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NewYork-Presbyterian/Weill Cornell Medical Center - Center for Advanced Digestive Care

NewYork-Presbyterian/Weill Cornell Medical Center - Center for Advanced Digestive Care

Anorectal Disorders

Gastrointestinal specialists and surgeons at the NewYork-Presbyterian/Weill Cornell Center for Advanced Digestive Care treat a range of anorectal diseases, including hemorrhoids, anal fistulas, infections, incontinence, and anorectal cancer, and have developed new medical therapies for bowel control (fecal incontinence).

For more information on anal fistulas, anorectal cancer and hemorrhoids, including symptoms and risk factors, visit our Health Library.

Anal Fistulas

Anal fistulas are abnormal, small channels or connections between the rectum and skin in the anorectal region. Anal fistulas often develop from an acute infection of an anal gland, located inside the anal opening. The infection causes an abscess to form, which then develops into a fistula or channel leading to the outside skin. Anal fistulas may also be caused by surgery, Crohn's disease, or radiation.

Diagnosis

Fistulas must be carefully diagnosed to determine their exact internal location. A physician will usually use an anoscope, a small instrument used to view the anal canal. Sometimes exams will be performed in the operating room. In order to rule out Crohn's disease or ulcerative colitis, your physician may perform either a colonoscopy or sigmoidoscopy.

Treatment

Most fistulas require surgery, with either surgical placement of a drain in the area of infection or surgery to remove the fistula (fistulotomy).

Anorectal Cancer

Anorectal cancer (anal cancer) is characterized by the growth of cancerous cells in the tissues of the anus. It is rare - about 5,000 Americans are diagnosed with this cancer each year.

Diagnosis

Your physician will perform a physical examination and take a full medical history. He or she will do a digital rectal examination to check for lumps or anything unusual by inserting a lubricated, gloved finger into the lower part of the rectum. Your physician may also use an anoscope or proctoscope - both are short, lighted tubes - to examine the anus and lower rectum, and perform an endoanal or endorectal ultrasound. A colonoscopy may be performed to evaluate the rest of the colon. Finally, your doctor may take a biopsy to check for cancer if an area appears abnormal.

Treatment

The treatment for anorectal cancer will depend on the stage of the cancer. Chemotherapy and radiation are generally the first line of treatment for anal cancers.

Surgery for small, contained cancers, or cancers located in the lower part of the bowel, is usually done as a local resection, which can preserve sphincter muscles.

For more extensive cancer, a resection is performed, in which the anus, rectum, part of the lower colon, and lymph nodes are removed through an incision made in the abdomen.

Researchers at the Center are currently evaluating the role of increased magnification in laparoscopic treatment of anal cancer to help identify nerves in order to preserve sexual and bladder function.

Fecal Incontinence (Bowel Control)

Fecal incontinence is characterized by an inability to control bowel movements and may be caused by a number of conditions:

  • an abscess or inflammation in the rectum or anal area
  • damage to the anal sphincter muscles or pelvic floor muscles from complications of childbirth
  • nerve damage from childbirth neurologic disorders
  • the result of a previous operation
  • damage to nerves that control the anal sphincters resulting from a stroke, diabetes, or multiple sclerosis
  • hemorrhoid surgery
  • chronic constipation or diarrhea
  • loss of storage capacity in the rectum resulting from radiation treatment and rectal surgery

Over 5.5 million Americans have fecal incontinence, which affects both adults (more women and older adults), and children.

Diagnosis

To diagnose fecal incontinence, our physicians conduct a number of tests, including anal manometry, which measures the strength of the anal sphincter muscles and their ability to respond to signals. An MRI and/or an anorectal ultrasound may also be done to visualize the structure of the sphincter. Proctography (also known as defacography) shows how much stool the rectum can hold, how effectively it holds it, and how effectively the rectum can evacuate. Proctosigmoidoscopy enables the physician to view the inside of the rectum and lower colon to detect disease or other problems such as inflammation, scar tissue, or tumors, which can cause fecal incontinence. An anal electromyography, which uses tiny needles to measure nerve damage, may also be done for nerve damage caused by injury during childbirth.

Treatment

Treatments for fecal incontinence will depend on the cause and severity of the condition, and may include medication, dietary changes, biofeedback, or surgery. Often more than one therapy or procedure is used to treat fecal incontinence.

Surgery can repair injury to the sphincter mechanism, or help constrict the sphincter using the patient's tissue or a device. Minimally invasive surgery may be possible for patients with rectal prolapse, where the walls of the rectum protrude through the anus, allowing for less postoperative pain, less medication, and more rapid healing when compared with traditional open surgical techniques. For individuals with very severe fecal incontinence, for whom other treatments do not help, a colostomy may be performed.

Physician-scientists at NewYork-Presbyterian Hospital are currently conducting research into using nerve stimulation for treating fecal incontinence.

Hemorrhoids

Hemorrhoids exist in everyone, but are only sometimes symptomatic. This occurs when blood vessels located in the anorectal region become swollen or inflamed. Hemorrhoids may be internal (inside the anus) or external (outside the anus).

Diagnosis

The presence of blood in the stool can be indicative of other digestive disorders, including colorectal cancer, so thorough evaluation and proper diagnosis is important.

Your physician will examine the perianal area for swollen blood vessels, and also perform a digital rectal exam using a gloved, lubricated finger, to detect any abnormalities in the region. He or she will also use an anoscope or proctoscope to view the anal tract.

To rule out other causes of bleeding, your physician may examine the entire colon or large intestine with colonoscopy, or just the bottom section, using sigmoidoscopy.

Treatment

Specific treatment for hemorrhoids will be determined by your physician based on your age, overall health, extent of the condition and your medical history. Medical treatment of hemorrhoids is aimed at relieving symptoms and may include:

  • sitting in plain, warm water in the tub several times a day
  • ice packs to reduce swelling
  • application of hemorrhoidal creams or suppositories
  • increasing fiber and fluids to soften stools

In some cases, it is necessary to treat hemorrhoids surgically. Several surgical techniques are used to remove or shrink internal and external hemorrhoids:

  • rubber band ligation
  • sclerotherapy
  • electrical or laser coagulation / infrared photo coagulation
  • hemorrhoidectomy