Everyone Poops...but me.

It’s Valentine’s Day.  My boyfriend is cooking me dinner and scrumptious aromas fill my apartment.  I longingly wait to eat the delicious food currently filling my oven. However, my achy, bloated stomach is trying to convince me otherwise.

It’s been almost a week since I’ve had a bowel movement and I have no desire to eat.

"Maybe if I take a laxative I’ll be able to clear my system and eat!" I think.

Horrible idea.

An hour later, I found myself writhing in pain on the floor suffering through painful spasms, with contractions riveting throughout my stomach feeling as if I was about to give birth! I could feel a giant mass making its way through my system as my boyfriend, who is clueless, tried to provide me comfort. What was supposed to be a romantic evening turned into a date night between me and the toilet.

That night, I decided it was time for me to see a doctor about my chronic constipation issues that I had been suffering with for some time.

I have to admit; I was pretty embarrassed when my family physician asked me to go into excruciating detail regarding my symptoms. How long has this been going on? At least a year. How often do you have a bowel movement? No more than once a week. What texture is it when you do? Uhh, looks like rabbit poop. Do you feel yourself straining? Um, yes. Do you eat fiber? Yes. Do you drink water? Yes. Do you exercise? Yes.

As I came to find out, chronic constipation is more common than I originally thought.  It accounts for over 2.5 million physicians visits a year. So fellow non-poopers out there, you are not alone! There is no need to be embarrassed! Physicians hear about this all the time.

Now that we are past the embarrassment factor, what are your first steps if you are suffering from infrequent or frequent constipation?

A few steps you can try at home before making the decision to seek aide from your doctor are:

1. Add fiber supplements to your diet. Over the counter examples include:

MetamucilÒ or PerdiemÒ supplements/powder. Both include psyllium husk which is a natural fiber that adds weight to your stool and helps it move through the intestines. It also helps by increasing the amount of water in your stool to make it softer and easier to pass. These are both brand name products but if you’re a cheapskate like me, you can also purchase a generic product such as Equate Fiber Therapy. Just make sure the main ingredient is Psyllium Husk fiber.

CitrucelÒ powder. The main ingredient in this supplement is methylcellulose which is a derivative of cellulose, a main component in the fruit and vegetables we eat. Like cellulose, it is not absorbed by the intestines and as it moves through it absorbs lots of water to help make your stool more watery and soft.

2. Exercise

In general, exercise is great for your body in any way, shape, or form. It’s great for your heart health, body image, and overall makes you feel good about yourself! But guess what? It also helps with constipation! Exercise helps to stimulate the contractions of intestinal muscles which are the “squeezers” that help push stool through your intestines. By helping your intestines “squeeze”, exercise also helps speed up the rate of digestion and defecation. Therefore, stool spends less time in the digestive tract preventing water from being absorbed back into the body and gives you a looser stool.

3. Water

The elixir of life. Water, like exercise, is over all a key factor in maintaining your health. When we are dehydrated, our body tries to pull water from any available source. So, if we have stool in our intestines, you better bet water is being sucked right out. And what does this leave us with? Nice, hard, painful stool with no lube to pass through our gut. Ouch! 

So you’ve tried the above home remedies and you still seem to have some constipation issues, what now?

Having suffered with constipation symptoms for some time and having already tried the above myself, my physician and I decided to try me on a course of Lubiprostone or brand name AmitizaÒ. This is a prescription medication used to help draw water into the intestines and help speed up the movement of stool. It is most commonly used to treat idiopathic constipation and opioid-induced constipation. Fun fact, if you are currently taking any prescription pain/opioid medications this could potentially be the cause of your constipation! Talk with your prescribing physician if you are experiencing these symptoms and they might prescribe you a medication such as Lubiprostone to help relieve your symptoms.

Unlucky for me, I wasn’t taking any opioid pain medications so this wasn’t the source of my constipation. Unfortunately for me, after a few months of Lubiprostone I was still having difficulties going to the bathroom! Plus, I still didn’t know the cause of my symptoms.

What could be causing your symptoms? Well, constipation can be caused by a whole plethora of issues. Here are some reasons but not extensive:  

• Opioid use (as mentioned above)
• Iron supplements
• Antacids
• Depression
• Stress
• Diabetes mellitus
• Hypothyroidism
• Irritable Bowel Syndrome
• Anal fissures
• Pelvic floor dysfunction
• Colon cancer

Notice colon cancer positioned way at the bottom. If you can’t poop, do you assume its cancer? Not at all. Cancer is one of the less common causes of constipation.  However, it shouldn’t be overlooked. If you have other concerning symptoms, such as bloody stool or recent unexplained weight loss of over ten pounds, these are more concerning symptoms you should bring up with your physician.

But, why can’t I poop, doctor?

Upon returning to my doctor, the dreaded words “It’s time for a colonoscopy” came out of his mouth. A COLONOSCOPY?! You have got to be kidding me! I remember thinking to myself. Here I am 22 years old headed in with all the old people for a colonoscopy.

My physician and I decided to move forward with the procedure to help rule out possible pathological causes of my constipation such as colon cancer, polyps, fissures, etc. If you are suffering with chronic constipation and have already tried medications, it might be time to discuss having a colonoscopy with your physician too.

What is a colonoscopy? Essentially, a physician inserts a tiny camera -- yes -- through your poop hole, and looks at all areas of your inner rectum and large intestine, which are the last parts of your digestive system.

I learned that a colonoscopy isn’t as bad as everyone says (once you get past the preparatory cleanse that is).

Before you go in for your colonoscopy, you get to drink the prep.  You are given a large pitcher with white powder and instructed to fill up the pitcher with water and drink the entire substance. The white powdery substance is either polyethylene glycol 3350, Magnesium citrate or senna which are all essentially osmotic laxatives that pull water into the intestines helping you to pass your stool. 

Fun fact: you can only eat/drink clear substances 24 hours prior to your procedure. What are “clear substances”? Essentially chicken broth, yellow/green/orange Gatorade, yellow/green/orange Jell-O, or water. Why no red Gatorade or Jell-O you ask? Red looks like blood on the camera!

Clearing out your intestines ahead of time will give the physician performing the procedure a much nicer view of your intestines, without any hindering poop in the way.  I had to do 2 days of the preparatory cleanse, rather than the standard 1 and got to enjoy yummy Jell-O, chicken broth, and water for 48 hours! This is standard for anyone with a complaint of constipation, they want to make sure you are squeaky clean!

Tips and tricks for beating the hunger and chugging the prep cleanse like a champ:

• Buy yellow/orange/green Gatorade powder or lemonade powder and add it to your drink. This makes it taste so much better!
• Invest in a heating pad. If you have an experience similar to mine, you will have some cramps!
• You will be hungry and you will crave chicken broth, so stock up!
• Don’t plan any events for the day of your prep cleanse, don’t even try and go to the store. You will have to run to the bathroom and I guarantee you’ll be there for a while.

Once you make it past the cleanse, the procedure itself is a breeze. In the waiting room you’ll see lots of patients, mostly over 50 years old, because as you know colonoscopies are highly recommended as a general screening procedure after the age of 50! Unless of course, you have constipation, then you’re lucky and get one before you're 50 years old.

They take you back, get vitals, place you in a gown, and then place an intravenous line to give you some sedating medications to keep you asleep throughout the procedure. Then its lights, camera, ACTION! You’re a movie star for around 30 minutes to an hour! Enjoy your fame.

The real fun comes after the procedure. As you’re slowly waking up you are told that during the procedure they used a slow stream of air to gently open the folded colon. Guess how all this air has to come out? You guessed it, prepare to play your trombone loud and proud!

During the procedure if the physician sees anything abnormal they may take a biopsy for further studies, but they will come discuss all findings with you after.

So what did they find on me? A whopping nothing. Which was a disappointment, but also a relief at the same time. Nothing pathological was found.  My diagnosis is idiopathic chronic constipation which means that nothing in particular is causing the constipation. Kind of an unsatisfactory diagnosis, but hey it could be worse. Idiopathic constipation is actually very common.  Like I said earlier, some people just don’t poop.  

After this procedure, I tried a new over the counter osmotic laxative called MiraLAXÒ. Lucky for me, this has actually been helping. Generally, MiraLAXÒ is used to help relieve intermittent constipation, but I have been taking it every day for the past year and it has helped tremendously. Because it’s not recommended to take daily, speak with your physician before considering this method of treatment.

All in all, pooping is a fact of life. We all do or try to do it. Constipation is not something to be embarrassed about it. Doctors hear about it all the time and we even deal with it ourselves (yours truly as a perfect example)! So, if you’re suffering, don’t continue to be miserable. Seek treatment, I promise you it will be worth it!

Remember, everyone poops... and so can you!

Jessica Lancaster

Osteopathic Medical Student - 2nd Year (OMS II)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences