Anal fissures, abscesses, infections Oh My!. There can be a lot going on at that
end of the spectrum so it’s best to take it slow and easy. A healthy diet and
cleanliness go along way here in reducing your risk.

Anatomy and Physiology
     The large bowel consists of the colon (5 feet long) and the rectum (8 inches long).
The large bowel is connected to the small bowel at the top end and to the anal
sphincters at the bottom end. The colon’s main function is to process the 3 pints of
liquid stool it receives each day into a manageable amount of solid stool, ready for
evacuation. The rectum coordinates the process of evacuation. Normally, a person
passes 150 grams of solid stool daily. The normal range of stool frequency is from 3
times per day to 3 times per week.

FUNCTIONAL DISORDERS

     Functional disorders are disorders in which the bowel looks normal but doesn’t work
properly. These are the most common problems affecting the colon and rectum. They
and are not caused by any particular disease but are rather a direct result of bad
diet and bowel habits.

Constipation
     Constipation is defined as small, hard, difficult, or infrequent stools. Constipation is
usually caused by:

• inadequate “roughage” or fiber in the diet,
• not enough fluid, or
• poor habits, especially putting off the call to stool.

     Putting off evacuation causes the stool to get harder and the muscular contraction
of the rectum to be less efficient. A person who is constipated will strain during a
bowel movement, sometimes producing anal problems such as fissures and
hemorrhoids.

     Treatment of constipation includes eating more fiber, drinking more water and
improving toilet habits. If these treatment methods don’t work, laxatives are a
temporary solution.  Laxatives should not be used long term as they can be habit
forming.

Irritable bowel (spastic colon)
     Irritable bowel (spastic colon) is a condition in which the colon muscle contracts very
powerfully and loses its normal coordination. The high pressure that builds up
causes abdominal cramps, gas, bloating, constipation, and urgent, explosive stools.

     Treatment includes avoiding caffeine, stabilizing the diet, minimizing stress, and
sometimes, taking antispasm drugs.

STRUCTURAL DISORDERS

     Structural disorders are those in which there is something visually abnormal that
may need to be removed by surgery. The most common structural disorders are
those affecting the anus, diverticular disease and colorectal or anal cancer.

ANAL DISORDERS

Internal Hemorrhoids
     Hemorrhoids can fall down enough to prolapse (sink or protrude) out of the anus.

     Treatment includes improving bowel habits, using elastic bands to pull the internal
hemorrhoids back into the rectum, or removing them surgically.

External 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 a blood
clot forms under the skin. This is called a pile and is very painful.

     Treatment includes removing the clot and vein under local anesthesia.

Anal Fissure
     An anal fissure is a split in the lining of the anus that occurs after straining. As a
result, the person experiences bleeding and intense burning pain after bowel
movements. The pain is caused by spasm of the internal sphincter muscle.

     Fissures often get better by themselves. Your doctor can recommend an ointment
that will relieve the pain. If they don’t improve, surgery may be needed to help the
sphincter relax.

Perianal Abscess
     When the tiny anal glands that open on the inside of the anus get blocked, the
bacteria that always live in the glands cause an infection. When pus forms, there is
an abscess (a pocket of pus). Treatment includes draining the abscess, usually
under local anesthesia in the doctor’s office.

Fistula-in-ano
     Fistula-in-ano often follows drainage of an abscess. A communication (tunnel) is
formed between the mouth of the gland that caused the abscess, and the skin
where the abscess was drained. Fistulas cause drainage, pain, and bleeding. They
rarely heal by themselves and usually need surgery.

Other Perianal Infections
     Sometimes the skin glands near the anus get infected and need to be drained. Just
behind the anus, abscesses can form in the pilonidal area.
Sexually transmitted diseases that can affect the anus include anal warts, herpes,
AIDS, chlamydia, and gonorrhea.

Diverticular Disease
     Colonic diverticula are little outpouchings of the bowel lining that get pushed out
through weak spots in the muscle of the bowel wall. They usually occur in the
sigmoid colon, the high-pressure area of the bowel.
Diverticular disease is very common in Western societies, and is caused by too little
roughage (fiber) in the diet. It rarely causes symptoms unless there is a complication.

     Complications of diverticular disease happen in about 10% of people. They include
infection (diverticulitis), bleeding, and obstruction. Surgery is needed in about half
the patients who have complications.

Polyps and Cancer
     Cancer of the colon and rectum is a major health problem in America today.
Colorectal cancer represents a complete loss of control of the way cells grow and
divide. Certain genes, responsible for maintaining control of cell growth, become
mutated. This happens primarily because of prolonged exposure of colon cells to
carcinogens (cancer-causing) chemicals in the stool.

     When a few genes are mutated, some control is lost and precancerous polyps
(adenomas) form.

     Cancer can be prevented by removing these adenomas before they turn to cancer.
When more genes become mutated, cell growth becomes even more out of control,
and untreated adenomas may enlarge and turn to cancer.

     Established cancer requires surgery and, if it is advanced, chemotherapy (and
radiation for rectal cancer).

     With prompt, expert treatment, most people can be cured of colorectal cancer.
Hardly anyone needs a permanent colostomy (surgery to create a new opening for
disposal of waste).

     Because colorectal cancer arises in a benign polyp, colonoscopy can prevent
colorectal cancer by finding and removing the polyps. People at special risk for
colorectal cancer include those who have had polyps or cancers in the past, or those
who have a history of colorectal cancer in their family.

Colitis
     Colitis is a group of conditions that cause an inflammation of the bowel There are
several types of colitis,including:

• Infectious colitis
• Ischemic colitis (caused by not enough blood going to the colon)
• Radiation colitis (after radiotherapy)
• Ulcerative colitis (cause not known)
• Crohn’s disease (cause not known)

     Colitis causes diarrhea, rectal bleeding, abdominal cramps, and urgency. Treatment
depends on the diagnosis, which is made by colonoscopy and biopsy.

Summary
     Many diseases of the colon and rectum can be prevented or minimized by good diet
and good bowel habits.
People 50 or above and anyone who is at risk for colorectal cancer or polyps should
undergo regular colon cancer screening. People who have symptoms of any of these
conditions should consult their doctor without delay.