The pain and inconvenience from hemorrhoids is usually the result of infection. The distended veins do little harm unless inflamed. The infection results from the retention of fecal matter in the folds of the mucous membrane. Straining at stool distends the veins and cracks the mucous membrane, thus opening up channels for infection. Abrasions are also often produced by rough toilet paper and by lack of care in the insertion of the enema tube. Thorough cleansing of the parts with water after bowel movement is an excellent preventive measure. This is the universal custom in India and is certainly more sanitary if less convenient than the method in universal use in western countries. The use of an antiseptic suppository after each bowel movement is a most useful precaution. Suppositories made of cocoa butter and containing two grains each of tannic acid are most excellent for this purpose.
When the bowels move freely three or four times a day hemorrhoids are rarely troublesome, at least when the precautions above recommended are employed. In many cases they apparently disappear. When persistent however, they should be removed. This may be done with perfect safety and with so little inconvenience that no one who suffers from hemorrhoids should hesitate to have them removed. Chronic irritation is an invitation to cancer.
This painful affection most generally follows hemorrhoids. If it does not speedily disappear when the bowels become regular, resort to operation is necessary. Operation is also indicated when the ulcer renders defecation painful and thus interferes with regular bowel action, which is most generally the case.
The operation need not be dreaded. The modern methods of dealing with surgical cases of this sort are entirely safe and nearly painless.
This is usually a form of eczema which is kept up by an irritating discharge from the rectum. The measures recommended for eczema will effect a speedy cure after the bowels have been regulated and the rectal irritation or proctitis has been cured.
In cases of prolapse of the rectum frequent movements of the bowels are necessarily avoided on account of the inconvenience involved. Such cases may be cured by a simple and safe surgical procedure. Such an operation should be the first step in the effort to cure the chronic constipation present After the operation, the free use of bran and paraffin at each meal will prove efficient.
Persons whose anal sphincters have been paralyzed by disease or by careless surgery often keep the bowels constipated to avoid annoyance from incontinence. In such cases it is of course necessary first of all to remedy the anal defect. This may usually be done by a skillful surgeon and the operation is attended by no serious risk.
Undue contraction of the anal sphincter is generally associated with fissure, hemorrhoids or rectal irritation. If not speedily relieved by removal of the source of irritation the operation of stretching the sphincter is necessary. Excessive tension of the sphincter appears to be sometimes present without evidence of local irritation.
Very hot fomentations applied two or three times a day for ten or fifteen minutes are almost a sovereign remedy for the abdominal tenderness usually found in chronically constipated persons, especially when colitis is present. The moist abdominal bandage used at night with a mackintosh cover is a very old-fashioned and still unrivalled remedy for tenderness, soreness and ill-defined pain in the abdomen. These remedies are more than merely paliative, but of course are not in themselves curative unless the constipation which gives rise to the congestion of the sympathetic nerve centers, to which the pain is due, is also cured by use of the proper means.
Apply very hot fomentations to the abdomen and administer a hot enema. Repeat the applications both of the fomentations and of the hot enema until the pain ceases as it soon will do. Heat is a most excellent antidote for pain. It also relaxes muscular spasm; it is thus a most appropriate remedy for intestinal colic.
So much is being said about "kinks" in current medical literature it is not remarkable that the laity should begin to take an interest in the subject. The writer's chief purpose in mentioning this subject here is to emphasize the fact that "kinks" are of far less consequence than was at first supposed. X-ray evidence has demonstrated that kinks and folds in the colon are seriously obstructive only in very rare cases. To advise a surgical operation simply because the X-ray shows a "kink" or fold in the transverse colon or a very pronounced prolapse is most improper. It has been proved that the so-called "Lane's kink" of the terminal ileum is seldom a source of trouble and very rarely requires surgical interference. By the adoption of an atoxic diet from which all animal protein is excluded and by the employment of the necessary measures for securing three bowel movements daily the troubles supposed to arise from "kinks" rarely fail to disappear; and without the adoption of these measures surgery affords only temporary relief, sometimes not even that, as a return for the very great risk to life and the severe suffering and shock involved in such operations as "short circuiting" and removal of the colon.
Diagram Showing Normal Colon and Ileocecal Valve.