Dr. Frederick A. Slezak, M.D.

The most common “anesthesia” used today for colonoscopy is propofol chosen for its quick onset of action and minimal after-procedure sedation. Often this medication is administered by a third-party (anesthesiologist or CRNA) with cardiac and respiratory monitoring allowing the endoscopist full concentration on the procedure itself.

An alternative is sedation with one or two agents such as fentanyl and midazolam (Versed), meperidine and Versed, or Versed alone.

In some cases, anesthesia is not necessary depending on the patient’s colon length, wishes, and level of anxiety especially when performed by a skilled endoscopist cognizant of those maneuvers that can potentially be uncomfortable to the patient. However, some physicians or institutions “require” that the patient be “anesthetized.” Options should be discussed with the physician performing the procedure. Anesthesia should not be used to hide poor technique.


Frederick A Slezak MD MBA FACS FASCRS FACG
Colon and Rectal Surgery
Consultant

Alternate email: faslezak@gmail.com<mailto:faslezak@gmail.com>

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A CT scan is not the preferred method to “detect” colon cancer. Most colon cancers are confirmed using colonoscopy, endoscopic photography, and biopsy. CT scans are primarily used to search for metastatic disease including involvement of the liver, larger lymph nodes, the presence of intra-abdominal masses and ascites. CT scans are used to evaluate the lungs for distant metastatic disease. The CT scan offers an image and does not provide histologic proof of cancer (unless done in conjunction with a biopsy - usually percutaneous and with a needle.

Possibly this question is “how accurate is CT colonography” which is a method to evaluate the colon for polyps and masses using computerized tomography. The method does work to find problems in the colon, but does not prove a diagnosis. Most patients who have an abnormal CT colonography require colonoscopy for definitive diagnosis.

Radiation therapy (usually in conjunction with radiation sensitizing chemotherapy) is generally reserved for pre-operative treatment of rectal cancer. The method is also known as adjuvant chemo-radiation therapy. More often the radiation is given before surgery. Sometimes radiation is used as a primary treatment with effective eradication of the tumor. Radiation treatment helps prevent local recurrence of the cancer and is not to prevent distant spread. Usually after surgery a patient will receive additional chemotherapy for that purpose. Each case is different depending on the size, location, and histology of the tumor. You should discuss your options with your surgeon, oncologist and radiation oncologist.

Leg pain and numbness after a colonoscopy is not normal. You should contact the physician who performed the procedure. More information is needed to offer any other comments.

This question is difficult to answer without additional information. What kind of “rectal” surgery? What is the ointment? Many factors contribute to the length of discomfort after a proctologic procedure. The duration can be a couple of days to four to six weeks depending on the condition and co-morbid factors. Simple steps help decrease pain and maybe shorten the healing period. Keep the area clean (showers are best) and dry. Ointments can smother the tissues and prevent healing. Avoid powders. Dry the area with a blow dryer set to low (don’t cook the skin). Witch hazel can damage the skin because of the alcohol. And, I am not a fan of the “sitz” bath because is an keep the area wet and cause maceration of the skin. If sitz are used, do not soak for an excessively long time and then carefully dry the area by patting with clean gauze or towel and finishing with a gentle blow with a hair dryer on low. Maintaining bowel regularity is important by avoid both constipation and diarrhea. And old-school recommendation is mineral oil – don’t do it!

Without additional information, this question is difficult to answer. In general, leakage from the anus is not normal and can be caused by many difference reasons. An examination by a qualified primary care physician (or better yet a colorectal surgeon) is warranted.

Most thrombosed hemorrhoids have resolution of pain in about 5 days. You are already halfway there. On occasion a thrombosed hemorrhoid should be removed for one of several reasons: the thrombosis erodes the overlying skin and the hemorrhoid painlessly bleeds (oozes) generally a dark red non-clotting blood for days. Because of the mess removal speeds up the healing process; after the pain is gone, the lump may take weeks to disappear and is can be annoying. Removal helps that problem; Finally, a thrombosed hemorrhoid might require removal in the acute period because of paid.

Topical creams really do not help thought it gives you something to do. Warm soaks can help the pain and decrease swelling.

Lancing the hemorrhoid and squeezing out the clot is NOT recommended (though very often performed in the ER and by PCPs). The damaged vein remains and recurrence is common. Excision is the preferred method is removal is warranted.

The answer to this question is complex and depends on quite a few circumstances:

1. Is the diagnosis correct? Prolapsing hemorrhoids, mucosal prolapse or full-thickness prolapse – An examination is necessary including an exam when seated on the commode
2. Age and gender
3. Prior surgeries for prolapse or hemorrhoids
4. Prior abdominal operations
5. Co-morbidities (other significant diseases that can affect the outcome of the operation)

A variety of operations are available all with good and bad points. Some are done from an abdominal approach and some are done from the perineum. Find an experienced colorectal surgeon and have a discussion once the diagnosis is confirmed.

If you have had surgery for rectal prolapse, you probably should avoid sitting on the toilet for long periods of time, straining on the toilet, excessive weight-lifting especially in a body-building program, and playing the tuba (not kidding) or other instrument that requires a lot of abdominal straining. Quit smoking especially if it causes coughing. No prolapse surgery is perfect and recurrence is common enough to be a problem for some.

Simple answer: You need to be evaluated for this bleeding. Though many aspects of your history are not given (gender, current medications, past medical history, etc.), blood in the stool with the symptom of abdominal pain is not normal and cannot be ignored. At minimum, a CBC is needed as well as a colonoscopy.

Based on the description, size, and material, this object should pass without any problem with your next bowel movement (or two). You may not see it unless you do some digging around. If you have a persistent sensation of something in the rectum, an examination by your doctor is in order which may include a proctoscopy. Because the object is silicone, likely it will not be seen on an x-ray.

Sounds like a small thrombosed external hemorrhoid. This condition is benign and usually resolves in 3 – 4 weeks while remaining painless and non-bleeding. If discharge or bleeding arises from the lump keep the scheduled visit. A small lump could be an opening to a fistula (usually preceded by swelling and pain) or a small verrucous lesion (often itches). Since you cannot see it, if it persists, someone needs to look at it if it gets larger or does not go away.

Non-healing after a peri-anal abscess implies the formation of a fistula. About 1/3 of patients with an abscess will develop a fistula which cannot be healed by medical means such as antibiotics and creams. On occasion, an abscess draining point will apparently heal over suggesting that the problem is resolved only to return day, months or even years later in the same spot. Healing of an abscess cavity could take longer than a month, but return to your PCP or referral to a colorectal surgeon for an examination is the next step.

Frederick A. Slezak, MD, MBA