Transcription:
Potty Talk: Back to Basics

Joey Wahler (Host): Potty training is associated with young children, of course, but adults can benefit from toilet retraining ensuring they're promoting good rectal health on the bowl. So we're discussing Potty Talk, Back to Basics. This is WakeMed Voices, a podcast from Wake Med Health and Hospitals in Raleigh, North Carolina, our guest Dr. Brenna Houlahan, a colan and rectal surgeon for WakeMed Health and Hospitals. Dr. Houlahan, thanks for joining us.

Dr Brenna Houlihan: Thanks for having me.

Joey Wahler (Host): So with today's topic, you might say we're doing our duty regarding people doing their duty. So first, how often per day should the average person do their business, shall we say?

Dr Brenna Houlihan: That's really a hard question to answer, because there isn't an honest answer for it. There's sort of more goals of what the stool should be like and the experience should be like more than an actual number. Aiming for about daily is probably about right, for most people, but really what we're hoping to get to is soft, easy bell movements that kind of just come out of you, obviously with the control that you have, that you're only on the toilet for a couple minutes and you're done.

So really aiming for that consistency and that ease is what's more important than the actual number, because for some people it's many stools a day and for some people, even on a good bowel regimen, it might still be every other day.

Joey Wahler (Host): Gotcha. So you mentioned soft and easy. So let's talk about how to get there. And though unpleasant, it's important sometimes to check what your movements look like. Right. So how should a healthy one appear?

Dr Brenna Houlihan: So everyone will look a little bit different. In general, you want a sort of bulked together, bowel movement. You don't wanna have to go multiple times with little bits a day, or sort of little pebbles. and you don't want it to be hard. So you wanna be able to. When you feel the urge to go to sit down, have it come out easily, not hurt, not sort of stretch your anus and, be able to jump off the toilet within two minutes. So looking at the exact type of it, everyone's stools are gonna look a little bit different depending on what you eat and your day to day, but in general, sort of bulked together, soft bowel movement is ideal.

Joey Wahler (Host): How about what lifestyle factors typically, including diet contribute to both the quantity and the quality of someone's BMs?

Dr Brenna Houlihan: So diet's very important, as we've kind of all heard a lot about fiber, which I think is kind of having a little bit of a popularity boost right now. The amount of fiber you have will really affect your bowel movements and the softness of it, and how fast things go through your colon. So, obviously vegetables and things like that are good for a multitude of reasons, but obviously have a lot of fiber in them. Hydration is also very important. So one of the things I recommend to just about every single person that comes into my office is starting a supplementation with a soluble fiber.

I like Metamucil personally, taking that with a large glass of water and then staying really hydrated throughout the day. And I think this is really nice, because I don't know about you, but I'm not always the best at eating vegetables every day or multiple times a day. And I think it's really tough if you sort of put all your chips in your diet because you might go on vacation and Eat poorly for a week and end up getting really constipated and having a lot of issues. But if you stay on the Metamucil every day, you're at least getting that bit of fiber in you because the goal is 25 to 35 grams of fiber a day.

Joey Wahler (Host): Interesting. And so you mentioned a supplement like Metamucil, what will that do for your stool and for your system?

Dr Brenna Houlihan: So Metamucil is a soluble fiber. It's just cilium husk. So there's many. Others that you can get as well. Obviously generic is fine as well. So cilium husk is usually the one I start with. At first other people really like Bena fiber, cuz there's less of a taste to it, but all of that will just allow your bowel movement to bulk together and also keep it on the softer side if you take it with liquid. So one of the things that's really interesting about Metamucil is it's great for loose stools or hard stools. If you're having hard stools, you wanna take it with a lot of water and that will soften your bowel movement kind of bulk it all together.

So it sort of all comes out at once, especially for people that have little bits of bowel movement multiple times a day that might have them just go one or two big bell movement instead. If you have loose stools, however though you can actually take it dry, such as a Metamucil cookie, and that can actually help almost not constipate you, but make your stool more formed. But again, bulk it and make it easier to come out. So I love it because it works for the whole spectrum.

So if there's somebody that kind of alternates between constipation and diarrhea, which is a form of IBS, They can kind of play around with how they take their Metamucil that day based on what's coming out of them.

Joey Wahler (Host): Gotcha. Now, one thing that was in the notes for our chat today, that I know you wanted to talk about that I find interesting to ask is. With increased cell phone activity. Many people now sit lingering longer on the throne, but why is that considered poor rectal health?

Dr Brenna Houlihan: The anus and not developing hemorroids and things like that is decreasing the amount of pressure we have in the anus. So that's why a buildup of stool, constipation, hard stools straining, all of that builds up the pressure, which can cause hemorrhoidal issues. So when you're on the toilet, the way that your bottom is actually sitting in there, your anus is a little bit lower, because you're sitting on the seat, and that increases your in interal pressure as well.

So when you have people sitting on there for 30, 45 minutes, calling it their office, they're really building up that inter anal pressure. And it also makes me worry. Their bowel movements. Aren't soft and easy because if you're having to sit on there for that long, you're probably straining some, your stool's probably hard. And then just in general, sitting on there increases that pressure. Let alone you're clearly not having quick, easy bowel movements.

Joey Wahler (Host): I think we've all walked into a public bathroom and heard something that tells us that someone's on their phone in some fashion, while also on the bowl. Doc, you mentioned 30 to 45 minutes. I didn't realize people were taking quite that long?

Dr Brenna Houlihan: Oh, yeah. I mean, I'll have patients say, well, it's my office, it's their hideaway, especially, people that have a lot going on busy jobs, busy family life, that will be their, period of time where they kind of sit there. I think men tend to be a little more guilty of it than women if I'm being honest, but yeah. People will really sit in there for a really long time.

Joey Wahler (Host): Men choosing those fantasy football lineups while they're doing their business, is that what's happening?

Dr Brenna Houlihan: Exactly, exactly. So, it's a good habit to break, just not doing that kind of decreases the amount of time on the toilet, which will really help as well.

Joey Wahler (Host): Now here's one thing I've been curious about, which is how about your body's positioning on the bowl? Namely, is it better to sit straight up with good posture, shoulders back, like you would in a regular seat or is it better to be hunched over?

Dr Brenna Houlihan: So, if you look at how people are on the Squatty potties, that you can kind of put around the toilet, it. For everyone's a little bit different, hunching is just never good for your posture. The sitting straight up isn't necessarily always a slight angle can sometimes actually help with your rectal angle. The Squatty potty that they sell actually helps align your rectum in the way that you are sort of born to defecate.

Joey Wahler (Host): Understood. So a few other things here now, bad rectal health can lead to hemorrhoids or anal fisures. What are those for those unfamiliar and how are they treated if you get them?

Dr Brenna Houlihan: So hemorrhoids, we all naturally have three columns of hemorrhoids. Every single person walking around this planet. They're just cushions of vessels in our anal canal. And we actually like them. They do help provide some control of our bowel movement. However with increased pressure, they can become engorged and these can, they can come out, they can bleed, they can itch and they can cause external hemorroids, that can be quite painful and people can feel them on the outside.

So all of that, there's different things we do usually just by having better stooling habits, we're able to get people's hemorrhoids to go back to sort of what we call it physiologic. So back to where they should be and not really have any other issue. There are other things we could do. Some office procedures such as banding, or obviously we can always cut them out as a surgical hemorrhoidectomy, but most of the time we really don't need to get there. If we kind of make some changes in the patient's day to day and their stooling habits, we're usually able to get really great results with just that.

In terms of fisures, fisures are basically just cuts that happen so it can happen. Which trauma to the area, which really can be just the form of a hard stool. So for a lot of people, if they have a big, hard stool that cuts the anus, most people will heal, but some people can become a chronic fisure and it will not heal. And that's when we usually start with medication as well. And then sometimes we have to move on to surgical intervention, either actually injecting Botox into the muscle, or sometimes cutting the muscle.

Joey Wahler (Host): So, actually I learned something there. I guess you're saying that if someone does have. Hemorrhoid condition, they refer to it as I've got hemorrhoids. It's kind of a misnomer because everybody has hemorrhoids. Just no matter what state they're in, right?

Dr Brenna Houlihan: Exactly. And the other thing I would also caution people of is everybody writes everything off as that's the tush is hemorroids so people can have fistulas. People can have fisures people can have absceses. All these different pathologies, or of course, scarier could have rectal mass or anal lesion and everything gets sort of chalked up to being hemorrhoids. So if you are having, blood in your stool, you are having significant symptoms. These are things that really should be worked up to make sure there isn't something going on that we can fix. Not everything that goes wrong down there is a hemotoid.

Joey Wahler (Host): the new colonoscopy recommendations are to start at age 45. And sometimes earlier, if you have a family history and if you've ever had blood from your anus, colonoscopy is something to discuss with your primary care provider.

How about cleanliness. Some people may feel they only need to wash their hands thoroughly after doing their business when they're in a public place, a public bathroom. But why is cleanliness important when you've just gone, regardless of where you are, even if you're home in your own bathroom by yourself?

Dr Brenna Houlihan: I mean, I'm kind of one of those wash my hands all the time kind of people. But obviously I work in a hospital. I think there's nothing better than keeping those hands clean. And I think the last couple years have definitely showed us how important that could be. In terms of cleaning your anus, though, that's also very important, and for some people, especially if they're having pain, it can be very hard for them to clean that area, especially with dry paper.

So things that can really help is, I don't know if you remember back in the beginning of the pandemic, when we all ran out of toilet paper, People were using something called Perry bottles, which are used a lot for postpartum women after they've given birth. And that you can sort of use as a makeshift Baday, because the Baday was also sold out at the beginning of the, of the pandemic, but using a B day or using a per bottle or wet wipes can be really helpful.

Especially if people are having a hard time cleaning due to discomfort, or if they do have a big hemroid hanging out there, it can be a little bit harder to clean.

Joey Wahler (Host): And if someone has had a bad experience on the bowl where there's been a lot of having to go a lot of having to wipe excessively, anything you can do to kind of soothe that area until it has a chance to get back to where it needs to be.

Dr Brenna Houlihan: Yeah. And one thing that's really helpful too, is sit baths, which quite literally. Sitting in a tub of warm water, and that can be either a physical tub or you can buy, sit baths that fit in your toilet, that you can get at any Walgreens or CVS. And doing that for 15 minutes, just in warm water, especially after a bowel movement will not only clean the area, but also kind of helps suit the area and tends to give a lot of symptomatic relief.

Joey Wahler (Host): So in closing here, doctor, I guess one main message. It seems you'd have for people listening is the toilet is a place to do your business, but not to conduct business. Right?

Dr Brenna Houlihan: Exactly. I couldn't have said it better myself.

Joey Wahler (Host): Well, thank you now, folks, we trust you're now familiar with things that are, number one, when it comes to doing number two, Dr. Brenna Houlihan, valuable information that let's face it, applies to all of us. Thanks so much again.

Dr Brenna Houlihan: Thank you so much.

And for more information about WakeMed General Surgery and Colon or Rectal surgery, please do visit wakemed.org. Again, that's wakemed.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to WakeMed Voices, a podcast from WakeMed Health and Hospitals in Raleigh, North Carolina, hoping your health is good health. I'm Joey Wahler.