← Ologies with Alie Ward
Ologies with Alie Ward
Coloproctology (COLON CANCER + BUTT FUN) with Carmen Fong
01:27:33
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.
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- [00:01]
Allie Ward
Oh hey, it's the fitted sheet that really doesn't care how you fold it. A.L.I.E. 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 what to Know when youn Can't Go. They have been decorated with so many medical awards. They got their MD 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. 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 dildo. But first, thank you to everyone via patreon.com Ologies for the 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 SR Forstner who wrote One Minute I'm learning about Volcanic Lightning, the next I'm emotionally invested in Salamanders. SR 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. This podcast is brought to you by Hotels.com make your next trip work for you. Hotels.com's new save your Way feature lets you choose between instant savings now or banking rewards for later. It's a flexible rewards program that puts you in control with no confusing math or blackout dates. Book now@hotels.com Save Your Way is available to loyalty members in the US and UK on hotels with member prices. Other terms apply. Csyke for details.
- [01:58]
Sponsor Voice
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- [02:28]
Allie Ward
Okay. Come along with me into the world of your colon. Also, I did an episode a few years ago called Field Trip My 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 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 colon, which means colon. And proctology derives from the Greek for anus. So coloproctology, 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, fiber maxing, 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.
- [03:59]
Dr. Carmen Fong
We're vibing.
- [04:00]
Co-host or Interviewer
We're vibing. Dude, I. There's so many questions. I hope you know how excited people are to learn about butt health.
- [04:07]
Dr. Carmen Fong
I can imagine, honestly. I mean, I. 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.
- [04:25]
Allie Ward
Okay, hold on. Let's back up a sec.
- [04:28]
Dr. Carmen Fong
Oh, yeah, my name is Carmen Fong, and my pronouns are she, her, they. Cool.
- [04:32]
Co-host or Interviewer
Okay, gastroenterology, proctology. Can you disambiguate this for the uninitiated?
- [04:40]
Dr. Carmen Fong
A hundred percent. Okay, 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 surgeons 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.
- [05:07]
Co-host or Interviewer
Oh, does it stop if you're a gastroenterologist, once you're no longer in the intestines, that sphincter. This is it, the
- [05:18]
Dr. Carmen Fong
ileocecal valve. Right. Is that. Thank you.
- [05:22]
Allie Ward
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
- [05:45]
Co-host or Interviewer
bowel movement, if you will, once it crosses that barrier. Is that like a different jurisdiction?
- [05:52]
Dr. Carmen Fong
That's interesting. So, no, actually. 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 helped with doing, like, a laparoscopy at the same time, which is kind of a crazy procedure.
- [06:15]
Allie 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.
- [06:42]
Dr. Carmen Fong
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, do 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.
- [07:00]
Co-host or Interviewer
When you were going through med school, did you have a lot of rotations and did you just land on. On bus and intestines, and you're like, I'm home.
- [07:08]
Dr. Carmen Fong
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? Aww, how dare you. 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.
- [07:54]
Co-host or Interviewer
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.
- [08:04]
Dr. Carmen Fong
Correct.
- [08:04]
Co-host or Interviewer
Is that true?
- [08:06]
Dr. Carmen Fong
Yes. Do 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? Yeah. And it's not. And then somebody else asked me, if you're looking at your colon, is it more like a pipe? But it's actually more like an empty tube sock. 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 put your thumb through. But then the harder ones, like your liver, so there's like squishy pieces and tube sock pieces, and. Yeah, you just throw it all back and 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 cool, laying on me. 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.
- [09:08]
Co-host or Interviewer
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? Soccer. Like one of those animal balloons that you haven't pumped up yet?
- [09:21]
Dr. Carmen Fong
Yeah, it's just sitting in the bottom of your pelvis.
- [09:24]
Co-host or Interviewer
And so then when there's food moving through it, then it kind of inflates. Like a bubble would? Yep.
- [09:28]
Dr. Carmen Fong
Oh, no way. Like a bubble. Like if there's gas, right? Like, if you're about to fart, there's going to 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 constant, you can probably feel almost like a little cylinder in the left side of your abdomen. That's your sigmoid colon. That's full of poop when it's full.
- [09:47]
Allie 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 into the rectum and then out your anus into the glare of the limelight.
- [10:36]
Co-host or Interviewer
I always wonder how, when doctors are palpating a stomach, how they know what the fuck's going on down there? Because I'm like, how do you.
- [10:43]
Allie Ward
It doesn't feel like anything.
- [10:45]
Co-host or Interviewer
How are you trained to do that?
- [10:47]
Dr. Carmen Fong
You know, that's a really good question. 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, you know, this feels like. But we are losing a little bit of that. Like, the art of physical examination because of CT scans and MRIs and all that. Just like, I'll scan you and we'll find out what's wrong.
- [11:06]
Co-host or Interviewer
Have you ever been called to get things out of a butt?
- [11:09]
Dr. Carmen Fong
Oh, 100%. I knew this question would come up.
- [11:11]
Co-host or Interviewer
I'm sorry. I didn't even think I had the question until I was like, wait a minute. How have I Got out. Talk to me.
- [11:17]
Dr. Carmen Fong
Actually, it's a joke that like at 3:00am, you know, if they call me, it's going to be like, get Dr. Fong's foreign body extraction tray. Because that means that I'm going to need the tongs and the clamp and the speculum. But yes, I have removed some things.
- [11:32]
Co-host or Interviewer
Anything that you're at liberty to share. Anything really? Wow ya.
- [11:36]
Dr. Carmen Fong
You know, most of it is like a long time ago, but my favorite one was a pink highlighter because my resident still texts 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 what 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. Oh no, 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.
- [12:22]
Allie 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.
- [12:32]
Co-host or Interviewer
If it's glass.
- [12:34]
Dr. Carmen Fong
How.
- [12:35]
Co-host or Interviewer
I mean, you must need like the gentlest of touches.
- [12:38]
Dr. Carmen Fong
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 dever, 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.
- [12:56]
Co-host or Interviewer
Did you have to sedate the patient?
- [12:58]
Dr. Carmen Fong
They were sedated. Absolutely, yes.
- [13:01]
Co-host or Interviewer
I mean I would be like, wake me up like a month later.
- [13:05]
Dr. Carmen Fong
Yeah. And 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 gotta 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.
- [13:23]
Allie Ward
Yeah.
- [13:23]
Dr. Carmen Fong
Then you should be asleep. Fortunately, knock on wood, that's never happened.
- [13:27]
Co-host or Interviewer
Do you have a PSA now for,
- [13:29]
Dr. Carmen Fong
for butt plugs with a foot 100% important.
- [13:33]
Co-host or Interviewer
Have a foot at the end of your butt plug, please.
- [13:35]
Dr. Carmen Fong
Have a handle. You know, make sure there's a handle. Make sure you can have a good grab on it if you can.
- [13:40]
Co-host or Interviewer
Oh, saving lives, saving pride, saving butts.
- [13:44]
Allie Ward
I'm sorry that.
- [13:45]
Co-host or Interviewer
That's one that you get asked so
- [13:46]
Dr. Carmen Fong
much, but no, people want to know, you know.
- [13:50]
Co-host or Interviewer
Yeah, well, okay, so I studied biology in college, right. 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.
- [14:07]
Allie Ward
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 thank 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. Aren't you glad you can do that? Of course you are. And 1 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 Chagas disease can also lead to a condition called megacolon, which sounds like a Marvel character, but it's more painful and potentially lethal. So according to the paper, acute, toxic, and chronic, a constipated and stuffed colon with a diameter nearing 5 inches is mega, obviously, and can require surgical correction to address whatever the underlying causes are. 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 8 foot long colon nearly 9 inches in diameter and carrying four 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 condition, and he actually went against orders from the government, and he provided free health care 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 Hirschsprung. 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.
- [16:45]
Dr. Carmen Fong
So from the bottom. 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 sp. 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 they 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, which is the connection between the colon and the small bowel. And then if you go above that, there's like, the. 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. Oh, so that's the part that controls your gerd.
- [17:47]
Allie 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.
- [18:01]
Dr. Carmen Fong
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. Or if you're pregnant, it relaxes your esophageal sphincters, and everything kind of sloshes back up.
- [18:13]
Co-host or Interviewer
Oh, that's why that happens?
- [18:16]
Dr. Carmen Fong
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.
- [18:26]
Co-host or Interviewer
And you mentioned before when you started recording that you've been pregnant, you're wearing a shirt right now that says Got hemorrhoids? Correct question mark.
- [18:35]
Dr. Carmen Fong
Yeah.
- [18:36]
Co-host or Interviewer
Where are the hemorrhoids? Which sphincter are the hemorrhoids? Where are those coming from?
- [18:43]
Dr. Carmen Fong
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.
- [18:52]
Allie 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.
- [19:13]
Dr. Carmen Fong
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 internal hemorrhoids are painless bleeding.
- [19:29]
Allie Ward
So that's inside your hole.
- [19:31]
Dr. Carmen Fong
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 it 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.
- [20:09]
Allie 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 gonna have some seals, some hoses are gonna underperform.
- [20:44]
Co-host or Interviewer
True or false. More people are having hemorrhoids younger because they're sitting on the toilet scrolling. Is that true?
- [20:52]
Dr. Carmen Fong
A hundred percent, yes.
- [20:54]
Co-host or Interviewer
Is that real? Tell me everything.
- [20:56]
Dr. Carmen Fong
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 food. Junk, you know, not gonna lie, that was me as well. Yeah. And so they were like, constipated too, on top of that and spending more time on 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 20s, 30s, 40s, all the way up,
- [21:40]
Co-host or Interviewer
all the way up and do over the counter things like tucks 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?
- [21:53]
Allie Ward
Like beauty contestants?
- [21:55]
Dr. Carmen Fong
Yes. So actually, that's the only thing I think Preparation age is good for, is for puffy eyes. Honestly. I know. Sorry. Preparation Age, I don't love it. Because what it does is the preparation age can kind of thin 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, tuck swipes. Sorry. Tux itch and irritation.
- [22:39]
Sponsor Voice
And then hemorrhoid flare up to relieve that painful burning on contact. Get tux medicated.
- [22:48]
Dr. Carmen Fong
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.
- [23:02]
Co-host or Interviewer
What's in a compound ointment?
- [23:04]
Dr. Carmen Fong
Yeah. So compound ointments include things like nitroglycerin, calcium channel blockers like diltiazem and nifedipine, also some lidocaine and some papificaine. 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, it's like, don't move. I don't want anything to move. This hurts. That clamping is what makes everything worse.
- [23:43]
Co-host or Interviewer
What about hemorrhoid surgery? Sometimes you've got to pull out the big guns.
- [23:47]
Dr. Carmen Fong
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 ligation, 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.
- [24:18]
Allie 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 more painful than any of those things. And shy David 00 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%.
- [25:04]
Co-host or Interviewer
Well, the problem is, unlike putting your arm in a sling, you have to use your butthole every day for something.
- [25:10]
Dr. Carmen Fong
You could be me. That is exactly what I tell people. 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 dissolved stitches have dissolved and then it just feels like you're like uncomfortable, but it's not like a sharp cut on your butt pain.
- [25:44]
Co-host or Interviewer
What do you feel like? Are some of the most common reasons people say? Dr. Fung, take me.
- [25:50]
Dr. Carmen Fong
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 is 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 ban 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, it can't swell anymore. So that's for 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. People are like, oh, my God, thank you. My fissure is healed. It's gone. No.
- [27:11]
Co-host or Interviewer
Is that covered by insurance?
- [27:13]
Dr. Carmen Fong
It is. It is, yeah.
- [27:15]
Co-host or Interviewer
Are they like, as long as you've got the vial out?
- [27:18]
Dr. Carmen Fong
Oh, okay. 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? Oh, my gosh. The only problem is I never have any left. Like, I. I usually put every last drop into the internal anal sphincter.
- [27:32]
Co-host or Interviewer
And.
- [27:32]
Dr. Carmen Fong
And yeah, insurance covers it. Nice Botox for your butt. Yeah.
- [27:35]
Co-host or Interviewer
Well, bleeding is a huge question though.
- [27:39]
Dr. Carmen Fong
So what amount of bleeding is normal?
- [27:41]
Co-host or Interviewer
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 symptoms like bleeding or they think it has to be bleeding in order for it to be cancer.
- [28:00]
Dr. Carmen Fong
So.
- [28:00]
Allie Ward
Yeah.
- [28:01]
Co-host or Interviewer
You see blood on the tipi.
- [28:03]
Dr. Carmen Fong
Yes.
- [28:04]
Co-host or Interviewer
What the hell do you do?
- [28:06]
Dr. Carmen Fong
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 8 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 a hundred percent, 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, 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 providers and sometimes we're like, here's some hydrocortisone and we think it's a hemorrhoid, but just make sure someone looks at it, okay? That's all. And then colonoscopy wise, right. So as you know, like the age is 45 now. We've decreased it in the couple years, which is awesome. You know, decreased the screening Age from 50 to 45.
- [29:13]
Allie Ward
Nice.
- [29:13]
Dr. Carmen Fong
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 20s and 30s, the youngest I've seen is 28, honestly. Yeah. And it was like super, super sad. But I've seen a ton of people in their like 30s, like 35, 38, 39. 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, can be precancerous like yours, right. 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. And then so you actually go in for a diagnostic colonoscopy to see what they can find. I would say 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.
- [30:15]
Co-host or Interviewer
There's also genetic links as well.
- [30:17]
Allie Ward
Right.
- [30:17]
Co-host or Interviewer
So if someone like my dad died from colon cancer.
- [30:21]
Dr. Carmen Fong
Sorry.
- [30:22]
Co-host or Interviewer
And you know, it was funny, he was like, well, you know, I had black stools and I. I didn't.
- [30:27]
Allie Ward
I didn't think much of it.
- [30:29]
Co-host or Interviewer
He thought it was just related to his chemotherapy. But he has multiple myeloma and then a side effect of the chemotherapy. He 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, 100%. If you're embarrassed by colonoscopy, like, just wait until you try to deal with colon cancer.
- [30:53]
Dr. Carmen Fong
Right? Yeah.
- [30:54]
Co-host or Interviewer
What?
- [30:54]
Dr. Carmen Fong
Yeah, you know, exactly. Yeah. Or like, a lot of people would be like, you know, the embarrassment of dealing with an ostomy, which, you know, for me, I try to destigmatize 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, like a permanent ostomy. Anyway. Okay, I digressed.
- [31:20]
Allie 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.
- [31:52]
Co-host or Interviewer
You get used to it.
- [31:53]
Allie Ward
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 in early, incredibly treatable stages, a colonoscopy is a cakewalk, man.
- [32:10]
Dr. Carmen Fong
It's a cakewalk.
- [32:11]
Co-host or Interviewer
It is, like, the easiest thing that can happen to your butt, like, ever.
- [32:16]
Dr. Carmen Fong
And you get a really good nap.
- [32:17]
Co-host or Interviewer
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.
- [32:30]
Dr. Carmen Fong
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.
- [32:44]
Co-host or Interviewer
But I'm wondering too, like, these rates of young people with colon cancer. I know that Chadwick's death really shocked
- [32:52]
Dr. Carmen Fong
a lot of people. He was so young.
- [32:53]
Co-host or Interviewer
I have a friend who, in his early 30s, was diagnosed with stage four. So sorry, 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.
- [33:07]
Dr. Carmen Fong
Yep.
- [33:08]
Co-host or Interviewer
We have a whole how to. But what about that line of, like, you're worried about it, but it's not quite time for you to get it checked out. Anything for that in between generation.
- [33:19]
Dr. Carmen Fong
Yeah. Which is like most of us right now. Right. So that would be you. 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 colonoscopy is the. 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.
- [33:42]
Co-host or Interviewer
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.
- [33:54]
Dr. Carmen Fong
I think that 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?
- [34:02]
Allie 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. Infoveillence 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 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 Mander, be 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. Fung says eat veggies with every meal, keep that fiber intake up, 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 than someone born in the 1990s. And James Van Der Beek 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.
- [36:40]
Dr. Carmen Fong
And then Ryan Reynolds had his colonoscopy on camera.
- [36:43]
Allie Ward
Raise awareness about something that will most
- [36:45]
Sponsor Voice
definitely save lives going in.
- [36:48]
Allie Ward
That's enough motivation for me to let you in on a camera being shoved
- [36:52]
Dr. Carmen Fong
up my and then I love that Ali Wong did a piece about it in her comedy special 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 getting to
- [37:17]
Allie Ward
take a drug induced nap for an
- [37:19]
Dr. Carmen Fong
hour 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.
- [37:34]
Allie 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 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.
- [38:29]
Co-host or Interviewer
I've wondered this, what it's like when
- [38:32]
Allie Ward
you have a diagnosis for someone.
- [38:34]
Co-host or Interviewer
Like, I got lucky. I had a precancerous situation that they snipped out, and I was one and done.
- [38:39]
Allie Ward
Right.
- [38:40]
Co-host or Interviewer
But what is that like when you
- [38:42]
Allie Ward
see something like that?
- [38:44]
Dr. Carmen Fong
Yeah, I always get, like, a really sinking feeling in my stomach, as I think anybody would. And then what you have to do is then you have to tell the patient that you're gonna 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 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 report show that 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.
- [39:45]
Allie Ward
What is the surgery like? When you're performing surgery, you've gotta go
- [39:50]
Co-host or Interviewer
through the abs and everything, right?
- [39:52]
Dr. Carmen Fong
Yes. There's a couple 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 5 millimeters each. And we put instruments through about the
- [40:04]
Allie Ward
diameter of a pencil eraser.
- [40:06]
Dr. Carmen Fong
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 flatus and starting to eat and stuff. So we try to do things laparoscopic and robotically. I save robotics for last because people always ask me, like, how do you do a robot surgery?
- [40:36]
Allie Ward
Yeah.
- [40:37]
Dr. Carmen Fong
So the same way that you do laparoscopy, which. So it's almost like a little tube that goes in through your belly button that 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 field through the robot. Robot apparatus.
- [41:04]
Allie Ward
So it's not an automated robot doing your surgery. It's Dr. Fong in a fucking mech suit. Amazing.
- [41:11]
Co-host or Interviewer
What's the benefit of robot. Is it a finer cut? Is it even a scalpel? Or is it like a cauterization?
- [41:17]
Dr. Carmen Fong
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.
- [41:40]
Co-host or Interviewer
Can you live without a whole large intestine?
- [41:43]
Dr. Carmen Fong
Yes. Yeah.
- [41:45]
Co-host or Interviewer
Really?
- [41:46]
Dr. Carmen Fong
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, the fascinating things, because 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 autotoxicity, 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 disease colon or if you have total colonic dysmotility. So some people can be born with like a colon that just doesn't move. And in those cases you go down like a bunch of steps or diagnosis like MRIs. And before we were like, hey, your colon really doesn't move. We're going to take the whole thing out.
- [42:40]
Co-host or Interviewer
Oh, okay. Constipation. Yeah, let's talk about it.
- [42:43]
Dr. Carmen Fong
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 they're having, and then like the electrolyte imbalance, balance in your body.
- [42:54]
Co-host or Interviewer
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 come. I sometimes call myself a toilet widow
- [43:08]
Allie Ward
because I'll just be.
- [43:10]
Dr. Carmen Fong
Oh, God, I haven't heard that one.
- [43:11]
Co-host or Interviewer
I'll be at a restaurant, you know,
- [43:14]
Dr. Carmen Fong
like, that's a new one.
- [43:15]
Co-host or Interviewer
Yeah, 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.
- [43:22]
Dr. Carmen Fong
That's so good.
- [43:23]
Co-host or Interviewer
I'll look like I got stood up on a date, but I'm like, he's just doing him.
- [43:27]
Allie Ward
We're going to talk about IBS in a minute. Of course.
- [43:29]
Co-host or Interviewer
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, haven't taken a shit what's going on?
- [43:45]
Dr. Carmen Fong
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, 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, this is a tough one.
- [44:17]
Allie Ward
So I dare you to remember that that empty stomach growling or that post meal gurgling in your guts is called the migrating motor complex. MMC baby.
- [44:27]
Dr. Carmen Fong
Okay. 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. 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, 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 insoluble fiber plus water. Water.
- [45:50]
Co-host or Interviewer
And what is psyllium husk? And how do we feel about like a Metamucil habit.
- [45:56]
Dr. Carmen Fong
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 5 grams of fiber, psyllium husk is the best way to go. It's the only one that's been really proven so far that in kiwis and Metamucil, if you get it in the store or 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.
- [46:23]
Co-host or Interviewer
And you just gotta really water it up.
- [46:25]
Allie Ward
Right? Yeah.
- [46:26]
Dr. Carmen Fong
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 wanna just like mix it in your coffee and be like, that's it for the day. You really. Yeah, yeah. That's not gonna do it.
- [46:41]
Co-host or Interviewer
Put it in a Coke and you're like, good to go in your Celsius for the morning.
- [46:45]
Dr. Carmen Fong
Iced coffee for the day.
- [46:46]
Co-host or Interviewer
No, that's not gon that. It's the only thing that's worked for 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?
- [47:03]
Dr. Carmen Fong
No. And I always tell people, especially for ibs, fiber will firm up loose souls, but it will also soften hard souls. Right. It does both things.
- [47:11]
Allie Ward
Fiber.
- [47:12]
Dr. Carmen Fong
Fiber is great. You don't want to overdo do fiber. Like, I saw like this fiber maxing trend on. Yes. Recently. Fiber maxing. Everyone's talking about it 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 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 bezoar. It's just like stuff that doesn't get digested and you have have to go in and skip it out.
- [47:43]
Allie 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 bezoar 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 Bezoars. And yeah, I'm going to link that for you to read. And the word comes from the Arabic aerobic for stone, used as an antidote to poison. But honestly, I would call the poison control hotline instead because bezoars, they're really hard to come by and I bet they'd be expensive. Now, speaking of things that are hard, not quite bezoars, 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.
- [48:43]
Co-host or Interviewer
And can't that block your little appendix?
- [48:45]
Dr. Carmen Fong
Yeah, it can block your appendix. Yes. Like an appendiculus. That's what I had.
- [48:50]
Co-host or Interviewer
Wait, did you, you, you had a. No, there's nothing. That's tmi. Are you kidding? So you had your appendix out?
- [48:57]
Dr. Carmen Fong
I have. I had it out 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. Good choice.
- [49:10]
Co-host or Interviewer
Do they build up over time like a blackhead or can it just be like a boop?
- [49:14]
Dr. Carmen Fong
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 vestigial, but it can build up. Yes. Like if it sits there. So you don't want things to back up into your pen.
- [49:31]
Co-host or Interviewer
And also you want an on ramp into fiber additions.
- [49:36]
Dr. Carmen Fong
Right? Yes.
- [49:37]
Co-host or Interviewer
You don't want to just dump it all at once. Right.
- [49:40]
Dr. Carmen Fong
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 fiber dosing.
- [50:03]
Co-host or Interviewer
And I imagine those fiber Gummies also, like, you gotta chug with a lot of water, right?
- [50:08]
Dr. Carmen Fong
Yes. Yeah. I have a couple fiber gummies that I love, and I do take them with water because of the gel, like the carrageenan, that actually can cause a little blockage. So drink water, lots of water. 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, I eat a ton of fruits and vegetables. I drink a lot of water. I work out. 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 imbalances. So we now know pretty well that magnesium is a great muscle relaxant that works for, like, sleep, it works for restless leg, but it 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 are certain bacteria that work better if you have just general IBS or like, other symptoms. And they're now fine tun tuning these strains. So fiber helps with the consistency of stool, but probiotics helps with the regularity of soil.
- [51:38]
Co-host or Interviewer
Can I ask you some questions? Do you have time for me to ask you some listeners?
- [51:42]
Dr. Carmen Fong
Yeah, of course. Yeah, yeah. Sorry, I just blabber on.
- [51:45]
Co-host or Interviewer
So, no, no, I have a million questions.
- [51:48]
Dr. Carmen Fong
All right, let's do it.
- [51:49]
Allie 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@fight colorectalcancer.org and thank you to sponsors of the show for making these weekly donations possible. If you've listened to the Kalology episode about beauty standards, you know that my approach to cosmetics is always a little weary. I don't approve makeup brands on this show because I don't like messaging that you need to wear a mask in order to feel or look beautiful. So I'm really choosy about what kind of makeup I wear and definitely about what I endorse. And Jones Road Beauty, I love them. They were created as kind of a skin first makeup brand. They enhance what you got instead of making you feel like you need a new face. Every formula is clean. It's high performing. I love the way it feels on my skin. They make this stuff called Miracle Balm that I have and I saw it online for a while and I was like, I wanna try it. I tried it. It was like, yep, this is something I love. You can use it on your cheeks,
- [53:05]
Co-host or Interviewer
you can use it on your lips,
- [53:06]
Allie Ward
your eyes, you can apply it with
- [53:08]
Co-host or Interviewer
your fingers, warms up.
- [53:09]
Allie Ward
They have it in different tones. I love a multitasker. That's the kind of cosmetic I'm talking about. So if you want a makeup that brings out your natural glow instead of of hiding it, Jones Road is the way to go. And for a limited time, our listeners are getting a free Shimmer face oil on their first purchase when they use the code Ologies at checkout. So just head to Jonesroadbeauty.com and use the code Ologies at checkout. And then after your purchase, they will ask you where you heard about them. So please support our show and tell them our show sent you. My face sent you. This podcast is brought to you by Squarespace. So is my entire life. I've used Squarespace ever since I started this podcast. So whether you're just starting out or you're you are scaling your business, Squarespace is an all in one website platform. It's designed to help your business stand out and succeed. They give you everything you need to offer your services to get paid all in one place. Whether you're doing things like consultations or events, you can show the world what you do with this great customizable website. It's designed to help grow your business. You can get paid on time. I love that they have on brand invoices. They have online payment. All of the things that you are overwhelmed to do Squarespace can handle. You can also streamline your workflow. They have built in appointment scheduling and email marketing tools which are huge right now. Again, I love Squarespace. Whether you are starting from the ground up and you just need a simple website or if you're a business and you want better, more streamlined portals. Squarespace, they know I love them. You know I love them. So head to squarespace.com for a free trial and when you're ready to launch, use the offer code ologies to save 10% off your first purchase of a website or a domain. Go do it. We love to have a balanced diet. Does it always happen? Of course not. Human beings and nutrient gaps occur for so many reasons. Genetics, dietary preferences, even modern farming practices. But Ritual has a team of scientists. I love them. They've poured over thousands of studies to figure out out what the common gaps between what people need for nutrients and what people are actually consuming over different life stages. And using their brains and science, they created the essential for women 18 multi and it has nine key nutrients. They're in two delayed release capsules. I always say this, they look like little lava lamps. But they are designed for the best absorption per day. I take Ritual every day. I personally notice that I feel better when I'm making sure I have B vitamins.
- [55:29]
Dr. Carmen Fong
Vitamins.
- [55:29]
Allie Ward
And sometimes my diet is not great. Popcorn for breakfast, waffle for dinner. Maybe other days I'm more on top of it. But every day I take Ritual Plus. All of Ritual's products are vegan. They're tested for heavy metals and allergens. It's high quality stuff. So instead of striving for perfect health, aim for supporting foundational health. Save 25 on your first month at ritual.comOlogies that's ritual.comOlogy Apologies for 25 off your first month. Look at that. Y' all have heard me talking about
- [55:58]
Co-host or Interviewer
quince for years and so many times
- [56:00]
Allie Ward
I'm like, I'm wearing quince right now. Wouldn't you know it, I'm wearing quints right now.
- [56:04]
Co-host or Interviewer
When it comes to clothes, I like quality over quantity.
- [56:07]
Allie Ward
There is so much fast fashion in the world and I love classic pieces that are worth having, that are worth hanging on to. And that's why so many people love quints, including my friends who are fashion designers. The fabrics feel great, the color cuts are thoughtful. I have friends who have gotten their Mongolian cashmere sweaters for gifts for every birthday of every friend that they know because it's like who doesn't love wearing a cashmere sweater? And the pricing actually makes sense. Quint works directly with safe ethical factories and cuts out the middlemen. So you're not paying for brand markup or really fancy retail stores, just quality clothing without a lot of markup. Right now go to quint.comologies for free shipping and 300365 day returns. That's a full year to wear and love it. And you will now available in Canada too. So don't keep settling. For clothes that don't last, go to Q-U-I-N-C-E.com ologies for free shipping and 365 day returns. That's quince.com ologies for delicious meals.
- [57:08]
Sponsor Voice
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- [57:30]
Allie Ward
like 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.
- [57:40]
Co-host or Interviewer
Let's talk colon cleansing. Oliver Callis, Megan Walker, Matt Thompson and first time question asker Cheryl Stragretto. Colon hydrotherapy. Yay 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?
- [58:01]
Dr. Carmen Fong
Yeah, so it's actually a nay for me for colon hydrotherapy. There's a couple reasons you would do it like if you were like, hey, you know, this week I feel especially 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. They will come out on their own.
- [58:35]
Allie Ward
But and no, 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 warm water pressure hose. You hold it in and then you release it several times over about 45 minutes.
- [59:06]
Dr. Carmen Fong
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. Oh, yeah. So it messes up your microbiome the same way that when you get a colonoscopy. You know, if you're doing that 4 liter colon prep before, some people will tell me that they can't poop for a couple 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. Oof.
- [59:58]
Co-host or Interviewer
Okay, so this brings me to. Let's talk about sex prep back there.
- [60:06]
Dr. Carmen Fong
Yeah.
- [60:07]
Co-host or Interviewer
Anonymous. Derek, Deviancy, Ben wanted to know. Pen 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. And Derek wanted to know if it's possible to overdo it.
- [60:26]
Dr. Carmen Fong
It.
- [60:27]
Co-host or Interviewer
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. And that's a question for all kinds of people.
- [60:43]
Dr. Carmen Fong
Awesome question.
- [60:44]
Allie Ward
Love that question.
- [60:44]
Dr. Carmen Fong
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 hours before you go. Because your rectal vault is really just that last portion, just that last like 8 centimeters or so. And you know, 8 centimeters hopefully is enough. But 8 centimeters or so is completely clean. Like all the poop should actually stay above it right after you poop. And nothing goes into the vault.
- [61:11]
Allie Ward
So yeah, the average human rectum, the final chamber of travel for your lunch. It's about 4 to 5 inches long. Although in taller, larger people like those assigned male at birth, it might be closer to 7 or 8 inches. And at the top of that, you would have to go through this bent kind of askew sphincter, the recto sigmoid 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 lap, loud vivid font, 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 a new one, lots of lube, go slow and you can even try a butt plug during your four stuff to relax things a bit little 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.
- [62:28]
Dr. Carmen Fong
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 anal douching things and they come in like bulbs 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 the shower head kind of attachment things. So I love the Fleet 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 that you can stuff up in your butt. And it sits right at the Sigma recto sigmoid. And then it stops the poop from coming down. So instead of having to, you know, douche immediately before sex, which kind of, 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.
- [63:31]
Allie 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 one 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 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 able people are going to clean up with this.
- [64:40]
Co-host or Interviewer
And going back to that. Jillian Jamstress, Iris Beanbag, the cat, David Robin, first time question, Ask her. Janelle, which is my sister's name, but I don't think it's her. Ethertog, Alex Minor and RJ wanted to. I mean, RJ Doidge says, okay, as a gay, what should we know that we don't because they don't teach it in health class or people are too embarrassed to ask. And other people wanted to know. Jamstress, are there health risks of doing anal? What qualifies as too deep? Dylan wanted to know, does anal sex lead to any health problems later? So a lot of people want to know butt stuff. Yeah. Yay or nay? From a. Oh my gosh.
- [65:20]
Dr. Carmen Fong
We could do a Whole episode on just. I know I was 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.
- [65:40]
Allie 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.
- [65:55]
Dr. Carmen Fong
I think the one thing people are usually trying to ask here is if things going in your butt all the time causes incontinence. I think that's what people are worried about. Because then the anus does stretch, right? So the anus does stretch, and it can cause, like, a little bit of laxity over time. 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, 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. Washing the anus itself for, like, rimming it kind of destroys the microbiome of your anus, and that causes a lot of pruritus ani, which is itchy anus. So you don't actually need to use soap to wash your butt. Yeah, because of the anal microbiome. It has its own microbiome, and it cleans itself. And I always tell people you don't actually 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. 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.
- [67:15]
Co-host or Interviewer
No. So wait, so you're in the shower. Can some gentle soap go in the Crack or what?
- [67:20]
Dr. Carmen Fong
Yes, crack is okay. Cracking cheeks are okay. So yeah, 100%. You should wash cracking cheeks because that is skin and that is like a totally different thing. But what I mean is like the media anus, which is kind of like the dark wrinkly area. You really don't need soap there.
- [67:36]
Co-host or Interviewer
Oh, my God.
- [67:36]
Allie Ward
So many questions, y'.
- [67:38]
Dr. Carmen Fong
All.
- [67:38]
Allie Ward
I did my best to humiliate Dr. Fong and debunk this, but unfortunately, every article I 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.
- [68:12]
Co-host or Interviewer
Anal bleaching, yes or no?
- [68:14]
Dr. Carmen Fong
No, no, you don't need it.
- [68:17]
Co-host or Interviewer
Why do people do?
- [68:19]
Dr. Carmen Fong
I know, ain't I, ain't I are supposed to be the color of the way they are. It's totally fine, you know. Right.
- [68:23]
Co-host or Interviewer
Thank you.
- [68:24]
Dr. Carmen Fong
I wouldn't worry about it. Okay.
- [68:26]
Co-host or Interviewer
Well, speaking of washing. Oh, this was a popular one. Iris, Alex, Agamemnon, Sean, Katie, Brit, John. First question. Oscar, Thorposaurus, Jess, Tony, Vessels. John says, why do we not all use bit 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 rectal health?
- [69:03]
Dr. Carmen Fong
Yeah, One of my 10 bowel commandments is bidet is the way. So. So yes, everybody should have a bidet. I don't know why we don't have them in the U.S. 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. Actually just washing the outside so make sure your anus is closed and then spray, rinse, pat dry. Love it. 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 these 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.
- [70:15]
Co-host or Interviewer
And for people who are afraid to use a bidet because they're like, well, what do I do afterward? You can dab yourself dry with the
- [70:21]
Dr. Carmen Fong
toilet paper, pat dry with toilet paper.
- [70:23]
Allie Ward
Okay.
- [70:24]
Dr. Carmen Fong
They make like toilet towels, but you can just pat dry with toilet paper.
- [70:27]
Allie Ward
Okay.
- [70:28]
Co-host or Interviewer
And you're talking to someone who has
- [70:29]
Allie Ward
two bidets in the house.
- [70:30]
Co-host or Interviewer
100% of our toilets have bidets. So I'm just, I'm asking the questions that other people are probably be like, do I?
- [70:36]
Dr. Carmen Fong
No. Those are excellent questions. Yeah.
- [70:39]
Co-host or Interviewer
Okay.
- [70:39]
Dr. Carmen Fong
Like we want to get it from all angles, right? Yeah.
- [70:42]
Co-host or Interviewer
And I know you can go like high end Japanese that's got more buttons than my car and then to like a, a tushy or something that's pretty much like one knob.
- [70:54]
Dr. Carmen Fong
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. Yeah, Works great.
- [71:03]
Co-host or Interviewer
I understand that in the UK bidets are illegal because their water supply is
- [71:08]
Allie Ward
not like up to clean standards.
- [71:10]
Dr. Carmen Fong
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, okay. 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.
- [71:25]
Allie Ward
Don't do it.
- [71:25]
Co-host or Interviewer
I mean, look up Fatberg and never again.
- [71:29]
Dr. Carmen Fong
So gross.
- [71:30]
Co-host or Interviewer
A Fatberg has gotta be the absolute worst noun. It's gotta be the worst object.
- [71:37]
Dr. Carmen Fong
Yeah.
- [71:37]
Allie Ward
That I can imagine. In an effort to save you some money on plumbing bills, I'm gonna de influence you on so called flushable wipes.
- [71:45]
Co-host or Interviewer
Okay.
- [71:45]
Allie Ward
Google Fatberg and send me the invoice for the psychotherapy.
- [71:49]
Co-host or Interviewer
It's worth it.
- [71:50]
Allie Ward
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 Mark Marlin. Were he a fisherman? I was horrified. I was traumatized to notice he was not wearing gloves. He was just raw dog in 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? 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 for my psyche.
- [72:29]
Dr. Carmen Fong
And I'm not grossed out by much. But I will tell you, that is Fatberg.
- [72:34]
Co-host or Interviewer
Dude, they're up there with a rat king. Like they're so it's bad. Okay, well, speaking of toilet accessories, Miranda Pan or Kari Heiser. Paige banking. Alex Minor, Chris Moore. Kestrel Wogamuth, Kestrel Wang. No squatty potties actually helpful or a little silly. And Paige says real or flim floor. And then also do they have an effect on hemorrhoids? Chris wants to know. And then Paige said, I 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.
- [73:08]
Dr. Carmen Fong
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 are some kind of like sweet 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 a 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. 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.
- [74:00]
Co-host or Interviewer
Okay.
- [74:01]
Dr. Carmen Fong
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.
- [74:08]
Co-host or Interviewer
Yeah.
- [74:08]
Dr. Carmen Fong
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. Plane. 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 constipation that we're now seeing is totally true. So people who work out too hard, the fight or flight response 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, 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 get to the airport three hours early.
- [75:05]
Co-host or Interviewer
Gotta get eyes on the gate.
- [75:07]
Dr. Carmen Fong
That's just me.
- [75:08]
Allie Ward
How to get eyes on Taryn Delaney Smith, a travel influencer, calls this L E O T G or leotige. Lay eyes on the gate. I think about it every time I go to an airport.
- [75:18]
Co-host or Interviewer
All right, this is a great question. A bunch of people had Jennifer, Karine, Jay, Nick Rider, Thuha, Annalise to 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? And. And Nick says secondarying 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 that's a good one.
- [75:47]
Dr. Carmen Fong
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. And yet 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 proctalgia 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, pionital 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. Much we don't know about the pelvic floor 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, literally tight ass. And the more you clench it, the more the muscle spasm, the more it's like, hey, 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.
- [77:02]
Co-host or Interviewer
Okay, and again, you've been pregnant. You and your wife have three kids now.
- [77:07]
Dr. Carmen Fong
Yep.
- [77:07]
Co-host or Interviewer
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 delivery.
- [77:19]
Dr. Carmen Fong
Yeah.
- [77:21]
Co-host or Interviewer
And also just in general, like, pregnancy and. And butt stuff.
- [77:25]
Allie Ward
Why?
- [77:27]
Dr. Carmen Fong
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's 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. 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. And the anus. The teaching is erectovaginal 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. Oh, okay. Because 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 cton 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 endo 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 quality of life issue.
- [79:08]
Co-host or Interviewer
Going from uteri to prostates. Orion Potato Puffer, David Greg Mai, Alex Minor, Katie Hammond. Potato says prostate massage.
- [79:18]
Allie Ward
Should we be doing it?
- [79:19]
Dr. Carmen Fong
Also?
- [79:20]
Co-host or Interviewer
Malai says, I don't have one. And I. I'm curious what's going on in there? I mean, it's right in front of it, right in front of your butthole.
- [79:29]
Dr. Carmen Fong
Okay. So literally 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 massaging it a little bit. There are things where, you know, doing it too much 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. See a urologist. Okay.
- [79:55]
Allie Ward
We do have a whole urology episode with your favorite urologist, Dr. Fenwa Millhous. 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 WebMD. 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. WebMD didn't say that last part, but it continues. Orgasm achieved slowly through perineum massage is sometimes known as a perineum of orgasm. Such a good drink, but let's cool things down. Just a sec.
- [80:49]
Co-host or Interviewer
Spencer wants to know, why do some farts smell way worse than others? Chelly Bean wants to know if someone gets the hair removed from the butthole. Are farts typically louder?
- [80:58]
Allie Ward
Whoa.
- [81:03]
Dr. Carmen Fong
Wow. I thought I've heard everything. It's like, like when the tree falls. I'm gonna say, ha. Hairs. No, because it's really more body habitus 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 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 going to be way more important than the few hairs that are around your anus. The hairs, what they do do is trap odor.
- [81:37]
Allie Ward
Oh.
- [81:38]
Dr. Carmen Fong
And. 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 an auditory thing. More like an odor thing.
- [81:54]
Allie Ward
Okay.
- [81:55]
Co-host or Interviewer
Are you ever in there? This is a question from Quinn, Lillian, Anonymous, Bri, Laina, and Jay. Are you ever in there?
- [82:03]
Dr. Carmen Fong
And you see.
- [82:04]
Co-host or Interviewer
See endometriosis?
- [82:07]
Dr. Carmen Fong
Yes.
- [82:08]
Co-host or Interviewer
What the fuck?
- [82:09]
Dr. Carmen Fong
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.
- [82:27]
Allie 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. 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 every 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.
- [83:39]
Dr. Carmen Fong
It's not common, but you do definitely see that on colonoscopy and on sigmoidoscopies and stuff. Yeah. My God.
- [83:45]
Co-host or Interviewer
And do you have to remove it or then do you have to get an OBGYN surgeon back in there?
- [83:50]
Dr. Carmen Fong
Oh, yeah, no, I remove it.
- [83:51]
Co-host or Interviewer
Okay.
- [83:52]
Dr. Carmen Fong
That's not something they would remove. They're like, not going to touch the rectum. So I remove that and then send his pathology. A lot of times it is a multidisciplinary urinary 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.
- [84:05]
Allie Ward
Okay.
- [84:07]
Co-host or Interviewer
Kimberly Butts, first time question asker, says, I feel it's my time to shine. My last name is Butts.
- [84:13]
Dr. Carmen Fong
Butts.
- [84:14]
Co-host or Interviewer
Yeah, we straight up Butts. A first time question asker, longtime listener. Why did smoking certain types of weed give me diarrhea? Is it similar to food sensitivity? Amy Oslin says, my father has explosive diarrhea every day. He thinks it's normal. And Katie wants to know.
- [84:32]
Dr. Carmen Fong
Super weird.
- [84:33]
Allie Ward
Feel free to skip.
- [84:34]
Co-host or Interviewer
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. Hot shits. Hot snakes, yeah.
- [84:57]
Dr. Carmen Fong
So hot shits because of the inflammation? Yes, 100%. That's why it feels warmer. And then also, like the bile acid, 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 smell worse? So all of it is related to. 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, bifidobacterium, 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 storm 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. No, I mean, I probably just see what he's eating. Like, is it a lot of beans? That would do it.
- [85:57]
Co-host or Interviewer
Can weed do that?
- [85:58]
Dr. Carmen Fong
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 Medic, 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 C. Diff where you can actually have constipation. So bugs are drugs.
- [86:26]
Allie Ward
I forgot to ask the difference between
- [86:29]
Co-host or Interviewer
colitis, ulcerative colitis, Crohn's disease. Those are autoimmune.
- [86:35]
Dr. Carmen Fong
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. Okay, yeah, I think I hear that term used interchangeably sometimes. 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 bloody diarrhea, abdominal cramping, and those have to be diagnosed with colonoscopy and biopsies and generally treated with medications like biologic medications that calm down your immune system. And then in severe cases, you end up with surgery to remove the disease. Port versions 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, 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. 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 gonna 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 IBM.
- [88:06]
Co-host or Interviewer
Last listener question. Dave Langenes, only person who asked this wanted to know why is a buttload precisely 126 gallons equal to two hogsheads? Have you ever heard this? I've never heard this, but I'm. I might have to do an aside on it.
- [88:22]
Dr. Carmen Fong
This might be an aside. Wow, you. You've stumped me with the last question. I actually do not know. I would like to know why a buttload is two hogs heads. And if. If two hogsheads can fit into your colon. I hope not.
- [88:36]
Co-host or Interviewer
I hope not.
- [88:37]
Allie Ward
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 buttload 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 bunghole. And sniffing a bunghole 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.
- [89:07]
Dr. Carmen Fong
I thought you were going to ask me how many people have sent me, like, pictures of their butts and their poop, but that's. The answer is a lot.
- [89:12]
Co-host or Interviewer
And, 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, 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
- [89:31]
Dr. Carmen Fong
slog or just tough? 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. 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.
- [89:53]
Co-host or Interviewer
Favorite thing about what you do.
- [89:59]
Dr. Carmen Fong
I really love that people get such satisfaction from finding someone who. 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.
- [90:39]
Co-host or Interviewer
Black stools.
- [90:40]
Dr. Carmen Fong
Yes. Black tarry stools. Get. Get it checked out. 100% constellation of symptoms is black tari stools. Abdominal bloating, unintentional weight loss. Right. So that's the key one.
- [90:50]
Co-host or Interviewer
I'm going to go on record and say, I love you. I think you're wonderful.
- [90:54]
Dr. Carmen Fong
Oh, no, I love you. So we are. It's mutual.
- [91:00]
Co-host or Interviewer
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 at a time. Yes, Only for a few minutes at a time.
- [91:12]
Allie 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 it 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@alieward.com Ology Coloproctology thank you again Carmen. Also everyone get her her book. We'll link that in the show notes as well. We are at Ologies on Blue sky and Instagram and I'm Allie Ward on both we have smallogies 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 alieward.com smologies Aaron Talbert admins Theologies Podcast Facebook Group Evelyn Malik makes our professional transcripts. Kelly R. Dwyer does a website Making our appointments is scheduling producer Noel Dilworth. Keeping things moving is Managing Director Susan and Hail 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 Jarrett 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? Checked Black tar stools, won't you come and get it checked? 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 drink. Put it in a matcha latte and you sip it. It's kind of like tiny, tiny tiny bobas made out of frogs 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. Pachydermatology, Homeology, Cryptozoology, Litology, Nanotechnology, meteorology olfactology. I guess all they solve is Uranus, huh?
- [93:38]
Dr. Carmen Fong
LinkedIn hiring pro can't predict the future,
- [93:41]
Allie Ward
but it can help you feel confident about future hires. Because Hiring Pro combines real time insights and candidate Data from the LinkedIn network with the criteria you've set for your role to deliver you a list of top fit candidates. Businesses who use LinkedIn are 24% less
- [93:57]
Dr. Carmen Fong
likely to reopen a role in the next 12 months.
- [93:59]
Allie Ward
Hire right the first time with LinkedIn hiring pro post a free job today at LinkedIn.com Pandora Ologies is sponsored by Strawberry Me. So every New Year's Eve, I like to sit down and write what I want for the year ahead. And then I put it in a jar with my favorite rocks. Don't worry about the jar or the rocks. And it's so helpful to write down what you want for career growth. But sometimes the next step is difficult. Inertia is real, but nothing really changes unless you change it. And Strawberry Me Career coaching can help you get out of that slump or help you start on a new path. They match you with a certified career coach. It's a real human. It's not an AI with questionable motives. And your career coach can help you strategize. They listen to what you want. They help you create a plan. And then this is so important. They hold you accountable so you don't just think about the thing, you do the thing. And I've used Strawberry Me and they've helped me break things down into smaller steps. And I see that I can stretch myself a little creatively. I can do a live show maybe here or there. And having someone who understands performance anxiety but still encourages me to keep going and tackle things has been really helpful. So if you're waiting for the right moment to level up, this is it. Go to Strawberry Me ologies and get 50% off your first coaching session. So that's Strawberry Me Ologies.