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I found the answers provided by the Dr. Dinesh Shah to be very helpful. Thank u sir for your valuable suggestion
Colorectal surgery is a specialized branch of medicine used to treat patients suffering from colon, rectum, and anus ailments (damage, obstruction, injury, ischemia, inflammation, or any other medical condition). The colorectal surgery involves varied procedures that, at times, require the assistance of many specialized and experienced surgeons, consultants, and nurses (colorectal nurses).
Colorectal surgery help patients with:
- Crohn's disease: In this disease, there is weight loss, extreme fatigue, malnutrition, severe diarrhea, abdominal pain. Crohn's disease is mainly an inflammatory bowel disorder where the digestive tract (lining) gets inflamed.
- Ulcerative colitis: In ulcerative colitis, there is inflammation and ulcer formation in the rectum and the colon.
- Diverticulitis: In diverticulitis, there is inflammation of the diverticula or pouches (formed on the walls of the colon).
- Colorectal Cancer: Also known as bowel cancer and colon cancer.
Colorectal surgery is also helpful in case of:
- Anal fissures: In anal fissures, there is a tear in the anal canal (lining of the lower rectum). As a result, a person may experience extreme pain and discomfort in passing the stool.
- Bowel or fecal incontinence: In bowel incontinence, there is an uncontrolled bowel movement, resulting in a sudden (unexpected and uncontrolled) passing of stool.
- Hemorrhoids or Piles: It is a condition whereby the muscles and veins of the rectum and the anus (lower part) get swollen and inflamed. Piles are often accompanied by pain, bleeding, and itching. There is difficulty in sitting and in bowel movements.
- Rectal prolapse: In rectal prolapse, the entire rectal wall or the rectal mucosa protrudes out (loses its attachment).
Anal fistula and Anal abscess
Colorectal surgery can be of different types:
- Colostomy: It is a surgical procedure that links the colon to the abdominal surface through an opening called the stroma. This creates an alternative pathway for the removal of the feces. Colostomy comes in handy when the colon fails to function normally (due to a disease or an injury). A colostomy can be temporary or permanent:
- In a temporary colostomy, the damaged part of the colon is removed temporarily. Once the condition improves, the colon (part removed) can be reattached through a colostomy reversal surgery.
- In a permanent colostomy, the colon (damaged part) is removed permanently through surgery.
- Hemorrhoidectomy: As the name suggests, Hemorrhoidectomy is used to treat hemorrhoids or piles. In this procedure, the hemorrhoids are surgically removed through an incision (around the anus).
In PPH (Procedure for prolapse and hemorrhoids), the hemorrhoidal tissue is repositioned back into its original position (in the anus). Once repositioned, the surgeon trims the tissue causing pain and discomfort--
- Inflammatory Bowel Disease (IBD) Surgery: The surgery is an effective treatment for Crohn's Disease and Ulcerative Colitis. Here, the surgeon removes the colon to treat the condition.
- Rectopexy: Rectopexy is beneficial for patients with rectal prolapse.
- Internal Sphincterotomy: This is helpful in case of anal fissures. To reduce the pressure, the surgeon makes a small cut is made in the internal anal sphincter. In Internal Sphincterotomy, the patient is normally given a local anesthesia.
- Colectomy: To treat diseases that may affect the colon, a surgeon may remove the entire colon (Total Colectomy) or just a part of it (Partial Colectomy). Colectomy may further be:
- Proctocolectomy: Both colon and rectum are removed.
- Hemicolectomy: The left or right portion of the colon is removed. If you wish to discuss about any specific problem, you can consult a General Surgeon.
A fistula is an abnormal, tube-like connection, a passage or hole that forms between two organs or an organ in your body and your skin. There are various types of fistulas that can develop in different parts of your body but the most common types are-
1. Obstetric Fistulas: This is the name given to a hole between the vagina and rectum or bladder. A vaginal fistula that opens into the urinary tract is called a vesicovaginal fistula and one that opens into the rectum is called a rectovaginal fistula.
A woman with obstructed labour or labour that is not attended by a doctor or a midwife, can suffer labor pain for up to six or seven days. And as the labour produces contractions that push the baby’s head against the mother’s pelvic, the soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow between the mother’s bladder and vagina and/or between the rectum and vagina.
This means that a hole forms on the vaginal wall between the urinary tract and her rectum. The urine and faeces thus start to leak from the vaginal opening causing soiling and foul smell.
Apart from labour, hysterectomies that damage the vaginal wall can also cause such types of fistulas.
Enterovaginal – A woman may have gas and foul smelling fluids leaking out of her vagina due to an enterovaginal fistula which is a hole between the vagina and the digestive tract. It’s usually caused due to inflammatory bowel disease or IBD and ulcerative colitis.
2. Anal fistula
These are fistulas that form between the end of the bowel and skin near the anus.
An anal fistula usually develops due to a previous or current anal abscess. An anal abscess is an infected cavity filled with pus found near the anus due to an acute infection in the internal glands of the anus.
Common symptoms are:
- Pain in the anorectal area
- Rectal bleeding
- Urinary symptoms, such as trouble initiating urination or painful urination
- Inflammatory bowel disease – a chronic condition of the GI track which causes inflammation
- Diverticulitis – An infection in the large intestine
- Tuberculosis, HIV
- Surgery near the anus
Anal abscess and likewise anal fistula are treated by surgical drainage in which an incision is made in the skin near the anus to drain the infection causing an anal abscess. Hospitalization may be required for patients who have impaired immunity like diabetics.
Anal fistula though has no medical treatment and surgery is almost always necessary to cure it.
- If the fistula is straightforward which means one that involves minimal sphincter muscle, a fistulotomy may be performed. This involves cutting open the whole length of the fistula so it heals.
- Seton is another procedure in which a surgical thread called a seton is placed in the fistula and left there to help it heal. If you wish to discuss any specific problem, you can consult a general surgeon.
An anal fissure can affect people of all ages, and it’s often seen in infants and young children. Constipation is a common problem in this age group and it is a major cause of this problem.
An anal fissure usually isn’t a serious condition. In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it’s considered chronic, or long term.
- A visible tear in the skin around the anus
- A small lump of skin just next to the tear
- A sharp pain in the anal area during bowel movements
- Streaks of blood on stools or on wiping
- Burning or itching around the anus
- Straining during childbirth
- Straining during bowel movements as a result of constipation
- Chronic constipation
- Inflammatory bowel disease (IBD)
- Overly tight anal sphincter muscles
In rare cases, an anal fissure may develop due to:
- Anal cancer which occurs due mostly to ano-receptive sex without barrier protection
- HIV infection
Let’s take a closer look at these risk factors.
- Anal fissures are common in infants and young kids. Older adults also become prone to anal fissures as the blood flow to the anorectal region decreases.
- Women also become prone to these fissures due to straining during childbirth.
- The inflammation that occurs in the intestinal lining in people with IBD makes the tissue around the anus more prone to tearing, further causing fissures.
- People who frequently experience constipation are at an increased risk for fissures. Also, one can suffer from fissures due to straining and passing large, hard stools. In both these cases, one may experience tears in the anal lining.
- Frequent diarrhea can also tear the skin around the anus and so can ano-receptive sex without protection. This can lead to sexually transmitted diseases like genital herpes, HIV/AIDS and infection with HPV virus which causes anal cancer.
Treatment usually helps control anal fissures and the discomfort it causes. Your doctor will prescribe stool softeners and topical pain relievers to stem discomfort. However, if these do not make your anal fissure go away then surgery may be required. And in addition to this, your doctor will also need to look for other underlying causes that can cause anal fissures like for example anal cancer.
- An anal fissure can be diagnosed by simple physical exam. The doctor looks at the area around your anus and follows it up with a rectal exam to confirm the diagnosis.
- This can mean the use of an anoscope. In this, the doctor inserts an anoscope into your rectum to be able to see the anal tear.
- An anoscope is a thin tube and it allows doctors to inspect the anal canal. An anoscope is also used to diagnose other causes of anal or rectal pain such as hemorrhoids or piles. If you wish to discuss about any specific problem, you can consult a General Surgeon.
Did you know that polyp formation is one of the common ailments of the large intestine, affecting close to 5-10 per cent of the population? Although majority of the polyps are asymptomatic in nature and do not form into cancer, it is important that you stay alert.
What is the disease all about?
When an abnormal growth arises from the lining of the rectum or colon, a polyp formation develops in the area. Rectum constitutes the last 12 inches of the intestine. It can be flat or take the shape of a broccoli. The latter is known as a pedunculated polyp. This being said, there is a small percentage of polyps that can turn into cancer over a span of 8-10 years. It is estimated that 95% of rectal cancers generate from polyps. Certain factors such as the size and type of the polyp decide the malignant nature of polyps. It is also dependent on the pre-cancerous changes.
The different types of polyps
There are 3 types of polyps. The first type of polyp is known as a tabular adenoma. This form has a 5 percent probability of turning into cancer. The second form of polyp is referred to as Tubulo-villous adenoma. There is a 20 percent risk of this form of polyp turning into cancer. The third form is known as a Villous adenoma. In terms of polyp size, there is a 1 percent risk factor involved of getting cancer in the polyp size is greater than 1 cm. Polyps that are in the range of 1-2 cm, has a 10 percent chance of turning into cancer. For the ones that are greater than 2 cm, there is a 40 percent probability of cancer.
Not too many symptoms are associated with rectal polyps. However, there are certain symptoms which are evident signs of rectal polyps. Some of them include bloody stool, abdominal pain, rectal bleeding, mucous discharge, diarrhoea, constipation etc.
A word on the diagnosis
A digital rectal exam or sigmoidoscopy can identify rectal polyps. They can also be identified with x-ray, colonoscopy, barium enema etc. During the process of colonoscopy, doctors focus on the changes in the lining of the colon. Although there is no full proof method of detecting polyps, most doctors rely on a combination of the above-mentioned techniques to lock in on the diagnosis.
The right treatment
Many polyps can be removed immediately at the time of colonoscopy. This method can prevent cancer and help a person avoid unnecessary complications. If the polyp is too large, a surgical intervention might be required. If the location of the polyp is situated in the lower portion of the rectum, it can be eradicated by a process known as transanal excision. If the polyp is located higher above the rectum, it is generally removed by a process known as Trans Anal Minimally Invasive Surgery. If you wish to discuss about any specific problem, you can consult a General Surgeon.
Do you bleed or feel pain during bowel movements, or the skin around your anus feels sore or itches? Or maybe there's a lump in or around your anus, or you feel as if your bowels haven't emptied completely? Then you may be suffering from piles. Piles or hemorrhoids are essentially swollen veins and muscles in your anal canal or around your anus. And they may stay inside your anus or come outside depending on the severity of the affliction.
Often, piles can be successfully treated with high-fiber diet, proper hygiene, and topical medicines or ointments. But in situations where non-surgical methods don't achieve desired results, surgery becomes the only option. And this may be particularly necessary for those suffering from large painful or bleeding hemorrhoids. The different surgical options are given below:
Hemorrhoidectomy - In this procedure, the surgeon makes incisions around the anus to remove the piles formations. Local or general anesthesia is offered during the operation, and you can usually return home on the same day. After the procedure, the area might require stitches and commonly remains very tender and painful for quite some time.
PPH or Procedure for Prolapse and Hemorrhoids - This method is minimally invasive and makes use of a stapler-like machine for repositioning the hemorrhoids and cutting off their blood supply. So eventually, the piles shrink and die without blood supply and your pain diminishes greatly. With this process, you can expect a faster recovery, less itching and bleeding, and minimal complications, if any.
Laser - An accurate and special laser beam is used in this method, to burn off the hemorrhoids.
Rubber Band Ligation - This procedure can be used for areas with fewer pain receptors. In this, a rubber band is tied around the base of hemorrhoid to stem the blood supply and destroy the affected tissue.
Sclerotherapy - This method involves the injection of a chemical solution around the blood vessel which supplies the hemorrhoid tissues, to shrink and kill them. Though non-invasive methods are preferred by many since they create less pain, hemorrhoidectomy may provide more long-lasting benefits. Here are some other aspects you need to consider regarding piles surgery:
Risks - Infection, bleeding, reaction to anesthesia, trouble with urination, fecal incontinence are some of the risks involved, though the surgery is usually quite safe.
Ways of treating pain - Pain, especially during and after a bowel movement, can be an issue for several days after the surgery. But it can be dealt with by taking prescribed pain medications, stool softeners, and soaking in a warm bath. Recovery can take up to 3 to 6 weeks after the procedure.
Avoiding recurrence - Following a high-fiber diet, maintaining good hygiene, taking lots of fluids, and avoiding straining or constipation can prevent piles from coming back. If you wish to discuss about any specific problem, you can consult a General Surgeon.
Colorectal surgery deals with the disorders of the rectum, anus and colon. Another name of colon is ‘large intestine’. These three body parts form the last stages of the digestive process. When the human waste passes through the colon, its salt and water are extracted before it exits the body as human excreta.
Common Colorectal disorders are:-
- Anorectal Abscess
- Anal fistula
- Anal fissure
- Rectal Prolapse
- Surgical Constipation
- Pilonidal Sinus
- Pruritus Ani
All these diseases are:
- Cause of significant patient discomfort & disability
- Major effect on overall quality of life
- Both men and women are equally affected
- Symptoms increase with age
Important Clinical Features of Anorectal Diseases are:
Bowel habits after colorectal surgery
Many patients report cases of diarrhoea, leakage of stool or gas, urgency to use the toilet and a feeling of insufficient evacuation of faeces. Relax; these conditions are not going to last forever. Your rectum and anus are adjusting to new conditions after this surgery. These organs may take six to twelve months to adjust to new bowel habits.
Is there a need to take a laxative or stool softener?
There is no need to take laxatives after a colorectal surgery. Drink lots of water to make your stool softer and easy to pass. If there is a water deficiency in your body, then it may lead to your faeces becoming hard. In that case, take milk of magnesium, colace etc.
Activities post surgery
You can continue with your normal schedule after this surgical procedure. Carry on running, jogging, exercising, climbing up the stairs etc. even after your surgery. Gastroenterologists recommend that patients should desist from lifting loads weighing more than 10 pounds so that there are no post surgery complications.
Diet after colorectal surgery
Avoid spicy and heavy to digest meals after your surgery. Once the intestines begin working normally, you can continue having your spicy food. Chew your food well to aid its digestion.
Returning to work after colorectal surgery
Most people are back to their work after taking a break of 2-5 days. If the surgery is pretty detailed, you may have to take a break of up to a month. Patients undergoing laparoscopic surgery may have to take a rest of 2- 4 weeks before they report back to work. Take it easy before slipping into your regular schedule. If working hurts after your surgery, don’t do it. If you wish to discuss about any specific problem, you can consult a General Surgeon.
What is a colonoscopy?
Colonoscopy is a procedure that enables your surgeon to examine the lining of the colon and rectum. It is usually done in the hospital or an endoscopic procedure room on an outpatient basis. A soft, bendable tube about the thickness of the index finger is gently inserted into the anus and advanced into the rectum and the colon.
Why is a colonoscopy performed?
A colonoscopy is usually done:
1) as part of a routine screening for cancer,
2) in patients with known polyps or previous polyp removal,
3) before or after some surgeries,
4) to evaluate a change in bowel habits or bleeding or,
5) to evaluate changes in the lining of the colon known as inflammatory disorders.
What preparation is required?
The rectum and colon must be completely emptied of stool for the procedure to be performed. In general, preparation consists of consumption of a special cleansing solution or several days of clear liquids, laxatives and enemas prior to the examination. Your surgeon and his or her staff will provide you with instructions regarding the cleansing routine necessary for the colonoscopy. Follow your surgeon’s instructions carefully. If you do not complete the preparation, it may be unsafe to perform the colonoscopy and the procedure may have to be rescheduled. If you are unable to take the preparation, contact your surgeon. Most medications can be continued as usual. Medication use such as aspirin, Vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your surgeon prior to the examination as well as any other medications you might be taking. It is essential that you alert your surgeon if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to colonoscopy. You will most likely be sedated during the procedure and an arrangement to have someone drive you home afterward is imperative. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
What can be expected during colonoscopy?
The procedure is usually well tolerated, but there is often a feeling of pressure, gassiness, bloating or cramping at various times during the procedure. Your surgeon will give you medication through a vein to help you relax and better tolerate any discomfort that you may experience. You will be lying of your side or your back while the colonoscope is advanced through the large intestine. The lining of the colon is examined carefully while inserting and withdrawing the instrument. The procedure usually lasts for 15 to 60 minutes. In rare instances the entire colon cannot be visualized and your surgeon may request an additional test such as a barium enema or a CT colonography.
What if colonoscopy shows an abnormality?
If your surgeon sees an area that needs more detailed evaluation, a biopsy may be obtained and submitted to a laboratory for analysis. A biopsy is performed by placing a special instrument through the colonoscope. Most polyps can be removed at the time of the colonoscopy. The majority of polyps are benign (non-cancerous), but your surgeon cannot always tell by the appearance alone. They can be removed by burning
(fulgurating) or by a wire loop (snare).
It may take your surgeon more than one sitting to do this if there are numerous polyps or if the polyps are very large. Sites of bleeding can be identified and controlled by injecting certain medications or coagulating (burning) the bleeding vessels. Biopsies do not imply cancer, however, removal of a colonic polyp is an important means of preventing colon and rectal cancer.
What happens after colonoscopy?
Your surgeon will explain the results to you after your procedure or at your follow up visit. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of the gas. You should be able to eat normally the same day and resume your normal activities after leaving the hospital. Do not drive or operate machinery until the next day, as the
sedatives given will impair your reflexes. If you have been given medication during the procedure, you will be observed until most of the effects of the sedation have worn off (1-2 hours). You will need someone to drive you home after the procedure. If you do not remember what your surgeon told you about the examination or follow up instructions. Call your surgeon’s office that day or the next to find out what you were supposed to do.
If polyps were found during your procedure, you will need to have a repeat colonoscopy. Your surgeon will decide on the frequency of your colonoscopy exams.
What complications can occur?
Colonoscopy complications include bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the bowel wall. Other complications of the procedure include the possibility of missed polyps or other lesions.
Should a perforation occur, it may be necessary for your surgeon to perform abdominal surgery to repair the intestinal tear. Blood transfusions are rarely required. A reaction to the sedatives can occur. Irritation to the vein that medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm, moist towels will help relieve this discomfort.
It is important to contact your surgeon if you notice symptoms of severe abdominal pain, fevers, chills or rectal bleeding of more than one-half cup. Bleeding can occur up to several days after a biopsy.
What are Hemorrhoids ?
Hemorrhoids (piles) are natural cushions of tissue and B.V. located at the junction of rectum and anus. Along with sphincter, this normal tissue is responsible for complete closure of anus and prevents any leakage. During a bowel movement these cushions become smaller to allow stool to pass throw. Every one has them, and problems only arise when they become larger then they should.
These anal cushions are normally fastened in the sphincter region by muscle and tissue. If too much pressure is exerted on them, the system of securing them may be damaged and cushions will swell and by friction they bleed or by force may protrude outside the anus.
How can we Diagnose : We can diagnose the Piles by asking the Clinical History and by doing per rectal examination . Depending upon symptoms Piles are of four Grade:
1. Grade I : Patient will complain Painless Bright Red colored Bleeding during or after passing stool.
2. Grade II : Patient will complain , something is coming out during passing stool.
3. Grade III : Patient will complain , something is coming out during passing stool and manual reposition is required to put it inside. It may be associated along with bleeding during passing stool.
What is Fistula in Ano?
A fistula in ano is a hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the peri anal skin. Secondary tract may be multiple and from the same primary opening inside.
How can we Diagnose it?
We can Diagnose it by following symptoms and signs -
- Perianal discharge: Patient may have pus discharge outside the anus.
- Skin excoriation
- External opening
What Treatment available for this disease ?
Various Procedures available Like VAAFT, LIFT Core surgery etc.