You have absolutely no control over peeing and/or pooping. A stroke or spinal cord problem—like bleeding, a tumor, or an injury—can wipe out the nerves to the bladder and intestines. This is a major emergency. Lie down and call 911.
* * *
Quick Consult
* * *
Can Your Bladder Explode from Holding Your Pee?
Let’s say you’re a frequent urinator for one of the reasons already listed. You’re seeing a new Bond movie in a packed theater, and your seat is in the dead center of your row. You have to pee, but Daniel Craig is about to take off his shirt, and you really don’t want to ask everyone in your row to miss this moment to let you through. You decide instead to just hold it in and concentrate on your popcorn. But wait—didn’t your mother warn you that holding your pee for too long would damage your bladder?
The normal adult bladder can hold half a liter of urine (about the size of a Snapple bottle). You’re usually not aware of your bladder until it’s halfway full; at that point, it lets you know that a bathroom trip should occur in the near future. If you try to hold on until the bladder reaches its maximum capacity, your bladder is going to . . . not explode. Instead, it will just ignore your protests and involuntarily empty itself into your pants. Be prepared to issue a profuse apology to the person in the next seat.
* * *
Diarrhea
EDITED BY BENJAMIN LEBWOHL, M.D., M.S.
Is there any symptom more socially awkward than diarrhea? That lingering fear that at any moment, you’ll have to flee the room, locate a toilet, and frantically hurl yourself into a stall before it’s too late? (What if you don’t even have time to wipe down the seat?!)
Do you think anyone has had diarrhea at their own wedding? While performing at a concert? In outer space? We like to ponder these questions. Maybe this explains why we never get invited to dinner parties anymore.
In the developed world, diarrhea is mostly just a nuisance. In other regions, however, diarrhea is actually a major cause of death in early childhood—not only because food contamination makes it so common, but because the lost fluids aren’t so easy to replace.
Strictly defined, diarrhea consists of an increase in the number of bowel movements to more than three per day, or an increase in the looseness of the stool. Diarrhea can be either acute (lasting up to two weeks) or chronic (lasting longer).
Acute diarrhea is usually due to infection (you just had to eat that gas station sushi) and improves within a few days. Bacteria or viruses promote the release of water from your intestines, filling your guts with liquid. They can also wipe out the cells that absorb food and water, which instead just pass directly through your system. Chronic diarrhea can also be from infection, though other possibilities include irritable bowel syndrome, inflammatory bowel disease, food intolerances, and medication side effects.
As long as you don’t have a fever or blood in your stool, you can take a drug like loperamide/Imodium to slow down the churn in your guts. If you have diarrhea for more than twenty-four hours, be sure to frequently sip replacement solutions (like Pedialyte) or broth. Water alone is inadequate, as your body needs salt to keep the fluid from ending up in your pee. Although sports drinks are better than nothing, they aren’t ideal because of their high sugar content.
If the runs keep coming, you’ve stopped bothering with pants, and you’re down to your last roll of toilet paper, for how much longer should you suffer before getting some professional help?
Take a Chill Pill
You get occasional diarrhea a few hours after meals. Keep a record of your symptoms and food intake, as you may spot some interesting patterns. Fructose, a major type of sugar found in fruit (and frequently added to many drinks), can sometimes be difficult to digest and cause diarrhea. Lactose, another major sugar found in milk, can also cause gas, bloating, and diarrhea in people missing the enzyme (lactase) needed to digest it. Try cutting back on milk products or try lactose-free milk or lactase supplements to see if your symptoms improve. Gluten, an oft-demonized protein found in wheat, rye, barley, and beer, wreaks absolute havoc on the guts of those with the autoimmune condition known as celiac disease, causing pain and diarrhea. Finally, spicy, fried, and fatty foods may cause diarrhea in those with sensitive tummies.
You keep your mouth busy with sugar-free gum or candies. The artificial sweeteners (like sorbitol, mannitol, and maltitol) in sugar-free gum and candies can give you a serious case of the runs. (For fun, search the internet for “sugar-free gummy bears and diarrhea.”)
You like your coffee black and frequent. Coffee is a superb laxative and the reason many people have their visit to the throne in the morning hours. If you have a long commute, you might want to drink your joe toward the end.
You’ve had diarrhea and stomach cramps for less than forty-eight hours. Viral gastroenteritis, also called stomach flu, is the major cause of sudden-onset diarrhea. Stomach upset and nausea are bonus features. The symptoms usually last for one or two days. If your symptoms aren’t improving after a few days, see your doctor.
You’ve been cruising the high seas. Large cruise ships sometimes fall victim to outbreaks of a specific cause of viral gastroenteritis known as norovirus. (It gives new meaning to the term “poop deck.”) Norovirus can also strike on land but truly thrives in closed, densely populated areas like ships. (Frat houses are another common location for outbreaks of norovirus—among other diseases.) Unfortunately, there’s nothing to do about this bug except drink plenty of fluids, wait for it to pass, and disinfect your hands often so you don’t spread it to others.
Make an Appointment
You have had a few days of abdominal cramps (with bonus points for recent travel outside of the country). If you have three or more days of consistent diarrhea and belly pain, you could have a bacterial infection that requires antibiotics. Streaks of blood in your diarrhea can be another sign of bacterial infection. (The major bugs that do this are E. coli, Shigella, and Salmonella.) Your doctor may prescribe antibiotics.
If these symptoms occur during foreign travel, doctors call it traveler’s diarrhea. You can reduce the risk of infection by washing your hands often, avoiding raw foods, and knowing the source of your water (and ice!). Many doctors prescribe antibiotics to bring on international trips in case you get diarrhea.
You have had weeks of intermittent diarrhea, along with belly pain that gets better once you’re off the toilet. You could have irritable bowel syndrome, or IBS, which can be associated with diarrhea, constipation, or both. This common condition, which affects one in ten people, causes a sensitive stomach that often feels better after the pipes have been cleared out. (In rare cases, a bowel movement actually makes the pain worse.) The diarrhea is related to food intake and should therefore occur only during the daytime, not waking you up at night unless you’re also sleep-eating. Your doctor may recommend dietary changes and/or medications to help your symptoms.
You’re hot and bothered. If you have chronic diarrhea alongside tremors, palpitations, weight loss, and the constant feeling that you’re too hot, you could have an overactive thyroid gland sending your metabolism and guts into overdrive. See your doctor for some bloodwork to check for this diagnosis.
You’re taking antibiotics or some other new medication. Medication-induced diarrhea is extremely common. The common culprits include antibiotics, NSAIDs (a class of pain medications that includes ibuprofen/Advil/Motrin and naproxen/Aleve/Naprosyn), colchicine/Colcrys (a gout medication), and metformin/Glucophage (a diabetes medication). If you think a medication is causing your diarrhea, speak to your doctor before stopping it. If you’re on antibiotics but your diarrhea continues for several additional days after stopping them, you should get tested for an infection called C. difficile, or C. diff. (Basically, the antibiotics kill all the good bacteria that normally fill the colon, and the nasty C. diff takes their place.)
Your diarrhea lasts for several days or weeks and is associated with weight loss, fever, joint pain, and/o
r mouth ulcers. You could have an autoimmune condition like celiac disease or inflammatory bowel disease (which includes ulcerative colitis and Crohn’s disease). In these conditions, your immune system gets confused and attacks the lining of your intestines, which become damaged and fail to properly absorb nutrients. As a result, more food just passes through your system and comes out as diarrhea. You will need a thorough workup, likely including blood tests, stool tests, and more advanced studies like a CT scan of your abdomen, an endoscopy, and/or a colonoscopy.
Get to the E.R.
Your diarrhea is red and bloody or black and tarry. An occasional drop or two of blood on your stool may just be from a small hemorrhoid. A more significant amount, however, can signal a life-threatening problem. You should get to the emergency room as soon as possible for a complete evaluation. (See here for more information about blood in your stool.)
You feel lightheaded and can’t keep any food or water inside. You’re probably really dehydrated from losing all that liquid into your diarrhea. Or worse, you could be bleeding into your guts somewhere. Weakness and a rapid heartbeat are further bad signs. If drinking a rehydration solution, like Pedialyte, doesn’t make you feel better, or you can’t keep anything down, get to the E.R. for an assessment and some intravenous fluids.
Constipation
EDITED BY BENJAMIN LEBWOHL, M.D., M.S.
Are you feeling full of it? More backed up than an L.A. freeway? Or perhaps you’ve sat on the throne for so long that you’re now reading this book for the third time? (Thanks for your attention, by the way.)
You may be one of the millions of Americans suffering from constipation. It’s a super common problem, especially among older adults, and is defined as having less than three bowel movements per week, lumpy/hard stool, great difficulty pushing out your stool, or the feeling you can’t fully unload no matter how much time or effort you spend in the loo. If your symptoms last for more than three months, your constipation is officially chronic.
If the mere diagnosis of constipation doesn’t bother you enough to take action, then consider this: just because you’re not releasing poop doesn’t mean your body has stopped making it. In fact, you’re probably sitting on a small mountain of your own feces right now—which, in addition to being gross, can also cause pain and long-term issues with your colon. (You’re welcome and do continue to enjoy your lunch!)
So how can you unload? Do you just need to stock up on yogurt that helps regulate the digestive system—whatever that means? Or do you need to take more drastic measures?
Take a Chill Pill
You, like your sense of humor, are quite dry. If you don’t drink enough liquids throughout the day and ignore your constant thirst, your colon is probably as dry as the Sahara, and your poop as hard as the pyramids. Drinking more fluids, particularly plain old water, will loosen up your stool and lubricate the path to the exit.
You have no idea what venti means. A tall cup of coffee helps increase the churn in your intestines and push stool through your system faster. Have an extra cup of joe with your breakfast . . . and just pray you don’t run into lots of traffic.
You’re on a low-fiber diet. Fiber refers to the complex, plant-derived carbs that your guts can’t break down or absorb. A high-fiber diet makes your stool soft and easy to push out. A low-fiber diet may increase constipation. Thus, you should try to increase your intake of high-fiber foods like fruits, vegetables, beans, nuts, and whole-wheat grains (as found in certain breads and pastas). At the same time, try to reduce your intake of low-fiber foods like white bread, plain pasta, cheese, and eggs.
You’re a couch potato. If you spend most of your day at a desk and most of your weekend on the couch, your colon is likely as limp as your quads. Try to walk at a decent clip for at least thirty minutes per day. In addition to mobilizing that pile of feces in your pelvis, you’ll do wonders for your heart and overall health.
You are an Executive Platinum Elite frequent flyer. Travel often leads to constipation—not only because the airplane toilet looks so forbidding (can you imagine running out of toilet paper in there?), but also because you’re out of your daily routine and breaking your customary diet. Unless, of course, you typically wake up to a hotel-style breakfast buffet in your own home. (If so, can we come over?) To keep yourself regular even while on the road, drink plenty of water and try not to stray too far from your usual mealtimes and foods. Some people also find it helpful to schedule daily sessions in the bathroom.
You feel a small child kicking your insides. Pregnancy increases levels of the hormone progesterone, which slows the movement of stool through the intestines. In addition, the iron in some prenatal vitamins can cause constipation. Your obstetrician may recommend dietary changes and/or stool softeners.
Your medications are slowing you down. Pills that can cause constipation include opioids (such as oxycodone, found in Percocet; hydrocodone, in Vicodin; and so on), blood pressure medications (specifically calcium channel blockers and diuretics), iron supplements, and some antidepressants and allergy medications.
Opioids are the biggest offenders by far. If you’re one of the few people with a good reason to be on long-term opioids, a medicine called methylnaltrexone/Relistor may help clear your pipes. Please don’t stop taking any medications without speaking to your doctor first.
* * *
Quick Consult
* * *
You’re Just Cleansing Your Wallet
The internet is teeming with magical cleanses and detoxes that claim to liberate your body from toxins and other evil spirits. We agree with the astronomer Neil deGrasse Tyson, who tweeted that when it comes to such diets, “the likelihood that a person uses the word ‘toxin’ correlates strongly with how much chemistry the person does not know.”
Indeed, while there are some legitimate toxins out there to avoid—for example, cigarette smoke—you won’t get much help from a week-long juice cleanse. There is no secret reservoir of toxins in your colon. There’s no reason to believe drinking a week’s worth of overpriced juice will offer any health benefits.
If you’re constipated, try following the advice in this chapter. If you feel tired and sluggish, try sleeping and exercising more. Otherwise, just stick with a diet that favors fruits and vegetables over meat and sugar. Most so-called toxins are imaginary villains being marketed to separate you from your hard-earned money.
* * *
Make an Appointment
You have significant belly pain that improves after defecation. You could have irritable bowel syndrome, or IBS, a common condition that causes abdominal pain along with frequent bouts of diarrhea, constipation, or both. The pain usually improves after a bowel movement. There’s no cure, but dietary changes and some prescription medications can help reduce your symptoms.
You’ve recently been feeling cold, tired, and bloated. Your thyroid gland, which regulates your metabolism, may not be churning out enough thyroid hormone. As a result, you may experience a wide range of symptoms, including constipation, weight gain, changes in hair and skin, fatigue, and the constant feeling that you’re cold. Your doctor can perform a simple blood test to check for this condition.
You have weight loss and/or drops of blood in your stool. It’s possible your constipation has dulled your appetite, resulting in weight loss, and that you’ve been straining on the toilet for so long that you’ve developed hemorrhoids, dilated blood vessels around the anus that sometimes bleed. On the other hand, both symptoms could also be explained by a tumor in your colon that is bleeding and blocking the flow of stool. You will likely need a colonoscopy, a procedure in which a doctor steers a small camera through your colon to look for abnormal growths.
Your constipation does not improve despite plenty of fluid intake, regular activity, and an increase in dietary fiber. You may still have run-of-the-mill constipation that is just tough to defeat. Your doctor may perform a basic evaluation to check for other causes of constipation. If no explanation can be found, you should
try using a medication to help purge your system, such as bisacodyl/Dulcolax or polyethylene glycol/MiraLAX. Work with your doctor to find the right combination.
Get to the E.R.
You have severe abdominal pain. You could have a bowel obstruction (blockage of the flow of stool through the intestines), appendicitis, or diverticulitis (infection in part of the large intestine). These can all stun the colon and cause acute constipation. In addition, chronic constipation increases the risk of developing these conditions. All are medical emergencies that require urgent attention.
Blood in Your Stool
Back in 2007, an enterprising young man became part of internet infamy with a stunt known as whole body flossing. He filmed a video of himself gradually swallowing an entire container of dental floss, slurping down an additional segment each hour, until one end came out in his poop . . . while still connected to the other end hanging out of his mouth.
Obviously, this is gross and dangerous, and no one should ever do it. Ever. Nonetheless, this stunt highlights the fact that the mouth is connected to the anus through a long, continuous tube that winds through your chest, abdomen, and pelvis.
This mouth-to-bum tube is known as the gastrointestinal (GI) tract. It includes the mouth, esophagus, stomach, small intestine, colon, and rectum. Its combined surface area is, according to one recent article, the size of a small studio apartment.
Am I Dying Page 16