Conditions and Treatment
The large intestine is a segment of the bowel that removes moisture from the remaining digested food material and retains the waste until it is passed.
Colon Polyps and Cancer
Cancer of the colon is a major health problem in the United States. It ranks as a leading form of cancer, along with lung and breast cancer. Importantly, colon cancer is also one of the most curable forms of cancer. When detected early, more than 90 percent of patients can be cured.
This disease begins in the cells that line the colon. There now is strong medical evidence that there are abnormal genes for colon polyps and cancer that can be passed from parent to child. The genes within each cell are the hereditary structures that tell the cell what it should do. It is becoming increasingly clear that certain genes control the growth of the cells on the lining of the colon. When these controlling genes are absent there is a tendency to grow polyps. The cells in the polyp eventually become uncontrolled and turn into a cancer. Colon cancer also can develop from other conditions, such as ulcerative colitis, a chronic inflammation in the colon.
A polyp is a growth that occurs in the colon and other organs. These growths, or fleshy tumors, are shaped like a mushroom or a dome-like button, and occur on the inside lining of the colon. They may be as small as a tiny pea or larger than a plum. It is important to note that while colon polyps start out as benign tumors, some polyps, in time, become malignant. In fact, the larger the polyp, the more likely it is to contain cancer cells. In most cases, it is a polyp called an adenoma polyp that develops into colon cancer.
Risk Factors for Developing Colon Polyps and Cancer:
- Family history of polyps, cancer and especially, colon cancer.
- Western civilization and diet
- Being over 40 years of age
- History of breast cancer
- Ulcerative colitis
An individual whose parents, brothers or sisters have colon cancer is at increased risk. In addition, certain unusual conditions, such as hereditary polyposis, lead to colon cancer 100 percent of the time. Persons living and eating in Western societies are exposed to certain factors that are detrimental to the bowel. Medicine is just beginning to learn about these. Also, females who have had genital or breast cancer are at an increased risk of developing colon cancer. Ulcerative colitis, after a long time, also can lead to colon malignancy.
As noted above heredity is probably the most important factor. The absence of a controlling gene within the cells is most likely a necessary event.
Other facts are known. Rural residents in Africa and India rarely develop colon polyps or cancer. Their diets are high in unprocessed grains (bran) and low in meat. Diets that are high in bran and roughage produce bulky stools that have a lower bacteria count. Further, it is known that animal fat in meat, when broken down by the body's intestinal juices, may change into certain compounds termed carcinogens. These compounds cause colon cancer in laboratory animals. When residents in developing countries eat a Westernized diet of meat, low roughage and refined grains, over time they develop the same incidence of colon polyps and cancer as people living in the Western world. So diet probably plays an important role in causing colon cancer.
Enough is now known about polyps that physicians generally place patients into one of three categories. In each of these the end result is an adenoma type polyp:
- The Ordinary Polyp - Most sporadic polyps occur between the ages of 40 and 60. There may be only one or two present and they may take ten years or more to develop into a cancer. There is a hereditary link.
- Familial Polyposis - This is a true hereditary condition in which the entire colon contains thousands of polyps. They begin at a very early age even under ten years old. And virtually every patient will eventually develop colon cancer. The only known preventative treatment is removal of the colon. Fortunately, the condition is not common.
- Lynch Disorder - This hereditary condition is more common than familial polyposis and less so than the ordinary polyp. In it there is a strong tendency for adenoma type polyps to develop in blood relatives; sisters, brothers, aunts, uncles and children. More polyps are seen and at an early age. Polyps and even cancer can occur in the 30's and even 20's. In some families there is an increased incidence of breast, ovarian, and other cancers. So a family history of this type warrants very close surveillance of all direct blood relatives.
The key to early detection of colon polyps and cancer is the concern and willingness of each person to seek medical attention from a physician. The physician will perform the following:
- Medical history - The patient's medical history will identify the presence of risk factors for colon polyps and cancer.
- Stool exams to detect occult (hidden) blood - Colon cancers and large polyps release minute quantities of blood; therefore, examination of the stool for occult blood is an important exam.
- Sigmoidoscopy - A visual exam of the rectum and lower colon, using a lighted, rigid or flexible tube, or endoscope, allows the direct detection of colon tumors.
- Colonoscopy - This procedure examines the entire 5-6 foot long colon. Physicians perform it when any of the above three detection methods suggests a problem. The exam is usually done under sedation. It is really the definitive test since colon polyps can be discovered and removed at the same time. Click here to view a short, informational video about the procedure.
- Barium Enema - This x-ray exam is an older, at times still useful, exam. Barium flows into the colon and x-rays are taken which then can outline the shadows of polyps and cancer. Polyps cannot be removed by this technique.
- Future tests - It is possible that a blood genetic test may become available to identify those individuals who are destined to develop colon polyps and cancer.
Removal of colon polyps reduces the risk of subsequent development of cancer of the colon. Polyps are usually removed using a colonoscope which allows the physician to visualize the inside of the colon. Biopsy equipment and snares (wire loops) are passed through the endoscope and, with electrical heat (electrocautery), remove polyps and small tumors. This procedure is performed in the outpatient setting under sedation.
Cancer of the colon is a serious but readily detected malignancy. Early detection promises a particularly high chance of survival. Most colon cancers start as polyps, which can usually be removed through a colonoscopic exam. Today, there is much that can be done to prevent and cure this cancer. The essential first step involves action by the patient.
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Diverticulosis and Diverticulitis
Diverticulosis is a condition in which outpouchings form in the walls of the intestines. These pouches, known as diverticula, are about the size of large peas. They form in weakened area of the bowels, most often in the lower part of the colon (large bowel).
Most people with diverticula do not have any symptoms from them. They may never know they have the condition. Some people feel tenderness over the affected area or muscle spasms in the abdomen. Pain may be felt on the lower left side of the abdomen or, less often, in the middle or on the right side.
Although the diverticula themselves do not cause symptoms, complications such as bleeding and infection may occur. Bleeding is an uncommon symptom and is usually not severe. Sometimes the pouches become infected and inflamed, a more serious condition known as diverticulitis. When inflammation is present, there may be fever and an increased white blood cell count, as well as acute abdominal pain. Diverticulitis also may result in large abscesses (infected areas of pus), bowel blockage, or breaks and leaks through the bowel wall.
Often diverticulosis is unsuspected and is discovered by an x-ray or intestinal examination done for an unrelated reason. The doctor may see the diverticula through a flexible tube (colonoscope) that is inserted through the anus. Through this scope, the diverticula may be seen as dark passages leading out of the normal colon wall. The doctor also may do a barium enema, an x-ray that reveals the outpouchings in the walls of the colon.
If rectal bleeding occurs, the doctor may take a special x-ray (angiography). In this procedure, dye is injected into an artery that goes to the colon, so that the site of the bleeding problem can be located. Diverticulitis may be diagnosed when a patient has pain and tenderness in the lower abdomen with disturbed bowel function and fever.
Diverticulosis is very common, especially in older people. Studies show that about 10 percent of people over the age of 40 and nearly half of people over age 60 have diverticulosis. But among those who are found to have diverticula, only about 20 percent develop diverticulitis, and of those, only a small number have very serious or life-threatening complications.
For most people, diverticulosis is not a problem. Diverticulitis, on the other hand, is a problem, sometimes a serious one. For instance, when one of the sacs (a diverticulum) becomes infected and inflamed, bacteria enter small tears in the surface of the bowel. This leads to small abscesses. Such an infection may remain localized and go away within a few days. In rare cases, the infection spreads and breaks through the wall of the colon causing peritonitis (infection of the abdominal cavity) or abscesses in the abdomen. Such infections are very serious and can lead to death unless treated without delay.
If you have diverticulosis with no symptoms, no treatment is needed. Some doctors advise eating a high-fiber diet and avoiding certain foods. Laxatives and enemas should not be used regularly. Patients with diverticulitis may be hospitalized and treated with bed rest, pain relievers, antibiotics, fluids given by vein, and careful monitoring.
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Hemorrhoids, or piles, are one of mankind's most common and nagging disorders. By themselves, hemorrhoids are rarely serious, but they can be extremely troublesome. In some instances, they may mask a more serious disorder, such as colon or rectal cancer. Therefore, hemorrhoids require the proper diagnosis and treatment by a physician.
Hemorrhoids are dilated (enlarged) veins which occur in and around the anus and rectum. They may be external (outside the anus) or internal and slip to the outside. In both of these instances, the hemorrhoids can be felt and seen as lumps or knots. Hemorrhoids also may remain inside the rectum and so cannot be felt or seen. These are called internal hemorrhoids.
A common cause of hemorrhoids is simply the standing position, in which all the blood above the rectum exerts pressure on the rectal and anal areas. Other conditions which contribute to hemorrhoids are: poor bowel habits, constipation, diarrhea, pregnancy, obesity, and especially frequent straining when having a bowel movement. However, some patients will have none of these conditions and still develop hemorrhoids.
Hemorrhoids can produce several uncomfortable, but non-serious problems.
- Thrombosis and Pain - A blood clot in the hemorrhoid may cause severe pain and usually demands immediate medical attention.
- Bleeding - Hemorrhoids can ooze fresh red blood, whether located externally or internally. External hemorrhoids often cause dripping of blood from the anus while sitting on the toilet. The blood might also be seen as soiling of the underwear. Internal hemorrhoids that bleed may produce fresh blood in the stool.
- Itching and Irritation - External hemorrhoids can be itchy, especially if the area is moist and irritated.
Hemorrhoids do not develop into cancer. However, both hemorrhoids and cancer can cause rectal bleeding. In fact, many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in persons over age 30, and especially in those over age 50, it should be considered a serious problem until an exact diagnosis is made. The physician who directly examines the rectal area can make the specific diagnosis.
Treatment of hemorrhoids varies depending on where they are, what problems they are causing, and how serious they are. Often, time and the normal process of healing clear hemorrhoids with little or no specific treatment.
When hemorrhoids require treatment, the following general measures are recommended:
- Keep the anal area clean, using a mild soap and gentle dabbing after a bowel movement. Avoid vigorous rubbing of the area.
- Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
- Eat a diet high in fiber (bran) and roughage. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids. Bulking agents, such as Metamucil, Effersyllium, Konsyl, Citrucel, and Per Diem Fiber, are available in drug stores. These also come in less expensive generic versions.
- Avoid straining when having a bowel movement.
- When thrombosis, pain, and tenderness occur, a 10 to 20 minute hot tub bath two or four times daily brings heat to the area, provides relief from the pain, and promotes healing. This is called a hot Sitz bath.
A common method of treating internal hemorrhoids is to use a small rubber band to tie off the base of the swollen vein. The blood circulation stops and the hemorrhoid then falls off. Repeat treatments are sometimes necessary.
Other treatments include infrared photocoagulation, lasers, and surgery.
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Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) usually affects a patient's colon or large intestine. IBS is a disorder of the colon but not a disease. A patient who has IBS can have a perfectly healthy colon. IBS is sometimes called spastic colon.
A patient with IBS experiences irregular and unnatural contractions of their colon. These abnormal contractions can be painful and uncomfortable and may lead to constipation or diarrhea. Air can accumulate in your colon and produce cramping and bloating. Symptoms can come and go.
IBS usually affects patients under 40 years old. Sometimes symptoms can be triggered by certain foods, such as caffeine, alcohol, raw fruits, vegetables, and milk products. However, by far, the most common factor associated with IBS syndrome is stress. The actual cause of IBS is unknown.
In order to determine whether you have IBS, your doctor will perform several tests in order to rule out other diseases with similar symptoms. You may be asked to have lab tests, x-rays, or a visual examination of your lower intestines called a Colonoscopy. Once your physician can rule out the other diseases, IBS can usually be confirmed.
Treatment for IBS includes diet modification. Reduce or eliminate foods that cause symptoms of IBS. Don't overeat. Increase the amount of fiber in your diet and consider taking a fiber supplement. We often recommend patients try a product such as BiosLife to increase fiber in their diet. Stress reduction is also important. Regular exercise and relaxation techniques can help alleviate symptoms of IBS. In some cases, your physician will prescribe medications that can help relax the muscles in your colon and reduce the abnormal contractions.
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