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What are hemorrhoids?

Hemorrhoids are basically irritated "cushions" or folds which are located on both the outside (external) and inside (internal) of the anus. These cushions are composed of blood vessels, muscle and elastic tissue and are thought to aid in the control of the passage of stool and gas. All mammals have anal cushions.

External hemorrhoids are covered with skin and thus very sensitive. They tend to swell when inflamed and can cause pain, burning, itching or all three, but rarely bleed. A "thrombosed" external hemorrhoid is when a clot forms and usually presents suddenly as an extremely painful, pea-sized lump just outside the anus. Urgent treatment is required for relief so one should not delay seeking medical attention.

Internal hemorrhoids are not covered with skin and typically present with a feeling of pressure within the rectum as opposed to pain. They can also bleed, protrude ("pop out") and cause burning and itching. The blood is usually bright red and is most commonly visualized after bowel movements on the tissue paper, in the toilet bowl, on the stool itself or all of the above.

What causes hemorrhoids?

The cause of hemorrhoids is actually unknown but there are numerous contributing factors, almost all of which are related to increased pressure around the anus:
  • Constipation
  • Diarrhea
  • Straining during bowel movements
  • Pregnancy
  • Heavy lifting
  • Sitting or standing for long periods of time
  • Obesity
  • Aging
  • Genetic factors

Do hemorrhoids cause cancer?

No. Hemorrhoids are a benign condition and are not a risk factor for cancer nor can they become cancer. However, the symptoms of hemorrhoids (e.g. bleeding) are similar to those of colorectal cancer so it is important not to treat yourself but to be evaluated by a specialist physician if you develop these symptoms.

How are hemorrhoids treated? Do I need to have surgery?

Fortunately, only 5-10% of patients who present with hemorrhoids need to have them surgically removed for relief of symptoms. The mainstay of treatment is dietary by increasing the amount of fiber (at least 20 grams a day) and fluids (64 oz. a day) in your diet. This leads to easier bowel habits and helps eliminate excessive straining that causes most hemorrhoid symptoms. Sitting in a warm bath for 10-15 minutes can also help provide some relief. Over the counter medications may also be effective.

What if the above conservative measures do not relieve my symptoms?

If conservative measure are ineffective or the hemorrhoids are more severe, special treatments may be required, most of which are done in the office. Rubber band ligation, injection sclerotherapy and infrared coagulation are quick and effective methods of treating internal hemorrhoid symptoms such as bleeding or protrusion. Surgical removal of the hemorrhoids is reserved for those that are very severe or fail all other treatments. It is performed under anesthesia and patients nearly always go home that same day.

Colon and Rectal Cancer

What is the cause of colon and rectal cancer?

Colon and rectal cancer is the second most common cause of cancer deaths in the United States. Almost all colon and rectal cancers start out as benign polyps, or abnormal growths, arising from the lining of the large intestine. These growths protrude into the intestinal canal and can either be on a stalk or be flat (sessile). They have the potential to increase in size and become cancer. Therefore, removing these polyps is currently the best way to prevent colon and rectal cancer.

Am I at risk to develop colorectal cancer?

Colorectal cancer is typically a disease of older people, with more than 90% of patients over 40 years of age and is seen most commonly in people in their 60s. However, this disease can occur at almost any age and affects men and women equally. People with a family history of colorectal cancer or polyps are at increased risk as well as those individuals with a personal history of inflammatory bowel disease (ulcerative or Crohn's colitis), colon polyps or cancer of other organs, especially of the breast, ovary or uterus. Populations with diets high in unsaturated fat and protein in conjunction with low-fiber intake are associated with a high incidence of colorectal cancer.

What are the symptoms of colon and rectal cancer?

The two most common symptoms of colorectal cancer are rectal bleeding and a change in bowel habits such as constipation or diarrhea. It should be noted that these symptoms are common in a number of benign diseases as well so it is essential to be thoroughly evaluated by a physician if you have a persistence of these symptoms. Abdominal or rectal pain and weight loss are usually late symptoms of the disease. Regrettably, many polyps and early stage cancers do not produce any symptoms, which is why screening for colorectal polyps and cancer is imperative.

Can colorectal cancer be prevented?

Yes!!! For the overwhelming majority this is true and the most important thing you can do for prevention is to get a screening test (see below). Please remember that any abnormal screening test needs to be followed by a colonoscopy. This is why many patients prefer to start with a colonoscopy as a screening test.

Colonoscopy and Colorectal Cancer Screening

How is colon and rectal cancer screened for?

Colorectal cancer screening should begin at age 50. People who have a parent or sibling with colorectal cancer or polyps may need to start their screening at 40 years old or even younger. Methods of screening include digital rectal exam, chemical testing of the stool for blood, flexible sigmoidoscopy and colonoscopy, barium enema and virtual colonoscopy.

What is a colonoscopy and when should I get one?

A colonoscopy is a test using a long, flexible tubular instrument with a video camera at the tip (colonoscope) to examine the lining of the entire colon and rectum while you are asleep so there is no discomfort. In addition, the colonoscope can also be used to perform biopsies and remove colon and rectal polyps. The colon is cleansed the day before with an oral laxative solution. The exam typically lasts 30-45 minutes and you go home shortly afterward.

You should get a colonoscopy if you are age 50 or older as part of a colorectal cancer screening test. A colonoscopy should be performed at least every 10 years. If you have symptoms such as rectal bleeding, change in bowel habits or abdominal pain or have a family history of colorectal polyps or cancer, you may require a colonoscopy earlier than 50 years old.

Are there other colorectal cancer screening tests besides colonoscopy?

Yes. The cheapest and least invasive is the Fecal Occult Blood Test (FOBT), which chemically tests the stool for blood you can't see, but only detects polyps or cancers that are bleeding at the time of the test. Three stools need to be tested on a yearly basis. A positive test needs to be followed with a colonoscopy.

A flexible sigmoidoscopy is similar to a colonoscopy except that it only examines the lower 1/3 of the large intestine. This exam should be performed every 5 years with or without yearly FOBT. If a polyp or cancer is found, colonoscopy is needed to examine the rest of the colon.

A barium enema is an X-ray of your colon and rectum filled with contrast and air to make the lining visible. This test is not recommended unless a colonoscopy is unavailable or cannot be completed.

Virtual colonoscopy uses a CT scan to examine the lining of the large intestine while it is filled with air. A computer program takes the CT scan images and displays them as if one were doing an actual colonoscopy. If any suspicious lesion is found, a standard colonoscopy would be required to evaluate it. However, there is insufficient data at this time to recommend its use in routine screening and is typically employed when a colonoscopy cannot be completed.

What are the risks and benefits of a colonoscopy?

The benefits of a colonoscopy is that it not only examines the entire colon and rectum, but can biopsy any suspicious lesions and remove polyps before they get the chance to possibly turn into a cancer. Fortunately, a colonoscopy is a very safe procedure with complications occurring less than 1% of the time. The risks include bleeding, a tear or perforation of the intestine and failure to detect a polyp, cancer or other abnormality.
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