Colorectal Disease

Together the colon and rectum make up your large intestine. For that reason, medical disorders that affect this area of the body may be called “colorectal” or “intestinal” disorders. Colorectal conditions range from common and often treatable problems such as chronic constipation, to rare or life-threatening disorders including anal cancer.

While the colon and rectum are both part the large intestine, they each play separate and important roles in our digestive process.

The colon absorbs water from digested food so it can be used elsewhere in the body, and it processes and helps eliminate solid waste from the body. The colon also contains many kinds of beneficial bacteria that help with the digestive process.

The rectum is the final portion of the large intestine. Muscles in the colon propel solid waste into the rectum, where it is temporarily stored and then emptied through the anal canal (anus).

Scripps gastroenterologists have extensive experience diagnosing and treating the full spectrum of colorectal disorders, including:

• Anal cancer, a rare form of cancer that occurs in the anal canal. Learn more about anal cancer treatment at Scripps.

• Clostridium difficile, also known as C. difficile or C. diff, is a type of bacteria that can cause diarrhea (sometimes called C. difficile diarrhea) or severe inflammation in the colon (called C. difficile colitis). Because C. difficile infections can be hard to treat — and pose serious health risks if left untreated — it’s important to seek care from doctors who have experience managing them.

• Chronic constipation, or infrequent bowel movements. Patients with chronic constipation generally have difficulty passing stool, or have fewer than three bowel movements per week, over an extended period of time.

• Colon cancer, sometimes called colorectal cancer, is a form of cancer that occurs within the colon. It is one of the leading causes of cancer death among men and women. Scripps doctors treat all forms of colon cancer, including hereditary colorectal cancer syndromes (such as familial adenomatous polyposis and Lynch syndrome.) Learn more about colon cancer treatment at Scripps.

• Colon polyps, also known as colorectal polyps, are small clumps of cells that grow on the lining of the colon or rectum. While many are benign (non-cancerous) and harmless, polyps should be removed because some may eventually develop into colon cancer.

• Diarrhea, a condition marked by frequent, watery bowel movements. While most people will experience temporary diarrhea during their lifetime, long-term diarrhea may be a sign of a more serious gastrointestinal problem.

• Diverticulitis occurs when small, bulging sacs form on the lining of the large intestine, usually within the colon. If small pieces of feces become trapped inside these sacs, they can become infected or inflamed.

• Fecal incontinence, also known as bowel incontinence, refers to a loss of bowel control. Symptoms can range from occasional leaking of stool, to complete and total loss of bowel control.

• Hemorrhoids are a common problem that affect men and women. They occur when veins inside the anus or lower rectum become swollen, and can cause rectal bleeding, pain during bowel movements and anal itching.

• Irritable bowel syndrome (IBS) is a fairly common, long-term condition that affects the colon. It causes abdominal pain or cramping, gas, bloating, diarrhea or constipation. It’s important to note that IBS is not the same as inflammatory bowel disease (IBD), which is described below. Unlike IBD, IBS can often be managed with dietary and lifestyle changes, and it does not increase your risk of colon cancer.

• Inflammatory bowel disease (IBD) is the name for a group of medical conditions that cause long-term inflammation of the digestive tract, including Crohn’s disease and ulcerative colitis. Learn more about IBD care at Scripps.

• Microscopic colitis is a condition that causes symptoms including weight loss and watery diarrhea. Unlike other inflammatory disorders that affect the colon, microscopic colitis cannot be detected with a routine colonoscopy or flexible sigmoidoscopy alone — tissue must be examined under a microscope to confirm a diagnosis. Symptoms of microscopic colitis can come and go, and often resolve with treatment.

• Rectal bleeding, which usually refers to blood that has passed through the anus and shows up on toilet paper or in the toilet bowl, can occur for many reasons. It may be a side effect of a common but treatable condition like constipation or hemorrhoids, or it may indicate a more serious gastrointestinal problem like colon cancer or an inflammatory bowel disease.

• Rectal cancer is a slow-growing form of cancer that occurs in the rectum. It is sometimes referred to as colorectal cancer. Learn more about rectal cancer treatment at Scripps.

Scripps gastroenterologists use a variety of tests and procedures to screen for and diagnose colorectal disease, including one or more of the following:

• Colonoscopy, an exam that allows doctors to see inside the colon and rectum using a camera attached to a thin, flexible tube (called a colonoscope). Colonoscopy allows doctors to examine the entire colon.

• Sigmoidoscopy, also known as flexible sigmoidoscopy, is similar to a colonoscopy — both are used to screen for or diagnose various types of colorectal disease, using a camera attached to a colonoscope. Sigmoidoscopy only looks at the last portion of the colon closest to the rectum, called the sigmoid colon. Learn more about the differences between colonoscopy and a sigmoidoscopy.

• Endoscopic ultrasound, or EUS, is a procedure that combines endoscopy and ultrasound to capture high quality images of the digestive tract. It’s often used to help diagnose colon cancer.

• Capsule endoscopy is a procedure that uses a tiny camera, which is placed inside a pill-sized capsule and swallowed, to take pictures of the gastrointestinal tract. The images are recorded on a device worn around the waist.

• Anal manometry is a test used to evaluate how well the muscles in the anus and rectum are working. It’s frequently used to diagnose fecal incontinence or chronic constipation.

Scripps also offers genetic counseling services and ongoing screenings for patients who are at high risk of developing one of several hereditary colorectal cancer syndromes. These include familial adenomatous polyposis and Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer).

Scripps offers a variety of medical and surgical treatment options for colorectal disease, including:

• Endoscopic mucosal resection is a procedure that removes abnormal or cancerous tissue from the gastrointestinal tract, including the colon.

• Fecal microbiota transplant, also called a fecal transplant or stool transplant, is primarily used to treat C. difficile diarrhea and colitis. During the procedure, fecal matter from a healthy, approved donor is transferred to a patient infected with C. difficile. The transplant allows beneficial bacteria found in the donor’s colon to replace the harmful C. difficile bacteria that have taken over the recipient’s colon.

Scripps is one of a few health care providers in Southern California that performs fecal transplants (currently considered an “investigational procedure” by the U.S. Food and Drug Administration).

• Bowel resection is a surgical procedure that removes a diseased portion of the colon or rectum. Sometimes the remaining portions of the colon and rectum cannot be reattached; when this occurs, the surgeon also performs a colostomy. During a colostomy, a surgeon creates an artificial opening on the outside of the body, called a stoma, for feces to pass through.

• Ileoanal anastomosis surgery, also known as J-pouch surgery, is typically used to treat ulcerative colitis. It allows patients who have had their colon and rectum removed to continue to pass stool normally, without the need for a colostomy.

• Drug therapy is primarily used to manage inflammatory bowel disease. There are several different types of medication available. These include anti-inflammatories, immune system modulators, antibiotics and probiotics.

• Hemorrhoid surgery, also known as hemorrhoidectomy, may be used to remove hemorrhoids that have not responded to previous treatments, including topical medication and dietary changes.

• Pelvic floor physical therapy is an effective non-surgical option for people with fecal incontinence, chronic constipation or rectal pain.

• If you have colorectal cancer, your gastroenterologist will work closely with Scripps cancer specialists to create a customized treatment plan. Learn more about colon, rectal or anal cancer treatment options at Scripps.

Scripps gastroenterologists offer consultations or care for people with colorectal disease at the following locations:

• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital (San Diego and Chula Vista)
• Scripps Green Hospital
• Scripps Clinic Carmel Valley
• Scripps Clinic Encinitas
• Scripps Clinic Rancho Bernardo
• Scripps Clinic Rancho San Diego