BoomerGirl Diary

Dear Crabby:

Seems like ever since I became perimenopausal, I’ve been having a lot of trouble with my bowels. I used to be pretty regular, but now I can go for days without any real results. I DO NOT want to become one of those old ladies obsessed with her bowels! Please help.

Backed Up in Boston

Dear Back:

Constipation is often the (pardon the pun) butt of jokes, but in reality, it’s an unpleasant problem to have. You feel bloated, sluggish, and sometimes headachy. Cramping, difficulty with passing stools, and hemorrhoids can occur. And you are forced to purchase laxatives, prunes and other high-fiber substances from smug high-school cashiers who aren’t buying that “It’s for my mother” line anymore.

Despite the young attractive actors openly discussing the state of their bowels on TV commercials, constipation is a subject no one really likes to discuss. As Backed Up indicated, it is often associated with the elderly, and while it is true that some older people become fixated on their bowel function, this is likely due in part to poor management of chronic constipation. If you went a week without pooping, you might want to talk about it, too.

In reality, it is a problem that cuts across all age groups, resulting in 2.5 million health care visits yearly in the U.S. alone. Lots of money goes toward dealing with the problem, too. $230 million in direct health care costs are attributed to constipation. It’s so common that if one of my patients has stomach pain with no fever or nausea, I think of constipation first—and I’m often correct.

Constipation is somewhat loosely (ha-ha) defined—infrequent stools (less than 3 weekly), or hard, dry stools that are difficult to pass, or trouble completely emptying the bowel. This may be a short-term problem, due to medications, surgery, illness, or severe dietary changes, and resolve on its own; or it may go on for some time. When symptoms are present for more than 3-6 months, it’s usually considered a chronic problem. There is also a type of Irritable Bowel Syndrome (IBS) that is constipation-predominant, which is why it is important for your health care provider to take a thorough history.

We women once again win the lottery—constipation is twice as likely in women, and increases as we age. Hoo-frickin-ray. Interestingly, it is also more common in non-whites, those of lower economic and educational groups, and those with depression. A low-fiber diet is also a risk factor. Anecdotally, I do hear a lot of women complain that it became an issue right around menopause.

There are multiple causes, as with many health problems, but some include slow transit of waste through the colon, problems with pelvic floor structure (from childbirth, age, trauma), medications—especially pain medication, neurologic disorders, and metabolic diseases. It’s important to have a thorough exam to determine what might help.

There are lots of myths about constipation. A couple really popular ones are that people become dependent on laxatives and also that toxins are reabsorbed from the gut when a person is constipated. These ideas were refuted by a team of gastroenterologists. You can read about it here: http://www.webmd.com/ibs/news/20050104/constipation-myths-debunked

So once you get up your courage to talk about (as one nurse I know put it) “The vicious cycle of pooping/not pooping,” and make an appointment with your health care provider, you can do some things while you wait that might help:

• If you are dehydrated, drink plenty of fluids

• Eat a variety of fruits, vegetables, and whole grains. In other words, a higher fiber diet (this can make some cases worse, so go slowly and don’t get crazy)

• Eat foods known to help the problem, like prunes and flax seed (grind them first — the flax seeds, not the prunes)

• Exercise

• The yoga teachers say that lying on your back with knees pulled into chest for a few minutes daily, i.e. “the wind reliever pose” helps with normalizing bowel function. Many of us are already embarrassingly and publicly familiar with this pose.

• Start taking a probiotic supplement like acidophilus or eating yogurt daily to reintroduce healthy bacteria into the gut (“Colon, I’d like you to meet A.C. Dophilus. A.C., meet my colon.”)

• Track your bowel movements for your health care provider. There is a pictorial rating chart available. Really. You can see it here: http://en.wikipedia.org/wiki/Constipation ** (Also some crazy info about constipation in bears. But I digress.) I suggest simply logging (tee-hee) the date, amount (S, M, L) and consistency (hard, dry, normal, diarrhea). Don’t get fancy now. We as health care providers do not need to know, for example, that “it looked like a monkey tail.” And for pete’s sake, do NOT bring in a specimen unless specifically requested. Anyway, this will give us some concrete (again with the puns) information about your condition.

Your health care provider should take a thorough history, check out your chart, and do an exam. A colonoscopy might be in your future, too, depending on how things look, your age, etc. If you’ve always wanted photos of your colon, this could be your chance. If you have already been making the lifestyle changes listed above, you may be started on medication, which could include laxatives or newer remedies that work on the bowel’s biochemical balance. Either way, you’ll start feeling better, and YOU can kick up YOUR heels to James Brown’s “I Feel Good,” just like that happy, happy lady in the laxative commercial.

** P.S.: A framed copy of this poop chart makes an excellent party gift. Just ask my friend Bev.