Proctology (Disorders of the rectum and the anus)

Proctology treats patients with disorders of the rectum and the anus including the perianal region. Patients may have various types of symptoms and may complain of anal pain, bleeding per rectum or in their stool, itching, leakage, foul smelling drainage or the presence of a growth or bump. A diagnostic colonoscopy may be performed to ensure no rectal or anal cancer is present.

Some of the conditions our experts diagnosis and treat are:

  • Anal Fistula
  • Anorectal Diseases
  • Colorectal Cancer
  • Crohn’s Disease
  • Fecal Incontinence
  • Hemorrhoids
  • Pilonidal Disease
  • Pruritus ani

An anal fistula is an infected tunnel that develops under the skin between the skin of the buttocks and anal canal in the colon. This condition is a reaction due to infection that starts in an anal gland and results in an abscess (puss-filled infection). A tunnel forms under the skin connecting to the infected gland, forming an anal fistula.

Some conditions such as Crohn’s disease, Colitis, chronic diarrhea and radiation treatment for rectal cancer can affect the lower digestive tract and increase the risk of developing an anal fistula.

Diagnosis

An anal fistula may not always be visible, as they can close on their own and then reopen. A visit with a colon and rectal specialist will help diagnose an anal fistula through a physical exam, imaging tests or a colonoscopy.

Treatment

Surgery is the best treatment for an anal fistula as there are currently no medications to cure it. Antibiotics can help to treat an anal fistula, but surgery is the most effective treatment in curing the condition. There are various surgical treatment options depending on location and severity of the anal fistula.

Anorectal disease is the name given to a group of conditions of the anus or rectum that are often painful. Most commonly, these conditions include hemorrhoids, anal fissures, anal warts, anal fistulas and anorectal abscesses and more.

Depending on which condition you might be experiencing, you will need a physical exam and likely an endoscopic examination of the lower colon, rectum and anus. Treatment options for anorectal disease usually include dietary and lifestyle changes, physical therapy or surgery for more persistent infections and symptoms. Treatment and recovery depend on the type and severity of the condition.

Sometimes, a small growth, called a polyp, can form on the inner wall of the colon or rectum. Although many polyps are benign (not cancerous), some become cancerous. Our Gastrointestinal Cancers Program provides all gastrointestinal cancer patients with a truly multidisciplinary approach to the treatment of their complex disease. For early non-advanced rectal cancers, surgery may be recommended. For more advanced disease, care is tailored specifically to the patient and their disease and can include a combination of surgery, radiation and chemotherapy. Physicians in the Gastrointestinal Cancers Program care for patients with gastric bile duct, gallbladder, gastrointestinal, colon and rectal cancers.

Diagnosis

Most often, a colonoscopy will be the most accurate way to diagnose rectal cancer. After diagnosis, your doctor will determine the stage of cancer by taking a tissue sample or biopsy. The patient will then need a series of images taken to determine if the cancer has spread and have a complete colonoscopy.

Treatment

Treatment begins with the initial evaluation to determine further care. This starts with a history and a rectal exam to evaluate the tumors relationship to the sphincter complex. CT scans of the chest, abdomen, and pelvis along with a complete colonoscopy are done to look for metastasis or spread of the disease. Surgery will depend on various factors like age, health, stage and grade of the tumor, and location of the tumor.

Crohn’s disease is an inflammatory bowel disease that can affect the gastrointestinal tract from the mouth to the anus. This disease causes inflammation of the digestive tract, leading to abdominal pain, diarrhea, fatigue and weight loss.

Diagnosis

There is no single test to diagnose Crohn’s disease. Your doctor will rule out other causes or conditions to help confirm the diagnosis by performing:

  • Blood tests
  • Fecal occult blood test
  • Colonoscopy
  • CT scan
  • MRI
  • Capsule Endoscopy
  • Balloon-assisted enteroscopy

Treatment

Crohn’s disease requires a multidisciplinary approach between gastroenterologists and surgeons to manage the condition. Treatment varies greatly depending on the symptoms and their severity. Treatments for Crohn’s Disease aim to help reduce inflammation and symptoms that arise. With consistent treatment, the goal is to limit any complications and improve prognosis. Therefore, treatments may need to be adjusted for effectiveness.

Fecal Incontinence, also known as anal incontinence, is the passage of gas or feces without control. Normally continence occurs through the interaction between sensory nerves, sphincter muscle control, pelvic floor muscular coordination and stool consistency. When one or more of these elements fails, incontinence can result.

This condition can occur when experiencing diarrhea and is typically chronic or recurring. It can also occur in people who may not be aware that they need to pass a stool. The most common cause is prior obstetric trauma, but there are many other possible causes including sphincter damage from prior surgery, nerve damage to the pelvic floor, or hemorrhoids.

Diagnosis

Thorough examination and visual inspection is performed to diagnose fecal incontinence, along with various tests to help determine the cause.

Treatment

Initial evaluation and treatment begin with a thorough history and exam, along with measures such as diet change, stool bulking, exercises or therapies, and antimotility medications. Patients who do not respond to initial approaches may need additional testing such as manometry or ultrasound evaluation of their sphincter complex. Successful surgical treatment depends on the underlying cause.

Hemorrhoids are a normal part of our anatomy and are located internally and externally around the anal canal and the anal opening. Hemorrhoids are recognized when bleeding, protrusion or itching occurs. In a normal state, they cause no symptoms.

Diagnosis

Your doctor can diagnose hemorrhoids through rectal exam. A short-lighted probe, called an anoscope, may be used to examine the inside of the anal canal where internal hemorrhoids are located. Some cases might need a colonoscopy to ensure symptoms are not related to a more serious condition in your rectum or colon. A colonoscopy may be needed to ensure symptoms are not related to a more serious condition in your rectum or colon.

Treatment

Most hemorrhoid symptoms improve with dietary and lifestyle changes or with medication. Other alternatives are rubber band ligation, infrared coagulation, sclerotherapy and surgical hemorrhoidectomy. Typically, hemorrhoids do not need surgery because as the blood clot dissolves, the external hemorrhoid will shrink.

Pilonidal Disease is an infection caused by ingrown hair that becomes imbedded in the skin, creating a pit that leads to inflammation. An ingrown hair can develop into a pilonidal cyst, abscess or sinus. Most people with this condition develop an abscess, which will turn into a pilonidal sinus.

Diagnosis

A pilonidal infection is usually visible and easily identified by a doctor. On occasion, a CT scan is needed to look for sinus cavities under the skin’s surface.

Treatment

These often spontaneously drain or require a small incision to drain. If patients develop a mature cyst with recurrent abscess and drainage, formal surgical treatment is an option. Surgery may be needed, if pilonidal disease progresses to the sinus stage.

Pruritus ani, or anal itching, is a common skin condition characterized by itching or burning around the anus. Many things including, irritants or fecal incontinence and long-term (chronic) diarrhea can irritate the skin, causing anal itching. Infections, skin conditions and other chronic conditions such as diabetes, thyroid disease, hemorrhoids and anal tumors can cause Pruritus ani.

Diagnosis

A physical or digital rectal exam may be required. Persistent anal itching could be due to a skin condition or other health issue that will require medical treatment.

Treatment

Through examination and a review of your medical history and habits, a doctor will be able to diagnose the cause of itching. Treatment for anal itching depends on the source of the irritation. Anti-itch creams or treatments for an infection are common.