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Colonoscopy - Part II

common problems affecting colon:
colon is the longest part of the large intestine, a tube-like organ connected to the small intestine at one end and the anus at the other.The colon is also known as the large bowel or large intestine. It is an organ that is part of the digestive system, also called the digestive tract .The digestive system is the group of organs that allow us to eat and to use the food we eat to fuel our bodies.The colon removes water and some nutrients and electrolytes from partially digested food.
Common local symptoms or the signs of a colon problem are as follows:-
*alternating diarrhea and constipation, or other changes in bowel habits.
*rectal bleeding or blood in the stool.
*abdominal bloating, cramps or discomfort.
*a feeling that the bowel doesn't empty completely.
*stools that are thinner than normal.

Steps to treat colon pain are as follows:
•Reduce your intake of certain foods. the first step in treating colon pain is to modify your diet to see if you can reduce inflammation and find relief.
•Adjust your lifestyle.
•Reconsider medications.
•Eat more fiber rich foods in your diet
•Get more exercise regularly

colonoscopy is an exam used to look for changes such as swollen, irritated tissues, polyps or cancer in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the patient's rectum.
There are many common problems affecting the colon and rectum. These conditions include:
(1) Irritable bowel syndrome, (2) Constipation,
(3) Hemorrhoids(, Piles),
(4) Anal fissures,
(5) Abscess,
(6)Crohn's disease,
(7) Ulcerative Colitis,
(8)'Polyps and
(9)Colon cancer.

Now let us study about the common conditions affecting colon.

(1) Irritable bowel syndrome:
Irritable bowel syndrome (ibs) is a common disorder that affects the large intestine. The common signs and symptoms of IBS include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both.
Symptoms of ibs include:
Abdominal pain or cramps, usually in the lower half of the abdomen,bloating,bowel movements that are harder or looser than usual,diarrhea, constipation or alternating between the two,excess gas,mucus in your poop (may look whitish).

The main trigger of ibs are
•too much fiber, especially the insoluble kind you get in •the skin of fruits and vegetables. food and
•drinks with chocolate, alcohol, caffeine, fructose, or sorbitol. carbonated drinks. •large meals.
Certain foods usually trigger ibs .foods could be making
ibs more uncomfortable are as follows:
insoluble fiber. dietary fiber adds bulk to the diet and, generally speaking, it helps keep the gut healthy.
Dairy products
Fried foods.
Beans and legumes.
Caffeinated drinks.
Processed foods.
Sugar-free sweeteners.

(2) Constipation:
Constipation is a condition when a person passes less than three bowel movements a week or has difficult bowel movements.
The common causes of constipation are as follows:
Constipation can have causes that aren't due to underlying disease. examples include Dehydration, lack of dietary fibre, lack of physical inactivity or medication side effects.
Symptoms of constipation:
•Passing fewer than three stools a week.
•Having lumpy or hard stools.
straining to have bowel movements.
•Feeling as though there's a blockage in your rectum that prevents bowel movements.
•Feeling as though you can't completely empty the stool from your rectum.

The measures to get your constipation out or relieve constipation include:
•Exercise regularly. moving your body will keep your bowels moving, too.
•Adjust your toilet posture.It may be easier to poop if you squat, raise your legs, or lean back.
•Check your medicines
•Prebiotics and probiotic

(3) hemorrhoids (piles):
The main cause of hemorrhoids:
Hemorrhoids can develop from increased pressure in the lower rectum due to: straining during bowel movements,sitting for long periods of time on the toilet, having chronic diarrhea or constipation.

Treatment of hemorrhoids:
Eat high-fiber foods, eat more fruits, vegetables and whole grains,use topical treatments, apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent,
soak regularly in a warm bath or sitz bath,take oral pain relievers.

Hemorrhoids are also called piles. hemorrhoids are one of the most common causes of rectal bleeding. they often go away on their own. The treatments can also help.

Symptoms of hemorrhoids are as follows:
Painless bleeding during bowel movement is the most common symptom, discomfort, itching or pain in the anal area. a sensitive or painful lump near the anus. stools that appear maroon or tarry in color ,a sign of bleeding.

(4) Anal fissure:
Anal fissure is a small tear in the lining of the anus.Anal fissure may occur when passing hard or large stools.

The causes of anal fissure:
Anal fissures are most commonly caused by damage to the lining of the anus or anal canal, the last part of the large intestine. Most cases occur in people who have constipation, when a particularly hard or large poo tears the lining of the anal canal. Other possible causes of anal fissures include persistent diarrhoea,
Bright red blood on the stool or toilet paper after a bowel movement, a visible crack in the skin around the anus, a small lump or skin tag on the skin near the anal fissure.

An acute anal fissure typically heals within 6 weeks with conservative treatment. Some disappear when constipation is treated. Snal fissures that last for 6 weeks or more are called chronic anal fissures.

Treatment of an anal fissure:
Anal fissures often heal within a few weeks, if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
Medicines for anal fissure:
Medications may also be prescribed for anal fissures, such as topical nitrates, calcium channel blockers, and a botulinum toxin-A injections, and are considered first-line therapy. These medications reduce anal sphincter tone, which, in turn, increases ano-dermal blood flow.

(5) Abscess in colon:
An abscess is a painful, swollen, infected, and pus-filled area just outside your colon wall that may make you ill with nausea, vomiting, fever, and severe tenderness in your abdomen.
If left unchecked, an abscess can lead to serious long-term digestive problems and even death, according to colon and rectal surgeons, also known as proctologists.

The cause an abscess in the colon:
Abdominal abscesses can be caused by a bacterial infection.The most common bacteria to cause them are found in the stomach and intestines. one of these is Escherichia coli or E. coli.

The american society of colon and rectal surgeons recommended that small mesocolic abscesses can be treated with intravenous antibiotics. In contrast, large abscesses may be drained percutaneously or by an open procedure.

It will probably take about 3 to 8 weeks for the abscess to completely heal. Most people get better without any problems but sometimes a tunnel can form between the old abscess and the outside of the body.

CT-scan in diagnosis of colon abscess:
The diagnosis of an abscess is usually obtained through history and physical examination but occasionally, imaging techniques such as computerized tomography (CT) or ultrasound (US) are used to assist in the diagnosis.

(6) Crohn's disease:
It is a chronic inflammatory bowel disease that affects the lining of the digestive tract.Crohn's disease is a type of inflammatory bowel disease (ibd). It causes swelling of the tissues (inflammation) in your digestive tract.
Crohn's disease can sometimes cause life threatening complications.
rare condition ,fewer than one million cases per year are reported in India.
Treatment can help, but this condition can't be cured.
It requires a medical diagnosis lab tests or imaging often required.
It is a chronic condition that can last for years or be lifelong.
It requires a medical diagnosis.
Crohn's disease can cause abdominal pain, diarrhoea, weight loss, anaemia and fatigue. some people may be symptom-free most of their lives, while others can have severe chronic symptoms that never go away.

Treatment is consist of anti-inflammatory medications.
Crohn's disease cannot be cured. Medications such as steroids and immunosuppressants are used to slow the progression of disease. If these aren't effective, a patient may require surgery. Additionally, patients with crohn's disease may need to receive regular screening for colorectal cancer due to increased risk.
Medications for crohn's diseases:
nonsteroidal anti-inflammatory drug, anti-inflammatory, steroid, immunosuppressive drug, vitamin and antibiotics
surgery,bowel resection,
self-care,dietary fiber,
enema ,
The main cause of crohn's disease:
One cause of Crohn's disease may be an autoimmune reaction—when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn's disease.

The common symptoms of Crohn's disease are as follows:
While symptoms vary from patient to patient, there are some common symptoms of inflammation of the GI tract caused by Crohn's disease;
persistent diarrhea;rectal bleeding;urgent need to move bowels;
abdominal cramps and pain.
sensation of incomplete bowel evacuation; constipation, which can lead to bowel obstruction.

Some of the earliest signs of crohn's disease include:
Appetite loss;abdominal pain;fever;exhaustion;
joint pain;nausea;pain and redness in eyes;red bumps on the skin.

Complications in crohn's disease:
Crohn's disease is not usually life-threatening, but it can cause severe or even fatal complications. Crohn's disease is a long-term inflammatory bowel disease (IBD). It most commonly affects the ileum, which is the end section of the small intestine, and the first section of the large intestine, or colon.

(7) ulcerative colitis:
It is a chronic, inflammatory bowel disease that causes inflammation in the digestive tract.Ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum.It ranges from mild to severe. Having ulcerative colitis puts a patient at increased risk of developing colon cancer.

The main cause of colitis:
The exact cause of ulcerative colitis is unknown, but there are things that appear to trigger or aggravate it. It may involve an abnormal immune response against some microorganism in which your tissues are also attacked. Genetics might also play a role. You are at higher risk, if a first-degree relative has it.

Ulcerative colitis is a lifelong condition that you have to manage, rather than a life-threatening illness. Still, it's a serious disease that can cause some dangerous complications, especially if you don't get the right treatment. Ulcerative colitis is one form of inflammatory bowel disease (IBD).
Ulcerative colitis is a long-term (chronic) disease. there may be times when your symptoms go away and you're in remission for months or even years but the symptoms will come back. If only your rectum is affected, your risk for colon cancer isn't higher than normal.

Foods that trigger Ulcerative colitis:
There are several foods that may trigger your symptoms, including fatty and greasy foods, spicy foods, high- sugar foods, caffeine, alcohol, and carbonated beverages.
The following foods may be suitable for a person who has just had a flare-up of Crohn's disease or Ulcerative colitis:
Diluted juices,applesauce,
canned fruit,oatmeal,
plain chicken, turkey, or fish;
cooked eggs or egg substitutes; mashed potatoes, white rice, or noodles.sourdough or white bread.

ZEPOSIA is the latest drug for treatment of Ulcerative colitis.Federal regulators (FDA)have approved the new drug Zeposia for treating moderate to severe Ulcerative colitis in adults. The medication is the latest in a line of drugs used to treat symptoms of this particular type of inflammatory bowel disease (IBD).
Vegetables that should be avoided with Colitis:
Avoid all raw or undercooked vegetables, including corn. It's fine to consume canned vegetables and potatoes, as long as the skin has been discarded. Try pureed vegetable soups for an easy way to digest vegetables. Because vegetables provide many important nutrients, it's important to include them in your diet.
(8) Colorectal Polyps (pre cancerous condition).
The main cause of polyps:
A polyp is the result of genetic changes in the cells of the colon lining that affect the normal cell life cycle.

The cause of colorectal polyps:The exact cause of bowel polyps is not known. It's thought they're caused by the body producing too many cells in the lining of the bowel. These extra cells then form into a bump, which is the polyp. Many factors can increase the risk or rate of these changes. Factors are related to your diet, lifestyle, older age, gender and genetics or hereditary issues.

A polyp is a growth inside of your body. Most aren non cancerous (benign), but a polyp contains abnormal cells or cells that may become abnormal (malignant or cancerous).
A polyp is usually a flat bump or shaped like a mushroom. Cancerous polyps can develop in many places in your body, such as your colon or uterus.

Polyps should be removed by Colonoscopy to prevent cancer.
Over time, small polyps can change their structure and become cancerous. Polyps are usually removed when they are found on colonoscopy, which eliminates the chance for that polyp to become cancerous.

Some polyps may be harmful and may turn in to cancer.
Colon polyps are growths on the lining of your colon or large intestine, part of your digestive tract. Most of them aren't harmful. But some can turn into colon cancer over time. For that reason, your doctor needs to take out any colon polyps you have.
Most colon polyps are harmless. But over time, some colon polyps can develop into colon cancer, which may be fatal when found in its later stages.

The time it take for cancer to form on a colon polyp:-
Time is on your side when it comes to colorectal cancer forming in a polyp. The process is estimated to take 10 years , a period that leaves ample opportunity for early discovery and treatment.

Foods causing polyps in the colon:
Fatty foods, such as fried foods,red meat such as beef and pork; processed meat; such as bacon, sausage, hot dogs, and lunch meats can cause Polyps.

Number of polyps that are normal in a colonoscopy:
Assuming that an endoscopist performs five colonoscopies on a daily basis, to reach an ADR of 25 %, more than five to six polyps must be detected for every five colonoscopies.
colonoscopies aren't usually painful because most patients receive a sedative before the procedure starts. the sedative makes you so sleepy that you usually don't feel or remember anything of the procedure.
For the procedure, you'll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. the colonoscope inflates your large intestine with air for a better view. The camera sends a video image to a monitor, allowing the doctor to examine your large intestine.
After Polyps are removed it can take up to a week for the patient to fully recover. during this time, patients should avoid all strenuous activities, which includes lifting anything over five pounds.
The diseases or conditions that can be detected by a colonoscopy are as follows:-
•Colorectal cancer. •Precancerous tumors or polyps.
•Inflammatory bowel disease such as Ulcerative colitis or Crohn's disease.

(9) Colon cancer and Colorectal cancer:
Colorectal cancer is a term used to describe both colon and rectal cancer. Both cancers affect the large intestine. Cancer cells that develop in the colon are called Colon cancer, while cancer cells that grow in the rectum are called Rectal cancer.
Colorectal cancer is a cancer of the colon and rectum, located at the digestive tract's lower end.
Early cases can begin as non-cancerous polyps. These often have no symptoms but can be detected by screening. For this reason, doctors recommend screening
( Colonoscopy) for those at high risk or over the age of 50 years.
Potential Causes of Colorectal Cancer :
The exact cause of Colorectal cancer is not known, but certain risk factors are strongly linked to the disease, including diet, tobacco smoking and heavy alcohol use. Also, people with certain hereditary cancer syndromes or a family history of Colorectal cancer have a high risk of developing the disease.

Colon cancers develop from precancerous polyps that grow larger and eventually transform into cancer. It is believed to take about 10 years for a small pre- cancerous Polyps to grow into cancer.

Progression of colon cancer in body:
Once cancer has developed in the colon, its progression will vary according to the cellular makeup of the tumor and other factors, such as the age and overall health of the patient. The general progression of colon cancer tends to be slow, but it is still a serious disease that warrants prompt medical attention.

The first anatomical place metastatic Colon cancer spreads:
While colon cancer can travel throughout the body, there are specific areas where it is more likely to spread. The most common include the liver and lungs, as well as the brain, distant lymph nodes and peritoneum (membrane that lines the abdominal cavity).

Colon cancer usually start in the lining of the colon and rectum:Almost all colon cancers start in the lining of the colon and rectum. When doctors talk about colorectal cancer, this is usually what they are talking about. There is no single cause of colon cancer. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

Symptoms of Colorectal cancer:
•A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool.
•Rectal bleeding or blood in your stool.
•Persistent abdominal discomfort, such as cramps, gas or pain.
•A feeling that your bowel doesn't empty completely.
Weakness or fatigue.

Colorectal cancer is curable disease:
Cancer of the colon and rectum are highly treatable and ofte curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of the patients.The majority of patients diagnosed with colon cancer can be treated and will go on to live normal lives.

•One in five colorectal cancer patients are between 20 and 54 years old.
•Whereas 30% of Colorectal cancer diagnoses are under age 55. The risk of colorectal cancer increases with age.
•90% of cases are diagnosed in individuals 50 years of age and older.

The symptoms or signs of end-stage colon Cancer:
•Dark blood in the stool.
•Constipation and/or diarrhea.
•Long, thin, pencil-like stools.
•Abdominal pain or bloating.
•Unexplained weight loss.
•Nausea and vomiting.

Liver Metastasis can happen fast in colon cancer:
About 20% to 25% of people are first diagnosed with colon cancer after the cancer has already spread to the liver, according to a study in Euroasian Journal of Hepato-Gastroenterology, and 40% to 50% see spread to the liver within three years of the original Colon cancer diagnosis.

Survival with Stage -IV colon cancer:
Treatment of stage IV colon cancer is mostly palliative and its median survival is reported to be approximately 9 months with best supportive care. With 5-FU/LV, median survival improved to 12 months, and with combination 5-FU/LV plus irinotecan or oxaliplatin it is reported to be between 14 and 19 months.

Usually if a suspected Colorectal cancer is found by any screening or diagnostic test, it is biopsied during a Colonoscopy. In a biopsy, the doctor removes a small piece of tissue with a special instrument passed through the colonoscope . Less often, part of the colon may need to be surgically removed to make the diagnosis.

The stage IV colorectal cancer is terminal one:
Stage IV colon cancer is the most serious and highest stage. The 5-year survival rate for stage IV colon cancer is just under 15%. This means that about 15% of people with a diagnosis of stage IV colon cancer will be alive in 5 years.

Information compiled by Dr Bhairavsinh Raol