Gastrointestinal Disorders
Functional disorders are those in which the bowel looks normal but doesn't work properly. They are the most common problems affecting the colon and rectum, and include constipation and irritable bowel syndrome (IBS). The primary causes for functional disorders include:
- Eating a diet low in fiber
- Not drinking enough water or other fluids
- Not getting enough exercise
- Traveling or other changes in routine
- Eating large amounts of dairy products
- Being stressed
- Resisting the urge to have a bowel movement
- Resisting the urge to have bowel movements due to pain from hemorrhoids
- Overusing laxatives (stool softeners) that, over time, weaken the bowel muscles
- Taking antacid medicines containing calcium or aluminum
- Taking certain medicines (especially antidepressants, iron pills, and strong pain medicines such as narcotics)
- Being pregnant
Treatment of constipation includes increasing the amount of fiber you eat, drinking more fluids, exercising regularly, and moving your bowels when you have the urge (resisting the urge causes constipation). If these treatment methods don't work, laxatives are a temporary solution. Note that the overuse of laxatives can actually aggravate symptoms of constipation. Always follow the package instructions on the laxative medicine, as well as the advice of your doctor.
Irritable bowel syndrome (IBS) (also called spastic colon, irritable colon, or nervous stomach) is a condition in which the colon muscle contracts more readily than in people without IBS. A number of factors can trigger IBS including certain foods, medicines, and emotional stress. Symptoms of IBS include abdominal pain and cramps, excess gas, bloating, and a change in bowel habits such as harder, looser, or more urgent stools than normal. Often people with IBS have alternating constipation and diarrhea.
Treatment includes avoiding caffeine, increasing fiber in the diet, drinking more fluids, monitoring which foods trigger IBS (and avoiding these foods), quitting smoking, minimizing stress or learning different ways to cope with stress, and sometimes taking medicines as prescribed by your health care provider.
Structural disorders are those in which the bowel looks abnormal and doesn't work properly. Sometimes, the structural abnormality needs to be removed surgically. The most common structural disorders are those affecting the anus, as well as diverticular disease and cancer.
Anal disorders
Hemorrhoids are swollen blood vessels that line the anal opening caused by excess pressure from straining during a bowel movement, persistent diarrhea, or pregnancy. There are two types of hemorrhoids: internal and external.
- Internal hemorrhoids — Internal hemorrhoids are normal structures cushioning the lower rectum and protecting it from damage by stool. When they fall down into the anus as a result of straining, they become irritated and start to bleed. Ultimately, internal hemorrhoids can fall down enough to prolapse (sink or protrude) out of the anus.
Treatment includes improving bowel habits (such as avoiding constipation, not straining during bowel movements, and moving your bowels when you have the urge), using elastic bands to pull the internal hemorrhoids back into the rectum, or removing them surgically. Surgery is needed only for a small number patients with very large, painful, and persistent hemorrhoids. - External hemorrhoids — External hemorrhoids are veins that lie just under the skin on the outside of the anus. Sometimes, after straining, the external hemorrhoidal veins burst and a blood clot forms under the skin. This very painful condition is called a pile.
Treatment includes removing the clot and vein under local anesthesia in the doctor's office.
Initial treatment for anal fissures includes pain medicine, dietary fiber to reduce the occurrence of large, bulky stools, and sitz baths (sitting in a few inches of warm water). If these treatments don't relieve pain, surgery might be needed to decrease spasm in the sphincter muscle.
Perianal abscesses can occur when the tiny anal glands that open on the inside of the anus become blocked, and the bacteria always present in these glands cause an infection. When pus develops, an abscess forms. Treatment includes draining the abscess, usually under local anesthesia in the doctor's office.
An anal fistula often follows drainage of an abscess and is an abnormal tube-like passageway from the anal canal to a hole in the skin near the opening of the anus. Body wastes traveling through the anal canal are diverted through this tiny channel and out through the skin, causing itching and irritation. Fistulas also cause drainage, pain, and bleeding. They rarely heal by themselves and usually need surgery to drain the abscess and "close off" the fistula.
Other perianal infections Sometimes the skin glands near the anus become infected and need to be drained. Just behind the anus, abscesses can form that contain a small tuft of hair at the back of the pelvis (called a pilonidal cyst).
Sexually transmitted diseases that can affect the anus include anal warts, herpes, AIDS, chlamydia, and gonorrhea.
Diverticular disease Diverticulosis is the presence of small outpouchings (diverticula) in the muscular wall of the large intestine that form in weakened areas of the bowel. They usually occur in the sigmoid colon, the high-pressure area of the lower large intestine.
Diverticular disease is very common and occurs in 10 percent of people over age 40 and in 50 percent of people over age 60 in Western cultures. It is often caused by too little roughage (fiber) in the diet. Diverticulosis rarely causes symptoms but when the occur, they might include tenderness over the affected area or muscle spasms in the abdomen.
Complications of diverticular disease happen in about 10 percent of people with outpouchings. They include infection or inflammation (diverticulitis), bleeding, and obstruction. Treatment includes antibiotics, increased fluids, and a special diet. Surgery is needed in about half the patients who have complications to remove the involved segment of the colon.
Colon polyps and cancer Each year 130,000 Americans are diagnosed with colorectal cancer, the second most common form of cancer in the United States. Fortunately, with advances in early detection and treatment, colorectal cancer is one of the most curable forms of the disease. By using a variety of screening tests, it is possible to prevent, detect, and treat the disease long before symptoms appear.
The importance of screening Almost all colorectal cancers begin as polyps, benign (non-cancerous) growths in the tissues lining the colon and rectum. Cancer develops when these polyps grow and their cells start to invade surrounding tissue. Removal of polyps can prevent the development of colorectal cancer. Almost all precancerous polyps can be removed painlessly using a flexible lighted tube called a colonoscope. If not caught in the early stages, colorectal cancer can spread throughout the body. More advanced cancer requires more complicated surgical techniques.
Most early forms of colorectal cancer do not cause symptoms, which makes screening especially important. When symptoms do occur, the cancer might already be quite advanced. Symptoms include blood on or mixed in with the stool, a change in normal bowel habits, narrowing of the stool, abdominal pain, weight loss, or constant tiredness.
Most cases of colorectal cancer are detected in one of four ways:
- By screening people at average risk for colorectal cancer beginning at age 50
- By screening people at higher risk for colorectal cancer (for example, those with a family history or a personal history of colon polyps or cancer)
- By investigating the bowel in patients with symptoms
- A chance finding at a routine check-up
Colitis There are several types of colitis, conditions that cause an inflammation of the bowel. These include:
- Infectious colitis
- Ischemic colitis (caused by not enough blood going to the colon)
- Radiation colitis (after radiotherapy)
- Ulcerative colitis (cause not known)
- Crohn's disease (cause not known)
Summary Many diseases of the colon and rectum can be prevented or minimized by maintaining a healthy lifestyle and practicing good bowel habits.
If you have a family history of colorectal cancer or polyps, you should have a colonoscopy beginning at age 40, or 10 years younger than your youngest family member with cancer. (For example, if your brother was diagnosed with colorectal cancer or polyps at age 45, you should begin screening at age 35).
If you have a personal history of colorectal cancer or polyps, you should have a colonoscopy before surgery or within 1 year after surgery and then a follow-up colonoscopy in 3 years. If the follow-up colonoscopy is negative, you should have a colonoscopy every 5 years.
If you have symptoms of colorectal cancer you should consult your doctor right away. Common symptoms include:
- A change in normal bowel habits
- Blood on or in the stool that is either bright or dark
- Unusual abdominal or gas pains
- Very narrow stool
- A feeling that the bowel has not emptied completely after passing stool
- Unexplained weight loss
- Fatigue
[FONT="]Inflammatory GI disorders[/FONT][FONT="] The term inflammatory bowel disease covers a group of disorders in which the intestines become inflamed (red and swollen), probably as a result of an immune reaction of the body against its own intestinal tissue. It includes Inflammatory Bowel Disease (IBD), Crohn’s Disease and ulcerative colitis.[/FONT]
Crohn disease is a chronic (slowly developing, long-term) inflammation of the digestive tract. It can affect any part of the digestive tract from the mouth to the anus but usually involves the terminal part of the small intestine, the beginning of the large intestine, and the area around the anus. The inflammation causes uncomfortable and bothersome symptoms and may produce serious damage to the digestive tract.
Crohn disease is sometimes called ileitis. It and a similar condition called ulcerative colitis are referred to together as inflammatory bowel diseases. These illnesses are known for their unpredictable flares and remissions.
The inflammation usually starts in one or more areas of the mucosa that lines the inside of the intestines.
- The disease may invade deeper tissues of the intestinal wall and spread to involve more areas of the bowel.
- Ulcers may form at the sites of the most intense inflammation.
- The ulcers may spread and become very large but are usually separated by areas of relatively healthy tissue with little or no inflammation.
- The mucosal lining of the intestines in Crohn disease is often described as looking like a cobblestone street, with areas of ulceration separated by narrow areas of healthy tissue.
- The inflammation damages the lining of the intestine so that it cannot absorb nutrients, water, and fats from the food you eat. This is called malabsorption, and it can result in malnutrition, vitamin and mineral deficiencies, gallstone, and kidney stones.
- As the inflammation invades deeper into the intestinal tissues, the intestinal wall becomes thicker, narrowing the bowel lumen (the space through which food passes). The intestinal lumen may become so narrow that it becomes obstructed, so that food cannot pass through at all. This obstruction is usually intermittent, meaning that it comes and goes, and gets better with medical treatment. Eventually, however, the obstruction can become permanent.
- If the inflammation in one area spreads all the way through the intestinal wall, the inflamed area can stick to other organs and structures in the abdomen. Crohn disease can also cause problems around the anus. These may include tiny but painful cracks in the skin known as anal fissures; tunneling sores called fistulas that cause abnormal connections between the bowel and the skin; or an abscess, a pocket of inflamed or dead tissue that is usually very painful.
[FONT="]Ulcerative colitis:[/FONT] [FONT="] A relatively common disease that causes inflammation of the large intestine (the colon). The cause is unknown.[/FONT]
[FONT="]Ulcerative colitis is a form of inflammatory bowel disease. It has some similarity to a related disorder, Crohn's disease.[/FONT]
[FONT="]The end of the colon (the rectum) is always involved in ulcerative colitis. When the inflammation is limited to the rectum, it is called ulcerative proctitis.[/FONT]
[FONT="]The inflammation may extend to varying degrees into the upper parts of the colon. When the entire colon is involved, the terms pancolitis or universal colitis are used.[/FONT]
[FONT="]Intermittent rectal bleeding, crampy abdominal pain and diarrhea can be symptoms of ulcerative colitis. Ulcerative colitis characteristically waxes and wanes. Many patients experience long remissions, even without medication. Ulcerative colitis may mysteriously resolve ("burn out") after a long history of symptoms.[/FONT]
[FONT="]Direct visualization (sigmoidoscopy or colonoscopy) with sampling of the lining of the bowel is the most accurate diagnostic test. Especially in new cases, infections and other diseases that can mimic ulcerative colitis have to be considered and excluded.[/FONT]
[FONT="]Long-standing ulcerative colitis increases the risk for colon cancer. Ulcerative colitis can also be associated with inflammation in joints, spine, skin, eyes, the liver and its bile ducts.[/FONT]
[FONT="]The treatment of ulcerative colitis may involve medications and/or surgery. Since inflammatory bowel disease is currently an area of active and productive research, new treatments are anticipated which, it is hoped, will be of value in ulcerative colitis.[/FONT]