Procedures

Why do I need a colorectal surgeon?

If your condition does not improve with medical management, surgery may be an option. As a highly trained colorectal surgeon, Dr. Lorber will personally consult with you to understand any surgical procedures she recommends.

In most instances, minimally invasive techniques can be utilized. A few examples of colorectal conditions requiring treatment include:

• Colon Cancer
• Rectal Cancer
• Diverticulitis
• Colon Polyps
• Rectal Prolapse
• Crohn’s Disease
• Ulcerative Colitis
• Anal Fissures
• Hemorroids
• Bowel Blockage

The primary purpose of a screening colonoscopy is to identify and remove polyps. Polyps are colonic growths that may be benign, pre-cancerous or malignant. It is unclear on sight alone which type they are therefore, it is necessary to remove all types of polyps. Removal of benign and pre-cancerous polyps is all that is necessary for treatment. Occasionally these growths contain a small focus of cancer and further interventions may be necessary. It is very important that this exam be carried out with the proper preparation in order to be able to visualize all polyps. Therefore, we encourage you to complete the preparation as instructed. Colon cancer is largely a preventable disease., given the widespread availability of this technology. Colonoscopy is 90% effective in preventing colon cancer.

Anesthesia
During the exam, you will be sedated by an anesthesiologist with a medication called Dipruvan. Most people are unaware that they are having the exam. The procedure usually takes between 15 minutes and 1 hour, depending on your colon. After the exam, you will remain in the recovery room for a short period of time while the sedation wears off.

Polyp removal
There is no pain during or after the polyp removal. Any polyps that are noted and removed during the colonoscopy are recovered for pathological examination. The polyp(s)/biopsies will be closely examined by a pathologist and the results will be available approximately one week after your procedure. You will receive a separate bill from pathology, which is not in our control. 35% of people will have a precancerous polyp removed during the procedure.

Post-op Limitations
You will be wide awake shortly after the procedure. However, you may not drive until the next day. You must arrange for a friend or family member to take you home. Legally, you are not allowed to go home in a taxi or Uber.

Risks
Colonoscopy is a low-risk procedure. The risks of colonoscopy include, but are not limited to, bleeding, infection, and perforation of the colon. The overall risk of screening colonoscopy (visualization only) is

1-3 in 10,000. The risk of therapeutic colonoscopy, colonoscopy with biopsy or polyp removal, is slightly higher. Because of this risk, long air trips should not be scheduled for 7 days following the procedure.

The proper medical term for polyp removal is Polypectomy. Most polyps can be removed with a colonoscope, the device used to perform a colonoscopy. Small polyps are snipped and the tissue removed. Slightly larger polyps are removed using a wire loop that cauterizes the removal site and prevents bleeding.

One of the main purposes of a colonoscopy is to identify and remove polyps. Polyps are colonic growths that may be benign, pre-cancerous or malignant. It is unclear on sight alone which type they are, therefore, it is necessary to remove all types of polyps.

Removal of benign and pre-cancerous polyps is all that is necessary for treatment. Occasionally these growths contain a small focus of cancer and further interventions may be necessary. It is very important that this exam be carried out with the proper preparation to be able to visualize all polyps.

Colon cancer is largely a preventable disease., given the widespread availability of this technology. Colonoscopy is 90% effective in preventing colon cancer.

Fecal incontinence also referred to as bowel incontinence, is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. This type of incontinence can range from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Some signs and symptoms include:

Having trouble holding a bowel movement, solid or liquid stool leaking when least expected, finding streaks of stool in the underwear and needing to find a restroom when out in public.

A number of underlying conditions can cause fecal incontinence including:

• Diarrhea
• Constipation – watery stools can leak out around hard stools. Constipation can also cause muscles of the rectum to stretch and weaken.
• Damage to Muscles or Nerves. Any damage to the anus can create incontinence issues as stool can leak out. Weak pelvic floor muscles also make holding stool in the rectum more difficult. Nerve damage can be caused by hemorrhoid surgery, a history of straining, childbirth, stroke, diabetes, multiple sclerosis and spinal cord injury
• Rectal change – radiation treatment for rectal cancer or other pelvic cancers can cause scarring of the rectum, reducing its ability to keep stool from leaking.
• Aging – As you age, muscles and tissues lose elasticity. As this ability to stretch becomes more limited, leakage can occur.
• Childbirth – puts a lot of stress on the body. If there is damage to the pelvic floor muscles during delivery, bowel control problems can appear immediately. Injuries during labor can also include the nerves, tearing of muscles during delivery, damage from forceps or an episiotomy.
• Gallbladder removal – due to an increased amount of bile in the intestines, it creates a laxative effect.
• Medication side effects
• Pelvic Floor Dysfunction. Pelvic floor strength is critical to digestive (bowel) health for both women and men. Here’s how a poorly functioning pelvic floor can create a situation for ABL:

Treatment relies on correctly diagnosing the underlying problem and can be easily controlled with lifestyle modifications including diet and behavioral modifications. If the condition is more serious, medications, non-invasive procedures or surgery may be an option

Ulcerative colitis, referred to as UC, is a chronic inflammatory bowel disease (IBD) known for its inflammation of the large intestine (rectum and colon). UC appears in a continuous pattern in the colon. The innermost lining becomes inflamed, and ulcers may form on the surface.

Some symptoms may include:

• Pain in the abdomen, joints, or rectum
• Gastrointestinal bloating
• Blood in stool
• Constipation
• Diarrhea
• Leaking of stool
• Urge to defecate
• Anemia
• Fatigue
• Fever
• Loss of appetite

The development of UC can be from an inappropriate immune system response, genetics or environmental factors (or triggers).

UC is a chronic, inflammatory condition and is thought of as an autoimmune disease. It is unpredictable and not always preventable.

UC can often be maintained by medication and dietary adjustments. More severe cases may involve surgical removal of part of the colon.

Hemorrhoids develop when veins in the lower rectum and anus swell or bleed. Generally, hemorrhoids are exacerbated by straining when having bowel movements, changes in bowel habits and pregnancy. Sometimes, there is no inciting factor.

Symptoms include itching, swelling, irritation, bleeding and pain.

Treatments include changes in lifestyle and bowel function, topical medications, office-based procedures (rubber band ligation, laser treatment, injections) or surgery.

Pilonidal disease involves cysts underneath the skin at the lower back. They may develop in adults and may become infected.

Symptoms include pain, inflammation, swelling and drainage.

Treatment depends on symptoms. Infections are treated with in-office procedures and antibiotics. Surgical treatments can prevent flares and recurrence.

 

Colon cancer occurs in the colon or rectum, typically at the digestive tract’s lower end.

Early cases can begin as noncancerous polyps. These often have no symptoms but can be detected by screening. For this reason, doctors recommend colonoscopy screenings for those at high risk or over the age of 50.

Colorectal cancer symptoms depend on the size and location of cancer. Some commonly experienced symptoms include changes in bowel habits, changes in stool consistency, blood in the stool, and abdominal discomfort.

Colorectal cancer treatment depends on the size, location, and how far cancer has spread. Common treatments include surgery to remove cancer, chemotherapy, and radiation therapy.

Diverticulosis is an infection that occurs in small, bulging pockets that can develop in the digestive tract.

Symptoms include abdominal pain (especially left side), fever, bloating, diarrhea or constipation, nausea and vomiting and people with anorexia.

Doctors will perform tests to confirm diverticulosis including bloodwork and imaging to evaluate and diagnose the infection.

Treatment may include antibiotics and diet modification to treat the majority of the diverticulosis if the condition is manageable. If the disease is more severe, surgery may be recommended. Treatments may also include physical therapy and biofeedback therapy.

Many conditions can lead to anal pain – which is often benign and easily evaluated in the office during an appointment.

Treatments include a wide array of options depending on the cause of the pain.

Rectal bleeding refers to bright red blood which occurs with or without bowel movement. You may see blood on the stool, toilet paper or in the toilet.

Rectal bleeding occurs due to conditions such as hemorrhoids, diverticulitis, anal fissures, colitis or cancer.

Rectal bleeding is diagnosed by examination in the office during an appointment. In most cases,  a colonoscopy will be required as part of your evaluation.

 

The pelvis contains many organs including the bladder, rectum, uterus, vagina, and prostate. The surrounding muscles help with bladder and bowel control and sexual function. The muscles can become weak or damaged, causing conditions such as prolapse, incontinence, outlet dysfunction and constipation.

Dr. Lorber can evaluate these conditions by conducting a procedure in the office.