with apologizes to Taro Gomi and Amanda Mayer Stinchecum

ToiletEverybody Poops (by Gomi & Stinchecum) has been a favorite children’s book for over ten years.  Kids love body functions; they find them hysterically funny.  Sadly, as we get older, many of us lose our sense of humor and find that we don’t want to talk about “it”. We consider the topic too private or too disgusting.  But honestly, our “daily constitution” is an important bodily function that we need to pay attention to.  Constipation causes a myriad of problems from pain, discomfort, bloating, depression, embarrassment, social isolation and more medical problems.  We are going to talk about it now and please forgive me if I should unintentionally offend any reader.

Years ago, when I was working in the hospital I developed a poster the nurses and doctors loved (and strategically placed it for bathroom reading).  It was titled “S#!t Happens” in big letters and then in smaller letters; “But when it doesn’t it is a medical emergency.” As a nurse, I know that people can die from constipation, I saw it firsthand.  While everyone is different and needn’t have a bowel movement (BM) every day, having one or two a week can be unhealthy.  So ask yourself this question: Have I not had a BM movement by the end of two days? If the answer is “yes” this needs to be addressed.

The best intervention for constipation is prevention.  Living with pain and taking medication to lessen that pain often means you are at risk for constipation. Medications that can cause constipation are opioids, antidepressants, anti-nausea drugs, iron, overactive bladder drugs and some NSAID’s. Other factors contribute to constipation, such as:

  • Moving less
  • Not drinking enough fluids (especially water)
  • Not eating enough fiber (fruits, vegetables, grains)
  • Experiencing pain while sitting on the commode
  • Lack of privacy.

Rule #1: Respect your body when it signals. Never resist the urge to have a bowel movement.  If you got to go, you got to go.

Rule #2: (as the lemurs in Madagascar sing) “MOVE IT”.  Simply moving around as much as you can; it stimulates the gut to work.

Rule #3: Drink fluids as much as you can (not alcohol and limit your caffeine—these dehydrate you).  If you get dry, your body will absorb more from your intestines and you end up with hard stool which won’t go anywhere.  Keep a glass or bottle of water within reach at all times.

Rule #4: Pay attention to your diet.  Eat more fiber-rich foods, like whole grains, fresh fruits and vegetables. Also you can eat prunes as a snack food.

Rule #5: Prevention: Before your start taking any pain medication or if you are noticing you are more irregular than normal, talk to your health care professional sooner rather than later. You may need (as we say in pain management), “some push and some mush” meaning a stool softener and a laxative. 

Example medications are:

  • Combination stool softener and laxatives:
    • Docusate (Colace: stool softener) + Senna (Senokot): a vegetable laxative
    • Senokot-S: laxative and stool softener all in one
  • Polyethylene glycol beads (Miralax)
  • Lactulose (Generlac) or sucralose may be suggested when other options are not working
  • Stronger laxatives may be recommended for a  short period or emergency use only
    • Milk of Magnesia,
    • Bisacodyl (Dulcolax)
    •  Magnesium Citrate
  • Methylnaltrexone ( Relistor ®); Lubiprostone  (Amitiza®)- prescription medication that may be suggested when non-prescription options fail.
Special Note: Bulking agents like Psyllium (Metamucil) can make things worse as they will sit in a sluggish colon and can form a “cement” block.

Sometimes home remedies are added benefits. Here is one that I would like to share called “The Recipe”:

  1. Equal parts bran cereal, applesauce, and prune juice (example: 1 cup of each)
  2. Mix into a container with a lid; store in the refrigerator
  3. Eat two tablespoons a day (preferable the same time each day)

As part of the pain plan that should be developed as one that best suits you, your constipation prevention plan should be geared in the same direction. What works for one person may be different from what works for another.

Remember that even though this can be an embarrassing problem for some, it is an important part of living a quality life.  After all, everybody poops.

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