Inside Colorectal Health with Surgeon Dr Hamish

Colorectal Health, Fissures, Haemorrhoids & Butt Play: Dr Hamish Urquhart Gets Deep Inside It

 

The Hole Conversation with Dr Hamish Urquhart (Sydney Colorectal Clinic, St Vincent’s Hospital)

If your butt could talk, it would probably say: “Stop ignoring me.”

In this episode of The Hole Conversation, Marc Lyons (founder of Happie Holl) sits down with Dr Hamish Urquhart, a colorectal surgeon at Sydney Colorectal Clinic and St Vincent’s Hospital in Sydney, to unpack what’s happening in the anus, rectum and colon — and why so many people suffer in silence when things go wrong.

We cover the big stuff (fissures, haemorrhoids, constipation, aftercare) and the very real stuff (why people present late, what foreign objects get stuck, and how a simple barrier balm can make a rough patch… less rough).

This is colorectal health — explained in a way that’s clinical, compassionate, and refreshingly un-awkward.

Who is Dr Hamish Urquhart? (And why he chose colorectal surgery)

Before Hamish became a colorectal surgeon, he started in engineering — and quickly realised it wasn’t the life. (Turns out, sitting in a warehouse of desks, working on a tiny component of a machine, is not everyone’s idea of a good time.)

What pulled him toward medicine was the human side: outcomes, people, care. And what pulled him toward colorectal health specifically was the sheer impact the gut has on the entire body — and the stigma that keeps people from getting help.

His mission is simple: de-stigmatise butt health and help people understand how the system works… and what happens when it doesn’t.

A simple breakdown: what the anus, rectum and colon actually do

Dr Urquhart explains the lower digestive system like the world’s most advanced plumbing (with better quality control than most modern apartment builds):

  • Small intestine: absorbs nutrients — tiny “gates” along the bowel take what your body needs from food.

  • Large intestine (colon): absorbs water and turns what’s left into stool.

  • Rectum: the storage zone (the bottom ~15cm) — your body’s “not yet” chamber.

  • Anal canal: the final ~4cm — where continence control lives (hello, sphincters).

Which leads to…

The sphincters: one you control, one you don’t (and why that matters)

The anus has an internal sphincter (smooth muscle, autonomic — runs in the background) and an external sphincter(skeletal muscle — the one you can consciously squeeze).

Hamish explains that this system is insanely sophisticated: it helps differentiate gas vs liquid vs stool, and it works even when you’re asleep.

It’s also why going too fast with anything anal (sex, toys, aggressive wiping, constipation) can cause problems. Because even if your external sphincter is on board… the internal one might need a warm-up.

But play tip from the surgeon: gentle, slow, gradual. Like stretching before a workout — because yes, your butt has muscles too.

Anal fissures: tiny tear, massive pain

If you’ve had an anal fissure, you don’t need a definition. You need a hug, a bath, and possibly a handwritten apology from your colon.

Dr Urquhart describes fissures as small tears in the anal canal that can begin as something minor — and then become debilitating. The pain can create fear of going to the toilet, triggering anxiety, avoidance, and a vicious cycle.

A key insight:
fissures often persist because the sphincter muscle spasms, which reduces blood flow, meaning the area can’t heal properly.

That’s why fissure treatment tends to focus on two things:

  1. Protecting the skin barrier

  2. Improving blood flow / relaxing spasm

Which is where aftercare comes in.

Barrier care (a.k.a. “fancy lip balm for your butt”)

Hamish talks about how patients started mentioning Happie Holl — and how he now recommends it as a non-medicated barrier balm, especially for people who can’t tolerate medicated ointments (some cause headaches or irritation).

If your butt is sore, irritated, fissured, post-surgery, or simply having a moment, this is your link:

👉 Sore Butt Soothing Balm: 

(Yes, it’s gentle. Yes, surgeons recommend it. Yes, it’s basically aftercare in a bottle.)

Skin tags, fistulas, abscesses: when fissures go from bad to worse

A chronic fissure can lead to a sentinel tag — a floppy bit of skin that forms from ongoing inflammation.

And if a fissure is left untreated long enough, complications can escalate:

  • Fistula: a tunnel connecting inside to outside

  • Abscess: infection/collection that can become severe

  • Horseshoe abscess: large abscess that can track around the anal canal (yes, it’s as nasty as it sounds)

Hamish is blunt about the big takeaway: presenting late is one of the biggest risk factors for serious complications.

Fissure vs haemorrhoids: how to tell the difference

This is the most useful “quick guide” in the whole episode:

  • Fissures: typically painful bleeding

  • Haemorrhoids: typically painless bleeding

Haemorrhoids are actually normal anatomy — they become “haemorrhoids” when the vascular cushions enlarge, bleed, itch, or prolapse.

And the best boring advice that actually works?

For haemorrhoids: fibre + less toilet time

Hamish references evidence that something as simple as extra fibre (think psyllium husk) can reduce recurrence significantly. Also: don’t camp on the toilet. Sitting too long encourages blood pooling and swelling.

Who does butt trouble affect?

Everyone. Every age. Every gender. Every orientation. Every “I swear I don’t even do butt stuff” person.

Hamish says he’s seen fissures from teens through to people in their 90s. And while his Darlinghurst patient base includes lots of men, the conditions themselves aren’t “a gay thing” or “a sex thing.” Constipation alone can do the job.

The real message: butt health is body health

This episode is exactly what The Hole Conversation exists to do: make butt talk normal, useful, and stigma-free.

If you take one thing from this:
your butt isn’t being dramatic — it’s communicating. And with the right care (medical advice + sensible aftercare), most issues can improve.

And if your butt needs a bit of support while it sorts itself out try the: Sore Butt Soothing Balm