Overview

Colonic Diseases

Your colon, also known as the large intestine, is part of your digestive system. It's a long, hollow tube at the end of your digestive tract where your body makes and stores stool. Many disorders affect the colon's ability to work properly. Some of these include

Colorectal cancer
Colonic polyps - extra tissue growing in the colon that can become cancerous
Ulcerative colitis - ulcers of the colon and rectum
Diverticulitis - inflammation or infection of pouches in the colon
Irritable bowel syndrome - an uncomfortable condition causing abdominal cramping and other symptoms

Treatment for colonic diseases varies greatly depending on the disease and its severity. Treatment may involve diet, medicines and in some cases, surgery.

Anatomy and physiology

The large bowel consists of the colon (5 feet long) and the rectum (8 inches long). Many time the rectum is referred to as the opening where stool emerges, but that is actually the anus. The rectum is just upstream from that area. Just upstream from the large bowel is the small bowel.

The colon's main function is to process the 3 pints of liquid stool it receives each day into a manageable amount of solid stool, ready for evacuation. The rectum coordinates the process of evacuation. Normally, a person can pass up to 150 grams of solid stool daily. However there is a lot of variation in the amount of stool a normal person passes. This can vary from 3 times daily to 3 times per week.

Diseases Of The Colon

Functional disorders

Functional disorders are disorders in which the bowel looks normal but doesn't work properly. These are the most common problems affecting the colon and rectum. The direct cause is frequently unknown.

Constipation

Constipation is defined as small, hard, difficult, or infrequent stools.

Constipation may be caused by : -

inadequate "roughage" or fiber in the diet
not enough oral fluid
poor habits, especially putting off the call to stool
movement problems in the large bowel, including slow or uncoordinated movement

A person who is constipated may strain during a bowel movement or just pass very hard stool. Passage of hard stool may contribute to the development of anal problems such as fissures (painful cracks in the anal tissue lining) or hemorrhoids. Treatment of constipation may include eating more fiber and improving stool consistency. If these treatment methods don't work, laxatives or enemas may be recommended.

Irritable bowel

Irritable or sensitive bowel is a condition in which the colon muscle contracts in an abnormal fashion, which may lead to several problems. Some patients have predominantly diarrhea, others constipation, and others mixed constipation and diarrhea. The abnormal contraction can lead to high pressure that builds up in the colon causing abdominal cramps, gas, bloating, and sometimes extreme urgency.

Treatment includes avoiding foods that make the problems worse, tailoring diet alteration to the particular symptoms, managing stress, and medications.

Structural disorders

Structural disorders are those in which there is something visually abnormal that may need to be removed, altered or repaired by an operation. These may include removing a portion of the colon for diverticulitis or for a cancer.

Anal disorders

Internal hemorrhoids

Internal hemorrhoids are normal blood vessels that line the inside of the anal opening. We are born with them. They are thought to be the fine tuning mechanism that allows us to contain gas and avoid passing it until we feel it is socially acceptable. When they become enlarged as a result of straining or pregnancy, they may become irritated and start to bleed. Occasionally internal hemorrhoids can become enlarged enough to protrude outside the anal opening.

New treatments are being developed all the time. Traditional care has included improving bowel habits, using elastic bands to pull the internal hemorrhoids back into the rectum, or removing them surgically. There are new devices that use sound waves to discover exactly where the excessive blood flow is occurring into these vessels and allow the doctor to specifically tie off the area.

Also there is the 'stapled' hemorrhoidectomy where a special device is used to pull the hemorrhoid tissue back into the body and staple it in place. Doctors can examine patients and pick the treatment that would best treat their problems.

External hemorrhoids

External hemorrhoids are veins that lie just under the skin on the outside of the anus. Usually they do not cause any symptoms. Occasionally a blood clot can form and can be very painful. Many times this will get better on its own. Sometimes, removal of the clot is done under local anesthesia in the doctor's office. These are not dangerous blood clots that can travel to other organs. The biggest concern they raise is pain.

Anal fissure

An anal fissure is a split or tear in the lining of the anus that occurs after trauma, which can be from a hard stool or even diarrhea. As a result, the person experiences bleeding and intense burning pain after bowel movements. The pain is caused by spasm of the sphincter muscle, which is exposed to air by this tear. The pain with bowel movements has been described as the feeling of passing razor blades.

Fissures are the anal problem misdiagnosed most commonly. They frequently are mistaken for hemorrhoids. Fissures often get better by themselves. If they don't improve, your doctor can recommend an ointment or medication that will relieve the pain. In certain cases, surgery may be recommended if the tear does not heal due to excessive sphincter spasm.

Perianal abscess

Our anal region has tiny glands that open on the inside of the anus and probably aid in passage of stool. When one of these glands becomes blocked, an infection may develop. When pus forms, there is an abscess (a pocket of pus). Treatment includes draining the abscess, usually under local anesthesia in the doctor's office.

Fistula-in-ano

In about 50% of cases after drainage of a perianal abscess, a tunnel develops from the gland on the inside of the anus to the skin around the anus. This is termed a fistula-in-ano. Fistulas drain mucous fluid onto the skin and blood. They rarely heal by themselves and usually need surgery.

Other perianal infections

Between the anal area and the tailbone, hair in this region can burrow under the surface and causing infection. This is called pilonidal disease. It may present as abscess in this area just below the tailbone or small draining openings. Usually surgery is needed to treat this problem.

Sexually transmitted diseases that can affect the anus include herpes, AIDS, chlamydia, and gonorrhea. Anal warts that are small growths on the anal skin that look like tiny pink cauliflowers and are caused by a virus (HPV).

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