Anorectal Disorders

Your rectum and anus sit at the end of your digestive system. Your body expels solid waste from the anal canal after absorbing water and nutrients from the food you eat. The anus and rectum are vital to the body's system of waste disposal, so anorectal conditions affect routine activities like going to the bathroom.

Body structure, diet, lifestyle and bacteria present in the waste produced by your body can all cause anorectal disorders. These disorders include:

• Anal cancer
• Anal fissures
• Anal fistula
• Anorectal abscesses
• Fecal incontinence
• Hemorrhoids
• Rectal prolapse

Although many people are reluctant or embarrassed to see their doctors about anorectal disorders, doing so is a critical step to maintaining good health. Diseases like colon or anal cancer have symptoms that can be mistaken for those of less serious anorectal disorders, like hemorrhoids or fissures. Only a physician can make an accurate diagnosis of the cause of your symptoms.

Surgeons at Cedars‑Sinai specialize in using minimally invasive surgery to treat a wide range of anorectal conditions. We help you get relief from conditions like fistulas, hemorrhoids and rectal prolapse. We also work with experts in our Colorectal Cancer Center to treat anal cancer.

Our treatment options for anorectal disorders include:

Anal Fistula Removal and Repair

We may remove smaller fistulas during an outpatient procedure. However, large fistulas require a more advanced approach, which may involve one or a combination of several options:

• Fistulotomy: removing the entire fistula and surrounding tissue 
• Fistula closure: closing the fistula opening with a flap (advancement rectal flap) or collagen and glue (fibrin)
• Ligation of intersphincteric fistula tract: a two‑step process to divide and then drain the fistula
• Seton placement: placing a loose thread to drain infection and keep the fistula open

Hemorrhoidectomy

Some hemorrhoids heal on their own or require nonsurgical treatments. Others need surgery to heal appropriately. We may recommend:

• Hemorrhoidectomy: removing the hemorrhoid and surrounding tissue
• Infrared light: using infrared light to harden and shrink the blood vessels
• Rubber band ligation: tying a small surgical band around the hemorrhoid to cut off the blood supply 
• Sclerotherapy: injecting chemicals into the hemorrhoid to help it shrink 
• Staples: stapling the hemorrhoid to cut off the blood supply

Reconstructive Surgery

An anal sphincter tear can have many causes, including cancer, childbirth, trauma and incontinence. We offer reconstructive options to rebuild the weakened or torn parts of the sphincter and anus to reduce pain and discomfort.

Transanal Endoscopic Microsurgery (TEMS)

Our surgeons offer an advanced technique for anorectal conditions that requires specialized skill and training. Transanal endoscopic microsurgery is a minimally invasive procedure to remove rectal polyps and tumors. We access the area through the anus instead of the abdomen. This technique offers many improvements, including:

• Precise tissue removal 
• Faster recovery time 
• Less bleeding
• Less scarring
• Lower risk of infection
• Less postoperative pain 

Managing your diet and lifestyle can help prevent or minimize many of the factors that lead to anorectal disorders. Here are suggestions that can help you maintain the best possible digestive health:

Avoid standing or sitting for long periods of time. These activities can put pressure on the veins in your anus and have the potential to cause hemorrhoids. If you must sit, consider using an inflatable doughnut cushion to pad your chair.

Do not rely on stimulant laxatives. These products work by irritating the walls of your intestines. Continual use can damage your bowels or make constipation worse. It is better to rely on a healthy diet with plenty of fresh fruits, vegetables and whole grains or to use a fiber supplement.

Do not strain. Straining, pushing or holding your breath during a bowel movement creates greater pressure in the veins of the lower rectum. Having a bowel movement should be a natural process.

Drink plenty of fluids. Having enough water is important for your digestion. The fiber you eat absorbs liquid, helping to make your stools bulkier and softer. The National Research Council (NRC) recommends that the average man should have about 12 cups of water (almost three liters) each day, while the average woman needs about nine cups (a little over two liters). Some of this fluid will come from the fruits, vegetables and other foods you eat or drink.

Eat high‑fiber foods. Eating more fruits, vegetables and unprocessed grains can help increase the bulk of your stools. Fiber also makes your stools softer. As a result, having a bowel movement involves less strain or pressure on your rectum and anus.

Eat meals on a regular schedule. This habit can help you avoid constipation. It is also a sound way to avoid overeating when you do have a meal.

Eat moderate proportions. Overeating produces more food waste and discomfort in your digestive system. Large meals put more demands on your digestive system all along the tract. In addition, overeating can lead to weight gain, which further stresses your body.

Exercise regularly. Exercise helps strengthen your muscles, including those of your bowel. Exercise also helps raise your metabolism and move food through your stomach and intestines more quickly. It also helps reduce the pressure on your veins.

Go to the bathroom as soon as you feel the need. Having a bowel movement as soon as you feel the urge to is an important step for digestive and bowel health. Delaying going to the bathroom can make your stool dryer and harder to pass.

Pay attention to your own body and how it responds to different foods. Some foods can have a laxative effect on our systems while others can have a constipating effect. Pay attention to foods that cause problems for you. Often dairy products or foods that are high in fat or sugar can cause digestive problems, including constipation and gas.

Relax while you eat. Being relaxed while you eat ensures that you chew your food well, your digestive juices flow more freely and the muscles in your stomach and intestines contract and relax regularly. Eating when you are under a lot of stress can affect how your intestines work, leading to stomach upset, bloating, constipation, diarrhea or a tendency to strain when having a bowel movement.

Take fiber supplements, if needed. If you are concerned about getting enough fiber in your diet, you may want to discuss fiber supplements with your doctors. Products, such as Metamucil™ or Citrucel™, that contain psyllium husks or cereals that contain bran can help keep stools soft and regular. If you do use fiber supplements, be sure to drink eight to 10 glasses of water or other fluids every day to avoid getting constipated. Add fiber to your diet slowly to allow your digestive system to adjust to it and to avoid gas.

Use medicines wisely. Most drugs have some effect on your digestion. While often mild or barely noticeable, some that are taken on a regular basis can be potentially damaging. Some narcotics given for pain relief can cause constipation; some high blood pressure drugs can cause diarrhea or constipation; and some antibiotics for infections can cause stomach upset or diarrhea. Certain pain‑relieving medications (e.g., aspirin, ibuprofen or naproxen) can upset your stomach and cause stomach bleeding, ulcers or diarrhea. Always ask your doctor or pharmacist about potential side effects and take medications as prescribed.

What causes blood in the stool? If I have this for more than a few days, should I be worried?

Many different conditions, including some that are life‑threatening, can cause blood in the stool. Bleeding could be a result of diverticulitis, inflammatory bowel disease or colorectal cancer. Bright red blood on toilet paper after wiping may be due to hemorrhoids or minor tears (fissures) in your anus caused by straining while moving your bowels. Certain foods, such as beets or licorice, can also turn your stools red.

No matter what you think the cause might be, you should talk to your doctor. Only a doctor can make an accurate diagnosis of what is causing the bleeding. Not only can he or she rule out more serious conditions, but also new techniques have made it possible to treat anorectal disorders quickly and with little pain on an outpatient basis.

I keep hearing that fiber is good for my digestive tract. How do I know how much I need?

According to the National Academy of Sciences' Institute of Medicine, most people need 21 to 38 grams of fiber each day. Foods like fruits, vegetables, whole grains and legumes (e.g., beans and lentils) contain fiber. Many people, however, do not get enough fiber in the food they eat.

Is it okay to take fiber supplements on a regular basis?

Fiber is important to your digestive process. It provides bulk to your stools and keeps them soft enough to pass easily through your body. Getting most of your fiber from fresh fruits, vegetables and unprocessed grains in your food is always the best option, but there is no evidence that taking fiber supplements regularly causes harm to your body.

When you start taking fiber supplements, start slowly to give your body time to adjust to the change, and be sure to drink plenty of water. If you have chronic constipation, a sudden change in bowel habits or abdominal pain, you should consult your doctor.

Is it possible to have too much fiber?

Ingesting a lot of fiber may affect how well your body can absorb important minerals. Insoluble fiber, such as that found in whole wheat, is more likely to interfere with mineral absorption than soluble (absorbs water) fiber, such as found in oats, dried beans and fruit. Phytate and oxalate (found in the husks of grains, seeds, dried beans and some vegetables) can keep your body from absorbing iron, calcium and zinc as well as it should.

As long as you are eating a wide variety of foods, it is unlikely that this will be a problem. In addition, if you start out taking high dosages of fiber supplements when your body is not used to it, you may experience gas and bloating.

How do I know when I should see a doctor about my digestive problems?

Many digestive problems can be corrected by time or better managing your diet and lifestyle, but not all of them. Some anorectal disorders can be brought on by infections or inherited conditions. If you have symptoms that do not go away or that involve pain, a sudden change in bowel habits or bleeding, you should check with your doctor.

What is a rectocele?

A rectocele is a bulge or hernia in the front wall of the rectum that pushes into the vagina. A tough, fibrous tissue separates the rectum from the vagina, but if this weakens, part of the rectum can protrude into the vagina. Rectoceles most often occur in postmenopausal women, and they can be caused by stretching and pushing while giving birth, chronic constipation, a chronic cough or repetitive heavy lifting.

Small rectoceles may produce no symptoms, but larger ones can cause tissue to bulge through the vaginal opening, difficulty in bowel movement or a feeling of pressure on or fullness in the rectum. Rectoceles can be treated with surgery or by inserting a ring (pessary) into the vagina to support the connective tissue.