To listen, click the link below.

Proctalgia fugax

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In 2016, life became painful and chaotic for Sam Anderson when he was diagnosed with colorectal cancer and then suffered a medical error during treatment. After that, Sam and his wife took matters into their own hands. At Mayo Clinic, the pair discovered a team of physicians that calmed their worries and restored normalcy.

Sam Anderson is finally back doing what he loves best: playing piano. Several nights a week, he can be found tinkling the ivories for dinner guests at one of the upscale eateries in Rochester, Minnesota.

"Making music, playing and singing has made me feel like a whole person again," says Sam, who recently underwent his second major surgery at Mayo Clinic to treat colorectal cancer.

For almost two years, Sam's ability to play the piano had been compromised due to painful symptoms caused by cancer that were exacerbated by a medical error during surgery in his home state of Florida.

The mistake — which involved Sam's urethra being nicked — coupled with spotty follow-up care, left Sam and his wife, Nancy, reeling and set them on a search for better treatment. That pursuit ended at Mayo Clinic, where Sam found an expert multidisciplinary care team that offered precision medicine and compassionate care. In addition to Mayo Clinic offering Sam a chance at normalcy, the clinic offered Nancy a job. That allowed the couple to relocate to Minnesota.

"Being at Mayo Clinic has made all the difference," says Nancy, who now is a Mayo Clinic social worker. "Here you just feel like you're in good hands. You actually know they care. Every doctor that walked through the door would say to us, 'I'm really sorry. You've been through so much.' And they genuinely meant it."

The treatment Sam received at Mayo Clinic also has given Sam and Nancy time to enjoy one another, one day at a time. "We've been married 39 years in September, and I feel like we really have a strong bond," Nancy says. "The thing that's changed is we just don't take things for granted like we used to."

Damage repaired, function restored

Sam's cancer was discovered in October 2016, and he had surgery in Florida soon after the diagnosis. It didn't go well. "Sam had come from another place after having a robotic resection for rectal cancer, and we had quite a bit of trouble trying to figure out what was going on," says surgeon John Pemberton, M.D., in Mayo Clinic's Division of Colon and Rectal Surgery.

Not only did Sam's urethra have a fistula, or hole, in it, he also had a foreign object — a surgical drain — in his pelvis that was left behind after the previous surgery. "All of this was pretty strange," Dr. Pemberton says.

As a result of the fistula, Sam's urine passed through his bladder into his urethra and then into his rectum, says Boyd Viers, M.D., in the Department of Urology. "It was a bad situation for him."

The painful symptoms from the injured tissues were unbearable at times. "Sam was having considerable difficulty sitting," Nancy says. "The pain was to the point where if we went out to eat, one of us would go into the restaurant and check what kind of chairs they had to see if they had cushions. We bought some cushions and carried those in the car, so we could take them into a restaurant, or wherever we went where he was going to have to sit down for any length."

"It is very satisfying and very relaxing for me to just sit down at the piano and play. Everything I do is very soft and flowing and mellow. I really want to slow things down for the people who come in."

Sam Anderson

At Mayo Clinic, Sam's team decided to perform a two-part operation. First, they removed the surgical drain that had been left in after his previous surgery, and Dr. Viers repaired the fistula by affixing a surgical flap onto Sam's urethra. Next, Dr. Pemberton removed the damaged colorectal tissue, which had been affected by the cancer and the misplaced urine. Muscle from Sam's thigh was grafted into the pelvic cavity in place of the tissue that had been removed.

Recovery from the October 2017 operation was slow. But over time, the fistula healed. Sam became accustomed to the colostomy that was created during the surgery, and he began to get comfortable with the process of waste collection and pouch maintenance. In spring 2018, the urinary catheter Sam had required following surgery was removed, and he resumed normal urinary function.

"I started to kind of figure out ways to live, ways to function, ways to do things I wanted to do and like to do," Sam says. "I got back into the workforce part time during the day, and I found a job in a restaurant playing piano. It is very satisfying and very relaxing for me to just sit down at the piano and play. Everything I do is very soft and flowing and mellow. I really want to slow things down for the people who come in."

Persistent disease, additional treatment

Sam's return to work and normal daily life was short-lived, however. In fall 2018, follow-up CT scans revealed his colorectal cancer was back.

"The cancer had returned to the same spot, only it was much larger this time," Sam says. "The decision was made to go in and remove the cancer. But in order to do that effectively, they had to remove all of the organs for the liquid waste part of my body. The bladder, the urethra, all of it came out in surgery that they did in December 2018."

In addition to removing tissue and internal organs, Sam's medical team administered a dose of intraoperative radiation therapy throughout his pelvic region. They also created a second ostomy in his abdomen for urine collection.

"I'm not 67 and feeling like I'm 80. I'm 67 and feeling like I'm 50 because I'm back in the workforce."

Sam Anderson

Since that surgery, Sam has had to adjust to living with two ostomies. He has to wear his clothing a certain way and take precautions to maintain and protect the bags. Sam also thinks differently about what he eats.

"There are things I used to enjoy eating that I don't anymore because I don't want to put my system through having to break that down and be worried about how they're going to go through the stoma and exit my body," he says.

But the devices are working correctly, and that is a source of comfort to him. Best of all, the pain in his pelvic regions is gone.

"As much as I don't like wearing these appliances, and there are certain things I have to do, it makes me feel younger, like I'm not sick and debilitated and getting old before my time," Sam says. "I'm not 67 and feeling like I'm 80. I'm 67 and feeling like I'm 50 because I'm back in the workforce."

Different outlook, new normal

For many patients like Sam, turning the page on their cancer treatment by receiving an ostomy — or two in Sam's case — can be energizing, Dr. Viers says. "It's interesting how patients transition through this," he says. "At first, they come in denial. Then they get angry, then sad and then acceptance. The majority of patients, once they get over their urinary and bowel function changing, they come to embrace and accept it."

And the apparatuses are designed to be as unobtrusive as possible. "Once patients get comfortable with them, these patients are doing everything that others would be doing, including going back to work, running marathons, and some people are swimming with these," Dr. Viers says.

Living with two ostomies is "just the new normal," Sam says. He will receive follow-up scans every three months to check for cancer recurrence. To date, his scans have been negative.

"I try to live one day at time," he says. "Walking into Mayo Clinic, any of the buildings, to see any physician or their teams, there is an air of confidence and trust, and of faith there that things are going to be OK."

HELPFUL LINKS

• Learn more about ostomies.
• Read about colorectal cancer care at Mayo Clinic.
• Check out the Division of Colon and Rectal Surgery and Department of Urology.
• Connect with others talking about Colorectal Cancer on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

The post Life After Colorectal Cancer: Music, Comfort and Ostomies appeared first on Mayo Clinic News Network.

To listen, click the link below.

Proctalgia Fugax

The post Proctalgia fugax: Mayo Clinic Radio Health Minute appeared first on Mayo Clinic News Network.

ANSWER: It’s unlikely that hemorrhoids are the source of your pain. Instead, the painful bowel movements you’re experiencing are much more likely to be due to a condition called an anal fissure. Your health care provider can confirm that with an exam. Anal fissures usually don’t go away on their own, so it’s important to have the condition properly identified and treated.

It’s common for people to assume that their hemorrhoids are the cause of painful bowel movements. But, although hemorrhoids often cause itching, irritation, sensitivity and other discomfort around the affected area, hemorrhoids rarely lead to pain during a bowel movement.

Anal fissures, however, are a frequent source of pain with bowel movements. These small tears occur in the skin around the anus or in the thin tissue that lines the anus, called the anoderm. An anal fissure may develop when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements.

When an anal fissure occurs, the tear can expose the ring of muscle that holds your anus closed. This ring of muscle, called the internal sphincter muscle, lies underneath the anal skin and tissue. That exposure may trigger spasms in the sphincter muscle. The spasms often trigger more pain, and they also prevent the fissure from healing. This sets up a vicious cycle of continuing pain.

A physical exam is typically all that’s needed to diagnose an anal fissure accurately. Treatment is completed in stages. How much treatment you need depends on how severe the fissure is and how well it responds to the initial treatment.

The first step in treatment is to increase the amount of fluid and fiber in your diet to make stools softer and easier to pass. That eases pressure on the fissure during bowel movements. Taking a bulking agent, such as Metamucil, Benefiber or Citrucel, can help.

If the fissure doesn’t heal within several weeks, the next step is to use a topical medication that’s applied to the skin to increase blood flow to the fissure, promote healing and help the sphincter muscle relax, thereby decreasing spasms. A topical form of nitroglycerin or the calcium channel blocker nifedipine is often used for this purpose.

If the fissure persists despite these therapies, your health care provider may recommend an injection of botulinum toxin type A (Botox) into the internal sphincter muscle. That eases spasms by paralyzing the muscle.

Finally, if a fissure still doesn’t heal with the other treatments, you may need surgery. A procedure called lateral internal sphincterotomy typically is used to treat chronic anal fissures. It involves cutting a small area of the internal sphincter muscle to reduce spasms and pain. Research has shown that, for a fissure that doesn’t heal over time with medical treatment, surgery is often effective. The procedure does, however, carry a small risk of causing brief incontinence to gas.

Make an appointment to see your health care provider, and have your situation evaluated. If it is an anal fissure causing pain during bowel movements, it’s important to start treatment as soon as possible to promote healing and prevent further damage. — Dr. John Pemberton, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Painful bowel movements may be due to anal fissure appeared first on Mayo Clinic News Network.

On the Mayo Clinic Radio podcast, Dr. Keith Stewart, Carlson and Nelson endowed director of the Mayo Clinic Center for Individualized Medicine, previews the "Individualizing Medicine Conference 2017," taking place Oct. 9-11 in Rochester, Minnesota. The conference features speakers from around the world on topics related to genomics and personalized medicine. Also on the podcast, Dr. Amanika Kumar, an oncologist at Mayo Clinic, explains the importance of having quality of life discussions with your health care provider before and during cancer care. And Dr. John Pemberton, a colorectal surgeon at Mayo Clinic, discusses treatment for common colorectal problems.

The post #MayoClinicRadio podcast: 10/7/17 appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Keith Stewart, Carlson and Nelson endowed director of the Mayo Clinic Center for Individualized Medicine, will preview the upcoming "Individualizing Medicine Conference 2017," which will take place Oct. 9-11 in Rochester, Minnesota. The conference will feature speakers from around the world on topics related to genomics and personalized medicine. Also on the program, Dr. Amanika Kumar, an oncologist at Mayo Clinic, will explain the importance of having quality of life discussions with your health care provider before and during cancer care. And Dr. John Pemberton, a colorectal surgeon at Mayo Clinic, will discuss treatment for common colorectal problems.

Here's your Mayo Clinic Radio podcast.

The post Individualizing Medicine Conference 2017 preview: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Keith Stewart, Carlson and Nelson endowed director of the Mayo Clinic Center for Individualized Medicine, will preview the upcoming "Individualizing Medicine Conference 2017," which will take place Oct. 9-11 in Rochester, Minnesota. The conference will feature speakers from around the world on topics related to genomics and personalized medicine. Also on the program, Dr. Amanika Kumar, an oncologist at Mayo Clinic, will explain the importance of having quality of life discussions with your health care provider before and during cancer care. And Dr. John Pemberton, a colorectal surgeon at Mayo Clinic, will discuss treatment for common colorectal problems.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Individualizing Medicine Conference 2017 preview appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Keith Stewart, Carlson and Nelson endowed director of the Mayo Clinic Center for Individualized Medicine, will preview the upcoming "Individualizing Medicine Conference 2017," which will take place Oct. 9-11 in Rochester, Minnesota. The conference will feature speakers from around the world on topics related to genomics and personalized medicine. Also on the program, Dr. Amanika Kumar, an oncologist at Mayo Clinic, will explain the importance of having quality of life discussions with your health care provider before and during cancer care. And Dr. John Pemberton, a colorectal surgeon at Mayo Clinic, will discuss treatment for common colorectal problems.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Individualizing Medicine Conference / quality of life in cancer care / common colorectal problems appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: 

ANSWER: Hemorrhoids are quite common, and they often follow the pattern you describe. Making some lifestyle changes may lower your chances of developing hemorrhoids. But, if those changes aren’t enough to keep them from coming back, and the hemorrhoids cause you considerable discomfort, then consider making an appointment with your doctor for an evaluation to see if treatment may be necessary.

Hemorrhoidal cushions are part of the body’s natural anatomy in the anal canal. They help keep stool in and control continence. The problem with hemorrhoids develops when veins in those cushions become swollen and bulge. Hemorrhoids can occur inside the rectum. Those are called internal hemorrhoids. Or, they can happen under the skin around the anus. Those are called external hemorrhoids. Internal hemorrhoids don’t cause any pain and usually don’t require treatment unless they start to bleed. External hemorrhoids are the ones that typically lead to the pain and discomfort people often associate with hemorrhoids.

Hemorrhoids develop due to increased pressure on the pelvic floor. That pressure often comes from straining during bowel movements and sitting for long periods of time on the toilet. It also may be a result of chronic constipation or diarrhea, obesity or pregnancy. External hemorrhoids tend to occur in the pattern you mention, developing over a three- to four-day period and then slowly going away.

One of the key factors in preventing hemorrhoids is being able to pass stool regularly without straining. There are a number of lifestyle changes you can try to help make that happen. They include exercising regularly, eating a healthy diet that is high in fiber, drinking plenty of fluids, and avoiding sitting for long periods of time.

When painful external hemorrhoids develop, self-care steps usually can relieve the discomfort. Over-the-counter creams, ointments, suppositories or pads designed to treat hemorrhoids contain ingredients such as witch hazel or hydrocortisone that can lessen pain and itching. These products are often effective, but don't use them for more than a week at a time. If used too often or for too long, they may cause side effects, such as a skin rash, inflammation or skin thinning.

Soaking in a warm bath or a sitz bath with plain water 10 to 15 minutes, two or three times a day may reduce hemorrhoid swelling. Ice packs or cold compresses also can ease swelling and pain. Over-the-counter pain relievers, such as ibuprofen, aspirin or acetaminophen, may help relieve some discomfort, too.

If hemorrhoids last more than a week despite home remedies, or if they cause pain and discomfort, then it’s time to make an appointment with your doctor. You also should see your doctor if you’re experiencing painless rectal bleeding, so he or she can rule out other more serious conditions. If your symptoms are due to hemorrhoids, your doctor may recommend removing the hemorrhoids surgically. A variety of techniques can be used to accomplish this. Most of them can be done in your doctor’s office and do not require an overnight hospital stay.

Incorporating changes into your exercise and diet routines now may help you avoid hemorrhoids in the future. If they do come back, try the self-care steps listed above. In most cases, no further treatment will be needed. But, if hemorrhoids continue to cause significant pain, see your doctor. — Dr. John Pemberton, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

The post Home Remedies: Relief from hemorrhoids appeared first on Mayo Clinic News Network.

ANSWER: Hemorrhoids are quite common, and they often follow the pattern you describe. Making some lifestyle changes may lower your chances of developing hemorrhoids. But, if those changes aren’t enough to keep them from coming back, and the hemorrhoids cause you considerable discomfort, then consider making an appointment with your doctor for an evaluation to see if treatment may be necessary.

Hemorrhoidal cushions are part of the body’s natural anatomy in the anal canal. They help keep stool in and control continence. The problem with hemorrhoids develops when veins in those cushions become swollen and bulge. Hemorrhoids can occur inside the rectum. Those are called internal hemorrhoids. Or, they can happen under the skin around the anus. Those are called external hemorrhoids. Internal hemorrhoids don’t cause any pain and usually don’t require treatment unless they start to bleed. External hemorrhoids are the ones that typically lead to the pain and discomfort people often associate with hemorrhoids.

Hemorrhoids develop due to increased pressure on the pelvic floor. That pressure often comes from straining during bowel movements and sitting for long periods of time on the toilet. It also may be a result of chronic constipation or diarrhea, obesity or pregnancy. External hemorrhoids tend to occur in the pattern you mention, developing over a three- to four-day period and then slowly going away.

One of the key factors in preventing hemorrhoids is being able to pass stool regularly without straining. There are a number of lifestyle changes you can try to help make that happen. They include exercising regularly, eating a healthy diet that is high in fiber, drinking plenty of fluids, and avoiding sitting for long periods of time.

When painful external hemorrhoids develop, self-care steps usually can relieve the discomfort. Over-the-counter creams, ointments, suppositories or pads designed to treat hemorrhoids contain ingredients such as witch hazel or hydrocortisone that can lessen pain and itching. These products are often effective, but don't use them for more than a week at a time. If used too often or for too long, they may cause side effects, such as a skin rash, inflammation or skin thinning.

Soaking in a warm bath or a sitz bath with plain water 10 to 15 minutes, two or three times a day may reduce hemorrhoid swelling. Ice packs or cold compresses also can ease swelling and pain. Over-the-counter pain relievers, such as ibuprofen, aspirin or acetaminophen, may help relieve some discomfort, too.

If hemorrhoids last more than a week despite home remedies, or if they cause pain and discomfort, then it’s time to make an appointment with your doctor. You also should see your doctor if you’re experiencing painless rectal bleeding, so he or she can rule out other more serious conditions. If your symptoms are due to hemorrhoids, your doctor may recommend removing the hemorrhoids surgically. A variety of techniques can be used to accomplish this. Most of them can be done in your doctor’s office and do not require an overnight hospital stay.

Incorporating changes into your exercise and diet routines now may help you avoid hemorrhoids in the future. If they do come back, try the self-care steps listed above. In most cases, no further treatment will be needed. But, if hemorrhoids continue to cause significant pain, see your doctor. — Dr. John Pemberton, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

The post How do I reduce or avoid hemorrhoid pain? appeared first on Mayo Clinic News Network.