Show Notes
Hello Gut Check project fans and KBMD Health family. I hope you're having a great day. It's your host Eric Rieger soon to be joined by my awesome co host, Dr. Kenneth Brown. It's time for Episode Number 53 and this is a really informative episode about what causes Hemorrhoids and believe it or not, would you maybe listening to this podcast on could be making your hemorrhoids worse? That's right The phone anyhow, how is this possible? We'll just check out Episode 53 it's it's very light but really informative and without wasting any more time let's get to our sponsors. And as always, I'll try until formulated by my partner Dr. Ken otter ideal chock full of polyphenols go to love my tummy calm doesn't matter if you're an athlete trying to protect your gut health. If you just want to protect your body from systemic inflammation, trying to daily go to love my tummy calm that's love my tummy, calm slash, KB MD get your polyphenols today, and of course unrefined bakery, great food, regardless of your specialty diet. If you need to be paleo or keto or certainly gluten free, head to unrefined bakery.com use code, gut check and save 20% off your first order. This is just great food, great groceries delivered to your door unrefined bakery.com use code gut check and save 20% off your first order. And last but not least, go to KB Md health.com. And you can peruse the three signature products that Dr. Brown endorses his own CBD as well as Brocelite chock full of severe things and of course auto deal. So go to KB Md health.com. Use code GCP and save 20% off of any order anytime. Alright, let's get to it. Episode Number 53 what is causing my hemorrhoids every day?
Hello Gut Check project fans and KBMD health family How are you doing? I'm Eric Rieger flanked here by my awesome co host, Dr. Kenneth Brown. It's Episode 53 What's up, man? That's
awesome. It's Episode 53. And you rarely refer to me as awesome. That's why I'm gonna use it three times in the same sentence. That's an awesome sentence. Usually it's I'm I'm here with my adequate co host, Dr. Ken Brown.
Yeah, I've never said that. And y'all will never use awesome again. That's probably not even true. So what's what's shakin here for Episode 53.
And this is exciting because Episode 53 it's gonna be all about hemorrhoids, hemorrhoids, hemorrhoids and Roy Roy. Yeah, this all came about because I was treating a patient in their mid 20s. And that person asked if it was unusual for me to be treating a person that was they felt that this was an older person's disease. And I said no, actually, I treat a lot of people in their 20s. And I started thinking about it. And I went, you know, I do treat a lot. And that person said, Why is that? And what I have not paused to think about and he goes you should do a show on it. Yeah, and I went absolutely. And as suggested we're doing a show on hemorrhoids. So I am declaring today officially national hemorrhoid Awareness Day. That's very
ambitious. I actually you're not you're not gonna believe me, but I actually believe that there is a hemorrhoid day. And there's actually a hemorrhoid month the hemorrhoid days October 19. And hemorrhoid month is November and I don't want to take it away from you. Maybe this could be hemorrhoid
30 minutes. Yes, yes. We all know this. Everyone knows that October 19. Everyone knows and it's also national clean your virtual desktop days national Kentucky day. National seafood bisque day 10 National LGBT Center Awareness Day. hemorrhoids gets buried under all that so I'm pulling hemorrhoids out and declaring today national hemorrhoid day.
So we're shining the light on him right. I'm changing. Everyone likes to have their hemorrhoids eliminated. Oh,
I emailed the national hemorrhoid committee and found out there is not one I made myself president. And by doing so. I voted. I was I filled a quorum and I was able to change it this morning. Today's national hemorrhoid day quit arguing with me. So I'm done. And I'll just go ahead and move on to I like the fact that you use the word quorum and they were using the words hemorrhoid because both of those are kind of hard to spell. Once you give me you were telling me you were second runner up in the deck. cater local spelling bee in 1978 was it
yeah much like your impromptu declared hemorrhoid national day I was the only one who showed up and I still came in second.
Alright, so before we jump into hemorrhoids man what's going on with your life? What's going on with the Rieger household?
We are preparing to actually follow your footsteps we are about to renovate the house and sweeping changes about to move everything out today to the house the one that we just moved into so we're going to really just
is upgraded did you do the renovations? Like we did? Did you flood the house first? No choose to renovate it. We
tried to order a freeze and it didn't quite work out. But now in about a week and a half we get started should take about a month. I don't think it's nearly as extensive as what you're doing. But yeah, we'll update some stuff. Mack is back in the throes of offseason basketball. Murray's got her new company up and going gage is back out finishing up his first full year in college. So you know, they're doing well. How
about you? That's awesome. Oh, the brown households doing well. Lots of tennis going on. I think Lucas is playing on that ITF circuit and both Carl and Lucas have tournaments this weekend. So that's, that's cool. love to see everybody healthy out there able to do that kind of thing. You know, suffering through a little bit of a small neck injury that I now i i appreciate when you can get out there and play the sports that you want to play and have fun the way you want to have fun. So
definitely check that what episode was was Wade McKenna,
who early on very early. Yeah, that was back in the original students how we even did this that was back in the spoony studio.
So his episode was specifically on stem cells from his perspective. He's one of the world's leading experts.
You throw a little y'all bro. Yeah, I'll throw a little information out there. Right. So I injured my neck. And which is a really, really common injury and there's typical traditional medicine that people do. And one of our read one of our guests maybe guest number five or six
Wade McKenna,
he's Dr. Wade McKenna happens to be a world expert on stem cell. So I texted him and said, Get an act thing going on. I want to I don't want to play around with this. I went and made an appointment with him. Super cool guy. Super cool staff absolutely phenomenal out at trophy club. He spent a long time with me. And we went through everything and I'm going to do stem cells. We're gonna see what happens. I hear Joe Rogan talk about stem cells all the time. Yeah. And honestly, there's varying differences with how people respond to it. But if you're gonna do it, you go with the person who's been doing it the longest that does the most the person that that Rogan had on to talk about it was who Wade used to open up his Panama clinic with Neil Riordan. Yeah. Neil Riordan.
I'm pretty excited. And we won't spend too much time because this is about hemorrhoids. However, I think it's really cool on that episode, if you go back and check it, you'll learn that lots of stem cell failure is due to people not knowing how to even even the physicians themselves may not be using the best technique for sure there's there's
handling of stem cells doing things but he did on our podcast, he explained how he did research as a residence. He has been doing this autologous bone marrow use with stem cells, which nobody, which people are now just scratching the surface. He's been doing it for a long time and even had the Panama clinic where because the laws were a little bit more relaxed, and he could do some things that he had been doing research on. So I'm excited. So I'll keep everybody updated to what happens because if it if it goes well, and I imagine it really well, I'll be really excited that I can if I look 20 years younger, not that I took 10 bottles of Toronto at one time for the anti aging polyphenols. It's because those stem cells are kicking in but you know, we'll see. All right. This is kind of cool. I didn't even realize this. This threw me off. I'm really excited. Also, on episode 35, we interviewed ron paul Bundy. Oh yeah. Yep. generosity, generosity fee. So Eric and I, my family's out of town. Eric brought his family we went and we participated in one of generosity feeds, making campaigns or what is it? Yeah, we
did the food baking campaign where we packed all of the lunches for over I think that one was 11,000 meals that we did for kids who essentially just don't have a means to eat during the weekends. Yeah,
it's it's absolutely shocking. So what Ron on that on that episode explained, is that how many children rely on the school system to get the only meals that they get right? Even in like what you would consider affluent areas, there's going to be people that still need the assistance. And so what they do is they have teamed up with a nutritionist and stuff that devised a very, I guess you would call it healthy, nutrient rich meal. Definitely that is sustainable. And so what we did is we packed rice and beans and seasoning and everything's all they got to do is you just give it to the child when they walk out the door, right and then they get there. We're able to eat over the weekend until the school is able to do it. I think it's a phenomenal thing and the fact that they're in so demand so anyways, it's been a year dude. And party on purpose is up again and we're gonna be sponsors again. So last year we helped sponsor What what? what Tim power setup with Austin down and yeah, it was a year ago. We were just
wondering that pandemic stuff. That's
what we were doing the pandemic, everybody was like this weird thing that's happening what's going on? Yeah, it was one year ago. So we're going to be sponsors, again, a party on purpose. And I would like everybody to take a look at Episode 35. And just see the special work that generosity feeds is doing and robbing Ron club Andy and his passion for it is really amazing. helps a lot of kids who just don't just don't have a voice, and it's pretty awesome. Yeah, so we've had some really sciency shows recently, a couple maybe a little too sciency. And, you know, I'm feeling like we're not doing good justice to the other arts. I went to a liberal arts college. Did you know that?
I did know that. Yeah.
My mom taught there and I went there. Good. Old Danna college that no longer exists.
So you're not going to the reunion. So what what is it about that and it reminded you of your college?
Well, I was gonna jump into the science of hemorrhoids. Oh, it's really cool stuff. And I thought, Wait a minute. No, let's, let's bring in some other arts into this. Let's be a full spectrum podcast.
Okay. I'm excited.
I'd like to kick some history. Okay.
Let's find out.
Yeah, let's kick some history. So I was sitting there preparing for this. And I'm, specifically I want to talk about the history of the toilet.
Ooh, yeah. Okay.
I mean, we take it for granted. It's something that in other people's worlds, my favorite thing is when patients come to me and they're like, I don't want to talk about this. But no matter what they're gonna say, I'm like, I talk about this all the time. Yeah. No, you can't say anything, but I'm not gonna go. Oh, yeah. So specifically the toilet and quick trivia quiz. Okay, first documentation of a toilet. Do you have any idea of when it actually took place? When when we when historians believe that there may have been the beginnings of writing about a particular thing that could have been a toilet? I'm just going to guess because of irrigation? Maybe in Rome? I don't know. That was interesting. 3000 bc and Scotland?
No kidding.
Yeah, that's what they that's what archaeologists believe was the first plausible thing that is a toilet, but it wasn't written about and you're exactly right. You're exactly right on this, but they think that the true record didn't start taking place until 315. Ad by the Romans. Okay.
Make sense?
Yeah. And this is kind of fun. Okay, because it's gonna play into what we're going to talk about later. All right. But the toilets at that time, were actually public toilets. And they were situated like in a square next to each other. And it was considered a social event to go poop. Oh, with the community.
So could that be considered the first buches?
They sell beaver nuggets?
Oh, my gosh, that explains so much. Because I was looking at these archeological digs. And there was these little carvings of like this little beaver with a hat. And I'm like, Yeah, yeah, the Romans actually started the first buches. But anyways, so they build these, these toilets in public locations where people would gather, and they would socially poop next to each other, right? Men and women, just just kind of part of it. And then there would be a stick attached to your toilet with a sponge on the end with which you would clean yourself.
Hopefully, you're
the first No, yeah, well, hopefully you are. But you're never the first because once it's there, it stays. And then you dip it in water and shake it off. And some historians believe that that is the origin of I'm not making this up of getting the wrong end of the stick. Wow. Well, trivia for you.
Yeah, I never knew what was the right end of the stick was thrown out. That's a really good point.
So if you're a private pooper, and Tim poop in public, remember that Romans would rather be like, Hey, I'm having a dinner party and a pooping party. So let's all eat and then we will go gather in the pooping room together and use the sponge that we've others have used 1000s of times,
the Romans had a lot of ideas, wrestling
things so thank goodness, during the medieval times, people became way more dignified, I mean, way more dignified. Sure. So they started pooping in private in a pot. Okay, which and then they would poop in their pot and then they would go to the window and they would throw it out on the street.
How pleasant
that's what they were doing. Yeah. So, yeah, the medieval times they would throw the contents out there. And then in 1560s, sir john Harrington developed the first flush toilet a pipe that went straight down john Harrington, where john Well, this is funny because sadly his invention would go ignored for 200 years. Wow. That's like one of those things where you're like, you invent something that is really novel and exciting. Yeah, they didn't have social media back then try and promote it. You can take out Facebook ads and know that so john was out there, here, you here, you can poop over here. And, you know, it was documented that he did it. But then in 1775, so 200 years later, Alexander Cummings took his idea put an S shape at the bottom it was a pipe Yeah, and then that controlled the fumes that were coming back out Sure. Which made a world of difference and POW it took off and I mean, it literally took off the poop took off unfortunately, Alexander Cummings didn't think it through too far because then it just went through an S shape and then into a pit. Okay in and so in 1848 everybody was using these toilets and Britain had to Britain actually required that homes be built with an ash room a s h Okay, not bathroom ashra Ashram Okay, where the waste would be collected in a pile of ash. And who knows? If you think you have a bad job where night soil men that was the night soil night soil man would come by and empty your ash room
say that fast.
can't apply for that job. So tell me Eric, what makes you qualified to be in Knight soil man,
I'm good at nothing else.
Who takes that job? So if you're if you're upset about your job, remember, you could have been paid Knight's oil man. And then of course the one that everybody remembers here. And so you this lead up to it was funny because I always thought this guy invented in 1861, a guy named Thomas crapper patented a series of toilets and then the whole expansion on plumbing took off and this is what you now have in your home you sit in your home. I bring this up because I don't really think that we can talk about hemorrhoids without on national hemorrhoids. I'm going to keep referring to this as national hemorrhoids. I don't think we can talk about hemorrhoids on national hemorrhoid day without discussing toilets because it all plays into it. Okay, so that's my history lesson for you. I don't think we've ever done history before.
Not well not about toilets. No, not quite like that. That's interesting. I actually always thought that with crappers first name was john. I didn't know as Thomas crapper. That's funny.
Yeah,
but it makes sense. No, no, you did say that. But the earlier the first guy was john Harrington. I guess they just overtime they kind of morph those two together. I think it's pretty
Thomas crapper. Funny. Yeah. Isn't that interesting? I'm gonna head to the john. Yeah. Take a crap. You're right. Right there.
Yeah, there.
There it is. That's how you want second place indicator spelling. Alright, so now back to the original question. Can younger people get him?
Absolutely.
So this is really intriguing. I went down some rabbit holes on this one. So as it turns out, recent data is showing that there is a significant increase in hemorrhoids with late Generation Z and millennials. Okay. And the real question is why? Me? There's
only because we've, we've talked about that long term sitting, can do that there must be something that's drawing people to either sit more frequently or more importantly, sit longer.
What do you think you are? 100%? Correct. On a prior episode, we did discuss a funny study. We thought it was kind of funny. We're in 2012. They did a survey in 2012. Right? 75% of the people admitted to taking their smartphone into the bathroom, the other 25 are lying about it. And then Verizon saw that as an opportunity. And they did their own study. And granted, it's from Verizon, June 2015 90% of the people admitted to it.
Well, they know where yours they probably definitely know.
Yeah, and there's an actual study ongoing right now. It started in 2018. I looked it up on clinical trials.gov where they are looking into the actual correlation to make it more scientific, interesting. And what they're saying is that as we continue to move forward, Generation Z, taking the phone into the restroom is basically built into the DNA. So I did I did a survey this morning, and I took a poll of Generation Z people around me now. Yeah, 100% of them said yes. 100% Use a phone. I believe that other estimates, maybe other regions, not in my area where 95%. But 100% of the Gen Z people that I interviewed, right said that they use their phone that way. So
this is important, because I think what we need to ask you is how many people did you ask my son? There's wine.
But that is 100%. It's a 100%. Yeah. So that's just shows to make sure that you look at the actual study design and data whenever something like this all the time, it's all the more time. So necessarily, the podcast is sponsored by these apps. But my medical practice is sponsored by these apps. Yeah, so I would like to give a shout out for our sponsors, YouTube, Instagram, Facebook, tick tock. Yeah, somehow Reddit got left off, but I believe read, it should be on there. So there's all these articles now talking about this. And there's certainly lots of opinion pieces. And there's lots of blogs and stuff where they're interviewing colorectal surgeons and gastroenterologist and asking their opinions. And they what they actually talk about is that it's probably not about the app. It's more about the time sitting on the toilet. And I believe that's part of it. And that's what I want to get into with this guy. Because I believe that there's more going on than that. And I have a theory as to why those apps in particular, cause more damage. You'll notice it like candy crush isn't on there and things like that. When people really spend time they tend to go to those apps and I'm going to explain that later. Okay, so let's start with some basics. Alright. Alright, you fire questions. And well, let's talk you know, just as much about this topic, as I do. So let's just say what are hemorrhoids?
It's when vessels of belief can becoming gorged people will probably notice them when they are external. But there are external internal hemorrhoids, you'll probably want to delineate between the two of those typically, oh, it's the number one reason that people notice bleeding, rectal bleeding, correct. They can become painful at different things like that. I don't remember how many vessels it is, can become a gorge two or three, typically, and, but if caught early enough, can be treated by a gastroenterologist and pretty much eliminated.
Yeah. 100%. So it is a natural collection of veins. And I remember talking to a colorectal surgeon, I use all the time, Dr. Macaluso, and he goes, Hey, keep in mind that this is an arterial venous connection also. And I only say this because this reminds me of a story what early on in my career, like really early on I was in the hospital, I get called to go see an ICU patient that was crashing, absolutely crashing cirrhotic patient that was crashing, and blood was shooting out of this person's butt. And they were just running bags, and his pressure just kept dropping. He's like, Hey, we can't we have no time to wait, you got to come in here. It's probably variceal his massive bleeding. I scope him up top. totally clean. No viruses. Yeah. And I'm like, well, and he's still bleeding. And I'm like, either he decompressed them. So I'm like, we had an emergency call and flip them around. And this is all bedside and I'm early on. So if what I mean by that is I guess over time, you start seeing more and you kind of, you know, shrug stuff off and go another one of these this was like, out of left field. Like on a like a Monday afternoon. They're like you need to cancel clinic and go to the ICU right now. And so I, I end up scoping this person in blood is throughout the entire colon. And I'm like, I can't find the source. I can't find the source. I'm coming back. And there, I come back. And I retroflex this is before I started treating hemorrhoids. And I'm like, the rectum is just feeling full of blood. Uh huh. And I I said call. Like, I apologize, forgot his name down so many years ago, but I said, Call this guy get them on the phone. He's a colorectal surgeon that had just left the university and had come over and was joined the group that Dr. Macaluso was at. And so I said, Man, I got this guy, whatever he goes, this could be a massive hemorrhoidal bleed. People forget that. It's an arteriovenous connection connection. Yeah. And he's like, Are you comfortable banding it I'm like, I've never done it. And he goes, just treat it like it's a virus. Like it's a variceal bleed. I'm like, okay, anyone describe what a virus sees is their sees when people have liver failure. pressure builds up and actually when the blood tries to go to the liver, it backs up, fills up and then it the spleen gets big, the spleen fills up and then you end up shunting blood. It's all applying up to the gastro esophageal veins. These come up this way. And those veins can dilate and they can actually pop. Oh, yeah. And unfortunately, people will bleed a ton when they actually have that. And so what we do is we go down with the camera and then we do a rubber band ligation on the various hillbillies. So at this point, he's like, I'm gonna come over and see what's going on. And I loaded up a banner. I put one band, and it's like a scene from a movie with the clouds this. Birds start chirping blood pressure comes up one band and I was like, Wow. So that's so although they can be a nuisance in very, very, very rare circumstances, they can be like a really big deal. And that particular time it was a really big deal. Yeah, it's a big deal. So, yes, collection of veins and they weren't like shock absorbers. So all of us have hemorrhoids. If you don't have hemorrhoids. You're an alien. Yeah. Or Ilan musk.
He lives Ilan.
I don't know. Yeah, I'm thinking he doesn't have them. He's, he's not of this world. He's not of this world. So and they look like shock absorbers. But when you build up too much pressure, then they will fill up. And they're it's a it's a vein that can actually stretch. Yeah. And if too much pressure builds up, then it goes into the extra hemorrhoids, then the extra hemorrhoids get big. And that's when people really notice them because they hurt because there's a line called the dentate line, where you have pain fibers below it. No pain fibers above it. So frequently, I'll get people that will come in when they have an external thing. Yeah. And then we realize well, it's the internal ones feeding the external so if you've ever had an external hemorrhoid it's probably because your internal your internal hemorrhoids have grown and it's created a diversion for the pressure over there. And it hurts bad over there. And you're right, they can bleed edge pain thrombose. incidence, how many people do you think have issues with hemorrhoids?
I don't know. How many people I've got no idea. It seems like it seems like it's it's really often for those that we see in our line of work, but that you know, that's that's a kind of a skewed sample size.
is a little bit skewed. Yeah.
I don't know. I'm just gonna throw a number out there cuz I really have no idea. One in more than 20. I don't know.
120. Okay.
I have no idea. It's probably bigger than that.
Well, this is interesting, because on up to date, which is supposed to be the most up to date thing that I subscribe to I pay service to the incident is a study show that up to 14% of us people had hemorrhoid issues. And that seemed really small. And I realized that I'm skewed on this. And then I started researching more. I went and found that study, it was done in 1989. Wow. The only study that was published on the incidence of true hemorrhoids was done in 1989. Now looking back and other studies where people are mentioning them on colonoscopies and such Yeah, it's way more than that more recent data is that one in three people have issues and that incidence is going up. That's one in three people seeking the care of a doctor interesting. And then I started looking at the number of people that are or the amount of money that's being spent in over the counter medications. It's in the hundreds of millions. So it's gotta be way it's gonna be even more than one in three. I would even say that most people at some point in today's society may have a hemorrhoid issue even if they don't realize that it's a hemorrhoid issue.
Yeah, wow. Yeah, I was I was off by at least three to five fold. They're
not close. So like but but you're exactly right. In my world. Everyone has a hemorrhoid. Yeah,
I feel like I've rescued because we see, dude.
It's like that. That time in Nebraska when I was running the the free STD clinic. And I got interviewed. They're like, how many people have committee? I'm like, all of them. All of them. Everybody does.
I was skewed. I didn't realize that there's I'm wearing my silver x suit.
So I am a hemorrhoid doctor or I treat hemorrhoids. So everybody seems to have it right. Or at least they funnel to me. I probably should remember that time and I did that free STD clinic. But anyways, alright, so why did I even bring up him? Why did I even bring up toilets? In the beginning, when we're talking about hemorrhoids?
Oh, because we're sitting. And on top of that, not only are we sitting, I know this, we're straining, we're gonna applying pressure. So applying pressure sitting for longer. I think when you're reading through your statistics, it sounds to me like the incidence is rising. So now we're going to start looking at what could potentially make us be sitting longer. In a spot where we are increasing our pressure,
we think 100%. So what people don't realize is, and it's funny, because this particular patient asked, Do you think that we're seeing more hemorrhoids because of COVID? Because people are sitting instead of? And yes, and then I started thinking about it. I was like, but why is the toilet different? Like how does this support, there's no support hole. So what you've done is they've put a hole there so that the your rectum is now lower, you form a king, the blood pools there And sure, which is why sitting on a toilet scrolling through your abs is one of the reasons why more blood can pool in that area.
Okay, so there was some context around that. So essentially sitting on the toilet seat is actually more conducive to forming hemorrhoids more rapidly than just sitting
somewhere flat. Correct. Okay. And then this is one of the things when we talk about the evolution of the, of the toilet. I was really funny because I was googling this. And then what came up was a blog that I wrote in 2011. About the angle of dedication. Yeah, angle that we poop at our Western toilets, actually are not conducive to proving right. And one of my biggest pet peeves is in the older population. They make the toilets very high, so that they can get off of it easy the wrong way to go. Exact wrong way to go. Because as you change from a sitting to a squatting position, yeah, squatting is how we're actually supposed to be moving. Yeah. Which is why if you go to Middle East, certain Asian countries, the toilets are on the ground. Yeah, that's really the way that you should be. Yeah. And they did a study, the blog that I wrote was a Japanese study where they took med students which is I just thought it was a funny study. And they did they put barium paste in these med students. And then they made them poop. multiple different angles. Yeah. So it was like, you're like, there's there's labs that do this where there's like an audience watching and you just kind of like I mean, that's just yeah, we're
the modern day ash. shovelers are
the descendants of the ash, soil man. What am I call night soil?
Well, people really sure it's not a job I'm going for No,
it's not but certainly the descendents night soil man.
They do now.
Dr. Satish Rao who runs the anal rectal lab, and I got in Georgia, he's probably gonna look this up and go, great, great, great. Night soil man. You can read some of the work that he's done on this Dr. Rouse done some most of the work on the anal rectal movement. I remember watching him in a lecture and he showed his lab which is a barium toilet. And then our panel of people that watch on a large screen as a cameras there. And he said john, unfortunately designed it a little bit wrong shift and walk up a couple steps and sometimes people they can't hold the Wow. Because the whole time I mean, I'm just like watching this as a gastroenterologist. I'm like, that is a profoundly invasive thing. When you go I'm gonna go to the doctor, what are you gonna do? I'm gonna I'm gonna go poop in front of an audience. Yes,
Ma'am, I'm missing my appointment.
Sir, you're 15 minutes late, we're gonna have to reschedule. Oh, shoot. So anyways, squatting is the best. So toilets contribute to it in its own right. Sure. And it's called the angle of dedication. Basically, you have a muscle that wraps around when you stand. It's there so that it kinks it. So that when you're walking around, you have several safeguards. So you don't put yourself right. Internal sphincter, external sphincter and even this thing. And that thing is always tight. The people retells muscles, so as you sit, the angle becomes so as it's, when you're standing, the muscles will tighten. And as you sit, the muscle relaxes, and then it allows for a straighter, straighter shot. Yeah. So that's one of the reasons the toilets are an important part. And then if you spend more time in it, so if you're wondering, the best way to poop, lift your knees up. squatty potty style. Oh, it's fine. Yeah, it's a product, but you can do it with anything, get your knees up above your hips lean slightly forward. And that's the best way to poop. So let's talk about prevention of hemorrhoids.
Well, since we were talking about toilet seat whole while ago, I was going to make sure you weren't going to say you should just poop on a flat board. So I'm glad that wasn't one of the solutions. Just sounds incredibly messy. So prevention, find things when number one probably find a way to to consume the foods that allow you to make good stool to come out. Be certain that you're not doing activities that make you want to stay on a toilet longer, walk around smoking, the new sitting.
Oh, explain that real quick. smoking's the new settings you through that our settings in settings, the new smoking, sorry, setting, sitting sitting, the new smoking
settings, the new smoking, there was a there's been a handful of different studies, but most recently, I think it was almost two years ago, there was a study where they showed that the comorbidities that people can develop over time was commensurate with how many hours of a day they were sitting and as people begin to sit longer and longer. throughout the day. They had more incidents of obesity, hypertension, just on and on die, diabetes. I can't remember what else lifespan, lifespan latwon lifespan and lifespan if ik quality of life,
the quality of life so the your likelihood of dying is equivalent. If used a certain amount of hours a day is equivalent to smoking like a pack a day. Yeah. For like 30 years.
Yep. Something like that. Yeah.
That's wild. Yeah. So
any and actually, they say that if you did that routinely, you actually couldn't overcome it through rigorous exercise. That's right. Yes. It was almost like there wasn't a way to combat the long sedentary periods of the day or something like that.
I remember exactly. You're making me Can you hold on the podcast? Well, I
mean, podcasts aren't two hours anymore.
We read that study. Back in the early days, Eric and I were doing marathon podcasts were like Joe Rogan gets that many views with three hours. Let's do six hours. Yeah,
I decided I didn't want to be a smoker.
So you're exactly right. Don't sit too long on a toilet. If you're sitting there for a very long time, then that's just gonna lead to hemorrhoids. And what you're talking about proper diet. So eating fiber, actually 20 to 30 grams of fiber. just published a blog yesterday, on getting enough fiber does have this Yeah. So go to Kenneth Brown, or go to Kenneth Brown, MD. com. You can see these you can see this blog. But basically, it's how to get 20 to 30 grams of fiber and soluble insoluble. The distinction. The distinction is, it's To me, it's a lot of overlap a lot of gray, I think you need both. Basically, if you're eating your veggies, in having some fruit, you're probably you're probably pretty good and getting your fiber. Yeah. So 20 to 30 grams. And then the question that everyone's gonna ask is, well, are there any supplements that I can take for this?
supplements for hemorrhoids, for hemorrhoids? I think there is one key ingredient within artron to that has research behind it and the horse just not
Yeah, so wild. So I just assumed that there would be like five or six that have. So I signed up to examine calm, shout out to them, because they actually go through the effort of doing everything research backed, and they have what's called a human matrix panel, where you can see what the human studies are. Alright, so it's the human matrix. So there's, there may be animal studies. And shockingly, the only one that showed any evidence of decreasing hemorrhoids was horse chestnut, or the extract and horse chestnut called asen. And I'll read exactly what the the one study that actually that they referenced on this is that supplementation of three times a day of horse chestnut, 40 milligrams asen, for over the course of a day in a short period of time with somebody with hemorrhoids was associated with this significant reduction in symptoms, bleeding and improvement in endoscopic evaluation. I didn't even know this. And what they showed is that there's a 32 response in the placebo arm, but an 82 response 82% response in the arm that actually got the horse chestnut, and most benefits were apparent within six days. So it's not like you have to take it forever. Wow. Now, what's really interesting is when we're talking about something like I'll try and steal that may help you go to the bathroom easier, and it's got a horse chestnut in it. I haven't even been having my hemorrhoids. Patients take it because I just really kind of use it for the polyphenol effect on those that do not have bloating. And if you have bloating, I'm gonna recommend it. Right. But now we're looking at a whole new aspect here of horse Jessa being for him, but
yeah, I remember when you first found that study, it was just kind of a eureka moment. I, I didn't know that.
Yeah. So now speaking of eureka moment, here's mine about this topic. So every other colorectal surgeon and gastroenterologist on all these different blogs or interviews or TV spots and stuff like that. They were there said, well, it's not really the phone that's doing it. It's just the time on the toilet. I want to disagree with that a little bit. And I'm gonna I'm gonna see if you agree cuz this is purely theoretical here. But there's something called pelvic floor dyskinesia, okay? pelvic floor dyskinesia is when the muscles down below. They are not responding the way that you want them to respond. Okay? It's very common in women who have had babies. And so I'll bring people in. And it's typical of the person that says, I get the urge, but I feel like I've not fully evacuated or it takes way too long to get the stool out. Yeah. And that's when I have my discussion about squatty potty and, and lifting your knees up above and leaning forward, making sure there's enough fiber the fiber will bind the stool together so that hopefully, it brings moisture in along with binding it so that it all comes on at once. The typical person that has something like this as they struggle to go and when they go to the restroom, it's small, uneventful stores, you know, they talk about it being just like small rattle millet, rabbit pellets, things like that. So now knowing that pelvic floor dyskinesia is associated with some emotional response, because it's muscles they tense up. And they believe that they are relaxing the muscles when in reality, they're tensing them. So when I examine somebody, I'll go, can you relax your anus for me? And they'll frequently, many times can't do it. I'll be like, contract your anus for me. And they'll squeeze their butt cheeks, but the anus doesn't contract, right? And then when I say try and expel my finger, like you're having a bowel movement, everything clamps down. And I'm like, does this and then I can get them to relax. And that's what Satish Rouse Dr. Satish Rao's whole lab works on is this and there's Laureen forgot her last name. lorien is a physical therapist that specializes in only this, and I spend a lot of patients so we're gonna have her on the podcast at one time to really deep dive into this one top pelvic floor experience, pelvic floor expert. And yeah, because it's not just deputation, it can, it can lead to dyspareunia, which is pain during intercourse, it can lead to spasms in the bladder called
status, it can lead to a lot of other things and that without with the poor, and that could be way off here poor pelvic floor tone can lead to the need for like bladder slings and stuff like that, for
sure. All of that over time leads to that. So the more you keep doing this, that's what a rectal seal is. Yeah, that's what prolapse happens from and other things. So it's not something that if you're having these issues, so if you're like the twin, mid 20 year old that's doing this, we got to correct these things now, because if you continue to let this happen over time, the muscles start relaxing the nerves start thinking it's normal. And then that happens. So my theory is this. Number one, you're on these particular apps, okay, these apps can be associated with an emotional trigger shares all imagine going into the bathroom sitting down, you hit Facebook, you're trying to go poop, and you realize that you weren't invited to a dinner party, a party. Yeah. And then you start going on, you start scrolling through the pictures. And it's emotionally upsetting. you hop on Instagram and see a very, or Twitter and see a very angry political posts that get you riled up. As you do this, your sympathetic tone goes up, which is the fight or flight, and you will tend to contract muscles. So I would love to do a study on that, in particular, like you get to use your phone in the bathroom, but you can only I'm just I'm have a great idea. We're gonna hold on and I need your help on that. Okay. Okay. So basically, these particular apps in general, put you on the toilet longer, but then you can actually become emotionally invested in what you're looking at. I think you and I should design an app. Okay. How would you do it?
probably find something that would make me completely relax. And well, actually, we we know people who have technology to have scientifically backed data to to help one relax, and possibly utilize a mobile device.
Yeah, we need a bit. So you're about brain.fm? Yeah, yeah. Dan Clark CEO. Interesting, very interesting. Imagine having we need to set the brain.fm has a patented technology, which is called neural phase locking, where and I'm going to, we've talked to their PhD. Oh, yeah, super smart. And I'm not going to pretend to explain it. But basically, you can increase the activity in a certain part of your brain so that you can focus when you want to focus Mack and sleep when you want to sleep. You can relax, chill,
anti anxiety, yeah, anti
anxiety. We got to sit with him and be like, let's team up.
awesome idea.
Let's do a pooping app where we're going to stimulate an area and then we'll just we'll combine that with the headspace guy. Have you ever listened to headspace?
Is that the guy from New Zealand or Australia?
Yeah, it's huge. headspace is huge. Yeah, you know. Hi. Welcome back.
Yeah, yeah,
we're gonna talk today about emotional stress it just hot Welcome back. I see that you're on the loo.
Don't stay here too long.
I'm going to talk you through this. Now make sure your knees are up. And you are leaning slightly forward. Please know while this app is running, no other apps can be opened.
You are stuck here until you're finished.
And at at a certain amount, you will be required to stand up walk around. And then we'll make it so that the only way to turn it off is the sound of a flushing toilet.
Yeah. Then that actually is not a terrible idea. Not
a terrible idea at all.
I'll tell you what was funny though. I got to confess some because I was laughing a little bit earlier before you got to that. In case y'all don't know, this guy, and I hardly ever been This guy does not use social media apps and watching you struggle for what people are looking for in Twitter. And what else did you mentioned Facebook and Instagram. That was awesome. He has no idea what makes you mad when you get on those apps. You're trying to find out.
But all I know is every day I get on my MySpace page, and it's just blank. I don't know why
people don't like me, man, you treat your your laptop like a Solitaire machine.
I actually believe that. Well, fortunately, I'm a total nerd. So I would rather actually read some journal articles. Yeah, no, totally.
Yeah. 100%.
Yeah. And I mean, shout out to everybody that's crushing it out there. Like, you know, Tony yuans. A friend and his Instagram is just chilling. Well, he's,
he's actually on it.
Yeah. He's doing a good job with that. Yeah. And I admire that. Yes. That's awesome. But yeah, but anyways, I think we should do it. We should get into the app business and figure out how to and obviously we can't afford the headspace guy at this point. But I think what how is your accent? Let's hear
no, now it's not very good. I would have to think about the
always starts with Welcome back. Yeah. And it's really cool. very soothing. Welcome back.
Very rarely get described with a calling voice. Eric is not really what happened.
You were starting to sound like the NPR SNL episode of Alec Baldwin.
That's the only thing I do.
Alright, so anyways, that's that's my theory, pelvic floor dyskinesia. So if you've ever been on the toilet and realize that you're looking at something that may be emotionally may be an emotional trigger, that may be causing some of the issues. Yes, that's my theory. And that's why I think that the advent of the smartphone is doing that. So now treatment, other than some prevention, so treatment, there's lots of treatment out there. That is a whole separate episode unto itself. Yeah, sure. And to do it justice, we will bring some serious experts in here that do like like a colorectal surgeon that does surgery and understands the anatomy inside and out. But the treatment that I do, that's a whole separate episode, of course, but basically, if you have them, speak with your doctor, I want to say one thing for sure. If you see rectal bleeding, it is never, never, never, ever, ever normal. Even if you're saying, Oh, it's probably just hemorrhoids. Now you need to have it checked out no matter what. Yeah, and as always, our little disclaimer is that this is a medical show, but I'm not your doctor, if you have anything, anything at all that you're concerned about, please discuss it with your doctor. And if this gets one person to go in and talk to their doctor about it, and we can remove a polyp or or you can prevent colon cancer. Yeah, that is a huge deal. And if it is hemorrhoids, you want to get them treated early before they become too big. Because the reality is that hemorrhoids come in different stages. Yeah, so in internal hemorrhoids, they're one through four. So internal hemorrhoids grade one, they pop up, they can bleed some times. But you don't really notice hole at grade two, when you go to the bathroom, they pop out. So frequently, patients will come to me and they're like, I felt something that I was going to the bathroom. And now I don't grade two hemorrhoids, they pop out spontaneously because you're in that position. And once the pressure is relieved, it goes back in grade three, you have to manually reduce it. And grade four, they stay out all the time. So if you're having any of this, if you're having any symptoms like that, the sooner you get it treated, the more likely you do not need surgery surgery, trying to avoid surgery at essentially all costs. The type of treatment I do is called is a modified banding procedure. So if you talk to your parents, and they say oh, I had hemorrhoid banding done, it hurt really bad. It's come a long way and the old way of doing it was to grab the hemorrhoid itself plays a rubber band and Remember when I said earlier that there's that dentate line below it is pain above it is no pain. The way that this works is the type of banding that I do is the reagan ligation right go up above where the dentate line is place a rubber band above the hemorrhoid. And the reason why is so that the vein that is supplying it, you actually create a little scar and it decreases the blood flow. So it isn't so much cutting out the hemorrhoid. It's just over time getting it to calm down. And I treat a lot of these. It's one of my favorite things to do because I get such good response from patients in a very quick amount of time where you do it, they come back and they're like, wow, I'm already better. That's fantastic. It is the safest, least invasive and most effective way to treat these symptomatic hemorrhoids. I got some videos on this. You can go to Kenneth Brown, MD calm and take a look. I'm a big big proponent, but mostly if you're having any symptoms, go talk to your doctor, get your colonoscopy done. We did a whole episode on colon cancer. Definitely. And so that's the really important thing.
random question and maybe this will help someone if you're sitting on the fence. What is the possibility or probability that a hemorrhoid will just suddenly resolve itself?
So that is a great question. Because remember, in the very beginning was said that they are shock absorbers. Yep. So they can actually increase in decrease. And there's a bunch of risk factors for hemorrhoids sitting a long time. pregnancy is one of them. So I have a lot of women that will say, Well, I got them with my first child, I got them with my second child, and then they and then they go away, because the pressure is relieved, and they can do this. People that modify their diet, they're like, it was really bad. But then I changed my diet, I increased a lot of fiber, and there is a chance that they can go away. So we always recommend first line is to try to do the preventative stuff. Let's change your diet. Let's change your lifestyle with the toilet. And if it doesn't get better and continues, and then we can actually treat them so yes, they can go away. And I think by the time this is why I think that the incidence is really underreported. Yeah. Because by the time somebody actually comes to me, it's never like, Oh, this this happened once a week ago. It's always like, all right, I've been dealing with these for a long time. They seem to keep getting worse. Because of my hobbies. I like to work out jujitsu I get a lot of people that strain a whole lot. It's just the nature of it because when you're straining a whole lot you're gonna have that I get a lot of you know, people that are in vigorous jobs that do that so it's it can happen any age, any lifestyle it can happen some of this is genetic also. So we do know that there is a genetic component where whether it's the elasticity of the veins or not that's all kind of been figured out but so yes, they can go away so by lifestyle modification, maybe even you know, supplementation according to the one study unexamined calm did help.
Yeah. Interesting. That's a lot of information about hemorrhoids well, and we never got to it. We
have spell hemorrhoid. Oh, let's see if we can do this is National hemorrhoid day and we are at the National hemorrhoid day spelling bee with reigning runner up Eric Rieger.
were no first place participant in that particular spelling the reigning runner up. He mm r h Lidy All right.
Let's do it in true spelling bee format.
So hemorrhoid hemorrhoid can you use them to sentence
my hemorrhoids are killing me today. hemorrhoids
go origin
of the Spanish origin the emulator IDs which by the way, this is really important we're gonna have to translate everything ever since our Silvia podcasts were huge in Spain right now. Huge Yeah, no toy these Mr. Ortiz? Okay. him Roy which I think would be Latin in origin.
It's gotta be hemorrhoid h MMR. h od?
Yeah, no, he m o r. Every time I do every time that's what made you lose back in 1978. No,
that's not what made me lose.
So anyways, I'm trying to make light of something that a lot of people are embarrassed to talk about. That was kind of the goal of today's podcast, but it's super important and easy to fix. so common that now we have 20 year olds coming in worried that they're abnormal and we've got very fit people thinking that's abnormal and it's it's really just something that's part of our society now and treating it and getting it treated early is probably the key to this.
Definitely. Well get yourself checked if you see any anal or bleeding when you wipe etc.
See the toilet go view so there's a few other diseases that cause bleeding and one of my favorites is ulcerative proctitis ulcerative colitis, I'm a big inflammatory bowel disease fan. We're working on some stuff for our inflammatory bowel disease patients. In the meantime, if you suffer from any bloating or change in bowel habits, remember artron to go to artron to calm and take a look at that now that you realize that there's horse chest in there right there on the label and you have some hemorrhoids I'd be curious to see if it affects them according to this one study and of course KB MD health calm for CBD and broccoli, the biohack combo of artron to CBD and broccoli.
For our for on camera like that.
Oh yeah, probably not.
Yeah. So this is broccoli. There we go.
We did a whole episode with the founder of broccoli and their PhD. I just love it when there's like minded people that are sciency and everything and so we'll say I don't know. Let me know if you take all three and your hemorrhoids you better be curious to see.
Absolutely. Well, that's gonna do it for episode number 53. Thank you all so much for joining us please like and share. And of course if you know anybody who suffers from hemorrhoids or you do Reach out to your gastroenterologist or your health care provider and they can point you in the right direction.
Now if you're in the neighborhood, I'd be happy to talk to you.
Alright, take care