Coloproctology (COLON CANCER + BUTT FUN) with Carmen Fong

Alley Ward, welcome toologies, I'm proud of you. For listening to this one in my Savior life, or 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 "Constopation Nation." What to know when you can't go?

They have been decorated with so many medical awards that 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 hemorrhide 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 blood hole.

Even your grandparents, you think you're granddad never had a finger up his butt?

I got a bridge to sell you. It comes with a free dough though. But first, thank you to everyone to be a patreon.com/alegies for supporting the show for a dollar or more a month and submitting your questions. Thanks to everyone out in allegiesmerch from allegiesmerch.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 SR4stner, who wrote, "One minute, I'm learning about volcanic lightning. The next, I'm emotionally invested in salamanders." SR4stner, 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. Okay, come along with me into the world of your colon. Also, I did an episode a few years ago called Field Trip, my butt, a colonoscopy, how to and write 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 of past couple years that told me that it helped them catch and treat diseases including cancers. So, we're going to link that re-arret. The colon comes from the Greek colon, which means colon, and proctology derives from the

Greek for Anus. So, colo proctology, we get deep, sit tight or walk around for prostate orgasms, shady polyps, colon cancer, branding, hot dog habits, and numitriosis, diverticulitis, butt plugs, heartburn, doucheous, badez, farts, vacation cost of patient in the nation, fiber

raxing, ostomy awareness, second swingers, the most fascinating crown jewels, pregnancy,

agonies, roids, fissures, fixes, IBS, hydrotherapy, a shocking shower revelation, and how a blissful colonoscopy could change in Savior life. With surgeon, author, earthly delight, and colo proctologist, Dr. Carmen Fong. I love her. We're vibing.

We're vibing, dude. There's so many questions I hope you know how excited people are to learn about butt health. I can imagine. Honestly. I mean, I listen 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. Okay, hold on. Let's back up.

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

Gastroenterology, proctology, can you disambiguate this for the uninitiated, a hundred percent? Okay. So, I'm a cruel or actual surgeon, and I guess that does get confused with GI's a lot. And of course, they do colonoscis and like really advanced endoscopy procedures and things

like that, but they're technically not surgeon surgeons. So the training is actually the same amount of time, but we are more doing a lot of like the abdominal operations. Most of us will actually also do colonoscis, but the one major difference is that colorectal surgeons do a lot of anal rectal stuff, which is like a true proctology.

“Oh, does it stop if you're a gastroenterologist once you're no longer in the intestines?”

Let's think to, is it the sequel, the Iliocicle valve, right, is it? Thank you. So, that's the valve or the gate between your small intestine to your large intestine. And a large intestine is also called a colon, there's a few different regions of your colon.

And I also wonder if people called it intestinal cancer, instead of colon cancer, if there would be less shy about screening or treatment, we can start calling it intestinal cancer, and start a trend or revolution, a bowel movement, if you will. Once it crosses that barrier, is that like a different jurisdiction? That's interesting.

So, no, actually.

Oh, 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

bit, in some cases we've held with doing like the laparoscopy at the same time, which is kind of a crazy procedure.

“So, an endoscopy, and no, 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. But then they can not 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. When you are going through med school, did you have a lot of rotations and did you just land on butt and intestines, and you're like, "I'm home?" Oh, I got. No.

So I actually went into this, because I wanted to be a plastic surgeon, because my background is an art, I was a visual artist in college, and so I was like, "I'm in a plastic surgeon, I'm going to make people beautiful, I'm going to fix like baby cleft lips and cleft pallets, and to this day my parents and my aunts grew the fact that I'm not a plastic surgeon, they're like, "Why didn't you do something useful?"

Um, dare you, but then now that, you know, they're all older, they're thinking me. That I 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 diagnose and treat and reconnect." But it's in God's because I really love being like the master of the abdomen and knowing

everything that's going on inside your body. 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, correct. Is that true? Yes, so you know, people ask me that a lot, they're like, "Once you're inside the belly,

does it look like that plastic figure where you put the little plastic pieces back in, you know?" Yeah, and it's not, and then somebody else asks me like, "If you're looking at your colon, is it more like a pipe?" But it's actually more like an empty tube sock, 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 like into like, really squishy dough, almost. Like the squishiest ones are like the pancreas, which you really can just like put your thumb through, but then the harder ones like your liver. So there's like, you know, squishy pieces and tube sock pieces. And yeah, you just throw it all back in, you don't have to stitch it back to the lining.

In the old days, actually, in the 1800s, they actually thought that things had to be stitched back up because when they dissected cadavers, I just read about this, which was crazy. Ooh, 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 like people stand up, there's gravity, and so things actually kind of all naturally dropped to the bottom. 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, yes, pumped up yet? Yeah, it's just sitting in the bottom of your pelvis. And so then when there's food moving through it, then it kind of inflates like a bubble would. Yeah. Oh, no way. Like a bubble, like what if there's gas, right?

Like, if you're about to fart, it's gonna be gas. Or if there's stool, it kind of fills up, and so you can actually feel like on the left side of your abdomen, if you're concentrated, 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. 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 you 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. I always wonder how it when doctors are palpating a stick,

how they know what the fuck's going on down there, because I'm like, how do you,

“what doesn't it be like anything, how are you trained to do that?”

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, uh, you know, this feels like, but um, we are losing a little bit of that, like the artificial examination because of CT scans and MRIs and all that. Just like a scan you and we'll find out what's wrong. Have you ever been called to get things out

question until I was like, wait a minute. How have I got to talk to me? Actually, it's a joke that,

like, a three a.m., you know, if they call me, it's going to be like, uh, 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 of things. Anything that you're at liberty to share, anything really, wow, yeah. You know, most of it is like a long time ago, but my favorite one was a pink highlighter, because my residence still texts me to this day and is like, once in a while,

“she'll be like, remember that pink highlighter? I don't know, like, how could we forget?”

But definitely tons of dildos, you know, and like, no sex framing or anything, you know,

do you do? Yeah, do you? A ton of dildos and people just kind of like underestimate the length and

the width of them sometimes, uh, 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. If you would like to know more about foreign objects rescued from the depths of an orifice, please enjoy our radiology episode. I got two words, wine bottle.

If it's glass, how, I mean, you must need like the gentlest of touches. 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 deaver, which is like a little over tractor that has like a little scoop on the end and that scooped

“perfectly around it. We tried every tool in the OR that night. Did you have to sedate the patient?”

They were sedated. That's the way it was. I mean, I would be like wake me up like a month later. 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, got to put you to sleep just for your safety, so you're not moving around and also if there's any kind of complication, right? Because the worst case scenario, if there's some kind of perforation, you know, we puncture the colon or something and we have to fix it.

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

Do you have a PSA now for, um, for bubbles with a foot, a hundred percent. Porting out the foot at the end of your butt. Please have a handle, you know, make sure there's a handle, make sure you can have a good grab on it if you can. Save in lives. Save in pride. Save in butts. I'm sorry that that's one that you get asked so much,

“but no, people want to know, you know, yeah. Well, okay, so I studied biology and college, right?”

So biometre. So I always think about the order of spinkters and I remember hearing that there were spinkters inside the body and being blown away by that. Just a side note, a spikter. It's just a round muscle that closes and opening. You have them in your expertory system, such as for example, your Anus, but also all along your intestines to kind of close off chambers. So imagine like a train with doors between the cars. And you can think a ton of nerve endings in your lower bowel

for being able to discern the pressure of a gas versus a solid and act as kind of a balancer to let farts through, which means every time you enjoy a fart, you're not pooping. Most of the time, are you glad you can do that? Of course you are. And one in five thousand people are born with a condition. It's called her sprung 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 shockous disease can also lead to a condition called mega colon, which sounds like a marble character, but it's more painful and potentially lethal. So according to the paper, mega colon, acute toxic and chronic, a constipated and stuffed colon with a diameter nearing five inches is mega. Obviously, and can require surgical correction to address whatever the underlying causes are. And there's one legendary

patient. It's a man who was so impacted. He was known inside show circles as balloon man. And when he died in 1892 with the age of 28, while straining to pass his cargo, the medical examiner found an eight foot long colon, nearly nine inches in diameter and carrying 40 pounds of excrement. And scientists say upon examination now, it's apparent that he had suffered from that her sprung disease, where your nerves are just not on board to let things pass. And I was like,

dang, who is her sprung? Who got the honor of being named for this? And it was a late 1800s doctor from Copenhagen. And Harold Herspring, he described this condition. And he actually went

while charging those who could afford it. And though the queen wanted each child's hospital bed

“to be surrounded by biblical passages, who was like, no, hag, I'm putting animal pictures up.”

Herspring, I like him. But yet there are spinkters also in your blood vessels, your eyes, sadly, I just found out that I had to rerecord the end of this aside, that your mouth and my mouth have been demoted and there no longer a spinkter, which is Pluto levels of heartbreak, but all we can do is soldier on. So from the bottom, from the bottom. So we have the external spinkter, which is

actually the part that you kind of feel, right? So I always know people like if you're feeling

your anus, like when you get to the tightness of your anus, that's the external spinkter. That's the part where you have voluntary control, where you're like, oh my gosh, I have to poop, I'm going to hold it, that's the part you're squeezing. And then there's just above that, the internal spinkter, the internal spinkter 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 then we'll hold it 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 iliosego valve, which is

a connection between the colon and the small bowel. And then if you go above that, there's like the

pyloris, which isn't technically a spinkter, but that connects the small bowel to a stomach. And then right up at the top of the stomach is the esophageos spinkters. Oh, so that's the part that controls your gird. So if you don't know what gird is, congratulations. It stands for gastroesophageal reflux disease. It's like wicked heartburn. It's when stomach acid just pops into your esophagease. Hey, it was going on up here because that spinkter is just on break. So if you have like a loose

esophageal spinkter, you have really bad gird because when you lay on your back, you know, everything kind of like sloshes back up. Or if you're pregnant, it relaxes your esophageal

“spinkters and everything kind of sloshes back up. Oh, that's why that happens. 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. And you mentioned before we started recording that you've been pregnant, you're wearing a shirt right now. This says got hemorrhoids. Correct. Questioner. Where are the hemorrhoids? Which spinkter are the hemorrhoids? Where is that coming from? 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 spinkter. 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. 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 if they pop out of your anus, they can bleed, they can cause pressure in a little bit of itching, but generally not painful. So I usually say, you know, internal hemorrhoids are painless bleeding. So that's inside your hole. 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 perplish lump on the outside. You get those residual external hemorrhoids, 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 phisher, which people ask me a lot about, and that really commonly gets mistaken for hemorrhoids. And you get both pain and bleeding, but that's more of a sharp

paper cut pain, because it's literally a tear at that dentate line. So right between the sphinters. So a phisher, 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 fishers are ruining your life, treat your butt whole gently, take a stool softener, drink more water, maybe consult an Etsy witch, whatever it takes. But as for avoids, about 5%

of younger people tend to get hemorrhoids. But 50% of folks over 50 do because of tissue weakening. It's like, if you drove an older car, you're going to have some seals. Some hoses are going to underperform. True or false. More people are having hemorrhoids younger because they're sitting on the toilet scrolling. Is that true? 100%. Yes. Is that real? Yeah. Tell me everything. Yeah. So I mean, part of the reason I wrote this book was that I was seeing so much more

conservation, 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

home a lot more, right? So they were working from home. They were sitting in front of the computer's

eight hours a day. So a lot more dietary lifestyle. And then on top of that, a lot of people were like drinking and eating junk. You know, not going to lie that was me as well. Yeah. And so they wrote like, constipated too on top of that and spending more time in the toilet. So yeah, no, hemorrhoids are not a disease of the old anymore. Like tons of people have it. I see tons of people in their 20s, 30s, 40s all the way up. And do over the counter things like

tucks and preparation age. Do those actually work? And do you have you heard speaking of plastic surgery? Have you heard of people using preparation age under their eyelids when

“their puffy like beauty contestants? Yes. So actually that's the only thing that I think”

preparation age is good for is for puffy eyes. Honestly, I know, sorry for preparation age. I don't love it because what it does is the preparation age can kind of shrink the blood vessels, but they're not also fins 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 age 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 swaps. Sorry, touch. And irritation. And then, hemorrhally to flare up. To relieve that painful burning on contact, get tuck's medicated pad. It's so that it's a little bit, but it doesn't heal it. Better things to use are 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 spankters and the spasm as well as the swollen blood vessels. What's in a compound ointment? Yeah. So compound ointments include things like nitric glycerin, calcium channel blockers, like daltisum, and nitphetopen, also some lighter cane, and some pupificane, so some long-end short-acting, like numbing agents. And then in some cases,

we'll add hydrochlorism, which is like the steroid, which helps with the inflammation, but also if there's a skin. But the key ingredient is really that muscle relaxation. It allows all those swollen blood vessels to re-absorbe back up a lot better. And then also decreases the spasm in your anus, which is like the secondary result of having hemorrids, your body clamps down, is like, "Ahh, don't move. I don't want anything to move this hurts." That clamping is what makes

“everything worse. What about hemorrids surgery? That had sometimes been to pull out the big guns?”

Yes, absolutely. So, you know, when we're trained, we actually learn like eight to nine different ways of treating hemorrids. 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 brand legation, which is like banding a hemorride, and then the exesional 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. Let's turn it over to the reddit form about hemorrids, where anonymous souls share their acne. And on a thread titled, "What's worse than hemorrids surgery?" Getting cheeky with it, a survivor of hemorrids 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 hemorridectomy was more painful than any of those things, and shy David Zero Zero chimed in. I was crying from the pain, even on maximum doses of painkillers, fainting on the toilet, not sleeping for days, not fun, but shy David says, "Worth it, 100%. Well, the problem is, it's like, unlike putting your arm in a sling, like,

“you have to use your bottle every day." Yes, something. You could be me. That is exactly what I”

tell people, like, if I cut a nodule off your hand, I can slap a bandaid on and be like, "Hey, don't touch it for two weeks." But it's your butt, and so you have to sit on it, you have to poop on it. The really bad pain is usually the first three or four days, because your body actually swells a little bit before it gets better, so the really bad swelling is the first three or four days, and then by the end of the first week or two weeks, your body actually kind of goes back down to normal,

most of the dissolvable stitches have dissolved, and then it just feels like, uh, you're, like, uncomfortable, but it's not like a sharp cut on your butt pain. What do you feel like are some of the most common reasons people say, Dr. Fong, take a look at me? 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 a check-out, especially with, like, the rise of early onset colorectal cancer, so I'm always,

like, if you have some bleeding that's, like, outside of normal range, which for most people, any bleeding is outside of normal. It's like something that has to get checked out. Just go get a check-out.

which is, like, a quick, really minimally invasive painless procedure, it takes, like, 20 seconds,

“and it does work. It bands the hemorrids, it kind of squeezes them, makes them, you know,”

die and dry out. They fall off in the in a couple days, and that hemorrid column is actually gone, like, that blood vessel has gone, so I can't bleed, I can't swallow anymore. So, that's your bleeding. The painful part, that is usually because of fissures, and so if it's a fissure, I treat it with a couple 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

this spanker. 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 spanker. Okay, sounds good. Very low risk of incontinence, but it actually really, really works. Like 85% of the time, people do not need the traditional internal spanker autonomy surgery, which is where I have to cut the whole muscle to relax it. It works. People are like, oh my god, thank you. My fissure is healed. It's gone.

No. Is that covered by insurance? Yes. It is. Yeah. Are they like as long as you've got the

“vial out? Oh, okay. The number of times you've asked 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 usually put every last drop into the internal anal spanker and, yeah, insurance covers it. Hey, Botox for your Bot. Yeah. Well, bleeding is a huge question now. So, what amount of bleeding is normal? Yeah, because so many people, especially, I mean, also, an absolute ramp up to a soapbox here on Colorectal cancer and younger people. And when to start getting colonoscopies, all 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. So, yeah, you see blood on the T.P. Yes, what the hell do you do? Blood on this feet? Go get it checked out. You know, so if you see a little blood on your toilet paper and it was profote, so say you like, you know, you feel a lump on your butt. You recently went on like an eight hour car ride or a 16 hour plan ride. You know, you were traveling and you got concentrated. 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, hemorrhoid bleeding is self-limited and it will stop in about two to three days. If it keeps going, 100% get it checked out. If it recurs, 100% get it checked out. And then, if it wasn't provoked, you would want to get it checked out, right? So, bottom line is, most of the time, like even if you're young, don't ignore rectal bleeding, at least have someone look at it. And that's like my soapbox, which is that like, you go to a lot of like providers and sometimes

we're like, here's some higher cortisol and like, you know, 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 last couple of years, which is awesome, you know, decreased the screening age from 50 to 45, 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 or 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 that 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 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 see the problem, though, sometimes, is that in younger people, these colonoscopies aren't getting covered unless you have very, very good reason, and then obviously it's like a whole insurance issue that I fight with insurance all the time about.

There's also genetic links as well, right? So if someone, like my dad died from colon cancer, I'm sorry. And you know, it was funny. He was like, well, you know, I had my blackstools and I didn't think much about it. He thought it was just related to his chemotherapy, but he has multiple myeloma and then a side effect of the chemotherapy was on colon cancer. I feel like everyone should know having colon cancer and what you have to deal with and also like be in dignity 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, like, what? Yeah, 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 ostamies 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

okay, I digress. 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. Ensure. I hear you an ostomy, it may not be on your birthday wishlist, but it can save your life. And while there has been stigma around them, there are so many creators online, I've seen a bunch that are showing it's really not that big a deal. You get used to it,

“you live with it, because nobody doesn't make poop. But if you want to avoid a colon cancer ostomy,”

or chemotherapy, or surgery, or death, get checked. When it comes to catching cancer in early, incredibly treatable stages, a colonoscopy is a cake walk, man. It's a cake walk. It is like the

easiest thing that can happen to your butt. Yeah. Like ever. And you get a really good nap.

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 ever. Best you've ever had. And then like the piece 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 this line for a few years. But I'm wondering too, like these rates

of young people with colon cancer, I know that Chadwick's death really shocked a lot of people who

“was so young. I have a film to in his early 30s was diagnosed with stage four. So sorry. I have”

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. Yep. 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? 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 their booked out like six, eight weeks, right? So if you're like waiting for end of year, your deductibles 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. 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. I think that the celebrities really, really helps. Obviously,”

so sad about Chadwick Boseman. And then I think those genes were underbeats, wasn't it? Right, too.

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 1221 paper titled "Internet Interest in Colon Cancer, Following the Death of Chadwick Boseman, InfoValance study found that there was "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 Vanderbeek, the star of Dawson's Creek, was also fighting colon cancer.

And since I had this chat with Dr. Fong, he passed away at the age of 48. And some factors that increase your risk of colon cancer are genetic, like something called Lynch syndrome, which increases cancer risk, particularly of the colon and uterus. But lifestyle and diet definitely increase the likelihood of colon, shall we say, large intestine cancer. So what can you do? Dr. Fong says, eat veggies with every meal, keep that fiber in take up,

hydrate, exercise a little every day to keep everything moving, and avoid ultra-processed foods, sugary drinks, and processed meats. Fried and char-girled meats have more carcinogens, and can also damage your colon cells and up the risk for cancer. So sorry salami, sorry hot dogs, sorry char-girled burgers, it was good or a little 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 1950s. And James Vanderbeek was vocal about

preventative screenings. And again, for an in-depth how-to and a right 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 listen to it, and it helped you a bunch, which is great. And then Ryan Reynolds had his colonoscopy on camera. We were in a special event. We'll most definitely save lives. That's enough motivation for me to let you in on a camera being shoved at my shit. 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 did it know was that right before the procedure they give you purple phone. And I have to say that as a working mother of two, getting to take a drug-induced nap for an hour. And so those people are really getting out. They're like, "Hey, you know, Columbus, please really not that bad. It's fully necessary.

“A colon cancer does are like preventable. That's the only thing I want to say. It's like”

100% can be preventable." So there are of course the stages of cancer. And obviously, 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 pre-cancerous 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 super-highway in your body. And then stage for the final stage, the cancer has made it to other organs, like distant lymph nodes, or your liver, or your ovaries, or your brain. So if you have a colonoscopy and they snip something off, they biopsy it and then they wait for the pathology report for a week or two. I've wondered this,

what it's like when you have a diagnosis for someone, like I got lucky, I had a pre-cancerous situation that they sniped out and I was one and done, right? But what is that like when you see

something like that? 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”

going to get a biopsy first. And then in 10 to 14 days have to break the news. So I would generally kind of like temper it with, hey, this looks suspicious, but we will know in two weeks and I promise I will call you. And I think most people are okay with that. And then for the actual breaking the news and you know, we do this a lot in medical school and we have to sit down. We have to look them in the eye, which I think always helps. I always try to do it in person. You know, and I think people

for whatever reason, whenever you say that, they know already and then they just need to hear it. But you know, hey, I 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. It's 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.

What is the surgery like when you're performing surgery? You've got to go through the abs and everything, right? 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 diameter of a pencil eraser. If you do an open surgery, I make a big cut kind of right in the middle and have to open everything

up over checkers 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 to return to a work, get out of the hospital, a lot faster, passing flightists and starting to eat and stuff. So we try to do things laparoscoping and robotically. I save robotic for last because

people always ask me like how do you do a robot surgery? Yeah. So the the same way that you do laparoscopy,

which so it's almost like a little tube that goes in through your belly button, then you do cut through the abs and then once you're in, you put the camera in and then the robot arms dock next to the bed while I sit out of console like on the other side of the room and control the robot arms. I love doing robot surgery because you actually get like a very fine dissection and like the very fine visual feel through the robot apparatus. So it's not an automated robot doing your surgery.

“It's Dr. Fong in a fucking mix suit. Amazing. What's the benefit of robot? Is it a finer cut?”

Is it even a scalpel or is it like a cotterization? It's actually more of a cotterization. So okay, almost like a tiny little pinpoint cotterization that allows you to cut and seal

you have to do like a total abdominal collect me 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.”

Can you live without a whole large intestine? Yes. Really? Yeah, I know. It's weird because you wouldn't think that you could, but you're small bowel adapts. You know, you have a rectum and you still have nutrient absorption and one of the fascinating things is in the 1890s. There was a sky he actually used to take out the colon routinely for people who had constipation. And he was like, you know, this is because of auto toxicity. So he called it into 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 debunks. We don't do that anymore for regular run of the middle 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 disability. So some people can be born with a 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 like, hey, your colon really doesn't move. We're going to take the whole thing out. Okay, constipation. Yeah. Let's talk about it. Most people have functional constipation where it's like a combination of factors like your physiology, the things you're eating, the amount of activity you're having, and then like the electrolyte imbalance in your body.

So some people are like chronically constipated. 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 so no, he's got myself a toilet widow because I'll just be, oh, god, I haven't heard that one. I'll be at a restaurant, you know, like, that's a new one. Yeah. It's like a war with over. You're just watching. You know, you don't know if they're coming back. You're just watching the door. That's so good. I'll look like

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

going on? So yeah, no. So I'm going to start with like the first answer, which is how often should

people poop, right? So I've kind of digested it down to one to three times a day, every one to three days. So the normal human colon should move food through and 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 an MMC, which is like a mass,

“mass, oh my god. This is a tough one. So I dare you to remember that empty stomach growling or”

that post meal gurgling in your guts is called the migrating motor complex. And I'm see, baby. 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 want people to tell me that you're like a toilet widow. And 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, that's just the way your corn 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 fiber is kind of gel everything up and move everything through almost like a

little like jelly-like mass. But I always tell people that if you don't drink water with your

“fiber, it will just turn into concrete and it won't move. So you have to have fiber and water.”

And the green leafy things like kale and like spinach and stuff, that is insoluble fiber. So while that stuff is also good because it actually kind of acts as a broom and sweeps everything out, it also triggers some irritation in your corn, which stimulates contractions. So you need both and you really need a good mixture of both. And I think it's going to be different for different people. But you need both soluble and soluble fiber plus water. And what is selium husk and how do we

feel about like a metamusell habit? Yeah, love it. Metamusell 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 need it, that extra five grams of fiber, selium husk is the best way to go. It's the only one that's been really proven so far, that in QE's. And metamusell, if you get it in the store, just make sure you get the actual selium husk one because you can do selium husk every day and that is a soluble

fiber that will help with conservation. And you just got a really water it up, right?

and then chug a glass or two of water afterwards. So you don't want to just like mix it in your coffee and be like, that's it for the day you really. Yeah, yeah, that's not going to do it. What did in a coke and you're like, did you go in your Celsius for the morning? Ice coffee for the

“day? No, that's not going to do it. That is the only thing that's worked for Jared's IVS at one point”

when everyone still had Twitter, he unfollowed everyone except for metamusell because he was like, I'm just going to only follow metamusell so he's the metamusell T-bo-t. You know,

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, fiber, fiber, fiber is great. You don't want to overdo fiber like I saw like this fiber maxing trend on. Yeah, recently, I have a maxing. Everyone's talking about it. And I was like, you actually can have too much fiber You probably can't have too much selium, 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 fugal with like a stool ball that just doesn't get digested. Yeah, it's called the bees ore. It's just like stuff that doesn't get digested and you have to go in and skip it up. 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 bazaar 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 Be Source. And yeah, I'm going to link that for you to read. And the word comes from the Arabic for stone used as an antidote to poison. But honestly, I would call the poison control hotline instead because beeswars, they're really hard to come by. And I bet they'd be expensive. Now speaking of

things that are hard, not quite beeswars, but little stony nuggets in your bowels are called fecal myths, which means poop rock, and you don't want them because they can get in places that they are not welcome such as the portal to your little finger-sized pouch off the start of your colon. If you still have yours, and can't that block your little appendix? Yeah, it can block your appendix,

“yes. Oh, like an appendix. That's what I had. We did not. You had that? No, there's nothing that's”

TMI. So you had your appendix out? I had it actually in medical school, and I had a little fecalist, like a little blockage. And I saw it was the Taco Bell I had the night before, when I was studying for my renal exam. But, and so I swore no Taco Bell since then. Good choice. Do they build up over time like a blackhead or can it just be like a poop? Yeah, that's a good question. So it can build up. And now we know there's a bunch of lymph nodes

in the appendix too. And so it does, you know, serve some purpose. It's not completely like the studio, but it can build up. Yes. Like if it sits there. So you don't want things to back up into your appendix. And also you want an on-ramp into fiber additions, right? Yes. You don't want to just dump it all at once, right? Thank you for that. Yes, yes, absolutely. So people are like,

I've never eaten any fiber before. Like I only had chicken nuggets and suddenly they're like 50

grams of fiber a day. No, you want to serve like usually I'm like do five grams a day for like a week. And then go up to 10, go up to 15 every week, every two weeks. The other reason being is that you'll get super bloated if you don't gently increase your fiber dosing. And I imagine those fiber gummies also, like you got to check with a lot of water, right? Yes, yeah. I have a couple of fiber gummies that I love and I do take them with water because of the the gel, like the care

again and 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, you know, I eat a ton of fruits and vegetables. I drink a lot of water. I work out, you know, I still can't poop. And then there are kind of like definitely like medical and hormonal reasons that people can 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 hypo thyroid, you can be pretty concentrated because of the water absorption. And then people have like electrolyte and balances. So we now know pretty well that magnesium is a great muscle relaxant that works for like sleep, it works for restless leg, but also works for

constipation, taking magnesium every day can actually kind of get you over that hump. And then the last part of your question is the probiotics. There's a ton of research out there. I love the microbiome.

“I think that's where the future has headed. And we now know that there's certain bacteria that”

work better. If you're constipated, there's certain bacteria that work better if you have like antibiotic associated diarrhea and there's certain bacteria that work better if you have just general

consistency of soul, but probiotics helps with the regularity of soul. And I ask you some questions. Yes, you have time for me to ask you some less. Yeah, of course. Yeah, yeah. So I just thought we're on.

So no, no, I have a million questions. All right. 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 fight colorectalcancer.org, which fights to cure colorectalcancer and serve as relentless champions of hope for all affected by this disease through informed patient support, impactful policy change and breakthrough research endeavors. They remain steadfast, saying every day we are moved by the collective heartbeat of people who bring hope and healing to people yearning for more seconds, hours, days and years with

the people they love. You can find out more at fight colorectalcancer.org. And thank you to sponsors of the show for making these weekly donations possible. Okay. You patrons submitted listener questions via patreon.com/alleges before we record it. So let's get to the bottom of some of your curiosities. Let's talk colorectalcancer, Oliver Callis, Megan Walker, Matt Thompson,

and first-hand question ask her, Cheryl Strigado, colon hydrotherapy. Yeah, your name 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? Yeah. So it's actually a nay for me for a colon hydropharopy. 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. Okay. Okay. On their own, eventually. I know gum does not stay in your intestines. But if you have little inflamed pouches in your colon, which is a condition called diverticulitis, you can get seeds stuck in them, which is why no seeds for you, seeds are off

the menu. If you have diverticulitis, if not, I don't go for it. But back to colon hydrotherapy, which yet 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. The high volume of water has caused some eucosal 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 proliferation. 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 for later 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, as one thing, the second thing obviously that being that you

flush out all that poop and it's going to take a few days to come back. Oh, okay. So this brings me to let's talk about sex prep back here. Yeah. Anonymous, Derek, DVNC, Ben, wanted to know, Ben says that with the internet's obsession with being bought and ready and spotlessly cleaner at all times. As long as I eat enough fiber, is that okay? DVNC said I sometimes hear people weren't about douche dependence and Derek wanted to know if it's possible to overdo it. Anonymous

“wanted to know, is it true that too many animals can wash out that beneficial bacteria?”

Also want to know when they're asking for men. Obviously, all kinds of vendors take it back there. A hundred percent question for all kinds of people. Awesome question. Love that question. So short answer being, you do not need to do a good fiber diet actually will get people cleaned out sufficiently. So if you poop 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 eight centimeters

or so, and you know, eight centimeters hopefully is enough. But a 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. So yeah, the average human rectum, the final chamber of travel for your lunch, it's about four to five inches long. Although in taller, larger people like those assigned male at birth, it might be closer to seven or eight inches. And at the top of that, you would have

to go through this bent kind of a skew, spincter, the recto sigmoid, spincter, deeper, which gets

you a picture, I need you also to know that I was working on this in public at a cafe, a very

“crowded cafe. And as soon as I clicked on the 2017 vice article titled in a loud vivid font,”

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

butt curious, but want to go about it with fewer surprises. 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 a fleets animal bottle full of warm tap water. You don't actually need all of that sodium phosphate solution. You really don't need mineral oil or blah, 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 were these sent me whole bunch of like anal-dushing things and they come in like bowls with sharp tips and

shower heads. Some of those things I don't love the sharp tips because I've seen people give them themselves visitors 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 fleets animal. They actually

just developed this awesome product in the UK, which I hope comes here soon. It's called an Abel,

which is like a little hydrogen gel that you can stuff up in your butt and it sits right at the regular breakfast sigmoid and then it stops the poop from coming down. So instead of having to you know, do immediately before sex, which kind of like takes out that, you know, the sexy vibe, right? You just like put something up there, stops everything up, and you go about your way, which I love the idea of. 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 Abel, a like the letter, dash ball. The website lays out an elevator pitch. It says, "Who has time for 45-minute toilet tanko?" Not you. Our ball gets you butt ready in half a minute so you can skip the waiting and slide straight into the good stuff. But how you ask on the edge of your toilet seat? Okay, so they say that the Abel gets shoved up during the fun and it parks itself at the top of the rectum,

like a VIP balancer 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,”

poop 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 if 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 Abel people are going to clean up with this. And going back to that,

Jill and Jamster's Iris, being back the cat David, Robin, first-hand class transgard Janelle,

which is my sister's name, but I don't think it's her, either dog Alex Minor and RJ wanted to be know. I mean, RJ Deutsch 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 Jamster's are their health risks of doing anal. What qualifies is 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. Yeah, you're nay from my gosh. We could do a whole episode. I know! 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 swab regularly for STI's and get this treated. You and your partner are treated. 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. I think the one thing people are usually trying to ask

“here is if thing is going in your butt all the time causes incontinence. I think that's what”

people are worried about because because then the anus does stretch. Right? So the anus does stretch and it can cause like a little bit of laxity over time. I have seen people have he glitched over time. But mostly time it's not super common. It does cause hemorrids. Right? So it can make inflamed hemorrids 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 for play that will allow a larger size

and you know length and 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

which is a genus. So you don't actually need to use soap to wash your butt. Yeah, because of the

anulmicroviome 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 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 edge because it's trying to heal. No, so wait, so you're in the shower

can some gentle soap go into crack or what crack is okay? Crack is okay. Okay, okay. So yeah,

“100% you should wash crack and cheeks because that is skin and that is like a totally different thing.”

But what I mean is like the immediate anus, which is kind of like the dark wrinkly area,

and really don't eat soap there. Yeah. Oh my god. You have questions. Y'all, I did my best to

humiliate Dr. Fong and debunk this. But unfortunately, every article I found from experts is like, water is fine. Keep the natural skin barrier healthy. And since we did this recording, I want you to know, it's 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

chlorox. Oh, speaking of different kind of bleaching, anal bleaching, yes or no. No. No. You don't need it. And why don't people speak? I know, Aina, Aina are supposed to be the color of the way they are. It's fully fine. You know, I thank you. I wouldn't worry about it. Okay. Well, speaking of washing, oh, this was a popular one. Iris Alex, Agamemon, Sean Katie, Britt, John, person who I ask her, Thoriposaurus, Jess, Tony vessels. John says, why do we not all use bidets? Katie says,

“bidets. Do we love them or love them? Sean says bidets. Truly better than toilet paper alone, right?”

Agamemon 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 rental health? Yeah. One of my 10 battle commandments is bidets the way. So, yes, everybody should have a bidet. I don't know why we don't have them in the US, you know, in Asia and Europe. People have them. Yes, they improve annual health. They improve

hemorrhides. They improve fissures for sure because of the overwiping that people do. And, you know, bidet, wash, rinse, pad 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 butt hole, right? Like you're not trying to give yourself an endoma. You're actually just washing the outside. So, next year, I ain't as close.

And then spray, rinse, pad 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 hemorrhides

“and all these things. Love the days. 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 bidets to the clean water supply and so it's clean water that goes in between your butt. It's not the toilet water. It's clean water goes into your butt and then just drops back in the toilet. And for people who are afraid to use bidet because they're like, well, what do I do afterward? You can dab

yourself dry within toilet paper. Pat dry with toilet paper. Okay, they make like toilet towels, but you can just patch dry with toilet paper. Okay. And you're talking to someone who has two bidets in the house, 100% of our toilets have bidets. So I'm asking the questions and other people are probably like, do I? No, those are excellent questions. Yeah. Okay. Like, we want to get it from all angles, right? And I know you can go like high end Japanese that's got more buttons than

my car and then to like a toshir or something that's pretty much like a one knob. 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 dollar bidet is like. Yeah, it works great. I understand that in the UK bidets are illegal because their water supply is not like up to clean standards. 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 clogs septic system. So they're not great for the environment at all.

Don't do it. I mean, look up fatberg and never again. So gross. So fatberg. A fatberg has got to be

the absolute worst noun. It's got to be the worst object that I can imagine in an effort to save

Okay, Google fatberg and send me the invoice for the psychotherapy. It's worth it. I will tell you

“that in one photo, a London sewer worker is holding up this greasy chunk that's about the size”

of a small marlin where he a fisherman. I was horrified. I was traumatized to notice he was not wearing gloves. He was just raw dog in his 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 from a psyche.

And I'm not grossed out by much, but I would tell you that is gross. That burned dude. They're up there with a rat king. Like they're so it's bad. Okay, well speaking of toilet accessories, Miranda Panner, Curry, Heiser, Page Manking, Alex Miner, Chris Moore,

Castro Wolgamov, Castro Onejnau, Squatty Potties, actually helpful or little silly. And

Page says Reeler Flimflam. And then also, do they have an effect on hemorrhides? Chris wants to know. And then Page said, I found I become rather dependent on it since I got one, which has made travel related constipation the worst. So yeah, tell us about it. So 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 as like in a squatting angle. The studies that look at squatty potties are some kind of like stool show that only 10 to 50% of people need them because of the way that it adjusts the anal rectal angle, which I thought was kind of cool. So for some people, it really will help because of the way that your anatomy is and for the rest of the people, you actually probably do not need one. The more important thing though is that when you're pooping,

you're spending about two to five minutes on the toilet max. If you're straining for that long that you think that you need a squatty pottie and you're sitting there like looking at your phone for an hour, your poop probably isn't ready yet. You know, it's either isn't ready yet or it's too

hard so I'm always like, "Get up, go do the dishes, walk around, do something else, like drink

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. Okay. Yeah, so in some people who works and then in some people, most people you really don't need it, travel constipation. I think you actually asked that question earlier. Yeah, the reason it's so terrible is because it's like the trifecta, right? So you're dehydrated because you're trying not to drink when you're on the airplane, you know,

and you don't want to pee on the airplane. You're eating junk from airports and you don't have your usual healthy diet. You're also sedentary and then there's also stress. Stress is like a huge factor in conservation that we're seeing as totally true. So people who work out too hard, you know, the fighter 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, you know, get around the person that go pee, I try to bring some fruits and vegetables with me. I try to bring my rubber gummies, my probiotics, and then I'm one of those people who get to the airport three hours early. So I got to get

eyes on the gate. Just me. I got to get eyes on the gate. Terran Delaney Smith, a travel influencer, calls this LEOTG or Leo Teach, lay eyes on the gate. I think about it every time I go to an airport. All right. This is a great question a bunch of people had Jennifer Carine, Jay, Nick Rider, Tuhah, Anne-Least-Young, Honey-Doo, Marta, Katie, O, Emily, wanted to know, Honey-Doo says, "Why is there sometimes a shark paying to the booty hole during the period?" And Nick says, "Secondary,

the period but paying question," Jennifer wants to know, "Why is this getting your period effect your bowel movements?" And if it wasn't a crap shoot, ha ha, already. They say. That's going on. So period effects 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 stool firmer. So we know that, like around the time of your period,

you actually can get more constipation in diarrhea, really both because of the way your body absorbs fluids. The shark shooting pain though is actually something a little bit different. That's called "Protelja Fugax." And so that's more common in women, but it's 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 a progtology, pionidal system, pelvic floor.

The three p's, because I do so much pelvic floor and we're just now finding out that there's so much we don't know about the pelvic floor 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

like this." And eventually when I start to go, and you feel that shark pain is being like, "Hey,

“we're in spasm. Can something let me out now?" In some cases, it'll be like some gas-triggering”

spasm, some soil in the rectal vault triggering the spasm. But it's actually a muscle spasm. That shark shooting pain. Okay. And again, you've been pregnant, even your wife have three kids. Now, "Yep, 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 and also just in general, like pregnancy and butt stuff. Why? Yeah, yeah, pregnancy and postpartum. So

constipation gets worse because of all the things we talked about, like increased relaxing 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 trimester, the constipation and the hemorrhids 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 of 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 anus. The teaching is erecto vaginal fish, although 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 vaginal, 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 this in six months, the information will go down and the skin will heal.

If it hasn't, I would definitely say Cia colorectal surgeon, because there's a ton of things we can do. We could pull like a little C-ton, ring through it, which is like a little rubber band, there's things we can do, such as like closing the fish to lie with the suture or an endolaneo advancement flap where I kind of pull like a flap over the rectal side and just close it up. So, I don't want women to be embarrassed by this. I want you to go fix it, because it's

super, super like quality of life, you know, issue. Mm-hmm. Going from uteride to prostate, Orion, potato puffer David Greg, Malai, Maiai, Mai, Alex, Minor, Katie Hammond, potatoes says prostate massage should we be doing it. Also, Malai says, I don't have one, and I'm curious what's going on in there.

I mean, it's right in front of it, right in front of your, yeah, 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, but it can cause a little bit of chronic prostititis and I've seen that happen. So, just be cautious, you know, and if it starts hurting or if you're starting having, like,

burning with urination, burning with ejaculation, things like that, go check it up, see what you're all just. Okay. We do have a whole year-all in G-upisode with your favorite, urologist, doctor, Phenomenal House. 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 piecepot. 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 orgasm. Such a cool drink. But let's cool things down, just a sec.

“Spencer wants to know why do some farts smell way worse than others?”

Telly being wants to know if someone gets the hair removed from the battle, our farts typically louder. Wow, I thought I heard everything. Like on the tree falls. I'm going to say hairs, no, because it's really more body-habitist

from what I've seen than the actual hair itself. Because normal anal canals, six to eight centimeters or so. But some people have really large butt cheeks, right? So the butt cheeks are going to 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, and actually I'm all for leave it natural and stuff like that. But what I have noticed is that when people were worried

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. Okay, are you ever in there? This is a question from Quinn Lillian, Anonymous,

Bre, Lina, and Jay. Are you ever in there, and you see... Enemy Tree of this? Yes. What the fuck? Yes, that's not common, but it isn't a differential,

which is that if you are having chronic rectal pain, or 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.

So, Anomitriosis, if you're lucky enough to not know about this, it is one 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 are 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 endometrialosis is called gaslighting on the part of doctors who tell you the 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 average,

which means some people a lot longer. Treatment for endometrialosis involves surgery to find and remove that airant tissue from wherever in his taken root, which might be your intestines. It's not common, but you do definitely see that on colonoscopy

and sigmoidoscopy is enough. Yeah, my God. And do you have to remove it?

“Or then do you have to get an OBGYN surgeon back in there?”

Oh, yeah, no, I remember. Okay. That's not something they would remove. They're like not going to touch the rectum, so I remove that. And then send us pathology.

A lot of times it is a multidisciplinary thing, so if they have to be there to remove other endometrial implants in the pelvis, we do that like all jointly in the OR. Okay. Kimberly Butte for some question asker says,

"I feel it's my time to shine. My last name is Butte." Butte? Yeah. So we straight up butte.

For some question asker, a long time 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 super weird. Feel free to skip, but why does diarrhea feel hot? Like since it's more water shouldn't feel cooler, what's happening?" So do certain drugs cause diarrhea? Is explosive diarrhea ever normal?

“And is it an irritation of the butte tissue that's hitting that acid?”

Is that why hot, hot shits, hot snakes? Yeah. So hot shits because of the inflammation. Yes. 100% that's why it feels warmer.

Okay. And then also like the bile acid, you know, as it's coming out, it actually should be warm, right? It's not a cold liquid that's coming out. It's like a hot liquid.

So that's the first thing.

Explosive diarrhea can be normal. And actually I remember now what the other question was, it was why does some of those smell work? Yes. So all of it is related to what you eat, right?

So things that are fermented by more gas producing bacteria will cause more gasiness 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,

I put a bacterium that kind of digested and causes like gassiness and explicit by diarrhea. I would say like three times a day is technically within normal limits still. Like if it's an explosive gassy stool, diarrhea technically is defined by four or more schools a day.

Like four or more runny schools where you can't keep up with your hydration. No, I mean, I'm probably just see what he's eating. Like is it a lot of beans? You know, like, that would do it. Can we do that?

Yes, we can do it. So weed does irritate the colon. It kind of stimulates contractility.

“But then I always tell people it's bugs or drugs too, right?”

So bugs or drugs have a huge influence on your colon. And we know that for example, opioids can constipate you. But things like metformin like diabetes medication can actually cause you that diarrhea. And then there's certain bacteria like cdf that will cause you to have diarrhea.

But then there's also a constipating type of cdf where you can actually have constipation. So bugs or drugs? I forgot to ask the difference between colitis, ulcerative colitis, Crohn's disease. Those are autoimmune diseases.

Those come under the category of inflammatory bowel disease, IBD, which is different from IBS, which is irritable bowel syndrome.

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 like

bloody diarrhea of abdominal cramping. And those have to be diagnosed with colonoscopy and biopsies. And generally treated with medications like biologic medications that, you know, calm down your immune system. And then in severe cases, you end up with surgery to remove the disease

portions of the bowel, like small bowel or colon. IBS on the other hand is super common. We know that a lot of people have it. And there's IBS C, which is constipation type, IBSD, 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 rolled out. IBD or cancer or diverticulitis. And you're still having like too many bowel movements today, or too few bowel movements today. Or a lot of people tell me they have urgency, which is like they feel like they have to go.

Even though nothing comes out. And even though people used to be like, oh, that just like a mental thing. You know, you just imagining it. Now we're seeing that a lot of it has to do with like abdominal hypersensitivity. You just feel things differently in your abdomen.

And then of course, the microbiome.

“Like I think we're going to see that it's really changes in your microbiome.”

And there's now we know there's different strands that are more prevalent in some IBS types. Last listener question, Dave Langanese, only person who asked this. Wanted to know why is a butt load precisely 126 gallons equal to two hogs heads. Have you ever heard this?

I've never heard this, but I might have to do an aside on it.

Yeah, this might be an aside. Wow, you've jumped into the last question. You actually do not know. I would like to know why a butt load is two hogs heads and if it's two hogs heads can fit into your colon.

I have not. I hope not. So just for fun, just for fun. A hogs head is a cask holding 300 liters or about 80 gallons. And a butt holds around 500 liters.

And a butt load, thereby is technically, yeah, about 120 gallons. Also, a bun is a stopper in a barrel. And if you take out the bun, you will have a bun hole. And sniffing a bun hole can tell you a lot about the liquid that's aging there in, like a whiskey or a wine.

“So tell everyone, you know, that's why text messaging was invented.”

I thought you were going to ask me how many people asked sent me like pictures of their butts

in their poop, but that's the answer is a lot.

Oh, my God. So, I mean, I love that getting pictures of people's buckles and poop is not even remotely the worst part of the job. In fact, it's probably delightful, but like what I'm going to guess is that colorectal surgeon there's definitely very hard parts of the job.

But what is something that's either a slog or just tough? I mean, I think most people are going to 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. We're 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 going to find out there's just one little more factor that we don't know about. Favorite thing about what you do. I really love that people get such satisfaction from finding someone who they can talk to about their butt problems.

Because for so long, I think people will be like, oh my God, I was so embarrassed. I didn't want to seek help, I didn't want to, you know, have anyone look at my butt and then they come talk to me and you're 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 get help 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 just never had someone look.

So early awareness, you know, more awareness and more education. That's the best part. Yeah, black tools. Yes. Black diary souls get it checked out 100%.

Consolation of symptoms is black diary souls abdominal bloating unintentional weight loss. Right. So that's the key one. I'm going to go on record and say, I love you. I think you're wonderful.

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

“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 in studies

up at alleyword.com/allegies/colopructology. Thank you again. Carmen, also everyone get her book. We'll link that in the show notes as well. We are an allegies on blue sky and Instagram and I'm at alleyword on both.

You can find in their own feed, just type in SMOLOG, IES, and your podcast app.

“Or you can see alleyword.com/smollegies.”

Aaron Talbert, Admin's The Allegies Podcast Facebook Group, Evelyn Malik, makes our professional transcripts.

A website making our appointments is scheduling producer Noel.

Still worth keeping things moving is managing director Susan Hale, and making sure all

“the cuts, gel, and come out smoothly are editors, Jake Jaffee, and lead editor Mercedes”

Madeland of Madeland audio.

Nick Thorvern, sound of the theme music, and if you stick around to the very end, you

know I may tell you secret. And this week is that I forgot to ask Jared earlier to make me a singer for the very end of this.

“I wanted him to make me a song that was like a black hole song, but was like black”

tarstools, won't you come and get it checked, black tarstools 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 forgot I got to 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 much latte and you sip it. It's kind of like tiny, tiny, tiny boba's, made out of frog's eggs. Personally, I like chune them up, and it's a snack that both my mouth and my butt hole can agree on.

All right, stay off the toilet for a long time, bye-bye. I guess all I saw was your any other time.