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August 16, 2000
Rhoid Rage
Hemorrhoids are common in men, but discussing them isn't
By Matt Villano

illustration: Skipper Chong Warson

I'm only 24 years old, and already my rear end is turning against me. No matter what I'm doing -- sitting, walking, running, or sleeping -- there's constant irritation down there, and it's been that way since the tenth grade. Some nights, my rear is so itchy that I awaken myself (and my girlfriend) with violent and uncontrollable scratching. During the day, while I'm at my desk, I usually have to squirm around in my chair in order to get comfortable. The worst is when I wipe: Two out of ten trips to the bathroom, streaks of blood appear on the toilet paper.

For years, I was convinced I had hemorrhoids, which are swollen veins in the rectum or anus. Then, in 1996, I visited a local gastroenterologist who set me straight. The doctor analyzed my stool for bacterial infection, gave me a digital rectal exam, and then informed me that my problem was in fact a condition known as anal fissures. He likened these to a split lip, and described them as small tears in the anal wall. He surmised that I developed them from constipation and from "squeezing too hard" -- and he prescribed a high-fiber diet to loosen my stool and take pressure off my anus.

Since then, taking two Metamucil tablets a day has improved my situation greatly, but the itching, squirming, and bleeding are all signs that the fissures are still there. They act up when I'm stressed out, when I've eaten badly, or when I sit for hours. And when they're bad, they're really bad; the discomfort arrives without warning and usually lingers for days or weeks. Though baby wipes and Preparation H provide short-term soothing, these are simply stopgap measures. I'm doomed to care for this condition for life.

And I am not alone. Recent statistics from the National Digestive Diseases Information Clearinghouse reveal that roughly 10.4 million people nationwide have hemorrhoids; the numbers for anal fissures are even higher. Men and women suffer equally from these problems, and some of the reasons, such as stress, are common to both sexes. Other causes, however, are very specific to men. Luckily, experts say, a few lifestyle changes can often alleviate the problem.

According to Peter Gardner, M.D., director of Gastroenterology Consultants PC in Stamford, Connecticut, a combination of poor eating habits and long stints on the toilet may be directly responsible for hemorrhoids and anal fissures in men. Dr. Gardner says that because many men eat low-fiber foods, they don't move their bowels frequently enough and usually bear down to force their stool out. To make matters worse, he adds, because many people spend too much time on the toilet, blood pools at the bottom of the rectum, increasing the likelihood of engorged veins.

"Unfortunately, the way toilet seats are built, they cause a constriction such that when sitting on one, the veins in the rectum tend to engorge with blood. This increased engorgement can lead to hemorrhoids," explains Dr. Gardner.

Care and treatment of hemorrhoids

In younger men, like me, this scenario can results in anal tears, or fissures. In older men, whose connective tissue has started to sag, the result can be permanently swollen veins, or hemorrhoids. For both conditions, Dr. Gardner says the best treatments are some of the methods I tried myself: increased fiber, analgesics, and shorter, magazine-free trips to the john. For hemorrhoids in particular, Dr. Gardner adds, there are some additional, more permanent solutions: laser surgery and rubber-band ligation.

While laser surgery aims to eradicate engorged veins by destroying them, rubber-band ligation attempts to eliminate bleeding or prolapsed internal hemorrhoids by using tiny rubber bands to pull hemorrhoids off the rectum. This process sounds extremely painful, but Missy Thompson, a medical assistant at Fairfax Colon and Rectal Surgery in McLean, Virginia, says that patients who opt for this method typically experience less pain than they would with surgery. When performing this procedure, Thompson uses an 8-inch-long medical instrument called a ligator to apply a small, pin-head sized rubber band around the hemorrhoid. The rubber band prevents further blood flow to that hemorrhoid, and over the next three to seven days the hemorrhoid and the rubber band fall off into the patient's stool.

"No procedure is totally without possible complications," says Thompson, "but this procedure has fewer complications and is less painful than hemorrhoid surgery."

Other experts agree; recent studies have concluded that rubber-band ligation is perhaps the most effective and painless strategy to eliminate hemorrhoids altogether. Believe it or not, another study shows that making breakfast a regular meal can help as well. Other treatments, geared toward alleviating discomfort, include herbal therapy, warm baths, and ice. Some researchers warn that certain analgesics, when used in excess, can exacerbate the situation and, in rare cases, may lead to further infection around the anus.

End the embarrassment

Experts agree that perhaps the biggest threats to men suffering from anal disease are embarrassment and silence.

"The anus is a particularly sensitive subject for men," says Rowland Miller, Ph.D., a professor of psychology at Sam Houston State University, in Huntsville, Texas, who studies embarrassment issues. "People, in general, are not used to admitting private health matters until they reach middle age. We're used to talking to physicians about more mundane matters."

Miller's suggestion? Openness. He insists that just as women share stories about personal health issues, such as menstruation, men can too. To discuss hemorrhoids, men must overcome their reluctance to discuss issues pertaining to the anus. Thomas and Dr. Gardner agree, adding that in order for them to treat hemorrhoids, the patient must be comfortable discussing the problem and exploring treatment options.

All this talk of truthfulness recently inspired me to share news of my problem with a friend. Sure enough, this buddy said he had anal fissures as well. In a cathartic visit several weeks ago, the two of us compared symptoms, traded horror stories, and exchanged treatment secrets. Today, though my anus doesn't feel any better, I do, knowing that other twentysomethings experience problems similar to mine. At times, this knowledge is more comforting than a warm bath, more soothing than a dab of Desitin. It's also free, personal, and most important, available all the time.

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