#11: Grapes of Wrath
“Guide the applicator deep into the rectum and whilst holding the bottle obliquely, squeeze slowly…”
Who the fuck says obliquely?!
I know that the instructions want me to hold the enema at an angle, but why not say, “hold it at an angle” instead of making people feel like they need to recite Shakespeare whilst sticking it up their bum?
*Holds up a discarded enema bottle*
“Alas, poor Yorick! I knew him, Prednisolone…”
It was the fourth night of taking daily enemas, and things had reached a bum note. The steroids hadn’t turned me into a mixture of rage and micro penis, but the enemas were having mixed results. The enemas are supposed to be taken before bedtime, with the mesalazine liquid staying in your colon overnight (or at least a few hours), but gravity (and guts) seemed to make this a near-impossible task.
I’d downloaded the instructions for the enema, as none came with the box. I’d imagine because it’s a pretty obvious procedure to anyone: stick the long bit up there, and squeeze the squeezy-looking end.
There are a few subtle nuances and knacks to it, though, like keeping it at an angle, so I’d found the appropriate version of the instructions online and read everything, just to be sure. The last thing I wanted was it to come spraying out of my nose from squeezing too hard…
As a final kicker to make it a little less rubbish (because doing enemas is, at best, ‘character building’), I decide to take a leaf out of the Van Wilder: Party Liaison playbook and play some Barry White whilst going through the - ahem - motions, because I might as well make a shituation* funny, right?
(It worked, too. If you’re ever presented with the opportunity, I suggest you try it…)
* (Literally) shit situation = Shituation. What do you mean it's not a word?!
Just So We All Know:
As mentioned in Meet Balls, enemas are a liquid or foam used to treat the lower parts of the colon and rectum. Enemas are particularly useful in targeting areas of the colon and rectum that are difficult to reach with medicines taken orally, or through a vein.
Enemas are inserted through the anus using a specially designed applicator. In the picture below, you can see that the applicator has been designed to allow the patient to squeeze the correct dosage of liquid when ready.
An enema treatment can come in both liquid or foam form, and usually administer either steroids or aminosalicylates (5-ASAs, otherwise known as Mesalazine) to the affected areas. According to Crohn’s and Colitis UK, “Foam enemas are often easier to retain than liquid enemas so can be particularly useful at the beginning of a flare-up, when the gut is most sensitive. Liquid enemas can usually travel further along the colon so will reach more of the inflammation.”
Using an enema can also reduce the likelihood of side-effects to the patient, as the administered drug avoids traveling through the bloodstream.
Note: If you buy multiple prescriptions, it may be worth looking into Prescription Prepayment Certificates (PPC).
'Roid Rage, Pt.2
Night number four, however, was to be particularly problematic. The internal monologue of this particular enema went something like this:
“Okay, here goes… OW. Hang on, it won’t go in. OW. No, still not going in. Am I doing this right? OW! Okay, let’s try a more oblique ang– OW, DAMMIT! “My daaaarlin’ I, can’t get enough of y-OW.” NOOOOPE. NOOOPE. NOPE. NOPE. NOPE.”
A brief, unflattering moment with a mirror later, and there appeared to be something new where the enema was supposed to go. Ah. Hello haemorrhoids, it’s nice to meet your acquaintance…
Just So We All Know:
Haemorrhoids (or piles) are a collection of blood vessels found inside the rectum and anus that act as ‘cushions’ to aid the passing of stool.
When someone goes to ‘do a poo’, the slight increase in pressure to the area allows the haemorrhoids to enlarge slightly, providing a better ‘cushion’ for your rectal and anal areas as the poo passes through.
Occasionally, a person’s haemorrhoids can become swollen or inflamed. In many cases, the change to the haemorrhoids will go unnoticed and won’t cause any symptoms.
However, when there is a change, they may include:
- Bleeding after passing a stool – the blood is usually bright red.
- Itchy bottom.
- A lump hanging down outside of the anus, which may need to be pushed back in after passing a stool.
- A mucus discharge after passing a stool.
- Soreness, redness and swelling around the anus.
Haemorrhoids aren't usually painful, unless their blood supply slows down or is interrupted.
Although doctors still aren’t sure on what exactly causes a haemorrhoid to become inflamed and swollen, there are a number of factors that can increase the chance of piles occurring. These include:
- Prolonged straining on the toilet (often due to a lack of fibre/constipation)
- Chronic diarrhoea
- Being overweight or obese
- Age (the older you are, the more likely you are to have piles)
- Pregnancy (increased pressure on your pelvic blood vessels - although they often get better after birth)
- A family history of haemorrhoids
- Regularly lifting heavy objects
- Having a persistent cough or repeated vomiting
- Sitting down for long periods of time
Haemorrhoid symptoms will often settle back down after a few days without any medical intervention, but there are a number of lifestyle changes that can help reduce the chances of inflamed haemorrhoids.
A gradual increase of fibre in the diet, drinking plenty of fluid (water, not caffeine/alcohol), going to the toilet when needed (as opposed to delaying it), avoiding medication with constipation symptoms, losing weight and regular exercise are all good, preventative measures.
The most common medical treatment for haemorrhoids is medication (in cream or tablet form). There are a few additional options available for more severe haemorrhoids, including banding; a non-invasive procedure that allows the haemorrhoid to safely fall off after a week or so. The most extreme cases may need surgery.
Losing My Sanitary
Although it felt like I was picking up almost as many stupid things on a daily basis as a YouTube comments section, getting piles did (regrettably) make sense. A crude piece of maths worked out that it was possible I could’ve gone to the toilet about 360 times in a month. THREE HUNDRED AND SIXTY.* For some iron-bowelled types, that’s nearly half their yearly outgoings...
* Method: 12 toilet trips a day (on average) for 30 days.
Going that many times that soon can also bring some additional issues. Whether it was down to the constant trips, dehydration, or other/both, my body had begun to unexpectedly strain and spasm when sat on the loo: a symptom that is both horrible to envisage, and hideous to go through. It was the bottom-end’s version of a dry-heave, and it undoubtedly added undue stress.
With the new inner inhabitants taking up rectal residency, it spelled a premature end to the nightly enemas, which was both blessing and curse. ‘Good’, because… well… no more enemas (plus my Barry White impression is pretty poor at the best of times), but ‘Bad’, because they were supposed to help calm things down, and stopping it left me feeling vulnerable. Plus, it made me feel like a bad patient for sacking it off, despite the obvious butt blockade.
All of this made the inevitable call to the GP’s for a home visit about as enjoyable as actually having piles. By now it was becoming the norm to have difficult - but understandable - phone calls with health service professionals, but when another string of conversations through gritted teeth provided an opportunity to chat with my GP that afternoon, I made myself (un)comfortable and awaited their response:
GP: “If the piles haven’t calmed down in 24hrs’ time, call back and I’ll arrange a visit.”
(Yeah, good luck with that – it looks like I’m trying to give birth to a couple of large marbles down there…)
GP: “There is one other thing that you could try, though…”
GP: “Erm, yeah… *nervous laughter* You could - as I’ve heard of this method before, but it’s entirely up to you - try freezing a sanitary towel and use that to help ease the swelling…”
Me: “…A frozen sanitary towel?”
Me: “…Yeah, alright. Don’t see why not. If it works, it works…”
Later that day, sanitary towels were bought (complete with nonsensical 5% VAT), frozen, and applied…
…and it didn’t work.
Fortunately, we had another backup plan in place (the old ‘crushed ice cubes in a bag’ technique), but after a few incidents (holes in said bag causing water to go everywhere; risk of frostbitten bum), it was tweaked into a half-decent compromise (crushed ice cubes in a bag, in a sock) and created a new meaning for ‘putting a sock in it’ in the process. The sanitary towels were used to mop up any water from the socks*, while future pairs of frozen socks were made and put in the freezer, which, on passing inspection, can really make you look like you’ve lost your fucking mind.
* It’s probably as close as I’d ever get to recreating the ‘blue liquid’ in the sanitary towel adverts…
The day passes, and despite my backside resembling the Antarctic landscape, there’s been little progress. A GP arrives in the late afternoon, and has the unenviable task of having to check for piles* in a patients’ bedroom, which, if you’ve never had to experience it before**, is unbearably awkward. Before leaving, the GP says that they’ll inform me if they can prescribe a strong cream instead of the suppositories, and leaves me to my frozen sock collection.
* At this point, I start to think I genuinely might be giving birth to a baboon’s arse…
** I’m on my own with this one, aren’t I?
I was also being left with the constant iterations of aches, cramps, chills, fatigue, hunger – and now, a wet backside.* The amount of times I visit the toilet increases (15 times), and I begin to cover my face with a towel upon every return trip, as the smell (eugh) reaches putrid levels. Not only do I think something’s crawled up my arse and died (baboon, maybe?), I’m pretty sure it’s taken my intestines with it, too.
* I’ve never worn an adult nappy, but trying to run to the loo with a bag full of ice cubes in your boxers (probably) provokes similar vibes. I quickly realise that tucking the top of the sock into my trousers stops it from falling out when moving, which (briefly) makes me feel a bit clever..
The unmistakable sensation of blood infrequently leaving the body in a hot stream when sat on the throne does nothing to quell those thoughts…
There’s further signs of deterioration after glancing at my face in the mirror: the outline of my skull is becoming ever present, and a plethora of never-seen-before veins are beginning to appear on the forehead. The dark circles around my eyes now show signs of shadows blended with overtiredness, and further down, peeking under a slightly-baggier t-shirt, my ribs are becoming easier to spot.
Elsewhere, my arms and legs are slowly losing the small areas of definition they had, while my lower back continues to ache chronically from the constant toilet trips. The joints in my fingers and toes have started to seize up if they’re left in any static position for longer than a few seconds, while foot cramp creates merry hell whenever either of my big toes is stationary for a matter of minutes.
Despite the abdominal torment, it was these cramps and fused joints that caused the most amount of distress. Their acute, erratic pains were the cherries on top of a month of attrition that now stretched to the extremities of the body. Living in constant dread of needing the toilet as the piles continued to show no signs of abating was pushing my resolve to new limits.
Twenty-four hours passed with no news from the GP. Lying down was now the only possible way to stay comfortable, as sitting was out of the question – not that it particularly bothered me. The ultrasound for my ballbag baby is due the following day, but by the Saturday morning (and after going to the toilet almost every hour overnight), I was in no fit state to travel.
Another difficult phone-call is made - this time the ultrasound department. I apologise profusely and feel awful for having to postpone at the 11th hour. Somebody else could’ve used that spot. I finish the call and meekly hope they find a patient in time.*
* I also have to miss a football match. Priorities, I know, but little disappointments begin to gain extra significance in moments like these. I’m given a programme from the match later that night, and I can smell the matchday on every page like a lucid dream.
When taking prednisolone, you’re told to take your entire dose in the morning with your breakfast, so that it doesn’t upset your stomach or keep you awake at times when you need sleep, such as after a big lunch/before bedtime.
Predictably, this means that the prednisolone is at its peak powers during the day before tailing off into the evening. For me, this was particularly tough to get used to, as it often felt like my body stored up its worst intentions for the evening, like a shit-flinging gremlin.
On this particular night, things became even worse.
Midnight had long since gone, and I’d already spent the past three hours incessantly trudging back and forth from the toilet. A few minutes of light sleep would be caught before I’d begin the journey once more, each time with added despair. Exhausted, my Mum had to prop me up while I sat on the toilet. At that moment, I felt that I could (literally) give no more.
Well, that’s what I thought…
As I’d been going to the toilet so often, Mum and I decided that having a protein shake at this point could be a good idea. First, it was liquid, so it could pass through the large intestine without causing a ruckus, and Second, if the body even took on a small amount of nutrients from it, then that’s surely a good thing, right?!
On any other night, it probably would’ve been a great thing; but as this was early Sunday morning, it was a bad thing. A very bad, “throw it back up almost immediately because, in your desperation to ingest something, you’ve drunk it far too quickly” thing.
During the years, I’d always been a little bit proud about my lack of being ‘properly’ sick – I went a number of years without as much as a dry heave, and (probably) added it to a covering letter for a job once when in the frenzied throes of a fugue state – so to find myself in this predicament was further confirmation that things weren’t well.
Once my body had been reminded of such evacuation procedures exist, it promptly carried on doing it: so much so, in fact, that the stuff coming ‘up’ looked the same as the stuff being flushed ‘out’, leaving me in an unenviable position of recalling - and giggling - about an episode of South Park where Cartman manages to crap out of his mouth to win a bet, while bringing up stuff that looked worryingly like coffee granules, or to use an appropriate name: blood.
We had to call 999 again.
In the early hours of Sunday morning, before the sun arrived late in the sky, we rung 999 again for the second time in a month. Due to my condition, Mum (again) had to call 999, and explain why someone who was experiencing vomiting and sickness needed an ambulance. I yelled toward the phone to correct the operator who thought I was going to the toilet fifty times a day. Even in my current state, the idea of going fifty times sounded absurd.
Mum decided it was a good idea to keep some of the sick for the paramedics to see when they arrive (not for them to keep as a present, but to help them with their diagnosis), and I’m told not to eat or drink anything until further notice. We pack a few essentials into a bag in expectation, rather than hope.
I’m propped upright in bed again, and wait for help to arrive.
THE SONG SUPPOSITORY
Joining the Good Ship Song Suppository this week are:
A double-barred blast of Cold As Ice, thanks to the original (Foreigner) and the expertly covered version (M.O.P.), a slab of oft-unheard Iron Maiden (Public Enema Number One), yet another track by Foo Fighters (Skin and Bones), and a beastly bit of Queens of the Stone Age (Sick, Sick, Sick) to cap things off.
Click on the Spotify playlist below to set sail on the ultimate Stool mini-soundtrack experience!