ANAL ITCHING
What is Anal Itching?
Anal itching or pruritus ani (proo-RIE-tus AY-nie) is itching around the anus (the outlet of the rectum), which may be temporary or persistent and accompanied by a strong, uncontrollable urge to scratch.
Possible causes of anal itching include:
• Local causes. Both dry skin due to aging and too much moisture around the anus from excessive sweating or from moist, sticky stools.
• Medical conditions such as fecal incontinence, skin disorders, yeast and other infections, hemorrhoids, anal abrasions, fissures, and fistulas, and anal tumors can all cause anal itching.
• Medications. Some antibiotics, as well as overuse of laxatives, can lead to diarrhea that can irritate the anus and cause excessive itching.
• Irritants from chemicals such as laundry soaps, colognes, douches and birth control products can irritate skin around the anus, and certain foods can cause diarrhea or may directly or indirectly irritate your anus as they exit your colon.
• Eating certain foods, smoking and drinking alcoholic beverages, especially beer and wine, may cause pruritus ani in some individuals. Some food items associated with anal itching are:
• Coffee, Tea
• Carbonated beverages
• Milk products
• Tomatoes and tomato products such as Ketchup
• Cheese
• Chocolate
• Nuts
• Personal habits such as scratching and excessive washing irritate the anus and aggravate itching.
• Other causes. Anal itching may be related to anxiety or stress.
• Sometimes, the cause is undetermined.
Symptoms
Anal itching is associated with other similar symptoms in and around the anus, including burning, soreness or pain.
Lifestyle and home remedies
Prevention of anal itching mainly involves washing properly and avoiding irritants. If you already have anal itching, try these self-care measures:
• Cleanse gently. Wash the area with water in the morning, at night and immediately after bowel movements.
• Dry thoroughly. Pat, don’t rub, the area dry with toilet paper or a towel, and keep the area dry with a piece of cotton gauze or non-medicated talcum or cornstarch powder.
• Use over-the-counter (OTC) treatments correctly.
• Don’t scratch. If you can’t tolerate the itching, apply a cold compress to the area or take a lukewarm bath to find some immediate relief.
• Switch tissue. Use moistened or extra soft unbleached, unscented toilet paper or unscented flushable bathroom wipes.
• Wear cotton underwear and loose clothing. Avoid wearing clothes that trap moisture such pantyhose and other tight-fitting garments.
• Avoid irritants such as bubble baths and genital deodorants, beverages or foods that you know irritate your anal area.
Should the itching persist, become too bothersome, or be accompanied by other symptoms, it would be best to see your colorectal specialist and discuss your problem with him.
What are anal warts?
Anal warts (also called “condyloma acuminata”) are skin eruptions that affect the area around and inside the anus and even the genital area. Usually, they do not cause pain or discomfort to afflicted individuals and patients may be unaware that the warts are present. Anal warts are thought to be caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact. HPV is considered a sexually transmitted disease. However, you do not have to have anal intercourse to develop anal condyloma. Anal warts can grow larger and spread if not removed.
What are the symptoms of anal warts?
Some patients will experience symptoms such as itching, bleeding, discharge and/or a feeling of a lump or mass in the anal area.
Treatment options
Topical medication – for small and superficial warts; sometimes for warts inside the canal.
Freezing the warts with liquid nitrogen.
Surgical removal – for bigger and recurrent warts; provides immediate result and can be done on out-patient basis but usually under anesthesia
Constipation
What is constipation?
Constipation is the presence of 2 or more of the following symptoms for at least 3 months:
• Straining more than 25% of the time.
• Hard stools more than 25% of the time.
• Incomplete evacuation more than 25% of the time.
• 2 or less bowel movements per week.
Constipation can be causedlow fiber diet; medical conditions such as hypothyroidism, diabetes, immobility, and neurologic disease; and some medications such as opiates, anti-hypertensives, iron and calcium supplements.
How is constipation detected?
Several examinations are needed by your specialist to determine the cause of your constipation:
• Digital examination—usually the first step, since it is relatively simple and may provide clues to the underlying causes of the problem.
• Colonoscopy—involves inserting a scope to visualize the inside of the large intestine and determine to rule out masses that are causing obstruction.
• Barium enema—a radiographic study where dye is inserted through the anal area, creating an image of the large intestine on x-ray.
• Colonic transit study—involves ingestion of a radiopaque marker and undergoing an x-ray to see where the markers are. It may show areas of the large intestine that exhibit slowed movement.
How is constipation managed?
Treatment depends on the possible cause as determined from the examinations done. Surgery maybe recommended if there is an anatomical problem (mass obstructing the intestine, internal prolapsed of bowels, elongated segment of large intestine etc.) causing the constipation. Otherwise, non-surgical intervention may be the key to improving the patient’s symptoms. These include:
• Treating the underlying medical problem.
• Patient counseling.
• Increasing physical activity.
• Increasing fluid intake.
• Using bulk-forming agents, laxatives, enemas or suppositories.
Diarrhea
What is diarrhea?
Diarrhea is passing out of loose, unformed or watery stool that occurs more frequently than normal. This may be accompanied by abdominal pain of the colicky type, feeling of being bloated, incontinence, anal pain, fever or chills.
What causes diarrhea?
• Diarrhea most often is viral in nature, and usually resolves after a few days.
• Bacterial diarrhea, such as food poisoning, may be accompanied by rectal bleeding.
• Some antibiotics may cause diarrhea.
• Inflammatory bowel disease such as Crohn’s disease, ulcerative colitis, or diverticulitis.
• Lactose intolerance.
Below are things to watch out for during an episode of diarrhea:
• High fever.
• Severe abdominal pain.
• Blood in the stool or black, tarry stools.
• Dehydration or feeling weak, tired or dizzy.
• Concentrated urine or urinating less than usual.
• Feeling thirsty.
Treatment
• Rehydration is important.
• Intake of water, fruit juices, salt-containing liquids such as warm broth and sports
drinks like Gatorade are recommended.
• In viral diarrhea, fluids and rest are usually enough.
• Persistent diarrhea (i.e., more than 3 days) or diarrhea accompanied by other
symptoms should NOT be treated with over-the-counter medications such as Imodium
without the advice of your doctor.
If a person cannot drink enough to keep up with the fluid lost during bowel movements, he should be brought to the hospital for rehydration. If any of these warning signs occur, please consult your specialist right away.
Hemorrhoids
What are Hemorrhoids?
Hemorrhoids are actually present in all individuals whether healthy of not. They are the vascular cushions which surround the general area of the rectum and anus. The term we call hemorrhoids is associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed. Internal hemorrhoids are located inside the anus while external hemorrhoids are located outside.
What are the types of internal hemorrhoids?
First degree hemorrhoids - hemorrhoids that bleed but do not come out during passage of bowel movement.
Second degree hemorrhoids - hemorrhoids that occasionally bleed and come out during bowel movement but go back in.
Third degree hemorrhoids - jemorrhoids that occasionally bleed and come out during bowel movement but can be pushed back in manually.
Fourth degree hemorrhoids - hemorrhoids that are pushed outside and cannot be pushed back in manually anymore.
Symptoms
There is usually bleeding of bright red blood dripping into the toilet bowl during bowel movement. Often, a mass or fleshy tissue comes out during straining.
Medical management
For first and second degree internal hemorrhoids:
• A high fiber diet that includes fruits and leafy vegetables.
• Adequate fluid intake.
• Avoidance of straining in the bathroom.
Rubber band ligation: for bleeding first and second degree internal hemorrhoids. This involves application of an elastic band at the base of the internal hemorrhoid.
Surgery: for persistent symptoms of bleeding, fleshy mass coming out, and problems with hygiene; unresponsiveness to medical management; or third or fourth degree or mixed (internal and external component) hemorrhoids.
• Hemorrhoidectomy - for third and fourth degree internal hemorrhoids. This is the traditional method of removing hemorrhoids. It makes use of a knife, scissors and other devices such as ligasure or harmonic scalpel.
• Stapled hemorrhoidopexy makes use of a surgical stapler to remove hemorrhoids and is associated with minimal post-operative pain.
• Transanal hemorrhoidal dearterialization - for second and third degree internal
hemorrhoids. This method makes use of Doppler ultrasound to detect arteries which are
then ligated. This method is also is associated with minimal post-operative pain.
Incontinence
What is fecal incontinence?
Fecal incontinence means absent or insufficient voluntary control over defecation. It involves a range of symptoms, from mild trouble holding gas to severe difficulty
holding formed stools. Many people are shy and embarrassed to talk about incontinence, but treatment options are available for this condition.
What causes fecal incontinence?
• Injury to the anal muscles or sphincters due to childbirth (more common cause), anal or rectal operation or trauma.
• Anal nerve damage due to pregnancy, childbirth or constant straining.
• Neurological disease, such as stroke.
• Age-related loss of anal muscle strength.
• Loose stools.
Leakage accompanied by blood in the stool may indicate inflammation (colitis), rectal tumor or rectal prolapse. These conditions require prompt evaluation.
How is the cause determined?
Detailed medical history which includes:
• Medical illnesses and medications
• Bowel habits and other bowel symptoms
• In women, history of past childbirths
Physical examination of the anal region
Additional studies, as necessary
• Anal manometry
• Defecography
• Pelvic nerve testing
• Endoanal ultrasonography
Treatment
Treatment is based on the underlying cause:
• Medications – for cases caused by a medical illness, such as bowel infection or inflammation.
• Surgery – for incontinence caused by injury to the sphincter muscles.
• Dietary changes and pelvic floor muscle exercises – if the muscles are intact but are functioning poorly.
For uncorrectable causes of incontinence, different measures may be recommended to make the problem more manageable:
• Enemas or rectal irrigation – help empty the bowel and reduce the chance of leakage.
• Medications – can help control diarrhea.
• Fiber supplements – usually improve constipation.
• Colostomy – may help improve quality of life in patients with severe, life-debilitating incontinence.
Painful skin irritation associated with incontinence may be addressed in various ways. Details may be discussed with your specialist.
What are the Main Treatment Options for Colorectal Cancer?
Surgery is the mainstay of treatment for colon or rectal cancer.
This entails removing the segment of the colon involved by the cancer as well as the lymph nodes draining via the mesentery. If the cancer is small and early, minimally-invasive laparoscopic surgery can be done, with smaller incisions, less pain, and faster recovery.
Additional treatment in the form of chemotherapy or radiation may provide additional benefit and this may be best discussed with your specialists.
How is Colon Cancer Diagnosed?
Colon cancer is best detected early, when there are still no symptoms. Screening for individuals with no risk factors to develop colon or rectal cancer starts at 50 years old. For those individuals with inherited risks such as those with significant family history, screening should start earlier. This is achieved through screening tests such as colonoscopy, fecal occult blood test with flexible sigmoidoscopy, barium enema and CT virtual colonoscopy.
On the other hand, if you are experiencing the typical symptoms of colon cancer or polyps, a colonoscopy would be the most appropriate test for you. If a polyp is found, it can be completely removed and sent to the laboratory to check for early malignancy. Removal of a benign adenomatous polyp prevents its progression to cancer. However, if a tumor is found instead under colonoscopy, a biopsy can be done quickly and safely to determine if it is malignant.
What Happens if You have Colon Cancer?
Colon cancer first begins as a tumor in the lining of the colon. Early symptoms maybe bleeding, abnormal fecal discharge, or unexplained anemia. As the tumor grows, it may begin to obstruct the flow of feces causing abdominal colic and changes in bowel habits. If the obstruction is left to progress, eventually the flow of feces and gas will be completely blocked, resulting in abdominal enlargement, pain and vomiting. Perforation of the large intestine with intra-abdominal infection is another complication of advanced tumors.
Aside from its effect on the intestines, colon cancer also spreads through the lymph nodes and affects other organs away from the colon. The most sites of metastasis are the liver, lung, and peritoneum (inner lining of the abdomen).
Colon cancer is staged according to severity:
Stage I - cancer does not go beyond the wall of the colon.
Stage II - cancer goes beyond the wall of the colon.
Stage III - the cancer has spread to the lymph nodes around the colon.
Stage IV - the cancer has spread to other organs.
COLORECTAL SPECIALISTS, INC.
At the Forefront of Colorectal Care in the Philippines
Stage 4 Colon and Rectal Cancer
*Note: There is No More Stage 5
There are various stories about colon cancer being detected at a terminal stage. Christine, 44 years old, never had any symptoms – no pain, no weakness and fatigue, now weight loss, not even a streak of blood during bowel movement. But one day, she just bled profusely in the toilet. The verdict was Stage 4 colon cancer.
Fred, 45 years old, did not ignore his symptoms. He had abdominal pain and bouts of constipation and diarrhea for several months. He was diagnosed with amoebiasis. When bleeding started, he underwent flexible sigmoidoscopy and barium enema. Both exams were normal. No one suggested a colonoscopy. Fourteen months from the onset of his symptoms, his colon was completely obstructed by cancer. He had to undergo emergency surgery. At the time of surgery, his doctors noted his liver to full of tumor as well. Stage 4.
Margie has 2 siblings who were survivors of colon cancer. She was advised to undergo screening colonoscopy. She declined. She eventually noted blood from her stools. During work-up, she was diagnosed to have rectal cancer that has spread to her lungs. Stage 4.
Most colon and rectal cancers are caught in later stages. This is because symptoms usually take time to manifest. More often, symptoms are dismissed as hemorrhoids, stomach flu or other inflammatory bowel diseases. Also, there is a common disregard for the importance of colorectal cancer screening.
There are certain symptoms that may indicate the presence of colon and rectal cancer. These include: recent changes in bowel habits, such as diarrhea or constipation; blood in the stool; persistent abdominal discomfort, such as cramps or gas pain; a feeling that bowel doesn’t empty completely; unexplained anemia, weakness or fatigue; and weight loss with no known reason.
Colon and rectal cancer, which is cancer of the large intestine or the lowest part of the digestive system, may be associated with a diet low in fiber and high in fat, calories, red meat, and processed foods. Other risk factors are a sedentary lifestyle, obesity, smoking, alcohol, diabetes, as well as a personal or family history of colon polyps or colorectal cancer. Age is also a risk factor. “About 90 percent of people diagnosed with colon cancer are older than 50,” says Dr. Manuel Francisco T. Roxas, a leading colorectal specialist, “although it can also occur in younger people, but much less frequently.” Thus, Dr. Roxas strongly recommends regular screening for those 50 years old and above.
In Stage 4 colon and rectal cancer, which is the final stage, the disease has spread to other parts of the body such as liver or lungs. Treatment for Stage 4 colon cancer entails a careful evaluation from experts to ensure correct staging. Then, a combination of treatment modalities can be applied such as chemotherapy, radiation and surgery (a surgeon removes the section of the colon affected by the tumor and joins the remaining healthy sections together).
A multidisciplinary teamwork approach is applied in the management of colorectal cancer. The team is composed of specialists from the field of Colorectal Surgery, Medical Oncology, Radiation Oncology, Pathology, Psychiatry and Enterostomal Nursing. The objective is to ensure that the best available care is provided the patient.
Colon and rectal cancer is best detected early, when it is most curable, before the development of symptoms. This is achieved through screening tests, particularly colonoscopy, which views the entire colon. At the same time, the surgeon can already remove any visible polyps (small, benign tissue which may eventually develop into colon or rectal cancer).
Various options for colorectal cancer screening are available. Routine screening is highly recommended, as follows: 1) fecal occult blood test yearly with flexible sigmoidoscopy every three years, or 2) colonoscopy every five to ten years, or 3) virtual CT colonography every three to five years.
Colorectal Specialists provides comprehensive, advanced, and efficient care to wide range of colorectal conditions. Its expertise is in the surgical management of colorectal cancer, diverticulitis, inflammatory bowel diseases, and other benign disorders like hemorrhoids, fissures, fistulae, polyps, constipation, fecal incontinence, sexually transmitted anorectal diseases, and other colorectal problems. It always strives to provide comfort, privacy and total quality service to its clienteles.
This specialist clinic is located at the 3rd Floor, Medicard Lifestyle Center, #51 Paseo de Roxas Cor. Sen. Gil Puyat (Buendia) Ave., Makati City, with Tel. No. 555-0832, Cell phone No. 09266305759. The clinic is open from Mondays to Fridays - 1:00 PM to 7:00 PM, and on Saturdays - 9:00 AM to 3:00 PM. Also, please visit www.colonandrectalspecialists.com or www.crsi.com.ph.
Who are at Risk of Colorectal Cancer?
* Age. About 90% of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
* Family history of colorectal cancer, or polyps in the colon - If you have a positive family history of colorectal cancer, you are more likely to develop this disease.
* Inflammatory bowel disease - A person who has a condition that causes inflammation of the colon such as ulcerative colitis or Crohn’s disease for many years is at an increased risk. Fortunately, these are not common in the Philippines.
* Personal history of cancer - A person who already had colorectal cancer may develop colorectal cancer a second time. Also, a woman with a history of cancer of the ovary, uterus, or breasts are at a somewhat higher risk of developing the disease.
* Diet - Colon cancer and rectal cancer maybe associated with diet low in fiber and high in fats, calories, red meat and processed foods.
* Sedentary lifestyle
* Diabetes
* Obesity
* Smoking