Human Condition: The grapes of wrath

From 'emerods' to haemorrhoids - anal retentive they ain't ... Brian Cathcart with a personal view of the history and pain of piles From 'emerods' to haemorrhoids ... Brian Cathcart with a not so analy retentive history of the pain and
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Indy Lifestyle Online
THERE IS A moment in the Old Testament when the Philistines capture the Ark and take it away to Ashdod, and then discover this is a bad idea. First spooky things start happening to their idols; then comes something far worse.

"The hand of the Lord was heavy upon them of Ashdod, and he destroyed them, and smote them with emerods. And when the men of Ashdod saw that it was so, they said: 'The Ark of the God of Israel shall not abide with us, for His hand is sore upon us.'" (I Samuel v: 6,7.)

Anybody who has suffered from "emerods" - also known as haemorrhoids or piles - will know just how sore. Of all the plagues rained down by the God of the Old Testament, the emerods of Ashdod must surely rank as the meanest. Piles are painful, sometimes extremely painful, but that is not all: they afflict you in a way that makes life peculiarly and all- consumingly uncomfortable.

The act of sitting down becomes so refined and delicate a business it is positively balletic. You lower yourself gingerly on to something soft and rest your weight mainly on that buttock. Sore. Try - very gently, rising and sinking again - the other buttock. Worse. How about the first buttock, but leaning forward? Up, down, slowly, slowly. Yes, that's better. For about five minutes; then you start again.

Walking can be murder, stairs impossible and a visit to the lavatory like major surgery without anaesthetic. Even lying down on your front doesn't give the kind of relief that would allow you to apply your mind to anything else. No wonder the Bible records that in Ashdod "the cry of the city went up to heaven".

But the pain and discomfort might just about be bearable if you could count on a little sympathy in your suffering, and that is one thing you will not get. Piles are embarrassing and so piles are funny. Your manoeuvres on sitting down, which would be viewed with kindness if they were the result of a bad back, are instead the cause of great ribaldry. Even your nearest and dearest will not be able to resist a patronising smile, as if it were somehow your own fault.

Call in sick with an honest account of your ailment (I wonder if anybody has ever done it. Imagine: "I'm sorry, I can't come to work today. I've got piles.") and you may be sure that the laughter at your expense that day will scarcely cease and your arrival next morning will be a cause of even greater mirth.

No, you may feel like you have a red-hot rusty ball-bearing up your bum, but this is something you must suffer alone, and in silence. Those jokes would be less infuriating were it not a fact that a good proportion of these merry people have had piles themselves, and know exactly what you are going through. For piles - generally associated with elderly judges - strike widely and indiscriminately through the population. Estimates vary, but according to Brian Hancock, consultant surgeon at the Wythenshawe Hospital in Manchester, probably one in three of us have them, or have had them. Some put the figure as high as 50 per cent.

Mr Hancock says they are most common among people in middle age, between 40 and 50 and (despite the popular assumption) "the instances are about equal between the sexes". Women are particularly prone during pregnancy. The young are not immune either - I had my first attack as a 20-year-old student, although I did not realise until some years later that that was what it was. Aesthetes get them, as well as Philistines. Lytton Strachey was a martyr to them (which may be why the photographs so often show him lying down), as was Evelyn Waugh. TS Eliot, who underwent an operation, told a friend: "Whatever you do, Ronnie, avoid piles." Then there was Alexander Pope, Charles Dickens, Gerard Manley Hopkins, Francis Kilvert (who used the biblical "emerods")

So ancient, so widespread and so distressing is the condition that it has its own patron saint, St Fiacre, an Irish hermit of Brittany who once, after an argument with a detractor, sat down heavily on a stone and miraculously left the impression of his buttocks upon it. Equally miraculously, believers with haemorrhoids subsequently found that it brought relief to rest their bottoms where the saint had sat. So, you may be wondering, what are these things and what causes them? We have three "anal cushions" down there. In good times these cushions, held in place by supporting tissue, are part of the working of the bowel - as Mr Hancock has written in the British Medical Journal, they "help to seal the upper anal canal and contribute to continence". When a cushion becomes "displaced and congested", however, you have a haemorrhoid - usually because of constipation or straining on the lavatory.

The usual symptoms are that you become aware of it, often painfully aware (that ball-bearing feeling), because it feels solid and slightly adrift ("prolapsed") in your back passage. It usually bleeds as well, which can be quite a shock. It happens because of our diet. Piles was one of the afflictions that the late Denis Burkett, the pioneering medical scientist, noticed was rare among patients in rural Africa. He concluded that widespread affliction in developed countries had something to do with the food we ate, and he soon became the leading medical advocate of a high-fibre diet.

As Brian Hancock says, with the richer, more processed diet in the developed world, "things move through us more slowly. Our motions are harder. There is a pressure-shearing motion which tends to drag the lining out. It's a bit like getting the toothpaste out of the tube through a narrow aperture; you have to force it."

And force it we do. The old notions that people in sedentary occupations such as judges, or boilermen who sit on hot pipes, are particularly prone to piles are nonsense, says Mr Hancock, although there is some evidence that young people in very stressful jobs may be especially at risk because of what is called "tight anus syndrome".

Nobody likes dealing with piles. Sufferers still put off going to the doctor to have them treated, while the doctors, it seems, like to pass the buck. Mr Hancock wrote in the British Medical Journal that haemorrhoids "are commonly relegated for treatment to a junior member of the surgical team".

But there is no reason to be gloomy. If you are lucky (as I have usually been), the discomfort will soon go away. There are plenty of creams, and doctors will often prescribe suppositories, although Mr Hancock has written disconcertingly that these "have little more than a placebo effect". Alternative medicine has a host of treatments.

If, as they say, symptoms persist, then the serious stuff begins. The doctor may try an injection or a tidier infra-red treatment. Should that fail, you may qualify for "rubber band ligation", which involves "tying off" the haemorrhoid to neutralise it with a long, suction-controlled pair of pliers. Finally, there is the dreaded "-ectomy". This is for patients with a permanent condition or with large piles that do not respond to other treatments. It involves going in with scissors and chopping it off, often a seriously painful business. The upside is you get two or three weeks off work to recover. You may now breathe freely, relax your buttocks and unclench your teeth. We can finish with an optimistic thought from Brian Hancock. He has a hunch that instances of piles are on the decline, possibly as a result of improved diet. He believes that there are fewer serious cases, which may be down to better health education. Because of our fear of cancer, it seems, as soon as we see blood in the lavatory we set aside any embarrassment and go straight to the doctor.