Colon Diseases Treatment and Care
Where is the Appendix?
Your appendix is a small tube of tissue that is attached to part of your intestine (colon). It sits in the lower right part of your abdomen and is about 5 to 10 centimeters long.
What is appendicitis?
If you have appendicitis it means your appendix is inflamed. Appendicitis tends to happen when the appendix gets blocked. Fluids, hard bits of stool or swollen lymph glands can get trapped in the appendix, and when this happens, the appendix becomes inflamed or infected. This leads to the painful symptoms of appendicitis.
What are the symptoms of appendicitis?
The first symptom of appendicitis is pain around your belly button. After a few hours the pain will probably travel to the right side of your lower abdomen. You probably won’t feel like eating and you might vomit.
Other symptoms include:
• Cramp-like pain in your abdomen
• Temperature (about 37.7’C to 38.3’C)
• Constipation, or less commonly, diarrhoea.
• Pain getting worse when you move, take a deep breath, cough or sneeze.
• Feel like you need to pass a stool.
• Feel more comfortable bent over, or lying with your knees drawn up.
But not everybody gets all of these symptoms especially if the appendix is not in the usual place.
If you have appendicitis, you will need surgery to take out your appendix. Your doctor may call this an Appendicectomy.
If you have appendicitis, you’ll need surgery to take out your appendix. If your appendicitis isn’t treated, your appendix can burst. This is called a ruptured or perforated appendix. A burst appendix can cause a serious infection inside your body.
There are two types of surgery for appendicitis:
Open surgery: your surgeon makes a cut in the lower right part of your abdomen to take out your appendix
Laparoscopy: The appendix is removed via small holes in the abdomen using a telescope. The scars are much smaller and the recovery is quicker.
Colonic cancer (bowel cancer):
Colonic cancer can occur anywhere in the colon. The cells that line the colon may become damaged causing them to divide in an uncontrolled way. This may result in polyp formation or cancer. It is the third most common cancer in men and the second most common cancer.
What are the symptoms?
• Bleeding from the back passage
• A change in the frequency of bowel activity
• Abdominal pain, weight loss and poor appetite.
What causes bowel cancer?
Bowel cancer often develops from a pre-cancerous growth, known as a polyp. Polyps are usually non-cancerous but if untreated, some can develop into cancer by growing in size and penetrating into the bowel wall. Risk factors include the following:
• Increasing age and diet high in fat, red or processed meat and low in high fibre.
• An inactive lifestyle and being overweight
• Family history of bowel, breast or ovarian cancers.
• A previous diagnosis of ovarian cancer or breast cancer or polyps in the colon.
• A previous diagnosis of ulcerative colitis or crohns disease.
How is the diagnosis made?
Diagnosis is made by examination of the colon either with a flexible telescope (colonoscope) or a special test called CT colonography. During colonoscopy if a cancer is seen a small tissue (biopsy) is taken from the cancer for laboratory examination.
What is the treatment?
The best chance of curing colonic cancer is with an operation which aims to remove the segment of colon with the cancer along with the blood supply and lymph nodes that supply it. The type of operation will depend on the location of the cancer. These operations can be done with open surgery or multiple small incisions (‘key-hole’ or laparoscopic surgery).
Will I need a stoma?
A colostomy , or artificial opening of the colon on to the abdominal wall is NOT usually necessary. The possibility of needing a stoma will be discussed with you and if it is required then you will get all the support that you need.
Are there any other forms of treatment?
Chemotherapy: Once you have recovered from your surgery it may be appropriate to recommend a course of chemotherapy. This will depend upon your general state of health and the stage of the cancer.
Liver surgery: If the cancer has spread to the liver it may still be possible to attempt to cure the cancer by removing a segment of the liver at an operation.
Colostomy: Some cancers can cause a blockage to the bowel and it may be recommended that a colostomy be performed to prevent this.
What are the chances of cure?
Appropriate surgery offers the best chance of cure possibly combined with chemotherapy. The earlier the cancer is detected and treated then the more likely the cure. In early cancers the cure rate is greater then 90%, in advanced cancers the chances of cure are less than 50%.
Will I need to be seen again?
You will be checked on a regular basis following your treatment. The frequency with which you will be seen will depend on the stage of cancer and will be tailored to your own particular circumstances.
What is constipation?
The term constipation means different things to different people. Constipation can mean difficulty going to the toilet to remove stool from the back passage and bowel movements may be infrequent. The stool may be hard and/or small and some people with constipation need to strain to evacuate stools. There may be discomfort in the back passage with a feeling that not all the stool is and this can be associated with bloating or being over full.
Is Constipation considered a disease?
It is not considered a disease. It is a symptom or sign that stools are passing too slowly through the bowel. Constipation can be acute (a short term problem) or one which is long term (chronic). Constipation can be a sign of an underlying disease.
What is normal bowel movements?
People differ a lot. It may be normal for some to pass stools 3 times a day for others its normal to pass 3 times a week. It is normal to have constipation for short periods at times. Lifestyle changes are often all that is needed to correct constipation. Drinking lots of fluids, keeping active and moving about by doing regular exercise also is helpful in keeping the bowel working. A change in habits or lifestyle such as traveling or new diet can make constipation worse.
What are the warning signs?
• Passing blood in the stools.
• Acute change in bowel habits that continues.
• Constipation associated with abdominal pains or distension.
• Constipation with vomiting.
What are the serious causes of constipation?
• Blockage in the intestine.
• Growth in the bowel including colon cancer.
• Diverticular disease: wear and tear of the colon
• Diseases of the nervous system.
• Side effect of some mediations.
Any special tests for constipation?
The best way is to exclude any major or serious cause of constipation.
• A digital examination of the back passage is needed.
• X ray to exclude bowel blockage.
• Colonoscopy: telescope examination of the whole colon.
Treatment options for constipation:
• Stool softeners.
• Enemas and suppositories
• Occasionally surgery may be needed
Having a stoma/Colostomy:
A stoma is an external opening of the bowel onto the abdominal wall. Faeces (stool) will then leave the body through the stoma into collecting pouch (stoma bag).
How is it created?
This is done by your surgeon. The bowel is brought up to the surface of your abdomen through a small tunnel. The bowel is then opened to expose the inside lining and held in place with absorbable stitches.
Where is the stoma sited?
Commonly, a stoma will be sited on either side of the abdomen depending upon the type of stoma required and which part of the bowel is used.There are several different types of stoma. A stoma created from small bowel is called an ileostomy, that from a large bowel is called a colostomy. Some stomas are temporary whilst others may be permanent. A temporary stoma may be sited, at the time of surgery when part of the bowel is removed.
What does it look and feel like?
The stoma is usually round in shape and will be pink and moist rather like the lining of your mouth. It is not painful. After surgery your stoma may be a little swollen though it will settle quite quickly. The stoma is covered by a bag which will collect any faeces.
Who will teach me to use my bag?
Your stoma care nurse is trained to help and teach you to look after your stoma. After surgery the stoma care nurse will visit you and help you to learn to look after the stoma and how to change the bag. Before you go home your stoma care nurse will advise you as to what type of bag you need as well as inform you as to how to order new supplies.
How do I clean my stoma?
The stoma can be cleaned with warm water and then the surrounding skin should be dried well. Once you have done this the new bag is applied. You will not need to use soaps or creams as this may cause skin irritation and the bag may not stick.
Can I go in the shower or bath or swimming after the operation?
Once the wound has healed you should be able to bath and shower. Stoma bags are waterproof so you may have your bag on or off when you bath or shower. Remember when you clean your stoma to make sure you dry the surrounding skin well before applying your new bag.
Will I need to have a special diet?
No, not especially. However, there are foods that may cause excessive wind and blockages of the bowel and it is best that they are avoided.
What about intimacy/sex?
Having a stoma does not prohibit intimate relations. Open conversations and sharing of your worries with your partner will help overcome most of this hesitance.
Can I have children?
Many women with stomas do conceive and have successful pregnancies. Men may initially have problems with erection or ejaculation but these are usually temporary. If these symptoms persist seems, then you may need to talk to your doctor.
Diverticular disease is a very common condition affecting the colon. Diverticula are small pouches created when the thin lining of the bowel protrudes through narrow gaps in its wall. The wall is also often thicker than normal. Only a small minority of patients (around 10-20%) develop any problems due to the pouches.
How and why does it develop?
It is likely to be due to diet. When there is little fibre in the diet, the stools are often small and hard. This can cause the pressure in the colon to increase forcing the pouches through the bowel wall.
What are the symptoms?
Most people have no symptoms. This can cause pain in the lower part of the stomach, often on the left side. The bowels may become irregular, sometimes with hard stools and there is often a sensation of bloating. Some patients report loose motion. The pouches can also cause bleeding.
Is it dangerous?
Occasionally, the diverticula can become infected (‘acute diverticulitis’). It leads to more severe pain often on the left side and a fever. Very rarely, the infection leads to an abscess or even perforation (a hole in the bowel) of the bowel. Usually patients with these conditions have severe pain, and require admission to hospital. However surgery for Diverticular Disease is hardly ever required.
Are tests needed?
Although Diverticular Disease is much more common, the symptoms it causes can mimic those of bowel cancer. So tests are often done mainly to rule out cancer. The usual test that is done is either a telescope examination (colonoscopy) or a CT scan. Occasionally both are required.
Is treatment required?
Reassurance that the symptoms are not due to a serious disease like bowel cancer is often enough. A diet with extra fibre may prevent the condition from getting worse but won’t get rid of the diverticula that are already there.
Is an operation ever needed?
Yes, but it is rare. If the bowel tube becomes very narrow (‘stricture’) the symptoms can be severe enough to warrant surgery to prevent a complete blockage. Occasionally, the bowel sticks to the bladder or vagina and makes an unnatural connection between the two known as a fistula. This occurs rarely but usually requires an operation to fix it. Another reason for surgery is if you have recurrent admissions to hospital due to infections. These operations can be done with single large incision (open surgery) or multiple small incisions (‘key-hole’ or laparoscopic surgery). Urgent surgery is sometimes needed for the most serious complications of diverticular disease such as abscess or perforation.
Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD) is a general term used to describe diseases that causes intestinal inflammation. There are two main forms of Inflammatory Bowel Disease. These are known as Crohns disease or ulcerative colitis which are both long-term (chronic) diseases which cause inflammation in the gastrointestinal tract. With both conditions the chances of developing either increases if there is a close family relative who also has the same condition. One of the main differences between Crohn’s disease and ulcerative colitis is the part of the gastrointestinal tract that is affected. In cases of ulcerative colitis inflammation only affects the colon and rectum (large bowel). In cases of Crohn’s disease inflammation can occur anywhere in the digestive tract from the mouth to the anus.
Crohn’s disease is an ongoing non-infectious condition that causes inflammation of the digestive tract. Inflammation can occur anywhere in the digestive tract from the mouth to the anus. The part of the small intestine known as the ileum is the commonest site to be affected.Other commonly affected areas include the colon and rectum as well as the back passage (anus) itself. In chronic cases the inflammation can damage sections of the digestive system resulting in an additional complications of narrowing the gut or abscesses. The actual cause of Crohn’s disease is unknown. It is believed that the immune system is responsible for the inflammation that occurs in Crohn’s disease but what causes the abnormal immune response is not fully understood.
Ulcerative colitis is a form of inflammatory bowel disease that affects the lining of the large bowel (colon) and back passage (rectum). The inflammation may be limited to the rectum (proctitis) but it may gradually move upwards and very occasionally may affect the whole of the large bowel.
What are the symptoms?
Most of the time sufferers feel well with no symptoms – this means the disease is inactive (in remission).The main symptoms are:
• Frequent and urgent need to pass blood and mucous.
• Diarrhoea ,abdominal pains and a general feeling of tiredness.
Occasionally, other symptoms occur and these may include reddening of the eyes, joint pain, skin lesions, loss of appetite, irritability and depression.
How can it be treated?
Ulcerative colitis can be cured by surgical removal of the large bowel. However, for most patients the disease can be controlled by drugs such as steroids.
When is surgery necessary?
Most people never need an operation. The colon may have to be removed if:
• A very severe attack of ulcerative colitis fails to respond to medical treatment
• Repeated attacks causing ill-health and pre-cancerous changes in colon
Can ulcerative colitis lead to cancer?
Yes. The risks are only substantial in patients with ulcerative colitis if their disease affects most of, or the whole, colon and has been present for many years.