Anal and rectal diseases
The rectum is the lower part of your large intestine where your body stores stool. The anus is the opening of the rectum through which stool passes out of your body. Problems with the rectum and anus are common. They include hemorrhoids, abscesses and fissures, incontinence, and cancer. Many people are embarrassed to talk about anal and rectal troubles. But seeing your doctor about problems is important. This is especially true if you have pain or bleeding. Treatments vary widely depending on the particular problem.
INTRODUCTION
The rectum is the lower part of your large intestine where your body stores stool. The anus is the opening of the rectum through which stool passes out of your body. Problems with the rectum and anus are common. Many people are embarrassed to talk about anal and rectal troubles. But seeing your doctor about problems is important. Most anal and rectal problems are treatable when diagnosed early. This program will help you understand anal and rectal diseases and problems. It discusses common diseases of the anus and rectum, as well as diagnosis and treatment.
THE DIGESTIVE TRACT
The digestive tract is made up of organs through which solid and liquid food pass. The rectum and anus are part of the digestive tract. Swallowed food goes through the esophagus, which is the feeding tube. Next, food passes through the stomach, where it is partially digested. Digested food goes from the stomach to the small intestines, where most nutrients are further digested and absorbed into the body. Fibers and digested food finally reach the colon. In the colon, the rest of the nutrients get absorbed and stools are formed. Stools are stored in the last part of the colon before being excreted. This part of the colon is made up of the sigmoid colon and rectum. Stool leaves the body through the anus. Two ring-like muscles open and close the anal opening to let stool pass through the body. These muscles are called sphincter muscles. The anal canal is a part of the anus. It is between the rectum and the anal opening. The anal canal is about 1 ½ inches long. The anus is formed partly from the outer skin layers of the body and partly from the intestine. The skin around the outside of the anus is called the perianal area.
GENERAL SYMPTOMS
Many anal and rectal diseases and problems have similar symptoms. The main symptoms are anal or rectal pain and bleeding. Bowel movements can trigger pain and bleeding. Bleeding may be mild, with only a small amount of bright red blood on toilet paper, or it may be more severe. Other common symptoms of anal and rectal diseases include:
• A change in bowel habits
• Drainage of pus
• Foul-smelling mucus from the anus
• Pressure in the area around the anus
• Swelling around the anus
Common anal and rectal diseases and problems may also cause: Anal itching Feeling full or bloated Frequently having gas pains or cramps Stool leakage Stools that are narrower than normal Tiredness
HEMORRHOIDS
Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are a common condition that affects millions of people. There are two types of hemorrhoids: internal hemorrhoids and external hemorrhoids. Internal hemorrhoids happen inside the body. External hemorrhoids happen outside the body in the skin around the anus. Hemorrhoids are often caused by straining during a bowel movement. Constipation causes stools that are hard and dry. The rectum has to push harder to get the stools out. When the rectum has to work harder, it can become damaged. This can cause the blood vessels in the rectum to swell, resulting in hemorrhoids. Other factors that can lead to hemorrhoids developing include:
• Aging
• Chronic diarrhea
• Pregnancy
Treatment for hemorrhoids often includes warm baths, a cream, or other medicine. Large hemorrhoids may require surgery or other treatments. Eating food rich in fiber may soften the stools and improve the symptoms of hemorrhoids. Using mild stool softeners may also help. Sitting for a few minutes in 3 to 4 inches of warm water can relieve the pain or discomfort of hemorrhoids. These are known as ‘sitz baths’ and can be done a few times a day. Some topical ointments could also help with the symptoms caused by hemorrhoids. These ointments may reduce the irritation of the skin, or the itching and pain caused by hemorrhoids. Large external or internal hemorrhoids are often treated surgically. There are several types of procedures that can be done to treat hemorrhoids. Swollen veins can be cut out surgically. The incision is closed with absorbable stitches that disappear on their own. Banding is another common surgical treatment option for hemorrhoids. This is done by placing a tight rubber band around the base of the hemorrhoid. It may be done in more than one setting and is usually not painful. If your healthcare provider recommends surgical treatment for hemorrhoids, ask him or her which method is best for you. Unfortunately, no treatment method guarantees that the hemorrhoids will not return.
ABSCESSES AND FISSURES
An abscess is a pocket of pus. An abscess can happen almost anywhere in the body, including the anus or rectum. An abscess in this area is sometimes called an anorectal abscess. Most anorectal abscesses happen close to the opening of the anus. Rarely, an abscess may develop higher in the anal canal, closer to the rectum. Anorectal abscesses are often caused by other health problems, such as Crohn’s disease. Sometimes abscesses can appear for no known reason. Anorectal abscesses may also be caused by:
• A blocked or inflamed anal gland
• Infection
• Sexually transmitted diseases, or STDs
An abscess can also develop when an anal fissure becomes infected. An anal fissure is a tear in the lining of the anal canal. Most anal fissures develop when large, hard stool is passing through the anal canal. The canal can overstretch, causing the lining to tear. Sometimes an anal fissure can also develop due to:
• Chronic diarrhea
• Inflammatory bowel disease
• Sexually transmitted diseases, or STDs
However, these causes are less common. Treatment for anorectal abscesses and anal fissures may include:
• Eating foods rich in fiber to soften stools
• Sitz baths to relieve pain and swelling
• Taking stool softeners
Sometimes an anorectal abscess needs to be surgically opened and drained. This relieves pain and swelling. Anal fissures may also require surgical treatment in severe cases. Surgery can help repair the tear in the lining of the anal canal. Other treatments may also be needed, depending on the cause of the anorectal abscess or anal fissure. For instance, medicines may be needed to treat an infection or an STD.
INCONTINENCE
Bowel incontinence is the inability to control your bowels. A person with bowel incontinence often cannot make it to the bathroom in time. Bowel incontinence is also called fecal incontinence. Bowel incontinence also refers to the accidental leakage of solid or liquid stool. For example, a person may try to pass gas and accidentally leak some stool. Bowel incontinence has many possible causes. Some examples include:
• Constipation
• Diarrhea
• Hemorrhoids
• Muscle damage or weakness
• Nerve damage
• Scarred or inflamed rectum
Bowel incontinence can be upsetting and embarrassing. However, depending on the cause, treatment is available. Bowel incontinence can be treated with:
• Diet changes
• Medication
• Pelvic floor exercises
• Bowel training
• Surgery
• Electrical stimulation
Diet changes to treat bowel incontinence include avoiding foods that make symptoms worse. For instance, foods that contain caffeine can make bowel incontinence worse. It also includes drinking enough fluids and eating the right amount of fiber. Medication may help if diarrhea or constipation is causing bowel incontinence. Antidiarrheal medicines or laxatives may be recommended. Pelvic floor exercises can help strengthen the pelvic floor muscles and prevent bowel incontinence. The exercises involve squeezing and relaxing the pelvic floor muscles 50 to 100 times each day. A healthcare provider can help with proper technique. Bowel training focuses on having regular bowel movements at specific times of the day, such as after a meal. Achieving a regular pattern, though, can take weeks or months. Surgery may be an option for bowel incontinence caused by injuries to the pelvic floor or sphincter muscles. It may also help if other treatments are unsuccessful. Talk to your healthcare provider about surgical options and if they are right for you. Electrical stimulation may also help some people with bowel incontinence. It involves placing a stimulator under the skin and electrodes in the nerves going to the anal canal and rectum. These nerves are then continuously stimulated with electrical pulses.
CANCER
Problems with the rectum or anus may also be caused by cancer. Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong and a tumor forms. If a tumor is cancerous, cells from the tumor can invade other tissues throughout the body. Cancerous cells can spread to different parts of the body through blood vessels and lymph channels. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the rectum will always be called rectal or colorectal cancer, even if it has spread to other places in the body. Cancer that begins in the anus will always be called anal cancer. Cancer that begins in the colon or rectum is much more common than cancer that begins in the anus. Age and health history can affect a person’s risk of getting rectal or anal cancer. These cancers are often seen in people older than 50 years of age. Other people are at an increased risk of rectal cancer. This includes people with:
• A family history of cancer of the colon or rectum
• A history of polyps in the colon or rectum
• A history of inflammatory bowel diseases
Other risk factors of anal cancer include:
• Being infected with HPV
• Having many sexual partners
• Having anal sex
• Having anal fistulas and other anal problems
• Smoking cigarettes
Treatments for rectal or anal cancer may include surgery, chemotherapy, radiation therapy, or targeted therapy. Often some combination of these treatments is used.
DIAGNOSING ANAL AND RECTAL DISEASES AND PROBLEMS
Doctors diagnose anal and rectal diseases and problems using different tests. This section explains the tests that may be used. Your healthcare provider will first perform a physical exam. This includes examining the external anal area, as well as a rectal examination with a gloved finger. Your stools may be tested by the lab. The lab checks your stools for blood and other signs of disease. Blood tests may also be done. X-rays and other imaging tests may be used to examine the rectum and anus. Other imaging tests that may be done include a CT scan or an MRI. Your doctor may insert a scope into your anus and rectum. A scope allows doctors to get a detailed look at the inside of the body. Your doctor can remove samples of abnormal tissue through a scope. This is called a biopsy. A pathologist examines the tissue under a microscope to see if it is cancerous or not. In most cases, a biopsy is the only sure way to tell if cancer is present.
SUMMARY
The rectum is the lower part of your large intestine where your body stores stool. The anus is the opening of the rectum through which stool passes out of your body. Problems with the rectum and anus are common. There are many tests that can be used to check for anal and rectal diseases. These tests help determine the cause of an anal or rectal problem. Treatment for anal and rectal diseases depends on the cause. Treatment may include diet changes, medicines, surgery, or other treatments. It may also include chemotherapy, radiation therapy, or targeted therapy if the cause is cancer. Many people are embarrassed to talk about anal and rectal troubles. But seeing your doctor about problems is important. Most anal and rectal problems are treatable when diagnosed early.
Medications associated
