Find what ails you: Literature written by Dr. Rosenfeld

Proctologist (BUTT Doctor) Thousand Oaks California: Specializing in colonoscopy, thrombosed hemorrhoids, hemorrhoid treatment, hemorrhoid surgery, anal fissures, anal fistuals, anal pain, anal abscess, anal itching, and pilonidal cyst disease.

IMPORTANT NOTE: If you have sharp anal pain or anal burning with bleeding, you most likely have an anal fissure, not a hemorrhoid. If you have these symptoms read the fissure-in-ano pamphlet.

DDR Brochure Anal Itching44

Anal Itching

DDR Brochure Fistula in Ano2

Fistula-in-ano

DDR Brochure Fistula in Ano11

Hemorrhoids

DDR Brochure Anal Itching43

Pilonida Cyst

DDR Brochure Anal Itching42

Fissure-in-ano

DDR Brochure Anal Itching411

Anal Warts

Colonoscopy Information Sheet

At this time you are due for a colon evaluation. The reason to evaluate the colon is to look for polyps (growths in the colon which can be pre-cancerous or non-precancerous), cancer, inflammation and other abnormalities. Without a colon evaluation there is a risk of developing colon cancer.

The two alternative to colonoscopy include a flexible sigmoidoscopy followed by a barium enema or a virtual colonsocopy. Virtual colonoscopy is neither the standard of care nor covered by insurance. Although the risks are smaller, these alternative exams are neither as good a colonoscopy, nor can diagnostic biopsies be performed. Just so you know I had my colonoscopy in October of 2009 so I know first-hand what you’re going through!

Below are the guidelines from the American Cancer Society.

American Cancer Society recommendations
for colorectal cancer early detection

People at average risk

The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps keeps some people from getting colorectal cancer. Tests thatt have the best chance of finding both polyps and cancer are preferred if these tests are available to you and your are willing to have them.

Beginning at age 50 both men and women at average risk for developing colorectal cancer should use one of the screening tests below:

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years*
  • Colonoscopy every 10 years
  • Double-contrast barium enema every 5 years*
  • CT colonsography (virtual colonsoscopy) every 5 years*
  • Stool DNA test (sDNA) – Finds DNA of polyps and cancer. It is very effective in finding cancer and less effective for finding polyps. If the test is positive (abnormal) a colonoscopy is mandatory. ***
    • ColoGuard

Tests that mainly find cancer

  • Fecal occult blood test (FOBT) every year*,**
  • Fecal immunochemical test (FIT) every year*,**
  • Stool DNA test (sDNA) – Finds DNA of polyps and cancer. It is very effective in finding cancer and less effective for finding polyps. If the test is positive (abnormal) a colonoscopy is mandatory.***
    • ColoGuard is the name of the test.

*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. An FOBT or FIT done during a digital rectal exam in the doctor’s ofice is not adequate for screening.
***This test is Medicare approved and covered by Medicare

People at increased or high risk

If you are at increased or high risk of colorectal cancer, you should begin colorectal cancer screening before age 50 and/or be screened more often. The following conditions make your risk higher than average:

  • A personal history of colorectal cancer or adenomatous polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A strong family history of colorectal cancer or polyps
  • A known family history of a hereditary colorectal cancer syndrome such a familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

Of the guidelines listed above for average risk patients and high risk patients, I feel that a full colon evaluation is the most reliable and accurate. Both of the CT colonography and colonoscopy will evaluate the whole colon. Of the two choices I prefer the colonoscopy as it is the gold standard. Colonoscopy is the only test which biopsies and polyp removal can be done at the same time as the evaluation. Colonoscopy has also been shown to be effective in decreasing the risk of the death from colon cancer by 50%. Virtual colonoscopy is not covered by insurance and diagnostic biopsies and polypectomy can not be performed at the same time so if abnormalities such as inflammation or a polp/cancer is found a colonoscopy will need to be scheduled. Barium enema is archaic and rarely used. It is done usually in times when a colonoscopy is unsuccessful to evaluate the area of the colon not accessible via the colonoscopy.

Colonoscopy is a very safe and effective procedure. The risks of colonsoscopy are small but include and are not limited to: death, stroke, heart attack, clots in the legs that can dislodge and go to the lungs, anesthesia complications, perforation (a hold in the colon), missed lesions (including polyps and cancer) and severe bleeding. Treatment for bleeding of perforation may require surgery; however; the will require hospitalization until you are well enough to go home.