The unmentionable

No one wants to talk about it, but many will get this pain in the butt.

Published January 5, 2000 5:00PM (EST)

If you haven't suffered through the most embarrassing medical condition on Earth, odds are you will. Up to 75 percent of us will get it, according to the Mayo Clinic. Half of all people over 50 will seek treatment for it. And none of us want to know the first thing about it.

The first rule of real estate -- location -- explains the eye-widening, mouth-puckering shame associated with hemorrhoids. Everyone has hemorrhoids. Three to be exact. When they act up they become a mass of swollen veins in the lining of the anus and rectum. There are internal and external hemorrhoids. You don't want to know much more than that.

Hemorrhoids are characterized by swelling, pain, itching and bloody stools. First time I saw the blood I did what any man would do in my position: I ignored it. For years. Mercifully, bloody stools are rarely a sign of cancer.

When I finally realized I should see a doctor, my physician pointed to the special "head down, buttocks up" table and asked me to assume the position. When I heard the urethane glove snap on his hands I thought to myself, "Why couldn't I have attention deficit disorder like everyone else?"

"Things could be worse," he said, noticing how mortified I was. "You could be me."

"You can't detect hemorrhoids with a digital rectal exam," he said as he put half his arm in. "They're too soft to feel." Sensing I was about to back-kick him to the wall, he cut himself short. "Relax, relax, relax," he said. "I'm checking for polyps or tumors."

Oh. Then I guess splitting my sphincter in two is OK.

On a subsequent visit, he wheeled out an anuscope and stuck in what looked like a dildo with lights. "Third-degree hemorrhoids," he said. "You need a specialist, probably surgery."

Hemorrhoids are classified into four categories. First-degree hemorrhoids protrude into the anal canal and bleed slightly. Second-degree hemorrhoids prolapse (slip out) during evacuation. Third degree hemorrhoids prolapse but require "manual reduction" (shoving the hemorrhoid back in with your fingers). Fourth-degree hemorrhoids are "incarcerated" (meaning, you're headed straight for the surgery table).

When I arrived at the specialist, I blanched at the sign on the door: "Colon and Rectal Surgery." There are no grand entrances through a door like that. One doesn't walk in as much as slink in. There were eight or nine people waiting, carefully avoiding eye contact and shifting painfully in their seats.

Dr. Sander Binderow is the busiest partner in one of the busiest colon and rectal practices in the country. I almost fainted in his examination room when I saw what looked to be a 2-foot dildo with a gun-like trigger and an open vial of KY jelly.

It was a sigmoidoscope. It's inserted into your anus all the way up to your colon. Air is introduced into the scope to aid in viewing. This is the only field of work where pumping air up your ass isn't considered a public relations ploy.

Mercifully, Binderow did not use the contraption, saving it, presumably, for the patients who complained too much about the long wait in the lobby. As I bent over the "bottoms up" table, Binderow spread my cheeks apart as far as he could, giving his lovely blond assistant an unobstructed view of what I used to think of as a private part. I longed for a shot of dignity the way a diabetic longs for a shot of insulin.

In the office of a rectal surgeon, ordinary gestures are pregnant with meaning. When Binderow put his hands to his mouth, which all doctors are prone to do, I couldn't help wondering if he was smelling his fingers. When I saw the "Bio-Hazard" canister in furious orange coloring, I couldn't help wondering what could come out of you that required a radioactive security measure.

Binderow explained I had third degree hemorrhoids and an anal fissure, which was in worse shape than the hemorrhoids. So bad, he said, he didn't need instruments to look inside. Fissure is a medical term for a crack or groove. I had a crack in the crack of my ass. The fun just never stopped.

Fissures are long narrow sores extending from the sphincter up into the anal canal. They are caused, like most hemorrhoids, by passing hard bowels and straining in the bathroom. They're extremely common in remedial dumpers like myself. As hard bowels pass the sphincter, they can literally tear the lining. Since they're both caused by the same activity, anal fissures and hemorrhoids tend to come in pairs.

I scheduled the surgery within a few days. It didn't require an overnight stay but it did require anesthesia. Thank God. Who in their right mind wants to stay awake for that?

There are different types of hemorrhoidectomy (the surgical removal of hemorrhoids). Binderow performed mine with a scalpel and cauterizer. He could have used a method called "ligation," where rubber bands are placed tightly over the base of each hemorrhoid like a pony-tail, eventually withering them away.

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Three days after my surgery, I sneezed. I thought my sphincter had flown out of my ass. The good thing about a hemorrhoidectomy is that you don't really need pain killers after the surgery -- the mortification masks most of it.

Though hemorrhoids can affect everyone, some people are more prone to the condition, according to Binderow. Affluent, upwardly mobile, highly stressed, hyper-busy people are more likely to get them. Rectal surgeons even have a name for this esteemed group: YETTS (Yuppie Executive Tight Sphincter Syndrome).

"The etiology of a lot of anal-rectal disease is pressure on the anus," said Binderow. "Hard stools are the culprit. They push on the hemorrhoids, rip at the lining and expand the sphincter."

According to the good doctor, the sports section of the daily paper is a leading cause of hemorrhoids and anal fissures in men. The bathroom isn't a library, he warns. "Go in, if nothing comes out, get out." Words to live by.

My surgery could have been avoided if I had been properly schooled in the toilet arts. Never hold your breath when you're on the bowl. It means you're trying too hard. Breathe. Don't effort. Don't strain. Be at one with the bowl. There is no place for struggle in the art of the Zen dump.

The Strain Refrain is one half of the puzzle. The other half is making sure your bowels are soft, which you can do by increasing its water content. But simply drinking a lot of water won't work because most of it gets absorbed by the small and large intestine. You have to eat a lot of fiber too. Fiber is the only thing that will transport some of the water away from the intestines to the anal canal. Water molecules bind to it and ride it all the way through the exit door.

Binderow has seen it all. Removed it all, too. Hemorrhoids aren't the only things he's taken out of anal canals. He's seen eggplants, candles, shampoo bottles, even a perfume decanter. "We have a little museum of artifacts," he said of the things he's pulled out of people's asses.

Shame and ignorance keeps Binderow and his five partners busier than one-legged men in an ass-kicking contest. Binderow himself cuts open 30-50 rumps a week. He doesn't see any let-up. Everybody's too embarrassed to talk about hemorrhoids and anal fissures to figure out how to avoid them.

"There's an unfounded uptightness about that part of the body," he said. "Even exhibitionists who walk around naked don't want to show you their anus." Binderow once had a patient complain about a bill containing his letterhead on the envelope. The patient didn't want anybody to read the words "Colon & Rectal Surgery."

There's a one in 200 chance that my hemorrhoids will come back after surgery. I've taken the magazine rack out of the bathroom, I'm drinking a gallon of water a day and I'm eating enough fiber to cement the government's food pyramid to the floor. Nothing motivates better than mortification. Except maybe the threat of a generously lubricated, air-shooting, gun-triggered colon-crushing rectal projectile.

By Michael Alvear

Michael Alvear is the author of "Men Are Pigs But We Love Bacon," a collection of his sex advice columns, to be published by Kensington Press in May. He lives in Atlanta.

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