Chapter 1: The Secret He Can’t Ignore

His name’s Mitchell—a 21-year-old college senior at a state school somewhere in the Midwest.

You could tell right away he was the type of college student who’d rather be anywhere but a hospital. He wore a faded hoodie with his school’s logo—Go Wildcats!—and kept glancing at his phone, like he was hoping for a last-minute excuse to bail. Honestly, who could blame him? But he stayed. That said something.

So, with summer break giving him some free time, he finally worked up the nerve to come to the hospital and finally face the problem that had been bugging him for a while. At the time, I was doing my clinical rotation in the colorectal surgery department, and he came in to see us.

Honestly, summer break is when a lot of students finally tackle the stuff they’ve been putting off. Mitchell looked a little sheepish, but determined. Like he’d made a pact with himself back in May and was sticking to it, no matter how awkward it felt to be here. He seemed to steel himself for what was coming—maybe he’d promised himself he wouldn’t chicken out this time.

Hemorrhoids.

He blurted it out with a little half-laugh, trying to make it less embarrassing, but his eyes darted away. You could tell he was mortified—honestly, who wouldn’t be? That’s pretty common—nobody wants to talk about this stuff, especially not at 21.

He told me that ever since he started college, he wasn’t sure if it was from sitting too long gaming or something else. He started feeling discomfort back there. He’d get constipated a lot, sometimes saw blood in the toilet—sometimes just a little, sometimes a lot. Every now and then, his butt felt weirdly damp and itchy, and there was pain too.

He shrugged, looking a bit defensive. "I mean, maybe it’s all the late nights gaming with my roommates, or maybe just not eating right. Sometimes I’d sit for hours. Anyway, the first time I saw blood, I kinda freaked out, but then I just... ignored it," he admitted.

At first, he did some Googling. Tried herbal sitz baths, warm soaks, ointments, all that stuff. But nothing really worked.

He even joked about trying some old Reddit remedies. "Some guy said witch hazel was the secret. Spoiler: it wasn’t. I think I tried every weird trick the internet had."

Later, he bought some over-the-counter creams. They helped a bit at first, but not completely. He still had constipation, bleeding, pain, and that weird damp feeling. It was making him miserable.

He said the creams gave him maybe a week of relief, but then the symptoms would creep back. "It’s like, every time I thought I had it beat, it’d come roaring back. You can’t exactly talk about this stuff with your friends, you know?"

Six months ago, he saw a doctor—not at our hospital. That doctor told him he had both internal and external hemorrhoids—what doctors call mixed hemorrhoids—and they were pretty severe. Surgery was recommended.

He described the other clinic—a little urgent care on the edge of town, with magazines from 2012 and a waiting room that reeked of Lysol. The doctor didn’t sugarcoat it. "He basically said, 'You need surgery.' I didn’t even know that was a thing for hemorrhoids."

At the time, he didn’t go for it. First, because he was short on cash and worried about the cost. Second, he figured it was just a minor case of hemorrhoids—he’d never heard of anyone actually needing surgery for them—so he kept toughing it out, popped some meds, and said no to the operation.

He explained, "My insurance has a crazy high deductible, and honestly, I figured I could just power through. I mean, nobody I know has ever had surgery for this stuff. I thought maybe it’d just go away on its own." Honestly, I couldn’t blame him for hoping.

But this time, it was obvious—things just weren’t getting better.

He said the last straw was waking up in the middle of the night with this wet, throbbing pain, and seeing bright red in the toilet again. "I just couldn’t pretend it was nothing anymore."

“A few days ago, the bleeding was really bad. The toilet water was bright red several times. And the dampness, pain, and this weird sensation like something was there were all really obvious. Honestly, it felt like my butt didn’t even belong to me anymore. If it wasn’t mine, that’d be great. This useless thing just keeps causing me trouble,” he said, dead serious.

He tried to make a joke out of it, but you could hear the frustration in his voice. "Like, if I could just trade in my butt for a new one, I’d do it in a heartbeat. I’m so over this."

So, he came to our hospital’s colorectal surgery department, ready to face this embarrassing problem head-on, once and for all.

He looked me straight in the eye and said, "Let’s just get this over with. I’m tired of living like this."

“Do your parents know?” I asked him.

After all, he was still a student—no job yet.

He hesitated, glancing down at his hands. "No way. I haven’t told them anything. I just... I don’t want them to freak out."

He said he hadn’t told his folks—didn’t want them to worry.

He added, "They already think college is stressful enough. If I called home and said, 'Hey, I need butt surgery,' my mom would lose her mind."

I gave him a reality check: “Your mixed hemorrhoids are pretty severe, and surgery is definitely an option. But don’t think that surgery is a magic fix. If you don’t take care of yourself—balance work and rest, get some exercise, keep things regular, and avoid constipation—the hemorrhoids can come back. Getting them removed doesn’t mean they’re gone for good.”

I tried to keep it real with him. "Look, surgery can help a lot, but you’ve gotta change some habits, too. More fiber, less sitting for hours, maybe get up and walk around between games, you know?"

That made him anxious again. "Oh man, I thought once they were gone, that’d be it."