are abnormal growths rising from the lining of the large intestine
(colon) and protruding into the intestinal canal (lumen). Some polyps
are flat; others have a stalk.
Polyps are one of the
most common conditions affecting the colon and rectum, occurring in
15-20 percent of the adult population. Although most polyps are benign,
the relationship of certain polyps to cancer is well established.
What are the symptons of polyps?
Most polyps produce no symptoms and often are found incidentally during
endoscopy or x-ray of the bowel. Some polyps, however, can produce
bleeding, mucous discharge, alteration of bowel function, or in rare
cases, abdominal pain.
How are polyps diagnosed?
Polyps are diagnosed either by looking at the colon lining directly (colonoscopy) or by x-ray study (barium enema).
There are three types of colorectal endoscopies: (1) rigid
sigmoidoscopy, (2) flexible sigmoidoscopy and (3) colonoscopy. Rigid
sigmoidoscopy permits examination of the lower six to eight inches of
the large intestine. In flexible sigmoidoscopy, the lower one-fourth to
one-third of the colon is examined. Neither rigid nor flexible
sigmoidoscopy requires medication and can be performed in the doctor’s
Colonoscopy uses a longer flexible instrument and usually permits
inspection of the entire colon. Bowel preparation is required, and
sedation is often used.
The colon can also be indirectly examined using the barium enema x-ray
technique. This examination uses a barium solution to coat the colon
lining. X-rays are taken, and unsuspected polyps are frequently found.
Although checking the stool for microscopic blood is an important test
for colon and rectal disorders, a negative test does NOT rule out the
presence of polyps. The discovery of one polyp necessitates a complete
colon inspection, since at least 30 percent of these patients will have
Do polyps need to be treated?
Since there is no fool-proof way of predicting whether or not a polyp
is or will become malignant, total removal of all polyps is advised.
The vast majority of polyps can be removed by snaring them with a wire
loop passed through the instrument. Small polyps can be destroyed
simply by touching them with a coagulating electrical current.
Most colon examinations using the flexible colonoscope, including polyp
removal, can be performed on an outpatient basis with minimal
discomfort. Large polyps may require more than one treatment for
complete removal. Some polyps cannot be removed by instruments because
of their size or position, surgery is then required.
Can polyps recur?
Once a polyp is completely removed, its recurrence is very unusual.
However, the same factors that caused the polyp to form are still
present. New polyps will develop in at least 30 percent of people who
have previously had polyps. Patients should have regular exams by a
physician specially trained to treat diseases of the colon and rectum.
Diverticular disease of the colon is a common condition that afflicts
about 50% of American by age 60 and nearly all by age 80. Only a small
percentage of those with diverticula of the colon have symptoms, and
even fewer will ever require surgery.
What is diverticulitis?
Diverticula are pockets or pouches that develop through weaknesses in
the colon wall, usually in the sigmoid or left colon, but may involve
the entire colon. Diverticulitis describes perforation or inflammation
of the diverticulum.
What are the symptoms?
The major symptoms of diverticular disease are abdominal pain (usually
in the lower left abdomen), diarrhea, cramps, alteration of bowel
habits and, occasionally, severe rectal bleeding. These symptoms occur
in a small percentage of patients with diverticulosis and are sometimes
difficult to distinguish from other intestinal disorders such as
irritable bowel syndrome.
Diverticulitis – an inflammation or infection of a diverticulum – may
cause one or more of the following symptoms: pain, chills, fever, and
change in bowel habits. Severe cases of diverticulitis may be
complicated by infections of the abdomen, drainage tracts to the
bladder or vagina, or bursting of the colon requiring emergency
What is the cause of diverticular disease?
Indications are that a low-fiber diet over many years creates increased
colon pressure and results in the development of diverticula.
How is diverticular disease treated?
Mild symptoms of diverticular disease are usually treated by diet and
occasionally medications to help control pain, cramps, and changes in
bowel habits. Increasing the amount of dietary fiber (grains, legumes,
vegetables, etc.) and sometimes restricting certain foods reduces
pressure in the colon so that complications are less likely to arise.
Diverticulitis requires more intense management. Mild cases may be
managed without hospitalization, but this is a decision best made by
your physician. Treatment usually consists of oral antibiotics, dietary
restrictions, and possible stool softeners. Severe cases require
hospitalization with intravenous antibiotics and strict dietary
restraints. Most acute attacks can be relieved with such methods.
When is surgery necessary?
Surgery is indicated for recurrent episodes, complications, or severe
attacks when there is little or no response to medication.
In surgery, usually part of the colon – commonly the left or sigmoid
colon – is removed and the colon is reconnected or “anastomosed” to the
rectum. Complete recovery can be expected. Normal bowel function
usually resumes in 1 – 3 weeks.
Who performs this type of surgery?
Colon and rectal surgeons are experts in the surgical and nonsurgical
treatment of colon and rectal problems. They have completed advanced
training in the treatment of colon and rectal problems in addition to
full training in general surgery. Colon and rectal surgeons treat
benign and malignant conditions, perform routine screening examinations
and treat problems surgically when necessary.
What are hemorrhoids?
Often described as “varicose veins of the anus and rectum”, hemorrhoids
are enlarged, bulging blood vessels in and about the anus and lower
rectum. There are two types of hemorrhoids: External and internal,
which refer to their location.
External (outside) hemorrhoids develop near the anus and are covered by
very sensitive skin. If a blood clot develops in one of them, a painful
swelling may occur. The external hemorrhoid feels like a hard,
sensitive lump. It bleeds only if it ruptures.
Internal (inside) hemorrhoids develop within the anus beneath the
lining. Painless bleeding and protrusion during bowel movements are the
most common symptom. However, an internal hemorrhoid can cause severe
pain if it is completely "prolapsed” – protrudes from the anal opening
and cannot be pushed back inside.
What causes hemorrhoids?
An exact cause is unknown; however, the upright posture of humans alone
forces a great deal of pressure on the rectal veins, which sometimes
causes them to bulge. Other contributing factors include:
Chronic constipation or diarrhea
Faulty bowel function due to overuse of laxatives or enemas, straining during bowel movements
Spending long periods of time (e.g. reading) on the toilet.
Whatever the cause, the tissues supporting the veins stretch. As a
result, the veins dilate; their walls become thin and bleed. If the
stretching and pressure continue, the weakened veins protrude.
What are the symptoms?
If you notice any of the following, you could have hemorrhoids:
Bleeding during bowel movements
Protrusion during bowel movements
Itching in the anal area
Do hemorrhoids lead to cancer?
No. There is no relationship between hemorrhoids and cancer. However,
the symptoms of hemorrhoids, particularly bleeding, are similar to
those of colorectal cancer and other disease of the digestive system.
Therefore, it is important that all symptoms are investigated by a
physician specially trained in treating diseases of the colon and
rectum. Do not rely on over-the-counter medications or other
self-treatments. See a colorectal surgeon first so your symptoms can be
properly evaluated and effective treatment prescribed.
How are hemorrhoids treated?
Mild symptoms can be relived frequently by increasing the amount of
fiber (e.g., fruits, vegetables, bread and cereals) and fluids in the
diet. Eliminating excessive straining reduces the pressure on
hemorrhoids and helps prevent them from protruding. A sitz bath –
sitting in pain warm water for about 10 minutes – can also provide some
With these measures, the pain and swelling of most symptomatic
hemorrhoids will decrease in two to seven days, and the firm lump
should recede within four to six weeks. In cases of severe, persistent
pain, your physician may elect to remove the hemorrhoid containing the
clot with a small incision. Performed under local anesthesia as an
outpatient, this procedure generally provides relief.
Severe hemorrhoids may require special treatment, much of which can be performed on an outpatient basis.
Ligation – The rubberband treatment – works effectively on internal
hemorrhoids that protrude with bowel movements. A small rubberband is
placed over the hemorrhoid, cutting off its blood supply. The
hemorrhoid and the band fall off in a few days and the wound usually
heals in a week or two. This procedure sometimes produces mild
discomfort and bleeding.
Injection and Coagulation can also be used on bleeding hemorrhoids that do not protrude.
Both methods are relatively painless and cause the hemorrhoid to shrivel up.
Hemorrhoidectomy – surgery to remove the hemorrhoids – is the best
method for the permanent removal of hemorrhoids. It is necessary when
(1) clots repeatedly form in external hemorrhoids; (2) ligation fails
to treat internal hemorrhoids; (3) the protruding hemorrhoid cannot be
reduced; or (4) there is persistent bleeding. A hemorrhoidectomy
removes excessive tissue that causes the bleeding and protrusion. It is
done under anesthesia and may, depending upon circumstances, require
hospitalization and a period of inactivity. Laser hemorrhoidectomies do
not offer any advantage over standard operative techniques. They are
also quite expensive, and contrary to popular belief, are no less
Other treatment include cryotherapy, BICAP coagulation and direct
current. Cryotherapy, popular 20 years ago, consists of freezing
hemorrhoidal tissue. It is not recommended for hemorrhoids because it
is very painful. BICAP and direct current are methods that shrink the
hemorrhoid. None of these treatments have gained widespread acceptance.