A colonoscopy is a procedure to look at the inner lining of your large intestine (colon and rectum) using a small camera on a flexible tube passed through the anus. The camera sends a video which lets the doctor carefully examine the intestinal lining. This routine procedure is quick with little discomfort, and provides a clear view of the large intestine. During this procedure, your surgeon may remove some samples of tissue for testing. This is called a biopsy. The tissue can then be viewed under a microscope and tested for any signs of disease. The exam takes less than an hour and can detect inflamed tissue, ulcers, polyps (small growths), and other abnormal growths.

According to The American Cancer Society a diagnostic colonoscopy is usually performed when a patient’s symptoms or tests indicate there may be signs of problems in the colon. Patients are referred for a diagnostic colonoscopy because they have the following symptoms:

• Blood in the stool
• Bleeding from the rectum
• Unexplained anemia (a condition in which your blood has a lower than normal number of red blood cells)
• Change in bowel habits
• Persistent abdominal pain

In addition your doctor may recommend a diagnostic colonoscopy if screening tests such as a manual rectal examination, a hemoccult test (to detect the presence of hidden blood in the stool), or a barium enema test (barium is used to make the colon visible to x-rays) suggests that additional information is needed to determine the cause of the problem.

If you are age 50 or older (depending upon your family history), your doctor may recommend a colonoscopy as a procedure to screen for colon cancer. A screening colonoscopy is done when a patient has no problems at all such as abdominal pain or rectal discomfort and when no significant findings are found during an examination. Screening for colon cancer is important since symptoms rarely show up until much later in the disease.

Patients are referred for a screening colonoscopy when:

• They are 50 years of age with no high risk factors.
• They have a personal history of colon cancer or colon polyps.
• They have a family history (first degree relative - parent, sibling, offspring) with colon cancer or colon polyps.

Polyps are growths in the colon or rectum. They protrude into the lining of the intestine and can be flat or have a stalk. Polyps are one of the most common conditions affecting the colon and rectum.

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Most anorectal conditions are quite common and frequently caused by benign disorders. Although they can often be treated in the outpatient setting, they sometimes require surgical intervention. Common anorectal conditions include fissures, fistulas, hemorrhoids, pruritis ani (anal itching), pilonidal disease, rectal pain, and condyloma/AIN (Anal Intraepithelial Neoplasm).

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Diverticular disease affects the large intestine (colon). There are two conditions that make up diverticular disease – diverticulitis and diverticulosis.

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Inflammatory Bowel Disease (IBD) is a term that describes diseases in which the digestive tract becomes inflamed (swollen) and includes Crohn’s disease and ulcerative colitis. IBD is chronic, which means it lasts for a long time and usually comes back over and over again. This means there will be periods of time when the disease flares up followed by periods when the symptoms decrease or disappear. IBD affects somewhere between 500,000 to two million people in the U.S. It affects an approximately equal number of both men and women. IBD is characterized by symptoms including abdominal cramps, bloody diarrhea, fever, and weight loss. Although it is not known what causes the intestines to become red and swollen, it is thought to be an overreaction of the immune system against its intestinal tissue. When the immune system doesn’t shut down appropriately, it damages the walls of the intestine. Since IBD runs in families, experts believe there may be a genetic predisposition as well.

Constipation refers to infrequent bowel movements, passing hard stools, or having difficulty passing stool. Constipation may include pain passing stools, straining to pass stools, or no bowel movements for three or more days. Constipation has many causes including side effects from medications, low fiber diets, overuse of laxatives, hormonal disorders, and diseases of other parts of the body that affect the colon.

Constipation is common in individuals affecting from 2% to 30% of the general population. However, it is important to separate acute (recently occurring) and chronic (long duration) constipation. Serious illness may underlie acute constipation (e.g., colon cancer) particularly if it is accompanied by additional symptoms including rectal bleeding, nausea and vomiting, and weight loss. If significant changes in your bowel habits occur for more than a week, you should contact your physician immediately for an appointment. Chronic constipation means you have symptoms for at least three days per month for more than three months. This is frequently cured by changing your diet to include more fiber, exercise, and drinking at least eight cups of water a day.

Fecal incontinence is the loss of bowel control leading to involuntary or inappropriately passing stool. Fecal incontinence ranges from occasionally leaking a small amount of stool and passing gas to a complete loss of bowel movements. Nearly 18 million adults in the U.S. have fecal incontinence and it is more common among older adults. Fecal incontinence can be embarrassing and upsetting, but your surgeon is experienced in talking about this condition so you should discuss this with him or her. Fecal incontinence is frequently caused by a medical problem and treatment is available.

Fecal incontinence has a number of causes including diarrhea, constipation, muscle damage or weakness, nerve damage due to disease or injury, overall poor health or chronic conditions, loss of stretch in the rectum, hemorrhoids, and difficult childbirth with injuries to the pelvic floor. (The pelvic floor contains muscle fibers that support organs in the pelvic region (e.g., bladder, intestines, uterus in females)).

Sometimes muscles of the lower pelvis surrounding the rectum (pelvic floor muscles) do not function normally. These muscles support the rectum and are critical for bowel movements and the passage of stool. Failure of these muscles to work properly makes passage of stool difficult.

There are a number of tests your surgeon may use to screen for pelvic floor issues and constipation. These include:

• Balloon Evacuation Test: This procedure involves inserting a small balloon into the rectum, which is then filled with water. You are then asked to use the toilet and try to expel the balloon. How long it takes you to expel the balloon is recorded with normal expulsion considered a time of one minute or less.
• Anorectal Manometry: This is a test used to assess functioning of the anal canal and is frequently used to diagnose the cause of chronic constipation or fecal incontinence.
• Defecating Proctography: This test may be used to study obstructed defecation. During this study the rectum is filled with a paste-like substance containing contrast material that can be seen on x-ray. You are then asked to sit on a toilet while an x-ray camera records you as you defecate and evacuate the material. The data are then analyzed for any structural defects such as a rectocel or prolapse (see below) that may affect normal bowel function.

Most people with colon or rectal cancer can be treated successfully and in effect cured.

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Sometimes diseases of the intestinal or urinary tract require that all or part of the intestines or bladder is removed. When this occurs, there needs to be another way to remove urine or feces from the body. A surgical procedure called an ostomy is performed where an opening is created in the abdomen (belly) for waste to pass through. The opening that is created is called a stoma. Because there are no muscles to control when waste passes through the stoma, waste and gases may pass out of the body at any time. An odor-proof plastic pouch attached to your abdomen collects the waste.

To help maintain your normal quality of life, you need to care for your ostomy. This means you will need to:

• Empty the pouch when needed
• Replace the pouching system as necessary - usually every 3-7 days
• Take care of your skin and stoma and watch for any skin irritation. The skin around the stoma must be protected from contact with the discharge of waste, which can cause irritation. As a result, you should clean the skin around the stoma with plain soap and water each time you change the pouch and dry the skin thoroughly.
• Cover the stoma when bathing since you don't want water to enter it.
• Irrigate the colostomy to help control when waste is eliminated. You will need your surgeon to approve and help guide you with this process.
• Measure the stoma when you purchase supplies. This will help ensure proper fit since the size of the stoma could change with weight gain or weight loss or due to other situations.
• Avoid buildup of adhesives around the stoma that hold the pouch. Remove these with gentle solutions to prevent the skin from becoming irritated.