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What You Need To Know About Hemorrhoids

Hemorrhoids are the swollen veins that can be found around the anus or in the lower rectal area. There are instances when the walls of these veins stretch so thinly that they bulge and get irritated. This usually happens when one is straining so hard, such as in cases of constipation.

 Also known as piles, hemorrhoids affect about 50 percent of adults especially those on their 50s.

 There are two different types of hemorrhoids - internal and external hemorrhoids. Internal hemorrhoids are those that develop within the anus or rectum while external hemorrhoids are those that develop outside the anus. Between the two types of hemorrhoids, it’s the external hemorrhoids that are the most common and are causing trouble.

 Causes and Risk Factors

Hemorrhoids tend to run in families. Hence, if you have a family member who has suffered from hemorrhoids, then you’re most likely to suffer from hemorrhoids too. There are also other factors that can increase one’s risk of getting hemorrhoids. These include obesity and pregnancy as they can build pressure on the lower rectum that can affect the blood flow in the area and cause the veins in the area to swell.

 Other factors that can increase one’s risk of getting hemorrhoids include straining during bowel movement (common when having constipation) and straining when lifting heavy objects. People who tend to sit or stand for hours in a day are also at risk of developing hemorrhoids.

 Symptoms of Hemorrhoids

Symptoms of hemorrhoids vary but the most common ones include:

 ●      Itching around the rectal area

●      Painful lump or swelling near the anal area

●      Irritation and pain around the anus

●      Painful bowel movement

●      Bleeding on the tissue after a bowel movement

 Diagnosing and Managing Hemorrhoids

When a person is suspected of having hemorrhoids, the doctor may do a visual examination of the area. Some doctors may do a digital rectal exam to check for other abnormalities in and around the anal area. If abnormalities are noticed, then the patient may be recommended for another test called sigmoidoscopy.

 Sigmoidoscopy is a test that involves the use of a special tool called a sigmoidoscope. This tool helps the doctor in visualizing the rectal area and may even help in looking closely at the hemorrhoid.

 Mild cases of hemorrhoids can be easily managed at home. These include lifestyle changes like adding more fiber in the diet and getting into regular physical activity. Some of the symptoms can be managed too through warm sitz baths and by using over-the-counter creams for pain/discomfort.

 Hemorrhoids that cause a great deal of discomfort and cause bleeding may require more than just home remedies. For these cases, a patient may be recommended for certain procedures like rubber band ligation, injection therapy, or sclerotherapy.

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Colorectal Surgery

COLON AND COLORECTAL SURGERY (SUCH AS COLECTOMY)

Whenever possible, minimally invasive surgery is used to treat diseases and conditions of the bowel; however, more invasive procedures such as ostomies are sometimes used to treat inflammatory bowel disease and colorectal cancer.

Severity of the disease or condition, patient history, current overall health, level of pain, diagnostic results, and lifestyle are carefully considered when determining which procedure is appropriate for the patient.

Laparoscopic     or colonoscopy surgery treats many     diseases of the intestinal tract, including cancer. It often is called     minimally invasive surgery because it requires small (typically up to a     half inch) incisions. Small tubes containing a video camera and surgical     tools are inserted through the incisions. The surgeon then uses the image     from the video camera inside the body to perform the procedure. Patients     who have laparoscopic procedures often have fewer complications, a shorter     hospital stay, less postoperative pain and scarring, and a faster return     to normal activities than those who have open surgical procedures. Despite     its advantages, laparoscopic surgery cannot be performed on all patients

Strictureplasty widens rather than shortens the     intestine and is used to treat patients with Crohn's disease

Ostomy     surgery involves     creating an opening from the inside to the outside of the body to remove     feces and urine. For example, a colostomy connects a section of the large     intestine to an opening (stoma) in the abdominal wall that allows feces to     be carried out of the body and deposited in a disposable pouch

Ileostomyor     colectomy surgery involves     removing the colon, rectum, and anus, with the lower end of the small     intestine (ileum) used for the stoma. Most colostomies and ileostomies are     permanent; however, some patients can have a temporary colostomy to     protect injured or diseased sections of the large intestine until it heals

Ileonanal     anastomosis involves     creating an artificial rectum

DIAGNOSTIC PROCEDURES (SUCH AS COLONOSCOPY)

Diagnostic procedures help determine the condition of the intestinal tract, including the extent and severity of disease, presence of tumors, and perforations in the bowel wall.

Colonoscopy allows a surgeon to examine the     entire intestinal tract. A sedative is usually given to patients who have     the procedure

Flexible     sigmoidoscopy involves a     flexible tube with a miniature camera that is inserted through the rectum     to examine the lining of the rectum and lower one-third of the intestinal     tract (the sigmoid colon). The sigmoidoscope also can be used to remove     polyps and diseased tissue

Lower     gastrointestinal (GI) series involves taking X-rays of the colon     and rectum to identify ulcers, cysts, polyps, pouches in the intestine     (diverticuli), and cancer

Magnetic     resonance imaging (MRI) is used     before and during colon surgery to determine the part of the colon that     must be removed to eliminate diseased tissue. MRI also can help surgeons     determine which patients will most benefit from chemotherapy and radiation

  ol

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What are colon polyps?

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Celebrities Who Had Colorectal Cancer

Image: Phalinn Ooi

Colorectal cancer is the third most common types of cancer. The American Cancer Society estimated that in 2016, there will be over 90,000 new cases of colon cancer and there will be over 30,000 new cases of rectal cancer.

Adults over the age of 50 are at greater risk for developing this type of cancer as well as those with family history of the disease, history of the Crohn’s disease or ulcerative colitis, and those who have history of endometrial, colon, rectal, breast, or ovarian cancer.

Thousands of people have already died because of this disease including the co-creator of “The Simpsons” Sam Simon. The following are other famous people who battled with colorectal cancer:

Sharon Osbourne

In 2002, Sharon Osbourne was diagnosed with colon cancer. Her drive to survive led her to undergo surgery and chemotherapy that in 2004, she was cancer-free.

Although several factors can predispose someone to the development of colorectal cancer, statistics have it that the lifetime risk for developing this type of cancer is higher among women than men.

Ronald Reagan

Reagan, who was the 40th president of the United States, is also one of those popular figures affected with colorectal cancer. He underwent surgery for colon cancer in 1985. Reagan recovered from the disease but passed away in 2004.

The type of treatment for colon cancer depends on one’s stage of cancer. If the cancer is detected earlier and localized in a polyp, then the doctor may be able to remove it through colonoscopy. For larger polyps, endoscopic mucosal resection may be advised.

Darryl Strawberry

The athlete was diagnosed with colorectal cancer that he underwent surgery and chemotherapy in 1998. Two years after, his cancer has returned. According to his agent, Strawberry’s cancer had spread to his lymph nodes.

Cancer cells can spread from one part of the body to the other. They can spread to other parts through the bloodstream or lymphatic system.

Carmen Marc Valvo

After being diagnosed with colon cancer, the fashion designer has been involved in many activities to increase the awareness of colorectal cancer.

Prognosis for colorectal cancer is better if it’s diagnosed earlier. Hence, people aged 50 and above are advised to get screened for colorectal cancer. Screening for colorectal cancer includes fecal occult blood testing, colonoscopy, or sigmoidoscopy.

Audrey Hepburn

Audrey Hepburn was a British actress and fashion icon who passed away in 1993 at the age of 63 due to colon cancer. Hepburn started to feel abdominal pains after returning from Somalia. After getting several tests, her doctor revealed that she has a rare form of cancer.

Surgical procedures were done to Hepburn but they were not successful. According to her doctor, the cancer has metastasized and it’s no longer operable. Hepburn returned to Switzerland where she spent her last days.

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Innovative recovery program for colorectal surgery patients could reduce lengths of hospital stay, save money

The cost of implementing an innovative quality improvement program that helps colorectal surgery patients recover faster is more than offset by savings from their reduced lengths of stay at hospitals of any size. The patient-centric program incurs sizable upfront investments in patient educational materials, dedicated time for frontline providers to develop and implement the pathway and develop a framework for measuring their performance. However, such programs can produce significant savings for hospitals of various sizes with varying volumes of colorectal surgery, according to new study results published online as an "article in press" in the Journal of the American College of Surgeons (JACS). The study will appear in a print edition ofJACS later this winter.

The researchers from Johns Hopkins Medical Institutions, Baltimore, analyzed the lengths of stay and costs documented in six published reports of Enhanced Recovery After Surgery (ERAS) programs that were implemented in U.S. hospitals for patients undergoing colorectal procedures between 2003 and 2015. Data from these reports were used to generate a financial model that reflects the net financial impact of implementing ERAS.

The data included implementation costs, reductions in length of stay and the per day reductions in direct variable costs associated with shorter hospital stays, as well as annual surgical caseload. This study is believed to be one of the first to project costs and potential savings associated with ERAS program implementation in the U.S. The information provided in the article may be helpful for clinicians considering adopting this approach to clinical care as a tool to facilitate conversations with senior hospital leadership about the investment.

ERAS programs create evidence-based protocols that promote the adoption of a standardized approach to adoption of evidence based perioperative care. Key elements include preoperative counseling about expectations for the procedure and hospitalization for patients and their families, optimizing preoperative and postoperative nutrition, minimizing the use of narcotic pain management, and promoting a culture of early mobility after surgery.

In previous studies, ERAS protocols have reduced complications, hospital stays, and costs, and improved the patient experience, according to lead study author Elizabeth Wick, MD, FACS, a colorectal surgeon at The Johns Hopkins Hospital, and associate professor of surgery at Johns Hopkins School of Medicine. "However, ERAS programs require initial investments in materials, clinician time and personnel, and capital equipment, which can be difficult for surgeons to justify to their hospital leadership. With the model described in this study, surgeons can plug in their case volumes and current length of stay and cost metrics and determine the potential cost-savings, based on published U.S. studies, they might expect at their hospital. The model gives surgeons a framework for having a sophisticated discussion about how to initiate these types of programs with hospital administrators and what type of return on investment can be anticipated. Hopefully it can be used to promote collaboration between surgeons and hospital leadership to really improve the quality, value and patient experience," Dr. Wick said.

The researchers used information from six ERAS program sites to develop a the model for this study to compare median length of stay with direct variable costs to the hospital, which includes laboratory, pharmacy, radiology, and respiratory care materials and services before and after ERAS implementation. From these data, researchers generated a conservative and an optimistic estimate of cost savings. A conservative one-day reduction in length of stay could save about $1,897 in direct variable costs, while an optimistic three-day reduction in hospital stay could save about $2,240 in direct variable costs.

Using the model, the researchers were able to adjust cost estimates by caseload. For hospitals with an assumed annual number of 100 colorectal procedures, the cost would be $117,875 for implementation of ERAS in the first year and $107,875 in annual maintenance costs. Implementation of ERAS in a hospital performing 250 colorectal procedures a year would cost $325,000 in the first year and $216,300 in annual maintenance. A large colorectal surgical program performing 500 procedures per year would cost $552,783 initially and $356,944 annually thereafter.

These costs are more than offset by net savings. At The Johns Hopkins Hospital ERAS protocols reduced length of stay on average by 1.9 days (26.4 percent) and direct variable costs by $1,897 per patient. With an annual caseload of 500 patients, ERAS protocols yielded a total cost savings of $948,500. Subtracting the $552,783 cost of implementing the ERAS program, net annual savings totaled $395,717.

A sensitivity analysis predicted cost savings in 20 of 27 scenarios (74 percent). Net costs were higher in the seven scenarios that were associated with conservative one-day reductions in lengths of stay. Scenarios associated with reductions of 3.0 days in length of stay were associated with savings of $107,130 to $1,322,220. The Johns Hopkins Hospital scenario showed a net saving of $159,720 to $634,720 depending on the daily length of stay cost saving.

"According to this model, ERAS is a beneficial program for any size hospital. There is no excuse for saying 'our hospital only does a few cases, so it's not worth it for us to invest in these protocols.' The benefit is there, even for a small surgery program," Dr. Wick concluded.