colonandrectalspecialists staff

Most people may experience anal discomfort at some point in their Lives, but they don’t talk about it because it’s quite an embarrassing topic to discuss. The most common complain involve pain and itching and in some cases may even involve bleeding.

“Anal diseases are any abnormalities in anus and the most common anal disease are hemorrhoids, anal fissure which is a wound in the anus and then fistulas or yung pigsa na pumutok na hindi gumagaling.”

The risk increases especially if you have a poor diet and hygiene. Too much moisture in your bottom can also lead to itching. But why this anal ailments may temporarily cause discomfort and soreness. There are many ways to alleviate the situation.

“One of the main message is even if this are common condition, this are not life threatening condition, best to have check up just to make sure. Especially if you’re at age 40 or 50 or if you have changes the way you move your bowels. “

What type of food should you eat to avoid anal discomfort ?

What treatment options are available for this kind of medical condition ? All these and more tonight on medtalk.

Joining us tonight, Dr. Armando Crisostomo a colorectal surgeon at the QualiMed Health Network. He is also a former president of Philippine College of Surgeons. Also joining us tonight, Dr. Manuel Francisco Roxas Consultant Director of The Medical City Colorectal Clinic and the chairman of the Department of Surgery of the Medical City.

Host : So as colorectal surgeons, you tackled the medical concerns of the rectum and the anus. So tonight is about anal diseases. What are Anal disease?

Dr. Manuel: Well, there are many diseases can actually affect the anus so we call them anal diseases because they affect lost and there several very common once for instance hemorrhoids, fissures and the abscesses and fistulas as well as anal warts. But other than that there are other condition that should be brought by the attention of the Doctor also so there are many conditions. So we love them all because we discussing in a topic like this, in a forum like this.

Host: So before we go to the diseases of the anus and the rectum, let first understand the function of the rectum and the anus.

Dr. Arman: Well the rectum or the anus considered the terminal portion of the gastro intestinal track. It is part of the expiratory system. So any excess food or waste materials that our body ingest and no longer needs are expelled to the very important part of the anatomy called the anus or rectum. And here usually, as we become adults the stools which form part of the waste materials become somewhat solid in character. And in children or babies we have not developed that ability to voluntarily expel the contents of the rectum but as we get older we developed that capability to be able to detect whether we’re going to passed out gas, or whether going to passed out something very soft, or we have some diarrhea or whether what is going to come out in solid. So an appropriate time our anus or rectum is very sensitive organ in itself. Because it’s able to distinguish whether you’re going to pass gas, liquid or solid tools at appropriate time. So it gives you this signals which are processed by your brain so at an appropriate time you’ll go to the comfort room to expel yourself. Just imagine if you put a mixture of air, water and the solid in your hand. Can your hand be able to expel air only, liquid only your hand cannot do that but they say anus and rectum can do that. So that how important that portion of the anatomy.

Host : So people realize how important it is

Dr Manuel: They will realize it when they get older, when they aged. One of the most important structures of the anus is the muscle. It allows you to either you hold it when you don’t want it to go or to release it. And if there’s weakening in the muscles people will notice that they can’t hold it as well anymore so it called incontinence. The function of the rectum is to store these things. If you don’t want to release it, it allows you to store it. And then its releases it in one nice go. Without that function people will just go constantly and it doesn’t have that satisfying expulsion that the muscle of rectum provides. So very complex and fascinating organ also at least.

Host: And because it’s very complex, very fascinating would like learn more about it. And these diseases or the pain and irritation come because of certain medical conditions that are brought about by maybe controlling it or maybe releasing it too much. Let’s go now to the diseases that cause anal pain and probably irritation and discomfort. What among the common diseases that should we tackle first?

Dr Arman: Maybe the most common we have worldwide the hemorrhoids.

Host: Let’s start with hemorrhoids, what exactly are hemorrhoids. How do they form and which part of the anus is affected?

Dr. Arman: Well, every one of us even as newborn we we’re born with certain tissues in our anal rectal area which try to cushion the expulsion of the fatal material. Now because of the certain pee disposing condition like poor bowel habits in which you have to little fiber in your diet or you tend to be constipated or you strain too much as you move your bowels, these cushion slide down it become somewhat in flame. And inside this cushion are certain blood vessels also. So that when this blood vessel slides down some of them get traumatized and they result in some symptoms like bleeding. Now in general we have 3 types of hemorrhoids; we have the external hemorrhoids which is found outside and this is only sensitive and therefore the main symptom of these hemorrhoids is pain. The second type of hemorrhoids are more of the internal hemorrhoid and these are the blood vessel are located so when you have internal hemorrhoid, these are the one that presents bleeding. If you have both its called the mixed hemorrhoids, so these patient will have mixed hemorrhoid it will feel something bulging out when they have particularly difficult bowel movement and then sometimes they also have bleeding as well. So depending whether you have hemorrhoid that is located externally, internally or mixed one that will determine the kind symptom that you will present.

Host: You mention that it is common.

Dr Arman: It’s quite common.

Dr Manuel: You have to understand all of us are born with hemorrhoidal tissues. That’s part of normal anatomy. It’s just that when people have symptoms due to the factor mention that’s when we label them as hemorrhoidal disease.

Host: All of us born with hemorrhoidal tissues and they triggered they become..

Dr Arman: When they slide down they become what we called pathologic or symptomatic hemorrhoid.

Dr. Manuel: You know our anus are uses every day. Just sitting down on them produces pressure. Eventually these structures become lacks, become loss as we aged as we use them constantly so that’s when some people developed hemorrhoidal symptoms.

Host: Do you only get hemorrhoids if you’re constipated or even when you have diarrhea?

Dr. Manuel: There are some actually, some are running families and some are young and they developed these symptoms also so it’s a chicken and egg situation. Some because of constant training will develop hemorrhoid. But there are others who’s anatomy impredisposes them to more hemorrhoidal symptoms and the more they strain the more they’re diet not too good then it worsen the symptoms.

Host: We’ll talk about diet, we’ll talk about taking in more fiber so that it doesn’t trigger those hemorrhoids, we’ll talk about that and more when medtalk return.

Host: Does it vary to person to person?

Dr. Manuel: Yes from type of hemorrhoid. So for instance internal hemorrhoid come out they come out when you move and sometimes patient have to push it back in. That one of the symptoms called the Prolapsed. Pain maybe one of the symptoms but usually because it flame so the pain generally, because what we called thrombosed hemorrhoid and the pain usually last a few days before it disappears. And that one of the ways we try to distinguish hemorrhoids from what we called fissures. Which we’ll talk about later. The pain you feel every day, every time you go is usually due to a fissure rather than a hemorrhoid.

Host: So we’ll distinguish it later. So Hemorrhoids..

Dr. Manuel: If they’re painful they really very swollen or very prolapsed and you can see that obviously from the outside.

Host: But upon check up with your doctor or will the individual know or like there’s a warning sign?

Dr. Arman: We’ll the most alarming for many patients is actually when they passes tool and there’s blood griped into the toilet bowl. That can very alarming from many patients. And it’s often the trigger that makes them seek consultation with physician or surgeons like us and well it can differly from one patient to another to extent and severity of the bleeding. But usually the bleeding stops after a few minutes.

Dr. Manuel: It’s just very scary because bright red and when it gripsed into the toilet bowl and it spread

Dr. Arman: Or when they wiped themselves after having bowl. There’s blood in the tissue.

Host: Ok so it that caused from alarm or..

Dr. Manuel: Well it’s the sign that you should get check up.

Host: Does it mean you have wound a pop blood vessel or a tare?

Dr. Manuel: It could be either one. But you know hemorrhoids are not a life threatening condition. Even if there bleeding usually they will stop but do we need to check that there’s nothing more serious that’s happening and if it’s just a hemorrhoid we really assure patient that it’s just hemorrhoid.

Host: Do you know if you have hemorrhoids? Will you know it until you pus?

Dr. Arman: You’ll feel it. Especially when it prolapses. After you wipe yourself often some patient feel there is something bulging in their anal area.

Dr. Manuel: What we do recommend is don’t presume its hemorrhoid. Let us, Let us Doctors be the one to tell you because we need to check up you thoroughly. Particularly at certain aged group, 40, 50 above. We need to make sure that there’s nothing more than just a hemorrhoid.

Dr. Arman: There are more serious disease conditions like rectal cancer or colon cancer that present also with bleeding and therefore sometimes the patient will dismissed it and think it just a hemorrhoid or sometimes because of embarrassment because you’re dealing with a very sensitive part of anatomy. They delay consultation and sometimes there are more serious problem occurring pala.

Host: Doctors we have question from twitter.. ”I am planning to work abroad, should I have my Hemorrhoids removed?”

Dr. Manuel: If you’re not feeling anything you shouldn’t. Because everyone has hemorrhoidal tissue and we only treat symptoms. And that’s one of our advocacies in our Philippine Society in Colorectal Surgeons. Sometimes were asked to remove hemorrhoids just because of these physical examination findings on work application for abroad. I think the agencies are afraid that these people will have hemorrhoid problem while they’re overseas and they will end up having to have it treated over there. But you know we only treat hemorrhoid when there’s symptomatic. So if patient are not feeling anything we don’t need to treat them.

Dr. Arman: We should take advantage of this opportunity to educate the public that not all hemorrhoids have to be removed. When you mention that it should be removed or advised that it should be removed seems to implicate that it has to be surgically excised. Right now we usually grade hemorrhoids from grade one the most, the smallest, and least symptomatic to grade four. And usually we advised surgery only if it is very severe grade four. You have bleeding, recur bleeding and the hemorrhoid has prolapsed to the point that even the patient cannot pushed it back any longer. So that is the only the type of hemorrhoid that should be surgically excised. The lower grades are form of hemorrhoids can be treated either based on their symptoms, dietary modification, better education on how to handle your bowel habits and even the really small symptomatic ones as mention by Dr. Ramy here, should actually not be given anything. They’re just observed.

Dr. Manuel: There are also non-surgical ways of treating them. For instance rubber bond ligation, or injecting what we called sclerotherapy agents. Which are easy for people to go through out-patient procedure so speak to us specialist first if you’re considering treatment of hemorrhoid whether it’s necessary or not.

Host: And necessary treatment will help you in preventing the hemorrhoids. Let say there’s treatment given, will the hemorrhoid come back after the treatment given. What are the preventive measures for it not to come back or recur?

Dr. Manuel: The treatment is a balanced what the patient feels and what he want. Surgery for instance can remove hemorrhoids more permanently but this can be very painful. So some patients don’t want the pain of surgery. So we offer them something less painful, less traumatic, but at the expense of the possibility of coming back but like I said hemorrhoids are not life threatening. Some people can have hemorrhoid and not want to anything done to them and that’s fine with us too. As long as we checked them up and make sure there’s nothing more serious than their hemorrhoids.

Dr. Arman: Most of our patient even after hemorrhoid rectum. We try to educate them and treat them so that they least the currence of any symptoms will be prevented. And it’s really all of modifying lifestyle, having more fiber on their diet and if you’re not able to take enough fiber even take in some either natural or artificial fiber supplements. That may help you have an easier bowel movement.

Host: So we’ve discussed and you enlighten us on hemorrhoids, now let’s go to fissures. Maybe we can use your model here doctor. Please help us understand what are fissures.

Dr. Manuel: This is the model of rectum and anus. The most important structure of anus are the muscles, these are the muscles over here, this is your rectum, these purple things here are your hemorrhoid, external going outside and internal. A fissure is just a wound in the anus that’s why it is painful if you notice this little red line over here. This organ over here that’s a wound. That’s the wound of a fissure. And this is the rectum, this is the example of a folip and this is the example of a tumor. So all of these may have similar symptoms but the most important symptom of fissure is pain because it’s wound. And then bleeding because the wound is fresh.

Host: Again, there’s bleeding. Why does this happen, why a fissure developed?

Dr. Manuel: Well trauma. Either you have a very hard stool that you forced out. Or you can have repeated bowl of diarrhea which will traumatized also your anus.

Host: Are there types for the fissure? Will the fissure recur?

Dr. Manuel: There are two types. The first type is the acute fissure which just happens recently and usually heals on its own like any wound within a month. And then, there’s a chronic fissure that keep coming back. And that’s the problem that most of our fissure patients deal with. They keeps coming back sometimes they think its hemorrhoid but it’s really the pain during bowel movement that let them visits us.

Dr. Arman: One characteristic symptom that alerts me to the possibility of a fissure, is that the patient will often complain when you see or examined them the pain is out of proportion to what you see on the rectal physical examination. And secondly, some of these patients develop a certain phobia already to having a bowel movement. They fear going to the comfort room anymore because each bowel movement seems to elicits that painful episode because of the bowel movement will traumatized the fissure again and again causing the development.

Host: Understandable. Of course you don’t want to see blood on your stool and you don’t want it such a so much pain from your description.

Dr. Arman: These causes a vicious cycle because of their fear of having a bowel movement this tend to withhold. And therefore it becomes even more constipated.

Host: Will that lead to hemorrhoids if they hold it and the stool become harder than it usually?

Dr. Manuel: They can have both hemorrhoid and fissure. In fact the interesting thing is most of our patient with fissure actually the first thing would tell us in the clinic is “Doc, I have hemorrhoids”. And then when we interview them, when we check them we tell them you know it’s not hemorrhoids causing your pain it’s the fissure and the fissure needs to be treated. If you only treat the hemorrhoids, then the symptoms of the fissure will persist that’s why it’s very important that the Doctor or the surgeon really distinguish what the patient is feeling. It’s hemorrhoidal symptoms or its fissures symptoms because the treatment may vary.

Host: So you can’t just self medicate it at home and assume that it might be a fissure or its just hemorrhoids.

Dr. Manuel: Well fissures like hemorrhoids are also not life threatening. So many people as long as they know it’s a fissure or hemorrhoid will live with it. And we only treat those who really want to have themselves treated. However again, like hemorrhoids you need to get checked up to make sure that it’s really just a fissure or hemorrhoid.

Host: There’s another disease doctor’s called anal abscesses which is closely linked to fistula. We’ll talk about that. It is a life threatening are these other two diseases life threatening we’ll talk about that.

Host: This time doctors let’s talk about anal abscesses and fistula.

Dr. Manuel: You know a pimple, a pimple in the face they’re usually a clogged pore and then the sebum accumulates and then it gets infected then it worst. That similar to abscesses or pigsa, there are glance also in the anus that secrete mucus and then they got clogged. And that mucus gets infected and becomes what we called a pigsa or an abscesses and it drains. Medyo malas lang because the bacteria in the anus is different than what you have on your skin. The bacteria are more inner length. So while the abscesses like this one, this is an abscesses here collecting pus its burst out in the skin the wound doesn’t heal after it burst out, the wound doesn’t heal because there is a connection between the wound to the inside of the anus so it continuously gets infected and that what we called a fistula.

Host: No wonder they’re closely linked.

Dr. Arman: The infection usually comes from the stool, the bacteria of the stool. Some of them enter that opening and continue reduce pus.

Host: You have to drain the pus.

Dr. Manuel: Well the pus has to be drain.

Host: it doesn’t drain on its own?

Dr. Manuel: Sometimes it does.

Dr. Arman: Many times it does actually draining on its own. Then it becomes a fistula.

Dr. Manuel: if it doesn’t drain out you drain it out. But then even that become a fistula.

Host: So it is automatic that if you have anal abscesses it will become a fistula whether or not to drain it?

Dr. Manuel: Well not automatic but very high, 50-75% at a time.

Host: Can you avoid that happening?

Dr. Arman: But in terms of the anus or the rectum, there’s really no way to prevent it. Because remember all of us are born with those kind of anal glance that our secrete mucus to help sort of lubricate the stool as they come out. So parang suwerte or malas na lang that some bacteria able to enter that opening and produce the infection.

Host: Is there a way para maiwasan ang magkapigsa in that area in which is common. You’ll hear once in a while, I have a pigsa in that area.

Dr. Manuel: It’s not easy to prevent. You can be the most hygienic and clean person and it still can hit you. So you just be aware in your condition I supposed and if it becomes a fistula.

Host: Is it connected to any other health problem? Is it a health concern?

Dr. Manuel: Of course it’s a health concern because it stills a long standing infection. There is a small risk that if you leave it for ten years it can developed into cancer. But there’s small risk. The biggest risk really is in those whose immune systems may not be as healthy. Diabetics, those on chemotherapy, and then the infections can be really bad.

Dr. Arman: Because their resistance to the infection is down.

Host: Is there medication to increase your immune resistance? Aside from the common medication we have?

Dr. Manuel: If you’re a chemotherapy agent, maybe. But you know that infection, that the fistula will remain. It really requires a form of surgery to heal it so there’s no medication that actually cure the fistula. What the medication will do perhaps lessen the chance of the infection becoming life threatening.

Dr. Arman: Unlike hemorrhoids, where in some most hemorrhoids cannot, should not be treated surgically. Once you have abscesses or a fistula it should be treated usually through surgery.

Host: Is this a part of or can you get it from sexually transmitted infection?

Dr. Arman: Occasionally yes. At least in my practice, I think ramy’s also, we’ll observe this to be slightly more frequent among homosexual men. And maybe because of that practice of having anal receptive intercourse, trauma, continuous trauma and of course poor hygiene in that area can contribute with it to the formation of anal abscesses and fistula.

Dr. Manuel: Let me add on, not majority are not homosexual. Majority are just run come out of mill. There more straight forward to treat but there are fistula that more difficult to treat and when we dig in to the history that’s when we find out that there are other conditions that maybe making it more difficult to treat. Whether it’s sexually transmitted or immune compromise condition or even tuberculosis. So many other but for most of the patient maybe 90% straight forward abscesses becoming fistula because of clogged infected gland.

Host: Can you be the cleanest and can still have the abscesses?

Both Doctors: Yes.

Host: Because you mention hygiene so I’m thinking lang kung sobra kang linis you can still have it.

Both Doctors: Yes.

Host: Walang pinipili.

Dr. Arman: walang pinipili. We would advised to the public not to self medicate. Especially a tendency again to a public it’s because of the embarrassment in seeking consultation is that they self medicate themselves too long with antibiotic. Thinking that it will disappear. Sometimes the symptoms get reduce. The inflammation subsides in antibiotics but very rarely do they get cured permanently just with antibiotic treatment.

Dr. Manuel: And you might drinking the wrong type of antibiotic by self medication. So you really need to see a doctor.

Host: Let’s talk about anal warts. Is this common? How do they developed?

Dr. Arman: Anal warts are still as not as common as the first 3 diseases that we have discussed. But again in my practice I’m seeing this more frequently now compared to 5 to 10 years ago. Anal warts will definitely majority of these if not all, is really a sexually transmitted. The main cause is actually is the HPV virus. HPV virus is the one who produces the symptoms.

Dr. Manuel: It’s similar to your cervical warts.

Host: So it’s the form of genital warts.

Dr. Arman: Genital warts or anal warts just have really one cause. the HPV virus.

Host: Human Phapiloma Virus.

Dr. Arman: It is the one that also leads to cervical cancer as well.

Host: Why did they form in that area? What are they like?

Dr. Manuel: Almost like that but they can call less. They can form into a group together that will look like cally flowers or even make it huge.

Dr. Arman: Sometimes they are small.

Host: Can they be look like as a hemorrhoids, no?

Dr. Manuel: Well to an expert I don’t really look like a hemorrhoid. And many of this people know they have a history.

Dr. Arman: Well, yeah some of these are just very small lesions but some of them can be really very large almost looking like the vegetable cauliflower.

Host: it’s not like the warts that we normally see like a dot.

Dr. Manuel: No, they group together and they grow faster. In fact one of our difficulties with these problem is they can recur even if we treat them they have a tendency to recur. Or they have the tendency to get reinfected with our partners again. So it’s a little more complexing in treating.

Dr. Arman: We have to treat this patient rather holistically but at least now compared before many of our patients choose to be embarrassed in admitting their sexually preferences but now they’re more open. And we’re able to advice them properly because of that. So aside of treating them either symptomatically or sometimes we apply some chemicals to sort of cauterized or actually surgically cauterized large lesions or we have to excised the relievery a large lesions we really advised them to really abstain from anal receptive intercourse and of course practice more hygienic sexual practices as well.

Dr. Manuel: The other issue with warts is because its sexually transmitted disease there maybe also other sexually transmitted diseases like gonoreha, syphilis and then also HIV which is also growing in this country. So that the big issue that we have to, that we will grafted more and more in the future.

Host: The statistic that you mentioned earlier that you noticed the last five years has increased.

Dr. Arman: I’ve really seen many more patients.

Dr. Manuel: When we were training in PGH, many years ago. Maybe we would see one a month. Now we’re seeing 3 a week. A charity services. That how fast they’ve become.

Dr. Arman: Our lifestyle in our country really has changed. That’s why I always tell my patient even if I’m able to remove or cauterized your warts I’m not able to eradicate the virus. The virus actually really stays there.

Host: You just cauterized the warts. What you see. You take it out via surgery or cautery.

Dr. Arman: But the virus sensually remains in that area so when your resistance goes down you can have recurrence with these warts again.

Dr. Manuel: The other thing is just like cervical warts that can cause cervical cancer, long standing anal warts can cause to anal cancer.

Host: So aside from taking it out you need to monitor that. And you should not feed that virus.

Dr. Arman: You really need to be monitored. You need to change you life style. And really improve on your immune system. Through good nutrition. Being physically fit, exercising.

Dr. Manuel: And safe sex.

Host: How often should one see a colorectal surgeon?

Dr. Manuel: For warts? It depends we see them weekly for the first weeks of treatment and then maybe monthly for the first 6 months and then every 3months. We have other things. Sometimes we give this immunization against this HPV also.

Host: To learn more about being more careful about and general well being and the rectum and the anus for this particular episode, I understand March is devoted to..

Dr. Manuel: Colorectal Cancer Awareness Month. It’s the international month for the colorectal cancer awareness.

Host: March is colorectal cancer awareness month. Please tell us about the activities for this month. And your advocacies.

Dr. Manuel: Well colorectal cancer is one of the most common cancers worldwide. Its number either number 2 or number 3, in some countries its number one. And this also one of the most preventable and curable cancer when caught early. So our advocacy campaign is really greater awareness so that we could pick it up early when its either preventable as folip or curable as an early stage cancer.

Host:  how do we catch it as a patient how do we identify or how do we know when to see our doctor?

Dr. Manuel: As long as reached 45 or 50, even if you’re feeling healthy and you’re not feeling anything else you should get screened. Either colonoschrophy  which can be good for 10 years if its normal. Or what we call a microscopic blood every year. It’s a stool exam that checked for microscopic blood every year and only if it’s positive it with be colonoscopy.

Dr. Arman: But that for average population. However if you have what we call a first degree relative meaning a brother, a sister, or your parents whom had a history of colon or rectal cancer the risk is higher and you should be screened earlier. Than the usual. 45 or 50 you should be screened maybe even 40 or young.

Dr. Manuel: of course there are warning sign. Screening is for people who are not feeling anything if you have warning sign this is not a screening anymore. You should get diagnosed. The warning sign are the blood on your stools. A change in your bowel habit, abdominal pain, unexplained weight lost, anemia if you’re pale and you don’t know why you’re pale.

Host: Are they open to get into colorectal exam? Are they open getting their stool?

Dr. Arman: More and more patient are getting more open. Again one of the reasons why we get a lot of advance stage in colorectal cancer in our country aside of course of the economic reason for the poorer section of the population there is again delay in consultation. They get embarrassed because they have colorectal bleeding. They’re fearful that somebody like one of us the colorectal surgeon will focus finger in very private part of your anatomy. That not a comfortable feeling or idea to have. So this causes delay.

Dr. Manuel: But we need to stress in general population that part of being healthy. Having a healthy lifestyle is getting yourself a screened, getting yourself check up. One of the sad things we often see in our practice you have very healthy, should be healthy 80y.o, they have no hypertension, and they have no heart disease have no diabetes. And yet they come to ask they have a cancer and we feel bad about it they had a colonoscopy maybe ten years previously this would have been avoided.

Dr. Arman: Or sometimes they will seek consultation with a physician who may not even bother to do rectal exam. Even if they’re already presenting with these warning signs. They will be often be prescribed the anti-hemorrhoidal preparations or even medication against what we call amoebasis. Very frequent because they dismisses the diarrhea and the rectal bleeding as due to amoeba. And without doing a rectal exam will just prescribed and not even, yun pala meron ng starting or beginning rectal cancer.

Host: So nadismiss yung potential diagnosis? Life style changes, doctors are there certain types of food that you should take more of or should you avoid spicy food if you already have the hemorrhoids.

Dr. Manuel: Well what’s in the literature about of risk factors for colorectal cancer in terms of food is high in fat content, low in fiber, red meat, processed meat, barbequed meat, all of these are factors.

Host: Everything in moderation but would you advice to your patient to completely avoid?

Dr. Manuel: What we would advice is even if you’re vegetarian or eating healthy get yourselves screened. Because that’s not guaranteed that you’re not going to get colorectal cancer. So screening is the most important aspect of healthy living. Exercise also has been shown to decrease the incidences. Obesity increases the risk. Diabetes also but still even if you’re not diabetic you get screened, cause you don’t know.

Host: Lalo na kung risk factor or if it’s hereditary. Doctors your final message to all of our viewers regarding in taking good care of our health most especially in this part of our body.

Dr. Manuel: Well for hemorrhoids and fissures is not life threatening condition. But it’s very common we do recommend if you have symptoms in the anus do not dismiss it. Get to see an expert who will then tell you if its fissure or hemorrhoids, you don’t have it to be treated if you don’t want to. But get checked because our advocacy is early diagnosis of potentially more serious problems like colorectal folips and cancers.

Dr. Arman: Well the good news is that majority of anal diseases including colorectal cancer can be prevented and can be detected or can be treated. So prevention necessity requires eating a lot of fiber, diet, exercising a lot, avoiding smoking, is just necessity healthy lifestyle and good bowel habits. In the same way in colorectal cancer. Most of these can be either prevented if you have healthy lifestyle or see a specialist in the earliest possible time and have yourself screened at a proper time. 

Enhanced Recovery After Surgery (ERAS) Update:
ERAS Society World Congress, Washington DC,May 9-12, 2015.
During the congress the Philippine delegation got together to form the ERASS Phil. Chapter.

Founding members:
Dr. Ramy Roxas - President
Dr. Connie Cruz - Vice President
Dr. Nina Siozon - Secretary
Dr. Nelson Cabaluna
Dr. Lorina Cabaluna
Dr. Hermogenes Monroy
Dr. Rodney Dofitas
Dr. Net Mariano
Dr. Celine Ancheta
Dr. Ray Resurreccion 
Dr. Noel Beley
Dr. Elena Malong
Dr. Elke Sauz
Dr. Dino Vargas

Industry partners:
Nestle - Joan Naranjo
Menerini - Dang Eclavia


WHAT   :  7th Biennial Congress of Asean Society of Colorectal Surgeons

WHEN   :  July 16-18, 2014

WHERE :  Singapore

Ano ang Colonoscopy?

Ang colonoscopy ay isang panloob na pagsusuri ng malaking bituka at tumbong, gamit ang isang instrumentong tinatawag na colonoscope.

Paano isinagawa ang pagsusuri?


Ang colonoscope ay may kalakip na isang maliit na kamerang nakakabit sa isang nababaluktot na tubo.  Hindi tulad ng sigmoidoscopy na ang naaabot lamang ay ang ikatlong ibabang bahagi ng malaking bituka, ang colonoscopy ay nagsusuri ng buong kahabaan ng colon.

Ang pasyente ay mahihiga nang patagilid sa kaliwang bahagi at ang mga tuhod ay ititiklop patungo sa dibdib. Pagkatapos mabigyan ng gamot na pampakalma at pang-alis ng kirot, ang colonoscope ay padadaanin sa puwitan. Ito ay dahan-dahan at maingat na ipapasok sa bukana ng malaking bituka at kung minsan ay pinaaabot sa pinakamababang bahagi ng maliit na bituka.

Nagpapakawala ng hangin ang scope upang mas maging malinaw ang pagtingin sa loob ng bituka. May kasama ring panghigop (suction) ang instrumento upang maalis ang mga dumi at tubig. Mas malinaw sa paningin ng nagsusuri kung ang scope ay papalabas kung kaya’t  kalimitang mas masusing eksaminasyon ang ginagawa sa ganitong pagkakataon. Gamit ang colonoscope, maaaring kumuha ng tissue samples sa pamamagitan ng maliliit na biopsy forceps. Maaaring magtanggal ng mga polyps gamit ang electrocautery snares.  Pwede ring kumuha ng litrato at magsagawa ng laser therapy.


Paano maghanda para sa pagsusuri?


Kailangang ganap na linisin ang bituka. Ang manggagamot ay magbibigay ng mga tagubilin para sa pagsasagawa nito. Ito ay maaaring kumbinasyon ng mga labatiba (enema); hindi pagkain ng solid food sa loob ng 2 o 3 araw bago ang pagsusuri; at paggamit ng laxatives. Karaniwang ipapatigil ang pag-inom ng aspirin, ibuprofen, naproxen, o iba pang mga gamot na nagpapalabnaw ng dugo ilang araw bago ang colonoscopy.

Hihilingin din ang  pag-inom ng maraming malinaw na likido(liquids) sa loob ng 1-3 araw bago ang procedure. Ang mga halimbawa ng malinaw na likido ay:

    * Kape o tsaa na walang gatas o creamer
    * Bouillon o sabaw na walang taba o mantika
    * Dyelatin (gelatin)
    * Sports drink
    * Sinalang katas ng prutas (strained fruit juices)
    * Tubig

Maliban na lang kung ipagbawal ng doktor, regular na inumin ang anumang resetang gamot. Itigil ang paggamit ng iron supplements ilang linggo bago ang test, maliban din kung sabihin ng doktor na ipagpatuloy. Ang iron ay maaaring magpaitim ng dumi na magpapalabo ng view sa loob ng bituka. Maghanap ng makakasama sa pag-uwi. Maaaring makaramdam ng pagkahilo at hindi makapagmaneho pagkatapos ng pagsusuri.


 Ano ang mararamdaman?


 Ang mga gamot na pampakalma at pangkirot ay nakapagpapa-relax at nagpapa-antok. Maraming pasyente ang hindi maka-alalang sila ay nag-colonoscopy. Bago ang pagsusuri, ang doktor ay nagsasagawa ng rectal exam upang makatiyak na walang mga pangunahing pagbabara (blockages) sa loob ng puwit. Maaring makaramdam na parang madudumi habang ang daliri o ang colonoscope ay ipinapasok sa loob ng puwit.


 Maaari makaramdam ng presyon habang ang scope ay gumagalaw sa loob ng bituka. Maaari ring makaranas ng bahagyang pagkirot at kabag habang nagpapakawala ng hangin ang colonoscope o habang ito ay itinutulak papaloob. Ang pag-utot ay kailangan at dapat na asahan.

Maaari makaginhawa ang pagsasagawa ng mabagal at malalim na paghinga. Ito ay makakatulong din upang ma-relax ang
abdominal muscles. Patuloy ding magkakaroon ng bahagyang pagkirot at kabag matapos ang procedure. Madadalas din ang pag-utot. Ang pagka-antok ay lilipas pagkaraan ng ilang oras. Dahil sa pagkakahimbing maaring walang maalala ang pasyente sa natapos na procedure.

Bakit isinagawa ang pagsusuri?

Ang colonoscopy ay maaaring gamitin para sa mga sumusunod na kadahilanan:

    * Pagsakit ng tiyan, pagbabago sa regular na pagdumi, o pagbaba ng timbang
    * Abnormal na pagbabago (tulad ng polyps) na nakita sa sigmoidoscopy o x-ray test (CT scan o barium enema)
    * Anemya dahil sa kakulangan sa iron (karaniwan kapag walang ibang dahilan ang nahanap)
    * Dugo sa dumi, o ma-itim na dumi
    * follow-up sa isang nakaraang karamdaman, tulad ng polyps o colon kanser

    * Inflammatory bowel disease (ulcerative colitis and Crohn's disease)
    * Screening para sa colorectal kanser

* Kumunsulta sa espesyalista upang talakayin ang colonoscopy.



2nd Floor, Podium Building, The Medical City,

Ortigas Avenue, Pasig City, Metro Manila

Tel No. (632) 9881000 or (632) 6356789 ext. 7789 ,

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

Clinic Hours: Mondays to Saturdays – 8:00 AM to 5:00 PM except Wednesdays

Ang Mga Espesiyalista

Manuel Francisco T. Roxas, M.D.

Robert L. Chang, M.D.

Catherine S. Co, M.D.

Carlo C. Cajucom, M.D.

Marc Paul J. Lopez, M.D.

Dione P. Sacdalan, M.D.



MANILA, Philippines - Hemorrhoids are
actually present in all individuals whether healthy or not. They are the
vascular cushions which surround the general area of the rectum and
The term hemorrhoids is associated with the symptoms when this part
of the body becomes enlarged, inflamed, thrombosed or prolapsed.
Many people have them without suffering from any symptoms, and
therefore these may be safely left alone. Treatment is usually required
for those whose hemorrhoidal symptoms such as excruciating throbbing
pain affect quality of life and daily living.
There are many traditional remedies and non-surgical treatments for
hemorrhoids. However, if none of these work, surgical procedures may be
required as a last resort.
Below are some misconceptions about hemorrhoids treatment and the truth behind each:
Misconception No. 1. All surgical procedures for hemorrhoids are very painful. Due
to this reputation of a painful operation, advances in
hemorrhoid surgery have focused on making it less painful. One such
operation is stapled hemorrhoidectomy. Using a specially designed,
single-use stapler instrument, hemorrhoids are excised and the anus
repaired from the inside. The end-result is that the surgical wound is
inside, and no wound is visible outside the anus. Scientific studies
have proven that this is less painful than traditional surgery.
Another advanced surgical technique is ****transarterial hemorrhoidal
dearterialization (THD). Using a Doppler ultrasound, the blood vessel
supplying the hemorrhoid is identified and ligated with stitches.
Deprived of its blood supply, the hemorrhoid then shrinks and shrivels.
Again there is no wound outside and is therefore almost painless.
Misconception No. 2. Another more common misconception about surgery
for hemorrhoids is that it can cause fecal incontinence, or the
inability to control farting or defecation. Again this is not true. When hemorrhoid
surgery is done properly, incontinence won’t develop.