DEAR DR. DONOHUE: One subject I have difficulty obtaining good advice for is hemorrhoids. They are nasty and cause pain and discomfort. Removing them is painful. I found a solution that worked for me: infrared coagulation. I had the problem for more than 30 years. I read many ads for a local hemorrhoid treatment center. I went and talked to a female doctor, one of the nicest people I have ever met. She persuaded me to proceed, and I did. After five treatments, my problem is gone. This procedure works. — F.H.

ANSWER: Hemorrhoids are dilated rectal blood vessels. For many, they cause no trouble. For others, they itch, are painful, bleed or do all three. Simple treatments sometimes produce gratifying results. One is sitz baths. The person sits in a tub of warm water. The knees are bent so that the buttocks and feet are in water. Fifteen to 20 minutes of sitting calms any inflammation and keeps the area clean. Hydrocortisone suppositories, used for one week, can be added to the sitz baths.

For some, such treatments don’t resolve the problem. Alternative ways to handle hemorrhoids are many. One is the infrared-light treatment you so successfully had. The light causes blood supply to the hemorrhoid to dry up, and that eventually leads to the vessel shrinking and sloughing off. It’s like surgery without any cutting. Laser beams, freezing and injecting hemorrhoids with liquids that shrink them are other ways to treat without surgery. Rubber bands can be wrapped around the base of a hemorrhoid, and it achieves similar results.

When hemorrhoids bulge out of the rectum, surgery is the preferred treatment.

DEAR DR. DONOHUE: I have never seen the problem of fecal incontinence addressed in your column. Please address it. It’s a very embarrassing condition. What can be done, short of surgery? — E.F.

ANSWER: The loss of bowel control — fecal incontinence — is one of the most disturbing, devastating and socially isolating conditions a person can have. It forces a person to stay home and remain close to a bathroom at all times.

The first step to take is to have a thorough examination of the rectum and of the muscles that keep it closed. Those muscles are called sphincters (SFINK-turs). An injury to those muscles and loss of their nerve control are two important causes of such incontinence. The exam includes a scope inspection of the rectum. Sometimes special X-rays employing barium paste are needed. Pressure generated by the sphincter muscles can be measured.

If your stools are watery, correcting that can correct loss of control. One to two tablespoons of methylcellulose (Citrucel) daily can firm stools. Loperamide can reduce the frequency of stool passage and can solidify the stool. It also tightens the sphincter muscles.

Based on what is found, the doctor can talk about other treatments. Surgery, which you say you don’t want, is a way of correcting some conditions. Repair of damaged sphincter muscles can restore control. Synthetic sphincters are available.

The specialists best equipped to guide you are gastroenterologists and colon surgeons.

DEAR DR. DONOHUE: In the past two years, I have fallen five times. My left side is weak. My neurologist says I have corticobasal degeneration. Is there a pill for it? I am 81. — V.M.

DEAR DR. DONOHUE: My brother has corticobasal degeneration. Is it hereditary? — C.B.

ANSWER: “Corticobasal” refers to the two places in the brain where nerve cells are dying off. The cortex is the outermost layer of the brain. The basal area is a place most important for movement. Clumsy walking, with many falls, rigid muscles on one side of the body and, in a few cases, a tremor are its principal signs. One hand usually becomes useless. It is not an inherited illness. No medicine is available for treatment. Physical and occupational therapy help a patient deal with the deficits it produces.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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