Leaky Bowels? Treatment Options for Fecal IncontinenceYou might be embarrassed to talk about your leaking bowels with anyone, even a doctor. But there are ways to improve the function of the rectal muscles. In this podcast, Dr. Tom Miller and colorectal…
From Interactive Marketing & Web
| 107
107 plays
| 0
October 13, 2015
Family Health and Wellness Dr. Miller: Fecal incontinence, oops, that happened again. We're going to talk about how to treat that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope. Dr. Miller: Hi I'm here with Dr. Bartley Pickron, and he's a surgeon here at the University of Utah and specializes in colorectal surgery. Bartley, tell us a little bit about how you fix fecal incontinence, and for the audience fecal incontinence is leakage of stool. Dr. Pickron: Well it ultimately depends on what the cause is. I mean most of the time we see patients with either weak or damaged anal sphincter muscles, and we have to go about and try to restore that normal anatomy. Dr. Miller: Fecal incontinence usually occurs in people who are a bit older. Dr. Pickron: Usually, but we're also starting to see it in some of the younger patients as well, as it gets a little bit more . . . a little bit less public taboo. Dr. Miller: Right, well it's obviously an embarrassing subject for people who have it. They're going to feel guilty but if they make their way to your office, what kinds of treatments do you offer to them? Dr. Pickron: Well it depends on the underlying problem. I mean, what we would like to do if at all possible is if the muscle is torn and damaged then there is surgery to repair that. There are also other options if it's just some weakness problems, for example, we can put in a device called a Sacral Nerve Stimulator. Dr. Miller: And that is a device that uses electric current to tighten muscle. Is that what that does? Dr. Pickron: Yeah it's pretty similar to . . . it kind of works along the same principles a pace maker does for the heart. This is a little device, it's implanted in a little tissue pocket on the buttock, and it has a lead that goes through one of the holes in the tail bone, and it just adds an extra stimulus to the nerves that go to the pelvic muscles to add some extra tone and strength. Dr. Miller: In 2015 these are new treatments? I mean is the field advanced since the middle of the last decade? Dr. Pickron: The Sacral Nerve Stimulator is certainly a new treatment for fecal incontinence. The urologist have been using it for urinary incontinence for some time, and one of the side benefits they saw when they first started using it was an improvement in bowel function, so then is subsequently got approved for the treatment of fecal incontinence too. Dr. Miller: Do you use and sling procedure like the gynecologists use for urinary incontinence sometimes? Dr. Pickron: Not currently. There's a couple of those coming down the pipeline through still in the experimental phase, but hopefully in the next couple of years we'll have an answer on that. Dr. Miller: Now once you're working with people with fecal incontinence, how well do these treatments work? I mean can they expect to be incontinence free, or can they expect to have no leakage after these surgeries or treatments? Dr. Pickron: You know, making a bad muscle perfect is a big challenge. Dr. Miller: But you can definitely make it a little better with some. Dr. Pickron: We can definitely make it a lot better. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |
|
Hemorrhoids—or Something Else?If you’re experiencing severe rectal pain, you might think it’s hemorrhoids, but it could be something worse. Dr. Tom Miller and Dr. Bartley Pickron talk about how to distinguish between…
From Interactive Marketing & Web
| 4,941
4,941 plays
| 0
November 25, 2020
Digestive Health Dr. Miller: I'm here today with Dr. Bartley Pickron and he is a surgeon in the department of surgery. He is also a specialist in colorectal surgery. It's good to see you. I have patients that come to me and they ask, "I've got this pain in my bottom/rectum," and they say, "I think I have a hemorrhoid." How often is it a hemorrhoid or is it something else? Is It a Hemorrhoid or Something Else?Dr. Pickron: Most of the patients we see for anorectal pain don't have hemorrhoids, but everybody has hemorrhoids to some degree. Dr. Miller: Most don't. Dr. Pickron: Most don't, but the real causes of pain are more things like fissures, an abscess, and other things that aren't hemorrhoids. Dr. Miller: Fissures can be incredibly painful. Dr. Pickron: They're horrible. Dr. Miller: What causes a fissure? Dr. Pickron: Usually it's a tear and it happens directly in the front or directly in the back. Most of the time these things heal up just fine, but if they don't and they get deep enough to where the anal sphincter gets irritated . . . Dr. Miller: Ouch. Dr. Pickron: . . . then you get a spasm of that muscle and that prevents the tear from healing and then you just enter this vicious cycle that just won't quit. Dr. Miller: So you use different therapies to try to repair that. Dr. Pickron: Yeah, generally we focus not so much on the tear but on the muscle itself because if we could make the muscle relax and stop the spasm then the tear generally heals just fine on its own. Types of Hemorrhoids and Associated SymptomsDr. Miller: While hemorrhoids aren't the usual cause, as you pointed out, they're both internal and external hemorrhoids, my understanding is that the external hemorrhoids can be painful. Dr. Pickron: They certainly can. The most common thing we see when they are painful is a thrombosis, where you get a big blood clot with the pain and swelling. Dr. Miller: Ouch. How do you treat that? Dr. Pickron: Most of the time, we let them these reabsorb on their own. If patients come in within the first two or three days after the event happens, then there is some benefit to removing it surgically because they'll get better faster, but usually once they're kind of over the pain curve and their symptoms are getting better, then the pain and swelling will generally just take care of itself. Preventing HemorrhoidsDr. Miller: After you do the treatment, is there any kind of change in diet that they might need to make? My understanding is that constipation, straining, those things can contribute to external hemorrhoids. What's your thought on that? Dr. Pickron: Absolutely. Constipation and particularly straining or sitting on the toilet for a long time during bowel movements reading the magazine, for example, all tend to predispose people to hemorrhoids. We recommend a change in bowel habits, usually by the addition of fiber or stool softeners and staying hydrated. Treatments for Fissures and HemorrhoidsDr. Miller: When do you treat a fissure or hemorrhoids with a procedure? Dr. Pickron: I'll talk about the fissures first and probably maybe 10 or 20% of those are actually treated surgically. We have creams that we can use that generally take care of things. If that doesn't work, Botox injection is an option. If those don't work, then the last resort is certainly surgery. Dr. Miller: So that's treatment for fissures, how do you treat hemorrhoids? Dr. Pickron: Again, most of these are treated non-operatively. There are procedures in the office we do. The most common thing we do is a procedure called rubber band ligation, where we put rubber bands around the hemorrhoids on the inside. That sounds pretty painful, but truthfully the internal hemorrhoids really have no sensation, so it's a very easy procedure to do and very well tolerated. It's usually just some mild pressure for about 24 hours and that's it. The ones that do need to be treated surgically, like I said, are typically the external ones and those are, fortunately for patients, fairly rare. Dr. Miller: It would seem to me to be rare, but are there times that the pain could be induced by something like a cancer? Dr. Pickron: It is. That's certainly one reason that these symptoms need to be evaluated very thoroughly. Dr. Miller: So if they're going on for weeks, that's something that probably ought to be looked at? Dr. Pickron: Right. So any combination of pain and bleeding and particularly if there is a little mass or something that just doesn't feel right, then that absolutely needs to be checked out. Other Causes for Rectal PainDr. Miller: Any other causes of rectal pain? I know that there's one that is a spasm that occurs from time to time in some people. Dr. Pickron: Some people get this kind of vague rectal pain, which as you mentioned is just kind of a spasm, it's fairly poorly understood. There are some options for it such as physical therapy, biofeedback, but these can be challenging things to treat. Dr. Miller: It comes on suddenly and then goes away over seconds to minutes, I think, sometimes. Dr. Pickron: Yeah, usually happens in the middle of the night. People kind of wake up and they feel this intense pressure almost like a Charley horse in their rectum, which not a pleasant sensation. Dr. Miller: Any other causes of pain? Dr. Pickron: Those are primarily the big ones, infections, abscesses are fairly common and those are typically treated with surgical drainage.
The symptoms and treatments for Hemorrhoids and similar ailments. |
|
A Potential Source of Your Abdominal Pain: DiverticulitisAbdominal pain, bloating and gas can be caused by any number of problems, but diverticulitis is a common source of those symptoms. It’s an infection of the large intestine that can cause mild…
From Interactive Marketing & Web
| 1,048
1,048 plays
| 0
September 09, 2015
Digestive Health Dr. Miller: Diverticulitis. What is it, how do you know if you have it, and would you ever need surgery for it? We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope. Dr. Miller: I'm here with Dr. Bartley Pickron. He is a surgeon and also specializes in colorectal surgery. He's a professor of surgery here at the University of Utah. Tell us, what is diverticulitis? How would a person know if they had that? Dr. Pickron: Well, diverticulitis is an infection of the colon. It usually comes from infected diverticula, which are little pouches in the colon. Dr. Miller: So when a person develops an inflammation due to an infection, what do they feel, or how do they know they might have an infection of the colon? Dr. Pickron: The majority of the time, it starts out with pain, usually in the left side, down toward the pelvis, and the pain usually comes on pretty quickly. They usually may have fever, not much of an appetite, and just generally don't feel good. Dr. Miller: And when should they, if they experience that, head to the doctor in your opinion? Dr. Pickron: Well, if it's the first time, then you should really get checked out within the next couple of days. The majority of people take a week's course of antibiotics and they do well, and most people never have a problem again. Dr. Miller: Would one ever need surgery for this? Does it ever get so bad that you would need to have part of the colon taken out where the infection occurs? Dr. Pickron: Well, it certainly can. I mean, some people have their first episode is a free perforation, which is a life-threatening condition. Dr. Miller: Now, perforation is described as . . . Dr. Pickron: Basically a hole erupts in the colon. Dr. Miller: And it leads to leakage . . . Dr. Pickron: Leakage of stool into the abdominal cavity. Dr. Miller: Not a good thing. Dr. Pickron: Not good at all. And so, like I said, that's usually a life-threatening condition that has to be taken care of with emergent surgery. Dr. Miller: What do you talk to the patient about in terms of surgical intervention? Dr. Pickron: Well, it really depends on their symptoms. A lot of the recommendations for this disease process have changed over the last five to 10 years. And so what we are really looking at now for people who require surgery are not really the number of episodes you've had per se, but more of the people who get an episode and really never recover from it. Just have this kind of lingering left-sided pain, and just general GI discomfort. Dr. Miller: That continues even after a course of antibiotics? Dr. Pickron: Usually after multiple courses of antibiotics. Dr. Miller: So then, it's time to take out part of the colon, I guess? Dr. Pickron: Right. Dr. Miller: And how much of the colon do you usually remove in order to repair this problem? Dr. Pickron: I mean, on average, it tends to be anywhere from 8 to 12 inches. It really depends on the extent of the inflammation that's present compared to the healthy colon that's left, that's not involved. Dr. Miller: And how do you do the surgery now? I understand that it's probably done laparoscopically? Dr. Pickron: Yeah, so we have some good minimally invasive options for this. Usually, we start out with a little quarter of an inch incision in the belly button, and we're able to put a camera into the abdominal cavity and take a look around and really see where the problem lies. Then we usually make about a two-inch incision kind of just above the bikini line, and we're able to do the entire surgery through that. Dr. Miller: So not a large incision as in the old days? Dr. Pickron: Not at all. You can still wear your speedo if you want to. Dr. Miller: That would be great, so . . . maybe not for me. How long does a patient plan to be off work for this, or how long can they expect the recovery to take? Dr. Pickron: Well, a typical hospital stay is anywhere from two to four days. And then, overall recovery, kind of depending on the fitness of the patient prior to surgery, is usually anywhere from three to six weeks. Dr. Miller: I have heard that after an episode of diverticulitis, patients have been told not to eat popcorn, or jam with seeds in it. Can you comment on that? I'm not so sure that isn't a myth. Dr. Pickron: It is a myth and it used to be the theory that plugging these little pockets makes diverticulosis turn into diverticulitis and so the theory used to be that if you ate nuts, popcorns, or seeds that you would plug these little pockets, but there's really no scientific evidence that shows that's true. And actually, these foods are all very good fiber sources, which can actually help with the progression of diverticulitis. Dr. Miller: So in general, you would tell patients after a bout of diverticulitis to increase fiber in their diet? Dr. Pickron: In the acute setting, to kind of tone it down a little bit, but once they've recovered, then, yes, about 20, 25 grams a day. Dr. Miller: So it sounds like if one has diverticulitis and it's not too severe, you're going to have that treated by your primary care physician, usually with antibiotics and rest, and then if it recurs or if it continues, if there are multiple episodes or whether it's a continuous rather nagging pain after multiple courses of antibiotics, you would recommend that the person see a surgeon, and preferably perhaps a colorectal surgeon? Dr. Pickron: Absolutely. Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com |