Q. I have a problem with hemorrhoids. I first noticed blood on the toilet paper several months ago. Now, I'm bothered by pain when I move my bowels and sometimes when I'm just sitting. What treatments do you recommend?
A. Many people are familiar with the term hemorrhoids but don't exactly understand this common condition.
Hemorrhoids, also known as piles, are simply swollen veins in the area of the anus. Everyone normally has veins at this site; it's only when they call attention to themselves by bleeding or by becoming swollen or painful that we consider them an abnormal condition. The term hemorrhoid comes from a Greek word meaning flow of blood.
There are two types of hemorrhoids, internal and external. Internal hemorrhoids are painless unless they develop a blood clot, infection or open sore. External ones, because they have a more sensitive nerve supply, are often painful. Both types can bleed or protrude from the anus.
Hemorrhoids often develop in response to increased pressure within the veins, which occurs, for example, during pregnancy or with constipation and repeated straining during bowel movements. At first, the soft, tiny, balloon-like swelling of hemorrhoids will recede into the rectum after a bowel movement.
After repeated episodes, the hemorrhoids may remain protruded from the anus and may not be able to be put back in place. This condition, called prolapse, leads to further swelling and makes the hemorrhoids vulnerable to inflammation, infection and painful blood clots.
The best treatment for hemorrhoids is preventing them. You can reduce the chances of problem hemorrhoids by 1) following a high-fiber diet to have soft stools; 2) avoiding straining during bowel movements; 3) moving your bowels when you feel the urge rather than waiting, and 4) avoiding being rough with the delicate anal skin.
For minor symptoms, start with simple treatments. Besides using the preventive measures above, you can sit in a tub of warm water (sitz bath), use stool softeners like Metamucil, and apply medicated ointments to the tender area to reduce swelling and pain.
Ask your doctor about ointments or suppositories. Active ingredients may include local anesthetics, anti-inflammation medicine like cortisone, and soothing moisturizers. If pain persists or there is bleeding that doesn't respond to simple remedies, you can have surgery to remove hemorrhoids.
It's important to get checked by your doctor before starting any home treatment to make sure there are no other causes of rectal bleeding, such as cancer, polyps or infection. This examination includes looking at the rectum through a small tube (proctoscope or sigmoidoscope). Your doctor may also want to get a barium enema X-ray of the colon.
Q. After visits to many doctors, thinking our son was hyperactive or emotionally disturbed or both, we were told by a neurologist that he has something called Tourette syndrome. What exactly is that?
The doctor said it causes vocal and muscular tics and sometimes compulsive behaviors. What specifically does that mean? Does this problem progress, and will our son's condition deteriorate?
A. Named after Gilles de la Tourette, a French physician, this condition is one of those often unsuspected disorders behind some children's unusual, sometimes bizarre behavior.
The cause of this rare disease is unknown, but it seems to run in some families. First showing up in childhood and affecting boys four to one over girls, Tourette syndrome produces unusual behaviors called tics. Tics are purposeless muscle movements that a person repeats over and over, even when asked to stop. Examples are twitching of the face, neck or shoulders.
Tics are different from habits of movement that some people display. The main distinction is that tics are involuntary movements, while habits are under a person's control, even though the person may feel compelled to perform them. Examples of habits of movement are repeatedly clearing the throat, sniffing or straightening clothing.
In the early stages, this syndrome can be difficult to diagnose, because many children exhibit habits of movement without developing tics or other symptoms. Also among its peculiar symptoms are vocal tics -- grunts and barking sounds -- as well as blurting out vulgar words and expressions, and repeating the words of others (echolalia).
Because children with Tourette syndrome appear unruly and seem to intentionally use foul language, they are often mistakenly considered disrespectful and undisciplined. In fact, some researchers have speculated that in years past people with Tourette syndrome were burned at the stake as witches for their unbridled use of blasphemous language.
This disorder can also trigger compulsive behavior: repetitive uncontrolled actions that are inappropriate to the situation at hand. Examples include repeatedly touching other people or doing tasks in a stereotyped, mechanical way.
The course of Tourette syndrome is unpredictable. Sometimes, the disorder clears up by itself; sometimes it worsens, persisting into adulthood and interfering with a normal life. Some children also suffer from hyperactivity, poor attention span and emotional difficulties. Mental retardation is not part of the condition.
There's no special test for Tourette syndrome; it is diagnosed by realizing that symptoms fit the picture of this disorder. Because symptoms can be subtle and even identical to other behavioral problems, diagnosis often takes months or years.
Fortunately, drug treatment, when necessary, does improve the condition in most children. The most commonly used medications are haloperidol, pimozide and clonidine. Because haloperidol and pimozide can have some serious side effects, they're only used in severe cases when other treatments have failed.
For more information and support, contact the Greater Washington Chapter of the Tourette Syndrome Association, P.O. Box 2388, Gaithersburg, Md. 20879, (301) 840-8576 or (800) 237-0717.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.