A report out this week says that one in seven adults, and one in three children are affected by constipation at any one time. That's a massive number. The equivalent of 182 people a day get admitted to hospital as a result of Constipation; 113 of those are as emergencies.
As a GP, bowel problems is one of the commonest things I see. It's hugely under-estimated, and for the vast majority of patients, something that can be easily treated with the right advice and medication. So what's the problem? Well, we don't like talking about it. Women will happily chat about the gory details of childbirth and periods, but rarely strike up a conversation over lunch and a glass of Sauvignon blanc about the last time they had a poo. Men will happily talk about lumps, bumps, rashes and sexual activities, but sharing what happens when they try and go to the toilet isn't top of the list. Men rate it as the same embarrassment factor they feel when talking about problems getting an erection. It's not an easy subject to bring up. 20% of people won't tell anyone they are struggling to go to the toilet. Let's get over that now - this blog is about your bowels.
As a nation we are also rubbish at knowing when we are constipated. While most people know that not having a poo for two weeks and sitting for hours on end straining is constipation, there are thousands of people who don't realise that their tendency to fart, and have massive poos can equally be a sign.
If you're not sure whether you're constipated, giving figures like "It's normal to open your bowels anywhere between three times a day, and three times a week" might help. If you don't poo that often, but when you do it's soft, easy to pass, you don't get bloated, have any tummy pains or wind, and don't feel sore after going, then that is probably normal for you.
That's not to say your bowel is jumping for joy in there - almost all of us could do with more bulky fibre in our diets, and this only comes from things like fruit, vegetables and wholegrains. Just try eating your five a day for a week and most people will see the difference. Many of us are "relatively" constipated, but not enough that it bothers us. More water, and more healthy foods is something we all need.
At the other end of the spectrum are people who have suffered their whole lives. It's surprisingly common for me to see a patient with tummy symptoms, and when I ask when they last had a poo, they will look sheepish and say "10 days ago - but that's normal for me!" Having to use fingers or pens to get the poo to come out; taking handfuls of laxatives. Loads of people get constipated as children - it can start right from birth. Once a child gets constipated, all the muscles in their bowel get stretched by the big amounts of poo that back up in there. When they do have a good clear out, those muscles don't just twang back to normal size. They end up loose, like a deflated balloon and loose muscles don't squeeze well. Your gut struggles to move the food along, so it goes really slowly, and the cycle starts all over again. The bacteria that live in your gut are busy feasting on all that poo, and they make lots of gas which escapes at the least convenient times. Your tummy feels bloated all the time, you get uncomfortable cramps and generally feel fat and horrible.
Older patients and children particularly can suffer from constipation with overflow - where there is a big hard lump of poo in the lower bowel, and softer runny poo escapes past it. This is especially confusing as it can look like diarrhoea or incontinence, but the underlying problem is constipation.
Some patients just accept this is normal for them and never do anything. Others come in only when the huge amounts of laxatives they have been taking to get by, seem to stop working, or the cramping pain in their tummy becomes more severe.
I was once told by a colleague that he tells patients "However long you have been constipated for, that's how long it might take to get your bowel back to normal". For some patients there are years of damage to try and undo, and it's more complicated and long term than eating All-Bran every day. There are lots of medications to help, but they need to be used - often in combination -and in a way that gives the bowel the best chance of recovering. Getting back to the right shape and getting the muscles working well takes time. Ironically for some patients, too much fibre can make their symptoms worse. It's a balancing act. Exercise is really important too at getting the bowel to work properly. Other patients have an underlying problem with how their bowels talk to the rest of their body; the nerves aren't sending the right messages. There are special bowel clinics that help these patients, with a range of life-changing treatments and expert advice.
The message is simple - talk about it. Most of us would feel better for looking after our bowels more. Many of us just need a bit of advice from a pharmacist about the occasional laxative. But if you are struggling, please come and see your GP. Symptoms like weight loss, bleeding from your bottom, and a recent change in how often you poo particularly need checking. Constipation is so common, and randomly one of my favourite things to treat because I know you had to pluck up the courage to come in and I know it can be improved, however we end up doing that.
If you want more information have a look at these websites: http://www.nhs.uk/Conditions/Constipation/Pages/Introduction.aspxhttps://www.bladderandbowelfoundation.org/ and