Stoma

What is a Stoma?
A stoma is a surgically created opening connecting an internal organ to the surface of the body. The most common types of stomas in intestinal surgery are "ileostomy" (connection of small intestine to the abdominal wall) and a "colostomy" (connecting the large intestine to the abdominal wall).

A stoma may be temporary or permanent. A temporary stoma may be required if the intestinal tract cannot be properly prepared for surgery because of blockage by disease or scar tissue. It may also be created to allow inflammation or an operative site to heal without contamination by stool. Temporary stoma can usually be reversed with minimal or no loss of intestinal function.

A permanent stoma may be required when disease, or its treatment impairs normal intestinal function or when the muscles that control elimination do not work properly or require removal; e.g. in low rectal cancer.

How Will I Control My Bowel Movements?
Once a stoma has been created, your stoma nurse will teach you to attach and care for a pouch called a stoma appliance (stoma bag). The pouch is made of plastic and is held to the body with an adhesive. The pouch is disposable and is emptied or changed as needed. The system is quite secure; "accidents" are not common and the pouches are odour-free.

Your bowel movements will naturally empty into the pouch. The frequency and quantity of your bowel movements will vary, depending on the type of stoma you have, your diet and your bowel habits prior to surgery.

Will Other People Know That I Have A Stoma?
Not unless you tell them. It is easily hidden by your usual clothing. You probably have met people with a stoma and not realised it!


Where Will The Stoma Be?
It is best placed on a flat portion of the abdominal wall. Before undergoing surgery to create a stoma, your stoma nurse will mark an appropriate place on your abdominal wall not constricted by your belt-line. A colostomy is usually placed to the left of your navel and an ileostomy to the right.

Will My Physical Activities Be Limited?
Usually no. All your usual activities, including active sports may be resumed once healing from surgery is complete.

Will A Stoma Affect My Sex Life?
Most patients with stomas resume their usual sexual activity. Many people worry about how their partner will think of them because of their appliance. This perceived change in one's body image can be overcome by a strong relationship, time and patience. Support groups are also available.

What Are The Complications of A Stoma?
Local skin irritation can occur; usually minor and can be easily remedied. Problems such as a hernia associated with the stoma or prolapse of the stoma (protrusion of the bowel) occasionally require surgery if they cause significant symptoms.




Living with a stoma will require some adjustments and learning, but an active and fulfilling life is still possible and likely. Your surgeon and stoma nurse will provide you with skills and support to help you better live with your stoma.

Source: ASCRS

Things You Need To Know About Haemorrhoids

What are haemorrhoids?
Also known as piles, haemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are 2 types:
          - External haemorrhoids
          - Internal haemorrhoids

External (outside) haemorrhoids:

Developed near the anus and are covered by very sensitive skin. These are usually painless, but if a blood clot (thrombus) develops in an external haemorrhoids, it becomes painful and hard. It may bleed if it ruptures.

Internal (inside) haemorrhoids:
Developed within the anud beneath the lining. Present with painless bleeding and protrusion during bowel movements. It can cause severe pain if it is completely prolapsed from the anal opening and cannot be pushed back inside.


What causes haemorrhoids?
An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include:
     - Aging
     - Pregnancy
     - Hereditary
     - Chronic constipation or diarrhoea
     - Straining during bowel movement
     - Overuse of laxatives or enemas
     - Spening long period of time on the toilet (e.g. reading)

What are the symptoms?

     - Bleeding during bowel movements
     - Protrusion during bowel movements
     - Pain
     - Sensitive lump
     - Itching around the anal area

How are haemorrhoids treated?

Mild symptoms can be relieved by increasing amount of fiber and fluid in the diet. Prevent excessive straining during bowel movements. A sitz bath (sitting in plain warm water for 10 minutes) can also provide some relief. With these measures, the pain and swelling will decrease in two to seven days.

Persistent symptoms or severe haemorrhoids may require special treatment:

Rubber banding ligation:
Works effectively on internal haemorrhoids that protrude with bowel movements. Can be performed as outpatient setting. A small rubber band is placed over the haemorrhoids, cutting off its blood supply. The rubber band will fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produce discomfort and bleeding and may need repeated banding for full effect.

Haemorrhoid stapling:

This is a technique that uses a special device to internally staple and excise internal haemorrhoid tissue. It may lead to shrinkage of internal haemorrhoids, but does not remove external haemorrhoids.  This procedure is performed under spinal or general anaesthesia.

Doppler-guided haemorrhoidal artery ligation:

·        An operative technique that employs Doppler ultrasound to ligate the haemorrhoidal blood flow. Relatively painless compared to stapler technique or excision as no cutting of tissues is performed.

               

      

v    Laser technique:

      A relatively new technique employing laser energy to shrink the haemorrhoids. Early reported results were good. Relatively painless compared to stapler technique.

          

    Haemorrhoidectomy:

     Surgery to remove the haemorrhoids. The most complete method to remove both internal and external haemorrhoids. Main disadvantage is severe pain after the operation.

               

  
 Do haemorrhoids lead to cancer?

      The answer is no. However, the symptoms of haemorrhoids, particularly bleeding are similar to those of colorectal cancer and other diseases of the digestive system. 

      Therefore, it is important that all symptoms are investigated by a surgeon specifically trained in treating diseases of the colon and rectum and that everyone 40 years or older undergo screening test for colorectal cancer.

      Do not rely on over-the-counter medications or other self-treatment. Visit a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed.

Source: ASCRS

A colonoscopy can save your life

What is a colonoscopy?

A colonoscopy is an outpatient procedure in which the inside of the large intestine is examined. It is performed under sedation. A colonoscopy enables the surgeon to see abnormalities like tumour, polyps, ulcers, inflammation, bleeding and diverticulosis. This procedure is commonly used to screen for colon cancer.

Why should I get one?

In Malaysia, colon cancer is the second most common cancer (NSR 2005). In nearly all cases, colon cancer starts as a pre cancerous growth in the colon called an adenomatous polyp, which usually doesn't cause symptoms. This is why it is important to have regular screenings. A colonoscopy detects polyps so they can be removed before they turn into cancer and cause symptoms. It has been shown that colon cancer deaths are declining due to screening.

Who is it for?

In Malaysia, it is recommended to start screening at the age of 40. Some people should begin screening earlier if they have any of the following:

               1. Personal history of cancer or precancerous colon polyps (adenomas)

               2. Relatives with colon cancer or adenomatous polyps

               3. History of inflammatory bowel disease (Crohn's disease or ulcerative colitis)       

               4. Family history of familial adenomatous polyposis (FAP) or hereditary non-polyposis 

                   colon cancer (HNPCC)

What happens during a colonoscopy?

During colonoscopy, the surgeon uses a colonoscope (long, flexible instrument) to view the lining of the colon. The scope is inserted through the rectum and advanced through the large intestine. Small amount of tissue can be removed for analysis (called a biopsy) if necessary, and polyps can be identified and removed. In many cases, colonoscopy allows accurate diagnosis and treatment without the need for a major operation.

What are the benefits of a colonoscopy?

The main benefit of a colonoscopy is that it detects and removes polyps before they can turn into cancer. Colonoscopies also can find colorectal cancer early. If cancer is detected and found early, 90 percent of these cases are curable.

What about the preparation?

To complete a successful colonoscopy, the bowel must be clean so that the surgeon can clearly view the colon. You will need to drink a bowel preparation to clean the bowel. Fortunately, today’s

bowel preparation is simpler than ever before. Without proper preparation, the colonoscopy will not be successful and may have to be repeated.

Can it be too painful – or even risky?
About 99 percent of patients should be able to be adequately sedated through conscious sedation
to be comfortable during their colonoscopy. Most patients don’t even remember the exam! 
When performed by specially trained professionals, colonoscopies are safe. The risk of perforation is less than 1 in 1,000 cases, and the risk of bleeding is less than 1 percent.

Source: Cleveland Clinic Florida

7 Steps to a Healthier Colon

In USA, nearly 144,000 people will be diagnosed with colon cancer in 2014. In Malaysia, colorectal cancer is the second most common cancer. It is also the most common cancer seen in males and third most common cancer seen in females (3rd National Cancer Registry, Malaysia). However, it is also one of the most treatable cancers if it is detected early. On top of that, you can take steps to lower your risk and keep your colon healthy, too. Start with these tips:

1. Test Time:

Get regular colon cancer screenings starting at age 40. That's the age at which your risk starts increasing, If colon cancer runs in your family, talk to a doctor about starting screening earlier.

2. Diet do's:

Add more fruits, vegetables, whole grain breads and cereals, nuts and beans to your diet. They are linked to a lower risk of some cancers and can help you to have normal bowel function.

3. Diet don'ts:

Limit your intake of red meat and foods that are high in fat or processed. They can increase your risk of colon cancer.

4. Weight watch:

Check your body mass index (BMI). Your risk of colon cancer increases if you’re overweight or obese.

5. Sweat more:

Include at least 30 minutes of moderate-intensity exercise five days a week. This will help you maintain a healthy weight and stay stress-free, which can decrease your risk.

6. Limit drinks:

Keep an eye on your alcohol consumption, which is a general risk factor like red meat. The recommended limits are one drink per day for women and two drinks per day for men.

7. Quit now:

On top of many other health risks, smoking increases your risk of colon cancer, so take steps to quit right away

Source: Cleveland Clinic