Do hemorrhoids have to hurt? Why do men spend so much time in the toilet? Is washing up after a bowel movement a better idea than using paper? What to do when we see blood on the toilet paper? Does the proctologist really have to use the fingers when examining the anus? These and many other questions about the “shameful” part of the body are answered by Dr. Skander Bouassida, chief physician and head of the coloproctology clinic at Vivantes Humboldt-Klinikum in Berlin.
- It is said that in today’s world there are no taboos, but according to Dr. There is at least one thing to Bouassid: it is the anus and all the ailments associated with it
- The problem with which patients most often report to a coloproctologist is hemorrhoids. Representatives of various professions complain about this ailment, most often they are… bodybuilders
- Problems with defecation may also be caused by too long visits to the toilet, which are the “domain” of men. – Women always ask themselves: “What is he doing there?” Meanwhile, it has to do with our ancient times, with caves, being in silence. This behavior is deeply ingrained in the psyche, explains the doctor
- A coloproctologist is a doctor who diagnoses and treats diseases of the perineum, colon and rectum. When someone at a party talks to him because he has found out that he is a doctor, Dr. Bouassida says: “I am a specialist in colostomy, colorectal cancer and fecal incontinence. Can I do something for you? ” And then usually there are no more questions
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Author: Clara Ott / The World
Die Welt: Do you have a favorite part of the gut?
Skander Bouassida: I like the head, or rather the human mind. It is remarkable and touching how close the lower digestive tract is to our thoughts and nervous system. Anyone who has had stage fright knows the source of diarrhea. There is ample evidence of emotional distress in sick people when their lower body is not functioning properly. Unfortunately, it doesn’t work the other way around: just because my anus is healthy doesn’t mean I’m happy …
Usually, when a doctor comes to dinner with friends or shows up at a party, he becomes the star of the evening. Everyone hugs him, and strangers suddenly show exceptional interest. Does it happen to you too?
No, I have this ready at hand: «I am a specialist in colostomy, colorectal cancer and fecal incontinence. Can I do something for you? ” And then usually there are no more questions.
Nobody drags you to the toilet and won’t show you something?
This happens sometimes in a supermarket. The patients, between the freezer and fresh fruit, want to show me how well the wound has healed after the surgery. But it is also a big city phenomenon.
When we spoke before the interview, you said that there are actually no taboos in Berlin – except for anything to do with anus.
Berlin is a really great city. However, faecal incontinence remains a taboo subject and it is difficult to talk about it. By the way, also at the university or later among doctors and nurses.
What sentence do you hear from your patients more often: “Doctor, something is wrong there …” or “Doctor, my wife sent me to you”?
Questions are rarely asked at all. Patients who come to see me have a very specific message to say, for example: “I have hemorrhoids”. This is often not true, although anything that itches or hurts in any way is commonly referred to as hemorrhoids. Some come to me with their partner, also of the same sex. If a patient comes and says: “I have a lump there” and is silent, he expects something. So the point is not that people do not come to us, but that they cannot communicate with us.
Do you feel pressured to be the first or only person they trust?
At first they do not trust me at all, they treat me as if I were to “rape” them during the examination. In our clinic, the examination is not performed on a gynecological chair, we do it in the side position. The patient can cover himself up, he does not have to undress, he is just revealing something. We conduct the research quickly and talk a lot about it.
About what?
About the study, because distracting attention from it only works when, for example, a nice doctor assistant is nearby. We say what exactly is going on, i.e. whether the buttocks are properly parted and whether everything is clearly visible. When you need to palpate, I say, “Attention, ointment is coming.” Usually there is a short silence and it’s all over. «How is it, now?» – this is the most common reaction of patients. They think it will get worse (laugh).
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So the study is really not embarrassing?
Yes, it is also rarely painful, unless the doctor has extremely long nails that should be cut or the patient suffers from a painful disease. It would be very painful to tear the anus. It is harmless, but it causes fear and sometimes excruciating pain. If someone needs surgery, most of the time it can be seen with the naked eye and without the use of fingers.
The alarm signal for a visit to your office is blood on the toilet paper?
Blood in your stool is a sign of many things, it can also be a symptom of cancer or a fistula. Blood is a sign of all inflammatory diseases, but bleeding is often completely harmless. There are also hemorrhoids. We are all born with nodules. It’s like the seal in a refrigerator – it keeps your pants clean. Sometimes the hemorrhoids are enlarged and make themselves felt at a certain age on a regular basis, but also after childbirth, constipation or in bodybuilders.
Every second adult suffers from it in their lifetime, so hemorrhoidal disease is a really common disease.
Yes, but what exactly is this disease? The enlarged, hanging hemorrhoid is very visible, but does not necessarily cause pain. Others, on the other hand, may not be as “spectacular” and the patients complain a lot about them. We only treat when there is pain and patients with hemorrhoids suffer.
This suffering can worsen the quality of life a lot, for example when we ride a bicycle or simply wipe ourselves with toilet paper. Moreover, it is recommended that if you experience pain, rinse yourself with water only, using the shower, as anything else could irritate and aggravate the pain. However, also people who are healthy are more and more recommended to shower them. Why is water better than toilet paper?
When you get up in the morning, you’d never think to scratch your face with dry paper. When you get your hands dirty, you don’t wipe them with a newspaper. You wash them, so yeah, the water is good. And it doesn’t matter how you do it, whether in the bathtub with a shower head, with a hand shower, or with a 3-dollar toilet. euro from Japan.
What about wet toilet paper or scented wipes? After all, they can irritate the skin.
Wet paper is probably better than dry paper. But there are preservatives in it that can be irritating. Ultimately, it’s an individual decision: if someone wipes himself off with toilet paper, doesn’t complain, feels good, then it’s all right. It’s not that something is right and something is wrong. However, it is worth remembering that the older we are, the more problems we have and the more important it becomes to take care of our skin.
Let’s go back to hemorrhoids for a moment. Is there any way to prevent inflammation and pain?
There are people who have a special predisposition to them, because it is primarily a problem with connective tissue. An important element of prophylaxis are bowel movements and a well-formed stool. By a well-formed stool I mean something like a sausage that drains easily, is not too hard and not too soft. People with chronic diarrhea suffer greatly from hemorrhoids, as do people with constipation. Diet, especially high-fiber diet can affect bowel movements. It contains everything that is “boring”, such as lettuce, fruit and vegetables, so choose fresh fiber instead of whole grain bread. Psyllium seeds also help, as their shells swell and affect the consistency of the stool.
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Why do pregnant women especially suffer from hemorrhoids?
Indeed, many women say: “The hemorrhoids spoiled my pregnancy or the first months after the birth of my baby”. Often these ailments are not “cared for” well enough. Basic medications, ointments and other methods are usually used to alleviate the inflammation responsible for painful anal congestion in pregnancy. I appeal to gynecologists to do more to help pregnant women who still complain about their condition.
Obesity is also of great importance in haemorrhoidal disease.
Exactly, this also applies to overweight people, with a “belly”. The only difference is that the pregnant woman will give birth, and the overweight man and woman will maintain their weight. Bodybuilders who have huge problems with hemorrhoids also suffer. But the biggest thing is talking about them. They actually come to us when things get really bad. And now a question for you: do you know in which profession this disease is considered an occupational disease?
Probably some kind of work that also involves lifting weights. Or maybe they are people who sit a lot?
Astronauts and pilots, actually fighter pilots. They are exposed to the stress of speed, so they wear special clothes: pants that press against their legs so that blood flows from the upper body to the legs. And it also happens in the anus. To counteract hemorrhoids, you would need to insert a vibrator, which would then work against gravity. This, of course, is not done, so fighter pilots and astronauts have problems with hemorrhoids, which are often difficult to treat as well.
Oh gosh, the astronauts are out of Earth for even a year or two, it must be very hard! I’ll come back to bodybuilders: where does it come from? Do you advise them to change their sports discipline?
They are young, active men who either put pressure on the muscles inappropriately or keep their entire body tense while playing sports, thus putting pressure on the hemorrhoids. It’s hard to deal with because to remedy it, you have to stop training. We try to do as much as possible to avoid this. They should be able to continue their sport. In general, the most important thing in everything is the right… exhaust.
Breathing and pressing leads us to the next topic. Germans often spend a lot of time in the toilet. What are we doing wrong?
Healthy people should just go to the toilet and feel relaxed there. Don’t think too much, don’t defecate, wash your hands, don’t sit there for hours with a newspaper in hand. The sitting position on the round opening is a position that causes your pelvic floor to over-stretch. Admittedly, this is a male problem. Women always ask themselves, “What is he doing there?” Meanwhile, it has to do with our ancient times, with caves, being in silence. This behavior is deeply ingrained in the psyche.
So we should let men do their job in peace?
Yes, you should. Nobody should get stressed in the toilet. You know how it is with children who sometimes have problems there. Everyone should have enough time to relax in the toilet. But the toilet should not become a second home. (laugh)
There is one more disturbing phenomenon. There are people who keep defecation. They practice continence so that they can suppress the urge to defecate for hours or even days. We can all stop this moment for a moment when we register a need for the first time, for example when we are standing in a line at a supermarket and we know that we are about to go home. However, some people avoid having a bowel movement at work or on the first weekend with a new boyfriend. Is it dangerous?
It’s not so bad that our intestines will burst. They can take it. Okay, that’s not the healthiest thing to do, but as we just emphasized, it’s about relaxing. Some people have trouble relaxing in someone else’s toilet. And they don’t want anyone to hear them. It is a difficult and stressful situation for them. This shows how incredibly connected the head, pelvic floor and anus are.
For many people, stress also causes the thought of a colonoscopy. How do you deal with such anxiety in patients?
A colonoscopy is a checkup, not a diagnosis. In other words, it can detect a polyp or other lesion before it degenerates and then remove it. After 15 years of the screening program, it was possible to prove that the incidence of colorectal cancer in Germany had decreased, which is unbelievable. Why, if only 5 percent. eligible persons had a colonoscopy performed? It found that this small percentage of people consequently had such an impact on cancer statistics as to make it measurable. Although the population is aging and not eating healthier, this rate has decreased as early stage cancers have also been found more frequently.
Finally, I would like to touch on a slightly more pleasant topic related to the anus, which is also an erogenous zone. During anal intercourse, you can use special sex toys, for example metal plugs, vibrators, balls or beads.
The main risk in this case is unprotected contact with others and sharing contaminated toys. Always put a condom on them. Some people also use fruit and vegetables for this purpose, which may not be clean either. Also, unsuitable objects, made of materials such as metal, wood or glass, which are chipped off, pose a problem. Professional anal toys always have a plate or a loop to keep them from getting lost, and they are made of materials that won’t break, are easy to hold and therefore trouble-free.
The anus is bent by 15-18 centimeters, which is why short toys are better. What about injuries to this part of the body?
There are some extreme practices that are beyond the capacity of the human body and can result in urinary incontinence. There are no statistics on this. It is not known if urinary incontinence is a common problem in these people, but it is certainly a medical problem. Extremity is always a problem. And there is one more trouble. When the foreign body disappears in the intestine, pressure builds up. You want to pull it out, and it doesn’t react, it doesn’t pull back. People go to the hospital with it. In the worst case, you even have to cut open the stomach to remove the foreign body. However, if there is a loop on it, you can easily pull it out yourself.
We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to the diet. Do you have to stick to it 100% to stay healthy and feel good? Do you really have to start every day with breakfast? What is it like with sipping meals and eating fruit? Listen: