Hemorrhoids are dilated veins in the anal canal, structural disease. They’re swollen blood vessels that line your anal opening. They are caused by chronic excess pressure from straining during a bowel movement, persistent diarrhea, or pregnancy. There are two types of hemorrhoids: internal and external.
Internal hemorrhoids are blood vessels on the inside of your anal opening. 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 stick) out of the anus.
- Improving bowel habits (such as avoiding constipation, not straining during bowel movements and moving your bowels when you have the urge).
- Your healthcare provider is using ligating bands to eliminate the vessels.
- Your healthcare provider removed them surgically. Surgery is needed only for a small number of people with very large, painful and persistent 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 blood clots form under the skin. This very painful condition is called a “pile.”
Treatment includes removing the clot and vein under local anesthesia and/or removing the hemorrhoid itself.
Anal fissures are also a structural disease. They are splits or cracks in the lining of your anal opening. The most common cause of an anal fissure is the passage of very hard or watery stools. The crack in the anal lining exposes the underlying muscles that control the passage of stool through the anus and out of the body. An anal fissure is one of the most painful problems because the exposed muscles become irritated from exposure to stool or air, and leads to intense burning pain, bleeding, or spasm after bowel movements.
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 your pain, surgery might be needed to repair the sphincter muscle.
Perianal abscesses, also a structural disease, can occur when the tiny anal glands that open on the inside of your anus become blocked, and the bacteria always present in these glands causes an infection. When pus develops, an abscess forms. Treatment includes draining the abscess, usually under local anesthesia in the healthcare provider’s office.
An anal fistula – again, a structural disease – 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 your anus. Body wastes traveling through your 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 your anus become infected and need to be drained, like in this structural disease. 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.
The structural disease diverticulosis is the presence of small outpouchings (diverticula) in the muscular wall of your 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% of people over age 40 and in 50% of people over age 60 in Western cultures. It is often caused by too little roughage (fiber) in the diet. Diverticulosis can sometimes develop/progress into diverticulitis
Complications of diverticular disease happen in about 10% of people with outpouchings. They include infection or inflammation (diverticulitis), bleeding and obstruction. Treatment of diverticulitis includes treating constipation and sometimes antibiotics if really severe. Surgery is needed as a last resort in those who have significant complications to remove the involved diseased 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 your colon and rectum. Cancer develops when these polyps grow and abnormal cells develop and 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 45.
- 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.