So here’s the situation. Sam Jeffries, a contestant on “Bachelor in Paradise,” hasn’t had a bowel movement in nine days. Medics on the show told her they may need to take her to a hospital to deliver a “poo baby.”
Is this the show with the older gentleman?
No, this is “Bachelor in Paradise.” They are running that one simultaneously with “The Golden Bachelor.” This woman is in her 20s. What do you think might be going on?
There are a couple of things that could be happening. Run-of-the-mill constipation happens because people don't drink enough fluid and eat enough fiber and aren’t getting enough physical activity. Everyone gets constipated once in a while, and a lot of people get constipated when they travel, because their diet and fluid intake is disrupted. That's not unusual. Those people generally take laxatives, and they get better.
Bigger problems arise in patients who have what we call slow transit constipation, meaning that the colon doesn't work well. Those patients can go a week without bowel function, which is their normal bowel pattern. Normal bowel function is one to three bowel movements a day. Some people only go every few days. Once you get to six or seven days without a bowel movement, that's getting prolonged and extreme. Patients who have slow transit constipation take increasing doses of laxatives to try to have bowel function. There is a group of patients who have pelvic floor dysfunction which manifests as constipation, meaning that they can't evacuate stool well.
There are times when someone can get so impacted that they end up in the operating room. We disimpact them in the operating room because it's hard to do in the clinic. The procedure is done under anesthesia, and basically, as gross as it sounds, I put a couple of pairs of gloves on and get the stool out.
OK. So there's no actual surgery involved?
Well, it is an operation, but it's not cutting the bowel. It is like delivering a baby, in a way.
How dangerous is constipation like this if it goes untreated?
It can be very uncomfortable for patients. There are rare patients, usually elderly, who get so impacted that the pressure of the stool erodes through and causes a perforation of the colon.
Are there other steps, like enemas, that people typically try before getting to this step?
Yes. For instance, the pelvic floor patients, the ones who have difficulty with evacuation, will take laxatives to make the stool soft and enemas to help stimulate the evacuation.
But sometimes it doesn't work, obviously.
Yeah, sometimes it doesn’t work. If they come to the hospital, the ER has access to more aggressive types of enemas.
What would you typically advise to avoid something like this happening? You mentioned eating enough fiber and drinking enough water. Anything else?
The first step in managing constipation is fluid and fiber. Particularly in Denver, it's a really dry climate, and lots of people are active and outdoors. They need to be pretty aggressive about their fluid intake.
That's number one, but for patients with more significant transit problems, there are some over-the-counter laxatives they can take. A lot of them will end up seeing gastroenterology, and there are other prescription medications they can take. Some patients have such slow transit that none of the laxatives work, and we actually take the colon out. That's a very small group of patients who are pretty miserable, but it's life-altering — going from having no bowel movements and needing massive doses of laxatives to having several bowel movements a day. Those are usually the happiest patients we deal with.
As far as the disimpaction itself, is there any recovery involved with that afterward? Or is it back to normal life?
We tell them to stay on laxatives and suppositories to make sure they're back on track. There are some people who have persistent problems with evacuation, and sometimes physical therapy helps with that. Especially women, but sometimes men as well, can have really tight pelvic floors. We have pelvic floor physical therapists here.
Is there anything else about constipation like this that you think is important for people to know?
It's one of those things that people don't really want to talk about, but you probably should bring it up with your primary care gastroenterologist rather than self-medicating. Not all constipation is benign; it can be a manifestation of colon cancer and a colonoscopy may be recommended.
There is some benefit in taking magnesium supplements in patients who don't have kidney dysfunction or problems with their electrolytes. They'll take 400 milligrams of magnesium at night, which draws water into the gut and makes the bowel movements in the morning easier. People will take that to help them sleep at night and find that it really helps with their bowel function.
