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Colon & Rectal Health at Saint Vincent Hospital

Colorectal Physicians & Surgeons of PA

The experts at Colorectal Physicians & Surgeons of PA specialize in traditional and advanced colonoscopies and laparoscopic colorectal surgery. They also offer comprehensive evaluation, medical management and treatment of all colorectal issues. The services they provide include:

Traditional and advanced colonoscopy including:

  • chromoendoscopy and narrow band imaging endoscopy for flat polyp and dysplasia detection
  • endoluminal stenting for strictures of the colon and rectum
  • ablation of radiation induced telangiectasia bleeding
  • giant polyp resection 

 
Traditional and advanced laparoscopic colorectal surgery including:

  • single access port surgery from the region's most experienced colorectal laparoscopists
  • ultra-low sphincter preserving rectal cancer surgery
  • transanal endoscopic microsurgery (TEM) resection for skin incision free rectal tumor surgery
  • elective sigmoid resection for complex and/or recurring diverticulitis
  • surgery for complicated and/or medically refractory inflammatory bowel disease

 

Full spectrum of medical and surgical care for benign anorectal disorders including:

  • acute perirectal abscess and chronic anal fistula care
  • sphincter muscle-sparing alternatives to traditional anal fissure and fistula surgery
  • minimally invasive pilonidal surgery for primary and recurrent pilonidal disease
  • anal warts, tags, and hidradenitis

 

Additional services including:

  • comprehensive surgical oncologic care for all tumors of the colon, rectum, and anus 
  • medical and surgical treatment for all manifestations of diverticular disease
  • comprehensive evaluation, medical management, office treatment, and surgical care of hemorrhoid symptoms
  • anatomic and physiologic evaluation of fecal incontinence, slow transit constipation, obstructed defecation, and pelvic floor descent

 

 

Meet the Experts

Colorectal Physicians & Surgeons of PA

                        
Patrick J. Recio, DO, FACS, FASCRS

Daniel Geisler, MD, FACS                      

 

Important Patient Documents

The following documents should be read and completed before your visit at Colorectal Physicians & Surgeons of PA. Please print, fill out and bring with you to your appointment.

  • Before Your Visit With the Doctor

  • Personal Communication of Patient Information

  • Acknowledgement of Receipt of Privacy Notice

  • Intake Form

 

Preparing for your Visit

Your first visit to the office will be more productive if you have decided in advance why the visit is important to you. You will have different reasons at different times. However, the reason you are going to your physician will usually fall into one of three categories listed below:

  • I am healthy as far as I know, but I want an evaluation of my colon.
  • I have noticed something, or someone else has, and I am concerned about it. Specific concerns about your colon raise three additional questions: Does your physician agree that something exists? Is the finding a sign of cancer? If it is not cancer, what is the best treatment?
  • I have recently been diagnosed with a condition and want to understand my options for treatment.

Before you go to your appointment you should also gather all of the information that is available about you. This should include your colon X-ray studies, colonoscopy reports, biopsy reports and any other studies that may be available. The written report of the observations related to these treatments and any prior surgeries is also very important. You should include reports from previous physicians or specialists who may have seen you in the past about this condition. You should include information about your family history as far as colon and rectal, breast, uterine and ovarian cancer is concerned. Additionally, an accurate list of your current medicines and allergies will be very useful.

Procedure Preparation

Procedure Preparation

Ambulatory Anorectal Surgery

Ambulatory Anorectal Surgery
Most anorectal surgical procedures are done in same-day surgery. A few more extensive procedures require hospitalization for one to three days. Your ability to tolerate the pain postoperatively and your doctor's concern about your wounds determine the time of discharge. See below for what to expect after discharge.

Medication
You will take home: 

  • A prescription for pain medication with instructions. If you need additional medication, call the office during normal business hours at 814-453-2777. (The doctor on call after hours will not renew narcotic pain medication by telephone.)
  • Bulk-forming stool softeners (for example, Konsyl®, Metamucil®, or Citrucel®) to be taken in a glass of water two or three times a day.

Bowel Function
Bowel movements after anorectal surgery are usually associated with moderate to severe discomfort. Constipation and diarrhea make the pain much worse and must be avoided. The trauma to the anal wounds caused by hard bowel movements will slow down the healing process.

Constipation
You should be sure to have a bowel movement at least every other day. If two days pass without one, take an ounce of milk of magnesia; if there is no result, repeat this dose in four hours.

Diarrhea
Diarrhea, usually caused by overuse of laxatives, is also a concern. If you have more than three watery bowel movements during a 24-hour period, stop taking milk of magnesia or other laxatives. Continue the bulk-forming agents. If the diarrhea persists, call your physician.

Bathing
After bowel movements, use a wet wash cloth, toilet paper, cotton or baby wipes to clean yourself. If possible, take a sitz bath or tub bath immediately. Baths should last 10 to 15 minutes with the water as warm as you can comfortably tolerate. Try to take at least three baths (or showers with a hand-held sprayer) a day.  Do not soak for extensive periods to avoid waterlogging the skin and eroding the natural protective skin oils.

Discharge/Infection
Some bloody discharge after bowel movements is normal for at least two to four weeks after rectal surgery. If you have profuse, continuing bleeding, call your doctor immediately. Postoperative infection around the rectal opening is surprisingly uncommon despite the obvious exposure to stool.

Urination
If you have trouble urinating, do so while sitting in a warm tub of water, or run the water faucet while sitting on the toilet. If the problem is severe or persistent, call your doctor.  

Diet
Eat a high-fiber diet, including plenty of fruits and vegetables. Try to drink at least six to eight glasses of water or juice per day to help keep the stool soft.  

Activity
On discharge there are generally no restrictions on walking, climbing stairs or riding in a car. After some procedures you will be asked to avoid strenuous activity or heavy lifting for 7 - 14 days.  You should avoid sitting on donut ring-type pillows.  

Causes for Concern
If any of the following occur, please call our clinic at 814-453-2777.

  • Problems with the incision(s), including increasing pain, swelling, redness, or drainage
  • Severe constipation (no bowel movement for three days) 
  • Diarrhea (more than three watery stools within 24 hours)
  • Difficulty urinating
  • Fever greater than 101 degrees
  • Severe bleeding
  • Nausea or vomiting
  • Chills  

 

Clear Liquid Diet

A clear liquid diet is made up of clear liquids and foods that are liquid at room temperature. Some examples of these foods or liquids are:

  • Juice, lemonade, limeade, orange drink, apple juice, any juice you can see through is acceptable. Remember – many of these have high levels of sugar.
  • Clear broth, bouillon, consommé
  • Jello, Italian Ice, Popsicles
  • Tea, coffee, decaffeinated tea/coffee (DO NOT put any milk or cream in your tea of coffee), Kool-Aid, carbonated beverages

The clear liquid diet does not provide all the nutrients, vitamins, minerals, or calories that your body needs.  It helps maintain adequate hydration, provides some important electrolytes, such as sodium and potassium, and gives some energy at a time when a full diet isn't possible or recommended.

A clear liquid diet is used before a test or surgery to make sure your colon is empty. The digestive tract is the path that food takes through your body as it is digested. You may also need this diet after stomach or bowel (small and large intestines) surgery. The goal of this diet is to provide liquids and part of the calories you need until you can eat solid food. Clear liquids are easily digested (broken down) and do not put a strain on your stomach or intestines.  

To avoid hypoglycemia, test blood glucose more often this day and use clear apple juice to maintain appropriate blood glucose level.  

Colonoscopy Prep:  HalfLytely

Very Important

  • Read and familiarize yourself with all the prep instructions.
  • Call the office with any questions or concerns at 814-453-2777.
  • Discuss diabetes and blood thinner medications with the physicians that prescribed them  

One week before the colonoscopy

  • Stop all iron-containing supplements and vitamins
  • Stop Plavix medication; if applicable
  • Purchase HalfLytely, and Dulcolax tablets  

Five days before the colonoscopy

  • Stop all Aspirin, Coumadin (Warfarin), and Motrin-type (NSAID) drugs
  • Avoid fiber supplements as well as high fiber/multigrain foods

One day before the colonoscopy

  • Prepare the HalfLytely solution according to the package instructions and refrigerate it well in advance of starting the prep
  • A very light breakfast is allowed until 8 a.m. (toast, bagel, cereal type of foods) (no fruits or vegetables allowed)
  • Take two Dulcolax tablets after breakfast
  • Unlimited clear liquids are allowed until midnight before the colonoscopy
  • Avoid all mannitol, lactulose and xylose sweeteners until after the procedure
  • At noon, or as soon as you return home from work, start drinking the HalfLytely Solution - eight ounces should be taken every 15-20 minutes until entirely consumed
  • The clean out process usually takes 4-8 hours
  • If nausea develops, take a one-hour break and then resume the prep
  • Hard candy and lollipops between HalfLytely doses helps suppress nausea
  • Continue to take clear liquids after the HalfLytely is completed
  • Take two additional Dulcolax tablets two hours before the planned bedtime
  • Do not eat or drink anything after midnight or the exam may have to be cancelled  

On the day of the procedure

  • Take your morning medications with a sip of water
  • Wear loose fitting, comfortable clothing
  • Avoid body powders/lotions
  • Arrive at the endoscopy facility two hours before your exam is scheduled
  • Bring a list of your current medications and allergies
  • Bring a photo ID and up to date insurance information

Colonoscopy Prep:  Miralax

Very Important

  • Read and familiarize yourself with all the prep instructions.
  • Call the office with any questions or concerns at 814-453-2777.
  • Discuss diabetes and blood thinner medications with the physicians that prescribed them
  • You will need to purchase 238 gm bottle of Miralax , 4 Dulcolax tablets and 64 oz of Gatorade, Powerade, Propel, etc. (all items sold over the counter)  

One week before the colonoscopy

  • Stop all iron-containing supplements and vitamins
  • Stop Plavix medication; if applicable

Five days before the colonoscopy

  • Stop all Aspirin, Coumadin (Warfarin), and Motrin-type (NSAID) drugs
  • Avoid fiber supplements as well as high fiber/multigrain foods

One day before the colonoscopy

  • A very light breakfast is allowed until 8 a.m. (toast, bagel, cereal type of foods) (no fruits or vegetables allowed)
  • Take two Dulcolax tablets after breakfast
  • Unlimited clear liquids are allowed until midnight before the colonoscopy
  • Avoid all mannitol, lactulose, sorbitol and xylose sweeteners until after the procedure
  • At noon, or as soon as you return home from work, start drinking the Miralax solution
  • Miralax should be mixed in clear liquids only (Recommended solutions include 64 oz of Powerade, Powerade Zero, Gatorade, G2 or equivalents.)
  • Mix the entire bottle of Miralax with 64 oz of liquid, 8 oz taken every 15-20 minutes until entirely consumed
  • The clean out process usually takes 4-8 hours
  • If nausea develops, take a one-hour break and then resume the prep
  • Hard candy and lollipops between Miralax doses helps suppress nausea
  • You may continue to take clear liquids after the Miralax is completed
  • Take two additional Dulcolax tablets two hours before the planned bedtime
  • Do not eat or drink anything after midnight or the exam may have to be cancelled  

On the day of the procedure

  • Take your morning medications with a sip of water
  • Wear loose fitting, comfortable clothing
  • Avoid body powders/lotions
  • Bring a list of your current medications and allergies
  • Bring a photo ID and up to date insurance information

Hemorrhoid Banding

Instructions for after Hemorrhoid Banding  
These simple instructions will answer most of your routine questions and facilitate your recovery from this simple but very useful procedure.   

You have undergone a simple office procedure for the treatment of your hemorrhoids. The hemorrhoid and the rubber band will fall off between three to seven days after application. There are several things you should be aware of after this procedure:  

  • Some individuals feel as if there is fullness in the rectum for a day or two. Sitting in a tub of warm water for 5-10 minutes two or three times a day should help relieve this sensation. Tylenol is usually sufficient to alleviate this sensation between soaks.  
  • It is important to avoid constipation. A well-hydrated, high fiber diet is recommended. A fiber supplement is recommended with each meal for those who do not tolerate a high fiber diet. If you do develop constipation, it is acceptable to take a mild laxative such as milk of magnesia. Having a bowel movement will not injure either the band or the hemorrhoid.  
  • Minor amounts of bleeding are common after a banding procedure. Should the bleeding be persistent or in large amounts, you should call the doctor immediately or go to the emergency room.  
  • Infection is quite rare following this procedure. If you develop a fever, inability to urinate or increasing pain, you should call the doctor or go to the emergency room immediately.  
  • The band is quite small and is most often not noticed when it passed. This will usually occur during a bowel movement.  It is not necessary for you to see the band to be assured it has passed.  

If you have any questions or concerns, please call the office at 814-453-2777.        

Major Bowel Surgery

Post-operative Ileostomy/Colostomy Instructions 

  • You will be scheduled for a follow-up appointment with your physician in four weeks. 
  • Remember to bring extra stoma supplies with you to the appointment.
  • Plan to follow up with the Enterostomal Therapy (ET) nurses. Call 814-452-7214 the next business day after discharge for an appointment time with them in 3 to 4 weeks.
  • Record your ileostomy output as you were taught in the hospital (date, time, amount, consistency). Ileostomy outputs should stay below 1200mL (34oz) daily; if over 1200mL consecutively for more than a day, contact our office for instructions.
  • Consistency of a typical ileostomy output should be pudding like or thicker. Watery output can lead to dehydration. If you have watery output, remember to drink plenty of fluids and eat something whenever you drink the fluids.  This will help slow down the output.

Signs of dehydration 

  • Dark urine color                
  • Dizziness
  • Pasty mouth
  • Nausea

Foods that can help thicken stools 

  • Starchy foods such as rice, pastas, breads  
  • Creamy peanut butter
  • Marshmallows
  • Crackers   
  • Pretzels
  • Bananas  
  • Cheeses

Supplies you should have in case of watery ileostomy output to prevent dehydration

  • Crackers/Saltines
  • Gatorade, Powerade or equivalent
  • Imodium AD – contact us and we will instruct you as needed 

Change the stoma pouch on a regular basis

  • Leaks can irritate the skin and should be cleansed and changed immediately. 
  • Persistent skin irritation should be evaluated by an ET nurse. 

When to call a physician

  • Watery ileostomy output with volumes greater than 1200mL over a 24 hour period
  • Temperatures greater than 101 degrees F
  • Severe redness or drainage of pus from the incision site
  • Nausea or vomiting that persists more than 12 hours
  • Worsening abdominal pain
  • Severe leg pain or swelling

Saint Vincent Health Center - Enterostomal Therapy Nurses can be reached at 814-452-7124.

Minimally Invasive Fistula Surgery

Post-operative Instructions for Minimally Invasive Fistula Surgery: Glue/Plug Procedures

Post-operative care

  • Follow a liquid diet for 72 hours.
  • After 72 hours slowly reintroduce solid foods. 
  • If you are prone to constipation, take a 100 mg docusate tablet (OTC) with each meal.
  • Call your physician if you feel you are becoming constipated.
  • Avoid rubbing or scrubbing the surgical site.
  • Limit NSAID use (Motrin /Advil, Naprosyn /Aleve, etc.).
  • Some drainage from the external wound is expected.
  • Call your physician if fever/chills, rectal bleeding, heavy drainage, swelling or increasing pain occurs. 

To provide the best environment for tissue integration into the anal fistula plug and/or glue, patient activity should be minimized. The following patient guidelines are strongly recommended:   

  • No strenuous activity for two weeks
  • No lifting items over 10 lbs (5 kg) for two weeks
  • No exercise beyond a gentle walk for two weeks
  • Abstinence from sexual intercourse and other forms of vaginal/rectal insertion (i.e. tampons) for at least two weeks
  • Shower standing up and bathe the area with water to soothe and keep it clean.

Call Colorectal Physicians & Surgeons of Pennsylvania with any questions or concerns at 814-453-2777.

Surgery Preparation Instructions:  Miralax

Very Important

  • Read and familiarize yourself with all the prep instructions.
  • Call the office with any questions or concerns at 814-453-2777.
  • Discuss diabetes and blood thinner medications with the physicians that prescribed them.

One week before the surgery

  • Stop all iron-containing supplements and vitamins
  • Stop Plavix medication; if applicable
  • Purchase 238 gm bottle of Miralax and Dulcolax tablets (both sold over the counter at your local pharmacy)  

Five days before the surgery

  • Stop all Aspirin, Coumadin (Warfarin) and Motrin-type (NSAID) drugs
  • Avoid fiber supplements as well as high fiber/multigrain foods

One day before the surgery 

  • A very light breakfast is allowed until 8 a.m. (toast, bagel, cereal type of foods) (no fruits or vegetables allowed)
  • Take two Dulcolax tablets after breakfast
  • Unlimited clear liquids are allowed until midnight before the surgery
  • Avoid all mannitol, lactulose, and xylose sweeteners until after the procedure
  • At noon, or as soon as you return home from work, start drinking the Miralax solution
  • Miralax should be mixed in clear liquids only (Recommended solutions include Powerade, Powerade Zero, Gatorade, G2 or equivalents.)
  • One capful of Miralax (17 gm) should be mixed in 8 oz of clear liquid and taken every 15-20 minutes until entirely consumed
  • The clean out process usually takes 4-8 hours
  • If nausea develops, take a one-hour break and then resume the prep
  • Hard candy and lollipops between Miralax doses helps suppress nausea
  • Continue to take clear liquids after the Miralax is completed
  • Take two additional Dulcolax tablets two hours before the planned bedtime
  • Do not eat or drink anything after midnight or the surgery may have to be cancelled 

On the day of the surgery

  • Take your morning medications with a sip of water
  • Wear loose-fitting, comfortable clothing
  • Avoid body powders/lotions
  • Arrive at the surgery facility two hours before your exam is scheduled
  • Bring a list of your current medications and allergies
  • Bring a photo ID and up to date insurance information