I have ovarian cancer. That is one of symptoms I had. I was diagnosed with colon issue incorrectly for over a year. I don’t think most physicians think of ovarian cancer initially.hope this patient did just have constipation
It sounded to me like you are very thorough. I just mentioned it because ovarian cancer is so often misdiagnosed. I have lived with it for ten years, so I’m one of the fortunate ones.
I’m sorry to hear this, Linda. I do usually pass the idea of could this be ovarian cancer? through my mind, but common things being common, I usually wait until the usual remedies for constipation don’t work to go there. I will have multiple other constipation episodes because it’s a common and complicated problem. An esstory about ovarian cancer diagnosis would be a good idea because ovarian cancer can be such a tricky wicket.
One of my colleagues in residency asked one day, "When do elderly women become so obsessed with everyone's bowels?" I was late in my pregnancy at the time, so I answered, "Pregnancy." He laughed. So did I. I had more than one older woman who came in to discuss her and her husband's bowel habits. And that was before the days of Miralax. Ah, what fun!
I am a bit confused... Do you recommend your patients trial adding insoluble fibre (or soluble fibre), and if that doesn't work, try the other one??? Do you just suggest patients Google what food has what? Here PEG is the first line medical treatment, and kiwifruit is the favourite natural therapy - maybe 3 a day, though that seems a lot! My memory of the dose is probably incorrect. But kiwifruit is meant to be more effective than prunes. Incidentally, how about prune juice or kiwifruit juice? Anecdotally, they cause diarrhoea in the unaware consumer! (Kiwifruit juice seems to be a NZ thing, we don't have it here in my local supermarket.)
Incidentally, I have a 50ish relative who uses regular enemas, her constipation is so non responsive to any of the treatment remedies. Probably IBS-C. Any last line resorts? In hospital (for back surgery) she was given colonoscopy prep in order to get things moving (they wouldn't discharge her until she'd moved her bowels).
There was no mention of fat consumption here. Isnt dietary fat a component of hydration? Also magnesium is a good additive component to DIY electrolyte recipes. Magnesium helps move stool along too. Remember miralax? Last comment is: why would anyone be embarrassed to talk frankly with their MD, RN, PA or NP? If you need medical help it does no good to dance around the issue. Your docs are not over in a corner snickering because you cant poop regularly.
Thank you for reading and commenting, T.S. I couldn’t fit everything into this one post. Stay tuned for mentions of some of the other things you suggest. I did mention miralax, but I do not use brand names in my Substack, in general. I should probably put that on my About page which is sorely in need of an update.
As for your last comment, I don’t know the answer to that. You would have to ask all of the patients who appear to be embarrassed to talk frankly with me about this and many other topics. You are correct, we don’t spend much time in the corner snickering. We mostly only snicker in front of the vending machines, but I try not to mention brand names in my Substack.
It is possible and I thought about that and intended to put a mention of that in the article, but I think I overlooked it. I like your instincts, though. Take a look at the med list when something goes wrong. The typical anxiety medications cause diarrhea as a side effect, and certainly any medication can cause any side effect, but I would not figure that until I’d tried multiple other things bc it is not likely.
I understand. That wasn’t the point of the piece. It happened to me with a different kind of medication, and that’s why I had an immediate response. But you didn’t jump to conclusions and that is so important.
I was today years old when I learned that there’s a difference between the soluble/insoluble fiber solution. I’ve been told to consume fiber via psyllium husk and all it does is slow things down even further so I abandoned it. I thought all anti-constipation treatment was the same. Thank you for this post! And now I’m mad at my doc who never explained anything to do with digestion which is why I avoid doctors. I wish there was someone like you around.
Thanks, Ellen. I have all the time I need with patients in the Doctoring Unpacked universe (even though I do point out that I have patients needing to be seen in the articles). I never have to rush through a visit at Doctoring Unpacked (except for rhetorical purposes) so I can lay out the whole story.
If there were a doc around who was good at and interested in constipation, their clinic would always be overfull. Our guts and the whole mechanics of pooping are so complicated. Thirty years ago we thought we had it mostly figured out and now we are much more humble (and wiser).
I’ve had six years of Clare’s version of constipation following a COVID infection and then five years of long COVID. Thankfully I’m past most of my disabling symptoms, but the constipation persists. I’ve had a colonoscopy, I’ve seen two GI docs and a functional medicine doc, have tried all the fiber supplements, increased water, and I’m a vegetarian who eats well, so I get both types of fiber. Nothing has moved the needle. The second GI and the FMD both theorized that I had SIBO or IMO, but the standard treatments for those did not work on me either. One doc wanted to do that treatment for longer, but my insurance company wouldn’t approve it.
All this was really a lead up to say that in all these years, every time I’ve attempted to type out constipation on my iPhone, auto-fill would never suggest it as an option - even when I would get as far as ‘constipa’. Only in the last six months or so is it now an option that auto-fill gives (when you get to ‘constip’). Clare couldn’t say the word, and for years neither could Apple 🤦🏼♀️. The shame and stigma are pretty ridiculous. But give Clare a full year of this problem and she’ll start to have no problem saying it to anyone who’ll listen 😂
I’m sorry to hear that, Amy, but not surprised. Guts and the mechanics of actually passing stool are complicated and we’re just barely beginning to understand them. We used to understand it and it was simple, but now it turns out we don’t and it isn’t.
There are lots of other tests that can evaluate other aspects of your pooping like rectal manometry. The problem may have nothing to do with your actual stool and more to do with how the parts of your defecatory mechanism are working.
I have ovarian cancer. That is one of symptoms I had. I was diagnosed with colon issue incorrectly for over a year. I don’t think most physicians think of ovarian cancer initially.hope this patient did just have constipation
It sounded to me like you are very thorough. I just mentioned it because ovarian cancer is so often misdiagnosed. I have lived with it for ten years, so I’m one of the fortunate ones.
I’m sorry to hear this, Linda. I do usually pass the idea of could this be ovarian cancer? through my mind, but common things being common, I usually wait until the usual remedies for constipation don’t work to go there. I will have multiple other constipation episodes because it’s a common and complicated problem. An esstory about ovarian cancer diagnosis would be a good idea because ovarian cancer can be such a tricky wicket.
One of my colleagues in residency asked one day, "When do elderly women become so obsessed with everyone's bowels?" I was late in my pregnancy at the time, so I answered, "Pregnancy." He laughed. So did I. I had more than one older woman who came in to discuss her and her husband's bowel habits. And that was before the days of Miralax. Ah, what fun!
There’s three old British joke. “My wife thinks there are two topics foot for discussion:the royal family and her bowels.”
I am a bit confused... Do you recommend your patients trial adding insoluble fibre (or soluble fibre), and if that doesn't work, try the other one??? Do you just suggest patients Google what food has what? Here PEG is the first line medical treatment, and kiwifruit is the favourite natural therapy - maybe 3 a day, though that seems a lot! My memory of the dose is probably incorrect. But kiwifruit is meant to be more effective than prunes. Incidentally, how about prune juice or kiwifruit juice? Anecdotally, they cause diarrhoea in the unaware consumer! (Kiwifruit juice seems to be a NZ thing, we don't have it here in my local supermarket.)
Incidentally, I have a 50ish relative who uses regular enemas, her constipation is so non responsive to any of the treatment remedies. Probably IBS-C. Any last line resorts? In hospital (for back surgery) she was given colonoscopy prep in order to get things moving (they wouldn't discharge her until she'd moved her bowels).
There was no mention of fat consumption here. Isnt dietary fat a component of hydration? Also magnesium is a good additive component to DIY electrolyte recipes. Magnesium helps move stool along too. Remember miralax? Last comment is: why would anyone be embarrassed to talk frankly with their MD, RN, PA or NP? If you need medical help it does no good to dance around the issue. Your docs are not over in a corner snickering because you cant poop regularly.
I appreciate the response! Thank you
Thank you for reading and commenting, T.S. I couldn’t fit everything into this one post. Stay tuned for mentions of some of the other things you suggest. I did mention miralax, but I do not use brand names in my Substack, in general. I should probably put that on my About page which is sorely in need of an update.
As for your last comment, I don’t know the answer to that. You would have to ask all of the patients who appear to be embarrassed to talk frankly with me about this and many other topics. You are correct, we don’t spend much time in the corner snickering. We mostly only snicker in front of the vending machines, but I try not to mention brand names in my Substack.
Your punny comments always make me chuckle! Great article about a common issue
I’m glad to hear it. Thanks, Laura!
It’s not a possible side effect of the medication? That’s what I immediately jumped to.
It is possible and I thought about that and intended to put a mention of that in the article, but I think I overlooked it. I like your instincts, though. Take a look at the med list when something goes wrong. The typical anxiety medications cause diarrhea as a side effect, and certainly any medication can cause any side effect, but I would not figure that until I’d tried multiple other things bc it is not likely.
I understand. That wasn’t the point of the piece. It happened to me with a different kind of medication, and that’s why I had an immediate response. But you didn’t jump to conclusions and that is so important.
Yes I was too polite to mention it but this one surely did take a long time to come out....
Gond one!
To the tune of Sound of Silence...
Constipation my old friend,
It bothers me now and then...
Someone else can add the next two lines and pass it on... 😂
Because my movement is in doubt.
I try and try, and it won't come out.
Thank you for the adorable snoring video….I needed that.
So glad you liked it. It’s so relaxing to watch her sleep.
An ignoble topic to some. Fix it and you have a friend for life.
Yep. It’s fundamental to how we interact with the world.
I do look forward to reading these every Saturday morning.
I’m so glad. I appreciate your telling me, Hurd.
Love the title...lol!
Thanks, Mary Anne! My editor helped get the words just right.
I was today years old when I learned that there’s a difference between the soluble/insoluble fiber solution. I’ve been told to consume fiber via psyllium husk and all it does is slow things down even further so I abandoned it. I thought all anti-constipation treatment was the same. Thank you for this post! And now I’m mad at my doc who never explained anything to do with digestion which is why I avoid doctors. I wish there was someone like you around.
Thanks, Ellen. I have all the time I need with patients in the Doctoring Unpacked universe (even though I do point out that I have patients needing to be seen in the articles). I never have to rush through a visit at Doctoring Unpacked (except for rhetorical purposes) so I can lay out the whole story.
If there were a doc around who was good at and interested in constipation, their clinic would always be overfull. Our guts and the whole mechanics of pooping are so complicated. Thirty years ago we thought we had it mostly figured out and now we are much more humble (and wiser).
constipation is sometimes an early symptom of Parkinsons
Yes, it is! In fact, I think constipation is one of the worst symptoms of PD. I really need to write a PD article. Thank you for the push.
I’ve had six years of Clare’s version of constipation following a COVID infection and then five years of long COVID. Thankfully I’m past most of my disabling symptoms, but the constipation persists. I’ve had a colonoscopy, I’ve seen two GI docs and a functional medicine doc, have tried all the fiber supplements, increased water, and I’m a vegetarian who eats well, so I get both types of fiber. Nothing has moved the needle. The second GI and the FMD both theorized that I had SIBO or IMO, but the standard treatments for those did not work on me either. One doc wanted to do that treatment for longer, but my insurance company wouldn’t approve it.
All this was really a lead up to say that in all these years, every time I’ve attempted to type out constipation on my iPhone, auto-fill would never suggest it as an option - even when I would get as far as ‘constipa’. Only in the last six months or so is it now an option that auto-fill gives (when you get to ‘constip’). Clare couldn’t say the word, and for years neither could Apple 🤦🏼♀️. The shame and stigma are pretty ridiculous. But give Clare a full year of this problem and she’ll start to have no problem saying it to anyone who’ll listen 😂
I’m sorry to hear that, Amy, but not surprised. Guts and the mechanics of actually passing stool are complicated and we’re just barely beginning to understand them. We used to understand it and it was simple, but now it turns out we don’t and it isn’t.
There are lots of other tests that can evaluate other aspects of your pooping like rectal manometry. The problem may have nothing to do with your actual stool and more to do with how the parts of your defecatory mechanism are working.
That is a very telling story about autocomplete.
Funniest headline ever! Thank you for that.😄
You’ve got a sizable nugget to start with, ar ar.
Thank you, Micaela! I think I’m funny! I first planned to write about constipation…in fact…let me make this story into a note. Stay tuned.