Insider Secrets from a Top Colorectal Surgeon

Too much stress makes you fart

Passing gas is completely normal. In fact, around eight in 10 adults report having gassy symptoms on a typical day. I tell my patients not to worry because that gas isn’t actually them. It’s a byproduct of the bacteria that live there, whose job is to help break down the food that your body can’t digest. How it smells depends on a million factors, including the variety of bacteria living there. But you might be making that gas worse if you’ve been under stress. There was a study in October 2021 from a team of international researchers that found people with high stress, anxiety or depression could have exacerbated gastrointestinal symptoms. It’s just another reason to find ways to manage stress.

What you think is a hemorrhoid might not be a hemorrhoid

I’m always astounded at how quickly people like to self-diagnose anal pain as hemorrhoids. It’s not always as simple as that. Itching and stinging in that area could mean dermatitis, and razor-sharp pain during defecation could mean you have fissures. But people feel something funny inside their butts, assume it’s hemorrhoids, and then slather that area with Preparation H or some other over-the-counter hemorrhoid treatment cream because they don’t want to see a doctor and confirm their suspicions. Unless you’re using a series of mirrors, you cannot see what’s actually going on down there. And even if you could, you’re probably not qualified to say what is or isn’t a hemorrhoid. Let your doctor make that diagnosis.

There’s no ironclad rule for the correct age for a colonoscopy

The age recommendation for getting a colorectal cancer screening used to be 50. But that’s changed in recent years. Now, according to the American Cancer Society, the U.S. Preventive Services Task Force and the Centers for Disease Control, the recommended age to get screened is 45. And that’s if you have no family history of colorectal cancer and no concerning symptoms like rectal bleeding, abdominal pain, unexplained weight loss and changes in your bowel habits. If you’re not sure, talk to your doctor. You might be a candidate for Cologuard, a test you can take at home that screens for precancerous polyps, but it depends on your personal risk factors. Again, talk to your doctor and don’t make a call based on what friends or family have done, assuming, “If it was fine for them, it’s probably fine for me.” What’s true for somebody else is not necessarily going to be true for you. 

Yep, you can get melanoma where the sun doesn’t always shine

Believe it or not, this is true. And it’s not caused by getting too much sunshine on your butt. (This isn’t a disease that only affects nudists.) Melanoma can occur in any skin cell that has melanin in it. Anal melanoma is extremely aggressive and almost impossible to cure, but it’s also very rare, making up just 4 percent of anorectal cancers. I’ve seen melanoma of the anus maybe three times in my 20 years of treating patients. So, don’t stress about it, but make sure to get checked if you have any weird symptoms or feel anything new back there. There’s no specific screening for anal melanoma, but it is worth mentioning to your dermatologist.

There is no such thing as a normal amount of rectal bleeding

Nothing makes me shudder like a patient telling me, “I had some bleeding down there, so my primary physician gave me a Cologuard test, and it was negative, so I’m fine.” First of all, those tests are only for asymptomatic people. Rectal bleeding always — always — needs to be checked by a professional. Even if it goes away after a few days, don’t shrug it off as probably nothing. Bleeding could signify anything from hemorrhoids to inflammatory bowel disease to colorectal cancer. So make an appointment with a colorectal specialist.

Never use a loofah down there

Don’t overthink washing your butt in the shower. Using a loofah is just asking for trouble, especially if you’re too aggressive with it. All your anus needs is a little soap and water, and make sure it’s soap that’s designed to be gentle on the skin. Just clean it like you would your arms or legs, with a washcloth and soap. And make sure you’re using a different washcloth and bar of soap for your butt than you are for the rest of your body, particularly your face. That’s a one-way ticket to getting pinkeye!

Your colon doesn’t need cleaning

Any type of colon cleanse, whether it’s a colonic or enema — where fluid is used to flush out waste material and bacteria from the colon — isn’t just a waste of time but potentially dangerous. People do get caught up in this idea that there’s “so much poop in your colon” so why not clean it out. I get it, but actually, the colon is supposed to be full of poop! It’s literally a poop-processing plant, and it works just fine if you leave it alone. There’s zero data that any kind of cleanse can help you get the “toxins” out of your colon. Poop isn’t a toxin, nor is anything in your GI tract unless you’ve swallowed poison. Leave your poor colon alone.

Witch hazel isn’t a cure-all

Pretty much everything made for your butt has witch hazel in it. From anti-chafing ointments to creams for anal fissures and hemorrhoids, it’s all loaded with witch hazel. There’s some evidence that witch hazel can relieve symptoms like itching and irritation, at least temporarily. But witch hazel is an astringent, a “pore-tightening” agent that can seriously dry out your skin in a bad way. That puts it in the same category as baby wipes. If you really want to relieve your symptoms without drying out your anus like it’s the Sahara desert, take a warm bath with a cup of Epsom salts.

There’s no correct number of bowel movements

People overthink and overanalyze a lot of things, but nothing is more ridiculous than obsessing over whether you’re pooping too much or too little. The frequency of bowel movements is affected by so many factors, like diet, lifestyle and a person’s overall health. In general, a healthy pooping schedule can run the gamut from three times a day to three times a week. Any more or less than that and you should at least bring it up to your doctor. What’s more important than frequency is how those bowel movements feel. Are you straining? Is there pain or bleeding? If not, stop counting the minutes between poops and let your body decide when it’s ready.

A little food in your stool isn’t cause for alarm

Seeing chunks of corn in your poop is one thing, but people have a tendency to freak out when they see undigested foods like carrots, nuts, seeds and sometimes even the skins of vegetables like tomatoes or bell peppers in their toilet bowl. Don’t hit the panic button! Many high-fiber foods are notoriously difficult to digest, so they pass through your body virtually unchanged. The only time to worry is if it’s accompanied by diarrhea or unexplained weight loss, which could be symptoms of Crohn’s disease, irritable bowel syndrome (IBS) or lactose intolerance.

Rectum spasms are real! And perfectly normal!

Having a sudden, sharp (if fleeting) pain in your rectum can be scary, but in most cases, it’s nothing to worry about. The key here is the pain comes on out of nowhere and isn’t related to pooping. It actually has a name — it’s called proctalgia fugax. The pain can be so intense that it’ll wake you from a deep sleep, and it usually lasts anywhere from a few seconds to a few minutes. We’re not sure exactly why it happens, but there’s speculation that it’s caused by stress, constipation and possibly even sex. Men can experience pain after an orgasm, and women can have pain with intercourse, and in both cases, it’s caused by what we call a “pelvic floor spasm.” I’ve been seeing this in both sexes more and more, and pelvic floor physical therapy can be really helpful in alleviating the discomfort. In France, all women who’ve given birth get weeks of free pelvic floor PT courtesy of the government, but in the U.S., most people still have no idea it exists.