The Scoop on Poop

When we started potty training Dylan, he had a hard time grasping the idea of pooping in a toilet. He gave one of those looks that said, “you want me to do what in that?!” After multiple failed attempts and numerous dirty, nasty underwear, we had success. Now, Dylan’s only issue with going poop in the toilet is the smell. When I peek in the bathroom in the middle of his “transaction” I see him holding his hand over his nose. And he still needs help with cleaning his butt, as there are still occasional dirty undies, but for the most part, he seems to be getting the hang of it.

The thing about Dylan is that he isn’t regular, but actually more of a constipated kid. He’ll usually go to the bathroom every three to four days. There was one time where he hadn’t pooped in five days and he had a downright poop emergency while I was in the middle of making the carline for his school. At the beginning of making the line, it started with a mild discomfort. By midline, he was crying, holding onto his butt, yelling “I have to go! I have to go, now!” I had to get out of the carline, jet to the closest store, run to bathroom with Dylan, where he nearly exploded. We ended up being late for school, but at least the disaster was averted. After this incident, I told him that he needed to give me more of a heads-up if he needed to go potty.

This reminded me of my patient, Jared.  He was an eighty-year old, heart disease, diabetic African American patient that started having problems with constipation for what felt like forever. Unlike Dylan, where he would ignore his poop until it was the last possible minute, Jared was obsessed with it. He would spend the entire visit with me, telling me when the last time he went, how many days would pass between poops, what he would eat that may have backed him up, what over the counter medications he would take to try to induce pooping. He would blame his medications for his constipation and start berating me for not taking him off of his blood pressure meds.

Constipation happens from time to time. Reasons vary from medical conditions, like hypothyroidism and diabetes, to medications, like antidepressants and blood pressure medications, to bad bathroom habits. When an underlying medical condition is the cause, the best thing to do is to try and minimize the medical condition by treating it. For example, if diabetes is causing a slow bowel transit time from secondary neurological complications, keep the diabetes controlled and eat a balanced diet that includes fiber to minimize its effects. If medications are to blame, perhaps switching to a different blood pressure medication may be the answer. If bowel habits are the issue, make potty time part of the routine. For some people, time is an issue and it’s never convenient to poop, particularly at work. If you never make the time, you will never have the time.

Other variables that can affect pooping can be related to laxative use, exercise frequency, and diet. People with chronic constipation have a tendency to over rely on laxatives, which can cause the bowels to shut down of intrinsic, spontaneous movements. Avoid use of them to only when absolutely necessary. Exercising to either extreme can cause problems. Movement is what triggers bowel inertia. Lack of any physical exercise will slow it. On the other extreme, too much exercise can cause fluid to be drawn out of your bowels, causing a hardening of the stool. Moderation is key for healthy bowel habits. Finally, diet is probably the largest variable in the poop conversation. A diet high in fat and lacking in fiber is the greatest risk. If you are taking any additional supplements, like whey protein or iron, these have a tendency to cause constipation as well. Taking ample water will also get your bowels going.

All sorts of bad things happen when constipation hits the fan. From hemorrhoids to rectal prolapse, it’s no joke. Poop is no laughing matter. You don’t have to take crap if constipation happens, but you have to put in the effort to change things. Talk to your doctor if it’s more than you can handle.

By: Dr. Juan Borja
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