After working in a busy family medicine practice for the last ten years, I see that one of the most common things we deal with is gastrointestinal (GI) issues: people experiencing on-and-off nausea (particularly with food), bloating or gassiness, and irregular stool patterns that are sometimes difficult to pass, or are liquid.
There’s no doubt that serious illnesses can present as GI issues, so we always have to be on the lookout for problems such as inflammatory bowel disease or, worse, cancer. Thankfully, these are not too common, and we are usually able to figure out what’s happening with a consistent approach to the problem while, most importantly, taking into account a patient’s age: as the likelihood of finding a serious or concerning diagnosis increases as we get older.
Something that experience has taught me, though, is that constipation is a cause of GI issues much more often than my training in medical school and residency led me to believe, and is harder to figure out than you’d think.
A person whose bowels have become slower over a long period, for instance, may have bowel movements every day but still have a good backlog of stool in their body that needs to come out to feel better. This could mean they experience nausea after eating, appetite falling off after starting to eat, excessive burping, or on-and-off cramping pain that can sometimes last hours or be severe.
My training also taught me that x-rays should not be necessary to confirm this person’s constipation, and that the diagnosis is made by talking to them and getting a story that sounds like constipation. But, if they are having bowel movements every day, it would be hard to convince this person that they’re constipated! If I look at an x-ray, however, and it looks like their entire large bowel is full of stool with almost no gas in it, I can show the patient the picture, and we can agree that perhaps there’s some element of constipation that might indeed be causing their symptoms.
If I didn’t use the x-ray to help sort this out, and if I didn’t suspect constipation based on their story, there’s not a whole lot else that would come about to help this person feel better. Their bloodwork would be normal, a CT scan could be normal, an abdominal ultrasound could be normal, and, eventually, the patient might get diagnosed with something like irritable bowel syndrome. There’s not a lot of effective treatment for that, and a lot of the treatment ends up being directed at the stress that the condition causes. I don’t know about you, but I would rather be constipated and have some hope of it getting better.
So, once we see the picture together, they get started on some simple and harmless laxative like PEG 3350. Kind of a scary name, I agree – polyethylene glycol – but this stuff does not absorb into your body. All it does is pull water into your bowel, from the top down, to help you clear your bowels better, and it’s best taken every day until you get relief (which means that once you see a lot of stool come out, you wouldn’t want to stop it totally, but instead cut back to half of what you took, to maintain things so that the symptoms don’t come back).
I find that a simple x-ray (just one picture of the abdomen) can help me confirm, or rule-out, constipation symptoms that can often be confusing. One of the most confusing constipation symptoms is loose diarrhea. This is surprisingly more common than you would think, again based on my experience in a busy family practice.
It turns out that if the bowel is full of stool, particularly for a long time, it can release water, but not just at the top where it’s needed to push things through. The body will generally push fluid into the bowel, and some of this may be down at the end of your colon near your rectum, possibly causing loose, watery, urgent stools. But this doesn’t mean you’re not constipated higher up.
Again, in these cases, I find it important to get one simple x-ray that I can look at with the patient, to confirm whether or not there’s a lot of stool in the colon. Because, certainly if someone has true diarrhea from some other cause, you shouldn’t see a whole colon full of stool. Without that picture, it sure is hard to convince people to take laxatives like PEG powder when they’re already experiencing loose, urgent, wet stools!
So, to summarize, bowel complaints like nausea and abdominal pain, and loose stools, can very much be associated with severe disease, so always reach out to our office to discuss what’s going on before taking matters into your own hands. However, if we have suggested to you after assessing you that there’s a possibility you might be constipated, keep an open mind. We might be wrong, but maybe there is an opportunity for you to feel better with a reasonably non-aggressive and non-serious intervention.
I finally want to mention that it is important to ask, “why are you constipated?” once we’ve confirmed that you are. Usually, something in your diet would cause this, like a lack of fiber or too much consumption of processed carbohydrates and foods that tend to gum up your bowels like nuts, ground flax, and bananas. Once we confirm the constipation diagnosis and get you feeling better with the prescribed laxatives and stool softeners, we should explore why you might be getting constipated, perhaps with the help of a dietitian.
And the last tip: don’t forget about walking regularly – it really helps your bowels move!
