Talking Sh*t: Colonoscopies, Stool Sizes, and Potty Talk

Summary

Podcast Summary: "Talking Sh*t: Colonoscopies, Stool Sizes, and Potty Talk"

Podcast: Bill and Giuliana: The Podcast
Episode Date: June 16, 2026
Host: Bill and Giuliana
Featured Guest: Dr. Ruckham

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Episode Overview

In this candid and humorous episode, Bill and Giuliana dive deep—literally and figuratively—into the questions people are too embarrassed to ask their doctors about colons, bowel movements, colonoscopies, and all things “potty talk.” The conversation is guided by their own experiences and the expertise of Dr. Ruckham, a renowned gastroenterologist with over 40,000 colonoscopies under his belt. The result is an episode that is as educational as it is entertaining, breaking stigmas and answering the internet’s most Googled (and giggle-inducing) questions about gut health.

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Key Discussion Points

1. Meet Dr. Ruckham and Episode Genesis

• [03:09] Bill and Giuliana introduce Dr. Ruckham, their personal gastroenterologist and a leader at Northwestern Medical Center.
• Dr. Ruckham inspired the podcast’s focus after Giuliana's personal anxiety about colonoscopy prep led her to late-night Googling.
• Notable Quote:

  “Who’s got a better colon?” – Bill, jokingly setting the episode’s playful competitive tone.
  “Always the woman.” – Dr. Ruckham, diplomatically. ([04:31])

2. How Often Should You Poop? What’s ‘Normal’?

• [04:51] Dr. Ruckham dispels myths about bowel movement frequency:

  “The definition of normal is three times a day to three times a week. That’s where 95% of people will be within.”
  “The consistency is irrelevant...as long as it’s your norm, that’s fine.”

• Discussion on how individual variations are normal and not to obsess over toilet habits unless there’s discomfort.

3. Diet, Aging, and Fermentation

• [05:34] Bill shares a misadventure with a fermented plum and the resulting GI chaos.
• Dr. Ruckham explains that certain foods (beans, onions, crucifers) are harder to digest as people age, leading to more gas due to fermentation by gut bacteria.

  “As we get older...things you used to digest, you may not digest as well...the bacteria in the colon ferment it and make gases.” – Dr. Ruckham ([06:29])

4. Weird Bathroom Triggers—What’s with Bookstores?

• [07:04] Giuliana brings up the infamous “Barnes & Noble Effect”—an urge to poop in bookstores or certain stores.
• Dr. Ruckham suggests it’s likely psychological:

  “You’re relaxed, and you’re letting Mother Nature take over.” ([08:40])

• Bill jokes about sending constipated patients to Barnes & Noble. ([08:54])

5. Colonoscopy Prep Panic and What Matters Most

• [10:09] Giuliana recounts her dread about finishing the dreaded colonoscopy prep drink and her Reddit search for reassurance.
• Dr. Ruckham provides practical advice:

  “If when you’re going to the bathroom, it’s coming out like clear water...then you’re done...you’re clean.” ([11:33])

• Longer preps are more potent, but clarity matters more than absolute volume.

6. Colonoscopy FAQs: Polyps, Cancer, and Anesthesia Choices

• [13:06-13:57] Risk of polyps, colon cancer, and the role of colonoscopy in prevention:

  “Looking the other way, most cancers started as a polyp. By removing them, you’ll eliminate the chance.” – Dr. Ruckham ([13:13]) “We reduce the risk of colon cancer by about 80%.” ([13:49])

• Bill discusses choosing to stay awake for his colonoscopy; Dr. Ruckham cautions this is rare and can be needlessly uncomfortable:

  “As a general rule…Men’s colons tend to be a little straighter than women’s…hence may be less uncomfortable.” ([14:40])

7. Fears, Anesthesia, and Out-of-Control Worries

• Bill explains his fear of being ‘out of control’ when sedated.

  “What control are you looking for in the next 30 minutes?” – Dr. Ruckham ([17:20])

• Dr. Ruckham dispels the myth that patients under sedation say embarrassing things.

8. Do All Colons Look the Same?

• [23:21] From listener mail: Are some colons ‘prettier’ or ‘nicer’ inside?
• Dr. Ruckham clarifies healthy colons look similar, but some have more twists, diverticula, or unique features:

  “If some colons have so many [diverticula], it almost looks like Swiss cheese.” ([23:51])

9. GLP1 Medications and Bowel Changes

• [24:14] With the rise of GLP1s (weight loss drugs like Ozempic), Dr. Ruckham notes they commonly slow gut motility, causing constipation:

  “When someone’s on a GLP1, we tell them not to take it for at least seven days before prep.” ([25:00])

10. Hemorrhoids and Anal Fissures: When to Worry?

• [25:07] Dr. Ruckham distinguishes internal and external hemorrhoids, their causes, and simple management:

  “Hemorrhoids are just blood vessels...they don’t turn into anything bad.” ([25:35]) Warm water is best; salt baths are outdated. On painful, hard hemorrhoids (“thrombosed”): sometimes lancing is needed for relief.

• Differentiates hemorrhoids from fissures—a tear caused by large, hard stools—treated similarly with warm baths and topical creams. Botox can be used for persistent fissures. ([29:53])

11. Poop Size and Shape: What Should You Be Proud Of?

• [28:01] Length or shape (“like a snake!”) isn’t important. Focus is on comfort, routine, and absence of pain:

  “I would refocus that and say that’s an irrelevant goal.” – Dr. Ruckham ([28:23])

12. Genetics, Diet, and the Mystery of Perfect Regularity

• Juliana wonders if her regularity is genetic despite her diet.

  “Probably you have just good colonic motility...stuff gets in and it pushes and it gets out.” – Dr. Ruckham ([35:41])

• Sitting too long on the toilet (reading, scrolling) may predispose to hemorrhoids. ([34:06])

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Notable & Memorable Quotes

• Bill: “Who’s got a better colon?” ([04:25])
• Dr. Ruckham: “Always the woman.” ([04:31])
• Dr. Ruckham: “The definition of normal is three times a day to three times a week.” ([04:51])
• Giuliana: “Since I was younger, I’ll walk into, like, a Barnes and Noble...and all of a sudden...I have to, like, immediately make a beeline.” ([07:04])
• Dr. Ruckham: “If when you’re going to the bathroom, it’s coming out like clear water…then you’re done, you’re clean.” ([11:33])
• Dr. Ruckham: “Looking the other way. Most cancers started as a polyp. So by removing them, you’ll eliminate the chance.” ([13:13])
• Dr. Ruckham: “Hemorrhoids are just blood vessels…they don’t turn into anything bad.” ([25:35])
• Dr. Ruckham: “I would refocus that and say that’s an irrelevant goal.” (On being proud of big bowel movements) ([28:23])
• Dr. Ruckham: “Probably you have just good colonic motility...stuff gets in and it pushes and it gets out.” ([35:41])

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Timestamps for Important Segments

| Segment | Timestamp Starts | |-----------------------------------------------|------------------| | Meet Dr. Ruckham & Episode Introduction | 03:09 | | Bowel Movement Frequency — What’s 'Normal?' | 04:51 | | Fermentation & Diet; Aging and Digestion | 05:52 | | The 'Bookstore Poop Phenomenon' | 07:04 | | Colonoscopy Prep Anxiety & Practical Advice | 10:09 | | Polyps, Cancer, Colonoscopy Purpose | 13:06 | | Anesthesia Fears & Sedation Discussion | 14:08 | | Listener Q: Do All Colons Look the Same? | 23:18 | | GLP1s and the Modern Poop | 24:14 | | Hemorrhoid Basics & When to Worry | 25:07 | | Poop Length/Shape: What Does It Mean? | 28:01 | | Genetic Regularity vs. Diet | 33:29 |

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Episode Tone & Takeaways

The episode is unfiltered, often hilarious, yet unflinchingly honest. Bill and Giuliana use wit and warmth to make “potty talk” approachable, asking questions millions of people have googled in secret. Dr. Ruckham demystifies bowel health, encourages listeners not to obsess over frequency or ‘perfection,’ and urges simple self-care and communication with doctors.

Best for listeners looking for:

• Practical, stigma-breaking info about bowel health
• A behind-the-scenes look at colonoscopies, hemorrhoids, preps, and GI quirks
• A mix of humor, relatability, and top-tier medical expertise

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Summary Verdict:
This episode is a must-listen (or read) for anyone wondering about “what’s normal” in the bathroom—and champions the idea that there’s no shame in talking sh*t.

Transcript

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[Podcast Host Bill]

Welcome to Bill and Juliana the podcast.

[Podcast Host Juliana]

Hey, everyone. Welcome to the Bill and Juliana Podcast.

[Podcast Host Bill]

We are very lucky to have Dr. Ruckham, who actually is our doctor. Your doctor, My doctor. He gave us both our colonoscopies.

[Podcast Host Juliana]

He did.

[Podcast Host Bill]

He has over 40 years of experience, and he's done over 40,000 colonoscopies, if you can believe that.

[Podcast Host Juliana]

At Northwestern.

[Podcast Host Bill]

Well, between Northwestern and University of Chicago.

[Podcast Host Juliana]

That's huge.

[Podcast Host Bill]

He's currently the head of the department at Northwestern Medical center here in downtown Chicago.

[Podcast Producer/Assistant]

Yes.

[Podcast Host Bill]

And he's a lovely man. Great Chicagoan.

[Podcast Host Juliana]

He's a big deal.

[Podcast Host Bill]

Yeah, he's a big deal here.

[Podcast Host Juliana]

Literally, you guys, everyone in Chicago is like, oh, colonoscopy. Dr. Ruckham. Dr. Ruckham. Like, he's like, such a big deal. This is an important episode because Dr. Ruckham did my colonoscopy as well as Bill's, and that is actually the reason we are doing this podcast. We came up with this podcast idea is because I was googling all this stuff in the middle of the night about the colonoscopy because I could not finish the prep the liquid, that gross liquid for the life of me, and let's get dirty. Let's get our hands dirty.

[Podcast Host Bill]

Let's get our hands dirty. Welcome to the show, Dr. Ruckum.

[Dr. Ruckham]

Thank you for having me.

[Podcast Host Bill]

Yeah, I mean, as people know, you are just a pillar at Northwestern, which is one of the great institutions in Chicago. You've done Juliana's colonoscopy. My colonoscopy. Coming right out of the gate. Who's got a better colon?

[Podcast Host Juliana]

I knew you were gonna ask that. I knew he was going to.

[Podcast Host Bill]

We're a very competitive couple.

[Podcast Host Juliana]

We are. Who does? Be honest?

[Dr. Ruckham]

Always the woman.

[Podcast Host Bill]

Yeah.

[Podcast Host Juliana]

Okay.

[CarMax Advertiser]

Smart answer.

[Podcast Host Bill]

Speaking of bowels, as long as we're on the subject, we were talking about this. You know, how often should you make a bowel movement? Is it twice a day? Once a day? Three times a day? Size. You know, shape. Like, with the Internet now, you get so much information at your fingertips, you don't know what to believe.

[Podcast Host Juliana]

So what's your. What do you really want to know?

[Dr. Ruckham]

How often, believe it or not, the Definition of normal is three times a day to three times a week. That's where 95% of people will be within.

[Podcast Host Juliana]

That's a huge range.

[Dr. Ruckham]

That's a huge range. But it's important because you don't want to needlessly say, hey, I need to go every day. If you go every two or even every three days and you're very comfortable and it's regular for you, that's your norm, that's fine. Interestingly enough, too, the consistency is irrelevant. So if someone said, I have one watery bowel movement a day, or I have lumpy stool every other day, and that's their normal, if they fit within three a day to three a week, it's normal.

[Podcast Host Bill]

I had a fermented plum once.

[Podcast Host Juliana]

I'm sorry, what?

[Podcast Host Bill]

I was at a health food store, and this guy Khalil, who owns Sun Life's like, you gotta try this fermented plum. And it was like a gusher. I mean, no offense, but I was in the bathroom all day. I woke up in the middle of the night with abdominal pain. Like, it was bad.

[Dr. Ruckham]

The whole thing. With fermentation, there's a lot of very good, healthy foods that when we eat them, they are not fully digested. And as we get older and older, could be 35 or 40, but you're older than you were when you were 20. Things that you used to digest, you may not digest as well. So let me give you a few examples. Beans, onions, mushrooms, broccoli, cauliflower, spinach, kale, garlic. A lot of those foods, you eat them, they go in your stomach, they go through 20ft of small intestine.

[Podcast Producer/Assistant]

20ft.

[Dr. Ruckham]

20ft, where food is digested and absorbed. And then if it's not fully digested and it gets into your colon, the bacteria in the colon see this food, and they can literally ferment it. And ferment it means they chew it up and they make gases.

[Podcast Host Juliana]

I have a question. It is a question that is a mystery to many. It is an incredibly embarrassing question for some. I'm going to ask you. I don't know if you have the answer to this. You might have to get back to us because you've probably never been asked this in your entire career.

[Podcast Host Bill]

Buckle up, doc.

[Podcast Host Juliana]

Are you ready?

[Dr. Ruckham]

I'm ready.

[Podcast Host Juliana]

But I think there are millions of people like myself affected by this, okay? Since I was younger, I'll walk into, like, a Barnes and Noble, okay? And all of a sudden, within five minutes, I don't know if it's the smell of the books. I Don't know what it. I'm like, where's the bathroom? I have to, like, immediately make a beeline. And then I found. I thought I was the only person in the world who had this weird thing happen. And then I've seen other people on social media talk about this phenomenon. And some people, it's a target. Some people, it's like a TJ Maxx, you know, isn't that weird? And what do you think it is?

[Dr. Ruckham]

So I don't think I can give you an answer that's medical, that's definitive. But if one was to speculate, you know, how your mind holds back impulses. And when you feel relaxed, if you're busy, you're working, your mind is doing other things. There may be just the natural suppression of needing to go to the bathroom. Kids try. Not that you're even holding it in school, but a lot of times kids won't go to the bathroom in school. And it's not that they're. I mean, some are holding it. They have accidents, and that's an issue. But many of them just don't. Many people. You'll hear this all the time. During the work week, they don't go to the bathroom as much. Saturday and Sunday, when they're home, they go. So it probably has to do with just the relaxation that you're feeling that you're not in hip, that you're in the store, and you weren't running and doing errands and catching a cab or getting in a new place.

[Podcast Host Juliana]

This is my happy place.

[Dr. Ruckham]

You're relaxed, I'm relaxed, and you're letting Mother Nature take over, which is what it should have done. Maybe a little while. That's just my guess. That's great, but I don't have a medical.

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For sure.

[Podcast Host Juliana]

Medical expertise.

[Paramount+ Advertiser]

What if I.

[Podcast Host Bill]

Stupid Barnes and Noble.

[Dr. Ruckham]

Either that or I would tell some of my constipated people to go to Barnes and Noble.

[Podcast Host Juliana]

By the way, Doctor, feel free to take my.

[Podcast Host Bill]

You do a joint venture with Barnes and Noble?

[Pets Best Insurance Advertiser]

Yeah.

[Podcast Host Juliana]

If I haven't gone to the bathroom in a while, I'm like, I should just go to the bookstore. I should probably just go grab something at home goods. So, Dr. Ruckham, literally the impetus for this podcast was my experience getting my colonoscopy. You don't know this yet. Okay. But when I was doing the prep for my colonoscopy, I heard all these stories about the liquid. The liquid's the worst. The prep is the worst. The colonoscopy itself isn't bad. That's what everyone says. It's the prep that people get nervous about, as you probably know. And so when I was doing the prep, I got all my stuff, I went to the pharmacy, picked it up, and the first couple sips, I was like, this isn't bad. Why does everyone complain about this? As the day went on, it was still fine, fine, fine. And then kind of by the end of the day, I started getting a little, like, exhausted from drinking it, wasn't loving it anymore. And then I had to set my alarm in the middle of the night to wake up to finish the prep. And so in the middle of the night, when I woke up, I kid you not, I literally. I had, like, this much left. I was like, I physically cannot take one more sip of this stuff.

[Podcast Producer/Assistant]

Okay.

[Podcast Host Juliana]

So much so. And you don't know this, but so much so that I thought, I. I have to cancel my appointment. Like, I'm gonna have to email his office or call the emergency line and be like, hey, I'm not coming in. Because I had an early morning appointment, and I literally could not finish the prep. So I went online and I searched. Do I have to finish the prep before a colonoscopy? And there were a million different reports. Couldn't get a straight answer. And then finally, it was actually on Reddit that I saw a line that said, I am a colonoscopy nurse of 20 years.

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And

[Podcast Host Juliana]

so I clicked it, and she said, if you're healthy, it's your first colonoscopy. There's nothing scary going on that you know of. Then, yes, you could leave some of the liquid behind. You don't have to take it all. And so that gave me reassurance I could go back to bed. I came in the next day, and I don't know if you remember, but when I came out of the colonoscopy and you guys woke me up, you were there.

[Podcast Producer/Assistant]

Bill?

[Podcast Host Juliana]

Yeah. I think I asked you, I said, how was I in there? You know, I wanted to know, like, was I. Yeah, well, cleansed out. Yeah. Did I do my job? Because I was curious by not having that final bit, was it still okay?

[Dr. Ruckham]

That's a common question. And people think about it. You know, part of the issue is not everyone scheduling a colonoscopy has a doctor's appointment where you'd have a chance to discuss things. Most of them, I turned 45. I'm getting a procedure. Do I need a waste of time to go to the office? And GI. Doctors don't require that it's scheduled. You can do it. So you really never had the chance. Simplest answer is if when you're going to the bathroom, it's coming out like clear water or almost like urine, like just a yellow tinge, pure water, then you're done. You're done, you're clean. So you don't have to drink anymore because you're as clean as you need to be.

[Podcast Host Juliana]

Love it.

[Dr. Ruckham]

The other part to it is there's different types of bowel preps. So some people get the whole jug, the 4 liter, which is more to drink, more potent because it'll flush you out. Some people get the shorter, the smaller two bottles.

[Arm and Hammer Advertiser]

Yeah.

[Dr. Ruckham]

And when you do the shorter one, it's ideally, you'd rather not take a shortcut from the shortcut.

[Podcast Producer/Assistant]

Got it.

[Dr. Ruckham]

You know, so those people I would try to encourage to drink it all. But again, if they're clear or yellow and watery, you're done.

[Podcast Producer/Assistant]

Got it.

[Dr. Ruckham]

So you don't have to finish the.

[Podcast Host Bill]

I had the big boy. I had the 4 liter or whatever it was. It was quite powerful.

[Podcast Host Juliana]

And you finished yours?

[Podcast Host Bill]

I finished mine. And the good news is, when I went in, you said, I'll see you in 10 years. So I had a clean bill.

[Dr. Ruckham]

That's a clean bill. And that means no polyps, because that's what we're looking for when we do this. Most polyps will never become cancer. Looking the other way. Most cancers started as a polyp. So by removing them, you'll eliminate the chance. What's the odds of a healthy 50 year old having a polyp? It's probably in the 35 to 40% range. So it's not uncommon at age 45 or 50 to have a polyp.

[Podcast Host Juliana]

I did have a polyp.

[Dr. Ruckham]

Yeah, but how many people. How many people will get colon cancer? It's about 4%.

[CarMax Advertiser]

Got it.

[Dr. Ruckham]

No test is 100%. There's things that could be missed. There may be cancers that don't start as a polyp.

[Podcast Host Juliana]

Yeah.

[Dr. Ruckham]

But in general, we're reducing the risk of colon cancer by about 80%. That's incredible. You might find some say 90%, some say 70.

[Podcast Host Juliana]

By doing a colonoscopy.

[Dr. Ruckham]

By doing a colonoscopy.

[Podcast Host Juliana]

Now I have to ask you. So when you go to a colonoscopy, you go under. Correct. Like you're out, I mean. Or twilight. What is it called?

[Snap Judgment Host Glenn Washington]

Twilight.

[Podcast Host Juliana]

Twilight.

[Dr. Ruckham]

So it's not general anesthesia. You're breathing out on your own. You're in a sedated to be comfortable. That's the focus, is comfort.

[Podcast Host Juliana]

Okay. And Obviously, that's what, you know, like, I was, like, excited about that. Because, of course, like, the last thing I want to do is be awake during a colonoscopy. Yet the person to my right, my husband, me opposite, psycho.

[Podcast Announcer]

He.

[Pets Best Insurance Advertiser]

What?

[Podcast Host Juliana]

What was your reaction when my husband said, I don't want to go under, I want to be awake for my colonoscopy.

[Podcast Host Bill]

I've never been under in my life. And I even did a shoulder surgery.

[Dr. Ruckham]

Yeah.

[Podcast Host Bill]

And I didn't go under.

[Dr. Ruckham]

So, you know, I will. Look, I've done. This sounds like a crazy number, but I've done over 40,000 colonoscopes. Colonoscopies. Wow. Okay. And I will probably do maybe 10, 12 a year. Where people request no sedation. I try to discourage it. Why not just be relaxed and comfortable? You just don't know how you're going to feel. Everyone's got their own nerves, sensitivity. The part that makes a colonoscopy potentially uncomfortable is when you're pushing it in the stretch that can occur. And if there's a loop. If there's a loop and you wouldn't know it, your colon could have a loop. And we go in and we just twist with our wrists, unravel and straighten it when we're coming out. There's no discomfort. It's just. It's straight. But you just don't know how people react. And some do. Amazing. And, you know, I say this objectively, no sexism involved. As a general rule of thumb. General. Men's colons tend to be a little straighter than women's. Women's tend to have a little more twists as they get older and they've had some children, their pelvic floor may drop a little, and there may be that twist.

[Podcast Host Juliana]

Is that why men go number two more often?

[Dr. Ruckham]

And I hear that all the time from the wives. Why am I constipated? And my husband goes every day. And as a rule of thumb, men tend to go a little more regularly than women. Still, there's no way that it can be not uncomfortable.

[Podcast Host Bill]

I won't do it. I will never. When I come back to you, when I'm 60, I am going under.

[Dr. Ruckham]

Yeah.

[Podcast Host Bill]

So I've never been under in my life. Still to this day, I've never been under. But I can't. I'm not doing that.

[Podcast Host Juliana]

What is this fear, Bill?

Hold on.

Let me ask you. Because my fear, when I go under, I've been under a lot. I'm not even scoliosis, breast cancer, ivf. I've been under A lot.

[Podcast Announcer]

Right.

[Podcast Host Juliana]

I've had a lot of propofol, a lot of all this stuff. My fear is like, God forbid something happens and I don't wake up.

Right.

I mean, that's. I think most people's fear. Is that your fear? What is your fear going on?

[Podcast Host Bill]

I mean, I spent a lot of time Googling medical treatments and things like that. And in Europe, believe it or not, they don't go under for colonoscopies in many parts of Europe. Right. From what I was Googling. And I'm like. Because it's unnecessary. And I just. I've never been under. I think it's also a lack of control. You know, I don't know what I'm going to say.

[Dr. Ruckham]

You know, that's the comment that I. The two things that I hear the most when someone says they don't want to is they say, I have this fear of losing control.

[Podcast Host Bill]

Yeah.

[Dr. Ruckham]

And I go like, what control are you looking for in the next 30 minutes?

[Podcast Host Bill]

You know?

[CarMax Advertiser]

Yeah.

[Dr. Ruckham]

And. And occasionally some people want to. They literally say, I have a meeting to get to. I don't want to be sedated. I want to just get up and leave. And, you know, we'll work with them. We'll always give them an iv, okay. In case. In case their blood pressure got a little low. We can give them fluids in case they throw in the white towel and say, I surrender.

[Podcast Host Bill]

I was close. I was close.

[Dr. Ruckham]

You know, that way we can. But. But, you know, you hate when you do that. When someone midstream says, give me the medicine, because you say, why did I have to put you through discomfort before you said it?

[Meaningful Beauty Advertiser]

Yeah.

[Podcast Host Juliana]

So if people ask for. They don't want the propofol. They do the milder one. Do you. Do people still say crazy stuff?

[Dr. Ruckham]

People are always worried that they're going to say something. They never do. They never do.

[Podcast Host Juliana]

You know what?

[Dr. Ruckham]

Some people, they just go to sleep, and they're just relaxing. And, you know, as the procedure's going on, I'm constantly with the nurse in the room. We're going like, bill, you know, open your eyes. And if you started, like, opening them, give him another milligram. Because we're trying to be two to three minutes ahead of when you may actually wake up a little more because it's titrated to the person's need. There's no fixed dose that's gonna work for everybody. We go a little at a time, a little. Another dose, another, and then you're ready.

[Podcast Host Bill]

I'm excited. I'm looking forward to 60.

[Dr. Ruckham]

But I will tell you when people ask me that and their spouses in the room, I always go, you said I love my husband.

[Podcast Host Juliana]

Oh, that's interesting.

[Dr. Ruckham]

Yeah, I just joke with you.

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[Snap Judgment Host Glenn Washington]

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[Podcast Host Juliana]

A lot of people have so many questions.

[Podcast Host Bill]

I have some questions written down from viewers.

[Podcast Host Juliana]

We literally have people who were so excited that you are coming on. Our best friends were very excited. We have a good friend in Chicago named David Wells, and we told him you were coming on, and he said, you know what? I want to know. Because we asked our friends, like, what do you want to know? And he said, I would love to know if they all look the same.

[Dr. Ruckham]

Like, you mean the colon?

[Podcast Host Juliana]

He said, like, are some nicer looking.

[Podcast Host Bill]

This guy's a knucklehead.

[Dr. Ruckham]

Yeah.

[Podcast Host Bill]

He wants to know if there's a prettier colon than the other.

[Podcast Host Juliana]

He said, are any attractive? Not like, this is crazy. No, it's not. Do they all look the same? I think is actually a very good question.

[Dr. Ruckham]

Well, they look the same if they're healthy, but there might be subtle turns and twists and diverticulum that, you know, if some colons have so many, it almost looks like Swiss cheese.

[Meaningful Beauty Advertiser]

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[Dr. Ruckham]

And you gotta be really careful, meaning you gotta say which one's the real opening and which one's the diverticulum. If they're bigger.

[Podcast Host Bill]

If they're bigger. A lot of people are now taking GLP1s, right. It's causing a lot of problems with their ball movements. Irregular ball movements, Freezing of the colon. What are you seeing? Now, in the industry with so many

[Dr. Ruckham]

people taking GLP1s, okay, so GLP1s in general work in two different ways. One, in the brain, they decrease your appetite. Two, they slow your gut motility so your stomach doesn't empty. So imagine how hungry you would be if you said you want a meal. After you've had a meal. You'd say, no, I'm full. Their stomachs don't empty as well, and that's the other reason they don't want to eat as much. But it can also affect the colon. People do get sometimes diarrhea from it. But a little more commonly is constipation that your bowel doesn't move as well. Constant cause it slows gut motility. So when someone's on a GLP1, we tell them to not take it for at least seven days.

[Snap Judgment Host Glenn Washington]

Got it.

[Dr. Ruckham]

The last dose should be seven days before the prep so that it's wearing off by the time you're taking the bowel prep and you clean out.

[Podcast Host Juliana]

Okay, what's the story with hemorrhoids? Like, at what point should you worry, Go to a doctor about a hemorrhoid? You know, sometimes, like, you get a hemorrhoid once in a while and it kind of goes back in and then, you know, like, bye, bye, you know, it's gone. But then sometimes, like, it can be a little feisty. Keeps coming, you know, keeps popping out and stuff like that.

[Podcast Host Bill]

Like, you could tell me about your, your issues.

[Podcast Host Juliana]

I don't have one right now.

[Podcast Host Bill]

I don't have one. Feel free to.

[Podcast Host Juliana]

I've had. I mean, I can admit, I mean, we've all had.

[Dr. Ruckham]

Hemorrhoids are a very. It's a very common question.

[Podcast Host Juliana]

Yes.

[Dr. Ruckham]

A common thing that people come in to see a doctor about. Hemorrhoids are just blood vessels, so the good news is they don't turn into anything bad. You know, people often wonder, well, if I don't do anything, will it turn? It's just a blood vessel. Okay, so now there's two types, and it's important to know the distinction. You know how people use the term rectum and anus, sometimes interchangeably, but medically, the rectum is the end of the colon. That's the end.

[Podcast Announcer]

Okay.

[Dr. Ruckham]

And after the rectum is the anus, which is the muscle that, you know, if you want to hold it, you can tighten it so the anus has nerves to it. That's where external hemorrhoids are in the anus. So external hemorrhoids can bleed and they can Hurt. Internal hemorrhoids are in the rectum, so they can bleed, but they don't hurt. Warm water, though, you know, like when you go on a hot bath, you know, no salt. You don't need any of that Epson. That's old folklore. Just warm water. You know how your fingers can shrivel up like prunes. When you've been in the bath long enough that your fingers are shriveling, the hemorrhoids can shrink, and that's what helps them. Hemorrhoids can be caused by a lot of things. It could be just bad luck. It could be you have diarrhea and you're going frequently. It could be a long plane ride.

[Podcast Host Bill]

I'm a runner, so I get a run.

[Dr. Ruckham]

A runner, a biker on those narrow bikes. Pregnancy when you're pushing. So a lot of things cause them, but most get treated easily.

[Podcast Host Bill]

I had a hemorrhoid once. This is a funny story. And I went into one of those float tanks you ever been in. It's, like, filled with Epsom salt. Right. And you float in these deprivation tanks. It was so pain. I had to get out because I don't know if the hemorrhoid had popped. But that salt in the wound. Oh, my God.

[Dr. Ruckham]

Yeah, we don't do. That's why we don't even do salt anymore. It's warm water.

[Podcast Host Bill]

It was awful.

[Dr. Ruckham]

But occasionally someone is in acute misery, like, they're writhing in pain. And that can sometimes be what we call a thrombosed hemorrhoid, where they feel it, and it feels like there's a walnut in there. It's hard, and you touch it. And if it's real, usually they'll still get better. It'll get better if you can bear with it a few days. But if it's really miserable, that's where a surgeon will literally lance it and pull out the wall.

[Podcast Host Bill]

Just take it out.

[Dr. Ruckham]

Yeah. And it'll be instant relief.

[Podcast Host Juliana]

Got it. People are very proud of themselves when it's like a. Like a foot longer, like a snake, Big, long. But is that better and healthier or the, like, single ones? And if they're floating versus sinking, like, what do we. What should we be proud of when we look down in the toilet? Because I'm very proud of.

[Dr. Ruckham]

I would refocus that and say that's an irrelevant goal. It's an irrelevant goal.

[Podcast Host Juliana]

Oh, really? So they can all be good. They can all be equal.

[Dr. Ruckham]

If you're evacuating, you're getting rid of waste, you're comfortable. It's your. It's your norm.

[Podcast Host Juliana]

Okay.

[Dr. Ruckham]

You don't have to.

[Podcast Host Juliana]

Got it.

[Dr. Ruckham]

Be, you know, like, so don't be

[Podcast Host Juliana]

so obsessed with it. Yeah, like, don't. It doesn't matter. So whether they're individual, whether it's whatever, as long as it's solid, I would

[Dr. Ruckham]

assume we'll show people charts, even, and we'll say, you know, is it watery, mushy, like soft serve ice cream?

[Podcast Host Juliana]

Yes.

[Dr. Ruckham]

I mean, we're talking. What will we say in an office 100? Is it a banana? Is it little nuggets? Are you straining? And they all can be fine if you're comfortable. If you're saying, I'm having hard stool and it's giving me cramps or when it goes through, it hurts. Some people, a big, bulky stool can cause not only a hemorrhoid, but another thing called a fissure.

[Podcast Host Bill]

Yes.

[Snap Judgment Host Glenn Washington]

Which.

[Dr. Ruckham]

A fissure is a tear in the anus, so the anal muscles stretch, stretch, stretch. And if it's so bulky and it keeps stretching, it tears. It's like a cut. And it hurts and it can bleed. So the history can sound very much like a hemorrhoid. It's just that when the doctor talks to a person, you'll say, did you have a big, hard, bulky stool when it came through? Did you know it was big? Did you know it hurt as it was coming through? And they go, yeah, and then it hurt. And I saw blood. That's a classic fissure.

[Podcast Producer/Assistant]

Okay.

[Dr. Ruckham]

The treatment is identical to hemorrhoids.

[Podcast Host Juliana]

Okay?

[Dr. Ruckham]

The warm baths, the creams, most heal occasionally, they don't. Occasionally. And then there's other things we do for fishers. I mean, if they're really not getting better. You know how people get Botox for wrinkles? Well, we can inject Botox in a fissure if some of the medical treatments don't work.

[Podcast Producer/Assistant]

Hi, I'm Cindy Crawford, and I'm the founder of meaningful beauty. When Dr. Sabah and I decided to do a skincare line together, he said to me, we are going to give women meaningful beauty. And I said, that's exactly right. We want to give women meaningful beauty, which means each and every product is meaningful. It has a reason to exist. It's efficacious. You're going to get results, and then you just go out and live your life. Meaningful beauty. Confidence is beautiful. Learn [e-mail]

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[Podcast Host Juliana]

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a [e-mail] Pet insurance products offered and administered by Pets Best Insurance Services, LLC are underwritten by American Pet Insurance Company or Independence American Insurance Company for terms and conditions, visit www.petsbest.com. policy products are underwritten by American Pet Insurance Company, Independence American Insurance Company or Ms. Transverse Insurance Company and administered by Pets Best Insurance Services LLC. $1 a day premium based on 2024 average new policies data for accident and illness plans pets age 0 to 10

[Snap Judgment Host Glenn Washington]

I'm Glenn Washington, host of Snap Judgment from KQED. Every week, Snap drops you inside someone's biggest decision, the kind of decision you can only make once with everything on the line. What do you believe? What do you want? And what would you risk to get it? Find out Snap Judgment New episodes every Thursday, wherever you get your podcasts.

[Morakan Rice Vinegar Advertiser]

And now, another mouthwatering recipe from Maracan, the world's finest rice vinegar. How about a Maracan hot chicken sandwich with tangy slaw and pickled cucumbers? It's bold, crispy and spicy with chili, garlic and bright, tangy notes. The secret? Morukan Genuine Brewed rice vinegar. It adds a zesty kick that elevates sauces, marinades and homemade condiments. Craving sweet and savory, try Maracan Seasoned Gourmet Rice Vinegar, a flavor bomb delivering perfectly balanced taste. Great for spring vegetables, fresh slaws and grilled proteins. Maracan has crafted premium rice vinegar in Japan since 1649 and brewed in the US for over 50 years. Next time you're at the market, pick up a bottle of Morrican Genuine brewed with a green label or season gourmet with the orange label. Then check out ricevinegar.com for more delicious recipes. Because the food you love is better with Maracan, the world's finest rice vinegar.

[Podcast Host Juliana]

Do you think some people just genetically are just genetically more able to have like, great movements? Because I kid you not, Bill, tell them the truth. I'm very regular. Really. I cannot say a bad thing about my movements. I know that sounds weird, but I'm not kidding. No, Bill, don't. We always talk about this?

[Podcast Host Bill]

No, not always. Thank you, though. No, no.

[Podcast Host Juliana]

Bill even says, he's like, it's unbelievable.

[Podcast Host Bill]

Well, what's unbelievable is how quickly you're in and out of the bathroom.

[Podcast Host Juliana]

Oh, like five seconds, I'm like, wait, you.

[Podcast Host Bill]

You just like in and out?

[Podcast Host Juliana]

That's what I mean. So. Okay. No, and it's my time.

[Dr. Ruckham]

Better if you can do it. By the way, people that sit on a toilet and read a magazine or a paper that can predispose to hemorrhoids.

[Podcast Host Juliana]

There we go. See, I don't do any of that.

[Podcast Host Bill]

I gotta stop.

[Podcast Host Juliana]

Yeah, you gotta stop scrolling on the toilet.

[Dr. Ruckham]

And I read the consistency. You know, I mean, I. I mean, I have people that, you know, they joke, they'll go, you know, it was like Secretariat.

[Podcast Host Juliana]

But I'm telling you, I think it's hereditary. Genetic. Cause I have. I am the most regular person two, three times a day. Solid in and out of there. Not stressed, not pushing. Nothing yet. Yet. My diet's not great. Like, I eat like a 12 year old boy who just discovered candy and junk.

[Dr. Ruckham]

Incredible.

[Podcast Host Juliana]

I don't drink water. Except for how much water do I drink a day? Half a cup?

[Podcast Host Bill]

Nothing.

[Podcast Host Juliana]

It's terrible. So you would think so. I wonder. No, this is a serious question. I didn't have this one prepar. Is it like maybe is it a family? Like, is it my ancestors? Like, is it something like we were. I'm from Italy. I don't know. Like, I'm just trying to figure out.

[Dr. Ruckham]

I'm not aware of anything that we could talk about genetically or heritage.

[Podcast Host Juliana]

Isn't that interesting though?

[Dr. Ruckham]

Probably you have just good colonic motility that, that, you know how the, you know, the colon in the stools in the middle and then there's the lining and underneath that there are muscles that, you know, push to propel the stool. But someone like you, from what you said, sounds like you just got good motility.

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Good motility.

[Dr. Ruckham]

Stuff gets in and it pushes and it gets out.

[Podcast Host Bill]

Thank you for carving out the time to come in and see us here in Chicago.

[Podcast Host Juliana]

Thank you, Dr. Ruckum. This was so wonderful.

[Dr. Ruckham]

What a pleasure. It's really been a joy.

[Snap Judgment Host Glenn Washington]

Foreign.

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[Dr. Ruckham]

Just make sure we protect each other.

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Welcome to the history books.

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[Podcast Announcer]

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