Colorectal Specialist/Proctology

Dr. Jerald Hurdle is a specialist in colorectal surgery and endoscopy. He is honored that surrounding medical professionals choose him to perform procedures on them and there family members. This is something all great physicians aspire to achieve, to be a clinicians physician. Patients come from Augusta, Portland, Canada, New Hampshire and Mass for his services. He provides unsurpassed care for disease of the Colon & Rectum, both medically and surgically. He routinely treats many ano-rectal conditions including hemorrhoids, infections, and common abdominal complaints. Routinely our patients suffer from symptoms of rectal pain, bleeding, itch, abdominal pain, diarrhea, and constipation. If required, we offer the most conservative approach for your condition with many effective, nonsurgical options for treatment.

Our colorectal treatments cover a vast array of treatments. We cover genital warts, pelvic floor rehabilitation, rectal bleeding, fecal incontinence, constipation, irritable bowel disorder, and inflammatory bowel disease.

Painless hemorrhoid treatments at KMC

He specializes in the latest treatment methods available for hemorrhoids and can offer immediate, painless, non-surgical relief of your symptoms. We can quickly improve your quality of life and treat your hemorrhoids without the lengthy recovery time of surgery. You will benefit from the experience of Dr. Hurdle utilizing painless hemorrhoidal treatment methods such as Infrared Coagulation (IRC), Banding and Sclerotherapy.

Colon cancer screening at KMC

We routinely screen patients for colon cancer and remove all polyps which cause cancer. Everyone over 50 years of age should have a colonoscopy under sedation for this reason. If you have a family history of colon cancer or polyps, this exam should be done at 40 years of age. Colon cancer is the "silent" killer, meaning most people have no symptoms until the most advanced stages.

Patient-Centered care at KMC

Kennebec Medical Consultants is committed to providing each patient with an exceptional level of care and attention. Our dedicated staff works together as a team to provide high quality, comprehensive care. We take great pride in paying close attention to each patient's needs.

Hemorrhoids what are they?

Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. Straining, exertion, pregnancy, and other activities can lead to bleeding, pain, itching and swelling of hemorrhoids. Sometimes hemorrhoids make it difficult to get clean after a bowel movement and can lead to rashes and irritation around the anal area. More severe hemorrhoids cause obstruction and stricture of the anal area making the process of having a bowel movement even harder and more discomforting. Once hemorrhoids have become enlarged producing symptoms the patient often will need an intervention to "shrink" or remove the hemorrhoids before they can obtain relief.

Hemorrhoid Treatment options?

There are three major methods of treating hemorrhoids in the office; Infrared coagulation (Laser), Rubber band ligation, and Sclerotherapy. All methods are essentially "painless" when performed by an appropriate physician. Office treatments require no down time, can be performed during a normal office visit, require no special preparation, no anesthesia, and no medication. These procedures can be done and you can go right back to work. A surgeon trained in rectal surgery can determine which treatment method will produce the best results for your condition.

  1. ColonoscopeInfrared coagulation (Laser) - Using a small probe, a burst of infrared energy is applied to the hemorrhoid's surface in an area where there is typically no sensation. This removes a couple millimeters of tissue and requires repeat applications to produce results. This can be effective for hemorrhoids that do not prolapse (bulge with bowel movements out of the anal canal).
  2. Rubber band ligation - One of the most permanent in office procedures for the removal of symptomatic hemorrhoids. A small band is placed around the base of the hemorrhoid, above the area where there is sensation. The band effectively will remove a large portion of the hemorrhoid, essentially leaving a smaller hemorrhoidal cushion. This typically can begin to produce relief after the first application. One band is placed per visit to decrease the chances of having any discomfort and bleeding. Having multiple bandings performed can be as effective as a full, inpatient surgery for removal of a patient's hemorrhoids. This treatment when done right will not produce pain and will produce immediate results.
  3. Sclerotherapy - An effective treatment for reducing bleeding internal hemorrhoids. While in the office a small injection is made into the hemorrhoidal vessels which are above the area of normal sensation. Over a period of time the hemorrhoid "hardens" and shrinks due to minor interruption of the blood supply. Can be very effective for patients on blood thinning medication who bleed with bowel movements.
  4. Hemorrhoidectomy - For the most severe of cases, your surgeon may recommend a hemorrhoidectomy which is a surgery performed in the hospital under general sedation. Typically this has been regarded as a painful surgery, but recently has been improved through the use of a tool called the harmonic scalpel. A harmonic scalpel hemorrhoidectomy uses ultrasound generated energy to gently remove the hemorrhoid, minimizing damage to underlying, sensitive tissue. This both decreases bleeding after the surgery as well as any "collateral" damage through traditional surgery with electrocautery and sutures. For most cases a surgery performed in this manner can be done on an "outpatient" basis without the need for an overnight hospital stay.

What is a colonoscopy?

A screening colonoscopy is an easy, outpatient procedure to prevent the formation of colon cancer.

Looking at the inside lining of the colon is one of the most important exams you can have to prevent colon cancer. This is done with a small, fiber-optic, camera called a colonoscope. When a colonoscope is used to look inside the colon, we call the exam a colonoscopy. To understand the term "screening colonoscopy", we should discuss some basics on how colon cancer develops.

Colon Polyp

This is a colon polyp.

All colon cancer begins as a small growth called a polyp. As we age, polyps grow more frequently throughout the inside of the colon.

Colon Polyp Over time some of these polyps may change from harmless to harmful and will require a colonoscopy for removal to prevent the growth of colon cancer.

Colon Polyp A "screening colonoscopy" refers to performing a colonoscopy to look for these polyps and remove them before they become colon cancer.

Colon Cancer

This is Colon Cancer

A screening colonoscopy is also performed to detect colon cancer early. The earlier colon cancer is found and removed, the better the outcome.

Having the colonoscopy

Having a colonoscopy is an easy, painless exam. While you are comfortably asleep, the colonoscope is carefully inserted and gently advanced through the colon. Air is used to inflate the inside of the colon. This allows visualization of polyps and other abnormalities.

Colon WaterAs the colonoscope is carefully removed, the colon is gently washed with water to ensure polyps are not overlooked.

This is a picture of a normal colon. Off to the right is a stream of water, washing the inside of the colon to ensure colon polyps and colon cancer are not missed.

If any polyps are found, the physician has special tools which can be placed through the colonoscope to remove them.

Colon Polyp SnareThis is a picture of a small colon polyp being removed with a special tool called a "snare". The snare is a small wire lasso which encircles the polyp and pinches it off at the base.

Fortunately, the colon cannot feel pain. You will wake up without knowing polyps were removed.

Colon Polyp RemovedThis is a picture of the same polyp after the snare pinched it off. It will now be suctioned through the colonoscope for examination.

Colon Polyps ForcepsThis is a picture of another special tool used to remove polyps. This tool is called the "forceps". The end of this tool opens wide and can pinch off a polyp as it closes. The polyp is then retrieved from inside the forceps for examination.

As the colonoscope is removed, air is suctioned out of the colon to prevent gas cramping when you wake up.

Colon Healthy InflatedThis is a picture of a normal, healthy colon which is inflated with air. Air may cause cramping if left inside the colon. Most of this air is removed at the end of the exam.

Once the colonoscopy is complete, it typically takes half an hour or so for you to wake up. Dr. Hurdle will talk with you after the exam, but you may not remember what was said. They will discuss all findings with you again one week after your colonoscopy. Once you wake up it's time to get a nice breakfast and relax.

What are polyps?

Colon polyps are small growths on the inside of the colon. They develop from normal cells that have started to divide and grow at an increased rate.

Notice the raised appearance of this polyp. It's growing more quickly than the surrounding colon.

Polyps can be classified by what type of cells they develop from, or by their appearance.

Colon Pedunculated PolypThis is a picture of a "pedunculated" polyp. This polyp has a stalk beneath it. It is a large polyp which was causing the person to have bright red blood with bowel movements.

This is a picture of a flat or "sessile" polyp. These polyps can be difficult to spot if the colon is not properly cleaned.

Colon Sessile PolypDepending on what cells a polyp has develped from, some polyps will grow rather quickly and carry a greater risk of developing colon cancer. Any polyps removed from the colon need to be examined under a microscope to determine if they carry this increased risk. Your physician should meet with you after your colonoscopy to discuss these results.

These are some examples of polyps classified according to their cellular type:

  1. Hyperplastic polyps - Low risk of developing into a colon cancer.
  2. Tubular adenomas - Slightly increased risk of colon cancer.
  3. Tubular-villous adenomas - More of an increased risk of colon cancer.
  4. Villous adenomas - High risk of developing into colon cancer.
  5. Serrated adenomas - Highest risk of developing into colon cancer.

Pictures of various polyps

Colon Polyp This is a flat polyp which is raised up slightly. It does not have a stalk like a "pedunculated" polyp. We would call this a "semi-sessile" polyp. After examining this polyp under a microscope, it was decided that it was a "villous adenoma". It carries a high risk of developing into colon cancer.

Colon PolypThese are two small polyps. They represent "sessile", or flat, polyps which can be difficult to spot (especially if the colon has not been cleansed well). These polyps were found to be "serrated adenomas" with a high risk of developing into colon cancer.

Colon PolypThis polyp is also a "semi-sessile" polyp which was difficult to spot due to the fact that it was growing behind a fold. It was found to be a "tubular adenoma" with a lower risk of developing into colon cancer.

As you can see from the above pictures it can be difficult to determine the risk a polyp carries of developing into colon cancer from appearance alone. Only your physician can determine when you may need a repeat colonoscopy based on the type, appearance, and number of polyps found.

Symptoms of colon cancer?

Colon cancer is one of the few types of cancer that usually does not produce symptoms until the later stages. We perform screening colonoscopies to find colon cancer early since it may not produce problems until it is rather advanced. One of the earliest symptoms of colon cancer is bright red bleeding with bowel movments. A common misconception is that colon cancer produces dark blood. Colon cancer is more likely to produce bright red bleeding.

Colon Cancer BleedingThis is a picture of colon cancer with active bleeding. Notice that the blood is bright red and not dark. Darker blood is more representative of blood from the stomach or small intestine. This is due to the fact that it becomes partially digested before it reaches the colon and produces the dark color.

Other common symptoms of colon cancer include abdominal cramping, a feeling that your bowels do not empty completely, and a change in the consistency or size of your bowel movements.

Colon Cancer GrownThis is a picture of colon cancer which has grown completely around the inside of the colon. Notice that the opening of the colon is now very small. This colon cancer produced symptoms of abdominal cramping and a change in the size of the person's bowel movements. Abdominal cramping was caused as stool passed through this area with difficulty. The person also experienced occasional bright red bleeding with more difficult bowel movements.

Colon cancer can also produce diarrhea by inhibiting the colon's ability to absorb water out of the stool. This can result in frequent, loose, and sometimes watery bowel movements.

Colon Cancer DiarrheaThis is a picture of colon cancer which was causing excessive diarrhea. The person experienced frequent diarrhea with an urge to use the bathroom unexpectedly.

Colon cancer may also produce weakness, fatigue and unexplained weight loss. These symptoms may not occur until the latest stages.

Colon Cancer BleedingThis is a picture of colon cancer which was bleeding constantly every day. The person was experiencing weakness and fatigue from the excessive loss of blood. The person also had lost weight due to the fact that the colon cancer had spread throughout the body.

If colon cancer is found and treated before these symptoms develop, the opportunity to cure is 95% or better. For this reason it is advised that everyone have a screening colonoscopy at 50 years of age . For people with a relative with colon cancer, it is recommended to have a screening colonoscopy at 40 years of age.

  • Anorectal Manometry
  • Anorectal Compliance Testing
  • Electromyography (EMG)
  • 2-D Anorectal/Vaginal Ultrasound
  • Anorectal Neuromuscular Rehabilitation
  • Electrical Stimulation Non-Surgical and Surgical Hemorrhoid Management
  • I+D or Excision of acute thrombotic hemorrhoids
  • Electrodessication
  • Laser treatment
  • Infrared Coagulation
  • Sclerotherapy
  • Rubberband Ligation
  • Sutureless Hemorrhoidectomy
  • An Anal Fissure Disease
  • Medical Management
  • Chemodenervation
  • Lateral Sphincteronomy
  • Fissurectomy
  • Anal Dilation
  • Cautery/Currettage Anorectal Condyloma /AAnanal condyloma/ anal dysplasianal Dysplasia (Anorectal Warts)
  • Anal Pap Smear
  • HRA (High Resolution Anoscopys)
  • Anorectal Biopsy
  • Surgical Excision
  • Ablation Abcess I+ Rectal BleedingD Screening of Colorectal Disease
  • Rigid sigmoidoscopy
  • Fiberoptic Flexible Sigmoidoscopy
  • Colonoscopy Bowel Manage Bowel Managementment
  • Diet
  • Probiotics
  • Pelvic Floor Rehabiliataion

Links

The following is a list of helpful medical websites for videos: