BAD: IT’S A REAL PAIN IN THE BUTT
At least half the readers of this book will, at some point in their lives, suffer from the uncomfortable symptoms of a disorder called BAD-benign anorectal disease. BAD is the medical equivalent of a real pain in the butt and can take several forms. For its host it can be distracting, irritating or excruciatingly painful.
The mildest in BAD’s range is pruritus ani, which is a common external anal itch. Because the worst thing to do if you have this condition is to scratch, the itchiness, combined with the restraint, drives people mad. Some men have to get up and leave business meetings because the itching is so unbearable.
The itching is caused by the sensitivity of the skin around the anus to bacteria and moisture from bowel motions. The only way to control it is by paying meticulous attention to keeping this skin washed and dry. Powder can be used as a drying agent; having to excuse oneself to visit the ‘powder room’ is not unusual. Itching is usually worse at night because there is less distraction then.
Proctitis is another form of BAD that makes men anxious. It is an inflammation of the lining of the rectum that can lead to a lot of bleeding. Although it does not hurt, proctitis generates anxiety because the associated bleeding is erroneously taken to be a sign of cancer.
The cause of the inflammation is usually unknown, although sometimes it can be traced to an infection. It is treated with intrarectal cortisone.
Proctalgia is an entirely different story. It is more common in men than women and can be extremely distressing and painful.
Typically, a man will wake in the night with an acute pain in the perineum. He may have an urge to have a bowel motion but that will not relieve the pain. The sharp, intense pain, generated by the external anal sphincter, can last from 10 to 30 minutes. Because it is so unbearable, men fear the worst and associate it with cancer.
There is, however, new treatment available for the very common condition of anal fissures. These little internal splits in the lining of the anal opening itch or hurt, and after defecation they can bleed and become most painful. While superficial splits often heal spontaneously, until now those that deepened sometimes needed to be surgically repaired.
A new cream has been released in Australia that is the chemical equivalent of surgery. Called Rectogesic, it can be self-administered until the fissure heals.
Fissures are associated with an intense spasm in the internal sphincter muscle. This spasm squeezes blood vessels and in so doing reduces blood flow to the site of the fissure, thereby inhibiting recovery. Surgery would previously have been needed to release the spasm, but now the cream can achieve the same result by relaxing the spasm and allowing blood flow to be re-established.
The cream contains glyceryl nitrate, which is the same substance people use in a patch on their chests to control angina. The drawback is that it causes mild headaches in 20 to 30 per cent of people who use it.
Haemorrhoids are the most well-known and most common manifestation of BAD, and information about treatment of this condition is provided in the following section.
The most common sign of haemorrhoids is blood on toilet paper. While there is no known relationship between haemorrhoids and bowel cancer, blood must always be investigated. In fact, any blood arising from any form of BAD must be checked: there is always a chance it could be a really bad sign.
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