An anorectal abscess is a painful swelling near the anus or in the buttock. The swelling contains pus. 60% anorectal abscesses are superficial and resulting from infection in small anal glands present in between internal and external anal sphincters (intersphincteric space). They are known as a perianal abscess. 30% of anorectal abscesses are deep-seated and results in systemic infection. They are call Ischiorectal abscess. Submucous abscess, pelvirectal abscess and pilonidal abscess developed from versatile cause are comparatively less common. Inadequate and improper management of anorectal abscess may potentially cause complication like fistula formation.


Fast facts on Anorectal abscess-

* Anorectal abscess should be drained at the earliest.
* Conservative medical management almost invariably invites complication like fistula formation.
* Surgical drainage of pus reduces the chance of fistula formation by 50%.


What causes Anorectal abscess?

* Blocked and infected anal glands (cryptoglandular infection).
* Untreated anal fissure that becomes infected.
* Sexually transmitted infections.
* Penetrating injury of the perianal or buttock region.
* Crohn s disease.
* Colon cancer.
* Tuberculosis.



What are the symptoms of Anorectal abscess?

Superficial abscess-

* Constant and throbbing pain that worsens on sitting down.
* Swelling, redness and tenderness of the skin around the anus.
* Discharge of pus.
* Pain is often associated with bowel movement.

Deep abscess-

* All or some of the symptoms of a superficial abscess.
* Fever with chill and rigor.
* General weakness.
* Sometimes fever is the only symptom of the deep abscess.

The anorectal abscess should preferably be explored under general or spinal anesthesia. Medical management often fails and subsequently fistula is formed.

Anorectal Abscess - Know In Detail About It!

Renal Tubular Acidosis is a medical condition. When the kidney is unable to acidify urine, it leads to the accumulation of acid in the body. Usually, when blood is filtered by the kidney, it passes through the tubules of the nephrons (the functional unit of the kidney).

Before it flows into the bladder from the kidney, the urine undergoes an exchange of salts, acids and other solutes. Renal tubular acidosis results in the formation of excessive amounts of acid because the kidneys cannot drain them. This may happen because the kidneys cannot reabsorb the alkaline bicarbonate ions from the urine in the early segment of the nephron or because of inadequate production of acidic hydrogen ions in the latter half of the nephron.

Renal Tubular Acidosis is simply associated with abnormal urinary acidification. Other functions of the kidneys remain unimpaired.
There are several different types of renal tubular acidosis-

  Distal Renal Tubular Acidosis (RTA)
This is the most fundamental form of RTA. It is characterized when the hydrogen ions are not secreted into the lumen of the nephron by the alpha-intercalated cells of the medullary collective duct of the distal nephron. When this happens the pH of urine cannot be brought down below 5.3. Renal excretion is inhibited and hydrogen ions are not eliminated which leads to academia. At the same time, Potassium ions cannot be absorbed by the cell which leads to hypokalemia. The end result is protein retention and potassium excretion. Distal RTA can lead to the urinary stone formation, calcium deposits in the kidney, rickets and osteomalacia and Sjogren s syndrome.

  Proximal RTA
When proximal tubular cells reabsorb 85% of filtered bicarbonates and 60% of filtered sodium from the urine, then this again leads to academia. The distal intercalated cells, however, function normally and so the academia is not as severe as in case of Distal RTA. The alpha-intercalated cells can acidify urine to a pH of 5.3 or less because they produce hydrogen ions. Proximal RTA is also associated with Fanconi Syndrome which is characterized by aminoaciduria, uricosuria, glucosuria, and tubular proteinuria.

  Combined distal and proximal RTA
Inherited carbonic anhydrase II deficit leads to combined distal and proximal RTA. This is accompanied by osteopetrosis, cerebral calcification, and renal tubular acidosis. Cases of combined distal and proximal RTA are very rare.

How is RTA understood?
The following steps are applied to analyze Renal Tubular Acidosis-
  Determining the anion gap in acidosis. The normal Anion Gap is 8-12 (4-6 mEq/L)
  Separating the renal from the extrarenal causes of normal anion gap acidosis
  Classifying the types of RTA
  If it is distal RTA, further tests will be necessary to support the diagnosis

How is RTA diagnosed?
Three types of tests can reveal if a person is affected by Renal Tubular Acidosis-
  Urine test
  Acid load test
  Physical examination

Treatment of RTA-
Doctors prescribe either or both of the following two types of therapies-

  Alkali therapy- The pH level of urine is restored and electrolytes are balanced
  Vitamin D supplements- If RTA leads to bone deformities or rickets, your doctor will prescribe vitamin supplements to strengthen your bones.

Timely diagnosis can prevent the effects of Renal tubular Acidosis from becoming compounded. With the right medication, a person can lead a healthy normal life.

What Should You Know About Renal Tubular Acidosis?

Colon cancer is believed to be one of the common types of cancer affecting people. As the name suggests, here, the point of origin of the cancer is the colon or the large intestine. Though colon cancer can affect anyone, people with unhealthy lifestyle (sedentary) and habits (excess smoking and consumption of alcohol), obesity, certain medical conditions like diabetes, or exposed to radiations (radiation therapy) are at a greater risk of colon cancer. Colon cancer may also be hereditary.

Colon cancer usually proceeds through five stages, stage 0 (zero), stage I, II, III and IV.

In stage 0, cancer remains in situ, (it remains confined within the innermost layer of the colon).
In stage I, cancer slowly starts spreading to the other layers (second and third) of the inner walls of the colon.
In stage II, cancer spreads further to the muscular walls of the colon (the lymph nodes, are, however, still not affected by this condition).
In stage III, cancer spreads outside the colon, affecting one or more lymph nodes.
Stage IV is more severe and metastatic. Here cancer has spread to and affected vital organs like the liver and the lungs.
Many of the symptoms do not appear at the initial stages. As a result, colon cancer mostly gets detected at a later (often metastatic) stage. Thus, a person should be alert. The initial symptoms, no matter how trivial, should be taken seriously. There is no harm in seeking medical help. It will only help you in the long run. 

The following symptoms are often the initial or first signs of something as big as colon cancer.

Unexplained poor appetite followed by sudden and rapid weight loss. Losing weight at an alarming rate without sweating it out needs thorough investigation. More than often, colon cancer interferes with the digestion process in a person. A person is not able to eat well. There is a feeling of being full (irrespective of how much you eat) all the time.
Constipation, gas or (and) diarrhea. Often overlooked and mistaken for common bowel disorder, these are some of the initial symptoms of colon cancer. The symptoms may be an outcome of polyps (abnormal tissue growths that can take place in any organs. These polyps are mostly benign in nature) or malignant tumors in the colon. Seek medical help if the conditions persist for more than a week. It is better to be safe than to be sorry.
A person feels exhausted, sleepy and weak all the time. The symptom may be an outcome of iron deficiency and anemia. Colon cancer can cause injury to the digestive tract. There may be bleeding followed by blood loss and hence the associated symptoms.
Mild to severe abdominal pain. The abdomen also appears tender than usual (in the case of metastatic tumor).
Stomach upset accompanied by pain, nausea, vomiting, cramps and at times, indigestion (an outcome of intestinal obstruction and inflammation).
There may be blood while passing stool.

Colon Cancer - What Signs You Must Watch Out For?

Colorectal surgery: How to be sure you need it?

Colorectal surgery is performed to repair damages that occur in the organs of the anus, rectum, and colon. The damage that takes place in these organs can be the result of problems with lower GI like diverticulitis (a condition wherein pouches known as diverticula in the colon wall become inflamed), cancer and inflammatory bowel disease (a group of intestinal disorders that bring about inflammation of the GI).

Who needs this surgery?

In general, colorectal surgery is an essential treatment option for ulcerative colitis, colorectal cancer, Crohn's disease (an inflammatory bowel disease that gives rise to inflammation of the gastrointestinal tract) as well as certain diverticulitis cases. In such cases, the intestinal tract undergoes major reconstruction.

There are also other bowel problems that may require surgery but not of a serious nature and these are anal fissures, hemorrhoids, bowel incontinence and rectal prolapse. Most of the surgical procedures will aid in repairing tears, get rid of blockages, or make tighter sphincter muscles (muscles that surround openings in the body).

Colorectal surgery is also performed in cases of pelvic floor disorders like rectocele (a condition in which the rectum bulges towards the vagina) and perineal hernia (a hernia that involves the pelvic floor).

At the same time, injury, ischemia or compromised blood supply and obstruction may require the performance of bowel surgery as well. Scar tissue and masses can form within the rectum, clogging the organ and preventing the normal discharge of feces from the body.

Problems like ulcerative colitis (an inflammatory bowel disease that leads to the development of ulcers in the colon as well as inflammation of the area) and diverticulitis can give rise to perforations in the rectum. Surgery is suggested in instances when drugs fail to treat the problem of ulcerative colitis.

Likewise, in the case of recurrent instances of perforations or complications in diverticulitis, surgery may be required to remove the portion of the colon affected.



Colorectal Surgery: How To Be Sure You Really Need it

Colon polyps are growths that are typically found in the large intestine. Although the causes behind the occurrence of colon polyps are not known, this condition is usually seen to affect adults.
These colon polyps might turn into colon cancer over a period of time; the development of cancer can happen over a number of years.
Colon polyps are usually symptomless; hence it becomes difficult to diagnose the condition. They are commonly found as additional results of screening tests for colon cancers. Screening tests are conducted when there is a suspicion of a disease but it displays no significant symptoms. The symptoms can only be visible if the polyps are enlarged. Typical symptoms include:
Rectal bleeding.
Changes in bowel conditions such as diarrhoea and constipation.
Changes in urination patterns.
Change in appearance of stool.
As the presence of most polyps becomes evident only during colon cancer tests, it is recommended that regular tests for colon cancer be conducted for adults over the age of 50. Some of these tests include:
Colonoscopy: This is highly recommended for detecting colon polyps. A small tube used for viewing is inserted into the colon by the doctor.
Flexible Sigmoidoscopy: It is similar to colonoscopy with the only difference being that the tube is smaller.
Computed Tomographic Colonography (CTC): Also known as virtual colonoscopy, various computer systems and X-rays are used to create a detailed picture of the colon so that the doctor can search for polyps.
The size of the colon polyps helps to identify if the polyp is cancerous or not. Chances of the polyp being cancerous are high if the size of the polyp is higher than 1 cm or 0.4 inches. Hyperplastic polyps (smaller polyps) do not become cancerous and hence, do not need to undergo a colonoscopy. Another form of polyp is the sessile polyp which is usually a flat growth without a stalk and grows on the inner wall of the colon. Similar to other polyps, these polyps can be found and removed using a colonoscopy or a sigmoidoscopy.

Causes and Symptoms of Colonic Polyps

Problems of the large intestine are very common and patients should usually consult gastroenterologists for the proper diagnosis and treatment

1. Bleeding per rectum: Bleeding through the anal canal or rectum is usually the most common problem of the patients. It can be due to following reasons: 

A. Piles also known as Hemorrhoids: Hemorrhoids are dilated venous channels of the anal canal. They occur due to long term constipation or chronic cough or due to less fibre intake in the diet. Sigmoidoscopy or proctoscopy is required for diagnosis. Treatment options include medicines and high fibre intake, Injection therapy(Sclerotherapy) for stopping bleeding from piles and Stapler hemorrhoidectomy if the piles are large.

B.  Polyps: Polyps are soft tissue growths seen in the large intestine. They are usually silent but can present with bleeding or anaemia. Polyps usually grow slowly in size and large polyps can turn into cancer of large intestine also known as colorectal carcinoma. Colonoscopy is required for the diagnosis. The gastroenterologists can diagnose the presence of polyps by colonoscopy. Smaller polyps can be removed by polypectomy by gastroenterologists without the need for open surgery. However large polyps or those polyps with suspicion of cancer require surgery.

C. Large intestine Ulcer: They can occur due to early cancer, SRUS, Infections or drugs. They require colonoscopy for the diagnosis. The gastroenterologists usually take Biopsy from the ulcer to know the cause of the ulcer. The mere taking of biopsy does not mean cancer and biopsy samples are seen in the microscope for better diagnosis.

D. Ulcerative Colitis and Crohn s disease: Ulcerative colitis is one form of Inflammatory bowel disease (IBD). The other IBD is known as Crohn s disease. Whereas ulcerative colitis involves only large intestine, Crohn s disease can involve any part of the gastrointestinal tract including small intestine. Ulcerative colitis and Crohn s disease present with Loose stools(diarrhea), bleeding , abdominal pain, weight loss, Anemia and Perianal fissures and  fistula. The diagnosis of IBD is challenging and involves blood tests, CT Scan abdomen, Colonoscopy with biopsy and clinical history. Management includes Medicines which control the inflammation such as Pentasa, Rowasa, Mesacol etc. Severe disease requires additional drugs such as Azathioprine and Anti TNF sich as Infliximab and Adalimumab. Occasional cases require surgery such as those with tight stricture of the intestine, severe dilatation of Large intestine (also known as Toxic megacolon), excessive bleeding, the disease not responding to medical management, or presence of cancer with IBD.

E. Anal fissures: Cut in the anal skin (fissure) causes severe pain in the anal area during passing motions. It is usually due to constipation or straining. It is usually treated by Gastroenterologists initially by medicines and ointments. If the pain continues Surgery is required named as Lateral internal sphincterotomy (LIS).

2. Loose motions or Diarrhea: Excessive passing of liquid motions is known as diarrhea or commonly lose motions. It is usually due to Infections caused by contaminated food and water. It is usually self-limiting. Severe cases with dehydration require admission for IV fluids and antibiotics for the infection. Loose motions for more than 6 to 8 weeks is known as chronic diarrhea. It is evaluated by blood tests and colonoscopy. Usual causes include tuberculosis, celiac disease, ulcerative colitis, microscopic colitis, Malabsorption such as chronic pancreatitis and small bowel bacterial overgrowth.

3. Irritable bowel syndrome (IBS): IBS is very common and at least 20 to 30 percent of Indian patients suffer from it. Symptoms include altered bowel habits such as diarrhoea or constipation, abdominal pain which is usually relieved or increased by defecation. Weight loss or bleeding is not the feature of IBS. Few simple blood tests are required and good medicines are now available for IBS. Few cases may require colonoscopy to rule out alternative causes of the symptoms.

Understanding colonoscopy: Colonoscope is a flexible tube with a camera at its tip to see the inside of the large and small intestine. Bowel preparation is required at least 8 hours before the procedure so that the inside of the large intestine can be seen clearly without the interference of stools.colonoscopy is an OPD based procedure where the patients are discharged the same day. A colonoscopy helps in evaluation symptoms of the large intestine such as loose stools, bleeding and abdominal pain.

In Detail About Colorectal Disorders!

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