Gastrointestinal specialists and surgeons in the Center for Advanced Digestive Care (CADC) of NewYork-Presbyterian/Weill Cornell Medical Center treat a range of anorectal disorders, including hemorrhoids, anal fistulas, infections, fecal incontinence, and anorectal cancer. Our doctors have developed novel treatments for fecal incontinence (also known as bowel incontinence), improving the quality of life of our patients. Surgeons employ minimally invasive approaches for patients who cannot tolerate conventional rectal surgery. Whatever the diagnosis, CADC physicians customize a plan of care to meet the individual needs of each patient.
Anal fistulas are abnormal small channels or connections between the rectum and the nearby skin. Patients may have pain, redness, or swelling in the area around the anus.
Anal fistulas often develop from an acute infection of an anal gland, located inside the opening of the anus. The infection causes an abscess to form, which then develops into a fistula leading to the outside skin. Anal fistulas may also be caused by surgery, Crohn's disease, or radiation therapy.
Diagnosis Of Anal Fistulas
Fistulas must be carefully assessed to determine their exact location inside the anus. To do this, CADC physicians usually use an anoscope -- a small instrument to view the anal canal. Sometimes the exam is performed in the operating room. In order to rule out Crohn's disease or ulcerative colitis, the physician may perform either a colonoscopy or sigmoidoscopy.
Anal (anorectal) cancer is rare. About 5,000 Americans are diagnosed with anal cancer each year.
Diagnosis Of Anal Cancer
CADC physicians first perform a physical examination of the patient and take a full medical history.
- The doctor will do a digital rectal examination by inserting a lubricated, gloved finger into the lower part of the rectum to check for lumps or anything unusual.
- The physician may also use an anoscope or proctoscope (short, lighted tubes) to examine the anus and lower rectum, and perform an endoanal or endorectal ultrasound.
- A colonoscopy may be performed to evaluate the rest of the colon.
- Finally, the doctor may take a biopsy (tissue sample) to be analyzed for cancer if an area appears abnormal.
Anal Cancer Treatment
The treatment of anal cancer depends on its stage (how big it has gotten and whether it has spread to nearby tissues).
- Chemotherapy and radiation therapy are generally the first types of treatment.
- Surgery for small, contained cancers, or cancers located in the lower part of the bowel, is usually able to be completed while preserving the anal sphincter muscles. These sphincter-preserving surgeries can be done in a few different ways, including robotic and endoscopic means.
- For more extensive cancers, CADC surgeons perform a procedure to remove the anus, rectum, part of the lower colon, and lymph nodes through an incision made in the abdomen.
- Some patients who cannot tolerate open abdominal surgery are able to undergo transanal endoscopic microsurgery to remove a small cancer.
The goal of anorectal cancer surgery is to remove cancerous tissue while preserving as much normal function as possible.
Fecal Incontinence (Bowel Control Problems)
Fecal incontinence (bowel incontinence) is characterized by an inability to control bowel movements. More than 5.5 million Americans have fecal incontinence, which affects both adults (more women and older adults) and children. It may be caused by a number of conditions:
- An abscess or inflammation in the rectum or anal area
- Damage to the anal sphincter muscles or pelvic floor muscles from complications of childbirth
- Nerve damage from childbirth neurologic disorders
- Complications of a previous operation
- Damage to nerves that control the anal sphincters resulting from a stroke, diabetes, or multiple sclerosis
- Hemorrhoid surgery
- Chronic constipation or diarrhea
- Radiation treatment and rectal surgery, causing a loss of storage capacity in the rectum
Diagnosis Of Fecal Incontinence
To diagnose fecal incontinence, CADC physicians conduct a number of tests, including:
- Anal manometry, which measures the strength of the anal sphincter muscles and their ability to respond to signals.
- An MRI and/or an anorectal ultrasound may also be done to visualize the structure of the sphincter.
- Proctography (also known as defacography) shows how much stool the rectum can hold, how effectively it holds it, and how effectively the rectum can empty.
- Proctosigmoidoscopy enables the physician to view the inside of the rectum and lower colon to detect disease or other problems that can cause fecal incontinence, such as inflammation, scar tissue, or tumors.
- Anal electromyography, which uses tiny needles to measure nerve damage, may also be done to check for nerve damage caused by injury during childbirth.
Treatment For Fecal Incontinence
Treatment for bowel incontinence depends on the cause and severity of the condition, and may include medication, dietary changes, biofeedback, or surgery. Often more than one therapy or procedure is used to treat fecal incontinence.
Our surgeons perform procedures to repair injury to the sphincter mechanism or to constrict the sphincter using the patient's tissue or a device. Minimally invasive surgery may be possible for patients with rectal prolapse, where the walls of the rectum protrude through the anus, resulting in postoperative pain after surgery, less medication, and more rapid healing when compared with traditional open surgical techniques.
CADC physicians now offer sacral nerve stimulation to treat fecal incontinence. With this approach, a small pacemaker-like device is implanted under the skin and stimulates the sacral nerve in the lower back to restore bowel control.
Most adults have hemorrhoids, but only some cause symptoms. With hemorrhoids, blood vessels located in the anal area become swollen or inflamed. Hemorrhoids may be internal (inside the anus) or external (outside the anus). For more information about hemorrhoids, visit our Health Library.
Diagnosis Of Hemorrhoids
Bleeding from the anus after a bowel movement may indicate a hemorrhoid. The presence of blood in the stool can also result from other digestive disorders, including colorectal cancer, so it is important to see a doctor to determine the cause.
To diagnose hemorrhoids, CADC physicians examine the anal area for swollen blood vessels and also perform a digital rectal exam using a gloved, lubricated finger to detect any abnormalities. They also use an anoscope or proctoscope to view the anal tract. To rule out other causes of bleeding, the physician may examine the entire colon or large intestine with colonoscopy, or just the bottom section using sigmoidoscopy.
How To Treat Hemorrhoids
The treatment of hemorrhoids depends on a patient's age, overall health, extent of the condition, and medical history. Medical treatment of hemorrhoids is aimed at relieving symptoms and may include:
- Sitting in plain, warm water in the tub several times a day
- Ice packs to reduce swelling
- Application of hemorrhoidal creams or suppositories
- Increasing fiber and fluids to soften stools
In some cases, it is necessary to treat hemorrhoids with surgery. At the CADC, several surgical techniques are used to remove or shrink internal and external hemorrhoids, including:
- Rubber band ligation
- Electrical or laser coagulation / infrared photo coagulation