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Conditions

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Hemorrhoid Removal

Hemorrhoids are cushions of vascular tissue that are a normal part of the anal anatomy. When these tissues enlarge, bleeding and discomfort occur. Treatment may include dietary changes and topical medication.

Large hemorrhoids may require surgery such as PPH (Procedure for Prolapse and Hemorrhoids). This procedure reduces the enlarged hemorrhoidal tissue, and is a less painful procedure compared to a conventional hemorrhoidectomy. Patients also recover faster than patients who undergo a conventional hemorrhoidectomy procedure. Our physicians will discuss the best treatment plan for your condition.

Pelvic Floor Disorders

Important statistics on pelvic floor disorders:

  • More than 50% of women age 55 and older suffer one or more of the problems caused by pelvic floor dysfunction.
  • 1 out of every 9 women will undergo surgery for a pelvic floor disorder.
  • 8 times more women than men suffer from a pelvic floor disorder.
  • Women who suffer from pelvic floor disorders underreport their condition due to embarrassment.
  • 1 out of 3 women will suffer sphincter muscle damage due to vaginal childbirth. This damage may lead to loss of bowel control.
  • 30% of women with overactive bladder or urinary incontinence also suffer from fecal incontinence.
  • 20% of patients suffering from genital prolapse (abnormally bulging vaginal tissues) also have fecal incontinence.
  • The lifetime risk of undergoing surgery for a pelvic floor disorder is 11%.
  • 60% of nursing home occupants suffer from fecal and/or urinary incontinence.

Although men can suffer from pelvic floor disorders, the obvious differences in anatomy and function of the pelvic organs and their support that exist between men and women, make this set of disorders much more common in women. Therefore, most of the information below is geared towards women; however we also treat men with similar disorders.

Pelvic
Floor

The “pelvic floor” refers to the pelvic diaphragm, the sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments and other tissues that hold up the pelvic organs (vagina, rectum, uterus and bladder). When this system is torn or weakens, the organs may shift, bulge and push outward or against each other. As a result, women may suffer from urinary or fecal incontinence or obstruction, vaginal prolapse, vaginal pain, sexual dysfunction, and other problems. Women who vaginally delivered several children and those who experienced tears in the perineum and pelvic floor during childbirth, are at higher risk for pelvic floor disorders.

Additional factors contributing to pelvic floor relaxation include aging, menopause, connective tissue disorders, degenerative neurologic conditions, and prior pelvic surgery. Any of these factors alone or in combination may occur acutely or over time, and result in some of the most common and feared health problems faced by women.

Pelvic floor disorders include:

  • Fecal incontinence (involuntary loss of feces)
  • Urinary incontinence (involuntary loss of urine)
  • Constipation
  • Rectal pain
  • Vaginal and/or rectal prolapse
  • Pelvic pain/trauma
  • Sexual dysfunction (Dyspareunia, Apareunia)

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Fecal Incontinence

The loss of control of bowel movements or gas is known as fecal incontinence. This condition is reasonably common, particularly in women who have had children. Studies have demonstrated that at least 30% of women will sustain damage to the anal sphincter muscles during childbirth. However, symptoms of fecal incontinence may not become clinically evident for decades.

Our physicians and staff understand the traumatic consequences of having to live with loss of bowel control. We empathize with this socially debilitating condition, and we do not want patients to suffer in silence. There are many options for treating and managing this disorder. Our goal is to provide options to allow patients to regain control of bowel function. Patient care is individualized, and Dr. Howard Kaufman will discuss surgical and nonsurgical treatment options aimed at improving your quality of life.

Our colorectal specialists work with patients to find the cause of incontinence which may include disorders of the colon and rectum, the anus, and/or the pelvic floor. Treatment depends on the cause and severity of fecal incontinence, and may include medication, dietary changes, biofeedback and exercise programs to strengthen anal and pelvic muscles, or surgery. In addition to evaluation of the muscles and nerves of the anus and rectum, we offer the latest therapies available in for patients who have failed traditional types of therapy.

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Obstructed Defecation

Not all patients with pelvic floor disorders have control problems. In fact, many patients may have a form of constipation known as obstructed defecation. In this condition, there may be defects in the muscles, connective tissues, or function of the pelvic floor that causes a patient to excessively strain in order to have a bowel movement. Persistent straining can worsen pelvic floor problems. Occasionally, a patient may need to assist with evacuation to have a bowel movement. When a patient presents to us with refractory constipation, special x-ray or other imaging tests may be ordered to help determine the cause of this disorder.

Rectal Prolapse

Rectal prolapse is different than prolapsing hemorrhoids. Rectal prolapse may involve the full lining and muscles of the rectum protruding with attempts at bowel movements. In more advanced cases, the rectum may protrude without straining. More milder forms may only involve the lining of the rectum (mucosal prolapse). Internal rectal prolapse occurs when the rectum telescopes on itself inside the pelvis and does not protrude out of the anus. Depending on the cause and type of prolapse as well as patient factors and desires, surgery may be performed through the abdomen (open, laparoscopic, or robotic) or via a “perineal approach” (through the bottom). Most patients who have incontinence or constipation associated with rectal prolapse will note improvements in theses associated symptoms following surgical correction.

Vaginal Prolapse

Prolapse comes from the Latin word, “to fall.” In medicine, this term indicates that an organ has slipped out of its proper place. Women with pelvic floor disorders may suffer from the rectum protruding through the back wall of the vagina (rectocele), the bladder protruding out through the anterior vaginal wall (cystocele) or the entire vagina (vaginal vault prolapse) or uterus (uterine prolapse) prolapsing through the vaginal opening. The small intestine may even prolapse (enterocele), especially in women who have had a hysterectomy. When an organ prolapses vaginally, it may be indicative of an unusually difficult labor during childbirth, obesity or the effects of constant straining on the female pelvic floor.

Sexual
Dysfunction

Women suffering from a pelvic floor disorder may experience dyspareunia (pain with intercourse) or apareunia (no sexual intercourse).

Services

Traditionally, the pelvic floor has been segmented by specialists treating disorders of the distal urinary tract, genital organs, and anus and rectum as separate entities. Disorders across these anatomic areas that are only separated by millimeters of tissue are common. When a compartmental approach is followed to treat women with a pelvic floor disorder, there is a possibility of inaccurately identifying which segment of the pelvic floor is causing the disorder. This approach may lead to an inadequate surgical repair, and the original problem can recur or additional problems may be unmasked. We recognize the need for a multidisciplinary approach to treat these disorders, therefore our team of specialists include colorectal surgeons, gynecologists, urologists, gastroenterologists, physical therapists, and radiologists.

Diverticulitis

The cause of this disease is unknown, but it is believed that the association of a diet not containing sufficient fiber which contributes to constipation, makes the muscles strain to move stool that is too hard, causing increased pressure in the colon. This pressure instigates the weak spots in the colon to bulge out and become diverticula.

Symptoms for diverticulitis and diverticulosis differ. Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. The most common symptom of diverticulitis is abdominal pain, with tenderness around the left side of the lower abdomen. Diverticulitis can be a source of rectal bleeding. If an infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.

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Incontinence:
Axonics – New Therapy for Fecal Incontinence

Fecal incontinence occurs when an individual loses control over his or her bowels and can be quite detrimental to leading a normal and active lifestyle. Those who suffer from this problem cannot gain the control they wish to have over their lives, leaving them unsure as to which steps should be taken to overcome the condition.

Axonics Therapy and InterStim® Therapy are designed to give control back to the sufferers of fecal incontinence. The debilitating condition is often caused by a damaging of the nerves and muscles that normally work to control your bowel movements. If you have tried other forms of treatment, such as diet changes and medication, but still experience fecal incontinence, Axonics Therapy or InterStim® Therapy may be viable options. To learn more about Axonics Therapy, please click here. InterStim® Therapy treatment involves a device called the InterStim® neurostimulator, which is placed under the skin, most typically within the upper buttocks. The device then sends mild electrical pulses to stimulate the nerves located in your back that control bowel movements, providing an increased amount of control for the individual.

Here are some statistics:

  • 83% of patients have achieved greater than 50% reduction in incontinent episodes per week
  • 47% of patients have achieved complete continence
  • 31% of patients have reported no use of undergarment protection (such as Depends) at the 12-month visit

Before the device can be properly utilized for the afflicted individual, the patient will have to undergo a short trial stage, which takes a few days while you go about your normal daily activity. A wire is inserted beneath the skin of the lower back and a test simulator worn on your belt then sends the electrical pulses to determine whether the process restores control to your bowel movements. If the trial period is a success, we can then move forward with the InterStim® Therapy.

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Crohn’s Disease

Crohn’s disease is a chronic disorder that causes inflammation of the digestive or gastrointestinal (GI) tract. Patients with Crohn’s disease have an immune system that mistakes food, bacteria, and other materials in the intestine for a foreign substance. The immune system reacts by attacking the intestine. This reaction causes chronic inflammation, which leads to ulcerations and bowel injury.

Although it can occur anywhere in the gastrointestinal tract, Crohn’s disease commonly affects the end of the small intestine (the ileum), and the colon. Crohn’s disease may also cause inflammation of the rectum and anus. In Crohn’s disease, all layers of the intestine may be involved, but normal healthy bowel may exist in close proximity to unhealthy bowel.

Ulcerative Colitis

Ulcerative colitis is a chronic (ongoing) disease of the colon, or large intestine. The disease is manifested by inflammation and ulceration of the colon mucosa (innermost lining). Tiny open sores or ulcers, form on the surface of the lining where they bleed and produce pus and mucus. Inflammation causes the colon to empty frequently, so symptoms typically include diarrhea and crampy abdominal pain.

Inflammation usually begins in the rectum, but it may involve the entire colon. When ulcerative colitis affects only the rectum, it is called ulcerative proctitis. If the disease affects only the left side of the colon, it is called limited or distal colitis, and when it involves the entire colon, it is called pancolitis. There are no areas of normal intestine between the areas of diseased intestine, and it affects only the innermost lining of the colon.

Prolapse

Prolapse can also involve the slippage of an organ out of its original location but not necessarily outside the body. Unless an organ protrudes through a genital orifice, a woman may not know that she has a prolapsed organ. Symptoms of urinary incontinence, rectal and/or vaginal heaviness or pain, constipation, and discomfort or pain experienced during sexual activity, may indicate vaginal prolapse.

Anal Fissure

An anal fissure is a small tear or cut in the skin around the anus, which can cause pain and/or bleeding. Due to the location of fissures, they become aggravated during and after bowel movements. Symptoms of an anal fissure include pain during defecation and red blood in the stool. Constipation or diarrhea can cause a tear in the anal lining resulting in a fissure. A chronic fissure may be due to poor bowel habits, tight or spastic anal sphincter muscles, scarring or an underlying medical problem.

Historically chronic fissures were treated with surgical disruption or division of the internal anal sphincter muscle. New medications include topically applied Nitroglycerin and Nifedipine, both of which may be used to decrease anal muscle spasm. Botox A, which needs to be injected, also decreases anal muscle spasm and may reduce the need to treat fissures surgically.

Anorectal Abscess

An anorectal abscess is a collection of pus in the anal or rectal region. It may be caused by infection of an anal fissure, sexually transmitted infections, or blocked anal glands. Symptoms include painful, hardened tissue in the perianal area, discharge of pus from the rectum, a lump or nodule, tenderness at the edge of the anus, fever, constipation, or pain associated with bowel movements. Treatment involves drainage of the abscess.

Warm sitz baths are useful for relief of the pain and swelling. Pain medication and antibiotics may be required.

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Pilonidal Disease

Pilonidal disease may involve three common occurrences:

  • Acute Abscess Formation: An abscess formation between the buttocks. Treatment may include simple incision and drainage.
  • Simple Sinus: Approximately 50% of patients who have a resolved abscess develop a pilonidal sinus.
  • Complex or Recurrent Disease: A small number of patients with a resolved pilonidal sinus go on to develop complex or recurrent pilonidal disease. Patients suffering from recurrent pilonidal disease have persistent, non-healing wounds which require repeated treatment.

There have been advances in surgical treatment that decrease recurrence of this disease. A specialist at the Center for Colorectal and Pelvic Floor Disorders will discuss all available treatment options with patients suffering from this disease.

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