Anal Pleasure and Health: A Guide for Men, Women and Couples (40 page)

HEMORRHOIDS. Hemorrhoids are one of the most common persistent health problems in Western industrialized societies. Experts estimate that from 50% to as many as 75% of adults in the US will experience them by age 50, but many younger people have them too. Hemorrhoids can occur in or around the anal opening, in the anal canal, or the lower rectum. As you may recall from Chapter 7, the anal canal is rich with blood vessels and cavernous spaces that can fill with blood, almost like the erectile tissue of the penis or clitoris. When the internal sphincter is chronically constricted, bowel movements require straining and pushing. Over time, anal veins and tissues become enlarged and stretched to form hemorrhoidal bulges. The relationship between hemorrhoids and excess sphincter tension has been noted since the 1940s (Turell, 1949).

These blood-filled bulges may be small and barely noticeable or large and impossible to ignore. The more severe ones protrude (prolapse) beyond the anal opening, especially during bowel movements. Most will go back in by themselves afterwards, but others require a gentle push. The worst ones protrude all or most of the time. Hemorrhoids often bleed, leaving bright red stains on toilet paper. Generally speaking, larger hemorrhoids are more painful. Some hemorrhoids temporarily grow larger because of blood clots within them. Usually, however, the clots dissolve on their own within a week or two.

External hemorrhoids are located under the skin around the anal opening. Internal hemorrhoids develop in the anal canal or lower rectum, either close to the junction with the anal canal (the "dentate line") or as much as a couple of inches inside the rectum. When viewed by a physician through an anoscope-a hollow, lighted tube gently inserted into the anal canal-internal hemorrhoids tend to look like a single dilated and elongated vein and can be quite long. Unless internal hemorrhoids protrude beyond the anal opening, blood with bowel movements, and perhaps a sense of rectal fullness or itching, will be the only signs that they exist. Both types are often caused or aggravated by constipation, diarrhea, and pregnancy, because all three conditions can create higher-than-normal levels of pressure, irritation, and tension in the anal area.

Hemorrhoids may co-exist with other problems of the digestive system. That's why sigmoidoscopies (visual examination of the lower colon with a flexible tube containing a light and tiny video camera) or colonoscopies (same concept but with a longer tube) are recommended at least every ten years beginning at age fifty, sometimes earlier. Polyps (common growths in the colon) can be easily removed. Small samples of suspect tissue can also be taken for evaluation in the lab. These procedures sound much worse than they actually are. Most people find the preparation (the use of laxatives to clear out the bowels) to be more uncomfortable than the procedures themselves. But any discomfort is well worth it. Early discovery of colon cancer or other diseases of the colon or rectum allow for treatment before they become serious.

Most hemorrhoids respond remarkably well to the seven-step selfhealing program I'll describe later in this appendix. The steps are based on the same approach to relaxation and awareness advocated throughout this book. Especially make sure you have plenty of fiber in your diet to counteract constipation by promoting large, soft stools. Even high-fiber foods my not be enough. So consider a fiber supplement such as psyllium (Metamucil®) or methylcellulose (Citrucel®), which can make a big difference, as can simple, but regular, exercise such as walking or swimming. But avoid straining which makes things worse-so no weightlifting when you have hemorrhoids.

If you try the program, but your symptoms don't improve noticeably over a period of several weeks, or especially if they get worse, it's time to consult your physician or a specialist about your treatment options. For moderately severe and persistent hemorrhoids, rubber band ligation might be worth considering. Easily done in a doctor's office with the help of an anoscope and a special device, a band is wrapped tightly around the base of the hemorrhoid, depriving it of blood. Within a couple of weeks it then withers and falls off. Discomfort is usually mild. This approach only works with certain types of hemorrhoids, but patient satisfaction is reported to be about 90% (Barnett, 1995).

With sclerotherapy, a chemical solution is injected around a hemorrhoid in order to shrink it. Electric or laser heat can be used to burn off the hemorrhoid. These procedures are less precise, thus healing may be prolonged and uncomfortable.

Some doctors recommend the use of progressively larger dilators to encourage sphincter relaxation. The concept behind this approach is right on target. But why not get the same results at a fraction of the cost by gently using your own finger or a series of butt plugs?

Two more drastic surgical options-sphincterotomy and hemorrhoidectomy-are very traumatic to the anus, yet you should know about them in case they're suggested to you. A sphincterotomy involves cutting the internal sphincter so that its ability to contract is limited. A hemorrhoidectomy involves using a scalpel to cut off the hemorrhoids and suture the surrounding tissues back together. These procedures are very invasive, with painful recoveries, and they often cause so much trauma that the analrectal musculature becomes even more constricted than before, setting the stage for future recurrences. Scarring is also a problem which significantly reduces the flexibility of analrectal tissues. I believe these approaches should be considered, if at all, as last resorts. Unfortunately, hemorrhoidectomies have historically been among the most over-performed of all surgical procedures. If a doctor suggests one for you, get a second opinion-or even a third.

I've noticed a fascinating phenomenon among some of my clients with hemorrhoids: After declaring that selfhealing methods aren't working for them, they discuss treatment options with a physician. Contemplating these procedures-especially the more draconian ones-is so distressing that they recommit themselves to selfhealing with revitalized motivation. Most soon realize that their previous efforts had been inconsistent and haphazard. In the vast majority of these cases, including some fairly severe ones, the hemorrhoids begin to shrink.

There are many alternative therapies worth considering as adjuncts to selfhealing or to standard Western medical treatments. Acupuncture can be effective for general stress reduction or for reducing spasms of the digestive tract. A few of my clients who've had trouble using their finger to gather information about their anal muscles have responded well to biofeedback devices using a small anal probe to clearly show pelvic muscular activity with visual and/or auditory signals. Body-oriented therapies that emphasize therapeutic touch, breathing, stretching, and movement can expand bodily awareness and help loosen the grip of long-established patterns of muscular holding.

FISSURES. A fissure is a tear, crack, or other lesion in the tissues around the anus or in the anal canal. Fissures cause burning and pain, especially during and after bowel movements, and may also bleed. People of any age or gender can have fissures. As with hemorrhoids, fissures are usually caused by straining to pass hard stools through a constricted anal opening. Many people prone to fissures find that their internal sphincters are "tension zones." As a result, they have a much higher tension level even at rest, and also a tendency for the anal muscles to go into spasm during defecation (Ehrenpreis, 2003). In some cases, fissures result from rough and insensitive anal sex play, especially when pain warnings are ignored or when drugs numb one's awareness.

Treatment for fissures includes a bland, non-irritating diet, the use of stool softeners, and warm baths several times daily. Medicated ointments may also ease the discomfort somewhat. The selfhealing program I'll outline shortly can speed recovery. Fissures that won't heal naturally are sometimes cauterized chemically or surgically removed (fissurectomy). Partial cutting of the internal sphincter, which I discussed in the previous section on hemorrhoids, is sometimes used. Needless to say, these procedures are traumatic to sensitive tissues and can lead to scarring, and even more muscle spasms. This condition is called anal stenosis-narrowing of the anal canal-and is a recognized sideeffect of surgical treatments.

In some cases, accompanying conditions such as intestinal parasites, rectal gonorrhea, chlamydia, or herpes prevent a fissure from healing. A fissure may also become infected, in which case antibiotics are necessary.

FISTULA AND ANALRECTAL ABSCESS. Tiny glands below the surface of the anal area or rectum can become infected and result in an abscess, which may then spread to surrounding areas. Sometimes a fistula forms, which is a passageway appearing at the surface. The fistula is the body's attempt to drain the abscess. It usually opens into the lower rectum near the anus. Occasionally, the fistula also leads into the urethra or vagina. Fistulas often go unnoticed unless drainage is either detected or the discharge is blocked, thus producing pain.

For unknown reasons, fistulas are most common among males between 20 and 40 years of age. They're also associated with chronic medical conditions, such as Crohn's disease or colitis (inflammations of the colon), diabetes, heart disease, rectal cancer, to name a few. Abscesses in the anal area can also be caused by Chlamydia.

Treatment typically involves resolving the underlying infection, the application of antiseptic solutions, and the use of stool softeners. Warm baths ease discomfort and promote healing. When the abscess and resulting fistula still don't heal, some degree of surgery may be necessary to drain the abscess.

CONSTIPATION. Constipation is defined as difficulty having bowel movements (some say fewer than three per week) or having to strain to pass small, dry, and hard stools. Large national surveys* in the US suggest that 2%-13% of the population report having constipation each year. Prevalence goes up to 25% among the elderly. Several factors contribute to constipation. The most common are: (1) insufficient bulk of stools due to poor diet, especially lack of fiber and water; (2) chronic tension of the anus, rectum, and/or pelvic floor muscles; (3) anxiety and worry about bowel movements; and (4) poor tone of the muscles involved in elimination. Other more serious causes include: (5) neuromuscular dysfunction caused by various diseases or medications that decrease motility (ability to move feces through the digestive system); and (6) actual obstructions in the digestive system due to various diseases.

Healthy bowel movements require stools that are bulky and moist (but not too moist) because bulk is necessary to trigger the "rectal reflex," which relaxes the analrectal muscles and initiates natural muscle waves (peristalsis) that move feces through the lower GI tract. Hard stools, typically combined with chronic tension, lock up the elimination process so that stools accumulate and cause bloating or lethargy.

Because constipation results from similar conditions as hemorrhoids, the two frequently occur together. Hemorrhoids can cause constipation by making bowel movements so uncomfortable that a person avoids them by tensing up. And constipation is a major cause of hemorrhoids because of the straining necessary to pass the hard stools. Thus, the two problems often perpetuate each other in a vicious cycle. Add anxiety to the mix and the problem can become chronic.

One indication of the large number of people bothered by constipation is the steady stream of advertisements for laxatives. Natural fiber supplements (as we're already discussed) can definitely help, as can stool softeners. But the regular use of stimulant laxatives is itself a major factor contributing to constipation. Not only do many people develop "lazy bowels" as they become dependent on laxatives, but the stimulants cause the muscles of the colon to contract, intensifying the fundamental cause of constipation-muscular tension-even further.

Most uncomplicated cases of constipation can be helped substantially through dedicated application of the selfhealing steps I'll be describing shortly.

IRRITABLE BOWEL SYNDROME (IBS). Unfortunately, Irritable Bowel Syndrome (IBS) is a very common problem of the lower intestinal tract, and the most common reason why people visit gastroenterologists, medical specialists who treat digestive system disorders (Tally, 2007). IBS is also known as "spastic colon" or "nervous indigestion." IBS is not an inflammatory bowel diseases like colitis or Crohn's disease, because there's no sign of inflammation. Obviously, this is a good thing, but IBS can wreak havoc on a person's life nonetheless.

The symptoms of IBS vary, but typically include unpleasant shifts between constipation and diarrhea-although some people mainly have one or the other-abdominal pain, gas and bloating, and sometimes heartburn. For reasons that remain something of a mystery-rarely is there an obvious structural abnormality-the bowel contracts either too much or too little. For instance, it may go into spasm right after a meal, producing cramps, diarrhea, and an intense urge to rush to the nearest toilet. Or weaker-than-usual contractions may lead to constipation and bloating. In some cases, mucous is noticeable on the stools. IBS episodes may be occasional or distressingly frequent.

As you might imagine, an episode of IBS typically obliterates any interest in sex of any kind. Even those who normally like anal stimulation will usually recoil at the thought. Some people who are especially prone to IBS have told me that anal stimulation, especially on the intense side, can trigger an episode-presumably by setting off intestinal muscle spasms-even when they were feeling fine immediately before. However, most IBS sufferers who enjoy anal sex can accurately sense when it's a good idea, and when it should be avoided.

The most common treatments for IBS are fiber preparations to help stabilize the consistency of the stool, and antispasmodic medications to help calm the muscles. Anti-diarrhea medications may also be useful. But harsh laxatives only make matters worse by disrupting the natural function of the colon.

Nowhere is the mind-body connection more apparent that with IBS. A fascinating observation is that people are rarely awakened by IBS attacks, which we would expect considering the level of waking distress they cause. Apparently the relaxation of sleep is sufficient to calm the colon somewhat. At the same time, high levels of emotional stress can definitely trigger IBS attacks. Once a person starts having IBS-usually during early adulthood-it tends to become a self-perpetuating, even life-long concern. The neuromuscular "wiring" of the digestive system becomes predisposed to react with hair-trigger sensitivity to certain foods, situations, and emotions, and is often utterly unpredictable.