All’s well if your end is well

Flying requires much time on our backsides, our tushes, our bums. Discussing the anus, the end of the intestinal tract, inspires much embarrassment and trepidation. Given how often aviators discreetly ask me questions, how much time is spent on our rears, and how common and problematic to pilots medical issues are “down there,” it's an important topic to discuss.

Most anal ailments can be avoided by eating a healthy, fiber-rich, low-fat diet and keeping weight in check.

The most ubiquitous and socially challenging issue, pruritus ani, or itchy bottom, is sometimes symptomatic of other problems that may indicate poor diet and hygiene. If present, start a food diary to identify specific items causing flare-ups: Spices, tomatoes, caffeine, and citrus fruits are often culprits. Unfortunately, the more one scratches this particular itch, the longer it will likely persist. Avoid perfumed soaps; use good quality tissue but pat, don’t rub. Wear loose-fitting underwear and sleep with a duvet, which prevents sweating while asleep. Creams, often steroid-based, are advertised for treatment but use cortisone sparingly as it eventually thins tissue, worsening itching. If symptoms continue, see your doctor because pruritus may suggest another problem. In kids, threadworms (known in the United States as pinworms) may be diagnosed, especially if the itching occurs in the early evening hours.

Everyone has heard of hemorrhoids. These vein clusters, resembling a small bunch of grapes, can swell and impede cleaning, cause bleeding and itching, and lead to pain if the blood inside clots (thrombosis). Again, have your doctor investigate your intestine to ensure the hemorrhoid is not something more sinister. Unfortunately, many colon cancers are initially mischaracterized by patients as hemorrhoids, so please get checked sooner rather than later. Many hemorrhoids are managed with lifestyle modifications, lassoing the errant vessels with rubber bands, injecting them with shrinking chemicals, or zapping them with laser beams. Sometimes surgery is required, and although many surgeons offer such therapy, choose carefully—a bad result can cause a lifetime of misery.

An anal fissure was once described to me as “a porcupine reversing out your tailpipe.” The agony is intense enough to cause one to faint or vomit. Poor diet is to blame, so grab some granola and avoid corned beef hash for breakfast. Bowel motion rendered hard by a low-fiber diet can tear delicate anal skin and subsequent attempts to evacuate causes rectal revolution. Other than learning to eat properly, treatment includes application of medicines and possibly surgery to remove the damaged area. Again, pick an expert.

The title of this narrative parodies Shakespeare’s play All’s Well that Ends Well, a central theme of which is the treatment of fistula-in-ano, a condition also believed to have troubled King Charles V and King Louis XIV of France. So what is this? Shakespeare’s ancestor, John Arderne, wrote a treatise on the topic: An abnormal connection or tunnel develops from the inside of the rectum to buttock skin with unpleasant sequelae; feces comes out the wrong way causing pain, swelling, infection, and a great deal of misery. Fistula was tough to treat until a clever plug was developed which blocks the tunnel, acting as a framework for tissue healing; in many cases this simple device solves the problem. (Patients who were treated with the plug talk about their lives before and after successful treatment in this video.)

A number of infections can cause skin breakdown, abscesses, and warts. As is often the case in medicine, early medical intervention equates to better results, so put your embarrassment aside and see your doctor.

I mentioned colon cancer earlier and with more than 140,000 cases per year, please consider a screening colonoscopy even if you are not experiencing any problems. Remember, eat well and look after yourself.

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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