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ANUS AND RECTUM DISEASES

UNDERSTANDING THE PROBLEM

The anus is the opening at the end of the digestive tract where stool leaves the body. The rectum is the section of the digestive tract above the anus where stool is held before it passes out of the body through the anus. The anus is formed partly from the surface layers of the body, including the skin, and partly from the intestine. The rectal lining consists of glistening red tissue containing mucus glands—much like the rest of the intestinal lining. The lining of the rectum is relatively insensitive to pain, but the nerves from the anus and nearby external skin are very sensitive to pain.

The veins from the rectum and anus drain into the portal vein, which leads to the liver, and then into the general circulation. The lymph vessels of the rectum drain into lymph nodes in the lower abdomen. The lymph vessels of the anus drain into the lymph nodes in the groin.

A muscular ring (anal sphincter) keeps the anus closed. This sphincter is controlled subconsciously by the autonomic nervous system. However, the lower part of the sphincter can be relaxed or tightened at will.

Disorders of the anus and rectum include:

  • Anal cancer
  • Anal fissure: a tear or ulcer in the lining of the anus
  • Anal itching: Itching in the anus and the skin around the anus (perianal skin)
  • Anorectal abscess: a pus-filled cavity caused by bacteria invading a mucus-secreting gland in the anus and rectum.
  • Anorectal fistula: an abnormal channel that leads from the anus or rectum usually to the skin near the anus but occasionally to another organ, such as the vagina.
  • Foreign objects in the anus and rectum which could include accidently swallowed objects, such as toothpicks, chicken bones, or fish bones, may become lodged at the junction between the anus and rectum (anorectal junction). Also, enema tips, surgical sponges or instruments, thermometers, and objects used for sexual stimulation may become lodged unintentionally in the rectum after being passed through the anus
  • Haemorrhoids (dilated, twisted (varicose) veins located in the wall of the rectum and anus)
  • Levator syndrome: sporadic pain in the rectum caused by spasm of a muscle near the anus (the levator ani muscle)
  • Pilonidal disease (an infection caused by a hair that injures the skin at the top of the cleft between the buttocks).
  • Proctitis: inflammation of the lining of the rectum (rectal mucosa)
  • Colorectal cancer
  • Polyps
  • Rectal prolapse (a painless protrusion of the rectum through the anus)
  • Diverticulitis disease, Colitis (see other pages of relevance)
UNDERSTANDING WHO SUFFERS

Diseases of the rectum and anus are common, and the prevalence in the general population is probably much higher than that seen in clinical practice since most patients with symptoms referable to the anorectum do not seek medical attention.

Age and the health history of a patient are the biggest factors to investigate as it affects the risk of getting various disorders as well as rectal or anal cancer. These types of cancer are often seen in patients that are older than 50 years of age and other people are at an increased risk of being diagnosed with rectal cancer.

This includes people with the following:

  • A family history of cancer of the colon or rectum.
  • A history of polyps in the colon or rectum.
  • A history of inflammatory bowel diseases.
POTENTIAL SIGNS AND SYMPTOMS

Common symptoms of anal and rectal diseases include:

  • Anal cancer: People with anal cancer often experience bleeding with bowel movements, pain, and sometimes itching around the anus. About 25% of people with anal cancer have no symptoms. In this instance, the cancer is found only during a routine examination.
  • Anal fissure: Fissures cause pain and bleeding, usually during or shortly after a bowel movement. The pain lasts for several minutes to several hours and then subsides until the next bowel movement. Anorectal fistulas can cause pain and produce pus.
  • Anal itching: In people with anal itching, certain symptoms and characteristics are cause for concern. They include:
    • Pus draining from the anus or around it (draining fistula)
    • Bloody diarrhoea
    • Bulging or protruding haemorrhoids
    • Perianal skin soiled with faecal material
    • Dull or thickened perianal skin
  • Anorectal abscess: Abscesses just under the skin can be swollen, red, tender, and very painful. Rarely, people have fever. Abscesses deep in the rectum often cause fewer symptoms but may cause fever and pain in the lower abdomen.
  • Anorectal fistula: An infected fistula may be painful and may discharge pus.
  • Foreign objects in the anus and rectum : Sudden, excruciating pain during bowel movements suggests that a foreign object, usually at the anorectal junction, is penetrating the lining of the anus or rectum. Other symptoms depend on the size and shape of the object, how long it has been there, and whether it has perforated (pierced) the anus or rectum or caused an infection.
  • Haemorrhoids:
    • External haemorrhoids form a lump on the anus. If a blood clot forms (called a thrombosed external haemorrhoid), the lump becomes larger and is more painful and more swollen than a haemorrhoid that is not thrombosed.
    • Internal haemorrhoids often do not cause a visible lump or pain, but they can bleed. Haemorrhoids may discharge mucus and create a feeling that the rectum is not completely emptied after a bowel movement. Itching in the anal region is usually not a symptom of haemorrhoids, but itching may develop if haemorrhoids make proper cleansing of the anal region difficult.
  • Proctitis: Proctitis typically causes painless bleeding or the passage of mucus from the rectum. When the cause is gonorrhea, herpes simplex virus, or cytomegalovirus, the anus and rectum may be intensely painful.
  • Colorectal cancer: Colorectal cancer grows slowly and does not cause symptoms for a long time. Symptoms depend on the type, location, and extent of the cancer/ Fatigue and weakness resulting from occult bleeding (bleeding not visible to the naked eye) may be the person’s only symptoms.
    • A tumor in the left (descending) colon is likely to cause obstruction at an earlier stage, because the left colon has a smaller diameter and the stool is semisolid. Cancer tends to encircle this part of the colon, causing alternating constipation and frequent bowel movements before obstruction. The person may seek medical treatment because of crampy abdominal pain or severe abdominal pain and constipation.
    • A tumor in the right (ascending) colon does not cause obstruction until later in the course of the cancer, because the ascending colon has a large diameter and the contents flowing through it are liquid. By the time the tumor is discovered, therefore, it may be so large that a doctor can feel it through the abdominal wall.
      Most colon cancers bleed, usually slowly. The stool may be streaked or mixed with blood, but often the blood cannot be seen. The most common first symptom of rectal cancer is bleeding during a bowel movement. Whenever the rectum bleeds, even if the person is known to have haemorrhoids or diverticular disease, doctors must consider cancer as part of their diagnosis. Painful bowel movements and a feeling that the rectum has not been completely emptied are other symptoms of rectal cancer. Sitting may be painful, but otherwise the person usually feels no pain from the cancer itself unless it spreads to tissue outside the rectum.
EXAMINATIONS USUALLY REQUIRED

Diagnosis of anal and rectal diseases and problems require a range of different test based on the condition:

  • Anal cancer : A manual examination and a biopsy are performed to verify the diagnosis.
  • To diagnose anal cancer, a doctor first inspects the skin around the anus for any abnormalities. With a gloved hand, the doctor probes the anus and lower rectum, checking for any portions of the lining that feel different from surrounding areas. An anoscope (a small rigid tube equipped with a light) may be inserted several inches into the anus to assist with examination.
  • The doctor then removes a sample of tissue from an abnormal area and examines it under a microscope (called a biopsy).
  • Anal fissure: A doctor diagnoses a fissure by gently inspecting the anus.
  • Anal itching: Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the itching and the tests that may need to be done
  • Anorectal abscess: A doctor can usually see an abscess if it is in the skin around the anus. When no external swelling or redness is seen, however, a doctor can make the diagnosis by examining the rectum with a gloved finger. A tender swelling in the rectum indicates an abscess. If the doctor suspects a deep abscess, CT can determine the extent and location.
  • Anorectal fistula: A doctor can usually see one or more openings of a fistula or can feel the fistula beneath the surface. A probe may be inserted to determine its depth and direction. By looking through an anoscope (a short, rigid tube) inserted into the rectum and exploring with the probe, a doctor may locate the internal opening. Inspection with a sigmoidoscope which is a much longer viewing scope, helps a doctor determine whether the problem is being caused by cancer, Crohn disease, or another disorder.
  • Foreign objects in the anus and rectum: a doctor can feel the object by probing with a gloved finger during an examination. An abdominal examination, sigmoidoscopy and x-rays may be needed to make sure the wall of the large intestine has not been perforated.
  • Haemorrhoids: A doctor can readily diagnose swollen, painful haemorrhoids by inspecting the anus and rectum. An examination with an anoscope (a short, rigid tube used to view the rectum) is done to evaluate painless or bleeding haemorrhoids. People who have bleeding from the rectum may require a sigmoidoscopy or colonoscopy to rule out a more serious condition, such as a tumor.
  • Levator syndrome: A doctor does a physical examination to rule out other painful rectal conditions (such as thrombosed haemorrhoids, fissures, or abscesses). The physical examination is often normal, but the muscle may be tender or tight. Occasionally, the pain is caused by low back or prostate disorders.
  • Pilonidal disease: To distinguish pilonidal disease from other infections, a doctor looks for tiny holes in or next to the infected area (pits).
  • Proctitis: Anoscopy or sigmoidoscopy, Blood tests and stool tests and sometimes colonoscopy
  • To make the diagnosis, a doctor looks inside the rectum with an anoscope or sigmoidoscope and takes swabs and a tissue sample of the rectal lining for examination. The laboratory then can identify the bacterium, fungus, or virus that may be causing the proctitis. Blood tests for syphilis and stool tests for Clostridium difficile are also done. A doctor may also examine other areas of the intestine using colonoscopy (examination of the entire large intestine with an endoscope) to look for Crohn disease or ulcerative colitis.
  • Colorectal cancer: Colonoscopy, Screening tests (Stool tests, Sigmoidoscopy, Colonoscopy, Computed tomography (CT) colonography); Diagnostic tests (Colonoscopy, CT scan, For HNPCC, genetic testing
  • Rectal prolapse: To determine the extent of a prolapse, a doctor examines the area while the person is standing or squatting and straining. By feeling the anal sphincter with a gloved finger, a doctor often detects diminished muscle tone. A sigmoidoscopy, colonoscopy, or barium enema x-rays of the large intestine may reveal an underlying disease.
PROPOSING TREATMENT AND WHY AIMIS

If Surgery is required for the Anus and Rectum Disorder or Disease, there are various minimal invasive surgeries dependent on condition. It must be noted that details may vary from patient to patient.

  • Anterior Resection of Rectum procedure is removing part or the entire rectum and mostly performed for patients with rectal cancer and after they have received radiotherapy. Anterior resection is also performed on patients with diverticular disease.
  • A total proctocolectomy and ileal-anal pouch surgery is described as the removal of the large intestine and most of the rectum in 2 stages. This procedure may be used for ulcerative colitis and familial polyposis as well.
  • A Total Mesorectal Excision, also known as TME, is a procedure currently used in nearly all rectal cancer patients and has changed rectal cancer outcomes across the world. TME is defined as a precise surgery where the surgeon takes their time to meticulously remove parts of the bowel where the tumour is observed as well as the surrounding tissue, called mesorectum. Surgeons will carefully follow the ‘planes of surgery’ and removed the tumour with a complete outer layer.
  • Abdominoperineal Excision of Rectum is used when it is required to remove the area of diseased bowel. During this procedure the rectum and anus is removed by minimal inclusion in the abdomen and around the anus. The diseased area of bowel and anus is removed and colostomy performed.

Robotic surgery or more accurately robotic-assisted surgery is the latest variation used for minimally invasive colon and rectal surgery. Robotic surgery is fast gaining popularity primarily in rectal operations as the robotic instruments are well suited to operating in areas such as the pelvis where laparoscopic surgery is more difficult.

If a surgeon recommends surgery to treat the Anus and Rectum condition, these are among the potential surgery types for minimally invasive da Vinci Surgery. AIMIS is an expert in all da Vinci Robotic surgeries related to Colon and Rectum conditions and provides advanced techniques offering many advantages over standard laparoscopy and open surgery.

Instead of a large abdominal incision used in open surgery, da Vinci surgeons make just a few small incisions - similar to traditional laparoscopy. The da Vinci System enables our surgeons to operate with enhanced vision, precision, dexterity and control.

As a result of da Vinci technology, da Vinci Surgery offers precise removal of cancerous and other tissue, as well as the following potential benefits compared to open surgery:

  • Less blood loss
  • Less pain
  • Shorter hospital stay
  • Quicker return of bowel function
  • Quicker return to a normal diet
  • Faster recovery
  • Small incision for minimal scarring

And offers the following potential benefits compared to traditional laparoscopy:

  • Lower conversion rate to open surgery
  • Fewer major complications
  • Shorter hospital stay
  • Quicker return to a normal diet
  • Quicker return of urinary function

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Treatments of the various conditions very munch depend on diagnosis. For simple conditions pharmaceutical management is often enough. Those conditions requiring surgery and other additional treatment are outlined below

  • Anal cancer: Surgery and a combination of radiation with chemotherapy
  • Anal fissure: Pharmaceutical management and potential Botulinum toxin injection and nitro-glycerine ointment or calcium channel blockers
  • Anorectal abscess: Cutting and draining the abscess
  • Anorectal fistula: Various Surgical procedures dependet on fistulas caused by Crohn disease, drugs, etc
  • Foreign objects in the anus and rectum that are not reachable by rectal retractor, surgery is required which potential sigmoidoscopy after removal to check for perforation.
  • Haemorrhoids: dependent on type and severity:
    • For external thrombosed haemorrhoids, removal of blood clot
    • For internal haemorrhoids, injection sclerotherapy or rubber band ligation
  • Pilonidal disease: For pilonidal abscesses, cutting and draining, pilonidal sinuses, surgical removal, For larger cysts, flap procedure
  • Proctitis: - Treatment of the cause
  • Colorectal cancer: Surgery sometimes with chemotherapy and radiation therapy
  • Rectal prolapse: Predominately Surgery
FURTHER INFORMATION ON INCREASED RISK GROUPS

Identification of intestinal ischemia often involves a high level of suspicion. Generally, those who are most susceptible are:

  • Anal cancer: Risk factors for anal cancer include certain sexually transmitted diseases
  • Anal fissure: Anal fissures may be caused by an injury from a hard or large bowel movement or from frequent loose bowel movements. Uncommonly, they may also be caused by penetration of the anus during anal sex. Fissures cause the anal sphincter to go into spasm, which worsens pain and prevents healing.
  • Anal itching: Most often, doctors do not identify a specific disorder as the cause of anal itching, and the itching goes away without treatment after a period of time. Many of the cases of anal itching can be due to hygiene issues or allergens, in a few cases specific disorder, such as pinworms or a fungal infection can be the cause. Of the specific causes, only inflammatory bowel disease and anal cancer (rare causes) are considered serious.
  • Anorectal abscess: An abscess develops when a mucus-secreting gland in the anus or rectum is blocked, and bacteria grow and multiply. Although the anus is an area that is rich in bacteria, infection generally does not occur because blood flow to the area is rich. When infection does occur, it usually is caused by a combination of different types of bacteria. People who have Crohn disease are at particular risk of abscesses. Sometimes, abscesses are a complication of diverticulitis or pelvic inflammatory disease.
  • Anorectal fistula: Anorectal fistulas are common among people who have an anorectal abscess, Crohn disease, or tuberculosis. They also occur in people with tumors, diverticulitis, cancer, or an anal or rectal injury. Fistulas that connect the rectum and vagina (called rectovaginal fistulas) may result from radiation therapy, cancer, Crohn disease, or an injury to a mother during childbirth.
  • Hemorrhoids: Increased pressure in the veins of the anorectal area leads to hemorrhoids. This pressure may result from pregnancy, frequent heavy lifting, or repeated straining during bowel movements (defecation). Constipation may contribute to straining.
  • Pilonidal disease: Pilonidal disease usually occurs in young, hairy men but can also occur in women. For unknown reasons, sometimes a hair irritates and grows into the skin, forming a cavity that may thus contain hair. Such a cavity is called a pilonidal cyst and typically forms at the top of the cleft between the buttocks. The cyst may cause no symptoms, or it may become infected. If the infection causes a collection of pus to form, it is called a pilonidal abscess. A pilonidal sinus is a chronic draining wound at the site. A pilonidal abscess causes pain, redness, and swelling. Sometimes pus drains spontaneously from the abscess.
  • Proctitis: The inflammation has many causes ranging from infection to radiation therapy.
  • Colorectal cancer:
  • People with a family history of colorectal cancer have a higher risk of developing the cancer themselves.
  • Some dietary factors also increase a person’s risk of colorectal cancer.
  • In Western countries, cancer of the large intestine and rectum is one of the most common types of cancer. The incidence of colorectal cancer begins to rise at age 40 and peaks between the ages of 60 and 75. Each year, about 135,000 people in the United States develop colorectal cancer.
  • Colon cancer is more common among women, and rectal cancer is more common among men. About 5% of people with colon cancer or rectal cancer have cancer in two or more sites in the colon and rectum that do not seem to simply have spread from one site to another.
  • People with ulcerative colitis or Crohn disease of the colon are at greater risk as well. This risk is related to the person’s age when the disease developed, the amount of intestine or rectum that is affected, and the length of time the person has had the disease.
  • People at highest risk tend to consume a diet that is high in fat, animal protein and refined carbohydrates and low in fiber.
  • Greater exposure to air and water pollution, particularly to industrial cancer-causing substances (carcinogens), may play a role.
  • Hereditary nonpolyposis colorectal carcinoma (HNPCC) (also called Lynch syndrome) comes from an inherited gene mutation that causes cancer in 70 to 80% of the people with that mutation. People with HNPCC often develop colorectal cancer before age 50. They are also at increased risk of other types of cancer, particularly endometrial cancer and ovarian cancer, but also stomach cancer, cancer of the small intestine, and kidney cancer.
  • Rectal prolapse
  • A rectal prolapse is often caused while straining, such as during a bowel movement.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Please refer to detailed section above.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Lower Gastrointestinal Problems including:

Right & Left Hemicolectomy, Subtotal Colectomy, Total Colectomy, Total Proctocolectomy with pouch, Anterior Resection of the Rectum, Total Mesorectal Excision, Abdominoperineal Excision and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Lower Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Lower blood loss
  • Greater precision
  • Few small incisions - Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • Shorter hospital stays
  • Return to normal activities quicker.

Over the past few years this innovative system has given millions of patients worldwide the benefit of minimal invasive surgery. The da Vinci Xi system has changed technology and the experience of surgery to patients around the world.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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