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The first rule of real estate -- location -- explains the eye-widening, mouth-puckering shame associated with hemorrhoids. Everyone has hemorrhoids. Three to be exact. When they act up they become a mass of swollen veins in the lining of the anus and rectum. There are internal and external hemorrhoids. You don't want to know much more than that.

Hemorrhoids are characterized by swelling, pain, itching and bloody stools. First time I saw the blood I did what any man would do in my position: I ignored it. For years. Mercifully, bloody stools are rarely a sign of cancer.

When I finally realized I should see a doctor, my physician pointed to the special "head down, buttocks up" table and asked me to assume the position. When I heard the urethane glove snap on his hands I thought to myself, "Why couldn't I have attention deficit disorder like everyone else?"

"Things could be worse," he said, noticing how mortified I was. "You could be me."

"You can't detect hemorrhoids with a digital rectal exam," he said as he put half his arm in. "They're too soft to feel." Sensing I was about to back-kick him to the wall, he cut himself short. "Relax, relax, relax," he said. "I'm checking for polyps or tumors."

Oh. Then I guess splitting my sphincter in two is OK.

On a subsequent visit, he wheeled out an anuscope and stuck in what looked like a dildo with lights. "Third-degree hemorrhoids," he said. "You need a specialist, probably surgery."

Hemorrhoids are classified into four categories. First-degree hemorrhoids protrude into the anal canal and bleed slightly. Second-degree hemorrhoids prolapse (slip out) during evacuation. Third degree hemorrhoids prolapse but require "manual reduction" (shoving the hemorrhoid back in with your fingers). Fourth-degree hemorrhoids are "incarcerated" (meaning, you're headed straight for the surgery table).

When I arrived at the specialist, I blanched at the sign on the door: "Colon and Rectal Surgery." There are no grand entrances through a door like that. One doesn't walk in as much as slink in. There were eight or nine people waiting, carefully avoiding eye contact and shifting painfully in their seats.

Next page | In the office of a rectal surgeon, ordinary gestures are pregnant with meaning