Colorectal cancer is the third most common cancer diagnosed in women and men in the U.S. The good news: It's often highly treatable when found early through routine colorectal cancer screening.

But knowing screening saves lives doesn’t always make it easier to schedule a colonoscopy. Many people delay getting a colonoscopy because they feel embarrassed, don't know when to start screening or worry about what the procedure involves. Meanwhile, colorectal cancer is increasingly affecting adults younger than 50.

So what do you really need to know about your colon health? To separate fact from fiction, colorectal surgeon Dr. Sarah Fox of Novant Health Colon & Rectal Surgery - Autumn Hall in Wilmington answers common questions about how to improve your colon health, how to detect colorectal cancer symptoms and more — including the rear end-related questions you might be embarrassed (but shouldn’t be) to ask.

Is it normal to have hemorrhoids?

I get asked this question most often. Yes, hemorrhoids are normal — because we’re born with them. Many people don’t realize that hemorrhoids are part of our normal anatomy. People often assume hemorrhoids are to blame when they experience pain or bleeding, but something else is usually the cause. I spend a lot of time educating patients on what is normal back there.

If I don't have a family history of colorectal cancer, should I get screened anyway?

Yes. Everyone older than 45 should get screened, even if you have no family history of colorectal cancer. The one positive thing about colorectal cancer is that it is largely curable through surgery.

Is it normal to be nervous about a colonoscopy?

Yes, and it’s also common to be uncomfortable with it as a concept. Many people worry, “What if you find something?” There’s a lot of fear of the unknown, including the anesthesia, and the often-dreaded colonoscopy prep. There are patients who get nauseated and even vomit with the prep, because of the volume of liquid you have to drink. But for most people, prep is not a big deal, and a colonoscopy takes only a few minutes.

Is it normal to have colon polyps?

Polyps are very common. Patients who have polyps are more likely to have them again on a follow-up colonoscopy. That’s why if you have a history of polyps, we follow you a bit more closely and have you do a repeat colonoscopy in one to five years, depending on the number, size and type of polyps you have. (A polyp can be benign or precancerous. If your doctor finds a polyp during your colonoscopy, they remove it and send it to a lab to determine the type.)

Is it normal to be constipated?

Yes. Some people have lifelong constipation. Some have a bowel movement three times a day, and that’s normal for them. Other people only go once a week or even once every 10 days, and that’s normal for them.

Constipation is a red flag only if there’s a change in bowel-movement habits. If you go from being a regular pooper after your morning coffee to going only once a week, that’s alarming and should be addressed with your doctor. But if you’re someone who has gone once a week your whole life, that’s normal.

Is it normal for children to be constipated?

Constipation is super common in children. It’s most often a byproduct of not hydrating enough during the day. This is really common in kids, and something that we as parents should pay attention to and help our children manage. Hydrating will prevent an uncomfortable belly. Constipation can be miserable, so making sure your child is drinking enough fluids is the cornerstone of preventing it.

How often should I be pooping?

The answer is really variable. There are plenty of people who go three times a week, and that’s probably the most common. But we’re all different and it really depends on what you’re putting into your body.

Is it normal to sit on the toilet for 20 minutes?

No matter what age you are, you don’t want to spend long periods of time on the toilet. It’s not good for your bottom. Kids are distractible, so if they bring something like a book into the bathroom, they’re more likely to sit for a long period of time because they’re not focusing. If your child is in the bathroom for prolonged periods of time, ask them if they’re feeling constipated.

Is it normal to wipe and see blood on the toilet paper?

Blood is never normal. I cannot stress that enough. It is always something worth talking to your doctor about. There are different reasons for blood, and we always want to make sure we’re ruling out cancer.

What should I stop eating or drinking for better bowel movements?

The key to keeping your colon healthy is to avoid ultra-processed foods. Prepackaged foods have become increasingly processed to improve their shelf life, and tend to be high in sugar and low in fiber.

Fiber keeps your colon healthy. It also helps lower your blood pressure, blood sugar and cholesterol. The recommended daily amount of fiber for women is 30 to 35 grams a day, and 35 to 40 grams a day for men. Most Americans don’t get that in their diet.

Ultra-processed foods create an increased risk of developing colorectal cancer. So focus on whole food sources like plant-based and animal-based proteins to keep your colon healthy.