Our Provider’s Blog

Excerpts from the Medical Director
25/Aug/2020

CHRONIC RECTAL OR PELVIC PAIN As we have discussed in previous articles, there are 3 common causes of rectal pain. THROMBOSED HEMORRHOIDS, FISSURES, AND ABCESSES. There are a number of causes of less significant irritation such as pruritus, skin tags, and anything else that can irritate the skin.

The least common cause of pain falls in the category of something we call Levator Syndrome/Spastic Levator/Pelvic Floor syndrome, or Chronic Proctalgia. Proctalgia literally translates to ‘rectal pain’. This can be intermittent discomfort which occurs over a matter of a few minutes and dissipates just as quickly, typically occurring at night, and called Proctalgia Fugax ( fleeting pain in the rectum ); or more chronic pain which can last days, weeks or in some cases many years. We refer to this more chronic discomfort as Levator or Pelvic floor syndrome. Although this has been related to pelvic surgery, or certain jobs requiring prolonged sitting or maintaining certain positioning, my experience has been that most often I can find no obvious cause! I have in fact seen it in a patient who had no rectum, it having been removed for inflammatory bowel disease many years before. Though we often use the term rectal to describe the pain, it is in fact in the muscles of the pelvic floor and the sphincter muscles. Examination will show no abnormalities on anorectal exam and colonoscopy. The diagnosis is made by eliciting pain on rectal exam within the sphincter and levator muscles of the pelvic floor. It is most often more severe on the left side.

Treatment can be difficult but is successful in most patients. It consists of warm sitz baths to relax and sooth the muscles. Physical Therapy including Kegel exercises and quite often Physical Therapy referral for more specialized treatment. If these measures alone are not effective, medicines such as Elavil ( amitriptyline ) can be used in low doses to bring about relief of pain. Though it is a benign disease it can be quite bothersome to patients. It is important when treating to remind patients that although it can take time, the majority of patients will get relief of their pain.

If you are suffering rectal pain, change in bowel pattern, rectal bleeding, or any colonic symptom…seek the advice of a Colorectal Surgeon! Remember, patients treated by Colorectal Surgeons have better outcomes. WWW.colondocs.net


20/Aug/2020

Quite simply, fecal incontinence refers to the inability to control bowel movements; resulting in the accidental loss of stool. This is a very significant problem for anyone affected. It can be debilitating to the point of making one a ‘bathroom cripple’; as it can be almost impossible to leave the house. In its mildest form patients might experience minimal seepage and drainage. In more serious cases, there is no control of bowel movements. The symptoms can be brought on by anything which changes stool consistency causing loose stool. This can be as simple as dietary factors; or more significant diseases causing inflammation of the colon. If there is no underlying muscle weakness, simply treating the underlying condition, correcting the loose stool, will treat the problem. Conditions caused by muscle weakness may also be treated by thickening the stool; but also require thorough examination of the pelvic floor muscles to evaluate their function. In many cases treatment of both stool consistency and muscle weakness are required to bring the patient adequate control.

The problem is much more common than physicians previously suspected. In the past there were few effective treatments and physicians and patients were reluctant to talk about the problem. We now recognize that it is a very common problem, especially among women who have had natural childbirth. During childbirth there is stretching and injury to the pelvic floor muscles and nerves. This causes temporary weakness that usually causes no problems in young women with normal muscle strength. Over time however, many women will experience gradual ongoing deterioration of nerve and muscle function, with increasing weakness. This results in worsening symptoms of leakage as they approach their 50s and 60s. This is in contrast to someone who has a significant muscle injury during childbirth, or patients who suffer an injury as a result of trauma. These patients respond well to simple muscle repair at the time of injury. This is in stark contrast to older women found to have a muscle defect from previous injury. Muscle repair is rarely successful in these patients. In fact, non operative treatment is very effective in most patients. Evaluation of patients suffering from symptoms of incontinence include a detailed history and physical exam. Examination quite often requires colonoscopy to rule out cancer or inflammation. In addition to standard rectal exam; ultrasound is used to examine the muscle for any possible defects and manometry is done to evaluate the strength of the muscle. Ultrasound and manometry can both be performed in the comfort of our office; taking only a few minutes to complete.

Treatment is then determined by the findings on our exams. We quite often will start by taking measures to thicken the stool such as the use of fiber products and antidiarrheal medicines. Physical therapy can be started to strengthen the muscles. For those people who fail medical treatment there are a couple of surgical options depending upon findings on ultrasound. As mentioned above, with significant muscle disruption, a surgical repair can be done. Unfortunately this has been found to be of limited effectiveness, and is rarely attempted.

In recent years a minimally invasive treatment using electrical nerve stimulation has been developed which has revolutionized the treatment of incontinence. Using a device called a sacral nerve stimulator, the nerves to the pelvic floor can be stimulated; improving muscle function and control. The device is placed under the skin as an outpatient procedure, much like a pacemaker is used for the heart.

In summary; we now have very effective treatment for incontinence! No need to suffer in silence!

If you are experiencing symptoms of incontinence, or have any other colorectal problems; contact us. As Colorectal Surgeons we have the training and expertise to best evaluate and treat your colorectal problems. Thank you, The physicians and staff of Tri-State Colorectal


20/Aug/2020

Colorectal cancer is the second most common cancer overall in the U.S. There are approximately 140,000 new cases diagnosed yearly; with 50,000 to 60,000 deaths! The risk of developing colon cancer increases with age; especially after the age of 45- 50. Cancer develops from polyps which are abnormal growths from the lining of the colon. It takes a number of years ( 3-5yrs or longer ) for a polyp to grow and undergo the change from benign to cancerous. This gives us the opportunity to examine the colon and remove polyps before they become cancerous. This is the reason that we recommend that everyone begin colon cancer screening by age 45-50 and continue screening every 10 years for life. Patients with a family history of cancer or polyps should begin screening at age 40 or ten years earlier than detection of the poly or cancer in their family member, and continue screening every 5 years. Colonoscopy is a painless procedure in almost all cases; being done under sedation or anesthesia. It is entirely normal to be apprehensive or afraid of any procedure. If you have questions or wish to schedule a colonoscopy don’t hesitate to call us. Our Board Certified Colorectal Surgeons can safely guide you through the entire process and procedure.

The primary treatment of colorectal cancer is surgery.

Patients treated by Colorectal Surgeons have better outcomes.


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