Coloproctology (COLON CANCER + BUTT FUN) with Carmen Fong

So, you don’t want colon cancer, but you DO want buttsex secrets? Have we got an episode for you. Coloprotocolgist Dr. Carmen Fong charms us in a brand-new episode about prostate orgasms, shady polyps, fibermaxxing, colon cancer branding, butt plugs, heartburn, douches, bidets, farts, vacation constipation in the nation, ostomy awareness, second sphincters, Crown Jewels, pregnancy agonies, ‘roids, fissures, fixes, endometriosis, diverticulitis, IBS, hydrotherapy, a shocking shower revelation, and how a blissful colonoscopy could change and save your life.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Alie Ward?

  Oh, hey, it's the fitted sheet that really doesn't care how you fold it. Ally Ward, welcome to Ologies. I'm proud of you for listening to this one. It might save your life, or it might make you horny. We'll see. Either way, this guest is thrilling. They are a colorectal surgeon and the author of the acclaimed book, Constipation Nation: What to Know When You Can't Go. They have been decorated with so many medical awards. They got their M.D. at Michigan State University. They did their surgery residency at Mount Sinai Beth Israel, then a fellowship in colon and rectal surgery at Stony Brook, and is a double board certified general and colorectal surgeon in private practice as a co-director of the Hemorrhoid Centers of America. They're so funny, so charming.

• 0:44Alie Ward?

  No question is too sensitive, and you need to send this to everyone you know with a butthole, even your grandparents. You think your granddad never had a finger up his butt? I got a bridge to sell you. It comes with a free deal, though. But first, thank you to everyone who at patreon.com/ologies for supporting the show for a dollar or more a month and submitting your questions. Thanks to everyone out in Ologies merch from ologiesmerch.com. And as always, thanks to the folks who review the show for me to read, which helps people discover it so much. This latest one is from S.R. Forstner, who wrote, "One minute I'm learning about volcanic lightning, the next I'm emotionally invested in salamanders." S.R. Forstner, thank you to that, and thank you to sponsors of the show who make it possible for us to donate each week to a related charity. How's your ponytail looking?

• 1:29Alie Ward?

  Maybe like a little thinner than it used to? We've talked about this in our menopause episode. At some point, it's bound to happen to all of us. So if you're ready for thicker, fuller hair, start your free online visit today at forhers.com/ologies for personalized care. So that's F-O-R-H-E-R-S.com/ologies. Individual results may vary. Featured products include compounded drug products, which the FDA does not approve or verify for safety, effectiveness, or quality. Prescription required. Price varies based on product and subscription plan. See website for full details, restrictions, and important safety information. Picture this: years of guaranteed research support and a vibrant scientific community that has your back.

• 2:10Alie Ward?

  You are a PhD student, postdoc, or early career faculty in the biological or biomedical sciences. That doesn't have to be a fantasy. HHMI has a program for you. The Howard Hughes Medical Institute supports scientists at every career stage with a people, not projects, approach, long-term support, and the resources for breakthrough science. Application's open now. You can find your program at HHMI.org/ologies. Father Ward, you say, there's no way you would need a career coach. You have it all together. That's a lie, and you know it. I actually hired a career coach, and without them, I wouldn't have started Ologies. It was one of the best investments I've ever made. And if you're like, I don't know where to find a career coach, I can help you.

• 2:53Alie Ward?

  You need an experienced pro who asks the right questions, sets you down a path where you're most likely to succeed. And that's what you can expect from a coach at today's sponsor, strawberry.me. This is so cool. They match you with a certified coach who's been vetted to work closely with company founders. And yeah, sometimes I'm like, oh, wait, that's right, I am one. And if you're founding a business, even if you're along the way and you're maybe stuck in a rut, or you have to make a decision about expansion, or what direction you want to take your company, that's what I did. I went to strawberry.me and I was like, okay, can you help me pare down some stuff? I think I have too much on my plate. I'm not sure what to say yes to and what to say no to. And they were super helpful in helping me streamline, and now I get to sleep more, and I enjoy that.

• 3:37Alie Ward?

  So get the help every entrepreneur needs. Go to strawberry.me/ologies. That's strawberry.me/ologies. You're the boss. Okay, come along with me into the world of your colon. Also, I did an episode a few years ago called Field Trip: My Butt, A Colonoscopy How-To and Ride Along. And since so many of you will be listening to that one next, we're going to re-release it this week as a bonus episode, because I've gotten so many letters from listeners the past couple of years that told me that it helped them catch and treat diseases, including cancer. So we're going to link that, re-air it. But colon comes from the Greek kolon, which means colon, and proctology derives from the Greek for anus. So coloproctology.

• 4:20Alie Ward?

  We get deep, sit tight, or walk around for prostate orgasms, shady polyps, colon cancer branding, hot dog habits, endometriosis, diverticulitis, butt plugs, heartburn, douches, bidets, farts, vacation constipation in the nation, fibromaxing, ostomy awareness, second sphincters, the most fascinating crown jewels, pregnancy agonies, roids, fissures, fixes, IBS, hydrotherapy, a shocking shower revelation and how a blissful colonoscopy could change and save your life with surgeon, author, earthly delight, and coloproctologist Dr. Carmen Fong. I love her.

• 5:18Speaker 01

  We're vibing.

• 5:19Alie Ward?

  We're vibing, dude. There's so many questions. I hope you know how excited people are to learn about butt health.

• 5:25Speaker 01

  I can imagine, honestly.

• 5:29Alie Ward?

  I mean.

• 5:29Speaker 01

  I listened to your colonoscopy episode and I loved it. And I was like, oh my God, everybody needs to listen to this colonoscopy episode before they go in. And then I was like, I'm actually surprised you haven't talked to like a gastroenterologist or like a, you know, proctologist, but yeah, people love guts.

• 5:44Alie Ward?

  Okay, hold on, let's back up a sec.

• 5:47Speaker 01

  Oh yeah. My name is Carmen Fong and my pronouns are she, her, they.

• 5:50Alie Ward?

  Cool. Okay. Gastrontology, proctology. Can you disambiguate this for the uninitiated?

• 5:59Speaker 01

  A hundred percent.

• 6:00Alie Ward?

  Okay.

• 6:00Speaker 01

  So I'm a colorectal surgeon and I guess that does get confused with GIs a lot. And of course they do colonoscopies and like really advanced endoscopic procedures and things like that. But they're technically not surgeon surgeons. So the training is actually the same amount of time, but we are more doing a lot of like the abdominal operations. Most of us will actually also do colonoscopies. But the one major difference is that colorectal surgeons do a lot of anal rectal stuff, which is like true proctology.

• 6:26Alie Ward?

  Oh, does it stop if you're a gastroenterologist once? You're no longer in the intestines. That sphincter, is it the sacral?

• 6:37Speaker 01

  The ileocecal valve. Right.

• 6:39Alie Ward?

  Thank you. So that's the valve or the gate between your small intestine to your large intestine. And a large intestine is also called a colon. There's a few different regions of your colon. And I also wonder if people called it intestinal cancer instead of colon cancer, if they would be less shy about screening or treatment. We can start calling it intestinal cancer and start a trend or revolution, a bowel movement, if you will. Once it crosses that barrier, is that like a different jurisdiction?

• 7:11Speaker 01

  That's interesting. So, no, actually.

• 7:12Alie Ward?

  Oh.

• 7:13Speaker 01

  So gastroenterologists will scope, like do an upper endoscopy, which is basically the mouth to the stomach. And then you can actually do some like really fancy advanced endoscopy, like a push endoscopy and push through the stomach and go into the small intestine, look through there a little bit. In some cases, we've held with doing like a laparoscopy at the same time, which is kind of a crazy procedure.

• 7:34Alie Ward?

  So an endoscopy, endo means inside, scope meaning look around. It means that you get a camera in your body. And an upper endoscopy, it starts at the mouth and it heads down. And a colonoscopy starts at the other end, goes up. And if they don't use one of those two holes, they may make a little portal through an incision, which is a laparoscopy. So finally, your guts are the main character and you get an exclusive screening for things.

• 8:01Speaker 01

  But then they can go all the way down into the small intestine. And then the other end is, you know, pun intended, they go from the bottom up and they scope from the bottom to the colon. So they can go from gum to bum, the same way that we do from gum to bum. It's just that we end up almost inside the body a lot more, rather than just in the intestine.

• 8:19Alie Ward?

  When you were going through med school, did you have a lot of rotations and did you just land on bust intestines? And you're like, I'm home?

• 8:27Speaker 01

  Oh, my God, no. So I actually went into this because I wanted to be a plastic surgeon because my background is in art. I was a visual artist in college. And so I was like, I'm going to be a plastic surgeon. I'm going to make people beautiful. I'm going to fix. Like baby cleft lips and cleft palates. And to this day, my parents and my aunts rue the fact that I'm not a plastic surgeon. They're like, why didn't you do something useful?

• 8:49Alie Ward?

  How dare you?

• 8:51Speaker 01

  But then now that, you know, they're all older, they're thanking me. They appreciate me now. But then when I went through residency and I was in training, I was like, oh, you know, but I love general surgery. I actually really love being inside the abdomen and being able to like, diagnose and treat and reconnect butts and guts, because I really love being like the master of the abdomen and knowing everything that's going on inside your body.

• 9:12Alie Ward?

  Mm hmm. I've heard recently that when you are getting an operation, they throw your intestines to the side and then they just shove them in there and let them rearrange themselves later.

• 9:23Speaker 01

  Correct.

• 9:23Alie Ward?

  Is that true?

• 9:25Speaker 01

  Yes. So you know, people ask me that a lot. They're like, once you're inside the belly, does it look like that plastic figure where you put the little plastic pieces back in, you know?

• 9:33Alie Ward?

  Yeah.

• 9:33Speaker 01

  And it's not. And then somebody else asked me, like, if you're looking at your colon, is it more like a pipe? But it's actually more like an empty tube sock.

• 9:40Alie Ward?

  Oh.

• 9:40Speaker 01

  So it's like a big cavernous space inside your abdomen and there's empty tube socks, which is the bowels. And then there's the solid organs, which I kind of liken to like really squishy dough almost. Like the squishiest ones are like the pancreas, which you really can just like put your thumb through. But then the harder ones, like your liver. So there's like, you know, squishy pieces and tube sock pieces. And yeah, you just throw it all back in. You don't have to stitch it back to the lining. In the old days, actually, in the 1800s, they actually thought that things had to be stitched back up because when they dissected cadavers, I just read about this, which was crazy.

• 10:13Speaker 02

  Cool. Laying on me.

• 10:14Speaker 01

  When they dissected cadavers, they were always on their back. And so they thought that the organs should be like laying in this, you know, flat plane on your back. But when people stand up, there's gravity. And so things actually kind of all naturally drop to the bottom.

• 10:27Alie Ward?

  So let's say that you haven't eaten, you wake up empty stomach, empty guts or whatever. Does that mean that it's sort of like an empty tube sock or like one of those animal balloons?

• 10:37Speaker 01

  Yes.

• 10:37Alie Ward?

  That you haven't

• 10:39Speaker 01

  Yes.

• 10:39Alie Ward?

  pumped up yet?

• 10:40Speaker 01

  Yep. It's just sitting in the bottom of your pelvis.

• 10:42Alie Ward?

  Mm hmm. And so then when there's food moving through it, then it kind of inflates like a bubble would.

• 10:47Speaker 01

  Yep.

• 10:47Alie Ward?

  Oh, no way.

• 10:48Speaker 01

  Yeah, like a bubble, like what if there's gas, right? Like if you're about to fart, there's gonna be gas. Or if there's stool, it kind of fills up. And so you can actually feel like on the left side of your abdomen, if you're constipated, you can probably feel almost like a little cylinder in this left side of your abdomen. That's your sigmoid colon that's full of poop. When it's full.

• 11:06Alie Ward?

  Okay, so large intestine, the colon, it's kind of like shaped like a boxy horseshoe under your abdomen. So on the right side of your body, it travels north and that's called the ascending colon. And then it takes a turn to travel across your abdomen, over your belly button. That's the transverse colon. And then it takes another turn on your left hand side to head south. And that is your descending colon. And that descending colon is kind of like the home stretch to your bottom hole, which is why massaging that descending colon or laying on your left side can help people poop or it can get the gas out. Also, at the end of this colon tube is the sigmoid colon, which is kind of like the very backstage area where poop waits to make its big debut

• 11:50Alie Ward?

  into the rectum and then out your anus into the glare of the limelight. I always wonder how when doctors are palpating a stomach, how they know what the fuck's going on down there? Cause I'm like, how do you, it doesn't feel like anything. How are you trained to do that?

• 12:06Speaker 01

  You know, that's a really good question. I, I mean, we did a lot, we do it a lot, like in medical school. And I think probably some people still fake it. They're like, ah, you know, this feels like, but um, we are losing a little bit of that, like the art of physical examination because of CT scans and MRIs and all that. I'm just like, ah, scan you and we'll find out what's wrong.

• 12:24Alie Ward?

  Have you ever been called to get things out of a butt?

• 12:28Speaker 01

  Oh, a hundred percent. I knew this question would come up.

• 12:30Alie Ward?

  I'm sorry. I didn't even think I had the question until I was like, wait a minute. How have I not, talk to me.

• 12:36Speaker 01

  Actually, it's a joke that like at 3am, you know, if they call me, it's gonna be like, uh, get Dr. Fong's foreign body extraction tray, because that means that I'm gonna need the tongs and the clamp and the speculum. But yes, I, I have removed some things.

• 12:51Alie Ward?

  Anything that you're at liberty to share, anything really wow you?

• 12:55Speaker 01

  You know, most of it is like a long time ago, but my favorite one was a pink highlighter because my residents still text me to this day and is like, once in a while, she'll be like, remember that pink highlighter? Like, how could we forget? But definitely tons of dildos, you know, and like no sex shaming or anything, you know, do you do you? A ton of dildos and people just kind of like underestimate the length and the width of them sometimes. Throughout the years, we've had like Starbucks bottles, candles, cucumbers. I had like a piece of a lamp once that was like a, like a glass globe.

• 13:31Alie Ward?

  Oh, no.

• 13:32Speaker 01

  That was pretty cool and hard to get out. Like if you try to get like a round, smooth object out of a tight cylinder. Yeah, that was difficult.

• 13:42Alie Ward?

  If you would like to know more about foreign objects rescued from the depths of an orifice, please enjoy our radiology episode. I got two words. Wine bottle. If it's glass, how, I mean, you must need like the gentlest of touches.

• 13:56Speaker 01

  Yeah, gentlest touch, you know, we literally like tried suction, almost like when they suction a baby out, we almost tried that. That didn't work because it was so heavy, but we ended up using, it's called a diver, which is like a little retractor that has like a little scoop on the end and that scooped perfectly around it. We tried every tool in the OR that night.

• 14:15Alie Ward?

  Did you have to sedate the patient?

• 14:17Speaker 01

  They were sedated.

• 14:18Alie Ward?

  Oh, that, I mean, I would be like, wake me up like a month later.

• 14:24Speaker 01

  Yeah. And we, we have that, you know, that full conversation beforehand, like, sorry, we tried to get this out while you're awake. And so, you know, we got to put you to sleep just for your safety. So you're not moving around. And also if there's any kind of complication, right? Because the worst case scenario, if there's some kind of perforation, you know, we puncture the colon or something and we have to fix it.

• 14:42Alie Ward?

  Yeah.

• 14:42Speaker 01

  Then you should be asleep. Fortunately, knock on wood, that's never happened.

• 14:46Alie Ward?

  Uh, do you have a PSA now for, um, for butt plugs with a foot?

• 14:50Speaker 01

  A hundred percent.

• 14:52Alie Ward?

  Important to have a foot at the end of your butt plug, right?

• 14:54Speaker 01

  Have a handle, you know? Make sure there's a handle, make sure you can have a good grab on it if you can.

• 14:59Alie Ward?

  Oh, saving lives, saving pride.

• 15:02Speaker 01

  Saving butts.

• 15:03Alie Ward?

  I'm sorry that that's one that you get asked so much, but.

• 15:07Speaker 01

  No, people want to know, you know? Yeah.

• 15:09Alie Ward?

  Well, okay, so I studied biology in college, right?

• 15:13Speaker 01

  Mm hmm.

• 15:13Alie Ward?

  As a bio major, so. I always think about the order of sphincters and I remember hearing that there were sphincters inside the body and being blown away by that. Just a side note, a sphincter, it's just a round muscle that closes an opening. You have them in your excretory system, such as, for example, your anus, but also all along your intestines to kind of close off chambers. So imagine like a train with doors between the cars and you can think a ton of nerve endings in your lower bowel for being able to discern the pressure of a gas versus a solid and act as kind of a bouncer to let farts through, which means every time you enjoy a fart, you're not pooping most of the time.

• 15:57Alie Ward?

  Aren't you glad you can do that? Of course you are. And one in 5,000 people are born with a condition. It's called Hirschsprung's disease, where those very sensory nerves don't function. Your body can't really tell the difference and sometimes it doesn't want to let anything out and that part of the bowel has to be removed. And that or ulcerative colitis or even Shoggy's disease can also lead to a condition called mega colon, which sounds like a Marvel character, but it's more painful and potentially lethal. So according to the paper, mega colon, acute, toxic and chronic. A constipated and stuffed colon with a diameter nearing five inches is mega, obviously, and can require surgical correction to address whatever the underlying causes are.

• 16:42Alie Ward?

  And there's one legendary patient. It's a man who was so impacted, he was known in sideshow circles as balloon man. And when he died in 1892 at the age of 28, while straining to pass his cargo, the medical examiner found an eight foot long colon, nearly nine inches in diameter and carrying 40 pounds of excrement. And scientists say upon examination now, it's apparent that he had suffered from that Hirschsprung's disease where your nerves are just not on board to let things pass. And I was like, dang, who is Hirschsprung? Who got the honor of being named for this? And it was a late 1800s doctor from Copenhagen and Harold Hirschsprung, he described this

• 17:25Alie Ward?

  And he actually went against orders from the government and he provided free healthcare to children who needed it while charging those who could afford it. And though the Queen wanted each child's hospital bed to be surrounded by biblical passages, he was like, no, hag, I'm putting animal pictures up. Hersprung. I like him. But yet there are sphincters also in your blood vessels, your eyes. Sadly, I just found out, I had to re-record the end of this aside, that your mouth and my mouth have been demoted and they're no longer a sphincter, which is Pluto levels of heartbreak. But all we can do is soldier on.

• 18:04Speaker 01

  So from the bottom, um, from the bottom, so we have the external sphincter, which is actually the part that you kind of feel, right? So I always tell people, like, if you're feeling your anus, like, when you get to the tightness of your anus, that's the external sphincter. That's the part where you have voluntary control, where you're like, oh, my gosh, I have to poop. I'm gonna hold it. That's the part you're squeezing. And then there's just above that, the internal sphincter. The internal sphincter is the part that's involuntary control, which means that your body, actually amazingly, when it senses poop, it will actually kind of close. And there's a response called a rare response, where it kind of senses whether it's poop or gas, so that it can let out gas if it's gas, and it will hold the poop if it's poop. I know, I'm always fascinated by this. There's a couple of rectal valves above that, and then there's the ileocecal valve,

• 18:49Speaker 01

  which is a connection between the colon and the small bowel. And then if you go above that, there's like the pylorus, which isn't technically a sphincter, but that connects the small bowel to the stomach. And then right up at the top of the stomach is the esophageal sphincters.

• 19:03Alie Ward?

  Oh.

• 19:03Speaker 01

  So that's the part that controls your GERD.

• 19:06Alie Ward?

  So if you don't know what GERD is, congratulations. It stands for gastroesophageal reflux disease. It's like wicked heartburn. It's when stomach acid just like pops into your esophagus, like, hey, what's going on up here? Because that sphincter is just on break.

• 19:20Speaker 01

  So if you have like a loose esophageal sphincter, you have really bad GERD. Because when you lay on your back, you know, everything kind of like sloshes back up. Or if you're pregnant, it relaxes your esophageal sphincters and everything kind of sloshes back up.

• 19:32Alie Ward?

  Oh, that's why that happens?

• 19:33Speaker 01

  Mm hmm. Yeah, well, it's the pressure from your abdomen, but also the relaxin, which is the hormone that relaxes all your muscles to allow you to fit the baby, relaxes everything else. It's kind of crazy.

• 19:45Alie Ward?

  And you mentioned before we started recording that you've been pregnant. You're wearing a shirt right now that says got hemorrhoids.

• 19:51Speaker 01

  Correct.

• 19:53Alie Ward?

  Question mark.

• 19:54Speaker 01

  Yeah.

• 19:55Alie Ward?

  Where are the hemorrhoid, which sphincter are the hemorrhoids? Where are those coming from?

• 20:02Speaker 01

  That's an excellent question. So technically, there's two kinds of hemorrhoids. There's internal hemorrhoids, which start just above the dentate line, which is like almost at the internal sphincter.

• 20:11Alie Ward?

  So the dentate line is like a border between your anus and your intestines. And it's usually just kind of a faint line, but it is like a border on a map. So much so that medicine often refers to it as a landmark. And depending on your interest, it can be a fun tourist destination for fingers and other objects. More on that later.

• 20:32Speaker 01

  So internal hemorrhoids, you can't feel because there's no sensation. You feel pressure, but not sharp pain. And so internal hemorrhoids tend to prolapse, as in they pop out of your anus, they can bleed, they can cause pressure and a little bit of itching, but generally not painful. So I usually say, you know, internal hemorrhoids are painless bleeding.

• 20:48Alie Ward?

  So that's inside your hole.

• 20:50Speaker 01

  And then there's external hemorrhoids, which start at the dentate line, kind of where the sensation is like, and I compare this to being like literally on the skin. So external hemorrhoids are the ones that you can feel. There's like a little bluish purplish lump on the outside. You get those residual external hemorrhoidal skin tags after the external thrombosis goes away. And that's external hemorrhoids, which tend to be more pain and not bleeding. And then there's also something in between, which is an anal fissure, which people ask me a lot about, and that really commonly gets mistaken for hemorrhoids. And you get both pain and bleeding, but that's more of a sharp paper cut pain because it's literally a tear at that dentate line. So right between the sphincters.

• 21:28Alie Ward?

  So a fissure, it's like a crack or a tear inside there. And it can happen from straining or dehydration or lack of fiber, which we're going to address a lot in a bit, or some other bowel changes. And if fissures are ruining your life, treat your butthole gently, take a stool softener, drink more water, maybe consult an Etsy witch, whatever it takes. But as for roids, about 5% of younger people tend to get hemorrhoids, but 50% of folks over 50 do because of tissue weakening. It's like if you drove an older car, you're going to have some seals, some hoses are going to underperform. True or false, more people are having hemorrhoids younger because they're sitting on the toilet scrolling. Is that true?

• 22:10Speaker 01

  A hundred percent, yes.

• 22:12Alie Ward?

  Is that real?

• 22:14Speaker 01

  Yes.

• 22:14Alie Ward?

  Tell me everything.

• 22:15Speaker 01

  Yeah, so, I mean, part of the reason I wrote this book was that I was seeing so much more constipation, so much more hemorrhoids. And right during the COVID pandemic, people were still coming in for hemorrhoids like three, six months afterwards. And I was like, wow, like, the amount of hemorrhoids is like skyrocketing. And, you know, we thought it was because people were sitting at home a lot more, right? So they were working from home, they were sitting in front of the computers eight hours a day. So a lot more sedentary lifestyle. And then on top of that, a lot of people were like drinking and eating junk, you know, not gonna lie, that was me as well.

• 22:46Alie Ward?

  Yeah.

• 22:47Speaker 01

  And so they were like constipated too, on top of that, and spending more time in the toilet. So, yeah, no, hemorrhoids are not a disease of the old anymore. Like, tons of people have it. I see tons of people in their twenties, thirties, forties, all the way up.

• 23:01Alie Ward?

  And do over the counter things like tux and Preparation H, do those actually work? And do you, have you heard, speaking of plastic surgery, have you heard of people using Preparation H under their eyelids when they're puffy, like beauty contestants?

• 23:13Speaker 01

  Yes. So actually, that's the only thing I think Preparation H is good for is for p- is for puffy eyes. Honestly, I, I know, sorry Preparation H. I don't love it because what it does is the Preparation H can kind of thin, or shrink the blood vessels, but then it also thins the skin. And so a lot of people, when they're trying to apply this for something that's like itching, burning, bleeding, blah, blah, very small instances, I've seen it work. And then I end up seeing, again, pun intended, the end result of Preparation H not working, where people come in, they're like, oh, my God, this is worse, this is itchy, this is bleeding, this is scratchy. Part of it is just like over application, it's kind of like thin the skin over time. And then also like tux wipes, sorry, tux.

• 23:59Speaker 03

  Hemorrhoid flare up. To relieve that painful burning on contact, get Tux Medicated Pads.

• 24:06Speaker 01

  It soothes it a little bit, but it doesn't heal it. Better things to use are a compound ointment. Find a colorectal surgeon who will prescribe a compound ointment. And it actually works a lot better because it's treating both the sphincters and the spasm, as well as the swollen blood vessels.

• 24:21Alie Ward?

  What's in a compound ointment?

• 24:23Speaker 01

  Yeah, so compound ointments include things like nitroglycerin, calcium channel blockers like dolutazam and nifedipine, also some lidocaine and some papivacaine, so some long and short acting like numbing agents. And then in some cases we'll add hydrocortisone, which is like the steroid which helps with the inflammation, but also thins the skin. But the key ingredient is really that muscle relaxation. It allows all those swollen blood vessels to reabsorb back up a lot better and then also decreases the spasm in your anus, which is like the secondary result of having hemorrhoids. Your body clamps down as like, eh, don't move. I don't want anything to move. This hurts. That clamping is what makes everything worse.

• 25:02Alie Ward?

  What about hemorrhoid surgery? That has, sometimes you've got to pull out the big guns?

• 25:05Speaker 01

  Yes, absolutely. So, you know, when we're trained, we actually learn like eight to nine different ways of treating hemorrhoids, which is crazy. Yes. Yeah. We can laser them. We can do infrared coagulation on them. We can inject them with a phenol solution, which kind of shrinks them down. We can tie them up, you know, either with stitches. And then the most common things though are rubber band legation, which is like banding a hemorrhoid. And then the excisional surgery, which is like the dreaded surgery that nobody ever wants and kind of always, you know, they fear on Reddit, from what I've heard.

• 25:37Alie Ward?

  Let's saunter over to the Reddit forum about hemorrhoids, where anonymous souls share their agony. And on a thread titled, "What's Worse Than Hemorrhoid Surgery? Getting Chicky With It," a survivor of hemorrhoid surgery wrote, "I have been through cancer, chemotherapy, immunotherapy, and a double mastectomy. I have had my gallbladder out and chronic back pain surgery. Bad enough I can barely walk at times. I had one baby vaginally and I had triplets via C-section. The recovery from the hemorrhoidectomy was

• 26:09Alie Ward?

  More painful than any of those things. And shy David zero zero chimed in. I was crying from the pain, even on maximum doses of painkillers. Fainting on the toilet, not sleeping for days, not fun, but shy David says, worth it 100%. Well, the problem is, is like, unlike putting your arm in a sling, like you have to use your butthole every day.

• 26:28Speaker 01

  Yes.

• 26:29Alie Ward?

  For something.

• 26:29Speaker 01

  You could be me. That is exactly what I tell people. Like if I cut a nodule off your hand, I can slap a Band-Aid on and be like, hey, don't touch it for two weeks. But it's your butt. And so you have to sit on it. You have to poop on it. The really bad pain is usually the first three or four days because your body actually swells a little bit before it gets better. So the really bad swelling is the first three or four days. And then by the end of the first week or two weeks, your body actually kind of goes back down to normal. Most of the dissolvable stitches have dissolved. And then it just feels like, oh, you're like uncomfortable, but it's not like a sharp cut on your butt pain.

• 27:03Alie Ward?

  What do you feel like are some of the most common reasons people say Dr. Fong, take a look at me?

• 27:09Speaker 01

  Yeah, I think bleeding and pain. So pain and bleeding are usually the most common reasons people come in. Especially if it's like bleeding where it's like a ton of blood. That's really scary, totally understandable. And you want to go get it checked out, especially with like the rise of early onset colorectal cancer. So I'm always like, if you have some bleeding, that's like outside of normal range, which for most people, any bleeding is outside of normal. It's like something that has to get checked out. Just go get it checked out. So if there's bleeding and it's painless bleeding, I usually have to band the hemorrhoids, which is like a quick, really minimally invasive, painless procedure. It takes like 20 seconds and it does work. It bands the hemorrhoids. It kind of squeezes them, makes them, you know, die and dry out. They fall off within a couple of days and that hemorrhoid column is actually gone, like that blood vessel is gone. So it can't bleed. I can't swell anymore.

• 27:51Speaker 01

  So that's your bleeding. The painful part, that is usually because of fissures. And so if it's a fissure, I treat it with a couple of things, either with that topical compound we talked about. Lately though, in the last 10 or 15 years, we've actually been doing a lot of Botox injections into the sphincter. Yeah. So I know, I love it. The same stuff that works in your wrinkles, you know, you can put it in your internal anal sphincter. Okay. Sounds good. Very low risk of incontinence, but it actually really, really works. Like 85 to 88% of the time, people do not need the traditional internal sphincterotomy surgery, which is where I have to cut the whole muscle to relax it. It works. People are like, oh, my God, thank you. My fissure is healed. It's gone.

• 28:28Alie Ward?

  No. Is that covered by insurance?

• 28:32Speaker 01

  It is. It is. Yeah.

• 28:34Alie Ward?

  Are they like, as long as you've got the vial out?

• 28:37Speaker 01

  Oh, OK. The number of times people ask me that, they're like, can you just put a little up here? Into my crow's feet right here?

• 28:45Speaker 01

  Oh, my gosh. The only problem is I never have any left. Like, I usually put every last drop into the internal anal sphincter. And yeah, insurance covers it.

• 28:52Alie Ward?

  Nice.

• 28:53Speaker 01

  Botox for your butt. Yeah.

• 28:54Alie Ward?

  Well, bleeding is a huge question, though.

• 28:56Speaker 01

  Mm hmm. So what amount of bleeding is normal?

• 28:59Alie Ward?

  Yeah, because so many people, especially, I mean, also, an absolute ramp up to a soapbox here on colorectal cancer in younger people and when to start getting colonoscopies, all of that stuff, because so many people ignore

• 29:14Speaker 01

  Yes.

• 29:15Alie Ward?

  symptoms like bleeding, or they think it has to be bleeding in order for it to be cancer. So, yeah, you see blood on the teepee.

• 29:22Speaker 01

  Yes.

• 29:23Alie Ward?

  What the hell do you do?

• 29:24Speaker 01

  Blood on the feet, go get it checked out. You know, so if you see a little blood on your toilet paper and it was provoked, so say you like, you know, you feel a lump on your butt. You recently went on like an eight hour car ride or a 16 hour plane ride. You know, you were traveling and you got constipated. You see a little blood. It's most likely nothing to be alarmed about, right? So 89, 90% of the time, rectal bleeding is truly because of hemorrhoids or anal rectal disease. I would still say, though, if you're seeing it for the first time, most of the time, hemorrhoidal bleeding is self limited and it will stop in about two to three days. If it keeps going, 100% get it checked out. If it recurs, 100% get it checked out. And then if it wasn't provoked, you would want to get it checked out, right? So bottom line is, most of the time, like even if you're young,

• 30:09Speaker 01

  don't ignore rectal bleeding. At least have someone look at it. And that's like my soapbox, which is that like, you go to a lot of like providers and sometimes we're like, here's some hydrocortone and like, you know, we think it's hemorrhoid, but just make sure someone looks at it.

• 30:21Alie Ward?

  OK.

• 30:21Speaker 01

  That's all. And then colonoscopy wise, right? So as you know, like the age is forty five now. We've decreased it in the last couple of years, which is awesome. You know, decrease the screening age from fifty to forty five.

• 30:32Alie Ward?

  Nice.

• 30:32Speaker 01

  Which means that, you know, we're catching more people, but now that we're still seeing a ton of people who are developing cancer in their twenties and thirties. The youngest I've seen is twenty eight, honestly. Yeah. And it was like, super, super sad, but I've seen a ton of people in their like thirties, like thirty five, thirty eight, thirty nine. And those are before the screening age. So just to throw out there, the difference between screening and diagnosis, right? So screening means you don't have symptoms and you're still getting checked out because you can have small polyps inside your colon that can be precancerous, like yours, right? Um, and develop into cancer and you want to catch them early and remove them so it doesn't turn into cancer. So that's what screening is for. But the diagnosis part is when you already have symptoms. And then in those cases, you're already having like abdominal bloating or some constipation, some bleeding.

• 31:17Speaker 01

  And then so you actually go in for a diagnostic colonoscopy to see what they can find. I would see the problem though, sometimes is that in younger people, these colonoscopies aren't getting covered unless you have very, very good reason. And then obviously it's like a whole insurance issue that I fight with insurance all the time about.

• 31:34Alie Ward?

  There's also genetic links as well, right? So if someone, like my dad died from colon cancer.

• 31:40Speaker 01

  I'm sorry.

• 31:40Alie Ward?

  And, you know, it was funny. He was like, well, you know, I had, uh, black stools and I, I didn't, I didn't think much about it. He thought it was just related to his chemotherapy, but he had multiple myeloma and then a side effect of the chemotherapy was on colon cancer. I feel like everyone should know having colon cancer and what you have to deal with. And also like the indignity that you have to deal with is so much worse than a colonoscopy. Like

• 32:06Speaker 01

  A hundred percent.

• 32:07Alie Ward?

  If you're embarrassed by a colonoscopy, uh, like just wait until you try to deal with colon cancer.

• 32:12Speaker 01

  Right. Yeah.

• 32:13Alie Ward?

  What?

• 32:13Speaker 01

  Yeah.

• 32:14Alie Ward?

  You know?

• 32:14Speaker 01

  Exactly. Yeah. Or like, a lot of people would be like, you know, uh, the embarrassment of dealing with an ostomy. Which, you know, for me, I try to de-stigmatize ostomies as well. It's like sometimes just like a very temporary thing, but a very necessary thing that can be life-saving. Especially if you're like removing like a cancerous portion of the colon or a portion with Really bad diverticular disease and it's like the safe thing to give you a temporary ostomy. And then in some cases, it's like a permanent ostomy. Anyway, okay, I digress.

• 32:39Alie Ward?

  And an ostomy, if you are not familiar, it's a detour for pee or poop to leave the body. So let's say that your lower intestines are permanently or temporary closed due to construction. So a surgeon can make a new opening in your abdomen to have waste leave the body into a sealed pouch that you can empty periodically. And sure, I hear you. An ostomy, it may not be on your birthday wish list, but it can save your life. And while there has been stigma around them, there are so many creators online, I've seen a bunch that are showing it's really not that big a deal. You get used to it, you live with it because nobody doesn't make poop. But if you want to avoid a colon cancer ostomy, or chemotherapy, or surgery, or death, get checked. When it comes to catching cancer

• 33:24Alie Ward?

  in early incredibly treatable stages, a colonoscopy is a cakewalk, man.

• 33:29Speaker 01

  It's a cakewalk.

• 33:30Alie Ward?

  It is like the easiest thing that can happen to your butt.

• 33:33Speaker 01

  Yeah.

• 33:33Alie Ward?

  Like ever.

• 33:35Speaker 01

  And you get a really good nap.

• 33:36Alie Ward?

  You get the best nap of your life and also you have free reign to go enjoy the best breakfast ever. The waffles I ate after my colonoscopy were the best I've ever had.

• 33:49Speaker 01

  Best you've ever had. And then like the peace of mind you get with, you know, with having like a clear colon and then you're like, hey, your colon's good and you get another 10 years before you have to do it again. It's kind of like jury duty. You get like that peace of mind for a few years.

• 34:03Alie Ward?

  But I'm wondering too, like these rates of young people with colon cancer, I know that Chadwick's death really shocked a lot of people. He was so young. I have a friend who in his early 30s was diagnosed with stage four.

• 34:16Speaker 01

  So sorry.

• 34:17Alie Ward?

  A cousin of mine as well. And like, so, okay, number one, if you're 45, get your colonoscopy. Just do it. Enjoy the nap. Enjoy the waffle.

• 34:26Speaker 01

  Yep.

• 34:27Alie Ward?

  We have a whole how to. But what about that line of like, you're worried about it, but it's not quite time?

• 34:34Speaker 01

  Yeah.

• 34:34Alie Ward?

  For you to get it checked out. Anything for that in-between generation?

• 34:38Speaker 01

  Yeah, which is like most of us right now, right?

• 34:40Alie Ward?

  So that would be you.

• 34:41Speaker 01

  Yeah, exactly. Me. So if you have any kind of symptom, go get it checked out. And the sooner you do it, the better, because a lot of times, people who do colonoscopies, they're booked out like six, eight weeks, right? So if you're like waiting for end of year, your deductible's been met, just go see the person sooner, like either a GI or colorectal surgeon, so that you can get on the schedule. If you have a symptom, it'll be covered.

• 35:01Alie Ward?

  I don't know if it's just my news feed that's tweaked by the algorithm, or if it is becoming more and more widely known that this is something people have to pay better attention to.

• 35:12Speaker 01

  I think the celebrities really, really helped. Obviously, so sad about Chadwick Boseman. And then I think it was James Van Der Beek, wasn't it recently too?

• 35:21Alie Ward?

  So Chadwick Boseman, this incredible actor who portrayed Black Panther, among a ton of other roles. He passed away in August of 2020 at just 43 years old from colon cancer, which came as a shock to millions of people around the world who didn't even know he was battling it. He was diagnosed at stage three in 2016, and then continued to film seven movies at the height of his career while undergoing treatment. And one 2021 paper titled "Internet Interest in Colon Cancer Following the Death of Chadwick Boseman" in "Fovalin's Study" found that there was, quote, "a significant increase in web-based activity related to colon cancer following Chadwick Boseman's death, particularly in areas with a higher proportion of Black Americans." And it continues, "This reflects a heightened public awareness

• 36:06Alie Ward?

  that can be leveraged to further educate the public, which is especially relevant as colon cancer rates are higher in Black Americans as well as Indigenous populations." And at the time of this recording, James Van Der Beek, the star of Dawson's Creek, was also fighting colon cancer. And since I had this chat with Dr. Fong, he passed away at the age of 48. And some factors that increase your risk of colon cancer are genetic, like something called Lynch syndrome, which increases cancer risk, particularly of the colon and uterus. But lifestyle and diet. Definitely increase the likelihood of colon, shall we say, large intestine cancer. So what can you do? Dr. Fong says eat veggies with every meal. Keep that fiber intake up.

• 36:51Alie Ward?

  Hydrate, exercise a little every day to keep everything moving and avoid ultra-processed foods, sugary drinks, and processed meats. Fried and char-grilled meats have more carcinogens and can also damage your colon cells and up the risk for cancer. So sorry salamis, sorry hot dogs, sorry char-grilled burgers. It was good while it lasted. And statistics show colon cancer ranks the highest form of deadly cancer among men under 50 and the number two cause of deadly cancer among women under 50. And according to this recent article I read that ran in Forbes, one colorectal surgeon said that someone born in the 1990s is four times more likely to have rectal cancer

• 37:35Alie Ward?

  than someone born in the 1950s. And James Vanderbeek was vocal about his story, he said many times, in hopes that it inspired people to get literal life-saving preventative screenings. And again, for an in-depth how-to and a ride-along, as well as some surprising findings from mine, see the Field Trip My Butt episode that we made a few years back. So many people have told me that you listened to it and it helped you a bunch, which is great.

• 37:59Speaker 01

  And then Ryan Reynolds, how does colonoscopy on camera?

• 38:02Speaker 04

  Raise awareness about something that will most definitely save lives. Going in. That's enough motivation for me to let you in on a camera being shoved up my [BLEEP].

• 38:12Speaker 01

  And then I love that Ali Wong did a piece about it in her comedy special.

• 38:16Speaker 05

  I just took a camera up your ass. And I was so nervous. But what I didn't know was that right before the procedure, they give you propofol. And I have to say that as a working mother of two.

• 38:35Speaker 05

  Getting to take a drug-induced nap for an hour.

• 38:40Speaker 01

  About her colonoscopy? And so those people really getting it out there, it's like, hey, you know, colonoscopy is really not that bad. It's totally necessary. Colon cancer deaths are like preventable. That's the only thing I want to say. It's like 100% can be preventable.

• 38:53Alie Ward?

  So there are, of course, the stages of cancer. And obviously, just because of math, we know that the higher number is less good. So let's run through colon cancer stages real quick. So stage zero is a colon polyp with some abnormal or precancerous cells. Stage one is a cancerous polyp on the wall of the colon. Stage two, this one has a few sub-stages, but for simplicity, the cancer has grown from the polyp into or through the wall of the colon. Stage three, it grows through it, through the outer wall of your colon, or it hits the nearby lymph nodes, which means that cancerous cells can kind of hit the superhighway in your body. And then stage four, the final stage, the cancer

• 39:34Alie Ward?

  has made it to other organs, like distant lymph nodes, or your liver, or your ovaries, or even your brain. So if you have a colonoscopy, and they snip something off, they biopsy it, and then they wait for the pathology report for a week or two. I've wondered this, what it's like when you have a diagnosis for someone. Like, I got lucky. I had a precancerous situation that they snipped out, and that was one and done, right? But what is that like when you see something like that?

• 40:02Speaker 01

  Yeah. I always get like a really sinking feeling in my stomach, because I think anybody would. And then what you have to do is then you have to tell the patient that you're going to get a biopsy first. And then, you know, in 10 to 14 days, have to break the news. So I would generally kind of like temper it with, hey, this looks suspicious, but we will know in two weeks, and I promise I will call you. And I think most people are okay with that. And then for the actual breaking the news, and, you know, we do this a lot in medical school, and we have to sit down, we have to look them in the eye, which I think always helps. I always try to do it in person, you know, and I think people, for whatever reason, whenever you say that, they know already, and then they just need to hear it. But, you know, hey, I have bad news, you know, the pathology

• 40:45Speaker 01

  report shows that it's cancer. And then people like the statistics, this is the outcomes, and these are the next steps is very useful. Having another person there, or having an advocate is super helpful, too. Someone who can actually listen and take notes while that person is probably still in shock and processing it.

• 41:03Alie Ward?

  What is the surgery like when you're performing surgery? You've got to go through the abs and everything, right?

• 41:11Speaker 01

  Yes, there's a couple of ways to do the surgery. So when we used to do it laparoscopically, we make small incisions like through the belly button, like several small holes that are five millimeters each and we put instruments through.

• 41:22Alie Ward?

  About the diameter of a pencil eraser.

• 41:24Speaker 01

  If you do an open surgery, I make a big cut kind of right in the middle and have to open everything up, put retractors in and kind of scoop everything out. It's rare that I have to do an open surgery at all these days because most things you can actually accomplish laparoscopically or robotically. And then in those cases, you actually have much less incision pain. You have like a lot faster return to work, get out of the hospital, a lot faster passing phlebotis and starting to eat and stuff. So we try to do things laparoscopic and robotically. I save robotic for last because people always ask me like, how do you do a robot surgery?

• 41:55Alie Ward?

  Yeah.

• 41:56Speaker 01

  So the same way that you do laparoscopy, which so it's almost like a little tube that goes in through your belly button, then you do cut through the abs. And then once you're in, you put the camera in and then the robot arms dock next to the bed while I sit at a console like on the other side of the room and control the robot arms. I love doing robot surgery because you actually get like a very fine dissection and like the very fine visual feel through the robot apparatus.

• 42:22Alie Ward?

  So it's not an automated robot doing your surgery. It's Dr. Fong in a fucking mech suit. Amazing. What's the benefit of robot? Is it a finer cut? Is it even a scalpel or is it like a cauterization?

• 42:36Speaker 01

  It's actually more of a cauterization. So almost like a tiny little pinpoint cauterization that allows you to cut and seal at the same time. And I can look right inside because I can direct the camera. And in some cases, you have to do like a total abdominal colectomy and take the entire colon out and all they have is like small bowel connected to your rectum. It has to kind of like adapt and become more like colon.

• 42:59Alie Ward?

  Can you live without a hole? Large intestine?

• 43:02Speaker 01

  Yes.

• 43:03Alie Ward?

  Oh, really?

• 43:05Speaker 01

  Yeah, I know. It's weird because you wouldn't think that you could, but your small bowel adapts. You know, you have a rectum and you still have nutrient absorption. And one of the fascinating things is in the 1890s, there was this guy. He actually used to take out the colon routinely for people who had constipation. And he was like, you know, this is because of auto toxicity. That's what he called it. And so like all these toxins were being like stored in your colon and your poop. So he would just take out the colon for like all the time. And since then, that's literally been debunked. We don't do that anymore for regular run of the mill constipation. We only do it for things like if you have IBD, like inflammatory bowel disease. And like, there's a lot of diseased colon, or if you have total colonic dysmotility. So some people can be born with like a colon that just doesn't move.

• 43:50Speaker 01

  And in those cases, you go down like a bunch of steps for diagnosis, like MRIs. And before we were like, hey, your colon really doesn't move. We're going to take the whole thing out.

• 43:59Alie Ward?

  Oh, okay, constipation.

• 44:01Speaker 01

  Yeah.

• 44:01Alie Ward?

  Let's talk about it.

• 44:02Speaker 01

  Most people have functional constipation where it's like a combination of factors, like your physiology, the things you're eating, the amount of activity you're having, and then like the electrolyte imbalance in your body.

• 44:13Alie Ward?

  So some people are like chronically constipated. They're like, I'm a constipation girly. And then others, for example, like my husband is like, once a day is not enough. I sometimes call myself a toilet widow because I'll just be.

• 44:29Speaker 01

  Oh, God, I haven't heard that one.

• 44:30Alie Ward?

  I'll be at a restaurant, you know?

• 44:33Speaker 01

  That's a new one. Yeah.

• 44:34Alie Ward?

  It's like a war widow where you're just watching. You know, you don't know if they're coming back. You're just watching the door.

• 44:41Speaker 01

  That's so good.

• 44:42Alie Ward?

  I'll look like I got stood up on a date, but I'm like, he's just doing him. We're going to talk about IBS in a minute, of course. But when it comes to constipation, is that like a microbiome problem? Is that a fiber problem? Is that a hydration problem? What are the common causes? And why does it happen when people are on vacation? And they're like, three days into a vacation, I haven't taken a shit. What's going on?

• 45:04Speaker 01

  So, yeah, no, so I'm going to start with like the first answer, which is how often should people poop? Right? So I've kind of digested it down to one to three times a day, every one to three days. So the normal human colon should move food through in about, literally it's like 12 to 72 hours. But most people, in about three days, you should have a poop. The other thing that happens, though, is that about 90 minutes after each meal, you know, you have like a, an MMC, which is like a mass, mass, oh my god.

• 45:35Alie Ward?

  This is a tough one. So I dare you to remember that empty stomach growling, or that post-meal gurgling in your guts is called the migrating motor complex. MMC, baby. Okay.

• 45:47Speaker 01

  Where it kind of sweeps everything out and moves everything through after you eat. And so that accounts for the fact that most people will poop after a large meal, right? Within an hour or two after a large meal. So that's actually normal, right? And so people, when people tell me that you're like a toilet widow, I'm like, does he eat like three large meals a day? And then he's just like pooping all the time? And it's like, so that's actually totally normal to poop, you know, one to three times a day and not crazy. And then, but it's also normal to poop like every three days if you're not having large meals, or if you're not having a ton of fiber, or that's just the way your colon moves. So the factors that go into it, right, are the amount of fiber, both soluble and insoluble fiber. Should be like 25 to 35 grams a day. But that's like, you know, fruits and vegetables and beans and legumes and whole grains.

• 46:32Speaker 01

  And the soluble fibers kind of gel everything up and move everything through, almost like a little like jelly-like mass. But I always tell people that if you don't drink water with your fiber, it will just turn into concrete and it won't move. So you have to have fiber and water. And the green leafy things like kale and like spinach and stuff, that is insoluble fiber. So while that stuff is also good, because it actually kind of acts as a broom and sweeps everything out, it also triggers some irritation in your colon, which simulates contractions. So you need both, and you really need a good mixture of both. And I think it's going to be different for different people. But you need both soluble and soluble fiber plus water.

• 47:09Alie Ward?

  And what is psyllium husk? And how do we feel about like a Metamucil habit?

• 47:15Speaker 01

  Yeah, love it. Metamucil, take it every day for the rest of your life. I actually don't, because I really eat a ton of fruits and vegetables. But if you needed that extra five grams of fiber, psyllium husk is the best way to go. It's the only one that's been really proven so far, that and kiwis. And Metamucil, if you get it in the store, just make sure you get the actual psyllium husk one, because you can do psyllium husk every day, and that is a soluble fiber that will help with constipation.

• 47:42Alie Ward?

  And you just got to really Water it up, right?

• 47:45Speaker 01

  Yeah, so I always tell people like stir it in the glass of water or juice or whatever. Drink it and then chug a glass or two of water afterwards. So you don't want to just like mix it in your coffee and be like, that's it for the day. You really.

• 47:58Speaker 01

  That's not gonna do it.

• 48:00Alie Ward?

  Put it in a Coke and you're like, where'd you go? And you're Celsius for the morning.

• 48:04Speaker 01

  Iced coffee for the day. No, that's not gonna do it.

• 48:07Alie Ward?

  That is the only thing that's worked for Jared's IBS. At one point, when everyone still had Twitter, he unfollowed everyone except for Metamucil because he was like, I'm just gonna only follow Metamucil. So he's a Metamucil devotee.

• 48:22Speaker 01

  You know, and I always tell people, especially for IBS, fiber will firm up loose soles, but it will also soften hard soles, right? It does both things. Fiber, fiber is great. You don't want to overdo fiber. Like I saw like this fiber maxing trend on TikTok recently.

• 48:36Speaker 06

  Fiber maxing. Everyone's talking about it and we.

• 48:39Speaker 01

  And I was like, you actually can have too much fiber. You probably can't have too much psyllium, especially if you're mixing with water. It does get washed out. But I've had a couple of cases of people who just ate kale for like 30 days. And then you can get like a giant fecalith, like a stool ball that just doesn't get digested. Yeah, it's called a bezor. It's just like stuff that doesn't get digested and you have to go in and scoop it out.

• 49:02Alie Ward?

  Sometimes it's hair. Sometimes it's undigested coconut fibers. Sometimes it's an impacted green ball formed in the fourth stomach of a goat and prized for its folk remedy as an antidote to poison. Sometimes a bezor is encrusted in gold and kept in Queen Elizabeth's collection of crown jewels, according to a delightful historical paper titled The Fascinating History of Bezors. And yeah, I'm gonna link that for you to read. And the word comes from the Arabic for stone used as an antidote to poison. But honestly, I would call the poison control hotline instead because bezors, they're really hard to come by and I bet they'd be expensive. Now, speaking of things that are hard, not quite bezors,

• 49:44Alie Ward?

  but little stony nuggets in your bowels are called fecaliths, which means poop rock. And you don't want them because they can get in places that they are not welcome, such as the portal to your little finger sized pouch off the start of your colon, if you still have yours. And can't that block your little appendix?

• 50:04Speaker 01

  Yeah, it can block your appendix. Yes, like an appendiculitis. That's what I had.

• 50:09Alie Ward?

  Wait, did you, you had a, not a, there's nothing that's TMI. Are you kidding? So you had your appendix out?

• 50:16Speaker 01

  I have. I had it actually in medical school and I had a little fecal lift, like a little blockage. And I swear it was the Taco Bell I had the night before when I was studying for my renal exam. But, and so I've sworn off Taco Bell since then.

• 50:28Alie Ward?

  Good choice. Do they build up over time like a blackhead or can it just be like a boop?

• 50:33Speaker 01

  Yeah, that's a good question. So it can build up. And now we know there's like a bunch of lymph nodes in the appendix too. And so it does, you know, serve some purpose. It's not completely like vesiculose, but it can build up. Yes, like if it sits there. So you don't want things to back up into your appendix.

• 50:49Alie Ward?

  And also you want an on-ramp into fiber additions, right?

• 50:55Speaker 01

  Yes.

• 50:56Alie Ward?

  You don't want to just dump it all at once, right?

• 50:59Speaker 01

  Thank you for that. Yes, yes, absolutely. So people are like, I've never eaten any fiber before. Like I only ate chicken nuggets and suddenly they're like 50 grams of fiber a day. No, you want to start like, usually I'm like, do five grams a day for like a week and then go up to 10, go up to 15 every week, every two weeks. The other reason being is that you'll get super bloated if you don't gently increase your fiber dosing.

• 51:22Alie Ward?

  And I imagine those fiber gummies also, like you've got to chug with a lot of water, right?

• 51:26Speaker 01

  Yes. Yeah. I have a couple of fiber gummies that I love and I do take them with water because of the gel, like the caraginin that actually can cause a lot of blockage. So drink water.

• 51:37Alie Ward?

  Lots of water.

• 51:37Speaker 01

  And then on top of that is activity. So gravity, you know, moderate activity, you know, 20, 30 minutes, three times a day. Those things get your colon moving. And then a lot of people will be like, hey, doc, you know, I eat a ton of fruits and vegetables. I drink a lot of water. I work out, you know, I still can't poop. And then there are kind of like, definitely like medical and hormonal reasons that people can't poop. So like in pregnancy, you actually have like increased progesterone and you know, kind of slows everything down. You have increased water absorption. Or if you have thyroid disease, you know, if you're hypothyroid, you can be pretty constipated because of the water absorption. And then people have like electrolyte imbalance. So we now know pretty well that magnesium is a great muscle relaxant that works for like

• 52:20Speaker 01

  sleep, it works for restless leg, but also works for constipation. Taking magnesium every day can actually kind of get you over that hump. And then the last part of your question is the probiotics. There's a ton of research out there. I love the microbiome. I think that's where the future is headed. And we now know that there's certain bacteria that work better if you're constipated. There's certain bacteria that work better if you have like antibiotic associated diarrhea, and there's certain bacteria that work better if you have just general IBS or like other symptoms. And they're now fine tuning these strains. So fiber helps with the consistency of stool, but probiotics help with the regularity of stool.

• 52:57Alie Ward?

  Can I ask you some questions?

• 52:59Speaker 01

  Yes, of course.

• 52:59Alie Ward?

  Do you have time for me to ask you some?

• 53:00Speaker 01

  Yeah, of course. Yeah, yeah. Sorry. I just blabbered on, so.

• 53:04Alie Ward?

  No, no, I have a million questions.

• 53:07Speaker 01

  All right, let's do it.

• 53:08Alie Ward?

  But first, let's get rid of some cash and let's send it to a cause of Dr. Fong's choosing. And this week, it's headed to fightcolorectalcancer.org, which fights to cure colorectal cancer and serve as relentless champions of hope for all affected by this disease through informed patient support, impactful policy change, and breakthrough research endeavors. They remain steadfast, saying, every day, we are moved by the collective heartbeat of people who bring hope and healing to people yearning for more seconds, hours, days, and years with the people they love. You can find out more at fightcolorectalcancer.org. And thank you to the sponsors of the show for making these weekly donations possible. This podcast is brought to you by Squarespace. If you haven't heard me gushing about Squarespace

• 53:50Alie Ward?

  for years, it's an all in one website platform. Whether you're trying to grow a business you have, or if you're just a baby business getting started, it has everything you need. That's where I secured my domain name. It helped me build a professional site. I can update it so easily. I've been using Squarespace since before Ologies existed. After procrastinating for years, I literally built my website in one evening. They have templates, they have flexible editing tools. Squarespace also makes it easy to share your work. You can book clients, you can get paid, they have built in tools for scheduling. And invoicing and email all in one place. Whenever someone I know needs a website, whether they're a scientist that needs to put their work up or someone who's just starting a business, I'm like, dude, Squarespace.

• 54:34Alie Ward?

  So head to Squarespace.com/ologies for a free trial. And when you're ready to launch, use offer code OLOGIES to save 10% off your first purchase of a website or domain. You can do it. Peppa Pig is your preschooler's best friend. Give the gift of bike riding confidence this year and help Peppa learn to ride her bike. Kids can imagine learning to ride a bike with the Ready Pedal Go Peppa Bicycle Playset. Put Peppa's helmet on, attach the push stick to her bike, and push to make her pedal. Ready Pedal Go Peppa and more from Peppa Pig are now available at all major retailers this holiday season.

• 55:16Alie Ward?

  Trips are full of unexpected discoveries. Maybe you see a sea slug or you find out that your friend still sleeps with a stuffed animal. But when it comes to your vacation rental, there should not be any surprises. When you book a Verbo vacation rental, if what you expect isn't what you get, Verbo Care has you covered. If something's broken or just not right, Verbo will work to make it right. Plus, you get 24/7 live human support with every booking. Grab your stuffy, we're going on vacay. So book today on the Verbo app. If you know, you're Verbo. Terms apply. See verbo.com/trust for details.

• 55:51Alie Ward?

  Listen, sometimes you get out of your routine. That happened to me recently when I went out of town and I realized I forgot my Ritual Essential for Women 18+ It's a multi that I've been taking for years. And guess who landed in another country without them? Me, didn't feel right. They contain nine key nutrients, two delayed-release capsules designed for optimal absorption. But Ritual, why do I love them so much? They have a team of scientists. They poured over thousands of studies to figure out what are common gaps that people need in their diet, but they don't actually consume. It's also designed to be gentle on the stomach. You can take it with or without food, which I love. Plus, I like that it looks like a tiny lava lamp. I tell you that every time, but it has these beads and oil, and it tastes like mint. Down the hatch. I usually take them in the morning.

• 56:36Alie Ward?

  And the reason why I've stuck with Ritual for so many years is because my schedule is all over the place. Sometimes I'm eating breakfast. Sometimes I'm running through an airport with one shoe. So instead of striving for perfect health, aim for supporting foundational health. Save 25% on your first month at ritual.com/ologies. That's ritual.com/ologies for 25% off your first month.

• 56:58Speaker 07

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• 57:29Alie Ward?

  Okay, you patrons submitted listener questions via patreon.com/ologies before we recorded. So let's get to the bottom of some of your curiosities. Let's talk colon cleansing. Oliver Callis, Megan Walker, Matt Thompson, and first time question asker Cheryl Stogretto. Colon hydrotherapy, yea or nay is what Cheryl wants to know. Matt Thompson is like, what is the danger of doing colon cleanses outside of pre-colonoscopy? Colon cleanses, what's the deal?

• 57:59Speaker 01

  Yeah, so it's actually a nay for me for a colon hydrotherapy. There's a couple of reasons you would do it. Like if you were like, hey, you know, this week I feel like specially bloated and I just want to try it. And you did it like once a year or once in your lifetime, fine. But I've had people be like, hey, I go every month. I go every six months. There's two things that I think are kind of dangerous. It's a super large volume of water. And so you're actually just like flushing everything in and then flushing like 60 liters of fluid back out. Like I've seen the TikTok videos of things they get out. Those are things that are going to come out on their own. Yeah, they will come out on their own eventually.

• 58:34Alie Ward?

  I know gum does not stay in your intestines. But if you have little inflamed pouches in your colon, which is a condition called diverticulitis, you can get seeds stuck in them, which is why no seeds for you. Seeds are off the menu if you have diverticulitis. If not, I don't know, go for it. But back to colon hydrotherapy, which yeah, involves a tube up the butt. Kind of like a less dramatic, uh, warm water pressure hose. You hold it in and then you release it several times over about 45 minutes.

• 59:04Speaker 01

  The high volume of water has caused some mucosal injury. So it can cause damage to the lining of the inside of your colon, like small tears and stuff. And in some severe cases, like not to scare people, but it can cause perforation. And I've definitely seen that where then you have to go get a surgery, blah, blah, blah. You don't want that. The second thing that it can mess up, though, is your microbiome because you're actually flushing out all the good bacteria that should be there. And I've had people where they're like, hey, you know, I get a colon cleanse like every month and I still can't poop. And part of it, I think we're going to find is that the good bacteria are actually getting flushed out.

• 59:36Alie Ward?

  Oh.

• 59:37Speaker 01

  Yeah, so it messes up your microbiome. The same way that when you get a colonoscopy, you know, if you're doing that four liter colon prep before, some people will tell me that they can't poop for a couple of weeks afterwards. And because your microbiome is messed up, you know, is one thing. The second thing obviously being that you flushed out all that poop and it's going to take a few days to come back.

• 59:55Alie Ward?

  Oof, okay. So this brings me to, um, let's talk about sex prep back there.

• 1:00:04Speaker 01

  Yeah.

• 1:00:04Alie Ward?

  Anonymous, Derek, Deviancy, Ben, wanted to know, Ben says, with the internet's obsession with being bottom ready and spotlessly clean at all times, as long as I eat enough fiber, is that okay? Deviancy said, I sometimes hear people warn about douche dependence.

• 1:00:21Speaker 01

  Yeah.

• 1:00:22Alie Ward?

  And Derek wanted to know if it's possible to overdo it. Anonymous wanted to know, is it true that too many enemas can wash out that beneficial bacteria? Also want to note, when they're asking for men, obviously all kinds of genders, take it back there.

• 1:00:38Speaker 01

  A hundred percent.

• 1:00:39Alie Ward?

  And this is a good question for all kinds of people.

• 1:00:41Speaker 01

  Awesome question. Love that question. So short answer being you do not need to douche. A good fiber diet actually will get people cleaned out sufficiently. So if you poop, you know, in the morning, you know, poop a couple of hours before you go, because your rectal vault is really just that last portion, just that last like eight centimeters or so, and you know, eight centimeters hopefully is enough, but eight centimeters or so is completely clean. Like all the poop should actually stay above it, right? After you poop, then nothing goes into the vault.

• 1:01:08Alie Ward?

  So yeah, the average human rectum, the final chamber of travel for your Lunch, it's about four to five inches long. Although in taller, larger people, like those assigned male at birth, it might be closer to seven or eight inches. And at the top of that, you would have to go through this bent, kind of askew sphincter, the recto-sygoid sphincter, deeper, which gets you into the sigmoid colon, which is the backstage vault where the poop is waiting. If I may paint you a picture. I need you also to know that I was working on this in public at a cafe, a very crowded cafe. And as soon as I clicked on the 2017 Vice article titled, in a loud, vivid font,

• 1:01:52Alie Ward?

  "How much can I fit up my ass?", I realized it was time to pack it up and go home to work. But also on that note, some tips say that if you have been curious about having things up your ass, but are afraid that it will feel like your lover is literally tearing you into one. Lots of lube, go slow, and you can even try a butt plug during your fore stuff to relax things a lot before replacing it with the main act. But yes, let's hear some more tips for those who are butt curious, but want to go about it with fewer surprises.

• 1:02:26Speaker 01

  So that's the first thing. If you have to poop, there are totally safe ways to do it. The safest way I usually recommend is just like a Fleet's Enema bottle full of warm tap water. You don't actually need all of that sodium phosphate solution. You really don't need like mineral oil or like blah, blah, blah, all those things. It's just like warm tap water in a bottle with a soft tip. I actually did a review for these people once where they sent me like whole bunch of like anal douching things and they come in like bowls with sharp tips and shower heads. Some of those things, I don't love the sharp tips because I've seen people give themselves fissures with the sharp tips. I've seen people give themselves some like hot water injuries with a shower head kind of attachment things. So I love the Fleet's Enema. They actually just developed this awesome product in the UK, which I hope comes here soon. It's called an A-ball, which is like a little hydrogel

• 1:03:11Speaker 01

  that you can stuff up in your butt and it sits right at the sigmoid, and then it stops the poop from coming down. So instead of having to, you know, douche immediately before sex, which kind of like takes out that, you know, the sexy vibe, right? You just like put something up there, stops everything up, and you go about your way, which I love the idea of.

• 1:03:29Alie Ward?

  Of course, I looked into this for you. And this is an innovation from Polari Labs in the UK. And yes, it's called an A-ball. A like the letter, dash, ball. Their website lays out an elevator pitch. It says, who has time for a 45-minute toilet tango? Not you. Our ball gets you butt-ready in half a minute. So you can skip the waiting and slide straight into the good stuff. But how, you ask, on the edge of your toilet seat. Okay, so they say that the A-ball gets shoved up during the fun, and it parks itself at the top of the rectum, like a VIP bouncer, making sure no uninvited guests, AKA poop, crash the party. So remember, at the top of your rectum, there's that sigmoid colon. And so it kind of like boop, right there,

• 1:04:13Alie Ward?

  so you don't get to that backstage waiting area. It's kind of like a hydrogel butt tampon that cleans things up along the way and then stands guard for you. And at four bucks a pop, I priced it out, it's about the same price as a buzzball. This could revolutionize what some people call dirt road journeys, making it more like just a smooth cruise on asphalt. I feel like the A-ball people are gonna clean up with this. And going back to that, Jillian, Jamstrous, Iris, Beanbag the Cat, David, Robin, first-time question-asker, Janelle, which is my sister's name, but I don't think it's her. Etherdog, Alex Minor, and RJ wanted to know. I mean, RJ Deutsch says, okay, as a gay, what should we know that we don't?

• 1:04:58Alie Ward?

  Because they don't teach it in health class, or people are too embarrassed to ask. And other people wanted to know, Jamstrous, are there health risks of doing anal? What qualifies as too deep? Jillian wanted to know, does anal sex lead to any health problems later? So a lot of people want to know butt stuff.

• 1:05:15Speaker 01

  Yeah.

• 1:05:16Alie Ward?

  Yay or nay from a doc.

• 1:05:17Speaker 01

  Oh, my gosh, we could do a whole episode on just this one.

• 1:05:19Alie Ward?

  I know.

• 1:05:20Speaker 01

  I'm telling you, the butt stuff. Okay, so no real health problems, right? So my counseling usually is just be safe. So you do want to be protected. If you are worried about any kind of like discharge, bleeding, pain afterwards, get it checked out. Make sure you're getting swabbed regularly for STIs. And get those treated, get you and your partners treated.

• 1:05:38Alie Ward?

  Oh, we have a really great STI episode with Dr. Ina Park that just came out a few weeks ago. And it's every question you have ever wanted to have addressed. Please do listen. And yes, we have these crotch episodes, like back-to-back. And I don't know what to do about it.

• 1:05:53Speaker 01

  I think the one thing people are usually trying to ask here is if things going in your butt all the time causes incontinence.

• 1:05:59Alie Ward?

  Hmm.

• 1:06:00Speaker 01

  I think that's what people are worried about because because then the anus does stretch, right? So the anus does stretch and it can cause like a little bit of laxity over time.

• 1:06:08Alie Ward?

  Mm hmm.

• 1:06:08Speaker 01

  I have seen people have fecal leakage over time, but most of the time it's not super common. It does cause hemorrhoids, right? So it can make inflamed hemorrhoids worse because of all the friction and stuff like that. So I'm like, use a lot of lube. You can do a lot of gentle preparation and foreplay that will allow a larger size and, you know, lengthen girth for penetration. And all of that is okay, as long as you stay safe. The one thing I don't love is actually washing your anus.

• 1:06:34Alie Ward?

  Hmm.

• 1:06:34Speaker 01

  Washing the anus itself for like remming, it kind of destroys the microbiome of your anus and that causes a lot of paritis ani, which is itchy anus. So you don't actually need to use soap to wash your butt.

• 1:06:45Alie Ward?

  Oh.

• 1:06:45Speaker 01

  Yeah, because of the anal microbiome, it has its own microbiome and it cleans itself. And I always tell people, you don't actually, you need to use soap when you wash your butt. You know, you wash the rest of your body, use a little water, warm water, use your fingertips, just rinse and then pat dry. That's the best thing you can do and leave it alone. When you're scrubbing it with a washcloth and soap and whatever, you're actually stripping that top layer of skin off and stripping off that natural microbiome layer, which then causes things to itch because it's trying to heal.

• 1:07:13Alie Ward?

  No. So wait, so you're in the shower. Can some gentle soap go into crack or what?

• 1:07:19Speaker 01

  Crack is okay. Cracking cheeks are okay.

• 1:07:21Alie Ward?

  Okay.

• 1:07:22Speaker 01

  So yeah, 100% you should wash the cracked cheeks because that is skin and that is like a totally different thing. But what I mean is like the median anus, which is kind of like the dark wrinkly area.

• 1:07:31Alie Ward?

  Mm hmm.

• 1:07:32Speaker 01

  You really don't need soap there.

• 1:07:33Alie Ward?

  Oh, my gosh. So many questions. Y'all, I did my best to humiliate Dr. Fong and debunk this, but unfortunately, every article I've found from experts is like, water's fine. Keep the natural skin barrier healthy. And since we did this recording, I want you to know. This is very personal. I have ignored this advice. I'm sorry, my skin barrier. Soap it is. I can't give you up. But there are gentler ones out there, so you can consider that. Because you definitely do not need like borax or a Mr. Clean Magic Eraser or a spray bottle of Clorox. Oh, speaking of different kind of bleaching. Anal bleaching, yes or no?

• 1:08:12Speaker 01

  No.

• 1:08:12Alie Ward?

  No.

• 1:08:14Speaker 01

  You don't need it.

• 1:08:15Alie Ward?

  Why do people do?

• 1:08:16Speaker 01

  I know, anal are supposed to be the color of the way they are. It's totally fine, you know?

• 1:08:21Alie Ward?

  Thank you.

• 1:08:22Speaker 01

  I wouldn't worry about it.

• 1:08:24Alie Ward?

  Okay, well, speaking of washing, oh, this was a popular one. Iris, Alex, Agamemnon, Sean, Katie, Britt, John, first question asker, Thoropasaurus, Jess, Tony Vessels. John says, why do we not all use bidets? Katie says, bidets, do we love them or love them? Sean says, bidets truly better than toilet paper alone, right? Agamemnon says, I love my bidet. I will forever be having a bidet. That said, too much of a good thing can be bad? Can it be too much water on the butt? Water pressure especially. They had great questions. Iris, do they have any effect on radical health?

• 1:09:01Speaker 01

  Yeah. One of my 10 bowel commandments is bidet is the way. So yes, everybody should have a bidet. I don't know why we don't have them in the US. You know, in Asia and Europe, people have them. Yes, they improve anal health. They improve hemorrhoids. They improve fissures for sure because of the over wiping that people do. And you know, bidet, wash, rinse, pat dry, and you're done. In terms of pressure, there isn't like a firm number on like, you know, too high pressure. But what I usually tell people is the spray shouldn't be going inside your butthole. Right? Like, you're not trying to give yourself an enema. You're, you're actually just washing the outside. So make sure your anus is closed and then spray, rinse, pat dry. Love it.

• 1:09:44Speaker 01

  It actually just gets rid of so many of those problems that people get from like wiping all the time and fissures and skin tags and hemorrhoids and all those things. Love bidets. I think part of the reason was in the early 80s, I want to say. But there was this like study that said that bidets made women have more UTIs. But that has since been debunked because it's actually clean water. Right? You're attaching your bidet to the clean water supply. And so it's clean water that goes up into your butt. It's not the toilet water. It's clean water goes into your butt and then just drops back in the toilet.

• 1:10:13Alie Ward?

  And for people who are afraid to use bidet because they're like, well, what do I do afterward? You can dab yourself dry with a toilet paper.

• 1:10:20Speaker 01

  Pat dry with toilet paper.

• 1:10:21Alie Ward?

  Okay.

• 1:10:22Speaker 01

  They make like toilet towels, but you can just pat dry with toilet paper.

• 1:10:25Alie Ward?

  Okay. And you're talking to someone who has two bidets in the house. 100% of our toilets have bidets. So I'm just, I'm asking the questions that other people are probably like, do I?

• 1:10:34Speaker 01

  No, those are excellent questions. Yeah.

• 1:10:36Alie Ward?

  Okay.

• 1:10:37Speaker 01

  Like, we want to get it from all angles.

• 1:10:39Alie Ward?

  Right?

• 1:10:40Speaker 01

  Yeah.

• 1:10:40Alie Ward?

  And I know you can go like high-end Japanese that's got more buttons than my car. And then to like a tushy or something that's pretty much like one knob.

• 1:10:52Speaker 01

  Yeah, I got one that was called like Big Cow and it works great for like 20 bucks. I just want to try it out, like to be like what a $20 bidet is like, it works great.

• 1:11:01Alie Ward?

  I understand that in the UK, bidets are illegal because their water supply is not like up to clean standards?

• 1:11:08Speaker 01

  Right, yeah. So I think that's a little bit different because they're not using like the fresh water in their septic system. But that's not the case here.

• 1:11:15Alie Ward?

  Okay.

• 1:11:16Speaker 01

  At least as far as I know. And then, as you know, wipes clog septic tanks and septic systems. So they're not great for the environment at all.

• 1:11:22Alie Ward?

  Don't do it. I mean, look up fatberg and never again.

• 1:11:26Speaker 01

  So gross.

• 1:11:27Alie Ward?

  Oh, fatberg. A fatberg has got to be the absolute worst noun. It's got to be the worst object.

• 1:11:34Speaker 01

  Yeah.

• 1:11:35Alie Ward?

  That I can imagine. In an effort to save you some money on plumbing bills, I'm going to de-influence you on so-called flushable wipes. Okay, Google fatberg and send me the invoice for the psychotherapy. It's worth it. I will tell you that in one photo, a London sewer worker is holding up this greasy chunk that's about the size of a small marlin. Were he a fisherman? I was horrified. I was traumatized to notice he was not wearing gloves. He was just raw dogging this fatberg. My mind raced and raced. I was like, why does he hate himself? How is his brain not capable of feeling fear? What is happening? Why? Why? Why?

• 1:12:16Alie Ward?

  And I zoomed in on the picture and I was very relieved to see that his rubber gloves were just the same ruddy peach color as his skin. But that was a rough, rough 30 seconds from my psyche.

• 1:12:27Speaker 01

  And I'm not grossed out by much, but I would tell you that it's gross.

• 1:12:31Alie Ward?

  Fatberg dude, they're up there with a rat king like they're so, it's bad. Okay. Well, speaking of toilet accessories, Miranda Panner, Kari Heiser, Paige Menking, Alex Minor, Chris Moore, Kestrel Wolgamuth, Kestrel One's Nose, Squatty Potties, actually helpful or a little silly? And Paige says reel or flim flam? And then also, do they have an effect on hemorrhoids? Chris wants to know. And then Paige said, I've found I've become rather dependent on it since I got one, which has made travel-related constipation the worst. So yeah, tell us about it.

• 1:13:06Speaker 01

  So you'll, you'll see the studies where it says that the ideal pooping angle is people squatting, because that's how we were like naturally meant to poop is like in a squatting angle. The studies that look at squatty potties or some kind of like stool, show that only 10 to 50% of people need them because of the way that it adjusts the anal rectal angle, which I thought was kind of cool. So for some people, it really will help because of the way that your anatomy is. And for the rest of the people, you actually probably do not need one. The more important thing though, is that when you're pooping, you're spending about two to five minutes on the toilet max. If you're straining for that long that you think that you need a squatty potty and you're sitting there like looking at your phone for an hour, your poop probably isn't ready yet. You know, it's either isn't ready yet or it's too hard. So I'm always like, get up, go do the dishes, walk around, do something else,

• 1:13:50Speaker 01

  like drink a glass of water and then come back and try again. That is going to be way more helpful in general than purely like a stool type device.

• 1:13:58Alie Ward?

  Okay.

• 1:13:59Speaker 01

  Yeah. So in some people it works and then in some people, most people, you really don't need it. Travel constipation, I think you actually asked that question earlier.

• 1:14:06Alie Ward?

  Yeah.

• 1:14:06Speaker 01

  The reason it's so terrible is because it's like the trifecta, right? So you're dehydrated because you're trying not to drink when you're on the airplane, you know, and you don't want to pee on the airplane. You're eating junk from airports and you don't have your usual healthy diet. You're also sedentary. And then there's also stress. Stress is like a huge factor in, in constipation that we're now seeing is totally true. So people who work out too hard, you know, the fight or flight response, right? Makes it so that you can't digest. And so you're like, hey, you're stressed out. Your body's not going to digest food. You're actually more worried about pumping blood to your heart and your brain so that you need to run away in an emergency and not worried about digestion. So actually that's four things that makes travel constipation worse. The way I usually get around it is I keep my water bottle with me, you know,

• 1:14:49Speaker 01

  if I have to be like, excuse me, excuse me, like eight times a day. Get around the person to go pee. I try to bring some fruits and vegetables with me. I try to bring my fiber gummies, my probiotics and then. I'm one of those people who gets to the airport three hours early.

• 1:15:03Alie Ward?

  I gotta get eyes on the gate.

• 1:15:05Speaker 01

  That's just me.

• 1:15:06Alie Ward?

  I gotta get eyes on the gate. Taryn Delaney Smith, a travel influencer, calls this L E O T G, or Leo Tej, lay eyes on the gate. I think about it every time I go to an airport. All right, this is a great question a bunch of people had. Jennifer, Corinne, Jay, Nick Ryder, Tuha, Annalise T. Young, Honeydew, Marta, Katie O., Emily, wanted to know, Honeydew says, why is there sometimes a sharp pain in the booty hole during the period?

• 1:15:32Speaker 01

  Oh.

• 1:15:32Alie Ward?

  And Nick says, secondary, the period butt pain question. Jennifer wants to know, why does getting your period affect your bowel movements? As if it wasn't a crap shoot, haha, already, they say.

• 1:15:44Speaker 01

  That's going on. So, period affects your bowel movements because of the hormonal changes. So, increase of estrogen and progesterone makes it so that it actually increases the water absorption in your colon and makes your stools firmer. So, we know that, like, around the time of your period, you actually can get more constipation and diarrhea. Really, both, because of the way your body absorbs fluids. The sharp shooting pain, though, is actually something a little bit different. That's called proctology fugax. And so, that's more common in women, but it is also super, super common in men. Like, I don't want to leave men out of this, because people will come in. And I kind of joke that my practice is proctology, pyonidal cyst, and pelvic floor, the three Ps, because I do so much pelvic floor. And we're just now finding out that there's so much we don't know about the pelvic floor

• 1:16:27Speaker 01

  and the way that the pelvic muscles interact with the rectum. And so, women tend to hold a lot of stress in your pelvis. So, literally, we'll just walk around, like, keeping our butts clenched all the time, like, oh, literally, tight ass. And, and the more you clench it, the more the muscle spasm, the more it's like, hey, you know, we're supposed to be like this. And eventually, when it starts to go, and you feel that sharp pain, it's being like, hey, we're in spasm. Can something let me out now? In some cases, it'll be like some gas triggering this response, some stool in the rectal vault triggering this response. But it's actually a muscle spasm, that sharp shooting pain.

• 1:16:59Alie Ward?

  Ooh, okay. And, yeah, again, you've been pregnant, you and your wife have three kids now.

• 1:17:05Speaker 01

  Yep.

• 1:17:05Alie Ward?

  Addison Alley says, as an OBGYN, I'm interested in what advice you would give to women or pregnant people who experience anal sphincter injury from

• 1:17:16Alie Ward?

  Delivery?

• 1:17:17Speaker 01

  Yeah.

• 1:17:19Alie Ward?

  And also, just in general, like pregnancy and butt stuff, why?

• 1:17:25Speaker 01

  Yeah, yeah, pregnancy and postpartum. So constipation gets worse because of all the things we talked about, like increased relaxin and hormonal changes and things like that. The increased abdominal girth, like you actually have more weight sitting on your pelvis. So everything is kind of getting squished out. So preventatively, in your first and third trimesters, the constipation and the hemorrhoids are usually the worst because you're the first trimester because of the hormones, the third trimester because of the anatomical differences. You do all the same things preventatively, right? The fiber, the water, the exercise, you know, use some of the compound ointments prophylactically if you can. The obstetric injuries, that is a really good question. So when you have like a first degree or second degree tear, it's usually kind of just through the skin, not a big deal.

• 1:18:07Speaker 01

  Sometimes when you get to a third or fourth degree, that involves the anus. And I can always tell because they're usually anterior, right? So the tear is between the vagina and the anus. The teaching is erecto-vaginal fistula when it becomes like a little abnormal tunnel that goes from your rectum to your vagina. And then when you fart, there's like air coming out of your vag or like some stool. Really, really horrible to deal with. People get so much like shame and embarrassment from it. The teaching is that generally a true obstetric injury like that heals in about six months.

• 1:18:36Alie Ward?

  Oh, okay.

• 1:18:37Speaker 01

  Because this, in six months, the inflammation will go down and the skin will heal. If it hasn't, I would definitely say see a colorectal surgeon because there's a ton of things we can do. We could put like a little Cetan ring through it, which is like a little rubber band. There's things we can do such as like closing the fistula with a suture or an endol-anal advancement flap where I kind of pull like a flap over the rectal side and just close it up. So I don't want women to be embarrassed by this. I want you to go fix it because it's super, super like quality of life, you know, issue.

• 1:19:05Alie Ward?

  Mm hmm. Going from uterine to prostates. Orion, Potato Puffer, David Gregg, Malai, Mai, Alex Minor, Katie Hammond. Potato says prostate massage, should we be doing it? Also, Malai says, I don't have one and I'm curious what's going on in there. I mean, it's right in front of it, right in front of your butthole?

• 1:19:26Speaker 01

  Yeah.

• 1:19:26Alie Ward?

  Okay.

• 1:19:27Speaker 01

  So literally, the, the front surface or the anterior surface of your rectum is the prostate. So yeah, prostate massage, sure, if it feels good, you're literally just poking your finger in the anus and, and massaging it a little bit. There are things where, you know, doing it too much, where it can cause a little bit of chronic prostatitis, and I've seen that happen, so just be cautious, you know? And if it starts hurting, or if you're starting having like burning with urination, burning with ejaculation, things like that, go check it out, see a urologist.

• 1:19:53Alie Ward?

  Okay. We do have a whole urology episode with your favorite urologist, Dr. Fenway Millhouse. It's just waiting for you. But back to the prostate. It's a walnut-sized gland. It lies between a rectum and a urethra in humans with penises. And if you will, please allow me to read from the book of Webb M.D. So it says, "The prostate is sometimes called the male G-spot or the P-spot, and prostate massage can be a sexual activity. Inserting a finger, penis, or device into the anus and stimulating the prostate from there can lead to orgasm for some people. You can also stimulate the gland from the outside by massaging the prostate through the perineum, which is the area between the anus and the scrotum, also known as the taint or the gooch." Webb M.D. didn't say that last part, but it continues,

• 1:20:37Alie Ward?

  "Orgasm achieved slowly through perineum massage is sometimes known as a perineum orgasm." Such a good drink. But let's cool things down, just a sec. Spencer wants to know, why do some farts smell way worse than others? Chelle Bean wants to know, if someone gets the hair removed from the butthole, are farts typically louder?

• 1:20:56Speaker 01

  Whoa.

• 1:21:01Speaker 01

  Wow, I thought I've heard everything. It's like, like when the tree falls.

• 1:21:09Speaker 01

  I'm gonna say hairs, no, because it's really more body habitist, from what I've seen, than the actual hair itself. Because normal anal canal is like, you know, six to eight centimeters or so. But you, some people have like really large butt cheeks, right? So the butt cheeks can actually go far beyond. And that farting, the clapping there, is gonna be way more important than the few hairs that are around your anus. Um, the hairs, what they do do is trap odor.

• 1:21:35Alie Ward?

  Oh.

• 1:21:36Speaker 01

  And actually, I'm all for like, leave it natural and stuff like that. But what I have noticed is that when people were worried about more of an odor issue, it's actually the hair. It's not the poop, right? So like, okay, in those cases, use a little gentle soap. But yeah, I don't know that it's like a, like an auditory thing, more like an odor thing.

• 1:21:52Alie Ward?

  Okay. Are you ever in there? This is a question from Quinn, Lillian, Anonymous, Bree, Lena, and Jay. Are you ever in there and you see endometriosis?

• 1:22:05Speaker 01

  Yes.

• 1:22:05Alie Ward?

  What the fuck?

• 1:22:07Speaker 01

  Yes, it's not common, but it is in a differential, which is that if you are having like chronic rectal pain or, you know, pelvic pain, and you've had a laparoscopy, you've seen a gynecologist and they can't diagnose it, you can have endometrial implants in your rectum that are causing that pain and spasm and bleeding.

• 1:22:25Alie Ward?

  So endometriosis, if you are lucky enough to not know about this, it is when tissue that's similar to uterine tissue shows up absolutely uninvited in places that are not your uterus. And so what, except that it's excruciatingly painful, particularly around one's period? Some symptoms are period pain in weird places, or so bad that it doubles you over and makes you wish that you were born a tree. Pain during or after sex or orgasm hurts. Painful bowel movements, heavy bleeding, infertility, and you can also experience pain. The pain is very bad pain. Another symptom of endometriosis is called gaslighting on the part of doctors who tell you that periods are supposed to hurt that bad.

• 1:23:08Alie Ward?

  Now, I am lucky enough to not have this, but I have friends who do. And if you've ever seen someone having to pull over because their period pain is so bad, you know that shit is not normal. But it takes on average nearly a decade to get properly diagnosed. And remember, that's on average, which means some people a lot longer. Treatment for endometriosis involves surgery to find and remove that errant tissue from wherever it has taken root, which might be your intestines.

• 1:23:36Speaker 01

  Uh, it's not common, but you do definitely see that on colonoscopy and sigmoidoscopies and stuff. Yeah.

• 1:23:42Alie Ward?

  My god. And do you have to remove it? Or then do you have to get an OB-GYN surgeon back in there?

• 1:23:48Speaker 01

  Oh yeah, no, I remove it.

• 1:23:49Alie Ward?

  Okay.

• 1:23:50Speaker 01

  That's not something they would remove. They're like, not going to touch the rectum. So I remove that and then send it to pathology. A lot of times it is a multidisciplinary thing. So if they have to be there to remove other endometrial implants in the pelvis, we do that like all jointly in the OR.

• 1:24:03Alie Ward?

  Okay. Kimberly Butts, first time question asker, says, I feel it's my time to shine. My last name is Butts.

• 1:24:11Speaker 01

  Butts?

• 1:24:12Alie Ward?

  Yeah. So we straight up Butts. A first time question asker, a long time listener. Why did smoking certain types of weed give me diarrhea? Is it similar to food sensitivity? Amy Osland says, my father has explosive diarrhea every day. He thinks it's normal. And Katie wants to know, super weird. Feel free to skip, but why does diarrhea feel hot? Like, since it's more water, shouldn't it feel cooler? What's happening? So do certain drugs cause diarrhea? Is explosive diarrhea ever normal? And is it an irritation of the butt tissue that's hitting that acid? Is that why hot shit's hot snakes?

• 1:24:54Speaker 01

  Yeah, so hot shit's because of the inflammation. Yes, 100%. That's why it feels warmer.

• 1:24:59Alie Ward?

  Okay.

• 1:24:59Speaker 01

  And then also like the bile acid, you know, as it's coming out, it actually should be warm, right? It's not a cold liquid that's coming out. It's like a hot liquid. So that's the first thing. Explosive diarrhea can be normal. And actually, I remember now what that other question was. It was, why does some parts smell worse?

• 1:25:13Alie Ward?

  Yes.

• 1:25:14Speaker 01

  So all of it is related to what you eat, right? So things that are fermented by more gas producing bacteria will cause more gassiness and different smells. So like, you know, obviously, we know that broccoli smells worse. Asparagus smells worse. Because those things have to be fermented by certain bacteria, by the bacterium that kind of digest it and causes like gassiness and explosive diarrhea. I would say like three times a day is technically within normal limits still. Like if it's an explosive, gassy stool. Diarrhea technically is defined by four or more stools a day. Like four or more runny stools where you can't keep up with your hydration. So, I mean, I probably just see what he's eating. Like, is it a lot of beans?

• 1:25:54Speaker 01

  That that would do it.

• 1:25:55Alie Ward?

  Can weed do that?

• 1:25:56Speaker 01

  Yes, we can do it. So weed does irritate the colon. It kind of stimulates contractility. But then I always tell people it's bugs or drugs too, right? So bugs or drugs have a huge influence on your colon. And we know that, for example, opioids can constipate you. But things like metformin, like diabetes medication, can actually cause you to have diarrhea. And then there's certain bacteria like C. diff that will cause you to have diarrhea. But then there's also a constipating type of of C. diff where you can actually have constipation. So bugs or drugs.

• 1:26:24Alie Ward?

  I forgot to ask the difference between colitis, ulcerative colitis, Crohn's disease. Those are autoimmune?

• 1:26:33Speaker 01

  Yeah, those are autoimmune diseases. Those come under the category of inflammatory bowel disease, IBD, which is different from IBS, which is irritable bowel syndrome.

• 1:26:43Alie Ward?

  Okay.

• 1:26:43Speaker 01

  Yeah, I think I hear that term used interchangeably sometimes. And and IBD tends to be a little more chronic. They're autoimmune. Certain populations tend to have more of it. And they can be a little bit more severe in that you can get like bloody diarrhea, abdominal cramping, and those have to be diagnosed with colonoscopy and biopsies and generally treated with medications, like biologic medications that, you know, calm down your immune system. And then in severe cases, you end up with surgery to remove the diseased portions of the bowel, like small bowel or colon. IBS, on the other hand, is super common. We know that a lot of people have it. And there's IBS C, which is constipation type, IBS D, which is diarrhea type, and then IBS mix, which is the mixed type. This tends to be more of a diagnosis of exclusion,

• 1:27:27Speaker 01

  which means that we've ruled out IBD or cancer or diverticulitis. And you're still having like too many bowel movements a day or too few bowel movements a day. Or a lot of people tell me they have urgency, which is like they feel like they have to go, even though nothing comes out. And even though people used to be like, oh, that's just like a mental thing. You know, you're just imagining it. Now we're seeing that a lot of it has to do with like abdominal hypersensitivity. You just feel things differently in your abdomen. And then, of course, the microbiome. Like, I think we're going to see that it's a it's really changes in your microbiome. And there's now we know there's different strands that are more prevalent in some IBS types.

• 1:28:04Alie Ward?

  Last listener question, Dave Langanese. Only person who asked this wanted to know why is a butt load precisely 126 gallons equal to two hogsheads? Have you ever heard this? I've never heard this, but I might have to do an aside on it.

• 1:28:20Speaker 01

  Yeah, this might be an aside. Wow, you've stumped me with the last question. I actually do not know.

• 1:28:27Speaker 01

  I would like to know why a butt load is two hogsheads and if two hogsheads can fit into your colon.

• 1:28:33Alie Ward?

  I hope not. I hope not. So just for fun, just for fun. A hogshead is a cask holding 300 liters or about 80 gallons. And a butt holds around 500 liters. And a butt load thereby is technically, yeah, about 120 gallons. Also, a bung is a stopper in a barrel. And if you take out the bung, you will have a bung hole. And sniffing a bung hole can tell you a lot about the liquid that's aging therein, like a whiskey or a wine. So tell everyone you know. That's why text messaging was invented.

• 1:29:05Speaker 01

  I thought you were gonna ask me how many people have sent me like pictures of their butts and their poop. But that's the answer is a lot.

• 1:29:11Alie Ward?

  Oh, my God. So, I mean, I love that, like, getting pictures of people's buttholes and poop is like not even remotely the worst part of the job. In fact, it's probably delightful, but like what I'm gonna guess as a colorectal surgeon, there's definitely very hard parts of the job, but what is something that's either a slog or just tough?

• 1:29:30Speaker 01

  I mean, I think most people are gonna say like dealing with insurance, but for me, because like I'm such like a curious person, like not being able to figure something out is the worst part of my job. And like, I don't know why, like we've done everything. And then there's that like 2% of me that's like, well, you know, someday we're gonna find out that there's just one little more factor that we don't know about.

• 1:29:51Alie Ward?

  Favorite thing about what you do?

• 1:29:57Speaker 01

  I really love that people get such satisfaction from finding someone who they can talk to about their butt problems. Because for so long, I think people will be like, oh, my God, I was so embarrassed. I didn't want to seek help. I didn't want to, you know, have anyone look at my butt. And then they come talk to me and be like, oh, my God, that was like so much easier than I thought. And that's part of the reason why I do this, because I really want people to be able to talk about their butt and gut health. So that if they're bleeding, they go and seek help a little bit sooner rather. Than being like, oh, my God, I don't want anyone to look at my butt. And then it turns out to be cancer and they they just never had someone look. So early awareness, you know, more awareness and more education. That's the best part. Yeah.

• 1:30:37Alie Ward?

  Black stools.

• 1:30:38Speaker 01

  Yes, black tarry stools. Get it checked out 100%. Constellation of symptoms is black tarry stools, abdominal bloating, unintentional weight loss. Right? So that's the key one.

• 1:30:48Alie Ward?

  I'm going to go on record and say, I love you. I think you're wonderful.

• 1:30:52Speaker 01

  Oh, no, I love you. So we are, it's mutual.

• 1:30:58Alie Ward?

  You're wonderful. Everyone should have your book on their nightstand or maybe on the back of their toilet, but only for a few minutes.

• 1:31:05Speaker 01

  At a time. Yes.

• 1:31:06Alie Ward?

  Only for a few minutes at a time.

• 1:31:10Alie Ward?

  So ask charming people alarming questions. And remember, your doctor has seen it all. And then they've gone deeper and seen even more. So go book your colonoscopy. And yes, I will link in the show notes and we'll re-release that field trip colonoscopy right along just for you. Feel free to send this episode to anyone who needs it. Dr. Fong is at Dr. Carmen Fong on Instagram. And we'll have more links and studies up at aliward.com/ologies/coloproctology. Thank you again, Carmen. Also, everyone get her book. We'll link that in the show notes as well. We are at Ologies on Blue Sky and Instagram, and I'm at Ali Ward on both. We have Smologies, which are shorter, kid-friendly episodes you can find in their own feed. Just type in S M O L O G I E S in your podcast app. Or you can see aliward.com/Smologies.

• 1:31:55Alie Ward?

  Erin Talbert admin Zeeologies Podcast Facebook group. Aveline Malik makes our professional transcripts. Callie Ardwire does the website, making our appointments. Is scheduling producer Noel Dilworth, keeping things moving, is managing director Susan Hale, and making sure all the cuts gel and come out smoothly. Our editors, Jake Chaffee and lead editor Mercedes Maitland of Maitland Audio. Nick Thorburn sounded the theme music. And if you stick around to the very end, you know, I may tell you a secret. And this week is that I forgot to ask Jared earlier to make me a stinger for the very end of this. I wanted him to make me a song that was like Black Hole Sun, but was like black tar stools. Won't you come and get it checked? Black tar stools. Won't you come and get it checked?

• 1:32:40Alie Ward?

  You get it. Also, if you're looking for more fiber and you like chia seeds, but you're like, I forget, I gotta soak them before you eat them, but you have no patience, you can add hot water to your dried chia seeds and then they swell up real quick. And then you maybe add a little ice, cool it down, and then you can add that to a drink. Put it in a matcha latte and you sip it. It's kind of like tiny, tiny, tiny bobas made out of frog's eggs. Personally, I like chewing them up and it's a snack that both my mouth and my butthole can agree on. All right. Stay off the toilet for a long time. Bye bye. Pachydermatology, homeology, cryptozoology, lithology, nanotechnology,

• 1:33:22Alie Ward?

  meteorology, geology, geology, geology, geology, geology.

• 1:33:34Speaker 07

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