How Constipation Became Taboo and Why Diet Isn’t the Only Way to Avoid It

As the story goes, Napoleon Bonaparte arrived late for the Battle of Waterloo — in which his army was eventually defeated — because at that moment he was busy in the bathroom, straining to evacuate.

But while constipation has plagued the French general for years and one in seven people in the world suffers from it, the biological process for passing stool is a little-discussed subject.

Millions of people suffer in silence from the effects of chronic constipation, a problem whose solution, according to experts, does not depend exclusively on diet, but also on a mental change that allows us to talk about it and, thus, get rid of the weight that entails this taboo.

“They train us as a child to get out of the diaper, but nobody checks how we are. From then on, we take care of ourselves,” Dr Anton Emmanuel, a specialist in gut health at University College London Hospital, told the BBC.

Three times a week

To understand exactly what constipation is, let’s start by explaining the process from the entry of food through the mouth to the exit of waste converted into fecal matter through the anus.

When we ingest and chew a food, it begins its journey through the digestive system. Once we digest it with the help of chemicals that our body produces, bacteria gradually start working on these leftovers that move up to the intestines.

When they reach the colon, all the nutrients have already been absorbed. And after about 15 or 18 hours there, our body eliminates this waste.

“What happens in cases of constipation is that the mobility in the intestine is slower”, explains Emmanuel.

It is estimated that a person may be suffering from constipation if they do not move their bowels at least three times a week, and if their stools are large and hard, or dry and lumpy, and if they have to strain to go to the bathroom or feel pain.

Impact

Constipation itself is not dangerous as as long as the fecal matter is inside the colon it does not cause any toxicity (the colon is prepared to contain it).

However, the person may feel uncomfortable and afraid that the urge to have a bowel movement may come at an inconvenient time.

“It’s a huge burden on the patient because (impacts) what they can eat, how they can dress and when they can socialize, which is a big issue in all of this,” explains Emmanuel.

Furthermore, from what we know today about the relationship between the brain and the gut, “constipation can change our mood”, explains Miguel Toribio-Mateas, a neurologist at London South Bank University, to the BBC.

This can affect women more, as certain hormones that are normally eliminated with stool remain circulating in the body and accumulate, increasing their levels.

Thus, women of childbearing age, when constipated, can feel the “double impact of estrogen or progesterone or whatever hormone they are producing that day that has not been expelled from the body (through the faeces)”.

That’s why they tend to complain the most about the effects of constipation.

Regardless of gender, “depending on the genetic predisposition, as well as the type of behavior and personality, some people feel less motivated and others more excited”, says Toribio Mateas.

We cannot forget about the physical symptoms that accompany constipation, which include, among others, nausea, swelling, headache and discomfort or pain in the region.

widespread problem

Emmanuel says the typical patient is a woman in her 30s who has been suffering from constipation since adolescence (generated by situations or experiences that are not linked to a medical problem) and who only seeks medical help after a long time.

They usually do this motivated by the diagnosis of a serious bowel problem in a family member or co-worker. Although, unfortunately, doctors do not always take this problem seriously enough, given that it is a widespread condition.

“Ironically, because it’s such a prevalent problem, many don’t consider it a symptom,” explains Emmanuel.

Constipation doesn’t just affect adults, it’s estimated that one in three children suffers from constipation at any given time.

As for causes, “most patients have a problem with the rate at which their bowels contract — that is, how quickly things move through the bowel — or with how their pelvic floor works, or both,” says Emmanuel. .

In other words, “it’s not the patient’s fault that he didn’t eat well or exercised enough,” he explains.

So, he says, it’s not something that can be solved by eating prunes, or foods that stimulate the gut, because that only solves the situation temporarily.

It wasn’t always like this

although today it is not “well regarded” to talk about intestinal transit, it was not always like this.

“In the Middle Ages, in both literary and medical texts, the subject of excrement is everywhere,” explains medical historian Louise Foxcroft to the BBC, adding that before there was not so much privacy around toilet use.

“Imagine London in the 18th century, before the sewer system. There were carts that passed through the city to collect the faeces (which they threw out the windows and were scattered everywhere) and took them to fertilize the fields.”

The secrecy around the matter developed with industrial cities.

“The idea of ​​privacy came about in the 19th century, particularly in the West, when life in cities became popular, and people started living in crowded places, sewers were built and toilets were created,” explains Foxcroft.

“Familiarity with how the body works was much greater then than it is now,” he adds.

In the 18th century, for example, constipation was a topic explored by some of the great writers of the time.

“Voltaire said that people who poop regularly and easily each morning are nature’s favorites. They are sweet, affable, graceful, thoughtful, forgiving and efficient. And a ‘no’ from their mouth is more graceful than a ‘yes’. ‘ from the mouth of a person with a cold”, says the historian.

It is that the division between mind and body is a relatively recent philosophical separation.

“It was once thought that the gut was where the emotions settled, not the heart,” says Foxcroft, adding that in medieval poetry there are many themes that deal with excrement and love, two things you share with your loved one.

Solutions

In addition to attitude changes towards constipation, what many are asking these days is what to do to prevent it.

“You need a certain amount of fiber (both soluble and insoluble) for stool to form, and you often don’t consume enough,” explains Toribio-Mateas.

Above all, it is important to consume a variety of fruits, vegetables and vegetables (including leafy greens), legumes, seeds, dried fruits and, ideally, whole grains.

Emmanuel suggests, in addition to a more balanced diet — where you eat at least three times a day —, drinking more fluids, walking more indoors or out and, if that doesn’t work, using mild laxatives.

And, above all, “when the body asks, don’t ignore the will because it’s not the right time, and go to the bathroom”.

“Likewise, when you’re there, don’t stay too long. When you’ve done what you had to do, don’t wait around to do more,” he adds.

Toribio-Mateas recommends, to break the taboo, “bringing a book you like to the bathroom, putting on music… thinking of alternative ways. Try to imitate the situation where you go to the bathroom to take a shower, in which you would do things to feel relaxed”.

“Don’t feel awkward doing this. Think you’re working on the communication between your brain and your gut.”

He also recommends talking about the problem, normalizing it, and sharing it with others.

“When you talk to someone about something that makes you feel unhappy, it’s like lifting a weight off your shoulders,” he says.