EP 676: Poo Problems a Pain in the Butt? Dr. Lakshman on New & Minimally Invasive Techniques in Colorectal Surgery & Colon Cancer Screenings

In this episode, Dr. Mistry and Donna Lee are joined by Dr. Thiru Lakshman of Texas Colon & Rectal Specialists. Dr. Lakshman is a colorectal surgeon who treats a variety of conditions affecting the colon, rectum, and anus. Today, Dr. Lakshman and Dr. Mistry discuss recent innovations in colorectal surgery, including robotic, laparoscopic, and other minimally invasive techniques. Dr. Lakshman also explains how our colons function, how to keep them healthy, and how to handle the most common poop problems. With the rate of colon cancer increasing in younger and younger adults, it is more important than ever to keep up with colon cancer screenings. The dreaded colonoscopy is vital in catching benign colon polyps before they can develop into colon cancer. If your colon could use some extra care, call Dr. Lakshman at 1-877-275-8277 or visit Texas Colon & Rectal Specialists online. 

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

Our Locations:

Round Rock Office

970 Hester’s Crossing Road
Suite 101
Round Rock, TX 78681

South Austin Office

6501 South Congress
Suite 1-103
Austin, TX 78745

Lakeline Office

12505 Hymeadow Drive
Suite 2C
Austin, TX 78750

Dripping Springs Office

170 Benney Lane
Suite 202
Dripping Springs, TX 78620

Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:15

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist and founder of NAU Urology Specialist. The bespoke urology practice in Austin. Oh,

Speaker 3: 0:27

A little callback from a previous guest

Speaker 2: 0:29

That's , I'm just making up words up now . Oh , I don't even know if , I mean , I'm joined as always by Donnel Lee . She really makes the show. She's our business development manager. She has been our practice manager and an integral part of our practices story For how many years now?

Speaker 3: 0:41

Seven years.

Speaker 2: 0:43

Chemistry . Seven years . She gets a sperm pin for every year she's been with us. That's right . She's got more sperm on her lapel than she did , than

Speaker 3: 0:47

She did in did in college <laugh> . That's right. I thought it was college. Is it high?

Speaker 2: 0:51

Did you go to college? I don't even know. I don't know . All right . Anyway, well, how do people get ahold of us? Don ,

Speaker 3: 0:56

You call us right away at (512) 238-0762 . You can also visit our super cute little website and see our shining little faces there. It's armor men's health.com. You can submit your questions that we will answer anonymously to that website. And remember that we're podcast able , when you get your car put on your favorite podcast site like Spotify, and we can be there, right there for you.

Speaker 2: 1:16

So I love surgeons.

Speaker 3: 1:17

I know you do.

Speaker 2: 1:18

And I feel like the urologist soulmate is the butt surgeon.

Speaker 3: 1:22

Ah , perhaps.

Speaker 2: 1:23

And we have the original man himself. That's right. Dr. Theu Lman .

Speaker 3: 1:27

He's like, no.

Speaker 2: 1:28

Dr. Lman , thank you so much for joining us today. Thank

Speaker 4: 1:30

You for having me.

Speaker 2: 1:31

You are, you are a member of Texas colorectal specialist. That is correct. And how long have you been in the Austin area?

Speaker 4: 1:36

So I've been in Austin in practice for 14 years.

Speaker 2: 1:38

Tell us about your , uh, education. Where'd you go to college and medical school?

Speaker 4: 1:42

Sure. I went to college at the University of Pennsylvania in Philadelphia, and then I went to medical school at the University of Kentucky. And then they

Speaker 2: 1:48

Have medical schools in Kentucky. Yeah's,

Speaker 4: 1:50

It's amazing. I know . Wow . Well,

Speaker 2: 1:52

Did they give you, did they give you safety knives and safeties ? Are there You'd

Speaker 4: 1:55

Be surprised.

Speaker 2: 1:55

You'd be surprised.

Speaker 4: 1:56

Yeah, that's right. Generally, we're lucky if at the end of a clinic day you find one set of teeth amongst

Speaker 2: 2:01

All the patients together . Wow .

Speaker 4: 2:02

Alright . Uh , no, it's , it was great. It was very nice. Yeah. My family actually is in the Tennessee, Kentucky area, so I went back home for medical school and then I went back to Philadelphia for many years. I did all my general surgery training up there , uh, at , uh, Jefferson University Medical College there, and then down to Florida at the Cleveland Clinic for my colorectal fellowship.

Speaker 2: 2:18

And , um, when, when you were coming up, robotics as a component of , uh, colorectal surgery wasn't necessarily kind of the standard, so you really had to learn a lot of that after training while you were in practice. What benefits does robotic and laparoscopic and minimally invasive surgery have for your field?

Speaker 4: 2:35

Yeah, I think it's huge. I think it's a huge benefit. And you're right, when I first started, like in my surgery training, there was, there was laparoscopy, you know, which is sort of the minimally invasive technique that's sort of been around for a long time, for the past 20 years or so, maybe even longer, 30 years. Robotics was just getting started. And it's really, I mean, as you know, you do robotic surgery as well too. It's really this sort of latest evolution of minimally invasive surgery. Colorectal surgery specifically really is well suited to minimally invasive surgery because a lot of the things we do, they already started doing laparoscopically many years ago, and it was a really natural evolution to do it robotically.

Speaker 2: 3:07

Now, not all colorectal surgeons are able to do this. I mean, most urologists that are gonna remove prostates do it robotically, but there are still, you know, a good number of open colorectal.

Speaker 4: 3:18

Absolutely. Actually, if you, the , we just were looking at this for another talk I was doing, the national rate of open colorectal surgery is still around 40%. 40 to 45%,

Speaker 2: 3:26

Which is fascinating because there's only 2% of prostates are removed open

Speaker 4: 3:30

Nowadays. That's it . 2% . I mean ,

Speaker 2: 3:31

98% are gonna be done open. I mean , robotically the rate

Speaker 4: 3:34

Of increases, it's really in , it's increasing steadily for sure. And what we're seeing is, is with robotics coming out, that the people that are adopting minimally invasive surgery are , uh, the , the number of colorectal surgeons is increasing significantly, but they're actually skipping laparoscopy and going straight to robotics as the modality. 'cause I think it's easier to learn. It's a little bit more intuitive. And so it's, it's almost like, you know, the, the benefits of robotic surgery is, it's like you're doing open surgery inside the belly.

Speaker 2: 4:00

Inside the belly. That's right. And it's , and it can be very intuitive for sure. Now, in , in, in our field, you know, we're seeing technological , uh, advancements. Uh, we're treating a lot more conditions that we were treating with medicines now with surgical interventions. Uh, what about your field? What, what are some of the technological advances that you've seen or medical advances you're seeing? Uh , or just kind of evolution of your practice?

Speaker 4: 4:21

Yeah. In colorectal surgery. So I think the first thing, obviously is minimally invasive surgical advancements. You know, like robotics, that's really making surgeries that were technically very difficult and that we're done with big, huge open surgeries. Now we can do with five, you know, centimeter size incisions, which all the benefits of that. Right. So less pain, better cosmesis, less time in the hospital. So I think that technological advancement is there within robotics itself. There's new technological advancements. Now, when I do a surgery on the robotic system, I'm able to look at blood flow in real time .

Speaker 2: 4:48

I mean , that's really a big a , a big improvement. Now we know that the anastomosis, because you not only have to remove the tumor, but you gotta put the colon back together. That's right. And that putting it back together can be real dangerous if it leaks, because now the person goes for another surgery. That's exactly right. But now you can evaluate that blood flow in real

Speaker 4: 5:04

Time . For sure. Yeah. We used to be able to, you can do it, and there's other ways you do it. We can actually do what's called a leak test. It's sort of like how you would look for a leak in a tire like suber water and , and , and , you know, insufflating with air. And we look for bubbles. We can still do that. But now by these added technologies of, you know, it's a , it's amazing. They basically inject something through the IV and 60 seconds later you can see all of the blood vessels light up a fluorescent green color. You just toggle a switch when you're sitting at the robotic console and you can see what's getting blood supply and what's not. And then, so, you know, the three main things we're looking at is we're looking at blood flow and we're looking at the , uh, tension. And then we're looking at the anastomosis itself. You know, the connection between the two pieces of bowel that we hook back together and robotically with these, these technological advancements, we can see the blood flow really in real time and look at it too.

Speaker 2: 5:49

So one day you got up and you were like, I could be a heart surgeon. I could be a urologist if I studied hard enough <laugh> . But instead you were like, I'm gonna spend my entire life in the colon where there's nothing but poop.

Speaker 4: 6:02

Yeah. You know, it's funny because patients, and it's invariably when I have them, like on the table up and I'm doing an exam on them, and they say, I just can't understand why you would decide to do this <laugh> ,

Speaker 2: 6:14

This ,

Speaker 4: 6:15

This, choose this as a

Speaker 2: 6:16

Career. I hear it all the time when I'm sitting on the stool and examining their testicles. They're like, why? Why would you do this ?

Speaker 4: 6:23

Well , we know why you, well,

Speaker 2: 6:24

You know , some of us have a thing, right?

Speaker 4: 6:26

<laugh> , the funny thing is that I'm there doing it and I'm like, well, if I wasn't here doing this, who would be doing? Somebody's gotta do it . Somebody's gotta do it . That's my my pat answer. Somebody's gotta do it. Right .

Speaker 2: 6:34

Somebody's gotta

Speaker 4: 6:35

Be here. No, I think for, for me, it was , um, it was a very varied specialty in the sense that I could do lots of different things when I was in medical school. And then I , I knew in medical school I wanted to do surgery, some type of surgery. I thought about neurosurgery and, and I realized a, I wasn't smart enough. And

Speaker 2: 6:50

You're way too funny. And, and you would've been a sore thumb in that boring university

Speaker 4: 6:54

<laugh> . I would see those, I would see those neurosurgeons, the residents. And by the end of their residency, their souls were so crushed <laugh> and so deflated. They had no, and

Speaker 2: 7:03

They aged so poorly, their

Speaker 4: 7:05

Humanity was gone . Out of all of 'em . I said, I don't wanna be like that. And I noticed the colorectal guys were like, you know, they , they dressed nicely. They were nice, they were friendly. They'd seem less stressed, you know, but in kohl , like a dermatologist. Yeah, like <laugh> . I wish,

Speaker 2: 7:18

I wish the dermatologist of surgery.

Speaker 4: 7:20

That's right. Yeah. Uh , but, but then I, when I, I knew I wanted to do surgery and I looked into , and I decided on general surgery and colorectal was the best fit for me because I could do small, minimally invasive procedures. I could do colonoscopies and then I can do big surgeries. I have a particular interest in cancer and colorectal cancer. And so I can do, I can focus on that. So,

Speaker 2: 7:38

And you do a lot of work to get people to get their screening colonoscopies. Absolutely. Colon cancer being one of the most preventable diseases. Why is it preventable? Because of colonoscopy?

Speaker 4: 7:48

Yeah. It's, it's the third most commonly diagnosed cancer in the United States each year about

Speaker 2: 7:53

Prostates number one. We are number one. Good for you . We are number

Speaker 4: 7:57

<laugh> . Um , we're shooting for it. We're shooting for number one <laugh> . Uh, it's , uh, so it's , it's very prevalent, you know? And I think now we're seeing more and more people get diagnosed because I think there's more screenings, but also I think there's a lot of environmental factors, which we Absolutely ,

Speaker 2: 8:11

Absolutely .

Speaker 4: 8:11

Diet . Yeah. Absolutely.

Speaker 2: 8:12

Environmental carcinogens.

Speaker 4: 8:14

Yeah. And I think there's particularly that

Speaker 2: 8:16

MRNA vaccines. I

Speaker 4: 8:17

Think <laugh> , oh,

Speaker 2: 8:17

There it is .

Speaker 4: 8:18

We're going down that route .

Speaker 2: 8:19

Well, we have an audience. How know , this is , we , we have an audience. We an audience. We have an audience. You're

Speaker 4: 8:24

Just tailoring to the demographic. I see. Nice. Um, but I think it's gonna come out that there's gonna be some particular environmental factors. 'cause I'm seeing, it used to be in the first half of my career, it was all people over the age of 60, 65. Now it's the majority. If , if not half of them are under the ages. Really? Oh, yeah. Oh my . I see. 25 year olds, 28 year olds, 35 year olds with really aggressive colon and rental cancers.

Speaker 2: 8:47

And these people have financial disincentives to get colonoscopies because they have high deductible health plans. They have commercial insurance, they may not be insured. That's right. Right. Unlike our Medicare population where it's easy to kind of force That's right . Yeah . To go through it. So ,

Speaker 4: 8:59

And that's, it's

Speaker 2: 9:00

Shifting. That's worrisome.

Speaker 4: 9:01

It is worrisome. And it's shifting, right? Because I think they're seeing from population studies that it's younger people are getting it. So now the , the screening age went from 50 to 45. And there's talk even that it may get lower to 40 actually. 'cause they're seeing, just like I was saying, we're seeing younger and younger people with it. But the reason it's so important is because of the colonoscopy. If you find a polyp, you're really heading it off of the pass . Right. The progression to a colon cancer is, you start off as a polyp. The polyp slowly grows over months to even years. And then not every polyp becomes a cancer. But every cancer, you know, 99% of all colon

Speaker 2: 9:32

Cancer, poly started , started as a polyp

Speaker 4: 9:34

Polyp . So if you can catch it a polyp, you've effectively cured it. And then you can identify that subset, that population of patients and say, we know you're a polyp former . We need to watch you more closely. We'll do colonoscopies more frequently. And that's how we can prevent it. I

Speaker 2: 9:45

Feel like somebody who was very well trained , I went to Baylor College of Medicine. Of course. I feel like that wasn't the standard conventional wisdom when I trained that the polyp became cancer. There were polyps and then there were villus polyps, and then there was, you know, like there was this, this range. Yeah. But, but has kind of the thinking changed now, like, like most polyps are bad.

Speaker 4: 10:05

No, you just didn't listen in many.

Speaker 5: 10:10

He was too busy.

Speaker 2: 10:11

You

Speaker 4: 10:11

Were thinking about all those testicular exams you were gonna do,

Speaker 2: 10:14

And so That's right . That's right. When it came to the colon, I was like, you know , you skipped that stuff. You just poop it out . But yes ,

Speaker 4: 10:18

No, it's , uh, it , it , what I would, how I describe it is it's actually a spectrum, right? And so it's, you start at the very benign end of the spectrum is they polyps what we call hyperplastic polyps, which are basically like ditzels little warts on the inside of the lining of the colon. And then the progression goes tubular adenoma, villa adenoma, tubal vous adenoma, and then dysplasia, which then becomes cancer. So it's really a sort of a spectrum from least, you know, less aggressive to more aggressive.

Speaker 2: 10:42

Well, your work , uh, in colon cancer screening and support of that is , uh, is is is amazing. How do people become patients of yours? And what's your website for

Speaker 4: 10:49

Sure. So you can go to TCRs colon docs.com . Uh, you can also just do a search for Texas colorectal surgical specialists. Is that right? Yeah, Texas Colorectal Specialists. Uh, we're also a subsidiary of Texas Oncology. So if you go to the Texas Oncology website, you can find us through there. That's probably the easiest way. Those, those methods.

Speaker 2: 11:06

Well, thanks for joining us today. Hello and welcome back to the Armor Men's Health Show. I'm Dr . Mystery , your host, board certified urologist and founder of NAU Urology Specialists. I'm always so honored to have my co-host Donna Lee. See, I'm me pumping you up more and more.

Speaker 3: 11:19

That's so nice that ice words are nicer than the bad words.

Speaker 2: 11:22

Donna Lee is a professional , uh, t-shirt , uh, designer. Mm-Hmm. <affirmative> . Mm-Hmm . <affirmative> . Mm-Hmm . <affirmative> . Uh , and , and on her part-time, she also , uh, you know, is our business development manager. So thank you very much. That's right .

Speaker 3: 11:30

You're welcome. For all the t-shirts. Thank

Speaker 2: 11:32

You. And we're joined again by one of my favorite surgeons in this city, Dr. Thru Laxman with Texas colorectal specialist. Thank you so much again for joining us, theu . Of

Speaker 4: 11:42

Course. Thanks for having me.

Speaker 2: 11:43

So , uh, we talked in the last segment about colon cancer screening, the importance of it, and kind of new innovations in , um, colorectal surgery. I thought we would spend a little bit of time just talking about chronic constipation in young women. Oh my gosh. My favorite , I'm kidding , kidding . I'm just kidding. I'm just kidding. You know , all of us happy to talk about it. All of us in surgery have like these, the , these third rail issues. That's right . And , and the chronic constipation in the middle aged woman. It just kind of litters, litters the surgical

Speaker 4: 12:11

Practice . I have a great technique for that. I said, let me introduce you to one of my younger associates, Dr.

Speaker 2: 12:15

Tur Lee . That's right.

Speaker 4: 12:17

They're an expert in

Speaker 2: 12:18

This field. This very complicated. Oh man . Funny . Oh man. You know, because so much of how the colon operates functional as well as anatomic. So you know , how we poop. And, and so much of the pooping problems occur from just bad choices that you've made , uh, in the beginning. Mm-Hmm .

Speaker 4: 12:34

It's very true. Yeah .

Speaker 2: 12:35

So , so I thought we would talk a little bit about just the function of the colon, how it works and what makes it not work so well. And

Speaker 3: 12:42

Do all colorectal surgeons eat good food? Like, do they eat organically? I wanna know

Speaker 2: 12:46

That. Well, we better than everybody . Chemistry . We do .

Speaker 4: 12:49

That's right . We tell everybody that we do that.

Speaker 2: 12:50

We do fiber . Right . What did you eat? What did you eat right after your colonoscopy? Uh ,

Speaker 4: 12:54

That's a great question. I think I had, I , I mean, I , I must be honest, I'm pretty sure I had Whataburger Whataburger

Speaker 2: 13:00

What ? Whataburger too was amazing. And Dr. Miller , he said he had a cheeseburger and oysters and champagne after .

Speaker 4: 13:05

Yeah . Yeah . That's right.

Speaker 2: 13:05

So you tell your patients to ,

Speaker 4: 13:07

He's a lot fancier though .

Speaker 2: 13:08

We all agree . We all agree. Champagne and oysters with a cheeseburger. I know . What restaurant was that? Okay, so, so when it comes to the function of the colon , uh, well , what is the colon's purpose?

Speaker 4: 13:18

Yeah. So, you know, at its , it's, it's , it's a pretty, you know, it's a , it's a pretty basic simple and elegant organ. If you think about it, the primary goal of the colon , just like you, just like me. That's

Speaker 2: 13:28

Right. Yeah. Simple me

Speaker 4: 13:29

Colon elegant, simple. That's right. Yeah. It's primary function is really water reabsorption. And it at its basis, you know, if you put in the lay layman's terms, you say it's basically turning liquid waste into solid waste. And so as waste that , you know, you eat food, it gets digested in the stomach and then into the small intestine, you have several feet of small intestine. It's at that point, stomach to small intestine. Most of the nutrient and vitamin reabsorption, all that stuff occurs as you get to the colon. It's trapping waste and it's converting and it's basically reabsorbing a lot of water. That's why when people get sick, if they have gastroenteritis or you know, montezuma's revenge, they get dehydrated. Right. Because you're losing all this water

Speaker 2: 14:05

Out of you poop because it doesn't get

Speaker 4: 14:06

Reabsorbed poop because it's not getting reabsorbed. So the primary function is water reabsorption and to create solid waste. Now, there are some things at the proximal or the beginning part of the colon where you do get some nutrients reabsorbed there too. But the primary function is that, and you're right in the sense that it's a , it can be a long-term , both functional and environmental thing that can affect your colon function. I hear a lot of stories of, of people that come in and they have chronic constipation. And I always ask 'em , I say , well, as a child, did you have a problem? They said , yeah, you know, my parents told me that they always had to give me like enemas and that I was in the bathroom all the time. And I think it starts at a young age. And then what happens from a mechanical standpoint is , is if you're chronically constipated and the stool is sitting in there for a while and you have a lot of stasis of the poop in there, you know, the colon actually becomes elongated too. Which then contributes to more constipation as

Speaker 2: 14:49

Well. I , I have a very long colon. I'm sure I'm telling, I it's impressive . Sure . You tell people impress my uvula and my colon are very long.

Speaker 4: 14:55

Oh, is that right?

Speaker 2: 14:56

So the colon moves poop through peristalsis. Correct . Meaning that the muscles have a contraction mechanism. That's right . That propels. So the heavier the thing is, the harder it is to move it. Is that right?

Speaker 4: 15:07

I suppose, yeah. I think if you think about it from a purely mechanical standpoint, I guess that's correct. That's

Speaker 2: 15:13

So why does fiber help us poop is the

Speaker 4: 15:14

Point. Yeah, that's a great question. So, and there's are different types of fiber, right? There's soluble and insoluble fiber and you can get 'em, you know, certain types of foods have certain types of fiber and fiber content in them. How the fiber works is, is it does two things. It traps waste and it draws the waste and sort of congeals it and solidifies it. Right? Which, to your point about making it sort of more bulky, right? Mm-Hmm. <affirmative> . But then it also can draw in a little bit more water and reabsorb a little bit more water as both things, you know? And that contributes to the propulsive activity of the colon. The colon has circular muscles around its lining, you know, and there's this very complex innervation of those circular muscles of the colon. And there's this very complex, we don't think about it, right? When we think about poop, we don't think about all the complex interplay between our brain. I do . And nerves . I do , I know you do <laugh> , you spend hours on the toilet thinking about this, right ? Mm-Hmm . <affirmative> . But that complex interplay between those things, actually con con contributes to it as well too. And that's why, you know, when you have more solid, bulky stool, particularly in the lower part of your colon, the rectum, which is the last part of the colon, it's highly innervated . And actually there's all these complex interplay of nerves in there that say, oh, this is more solid waste. This is more liquid waste. This is gas. I need to fart. You know , in your case, I need to change my diapers. I know , whatever, whatever it may be. You know? Um, so, but yes to , to your point about the bulkiness of the stool, if it's too bulky, yes, it can be difficult to pass it. So we have to find the body's trying to create this appropriate balance.

Speaker 2: 16:35

All of this innervation stuff that you're talking about of the distal or the end of the colon is important. 'cause I think that the body feels like it failed us if we poop or pee on ourselves . And so we have all these mechanisms to like keep us from pooping and peeing on ourselves . What risk factors do you see that when people do start having fecal incontinence? What are some risk factors and what , and like, I know it sounds weird, what are , what are the symptoms like of fecal incontinence?

Speaker 4: 16:59

Yeah. You know, I'm glad you bring this up because unfortunately it's very common and you know, no one wants to talk about it for some reason. You're lucky. PE people , women, people don't mind talking about urinary incontinence. It's sort of like not, I'm not saying they love talking about it, but you're more <laugh> . You're more likely gonna have a, yeah . Older

Speaker 2: 17:15

Pe people at parties aren't telling you their peeing their pants.

Speaker 4: 17:17

No, they're not

Speaker 2: 17:18

Pooping their pants. Yeah . Pooping their pants , pooping their pants. We'll edit

Speaker 4: 17:21

That one up , you know ? But I think it's le it's more socially acceptable for an older woman to be like, oh, when I, when I cough or when I do, I have a little bit of leakage. 'cause every woman expects that .

Speaker 2: 17:29

Don't try to pretend to be like me. Yeah,

Speaker 4: 17:30

You're right. I'm sorry. I always wanted to be like ,

Speaker 2: 17:32

Stay , stay , stay in your lane . Stay

Speaker 4: 17:33

In my lane. But those same women probably could have some component of fecal incontinence as well too. But no one's gonna talk about it. There's this data point that says there's around 12 million people in the United States that have some form of fecal incontinence.

Speaker 2: 17:45

And it's very uncomfortable to discuss it. Very uncomfortable.

Speaker 4: 17:47

What do you think ,

Speaker 2: 17:47

What do you think the primary care doctors are telling these patients when they say I'm leaking a little poop? You think they're just saying,

Speaker 4: 17:52

They say, go see a colorectal surgery . They say,

Speaker 2: 17:55

Right, and then , and then your wait time is six months. And then I think a lot of people get discouraged. And I think that makes it difficult to

Speaker 4: 17:59

Treat. It is difficult and it's, and it's an embarrassing topic, but your , to your question about the , the risk factors, I mean it , we tend to see it more often in women than men. And I think that's because of primarily women are , you know, childbearing and when they're having babies, that's probably the primary risk factor. Or causative, you know, issue for a fecal incontinence, you have this large baby, it's pushing on the pelvis sometimes there's a lot of trauma with childbirth as well too. And it's, there's this complex, you know, web of nerves that sit in the pelvis that control bowel function, bladder function, sexual function, and all those nerves can get sort of irritated and damaged sometimes permanently with childbirth or pelvic trauma. And what happens is, is as a younger woman, they're able to accommodate that better, right?

Speaker 2: 18:38

'cause they have more strength than their pelvis .

Speaker 4: 18:39

They have more strength than their pelvic floor. And as they get older, the strength goes away. Hormonal changes with menopause, other things like that. Then you add in the factors of straining and constipation and irregularity, bowel movements. And then everything sort of like culminates with these, these episodes of first, you know, small amounts of leakage and then it gets worse and worse.

Speaker 2: 18:54

And you know, for 70% of women, you're gonna be able to treat them medically, but 30% will really benefit from some type of surgical intervention. Would , would you agree?

Speaker 4: 19:02

Correct . Yeah, I'd say so.

Speaker 2: 19:03

And as I practice more and more in medicine, I'm finding that as we have an aging population, neurogenerative diseases like Parkinson's and multiple sclerosis, they're having increasing numbers of urinary manifestations that are kind of unrecognized. Do you think that the same goes through for colon and and fecal issues in this population? Yeah .

Speaker 4: 19:21

I'd even argue that probably that exact same population that you're seeing probably have some component of fecal incontinence, but to our earlier point are probably not even talking about it,

Speaker 2: 19:29

You know? Right . And and most of the time they're getting primarily cared for by a neurologist who, and we know these people, they don't wanna look at anything below the chin. That's right. You know? Yeah, that's right. These people are very uncomfortable with poop and pee for sure. And joking. That's right. That's right. And all

Speaker 4: 19:42

Of these things . I thought about neurology when I was in medical school and I realized you don't cure anything in neurology . Yeah.

Speaker 2: 19:46

We all did. Everybody goes through those six weeks thinking about becoming neurologists. That's right. Yeah . And so then at the very end of the pooper is where a lot of people start having problems, right . Hemorrhoids, fissures and anal itching and things right there. Sure . And most of those things can be taken care of with good dietary hygiene as well, right ?

Speaker 4: 20:02

Absolutely. Yeah. Sometimes just the simple act of adding fiber, you know, enough fiber or fiber supplement to your diet takes care of all those problems. You create a more easy to pass complete well-formed bowel movement and you're sitting on the toilet less, which means you're screening less, which means then your hemorrhoids, which are just blood vessels that we all have, you know, it's this common misnomer. One

Speaker 2: 20:20

On the left, two on the right. That's

Speaker 4: 20:22

Right. Good for you. You did listen in medical school. I did.

Speaker 2: 20:24

Yeah.

Speaker 4: 20:24

Just that

Speaker 2: 20:25

Part about that . Just that one part. Just that one part. Yeah . Because I always thought I had an extra one. <laugh> ,

Speaker 4: 20:29

Maybe you do . You are special overachiever. That's your u You thinking about that ? I was coming down, the UO is hanging

Speaker 2: 20:34

Down. Wow . That's a low ula .

Speaker 4: 20:36

By sitting and straining and pushing, you're engorging those blood vessels. It's like I tell people it's like having varicose veins of the anal canal and then those get swollen and irritated. Those cause you know, mucusy leakage that makes you wipe more, that makes , and

Speaker 2: 20:47

You itch and it goes through the whole problem .

Speaker 4: 20:49

So That's exactly right .

Speaker 2: 20:49

It's a big, so good dietary hygiene and fiber. Uh, we are looking for a sponsorship from Metamucil. If any of you people are listening, share it through . I really appreciate you coming on board . It's always so much fun to have you . My pleasure. How do people make an appointment with you for their screening colonoscopy or other colorectal needs? For

Speaker 4: 21:05

Sure. You can reach us at our website, ww dot TCRs colon docs.com. You can go to the, you can do a web search for Texas colorectal specialists. You can also look at the Texas Oncology website and you can find a link to us through there just to a search for colorectal surgery. And like you mentioned, we run the gamut of from very minor, everyday benign issues like anal itching or hemorrhoids to screening colonoscopies to complicated colorectal cancers and minimally invasive surgical techniques . So we really, we from soup to nuts. Take

Speaker 2: 21:32

Care of it. Thank you so much. Thank you.

Speaker 1: 21:33

The Armor Men's Health Show is brought to you by NAU Urology specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.