Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
It's Wellness Wednesday, sponsored by theValley Health System. On this week is
doctor to ten thank'ee with the ValleyHealth System General Surgery Residency Program. Good
morning, Good morning, how areyou. I'm doing good? How are
you? Thank you so much forbeing here. This week's topic is not
every pain in the behind is ahemorrhoid. And I think this is such
an important topic to discuss because Ithink people sometimes just get nervous talking about
(00:24):
certain medical issues. Yes, wegot to make it more common and unfortunately,
due to the passing of some celebritiesout there like Kirsty Alley or Chadwick
Boseman who have passed from colon cancer, these are things we need to discuss
so people can get ahead of someof these conditions. Now, what are
some common conditions that can cause painin the anal or rectal area aside from
(00:46):
hemorrhoids. That's a great question.So hemorrhoids are definitely the most common one
that we see even in the colorectalclinic. On top of that, the
next thing would probably be anal fissures, and then after that peri anal or
perirectal absence and fistulas, and thenprobably The last thing that I see,
especially here in Vegas in the warmermonths, is something called proitis ani,
(01:07):
which actually basically is a fancy wordfor anal itching, but as it progresses
it can actually become painful, causingbreaks in the skin and even sometimes bleeding.
Okay, now, how can somebodytell the difference between hemorrhoid related pain
and other types of anal rectal painlike you mentioned? So sometimes it may
be tough, just you know,going off of what kind of pain you're
(01:27):
feeling. But you know, hemorrhoidsare usually going to be a more chronic
issue unless it's a thrombost hemorrhoid.So hemorrhoids, you know, are these
veins around the anal canal which getsswollen when you are straining, when you
are bearing down, sitting on thetoilet for a long time, and you
know, constipation, heavy weight lifting. These are things that can aggravate them.
(01:49):
So with hemorrhoids, you may feelswelling, you may feel things popping
out of the rectum while you're havinga bowel movement, but most commonly with
hemorrhoids, any discomfort that you're havingis during bowel movements and shortly afterward gets
a bit better. If it's athrom boast hemorrhoid, that's when a blood
clot forms in one of those veinsand it causes acute swelling. So you
may find that you have an episodewhere you strain or you pick up something
(02:09):
heavy and the right afterward you feelthe sharp pain and swelling in the anal
area, and that could be athrom boast hemorhoid. Okay, I know
when I was pregnant, I rememberthat a lot of people said, Oh,
you're pregnant, and you're you know, far down the line, you're
going to experience hemorrhoids. Now,there are some other conditions that can occur
where you know, then hemorrhoids canhappen because of what you're going through.
(02:30):
Is that correct? Yes, absolutelyso. Pregnancy is a very common one.
A lot of women experience hemorrhoids orsymptomatic hemorrhoids during pregnancy, which tend
to get better after they deliver,and that's from pressure on the blood vessels
in the abdomen from the fetus.However, obesity liver disorders can also cause
(02:51):
hemorrhoidal swelling and symptoms. So it'snot just you know, you know,
straining or something like that. Itcan be many things. It can lead
to exacerbations of hemorrhoidal symptoms. Okay, now, what are those symptoms of
anal fissures and how do they differfrom hemorrhoid symptoms. I know I've heard
you say the term just a littlebit ago, but kind of talk us
through those symptoms. Yeah, thegreat question again. So, fissures are
(03:14):
typically associated with a sharp, almostburning kind of pain, usually just during
or right after a bowel movement.Now, fissures have an interesting sort of
etiology or pathogenesis where everyone gets tearsin the anal lining. Right, you
have a hard bowel movement, orwipe too hard, or any of these
things can cause a tear in theanal skin. Those normally heal. Sometimes
(03:38):
they don't heal. Now, ifan anal tear doesn't heal, it leads
to a fissure. That's because there'schronic inflammation. The skin edges over there
become chronically inflamed. They can't healproperly. You get abnormal tissue forming at
the base of the fissure, andthat's what leads to what we call a
fissure, as opposed to just atear. Okay. Most of the time,
fissures still will get better on theirown. However, if they don't,
(04:00):
that's when medical intervention becomes necessary.Okay. Things that will keep them
from healing are constipation again, havinghard bowel movements that are passing over them.
Now. Sometimes things that people areafraid to talk about but they can
lead to fissures would be sexually transmittedinfections, so things like chlamydia, ganorrhea,
herpies, any of those could leadto a fissure. HIV infection is
(04:23):
another thing you have to be carefulof causing fissures. And then you know
the stuff that we all worry aboutthe most is cancers, so anal cancer,
rectal cancer, and then autoimmune disorderslike Crone's disease can also lead to
anal fissures. Okay. Fortunately formost people with fissures, they are self
limited. They get better on theirown. If they don't, we can
(04:44):
give you topical creams to help withthem. We can give botox injections if
topical creams don't work. Wow,But the mainstay of treating them really is
just bulking up and softening your stoolwith fiber, making sure you drink lots
of water and keeping those bowel movementssoft and easy pass right. It's good
to keep top of mind how muchyour diet can affect everything going on in
(05:05):
your body. Now, let's diveinto a little bit more about anal obsesses
and fistulas and how they can causesimilar discomfort towards like just like hemorrhoids can,
but those distinctive signs between the two, so people can really recognize the
difference. Yeah, great question.So, perianal abscesses and chronically fistulas will
(05:27):
typically occur as an acute episode whereyou start to notice pain and swelling around
the anus that worsens. It doesn'tjust stay the same, it doesn't get
better. And then as it progresses, you notice the swelling is increasing increasing,
and then it may even rupture spontaneouslyand start oozing. You may have
bleeding, you may have pus strainingout of there. And these patients can
(05:49):
also develop fevers, you know,just feelings of malaise overall, feeling ill
and under the weather. Okay,and that's just from the infection that's going
on there. Now again, youknow, with an abscess, it can
chronically if it persists right and leaveswhat we call a fistula behind it can
keep coming back, so people maycome in and complain. You know,
(06:11):
I had to boil around my ans. It drained and seem to get better,
and then three months later, sixmonths later again, the same thing
happened in the same spot. Andwhat's happened there is that abscess has turned
into a fistula, which means there'sa persistent connection from where the abscess started
on the inside of the rectum andthe skin on the outside, and that
connection seals over, allows fluid tobuild up, forms an abscess again,
(06:34):
and then it drains. Fistulas whenthey're in that state then end up requiring
surgical intervention. An absess may justneed to be drained and it goes away,
but if it does lead to afistula, which can happen thirty percent
of the time, then we definitelyhave to go towards surgery. Okay,
And I think this is probably avery common theme with lots of medical issues.
The earlier you go in when youkind of have that first sign of
(06:57):
something that doesn't feel right, thebetter chances are that you're going to prevent
something worse happening down the line.So It's a little tough to say with
abscesses leading to fistulas and what stageyou have to intervene to stop it from
leading to a fistula, or ifthere is really any temporal relationship there.
But we do know that, youknow, looking at all patients who come
in with perianal abscesses, about thirtypercent will lead to fistila's long term.
(07:20):
Okay, good to know. Now, I feel like more and more people
are starting to talk about pelvic floorhealth. Now, can pelvic floor issues
contribute to anal or rectal pain?And what are those indicators of that specific
condition? Yes? So, peblicfloor dysfunction is a huge topic that we
could probably spend an entire day talkingabout. But to kind of briefly summarize
(07:43):
and talk about the two things Isee most commonly in the office right.
One is something called levator Ani syndrome, which is where the muscles that hold
up your pelvic floor that run basicallyfrom your pubic bone in the front to
your tailbone in the back, aretight. And that's elevator Ani syndrome that
causes pain. But it's a dullkind of crampy pain. It may or
(08:05):
may not be related to when you'rehaving bowel movements. Sometimes it can be
postural, It can be exacerbated byanxiety, It can be exacerbated by cold
by activity. People with that mayfind that even just warm compresses can help.
It may also they may also findthat helping treating their hemorrhoids can help
treat the elevator ani syndrome. Sosome of the same things making sure your
(08:26):
stool is soft, making sure you'renot straining can help. But oftentimes these
patients require public floor physical therapy tohelp train those muscles to relax, okay,
because it's actually a problem with thosemuscles just being too tight. Sure.
The other thing that we see alot of is peblc floor diysinergia,
also known as anismus, which iswhere normally, when you go to have
(08:46):
a bowel movement, your public floormuscles relax or to let the stool out
right, so you press on yourbelly right with your ab muscles, your
pelc floor relaxes and the stool comesout through your anus. And people with
public floor distinergi or that relaxation neverhappens, so they're pushing and straining against
a closed door basically, so youkeep pushing the door that lets it out
(09:07):
through the pelvic outlet doesn't open andthe stool gets stuck in there. Those
patients actually may come to me complainingof hemorrhoids or a fissure, and no
matter what they do to try andtreat the hemorrhoids, right they might be
taking stool softeners, they've increase theirfiber intake, they're drinking lots of water
their stool when it does come outas soft, but they're still just having
to strain because that door just isn'topening, and that also ultimately may require
(09:31):
public floor physical therapy. The firstthing that we do is start them on
fiber supplementation just to try and stimulatesome of the normal reflexes that happen in
the pelvis and allow for relaxation there. But if that doesn't work, then
pelvic floor physical therapy or even potentiallybotox injection would be treatment outcome or treatments
that you use next. And thenafter that we start talking about surgery if
(09:54):
they really really don't respond. SoI'm curious to know with issues in the
anal erectal area, how much ofthat is associated with genetics. That's a
great question. We really don't havegood statistics to say what genetic component there
is to these things, but wedo know that public floor issues do tend
to be increased in patients who haveanxiety, women who've had a history of
(10:18):
sexual abuse or sexual assault or rape, and it probably has to do with
certain psychological factors. We don't knowwhat is happening exactly, but we do
know that there is some sort ofpsychosomatic component where the brain is somehow not
controlling peblic floor muscles the way itshould because of some sort of experience previously
in life. Sure. Interesting,Now, what are those diagnostic methods that
(10:43):
are being used by healthcare professionals toidentify the underlining cause of anal and rectal
pain? So the great thing isthat most of these conditions can be diagnosed
on physical exam. So if youcome in and I do an exam,
we can see if there's a fissure, we can see if they're hemorrhoids.
We can even tell to some degreeis there anisthmus or public floor distinergia just
(11:05):
on exam. Okay, now youknow fissures and hemorrhoids. Obviously, we
can then treat pretty easily the bigthing you're going to see with all public
floor issues or hemorrhoids, anything isstool softening with fiber, supplementation, drinking
water, not straining. That's kindof the month I go through with all
my patients all day, every day. Make sure you're on fiber, make
sure you're on water, make sureyou're not straining. Spend less than ten
(11:28):
minutes on the toilet. That cantreat so much of all of these conditions.
Wow, And then you know,if it's not hemorrhoids, it's not
a fissure or something obvious like that. Right, then you know, maybe
it's an abscess. Right, anabscess you can sort of see. You
treat it again based on what youfind on exam. If there's a fistula
like we talked about, where thatabscess has remained persistently, you know,
(11:48):
from the anus or from the rectumto the skin, we may get some
imaging to explore it, or wemay just say, you know, we
know it's here, we know itneeds to be fixed. We can take
you to the operating room and fixit there. We don't need to do
it any more diagnostic workup depending onwhat we see on exam. And then
the pelvic floor dysfunctions become a littlebit more complicated. That's where we end
up talking about doing MRIs or depicography, which is an exam that actually looks
(12:13):
at the movement in real time ofthe pelvic floor muscles while someone is trying
to defecate. Okay, so thatbecomes a little bit more advanced. But
still, you know, for patients, it's not a terrible experience of having
to go through these diagnostic tests.Okay. I like those reminders that you
said that you tell patients constantly.Again, that's it's your fiber intake,
the amount of water that you drink, Notice the amount of time that you're
(12:35):
spending in the bathroom. I mean, good stuff, just to kind of
keep top of mind. Again,I think this is a topic that a
lot of people just are nervous justto you know, even just say out
loud if they're experiencing pain in certainareas of their body. People just get
nervous. Is there anything that youjust want to remind people about things they
need to just always kind of justbe on the lookout, just to get
(12:56):
ahead of potential issues down the line. I think the big thing, like
you said, is just sort ofkeep ahead of your bowel habits, make
sure that they are you know,in good order and that you're not having
any issues with straining or anything.That is the greatest preventive strategy you can
use for hemorrhoids, fissures, anything, as well as the treatment, which
(13:16):
is what's so great about it,right, We can treat these and prevent
them pretty easily. Now, thething that people need to always be in
keep in mind is that what youmay think is a hemorrhoid may not always
be a hemorrhoid. And that's wherewe come into sort of the scarier topics
right, things like cancer or IBDsuch as crones. So, anal cancer
(13:39):
is something that is increasing in incidentsin the United States. Some of that
has to do with you know,HPV becoming more and more prevalent. Anal
cancer is caused by human papyllamavirus,the same virus that can cause anal warts.
So make sure you get your gardosel vaccine everyone, and you know,
so, anal cancer is something toalways be on the lookout for.
Rectal cancer. Also, make surethat you're getting your colonoscopies. A low
(14:01):
rectal cancer can look like an analcancer as well. It can invade into
the anal canal cause you know,a mass that you can feel or see
or cause bleeding right there. Sure, So if you are having bleeding,
you know, definitely follow all ofthe things we talked about that you can
do to treat it yourself, butgo get it checked out just to make
sure if you feel a mass that'sthere, same thing, you know,
(14:22):
do what you can at home,but get it checked out just to be
on the safe side. Absolutely,and then keep on top of your screening
with colonoscopies. Recently, because ofthe increase in young people getting colon cancer,
we've shifted our screening age start fromfifty to forty five. So now
everyone should be getting their first colonoscopyat forty five, okay, and then
either ten years if it's normal,or you know, five years if they
(14:43):
see abnormalities or your high risk rightyou have a family history of colon cancer
or whatever your doctor tells you basedon what they find on the colonoscopy.
After that, awesome, Well,thank you so much, doctor, thankye,
that was really great information. Iappreciate your time today. Thank you
so much for having me. You'revery welcome,
It's Wellness Wednesday, sponsored by theValley Health System. On this week is
doctor to ten thank'ee with the ValleyHealth System General Surgery Residency Program. Good
morning, Good morning, how areyou. I'm doing good? How are
you? Thank you so much forbeing here. This week's topic is not
every pain in the behind is ahemorrhoid. And I think this is such
an important topic to discuss because Ithink people sometimes just get nervous talking about
(00:24):
certain medical issues. Yes, wegot to make it more common and unfortunately,
due to the passing of some celebritiesout there like Kirsty Alley or Chadwick
Boseman who have passed from colon cancer, these are things we need to discuss
so people can get ahead of someof these conditions. Now, what are
some common conditions that can cause painin the anal or rectal area aside from
(00:46):
hemorrhoids. That's a great question.So hemorrhoids are definitely the most common one
that we see even in the colorectalclinic. On top of that, the
next thing would probably be anal fissures, and then after that peri anal or
perirectal absence and fistulas, and thenprobably The last thing that I see,
especially here in Vegas in the warmermonths, is something called proitis ani,
(01:07):
which actually basically is a fancy wordfor anal itching, but as it progresses
it can actually become painful, causingbreaks in the skin and even sometimes bleeding.
Okay, now, how can somebodytell the difference between hemorrhoid related pain
and other types of anal rectal painlike you mentioned? So sometimes it may
be tough, just you know,going off of what kind of pain you're
(01:27):
feeling. But you know, hemorrhoidsare usually going to be a more chronic
issue unless it's a thrombost hemorrhoid.So hemorrhoids, you know, are these
veins around the anal canal which getsswollen when you are straining, when you
are bearing down, sitting on thetoilet for a long time, and you
know, constipation, heavy weight lifting. These are things that can aggravate them.
(01:49):
So with hemorrhoids, you may feelswelling, you may feel things popping
out of the rectum while you're havinga bowel movement, but most commonly with
hemorrhoids, any discomfort that you're havingis during bowel movements and shortly afterward gets
a bit better. If it's athrom boast hemorrhoid, that's when a blood
clot forms in one of those veinsand it causes acute swelling. So you
may find that you have an episodewhere you strain or you pick up something
(02:09):
heavy and the right afterward you feelthe sharp pain and swelling in the anal
area, and that could be athrom boast hemorhoid. Okay, I know
when I was pregnant, I rememberthat a lot of people said, Oh,
you're pregnant, and you're you know, far down the line, you're
going to experience hemorrhoids. Now,there are some other conditions that can occur
where you know, then hemorrhoids canhappen because of what you're going through.
(02:30):
Is that correct? Yes, absolutelyso. Pregnancy is a very common one.
A lot of women experience hemorrhoids orsymptomatic hemorrhoids during pregnancy, which tend
to get better after they deliver,and that's from pressure on the blood vessels
in the abdomen from the fetus.However, obesity liver disorders can also cause
(02:51):
hemorrhoidal swelling and symptoms. So it'snot just you know, you know,
straining or something like that. Itcan be many things. It can lead
to exacerbations of hemorrhoidal symptoms. Okay, now, what are those symptoms of
anal fissures and how do they differfrom hemorrhoid symptoms. I know I've heard
you say the term just a littlebit ago, but kind of talk us
through those symptoms. Yeah, thegreat question again. So, fissures are
(03:14):
typically associated with a sharp, almostburning kind of pain, usually just during
or right after a bowel movement.Now, fissures have an interesting sort of
etiology or pathogenesis where everyone gets tearsin the anal lining. Right, you
have a hard bowel movement, orwipe too hard, or any of these
things can cause a tear in theanal skin. Those normally heal. Sometimes
(03:38):
they don't heal. Now, ifan anal tear doesn't heal, it leads
to a fissure. That's because there'schronic inflammation. The skin edges over there
become chronically inflamed. They can't healproperly. You get abnormal tissue forming at
the base of the fissure, andthat's what leads to what we call a
fissure, as opposed to just atear. Okay. Most of the time,
fissures still will get better on theirown. However, if they don't,
(04:00):
that's when medical intervention becomes necessary.Okay. Things that will keep them
from healing are constipation again, havinghard bowel movements that are passing over them.
Now. Sometimes things that people areafraid to talk about but they can
lead to fissures would be sexually transmittedinfections, so things like chlamydia, ganorrhea,
herpies, any of those could leadto a fissure. HIV infection is
(04:23):
another thing you have to be carefulof causing fissures. And then you know
the stuff that we all worry aboutthe most is cancers, so anal cancer,
rectal cancer, and then autoimmune disorderslike Crone's disease can also lead to
anal fissures. Okay. Fortunately formost people with fissures, they are self
limited. They get better on theirown. If they don't, we can
(04:44):
give you topical creams to help withthem. We can give botox injections if
topical creams don't work. Wow,But the mainstay of treating them really is
just bulking up and softening your stoolwith fiber, making sure you drink lots
of water and keeping those bowel movementssoft and easy pass right. It's good
to keep top of mind how muchyour diet can affect everything going on in
(05:05):
your body. Now, let's diveinto a little bit more about anal obsesses
and fistulas and how they can causesimilar discomfort towards like just like hemorrhoids can,
but those distinctive signs between the two, so people can really recognize the
difference. Yeah, great question.So, perianal abscesses and chronically fistulas will
(05:27):
typically occur as an acute episode whereyou start to notice pain and swelling around
the anus that worsens. It doesn'tjust stay the same, it doesn't get
better. And then as it progresses, you notice the swelling is increasing increasing,
and then it may even rupture spontaneouslyand start oozing. You may have
bleeding, you may have pus strainingout of there. And these patients can
(05:49):
also develop fevers, you know,just feelings of malaise overall, feeling ill
and under the weather. Okay,and that's just from the infection that's going
on there. Now again, youknow, with an abscess, it can
chronically if it persists right and leaveswhat we call a fistula behind it can
keep coming back, so people maycome in and complain. You know,
(06:11):
I had to boil around my ans. It drained and seem to get better,
and then three months later, sixmonths later again, the same thing
happened in the same spot. Andwhat's happened there is that abscess has turned
into a fistula, which means there'sa persistent connection from where the abscess started
on the inside of the rectum andthe skin on the outside, and that
connection seals over, allows fluid tobuild up, forms an abscess again,
(06:34):
and then it drains. Fistulas whenthey're in that state then end up requiring
surgical intervention. An absess may justneed to be drained and it goes away,
but if it does lead to afistula, which can happen thirty percent
of the time, then we definitelyhave to go towards surgery. Okay,
And I think this is probably avery common theme with lots of medical issues.
The earlier you go in when youkind of have that first sign of
(06:57):
something that doesn't feel right, thebetter chances are that you're going to prevent
something worse happening down the line.So It's a little tough to say with
abscesses leading to fistulas and what stageyou have to intervene to stop it from
leading to a fistula, or ifthere is really any temporal relationship there.
But we do know that, youknow, looking at all patients who come
in with perianal abscesses, about thirtypercent will lead to fistila's long term.
(07:20):
Okay, good to know. Now, I feel like more and more people
are starting to talk about pelvic floorhealth. Now, can pelvic floor issues
contribute to anal or rectal pain?And what are those indicators of that specific
condition? Yes? So, peblicfloor dysfunction is a huge topic that we
could probably spend an entire day talkingabout. But to kind of briefly summarize
(07:43):
and talk about the two things Isee most commonly in the office right.
One is something called levator Ani syndrome, which is where the muscles that hold
up your pelvic floor that run basicallyfrom your pubic bone in the front to
your tailbone in the back, aretight. And that's elevator Ani syndrome that
causes pain. But it's a dullkind of crampy pain. It may or
(08:05):
may not be related to when you'rehaving bowel movements. Sometimes it can be
postural, It can be exacerbated byanxiety, It can be exacerbated by cold
by activity. People with that mayfind that even just warm compresses can help.
It may also they may also findthat helping treating their hemorrhoids can help
treat the elevator ani syndrome. Sosome of the same things making sure your
(08:26):
stool is soft, making sure you'renot straining can help. But oftentimes these
patients require public floor physical therapy tohelp train those muscles to relax, okay,
because it's actually a problem with thosemuscles just being too tight. Sure.
The other thing that we see alot of is peblc floor diysinergia,
also known as anismus, which iswhere normally, when you go to have
(08:46):
a bowel movement, your public floormuscles relax or to let the stool out
right, so you press on yourbelly right with your ab muscles, your
pelc floor relaxes and the stool comesout through your anus. And people with
public floor distinergi or that relaxation neverhappens, so they're pushing and straining against
a closed door basically, so youkeep pushing the door that lets it out
(09:07):
through the pelvic outlet doesn't open andthe stool gets stuck in there. Those
patients actually may come to me complainingof hemorrhoids or a fissure, and no
matter what they do to try andtreat the hemorrhoids, right they might be
taking stool softeners, they've increase theirfiber intake, they're drinking lots of water
their stool when it does come outas soft, but they're still just having
to strain because that door just isn'topening, and that also ultimately may require
(09:31):
public floor physical therapy. The firstthing that we do is start them on
fiber supplementation just to try and stimulatesome of the normal reflexes that happen in
the pelvis and allow for relaxation there. But if that doesn't work, then
pelvic floor physical therapy or even potentiallybotox injection would be treatment outcome or treatments
that you use next. And thenafter that we start talking about surgery if
(09:54):
they really really don't respond. SoI'm curious to know with issues in the
anal erectal area, how much ofthat is associated with genetics. That's a
great question. We really don't havegood statistics to say what genetic component there
is to these things, but wedo know that public floor issues do tend
to be increased in patients who haveanxiety, women who've had a history of
(10:18):
sexual abuse or sexual assault or rape, and it probably has to do with
certain psychological factors. We don't knowwhat is happening exactly, but we do
know that there is some sort ofpsychosomatic component where the brain is somehow not
controlling peblic floor muscles the way itshould because of some sort of experience previously
in life. Sure. Interesting,Now, what are those diagnostic methods that
(10:43):
are being used by healthcare professionals toidentify the underlining cause of anal and rectal
pain? So the great thing isthat most of these conditions can be diagnosed
on physical exam. So if youcome in and I do an exam,
we can see if there's a fissure, we can see if they're hemorrhoids.
We can even tell to some degreeis there anisthmus or public floor distinergia just
(11:05):
on exam. Okay, now youknow fissures and hemorrhoids. Obviously, we
can then treat pretty easily the bigthing you're going to see with all public
floor issues or hemorrhoids, anything isstool softening with fiber, supplementation, drinking
water, not straining. That's kindof the month I go through with all
my patients all day, every day. Make sure you're on fiber, make
sure you're on water, make sureyou're not straining. Spend less than ten
(11:28):
minutes on the toilet. That cantreat so much of all of these conditions.
Wow, And then you know,if it's not hemorrhoids, it's not
a fissure or something obvious like that. Right, then you know, maybe
it's an abscess. Right, anabscess you can sort of see. You
treat it again based on what youfind on exam. If there's a fistula
like we talked about, where thatabscess has remained persistently, you know,
(11:48):
from the anus or from the rectumto the skin, we may get some
imaging to explore it, or wemay just say, you know, we
know it's here, we know itneeds to be fixed. We can take
you to the operating room and fixit there. We don't need to do
it any more diagnostic workup depending onwhat we see on exam. And then
the pelvic floor dysfunctions become a littlebit more complicated. That's where we end
up talking about doing MRIs or depicography, which is an exam that actually looks
(12:13):
at the movement in real time ofthe pelvic floor muscles while someone is trying
to defecate. Okay, so thatbecomes a little bit more advanced. But
still, you know, for patients, it's not a terrible experience of having
to go through these diagnostic tests.Okay. I like those reminders that you
said that you tell patients constantly.Again, that's it's your fiber intake,
the amount of water that you drink, Notice the amount of time that you're
(12:35):
spending in the bathroom. I mean, good stuff, just to kind of
keep top of mind. Again,I think this is a topic that a
lot of people just are nervous justto you know, even just say out
loud if they're experiencing pain in certainareas of their body. People just get
nervous. Is there anything that youjust want to remind people about things they
need to just always kind of justbe on the lookout, just to get
(12:56):
ahead of potential issues down the line. I think the big thing, like
you said, is just sort ofkeep ahead of your bowel habits, make
sure that they are you know,in good order and that you're not having
any issues with straining or anything.That is the greatest preventive strategy you can
use for hemorrhoids, fissures, anything, as well as the treatment, which
(13:16):
is what's so great about it,right, We can treat these and prevent
them pretty easily. Now, thething that people need to always be in
keep in mind is that what youmay think is a hemorrhoid may not always
be a hemorrhoid. And that's wherewe come into sort of the scarier topics
right, things like cancer or IBDsuch as crones. So, anal cancer
(13:39):
is something that is increasing in incidentsin the United States. Some of that
has to do with you know,HPV becoming more and more prevalent. Anal
cancer is caused by human papyllamavirus,the same virus that can cause anal warts.
So make sure you get your gardosel vaccine everyone, and you know,
so, anal cancer is something toalways be on the lookout for.
Rectal cancer. Also, make surethat you're getting your colonoscopies. A low
(14:01):
rectal cancer can look like an analcancer as well. It can invade into
the anal canal cause you know,a mass that you can feel or see
or cause bleeding right there. Sure, So if you are having bleeding,
you know, definitely follow all ofthe things we talked about that you can
do to treat it yourself, butgo get it checked out just to make
sure if you feel a mass that'sthere, same thing, you know,
(14:22):
do what you can at home,but get it checked out just to be
on the safe side. Absolutely,and then keep on top of your screening
with colonoscopies. Recently, because ofthe increase in young people getting colon cancer,
we've shifted our screening age start fromfifty to forty five. So now
everyone should be getting their first colonoscopyat forty five, okay, and then
either ten years if it's normal,or you know, five years if they
(14:43):
see abnormalities or your high risk rightyou have a family history of colon cancer
or whatever your doctor tells you basedon what they find on the colonoscopy.
After that, awesome, Well,thank you so much, doctor, thankye,
that was really great information. Iappreciate your time today. Thank you
so much for having me. You'revery welcome,
Popular Podcasts
Bookmarked by Reese's Book Club
Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!