Coloproctology (COLON CANCER + BUTT FUN) with Carmen Fong

What It Covers

Colorectal surgeon Dr. Carmen Fong covers colon cancer screening, hemorrhoid treatment, constipation causes, anal health, and butt-related sexual health with Ologies host Alie Ward. The episode spans colonoscopy timing, fiber intake targets, bidet use, IBS versus IBD distinctions, pregnancy complications, and why rectal bleeding at any age warrants medical evaluation.

Key Questions Answered

• •Colon cancer screening age: The recommended colonoscopy screening age dropped from 50 to 45, but people in their 20s and 30s are increasingly diagnosed — the youngest Dr. Fong has treated was 28. Anyone with symptoms like rectal bleeding, unintentional weight loss, black tarry stools, or abdominal bloating should pursue a diagnostic colonoscopy immediately regardless of age, as insurance covers symptom-driven procedures even before screening age.
• •Hemorrhoid treatment hierarchy: Skip Preparation H — it thins skin over time and worsens symptoms with repeated use. Instead, request a compound ointment from a colorectal surgeon containing nitroglycerin or calcium channel blockers like diltiazem, lidocaine, and optionally hydrocortisone. These relax the anal sphincter spasm that worsens hemorrhoids. For persistent bleeding hemorrhoids, rubber band ligation takes roughly 20 seconds, is painless, and permanently eliminates the targeted blood vessel.
• •Fiber and hydration protocol: Target 25–35 grams of fiber daily combining both soluble fiber (psyllium husk, beans, oats) and insoluble fiber (kale, spinach). Psyllium husk via Metamucil is the most evidence-backed supplement. Always chase fiber with two full glasses of water — fiber without adequate hydration compacts into concrete-like stool. Increase fiber intake gradually by 5 grams per week to avoid bloating, gas, and potential fecal impaction from sudden high-fiber diets.
• •Rectal bleeding response protocol: Roughly 89–90% of rectal bleeding originates from hemorrhoids or other benign anorectal conditions. However, any unprovoked bleeding, bleeding lasting beyond two to three days, or recurring bleeding warrants evaluation by a colorectal surgeon or GI doctor. Painless bleeding typically signals internal hemorrhoids; painful bleeding with a sharp paper-cut sensation indicates an anal fissure. Botox injections into the internal anal sphincter resolve fissures 85–88% of the time and are covered by insurance.
• •Colon cancer risk reduction: Lifestyle factors meaningfully affect colorectal cancer risk. Eat vegetables with every meal, maintain 25–35 grams of daily fiber, hydrate consistently, and exercise 20–30 minutes daily to stimulate colon motility. Avoid ultra-processed foods, sugary drinks, and processed meats. Fried and chargrilled meats contain carcinogens that damage colon cells. Genetic factors like Lynch syndrome and demographic factors — colon cancer rates are higher in Black Americans and Indigenous populations — also elevate risk and may justify earlier screening.
• •Bidet and anal hygiene protocol: Bidets reduce hemorrhoids, fissures, and skin tags caused by repeated wiping. Use clean water supply bidets with the spray directed at the exterior only — not inserted — then pat dry with toilet paper. Avoid soap directly on the anus itself, as it strips the natural microbiome and causes pruritus ani (chronic itching). Soap on the surrounding crack and cheeks is appropriate. Colon hydrotherapy done frequently flushes beneficial gut bacteria and risks mucosal tears or perforation; occasional use carries lower risk.