hemorrhoidal

Colonoscopy and flexible sigmoidoscopy are procedures that let your doctor look inside your rectum and colon (large intestine). They use instruments called scopes. Scopes have a light and a tiny camera attached to a long, thin tube. These procedures let your doctor see problems such as inflamed tissue, ulcers, polyps, and cancer.

Colonoscopy checks your entire colon and rectum. Flexible sigmoidoscopy checks the rectum and the lower colon (sigmoid colon) only.

A virtual colonoscopy also looks inside your rectum and part of your colon. But it does not use a scope. Instead, it is an x-ray test. Another name for this test is CT colonography.

You may need a colonoscopy, virtual colonoscopy, or flexible sigmoidoscopy to find the cause of unexplained symptoms such as:

• Bleeding from your anus (the opening of the rectum through which stool passes out of your body)
• Changes in your bowel activity, such as diarrhea
• Pain in your abdomen (belly)
• Unexplained weight loss

Doctors also use these procedures to screen for colon polyps and cancer. Screening is testing for diseases when you have no symptoms. It may find diseases at an early stage, when they are easier to treat. If aren't at higher risk for colorectal cancer, your health care provider will likely recommend you start getting screenings at age 45. If you are at higher risk, you may need to start getting screened for colorectal cancer earlier.

There are also other tests to screen for colorectal cancer, including stool tests. Talk with your provider about which test is right for you and when and how often you should get it.

To prepare for a colonoscopy, virtual colonoscopy, or flexible sigmoidoscopy, you will need to:

• Talk with your doctor about any health problems you have and all of the medicines and supplements that you take. You may need to stop taking some of your medicines and/or supplements before the procedure.
• Follow the bowel prep instructions from your doctor. The bowel prep clears the stool out of your colon, so your doctor will be able to see the colon during the procedure:
  • You may need to follow a clear liquid diet, usually for about one day before the procedure. Avoid red or purple drinks or gelatin; the dye can look like blood in the colon. You probably need to stop eating and drinking the night before the exam.
  • You will need to take some laxatives. They may be pills, a powder that you dissolve in liquid, an enema, or a combination of these. The laxative will cause diarrhea, so you need to stay close to the bathroom.

For a virtual colonoscopy, you will also need to drink a contrast medium the night before. The contrast medium is a dye or other substance that is visible on x-rays. It can help your doctor tell the difference between stool and polyps.

For a colonoscopy:

• You will have the procedure at a hospital or outpatient center. It usually takes 30 to 60 minutes.
• You will get IV (intravenous) sedatives or anesthesia, usually along with pain medicine, so you won't be awake or feel pain during the procedure.
• You'll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. The scope inflates your large intestine with air for a better view. The camera sends a video image to a monitor so your doctor can see your colon.
• Once the scope reaches the opening to your small intestine, the doctor will slowly remove the scope. While doing so, your doctor will examine your colon again.
• If you have polyps, your doctor may remove them and send them to a lab for testing. Most polyps aren't cancer, but removing them can prevent them from becoming cancer later on.
• If you have abnormal tissue, your doctor may do a biopsy.
• The sedative or anesthesia takes time to wear off completely. You'll stay at the hospital or outpatient center for 1 to 2 hours after the procedure. Then you will need someone to drive you home.

For a virtual colonoscopy:

• You will have the procedure at a hospital or outpatient center. It usually takes about 10 to 15 minutes.
• You do not need anesthesia.
• You'll lie on a table while a specially trained x-ray technician inserts a thin tube through your anus and into your rectum. The tube inflates your large intestine with air for a better view.
• The table slides into a tunnel-shaped device where the technician takes the x-ray images. You will turn over on your side or stomach to get more images taken.

For a flexible sigmoidoscopy:

• You will have the procedure at a hospital, medical office, or outpatient center. It usually takes about 20 minutes.
• You do not need anesthesia.
• You'll lie on a table while the doctor inserts a thin tube through your anus and into your rectum. The tube inflates your large intestine with air for a better view. The camera sends a video image to a monitor so your doctor can see your lower colon.
• Once the scope has reached the top of the lower colon, the doctor will slowly remove the scope. While doing so, your doctor will examine your lower colon again.
• If you have polyps, your doctor may remove them and send them to a lab for testing. Most polyps aren't cancer, but removing them can prevent them from becoming cancer later on.
• If you have abnormal tissue, your doctor may do a biopsy.

You may feel cramping in your abdomen or bloating during the first hour after the any of these procedures. If the doctor removed polyps or performed a biopsy, you may have light bleeding from your anus. This bleeding is normal.

For a virtual colonoscopy or a flexible sigmoidoscopy, you go back to your regular activities and diet right after the test. For a colonoscopy, you can expect a full recovery and return to your normal diet by the next day.

Your doctor will give you the results of your procedure. If you had a biopsy, it can take a few days to get those results.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your anus is the opening at the end of your large intestine. It is where stool (poop) leaves your body. The anus is formed partly from your outer layers of skin and partly from your intestine. Anal cancer is a type of cancer that forms in the tissues of your anus.

Anyone can get anal cancer, but you are more likely to develop it if you:

• You have an infection with high-risk HPV, especially if you have certain types. Most anal cancers are related to HPV infection.
• Have a weakened immune system, from conditions such as HIV or because of medicines you need to take after an organ transplant.
• Have had vulvar, vaginal, or cervical cancer.
• Have many sexual partners.
• Have anal sex.
• Smoke cigarettes.

The signs and symptoms of anal cancer may include:

• Bleeding from the anus or rectum
• A lump near the anus
• Pain or pressure in the area around the anus
• Itching or discharge from the anus
• A change in bowel habits, such as narrower stools, having to go more often, or bowel incontinence

To find out if you have anal cancer, your provider:

• Will take your medical history, which includes asking about your symptoms.
• Will ask about your family health history.
• May do a digital rectal examination (DRE). A DRE is an exam of the anus and rectum. For the exam, your provider will insert a lubricated, gloved finger into the lower part of your rectum to feel for lumps or anything else that seems unusual.
• May order tests that examine the anus and rectum, such as:
  • An anoscopy, an exam of the anus and lower rectum using a short, lighted tube called an anoscope. There is also a type of anoscopy called a high-resolution anoscopy. It uses a special magnifying device called a colposcope along with the anoscope to view these areas.
  • A proctoscopy, a procedure to look inside the rectum and anus using a thin, tube-like instrument with a light and a lens.
  • An endo-anal or endorectal ultrasound, a procedure in which an ultrasound probe is inserted into the rectum.
• May do a biopsy during an anoscopy or proctoscopy.

The treatments for anal cancer include radiation therapy, chemotherapy, and surgery. Which treatment you get will depend on how advanced the cancer is, your overall health, and your preferences.

You may be able to lower your risk of getting anal cancer by getting an HPV vaccine and not smoking. Contact your provider if you need help quitting smoking.

It is currently not known if using condoms can prevent anal HPV infections. But using latex condoms every time you have sex can help prevent HIV, a risk factor for anal cancer. And they also help prevent other sexually transmitted infections (STIs). If your or your partner is allergic to latex, you can use polyurethane condoms.

If you are an adult with HIV, it's important to get an anal cancer screening every year. The screening checks for anything that seems unusual, such as lumps, burning, and precancer cells (cells that could turn into cancer). The screening will include a digital rectal exam. If anything unusual is found, you will have an anoscopy or high resolution anoscopy.

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Colorectal cancer is cancer that develops in the tissues of the colon or rectum. Your colon and rectum are part of your digestive system:

• Your colon is the first and longest part of your large intestine. It absorbs water and some nutrients from foods. It also changes the leftover waste products into stool (poop).
• Your rectum is the lower part of your large intestine. It's where your body stores stool.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that affects either of these parts may also be called colorectal cancer.

Colorectal cancer happens when there are changes in your genetic material (DNA). These changes are also called mutations or variants. Often, the genetic changes that lead to colorectal cancer happen during your lifetime and the exact cause is unknown. But certain genetic changes that raise your risk for colorectal cancer are inherited, meaning that you are born with them.

Besides genetics, other factors, including your lifestyle and the environment, can affect your risk of colorectal cancer.

Anyone can get colorectal cancer, but certain factors make you more likely to develop it:

• Being older; your risk of getting colorectal cancer increases as you age.
• Having a personal or family history of colorectal cancer.
• Having a history of adenomas. Adenomas are colorectal polyps (growths) that look abnormal under a microscope or are 1 centimeter or larger. Adenomas are not cancer, but they can sometimes turn into cancer over time.
• Having a genetic syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer).
• Having chronic ulcerative colitis or Crohn disease for 8 years or more.
• Having three or more alcoholic drinks per day.
• Smoking cigarettes.
• Being Black; Black people have an increased risk of colorectal cancer and death from colorectal cancer compared to other races.
• Having obesity.

Colorectal cancer may not always cause symptoms, especially at first. If you do have symptoms, they could include:

• A change in bowel habits that lasts more than a few days, such as:
  • Diarrhea
  • Constipation
  • Feeling that the bowel does not empty completely
  • Your stool is narrower or has a different shape than usual
• Blood (either bright red or very dark) in the stool
• Frequent gas pains, bloating, fullness, or cramps
• Weight loss for no known reason
• Fatigue

Because colorectal cancer may not cause symptoms at first, it's important to have screening tests for colorectal cancer. Screening tests look for signs of a disease before you have any symptoms. They can help find cancer early, when it may be easier to treat.

Most experts recommend that start screenings at 45 and continue until at least age 75. People over 75 and those who are at high risk should talk to their providers about how often you need screening and what type of test they should get.

The types of tests include different stool tests and procedures such as colonoscopies and flexible sigmoidoscopy. Talk with your provider about how often you need screening and what type of test you should get.

If you have symptoms that could be caused by colorectal cancer or if your screening test results are abnormal, you may need to have more tests to find out if you have cancer. Possible tests include:

• A physical exam.
• A digital rectal exam. For this exam, your provider inserts a lubricated, gloved finger into your rectum to feel for lumps or anything unusual.
• The tests that are also used for screening (colonoscopy, stool tests, etc.) and biopsy, if you have not already had them.
• Other blood and tissue tests.

Your treatment options usually depend on your age, your general health, how serious the cancer is, and which type of cancer you have.

For colon cancer, your treatment may include one or more of these options:

• Surgery.
• Radiofrequency ablation, a procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity).
• Cryosurgery, a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue.
• Chemotherapy.
• Radiation therapy.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

For rectal cancer, your treatment may include one or more of these options:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Active surveillance, which means having regular tests to see if your rectal cancer has changed. If the tests show the cancer is starting to grow, then you will have treatment to try to cure the cancer.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

Avoiding the risk factors that you have control over may help prevent some cancers. That includes:

• Not smoking
• Limiting alcohol to under three drinks per day
• Managing your weight

There are also other steps you can take to try to prevent colorectal cancer. They include:

• Getting regular colorectal cancer screenings
• Having polyps removed before they can become cancerous
• Getting regular exercise

An ostomy is surgery to create an opening (stoma) from an area inside the body to the outside. It treats certain diseases of the digestive or urinary systems. It can be permanent, when an organ must be removed. It can be temporary, when the organ needs time to heal. The organ could be the small intestine, colon, rectum, or bladder. With an ostomy, there must be a new way for wastes to leave the body.

There are many different types of ostomy. Some examples are:

• Ileostomy - the bottom of the small intestine (ileum) is attached to the stoma. This bypasses the colon, rectum and anus.
• Colostomy - the colon is attached to the stoma. This bypasses the rectum and the anus.
• Urostomy - the tubes that carry urine to the bladder are attached to the stoma. This bypasses the bladder.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The rectum is the lower part of your large intestine where your body stores stool. Problems with rectum are common. They include hemorrhoids, abscesses, incontinence and cancer.

Many people are embarrassed to talk about rectal troubles. But seeing your doctor about problems in this area is important. This is especially true if you have pain or bleeding. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Gastroenteritis is an inflammation of the lining of the stomach and intestines. The main symptoms include vomiting and diarrhea. It is usually not serious in healthy people, but it can sometimes lead to dehydration or cause severe symptoms.

There can be many different causes of gastroenteritis:

• Viruses
• Bacteria
• Parasites
• Chemicals
• Reactions to certain medicines and food

Viral gastroenteritis is the most common type. It can be caused by many different viruses, including noroviruses and rotaviruses. Some people call viral gastroenteritis the "stomach flu." But this name is not medically correct. It is not caused by flu viruses. The flu is a respiratory infection that affects your nose, throat and lungs.

When gastroenteritis is caused by consuming foods or drinks contaminated with viruses, bacteria, parasites, or chemicals, this is called food poisoning.

The viruses, bacteria, and parasites that cause gastroenteritis can also spread from person to person. You could be infected when you touch something that has the germs on it and then touch your eyes, mouth, or nose.

The symptoms of gastroenteritis include:

• Diarrhea
• Pain or cramping in your abdomen (belly)
• Nausea
• Vomiting
• Sometimes fever

Gastroenteritis is usually not serious. But it can sometimes cause lead to dehydration or cause severe symptoms. Certain people are at higher risk for these problems. They include:

• Pregnant women
• Older adults
• People with weakened immune systems or other serious health conditions
• Infants
• Babies who were born prematurely or have other health conditions

If you or a family member are at higher risk and have symptoms of gastroenteritis, contact a health care provider right away. Even if you are not at high risk, it is possible to become dehydrated or have more serious symptoms. There are some warning signs to watch for. It's important to contact a provider right away if you or your child have any of them:

• For adults, they include:
  • Change in mental state, such as irritability or lack of energy
  • Diarrhea lasting more than 2 days
  • High fever
  • Vomiting often
  • Six or more loose stools in a day
  • Severe pain in the abdomen (belly) or rectum
  • Stools that are black and tarry or contain blood or pus
  • Symptoms of dehydration, such as thirst, dry mouth, headache, dark-colored urine, and urinating less than normal
• For infants and children, they include:
  • Change in the child's mental state, such as irritability or lack of energy
  • Diarrhea lasting more than a day
  • Any fever in infants
  • High fever in older children
  • Frequent loose stools
  • Vomiting often
  • Severe pain in the abdomen (belly) or rectum
  • Signs or symptoms of dehydration, such as thirst, dry mouth, urinating less than usual or no wet diapers for 3 hours or more, and no tears when crying
  • Stools that are black and tarry or contain blood or pus

To find out if you have gastroenteritis, your provider:

• Will do a physical exam
• Will ask about your symptoms
• May do tests of your stool

Usually, people with gastroenteritis get better on their own, with rest and plenty of fluids and electrolytes. Your provider may suggest that you take a probiotic. Studies suggest that some probiotics may help shorten a case of diarrhea.

People with more severe symptoms may need medicines to control nausea or vomiting. Providers may also give other medicines for certain types of gastroenteritis, such as antibiotics for some bacterial types and antiparasitic medicines for some parasitic types.

Gastroenteritis cannot always be prevented. But proper hand washing, cleaning surfaces that may be infected with germs, and safe food preparation may help prevent some of the infections that can cause gastroenteritis. There are vaccines for infants to protect against rotavirus infections.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Signs of bleeding in the digestive tract depend where it is and how much bleeding there is.

Signs of bleeding in the upper digestive tract include:

• Bright red blood in vomit
• Vomit that looks like coffee grounds
• Black or tarry stool
• Dark blood mixed with stool

Signs of bleeding in the lower digestive tract include:

• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus.

The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. A type of endoscopy called colonoscopy looks at the large intestine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Ulcerative colitis (UC) is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease.

UC can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families. The most common symptoms are pain in the abdomen and blood or pus in diarrhea. Other symptoms may include:

• Anemia
• Severe tiredness
• Weight loss
• Loss of appetite
• Bleeding from the rectum
• Sores on the skin
• Joint pain
• Growth failure in children

About half of people with UC have mild symptoms.

Doctors use blood tests, stool tests, colonoscopy or sigmoidoscopy, and imaging tests to diagnose UC. Several types of drugs can help control it. Some people have long periods of remission, when they are free of symptoms. In severe cases, doctors must remove the colon.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The anus is the opening of the rectum through which stool passes out of your body. Problems with the anus are common. They include hemorrhoids, abscesses, fissures (cracks), and cancer.

You may be embarrassed to talk about your anal troubles. But it is important to let your doctor know, especially if you have pain or bleeding. The more details you can give about your problem, the better your doctor will be able to help you. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases