What can I do for hemorrhoids?
Summary
TLDRIn this enlightening and humorous conversation, Dr. Megan Turley, a colon and rectal surgeon, dispels myths and sheds light on hemorrhoids, explaining their function, causes, and treatments. She emphasizes the importance of not dismissing rectal bleeding and the need for proper evaluation, advocating for open discussions about anorectal health to reduce stigma and shame. Dr. Turley also highlights her approach to treating hemorrhoids with office procedures and stresses the significance of early detection for conditions like colon cancer.
Takeaways
- 😀 Hemorrhoids are normal anatomical structures that everyone has, serving functions like providing moisture in the anal canal and aiding in 'anal sampling' to differentiate between gas, liquid, or stool.
- 😅 The interview starts with humor, acknowledging the sensitive nature of discussing rectal issues and aiming to normalize conversations around them.
- 🩺 Hemorrhoids can be internal or external, with internal hemorrhoids being up in the anal canal and prone to bleeding and prolapse, while external ones are highly innervated and sensitive due to being made of skin.
- 🤰 Pregnancy and hormonal changes, including those related to breastfeeding and menopause, can exacerbate hemorrhoidal issues due to their effects on bowel habits and the anorectal area.
- 💊 Conservative management of hemorrhoids includes fiber supplementation, warm baths, over-the-counter numbing creams, ibuprofen, and prescription steroid suppositories.
- 🍽 Dietary habits significantly impact hemorrhoidal symptoms; a high-fiber diet can help alleviate constipation and diarrhea, which are common triggers for hemorrhoid problems.
- 🏥 In-office procedures for hemorrhoids include rubber band ligation for internal hemorrhoids and excision for external ones, aiming to reduce symptoms and improve patient quality of life.
- 🚫 The script emphasizes the importance of not self-diagnosing and the potential risks of ignoring rectal bleeding, which could indicate more serious conditions like cancer.
- 👩⚕️ Dr. Megan Turley encourages patients not to feel embarrassed about seeking help for anorectal issues and stresses the importance of professional evaluation for proper diagnosis and treatment.
- 🔍 The discussion highlights the need for further investigation when conservative treatments fail to stop rectal bleeding, with a colonoscopy being a critical step in ruling out serious conditions.
- 🌐 The interview concludes with a reminder of the importance of screening for colorectal cancer, especially for those with a family history or showing symptoms, and the value of seeking second opinions in healthcare.
Q & A
What is Dr. Megan Turley's specialization?
-Dr. Megan Turley is a fellowship-trained colon and rectal surgeon with a comprehensive robotic surgery practice.
What is the primary function of hemorrhoids according to the discussion?
-Hemorrhoids serve as vascular cushions in the anal canal, providing moisture and mucus, and aiding in anal sampling, which is the body's ability to discern the nature of rectal gas or content.
What is the difference between internal and external hemorrhoids?
-Internal hemorrhoids are located up in the anal canal, can bleed, and may prolapse or fall out during bowel movements. External hemorrhoids are made of skin and can become engorged and sensitive, often causing discomfort or pain.
What are some common causes of hemorrhoidal troubles mentioned in the script?
-Common causes include constipation, diarrhea, straining from various activities, pregnancy, hormonal changes, and lifestyle changes like starting a new exercise regimen or diet.
How does Dr. Turley describe the process of treating hemorrhoids in her practice?
-Dr. Turley starts with a consultation to understand the symptoms, followed by an examination that includes looking for external issues, performing a digital rectal examination, and using an anoscope to examine the hemorrhoidal tissue.
What is the role of fiber in managing hemorrhoidal symptoms?
-Fiber supplementation is crucial in managing hemorrhoidal symptoms as it helps regulate bowel movements, reducing constipation and diarrhea, which can exacerbate hemorrhoids.
What are some non-surgical in-office procedures for treating hemorrhoids?
-In-office procedures include rubber band ligation for internal hemorrhoids, which cuts off blood supply causing the tissue to fall off, and excision for external hemorrhoids to change the topography of the anal opening.
What is the significance of the cultural stigma around discussing rectal issues, and how does it affect patients?
-The cultural stigma around discussing rectal issues can cause patients to feel shame and embarrassment, which may prevent them from seeking necessary medical care and evaluation.
Why is it important for individuals experiencing rectal bleeding to seek medical attention?
-Rectal bleeding is not normal and can be a symptom of more serious conditions like colon cancer. It is essential to seek medical attention for proper evaluation and diagnosis.
What are some common misconceptions about hemorrhoids discussed in the script?
-Common misconceptions include the belief that hemorrhoids are always painful or problematic, and that rectal bleeding is a normal symptom of hemorrhoids. In reality, hemorrhoids are normal anatomical structures, and bleeding is a symptom that requires medical evaluation.
What advice does Dr. Turley give regarding the use of over-the-counter treatments for hemorrhoids?
-Dr. Turley suggests that over-the-counter treatments like Preparation H or other creams may not be as effective as more targeted approaches like hot baths, ibuprofen, and prescription steroid suppositories, especially for acute hemorrhoidal problems.
What is the role of a colonoscopy in evaluating rectal bleeding?
-A colonoscopy is essential in evaluating rectal bleeding as it allows doctors to examine the colon and rectum for abnormalities such as polyps or cancer, which may be causing the bleeding.
What are some alternative methods to a traditional colonoscopy mentioned in the script?
-Alternative methods include the use of a pill cam, which is a swallowable camera, and a colig guard or 'poo in the box' test, which analyzes stool for signs of blood or other abnormalities.
Outlines
😀 Introduction to Dr. Megan Turley's Discussion on Hemorrhoids
Dr. Megan Turley, a fellowship-trained colon and rectal surgeon, introduces the topic of hemorrhoids in a light-hearted manner, discussing the common misconceptions and the importance of understanding the condition. She explains that hemorrhoids are vascular cushions in the anal canal that everyone has and serve important functions, such as providing moisture and aiding in 'anal sampling' to differentiate between gas and stool. The conversation begins with humor, including a joke about a man with plastic horses in his rectum, setting a tone of openness and comfort for discussing this sensitive topic.
😅 The Anatomy and Function of Hemorrhoids
This paragraph delves into the anatomy of hemorrhoids, distinguishing between internal and external types. Internal hemorrhoids are located up in the anal canal and can cause bleeding or prolapse when they become engorged, especially during sitting and straining. External hemorrhoids, on the other hand, are made of skin and can become sensitive and swollen. Dr. Turley emphasizes the importance of recognizing hemorrhoids as a normal part of anatomy and discusses how symptoms arise when these structures become problematic due to various factors such as straining, constipation, or pregnancy.
😓 Hemorrhoids and Lifestyle Factors
The discussion continues with the exploration of lifestyle factors that can contribute to hemorrhoid issues, such as constipation, diarrhea, and straining from heavy lifting or illness. Pregnancy is highlighted as a significant risk factor due to hormonal changes and physical pressure from the growing fetus. The paragraph also touches on the impact of hormone changes during breastfeeding and menopause on hemorrhoid symptoms, underlining the complexity of the condition.
😖 Addressing Hemorrhoid Symptoms and Treatments
This paragraph focuses on the practical aspects of addressing hemorrhoid symptoms. Dr. Turley suggests starting with dietary changes, particularly increasing fiber intake, to manage bowel movements and alleviate pressure on hemorrhoidal tissues. She also recommends over-the-counter treatments like Preparation H and warm baths to soothe discomfort. The importance of differentiating between 'fluffers' and 'pushers' in hemorrhoid management is emphasized, with the former changing stool caliber and the latter stimulating bowel movement.
😉 Hemorrhoid Management and the Role of Hygiene
The conversation shifts to the role of hygiene in managing hemorrhoids. Dr. Turley advocates for gentle cleaning practices, such as using mild soap and water, and minimizing the use of toilet paper to avoid micro-tears that can exacerbate itching and discomfort. She also discusses the use of bidets for maintaining cleanliness and the importance of not overcomplicating anal hygiene.
😡 The Stigma and Shame Surrounding Hemorrhoids
Dr. Turley addresses the cultural stigma and shame associated with hemorrhoids and anal health issues. She emphasizes that these conditions are not a reflection of a person's cleanliness or morality and encourages people to seek medical help without embarrassment. The paragraph also touches on the societal expectations for women to be clean and the impact of these expectations on the willingness to discuss or seek treatment for such issues.
😣 In-Office Procedures for Hemorrhoid Treatment
This paragraph outlines the in-office procedures available for treating hemorrhoids. Dr. Turley describes rubber band ligation as a common method for treating internal hemorrhoids, which involves cutting off blood supply to the tissue, causing it to fall off. She also discusses other procedures such as infrared coagulation, sclerotherapy, and hemorrhoid liation, highlighting the importance of conservative treatments before resorting to surgery.
😖 The Impact of Hemorrhoids on Quality of Life
Dr. Turley discusses the significant impact that hemorrhoids can have on a person's quality of life, causing symptoms like urgency, pain, and seepage. She stresses that while hemorrhoids are a common condition, they should not be dismissed as a minor issue, and people suffering from them should seek medical attention to improve their condition and regain their ability to enjoy daily activities.
😡 The Importance of Seeking Medical Evaluation for Hemorrhoids
The final paragraph emphasizes the importance of seeking medical evaluation for hemorrhoids, especially when conservative treatments fail to resolve symptoms. Dr. Turley explains that persistent bleeding is not normal and should be investigated further, potentially requiring a colonoscopy to rule out more serious conditions like cancer. She encourages patients to advocate for themselves and seek second opinions if necessary.
Mindmap
Keywords
💡Hemorrhoids
💡Anal Canal
💡Prolapse
💡Constipation and Diarrhea
💡Fiber Supplementation
💡Pregnancy
💡Infrared Coagulation
💡Rectal Cancer
💡Colonoscopy
💡Anoscope
💡Banding
Highlights
Dr. Megan Turley discusses her role as a colon and rectal surgeon with a comprehensive robotic surgery practice in Austin, Texas.
Dr. Turley explains the anatomical and functional aspects of hemorrhoids, emphasizing that everyone has them and their role in anal health.
A humorous anecdote about a man presenting to the emergency department with five plastic horses in his rectum.
Dr. Turley provides detailed information on the symptoms and types of hemorrhoids, distinguishing between internal and external hemorrhoids.
Discussion on the causes and risk factors for hemorrhoids, including constipation, diarrhea, straining, pregnancy, and hormonal changes.
Dr. Turley emphasizes the importance of fiber supplements and hydration in managing hemorrhoid symptoms.
The conversation highlights non-surgical treatment options for hemorrhoids, including topical medications, warm baths, and over-the-counter remedies.
Dr. Turley shares that some hemorrhoid issues can be resolved with in-office procedures like rubber band ligation.
Explanation of more invasive treatments for severe hemorrhoids, such as hemorrhoidectomy and the potential recovery time involved.
Dr. Turley stresses the importance of seeking medical evaluation for rectal bleeding, as it can sometimes indicate more serious conditions like cancer.
Dr. Turley and the interviewer discuss the stigma and embarrassment associated with hemorrhoids and other anal health issues.
The importance of proper cleaning and hygiene for anal health is highlighted, including the use of gentle methods and products.
Dr. Turley describes her broader role in treating various colorectal conditions, including cancer, inflammatory bowel disease, and diverticulitis.
The conversation touches on the importance of screening for colorectal cancer, especially in individuals over 45.
Dr. Turley shares some of the unusual items she has removed from patients' rectums, emphasizing the importance of using proper tools for anal intimacy.
Transcripts
[Music]
hello everyone we're here today with Dr
Megan Turley she is a fellowship trained
colon and rectile surgeon with a
comprehensive robotic surgery practice
in Austin Texas she works at Texas colon
and rectal specialist in Austin thank
you so much for having me yay I was so
excited to talk about hemorrhoids today
I know how excited you are the most
excited yeah talk him out buttholes and
all that stuff poop all the things I'm
sure you hear a lot of poop jokes all
day do you know yeah I hear some good
ones and some that are basically like
poop but that's mostly for my kids oh
okay that's hilar I all like the little
like poop my like toys and figureheads
we have a lot of those around so fun
right I'll tell you a joke then okay's
up a man presents to the emergency
department with five plastic horses in
his rectum his condition is described as
stable oh my god well don't jokes that's
amazing oh my gosh I love that okay well
we can add sprinkle more those as we go
but all right okay so we have a question
from Kate and greenbell South Carolina
she says I have some summered
hemorrhoids that are not going away what
can I do about it so now so let's kind
of you know that's just an open-ended
question so can you describe to
everybody like what a hemorrhoid is
absolutely the very first thing you
should know is that hemorrhoids are like
arms they are anatomic everyone has them
they are vascular cushions in the anal
Canal the function they serve it tends
to be both providing kind of moisture
and mucus in the anal Canal as well as
doing what's called anal sampling so
sometimes people don't give the anus and
rectum enough credit for the job they do
but I want you to consider probably even
within the last few weeks you've been in
a place a crowded place with people you
respect and you decide you're going to
eek out a silent fart now in that moment
the nerves muscles and your brain have
to decide is this gas liquid or stool is
it going to be loud or is it going to be
quiet so your butthole has to figure
that out or else people would just be
their pants in public I'm sorry
can I say yeah okay people would just be
their pants in public all the
time if they were wrong yeah right so
now those signals can get messed up in
different types of anoral pathology so
for people who have thrombos external
hemorrhoids who have hemorrhoid crisis
all those things can get a little bit
mixed up but anyway that's the term anal
sampling is the ability of your body to
know like is this an okay time to try
and squeak this out or am I about to do
am I about to have like a big emergency
here I just I think this saw so funny I
saw something on Instagram the other day
and somebody was like it was a door and
the door like butthole and then it said
it was like a fart sh said fart and like
the fart was like getting ready to go
out the door and then some the guy was
said diarrhea and it like ran out the
door first oh yeah so it just think that
so so essentially anyone who comes to my
office to talk about hemorrhoids I
really listen to what the actual
symptoms are because essentially for
most people unless you're a proctologist
and or a GI doctor hemorrhoid really
just means like there's a problem with
my anus I can barely eek the words out
to tell you what it is and so our job in
proctology is to really figure out like
what are the symptoms that are bothering
you because most the time if hemorrhoids
aren't bothering you they certainly
don't bother me now as far as the
anatomy goes so hemorrhoids benign do
not cause any problems longterm but kind
of with the exception of like torrential
bleeding or what we call audible
bleeding that's where people tell me
they're like I sit on the toilet and I
can actually hear blood hitting the
water so that's kind of like a different
you know a different set so hemorrhoids
internal hemorrhoids and external
hemorrhoids are kind of the way we
designate and it can kind of help you
understand what the symptoms are so
internal hemorrhoids are up in the anal
Canal they tend to get big and engorged
when sitting and straining they can
bleed and they can fall out your butt
that's called prolapse so that if you
sit and you bear down and have a big
bowel movement and you feel like as
you're wiping you're pushing tissue that
belongs on the inside back up into the
inner Canal that's hemorrhoid prolapse
external hemorrhoids are made of skin
your anus or your butthole is made of
skin just like the skin on your hand
it's squamous tissue it's highly
innervated very sensitive for better or
worse and so when people have external
component of the hemorrhoid that can be
both the vascular involvement so a
tissue that gets bigger and smaller
based on your bowel habits if you're
sitting and straining if you're hiding
from your kids with your anal Canal
unsupported over the toilet bowl while
you finish that last YouTube video or
you're texting your mom and you just
want to get that final thought out and
then when you wipe you're like my God
are these grapes no it's just your
hemorrhoidal tissue filling with blood
because your Canal's unsupported at that
time now because it's made of skin there
that actually belongs on the outside so
a lot of people tell me like oh I have I
have hemorrhoid prolapse I have tissue
that's not supposed to be there well
external hemorrhoids are supposed to be
there that's skin it lives on the
outside now whether or not you like how
much skin there is or the vascular
component so whether or not get bigger
and smaller when you're sitting and
straining like those are things that are
modifiable but U just the mere presence
of tissue on the outside of your anal
Canal is pretty
normal I have a speech love in my office
it's called every anus is a flower and
all our petals are different oh and I
won't go into the details but
essentially it just means that like
butth holes are different and but holes
can be different when you're young when
you get older if you practice anal
intimacy if you have lots of babies if
you have surgery if you get infection
collections next to your butt and you
need surgery for that bottoms just look
different over time and there's
something wrong with that if you're
having symptoms that's when we want to
see you yeah I say that too about vulvas
you know it's like everybody's vulva is
different I have a lot of people come in
like my vulva looks weird it you know it
doesn't look like anybody else is I'm
like well what you know where are you
getting this information see either
usually like pornography or something or
just an anatomical pictures in an
anatomy book and everything looks
perfect in those things and the reality
is like you said about butth holes it's
like no one's is the same everybody is a
little different I think the more we
normalize this and talk about it like
okay like we all have them yes
absolutely and truly unless your partner
is a proctologist they probably don't
notice or think anything about your anal
opening other than they're excited to be
there because that's something you guys
have chosen to do yeah yeah around the
holidays I posted something on my
Instagram that was like everybody has a
butthole but don't be one yes I thought
was nice I love that or ask guess yeah
all the
same Okay cool so so what why I mean why
do they happen so you've basically said
How you know this tissue is normal but
then you know it's highly vascularized
so that means increased blood flow and
all that stuff for people that don't
necessarily know what that means so why
you know what are some common reasin
sure so everyone's body is a little bit
different and so some people are
predisposed to having Troublesome
hemorrhoids and some people are not I
really can't tell you kind of in your
families like who will or will not be
however there are some things that do
put people at risk so constipation and
diarrhea can give people hemorrhoidal
troubles and that can either be
engorgement sensation at the anal
opening it can be lots of mucus it can
be tissue that falls out that you have
to push back in it can be bleeding with
wiping and it can be that external
engorgement component now some people in
the setting of straining and I mean
straining in any sense so straining to
poop straining to move a piano straining
in the setting of like moving a hot tub
straining when you get sick and you're
throwing up a lot all those things can
change hemorrhoidal components and can
kind of precipitate them being more
bothersome than other times pregnancy
also a big one unfortunately not just
big old baby heads but the hormonal
changes surrounding pregnancy
surrounding things like ibf surrounding
things like breastfeeding and we pain in
and menopause all of those hormone
changes can change the way that our our
stools kind of form and evacuate and
those can all kind of precipitate
hemorrhoidal troubles do you think it
has more to do with estrogen or what
what do you think the hormonal
components should do so yes and no so
it's a combination of estrogen and
progesterone and our Gynecology
colleagues could probably get a lot more
sexy in the weeds as far as the
descriptions about which are more
constipating at one time or another but
because hemorrhoids can basically all
hemorrhoids can be exacerbated by all
types of hormone changes then I'm not
going to specifically assigned to one or
the other no I mean don't fingers don't
fingers I think hormones get like a bad
rep too especially estrogen like you
know that it's there's never absolutes
you know right there's it's just
understanding that but yeah I think that
there's almost a lot of embarrassment
especially postpartum with people saying
oh my gosh I have
H I'm like you know how many other
people have hemorrhoids that come in
here they marking all their Pap work but
they're not shouting it on the rooftops
I mean people aren't talking about this
on social media and stuff like that and
so yeah so it's pretty you know it's I
don't think it's anything to be
embarrassed about I mean it can be
embarrassing because it's your brought
ho but also you know it's it can happen
to anybody pretty much and apparently
moving Pian is a big
thing I see people holiday
piano moving all things that you think
it's just kind of like the force the
intra like abdominal pressure that
bearing down pressure on the tissue the
Val Salva uh motion so we call it kind
of breathing against the closed glaus
which means like when
you that oh also we didn't even I didn't
even blame my weightlifters I see lots
of people who are trying to make
Lifestyle Changes who are coming in
because they've just started trying to
like either like quotequote like get
jacked right so taking higher protein
powder plus heavy lifting without good
like a good breath control and I can see
those kind of causing different
hemorrhoidal stuff as well that being
said treating hemorrhoids that kind of
starts at the top right so the things
that you eat affect what comes out so
spicy in spicy out like if you're not
eating kind of overriding enough fruits
and vegetables things like that so I
have all my patients start on a fiber
supplement I take warm myself I am fiber
agnostic I do not care about brand or
whether you go the geriatric generic
route from like your you local pharmacy
or whether or not you get in the weeds
with the Millennials and do like Olli
pop water or whatever just as long as
you're hitting that 25 to 35 grams of
fiber in a day that's what's going to
try and kind of attenuate that
difference between constipation and
diarrhea so that's the place that I
start and it's act it's pretty
incredible how much that makes a
difference for hemorrhoidal symptoms of
enouragement bleeding and and prolapse
really really really helps so much so
that I have people come into their
followup just to tell me that they were
surprised that it worked yeah I think
that's great I think also yeah
understanding the mechanics behind it
right I think where people don't
understand is okay well I have a
hemorrhoid what am I supposed to do yeah
like kind of with the recommendations
with the fiber and things like that but
then also like you were saying like the
closed glotus just understanding like
breath so closed glotus is basically
when you're holding your breath and not
letting anything out but if you can do
it if you hold your breath with like a
slow exhale basically that is taking off
some of that pressure so if you are
starting to work out more and you're
noticing more are these symptoms it's
not necessarily saying to stop it's just
more of hey what as we take on new
routines new diets and and nutrition and
things like that our body is Shifting so
kind of being more gentle with yourself
and understanding okay well what switch
what are some exercises that I'm doing
that I feel like I'm straining more
so from a PT perspective you know I
would say which ones are you straining
on the most right so maybe we either
decrease that weight and then slowly
build you back up or rryy clo like a
slow like exhale when you're doing it
and then kind of seeing how you're
feeling with that aspect and then also
diaphragmatic breathing so you get the
diaphragm that helps prep push kind of
everything down and relax your pelvic
floor and then as you exhale everything
comes back up so with choc dimatic
breathing in previous episodes and it's
some of the videos are on my Instagram
and stuff but the point is is that yeah
all of that stuff I think that's awesome
and
so when so f is a good one and what you
know people I think when people hear
hemorrhoids are just like oh Preparation
H what is that even like what are your
thoughts give me give me in give me in
give me it all so you so for acute
hemorrhoidal problems so bleeding
prolapse itching pain yeah but you can
spend $1 million on the on the aisle in
the pharmacy and you probably would as
be just as good making a PST out of that
bill and apply to your butt it's like
something just doesn't work so what
works when you're when you're having
emid troubles in a short duration so
less than two weeks you can use things
like preparation age topical lidocain
that's kind of a numbing medication
honestly what people tell me works the
absolute best is sitting in the hot bat
relaxes the muscles of the pelvic FL
decreases that that inflammation and the
itching sensation you don't have to put
any special salts or anything in there
but that's like a a good really good
place to start a lot of people get
muscle spasm along the anal canal in
conjunction with hemorrhoid troubles so
medications like ibuprofen can be really
helpful probably even more so than
Tylenol although you can take them both
at the same time in these settings
prescription steroid suppositories
really are the most helpful in an acute
setting what I tell people is like you
if you get a mirror and you look and
you're like I don't even know where my
anus opening is make a guess put the
suppository as high up as you can
because the the entryway for all of that
engorgement and fullness is going to be
higher up in the anal canal and so
shmear it all over your anal skin isn't
going to do a whole lot of good but
getting it more up in the anal Canal can
be really helpful so like when in when
having troubles with hemorrhoids sit in
the hot bath tal andol ibuprofen steroid
suppositories up high in the anal Canal
numbing medic
often before you use a bowel movement
can be helpful so that's like your
lidocaine that's even over the counter
and then don't get constipated so use
your fiber supplementation and your
laxatives one thing that people find
helpful is to try to differentiate your
bow aisle in the pharmacy which is going
to be at a risk of being grass it's
going to be the fluffers and the pushers
so the fluffers are going to change the
caliber of your stool those are things
like powdered fiber supplementation
which I think is better than gummies or
tablets or things like that I don't have
any evidence I can't point to the
scientific paper that says that but um
kind of anecdotally in our society
that's what we believe it also
guarantees that you're drinking eight
ounces of water to try and get that in
so once you take your fluffer and you
need to drink it with plenty of water or
else you're going to poop out a fiber
brick then you can discuss whether or
not you need a pusher or laxative so
those are things with lax in the name
dokal LAX Miralax and those
over-the-counter type things those help
you kind of stimulate the bells to move
and can be really helpful when taking in
conjunction
too um it's about water yeah water and I
think water and exercise like
movement people do like like pelvic
Mobility kind of almost like they look
in the mirror like raise your heads up
hike your pelvis Rock back and forth
mean your colon is lined up all along
your abdomen and so getting all of that
moving too and even just walking I think
that yeah you know in our society now
there's a ton of sitting less exercise
and a lot of coffee right and so hey I
she's hiding her coffee but I am a huge
advocate for you know I love coffee so
I'm not saying anti- coffee stuff but
what it's saying is like yeah getting
people to kind of think like okay what
are some other things that I can be
doing that can help us
Beday huge fan of Beday so when people
come in saying like oh I have a
hemorrhoid problem often times it's
actually not not in a ically a
hemorrhoid problem it's a constellation
of symptoms right so anal pain anal
itching excess tissue moisture changes
so Beday are awesome for doing a number
of things so if you have anal
itching treat your butt like a baby butt
stop putting product on your butthole go
to exactly what you do for a baby right
do you just take a giant poop gentle
soap and water or a bedet quit wiping so
hard the you know the bougie wipes that
are kind of marketed to people as like
some sort of anal hygiene really more of
a self-cleaning oven so gentle soap and
water minimizing product easy on the
wiping those micro tears that you get
using toilet paper and being vigorous
can lead to these like very small
excoriations on the skin which
perpetuate this itch cycle well it's
funny because it's like even when we're
just like talking about poop right we
don't even have these conversations like
and even talking with the bul bus like
how can you even clean it right are like
scrubbing it with their their lofas and
like there's bacteria in there and just
just water some light soap the same
thing like when you're wiping your
butthole be gentle Easy Does It Easy
Tiger Easy Tiger but yeah like I have
I'm a huge fan of the the that like you
don't have to go out and get this huge
thing of your house you could get I got
one at Amazon for like 30 bus and he put
it on I accidentally turned it up super
high once and I was like I'm pretty sure
that probably a right or something
something I don't know but anyway the
point is like those are great too and
then like if you're traveling or
something those Perry bottles spray the
spray bottle you spray your cat with
totally fine to use on your butt yeah
well like when people train their cats
they like oh I know that that's cool I
don't have a cat but I just heard that
like if you're like no get off
that okay well or like if you're tra and
you don't want to bring the Parry bottle
like just those like wet wipes or
something like that kind of help I just
think it's so odd how much toilet paper
we is like like during coid when
everybody was buying all that toilet
paper I was like is everybody giving
themselves hemorrhoids at this point
like I wonder if there's a huge influx
IDs they didn't make it to the
office is true yeah yeah what I tell
people when when you talk about butt
stuff is I'm going to propose a toolkit
right and it and then you choose how
many things out of the toolkit you're
going to use in a different in a given
day in a given scenario right so like
you know oh I can't use a bedet because
my work doesn't have a bed I work in a
proctology office and I don't have a
bedet here so like I get it Google
probably doesn't have it I don't know
maybe Google does have a bday or apple
does I I've actually never been anywhere
that has one except for my
house yeah for things like I tell people
yeah you know you should take fiber you
know take your fiber supplement daily
take a laxative as needed yet don't take
a giant amount of Miralax and then go to
work that sounds incredibly
uncomfortable if you are a driver or
time it think about it fit it into your
day in a way that makes sense I can't
prescribe a agenda that's going to work
for everyone so you do have it does
actually take a little bit of work to
like know thyself Know Thy body and know
whether not when I give you fiber fiber
and mirax if you're G to poop on your
commute sorry no I yeah you shouldn't do
it with like a 10hour play right and
like just clog up the toilet no it's the
same I mean it really goes with
everything else it's like understanding
how to manage your symptoms and why and
you know if you're more susceptible to
them you start learning like what's in
your diet exercise pelvic Mobility hip
mobility breath work learning how to
relax your more there's different
stretches you can do for that like you
were saying spasming around the anus and
it's funny because when people come in
for PT sometimes they're referred by
their doctor and they're like I don't
know why I'm here I'm like oh okay like
I I get it because there's a lack of
information yeah and then they explain
all this and then they're like my gosh
that's crazy you know and the other
thing I'll see too is like when people
are really stressed out right and eating
really fast and not digestion digesting
so their body's in that fight or flight
so the digestion slows down and that all
starts in the M yep you know I think
people don't think about I mean I until
I was into public Flor I didn't think
about it I mean hard they took lunch
breaks I just swallowed they whole and
like why am I gloated and constipated
all the
time but yeah so that's
Funway all right
so
what what are some nod so we just talked
about some nod surgical things that into
it so say they do those things and you
know it's just not not getting better
one or some so they can come in and see
hypothetically fa they come see you yep
what are some in office procedures or
like what are some things that you could
prescribe for that next level sure so
I'll just give kind of like a a brief
overview of what it's like to come to a
proctology office and what I try and do
very much in my practice is make making
the appointment the most painful thing
right you finally decide like this I've
had enough so come to the office
obviously paperwork blah waiting room
looks like everyone else is waiting room
come to the office we meet we have some
like cursory chat what are your symptoms
just and almost everyone says like I
have a hemorrhoid I'm like what does
that mean to you so is it bleeding is it
itching is it redundant tissue and then
after we kind of get a sense of what
your symptoms are then I do an exam the
way I do an exam is first I look on the
outside so looking at the anal skin
looking for things like infection
collections which are pretty rare
usually if someone has a big sore in
there but they know about it they tell
me about it looking for things like
fissures which are small Cuts in the
anal Canal that can cause an extreme
amount of pain during bowel movements
those are I have to credit a dear
patient of mine who described it as like
pooping a pineapple right like real
spiky real sharp while having B
movements so I look for things like
fissures then I look at the caliber of
the external skin so is the external tag
is it part of the skin itself when I
retract or pull on it does it bring down
internal hemorrhoid tissue kind of
concerning for PRX are they all over
like circumferentially around the anal
opening or is it in one location versus
another is there a thrombos external
hemorrhoid which is a blood clot on the
outside in that skin those are extremely
painful and they look really tender and
then after that is a digital rectal
examination which is an examination with
the finger so finger in the bottom
feeling for any masses or irregularities
nodular ities changes in the mucosa
which is the tissue rinding the rectum I
always feel for muscles of the pelvic
floor to evaluate for tenderness there
or peen um and then I use a small scope
called an anoscope it's a just a couple
of inches long just a little bit bigger
than my finger and it has a side a side
slit that allows me to look at the
hemorrhoidal tissue itself everybody's
got some element of hemorrhoid tissue
some people have big bulky hemorrhoids
people who have big bulky hemorrhoids
who it doesn't bother them then it
doesn't bother me nothing to do but
they're like big bulky hemorrhoids and
they bleed big bulky hemorrhoids and
they fall out so for internal
hemorrhoids internal hemorrhoids without
a significant external component or an
extal component that doesn't bother you
you can do things in the office like
rubber band liation and essentially what
that is it's like if you put it like a
hair tie at the top of a like a plastic
bag right so the tissue there's tissue
on the outside and tissue underneath it
it cuts off the blood supply to the
extraneous tissue which then Falls off
with your poop in a couple of days most
people tolerate it really well women
tolerate it awesome because they
understand that you can bleed and have a
little bit of pelvic pressure and you're
not
dying my male patients take a little bit
more counseling yeah usually I'm I'm a
very conservative surgeon and so I
usually Place one and see how people do
I say go home hang out don't go like
don't write on your pelaton like don't
you know go on a family horseback ride
tomorrow but like pretty much other than
that you can do whatever you'd like if
that resolves the symptoms awesome not
usually the case usually it takes a
couple treatments for banding of
internal hemorrhoids then I have people
come back in about two weeks they say
yeah it really helped but didn't resolve
then we can place kind of two or three
more bands at that time to see if that
resolves the issue usually I give people
about two or three sessions to declare
themselves right if you have all of your
symptoms resolve at that time then we're
done if I find myself banding you into
Oblivion like you're coming in every few
weeks and it's still bleeding it's
that's just not working and we need to
start using another tool you talk about
the external or the excisional method
after this other therapies people do
infrared coagulation sclerotherapy in
the anal Canal hemorrhoid liation
there's a bunch of different other
strategies personally I think that
hemorrhoid banding is is easy well
tolerated done in the office and quick
so I use that as my in-office modality
now for externals I kind of include that
Under The Heading of anal
Landscaping changing the Topography of
your anal opening so for people who
don't really have acute hemorrhoid
issues but they have redundant external
anal skin either as a souvenir from a
prior hemorrhoid things like that so yes
you can excise these the risk is is that
the skin that grows back or the way that
it heals is not version 1.0 it's version
2.0 it looks different it feels
different it functions a little
different most people will tolerate it
well really well but if you make tags
you'll continue to make tags into the
future and so sometimes cos medically
you just have to make sure that you
understand that it may come back and
just may not be be different yeah your
your anus skin will look a little bit
different so those are in-office based
procedures so for people who have
substantial internal and external
hemorrhoid together so usually in three
columns um sometimes two columns are
more dominant or one column's more
dominant can expain column oh yeah so
column means the internal and external
component together so these are in lines
that run up the anal Canal from the
outside to the inside or inside to the
outside depending on your perspective so
for those people hemorrhoid exision is
kind of the the way to go and what that
is is going all the way to sleep in an
operating room lots of numbing
medication and then using a cery of some
sort to excise the tissue and put it in
the bucket some people sew the defect
closed some people leave it open what I
counsel patients is that it works great
right by the time you are recovered you
are no longer prolapsing prolapsing
internal hemorrhoids you're no longer
bleeding the external component is much
reduced sometimes you have to get some
detailing work later on but but it's
extremely painful I tell people take
four weeks off of work like that's a
long time I think people don't realize
how long that is you know and
cauterizing is basically just kind of
cutting off the blood flow cutting it
off with heat yeah it's so people that
is but yeah no I think that there is
this assumption that almost all of a
sudden you just need to go into surgery
immediately because they're embarrassed
or whatever like you're saying it's like
you can have a hemorrhoid and not have
symptoms and it's like this also with
like bashal prolapse too people somebody
can come in with a small prolapse and
have so many symptoms and I'll see
somebody with a pretty significant
relapse and didn't even know it was
there they just they found out because
of their OB or they just s symt or they
didn't have symptoms but we were maybe
their back pain didn't get better and we
were like okay well let's look at some
let's look at the P floor and see what's
going on there but yeah do do You' think
I just think silent farts are so funny
but they're so smelly because they're
literally silent but deadly what can
that c hemor if you're like secretly
farting all the time no Oh I thought
that was like
Wow stop it out
I don't think
so no it's just a it's just a tribute to
the extreme sensitivity of that
neuromuscular system I thought that's
where it was going my parents are GNA be
so proud of this you are literally a Ral
thet like what I think they I think they
like to think about the complex rectal
cancers that I'm curing with the robot
right I think they like to think about
that aspect of my job like
curing rectal cancer colon cancer big
abdominal surgery like healing people
with crohn's disease that's what they
like to think about not like did you
hear a podcast on on farts
and well yeah I mean you're doing all
those amazing things too and we can
definitely talk about that another
podcast if your family sarett um I was
just thinking more like a public floor
perspective which also you know I've had
people come in after rectal cancer and
do really well
in that you know just the inability
sometimes that that inability to kind of
know if you're about to poop or and you
don't know and so learning that it's the
bi feedback and just understanding hey
what's this New Sensation that I'm
feeling too it's a huge a huge part of
my practice it's the you know the sex
you make your parents proud is curing
cancer right but yeah the entire purpose
of of doing any medical intervention is
that people need to then go forth and
live their life not just be alive and
with people who have debilitating
proctologic symptoms they can't do that
right so people people who have feal
urgency can't go on a run with their
friends can't go to the movies like
can't go on a plane like that and it and
it's amazing how much people suffer with
that and then I do have another soap box
that I have to get on sure up we have
this cultural phenomenon of cleanliness
and godliness and so people truly feel
like deep amounts of shame that if
there's something wrong with my butthole
it must be related to me not being good
or clean or holy like all of these
things can like come into play and it
doesn't necessarily have to be conscious
but the amount of shame that people
carry with them that prevents them to
from coming to the office or seeking
care like
this I can help you with this this is
easy this is good we can take care of
this it has nothing to do with your
morality or your cleanliness or or you
know if you have leakage or seepage like
that is not about morality it's about
your biology and it's like giving you a
hard time but we can make that better
yeah exactly well because it's taboo to
talk about this stuff and especially for
women it's like
to be clean yeah oh my God supposed to
be right you're not supposed to poop
don't don't you're smell like Rosa uh
mine do but that's a separate
appointment yeah no I think that even
people coming in Republic or PT I
already know that there's something on
that's like especially with rectal
prolapse which is we can talk about
another side
basically you know when the rectum Falls
more into the vagina I also see people
say that you know they wi wi white and
then they're clean clean right it's
clean and then you know two hours later
they have boom Yep they're so
embarrassed I'm like okay first of all
everybody's had a Bo I'm sorry everybody
is shed at some point in their lives
like it is it just happens it's more and
the fiber helps with that if you have a
rectus seal if you have sticky poops
that get caught on your external
hemorrhoids the fiber really does help
with that and the cleanliness part yeah
just for a laundry sake yeah no I mean
and there is there's a lot of Shame
around it and it's almost like socially
acceptable for men to talk about it yeah
like I've always been a big talker about
the point where like my growing up in my
family prob every lady I'm like oh I
don't you're like I am am guess what I
have the biology to do this that's what
you poop too you poop too Everybody
Everybody Poops Everybody Poops but yeah
I mean and yes I want to make sure
everybody knows that you do more than
hemorrhoids right if you want to go
through all the the things that you do
treat just yeah so a colon and rectal
surgeon does surgical management of
diseases of the the true colon and the
rectum so from the right colon including
the appendix all the way over to the
sigmoid colon and the the rectum and the
anus and the anal opening so that
includes things like cancer inflammatory
vowel disease like Crohn's and
ulcerative colitis it includes things
like Diverticulitis and diverticular
surgery we do emergency surgery we do
elective surgery in we do comprehensive
management of rectal cancer working in
tumor boards to make sure people are
getting kind of the best guideline based
care in a disease that's incredibly
complicated we do the post-operative
management and surveillance so things
like looking at uh new Plumbing
connections that we make surgically
making sure there's no recurrence of
cancer or recurrence of disease and then
kind of what brings me on this podcast
is talking about you know what it you
know what is proctology like what are
the ways that your butthole can give you
frustrations and what's worth noting is
that a lot of people uh just say like oh
I have bleeding that's a hemorrhoid like
you got to get you got to get looked at
it's not normal to bleed from your butt
it's not normal to bleed from your butt
period it's not normal and so for people
who have ongoing bleeding you got to get
you got to have a conversation with your
medical provider you got to get a
colonoscopy got to make sure that you're
taking care of yourself so you can be
there to take care of your family uh
symptoms like rectal bleeding rectal
pain or all things that you know is it
probably a hemorrhoid yeah but in some
people it's not and I would hate for
your symptoms to be written off as just
a hemorrhoid when there's something else
that needs to be evaluated well I think
that that's also what it is I was
talking to a client earlier and she was
like oh my gosh I'm I have a hemorrhoid
and I'm so worried about it and and this
person I know they waited and then they
found out it was cancer and so I find
people jump to cancer all the time and
so what you know what is the biggest
distinguisher I mean om is obviously
people want to get it checked out in
general but and I what I see too
especially with like colon cancer
becoming much more up
your EXC me oh my
goodness much
more I know this is a little off topic
but it has to do with hemorrhoid and
anal Health basically and so if we're
not understanding this and just
embarrass to embarrassed to ask it's
like I mean this is what people you
people like you see every day doct like
you Insurgent so you have to be I I I
truly there is no one that I've given an
award to for surprising me yeah you I'm
not gonna say you can't surprise me you
certainly one of you out there could I
would be very excited to meet you but
really
like so much is normal yes you are you
are normal yes you are normal yes yes
because yes normal
and you know you might feel a little
embarrassed but you know if hopefully
hearing the way we're talking about this
is making it a little bit less taboo and
less scary I mean literally your Wi-Fi
password is starts with poop and so it's
like you have to have upun with it yes
yes and your problems are not unique we
just haven't done a great job of
branding right like like the appendix
great job appendix appendix team
congratulations gallbladder great job
everyone's like oo had to go the
hospital colitis G GBL her out like oh
you could say that you can say that yeah
during Thanksgiving and your grandma
would be like I also have a golf right
but but other problems that are so much
more common around things like
hemorrhoids anal pain fissures urgency
seepage Beal incontinence all those
things are far more common we're just
really bad at branding so well it's it's
literally digest so it's like we're more
open to talk about throwing up like oh I
vomited you know I got sick upet tummy
yeah versus like oh I have diarrhea you
know I honestly I I love it when
somebody is so open about like sorry
can't coming out I've got diarrhea I'm
like I am fully on board with you just
being so open about
that yes but yeah I mean it's it's
digestion and it's literally food you
just stay and you know hours ago and it
is just like peeing just out of your
butthole well you should similar out of
your mode if you're peeing out your
butthole I also would like to see you
yes but what I'm saying is like what
comes in comes out and it's in the form
of Po body yes and it's and it's biology
and it's great I mean it that's that's
how these body machines keep working I
think we were going to talk about how
like like who has a hemorrhoid and who
has cancer yes yes so
the the most honest way I can answer
that is come and get evaluated and you
can have hemorrhoids and cancer so if
you are a if you are a human and you
are an
adult colon and rectal cancer is
extremely rare outside of familial
syndromes in teenagers and young adults
that being said I have a patient panel
that includes people in their early 30s
with colon and rectal cancer and so if
you are bleeding you need to be
evaluated
usually how that goes if someone comes
to me with rectal bleeding we try some
conservative management right if I can
cure your hemorrhoids with fiber a day
and you come back and say I am no longer
bleeding and I'm 25 we can do a jumping
high five and you can go on your Merry
way but if you if I have not resolved
your bleeding with conservative
intervention right so try the fiber that
didn't help we do a band that didn't
work you you are on your way to
colonoscopy City so I can tell you with
certainty it's just your hemorrhoid
bleeding it is not an uncommon scenario
that people come to the office for what
they believe to be hemorrhoidal bleeding
and the colonoscopy says yes you do have
hemorrhoids and you also have a Cancer
and so that does need to be evaluated
too and um we're really good at working
with people to get get access to those
types of studies so all my colleagues
are very attentive to it you should not
be written off as just hemor bleeding if
we can't make your bleeding stop you
need a colonoscopy yeah and if you're
obviously if you're not in Austin and
you're being dismissed and you're like
something's wrong please find another
provider find some that will listen to
you I can't tell you even me being in
the medical field how many times I've
been kind of gaslit and just like oh
you're fine you're fine I'm like I'm not
you know and it's it's it's important
that we advocate for ourselves yeah no
this is kind of like a half lie right
where I'm me say no one's going to be
offended if you seek another opinion um
they are I feel like that's weird you
know I totally had hurt feelings when
people don't want to see me anymore but
at the same time I'm like a b like well
I mean that's human nature though it's
like it some some not everybody's gonna
get along with you not everyone's gonna
get along with me yes it it hurts but
it's also like obviously there was
something in me or or what they were
wanting was not what I was providing and
but the reality is ultimately they're
getting the care that they want and you
know yes and then the other thing is
screening screening screening coloral
cancer is identified on screening and so
our current guidelines as of 2021 if
you're 45 years old with no symptoms
please go get yourself screened get
yourself screened with a colonoscopy and
you know my obviously my procedur less
bias is that a colonoscopy is the way to
go I think the benefits certainly
outweigh the risks of the procedure
specifically with regards to polyps and
prevention of cancer into the future so
we can remove polyps at the time of
colonoscopy while not all polyps grew up
to become cancers almost all cancers
started out as polyps that's a a that is
different than doing something like a
colig guard or or a poop in the box or a
blood test or things like that that are
sometimes offered as equivalent gradings
yeah that's what I'm going to ask you
because I've heard people say like
there's this pill that you can take and
then they can you explain that the new
form of the poop in a box no isn't there
a pill that they're saying like rep not
replaces colonos was like kind of like
the first step of ping us oh like a pill
cam where you like swallow the camera
and then some poor soul has to look at
hours of video footage of your digestive
tract yeah yeah so pill cams great
definitely a rule for them the challenge
with that is you still have to take a
bowle preparation but you don't get the
MP okay so you have to do and again if
right and if there's something that you
so the next step for any of those tests
being abnormal or equivalent is a
colonoscopy so if you have find yourself
you know holding a positive colig guard
test in your hand you need a colonoscopy
if you got a CT urography right like oh
can I just like lay in the MRI scanner
and you guys like sure but if I see
something abnormal or equivocal you get
a colonoscopy and it can't see small
polyps and removing those can prevent
cancer in the future yeah I think people
think that M sometimes are like the Nel
like I mean there's so many images in
there talk so much about wrecked steel
yeah and it's just it's not the en all
you all no yeah not at all really kind
of just give you some ideas of what's
going on y we talk about
toolkits as like ways to kind of treat
medical problems but these are also
tools with specific functions for
diagnosing problems too
yeah what last question a little off
topic but you you hear more or at least
maybe it's just me but a lot of younger
men like in their third not a lot excuse
me but younger men in their 30s kind of
getting late stage colon cancer what
what do you think so the honest answer
is we don't know why young people are
getting more colon Ral cancer so you can
you can Google it and see a hundred
different hypotheses but the answer is I
don't know and that's why as far as
early onset disease so age less than 50
age less than 45 depending on what
guidelines you're looking at we have to
be listening you have to be listening to
people that come to your office you have
to be listening to your friends and
family you have to be willing to say
like hey bleeding at your bottom is not
normal and UNL and like you you got to
get that looked at it it's worth it's
worth the inconvenience of interacting
with the Medical Group to make sure that
you are healthy and safe we are losing
too many like beautiful young lives who
they have a role in their families in
their workplace in their friend groups
like because someone told you it was a
hemorrhoid because you didn't ever want
to say anything because you thought it
couldn't happen to you and like yeah I
mean what I would rather do negative
colonoscopies all day long and do
jumping high fives with you afterwards
and just be so proud that you saw it
care yeah deal with hemorrhoid stuff
later just make sure it's not anything
serious I I haven't told you this I'm a
cancer survivor myself I did not and so
basically I remember it was in 2019 I
had L those my colar around and end up
being hot chick I'm fine I'm good it's
been four years but the point was that
my first doctor kind of dismissed me and
then I went back again and it was kind
of dismissed and then I went to somebody
else was like I need this biopsy like I
need this biopsy and it was like as soon
as oh in the the initial scan missed it
somehow it was a golf ball size tumor
but my point is that I thought it was
stupid that I was getting it looked at
initially I thought it was dumb I I had
just started my business and I was like
this is a waste of $300 or whatever it
was why am I here yeah and please please
please just do it just get it checked
out and then it's just you know off your
bucket list of things should do and then
you don't have to worry about it because
I mean even just con that low grade fear
of worrying about it can take you know
can take a lot of stress on you too you
know so yeah props you for saving people
saving cancer saving people from cancer
or yeah yeah so any fun things that you
would like to add at the end here like
any stories or any I mean I'm sure what
is like the most common thing people ask
you when you tell them what you do oh
it's it's always what is the strangest
thing you've removed from someone's
rectum a
toothbrush the vibrating
ones oh oh okay okay nothing
else a dog Kong a what a dog Kong like
would you put peanut butter in and give
to your dog it's like shaped like a
pyramid oh I didn't even know that this
were a thing and anal intimacy can be an
important part in relationships but
please use designated toys with handles
or
flanges yeah and lots of blop and lots
of blop yeah the rectum is not
lubricated the way there vagina
in correct yeah yeah handles and blanes
please cool yeah yeah well thank you so
much for coming or I came here
so thank you for having me this is a if
if one person who's having bleeding gets
a colonoscopy because of our chat and if
one person who's been suffering with
what they thought was like Eternal
damnation of hemorrhoids gets it
evaluated pops a band on that sucker and
feels better my job son yeah yeah so
thankful that we were able to chat
you're so F thank you all right yeah you
guys are welcome to reach out to me if
you ever have questions um I'm
on I'm on Twitter you're on Twitter yeah
what's your Twitter handle cutting humor
I'll have to re like open it up but I
would or I can also tag where you're
working too yeah come and see me if
you're in Austin cool all right thank
sweet thank
you
[Music]
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