PREFACE

This booklet entitled "Treating Hemorrhoids (and Other Rectal Disorders)" has been prepared with but one objective in view - that of furnishing helpful information to the sufferer of rectal diseases. If you are so unfortunate as to be afflicted, it is hoped that this information might lead you to regain your health and former well being through our prompt, proven, and relatively painless methods of treatment as many thousands of others have done during these many years.

The purpose of this little booklet is to call your attention to a very important group of diseases which occur frequently but are little understood. It will present a discussion of the most common rectal ailments in plain, concise and understandable language. It will cover the most common symptoms, some of the causes, and the common sense remedies for these diseases. It will point out how these ailments affect vital organs and cause vague aches and pains in remote parts of your body. The information will enable you to realize the absolute waste of money and time spent in an effort to rid yourself of your ailment through the use of home remedies. The booklet will also point out your limited chances of having the pain and suffering from a surgical operation rewarded with satisfactory relief.

Recognizing the desperate need for milder but effective and adequate treatment to take the place of hospital surgical operations in these diseases, our clinic staff has for years dedicated itself to this end. We treat without hospitalization. This means less pain, less loss of time and less expense.

INTRODUCTION

Diseases of the rectum and colon are the most common of all physical ailments and yet they are perhaps the least understood and most neglected.

85%

It is a well established fact that more than 85% of adults suffer from some form of rectal ailments. Dr. Alfred Cantor, editor of the American Journal of Proctology, makes the flat statement that, "pathologically speaking, every adult has hemorrhoids." Hemorrhoids strike during the most active years of life.

Because a frank discussion of rectal diseases is too frequently lacking due to modesty and timidity, it is our hope that the contents of this book will provide a practical means of alerting you to their vital importance. The serious effect these diseases have on your life and the dangers of neglect will be set forth. The average doctor has a strong natural dislike for treating diseases of the rectum. This dislike combined with the modesty and timidity of the patient retards the advance of education on this issue - and the timely application of remedial treatment. An article appeared in Reader's Digest entitled, "Hemorrhoids, the Disease No One Talks About." Although this is one of the rare educational breakthroughs into public print, the title, itself indicates the usual shroud of secrecy. Why?

The rising death rate from Carcinoma(cancer) of the lower bowel ranks high as a cancer killer. The general feeling is that neglect is largely responsible for this state of affairs. We cannot overemphasize the importance of a careful examination in each case in which a rectal ailment is suspected.

Consider your own case as an example. What kind of an examination did you receive when you went to various doctors for relief from your rectal troubles? How often did you have a thorough examination of your rectum? In your physical examinations; examination for employment, insurance, lodge, etc., your heart, lungs, chest, abdomen, reflexes, eyes, ears, nose, throat, tonsils; everything else was examined but too often your rectum was ignored. Yet your digestive tract (extending from your mouth and stomach to your anus) is the largest and one of the most important organs in your whole body. It is the part which handles your food and extracts all of the vital energy from it -when in a healthy state. It distributes these vital elements to other organs, keeping them functioning. Also, it is that essential organ which eliminates all of the solid and much of the liquid toxic waste material produced and accumulated within your body. Stop the function of this organ for any extended length of time and the result would be death. Yet there are thousands upon thousands of miserable individuals going through life each day with the function of this tract badly impaired due to the presence of hemorrhoids (piles) or other inflammatory conditions extending along its secreting surfaces.

HOME REMEDIES

The manufacturers of home remedies for hemorrhoids (piles) enjoy a ready and lucrative market for their products. This is the case in spite of the fact that a home remedy which will cure hemorrhoids has never been discovered. The large enterprise is built upon two main principles; the fact that hemorrhoids and other rectal ailments do exist - almost universally in the human race and that temporary relief can often be obtained from their product. All home remedies advertise relief from your piles. Relief which temporarily eases the soreness or irritation is all that one can expect. This often lulls the sufferer into a sense of false hope while the rectal disease is allowed to grow progressively worse. Serious inroads are often made undermining the stricken one's general health and well being before he is jolted into a sense of reality. Self treatment has been known to lead to the dangerous results of incurable disease.

THE CHOICE IS YOURS

For the rectal sufferer there is usually nothing offered but the choice between home remedies on the one hand, the pain-easing drugs of the physician and druggist on another and the radical operation of the surgeon. This leaves the door wide open for a positive, more scientific and less painful approach to rectal care. We are in a position to offer you this care with our treatment service along with our experience of many years, in practice and our skill in treating these diseases.

SURGICAL OPERATIONS
[Hemorrhoidectomies]

"Piles can be cured only by a surgical operation!" This is the prevailing understanding by the masses of people... nothing could be farther from the truth! If one could hear the stories of the many hundreds of patients who come to us, he would realize the absolute absurdity of such an opinion. Somewhat less than half of all patients under treatment at our clinic today have already had one or more rectal operations before coming to us.

Many family physicians do not perform these surgical operations for hemorrhoids (hemorrhoidectomies) themselves. The patient is instead referred to a surgeon and the surgeon does the rest. He removes the hemorrhoidal tumors by his method of choice which usually means cutting them away with either the knife or the scissors. One quite common and favorite procedure is the "clamp and cautery method." This consists of grasping the pile tumor with the forceps and then applying a crushing clamp which shuts off the blood supply to the part of the hemorrhoid to be cut off. The remaining stump is burned or seared with cautery. Another modification of this procedure is one in which the stump is sewed or tied (ligature method) instead of being seared with cautery.

The pain and suffering which follows one of these surgical operations is best described by one who has been through it. What makes matters worse, in a high percentage of cases, there is a recurrence of the rectal trouble with the same old symptoms, or similar, within a period of from two to four years after the operation. This calls for another operation with all of the accompanying suffering and misery. It calls for the loss of another month or two of work, and the added burden of more sky-rocketing hospital surgical bills. There is also the ever-present possibility of some disastrous after-effects from the surgery to be considered - such as "loss of control" or "rectum too tight." These dreadful prospects need not be yours, however, because even the ex-surgical cases can be successfully corrected by our treatment.

THE DANGERS OF NEGLECT

The average person seldom visits a doctor unless he is suffering or is in severe pain. Most people think they must have pain with hemorrhoids ... or any other rectal disorder. This mistake could hardly be more tragic. Many rectal ailments are entirely free of pain. These are the ones which progress insidiously, often terminating in something really serious. Hemorrhoids (piles), for example, are generally painless unless they protrude (come out), or are strangulated (stay out). or become ulcerated or abscessed. The only indication of something wrong may be a vague uncomfortable feeling in the general direction of the rectum. Even this is absent at times. Hemorrhoids may be in the process of development in the rectum of a man or woman for a period of from three to ten years before the person becomes aware of it . The first sign that all is not well is often a slight trace of blood at time of stool. This is the time to do something about it.

PROCRASTINATION

The price of procrastination is often much too high. The least it can do is to allow the disease to work day and night, relentlessly undermining the tissues, progressively enlarging the area and worsening the condition. Once it has a firm grip, seldom, if ever, does it get better by itself. The worst it can do is to develop into something no one can help.

Delay has another great danger. It takes the form of pain, distress or even failure of proper function of other organs or structures of the body caused by a developing rectal ailment and affected through the common nerve supply.

RECTAL EXAMINATION

Our examination is accomplished by means of specially designed instruments of proctology which are electrically lighted to provide a clear and direct view of the interior of the rectum. With such instruments, the inside of the rectum can be seen as clearlv as looking at the palm of your hand. The examination is performed as easily and painlessly in uncomplicated cases as an examination of the nose or throat. The gratifying part of this procedure to the physician is the fact that he does not have to do any guessing. Two good eyes and a thorough knowledge of the work at hand provides those necessary prerequisites leading to a correct diagnosis.

The same type of instrument which provides the clear view in the examination is also used in our treatment. Thus, the interior of the rectum and the treatment itself is in full view of the doctor at all times. The thoroughness of the examination is emphasized by following the steps which are generally taken in our rectal examinations: inspection, palpation, digital examination. anoscopy, and proctoscopy. This is often in striking contrast to the experience described by many patients of examinations received elsewhere. Sometimes the examination consists of listening to what you have to say regarding your rectal troubles. Then. without an inspection or examination of any kind, the doctor will write you out a prescription for a suppository, salve, or rectal ointment. Often the extent of the rectal examination will consist of insertion of the rubber-gloved finger into the rectum. This is called a digital examination. Important as this is as a part of the examination technique, a positive diagnosis cannot be made solely on the basis of a digital examination. This statement has the concurrence of all major authorities on proctology.

Why it is that every orifice of the body will receive a careful and painstaking search during a general physical examination except the rectum is difficult to understand by one familiar with the damage and suffering which results from neglected rectal ailments. The use of electrically illuminated instruments such as the proctoscope and sigmoidescope, mentioned before, are necessary and important steps in a complete and thorough rectal examination. No intelligent diagnosis can be made without a thorough examination. The patient at our Clinic can expect to be thoroughly examined with the help of the most modern facilities now available to doctors specializing in rectal diseases.

DISEASES OF THE RECTUM

The well established belief is that whatever happens to the rectum must be "piles" or hemorrhoids. Thus, we may have "bleeding piles", or "protruding piles", "itching piles", etc. Contrary to this belief is the fact that there are 50 or more different diseases which can occur to that organ. The doctor specializing in rectal diseases must concern himself with this variety, but the most common and prevalent forms of rectal diseases are discussed here.

They are:

A brief description of each disease follows.

HEMORRHOIDS [PILES]

By far, the most common of all rectal ailments is hemorrhoids. Hemorrhoids are soft pouches or oblong swellings filled with blood from very tiny blood vessels which have become greatly enlarged due to the disease. The hemorrhoids may be as small as a kernel of wheat or as large as a lemon. They are usually bright or dull red in color but may become purple or even black. Hemorrhoids may or may not bleed. They may protrude (come out or swell up) or they may simply cause "nervousness" or "extreme annoyance" or "pressure at the opening."

As a general rule, hemorrhoids have been under development for years before they bleed or protrude to arouse the patient's concern. In the meantime they give rise to numerous indirect symptoms, a few of which are listed here: 1. Nervousness 2. Fatigue 3. Dull ache 4. Pressure or uneasiness upon sitting 5. Pressure or weight upon standing 6. Feeling of fullness 7. Something obstructing passage of stool 8. Aching of hips and legs 9. "Tail bone ache" 10. Incomplete evacuation.

The one thing which stands out to characterize both hemorrhoids and prolapse is the fact that symptoms come in repeated attacks followed by periods of relief. These attacks may be as far apart as a year or more at first and when relief comes, the patient is lulled into false sense of security. He mistakenly thinks that his hemorrhoids are gone. Whatever happens to be the case and whatever he happens to be using at that time gets the credit for curing his hemorrhoids. Little does he realize that his hemorrhoids are still here and that the symptoms would have subsided anyway, regardless of whether he had used anything or not. During the periods of remission the hemorrhoids are gradually increasing in development. They will come back. Each attack will be more severe. It will last longer and the period of relief will be shorter as the disease progresses.

Please also refer to the section entitled Prolapse.

OUR TREATMENT OF HEMORRHOIDS

Our treatment is not a "secret method." Neither is it the injection method, nor "shots", nor surgery, nor do we "burn them out with electricity." it is an electronic treatment with an "accepted practice" rating receiving its greatest interest by the Medical Profession in the 1930's. Popular support faded, however, because of the "disadvantages" of the "expense of the instrument" and "the consumption of much time in its application." In the meantime, many important refinements and improvements have been added to the development of this treatment by our staff doctors.

The electronic action causes the hemorrhoid to shrink and shrivel up. This is accomplished with little or no pain by a chemical change which takes place within the hemorrhoid itself, ultimately causing complete obliteration of the diseased mass. In a few cases during treatment there is a moderate discomfort experienced. The treatment usually takes less than 15 minutes. The patient seldom arises from the treatment table with anything unpleasant to remind him of his treatment.

There are hundreds of individuals today who are bravely trying to "live with their hemorrhoids" on advice of their physician because they are unfit for surgery due to chronic debilitating diseases such as cardiac (heart) disease, diabetes, etc. To these people, we offer hope. This assurance is also offered to the aged, for age is not a hindrance. Some have been successfully treated here in their eighties and nineties.

TREATMENT OF OTHER RECTAL DISEASES

In some rectal diseases there are other types of treatment required besides the one described for hemorrhoids but they are all "ambulatory treatments" (up and walking around) and all without hospital surgery.

PROLAPSE [PROLAPSUS]

Prolapse is a form of protrusion from the rectum other than hemorrhoids. It ranks second only to that ailment in being the most common of all rectal diseases. Just as in hemorrhoids, the same tiny blood vessels which have become greatly enlarged are the cause of the trouble. But instead of forming individual pouches as we find in hemorrhoids, the whole swollen lining of the rectum forms a thick ring which entirely surrounds the inside of the lower part of the rectum. Prolapse is an enlarged and advanced case of chronic hemorrhoids. It comes in two types, partial and complete. Partial prolapse is a folding down of this thickened ring within the rectum. It obstructs the free passage of stool and gives rise to many symptoms listed under hemorrhoids with particular emphasis upon the the feeling of "weight" or pressure. In complete prolapse the swollen ring covered by the lining (mucus membrane) of the rectum protrudes on the outside through the anal orifice into puffy folds. It may, or may not bleed at this time, but certainly causes pain and discomfort during protrusion. Besides the symptoms listed under "Hemorrhoids", prolapse may also manifest itself by the following:

1. Mucus discharge
2. Difficult and unrewarding evacuation
3. Failure of satisfaction at stool
4. Moisture about the buttocks
5. Bleeding
6. Protrusion
7. Pain
8. Dull ache

Prolapse is one of the most troublesome and disagreeable of all rectal ailments. There is a feeling of something in the rectum which retards the passage of stool, as though there is an obstruction. Often there is a desire to strain and strain with no results. The patient may experience the feeling that the stool can be forced just to the opening - and no further. Even after the bowel movement there is a feeling of failure to finish; that the rectum is not completely emptied. It affects people of all ages and both sexes.

The evidence is clear that once the disease of hemorrhoids or prolapse is established, it never gets well by itself. It simply becomes progressively worse in recurrent attacks until the bleeding, protrusion and pain prevent the person from working and earning a living. Patients come to us wearing home-made diapers, harnesses made of fabric webbing and all kinds of contrivances for holding the hemorrhoids or rectum in place. Many of these cases extend over periods of from ten to thirty years. The surgeon will tell you that radical hospital surgery is the only way to effect a cure in cases as bad as this. We assure you even more emphatically that this simply is not true.

Procidentia is another form of complete prolapse. Fortunately, this kind is rare. It is a type of protrusion in which not only the lining of the rectum but the whole muscular tube telescopes out through the anal orifice.

THROMBUS [THROMBOTIC EXTERNAL HEMORRHOID]

Rectal (rather Anal) thrombus is a common ailment which comes on suddenly. It is marked by acute pain and the appearance of a dark purplish lump just outside the anal opening. The lump is caused by the breaking of a small vein with the escape of blood beneath the skin. The extreme pain is due to pressure upon the superficial nerve endings just as pressure from a boil. The size of the lump filled with blood varies from that of a pea to that of a walnut. The formation of thrombus generally follows heavy lifting, spasms of coughing or sneezing, straining at stool, taking of active laxative, etc. It may also occur without any apparent provocation. The lump may form immediately or appear overnight. The blood becomes clotted shortly after the lump forms. if, or when it ruptures, there is almost immediate relief from the pain and aching but with the relief comes the peril of having complications such as recurrent attacks, the formation of irritating skin tabs or miserable itching if the cause is not remedied. In cases of smaller thrombus there sometimes occurs an absorption of the clot by the blood stream. Consequently there will be no abscess formation or rupture but the complications are just as imminent as in the former.

Anal thrombus or "thrombotic hemorrhoid", although often confused with actual hemorrhoids, is not a true or usual type hemorrhoid. The lump forms suddenly instead of gradually as in hemorrhoids. It is filled with a clot instead of small diseased functioning veins as in hemorrhoids. The lump is formed in the skin on the outside instead of protruding down from the inside as in hemorrhoids and the recovery from the acute attack is rapid in thrombus, whereas in hemorrhoids, the recovery - if any - is gradual. The formation of thrombus is a signal pointing to the underlying cause which will usually be found in the rectum. It is unwise to leave such a condition untreated with the forlorn hope that it will cure itself.

SKIN TABS [HYPERTROPHIED EXTERNAL HEMORRHOIDS]

Skin tabs are the shapeless lumps and flaps of skin or flesh found around the anal outlets of the victim possessing the disease. Although they are not hemorrhoids at all, because their blood supply instead of being over-abundant is meager, are none-the-less often considered in this category by some and confused with actual hemorrhoids by others. The presence of a tab gives mute testimony to the suffering of the person at an earlier date when an infected rectal crypt (lubricating gland) became abscessed and swollen (See Crypts) or a thrombus formed and proper treatment was denied. In either case, again the swelling will gradually diminish in size and the acute pain subside. The gradually declining soreness and increasing sense of comfort tends to give the patient the mistaken feeling that his troubles are over. He will now have a tab of skin at the anal orifice as a constant reminder of his days of acute suffering, This becomes a real problem in cleanliness and if there is more than one tab, the problem is multiplied. Itching (pruritus) often develops to make a bad situation intolerable. If the tabs are left unattended, they characteristically become intermittently inflamed or engorged and very painful at times. Skin tabs do not occur unless there is some acute inflammatory rectal condition to cause them, such as: cryptitis, papillitis, thrombosis, hemorrhoids, etc. Therefore, their very existence clearly indicates the presence of some more serious rectal ailment which needs your careful attention.

FISSURE

Extreme pain is the one outstanding feature which characterizes this disease. A hot, smarting, sickening, unbearable pain which comes on during or shortly after bowel movement and lasts from a few minutes to several hours. Rectal fissures (rather anal fissure) is a slit-like ulcer located just within the anal opening and sometimes extends the full length of the canal. it resembles a tear or a crack in the lining skin. The muscles become tense and irritable - the opening tight. The cause of anal (or rectal) fissure is generally due primarily to the presence of hemorrhoids, however severe or mild the case may be. Other rectal causes are enlarged papilla, polyps, inflamed crypts, proctilis. etc.

Even the thought of bowel movement turns the patient frantic with the fear of the smarting, burning pain which is sure to follow. Strong people have been known to faint at this time. The morbid dread of bowel movement causes many to put it off as long as possible. This, of course, permits drying of the stool which increases its hardness, and the eventual movement is more difficult than ever. The tissues are then torn again exposing the nerve endings lying beneath. Besides the pain, bleeding often follows. The accumulated harm done to the body makes nervous wrecks out of some people.

CRYPTS [POCKETS]

These are tiny mucus glands of lubrication arranged in a circle around the upper end of the anal canal. They resemble pockets in a coat without flaps or covers. The mouths or openings of these pockets point upward into the rectum and they are within the grasp of the sphincter (shut off) muscles. just before bowel movement, the sphincter muscles contract and squeeze out a little drop of lubricating mucus from each of these crypts. Because of their delicate nature and position in the rectum with the openings upward, they are easily injured, possibly by some hard particle in the stool. From this combination of circumstances comes one of the most common sources of infection in the rectum. This leads to swelling. The opening or mouth of the crypt, normally closed, now swells open. Fecal matter and other infective material collects in the crypt. This is the beginning of abscess formation. The infection will now take one of many courses. The abscess may extend itself out through the buttocks causing a fistula, or it may lodge in the soft tissue causing a large abscess cavity later to be lanced. The infection may extend downward toward the anal opening causing a large swelling there which is either lanced and cared for, or ruptures itself, causing a sizeable skin-tab. It may, on the other hand, cause a fissure or Sentinel Pile. Any one of these courses is usually accompanied by all the throbbing pain and pressure of acute abscess. The pain of cryptitis (inflamed or infected crypt) is usually of the sharp lancinating or burning variety. The very intense pain from spasm of the powerful contractile sphincter muscle may also develop from the inflammatory process. The bladder and genitals may be affected. At other times, the infection of cryptitis is of such low grade nature that pain is not intense but transitory. It may then manifest itself by a feeling of heaviness or dull rectal ache, uneasiness after bowel movement, or aching in the hips and legs - sciatica!

Cryptitis is a common source of active rectal infection. It is also the cause of many other serious rectal diseases.

PAPILLA

These are very small cone-shaped or teat-like projections which are found protruding from an encircling ring at the upper end of the anal canal. The ring is a little more than an inch inside the anal opening. Ordinarily, papillae (plural of papilla) are about half the size of a safety match-head and their presence is unknown to the individual, and unfelt. Often papillae become bruised, cut, torn, or otherwise injured by the passage of hard stool, by the presence of some hard particle in the stool (such as nut shell fragment), or by the insertion of a rectal tube or syringe, etc. They then become acutely inflamed, swollen, enlarged, and very tender. The swollen masses extend into the canal of the rectum like sore thumbs. Subsequent stool passages add to the irritation by rubbing and pushing against the inflamed papillae during passage. As the trouble continues the papillae increase in size. After the acute inflammation subsides, the swelling usually remains and the papillae become tough and fibrous.

Papillae have been found to be the cause of protrusion in many cases when they become so large and long that they come out at time of stool. This, always causes pain until they are pushed back because the sphincter (shut off) muscles clamp down upon them in a pinching action. The irritation may spread to the sphincter muscles themselves, causing the unbearable pain of sphincter spasm. A prolonged or continued irritation from papillae can, and often does, cause stenosis (tight rectum). Anal (or rectal) fissure is often caused by a papilla.

One of the most common indications of the presence of one or more enlarged and irritating papillae is a vague, persistent feeling of uneasiness in the rectum. Others are: 1. Sitting on one hip; 2. Dull pain; 3. Thick sticky discharge [slight amount]; 4. Sense of incomplete evacuation; 5. Crawling sensation; 6. Discomfort when sitting.

Enlarged (hypertrophied) papillae are constant trouble-makers and unless they are skillfully and successfully cared for, they will not only become worse but often lead to more serious complications.

ABSCESS

Abscesses are very common in the region of the anal opening and buttocks, and since the cavity of pus formed is due to tissue disintegration, its importance should not be underestimated. Chronic neglected abscess often leads to fistula formation with many openings, loss of control of the bowels, or massive tissue disintegration.

Abscess usually begins with a tender swelling somewhere near the anal opening. As it progresses there is heat, redness, and a dull steady ache which later becomes a throbbing pain. Chills and fever may also be experienced. It may reach a climax and break exuding forth the contents of pus and blood. This is followed by immediate relief from the pain but because of the tendency to improper healing and to fistula formation, the relief often marks the beginning of trouble instead of the ending of it.

Abscess is caused by anything from the outside entering into the soft tissues of the buttocks by penetrating the skin (such as cuts, bruises, abrasions); or through the rectum by way of crypts, papillae, fissures, hair or sweat glands; and there are innumerable other causes. See Fistula.

FISTULA

A fistula is a tube filled with pus. Anal or rectal fistulae (plural of fistula) have one or more openings in the buttocks near the anal opening, and another one (the feeder) is inside the anal canal or rectum. An abscess almost always precedes fistula, although an abscess may exist without being fistulous. (See Abscess). As the abscess forms, all of the typical symptoms of pain, swelling, heat and redness appear. These continue until such time as the abscess points and breaks, or is lanced by the attending physician.

With the evacuation of pus and the subsiding of the pain, the patient is often led to believe that his trouble is over. Then comes the complacent shattering reality, for it is only a matter of time until the opening (or fistula), which has drained the abscess and has remained open, becomes clogged. When this occurs, the patient again undergoes the same suffering as before until the fistula tube reopens or a new opening is formed to provide drainage for the accumulated pus and debris.

If the fistula drains continuously, the pain and suffering is often negligible. The fact must be borne in mind, however, that more serious than the pain, there is a continuous absorption of pus and toxic material into the blood stream night and day, year in and year out, thus poisoning and impoverishing the entire system. Not a day passes without dozens of people being advised by their physicians or dentist, to have one or more of their teeth extracted because they are abscessed or affected with pyorrhea. This is the customary advice because it is known that many constitutional and chronic ailments, such as indigestion, rheumatism, skin diseases, and many others, are caused by the absorption of toxins or poisons from some chronically infected area. The two most commonly known and prolific sources of pus infection are the teeth and tonsils. The advice is well given and is often followed by the most gratifying and unexpected results, but did you ever stop to think of the quantity of pus and toxins absorbed from one chronically discharging fistula? It is our belief that the most common variety of fistula secretes and discharges more pus in twenty-four hours than would be formed in one week if every tooth in your mouth were affected with pyorrhea. The chances are that you never considered your fistula from this standpoint.

Some fistulae (plural for fistula). due to their location and size, permit a constant escape of fecal material and gas from the bowel with the attendant disagreeable odor. If fistulae are neglected, allowed to stop up and gather from time to time, they eventually undermine all of the tissues surrounding the rectum until the area presents a picture similar to a plot of ground undermined by gopher holes.

Fistula is a critical ailment which is best cared for by skillful and experienced hands. Our methods are conservative. There is no hospitalization and we can reasonably assure satisfactory results in every case we accept for treatment.

POLYPS [POLYPOID GROWTHS]

A polyp is a smooth growth or tumor having a stem-like attachment (similar to a toy balloon) to the mucous membrane lining of the bowel. Wherever a mucous membrane exists there is the chance for development of polyps (polypi). So polyps are found in such places as the nose, throat, bladder, female organs. rectum, and lower bowel. Polyps are of two general types: malignant (cancerous) and benign (non-cancerous). All growths are considered in danger of undergoing cancerous degeneration at any time.

The size and location of polypoid growths determine the symptoms. Polyps often exist in the rectum, or lower bowel, without the patient's knowledge. Periodic bleeding may be the first and only sign of their presence in the lower colon and rectum. If the growth becomes large enough to protrude out through the anal opening, the symptoms can become quite severe causing pain and great discomfort, particularly at time of bowel movement. There may be a dragging sensation in the rectum at time of stool, a constant feeling of incomplete defecation, often bleeding, the passage of clots, and signs peculiar to ulceration in many instances.

Because of the gravity of the ailment, it hardly seems necessary to have tourge the patient, for his own best interest, to seek early and proper care for polyps.

POST SPHINCTER ABSCESS

Post sphincter abscess, which means literally an abscess behind the sphincter muscle, is not rare but is a condition which frequently causes the patient considerable frustration in achieving a satisfactory treatment and cure. The patient suffering from post-sphincter abscess may do so for years, being told he has neuralgia, Cocygodynia, or arthritis of the Coccyx (tail bone), and frequently will use liniments and salves copiously, to no avail.

The characteristic complaint is a backache at the end of his spine (tailbone ache). After sitting for awhile, he will have some difficulty getting to his feet. He will often unconsciously sit on one side of his buttocks instead of sitting evenly on both. There will be pain during bowel movement and a dull aching sensation afterward.

Because of the deep-seated location of these abscesses, routine examinations will often fail to identify them. Once the disease is recognized and the abscess located, treatment brings instantaneous relief as the offending pus is removed from the cavity.

PRURITUS [ITCHING]

Pruritus, usually called "itching piles", is not piles at all, although it may occur in persons who have piles (hemorrhoids). It is without a doubt the most tormenting of all rectal diseases, and at the same time, the most stubborn and difficult to successfully treat. Once a foot-hold has been gained, there is little, if any, relief from the agonizing itching day or night ,year in and year out. As the affliction continues it becomes more complicated and more severe. In their desperation patients often scratch themselves until they are raw. The itching is really a symptom-complex, and the cause must be removed if the desired results are to be obtained.

The itching is generally more pronounced at night when in bed and it is a constant robber of sleep and rest. As the condition progresses, the amount of sleep lost due to scratching, either consciously or unconsciously, increases. This loss seven nights in the week, and thirty nights in the month, soon begins to tell on the individual, no matter how strong he is. It affects him both physically and temperamentally.

"There is no single disease which runs so chronic a course, is so extremely rebellious to treatment, and for which such a multitude of remedies has been advanced as 'pruritus ani'," - so says Dr. William A. Rolfe, a prominent Proctologist of Boston. The average pruritus sufferer needs little to convince him of this because he has generally already used the various home remedies and drugstore preparations, including the run of anesthetic ointments and salves, and has found them disappointing.

The causes of pruritus ani are legion and often most obscure but they generally fall within two main groups. Group number one is the local rectal ailment. It is our experience that in the great majority of cases there is some pathologic (diseased) condition of the rectum or anal canal which is the primary cause. This may be the presence of hemorrhoids, infected crypts, skin tabs, fistula, fissure, polyps, the discharge of secretions, etc. These must be remedied if permanent relief is to be realized. The second group is allergy. This may mean food allergy or allergy in other forms. Of course, many people are aware of various allergical manifestations shown in various ways, such as a case of hives from eating strawberries or clams, or in being stung by a bee. It is quite common for individuals to suffer a severe skin dermatitis from contact with poison oak or ivy, and many suffer skin eruptions and itching from taking certain medicines.

By basing our treatment upon these two fundamental causes, we have been able to obtain permanent and gratifying relief in many cases.

HEMORRHAGE

Hemorrhage or bleeding from the rectum never occurs normally. It deserves its just concern. Bleeding may be experienced in many different rectal diseases including hemorrhoids, and others discussed in this book. It may be a warning of cancer. Bleeding may be slight or severe. The cause of rectal bleeding can ordinarily be determined by careful anorectal examination and proctosigmoidescopic study. This examination is routine in our clinic for patients suffering from rectal hemorrhage.

CANCER [CARCINOMA]

No one in America today is free from the threat of cancer. It can happen to anyone and it ranks as one of the greatest killers of our time. Much attention has been placed upon lung cancer because of the controversy over the question of how much tobacco smoking causes the disease. The necessity of a great many hysterectomies commonly due to cancer of the uterus is causing great alarm among women. Breast cancer, stomach cancer, blood cancer, all receive their share of publicity and all contribute their share of fear and dread. There is now developing a new realization bolstered by the hard cold facts of statistics, drawing increasing attention and concern to another field of cancer: that of the rectum. Today. cancer of the rectum is one of the nation's foremost cancer killers. The number of new cases has increased each year. An estimated 140,000 Americans will develop cancer of the lower bowel in 1986. 63,000 who already have this disease will die. The number of stricken individuals has nearly doubled between 1969 and 1985. At last, cancer of the bowel has broken through the customary mask of stony silence traditionally covering these ailments as newspaper headlines spelled out the reason for the illness and death of some of our elder statesmen. Recently a number of articles on this form of cancer has appeared in popular magazines.

The rapid increase of this disease involving the lower bowel is of grave concern to the healing profession and focuses attention on two main reasons for this increase. Number one is the typical failure of the patient to respond to warnings of things wrong in this region of the body such as bleeding, pain, change in habits of the bowel, etc., which should alert him to seek an examination. Number two is the prevalence of unskilled or inadequate examinations. In a recent televised address, the head of the American Cancer Society mentioned the increasing existence of cancer of the lower bowel and the fact that a sigmoidescopic examination is not possible in every doctor's office. A thoroughly alerted and informed public and healing profession can do as effective a job of reducing cancer of the bowel as they have in other areas of the body, if cooperation is as complete.

To point out what cooperation and an informed public can do, we note the continuously yearly drop in death rate from cancer of the female reproductive organs during the past decade. This decline has been going on in contrast to the rise in bowel cancer because women are going to their doctors, usually on the very first signs of malignancy, and they also go for periodical examinations as a means of prevention and early detection.

The best means of avoiding cancer are prevention and early detection. Prevention is accomplished by maintaining the organs in a normal state of health and function. This involves eliminating all irritating and inflammatory disease processes, including hemorrhoids and every other rectal ailment, no matter how mild. Early detection is accomplished by having a complete examination at the first sign of trouble. Prevention and early detection are the greatest bulwarks to protect you against the ravages of cancer of the rectum and may mean the difference between your life and death.

It is a well known and accepted fact that when cancer is detected in its early stages, it is often curable. Some of the signs that one should respect and suspect are any departure from the normal feeling around the rectum. The normal feeling is actually an absence of feeling except, of course, at time of stool. Otherwise, you should be no more conscious of the fact that you have a rectum than you are of the fact that you have a spleen. Bleeding, no matter how slight, especially if repeated, should be investigated. Pain, soreness, burning sensation, heaviness, swelling, or any change in bowel habit are symptoms which should lead the patient to seek an early examination.

Constipation is one of the most common disorders in America today. Indeed, its high degree of prevalence often gives the ailment the status of normalcy and respectability. Many doctors have the opinion that daily regularity of bowel movement is simply unnecessary but we need only to refer you to your own experience and the difference in the way you feel when regular or irregular. Constipation not only accompanies most rectal diseases but it is frequently the cause of them. It is evidence of functional impairment or obstruction at some point in the intestinal tract and is one of the most harmful disorders afflicting mankind. We are positive that hundreds of people who are sick and ailing, and on the verge of despair in their effort to get well, would have their health and vigor entirely restored if they could be relieved of their constipation. Correction of the existing rectal disorder generally greatly relieves constipation and in many cases entirely eliminates it.

To enter fully into a discussion of the causes, symptoms, ramifications, and complications of constipation would far exceed the limits of this booklet. Only two of the hundreds of causes will be considered here. The first and very important one is the presence of some complicating disorder of the rectum. The second one is the use of laxative or cathartic drugs. The last mentioned cause must not be overlooked because every dose taken removes you that much farther from permanent relief while their habitual use causes many of the rectal diseases mentioned in this book.

TIME

The time necessary for a complete recovery in an uncomplicated case of hemorrhoids by our mild. non-surgical method, is about 10 to 14days for the patient who comes to the clinic from out of the city and chooses to remain in the city for the duration of the treatment. For those patients living not a great distance from Portland, and where it would be more economical to return home between treatments, we administer our treatment once per week. in these cases, about 10 treatments are usually required.

COST

Included among the reasons some people give for postponement of needed services for rectal diseases is the cost. The cost of our treatment is much less than the average hospital operation.

Our fees are modest making our services available to almost everyone. It is our sincere desire to keep them at a minimum so that anyone desiring our services might enjoy the benefits without finding the cost prohibitive.

Examination necessary: A moment's thought will convince the patient of the impossibility of telling him what the cost will be in his case before an examination is made. Everything depends upon the examination. It lets us know what kind of ailment it really is, how extensive it is, how long it will take to get rid of, and of course what the cost will be. Patients have asked us what the average cost is, and we might reasonably answer this question by asking, how do we know your case is average? An examination is so inexpensive. It takes so little time, and is generally no more distressing than an examination of the nose or throat... and so important! Why put it off?

The wise person is that person who, if he already enjoys a sound body, does all that is reasonable to maintain it. If sickness comes, he does all that is possible to regain his health. He know,, that it is bad to guess at the cause of his ailment, to put off examination, or to delay treatment. What enjoyment is there in money, or your work, or anything else without good health? You are entitled to your shareof good health if it is possibly obtainable. Good health is one of the very few things that can be enjoyed in this life. We gladly accept VISA and MASTER CARD.

REGARDING INSURANCE

We would like to point out four pertinent points regarding our conviction and policy relating to insurance: 1. To sum up our previous conclusions, pre-paid insurance does not pay everything or cover everything. Very few, if any, insurance companies will pay these kind of bills completely. The insurance policy is almost always just a partial help financially- Our treatment, on the other hand, is just a fraction of that cost. As a matter of fact, many patients have found that the cost of our treatment is about equal to the part they would have to pay for their surgical Hemorrhoidectomy. The part that the insurance did not cover. 2. The usual surgical-hospital operation for hemorrhoids incapacitates the patient for at least six weeks, a time in which the patient experiences time lost from his employment. In many instances, this means considerable loss of income and separation from the details of his job or business. It is well to remember in this connection that our treatment for hemorrhoids not only sharply minimizes time loss, but there is none of the disabling after-pain that characterizes hospital surgery. For patients whose employment is in the greater Portland area, time loss is practically nil. For patients coming from farther away, the only time loss is the brief period of time spent in Portland while treatment is underway. Measured in dollars and cents, money can often be saved by our kind of service, even in cases where the average extent of surgical hospital costs would be paid by insurance. 3. A good share of our work is correction and treatment for complications and inadequacies suffered from previous rectal surgery. This fact, of course, points out the inherent dangers in choosing a method of treatment simply because the insurance policy provides part of the payment for such a method. Whenever this happens, no money is saved and suffering and trouble are further penalties. We cannot overemphasize the fact that for so prized a possession as a person's health, treatment that is most apt to cure with the least discomfort, time loss, and the least chance for dangerous complications, is of primary importance. Whether the insurance company will or will not pay the bill, in whole or in part, should only be of secondary importance.

CONCLUSION

The Sandy Blvd. Clinic is located at 2026 N.E. Sandy Boulevard, Portland, Oregon 97323. It is easily accessible by bus, automobile and taxi. If you come from out of the city, phone 232-7609 and the receptionist on duty will be most happy to help you to the Clinic.

It is our hope that the contents of this booklet have been beneficial to you, as a source of information, as a source of guidance, and as a medium of warning, intended to steer you away from the pitfalls of neglect.

We are hopeful, if you suffer from rectal disorders, or if you suspect trouble in this area of the body, that you will avail yourself of the service we have to offer - proper, scientific, competent examination and treatment, intelligently applied by doctors of long experience and training. We are sure you will be completely satisfied.