The Pain in the Anus
Great way to start the visit, lady. "Thanks for your patience. So what can I do for you?"
She complained of rectal pain and bleeding for one week, which evidently became emergent around 3 am that morning. She had an anal fissure, mild in severity, with no active bleeding and a normal hematocrit.
After a detailed discussion of the pathophysiology and treatment of her disorder, she seemed upset. "You mean I waited all this time and you aren't even going to do anything for me? I read on the internet about all these treatments..."
Like what? You really just need to eat more vegetables, take some stool softeners and try some warm tub soaks. If that doesn't work you can follow up with the specialist for other options.
"But aren't you even going to prescribe me anything...some lotion, or maybe give me a shot? And what about this pain?"
Pain pills will just constipate you more and make the problem worse. Unless you start having softer stools more often than once a week there isn't any cream in the world that's going to help you. And we don't give botox shots in the ER, sorry.
"This is ridiculous," she fumed. "I could have just gone to the drugstore and gotten all of that stuff."
Yes it is, and you certainly could have. Good luck!
That reminds me, if you've never read the story of Bob the Anal Fissure, then you are in for a treat. Here's a teaser:
"At first Bob wasn't so bad. Occasional itch and discomfort. Nothing that I couldn't handle. A mint flavored suppository now and again seemed to do the trick.
But then about a year ago my cruel master Bob began requiring more and more from me. Itching on a scale that can only be described as "hellish" was the order of the day. I had a permanent brown stain on my index finger from trying to scratch the inside of my colon through my troubled anus.
I had lost all sense of decorum. I no longer cared what people thought. I often walk around in public with my hand down my pants, finger firmly implanted, trying to appease the evil God Bob.
In my spare time I would daydream about modifying various farm implements to deal with the overwhelming itch. I even went so far as to order a tined hand trowel.Finally, I went to see a doctor..."
read the rest!