Our Provider’s Blog

Excerpts from the Medical Director

If you have been following our posts you have heard the term rectal or perirectal abcess. The term refers to an abcess/infection occurring around or near the anal opening or on the buttock. They represent one of the 3 causes of anorectal pain. Anyone who has had an abcess anywhere on the body is aware of how painful they are. This is especially true in the anorectal area which is very sensitive to pain! They are the result of an infection which begins in one of the small mucous glands which lie within the external anal canal. The infection can then spread out into skin and subcutaneous tissue surrounding the anal opening…resulting in an abcess, which is a loculated area of pus. The symptoms consist over severe pain and swelling with redness and localized temperature increase. Generalized symptoms of infection are rare and seen only with severe infections. Although many people have never heard of a perirectal abcess: as Colorectal surgeons we see them often. The most important aspect of treatment is early incision and drainage! This cannot be emphasized enough, and is true of any abcess. There is no role for antibiotics except in patients with severe infections or those who are immuno-compromised: and then only after incision and drainage! A common mistake made by clinicians is to send a patient home on antibiotics with the expectation that the abcess will resolve. The infection is resolved only when drained by a surgeon or after many hours/days of pain when it ruptures on it”s own. As noted, the most important treatment is incision and drainage. This can be done by any clinician or surgeon who has the experience to perform the procedure. It is done under sedation or anesthesia with the use of a local anesthetic as well. Patients get immediate relief of their pain despite the incision!

All patients should see a Colorectal Surgeon for follow up if their initial drainage was not done by someone familiar with anorectal anatomy. This is because of the possibility of developing a fistula after drainage of the abcess. A fistula is a small subcutaneous tunnel from the drainage site on the skin to the opening of the mucous gland within the anal canal. This happens in approximately half of the cases. Though it is not serious, it can result in chronic drainage and recurrent infections. Treatment requires a detailed knowledge of the anatomy of the anal canal and rectum. Colorectal Surgeons are board certified in the diagnosis and treatment of complex colorectal problems such as fistulas. The treatment of a fistula requires performance of a fistulotomy, or in some cases more complex procedures to close the fistula. In fact, many Colorectal surgeons will do the fistula surgery at the same time as their initial incision and drainage; saving the patient a second surgery. As noted, patients get immediate relief of pain after drainage. The wound is left open without sutures. Post op care consists of warm soaks ( sitz baths ), mild analgesics, cotton or gauze pads for drainage, and return to normal activities as soon as comfortable. Many patients resume normal activities within a week or so. If you have anorectal pain for any reason…see a Colorectal Surgeon. Call us at 812-301-8110



Funny name, right? It’s a Latin term meaning ‘itchy anus’. Chronic burning and itching is a very common problem. It is often mistaken for a hemorrhoid problem; think about many of the adds and TV commercials which refer to the burning and itching of hemorrhoids! Though itching is not uncommon during the healing process after other anal conditions or surgery, chronic burn and itch is not a symptom of hemorrhoids. There are a number of factors which can cause burning and itching. Anything causing loose, frequent stools can result in pruritis secondary to repeated wiping and the fact that stool is alkaline and an irritant. Various foods have also been found to cause irritation…caffeine, beer and wine, dairy products, chocolate and tomato based products are common offenders. Many times excessive cleaning and wiping can prolong or cause the problem. Soap and many topical ointments can in fact cause irritation. Skin infections such as Herpes, HPV, and Shingles can cause severe symptoms. Often there is no clear cut cause identified.

Treatment consists of treating any underlying cause that can be identified. Except in those cases related to infection, we take a very practical approach to eliminate possible sources of the irritation. This consists of treating loose stool, avoidance of soap and the overuse of topical creams. I like to think of the way we treat burns; remove the burning irritant! Avoid soap and those things in the diet which can cause irritation. Cleansing with plain warm water or a vinegar and water solution on a kleenex or cotton ball: this neutralizes the alkaline effect of the stool. Milk of Magnesia can also be applied to soothe the skin after bowel movements. Something I learned from patients is the application of Vitanin A & D ointment as a skin barrier. Often seepage is noted between bowel movements and wisps of cotton can be used to absorb the drainage. Most patients will find that as symptoms improve, the seepage ceases. I personally recommend the use of psyllium daily. This helps thicken the stool and makes it easier to clean after bowel movements. I also learned this from a patient who told me that he was virtually cured after starting psyllium. As he described…I now have a “white wipe”! Often treatment can be a process of trial and error. It tends to be a chronic or recurring problem in most patients. That said, by adhering to the basic principals most patients can bring their symptoms under control.

If you are experiencing any anorectal symptoms, contact a Board Certified Colorectal Surgeon. We have the training and expertise to treat all of your Colorectal problems. From colon cancer screening and treatment to anorectal disease. Outcomes are better when treated by a Colorectal Surgeon.


Fecal Incontinence affects 1 in 12, or currently 20 million adults in America on a daily basis. TriState Colorectal is proud to offer the new Fecal Incontinence Center, where patients can meet the surgeon, go through evaluation and testing in our office, and ultimately determine the best treatment- sometimes non surgical and other times surgical options are best.

Yesterday, Dr Matheson was the first surgeon in the Tri State area to implant the new, smallest and fastest rechargeable sacral nerve modulator. This technology will continue to help our patients take back control and live life their way! Call today for your appointment to start on the path to regaining control and living life your way!!!


We at Tri-State Colorectal are pleased to announce the opening of our Fecal Incontinence Center. This will allow our physicians and staff to fully evaluate patients suffering with fecal incontinence. This will include an in depth history and physical exam including anorectal ultrasound and manometry; all in the comfort of our office. This will be followed by treatment to correct the condition. This consists of physical therapy, measures to thicken the stool, and rarely surgery. We are excited to be providing the most modern treatment method called Sacral Nerve Stimulation. This consists of using electrical stimulation of the nerves to the pelvic floor; a type of ‘pacemaker’ for the muscle; which has been found to be very effective. Call now to schedule an appointment.


Diverticulosis is a condition which develops in a large percentage of the population as we age. Well over 50% of us will have the condition once we reach the age of 50-60; with the incidence approaching 80% by age 80.


Diverticulosis is not a disease, but a condition. It is the result of weakness which develops within the connective tissue of the wall of the colon. It is a normal process of aging much like developing wrinkles or gray hair. It becomes a problem or ‘disease’ when it causes inflammation called diverticulitis; or bleeding.


Diverticula are small out-pouchings of the colon wall which develop where the small blood vessels penetrate the bowel wall carrying blood to the inside layers of the colon.

Though the vast majority of people have diverticulosis, a relatively small percentage of people develop symptoms. Approximately 10% of those with diverticula will develop diverticulitis. Of those with diverticulitis 85% will recover without further episodes of inflammation. The vast majority of patients can be treated as an outpatient with antibiotics, with full recovery expected. Hospitalization is required in only 10-15% of patients. Overall, less than 1% of patients ultimately require surgery.


It is thought that diverticulitis is caused by increased pressures within the colon; resulting in decreased blood flow, inflammation and perforation of the diverticula. For this reason we recommend diets high in fiber for all patients; but especially those with a history of diverticulitis. This however, will not completely eliminate the risk of diverticulitis!

Contrary to popular belief, peanuts, seeds, nuts, and popcorn have not been found to increase the risk of diverticulitis. We therefore do not put restrictions on diet; while encouraging a diet high in fiber.


Diverticulitis usually presents as left lower abdominal pain. This can be relatively mild and may resolve on it’s own in mild cases. In more severe cases the pain increases in intensity, with fever, chills and other generalized symptoms of infection. These cases should be evaluated urgently, with CT scanning af the abdomen to assist in making the diagnosis. Treatment is then initiated depending on severity of symptoms and the findings on CT scan. Following recovery, all patients should undergo colonoscopy to rule out other causes of the symptoms, such as cancer and other types of inflammation.


Bleeding is a much less common complication of diverticulosis. Though the bleeding can be significant, it stops spontaneously in 90% of patients. Any bleeding requires a thorough evaluation. This will be discussed in upcoming articles.


For questions or to make an appointment call us at (812)-301-8110 Tri-State Colorectal.


What is an Anal Fissure?

Anal or rectal pain is one of the most common anorectal complaints and can be associated with rectal bleeding. Most frequently, the assumption is that the rectal bleeding is due to hemorrhoids; however, it is quite rare for hemorrhoids to cause pain. The most common cause is actually an anal fissure.


Fissure pain is commonly associated with hard bowel movements and can last from a few minutes to several hours. The association is so strong that many people will avoid having a bowel movement to escape the pain. This actually worsens the problem as delaying elimination of stool will make it even more dry and hard, exacerbating the fissure further. Because fissures are the result of a tear in the lining of the anal canal, slight bleeding is not uncommon. The diagnosis can usually be made from the history and a cursory evaluation to exclude other causes.


Treatment for Anal Fissures

Treatment for anal fissures involves addressing the cause of the hard stools. Frequently the addition of fiber supplements and fluids is sufficient to heal the fissure. Stool softeners and other topical adjuncts may also be added. Warm tub baths are generally helpful with pain relief. While the vast majority of fissures will heal with such simple approaches, chronic fissures that do not resolve after several weeks of conservative treatment may require surgical intervention. This requires relaxation of the anal muscles which in turn allows the fissure to heal.


Fissures do not cause colon cancer or increase the risk of developing cancer. However, if there is any concern for other associated problems further testing may be recommended.


Written by: Dr. Chilikuri


What is Hemorrhoid Ligation?


Hemorrhoid ligation, or banding, is a simple procedure often used to treat symptomatic

internal hemorrhoids. This consists of placing a ‘tourniquet’ in the form of a small

rubber band around the base of an internal hemorrhoid. The hemorrhoid will then

slough off after a few days.


Hemorrhoid Ligation Procedure


The procedure is usually done in the office, without sedation; taking only a few

minutes. There is minimal discomfort, consisting of pressure or rectal spasm. This lasts

anywhere from a few hours to a couple of days. Some patients have little or no


Warm water soaks ( sitz baths ), and non narcotic pain medicines are used to treat the

discomfort. Patients can resume activities as soon as they are comfortable, often the

same day.


Potential Complications


Complications include significant bleeding and infection, but are very rare.

As noted, the procedure is done to treat symptomatic hemorrhoids.


The Evaluation


Examination should be done by someone trained in the anatomy and diseases of the

anal canal and colon; such as a colorectal Surgeon. The evaluation should include a

detailed exam of the anal canal, and quite often colonoscopy to rule out a colonic

source of the symptoms.


Stay tuned for further discussions about common anorectal and colon problems.


First of all, hemorrhoids are normal structures. They consist of columns of vascular tissue within the anal canal. Most of us have 3 columns. We only notice them when they cause problems. It is at this point that a patient might seek medical advice.

Anatomically, each hemorrhoid consists of an internal and external component. The internal portion lies within the lowermost portion of the rectum and is insensitive to pain. This is what allows ligation and other treatment without discomfort. The external aspect of the hemorrhoid lies just at the opening; which most of us know is extremely sensitive! In fact, it is important to realize that external hemorrhoids cannot be treated surgically without some type of anesthesia.

In a ‘nutshell’, the symptoms caused by internal hemorrhoids are painless bleeding, protrusion, or both. It is at this point that examination and treatment are warranted.

Examination should be done by someone trained in the anatomy and diseases of the anal canal and colon; such as a colorectal Surgeon. The evaluation should include a detailed exam of the anal canal, and quite often colonoscopy to rule out a colonic source of the symptoms.

If the symptoms are being caused by the internal hemorrhoids, treatment will be started. This may consist simply of fiber to treat constipation, sitz baths, and topical ointments. Most patients respond very well to these measures.

If medical treatment fails, ligation can then be used to treat the internal hemorrhoids as described above. This is the most common treatment but other minor procedures can also be considered. .

Hemorrhoids are a normal part of the body. So of course, we all have hemorrhoids! They require no treatment unless they cause symptoms. Be wary any practitioner who recommends ligation or other procedures if you have no symptoms! When they cause bleeding, pain, or protrusion, call or come in to our walk-in clinic for evaluation and treatment. Most hemorrhoid problems can be treated without surgery. Consult the areas only Board Certified Colorectal surgeons before undergoing any surgery.
Remember, patient outcomes are better when treated by a colorectal surgeon!

Hopefully this has helped answer any questions or concerns you might have about hemorrhoids and treatment. Stay tuned for further discussions about common anorectal and colon problems.

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