DEAR DR. DONOHUE: Last week at the doctor’s office, I talked to the gentleman next to me in the waiting room. The topic was my problem – a rectal fissure. He said he knew several people with the same problem. He said no one talks about this problem, and there must be treatments other than hemorrhoid ointments. Will you address this problem? Are there any old remedies you know of? – V.M.

ANSWER: Rectal fissures are actually anal fissures. The anus is the end of the colon. It measures about 1.5 inches (about 4 cm) long. Fissures are linear tears of the anal lining. They’re very much like a cut from a sharp knife. Most often, the lining tears when it has to stretch beyond the bounds of its elasticity when passing hard stool. Fissures can also come about from an overactive anal-sphincter muscle. The anal sphincter keeps the anus closed and is voluntarily opened only for elimination. A sphincter muscle gone into spasm can also tear the rectal lining.

To prevent fissures and to heal ones already there, a person must keep the stool soft. That’s accomplished by adding fiber to the diet or by using a stool softener like Colace.

Sitz baths are an old and effective treatment. Fill a bathtub with about 2 inches of warm water and squat in the water for 15 minutes two or three times a day. If you keep your stools soft, sitz baths can often end the pain of an anal fissure in a week or so.

Nitroglycerin ointment, the same ointment used for angina chest pain, can sometimes speed fissure healing. Lidocaine ointment, a numbing agent, takes the pain away. Surgery is reserved for fissures that don’t heal on their own.

DEAR DR. DONOHUE: I am a 52-year-old female. This past year I have had three eye hemorrhages. I went to my eye doctor and got a complete examination of my eyes. The doctor told me not to worry. He said I probably rubbed my eye hard.

A friend told me that taking vitamin E can cause eye hemorrhages. Is there any truth to that? I take it. The hemorrhages happen in the middle of the day and, when I happen to look in the mirror, I can see them. My eye does not feel sore. Any insight you can give would be appreciated. – J.S.

ANSWER: Your hemorrhages must have been subconjunctival hemorrhages. The conjunctiva is a clear membrane that covers the front of the eye. Beneath it are delicate blood vessels. A cough, a sneeze or even lightly rubbing the eye can break one of the vessels. Blood leaks out. A look in the mirror presents a terrifying image. The white of the eye turns bright red.

These bleeds do not affect vision and do not damage the eye in any way. They aren’t painful. They clear up in about two to three weeks. You can liken them to a skin bruise.

Vitamin E in very high doses interferes with clotting in laboratory animals. If you are taking high doses of the vitamin, stop.

In extremely rare instances, subconjunctival bleeding might result from a defect in the clotting process. But people with such defects bleed in other places – their gums, for example, or their noses. They also bruise easily.

DEAR DR. DONOHUE: My left testicle is four times the size of my right. After being examined by two urologists, I have been told by both that I have a hydrocele.

Please tell me how I got it. Should I have an operation to correct it? – P.C.

ANSWER: The testicles are covered by a double ply of tissues. Between the two plies is a tiny space. That space can fill with fluid to become a hydrocele. The fluid can come from the abdomen. Rarely, it comes from a testicular tumor. Both events are unusual. More often than not, the fluid forms for reasons that cannot be explained. You have been examined by two urologists. Neither would neglect to tell you if you had a dangerous hydrocele. Hydroceles seldom are dangerous.

You should have the hydrocele fixed if it causes you discomfort.

DEAR DR. DONOHUE: My son, 15, had a physical with blood work done. His alkaline phosphatase was high. The doctor is rechecking it in three months. He has grown an inch in the past three weeks. What could be the explanation? – J.W.

ANSWER: Alkaline phosphatase is an enzyme found in bone and liver. High blood levels can be an indication of trouble in either of those two places. Since there are other liver tests on a blood-screen panel and since your son’s tests were normal, the assumption is his alkaline phosphatase comes from bones. An explanation for the rise is most likely his rapid growth. Alkaline phosphatase is high in growing children. The doctor can assure you of that in three months.

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.