This is a PSA about your anus. If you’ve never had any troubles with your anorectal area, move along, and maybe return if you do.
Old Harold has spent most of his working life saddled to an office chair with little regard for what he was sitting on…his ass. This along with a poor diet resulted in about a 15 year war to regain the simple pleasure of taking a dump. November 14, 2007 after Harold had eaten some pickled cheese that did not digest well, it came out after a day or two like a cinder block. An anal fissure resulted and a battle for optimal fecal consistency, dimension and volume ensued.
For those afflicted, subsequent pain can cause the sphincter to spasm at the worst possible time, and pain/irritation can also trigger an all-out flush of the system. Upon closer inspection, the fissure was accompanied by a crop of hemorrhoids…veins naturally present in the area but enlarged by sitting and baring down to initiate a movement.
What can you do about a fissure, hemorrhoids and diverticula (out pocketing of the colon that can get irritated/infected resulting in diverticulitis)? There are several remedies. Do what you can to soften your stool, and wait it out as you heal. As Old Harold found, however, attempts to soften can also be accompanied by negative effects of increased bulk and volume. Increasing fruits and vegetation can work for some, adding fibre sources like bran-based cereal, psyllium or hydrolyzed guar gum (supposed to be good for IBS) can add to the cause, and then there’s softeners like lactulose, sodium docusate, magnesium salts and Restoralax (actually when Restoralax came on the market it was a game changer, as many things either didn’t really work well or were inconsistent). There are also options like calcium channel blocker cream to relax the sphincter, botox injections to do the same, massage and dilatation and surgical intervention (cutting or weakening of the inner sphincter).
The anal sphincter is composed of an inner and outer sphincter with the outer under voluntary and inner under involuntary control. Root causes of problems are typically sitting or standing all day, lack of exercise, highly refined diet, drugs that constipate, and for some, it’s poor procedure and/or posture while defecating. Straining is a no-no and the western toilet takes us away from thousands of years of squatting to a few hundred years of sitting to do the deed. Anatomically, sitting maintains a kink in the colon so you don’t have a straight shot, which can also extend the time needed to finish the job.
So what to do? First you need to know that you’ll eventually find an option that works for you. If it’s a simple fix, great, if not keep trying until you get it right. Work with your doctor, and as most people do now, consult Dr. Google. If you need to change your diet, or end up taking a supplement or softener, pay attention to how much you change or take as over- or under-doing it can cause further issues. Sitz bath’s, i.e., soaking/rinsing with warm water/Epsom salts can provide relief, but you need to limit the time (Old Harold recalls seeing they should be kept to less than 20 min). Old Harold could never figure out how to use the sitz bath that fits into your toilet, so he just half fills the tub, lies on his side and splashes the area with water, and just generally tries to relax. Be careful wiping — actually don’t wipe so much as dab, or better yet jump in the shower for a quick rinse or get a bidet wand you can hook to your toilet water line and give yourself a spritz, and blow dry to keep things dry. When Old Harold has problems, he sometimes also goes commando to keep things from steaming up, which can encourage microbial growth causing further irritation. If you try ‘special’ pills, creams, salves, foams or suppositories ‘guaranteed’ to cure you, don’t be surprised if they don’t work well if at all, and if they don’t work and you find lubricant helps, you could try something like Anusol gel that has minimal ingredients.
So what about posture? You could buy a stool like a squatty potty, or make one yourself. Old Harold first tried just a 2×4 with heels 1.5 inches off the ground and settling for 3.5 inches (in case you didn’t know, a 2×4 is actually 1.5×3.5 inches). Apparently, keys are to have your knees above your hipbones, don’t slouch and rest your hands or elbows on your thighs/knees. Again, find what’s comfortable…Old Harold first tried a squatty potty and it didn’t work well…so some things might need a bit of time to get used to.
So what about procedure? Your biggest problem might be your ass has been working well for years without your intervention, and your focus now might not be helping. Go to the bathroom when you need to go, not before, and not to long after the call. When you sit, your colon works in waves of contraction. If you miss the wave, don’t try to grunt one out, just wait for the next wave…and if one doesn’t come along after say 5 min, don’t just sit there, get up and go for a walk (pull your pants up first!). When the process starts, relax, let it happen gradually, and when you breath out, focus on relaxing the area, again letting things happen naturally. If you get part way through and need some help, you could try slow rhythmic breathing to gently start a wave. An old-time doc also once said, a brief clinch before starting can sometimes help, presumably compressing any hemorrhoidal tissue before starting so it doesn’t get trapped or drag.
The last three things a person needs to know are first, you are unique and what works for others might not work well for you so it might take some trial and error. Second, what works for you might not always work, and you may need to make adjustments to keep things moving along, and third, pay attention to your fluid levels because if things get dried out, some stuff you might be taking to keep things moving along (ex. wheat bran) could turn a smooth surface into sandpaper and make things worse.
And lastly, if you’ve got problems down there, don’t hesitate to bring it to your doctors attention to make sure there isn’t anything more sinister lurking down there. After all, they’re the experts in asstrology.
These days Old Harold lives without many problems, but occasionally an extra piece of pizza creates a square peg that has to go out a round hole, and I have to re-remember the things I need to do to return to peace to my sanctum sanctorum, the throne room, the john, the biffy.
Peace out and happy movements