A healthy and active lifestyle can help reduce your chances of developing colon cancer. Along with healthy lifestyle choices, following your colorectal surgeon’s recommendations concerning regular colon screenings can help reduce your risk further.

Prevention Advice

Examine Dietary Habits – A healthy colon requires adequate quantities of fiber to aid digestion. Because most western diets are poor in good quality fiber, it may be necessary to alter your diet to ensure you get adequate daily fiber. Along with a high fiber intake, it is suggested to limit the amount of fat and cholesterol consumed. Consuming excessive amounts of fat or cholesterol can increase your risk of colon cancer.

Remain a Healthy Weight – Carrying excess body weight has been linked to an increased risk of colon cancer as well. Check your body weight by calculating your body mass index to make sure your weight category falls within the healthy zone. If you find yourself to be overweight, speak with your doctor about appropriate methods of healthy weight loss.

Maintain an Active Lifestyle – Regular exercise is an important component of a healthy lifestyle. It is suggested that most people participate in physical activity for at least 30 minutes each day. Some activities may include walking, running, swimming or cycling. Combining an active lifestyle with healthy dietary habits can greatly reduce your risk of developing colon cancer.

Quit Unhealthy Habits – Harmful habits such as drinking excessive amounts of alcohol, smoking cigarettes or participating in recreational drug use can negatively affect your health and increase your risk of colon cancer. Giving up these behaviors is difficult but there are many resources available to you to help make lifestyle changes like these easier. Consult your doctor for information about medications and support programs that might help.

These are only few prevention tips for colon cancer to be taken into consideration. It is important to undergo regular colon screenings as early detection provides the best chance of successful treatment. Appropriate screening for colon cancer begins by determining your individual level of risk based on your family and personal medical history. Screening options for colon cancer include:

1. Home FOBT (fecal occult blood test) alone every year
2. Flexible sigmoidoscopy alone every 5 years
3. Home FBOT every combined with flexible sigmoidoscopy every 5 years
4. DCBE (Double contrast barium enema) every 5 years
5. Colonoscopy alone every 10 years

Your screening options will vary depending on what your colorectal surgeon sees fit based on your individual level of risk.

Though regular exercise is an important part of any healthy lifestyle, finding an appropriate workout routine after undergoing colon surgery or treatment for colon cancer in Los Angeles can be tricky. Patients generally benefit from regular exercise while recovering, but it is important to engage in light activities that reduce your chances of straining tender abdominal tissues. As a general rule, consult your colorectal surgeon before engaging in any kind of post-surgery activity, but here are some tips on working out after colon surgery and why it can be a significant help in staying healthy and cancer-free.

Walk Before You Run

One of the simplest activities to engage in following colon surgery is just to stand and walk. You will likely be supine for several days after surgery, and though you should stay put if recommended to by your doctor, simply getting a few steps in and stretching your legs will help you retain some level of physical activity during the recovery phase. If this proves to be difficult, the support of a cane or walker may be necessary during this initial period.

After a few weeks, ask your doctor if you’re ready to resume regular activity. Typically, patients can engage in running, jogging or some other kind of aerobic activity about four to eight weeks after abdominal surgery. Exercise is especially important for patients of colorectal cancer, as any form of regular exercise can help to reduce your risk for cancerous growth and studies have shown that exercise can reduce the mortality risk of patients with colorectal cancer.

The American Cancer Society recommends a minimum of 30 minutes of physical activity nearly every day of the week. If you’re unsure about what kinds of exercises will be safe to engage in after surgery, consult your doctor.

No Strength Training, No Sit-ups

Heavy lifting of any kind is unwise following colon surgery, so remember to avoid lifting anything that requires you to use both hands. Obviously, this also means you will need to wait to resume any kind of strength training or weight lifting until your doctor has given you the go-ahead. Sit-ups can also be problematic after surgery, as they can damage the tender tissues that were affected during the operation. However, just sitting up in your bed may help, even just a few days after surgery, to avoid lying prostrate for prolonged periods of time.

After undergoing colon surgery, it is vital to take things slowly. Exercise is important, but jumping back into strenuous activity too quickly can be detrimental to your health post-surgery. Be sure to direct any questions about any physical activity to your doctor before jumping into it.

Life-saving Potential

Though aspirin should not be used in lieu of other treatments for colon cancer, this is the first time the over-the-counter medicine has come into discussion as a potentially useful drug for complementing other cancer treatment procedures. Aspirin is by no means a treatment of cancer in and of itself.

A Few Caveats

More research is needed before experts can definitively recommend daily aspirin use to all older patients of colon cancer. The study’s results do not conclusively prove that aspirin use has any direct impact on the reduction of colorectal cancer, although they do seem promising. The study draws a correlation between those who were prescribed aspirin and those who survived, but did not factor in cause of death or the likelihood that many patients were taking aspirin to treat heart disease or stroke rather than colorectal cancer. Additional research into the subject must continue, including controlled trials that look at comparisons between participants who do and do not use aspirin in more depth.

It is also important to note that aspirin can produce a number of troubling side effects, including internal bleeding and increased chances of complications during surgery and other cancer treatments. As a result, any aspirin use should be preceded by a discussion with your gastroenterologist about the drug’s potential impacts on your health and well-being.

Keep in mind that the most important factor in preventing colorectal cancer and its recurrence is healthy living. A healthy diet, exercise and avoiding potentially hazardous lifestyle choices like smoking and drinking are the very best methods of prevention. If you have any questions about how to live healthy during or after treatment for colon cancer, contact Los Angeles Colon and Rectal Surgical Associates.

Until you can schedule an appointment with a colon and rectal specialist (also known as a proctologist), here are some common factors that contribute to the worsening of hemorrhoid symptoms:

1. Constipation – This is an important cause of hemorrhoids. Constipation contributes to an unhealthy amount of pressure on the rectal area which causes veins to swell. Over time, the constant pressure and swelling can lead to the development of hemorrhoids.

2. Age – As the body ages, muscles tend to lose their strength and people tend to become more sedentary. This lack of movement can lead to the development of hemorrhoids.

More than half of the population will suffer from symptoms of hemorrhoids at some point in their lives and most of these people will be over the age of 50. Give yourself a better chance of avoiding hemorrhoids by staying active and leading a healthy lifestyle.

3. Prolonged sitting – It’s hard to avoid sitting for long periods of time, especially if you have an office job. Unfortunately, prolonged sitting increases your chances of developing hemorrhoids. You can reduce your chances of getting hemorrhoids by taking a few minutes each hour to stand and stretch in the office.

Another solution is to bring a small cushion to sit on at work to decrease the amount of pressure on the rectum from sitting all day.

4. Pregnancy – Pregnancy greatly increases the amount of pressure put on the veins returning blood from the rectum and unfortunately, is a major cause of hemorrhoids. Make sure to stretch as much as possible in order to fight off your chance of developing hemorrhoids. In bed lying on your left side will reduce help keep your baby’s head off of the major abdominal vein that returns blood flow from your lower extremities and rectum.

5. Heavy Lifting - Many people have professions that require heavy lifting and moving, and over time the constant strain causes hemorrhoids to develop. Although it’s hard for some to avoid such work conditions, there are always preventative measures to take to lessen the chance of getting hemorrhoids.

Living an overall healthy lifestyle is the best way to decrease your chances of developing hemorrhoids. This means exercising daily and eating the right foods. Eating healthy is just one aspect of living a healthy lifestyle but it’s definitely a good start. Make sure to eat plenty of fruits and vegetables that are high in fiber, and drink at least 8 glasses of water a day.

Try to avoid straining or putting excessive pressure on your back and rectal area. This means taking the time to stretch and stand at work, avoiding heavy lifting and sitting for long periods of time on the toilet. Remember, any extra straining is likely to increase your chance of developing hemorrhoids.

Initial Treatment

If polyps containing cancer cells are found during a rectal exam, a colonoscopy will be performed to locate any additional polyps and remove them from the rest of the colon. Polyps larger than one centimeter in size are more likely to be cancerous.

Even small polyps are removed. Although these tiny polyps take many years to grow they pose very little risk of cancer. This is not the case for those who have inherited polyp syndromes.

Hyperplastic polyps are located within the colon and rectum. These polyps are not likely to develop into cancer. Adenomatous polyps are the type of polyps with malignant potential and are removed during a colonoscopy.

Risks of Polyp Removal

Although complications are rare during a colonoscopy, here are some risks:

• Puncturing the colon.

• Bleeding caused by polyp removal.

• Sedative complications during polyp removal.

• Injury to the spleen.

Ongoing Treatment

Making sure to keep up with regular colon screening in order to prevent colon polyps from becoming cancerous.

If you are someone who has had several colon polyps in Beverly Hills removed, regular follow-up exams may be necessary. Make sure to talk to your doctor to figure out what kind of follow-up schedule works best for you.

Continued Treatment if Condition Worsens

Sometimes, larger polyps found within the rectum will need to be surgically removed. These larger polyps have a high risk of becoming cancer and cannot be removed through a regular colonoscopy.

If cancer is found in any of the polyps removed, you will begin treatment for colorectal cancer.

The new stool-based examination targets molecular markers in a patient’s bowel movement. A recent study evaluated 500 patients who had previously been diagnosed with colon polyps and were currently undergoing colonoscopy or follow-up care. In these patients, the stool-based examination was highly sensitive to a number of critical early cancer screening targets. The test was also unaffected by factors that often influence other testing procedures, such as medication use, gender, race or weight.

One of the benefits of the stool based test is that it does not require patients to alter their lifestyle to undergo the examination. By offering a supplemental examination that does not call for fasting or preparation, more individuals may be willing to undergo screening for colon and rectal cancer.

The researchers did note that age was a factor that may influence the results of the stool-based examination. However, even in individuals of a higher age the test provided other markers that could be evaluated further for signs of colorectal cancer, especially when combined with other traditional screening efforts.

The stool-based examination is not intended to replace colonoscopy, and is not yet being implemented in the regular screening of colorectal cancer. However, research indicates that this type of cancer screening may become a beneficial supplement to traditional colonoscopy screening exams in the future.

A team of researchers recently reported in the journal of Gastrointestinal Endoscopy that many physicians are unable to view pre-cancerous lesions in the colon in about one-third of patients who did not adequately prepare for their colonoscopy. This is an unnecessary risk for patients who are undergoing a colonoscopy, and highlights the necessity of following your physician’s instructions closely prior to your exam.

The day prior to your colonoscopy it is important to begin your preparation diet. You will not be able to consume solid food, and will be limited to only clear liquids. Then, the night before your procedure you will be asked to drink a bowel cleansing fluid. The bowel cleansing fluid is not as effective if you have not followed the prexcribed diet prior to drinking the fluid, and it is important not to skip these preparations.

The early-detection of colorectal cancer is crucial for successful treatment. By not preparing properly for your exam you could be putting yourself at an increased risk for a delayed diagnosis. Speak with your colorectal specialist about how to prepare for your colonoscopy. Follow the directions closely for the best results from your screening examination.

Get the PDF version of this article

BEWARE: IT’S NOT ALWAYS JUST HEMORRHOIDS…

Anal Pain is common, and commonly misdiagnosed. Most patients and many clinicians assume that a complaint of anal pain is synonymous with a diagnosis of hemorrhoids, especially when the pain is associated with the presence of bright red blood. A familiarity with the causes of anal pain will help the physician arrive at a correct diagnosis and begin the correct treatment.

HOW TO BEGIN THE EVALUATION

Internal hemorrhoids are associated with itching, a discharge or blood on the tissue. Hemorrhoids rarely cause pain unless they are markedly inflamed or thrombosed. When evaluating a patient with anal pain, a thorough history must be obtained, noting the time, and manner of onset. The physician should also note any associated symptoms such as fever or the sudden relief of the pain, which might indicate a spontaneously drained abscess. A visual inspection may reveal anal erythema, which could be secondary to an abscess, a fistula, a thrombosed external hemorrhoid or an irritation due to the use of soap on the perianal area. Palpation might reveal a fluctuant area, or point tenderness. A digital exam may uncover a fluctuant abscess hidden in the anal canal. At this point, most clinicians will refer the patient to a specialist for anoscopy or sigmoidoscopy if the cause of the pain cannot be found.

COMMON CAUSES OF ANAL PAIN:

Anal Fissure

Figure 1. A person with anal pain

Anal fissures are linear tears in the anal canal, commonly the result of constipation, a difficult bowel movement or uncontrolled diarrhea. Fissures typically occur in the anterior or posterior midline and are associated with acute pain and occasionally with rectal bleeding. The pain may occur immediately after a bowel movement or may be delayed for several hours. The pain is often severe, and described as feeling like the passing of razor blades during the bowel movement. An associated external sentinel anal tag or an internal hypertrophic anal papilla are often seen. The anal sphincter is hypertonic, interfering with the local flow of blood and resulting in non-healing of the fissure. Treatment is aimed at improving blood flow by decreasing anal sphincter tone. This can be achieved with a topical vasodilator such as Nitroglycerine, or with a calcium channel blocker such as Diltiazim or Nifedipine. Botox injections temporarily paralyze the internal anal sphincter, allowing for increased local blood flow with healing of the fissure in up to 50% of patients. A surgical lateral internal sphincterotomy may be necessary if other measures fail.

Anorectal Abscess
A perianal or perirectal abscess forms as a result of an obstructed and infected anal gland. The pain associated with an abscess is often gradual in onset and constant. The patient may report a history of fever or general malaise. As the abscess enlarges, the increased pressure within the abscess cavity may result in excruciating pain. The skin overlying the abscess may be erythematous or indurated. A palpable abscess may be firm or fluctuant. Incision and drainage of the abscess, often performed as an office procedure, may be all that is necessary to resolve the problem. However, antibiotics may be used in addition to drainage if there is associated cellulitis. A delay in recognition may result in systemic sepsis and rarely Fournier’s gangrene. Up to half of the patients treated for an abscess may develop a fistula, which is a tubular communication between the anorectum and the perianal skin. A fistula may require additional surgical treatment.

Thrombosed External Hemorrhoids
An external hemorrhoidal vein may develop a blood clot within its lumen. This is known as a thrombotic hemorrhoid. The thrombotic may occur as a result of straining with a bowel movement or during other physical exertion. The thrombosed hemorrhoid appears as a firm, purple, grape-like nodule adjacent to the anal canal. Occasionally, there may be multiple, simultaneous thrombotics in multiple locations. Painless thrombotics may be followed and allowed to regress spontaneously without any intervention. If the thrombotic causes acute stretching of the overlying skin, severe, localized pain may result. Sitz baths and topical preparations may provide a modicum of pain relief. If the clot is under extreme pressure, superficial skin breakdown with venous rupture and persistent oozing may occur. In many cases, the clot and swelling will resolve over several weeks. When identified early, painful thrombosed hemorrhoids may be opened or excised in the office setting using local anesthesia. Hemorrhoidal sclerotherapy and banding do not have a role in the management of acute thrombosed external hemorrhoids.

Sexually Transmitted Diseases
Perianal herpes simplex virus infections may lead to scattered superficial ulcers on the perianal skin. Early lesions are vesicular in nature. A diagnosis is made either by obtaining a previous history of herpetic ulcers, or by observing new lesions occurring ten days after the first physical exposure to the virus. The anal lesions can be painful, with burning pain radiating down the leg. The vesicular fluid can be cultured, with the demonstration of the virus. Symptomatic treatment includes the use of anti-viral agents such as Acyclovir, which may shorten the course of an outbreak. Acyclovir does not prevent further occurrences, but may lessen their frequency. Herpetic lesions will regress spontaneously with or without treatment, but will invariably recur. The frequency of outbreaks seems to decrease over time. Other infections such as anal warts, syphilis or HIV related ulcers might also be a source of anal pain.

Don’t Forget Pruritus Ani.
Anal itching and scratching can lead to anal pain. The itching may be secondary to the use of any kind of soap on the perianal area, pinworm or other types of infections, or may be related to psychological stress. Discontinuing the use of perianal soaps may relieve the itch and eradicate the pain. Hemorrhoidal therapy may not relieve itching and pain unless the use of soap is discontinued and any other underlying pathology treated.

LESS COMMON CAUSES OF ANAL PAIN:

Anal Cancer
The incidence of squamous cell anal canal cancer is increasing. It affects heterosexual men and women and is not uncommon in HIV positive anoreceptive men. Anal cancer is thought to be related to prior exposure to HPV, the human papilloma virus. Anal warts, or condyloma, contain HPV and can be detected by a careful visual or digital rectal examination and anoscopy. Malignant lesions are firm, commonly nodular and occasionally ulcerated. Any such lesion mandates the performance of a careful anorectal exam and biopsy. If identified early, squamous anal cancers respond extremely well to potentially curative chemoradiation. Radical surgical interventions, including wide local excision or abdominoperineal resection, are reserved for refractory or recurrent disease.

Rectal Cancer
Adenocarcinoma of the rectum typically presents with rectal bleeding, and less commonly with rectal pain or pressure. If the lesion is close to the well-innervated dentate line in the anal canal, sharp anal pain may be reported. All patients with anorectal pain or bleeding of unclear etiology should undergo a proctoscopy or flexible sigmoidoscopy to rule out a distal anorectal adenocarcinoma or other rare rectal tumors. The precise location of the lesion in the anorectum must be noted, as this may be a guide to the type of operation used to remove the tumor. While chemoradiation may assist in decreasing local recurrences, operative extirpation remains the mainstay of treatment. Most of these lesions can be removed using laparoscopic techniques with sphincter preservation. More distal lesions may require an abdominoperineal resection for cure. Survival rates are excellent for rectal cancer discovered at an early stage and appropriately treated.

Proctalgia Fugax or Levator Spasm
Proctalgia fugax is a painful spasm of the pelvic floor, often occurring at night. The etiology is unclear but may be related to psychological stress. The mainstay of treatment includes fiber supplementation, levator massage or ultrasound therapy, muscle relaxants, or anti-anxiety medications. These therapies are associated with variable degrees of success.

Inflammatory Bowel Disease
Crohn’s disease can affect the anorectum. Patients commonly report associated diarrhea. Fissures in atypical locations, large irregular anal tags, recurrent abscesses, and complex fistulas may be seen on exam. All of these may be associated with significant pain. Local and systemic therapy is often required to control symptoms. Ulcerative colitis affecting the rectum is also known as ulcerative proctitis, and may be a cause of anorectal pain. Diagnosis is made by performing a proctoscopy and biopsies. Treatment with various topical or systemic medications usually helps to resolve the pain.

Miscellaneous Causes of Anal Pain
Diarrhea, constipation or a fecal impaction can be quite uncomfortable. Appropriate treatment will resolve the pain. Radiation proctitis may result from radiotherapy to the rectum and to areas adjacent to the rectum, as during the treatment of prostatic carcinoma, or in the treatment of various gynecologic malignancies. Other rarer, causes of anal pain include a solitary rectal ulcer, anal trauma and coccydynia, also known as tailbone pain

A VEXING PROBLEM. SATISFYING TREATMENTS.

While anal pain is a common symptom, a focused evaluation and careful examination is essential in determining the correct diagnosis. A delayed or incorrect diagnosis can be vexing for the patient and the physician, and may have far reaching repercussions if an occult lesion is discovered at a late stage. Consultation with a specialist may allow for early diagnosis and treatment.

Also used to treat certain conditions and injuries after childbirth, a sitz bath helps decrease hemorrhoidal discomfort by increasing the circulation of blood to the affected area. This results in a reduction of swelling, pain and other unpleasant symptoms of the condition. It should be noted a sitz bath works only for external hemorrhoids.

Best results are obtained by sitting in the sitz bath for 10 to 30 minutes several times per day. There should be enough water in the bath to cover the buttocks and hips. Salt may be added to the water to further reduce the swelling, pain and general discomfort. Some people find alternating warm water with cold throughout the day brings the best relief. After the bath, the anal area should be carefully cleaned with a towel. Rubbing should be avoided, as this can further irritate the condition. The sitz bath device needs to be washed after every use to prevent infection.

While using a sitz bath can be helpful in treating hemorrhoids in Los Angeles, it is not a substitute for consulting with a colon and rectal specialist about the problem. The condition can be a sign of more serious health problems that can only be diagnosed and treated by a physician.

According to the Journal of the National Cancer Institute, multiple screenings using flexible sigmoidoscopy increased the detection of colorectal cancer or advanced adenomas in women by one-fourth and by one-third in men. Although a colonoscopy offers a complete view of the colon, flexible sigmoidoscopy combined with a fecal occult blood test is still considered to be a screening test for colorectal cancers and polyps.

Endoscopic techniques have a greater sensitivity in the detection of colorectal cancer than fecal occult blood testing alone, and repeated screenings reveal a larger number of carcinomas and colorectal adenomas in comparison to only one screening. The PLCO cancer screening trial attempted to determine what time interval the repeated flexible sigmoidoscopy screenings would be most effective.

Researchers analyzed persons aged 55-74 undergoing flexible sigmoidoscopy. The participants were subsequently screened at intervals of 3 years and 5 years. The study was conducted from 1993-2001.

Among the 77,447 people participating in the study, 67,073 had a minimum of one flexible sigmoidoscopy and 39,442 had two. The study showed that the second screening increased the quantity of cancers detected by 26% in women and 34% in men. Advanced adenomas or colorectal cancers were detected in 3.8% of participants following the first screening and 4.5% after both screenings– an increase of 32%.

This research is beneficial for those who are at an increased risk for colorectal cancer in Beverly Hills. It is important to speak with your colon and rectal specialist about early detection and screening for colon cancer. In many situations, a single screening exam is not sufficient to fully examine the colon for growths, and for many people a second screening may prove beneficial.