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Polyps
Colon Cancer
(look at our colon cancer
survival data on Outcomes page)
Diverticulosis
Diverticulitis
Crohn's Disease
Ulcerative Colitis
What are the symptoms of
ulcerative colitis?
Can ulcerative colitis cause
complications?
How is ulcerative colitis
diagnosed and treated?
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. For patients
with a family history of colon cancer, and in
African-American patients, screening should begin even
earlier, at age 45. Total colonoscopy or a
flexible sigmoidoscopy is also recommended to look
for any polyps. 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 diverticulum 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.
In some cases there can even be a rupture between the
colon and the bladder or other organs, or through the
skin. When this occurs, stool from the colon will
actually flow through the perforation into the bladder,
or vagina, or out through an opening to the skin.
This sort of false passage is called a "fistula". Diverticulitis most often affects middle-aged and
elderly persons but can occur in young people as
well.
It is
thought that diet plays a major role in the development
of diverticulosis and diverticulitis. It is interesting
to note that diverticulitis rarely occurs in African
countries, but is quite common in North America, and
other industrialized nations. If one compares dietary
habits between these 2 different groups, there is much
less fiber and "roughage" in the typical American diet.
This probably accounts for the increased incidence of
diverticulosis in the USA. The intestines seem to stay
healthier if the stool is bulky and contains lots
of moisture. It is for this reason that a high fiber
diet with 6-8 glasses of water or juice per day is
recommended in patients with diverticulosis, and even if
you don't have this disease, this is a good general
dietary regimen to follow.
The symptoms of diverticulitis include localized
abdominal pain and tenderness, usually low on the left
side, loose bowel movements or
constipation, and fever. A blood test shows an increased
number of white blood cells. Patients often have
pain severe enough to go to the emergency room. A
CAT scan is a frequent test done to confirm the
diagnosis.
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. Milder cases can be treated without
being hospitalized, with oral antibiotics. More severe
cases may require a brief or sometimes more extended
hospital stay.
In some
patients, the first attack is more
severe. Sometimes the infection breaks through the wall
of the colon, causing a perforation. If this happens,
the abdominal cavity can become infected fairly quickly.
This is called peritonitis. In patients who have
peritonitis, there is usually much more pain and
tenderness. In these cases, patients almost always
require emergency surgery, and a colostomy may be
necessary in order to get the problem corrected.
If a colostomy is necessary, it usually can be
"reversed" at a second operation either several weeks or
months later.
If the first
episode is not so severe as to require surgery, patients
can usually get back to a fairly regular routine not
long after the antibiotic treatment is completed. In
some cases, there may be reasons to consider a planned
surgical removal of the involved colon even after the
first episode. But in the majority of cases, one could
just continue treatment with careful attention to diet
and bowel habits (avoiding constipation and straining
while on the toilet). If a second episode occurs, or if
there are recurrent episodes, surgery is usually
considered in these cases. The surgery can usually be
planned in advance. This is called "elective surgery".
In these cases, colostomy is not usually necessary.
The affected part of the colon can be removed, and the
two ends can be sewn (or "stapled") back together.
If elective
surgery as planned, it would be important to have had a
fairly recent colonoscopy, in which a flexible lighted
scope is passed upward through the anus to visualize all
of the lining of the colon. This will ensure that there
are no other problems inside the colon, such as polyps,
cancer, or some inflammatory disease.
The surgery
is done through a lower abdominal incision, usually
running about from the naval down to the pubic bone. In
most cases, the portion of colon involved with
diverticulitis is called the "sigmoid colon". This is
the part of the colon just above the rectum, which is
the part of the large intestines in the pelvis. The
hospital stay can range anywhere from 3-to 7 days, and
if any of complications occur, the hospital stay could
be longer. In some cases, the procedure can be
done with "laparoscopy", in which smaller incisions are
used, but the hospital stay is still typically about the
same.
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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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