The Ins and Outs of Gay Sex (7 page)

To achieve one soft bowel movement a day, I advise patients to take stool lubricants and bulk agents.
The most common stool softener is docusate sodium (Colace), a gel-cap containing an oil that is not absorbed into your system.
(So don’t fret about extra pounds.
) The oil stays in your digestive tract mixing with your stool so that it slips out easier.
This decreases trauma to your hemorrhoids and promotes healing.

Plant fiber is an important, although often missing, part of our diet and is crucial in the treatment of most anorectal disorders.
The fiber is not absorbed into your system.
Instead, it remains in your intestine, where it absorbs water
and holds it in your stool.
Your stool is bulkier, softer, and less traumatic as it passes over inflamed hemorrhoids.
Fiber also shortens the transit time of feces through your colon and has been shown to decrease colon cancer rates.

I’m sure you’ve heard some elderly person expound on the virtues of prunes in producing “regularity.”
This is because prunes contain a lot of fiber.
Other foods similarly high in fiber include vegetables, fruits, and unprocessed grains.
Lettuce, contrary to popular belief, contains very little fiber.
(But spinach and cabbage do.
)

Because the typical “American” diet is long on junk food and short on fiber, I advise taking bulk agents that are natural fiber supplements.
Psyllium husk, the most common fiber supplement, is available in health food stores as well as in commercial preparations.
Metamucil, Fibercon, and Citrucel are common brands available in powder, wafer, or tablet form.
They contain varying amounts of fiber with sugar or nonsugar sweeteners, so read labels carefully (especially if you don’t want sugar) and choose the preparation that works best for you.
Start with a single evening dose, because initially fiber supplements promote gas.
Once you can tolerate a daily dose, increase it to twice a day.
Fiber supplements are not habit-forming laxatives.
Drink plenty of liquid when taking a fiber supplement.
As mentioned, the fiber absorbs water and holds it in your stool.
If you just take fiber and don’t drink enough water, the fiber remains dry; the end result is something akin to shitting the proverbial brick.

Not only is it important that your stool be of the right consistency, it must not contain any irritants.
Most of us are unaware of how caustic stools can be to our sensitive anorectal tissues.
People with hemorrhoids often know that certain foods bring on an attack.
If you know what bothers you, eliminate it from your diet.
(See “Anal Pruritus (Itch)” for a list of common food offenders.
)

When hemorrhoids flare, topical creams and ointments often provide relief.
Preparation H and other common over-the-counter medications may help soothe swollen tissue.
Choose a cream containing 1 to 1.
5 percent hydrocortisone, which doesn’t require a prescription.
If you want a stronger and often more effective 2.
5 percent hydrocortisone cream, you will need to consult your physician for a prescription.

I am often asked which is more effective, a suppository or cream.
Obviously for an external problem, use a cream applied directly to your irritated area.
If your main complaint is bleeding hemorrhoids, then a suppository or cream with an applicator for insertion into your rectum is most effective.
Start with a suppository at bedtime, but if your symptoms are severe, morning-and-evening dosing may be necessary.

I have also found that medicated pads such as Tucks can help reduce swelling and soothe irritation.
If pain and swelling are severe, you may get added relief if you keep pads in the refrigerator and apply them cold directly to your anus.

The sitz bath is another mainstay of hemorrhoid treatment.
It involves submerging your anal area in warm water—bath temperature, not scalding.
(Remember, we are not making chicken soup here.
) The warm water helps reduce swelling and relaxes your anal sphincter, which can go into spasm during hemorrhoid flare-ups.
Fancy and often expensive sitz bath attachments that hook up to the toilet are available in most pharmacies and surgical supply stores.
You don’t need a prescription to buy them, but a simple bathtub is just as effective and may also relax your whole body in the process.

Men with particularly painful hemorrhoid attacks often constipate themselves to prevent the pain a trip to the bathroom brings.
This is one of the worst things to do.
When your bowel movement finally does come—as it must—it
will be as hard as a rock and more damaging to your already inflamed anus.

One patient I treated discovered that constipation was definitely not the way to go when his hemorrhoids flared and tried laxatives instead.
Also not a good idea.
He called screaming after his first episode of diarrhea because his ass felt like it was on fire.
Laxatives are highly caustic.
When passed with diarrhea, they burn your already inflamed hemorrhoids.

If hemorrhoids do not resolve within a few days, then consult a doctor.
Your physician may recommend a number of possible treatments, so know your options.

Surgical removal is the only option for external hemorrhoids.
Since they have pain receptors, they cannot be burned or rubber-banded or treated by any of the other modalities commonly used for internal hemorrhoids.
Many physicians will tell you that your hemorrhoids do not need to be treated—particularly if you are dealing with anal tags (from a prior thrombosed external hemorrhoid or chronic irritation).
This is good advice.
When a hemorrhoid is removed surgically, the area becomes inflamed from bacteria that pass in the stool.
This inflammation can leave you with another tag in place of the one your doctor removed.
I tell patients that their anus will never be as smooth as the day they were born, because it just doesn’t heal that way.
As long as you understand this, you can make a sound decision.

Internal hemorrhoids don’t sense pain, so treatment options differ.
The following are the most common treatments physicians recommend and usually are performed right in their offices:

Rubber-band ligation.
A rubber band is shot around the hemorrhoid through a small instrument inserted into your anus.
Although generally painless, the hemorrhoid dies because the rubber band stops blood
flow to it.
(The hemorrhoid is essentially strangled.
) You may notice a little bleeding and discomfort.
Usually only one hemorrhoid is treated at a time, so multiple trips to the doctor are required.


Infrared photocoagulation or cautery.
Both treatments involve the same principle:
The blood supply to the hemorrhoid is clotted off (either by infrared light or electricity) and it dies.
Again, discomfort is usually minimal (you may feel some heat), and multiple trips to the doctor are required.
Beware of doctors who tell you that infrared photocoagulation is the same as laser surgery—it is not.


Sclerotherapy.
This treatment is especially common for internal hemorrhoids among older physicians, whereby a caustic fluid is injected into each hemorrhoid and causes the blood to clot (sclerose).
Hemorrhoids die and eventually slough.
Most physicians tackle only one hemorrhoid at a time.

None of these three treatments will rid you of your external hemorrhoids, all require multiple visits to your doctor over several weeks, and all are not as effective for long-term eradication as a standard surgical hemorrhoidectomy, whereby your entire hemorrhoid is cut away.
On the plus side, however, these procedures are less painful with quicker recovery than standard surgical techniques and can be performed right in the doctor’s office.
You probably won’t even miss a day of work.
Your external hemorrhoids (if any) can be removed with local anesthesia once your internal hemorrhoids are gone.

Surgical removal, whether performed with a knife or laser, is the most effective and permanent way to eliminate hemorrhoids.
It is also the most painful.
I had a patient who would rather stand on his head after every bowel movement until his hemorrhoids went back inside his anus than have surgery.
He finally consented to surgery when he developed a back problem from his contortions.
Invariably after surgery most patients tell me, “The first week was
hell, but now that it’s over I shouldn’t have waited so long.”

Although surgeons have made great strides in pain control and a hospital stay is no longer required after a complete hemorrhoidectomy, do not expect to be up dancing for days.
Surgery is usually reserved for the most severe cases where there is bleeding, an extensive external component, and/or hemorrhoids prolapse (hang) out of the anus.

A controversy rages among surgeons as to the efficacy of the laser over the knife.
Lasers cause less damage and scarring to the anus.
They seal small blood vessels and nerve endings, and some people report less pain after laser surgery.
In the end what probably is more important is that you choose a skilled surgeon whom you can trust, whatever his surgical method.

A beefy patient lay across my examining table insisting that I remove his external hemorrhoid.
I squinted and moved from side to side, trying to imagine how this barely visible nubbin of extra skin could possibly be causing him any problems.
“It’s so tiny,” I said.
“There’s no reason to remove it.”

“I want it off.
It shows up in my close-ups.”

Because for many gay men, their anus and rectum function as sexual organs, this fact may affect what constitutes optimal treatment for hemorrhoids.
Some men complain that even the smallest hemorrhoid impairs their sex life and they want it removed.
It is important to talk to your doctor about this and ask for guidelines about resuming anal sex after treatment.
Porno stars aside, it is important that you realize that anal tags and mild hemorrhoids very often have no effect on anal intercourse (from a functional, not aesthetic, perspective), and it may be best to leave them alone.