Print friendlyGastroenterology and Health
Napoleon, hemorrhoids, anusitis
Think "refrigerator" when treating hemorrhoids
By Dr. W. Gifford Jones
September 15, 2003
Would Napoleon Bonaparte have won at Waterloo if he hadn't been suffering from painful hemorrhoids? Directing the battle while on horseback with swollen hemorrhoids could not have been easy. We'll never know the answer to that question. But today there are solutions for treating this common condition. One answer is as close as the refrigerator door. But there's a major pitfall to avoid.
While I was reading about Napoleon‚s life I received this letter from a reader. She wrote, " I'm pregnant and have suffered for months from hemorrhoids. And even when not pregnant I'm always annoyed by rectal itching and burning. I'm at my wit's end as I've tried every over-the-counter preparation without relief. What can I do?"
In all probability, this woman has two problems, hemorrhoids and anusitis. This is often the case whether you're pregnant on not. I was first alerted to this possibility by Dr. Warren Rudd, Director of the Rudd Clinic in Toronto. And unless both conditions are treated, the symptoms continue. Ninety-nine percent of people have never heard of anusitis. It's an inflamed area just inside the anus. Most patients complain of a small amount of discharge around the anal area. This constant wetness macerates the skin, causing multiple tiny cracks, which in turn trigger itching. Anusitis is often missed by doctors for several reasons. First of all it's only 3.0 centimeters (1.2 inches) in length. So when doctors insert a sigmoidoscope to examine the large bowel, they pass by this area so quickly they fail to see it. Besides, unlike the higher rectal area, the anal canal is always collapsed, and a collapsed bowel is not as easy to see as one that's dilated.
Dr. Rudd examined 100 consecutive patients who were referred to the clinic due to hemorrhoids. But only 31 percent had this problem. He found that 34 percent had anusitis, and the rest had a variety of other anal and rectal problems.
What causes anusitis is debatable. But Dr. Rudd places coffee, beer, colas, pizza, and garlic high on the list. Antibiotics, diarrhea, and tension may also play a role.
We've known for years that cold temperature (cryosurgery) is useful to relieve the swelling and pain of sport's injuries. It's also valuable to ease the discomfort of both hemorrhoids and anusitis. And today, there's a novel way of applying cold to the anal canal. "Anurex," is one of the best kept secrets for treating this condition. It's a reusable probe containing a cold gel which is gently inserted into the rectum after being cooled in the freezer for a minimum of one hour. The probe is left in the rectum for six minutes, removed, washed, and placed back in the freezer.
Anurex is normally used twice a day for two weeks. Then, once a day for another two weeks. Patients can then use it as needed. The results are good. Ninety percent of patients are relieved of itching and burning within one to two days. It also helps those who complain of leakage and stains on their underwear. As one patient said to me, "It's my magic wand." And since it's "drug free" Anurex is of particular benefit to pregnant patients.
For patients who also have large hemorrhoids, another procedure is required. Dr. Rudd has been treating hemorrhoids for years by placing a tiny rubber band over the neck of the hemorrhoid, then freezing it with nitrous oxide. The rubber band shuts off the blood supply to the hemorrhoid. Several days later, the rubber band and the pile drop off. This leaves a raw area that takes two to three weeks to heal. Most patients require one or two more visits to destroy remaining hemorrhoidal tissue. The technique is 99 percent effective. The most common complication is a small blood clot occurring in the anal area. This happens in about three percent of cases.
Some people, particularly pregnant women, believe they have hemorrhoids when they feel a painful lump at the anal area. This is usually a hematoma (blood clot) which may subside with warm sitz baths. If not, the clot must be removed by an incision.
Anurex is available at most pharmacies in Canada.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at letters@canadafreepress.com
