Polyps

Polyps are small growths that develop along the lining of  the colon.  They often look like small nubbins, similar in appearance to the bumps on the outside of a squash.  Some have a stalk or pedicle, giving them a mushroom look.  Others are flat, like a small patch of miniature shag carpet.

Polyps are important because it is now known that most colon cancers arise from benign (non-cancerous) polyps.  If we can identify patients who have colon polyps without cancer, we can probably prevent those patients from getting cancer, by removing their polyps. 

Most polyps can be removed without surgery. The procedure is called colonoscopy, and it involves passing a long flexible scope up into the colon through the anus.  The polyps can be seen, snared with a wire loop through the scope, and removed for analysis.  Some polyps may be too large or too flat (the "shag carpet" type) to be removed through the scope.  Is such cases, surgery may be recommended to remove the polyp.

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Colon cancer

Colon and rectal cancer are very common, ranking just below lung and breast cancer in frequency.  Symptoms of colon or rectal cancer are often minimal, but may include rectal bleeding, abdominal pain, or an alteration in your usual bowel habits (new onset of diarrhea or constipation, a change in the thickness or "caliber:" of the stool, black or burgundy stools).

With the advent of colonoscopy,  there has been much interest in screening for colon cancer.  It is strongly recommended that patients over age 50 be checked annually for any hidden blood in the stool. A screening flexible sigmoidoscopy or total colonoscopy is recommended at age 50 also, to look for any polyps in the  rectum and lowest part of the colon.  Finding polyps before they have the opportunity to develop into cancer is currently the best method available to decrease the incidence of colon and rectal cancer.  If no polyps are seen, the screening colonoscopy is recommended every 10 years;  If flexible sigmoidoscopy is used for screening, it should be repeated every 5 years.

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Diverticulosis

Diverticulosis is a disorder of the bowel, mostly of the colon, that generally affects people over 50 years of age. Diverticulosis involves the formation of pouches (diverticula) along the wall  of the colon. 

Diverticulosis is very common in older people. Diverticulosis may be the result of a diet low in roughage (fruit and vegetable fibers). Although in many cases there are no symptoms, some patients may have occasional abdominal pain and rectal bleeding. A barium enema X ray examination, sigmoidoscopy, or colonoscopy is used to reveal the presence of diverticula.

Treatment for diverticulosis includes a high-fiber diet and plenty of liquids, about 6 to 8 glasses of water or juice per day.  This increases the bulk and water content of the stool which helps in turn to reduce intestinal pressure. This could help to prevent diverticulitis (inflammation of the diverticula) from developing.   In some cases, the diverticula cause massive bleeding from the rectum due to the presence of blood vessels alongside the diverticula.  Although such bleeding usually stops on its own, surgery is necessary if the bleeding does not stop.

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Diverticulitis

Diverticulitis is a common disease of the bowel, the main part of the large intestine. Diverticulitis results if a diverticulum in the colon becomes inflamed. Bacteria may subsequently infect the outside of the colon if an inflamed diverticula bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal illness (peritonitis). Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organs in the pelvic area. Diverticulitis most often affects middle-aged and elderly persons.

The symptoms of diverticulitis include localized abdominal pain and tenderness, loose bowel movements or constipation, and fever. A blood test shows an increased number of white blood cells.

An acute attack of diverticulitis is usually treated with antibiotics, and diet modification, avoiding roughage, such as popcorn, nuts, and seeds.  Fiber may also be limited in the initial treatment phase.. When the infection has been controlled, patients suffering from such an attack are also placed on a high-fiber diet. Patients who have recurring acute attacks or complications, such as peritonitis, require surgical treatment.

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Crohn's Disease

Crohn's disease, known medically as regional ileitis or regional enteritis, is a chronic, inflammatory condition of the intestine. There is no known cause, although it may be hereditary. It is usually confined to the lower end of the small intestine (ileum), but may involve the large intestine (colon) and may occur anywhere in the GI tract. The symptoms include intermittent attacks of diarrhea and abdominal pain, weight loss, and fever. Rarely, the intestine may become blocked or ulcerate into adjacent areas via fistulas. Treatment involves a nutritious diet, painkilling drugs, antibiotics, and sometimes corticosteroids. If complications occur, the physician may recommend surgery to remove the diseased section of intestine, though the inflammation has a tendency to recur.

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Ulcerative Colitis

Ulcerative colitis is a disorder of the large intestine, in which the colon becomes inflamed and ulcerated. It usually occurs in persons between 15 and 35 years old. The underlying cause is not known.

Q:   What are the symptoms of ulcerative colitis?

A:   The most common symptom is a series of attacks and bloody diarrhea that vary in severity and duration from one person to another and from one attack to another. They may start suddenly or gradually and may occur as frequently as 10 or 15 times in 24 hours. The attacks are often accompanied by pain and spasms around the anus (tenesmus). Attacks may also cause fever, loss of appetite, and weight loss.

With mild attacks, the symptoms are less alarming. The patient may feel tired, but usually there are no signs of generalized illness.

The symptoms usually disappear between attacks, although some patients may suffer from mild chronic diarrhea.

Q:   Can ulcerative colitis cause complications?

A:   Yes. The most serious complications are associated with a sudden attack of bloody diarrhea, perforation of the intestine, peritonitis, and intestinal bleeding.

Persons with ulcerative colitis may also develop anemia, arthritis, inflammation of the eyes, or tender nodules under the skin. If ulcerative colitis persists for longer than about 10 years, there is a greater than average chance of developing cancer of the colon.

Q:   How is ulcerative colitis diagnosed and treated?

A:   A positive diagnosis may require an internal examination of the colon and a barium enema X ray.

Mild attacks of ulcerative colitis are usually treated with antidiarrheal drugs, a low-fiber diet, and rest. Sulfonamide drugs may control the symptoms of a severe attack. Treatment with corticosteroids may also be necessary.

Persons who suffer an extremely severe attack may require hospital treatment. If complications develop, such as peritonitis or intestinal bleeding, emergency surgery may be necessary.

The outcome of ulcerative colitis is variable. However, most patients suffer repeated attacks over many years, and about 30 percent eventually require some form of surgery.

Patients with recurrent ulcerative colitis should have regular internal examinations of the colon to check for early signs of intestinal cancer. In most cases, it eventually is necessary to remove the colon (colectomy). The function of the anal sphincter can be preserved with a pouch procedure, and a permanent colostomy can usually be avoided.

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