MedStar Montgomery offers nationally and internationally recognized expertise in all aspects of colon and rectal health. When you seek care from our specialists, you have a full range of treatment options available to you.
Our physicians treat a large volume of patients every year, giving us the necessary experience and expertise to handle even complex cases. The conditions we treat include:
- Anal and Rectal Conditions (including abscesses, fissures, hemorrhoids, and prolapses)
- Benign Tumors of the Colon and Rectum
- Diverticular Disease
- Pelvic Floor Disorders
Anal and Rectal Conditions
Anal/rectal conditions may have symptoms or signs of pain, bleeding, or discharge, and the most common of these are:
- Abscesses are infected gland sites filled with pus. Typically, a colon and rectal surgeon will incise and drain the infected area. This is usually done as an office procedure, but may sometimes require hospitalization if there is an underlying condition, such as diabetes. About half the time, the abscess heals, and about the other half, a fistula results.
- Anal fistulas are abnormal connections between the rectum and surrounding skin (a fistula describes any abnormal connection between an organ, vessel or intestine and another organ, vessel, intestine, or your skin). Many anal fistulae begin as anal abscesses, a pus-filled cavity near the anus or rectum. When the abscess bursts, it may cause a fistula. One of the most common treatments is a surgical procedure called an anal fistulotomy. Fistulae differ from patient to patient. The tunnel, or path, each fistula takes may vary. Your surgeon will need to determine how much muscle lies between the fistula tunnel and the skin’s surface before performing a fistulotomy.
- Fissures are small tears in the skin of the anus. Fissures typically cause pain and often bleed during a bowel movement. Most fissures can be managed by adding more fiber to the diet to normalize bowel movements and medications to calm the pain and relax the sphincter muscle. Surgery is sometimes recommended when medication fails. To treat an anal fissure, your colon and rectal surgeon will place a small cut on one outside margin of the internal anal sphincter muscle, also called a lateral internal sphincterotomy. This decreases pain and spasm and allows the fissure to heal.
- Hemorrhoids are swollen, painful veins located near your rectum or anus.
- Internal Hemorrhoids are veins around the anus in which increased venous pressure and/or the vein walls have weakened, resulting in bulging veins. With the repeated pressure of bowel movements, the veins may burst, causing bleeding. Minor hemorrhoids are managed by dietary changes. Advanced hemorrhoids that bleed and prolapse (stick out) need invasive treatments, including rubber band ligation and hemorrhoidectomy.
- External Hemorrhoids lie beneath the skin near the opening of the anus. These may become painful if one or more suddenly clot. If these are diagnosed within 48 hours, removal is appropriate. If diagnosed later, these clots will dissolve spontaneously often leaving a skin tag.
- Pilonidal dimple is a condition that occurs on the crease of the buttocks. A pilonidal dimple is a broad term that includes:
- Pilonidal abscess, caused by an infected hair follicle
- Pilonidal cyst, formed when there has been an abscess for a long time
- Pilonidal sinus, caused by a tract, or tunnel, forming under the skin
- Pit or pore that contains dark spots or hair
- These may become infected and cause intense pain and drainage. The treatment for pilonidal cyst is excision. Your surgeon completely removes the abscess and all of the infected tissue surrounding it. This is the most effective technique with the best chances for a complete cure. There are two options for healing:
- Open healing means your doctor leaves the wound open and does not close it with stitches. This allows the wound to heal on its own. The re-infection rate is very low. It takes a few weeks to fully heal and you need to pack the wound twice a day for the duration of the healing time.
- Closed healing means your doctor closes the wound with stitches. Healing time is faster and there is no packing or aftercare, but the infection rate is higher than with open healing. Because the wound was closed, if there is an infection, you may need to undergo surgery again to open the wound and let it heal on its own.
- Rectal prolapse is a condition in which the ligaments and muscles around the rectum weaken. This causes the tissue lining the rectum and part of the large intestine to slip down through the anal opening. It occurs most often in young children and in the elderly.
Benign Tumors of the Colon and Rectum
Benign tumors of the colon and rectum are usually discovered because a patient is examined for symptoms—such as rectal bleeding, changes in bowel habits (frequency of bowel movements, constipation, incontinence, urgency for bowel movements), or abdominal pain—or as a finding at a screening endoscopy.
Diagnosis of benign tumors of the colon and rectum require a complete medical history and physical examination and an endoscopy (that may include an anoscopy, sigmoidoscopy, or colonoscopy, depending upon what segment is to be evaluated). During an endoscopy, your doctor may remove a small piece of tissue from the tumor, called a biopsy. In the lab, pathologists will examine the tissue under a microscope and look for possible signs of malignancy (cancer).
Your doctor may also order the following imaging studies to determine the size and location of the tumor:
- X-rays- contrast studies of the stomach, small bowel, and/or colon
- Ultrasound of the rectum
- MRI scan of the abdomen and/or pelvis
- CT scan of the abdomen and/or pelvis
Usually, localized surgery is performed to remove the benign tumors of the colon and rectum is usually localized surgery to remove the tumor, but surgical procedures may include endoscopic, minimally invasive (laparoscopic), or open abdominal surgery or transanal endoscopic microsurgery.
Diverticula (a sac or pocket that develops in the wall of a body structure) are often found in the colon, usually in the left side. When a diferticulum develops a hole, which may be very tiny, this is called a perforated diverticulum. This perforation may lead to an abscess or an infection in the abdominal cavity, or it can cause massive bleeding though patients do not have a perforation and massive bleeding of a diverticulum at the same time.
Symptoms of such a condition can be abdominal pain, cramping or bloating, nausea, or fever.
Your doctor may order a series of tests that will help to confirm a diagnosis of diverticular disease. These may include blood tests of a CT scan. At some point, a colonoscopy is performed to see the diverticula and make sure there is no other tumor or disease.
Diverticulitis may be treated by antibiotics and bowel rest, i.e. temporarily stopping solid foods. For patients with abscess, whose attacks do not respond to antibiotics, or who have frequent, repeated attacks may need surgery (minimally invasive [laparoscopic] or open abdominal surgery).
Pelvic Floor Disorders
Pelvic Floor Disorders are muscle and nerve conditions that affect one's ability to control or promote bowel movements.
The rectum is the last part of the large intestine and is held in place by muscles and ligaments of the pelvis. When these muscles and ligaments weaken, the rectum may slip and turn inside out of the anus. This is called rectal prolapse. Rectal prolapse may lead early to constipation and later, to fecal incontinence, the inability to control bowel movements.
A patient may experience one or more of the following symptoms:
- Straining during bowel movements
- Tissue protruding from the anus
- Late fecal incontinence
Diagnosis of these conditions requires the following:
- Your doctor will ask for a complete medical history and will perform a thorough physical examination.
- Your doctor may order a series of tests that will help to confirm a diagnosis of rectal prolapse and fecal incontinence. These may include:
- Digital Rectal Examination (DRE). Your doctor will perform this test in the office. Your doctor will insert a gloved finger into the rectum to examine the rectum.
- Your doctor may ask you to sit on the toilet and push down as if you were having a bowel movement. The rectal prolapse may be seen.
- In some patients, the rectal prolapse cannot be directly observed. Using a defecating proctogram, a series of X-rays show the mechanics of the bowel movements, and the internal rectal prolapse is seen.
- Anorectal manometry is a test that measures the strength of the sphincter muscle.
- A lower endoscopy is performed to verify there is no other disease.
Treatment for rectal prolapse usually involves surgery, as the prolapse will not self-correct. For active patients, abdominal surgery to correct rectal prolapse is performed. The rectum is dissected free from the pelvic connections and is pulled up into its normal position and fixed to the sacral bone.
For older patients, an approach from the bottom may be used, but the recurrence of rectal prolapse is more frequent. In one approach the prolapsed rectum is cut off and rejoined. In another approach the lining of the rectum is dissected off and the remaining muscle is pleated and folded up inside.
Fecal incontinence is due to weakened sphincter muscles or injury to the nerves that serve these control muscles. This disorder most often is due to injury associated with childbirth. Different degrees of continence are denoted by the ability to control gas, liquid stool, or solid stool.
Your doctor may order a series of tests that will help to confirm a diagnosis of fecal incontinence. These may include:
- Digital Rectal Examination (DRE). Your doctor will perform this test in the office. A gloved finger is inserted into the rectum for examination.
- Anal ultrasound is performed to show the muscles and detect tears in muscles.
- Pudendal nerve test to show the function of these nerves that serve the sphincter muscles.
- Manometry to test the tone and strength of the control muscle.
- Endoscopy to look for associated diseases.
- Correction of stool consistency aids control.
- Biofeedback is physical therapy to strengthen weak muscles.
- Torn and separated muscles may respond to repair of the muscle defect.
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