The rectum is the lower part of your large intestine where your body stores stool. Problems with rectum are common. They include hemorrhoids, abscesses, incontinence and cancer.

Many people are embarrassed to talk about rectal troubles. But seeing your doctor about problems in this area is important. This is especially true if you have pain or bleeding. Treatments vary depending on the particular problem.

What are hemorrhoids?

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

What causes hemorrhoids?

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

What are the symptoms of hemorrhoids?

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

How can I treat hemorrhoids at home?

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

When do I need to see a health care provider for hemorrhoids?

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

How are hemorrhoids diagnosed?

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

What are the treatments for hemorrhoids?

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

Can hemorrhoids be prevented?

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

When you eat, your body breaks food down to a form it can use to build and nourish cells and provide energy. This process is called digestion.

Your digestive system is a series of hollow organs joined in a long, twisting tube. It runs from your mouth to your anus and includes your esophagus, stomach, and small and large intestines. Your liver, gallbladder and pancreas are also involved. They produce juices to help digestion.

There are many types of digestive disorders. The symptoms vary widely depending on the problem. In general, you should see your doctor if you have

• Blood in your stool
• Changes in bowel habits
• Severe abdominal pain
• Unintentional weight loss
• Heartburn not relieved by antacids

The colon and rectum are part of the large intestine. Colorectal cancer occurs when tumors form in the lining of the large intestine. It is common in both men and women. The risk of developing colorectal cancer rises after age 50. You're also more likely to get it if you have colorectal polyps, a family history of colorectal cancer, ulcerative colitis or Crohn's disease, eat a diet high in fat, or smoke.

Symptoms of colorectal cancer include

• Diarrhea or constipation
• A feeling that your bowel does not empty completely
• Blood (either bright red or very dark) in your stool
• Stools that are narrower than usual
• Frequent gas pains or cramps, or feeling full or bloated
• Weight loss with no known reason
• Fatigue
• Nausea or vomiting

Because you may not have symptoms at first, it's important to have screening tests. Everyone over 50 should get screened. Tests include colonoscopy and tests for blood in the stool. Treatments for colorectal cancer include surgery, chemotherapy, radiation, or a combination. Surgery can usually cure it when it is found early.

Colorectal cancer is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer, for short. As the drawing shows, the colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.

Sometimes abnormal growths, called polyps, form in the colon or rectum. Over time, some polyps may turn into cancer. Screening tests can find polyps so they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment works best.

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the colon or rectum, it is called colorectal cancer. Sometimes it is called colon cancer, for short.

Of cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the United States, but it doesn’t have to be. Colorectal cancer screening saves lives. Screening can find precancerous polyps—abnormal growths in the colon or rectum—that can be removed before they turn into cancer. Screening also helps find colorectal cancer at an early stage, when treatment works best. About nine out of every 10 people whose colorectal cancers are found early and treated appropriately are still alive five years later.

If you are 45 years old or older, get screened now. If you think you may be at increased risk for colorectal cancer, speak with your doctor about when to begin screening, which test is right for you, and how often to get tested.

What Is Colorectal Cancer?

Colorectal cancer is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer, for short.

What Are the Risk Factors for Colorectal Cancer?

Your risk of getting colorectal cancer increases as you get older, and there are other risk factors.

What Can I Do to Reduce My Risk of Colorectal Cancer?

The most effective way to reduce your risk of colorectal cancer is by having regular colorectal cancer screening tests beginning at age 45.

What Are the Symptoms of Colorectal Cancer?

Colorectal cancer doesn't always cause symptoms, especially at first.

What Should I Know About Screening?

Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer. Screening tests can also find colorectal cancer early, when treatment works best.

Questions to Ask Your Doctor

Several screening tests can be used to find polyps or colorectal cancer. The benefits and risks of these screening methods vary. Discuss with your doctor which test is best for you.

The Digestive System

The digestive system is like a long tube that runs from the mouth to the anus and includes organs that help the body digest and absorb food and nutrients. The organs that make up the digestive system include the mouth, esophagus, stomach, small intestine, large intestine (or colon), rectum, and anus. Inside these organs is a lining called the mucosa. The digestive tract also contains a layer of smooth muscle. The muscle moves food through the tract in a wavelike movement called peristalsis, helping to mix it and break it down.

The liver and the pancreas also belong to the digestive system. They produce digestive juices that empty into the small intestine through ducts. The gallbladder stores the liver's digestive juices.

Digestion begins in the mouth. Chewed food is swallowed and moves into the pharynx, and then is pushed down the esophagus into the stomach. There, food is churned by smooth muscle contractions and mixed with digestive juices produced by the stomach. The stomach slowly empties its contents into the small intestine, where food dissolves into juices secreted from the pancreas, liver, and intestine. As the digested food moves through the small intestine, its nutrients are absorbed into the intestinal wall and into the bloodstream, where it is transported throughout the body for distribution. The colon removes water from the digested matter and converts it into a mostly solid mass of waste material, consisting largely of indigestible elements of the food, called fiber, and older cells that have been shed from the mucosa. Waste material is then expelled as feces.

The Colon

The small intestine joins the large intestine, or colon, in the right lower abdomen. The colon is a muscular tube about 5 feet long. It's made up of four sections: the ascending colon, which extends upward on the right side of the abdomen; the transverse colon, which goes across the body from the right to the left side in the upper abdomen; the descending colon, which continues downward on the left side; and the sigmoid colon (called this because of its "S" or "sigmoid" shape). The sigmoid colon attaches to the rectum, which ends in the anus.

The colon is composed of a number of different layers of tissue:

• The mucosa, the innermost layer, includes a single layer of epithelial cells, a layer of connective tissue, and a thin muscle layer. It is lined with goblet cells, glands that secrete mucous to help the passage of material through the colon.
• The submucosa is a layer of connective tissue beneath the mucosa.
• The circular muscle is a band of muscle that wraps around the entire colon and helps move waste material through it.
• The longitudinal muscle runs lengthwise along the colon. It works in conjunction with the circular muscle to create the wavelike motion of peristalsis.
• The serosa is the outermost layer of the colon.

Colon Function

The major function of the colon is to extract water, salts, and nutrients from partially digested food, and to propel the residue to the rectum and anus for expulsion. When the contents of the small intestine reach the colon, they're liquid. By the time they are expelled as feces, they're solid. About 2 pints of liquid matter enter the colon each day; stool volume is about a third of a pint. The difference between these two amounts is what the colon has absorbed in the course of digestion. If the digested matter lacks enough water, the colon can also add water to it to soften the stool. Maintaining this balance is one of the colon's most important functions.

By the time the partially digested food enters the colon, most of its nutrients have been absorbed by the small intestine. However, the process of digestion isn't over. The colon contains large numbers of bacteria. The most important of these are the lactobacilli and bifidus bacteria, which live in a symbiotic (mutually beneficial) relationship with the colon. They ferment the soluble fiber in food, forming valuable short-chain fatty acids that nourish intestinal cells, help regulate production of cholesterol, and are thought to help prevent a variety of diseases (including cancer). Beneficial bacteria also help to keep harmful bacteria in check. In addition, intestinal bacteria synthesize vitamin K, important in blood clot formation.

Figure 23.21 Large Intestine The large intestine includes the cecum, colon, and rectum.

Rectal valve is one of three transverse folds in the rectum where feces is separated from flatus

Rectum is part of the large intestine between the sigmoid colon and anal canal

Rectum

Food residue leaving the sigmoid colon enters the rectum in the pelvis, near the third sacral vertebra. The final 20.3 cm (8 in) of the alimentary canal, the rectum extends anterior to the sacrum and coccyx. Even though rectum is Latin for "straight," this structure follows the curved contour of the sacrum and has three lateral bends that create a trio of internal transverse folds called the rectal valves. These valves help separate the feces from gas to prevent the simultaneous passage of feces and gas.

Large Intestine

The large intestine includes the cecum, colon, and rectum.

Absorption, Feces Formation, and Defecation

The small intestine absorbs about 90 percent of the water you ingest (either as liquid or within solid food). The large intestine absorbs most of the remaining water, a process that converts the liquid chyme residue into semisolid feces ("stool"). Feces is composed of undigested food residues, unabsorbed digested substances, millions of bacteria, old epithelial cells from the GI mucosa, inorganic salts, and enough water to let it pass smoothly out of the body. Of every 500 mL (17 ounces) of food residue that enters the cecum each day, about 150 mL (5 ounces) become feces.

Feces are eliminated through contractions of the rectal muscles. You help this process by a voluntary procedure called Valsalva's maneuver, in which you increase intra-abdominal pressure by contracting your diaphragm and abdominal wall muscles, and closing your glottis.The process of defecation begins when mass movements force feces from the colon into the rectum, stretching the rectal wall and provoking the defecation reflex, which eliminates feces from the rectum. This parasympathetic reflex is mediated by the spinal cord. It contracts the sigmoid colon and rectum, relaxes the internal anal sphincter, and initially contracts the external anal sphincter. The presence of feces in the anal canal sends a signal to the brain, which gives you the choice of voluntarily opening the external anal sphincter (defecating) or keeping it temporarily closed. If you decide to delay defecation, it takes a few seconds for the reflex contractions to stop and the rectal walls to relax. The next mass movement will trigger additional defecation reflexes until you defecate.If defecation is delayed for an extended time, additional water is absorbed, making the feces firmer and potentially leading to constipation. On the other hand, if the waste matter moves too quickly through the intestines, not enough water is absorbed, and diarrhea can result. This can be caused by the ingestion of foodborne pathogens. In general, diet, health, and stress determine the frequency of bowel movements. The number of bowel movements varies greatly between individuals, ranging from two or three per day to three or four per week.

Bowel incontinence is 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 get to a toilet. Millions of Americans have this problem. It affects people of all ages - children and adults. It is more common in women and older adults. It is not a normal part of aging.

Causes include

• Constipation
• Damage to muscles or nerves of the anus and rectum
• Diarrhea
• Pelvic support problems

Treatments include changes in diet, medicines, bowel training, or surgery.

Fecal incontinence, also called accidental bowel leakage, is the accidental passing of bowel movements—including solid stools, liquid stools, or mucus—from your anus.

The most common type of fecal incontinence is called urge incontinence. When you have urge incontinence, you feel a strong urge to have a bowel movement but cannot stop it before reaching a toilet. If you have urge incontinence, your pelvic floor muscles may be too weak to hold back a bowel movement due to muscle injury or nerve damage.

Another type of fecal incontinence is called passive incontinence. When you have passive incontinence, leakage occurs without you knowing it. If you have passive incontinence, your body may not be able to sense when your rectum is full.

Fecal incontinence can be upsetting and embarrassing. Some people may feel ashamed and try to hide the problem. You may be afraid or embarrassed to talk about fecal incontinence with your doctor. However, talking openly and honestly with your doctor is important in diagnosing and treating your fecal incontinence.

Does fecal incontinence have other names?

Fecal incontinence is also called

• accidental bowel leakage
• bowel incontinence
• encopresis—a term used mostly for fecal incontinence in children

Medical experts consider fecal incontinence a common problem, affecting about 1 in 3 people who see a primary health care provider.

• Fecal incontinence is more common in older adults.
• Among adults who are not in hospitals or nursing homes, between 7 and 15 out of 100 have fecal incontinence.
• Among adults who are in hospitals, between 18 and 33 out of 100 have fecal incontinence.
• Among adults who are in nursing homes, between 50 and 70 out of 100 have fecal incontinence.

Fecal incontinence occurs in about 2 out of 100 children.

If you have fecal incontinence, you may also have other health problems, including

• diarrhea
• poor overall health
• chronic diseases and disorders such as
  • irritable bowel syndrome
  • type 2 diabetes
  • diseases that affect the nerves of your anus, pelvic floor, or rectum
  • inflammatory bowel disease
• damage to or weakness of the muscles of your anus, pelvic floor, or rectum
• damage to the nerves in your anus, pelvic floor, or rectum
• urinary incontinence
• proctitis

A bowel movement is the last stop in the movement of food through your digestive tract. Your stool passes out of your body through the rectum and anus. Another name for stool is feces. It is made of what is left after your digestive system (stomach, small intestine, and colon) absorbs nutrients and fluids from what you eat and drink.

Sometimes a bowel movement isn't normal. Diarrhea happens when stool passes through the large intestine too quickly. Constipation occurs when stool passes through the large intestine too slowly. Bowel incontinence is a problem controlling your bowel movements. Other abnormalities with bowel movements may be a sign of a digestive problem.

The anus is the opening of the rectum through which stool passes out of your body. Problems with the anus are common. They include hemorrhoids, abscesses, fissures (cracks), and cancer.

You may be embarrassed to talk about your anal troubles. But it is important to let your doctor know, especially if you have pain or bleeding. The more details you can give about your problem, the better your doctor will be able to help you. Treatments vary depending on the particular problem.

General Information About Rectal Cancer

KEY POINTS

• Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum.
• Health history affects the risk of developing rectal cancer.
• Signs of rectal cancer include a change in bowel habits or blood in the stool.
• Tests that examine the rectum and colon are used to diagnose rectal cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

KEY POINTS

• Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.
• Being infected with the human papillomavirus (HPV) increases the risk of developing anal cancer.
• Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.
• Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.
• Certain factors affect the prognosis (chance of recovery) and treatment options.

Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.

The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body. The anus is formed partly from the outer skin layers of the body and partly from the intestine. Two ring-like muscles, called sphincter muscles, open and close the anal opening and let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 1-1½ inches long.

The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not anal cancer.