Conditions and Treatments

To evaluate minor rectal bleeding, your doctor may perform a digital rectal examination. In addition, an endoscopic procedure such as anoscopy, flexible sigmoidoscopy or colonoscopy may be recommended. Minor rectal bleeding refers to the passage of a few drops of bright red (fresh) blood from the rectum, which may appear on the stool, on the toilet paper or in the toilet bowl. This brochure addresses minor rectal bleeding that occurs from time to time. Continuous passage of significantly greater amounts of blood from the rectum or stools that appear black, tarry or maroon in color can be caused by other diseases that will not be discussed here. Call your doctor immediately if these more serious conditions occur. Because there are several possible causes for minor rectal bleeding, a complete evaluation and early diagnosis by your doctor is very important. Rectal bleeding, whether it is minor or not, can be a symptom of colon cancer, a type of cancer that can be cured if detected early. What are hemorrhoids? Hemorrhoids (also called piles) are swollen blood vessels in the anus and rectum that become engorged from increased pressure, similar to what occurs in varicose veins in the legs. Hemorrhoids can either be internal (inside the anus) or external (under the skin around the anus). Hemorrhoids are the most common cause of minor rectal bleeding, and are typically not associated with pain. Bleeding from hemorrhoids is usually associated with bowel movements, or it may also stain the toilet paper with blood. The exact cause of bleeding from hemorrhoids is not known, but it often seems to be related to constipation, diarrhea, sitting or standing for long periods, obesity, heavy lifting and pregnancy. Symptoms from hemorrhoids may run in some families. Hemorrhoids are also more common as we get older. Fortunately, this very common condition does not lead to cancer. Hemorrhoids and rectal polyps are common causes of minor rectal bleeding. How are hemorrhoids treated? Medical treatment of hemorrhoids includes treatment of any underlying constipation, taking warm baths and applying an over-the-counter cream or suppository that may contain hydrocortisone. If medical treatment fails there are a number of ways to reduce the size or eliminate internal hemorrhoids. Each method varies in its success rate, risks and recovery time. Your doctor will discuss these options with you. Rubber band ligation is the most common outpatient procedure for hemorrhoids in the United States. It involves placing rubber bands around the base of an internal hemorrhoid to cut off its blood supply. This causes the hemorrhoid to shrink, and in a few days both the hemorrhoid and the rubber band fall off during a bowel movement. Possible complications include pain, bleeding and infection. After band ligation, your doctor may prescribe medications, including pain medication and stool softeners, before sending you home. Contact your doctor immediately if you notice severe pain, fever or significant rectal bleeding. Laser or infrared coagulation and sclerotherapy (injection of medicine directly into the hemorrhoids) are also office-based treatment procedures, although they are less common. Surgery to remove hemorrhoids may be required in severe cases or if symptoms persist despite rubber band ligation, coagulation or sclerotherapy. What are anal fissures? Tears that occur in the lining of the anus are called anal fissures. This condition is most commonly caused by constipation and passing hard stools, although it may also result from diarrhea or inflammation in the anus. In addition to causing bleeding from the rectum, anal fissures may also cause a lot of pain during and immediately after bowel movements. Most fissures are treated successfully with simple remedies such as fiber supplements, stool softeners (if constipation is the cause) and warm baths. Your doctor may also prescribe a cream to soothe the inflamed area. Other options for fissures that do not heal with medication include treatment to relax the muscles around the anus (sphincters) or surgery. In a colonoscopy, the physician passes the endoscope through your rectum and into the colon to examine the tissue of the colon wall for abnormalities such as polyps. What is proctitis? Proctitis refers to inflammation of the lining of the rectum. It can be caused by previous radiation therapy for various cancers, medications, infections or a limited form of inflammatory bowel disease (IBD). It may cause the sensation that you didn’t completely empty your bowels after a bowel movement, and may give you the frequent urge to have a bowel movement. Other symptoms include passing mucus through the rectum, rectal bleeding and pain in the area of the anus and rectum. Treatment for proctitis depends on the cause. Your doctor will discuss the appropriate course of action with you. What are colon polyps? Polyps are benign growths within the lining of the large bowel. Although most do not cause symptoms, some polyps located in the lower colon and rectum may cause minor bleeding. It is important to remove these polyps because some of them may later turn into colon cancer if left untreated. What is colon cancer? Colon cancer refers to cancer that starts in the large intestine. It can affect both men and women of all ethnic backgrounds and is the second most common cause of cancer deaths in the United States. Fortunately, it is generally a slow-growing cancer that can be cured if detected early. Most colon cancers develop from colon polyps over a period of several years. Therefore, removing colon polyps reduces the risk for colon cancer. Anal cancer is less common but curable when diagnosed early. Most colon cancers develop from colon polyps over a period of several years. Therefore, removing colon polyps reduces the risk for colon cancer. What are rectal ulcers? Solitary rectal ulcer syndrome is an uncommon condition that can affect both men and women, and is associated with long-standing constipation and prolonged straining during bowel movement. In this condition, an area in the rectum (typically in the form of a single ulcer) leads to passing blood and mucus from the rectum. Treatment involves fiber supplements to relieve constipation.

Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. What is diverticulosis? Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon. Who gets diverticulosis? Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. As a person gets older, the pouches in the digestive tract become more prominent. Diverticulosis is unusual in people under 40 years of age. In addition, it is uncommon in certain parts of the world, such as Asia and Africa. What causes diverticulosis? Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis. The easiest way to increase fiber intake is to eat more fruits, vegetables and grains. Diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables. Most doctors believe this condition is due in part to a diet low in fiber. What are the symptoms of diverticulosis? Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps or constipation due to difficulty in stool passage through the affected region of the colon. How is the diagnosis of diverticulosis made? Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen using other imaging tests, for example by computed tomography (CT) scan or barium x-ray. What is the treatment for diverticulosis? Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms and, therefore, do not need treatment. When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables and grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose, or poly-carbophil. These products come in various forms including pills, powders and wafers. Supplemental fiber products help to bulk up and soften the stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort. Bleeding in the colon may occur from a diverticulum. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. If left untreated, diverticulitis may lead to an abscess outside the colon wall or an infection in the lining of the abdominal cavity. Are there complications from diverticulosis? Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer. Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation. Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess. Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum. Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or

What is a colon polyp? Polyps are benign growths (noncancerous tumors or neoplasms) involving the lining of the bowel. They can occur in several locations in the gastrointestinal tract but are most common in the colon. They vary in size from less than a quarter of an inch to several inches in diameter. They look like bumps growing from the inside lining of the bowel protruding out. They sometimes grow on a “stalk” and look like mushrooms. Some polyps can be flat. People can have several polyps scattered in different parts of the colon. Some polyps can contain cancer, although the vast majority of polyps do not. Larger polyps are more likely to become cancerous than smaller ones. How common are colon polyps? What causes them? While uncommon in 20 year olds, more than 40% of persons over 50 have precancerous polyps in the colon. Smoking, obesity, diabetes, and inadequate exercise are risk factors for polyps, but many people with none of these risk factors have precancerous polyps in the colon. There are genetic risk factors for developing polyps as well. What are known risks for developing polyps? The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, people with a personal history of polyps or colon cancer are at higher risk of developing new polyps in the future than a person who has never had a polyp. In addition, there are some rare “syndromes” that run in families which increase the risk of forming polyps and cancers, even at younger ages How are polyps removed? Almost all precancerous polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; most involve removing them with a wire loop or biopsy forceps, sometimes using electric current. This is called polyp resection or polypectomy. Because the bowel’s lining isn’t sensitive to cutting or burning, polyp resection doesn’t cause discomfort. Polypectomy during a colonoscopy procedure using a wire loop, or snare device, to remove the polyp. How are polyps found? Screening to detect polyps is important because most polyps do not cause any symptoms. Several screening techniques for detecting polyps and cancers in the colon are available: colonoscopy, tests on stool samples, sigmoidoscopy, or radiology tests such as a computed tomography colonography (CTC). Colonoscopy is the best test for finding polyps and the only test that allows for removal of polyps during the exam. Other commonly used tests can be performed on a sample of your stool, which look for small amounts of blood or abnormal genetic material (DNA) in your stool, as it can be a sign that you have polyps or cancer in your colon. Larger polyps can cause trace amounts of blood in the stool which may not be seen by the naked eye, but can be detected by these special stool tests. Stool based tests detect only a fraction of large precancerous polyps. When any test other than colonoscopy is positive (abnormal), a colonoscopy must be performed. Colonoscopy with removal of polyps is performed to help prevent a person from developing colon cancer. Because your doctor cannot always be certain of the polyp type by its appearance alone, doctors generally recommend removing polyps found during a colonoscopy. After the polyp has been completely removed, it is examined under a microscope by a pathologist to determine the type of polyp and if it was the type of polyp that could have turned into cancer. This information will help your doctor make recommendations about the timing of your next colonoscopy. What are the risks of polyp removal? Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole or tear) of the colon. Bleeding from the polypectomy site can be immediate or delayed for several days; persistent bleeding can almost always be stopped by treatment during a repeat colonoscopy. Perforations rarely occur and can sometimes be closed with clips during the colonoscopy, but other times require surgery to repair. How often do I need a colonoscopy if I have polyps removed? The timing of your next colonoscopy depends on several factors, including the type, number and size of polyps removed. The quality of cleansing affects your doctor’s ability to see the inside surface of the colon where polyps form. If your colon is inadequately cleansed, your doctor may recommend repeating a colonoscopy sooner. Your doctor will decide when your next colonoscopy is necessary.