FAQ

Colonoscopy

A colonoscopy is an examination used to detect any diseases in the colon and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A small video camera at the tip of the tube allows the doctor to see the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed during a colonoscopy. Tissue samples (biopsies) can also be taken during a colonoscopy.

Hemorrhoids

Hemorrhoids are swollen blood vessels in the lower part of the rectum. Constipation, physical activity, pregnancy, and other types of strain on the lower rectum can cause the blood vessels to become so thin that they bulge out and become irritated. Hemorrhoids are one of the most common causes of rectal bleeding. They are rarely dangerous, but you should contact your doctor to make sure you do not have a more serious condition. 

Hemorrhoids are and remain benign, but they can be very uncomfortable and cause pain, burning, itching, and, last but not least, bleeding. Hemorrhoids are classified into four degrees of severity:

• Grade 1: Hemorrhoids are internal and cause bleeding.
• Grade 2: Hemorrhoids fall out during bowel movements and slide back on their own
• Grade 3: The hemorrhoids no longer slide back after defecation, but can be pushed into place.
• Grade 4: Hemorrhoids always hang outside the rectal opening and may ulcerate.

Hemorrhoids that resolve on their own can leave behind small external skin flaps called marisci. Unlike hemorrhoids, they don't bleed and don't usually cause pain, but make hygiene difficult.

What does hemorrhoids feel like

Hemorrhoids can manifest themselves in several ways:

• Hemorrhoids can cause a little blood on the paper when wiping, but heavier, fresh bleeding can also occur during bowel movements.
• Hemorrhoids can cause burning and itching, not to mention pain, possibly as an acute case where they hang outside and get trapped in the anus.
• External hemorrhoids make hygiene very difficult.
• In any case, you should be examined by a doctor, as intestinal diseases other than hemorrhoids can cause bleeding.

How does the survey take place?

The doctor (usually the surgeon) will insert a finger into the rectum and then perform a so-called anoscopy, which is an examination of the anal canal using a scope. If there has been bleeding, a scope examination higher up in the intestine (sigmoidoscopy) should also be performed, as bleeding may be a sign of a polyp or intestinal inflammation or, in rare cases, cancer.

How to treat hemorrhoids

Internal hemorrhoids (Grade 1) may cease to cause symptoms, especially if they are a result of constipation that has been treated with a laxative. This also applies during pregnancy.

In these cases, hemorrhoid ointments, suppositories and creams can provide relief. They contain substances for local anesthesia and often adrenal cortex hormone (steroid), which can reduce the tissue reaction. These are usually prescribed by your doctor and should only be used for short periods of time.

What types of surgery are available for hemorrhoids

There are four types of surgery available for treating hemorrhoids. The choice of surgery depends on the severity (see box on the right).

Grade 1 and 2 hemorrhoids can often be managed on an outpatient basis with the so-called 'elastic method'.

Grade 3 and 4 hemorrhoids can only be effectively treated by one of the three types of surgery, Stapler method, THD surgery or open surgery, performed in a hospital, public or private.

If severe hemorrhoids have developed after pregnancy and childbirth, you may want to wait a while before considering surgery.

Elastic method (McGivney treatment)

Using a special device, a tight rubber band is pushed over the hemorrhoids to their root. This stops the blood filling in the hemorrhoids, which withers and falls off after two to four days. The treatment usually causes little discomfort and rarely any pain and must be repeated every few weeks to ensure that all hemorrhoids are removed this way. There may be some pain after treatment.

The Stapler method

A relatively new type of surgery called the 'stapler method' is now offered in most regions. This type of surgery leaves no open wounds, less pain and a shorter healing time. The method consists of putting the prolapsed hemorrhoidal tissue back in place to restore the normal rectal opening. This is done by using a special instrument called a 'stapler'. The instrument cuts a mucosal band a little way up the rectum and the prolapsed tissue with the hemorrhoids is hoisted into place. At the same time, part of the blood supply is cut off, causing the hemorrhoids to collapse. An inner ring of tiny titanium clips is left behind, which will be expelled over the course of months without you noticing anything. In some cases, however, it may be necessary to remove excess, thickened skin or skin flaps (manisci) at the same time, which is why there will be smaller wounds.

This type of surgery can be performed either under spinal or general anesthesia. Often the operation lasts no more than 15 minutes and you can go home the same day.

The vast majority of hemorrhoid cases will be suitable for this type of surgery, which has now been used for a number of years and is well documented. In a few (severe) cases, it may be necessary to repeat the operation later to achieve a final good result that will last in the future.

THD surgery (Transanal Hemorrhoid De-arterilization)

This operation uses an ultrasound probe to locate the internal arteries to the hemorrhoids, which are then constricted and the hemorrhoids will shrink. If there is also a loose mucous membrane, this will be sewn up so that an exit through the anus is no longer possible.

Open surgeryThe hemorrhoids are removed together with the excess skin/mucosa, either under local, spinal or general anesthesia. The operation causes more pain than the stapler method and it takes 4-6 weeks for the wounds to heal.

The number of hemorrhoid surgeries in 2011 was: Women 2545, Men 2883. It is not exactly possible to say how the operations are distributed between the individual types of staples, THD and open operations.

Varicose veins (varicose veins)

Varicose veins (varices) are visible, irregular enlargements in the superficial blood vessels (veins) of the legs. The function of the veins is to return blood to the heart. The veins contain venous valves, which prevent blood from flowing in the wrong direction when movement of the leg muscles increases blood pressure in a vein. Varicose veins occur when the venous blood pressure in the blood vessels of the legs becomes so high that the blood vessel gives way and expands. In people with very elastic connective tissue, varicose veins can form at normal venous blood pressure. In most cases, the development of varicose veins is due to a combination of leaky venous valves, compliant connective tissue, and sedentary work. Genetics (heredity) plays a major role in the development of varicose veins. Therefore, varicose veins are most often seen in several family members.

Blood in stool - should I be worried

Blood in the stool is caused by bleeding from the gastrointestinal tract. Hemorrhoids, tears, chronic intestinal inflammation, stomach ulcers, and tumors in the intestinal tract are the most common causes of blood in the stool. The first time you notice blood in your stool, you should always contact your doctor. If you have both stomach pain and blood in your stool, call your doctor immediately.

Blood in the stool can be a sign of serious illness, such as cancer or chronic inflammation of the intestine. However, in most cases, blood in the stool is a sign of less serious conditions, such as hemorrhoids or tears in the rectum. Blood in the stool may be visible fresh blood, black stool, or occult blood (detected by a stool test).

Irritable bowel

Is a functional bowel disorder consisting of abdominal pain/discomfort with disturbed bowel habits and/or stool consistency, often with relief of symptoms after a bowel movement. Irritable bowel syndrome (IBS) can begin at any time in life, but often starts in childhood or young adulthood. 15% of the population has irritable bowel syndrome (IBS).

Peptic ulcer

A stomach ulcer is a sore in the lining of the stomach or upper duodenum. Stomach ulcers are now mainly considered to be an infection, which in most cases is caused by the bacterium Helicobacter pylori (abbreviated HP) – the stomach ulcer bacterium. It is estimated that 95% of ulcers in the duodenum and 70% of ulcers in the stomach are caused by infection with Helicobacter pylori. Stomach ulcers can be seen during an examination of the stomach and duodenum using a telescope ( gastroscopy). The examination can be performed orally (through the mouth) or nasally (through the nose with a thinner endoscope). At the clinic, we offer both types of examination.

Gastroscopy

A gastroscopy is a binocular examination of the esophagus, stomach and duodenum (the first part of the small intestine). Gastroscopy uses a thin, flexible telescope the thickness of a little finger, called a gastroscope, which is passed through the mouth "oral gastroscopy" or the nose using a 5 mm wide flexible telescope "nasal gastroscopy" down through the esophagus and stomach to the duodenum. The binoculars have a video camera located at the tip that transmits color images from inside the body to a screen. In addition, various instruments can be inserted through the gastroscope, allowing tissue samples to be taken or treatments such as removing polyps to be performed as part of the examination.

Binocular examination (endoscopy) 

Endoscopy is a non-surgical procedure used to examine the digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, the doctor can see images of your digestive tract on a screen. During an upper endoscopy (gastroscopy), an endoscope is gently inserted through the mouth or nose and into the esophagus, allowing the doctor to view the esophagus, stomach, and upper part of the small intestine (duodenum). Similarly, an endoscope can be inserted into the large intestine through the rectum. This procedure is called sigmoidoscopy or colonoscopy, depending on how much of the large intestine needs to be examined.

Abdominal pain

The vast majority of people experience stomach pain at some point in their lives. Stomach pain is often something that goes away quickly, but it can also be recurring. Approximately 10-15% of Danes experience stomach pain or stomach problems during a calendar year, and many of them are unsure whether they should seek medical help for their stomach pain. Abdominal pain is a symptom that can be caused by many different things. There are many different organs in the abdomen that can cause abdominal pain. A distinction is made between pain in the stomach and pain in the intestinal region. For recurrent or persistent abdominal pain, you should contact your doctor to determine the cause.

Large intestine bulges

Diverticula are bulges in the lining of the large intestine and are very common in people over the age of 40. It is a harmless condition that does not necessarily cause symptoms.

Some of the people who have pouches (diverticula) develop inflammation in them, diverticulitis, possibly due to the accumulation of feces in the pouches, which causes excessive bacterial growth.

Inflammation of the pouches, diverticulitis, often causes the following symptoms:

• Pain and tenderness in the lower left abdomen (where the last third of the intestine is located)
• fever
• partial or complete lack of bowel function
• Affected general condition and vomiting

Examination and treatment

Most cases of diverticulitis (inflammation of the pouches) do not require any special treatment other than over-the-counter painkillers, a high-fiber diet, and plenty of fluids. If fever, general malaise, or severe pain occurs, antibiotic treatment is usually indicated and, in rare cases, surgery. Your doctor can assess whether you need treatment.

The diagnosis is often made clinically. In complicated diverticulitis, hospitalization is indicated. A CT scan of the abdomen is performed to confirm the diagnosis and rule out other causes of abdominal pain.

You will be offered a binocular examination when the disease has completely subsided. Typically, the colonoscopy is performed 4-8 weeks later. The CT scan is offered to rule out the possibility of malignant disease.

Polyps in the colon or rectum

Polyps in the large intestine (colon) or rectum are common. Some polyps (adenomas) are early precursors to cancer. The vast majority are only a few millimeters in size, but polyps can grow up to several centimeters and the risk of cancer development increases with size. It is known that almost all cases of colon and rectal cancer originate from such polyps, but very few polyps will develop into cancer, and if they do, it happens over several years. However, the link is so strong that all patients with polyps in the bowel should be thoroughly examined and most should be monitored for a number of years to reduce the risk of developing cancer.

The cause of the development of polyps is unknown, but it is assumed that there is some connection with diet. However, it is not possible to give preventive dietary advice. In addition, in rare cases, polyps can be hereditary. Polyps are most often seen in the elderly and rarely in people under the age of 40.

Polyps rarely cause symptoms and are often only found when the doctor examines you for other conditions, such as hemorrhoids. Occasionally, large polyps in particular can cause symptoms such as bleeding, altered bowel movements or anemia.

Examination and treatment

There are several tests that can determine if you have polyps in your bowel.

Rectal examination (rectal exploration) - With a finger in the rectal opening, the doctor examines the lower 8-10 centimeters of your rectum.

Binocular examination of the lower colon (sigmoidoscopy) - The lower part of the colon is emptied before the examination. A thin, flexible scope can be used to inspect the lower part of the colon, take tissue samples and remove any polyps. If polyps are found on sigmoidoscopy, a full colonoscopy should always be performed to rule out polyps in the rest of the colon.

CT scan of the colon - First, we inject a liquid contrast agent into your intestine and blow air into the bowel. This is followed by a CT scan of the bowel. The scan cannot detect polyps smaller than about 1 cm, nor can it take a tissue sample or remove polyps.

Colonoscopy - After emptying the intestine, a thin, flexible binocular about 11⁄2 meters long is inserted through the rectal opening and equipped with a camera at the tip. A TV screen shows the inside of the intestine and the binoculars are guided through the entire colon to the transition between the large and small intestine. During the retraction, all sections of the intestine can be thoroughly inspected, tissue samples can be taken and any polyps can be removed.

How to remove the polyps

Small polyps in the colon and rectum are removed through a binocular examination (colonoscopy or sigmoidoscopy) with small forceps or with an electric sling. For very large polyps, it may be necessary to perform a surgical procedure where a piece of the intestine is removed because the risk of perforation may be too great to remove the polyp via the scope.

If you experience fever or pain or poor general condition in the first 2 days after having a polyp removed, contact your GP or the Emergency Medical Service. Approximately 14 days after polyp removal, the results of a microscopic examination of the polyp or polyps will be available. You can get an answer by calling or writing to the clinic.

In a few percent of cases, bleeding occurs during polyp removal using a scope (sigmoidoscopy or colonoscopy). The bleeding is usually minor and stops during the examination, but rarely surgery is required. An even rarer complication is a perforated bowel, which may require emergency surgery to close the hole.

Control

Depending on the size of the polyp, where it was located and the results of the microscopic examination, we offer you regular check-ups after polyp removal.

The check-up involves a re-examination of your intestines to ensure that no new polyps develop and to reduce the risk of developing cancer.

Irritable bowel syndrome

Irritable bowel syndrome (irritable bowel syndrome) is a condition characterized by abdominal pain, bloating and alternating bowel movements. It is a common disease, with approximately 10 to 20 percent of the population affected by the disorder, which is far more common in women than in men.

Irritable bowel syndrome is a disorder of bowel function with no detectable changes in the colon itself in various tests. However, tissue samples have shown that there may be some inflammation of the mucosa.

Why do you get irritable bowel syndrome

The cause of irritable bowel syndrome is unknown, but it is thought that the following factors may play a role:

• Western lifestyle. This means poor diet (too little fiber, too much fat and sugar), lack of exercise.
• Altered pattern of bowel movements and nervous system in the intestine.
• Increased sensitivity to pain from the gut. The gut bacteria affect the gut's sensory, motor and immune systems, and this is communicated to centers in the brain. In this way, gut bacteria can affect the intestinal system, making you more sensitive and experiencing pain from the area.
• Genetic background.
• Psychological factors such as anxiety, stress and mood swings.
• After an intestinal infection with pathogenic bacteria, for example Salmonella.

The symptoms of irritable bowel syndrome

• The stomach is bloated and distended.
• Abdominal pain - may disappear with bowel movements.
• Stools are thin, hard or mixed.
• Bowel movements several times in a row in the morning with a feeling of not emptying the bowel ("morning running").

How does the doctor make the diagnosis

Diagnosis is made based on the symptoms.

At least 3 days/month for 3 months with abdominal pain that cannot be explained by structural or biochemical abnormalities - and has at least two of the following three characteristics:

• relieved by defecation;
• change in stool frequency;
• change in the shape (appearance) of the stool

At the same time, in some cases, inflammation or other intestinal diseases will be ruled out with, for example, binocular examinations and perhaps also tests for lactose intolerance or gluten allergy.

What treatments are available for irritable bowel syndrome

It often takes a long time to find the best individual treatment for IBS. As IBS symptoms vary greatly over time and it can be difficult to remember days and weeks in the past, it is recommended to use a symptom diary while working towards the best treatment.

Diet and irritable bowel syndrome

Almost all patients find that certain foods exacerbate their symptoms. Among the foods that most often cause problems are those that cause increased air/water content in the gut, such as onions, cabbage, beans and dairy products. In addition, most people experience worsening of symptoms with increased intake of carbonated drinks and/or artificial sweeteners. However, actual food allergies are very rare.

As the symptoms of IBS vary greatly over time, be careful not to assume that a day with multiple symptoms is due to eating a particular food that day. It's often a coincidence, so try eating suspect foods several times before "ruling them out"/removing them from your diet completely. Be aware that your diet should never be one-sided, as this can lead to deficiency states.

Be critical of diets

No diets have been studied extensively for patients with irritable bowel syndrome. You should therefore have a healthy dose of skepticism when trying out a diet.

The Low FODMAP diet is the best studied diet for the treatment of IBS symptoms. Unfortunately, the diet has not been studied on many patients and it has never been investigated whether it is better than the standard Danish diet. When you are on the diet, you remove certain dietary components called FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols), which are the dietary components that are theoretically the worst at causing increased air/fluid development in the gut.

After this, it is important to reintroduce the dietary components one by one. The diet can be tried in patients with pain and/or bloating, but as it is difficult and very invasive at first, consider allying yourself with a dietitian or reading carefully before starting. If you don't have the guidance of a dietitian, there is a risk that your diet will become so one-sided that you become malnourished. The diet has only been shown to work under dietitian guidance.

The Swedish IBS diet is another possible diet that is less intrusive in everyday life and seems to work just as well as the low FODMAP diet. This diet recommends eating small, frequent, regular meals (3 main meals, 3 snacks), eating slowly in a calm environment and chewing food properly. Do not overeat. In addition, reduce (without eliminating): dietary fat, spicy foods, coffee and other caffeinated drinks, alcohol, chewing gum, soda and other carbonated drinks, artificial sweeteners, cabbage, legumes, onions, milk sugar, and distribute dietary fiber (e.g. coarse bread, raw vegetables) throughout the day.

Lactose-free diet (lactose-free diet). Many IBS patients experience fewer symptoms when they remove lactose from their diet. However, there are no more IBS patients with genetic lactose intolerance ("real milk intolerance") than among the average Danish population. If you remove dairy from your diet, you need to be very careful to get enough calcium in your diet from other sources (e.g. lactose-free diet) or calcium tablets.

Exercise can make a difference

Exercise has been shown to reduce the symptoms of IBS. Patients who exercised 20-60 minutes 3-5 days a week felt better. The exercise ranged from walking to hard fitness. Patients chose the type of exercise they wanted to do.

Medical treatment for symptoms of irritable bowel syndrome

Symptoms can be treated individually and/or based on the most bothersome symptom. There is currently no single treatment that can relieve constipation, diarrhea, abdominal pain or bloating all at once. It is very important to understand that none of the treatments below will completely eliminate symptoms, but they can reduce/mitigate the severity of symptoms.

It is often necessary to try several types of medication and/or combinations of medications to find the one that best relieves the symptoms. It's often a lengthy process that requires close collaboration between patient and doctor and a certain amount of patience.

Medication for constipation

Always start by ensuring a fluid intake between 1.5-2L of fluids per day, daily exercise and regular meals and toilet visits. Despite this, many people still need laxatives.

HUSK (flea seed husk) is a fiber supplement that absorbs water. HUSK will usually be the first choice. It is important to start with a small dose that can be increased over a few days. The treatment should be tried for 4 weeks before you can say for sure if there is any effect or not. Some will experience worsening bloating and/or abdominal pain and then treatment is stopped after 4 weeks.

The second choice is laxatives that draw water into the intestines (osmotic action). Here you can choose between magnesia (tablets) and movicol/moxalole/gangiden (powder). If there is not enough effect, you can switch

The doctor will recommend the same measures as described under "What you can do yourself".

In addition, depending on the dominant symptoms, the doctor will recommend the following:

• Medication to stimulate bowel movements.
• Laxatives, for example Magnesia one to two pieces (0.5 - 1 g) in the evening.
• Very rarely antidepressants (small doses), cognitive therapy or mindfulness meditation.
• As something completely new, fecal transplantation, i.e. the supply of feces from healthy people (not yet routine treatment).

Is it risky to have irritable bowel syndrome

The condition can vary greatly, as there are many factors involved. There is a correlation with other disorders such as headaches, fibromyalgia, and chronic fatigue syndrome. It has been shown that a small percentage of people will later develop detectable disease in the intestine, but there is no evidence that IBS increases the risk of intestinal cancer.

What is a fat nodule

A lipoma is a group of fat cells that appears as a soft lump under the skin. It is quite common and completely harmless to have a lipoma.

Fat nodules are covered by normal skin and feel soft and rubbery in texture. It is also often possible to shift the fat nodule slightly under the skin. Most people only have one fat nodule, but you can also have many of them on your body.

Fat nodules can be located anywhere, with the shoulders, upper arms, back and thigh being the most common. Most often the nodules are less than five centimeters and grow very slowly. There is usually no pain associated with fat nodules, but if they press on a nearby nerve, they can cause pain.

Why do you get a fat nodule

Adipose nodules are caused when fat cells gather in a lump with a thin membrane around it. It's not entirely clear why people get fat nodules, but getting fat nodules can run in the family.

How to treat a fat nodule

Adipose nodules are harmless and not a precursor to cancer. Therefore, it is usually not necessary to treat them. However, they can be removed if necessary, for example if they cause cosmetic discomfort or if they are pressing on a nerve. This can either be done by cutting away the fat nodule or using a liposuction technique.

If you are unsure if it is a fat nodule or if it cannot be displaced, you should contact your doctor to have the nodule assessed.