Hemorrhoids

Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

Nearly 3 out of 4 adults will have hemorrhoids from time to time. Hemorrhoids have several causes, but often the cause is unknown.

You often can relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments including:

• Eating high-fiber foods.
• Using topical treatments.
• Soak regularly in warm bath.
• Take oral pain relievers.

If you have bleeding during bowel movements or you have hemorrhoids that are bothersome, talk to your doctor. Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

If medical treatment is needed for the treatment of your hemorrhoids, your doctor may recommend rubber band ligation. During this procedure, your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week.

Only a small percentage of people with hemorrhoids require surgery.

Anal fissures

An anal fissure is a small tear in the thin tissue that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

Anal fistulas

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus).

Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland.

Treatment of anal fistula depends on the fistula's location and complexity. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Damage to these muscles can lead to fecal incontinence.

Colon cancer is a type of cancer that begins in the large intestine, or colon. The colon is the final part of the digestive tract. Colon cancer sometimes is called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.

Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous, or benign, clumps of cells called polyps that form on the inside of the colon. Over time, some of these polyps can become colon cancers.

Personalized cancer care

Receiving a cancer diagnosis is life-altering and overwhelming. Our care team will work with you to create a cancer treatment plan designed to meet your needs and preferences — whether you need radiation, chemotherapy or surgery, or would benefit from cancer support groups. Our goal is to provide you with the highest quality of life possible. Learn more about our oncology services and teams.

Crohn's disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.

Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. This inflammation often spreads into the deeper layers of the bowel.

Crohn's disease can be painful, debilitating and sometimes may lead to life-threatening complications.

While there's no known cure for Crohn's disease, therapies can greatly reduce its signs and symptoms, and even bring about long-term remission and healing of inflammation. With treatment, many people with Crohn's disease are able to function well.

The goal of Crohn's disease treatment is to reduce or eliminate the inflammation that triggers your symptoms. This may lead not only to symptom relief, but also long-term remission and reduced risks of complications. Crohn's disease treatment usually involves drug therapy, nutrition therapy or a combination of both.

If diet changes, drug therapy, or other treatments don't relieve your signs and symptoms, you and your healthcare team may consider surgery. Nearly half of patients with Crohn's disease will require at least one surgery. However, surgery does not cure Crohn's disease. The best approach is to follow surgery with medication to minimize the risk of recurrence.

Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems.

The presence of diverticula is known as diverticulosis (die-vur-tik-yoo-LOE-sis). When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis.

Treatment of diverticulitis depends on the severity of your signs and symptoms. If your symptoms are mild, you may be treated at home with antibiotics to treat the infection and a liquid diet to help your bowel heal.

Your health care team may recommend a primary bowel resection or bowel resection with colostomy surgery to treat your diverticulitis if:

• You have a complication, such as a bowel abscess, fistula or obstruction or a puncture in your bowel wall.
• You have had multiple episodes of diverticulitis.
• You have a weakened immune system.

Your health care provider may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven't had the test in the previous year. There doesn't appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy — which is risky during a diverticulitis attack — can exclude colon cancer as a cause of your symptoms.

Rectal cancer begins in the rectum, which is the last several inches of the large intestine. It starts at the end of the final segment of your colon and ends when it reaches the short, narrow passage leading to the anus.

Cancer inside the rectum, or rectal cancer, and cancer inside the colon, or colon cancer, often are referred to together as colorectal cancer.

While rectal and colon cancers are similar in many ways, their treatments are quite different. This mainly is because the rectum sits in a tight space, barely separated from other organs and structures. The tight space can make surgery to remove rectal cancer complex.

In the past, long-term survival was uncommon for people with rectal cancer, even after extensive treatment. Thanks to treatment advances over the last few decades, rectal cancer survival rates have greatly improved.

Rectal cancer treatment often involves a combination of therapies. When possible, surgery is used to cut away cancer cells. Other treatments, such as chemotherapy and radiation therapy, may be used after surgery to kill any cancer cells that remain and reduce the risk that cancer will return.

Which operation is best for you depends on your particular situation, such as the location and stage of your cancer, how aggressive the cancer cells are, your overall health and your preferences.

If surgeons are concerned that the cancer can't be removed completely without damaging nearby organs and structures, your doctor may recommend a combination of chemotherapy and radiation therapy as your initial treatment. These combined treatments may shrink the cancer and make it easier to remove surgically.

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and sores in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

Ulcerative colitis can be debilitating and sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and bring about long-term remission.

Ulcerative colitis treatment usually involves either drug therapy or surgery. Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

Cancer Surveillance

You'll need more frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years, beginning as soon as eight years after diagnosis if the majority of your colon is involved or 15 years if only the left side of your colon is involved.

For rectal cancers that are located near the anus, it might not be possible to remove the cancer completely without damaging the muscles that control bowel movements. In these situations, surgeons may recommend an operation called abdominoperineal resection (APR) to remove the rectum, anus and some of the colon, as well as nearby tissue and lymph nodes. The surgeon creates an opening in the abdomen and attaches the remaining colon, also called a colostomy. Waste leaves your body through the opening and collects in a bag that attaches to your abdomen.

Fistulotomy

The surgeon cuts the fistula's internal opening, scrapes and flushes out the infected tissue, and then flattens the channel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the channel. Fistulotomy may be done in two stages if a significant amount of sphincter muscle must be cut or if the entire channel can't be found.

Advancement rectal flap

The surgeon creates a flap from the rectal wall before removing the fistula's internal opening. The flap is then used to cover the repair. This procedure can reduce the amount of sphincter muscle that is cut.

Seton placement

The surgeon places a silk or latex string into the fistula to help drain the infection.

Fibrin glue and collagen plug

The surgeon clears the channel and stitches shut the internal opening. Special glue made from a fibrous protein is then injected through the fistula's external opening. The anal fistula tract also can be sealed with a plug of collagen protein and then closed.

Ligation of the intersphincteric fistula tract

Ligation of the intersphincteric fistula tract (LIFT) is a two-stage treatment performed for more-complex or deep fistulas. LIFT allows the surgeon to access the fistula between the sphincter muscles and avoid cutting them. A seton is first placed into the fistula tract, forcing it to widen over time. Several weeks later, the surgeon removes infected tissue and closes the internal fistula opening.

If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening, or stoma, in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.

Colon cancer treatment often involves a combination of therapies. When possible, surgery is used to cut away cancer cells. Other treatments, such as chemotherapy and radiation therapy, may be used after surgery to kill any cancer cells that remain and reduce the risk that cancer will return.

If surgeons are concerned that the cancer can't be removed completely without hurting nearby organs and structures, your doctor may recommend a combination of chemotherapy and radiation therapy as your initial treatment. These combined treatments may shrink the cancer and make it easier to remove during an operation.

If your colon cancer is small, your doctor may recommend a minimally invasive approach to surgery, such as:

• Removing polyps during a colonoscopy (polypectomy).
  If your cancer is small, localized, completely contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy.
• Endoscopic mucosal resection
  Larger polyps might be removed during colonoscopy using special tools to remove the polyp and a small amount of the inner lining of the colon in a procedure called an endoscopic mucosal resection.
• Minimally invasive, or laparoscopic, surgery
  Polyps that can't be removed during a colonoscopy may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.

If the cancer has grown into or through your colon and is more advanced, your surgeon may recommend:

• Partial colectomy
  During this procedure, the surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy).
• Surgery to create a way for waste to leave your body
  When it's not possible to reconnect the healthy portions of your colon or rectum, you may need an ostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening. Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.
• Lymph node removal
  Nearby lymph nodes are usually also removed during colon cancer surgery and tested for cancer.

Hemorrhoid removal

Choosing one of various techniques, your surgeon removes excessive tissue that causes bleeding. The surgery can be done with local anesthesia combined with sedation, spinal anesthesia, or general anesthesia. Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications can include temporary difficulty emptying your bladder, which can result in urinary tract infections. This complication occurs mainly after spinal anesthesia. Most people have some pain one to three days after the procedure, which medications can relieve. Soaking in a warm bath also might help.

Hemorrhoid stapling

This procedure blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids. Stapling generally involves less pain than hemorrhoidectomy and allows for earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Complications can also include bleeding, urinary retention, and pain, as well as, rarely, a life-threatening blood infection (sepsis). Talk with your care team about the best option for you.

This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally. In some cases, a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend a procedure called lateral internal sphincterotomy, or LIS, which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment.

To treat cases of complex anal fistulas, the channel may be filled with healthy muscle tissue.

A treatment option where the surgeon creates a temporary opening in the abdomen to divert waste into a collection bag, to allow the anal area time to heal.

The surgeon removes diseased segments of your intestine and reconnects the healthy segments, known as anastomosis. This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive, or laparoscopic, procedure.

Larger rectal cancers that are far enough away from the anal canal might be removed in a procedure that removes all or part of the rectum. Nearby tissue and lymph nodes also are removed. This procedure preserves the anus so waste can leave the body normally. How the procedure is performed depends on the cancer's location. If cancer affects the upper portion of the rectum, that part of the rectum is removed and the colon is attached to the remaining rectum. All of the rectum may be removed if the cancer is located in the lower portion of the rectum. Then the colon is shaped into a pouch and attached to the anus.

For your first appointment, bring your current prescription information or medical records from non-Mayo Clinic Health System facilities. Complete a medical records release form to authorize the transfer of health records from another healthcare facility to us. Visit our Medical Record Forms page for this form and other forms in multiple languages.

Your first appointment with the surgeon is a consultation. If you are a new patient, the surgeon will do a focused history, physical exam and review of prior lab tests or X-rays. If surgery is recommended, you and the surgeon will discuss the surgical procedure, how you should prepare for the surgery and determine a date for the surgery. If needed, the surgeon may order further imaging or laboratory studies prior to scheduling surgery. If a minor in-office procedure needs to be performed, the surgeon may be able to complete it during your first visit, if schedules permit.

Most surgeries require a follow-up appointment with the surgeon in the clinic within one to two weeks after your surgery and are included in the cost of surgery. Whenever possible, we try to schedule tests and follow-up with the surgeon on the same day.

Our Patient Account Services representatives can assist you with any issues related to billing and insurance. We also offer financial assistance if you are unable to pay for care due to financial hardship.

Yes. Call the appointment number at your preferred Colon and Rectal Surgery location.

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