moderate pain, a dull ache, or essentially nothing for the first 36 to 48 hours. A sense of urgency to have a bowel movement is normal after these treatments. If discomfort is mild, take over-the-counter medications such as Tylenol® or Advil®. Do not take aspirin or products containing aspirin because they promote bleeding. Taking warm baths for 15 to 20 minutes will help relieve your discomfort. If your pain is severe, call the office and speak with the nurse. Generally, it takes two to four treatments, from the American Society of Colon and Rectal Surgeons (ASCRS) Websiteree to six weeks apart, to treat the prolapsing internal hemorrhoids. Usually, only one area, or occasionally two, is treated at a time. Remember that bleeding and prolapse will probably persist until all the hemorrhoids and prolapsing tissue have been treated.
Diet After your treatment, it is important to keep your bowel movements soft and regular. Eat foods high in fiber and drink plenty of water (8 to 10 glasses a day). Continue the fiber supplement recommended by your doctor. Caffeine contributes to constipation so limit your consumption of coffee, tea, colas, and chocolate.
Activity You may continue your normal physical activities. You will be able to drive your car, walk upstairs, and do normal exercise immediately.
What if I need a refill on pain medication?
If you need a refill for a pain medication prescription, you must call your doctor during normal business hours. Our policy is that we do not refill pain medication prescriptions after hours or on weekends because your chart is not available. The doctor on call is not allowed to refill your prescription.
What should I be concerned about after my treatment?
If any of the following problems occur, please call our office and speak with a nurse who will help you with your problem or have the doctor call you.
Pain that does not gradually lessen in three days
Increasing pain several days after treatment
Tender swelling in the anal area
Fever or chills
Difficulty urinating
Constipation (no bowel movement for three days)
Diarrhea (more than three watery stools within 24 hours)
Increased bleeding (more than one cupful)
Three to four large bloody bowel movements within three hours
Drainage of pus from the rectum
If your own doctor is unavailable, the doctor on call is available 24 hours a day, every day of the year. After hours, call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort, and expense.
What is rectal prolapse?
Rectal prolapse occurs when the upper portion of the rectum telescopes itself inside out and comes out through the rectal opening. It is seen most often in elderly women, but it can occur in men and women of any age.
What causes rectal prolapse?
Rectal prolapse is associated with chronic straining to pass stool. It is known that the attachments of the rectum to the pelvic bones progressively weaken. When these attachments are weak, straining to pass stool causes the rectum to turn itself inside out. In many cases, the cause is unknown.
What symptoms occur with rectal prolapse?
The primary symptom is the feeling of tissue coming out of the rectum. Bleeding and mucus drainage frequently accompany rectal prolapse. When the problem first starts, the rectum may turn itself inside out but not come out of the rectal opening. During this phase, a common symptom is a frequent urge to have a bowel movement when there is no need to pass stool. As the prolapse progresses, the rectum comes out with bowel movements and returns inside by itself. Later the prolapse may occur with any activity and finally just standing up may cause it. It may become necessary to push the rectum back inside. Constipation commonly occurs with rectal prolapse. The chronic straining associated with constipation may be a predisposing factor, or constipation may occur because the prolapse partially blocks the rectal opening. Continued straining and the prolapse itself may damage the sphincter muscle that controls the passage of stool. If that occurs, accidental bowel leakage, or ABL results. It can be difficult at times to differentiate true accidental bowel leakage from mucus discharge directly from the prolapsed tissue.
How does rectal prolapse differ from hemorrhoids?
Hemorrhoids are a cluster of anal cushions (spongy tissue with a lot of blood vessels). A ring of hemorrhoids lies under the skin just outside the rectal opening. A second ring lies under the lining of the rectum just inside the rectal opening. If inside hemorrhoid enlarges, it may come out the rectal opening with a bowel movement or during exercise. However, only the lining and the blood vessels come out, unlike rectal prolapse where all layers of the rectal wall come out. An examination is necessary to determine the diagnosis.
How is rectal prolapse diagnosed?
Your doctor can usually diagnose rectal prolapse by taking a careful history and performing a complete anorectal examination. To demonstrate the prolapse, the patient may be asked to strain as if having a bowel movement or to sit on the commode and strain prior to examination. If the prolapse is internal or the diagnosis uncertain, a video defecogram (x-ray pictures taken while the patient is passing contrast instilled in the rectum) can help the doctor determine whether surgery would be helpful and what procedure would be best. Anorectal manometry, a test that measures whether or not the muscles around the rectum are functioning normally, may also be used.
How is rectal prolapse treated?
Rectal prolapse can be corrected. Options are available for treatment, regardless of the age and condition of the patient. Treatment depends on the age of the patient and the severity of the condition. In adults, a high-fiber diet to prevent constipation and straining is recommended if the symptoms are mild. Surgical correction is required in adults if the prolapse does not resolve by itself. Rectal prolapse can successfully be repaired through either an abdominal or rectal procedure. Your doctor will discuss which procedure is most appropriate for you. If incontinence accompanies the prolapse, the incontinence improves over half the time after the prolapse is corrected. If continence does not improve, another treatment is available. Rectal prolapse in children frequently corrects itself. The doctor will instruct parents on how to reduce the prolapse when it occurs and how to prevent constipation in their child.
What is diverticulosis?
Diverticulosis of the colon is a common condition affecting many Americans who are middle-aged or older. Approximately 50% of people over age 50 have diverticulae. Only a small percentage of these people eventually require treatment. Diverticulosis is the presence of pockets (diverticulae) that develop on the wall of the large intestine or colon. They occur at weak areas in the bowel wall and are most often found on the left side (called the sigmoid colon), but they can be found anywhere throughout the colon.
What causes diverticulosis?
Diverticula occur gradually over time and are due to excessive pressure or spasms within the bowel. The amount of fiber and fluid intake affects what kind of action occurs in the bowel. The American diet is high in processed foods that have had the natural fiber removed. When fiber and fluid are lacking, the stool becomes hard and dry. The muscles in the wall of the colon need to squeeze with greater force, causing a bulge to form in the colon wall, which eventually becomes a pocket or diverticulum.
What are the symptoms of diverticulosis?
Diverticulosis presents in several different ways. Most people with diverticulosis have no symptoms. If they do, possible symptoms include left lower abdominal pain, diarrhea, cramps, and a change in bowel habits. Some patients with diverticulosis can have severe rectal bleeding. These symptoms can also be the result of other conditions. An examination is necessary to make the correct diagnosis.
What can I do to prevent diverticulosis?
The prevention of diverticulosis and treatment of its symptoms are managed in the same way – with diet and occasionally with medication You should increase your intake of dietary fiber to 25 grams daily and liquid to 8-10 glasses daily. High-fiber foods and commercial fiber products add bulk to the diet, which helps achieve regular bowel habits. Fiber holds water, which helps to soften the stool. Soft stool requires less pressure to move it through the colon. Diverticulae formation may be reduced or even stopped.
High-fiber Foods Can Be Found In Most Food Groups:
Legumes: The bean family excels in fiber, especially the soluble, cholesterol-lowering type. They include kidney, pinto, navy, lima, and baked beans.
Whole Grains: Wheat bran and oat bran are present in a variety of cereals and bread. The label should say that the bread contains whole wheat or whole grain. Plain wheat bread may lack fiber. One cannot always tell by the color. Some manufacturers artificially color bread brown to make it look more wholesome.
Whole Fresh Fruits: Valuable pectin fiber is found in the skin and pulp. Figs, prunes, and raspberries have the highest fiber content.
Cooked or Stewed Fruits: Prunes and applesauce are good choices.
Green Leafy Vegetables: Spinach, celery, and broccoli are good examples.
Root Vegetables: Potatoes, turnips, and carrots are excellent sources.
Since fiber can cause rumbling intestinal gas and even some mild cramping, the amount taken should be increased gradually. The goal should be 25 to 35 grams of fiber each day, which will usually produce one to two soft, formed stools per day.
The following are good general rules:
What is diverticulitis?
Diverticulitis is an infection in a diverticulum or pocket in the colon. It occurs when the opening of a diverticulum is blocked with stool and the diverticulum ruptures, resulting in a localized infection. Symptoms may include abdominal pain, chills, fever, or a change in bowel habits.
Complications can result in bowel perforation, abscess or infection into another organ.
Mild cases can be managed at home with oral antibiotics and a modified diet. Severe cases require hospitalization with intravenous antibiotics and no food or fluid by mouth. Surgery becomes necessary with recurrent episodes, complications, or a poor response to medications.
When surgery is required, the affected part of the colon is removed and the remaining colon reconnected. Bowel activity typically returns in three to five days and becomes routine in approximately three weeks.
What is High Resolution Anoscopy?
High Resolution Anoscopy, or HRA, is a procedure that allows for examination and evaluation of the anal canal. Using a small thin round tube called an anoscope, the anal canal is examined with a high-resolution magnifying instrument called a colposcope. Application of a mildly acidic liquid onto the anal canal facilitates evaluation of abnormal tissue such as anal dysplasia. If indicated, a biopsy can be obtained. A digital rectal examination is also done at the time of the procedure. The procedure is performed in the office and generally lasts about 15 minutes. It is usually very well tolerated with mild if any discomfort. Significant risks such as bleeding or infection are extremely rare. Note should be taken that HRA is very different from colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA. No bowel prep is needed for this examination.
Who needs a High Resolution Anoscopy?
The procedure is used in the treatment and surveillance of anal dysplasia and the prevention of anal cancer. It is performed on patients with abnormal anal cytology or anal Pap test. Anal Pap tests are obtained on individuals who are at risk for genital or anal HPV (Human PapillomaVirus) infections, even in the absence of signs or symptoms of infection.
