Benign or Noncancerous Conditions Treated
While treating cancer is a major focus for City of Hope’s Division of Colorectal Surgery, we are also dedicated to assisting people confronted with a range of benign conditions that are best addressed through surgery.
For complex procedures, we work in close collaboration with other specialists. For instance, experts from our division tackle pelvic reconstructive surgery in teamwork with urologists and pelvic and sacral surgery alongside orthopedists and neurosurgeons. No matter what the challenge, our experts employ leading-edge approaches and develop treatment plans tailored to each patient.
An anal fissure is a skin tear in the anal canal that frequently causes severe anal pain, occasional bleeding, and sometimes itching or a little lump (“painful hemorrhoid”). Anal fissures can range from an annoyance to a debilitating problem. Even though surgery is extraordinarily successful in addressing the condition, most patients prefer to start with nonsurgical management, such as applying specially medicated creams or having Botox injected.
The colorectal surgeons at City of Hope are the specialists to diagnose and manage anal fissures, be it with or without surgery.
Hemorrhoidal cushions consist of veins in the rectum and anus and are part of our normal anatomy. Symptomatic hemorrhoids can occur at any age when these vein plexuses become engorged such that they can protrude or cause some bleeding. Internal hemorrhoids are typically painless, external hemorrhoids can occasionally be very painful. It should be noted that chronic pain in the area is more often caused by other conditions.
Before recommending a specific treatment, it is important for a doctor to carefully assess a patient’s complaints and diagnose the problem. Among other things, this entails making sure that symptoms aren’t caused by an unrelated, more serious condition.
The colorectal surgeons at City of Hope are specialists for hemorrhoids and related anorectal problems. They have expertise in the nonsurgical treatment of hemorrhoids, as well as numerous surgical options.
An abscess is a swollen pocket where pus collects, while a fistula describes an infected tunnel that forms between the exterior of the anus and the anal canal. These two conditions are related to each other whereby the abscess is the more acute and the fistula the more chronic form. An abscess often causes severe anal pain and potentially other signs of an infection. A fistula may cause recurrent drainage and intermittently form an abscess, resulting in occasional and often cyclic pain.
If an abscess is not promptly drained, it can lead to a blood infection that may require hospitalization. Treatment of a fistula can be extremely complicated because of how close it is to the anal sphincter muscle, which doctors will aim to preserve in order to safeguard a patient’s quality of life.
The colorectal surgeons at City of Hope are specialists for anal abscesses and fistulas and have expertise in numerous surgical options for these conditions.
Anal warts, aka anal condyloma acuminata, are the result of infection with the human papillomavirus (better known as HPV) and may be associated with other genital warts. They may represent a precursor to anal cancer. Treatment usually involves the removal or destruction of warts in one or more sessions.
The colorectal surgeons at City of Hope are specialists for anal warts and have expertise in numerous surgical options for treatment.
Anal intraepithelial neoplasm (AIN), or anal dysplasia, is the medical term for severe changes in cells of the anal canal that may progress and lead to anal cancer. This condition results from infection with human papillomavirus (better known as HPV).
AIN is diagnosed with the anal pap smear or through direct evaluation and biopsy by a physician. Treatment involves the removal of the areas where the irregular cells have grown, with follow-up visits to ensure the recurring AIN is recognized and treated as early as possible.
The colorectal surgeons at City of Hope are specialists for anal dysplasia and anal cancer and have expertise in both nonsurgical and surgical management of these conditions.
Bowen disease is a rare subform of anal dysplasia, a condition in which cells in the lining of the anus undergo changes that can progress and lead to anal cancer. Patients can experience an inflamed, occasionally itchy rash that doesn’t heal.
Bowen disease is diagnosed with a biopsy, in which a tiny skin sample is tested by a lab. Treatment usually involves removing areas where the irregular cells have grown, along with follow-up visits to evaluate the result.
The experts in City of Hope’s Division of Colorectal Surgery specialize in Bowen disease and anal cancer, including nonsurgical and surgical approaches to treatment.
Paget disease is an exceedingly rare precancerous condition that affects specific areas of the skin, potentially in one or more areas around the anus, perineum and genitals, and breasts. Symptoms include redness, itchiness, and discomfort.
For these skin areas, Paget disease is diagnosed with a biopsy, in which lab experts assess tiny samples. Treatment may be complex but under the best circumstances involves surgery to remove the affected areas.
The colorectal surgeons at City of Hope have expertise in nonsurgical and surgical management options for anorectal Paget disease and collaborate on challenging cases with specialists from gynecology, urology, and plastic surgery.
A pilonidal cyst is a nest of hair underneath the skin surface, typically located in the cleft just above the buttocks. Mostly seen in younger people in their 20 to 40s, these hair nests may develop an infection with swelling, redness, and pain. In most patients, surgery to remove the hair nest and any pockets of infection are necessary.
The colorectal surgeons at City of Hope are specialists for pilonidal cysts, with expertise in nonsurgical and surgical management options.
An anal stenosis or stricture is a tight scaring of the anus that results in narrowing of the anal opening. This may have different causes, but inflammatory bowel disease (Crohn disease), prior surgery, or side effects of radiation treatment to the area are the most common reasons. Most patients experience difficulty evacuating stool without laxatives.
The colorectal surgeons at City of Hope specialize in anorectal problems such stenosis. They have the expertise to develop and carry out a personalized nonsurgical or surgical treatment plan for each patient experiencing anal stricture.
Colorectal polyps are abnormal growths in the colon and rectum that can develop into cancer. They are commonly found during standard screening exams and affect more than 30% of American adults at some point in their lives.
It’s important to remove colorectal polyps to specify their nature and reduce the risk of developing colorectal cancer. Most polyps can be removed during normal or advanced colonoscopy, which is one of the reasons, colonoscopy is considered the gold standard for colon cancer screening. In some cases, patients may require surgery, in rare cases even resection of the colon. But it is our strong belief that in absence of cancer, any effort should be taken to avoid unnecessarily removing parts of the colon.
The colorectal surgery team at City of Hope employs a multidisciplinary team-based approach, working with our colleagues in advanced interventional gastroenterology to ensure that polyps are removed safely and as gently as possible using the latest techniques and technologies.
A rectocele occurs when the front wall of the rectum bulges into the back wall of the vagina. This is a widespread problem related to pelvic organ instability that often does not produce symptoms. Other pelvic organs including the bladder and small intestines can also bulge into the vagina and produce similar problems.
Symptoms may occasionally include difficulty with complete bowel evacuation, straining, constipation, rectal pain, and pain with sexual intercourse. However, the majority of rectoceles are “innocent bystanders” and not directly responsible for the mentioned symptoms.
The colorectal surgery team at City of Hope employs a multidisciplinary team-based approach, working closely with our colleagues in urogynecology to ensure that patients who have symptoms that interfere with their daily lives are offered the full spectrum of nonsurgical and surgical treatments.
Diverticular disease, or diverticulitis, is a condition in which little outpouchings, called diverticula, form in the colon and become inflamed and cause symptoms such as pain, nausea, fever, constipation and even bleeding. While these pockets do not represent a risk for cancer, they have a similar age-dependent increase in incidence as colorectal cancer and may occasionally be mimicked by colorectal cancer.
Diverticula may also form without advancing to diverticulitis. Many if not most Americans will develop diverticula during their lifetime as a result of diets and other habits commonly seen in the U.S.
The colorectal surgeons at City of Hope are experts in the management of diverticulitis and the presence of diverticula: They carefully analyze the benefit of an operation to remove the diseased segment of the colon. If surgery is needed, we have all of the modern technologies at hand to minimize the impact of these conditions and accelerate recovery.
Crohn’s disease is an inflammatory bowel disorder that can affect any part of the gastrointestinal tract, including the gastrointestinal wall’s surface, its deeper layers and even the entire bowel wall.
Crohn’s disease can present as abdominal disease, anorectal disease, or both. Typical symptoms include abdominal pain, ongoing diarrhea, bloody bowel movements, fever, and unintentional weight loss.
The colorectal surgery team at City of Hope employs a multidisciplinary team-based approach, working closely with our colleagues in gastroenterology to ensure that each patient facing this complex disorder receives individualized treatment designed to provide the best outcome. We specialize in the latest, gentler surgical approaches and treatments for complications related to Crohn’s disease.
Ulcerative colitis (UC) is an inflammatory disease confined to the internal lining of the large bowel wall. Symptoms can include diarrhea, pain, cramping, bleeding, and urgent need to defecate, sometimes with the inability to pass stool. The disorder can go into remission and recur.
There are several medications available for UC. In cases where they are not effective, surgery can be used to cure the condition. Other reasons that a patient may require surgery include cancer or precancerous growths found during a colonoscopy.
The colorectal surgery team at City of Hope employs a multidisciplinary team-based approach, working closely with our colleagues in gastroenterology to ensure that each patient facing this complex disorder receives individualized treatment designed to provide the best outcome. We specialize in the latest, gentler surgical approaches and treatments for complications related to ulcerative colitis.
There are several potential causes for problems related to a colostomy or ileostomy, requiring thorough medical evaluation and treatment. Most problems can be treated without surgery.
City of Hope’s team of ostomy nurse specialists and colorectal surgeons have the experience and expertise to effectively address issues related to ostomies, with a focus on providing our patients with the best possible quality of life.
In select patients whose colon had to be completely removed, continent ileostomy is an alternative to wearing an external ileostomy bag. This surgery involves the creation of an internal bowel reservoir with a valve mechanism, also known as a Kock pouch, Barnett continent intestinal reservoir (BCIR), or T-pouch.
After recovery, stool will not leak out and patients drain stool a few times a day by inserting a tube through a small flat opening that otherwise can be hidden under a bandage. The BCIR offers advantages over the similar J-pouch, which has to be emptied more often.
City of Hope is one of only a handful of centers in the U.S. with colorectal surgeons who have the skill and experience needed to perform these complex surgeries. It’s important to note that not every patient will qualify for this treatment.
Pelvic floor dysfunction is a group of disorders that change the way patients have bowel movements and that sometimes cause pelvic pain. These disorders can be debilitating and embarrassing for patients and may be hard to diagnose and treat. Symptoms vary by type of disorder.
Treatment depends on the cause of the problem and the severity of the symptoms. The colorectal surgery team at City of Hope employs a multidisciplinary team-based approach for diagnosing and treating these challenging conditions. Our goal is to improve the quality of life for patients who are struggling with these debilitating conditions.
Fecal incontinence can have several causes, requiring specialized evaluation and treatment. These services are available at City of Hope, with individualized plans for therapy that could involve drug treatment, surgery, or sacral nerve stimulation, in which an implanted device helps reestablish normal function in the muscles of the bowel and anal sphincter.
Constipation is common and often can be treated successfully using drug therapy. In some cases, constipation requires additional specialized evaluation and treatment, including possible surgery.
At City of Hope’s Division of Colorectal Surgery, a team of experts uses the latest techniques and state-of-the-art, gentler procedures that minimize side effects and recovery time.