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Colorectal Surgery

TRUE Care for Colorectal Health.

At Wilmington Health we provide high-quality surgical care by utilizing robotics, laparoscopy, and minimally invasive surgical procedures. Dr. Gentry Caton is a dedicated and experienced Colorectal and General Surgeon who performs everything from colonoscopies to colorectal, anal, hernia, and fecal incontinence surgeries. He also offers surgery using the da Vinci Robotic Surgical System, which provides patients minimal scarring, quicker recovery, and shorter hospital stays.

Colorectal Surgery Services

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Watch to learn more about Hemorrhoids, Colorectal Cancer, Fecal Incontinence, and Diverticular Disease.

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Robotic Surgery

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Dr. Gentry Caton performs this minimally invasive surgical procedure to remove large polyps and early cancers in the lower rectum.

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Please find the Wilmington Health Referral Form here

Our goal is to make your referral process as seamless as possible. If you have a patient you would like to refer to Wilmington Health, please download, complete, and fax the form below to 910-341-1900. Please note we will be unable to except referrals faxed to any other fax line.

There are a variety of anal contions that a person could have, some of them include: 

Anal Pain

Anal pain could accur before, during, or after a bowel movement. It could range from a mild ache that can get worse over time to a pain that is so bad that it could restrict daily activies. There are many cuases for anal pain, most are common and treatable. If anal pain does not go away within 24 to 48 hours it is important to see your physician. If a fever is present with anal pin, a more urgent appointment is needed. For more information please click here

Anal Warts

Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), the most common sexually transmitted disease (STD). The warts affect the area around and inside the anus, but may also develop on the skin of the genital area. They first appear as tiny spots or growths, often as small as a pin head. They can grow quite large and cover the entire anal area. For more information please click here

Treatment options include but are not limited to, antibiotics, in office or outpatient procedures, or surgery.

Anal Fissure 

An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as hemorrhoids. For more information please click here

Abscess and Fistula

An anal fistula (also called fistula-in-ano) is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus. This often results from a previous or current anal abscess. For more information please click here

Pruritus Ani

This condition causes irritation of the skin near the anus, resulting in a strong urge to scratch the area. In many cases, no specific problem is found to explain the itching. These cases are called “idiopathic” (from unknown cause). For more information please click here


A colonoscopy allows a doctor to look inside the entire large intestine, which is also called the colon. The procedure enables the physician to see things such as inflamed tissue, abnormal growths and ulcers. It is most often used to look for early signs of cancer in the colon and rectum. (Read about “Colorectal Cancer“) It is also used to look for causes of unexplained changes in bowel habits and to evaluate symptoms like abdominal pain, rectal bleeding and weight loss. (Read about “Gastrointestinal Bleeding“)

The colon, or large intestine, is the last portion of your digestive or gastrointestinal tract. (Read about “Digestive System“) The colon is a hollow tube that starts at the end of the small intestine and ends at the rectum and anus. The colon is about 5 feet long, and its main function is to store unabsorbed food waste and absorb water and other body fluids before the waste is eliminated as stool.

There are things you must do to prepare for a colonoscopy. Your colon must be completely empty for the colonoscopy to be thorough and safe. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says to prepare for the procedure you will have to follow a liquid diet for 1 to 3 days beforehand. The liquid diet should be clear and not contain food colorings, and may include:

  • fat-free bouillon or broth
  • strained fruit juice, no purple or red grape juice
  • water
  • plain coffee
  • plain tea
  • diet soda
  • gelatin, not purple or red

Thorough cleansing of the bowel is necessary before a colonoscopy. You will likely be asked to take a laxative the day before the procedure, and possibly on the day of the procedure. In some cases, you may also have an enema. The American College of Gastroenterology (ACG) says it is important to let your doctor know of any medical conditions you have or medications you take on a regular basis such as:

The staff where you have the procedure will also want to know if you have heart disease, lung disease or any medical condition that may need special attention. (Read about “Coronary Heart Disease” “Respiratory System“)

In a traditional colonoscopy, you will also need to arrange for someone to take you home afterward, because you will not be allowed to drive after being sedated. For the colonoscopy, you will lie on your side on the examining table. You will be given pain medication and a moderate sedative to keep you comfortable and help you relax during the exam. (Read about “Anesthesia“) ACG says the doctor and a nurse will monitor your vital signs, look for any signs of discomfort and make adjustments as needed.

The doctor will then insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope. The scope transmits an image of the inside of the colon onto a video screen so the doctor can carefully examine the lining of the colon. The scope bends so the doctor can move it around the curves of your colon.

You may be asked to change positions at times so the doctor can more easily move the scope to see better the different parts of your colon. The scope blows air into your colon and inflates it, which helps give the doctor a better view. Most patients do not remember the procedure afterwards, according to NIDDK.

The doctor can remove most abnormal growths in your colon, like a polyp, which is a growth in the lining of the bowel. (Read about “Colon Polyps“) Polyps are removed using tiny tools passed through the scope. Most polyps are not cancerous, but they could turn into cancer. (Read about “Cancer: What It Is“) Just looking at a polyp is not enough to tell if it is cancerous. The polyps are sent to a lab for testing. (Read about “Laboratory Testing“) By identifying and removing polyps, a colonoscopy likely prevents most cancers from forming.

The doctor can also perform a biopsy. (Read about “Biopsy“) That is the removal of tissue samples to test in the lab for diseases of the colon. In addition, if any bleeding occurs in the colon, the doctor can pass a laser, heater probe, electrical probe or special medicines through the scope to stop the bleeding. The tissue removal and treatments to stop bleeding usually do not cause pain. In many cases, a colonoscopy allows for accurate diagnosis and treatment of colon abnormalities without the need for a major operation, according to ACG.

During the procedure, you may feel mild cramping. NIDDK says you can reduce the cramping by taking several slow, deep breaths. When the doctor has finished, the colonoscope is slowly withdrawn while the lining of your bowel is carefully examined. NIDDK says bleeding and puncture of the colon are possible but uncommon complications of a colonoscopy.

Expect to be in the examination area for 30 to 60 minutes. The actual exam of the colon will take less time than that. The sedative and pain medicine should keep you from feeling much discomfort during the exam. You may feel some cramping or the sensation of having gas after the procedure is completed, but it usually stops within an hour. You will need to remain at the colonoscopy facility for 1 to 2 hours so the sedative can wear off.

Rarely, some people experience severe abdominal pain, fever, bloody bowel movements, dizziness or weakness afterward. If you have any of these side effects, contact your physician immediately. Read your discharge instructions carefully. Medications such as blood-thinners may need to be stopped for a short time after having your colonoscopy, especially if a biopsy was performed or polyps were removed. Do not however make that decision yourself without discussing all of the issues with your doctors. NIDDK says full recovery by the next day is normal and expected and you may return to your regular activities.

In addition to traditional colonoscopy, there is also a procedure called virtual colonoscopy (VC). VC uses x-rays (Read about “X-rays“) and computers to produce two- and three-dimensional images of the colon from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. Virtual colonoscopy is also called CT colonography. (Read about “CT Scan – Computerized Tomography“) Magnetic resonance imaging (MRI) technology can also be used. (Read about “MRI – Magnetic Resonance Imaging“)

While preparations for VC vary, you will usually be asked to take laxatives or other oral agents at home the day before the procedure to clear stool from your colon. You may also be asked to use a suppository to cleanse your rectum of any remaining fecal matter.

VC takes place in the radiology department of a hospital, medical center or in specialized centers. The examination takes about 10 minutes and does not require sedatives. After the examination, the information from the scanner must be processed to create the computer picture or image of your colon. A radiologist evaluates the results to identify any abnormalities.

You should discus the advantages and disadvantages of both virtual and traditional colonoscopy with your doctor.

Related Information:

    Flexible Sigmoidoscopy

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

To help you prepare for your procedure please click on the links below to download the printable forms.

Clear Liquid Diet Menu

Colonoscopy Pre-Op

Golytely Split Dose Prep

Miralax Split Dose Prep

Colorectal Cancer

HealthIt’s the type of cancer no one wants to talk about. But according to the American Cancer Society (ACS), cancers of the colon and rectum are among the most common cancers in the United States. (Read about “Cancer: What It Is“) They occur in both men and women and are most often found in people who are over fifty years of age.

The colon and rectum make up the large intestine. During digestion, the colon removes nutrients from food and stores waste until the waste matter passes out of the body. (Read about “Digestive System“) Cancers that occur in either part of the large intestine are termed colorectal cancer.

Risk factors

Our COLORECTAL CANCER RISK ASSESSMENT can help you learn more about your own risk factors, based on guidelines from the National Cancer Institute.

Simply click on the link for the form. Fill it out online to learn more about how specific things affect the risk of developing colorectal cancer. When you’re done, you may want to print it out and share it with your doctor. Any information you enter will NOT be saved once you close the window. This is to protect your privacy. When you’re done, simply close the form window, and continue reading.

It was originally thought that a diet low in fiber put you at a higher risk. But, according to the National Institutes of Health, recent studies have shed some doubt on this theory, although research continues. (Read about “Fiber and Health“) However, the American Medical Association (AMA) says that other lifestyle factors have been linked with a higher risk, including a diet high in fat, calories and alcohol, as well as smoking and obesity. (Read about “Quit Smoking” “Obesity“)

According to the National Cancer Institute (NCI), other known risk factors include the following:Digestive System

  • Colorectal cancer is more likely to occur as we get older, although it can occur in young people as well.
  • The presence of certain types of polyps (Read about “Colon Polyps“), or benign growths, on the inner wall of the colon or rectum, can indicate an increased risk. In particular, a hereditary condition called familial polyposis (Read about “Genetics“), in which hundreds of polyps form, is considered an important risk factor.
  • Having a personal history of colorectal cancer or certain other types of cancer can put you at a higher risk.
  • Having someone in your family who’s been diagnosed with colorectal cancer can put you at a higher risk. (Read about “Family Health History“)
  • Having a condition called ulcerative colitis (Read about “Ulcerative Colitis“) in which the lining of the colon becomes inflamed also increases your risk.

Reducing your risk

According to NCI, studies are now underway looking into a number of potential ways to reduce the risk of developing colorectal cancer. (Read about “Clinical Studies“) Among the things being examined are smoking cessation, use of dietary supplements, use of aspirin, decreased alcohol consumption and increased physical activity.

Until the results of such studies are known, the strongest weapon against colorectal cancer is early detection. Therefore, it’s important to know the warning signs of colorectal cancer. ACS says these include:

  • changes in bowel habits
  • changes in the stool
  • blood in the stool (Read about “Gastrointestinal Bleeding“)
  • vomiting
  • abdominal discomfort, bloating or cramps
  • unexplained weight loss or excessive fatigue

If you notice such changes, see your doctor right away.

Tests and staging

ACS, the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer (a group that comprises representatives from the American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy) say there are different tests that can be used. ACS urges screening for colorectal cancer begin at age 45 for most people. Family history and other risk factors may indicate a need for earlier testing. Tests include:

Tests that detect polyps and cancer:

Tests that primarily detect cancer:

  • Annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer
  • Annual fecal immunochemical test (FIT) with high test sensitivity for cancer
  • Stool DNA test (sDNA), with high sensitivity for cancer, every 3 years

These tests work in different ways. For example, a fecal occult blood test can check for hidden blood in the stool. According to the U.S. Centers for Disease Control and Prevention (CDC), studies show a 33 percent drop in deaths from colorectal cancer for people who had an annual fecal occult blood test. (Read about “Laboratory Testing“)

Flexible sigmoidoscopy uses a small lighted tube to inspect the wall of the rectum and part of the colon. The CDC says up to three quarters of polyps and 65 percent of cancers can be detected this way. For people over the age of fifty, even if they have no symptoms or known risk factors other than age, AMA recommends an annual fecal occult blood test and/or flexible sigmoidoscopy at least every five years. Higher risk individuals may need more aggressive screening; ask your doctor.

Colonoscopy, which inspects the entire colon, is also used at times. Traditional colonoscopy uses a tube with a camera and lights to inspect the colon. What is called virtual colonoscopy uses imaging techniques. In both colonoscopy and sigmoidoscopy, the doctor can also take samples of tissues for more examination. (Read about “Biopsy“) Doctors can also manually examine the area or use a series of x-rays using a double contrast barium enema to help outline the area on the x-rays. (Read about “X-rays“)

If any of these tests indicates a potential problem, a colonoscopy is likely to be performed to confirm the diagnosis.

The doctor needs to know the stage of the disease to plan treatment. The following stages are used, according to NCI:


  • Stage 0 (Carcinoma in Situ)In stage 0, abnormal cells are found in the innermost lining of the colon only. These abnormal cells may become cancer and spread. Stage 0 is also called carcinoma in situ.
  • Stage IIn stage I, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but it has not spread to the outer wall of the colon or outside the colon.
  • Stage IIIn stage II, cancer has spread to the outer layer of the colon and perhaps through the colon wall and may have spread to nearby tissue.
  • Stage IIIIn stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Stage IVIn stage IV, cancer has spread to other parts of the body, such as the liver or lungs.


  • Stage 0 (carcinoma in situ)In stage 0, abnormal cells are found in the innermost lining of the rectum only. Stage 0 is also called carcinoma in situ.
  • Stage IIn stage I, cancer has spread beyond the innermost lining of the rectum to the second and third layers and involves the inside wall of the rectum, but it has not spread to the outer wall of the rectum or outside the rectum.
  • Stage IIIn stage II, cancer has spread through the rectal wall and may have spread to nearby tissue.
  • Stage IIIIn stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Stage IVIn stage IV, cancer has spread to other parts of the body, such as the liver, lungs or ovaries.


If cancer is present, NCI says surgery to remove the tumor is the most common treatment. Different types of surgery for this cancer include:

  • Local excision – If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube with a cutting tool through the rectum into the colon and cut the cancer out.
  • Radiofrequency ablation – This uses a special probe with tiny electrodes to kill cancer cells. Depending on how the probe is inserted, it may be done under local anesthesia.
  • Cryosurgery – This is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.
  • Laparoscopy – Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
  • Open surgery – The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver (Read about “The Liver“) to see if the cancer has spread.

When a section of your colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, NCI says the surgeon creates a new path for waste to leave your body. The surgeon makes an opening (stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place. For most people, the stoma is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent stoma.

In addition to surgery, chemotherapy or radiation may also be used. Biological therapy may also be an option. All treatment plans should be carefully discussed with your doctor. (Read about “Radiation Therapy” “Cancer Treatments“)

As with so many other types of cancer, early detection can increase your chances of surviving colorectal cancer. Unfortunately, many people shy away from discussing this topic, even with their doctor.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

The frequency of bowel movements among normal, healthy people varies from three a day to three a week and healthy people may fall outside both ends of this range, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The American College of Gastroenterology (ACG) says constipation is a digestive condition (Read about “Digestive System“) where the bowels move infrequently and the consistency of the stool is often dry and hard.

Constipation is one of the most common gastrointestinal complaints in the United States. More than 4 million Americans have frequent constipation, according to NIDDK. Those reporting constipation most often are women and adults ages 65 and older. Pregnant women may have constipation (Read about “Healthy Pregnancy“), and it is a common problem following childbirth (Read about “Childbirth“) or surgery.

The usual reason for constipation is that extra water is absorbed into the body because the stool is slow moving through the intestine. The reasons for this can include:

Of these, NIDDK says that the most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs and meats. Fiber – both soluble and insoluble – is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

Americans eat an average of 5 to 14 grams of fiber daily, which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed.

Drinking enough water is important too. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass.

ACG says that any change in bowel habits, such as the onset of constipation, should be checked by a doctor. It could be an indication of a more serious problem. The tests the doctor performs depend on the duration and severity of the constipation, the person’s age, whether there is blood in stools (Read about “Gastrointestinal Bleeding“), recent changes in bowel habits or weight loss have occurred. If symptoms are severe, more extensive tests may be used to measure how well food moves through the colon, how well the rectal muscles contract and relax, and whether there are any obstructions. Other tests to rule out serious problems may also be used, including barium enema x-ray, colonoscopy or sigmoidoscopy. (Read about “X-rays” “Colonoscopy” “Flexible Sigmoidoscopy“)

If there are no problems other than constipation, lifestyle changes include adding more fiber to your diet, drinking more water and getting more exercise. (Read about “Getting Started on Fitness“) Your doctor may recommend a laxative or stool softener. It is important that you don’t overuse laxatives. Over time, according to NIDDK, laxatives can impair the natural muscle action of the intestines, leaving them unable to function normally. An ongoing need for laxatives is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.

Related Information:


All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Crohn’s disease is an uncomfortable inflammation of the digestive tract. It usually attacks the small intestine but can also be found anywhere from the mouth to the anus.

The American Academy of Family Physicians says Crohn’s is one of the Inflammatory Bowel Diseases (IBD). The other IBD is ulcerative colitis (Read about “Ulcerative Colitis“) which causes inflammation and ulcers in the top layer of the lining of the large intestine. Crohn’s on the other hand extends deep into the tissue of the affected organ. Up to a million people may suffer from the disease according to the Crohn’s & Colitis Foundation of America. Neither Crohn’s nor ulcerative colitis should be confused with irritable bowel syndrome or IBS, which is a non-chronic condition. (Read about “Irritable Bowel Syndrome“)

Symptoms and diagnosis

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), the first signals of Crohn’s are abdominal pain and diarrhea. (Read about “Diarrhea“) The pain is usually below the naval and on the right side. There are other early warning signs:

Since many of the symptoms also could point to other problems, NIDDK says a careful physical exam and other tests are needed to diagnose Crohn’s. A correct diagnosis can take time. Some of the tests your doctor can use are:

  • Blood tests to check for anemia caused by bleeding and to check for high white cell count which could indicate inflammation (Read about “Laboratory Testing” “Complete Blood Count“)
  • An upper gastrointestinal (GI) series to take a look at the upper intestine with x-rays (Read about “X-rays“)
  • Colonoscopy and/or flexible sigmoidoscopy where a small flexible tube with lights and a camera are inserted into the anus to see into the large intestine (Read about “Colonoscopy” “Flexible Sigmoidoscopy“)
  • Capsule endoscopy also known as the camera pill is a swallowable capsule containing a tiny camera that has Food and Drug Administration (FDA) approval. It takes pictures twice a second as it glides through the small intestine. It is then excreted from the body. It is intended to visualize the inside of the small intestine to detect polyps, cancer or causes of bleeding and anemia. (Read about “Endoscopy” “Gastrointestinal Bleeding” “Anemia“)

Causes and complications

Unfortunately, no one is sure of the cause of Crohn’s. There does seem to be a hereditary factor. (Read about “Genetics” “Family Health History“) The National Digestive Diseases Information Clearinghouse states that 20 to 25 percent of patients may have a close relative with IBD. The Crohn’s and Colitis Foundation of America says that the most common theory today is that a virus or bacteria cause the inflammation. (Read about “Microorganisms“)

The most common complication is a blockage of the intestine. Crohn’s can also cause ulcers that become infected and can tunnel deep into the tissue and on to other organs. There can also be nutritional complications with the body unable to absorb nutrients.

According to the Crohn’s and Colitis Foundation of America, there are other complications associated with Crohn’s:

Sometimes these complications clear up as the Crohn’s is treated. They sometimes require separate treatment.


NIDDK says there is no cure for Crohn’s. Treatments are designed to decrease the inflammation and relieve the symptoms. Various medications can be used to control the inflammation. They include:

  • anti-inflammatory drugs, such as sulfasalazine, mesalamine, aminosalicylates and corticosteroids
  • immune system suppressors such as azathioprine, mercaptopurine, infliximab, adalimumab, natalizumab, certolizumab pegol and cyclosporine
  • antidiarrheals or laxatives, depending on symptoms
  • supplements, such as iron, calcium and vitamin D

Immune modifiers or immune system suppressors are drugs that target the immune system to reduce inflammation. Biologic response modifiers can also act on the immune system. (Read about “The Immune System“) Some of them are genetically engineered antibodies that block inflammation caused by a protein called tumor necrosis factor. The Food and Drug Administration (FDA) approved several of these drugs for patients with moderate to severe Crohn’s disease who have not found relief with other treatments. Some of these drugs are also used to treat the inflammation of other diseases, such as rheumatoid arthritis. (Read about “Rheumatoid Arthritis“) There are side effects of the drugs. Tuberculosis, fungal infections and other serious opportunistic infections including histoplasmosis, listeriosis and pneumocystosis, have been reported. (Read about “Tuberculosis” “Listeriosis“) Some of these infections have been fatal.

In addition to drugs to control inflammation, other types of medications may be used. Antibiotics (Read about “Antibiotics“) can be used to treat bacteria that may be flourishing in ulcers. (Read about “Peptic Ulcers“) Pain relievers can be used. Medications can also be used to treat different symptoms such as constipation or diarrhea. (Read about “Constipation” “Diarrhea“) Diarrhea will usually subside as the inflammation does, but you can also ask your doctor about antidiarrheal agents. Patients who are dehydrated (Read about “Dehydration“) because of diarrhea may need treatment with fluids and electrolytes. Iron supplements may be needed to avoid anemia if there is a lot of gastrointestinal bleeding. (Read about “Iron Supplements” “Anemia” “Gastrointestinal Bleeding“) If you are using corticosteroids, you should talk to your doctor about taking supplemental calcium (Read about “Calcium“) and vitamin D to reduce the risk of osteoporosis. (Read about “Vitamins & Minerals” “Osteoporosis“)


The Crohn’s and Colitis Foundation of America says surgery is usually considered a last resort for Crohn’s patients. The diseased portion of the small intestine can be removed and the two healthy sections are joined together. NIDDK says this should not be considered a cure. Often Crohn’s reappears near the junction and spreads. If the large intestine is diseased, a doctor may recommend the removal of the intestine. In this case, a small opening is made in the wall of the abdomen, which will be used to expel waste. A pouch is worn over the opening to collect the waste. This treatment is called a colostomy.

Living with Crohn’s

Crohn’s disease may go into remission for years after treatment. Crohn’s is a serious chronic disease but is usually not considered a fatal illness.

Related Information:

    Digestive System

    Diverticular Disease

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

As we get older, we develop many conditions and diseases. One of them many of us will get is called diverticular disease. It’s a condition of the colon and the American Society of Colon and Rectal Surgeons (ASCRS) says that by the time people are 60, fifty percent of them have it.

What it is

There are two conditions that fall under the heading diverticular disease. They are:

  • diverticulosis (note the “os” after the l)
  • diverticulitis (note the “it” after the l)

Diverticulosis is a condition where there are small pouches in the colon that bulge outward, like when an inner tube pokes out of a weak spot in a tire. Those pouches, plural, are called diverticula. If you have them, you have diverticulosis.

Ten to 25 percent of the people with diverticulosis have pouches that get infected and inflamed, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). That is called diverticulitis.

It’s believed that diverticular disease is caused by a low fiber diet. (Read about “Fiber and Health“) It was first identified in the United States in the early 1900’s. That’s about the same time processed foods, low in fiber, were introduced into the American diet. It is common in the industrialized west where low fiber diets are common, but rare in Asia and Africa where high fiber vegetable diets are common, according to NIDDK.


Most people with diverticulosis don’t have any symptoms. The ones that do occur can also mimic other conditions such as stomach ulcers and irritable bowel syndrome (Read about “Peptic Ulcers” “Irritable Bowel Syndrome“). NIDDK and ASCRS list the following as possible symptoms:

  • mild cramping
  • diarrhea (Read about “Diarrhea“)
  • constipation (Read about “Constipation“)
  • bloating

There can also be abdominal pain, usually on the lower left side as opposed to the lower right side, which is a symptom of appendicitis. (Read about “Appendicitis“) In a very few cases there can be bleeding. (Read about “Gastrointestinal Bleeding“)

Diverticulitis can have many of the same symptoms; which can be accompanied by fever, chills, bloody diarrhea (Read about “Diarrhea“) and more pain. If the infection isn’t cleared up, it can result in complications such as abscesses and even peritonitis, which can be fatal.


ASCRS says that diverticular disease is usually treated by diet modifications. The goal is to increase the amount of fiber in a person’s diet. There is some controversy about avoiding certain foods. It once was standard for doctors to advise patients to avoid foods that had difficult to digest residue, that includes foods with seeds, such as tomatoes and cucumbers, nuts and popcorn. The concern was, and is, that those seeds and undigested portions could become trapped within the diverticula and trigger inflammation and infection. However, no scientific data support this treatment measure, according to NIDDK. Decisions about diet should be made, in consultation with your healthcare provider, based on what works best for each person.

Treatment for diverticulitis requires first clearing up the infection, usually with antibiotics. (Read about “Antibiotics“) Medications are sometimes used to help manage cramps and bowel habits.

Surgery is considered a last resort by both NIDDK and ASCRS and is used to remove the severely damaged portion of the colon.

The best way to delay and maybe even prevent diverticular disease according to NIDDK is to eat more fruit and vegetables along with other foods high in fiber.

Related Information:

    Digestive System

    Fresh vs Frozen

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) calls fecal incontinence the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you can get to a toilet. Or stool may leak from the rectum unexpectedly.

More than 6.5 million Americans have fecal incontinence. It affects people of all ages – children as well as adults. Fecal incontinence is more common in women than in men and more common in older adults than in younger ones. It is not, however, a normal part of aging.

Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed or humiliated. Some don’t want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced because treatment can improve bowel control and make incontinence easier to manage.

Fecal incontinence can have several causes, according to NIDDK:

  • Damage to the anal sphincter muscles – Fecal incontinence is most often caused by injury to one or both of the ring-like muscles at the end of the rectum called the anal internal and/or external sphincters. The sphincters keep stool inside. When damaged, the muscles aren’t strong enough to do their job, and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if the doctor uses forceps to help deliver the baby or does an episiotomy, which is a cut in the vaginal area to prevent it from tearing during birth. (Read about “Childbirth“) Hemorrhoid surgery can damage the sphincters as well. (Read about “Hemorrhoids“)
  • Damage to the nerves of the anal sphincter muscles or the rectum – Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that sense stool in the rectum. (Read about “Nervous System“) If the nerves that control the sphincters are injured, the muscle doesn’t work properly and incontinence can occur. If the sensory nerves are damaged, they don’t sense that stool is in the rectum. You then won’t feel the need to use the bathroom until stool has leaked out. Nerve damage can be caused by childbirth, a long-term habit of straining to pass stool, stroke (Read about “Stroke“), and diseases that affect the nerves, such as diabetes and multiple sclerosis. (Read about “Diabetes” and “Multiple Sclerosis“)
  • Loss of storage capacity in the rectum – Normally the rectum stretches to hold stool until you can get to a bathroom. But rectal surgery, radiation treatment and inflammatory bowel disease can cause scarring that makes the walls of the rectum stiff and less elastic. The rectum then can’t stretch as much and can’t hold stool, and fecal incontinence results. Inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, also can make rectal walls very irritated and thereby unable to contain stool. (Read about “Radiation Therapy” “Ulcerative Colitis” “Crohn’s Disease“)
  • Diarrhea – Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. Even people who don’t have fecal incontinence can have an accident when they have diarrhea. (Read about “Diarrhea“)
  • Pelvic floor dysfunction – Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele) and/or generalized weakness and sagging of the pelvic floor. Often the cause of pelvic floor dysfunction is childbirth, and incontinence doesn’t show up until the mid-forties or later. (Read about “Pelvic Floor Disorders“)

Diagnosis & treatment options

To diagnosis the cause, NIDDK says the doctor will ask health-related questions and do a physical exam and possibly other medical tests.

  • Anal manometry checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum.
  • Anorectal ultrasonography evaluates the structure of the anal sphincters. (Read about “Ultrasound Imaging“)
  • Proctography, also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool.
  • Proctosigmoidoscopy allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors or scar tissue. (Read about “Flexible Sigmoidoscopy“)
  • Anal electromyography tests for nerve damage, which is often associated with obstetric injury.

Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training or surgery. More than one treatment may be necessary for successful control since continence is a complicated chain of events.

Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, making it less watery and easier to control. Also, avoid foods that contribute to the problem. They include foods and drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly.

You can adjust what and how you eat to help manage fecal incontinence, according to NIDDK. Keep a food diary, list what you eat, how much you eat and when you have an incontinent episode. After a few days, you may begin to see a pattern between certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods that typically cause diarrhea, and so should probably be avoided, include:

  • caffeine
  • cured or smoked meat like sausage, ham, or turkey
  • spicy foods
  • alcohol
  • dairy products like milk, cheese, and ice cream (Read about “Lactose Intolerance“)
  • fruits like apples, peaches, or pears
  • fatty and greasy foods
  • sweeteners, like sorbitol, xylitol, mannitol and fructose, which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices

NIDDK also suggests that you eat smaller meals more frequently. In some people, large meals cause bowel contractions that lead to diarrhea. You can still eat the same amount of food in a day, but space it out by eating several small meals.

Eating and drinking at different times may help. Liquid helps move food through the digestive system. So if you want to slow things down, you could drink something half an hour before or after meals, but not with the meals.

You may need to adjust your fiber intake. (Read about “Fiber and Health“) Fiber makes stool soft, formed and easier to control. Fiber is found in fruits, vegetables and grains. NIDDK recommends people eat 20 to 30 grams of fiber a day, but stresses that people should talk with their doctor, and add the fiber to the diet slowly so the body can adjust. Too much fiber all at once can cause bloating, gas, or even diarrhea. Also, too much insoluble, or indigestible, fiber can contribute to diarrhea. So if you find that eating more fiber makes your diarrhea worse, you could try cutting back to two servings each of fruits and vegetables and removing skins and seeds from your food.

It’s also important to get enough to drink. NIDDK says people need to drink eight 8-ounce glasses of liquid a day to help prevent dehydration (Read about “Dehydration“) and to keep stool soft and formed. Water is a good choice, but avoid drinks with caffeine, alcohol, milk or carbonation if you find that they trigger diarrhea.

Over time, diarrhea can rob you of vitamins and minerals. Ask your doctor if you need a vitamin supplement. (Read about “Vitamins & Minerals“)

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

They aren’t something that’s fun to talk about but it’s important that you are aware of them, since half the population will get hemorrhoids by the time they are 50, according to the National Digestive Diseases Information Clearinghouse (NDDIC). Yes, half – they are that common.

What are hemorrhoids

They’ve been called the varicose veins (Read about “Varicose Veins“) of the anus and the rectum. They are blood veins that are swollen. They can be inside the anus (internal) or outside (external). When they are inside they tend not to be painful but they will bleed. External ones can be painful and itchy. There are also internal ones that protrude from the anus; those are called prolapsed.

Who gets hemorrhoids

Anyone can get hemorrhoids. The exact cause is unknown, but the American Society of Colon and Rectal Surgeons (ASCRS) says the following contribute:

  • aging
  • constipation (Read about “Constipation“)
  • diarrhea (Read about “Diarrhea“)
  • pregnancy (Read about “Healthy Pregnancy“)
  • heredity (Read about “Family Health History“)
  • overuse of laxatives
  • straining during bowel movements
  • spending long periods of time on the toilet (like reading)

The American Academy of Family Physicians (AAFP) says that being very overweight (Read about “Obesity“) or standing or lifting too much can make hemorrhoids worse.


Some sort of bleeding is usually one of the first signs of hemorrhoids, but if you’re noticing blood, you should not make any assumptions. Bleeding could also be a sign of other diseases such as colorectal cancer, (Read about “Gastrointestinal Bleeding” “Colorectal Cancer“) so it’s imperative that you see a doctor if you experience rectal bleeding.

Others signs of hemorrhoids, according to ASCR:

  • protrusion from the anus during a bowel movement
  • itching in the area
  • pain
  • lumps that are sensitive

Diagnosis can be made by a doctor during a physical exam. Other medical conditions, such as fissures, fistulae, abscesses or just irritation of the anus can have some of the same symptoms but are treated differently.


Hemorrhoids aren’t very serious and symptoms often go away on their own. If they are being aggravated by constipation, AAFP recommends increasing the amount of fiber in your diet. (Read about “Fiber and Health“) Some other ideas from NDDIC are:

  • Warm tub or sitz baths a few times a day in plain warm water for about 10 minutes each
  • Ice packs to help reduce the swelling
  • Hemorrhoidal creams or suppositories for a limited period of time

Some external hemorrhoids result from a hard blood clot. Your doctor may advise having that removed surgically. It is usually done on an outpatient basis with local anesthesia. A rubber band treatment is often used to treat internal ones. The band is wrapped around the hemorrhoid and the blood supply cut off. Other surgery is sometimes required in severe cases.


Since a major cause of hemorrhoids is constipation and the resulting straining during bowel movements that occurs, it’s important to try to stay regular. AAFP offers these suggestions:

  • increase your fiber intake, fresh fruit, leafy vegetables and whole grains are good sources
  • drink at least 8 glasses of water a day
  • regular exercise
  • avoid laxatives
  • do not delay using the bathroom when you feel the need

Hemorrhoids aren’t something that people enjoy talking about but they should take comfort in the fact that they are not in the minority. Your doctor discusses the issue all the time with people and can help you get relief. Also, what you think is just a hemorrhoid could be something much more serious. Delaying discussing it could be dangerous.

Related Information:

    Digestive System

    Cancer Check-ups

    Irritable Bowel Syndrome

    Healthy Pregnancy

    Avoid Back Pain

    Fighting Weight Gain

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Rectal Prolapse

Rectal prolapse is a condition where the rectum (the last part of the large intestine) loses the normal attachments that keep it fixed inside the body, allowing it to slide out through the anal opening, turning it “inside out.” Rectal prolapse affects mostly adults, but women ages 50 and older have six times the risk as men. It can be embarrassing and often has a negative effect on a patient’s quality of life. Although not always required, the most effective treatment for rectal prolapse is surgery.


A number of factors are linked to rectal prolapse, there is no clear cut “cause.” An estimated 30% to 67% of patients have chronic constipation (infrequent stools or severe straining) and an additional 15% have diarrhea. In the past, this condition was assumed to be linked to giving birth multiple times by vaginal delivery. However, as many as 35% of patients with rectal prolapse never gave birth and it can occur in men. 


Sometimes people wonder whether hemorrhoids and rectal prolapse are the same. Bleeding and/or tissue that protrudes from the rectum are common symptoms of both, but there is a major difference. Rectal prolapse involves an entire segment of the bowel located higher up within the body. Hemorrhoids only involve the inner layer of the bowel near the anal opening. Rectal prolapse can lead to fecal incontinence (not being able to fully control gas or bowel movements).


During the first visit, your colon and rectal surgeon will perform a thorough medical history and anorectal exam. In some cases, a rectal prolapse may be “hidden” or internal, making diagnosis more difficult. You may be asked to sit on a toilet at your physician’s office and strain as if having a bowel movement.

Videodefecogram: X-rays are taken while you are having a bowel movement to test muscle movement.

Anorectal Manometry: Evaluates muscle functions and reflexes of the pelvis, rectum and anus used during bowel movements. 


Constipation and straining play a role in this condition, correcting this may not improve an existing rectal prolapse. There are several methods used to surgically repair rectal prolapse. Your colon and rectal surgeon will make the decision what surgery to use based on your age, physical condition, extent of prolapse and the results of tests. Options include removing part of the rectum or pulling the rectum back up and anchoring it. Sometimes mesh is used to reinforce the rectum.

Possible surgical approaches:

  • Abdominal repair through traditional surgery (open approach)
  • Laparoscopic surgery
  • Robotically assisted surgery 

Post Treatment Prognosis 

A large majority of patients, surgery relieves or greatly improves symptoms. Prolapse or some other condition may have weakened the anal sphincter muscles. However, these muscles have the potential to regain strength after the prolapse has been corrected.

Factors that influence outcome include:

  • Condition of the anal sphincter muscles before surgery
  • Whether the prolapse is internal or external
  • Overall health of the patient

It may take as long as one year to determine the impact of surgery on bowel function. Chronic constipation and straining after surgical correction should be avoided.

Pilonidal disease is a chronic skin infection that is in the crease of the buttocks near the coccyx (tailbone). It is more common in men than it is in women and most often occurs between puberty and age 40. Obesity and thick, stiff body hair make people more prone to pilonidal disease.


Often hair grows in the cleft between the buttocks. These hair follicles can become infected. Further, hair can be drawn into these abscesses worsening the problem.  


The symptoms can vary from mild to severe. Symptoms may include:

  • Small dimple
  • Large painful mass
  • Clear, cloudy or bloody fluid drainage from affected area
  • If infected, the area becomes red and tender and the drainage (pus) smells foul
  • If infected, may have fever, nausea or feel ill


Diagnosis is usually confirmed by a physician doing an examination of the buttock area.


The primary treatment for an acute abscess is usually drainage. An incision is made that allows pus to drain, reducing inflammation and pain. This procedure can usually be done in a physician’s office under local anesthesia. Treatment depends on the disease pattern. 

Surgical Treatment 

Complex or recurring infections must be treated surgically, either through excision or unroofing the sinuses. Unroofing the sinuses, involves opening up the abscess and the tracts and trimming the edges of skin. 

Larger, open operations often result in better outcomes, although healing takes longer. Closure with flaps has a greater risk of infection, but may be required in some patients. Your colon and rectal surgeon will discuss all the options and help you choose the most appropriate surgery.

Postsurgical Prognosis 

When the wound is closed, it must be kept clean and dry until the skin is fully healed. If the wound is left open, dressings or packing are used to help remove secretions and allow the area to heal from the bottom up.

After healing, the skin in the buttocks crease must be kept clean and free of hair. It is necessary to shave or use a hair removal agent every 2 or 3 weeks until the age of 30. After that age, hair shafts thin out and soften and the depth of the buttock cleft lessens. Pilonidal disease can be a chronic, recurring condition so it is important to follow your physician’s postsurgical care instructions.

It’s estimated by the Crohn’s and Colitis Foundation (CCF) that half a million people in the United States suffer from ulcerative colitis. It’s one of the inflammatory bowel diseases (IBD). The other is Crohn’s disease. (Read about “Crohn’s Disease“) Both cause inflammation to the large intestine. Crohn’s also impacts other parts of the digestive tract. Ulcerative colitis however is limited to the lining of the large intestine. Ulcerative colitis is mainly a disease of the young, with most cases starting in people between the ages of 15 and 40 according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It would appear to have a genetic connection. (Read about “Genetics“) CCF says 20 percent of ulcerative colitis patients have a close relative with ulcerative colitis or Crohn’s.

The causes and symptoms

There is no proven theory as to what exactly causes ulcerative colitis. One strong theory is a virus or bacteria invade the lining of the colon. (Read about “Microorganisms“) This results in inflammation and ulceration of that lining. It can be in a small, limited area or affect the entire colon. Ulcerative colitis patients also have abnormalities of their immune systems (Read about “The Immune System“), according to NIDDK. It isn’t known however if those abnormalities are the cause or the result of the disease.

The first sign of ulcerative colitis is cramps in the abdomen and bloody diarrhea. (Read about “Diarrhea“) NIDDK also lists the following as symptoms:

Some of the symptoms mimic irritable bowel syndrome (Read about “Irritable Bowel Syndrome“) or another condition called ischemic colitis which is caused by reduced blood flow (Read about “Ischemic Colitis“) but ulcerative colitis is much more serious. Only your doctor will be able to diagnose the disease correctly.


Once other potential causes of the symptoms are ruled out, things such as infections or food poisoning, the doctor will proceed with other tests. A blood test could look for anemia (Read about “Laboratory Testing” “Complete Blood Count” “Anemia“) which would indicate bleeding in the colon or the rectum. (Read about “Gastrointestinal Bleeding“) Ultimately, the doctor will probably examine the colon with a small camera to look at the lining. Those procedures are called sigmoidoscopy or colonoscopy. (Read about “Colonoscopy” “Flexible Sigmoidoscopy“) The doctor will also probably take samples of the colon lining to be tested.


Most patients are treated with drugs and diet changes. There are no specific foods that cause the disease but some can cause more discomfort than others. Also because of the diarrhea and bleeding, proper nutrition is important to the medical management of the disease says CCF. Drugs are used by some 60 percent of ulcerative colitis patients according to NIDDK. All of them are aimed at reducing the inflammation and allowing the colon to heal. Types of medications include:

  • anti-inflammatory drugs, such as corticosteroids, mesalamine and others
  • immune system suppressors such as azathioprine, mercaptopurine, cyclosporine and infliximab
  • antidiarrheals
  • laxatives
  • iron supplements, which can help to prevent anemia due to internal bleeding (Read about “Anemia“)

Different drugs can work better with different patients, so you my need to try several different medications before finding one that brings relief.

Surgery may be required eventually by up to 40 percent of patients says NIDDK. There are three types of surgery according to NIDDK. All of them involve the removal of the large intestine or colon. They differ in what is done with material coming from the small intestine and how it is removed. They are:

  • A Brooke ileostomy where a small hole, called a stoma, is cut in the abdomen. The small intestine is attached to the stoma and waste exits into a pouch. The pouch is emptied as needed.
  • A continent ileostomy uses the lowest part of the small intestine, called the ileum to create a pouch inside the abdomen. The waste empties into this pouch. The patient removes the waste by inserting a tube into a small leak proof opening in their side. An external pouch is only needed for a few months.
  • An ileoanal anastomosis allows normal excretion of waste. The ileum is attached to the non-diseased part of the rectum and the anus. The ileum once again acts as a pouch but the waste is expelled in the normal manner.

Surgery choices depend on the severity of the disease and the individual’s medical condition. Discuss the issues with your doctor. One good bit of news about the surgery is that once the colon is removed the ulcerative colitis is cured.


Ulcerative colitis does not stand alone as a disease. It can also cause problems in other parts of the body, according to NIDDK, including:

No one knows for sure why problems such as these would occur outside the colon. NIDDK says scientists think these complications may occur when the immune system triggers inflammation in other parts of the body, adding that such complications are usually mild and tend to go away when the ulcerative colitis is treated.

One other complication is the chance of colon cancer. (Read about “Colorectal Cancer“) NIDDK says about 5 percent of people with ulcerative colitis develop colon cancer. The risk increases with the duration and the extent of the disease. If only the lower colon and the rectum are involved, the risk is no greater than normal, but if the entire colon is involved, the risk soars to 32 times the normal rate.

Related Information:

    Digestive System

    Primary Immunodeficiency

    Immune System Glossary

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

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