Well. How y'all doing?
There was a freeze, Texas is broken. Louisiana is back to "normal". Spring weather is peeping. College baseball started. The sun is still sort of out at 6pm. All things making me feel like I can breathe, and I'll be tan again soon. #priorities
My little old grumpy dog tore her ACL on Lundi Gras. The dogs I own prefer to have
emergencies or urgencies on holidays or at nighttime when the regular vet is closed and we are then obligated to go to the *most* expensive vet available. So we'll be doing dog surgery this month after a small beach trip. She loves the beach so much, I can't bring her there with a new surgery incision and pin her up in a baby pack and play. She needs to hobble and go in the dirty gulf water. Notice how I said *needs*. I love my dogs more than is probably considered normal and her tripod walk/run is heartbreaking and so cute.
As promised in my last blog, if you caught it, I will continue to write about things that are hard to talk about, or embarrassing, or confusing, and common.
And let me tell y'all what. I feel like the only 2 things I been seeing at my job are potential COVIDs and CONSTIPATION. Covid constipation is not a thing but I think it is. I just can't even tell y'all how many times a day people come into the urgent care complaining about abdominal pain and have "no idea why" and then I ask them when is the last time they pooped, and they say "I don't know." Or "it's been a minute" (if you are not from Louisiana, "it's been a minute" means it's been a long while). Or "2 weeks ago." Urgent Care providers: can I get a Amen??
WHAT.
If that happened to me ..2 WEEKS.. I would be one hell of an angry little person. Or I would maybe die.
Guys. "I only go once a week but that's normal for me" is NOT normal!
We are supposed to poop. Every single one of us. Even the most attractive amongst you. And if you disagree, LMK how attractive you are with hemorrhoids or a bowel obstruction and a nasogastric tube in your face because you're puking because you won't poo. I did not make that up. Story time: On 2 separate occasions, I have actually referred children to a GI doctor, after they did not heed my repeated warnings (threats) that if they did not begin to drink water and poop more often, they could end up in the hospital..........One guess.
They refused to drink water (it's gross) and they did, in fact, end up in the hospital, with little tubes up their noses because they developed bowel obstructions and had to be hospitalized to "get it all out".
Are you feeling inspired? I feel like I'm having that effect on you.
I absolutely had to steal this from Healthline.com:
"So, what exactly is poop??
Well, it’s mostly just undigested food, proteins, bacteria, salts, and other substances that are produced and released by intestines. Although everyone is unique in the size, shape, and smell of their poop, there are a few things that indicate a healthy (or unhealthy) poop." (1)
Hilarious. I knew I wasn't the only one to write about poo, but, Healthine is my go-to patient reference or at-a-glance resource, and they wrote a humorous article about a humorous blog I am also attempting to write. #mypeople
We're past due for pictures. This is too many words already. The Bristol Stool Chart!
Alright Alriiiight. Poop pictures.
Pretty self explanatory. Might seem stupid or weird or gross or silly or embarrassing, but it's actually been proven through research to correspond to measured "whole gut transit time". (2) Meaning, patients picking which picture matches their actual poops, was accurate when that same patient swallowed "radiopaque" (can be seen on an xray) capsules that measured how fast food passes through their systems! (3) Why does this matter?
Well, when you come to an urgent care, or your doctor or provider, complaining of abdominal pain, and we ask you (*most people - again - we are not thinking about people with things like IBS, Crohn's, etc) to point to a picture of what poop number you are most of the time... we can tell if there is, or isn't a problem there.
You wanna live at a 3 or 4.
You go to New Orleans for your bachelorette party or Mardi Gras and you're gonna be living first in that 6-7 zone then when it's back to reality on Monday, I bet you are in that 1-2 zone for a day or two. LOL Listen, I just know things.
Let me tell you where way too many people live, way too much of the time... between Types 1, 2 and 3.
Maybe you wear this Type 1-2 status as a badge of honor, because you think you are less gross because you "use it" less often. I'm here to tell you, that your future body is grabbing you by the shoulders and shaking you.
So, what is considered constipation?
One definition: "Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass." (4)
Another definition: "Constipation is often thought of as a decrease in frequency of stools and many people believe they are constipated if they do not have a bowel movement each day. This is not correct, as many persons have as few as three bowel movements each week and are healthy...constipation means too much straining with bowel movements, passage of small hard stools or a sense that they have not completely emptied their bowels. The American College of Gastroenterology defines constipation based upon symptoms including unsatisfactory defecation with either infrequent stools, difficult stool passage or both." Translation: you have to strain to force it out, it hurts, or you always feel like you never get it all out, or it doesn't happen often enough. Or any combination of these.
If you did any calculating... no common core required... 3 bowel movements per week, call it 1 in a day... is every other day..... So, as previously stated, you once-a-weekers ... gotta get it together!
So, what are the consequences of chronic (meaning long-term, consistent) constipation?
How does pooping happen?
It's "sophisticated" according to this journal article. Oo la la. Pinky up.
It involves..."rectal filling, awareness of rectal filling, and the ability to propel the stool and relax the pelvic floor muscles in a coordinated fashion." (6) And you thought you were uncoordinated because you couldn't hang in dance class or make contact with a T-ball.
Take that, Karen!! I poo every day!!!
The way this goes, is that you eat food, and drink drinks, and they start to break down into a liquid in your stomach. Nutrients, and quite a bit of water gets absorbed through your intestinal walls along the way, and what's left over (the definition of poop above) fills your "rectal vault." There are 2 sphincters (sfink-ters) that are like poop gate-keepers. The internal one is not under our conscious control, and the external one, is.
This is when your external sphincter is no longer in the fight. Mayday! Mayday!
So, step 1ish: "The colon receives approximately 1.5 L (that's 3 regular size bottles of water, of water) of liquid effluent (effluent meaning outgoing waste water from digestion) daily from the small intestine, with 200 mL to 400 mL (that's about 1/2 to a whole bottle of water) excreted in the stool. The functions of the colon are to absorb fluid and transport waste to the rectum, where it is expelled or stored until defecation is convenient". (6) Notice how water is like, really necessary for proper stool formation/bulking. If you don't drink enough water, you are chronically dehydrated, you sweat a lot, or you are sick, "stool that remains in the colon longer will become drier, which can lead to scybalation (pebble-like stools) and impaction if the stool becomes too large and hard to pass through the anal canal." (6) Ouch.
Step 2ish: Motility (meaning, movement). Your colon makes two moves. A squeeze and a push. "...two characteristic movements in the colon achieve the absorptive and transport functions (5). Repetitive nonpropulsive contractions (the "squeeze") move stool in a manner that aids in absorption and mixing of content. Larger, coordinated contractions (known as high-amplitude propagated contractions [HAPCs]) bring stool forward (the "push", sometimes called "peristalsis") in mass movements from the ascending colon down to the left colon (Figure 1)." Squeeze and push. The time this reflex/process is most active is early in the morning. No coincidence.
There are many chemicals, hormones, neurotransmitters, signals, however you like to think of them, that are involved in pooping. But it's basically: eat/drink, digest, absorb water and nutrients, squeeze and push, rectum becomes distended (stretches), send signals to brain AKA calls nature, and you either do it or ya don't.
SO many medications can affect bowel patterns. Many medications cause constipation. I bet you take some of them. There are people who are born with different genetic or anatomical (the way their bodies are made) issues that prevent them from having control over their sphincters. There are injuries (including spinal cord, gun shot wounds, etc..) and conditions (cancers, IBS/Chron's) that lead to incontinence. Incontinence means "unable to restrain natural discharges or evacuations of urine or feces." Meaning you lost voluntary control of urine/bladder/stool/external sphincter. (7)
Want to know what else can lead to incontinence? Chronic constipation. Wild guess. The exact term is called "Encopresis". Encopresis "sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing. Typically it happens when impacted stool collects in the colon and rectum: the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling (distention) of the bowels and loss of control over bowel movements."
The kids I referred to GI that got admitted to the hospital for their bowel obstructions? Yep. Both of them ended up being diagnosed with encopresis. SO, so frequently, nearly every time I work, I talk to a patient who tells me they are having liquid stools and unless I ask them, they aren't ever going to volunteer this information. We then learn that you can have "diarrhea around constipation." And the name of that is encopresis.
Other consequences of chronic constipation:
"Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
Stool that can't be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus."(8)
Story time! I am a nurse (practitioner, eye roll). But, I have a large group of nurse friends that worked on the 5th floor of a hospital I won't name with a surgeon I won't name. And, I won't put a picture of a rectal prolapse here (I'll let you Google those images at your leisure), but this particular surgeon had a certain affinity for ordering real-food interventions for rectal problems. True story: New Order: "Milk & Molasses gravity enema." "Sprinkle sugar/salt mixture onto rectal prolapse as needed." Exactly what you envision is what occurred. I did it. With my own hands and eyeballs. More than once. The cafeteria workers would walk across the street to the grocery store to buy bottles of molasses for us nurses to accomplish this... task. Can't make this shit up. See what I did there.
Ever talk to anybody that had a hemorrhoidectomy? 10/10 bet they don't recommend it.
These xrays are a drop in the bucket. So much gas. So much poop. Every single person complaining of abdominal pain with no idea (?!) why they are hurting. Every single person complaining of cramping, sharp pains, no appetite, nausea, sometimes vomiting. Also, a topic for another day, is that people somehow almost never relate what they EAT, to how their STOMACHS feel! Guys - food is medicine or poison - it will catch up with you in one way or another. Eating poorly doesn't always mean a heart attack or a stroke, or obesity or high cholesterol. The big bad warnings on public service announcements and commercials aren't the only consequences of a bad diet, lack of water and lack of exercise/activity. Living on boxed, frozen, fast, fried, greasy foods with little to no fruits, vegetables and water is absolutely going to catch up with you.
OKAYYYYY. Jeezus. How do I prevent it??
Stop holding it in! When you have to go - GO! Who cares if you're in public. The longer that stool sits in your rectal vault, the more water your body takes back from it, leading it to be dehydrated (dry) and hard(er) to get out - which can lead to pain, fissures (tears), straining, and loss of the body-brain signal that gives you the urge to go. Super common in kids, also happens in adults that are embarrassed to go in public or at work.
Stay hydrated! With w a t e r. Actual water. Teach your kids to drink water. Teach yourself to drink water. Water is not meant to entertain you, it's meant to keep you healthy, all your parts moving, the ultimate "detox", wrinkle plumper, and poop maker. The common "rule" is to drink your body weight in ounces of water per day. Every single source you look at on the internet will tell you something different. The sources and people I trust, go by the body weight in ounces rule, with a cut off at 90 oz per day for females and 150oz per day in males. HOWever... Every single person's needs are different. If you work inside vs. outside, how much you weigh, if your kidneys and heart work well or not, if you exercise and sweat, how much salt/sugar you eat, and on and on and on my friends. The *best* way (in my opinion and what I tell my patients, instead of assigning a number of ounces) is to look at the color of your pee. (9)
Eat fruits, vegetables, whole grain breads, beans. Foods that have a lot of fiber. Fiber absorbs cholesterol and keeps you regular. Raw fruits and vegetables are best, but cooked ones are great too. Not all vegetables and fruits are made equal, some have more fiber than others, but just start with what you like and build up from there.
Move! Walk, run, stand, jazzercise, lift weights, cross-train, walk your dog, walk your cat, do yoga, garden, ride a bike, cut the grass, paddle a kayak, vacuum and mop - whatever activity gets your heart rate up and gets you moving!
If you must - take medications to keep you going if you're doing "everything right", but also see a doctor. If you're doing "all the right things" and still having problems, you gotta go see somebody about it. Another point I'll make though, and I did write another blog about this - not all healthy foods work well for all people. Just because something is healthy doesn't mean you will digest and expel it well. Cauliflower, for example, tries to kill me each time I have it. Slowly. Cauliflower is very healthy. My body hates it. It hates me. It hurts me. I curse it. You can figure out if certain healthy foods don't agree with you by eating them by themselves with foods you are certain are easy for you, or by eliminating what you think may be causing you a problem. Google: FODMAPS. Also, I have a blog titled "That's Why There's Corn in Your Poop" if you'd like to read more about it...start there...here... there/here.
Constipation medications are not all the same!! If you are anti-water, and you take laxatives - ouch. There are several "categories" ("classes of drugs" is the medical saying) of over-the-counter medications that can be taken to prevent and relieve constipation. That is too lengthy a discussion for me to have here, because this is already getting too long - but if you want to read up on them - click here! Knowing what the type of medications are, is a way to empower yourself with knowledge about what you or a person you are taking care of needs. It'll help you pick from the dozens of medications that can be confusing when standing in the store (9)
Babies and children are different. They can't just take any medications. Babies get constipated because they don't move that much, they don't exercise, they don't drink water, sometimes because they are on formula, or mom changed her diet and the breast milk is different or sometimes for no reason at all other than they want to scream and cry and make you miserable, mom! Babies should not drink water! Do not feed babies, especially under the age of 6 months, water. If your baby is constipated - go to the pediatrician and talk about it. There are options like prune juice, apple juice, or a prescription medication called Lactulose that is safe even in newborns. I'm not writing specifics here because this blog is not giving medical advice or prescription directions, just informative! Children can and should drink water all the time. Remember - I am here for tough love, not cottony clouds of niceness - your kids only learn to like what they are given. Get them used to water, and they'll drink it. If they aren't given water, and it's all sugary stuff all the time - water will be a fight, and ain't nobody got time.
SO! How's that? Go out there and poop like a champ, champ. See ya next time!