Inflammatory Bowel Diseases

Inflammatory bowel disease, also known as IBD, is a term referring to multiple autoimmune conditions affecting the gastrointestinal tract, the most common of which are ulcerative colitis and Crohn’s Disease. A person diagnosed with IBD in Rockville will experience a lifetime of inflammation of the intestine either chronically or episodically. Without treatment, inflammatory bowel disease can lead to serious complications, including bleeding ulcers and an increased risk of colon cancer.

Did you know… that inflammatory bowel disease affects an estimated 1.4 million Americans? Due to the type and severity of symptoms it produces, most people with IBD are diagnosed before age 30. No one knows what causes inflammatory bowel diseases, though some people may carry a genetic predisposition to IBD. While there is no cure, treatments are available to improve quality of life and minimize long-term complications of the disease.

What are the symptoms of inflammatory bowel disease?

IBD symptoms often mimic those of a GI virus. It is normal to experience abdominal cramping and fever, as well as a loss of appetite. Over time, however, symptoms can grow more severe and include bloody diarrhea, weight loss and nutritional deficiencies. In addition, the symptoms of IBD are either ongoing or recurring, unlike those of a virus which resolve within a few days.

What is the difference between Crohn’s Disease and ulcerative colitis?

Crohn’s is a severe form of IBD that causes inflammation within the entire digestive tract. Ulcerative colitis is less severe, affecting only the large intestine. Diagnosis usually requires a process of elimination to rule out other health problems and diseases that can produce similar symptoms.

What types of IBD treatments are available in Rockville?

Here in Rockville, we are fortunate to have many resources for treating IBD. For many patients, conservative treatment measures, such as the use of immunosuppressants and anti-inflammatory medications are effective for managing IBD. However, some patients will require surgery to achieve adequate relief and improvement in symptoms. IBD surgery can provide a permanent cure for individuals suffering with ulcerative colitis when the entire colon and rectum are removed. Those with Crohn’s however, cannot be cured with surgery; but they may find significant relief when diseased areas of the intestine are removed.

Colorectal cancer is a disease in which cancerous cells form in the tissues along the inner walls of the colon or rectum. The disease typically begins as benign tumors called polyps, which may remain in the colon for several years before becoming cancerous. While not all polyps become cancerous, a small percentage of them eventually do. Preventive colon cancer screening is available to identify and remove these polyps before they become cancerous. Unfortunately, many polyps are not identified and are allowed to progress into malignancy, resulting in a diagnosis of cancer.

Did you know… the average person’s risk for developing colorectal cancer during their lifetime is 1 in 20? It is the third-most common cancer diagnosed among American adults (excluding skin cancers) and responsible for 132,700 new cases every year. Fortunately, the disease is highly treatable – especially in its early stages when it is easiest to cure. To date, there are more than 1 million colon cancer survivors in the U.S. alone, and those numbers are rising year after year.

Frequently Asked Questions

What are the risk factors for developing colon cancer?

Anyone can develop colon cancer, though it is most prevalent in men and women ages 50 and older. It is at this age that people with average risk for the disease should begin screenings for the disease and the pre-cancerous polyps that cause it. Some people – specifically those with ulcerative colitis, a family history of colon cancer, and people of African American descent –should begin screening for colon cancer earlier, as they are at increased risk of the disease.

What are the symptoms of colon cancer?

Colorectal cancer often produces few or no symptoms in its earliest stages. It is often referred to as a ‘silent disease’, in that it typically produces symptoms only after it has progressed. That is why screening is so important, as routine colonoscopies and other exams can pinpoint even the smallest polyps or cancerous lesions before they can spread. When it does produce symptoms, they may include narrow bowel movements, cause bloody stools, bloating or abdominal pain.. Some people also experience changes in bowel habits, such as constipation or diarrhea, and many report unexplained weight loss and fatigue.

What is the treatment for colon cancer?

Colon cancer treatments have improved significantly in recent years, improving long-term outcomes for many patients. Depending on the stage of a patient’s disease, treatment may involve surgery to remove the cancer, affected portions of the colon and any affected lymph nodes, as well as additional treatments, such as chemotherapy or radiation therapy.

Read more about:

• Polyps of the Colon and Rectum

Tomorrow’s Technology, Today.

Dr. Bennett offers the most advanced surgical treatment in colon & rectal cancer available to patients today by utilizing the latest equipment in robotic surgery, the da Vinci Surgical System.

Traditionally a large open abdominal incision, which may extend from the pubic bone to just below the sternum, is used to remove the cancer and then reconnect the digestive track and preserve normal bowel function. Open colorectal cancer surgery can be quite painful for the patient. It also involves an extended hospital stay and increased risk of infection.

Did you know… surgeons who use the da Vinci Robotic System for colorectal surgery are able to complete an entire procedure using only a few tiny incisions? The surgeon maintains full control of the entire surgical process while the robot perfects the precision and accuracy of the procedure. In fact, the da Vinci robot compensates for many types of human error and inadequacies, even going so far as to provide instruments with greater wrist rotation than humans are capable of. It also has the ability to provide high definition magnification of the treatment area, providing the surgeon with a better view during surgery.

Some patients may be eligible for the minimally invasive da Vinci® Surgery for Colorectal Cancer. State-of-the-art da Vinci® technology is used to help the surgeon perform a more precise operation than conventional surgery allows. The da Vinci® Surgical System provides the surgeon with enhanced capabilities, including high-definition 3D vision and a magnified view, as the surgery is performed through just a few tiny openings.

Unparalleled Accuracy leading to Results

The da Vinci Surgical System provides surgeons with optimal precision and dexterity in the most minimally invasive procedures. For patients, that means that da Vinci® Surgery may offer numerous benefits over traditional open surgery including:

• quicker return to a normal diet and bowel function
• significantly less pain
• less blood loss and risk of wound infection
• shorter hospital stay and recovery time

Genetic testing is an important part of our practice here at Metro Colon and Rectal Surgery PC , as we believe the information it provides can be life-saving for patients with a predisposition to colon cancer. Hereditary nonpolyposis colorectal cancer (Lynch Syndrome) and familial adenomatous polyposis (FAP) are the two most common inherited colon cancer syndromes. Those with Lynch Syndrome – the most common of the two syndromes – have an 80 percent chance of developing colon cancer in their lifetimes. For those with FAP, the rates of cancer rise to nearly 100 percent. Genetic testing can help identify a person who is at increased risk of colon cancer and provide options for early screenings and interventions.

Did you know… that approximately 5 percent of all cases of colorectal cancer are caused by inherited disorders? Testing positive for a condition like Lynch Syndrome significantly increases the risk of developing colon cancer at some point in life – often at an early age. Not to mention, the condition can also indicate a higher risk of other cancers, such as stomach and uterine cancer.

Frequently Asked Questions

Who should undergo colorectal genetic testing?

Anyone with a parent, sibling or other blood relative with Lynch Syndrome or FAP should also be screened hereditary colon cancer syndromes. We also recommend that every patient diagnosed with colorectal cancer also consider genetic testing, as doing so can help other family members determine whether they are at risk.

What can I expect from colorectal genetic testing?

We are proud to offer highly advanced medical screenings that search for known gene mutations associated with Lynch Syndrome and FAP. For Lynch Syndrome, there are a number of genes we look for, including MLH1, MSH2, MSH, PMS2 and EPCAM gene mutations. Our tests also look for mutations in the adenomatous polyposis coli (APC) gene, which is responsible for most cases of FAP. However, it is important to note that a small percentage of FAP cases are caused by new and unknown gene mutations.

What happens if my colorectal surgeon detects an inherited colon cancer risk?

For patients with Lynch Syndrome, genetic testing provides the opportunity to have earlier and more frequent colon cancer screenings, which increases the likelihood of preventing colon cancer in the future. Those with FAP may be offered medical options for reducing cancer risk or otherwise identifying colon cancer in its earlier and more treatable stages.

A pilonidal cyst is an accumulation of hair and skin debris that typically occurs at the base of the tailbone. These cysts become infected, filling with pus. In most cases, they resemble an enlarged pimple, though they can grow to become an enlarged mass. It is not uncommon for a hole or small tunnel to develop in the skin surrounding these cysts. These cavities are known as pilonidal sinuses, and they can make a person prone to recurrent infections. Also known as pilonidal disease, this condition almost always requires colorectal surgical treatment to fully resolve.

Did you know… pilonidal disease was first ‘discovered’ and documented 1833? It took many decades before the condition was named. The term pilonidal is a derivative of two Latin terms; the first – pilus – meaning ‘hair’, and the second term – nidus – meaning ‘nest’. Today, doctors and researchers better understand this condition, which is most common between 15 to 30 years of age.

Frequently Asked Questions

What are the risk factors for developing pilonidal cysts?

Aside from being a young adult, other factors believed to increase the risk of pilonidal disease include obesity, coarse and stiff hair, a sedentary lifestyle and a family history of the condition. People who wear tight clothing or participate in certain exercises like horseback riding or bike riding may also be prone to developing blocked hair follicles.

What are the symptoms of a pilonidal infection?

A pilonidal cyst is visible and palpable to the touch. It is normal for a cyst to drain blood, pus or even clear liquid, growing increasingly red and tender over time. An infection typically causes pus with a foul odor and is sometimes accompanied by fever.

How will a colorectal surgeon treat pilonidal disease?

Treatment for pilonidal disease usually includes draining an acute abscess. This process is quick and typically performed under local anesthesia in the comfort of your doctor’s office. For chronic conditions, surgery may be needed to excise the sinuses surrounding the cysts.

Read more about Anorectal Disorders

• Anorectal Abscesses and Fistulas 
• Anal Fissures
• Hemmroids

Volvulus is a serious condition caused by a twisting of the bowels. It occurs when the bowels lack normal attachments inside the abdomen allowing them to twist and rotate. The condition obstructs the flow of the bowel and the intestine can infarct. It is essential to seek immediate treatment for volvulus  to maximize outcomes and prevent serious complications. In most cases, people who receive prompt treatment for volvulus do not experience long-term complications.

Did you know… that most cases of volvulus are caused by a birth defect known as malrotation? Some people with intestinal volvulus never experience symptoms and are never diagnosed during their lifetimes. Others develop symptoms later in life and are eventually diagnosed in adolescence or adulthood. The majority of people with this congenital abnormality, however experience symptoms within the first year of life.

Frequently Asked Questions

What are the symptoms of volvulus?

A person with volvulus will have symptoms that mimic those of a bowel obstruction. The symptoms can appear suddenly and include abdominal pain, vomiting bile, bloody stools, severe constipation or a distended abdomen. Rapid heart rate and rapid breathing are also common with this condition. Less commonly, the symptoms of volvulus may come and go in intermittent episodes, seeming to resolve on its own. This situation occurs as a result of the bowel twisting and untwisting on its own.

How does a colorectal surgeon diagnose volvulus?

We have many diagnostic tools by which we can diagnose volvulus in a patient. Specifically, these include x-ray imaging such as a CT scan of the GI tract, which can reveal a twisted bowel. Other tests include blood tests and stool sampling, as well as a barium enema to diagnose malrotation of the bowel.

What happens during volvulus surgery?

In most cases, volvulus is an emergency condition that requires immediate surgery. During the procedure, which may be performed with minimally invasive techniques, the bowel is untwisted and any dead tissue or inadequately attached segments of the bowel are removed.

Fecal incontinence is an embarrassing condition in which a person is unable to fully control his or her bowels. For some, it is an occasional bowel leakage, such as when passing gas. For others, however, fecal incontinence can be a total loss of bowel control. Though it usually is not caused by a serious medical issue, bowel incontinence is disruptive to overall quality of life, preventing many people from enjoying activities or social events for fear of embarrassment. We encourage anyone experiencing fecal incontinence to seek medical attention for the condition. With treatment, many patients are able to return to normal bowel control and prevent painful skin irritation that is often associated with the condition.

Did you know… some cases of fecal incontinence can be resolved with  supervised muscle strengthening exercises with biofeedback monitored by a trained physical therapist. This approach improves incontinence in 50% of patients.

Frequently Asked Questions

What are the causes of fecal incontinence?

The cause of fecal incontinence can be one of many different reasons, including medical conditions such as diabetic nerve damage, injuries sustained during vaginal delivery, advanced age, or previous anorectal surgery. Sometimes, fecal incontinence is brought on by problems with bowel movements, such as chronic diarrhea, constipation, or chronic straining.

Who is at risk of developing poor bowel control?

Nearly everyone experiences fecal incontinence at some point, though it usually occurs during short-term bouts of diarrhea. Middle-age to senior females – especially those who have given birth – are at a slightly higher risk of fecal incontinence than the rest of the population. In fact, estimates suggest that 10 percent of all women over age 40 have some degree of fecal incontinence.

What kinds of fecal incontinence treatments are offered ?

Treatment for fecal incontinence varies depending on the cause of the condition. For some, medication or lifestyle changes are enough to resolve the problem. For others, colorectal surgery may be necessary to repair a damaged sphincter muscle, treat a rectal prolapsed or address some other related condition. Your colorectal surgeon may examine the anal area and use a probe to gently test the muscles around the anus. Additional tests, such as a anal manometry, MRI, or balloon expulsion test, may be necessary to determine the cause of incontinence.

Diverticulosis and diverticulitis are disorders of the colon sometimes referred to as ‘diverticular disease’. The disease occurs in the colon, where pouches can form and bulge out from the colon walls. This condition – diverticulosis – does not cause symptoms on its own. Pouches that develop blockages can become irritated, infected and inflamed – a condition known as diverticulitis.

Did you know… many people live with diverticulosis for a long time before receiving a diagnosis? This is because diverticulosis is generally asymptomatic. At most, people with this condition may experience some mild bloating, cramps and blood in the stool. Unless they develop diverticulitis, many people are not diagnosed with diverticular disease until they have a routine colonoscopy or other diagnostic test ordered for unrelated reasons.

Frequently Asked Questions

What are the symptoms of diverticulitis?

A person experiencing an acute diverticulitis attack may develop a fever and experience severe abdominal cramping. It is often accompanied by vomiting, nausea and constipation. It is important to see a doctor if these symptoms occur, as treatment may be necessary.

Who is at risk for developing diverticular disease?

Diverticulosis and diverticulitis typically occurs in adults – particularly those over age 40. At that age, the risk gradually increases, with an estimated 50 percent of people over age 60. Only a small percentage of people with diverticulosis develops a problem with their disease.

Will I need surgery to treat my diverticulosis or diverticulitis?

We always suggest conservative treatments, such as increased fiber and water consumption, to prevent complications. Some people will require medical interventions. Antibiotics and a short-term liquid diet can help treat a diverticulitis attack, however, some individuals with recurring attacks will require colon surgery to remove an area of diverticular disease of the colon prone to infections.

Read More About:

• Inflammatory Bowel Diseases

Crohn’s Disease is a debilitating gastrointestinal disease that causes chronic inflammation of the gastrointestinal tract. A form of inflammatory bowel disease, an estimated 700,000 people are believed to have Crohn’s Disease in the U.S. alone. The condition affects both genders and people of all ages, though it is most prevalent among young adults and adolescents. People with Crohn’s Disease have altered immune systems that perceive healthy bacteria as a threat, causing the body to constantly fight these organisms. Over time, the walls of the intestines thicken and suffer irreversible damage.

Did you know… the symptoms of Crohn’s Disease typically come in ‘waves’ or ‘flare ups’? These usually include severe abdominal pain, cramping, fever, constipation and diarrhea. Crohn’s symptoms may be exacerbated by certain lifestyle factors, such as stress and diet. Managing these components can help reduce the frequency and severity of flare-ups, although people with Crohn’s require medical management of the condition.

Frequently Asked Questions

What are the risk factors for Crohn’s Disease?

Researchers are not sure exactly what causes the condition, but they do know that some people are genetically pre-disposed to developing the disease. In fact, as many as 1 in 5 people with Crohn’s have a close relative with the disease. Researchers also believe that Crohn’s can be ‘triggered’ by other external factors, such as certain foods, cigarette smoke, or even certain types of bacteria. Once the reaction has begun, it cannot be stopped. Anyone can develop Crohn’s – including those with no family history of the disease.

What are the complications of Crohn’s Disease?

Crohn’s Disease tends to worsen over time when not properly managed. In addition to severe discomfort, people with this condition may experience weight loss, ulcers, skin rashes, and inflammation of the eyes and mouth. Children may have stunted growth due to nutritional deficiency. Some people with Crohn’s Disease develop secondary disorders, such as arthritis, gallstones and kidney stones.

How can a colon and rectal surgeon treat Crohn’s Disease?

The first line of treatment for Crohn’s Disease is always as conservative as possible and may include the use of nutritional supplements and medications. There is no cure for Crohn’s Disease, but many people are able to reduce inflammation, avoid nutritional deficiency and alleviate uncomfortable symptoms with treatment.

When drug therapy and other treatments are not effective, surgery may be recommended to remove the damaged portion of the digestive tract and reconnect the healthy sections. In fact, approximately 50 percent of all patients with Crohn’s Disease will eventually require at least one surgery to treat the condition. In some cases, surgery may also be used to drain perianal abscesses and treat anal fistulas.

There are several types of Hereditary Polyposis Syndromes, all of which are characterized by multiple polyps growing throughout and sometimes outside of the colon. While rare, the conditions are genetic, meaning they are passed down through generations of the same family. Researchers have identified cause of hereditary polyposis, and it is now known to be secondary to a gene mutation. Treatment for people who live with one of these diseases typically consists of genetic testing, regular screenings, polyp removal, bowel resection, removal of other organs and treatment of malignancies.

Did you know… that all hereditary polyposis syndromes can be classified into one of two categories? Hamartomatous polyposis syndromes are the most common and are characterized by widespread growth of non-cancerous juvenile polyps throughout the colon. Adenomatous polyposis syndromes, however, cause growths along the lining of the colon that are at risk of becoming cancerous. The hereditary polyposis syndromes include: Peutz-Jeghers syndrome Juvenile polyposis Cowden’s disease Familial adenomatous polyposis Gardner syndrome Turcot syndrome Lynch syndrome (HNPCC)

 

Frequently Asked Questions

I have a family member with hereditary polyposis syndrome. Do I need to be screened?

If you have a blood relative with one of the hereditary polyposis syndromes, it is important that you be screened for the condition yourself, regardless of your age. The type and frequency of screenings vary according to the type of disease a person has. For example, children in early adolescence who have been diagnosed with Peutz-Jeghers syndrome may need to undergo frequent upper and lower endoscopies.

Is there a higher risk of cancer associated with hereditary polyposis syndrome?

Yes, especially in people with adenomatous polyposis syndromes. Polyps and growths in these individuals almost always become cancerous by age 40. People with hamartomatous polyposis syndromes have a lower risk of cancer, though it still remains much higher than in people without hereditary polyposis syndromes.

How will a colorectal surgeon treat this condition?

Surgical treatments are often used to remove lesions and polyps within the GI tract and biopsy areas suspected of malignancy. In some individuals, a partial or subtotal colectomy may be necessary to reduce the risk of developing colon cancer.