Tiny rectal tear causes great pain

DEAR DR. DONOHUE: Last week at the doctor's office, I talked to the gentleman next to me in the waiting room. The topic was my problem -a rectal fissure. He said he knew several people with the same problem. He said no one talks about this problem, and there must be treatments other than hemorrhoid ointments. Will you address this problem? Are there any old remedies you know of? -V.M.

ANSWER: Rectal fissures are actually anal fissures. The anus is the end of the colon. It measures about 1.5 inches (about 4 cm) long. Fissures are linear tears of the anal lining. They're very much like a cut from a sharp knife. Most often, the lining tears when it has to stretch beyond the bounds of its elasticity when passing hard stool. Fissures can also come about from an overactive anal-sphincter muscle. The anal sphincter keeps the anus closed and is voluntarily opened only for elimination. A sphincter muscle gone into spasm can also tear the rectal lining.

To prevent fissures and to heal ones already there, a person must keep the stool soft. That's accomplished by adding fiber to the diet or by using a stool softener like Colace.

Sitz baths are an old and effective treatment. Fill a bathtub with about 2 inches of warm water and squat in the water for 15 minutes two or three times a day. If you keep your stools soft, sitz baths can often end the pain of an anal fissure in a week or so.

Nitroglycerin ointment, the same ointment used for angina chest pain, can sometimes speed fissure healing. Lidocaine ointment, a numbing agent, takes the pain away. Surgery is reserved for fissures that don't heal on their own.

DEAR DR. DONOHUE: My left testicle is four times the size of my right. After being examined by two urologists, I have been told by both that I have a hydrocele.

Please tell me how I got it. Should I have an operation to correct it? -P.C.

ANSWER: The testicles are covered by a double ply of tissues. Between the two plies is a tiny space. That space can fill with fluid to become a hydrocele. The fluid can come from the abdomen. Rarely, it comes from a testicular tumor. Both events are unusual. More often than not, the fluid forms for reasons that cannot be explained. You have been examined by two urologists. Neither would neglect to tell you if you had a dangerous hydrocele. Hydroceles seldom are dangerous.

You should have the hydrocele fixed if it causes you discomfort.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.