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It was a sigmoidoscope. It's inserted into your anus all the way up to your colon. Air is introduced into the scope to aid in viewing. This is the only field of work where pumping air up your ass isn't considered a public relations ploy.

Mercifully, Binderow did not use the contraption, saving it, presumably, for the patients who complained too much about the long wait in the lobby. As I bent over the "bottoms up" table, Binderow spread my cheeks apart as far as he could, giving his lovely blond assistant an unobstructed view of what I used to think of as a private part. I longed for a shot of dignity the way a diabetic longs for a shot of insulin.

In the office of a rectal surgeon, ordinary gestures are pregnant with meaning. When Binderow put his hands to his mouth, which all doctors are prone to do, I couldn't help wondering if he was smelling his fingers. When I saw the "Bio-Hazard" canister in furious orange coloring, I couldn't help wondering what could come out of you that required a radioactive security measure.

Binderow explained I had third degree hemorrhoids and an anal fissure, which was in worse shape than the hemorrhoids. So bad, he said, he didn't need instruments to look inside. Fissure is a medical term for a crack or groove. I had a crack in the crack of my ass. The fun just never stopped.

Fissures are long narrow sores extending from the sphincter up into the anal canal. They are caused, like most hemorrhoids, by passing hard bowels and straining in the bathroom. They're extremely common in remedial dumpers like myself. As hard bowels pass the sphincter, they can literally tear the lining. Since they're both caused by the same activity, anal fissures and hemorrhoids tend to come in pairs.

I scheduled the surgery within a few days. It didn't require an overnight stay but it did require anesthesia. Thank God. Who in their right mind wants to stay awake for that?

There are different types of hemorrhoidectomy (the surgical removal of hemorrhoids). Binderow performed mine with a scalpel and cauterizer. He could have used a method called "ligation," where rubber bands are placed tightly over the base of each hemorrhoid like a pony-tail, eventually withering them away.

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Three days after my surgery, I sneezed. I thought my sphincter had flown out of my ass. The good thing about a hemorrhoidectomy is that you don't really need pain killers after the surgery -- the mortification masks most of it.

Though hemorrhoids can affect everyone, some people are more prone to the condition, according to Binderow. Affluent, upwardly mobile, highly stressed, hyper-busy people are more likely to get them. Rectal surgeons even have a name for this esteemed group: YETTS (Yuppie Executive Tight Sphincter Syndrome).

"The etiology of a lot of anal-rectal disease is pressure on the anus," said Binderow. "Hard stools are the culprit. They push on the hemorrhoids, rip at the lining and expand the sphincter."

According to the good doctor, the sports section of the daily paper is a leading cause of hemorrhoids and anal fissures in men. The bathroom isn't a library, he warns. "Go in, if nothing comes out, get out." Words to live by.

My surgery could have been avoided if I had been properly schooled in the toilet arts. Never hold your breath when you're on the bowl. It means you're trying too hard. Breathe. Don't effort. Don't strain. Be at one with the bowl. There is no place for struggle in the art of the Zen dump.

The Strain Refrain is one half of the puzzle. The other half is making sure your bowels are soft, which you can do by increasing its water content. But simply drinking a lot of water won't work because most of it gets absorbed by the small and large intestine. You have to eat a lot of fiber too. Fiber is the only thing that will transport some of the water away from the intestines to the anal canal. Water molecules bind to it and ride it all the way through the exit door.

Binderow has seen it all. Removed it all, too. Hemorrhoids aren't the only things he's taken out of anal canals. He's seen eggplants, candles, shampoo bottles, even a perfume decanter. "We have a little museum of artifacts," he said of the things he's pulled out of people's asses.

Shame and ignorance keeps Binderow and his five partners busier than one-legged men in an ass-kicking contest. Binderow himself cuts open 30-50 rumps a week. He doesn't see any let-up. Everybody's too embarrassed to talk about hemorrhoids and anal fissures to figure out how to avoid them.

"There's an unfounded uptightness about that part of the body," he said. "Even exhibitionists who walk around naked don't want to show you their anus." Binderow once had a patient complain about a bill containing his letterhead on the envelope. The patient didn't want anybody to read the words "Colon & Rectal Surgery."

There's a one in 200 chance that my hemorrhoids will come back after surgery. I've taken the magazine rack out of the bathroom, I'm drinking a gallon of water a day and I'm eating enough fiber to cement the government's food pyramid to the floor. Nothing motivates better than mortification. Except maybe the threat of a generously lubricated, air-shooting, gun-triggered colon-crushing rectal projectile.
salon.com | Jan. 5, 2000

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