« 3 mistakes pain patients make | Home | please don’t drink the bleach. »
all about… [embarassing topic deleted]
By | July 26, 2010
here is a subject nobody wants to think about, until it’s personal:
constipation.
even hearing the word might make you flinch, or snicker, and for good reason. it’s from the latin com- “together” + -stipare “to cram”.
some say that the leading cause of constipation is “lofty expectations.” people do expect to “go” quickly and easily and on a somewhat regular basis, and can become quite alarmed if this is not the case.
i don’t know how reassuring it is, but i often review with folks some details about how the bowel works.
the only reason we get any benefit from food at all, really, is because of the friendly microorganisms that live in there (including normal bacteria, protozoa, and fungi). for example, about 1/3 of fecal matter by weight is made of “normal flora”, dead and alive.
at the digestive level, humans are less individuals than they are ecosystems. and all ecosystems have their ups and downs.
science!
babies are born with a sterile gut, and normal flora are quickly added by mother’s milk. addition of other kinds of food change the ecosystem by adding completely different bugs.
a diet full of simple carbohydrates – white flour, corn syrup – changes the ecosystem. a diet full of meat versus fish versus beans changes the ecosystem.
various germs may not make a human sick, but might change the ecosystem, so that some kinds of flora become more or less dominant. antibiotics, laxatives, and probiotics all affect the balance of power in the ecosystem. and all of these issues influence “regularity.”
joke! kidding!
the ecosystem is also subject to the vagarities of the “enteric nervous system.”
the guts have their own nervous system, with more nerve cells than the spinal cord has. it is connected to the central nervous system (brain and spinal cord) through the vagus nerve, but if the vagus nerve is cut, the enteric nervous system keeps working independently. sensory nerves in the guts carry information about the chemical environment and mechanical conditions (for example, stretching or cramping). motor nerves make the muscles work and manage secretions. the neurotransmitters that carry these data, fluctuate adaptively according to conditions.
researchers in this field write papers like “Influence of anxiety on visceral sensitivity” and “Inflammation and visceral hyperalgesia.” (hyperalgesia means abnormal pain sensitivity.) the ecosystem is affected by conscious and unconscious stresses.
the take-home message in most cases is, don’t worry about it, because it is always going to be subject to change without notice.
you might be a person who is prone to constipation, or you might be taken by surprise when you’ve never had it before. don’t worry about it! change is normal.
do what you can to help the healthy normal flora thrive, and to keep life easy for the nervous system of the guts – drink plenty of water, eat a healthy whole-foods diet, don’t binge or purge, get plenty of sleep and whole-body exercise, maintain healthy spiritual practices. don’t freak out if the ecosystem gets out of whack once in a while – just gently guide it back into balance as best you can.
just look how happy these folks are.
there are other cases, though, where constipation can be health- or life-threatening. it is not ordinary constipation, but is called severe constipation (technical term!).
it can occur
– when people take narcotic pain relievers (which sedate the bowel muscle)…
– or other constipating drugs (calcium channel blockers, “overactive bladder” drugs),
– have hormone problems (for example, thyroid disease)…
– or nerve damage (for example, due to diabetes, parkinson’s, or MS) that changes gut function,
– or have anatomical issues (surgery, fissures) that make it difficult to move the bowels.
(many people have more than one of these issues.)
these folks are at risk for severe constipation, with no bowel movements at all for days on end, and usually with belly pain, bloating (belly full of gas, without burping or farting it away), nausea, and loss of appetite. they often become dehydrated, and can easily end up in the hospital.
break “the laxative habit”… with a laxative
as you can tell, severe constipation is not the same as “occasional irregularity” or “sluggish metabolism,” and is not a problem of “lofty expectations.” it is a medical problem!
unfortunately, most doctors get no training in how to deal with severe constipation, and, when they don’t simply turf the question to a nurse, they may mistakenly treat it the same way they’d treat “lofty expectations”: recommending fiber, water, and exercise, or vaguely suggesting “a stool softener.” one exception is in palliative care, where they take constipation much more seriously, probably because so many of their patients use narcotic pain medicines, and also because their main business is improving comfort rather than curing disease.
i personally am rather aggressive with severe constipation (i learned about it from a palliative care doctor!). my motto is “treat it daily, and on day 3″ (see this handout for details).
i’ve been known to send patients to the hospital for this problem: an older man whose usual routine (which i had just found out about) of dis-impacting himself with a tiny spoon no longer worked, and who had severe pain (no b.m. for 3 days); a younger man on opioid pain medicines who became “blocked up” and could not stop vomiting (nothing for 10 days); an older lady who was very thin and stopped eating and drinking due to nausea caused by the problem (5 days)… and more. i am often consulted when the person has gone much longer than day 3! …which makes me sad.
phenolphthalein, “medically proven” carcinogenic! (no longer found in ex-lax)
i also have seen quite a few young children with this problem.
just like with adults, it usually starts with one episode of severe constipation from which the child never fully recovers. with kids, the bad news is that they are even less communicative about the issue than adults. the good news is that parents are usually very vigilant with their child’s long-term “aftercare” or re-training of the bowel to function normally… much more vigilant than they would be for themselves, unfortunately.
when a person of any age has an episode of severe constipation, the bowel muscle usually becomes stretched out and thin, and it takes time to shrink down and become thick and strong again. this is why, without proper aftercare, episodes can occur over and over again.
during recovery, people benefit greatly from a daily regimen of fiber, softener (e.g., prune juice!), and plenty of water, as well as a month of probiotics (the ecosystem is often pretty messed up from all the chemicals needed – natural or pharmaceutical – to clear the blockage), and special exercises to restore mobility and tone to the belly and pelvic floor. (see handout!)
my final advice: treat it daily, and on day 3!
dad vs. m.o.m.
Topics: Uncategorized | No Comments »
