Gastrointestinal specialists and surgeons in the Center for Advanced Digestive Care (CADC) of NewYork-Presbyterian/Weill Cornell Medical Center treat a range of anorectal disorders, including hemorrhoids, anal fistulas, infections, fecal incontinence, and anorectal cancer. Our doctors have developed novel treatments for fecal incontinence (also known as bowel incontinence), improving the quality of life of our patients. Surgeons employ minimally invasive approaches for patients who cannot tolerate conventional rectal surgery. Whatever the diagnosis, CADC physicians customize a plan of care to meet the individual needs of each patient.
Diagnosis of Anal Fistulas
Diagnosis of Anal Cancer
- The doctor will do a digital rectal examination by inserting a lubricated, gloved finger into the lower part of the rectum to check for lumps or anything unusual.
- The physician may also use an anoscope or proctoscope (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, the doctor may take a biopsy (tissue sample) to be analyzed for cancer if an area appears abnormal.
Anal Cancer Treatment
- Chemotherapy and radiation therapy are generally the first types of treatment.
- Surgery for small, contained cancers, or cancers located in the lower part of the bowel, is usually able to be completed while preserving the anal sphincter muscles.
- For more extensive cancers, CADC surgeons perform a procedure to remove the anus, rectum, part of the lower colon, and lymph nodes through an incision made in the abdomen.
- Some patients who cannot tolerate open abdominal surgery are able to undergo transanal endoscopic microsurgery to remove a small cancer.
Fecal Incontinence (Bowel Control Problems)
- 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
- Complications 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
- Radiation treatment and rectal surgery, causing a loss of storage capacity in the rectum
Diagnosis of Fecal Incontinence
- 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 empty.
- Proctosigmoidoscopy enables the physician to view the inside of the rectum and lower colon to detect disease or other problems that can cause fecal incontinence, such as inflammation, scar tissue, or tumors.
- Anal electromyography, which uses tiny needles to measure nerve damage, may also be done to check for nerve damage caused by injury during childbirth.
Treatment for Fecal Incontinence
Diagnosis of Hemorrhoids
How to Treat Hemorrhoids
- 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
- Rubber band ligation
- Electrical or laser coagulation / infrared photo coagulation