Pill Pushing©

Things that go wrong with your bum - (10/23/2019)

By Dr. Ron Gasbarro

Flat, flabby, or Kardashian in dimension, everyone has just the one. Yet, the names for it are aplenty: Ass, buttocks, backside, behind, booty, bottom, bum, buns, butt, caboose, can, cheeks, derrière, duff, fanny, haunches, heinie, keister, posterior, rear, rear end, rump, seat, tail, tail end, tush, the vertical smile (per Hawkeye Pierce). There are others too crude to mention. The medical term of the muscle is gluteus maximus. 

We sit on it. We couldn’t do the rumba without it. You know yours from your elbow. It is easier to see others’ than our own. In between those round globes of flesh, fat, and muscle is the anus. The anus leads us to the rectum, the last stop for the stuff you put into your mouth that your body passes on. “Here’s that fifth cupcake he stuffed into his mouth,” said the ileum to the cecum. “Move it along! Plenty of creamed corn coming next!”

As magnificent as the design of the human body is, things can still go south at one’s back door. Let’s attempt to demystify the great anal divide.

Hemorrhoids

Do you know what happens when you do not eat enough roughage, and you sit on the toilet fighting to pass a 3-pound dry stool? The veins around the anus stretch under pressure. They bulge or swell like a knot of blazing charcoal. These varicose veins of your bottom itch and may bleed. That’s when you wished you made that appointment to have a colonoscopy because all you think about is cancer. Hemorrhoids can be inside or outside the anus. If it is outside the anus, you can feel it. If it is inside the anus, your kingdom for a bottle brush!

Anything from pregnancy to senior age to anal intercourse can cause a hemorrhoid (also called piles). If your diet is one of Fritos™, Velveeta®, and grape Nehi®, expect gridlock in your colon. If and when all that junk wends its way through your 5-foot long large intestine, it will be more difficult to pass than three fat guys getting off the elevator all at once.

What helps?

There are analgesic creams. Witch hazel pads – like Tucks® - can be soothing. The Preparation H® that you only use to lift the bags under your eyes? Use it in your butt instead. Some people require surgery if their hemorrhoids are complicated or extensive. And grab an apple or a salad periodically. Drink fluids (liquor does not count!). Soon, you will find that you can enjoy your now daily dump.   

Fanny fun #1: Why are piles called hemorrhoids instead of ass-teroids?

Flatulence
In some cultures, flatulence is saying to your host that you are relaxed and enjoyed the meal you were served. Just kidding! Only the family dog appreciates and is charmed by farting. Farting results in screaming laughter among Cub Scouts camping in the woods. The whoopee cushion has been a favorite practical joke device since the 1920s. Farting is man’s common bond. Everyone has a bout of flatulence now and then. Queen Elizabeth. Pope Francis. Jennifer Aniston. Carrot Top.

What causes flatulence? 
Gas in the digestive system is part of the digestive process. Expelling excess gas, either by burping or passing gas (medical term: flatus, Latin for “a breaking wind”), is normal. Some people emit a noxious, poisonous, toxic, hair curling, knee buckling, noisy, wet rumbling explosion that will clear the room. The cleverer of us can rip out an SBD (silent but deadly) fart that everyone blames on the cat. Or Uncle Fred. 

According to the Mayo Clinic, the consumption of certain foods, the inability to fully digest certain foods, or by a disruption in the bacteria typically found in the colon can result in excessive and odiferous intestinal gas. The culprits are beans and lentils (the magical fruit!); cruciferous veggies such as broccoli, cauliflower, cabbage, and Brussels sprouts; dairy products; and carbonated drinks such as soda and beer. 

Excessive intestinal gas — belching or flatulence more than 20 times a day — sometimes indicates a disorder such as diabetes, celiac disease, inflammatory bowel disease, ulcers, irritable bowel syndrome, lactose intolerance, and other conditions. A chronic windbreaker should seek medical help so that the condition can be treated, for the good of the entire zip code. 

What helps?
Simethicone can be purchased at any pharmacy (Gas-X®, Mylicon®, Phazyme®, Mylanta® Gas Maximum Strength). Home remedies include fenugreek seeds, ginger, cinnamon tea, apple cider vinegar, water, walking, and yoga poses (the latter of which may need to be done at home instead of in a roomful of others practicing yoga. Namaste!)

Farting contests occur in the US, UK, and China. This year, India has its first farting contest. The categories are the loudest, the longest, and the most musical. If one wants to enter the fart-off, the event planners suggest practicing to any Taylor Swift song. They also recommend a flatulence-friendly diet of radish, beans, and boiled potatoes for on-demand gas passing. 

Fanny fun #2: What did one butt cheek say to the other? “Between you and me, it stinks in here.”

Anal itching
Itching around the anal area is one of the principal causes of insanity. Dreams of sitting on a cactus, envying porcupine quills, secretly backing into a corner of your desk. Anything to make the continuous prickling stop. And once you start itching, it only gets worse and infected.

What causes anal itching? 
Poor hygiene for starters. For gosh sakes, take a shower and change your underwear. Soon, you will stop digging back there. 

Let’s get more medical now. A parasite, a virus, a fungus, or a bacterium can cause an infection back there. Have it diagnosed and treated. Your healthcare professional may want to do an anoscopy. In this procedure, a short plastic or metal tube is gingerly inserted into the anus and rectum to check for fissures (small skin tears), growths, or any other problems. Anal itching can be a side effect of some medicines used to treat gout, arthritis, or infections (antibiotics). When the cause of the itching is a sexually transmitted infection (STI), such as chlamydia, gonorrhea, genital herpes, or syphilis, one would have accompanying symptoms such as bleeding, fever, or burning during urination. Get thee to a clinic. Stat! 

What helps?
A slew of medications exists to treat anal itching. Antibiotics will knock out a bacterial infection. The antibiotic may be topical or taken internally. An antifungal helps kill an itchy yeast infection. An anti-itching medicine, such as diphenhydramine (e.g., Benadryl®), may keep your sanity intact. A steroid, such as prednisone or methylprednisolone, can decrease the fire in the anus. Capsaicin is available as a cream or ointment. Because capsaicin is derived from chili peppers, do not apply it to broken skin, as it will burn. Like. Hell. 

Fanny fun #3
: Why couldn’t the toilet paper cross the road? Because it got stuck in a crack.

Diarrhea and constipation
These two conditions are the yin and yang of the digestive system. One can have either or both – at the same time! If stools are like granite and are stalled in the bowel, they cause a back up of watery contents behind them (e.g., your 4 cups of morning coffee). Eventually, the watery contents spill around the sides of the hard stool and cause sudden and explosive diarrhea. Not pleasant. Try a mild laxative for relief. The next step would be a stick of TNT. 

What causes diarrhea?
Several factors can trigger diarrhea. Bacteria such as E. coli can result in bloody diarrhea – and parasites – such as amoebas – can cause diarrhea. Traveler’s diarrhea can occur if one is in a foreign country and eats or drinks contaminated foods (Don’t drink the water, as the warning goes.) The most notorious side effect of antibiotics is diarrhea. 

According to the Mayo Clinic, diarrhea can short be short-lived – a few days at the most. Lengthy bouts of diarrhea can be a symptom of something bigger, such as irritable bowel, a persistent infection, or inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease. Dysentery is another IBD usually caused by the bacterium Shigella dysenteriae and is notable because of its severe cramping and fever. Chronic diarrhea can dehydrate the person, which is especially dangerous in the very young, the very old, and those with compromised immune systems. Lactose intolerance can cause diarrhea. There are many lactose-free products now available for those who cannot tolerate dairy foods. 

Bottom line: The intestines are sensitive to many factors, extrinsic and intrinsic. Therefore, the patient should keep track of severe and prolonged diarrhea, particularly if painful cramping and blood are associated with the bowel movements.   

What causes constipation?
A poor diet, that is, one with low fiber, and inactivity are the main reasons for constipation. For that, drink water, eat a salad, and get off the couch and go for a walk. However, constipation can be caused by pregnancy, by some medications, particularly oral opiates (morphine, hydrocodone, oxycodone), iron tablets, and the excessive use of laxatives. While laxatives, used short-term, can put an end to constipation, they can “paralyze” colonic contractions – a Catch-22. Once the colon becomes hooked on laxatives, it will become lazier than your Cousin Elmo, making the body continuously constipated.

Fanny fun #4: What do you call an adult diaper? A bum wrap. 

Things that you insert in your rear – Could you? Should you? 
In grade school, you were likely told, “Never put anything in your ear smaller than your elbow!” With the rectum, the opposite is true. Too much stretching of the anal sphincter with sex toys or anything from the produce department at the market can result in fecal incontinence over time. A 2016 study revealed: “The findings support the assessment of anal intercourse as a factor contributing to fecal incontinence in adults.” [Markland, 2016]. 

Be prepared because anal sex and anal rape have hit the front page. As more women step up and accuse men of unwelcome sex, these activities are being talked about more often. In Ronan Farrow's 2019 book Catch & Kill, former NBC News employee Brooke Nevils alleges that Matt Lauer, formerly of the Today Show and would-be sexual aggressor, anally raped her. So, get ready for the new cocktail party parlance! 

A few pointers as to what is true/not true about anal insertions:
You DO need a condom for anal sex. STIs can be volleyed back and forth between partners.
DO NOT go from vaginal to anal or anal to vaginal without putting on a fresh condom. If not, the parties involved may have all sorts of post-coital complications.
Anal sex can be painful if done incorrectly. The 3 Commandments of Anal Sex are 1.) Thou shalt communicate; 2.) Thee should relax; 3.) Ye shalt lubricate. Lubricants abound at pharmacies. Some are fruit-flavored!

Raise your hand if you’ve ever had anal intercourse

Why isn’t anal intercourse discussed by sex educators, counselors, and parents with their teens and young adults? For no good reason! Hence, misinformation is aplenty on the internet. Know that receptive anal sex carries the same risks for both men and women. For women, there may be a high degree of coercion and emotional distress associated with heterosexual anal intercourse. This facet should be included in healthy and unhealthy relationship education. For men who have sex with men (MSM), there are tops, bottoms, and versatile – this needs no further discussion. As for “fisting,” look it up and make your own conclusion. 

A 2017 survey sponsored by the makers of LifeStyles® and SKYN® Condoms showed that 36% of millennials have female anal sex, and 15% have male anal sex at least some of the time. Note: You do not have to be a gay male to have receptive anal sex. Older millennials make up approximately half of the segment of those who use vibrators (44%), while 25-20-year-olds make up 34% and 18-24-year-olds 22%.

Should one fear getting anal cancer?
If anally active, one should be concerned. According to the American Society of Colon and Rectal Surgeons (ASCRS), of every 3 people who develop anal cancer, 2 are women. Less common than colorectal cancer, anal cancer affects about 1 in 500 people in their lifetime versus 1 in 22 people with colorectal cancer. 

The most common risk factor for anal cancer is an infection from the human papillomavirus (HPV). HPV is a sexually transmitted virus that may also cause warts in and around the anus or genitals in both men and women, says the ASCRS. HPV has been implicated in ovarian cancer. However, anal cancer can occur without the presence of warts. Both young men and women should get the HPV vaccine. 

Fanny fun #5: Someone butt-dialed me again yesterday. It seems that only a-holes want to call me.

Bottoms up!

This article is for informational purposes only. Consult with a healthcare provider for any personal issues. 

Reference
Markland AD, Dunivan GC, Vaughan CP, Rogers RG. Anal Intercourse and fecal incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey. Amer J Gastroent. 2016;111:269-74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5231615/

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com.  Read more at Rx-Press.com


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