Expert: Jennifer Davids, MD,
colorectal surgeon at UMass Memorial Medical Center and assistant professor of surgery at the University of Massachusetts Medical School. Her clinical interests include colorectal cancer, inherited colorectal cancer syndromes, minimally invasive surgery and inflammatory bowel disease.
Q: I have been diagnosed with full thickness rectal prolapse. Is there anything I can do besides surgery to help this? Are there any minimally invasive procedures to repair this? I am 50 years old in relatively good shape and health.
A: The organs that reside in the pelvis, including the rectum, as well as the bladder, vagina, and uterus, are normally suspended by ligaments and muscles within the pelvic floor. Over time, these muscles and ligaments can stretch and weaken, causing the pelvic organs to descend, or "prolapse" through the pelvis. In the case of rectal prolapse, patients will observe the presence of rectal tissue, which is smooth, moist, and pink, protruding through their anus. This generally will occur following an episode of straining or constipation, or bearing down while lifting a heavy object. The tissue may spontaneously return back through the anus, or it may require direct pressure to encourage it back in place. In some instances, the protruding tissue becomes stuck out of the anus, a condition that requires urgent medical evaluation.
Ultimately, rectal prolapse requires surgery to correct. The goal of surgery is to prevent the rectum from prolapsing again. There is a spectrum of surgical approaches available to treat this condition-- we perform these here in the Division of Colon and Rectal Surgery at UMass Memorial. In general, abdominal approaches are more appropriate for younger, fit patients, such as yourself. These procedures aim to re-suspend the rectum inside the pelvis, thereby preventing prolapse. This can be done through an open incision or laparoscopically, which is a minimally invasive technique with only a few tiny incisions. There are also techniques that involve surgically excising the prolapsed segment of rectum through the anus, which does not require an abdominal incision. This does have a higher rate of re-prolapse, or recurrence, and is generally favored for older patients who may have many other medical problems. Our team of Colon and Rectal Surgeons here at UMass Memorial has significant experience and expertise in treating rectal prolapse, and can help you make a decision that's right for you. Feel free to contact us at 508-334-8195.
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Q: Can anal sex cause problems with your colon? Does it increase the chances you'll get colon cancer? Thanks.
A: Unprotected anal receptive intercourse is a means of transmitting the Human Papilloma Virus (HPV), a sexually transmitted disease (STD). Infection with certain strains (or types) of HPV is associated with development of anal condyloma (warts) or anal cancer. Anal cancer occurs in the anal canal and anal skin. Anal cancer is different from colorectal cancer in many ways. Colorectal cancer is not associated with HPV and therefore is not a known risk of having anal sex. It's safest to always use a condom for any type of sexual activity, although this only provides 70% of protection against HPV, as it does not prevent all skin-to-skin contact. Talk to your doctor if you have anal or genital warts, anal pain, or rectal bleeding.
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Q: I recently read that a daily aspirin reduces risk of colon cancer. I am 45 years old and have a family history of colon cancer. Should I be taking an aspirin or 2 a day?
A: There is a lot of publicity in the media about studies linking aspirin to decreased risk of colorectal cancer. This link between aspirin and colon cancer risk reduction initially came as an unexpected finding in a large population-based study in the late 1980s. Since then, many observational studies and clinical trials have been conducted in an attempt to determine the true effects of aspirin on colorectal polyps (precancerous lesions) as well as colorectal cancer. Many of these studies have shown a reduction in overall risk of polyps and cancers, but this also comes with increased risk of side effects from long-term aspirin use, which include gastritis and ulcer disease.
Currently there is no agreement on what dose of aspirin is needed, and for how long treatment should be. Further research is ongoing to determine the best dose and timing, as well as to see if a particular subgroup of the population would benefit more than others. Aspirin also has a known benefit to the cardiovascular system, so people with underlying cardiovascular disease may also receive this additional benefit by taking the drug on a daily basis. People with a family history of colorectal cancer, such as yourself, or those with prior polyps that have been removed, may have more to gain from long-term aspirin therapy.
The data is not yet out on this-- stay tuned! In the meantime, it would certainly be valuable to have this conversation with your primary care physician who knows you best. Also make sure that you are undergoing screening colonoscopy. You may already be due for a colonoscopy if your affected family member was a first-degree relative (mom, dad or a sibling).
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Q: If I have colon cancer will I need a "bag"?
A: Many people are concerned that, if they require surgery for colorectal cancer, they will need a "bag," also called a stoma or ostomy. A stoma is a small opening in the abdominal wall and skin through which the intestine or colon is brought and attached. This allows the bowel contents to be drained externally into a small plastic bag that adheres to the skin. This is easily concealed under your clothing.
In a healthy person, the colon is a roughly 3-foot long tube (the last 15cm is referred to as the rectum), through which fecal contents pass, and exit through the anus (in the form of a bowel movement). The sphincter muscles wrap around the anus and help you to control your stools. One of the major advances in colorectal surgery over the past 20 years is the introduction of "sphincter-sparing surgery," which allows patients to retain the normal function of their gastrointestinal (GI) tract, without the need for a colostomy bag. When a patient comes to my office with colorectal cancer, my priority is not only to remove and treat the cancer, but also to restore GI function to normal whenever possible. With that being said, this is not always possible, particularly for certain rectal cancers that are on or near the sphincters, for cancers that have caused a blockage, or for patients who have baseline incontinence (inability to control bowel function). Sometimes, when sphincter-sparing surgery is performed, particularly for rectal cancer, is it necessary to have a temporary stoma, to divert the fecal stream while the rectum heals from the operation. In this instance, an additional operation will be needed to "reverse" the stoma and put the intestinal tract back in continuity.
Many patients who require stomas, either permanent or temporary, are initially overwhelmed, but most everyone adapts quickly and they are able to return to their normal activities. Here at UMass Memorial Medical Center, it is very important to us that all patients with stomas have support. Our patients are visited by our enterostomal therapists before they are discharged, and they continue to receive visiting nurse support at home. Our outpatient practice also includes an enterostomal therapist and a nurse who specializes in stoma-related issues. Additionally, we now are pleased to offer a monthly Ostomy Support Group at our office at 67 Belmont Street in Worcester. The first meeting will be on September 18 from 6-7pm. Call us for more information: (508) 334-8195.
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Q: My father died of metastatic colon cancer. My question is can taking fiber supplements and vitamin D supplements help decrease your chances of developing colon cancer. If so how much of each supplement should be taken daily.
A: Like many other cancers, colorectal cancer is thought to have both a genetic and environmental component. We know that individuals such as yourself, with a parent, sibling, or child with colorectal cancer, are at increased risk. Other than undergoing screening colonoscopy to detect and remove polyps (precancerous lesions), is there anything else that is recommended to decrease the risk of developing colorectal cancer, such as dietary modifications, vitamins, or supplements? This is a great question.
To date, there have been several large environmental studies that have shown mixed results with respect to dietary fiber and colorectal cancer risk reduction. Each of these studies had somewhat different and contradictory findings, and many did not descriminate between the type and amount of fiber consumed. Despite the lack of clear data supporting fiber as a colorectal cancer risk-reducer, we nevertheless recommend consuming a total of 25-35g of fiber per day for optimal colon health. Most Americans will find that this is substantially more than they normally consume, even with a diet fairly rich in fruits and vegetables. Fiber adds bulk to the stools and regulates the consistency, preventing the stools from becoming either too hard or soft. Fiber supplements can be purchased over the counter at the drug store, and are sold as powders, gummy chews, or biscuits.
Similarly, the data are also somewhat mixed for vitamin D. Vitamin D can be taken as a dietary supplement and is naturally in some foods (such as fish), but it is also produced by the skin upon exposure to sunlight. Interestingly, it has been observed in large studies that people living in high latitudes, who have the lowest vitamin D levels, have the highest risk for colorectal cancer and many other cancers. Scientists have discovered numerous mechanisms by which vitamin D may prevent cancer growth, through a variety of molecular pathways. Despite these promising links between vitamin D and reduced risk of cancer, more controlled studies, in which people were given large doses of vitamin D, failed to show a benefit in terms of actual colorectal cancer risk reduction. The bottom line is that there currently is insufficient evidence to recommend vitamin D supplementation for the purpose of reducing risk of colorectal cancer. As a side note, I also want to mention that it is also not recommended to sunbathe for the purposes of getting adequate vitamin D. This activity is associated with an increased risk of skin cancer, a risk far more substantial than any potential benefit of vitamin D.
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Q: My deceased Mom had colon Ca. My question is, does severe rectal itching, for 10 years, ...scratching, bleed at times. Had fissures. Negative Colonoscopies x 5. Have any bearing on Colon or retal Ca in the future? No constipation, diarrhea or other GI problems. What causes the intense itching? GI doctor did not find any cause. I am clean and dry.
A: I am glad to hear you have been keeping up with getting colonoscopies on a regular basis. Because of your family history of colon cancer, you should never wait more than 5 years between colonoscopies. Having your screening colonoscopies is the your best defense against colon cancer. On average, it takes a colon cancer 10 years to grow from a tiny polyp, which is a precancerous lesion. Polyps are removed at the time of colonoscopy, before they ever have the chance to progress to a cancer.
Regarding your symptoms of itching-- this alone does not confer an increased risk of colorectal cancer. Your description of persistent burning, itching, and scratching sounds consistent with a benign condition called 'pruritis ani.' Patients with this condition report itchy Skin around the anis. When this skin is scratched, it becomes thickened, cracks, and may bleed. Attempts to improve hygeine with creams, soaps, and wipes only aggravate the situation. Symptoms may be worsened by certain foods, including coffee, red sauce, and chocolate. Diarrhea may also exacerbate the discomfort. The best initial way to treat pruritis is to avoid soap and alcohol-based wipes, and to only use water and gentle toilet paper. Once the perianal skin is clean and dry, a barrier cream such as desitin may be applied. If symptoms do not improve with these simple measures, it is advisable to seek medical attention, as this could be a different condition, such as dermatitis, fungal infection, skin cancer, anal fistula, fissure, condyloma, or even anal cancer. Here at UMass, our division of Colon and Rectal Surgery manages these conditions routinely and is available for office consultation.
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Topic: Colorectal Health
Expert: Jennifer Davids, MD,
colorectal surgeon at UMass Memorial Medical Center and assistant professor of surgery at the University of Massachusetts Medical School. Dr. Davids received her medical degree from Yale University School of Medicine and completed her residency at Cornell/New York Presbyterian Hospital and Brigham and Women's Hospital.
She also completed her fellowship in colorectal surgery at our Medical Center and is board certified in general surgery. Her clinical interests include colorectal cancer, inherited colorectal cancer syndromes, minimally invasive surgery and inflammatory bowel disease.