Carter's "Injury"

Treating those hemorrhoids

When the White House forthrightly announced that Jimmy Carter was in severe pain from a bad case of hemorrhoids and that surgery was being considered, inevitably there were some jokes. It is not an ailment an individual elects to advertise unless, like Carter, he must in order to cancel a day's schedule without giving the stock market a heart attack. There was also a great deal of sympathy, tacit and expressed. Wrote one Egyptian: "May Allah cure you. This illness should have been inflicted on an unjust leader rather than you, O Carter."

Hemorrhoids, or piles, are one of civilization's oldest medical complaints. They afflict perhaps half of all adult Americans. One famous sufferer was supposedly Napoleon, who is said to have had such excruciating pain at Waterloo he could not sleep or sit on his horse. Carter's "physical injury," as he described it, was less debilitating. It only cost him, besides that one day's appointments, his daily jogging and a quail hunt.

Hemorrhoids are a swelling of veins in the rectum and anal canal. These vessels can become so distended that they protrude, rupture and bleed. If piles develop near sensitive nerve endings, they can be extremely painful. No one is quite sure just what starts the swelling, but heredity seems to play an important role. Says Dr. Norman Nigro, chief of colon and rectal surgery at Detroit's Wayne State University: "Hemorrhoids run in families. People inherit veins that are apt to become dilated." Habit may also be a factor, including the "bathroom as library" syndrome. Explains Los Angeles Proctologist Michael Freilich: "We were not meant to sit on toilets, we were meant to squat in the field." The American diet is also a culprit. Heavy on processed foods, light on fiber for bulk, it can produce constipation and straining. Obesity and pregnancy, too, may contribute to hemorrhoids because of the extra pressure.

Fearful of the cost and trauma of traditional surgical cures, or simply embarrassed, most sufferers medicate themselves. Popular over-the-counter preparations can indeed relieve some symptoms temporarily. So can hot baths and a change in diet and bowel habits. But doctors emphasize that whenever rectal bleeding occurs, there should be a prompt proctological examination; while hemorrhoids themselves are not life-threatening, such bleeding may be a sign of cancer or some other serious ailment. Happily, most hemorrhoid complaints can now be treated simply and almost painlessly in the doctor's office.

If the hemorrhoids are internal, away from the lower rectum's nerve endings, physicians often rely on a technique known as rubber-band ligation. A tiny rubber band is looped tightly around the swollen region. No longer drawing nourishing blood, the hemorrhoid withers away. Carter, plagued by hemorrhoids since college, had just such a procedure in 1974. Some doctors inject a special solution into nearby tissue that constricts the vessels and thus cuts off the blood supply. Still another technique involves dilating, or widening, the anus with stretching devices.

Particularly useful for piles near the sensitive anus is cryosurgery. A probe, cooled by liquid nitrogen (temperature: -196DEG C or -321DEG F), painlessly freezes the troublesome tissue. But freezing produces a foul-smelling discharge that requires wearing a sanitary pad for a few weeks. It is also more expensive: several hundred dollars vs. about $50 for each hemorrhoid by the ligation method.

As for Jimmy Carter, his discomfort, both private and public, was more easily ended. Last week, after rest and "routine pain medication," he was so improved that his doctors decided against surgery unless there is another flare-up.

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