MedSoup 0:04
Welcome to the MedSoup Podcast, where we talk about trending healthcare topics. I’m your host, Laura Schumacher, let’s dig in.

MedSoup  0:13
Today we are talking with Benng Chong of Paragon Colorectal Care. Paragon Colorectal Care is a division of Paragon Surgical in Concord, North Carolina. Dr. Chond completed his fellowship training in colon and rectal surgery at the Orlando Colon and Rectal Clinic in Orlando, Florida. He has a special interest in treating rectal cancer and anal rectal disorders. Dr. Chong is board certified and is experienced in both traditional and robotic surgical techniques. 

MedSoup 0:43
Over the past 50 years, Paragon Surgical Specialist has earned a reputation of excellence by combining technical proficiency, advanced surgical techniques, and compassionate care. Each day they strive to set the standard for general, thoracic, laparoscopic, vascular, and cancer surgery in the region. 

MedSoup 1:04
So, hi, Dr. Chong. Thanks for joining us today. 

Dr. Benny Chong 1:07
Hello.

MedSoup 1:08
So, we’re going to discuss understanding hemorrhoids and when to seek a medical professional. Dr. Chong’s with us today. Can you just explain the basics of what a hemorrhoid is? 

Dr. Benny Chong 1:21
Sure. Now, I will have you know that one of my mentors told me before, everyone is born with two arms, two legs, and three hemorrhoids. So, just because you notice it does not mean that it just started.  Hemorrhoids are actually...the easiest way to think about it is that they are a collection of blood vessels inside and stuff that we do throughout our lifetimes. Such as in females having babies sitting in the pelvis,  pushing and straining because of childbirth, constipation, pushing and straining on the toilet, heavy lifting, cross-fitters, all these things will lead to these balloons of blood vessels to inflate. They can never deflate to the same size. So, over time when you do things like this over 20, 30, 40 years, you notice complaints of hemorrhoids. 

MedSoup 2:07
So, cross-fitters?

Dr. Benny Chong 2:08
Heavy lifting, pushing and straining, and bearing down while you hold your breath, that increases intra-abdominal pressure and you notice a lot of pressure right at the stomach and also right at the level of the butt. 

MedSoup 2:22
Wow, so, I guess this is a pretty common condition?

Dr. Benny Chong 2:28
Very common. 

MedSoup 2:30
So, you know, you talked about who typically gets hemorrhoids, but are there other risk factors in terms of diet or other lifestyle factors that can contribute? 

Dr. Benny Chong 2:41
Yeah, one of the main things that I see in patients with a prolonged history of constipation or even diarrhea. In terms of constipation is because a lot of patients spend quite a bit of time sitting on a toilet, and they can’t evacuate, so they have to push and push. Again, this just leads to eventual prolapse or popping out of these hemorrhoids. 

MedSoup 3:04
So, how do you know that you have them? I mean, is it just discomfort, or what are some of the symptoms someone might experience? 

Dr. Benny Chong 3:12
One of the, actually more common symptoms is bleeding and protrusion of tissue. What a lot of patients report is they feel a lot of swelling in the backside after a bowel movement that subsides over time. It feels kind of squishy, if you will, after a bowel movement and then that area just kind of go away. 

MedSoup 3:35
So, how would they know when to call a doctor when it was serious enough to have something addressed? 

Dr. Benny Chong 3:42
So, definitely, if you have new-onset pain in the bottom, you should be concerned because there are many different things that can pose or that can present as pain. Such as something that’s benign as a tear because of constipation or benign like a hemorrhoid, but you can also have other things going on that may cause you pain. Then other symptoms that can present themselves with our, just a prolapsing or protrusion of tissue are alike. 

MedSoup 4:18
There could be another condition going, and this is just, you know, they’re experiencing symptoms where may or may not be hemorrhoids. It could be something else going on?

Dr. Benny Chong 4:30
Correct, so if you have any persistence of symptoms that don’t go away or new onset of symptoms that persist, then definitely seek help. 

MedSoup 4:43
Well, you see all of the commercials about, you know Preparation H and different home remedies that you can use but, is that kind of like false security for something like that?  Or should they, you know, anytime they have discomfort back there should they, you know, discuss, you know, have an initial discussion with a physician?

Dr. Benny Chong 5:05
Well, I definitely agree with trying over-the-counter approaches first because, again, if it’s something sinister it shouldn’t go away with over-the-counter treatments. But. If you don’t get any relief from something like that, then you should seek treatment. 

MedSoup 5:19
So, you’re saying that once a hemorrhoid develops, it may reduce, but it doesn’t necessarily go away, is that true?

Dr. Benny Chong 5:27
Yes, that is true. Some of your symptoms may improve over time, especially if you can modify the aggravating factors, but usually, because of the nature of the disease, it will eventually get worse. 

MedSoup 5:43
Now, what requires surgery, and what stage does it need to get to when someone actually needs to seek the help of a surgeon?

Dr. Benny Chong 5:52
So, actually hemorrhoid treatment is very personal. The exact same hemorrhoid may cause one person no issues at all while someone else may come in with the exact same hemorrhoid and say, “oh my God, cut these things up. I cannot stand them.” So, I counsel all of my patients. The surgery sucks. You will hate me. However, my recommendation for treatment will depend on how these things bother you. 

MedSoup 6:15
So, why are they going to hate it so much? Is it that uncomfortable, or what happens during and after surgery? 

Dr. Benny Chong
Yeah, hemorrhoid surgery is not a fun entity. Back in the day, you know, surgeons had to go in and just really remove these areas and repair them with sutures. Most patients who have undergone a hemorrhoidectomy will tell you they remember the pain. 

MedSoup 6:40
Oh, gosh. So, what type of surgery do you use now? 

Dr. Benny Chong 6:43
So, hemorrhoidectomy is definitely one way that we still practice to remove hemorrhoids, which is the tried and true method. And then, there are newer methods to treat prolapsing hemorrhoids such as a transitional hemorrhoidal or DRT realization, what is a method where I have a device at a hospital that I can identify blood flow to the hemorrhoids and tie these areas off and the same stitches carry outwards onto the hemorrhoid and secured upstream. The beauty of the procedure is there’s no cutting involved. However, it’s still a very effective hemorrhoid treatment, and then the lesser of all, this is a hemorrhoidal banding in the clinic.  Where we actually secure the hemorrhoidal bundle with a tight rubber band, and over time that area will scar down and shrivel op. 

MedSoup 7:36
How long would they have to deal with that before it scars and shrivels up?

Dr. Benny Chong 7:43
So, usually, it falls off within a week or so. However, during that time period, patients have minimal to no complaints. 

MedSoup 7:49
How do they continue to have bowel movements in recovery from the surgery? I mean, that’s going to be the uncomfortable part.

Dr. Benny Chong 7:57
It definitely is, and so again, the main thing that I stress to them is you need to change your dietary habits, which again is one of the more common causes of hemorrhoids in the first place. 

MedSoup 8:09
Okay, so, when they’re recovering they may have a special diet that helps creating more softer stool or would they use a stool softener or something like that?

Dr. Benny Chong 8:18
Yep. Stool softeners, plenty of fiber, plenty of water, and miralax if needed and really just avoiding constipation.

MedSoup 8:27
So, if someone has hemorrhoids and it’s not severe enough to where they feel like they need to have it addressed, but it’s uncomfortable during the day. So, some of the things that they can do or the phone remedies, over the counter medications, and dietary changes. 

Dr. Benny Chong 8:45
Yep, I would start with that first.

MedSoup 8:49
Just one other thing, so, someone has surgery. What are the chances that their hemorrhoids will return?

Dr. Benny Chong 8:56
So, if we can alter all the lifestyle habits that cause hemorrhoids in the first place, then it is highly unlikely they will return. However, from what I’ve seen is most patients will regress to the previous ways. And so hemorrhoids do return, but again, treatment is only offered depending on how the severity the symptoms are.

MedSoup 9:21
This is with pretty much any age, correct? I mean adults, correct? It could be young adults, older adults?

Dr. Benny Chong 9:28
Yep, sure is because of exercise nowadays, actually. Doing Crossfit and things like that. 

MedSoup 9:37
Is there a better exercise that somebody, who wants to live, like a decently healthy lifestyle and be aware of you know, the risk for colon cancers and hemorrhoids and other GI issues. What are some of the things that you’d recommend? 

Dr. Benny Chong 9:52
I think the main thing is, when you do heavy lifting, don’t hold your breath. Most people hold their breath and that’s when you get the increase in intra-abdominal pressure. But, if you’re able to isolate muscle groups, exhale deep when you’re performing heavy lifting, then it should limit the amount of damage or the amount of worsening hemorrhoids.  

MedSoup 10:17
That’s interesting because I don’t think most people think about that. They don’t think, “I am doing exercise. I am going to be healthy. I’m going to get hemorrhoids because of the way I’m holding my breath during Crossfit.” So, it’s interesting to know. When patients have issues going on their backside, how do you make them feel more comfortable about talk about these things because some people feel like it's taboo, but I mean, it’s so common, but they’re kind of afraid to talk about it? 

Dr. Benny Chong 10:48
A lot of times, I just bring them down and to a certain level and say you are not special, everyone has hemorrhoids, and to try to generalize everything. You know, tell them that I’ve seen this before, I’ve seen patients who are very uncomfortable, and I’m going to have a chaperone with me. You really let me know when is an uncomfortable point where you need me to stop the exam.  

MedSoup 11:17
And would someone self-refer to you, or do they need to be referred through their primary care physician?

Dr. Benny Chong 11:22
I think, for the most part, it’s going to be dependent on a patient’s insurance.

MedSoup 11: 28
Okay, so if they have questions about that, they can call the office and if they need to have a referral by their primary care, then Paragon can see that it gets done. 

Dr. Benny Chong 11:38
Yeah, we will.

MedSoup 11:40
Okay, great. Thank you!