In the middle of an otherwise complicated visit, an older woman reminded me of a very basic treatment for constipation that she discovered 40 years prior. It involves no medication, no special diet, and no unpleasant bowel regimen. It does, however, require a certain maturity of character. This technique demands assertiveness, social bravery, and a measure of self-assuredness that might be difficult to hone. In Clint Eastwood’s movie The Good, The Bad, and The Ugly, there is an iconic line that goes: “When you have to shoot, shoot. Don’t talk.”
So let it be with moving the bowels.
My patient told me that most of her life she was embarrassed to go to the bathroom in public places such as school, and then later work. She would hold her bowel movements against the tide of peristalsis telling her to relieve the pressure. She didn’t want the boys to know that she too defecated, or the popular girls to snicker at her as they seemingly excreted nothing but perfume and wavy hair.
By missing her body’s natural signals, by resisting the natural rhythm that wanted to move things along, she would back things up, creating the preconditions that would cause discomfort, immobility, and intestinal dysfunction later in the day as she struggled to make things happen on a socially convenient schedule. And once the train stayed off the tracks for too long, a pattern of dysfunction became normal.
This may have done lasting, permanent damage to her system.
The bowels move materials using coordinated, progressive contractions, moving like waves through smooth muscle. The assembly line moves in synchrony, and can be triggered to start going by the thought of food, ingestion of food, and circadian rhythms. The gastro-colic reflex is a well-known example. After receiving food in the stomach, the rest of the gastrointestinal system gets a cue to start moving things along. It is best to ride the wave.
As my patient matured, and cared less about what people might think about her retreating to the bathroom on cue, she began riding the natural waves, at work, at home, wherever. After completing an appropriate medical evaluation, colonoscopy, and gastrointestinal evaluation showing things were ok, she decided to get back to basics. A typical morning might be eating breakfast, drinking some coffee, and then 1 hour later like clock work getting up and heading to the toilet when the feeling began. Bosses, boyfriends, barbies be ignored.
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After a while a certain understanding was reconnected between her behaviors and her parasympathetic nervous system. A circadian rhythm also kicked in, and the whole show became a natural symphony. OK, so maybe not that beautiful, but I digress.
In addition to drinking plenty of water, exercising, getting fiber from fruits and vegetables, perhaps constipation for some people can be thought of as a social timing problem. Like brave actors who go out upon the stage under the bright lights and overcome their anxieties about being watched, scrutinized, and exposed, we should ourselves go with the natural flow, following our bodies’ rhythms and reflexes no matter how embarrassing.
I think this is particularly important for young girls, who are held to higher standards of propriety and appearance, encouraged to cloak themselves and their bodily realities more than boys. For boys, by contrast, pooping and flatulence can even be celebrated as a sort of social currency. But that is another topic for another post!
When you have to shoot, shoot. Don’t talk. Go to the bathroom. It might help more than you think.