Prior to launching a herd of Boy Scouts out onto the world famous Bowron Lake canoe circuit, we were briefed by the park ranger on a couple of the finer points of the circuit. “First,” barked the ranger, “have your bear stick ready at all times and be prepared to use it properly.” “How exactly do we do that?” I inquired, purely for the benefit of the boys. “Well,” he replied, barely suppressing a smirk while reaching for a thick staff. “You take it like so and then swing it like this into the back of the knees of someone else in your group. Then you run like mad.”

“Secondly, please do not toss any food into the outhouse pits. Porcupines and bears will actually crawl down into the pits and we are none too pleased about being called out to fish some angry, smelly forest creature from the depths of a cesspool.” While the thought of having a burly black bear belching beneath your buttocks might be a tad disturbing, I’m not sure I’d like to be the next guy to use the commode after a perturbed porcupine was trapped beneath my keyster. “Hey Bill, believe it or not I think I picked up a few splinters sittin’ in the honeywagon. Got a light and some tweezers?”

What are some other pains-in-the-butt that you as patients and we as doctors must deal with?

I would like to discuss three common anal ailments, which to those of you in search of a romantic mood-setter for your next date, will no doubt come as a blessing.

Many mistakenly feel that symptoms of pain, bleeding or itchiness are due to hemmorhoids. They have treated themselves, sometimes for years, with Preparation H when had they simply seen a competent doctor, they could have been relieved of their misery long before.

PRURITIS ANI refers to a ferocious itch and irritation of the anal area. Despite all efforts to do otherwise, the urge to scratch or rub is so intense that it is difficult to resist even while sleeping. Pawing at one’s derriere is not acceptable dinner etiquette (unless of course dinner is on the Bowron Lakes with a flock of Boy Scouts.) This common and uncomfortable condition has been known to ruin promotions, distract fellow golfers and spoil desserts. If you have this irritating affliction, do not suffer. See a doctor who will first make sure there is no pinworm or fungal skin infection. You will then be advised to avoid soaps, scented TP, and certain foods such as peppermint, caffeine, alcohol and citrus. But most importantly, DO NOT SCRATCH! The itch-scratch cycle means that when skin is scratched, it releases chemicals, such as histamine, that invariably induce more itchiness. This leads to more scratching, hence the cycle. I treat this with a special salve combining an antibiotic, nitroglycerin paste (no explosion jokes here please) and a bit of soothing steroid.

ANUSITIS refers to inflammation around the anal area and can be a cause of pruritis ani. The commonest of all anal problems, this inflammation leads to wetness, which in turn causes small cracks, infection and itchiness. Like any inflamed joint or muscle, ice can be applied to reduce the swelling. If you find that scooping ice cubes out of your lemonade for this purpose is not terribly popular on your beach, you might consider purchasing a cryoprobe such as ANUICE or ANUREX (see, no kidding.) Alternatively, try getting a rubber glove, filling one finger of it with water and freezing it. Smear the glove with Fucidin H cream and insert this probe twice a day for six minutes. Tremendous relief occurs within a couple of days. Ziplock the glove and place it in the freezer. (Warning: This might be a good time to teach your kids about the evils of stealing someone else’s popsicles.)

ANAL FISSURE means that a painful small tear has occurred in the anus. Passing stool is akin to passing broken glass and this condition, found in kids and adults alike, is the commonest cause of painful rectal bleeding. Again nitroglycerin is the key to treatment as it allows the tense sphincter to relax. Soften the stool with fibre, water and even medication. Should conservative treatment fail then there is always a hungry surgeon more than eager to fix the face of your fissures forever.

Finally, if that bummer of a pain happens to occur when you’re in the company of a bevy of Boy Scouts deep in the Canadian wilderness, don’t forget to check… for quills.

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