What in the world is the public's fascination with bowel movements? I mean, I thought I would be spending my days helping people get healthier, not talking about their super-ability and/or inability of thier internal garbage disposal and sewer pipes to get rid of their space junk. You know, as a FP, #2 talk dominates probably more than any other problem on a regular (or irregular) basis, especially when you have a largely geriatric patient population. I thus wanted to share some insights, theories, and myths I have learned over the years.
Myth #1: Your pooh does not provide an indication of your overall health.
One of my patients, an elderly gentleman and prior cattle farmer, is somewhat obsessed with his excrement. On every visit, and at least every two weeks, he communicates with me in detail about his bowels. The details are so explicit that even I get a little nauseated and sickened and I try to move the conversation along to more pertinent details. Just to give you an idea, it takes him about 8 minutes to describe his garbage. Now yes, he does have medical conditions that affect his bowels on a daily basis, but he has been "going well" for years. Why does someone have such interest in their toilet orphan that they study it with such detail that it takes that long to describe it? I have a theory. As a cattleman, I believe that there is a long-held tradition and a secret book passed down from one cattleman to another that describes the characteristics of cow patties and how each individual characteristic of the patty correlates with the internal health of the cow (I believe, my friends, this is the true purpose and tradition of a well-known "cult" in the USA - the Masons). I have news for you friends. I do not believe this to be true of cattle, and even if it was, I don't think you can apply it to people, since we obviously don't have hooves or a tail. Your pooh has everything to do with what is going on outside your body, as it is essentially in a tube that runs through your body, not into it (if your pooh runs into your body, you really have a problem, and may truly be full of it). It does, however, tell you information about what you have eaten and how you digest what you've eaten, which if you don't remember that, then I think that is a more pressing problem to worry about and discuss with your doctor. Thus, it is a myth - your dookie says nothing about your internal health.
Myth #2: "When I eat, my food goes right through me."
Okay, what this complaint usually means is that when you eat certain foods, you have to go sit on the porcelain throne within a fixed amount of time. Some, however, believe that they eat and food traverses the 26 feet of bowel and makes its presence known for ejection within 10 minutes or so. This would equate to a rate of speed of 2.6 feet per minute through something with more twists and turns in it than Bill Clinton trying to define what "intercourse" really means. This speed is 1/2 the speed of the movement of the sloth, the slowest mammal on earth. In truth, what people actually experience is that the food actually causes the bowels to spasm and move your previous meals on down the shoot, causing the swoon for the bathroom. Don't believe me? Swallow gum or corn and then don't have either of those substances in your diet for a week. Keep an eye out for what you see and how quickly. If the thought of doing that is just too icky, swallow a coin, set a metal detector next to your commode, and when you go, turn it on and see how many days it is until it alarms. See, medicine doesn't always require expensive tests to figure out answers! My son can attest to this. His bowel transit time for a penny was about 70 hours. He's in training now, so we hope to cut his time by 35 hours or so he'll qualify for the 2016 olympics!!
Myth #3: "I don't know what it was like!!"
I hear this quote frequently from patients who come in complaining of bowel problems and in obtaining an accurate history, are asked to describe their doo-doo. Come on now, you can't tell me that you don't look at it, especially if you are a guy. Guys are extrodinarily proud of their accomplishments in the bathroom, as evidenced by their willingness to brag about it as teenagers, show it to their friends, leave it unflushed for others to admire in public restrooms, etc. Now I have never been in invited to the "inner circle", otherwise known as the women's restroom, when occupied, but if I were a fly on the wall, I would suspect women do the same thing, just in a more discrete manner. Want proof? Okay, well, I theorize that this is the reason women go to the restroom together at public places. I mean, do we really know why they go together? I think in women's code, that what it means to "freshen up." Proof number two is IBS. No, not the International Builders Show, not International Bible Society, not Internet Banking System, not Inflatable Boat, small. I'm talking Irritable Bowel Syndrome. This medical malady affects 25-55 million people in the US, and affects about 15-25% of women, twice as many as men. Now, to establish the diagnosis of IBS and exclude other diagnoses, a description of terd patterns and characteristics are required. The most common used scale to medically describe poo is the Bristol scale, which is detailed below.
Now if this medical condition affects more women than men, and requires the descriptive features as above to aid in that diagnosis, well, then, do I need any more proof? Don't tell us stories, we aren't stupid. Don't be ashamed, we are doctors. Don't feel guilty, it's not a sin. You can tell us you look at your pooh. I know some counselors to help you if you are in denial, and for those family members who plan an intervention for those in denial, check out "Frank's Doodie Denial Intervention Services" based out of Muskogee, OK (they throw in a free septic tank clean out!) and for a small fee we won't put your name in our book of "Poop Perousers and Excrement Experts: People who are Fecal Focussed."
So, that sums it up! This is a long blog, but I felt it was necessary. I don't have a fancy of kaka, nor do I enjoy talking about it, but as evidenced by my post, most Americans do (do)! It is an obsession. Why else would we have a scale to describe it, thousands of office visits a year to address it (resulting in lost productivity time in the bathroom, because I'm not following you in there), medicines to loosen it, soften it, firm it, slow it down, speed it up, make it bigger, make it smaller, help it make the turns easier and help it hurt less. In the words of Martin Luther King, Jr, "Our lives begin to end the day we become silent about things that matter." So if there is a problem, speak up! Stuck on the slow train? Speak up! Swelling like a toad with a 130 degree tempurature? Speak up! Hurting like a punch in the gut? Speak up! But I will tell you my friends, the solution is simple - just let it go, just let it go.