A common obsession

I am sure that many people seeing the headline of this column will think it is referring to a mental disorder. For those who have faced the challenges of constipation, it sometimes can seem like a mental disorder – a fixation and obsessions with one’s “movements.”

Bowel movements often come into play, either as a primary or at least a secondary issue in a geriatric medical assessment. There is a tendency to ignore the problem of constipation, trivialize it or accept it as “normal with age.”

People try a whole range of medications and “natural” products to achieve the goal of an easy-to-expel, well-formed bowel movement.

The food industry has recognized the size of the market for such products and created the “regularity” industry. Thus products are sold by happy-faced models who pick up boxes of cereals with looks of satisfaction on their faces.

When I was a medical student in Dundee, Scotland, I sat through a masterful presentation by the famous physician Denis Burkett, who spent many years in Africa studying, among other subjects, the dietary habits and their effects on the bowel movements of indigenous peoples.

Burkett showed us a photograph of a white missionary standing next to a native, each behind his most recent bowel movement. That of the missionary was a few pellet-sized droppings and that of the native was a mound that went above his ankles. Burkett said, “The missionary produced this after an hour of pushing and squeezing; the local tribesman, in two minutes with no effort al all.” The class howled in laughter, but the message was not lost on any of us.

Most people have at some time experienced difficulty with regularity, perhaps following a prolonged trip, a change in diet or the use of certain medications that have constipating side effects.

Some people have, all their lives, been excessively concerned about their bowel movements. Some may have had a parent or grandparent who was fixated on regularity as a physiological necessity and who plied them with laxatives, sometimes in the form of daily castor oil – a potent bowel stimulant. Parents may have added milk of magnesia or senna products to their children’s diet on a daily basis.

As adults, these people often suffer from the unfulfilled quest for the satisfying bowel movement and go from one doctor to another, being tested and treated with multiple products, including herbal supplements and “natural” products. Patients have shown me the “magical natural tea” from Europe, which contains the potent laxative senna.

Some people are unaware that certain medications may cause constipation. They include medications used for urinary symptoms and mood disorders,  some over-the-counter medications for respiratory symptoms, and codeine products.

An inadequate amount of fibre (also called roughage) in our diets may also cause constipation. The main sources of fibre for Canadians are whole grain products, such as breads and cereals, and fruits and vegetables.

One of my favourite “tricks,” which I learned years ago and recommend to my patients with regularity problems, is to eat oatmeal (not the instant type) in the mornings. Add a few tablespoons of Red River cereal to it before cooking (it can be prepared in a microwave). Red River cereal contains flax, among other grains.

Oatmeal promotes regularity, and it tastes good, too, when fruit and/or yogurt are added to it. With some luck, it will work for you.

Dr. Michael Gordon is medical program director of palliative care at Baycrest and co-author with Bart Mindszenthy of Parenting Your Parents (Dundurn Press).