Constipation

Main text from BP issue 2

Updated Dec 2015
The longer lasting Life Of A Constipated Tom Tit – What Can You Do About Drug/Diet Induced Constipation
It’s a scary feeling…….That large plate of spaghetti bolognese from 5 days ago is swimming around in your bowels, fighting for space alongside 7 bowls of cornflakes, a packet of custard creams, 60 vinegar-soaked chips, 2 cheeseburgers, various chocolate bars and a massive Indian curry. Your stomach’s swelling by the hour and you feel like you’re just about to give birth-but you’ve swallowed 5 laxatives and plugged in a suppository and still nothing. What do you do?
Those of us who have taken a bite out of the ‘drug misuse’ apple know that it doesn’t always come out at the other end in a quiet or comfortable fashion. Some heavy users can go 2-3 even 4 weeks without a trip to the loo and if you’re a working girl (or boy) having sex with a chock-a-block bowel can be most unpleasant. We’ve all heard of the advice, ‘fresh air, plenty of exercise and lots of fresh fruit an’ veg’. Well you might get the exercise running around chasing your gear (- it’s still exercise), but the fresh air – fruit an’ veg stuff isn’t always so easy and besides, a big enough smack or methadone habit can constipate the healthiest person.
Prevention really is the best cure, particularly for those who are susceptible to bowel troubles. Using the odd laxative or suppository is okay, just don’t go mad doing it. Using them over a long period of time is seriously bad news, eventually your sewage system will pack up altogether. Certain things can cause your bowels to become ‘dependant’ and shouldn’t be taken regularly. It helps to know a bit about your bodily functions in order for it to receive the right attention. There are however, things you can do to help yourself in this department -no matter how bad things there are still things that you can do to help. So read on!

(There are no particularly palatable words for faeces, shit, excreta, pooh, stools, waste, pony, tom tit etc so we will mix and match, okay? )

 

Digestion and absorption: small intestine The small intestine is about 20 feet (6 meters) long and has three parts: the duodenum, jejunum, and ileum. The duodenum is where most chemical digestion takes place. Here, bile from the gallbladder and enzymes from the pancreas and intestinal walls combine with the chyme to begin the final part of digestion.

Digestion and absorption: small intestine
The small intestine is about 20 feet (6 meters) long and has three parts: the duodenum, jejunum, and ileum. The duodenum is where most chemical digestion takes place. Here, bile from the gallbladder and enzymes from the pancreas and intestinal walls combine with the chyme to begin the final part of digestion.

The Journey Traveled…..

When your food reaches its final stage of digestion in the small intestine, it has become a thick, watery liquid. It is moved along its way by the continuous contraction and relaxation of the intestinal muscles (peristalsis). The surrounding large intestine or colon absorbs this liquid into its walls, feeding blood vessels and maintaining peristalsis. Whatever waste remains will then become your pooh.  You may not know it, but there is an extensive nervous system in your intestines. There are actually more neurons in the intestinal or enteric nervous system, than in your central nervous system, which includes the brain and spinal cord. Certain chemicals in your brain, like serotonin, also play a role in coordinating movement in the intestines. Usually, the intestines have a normal wave-like movement (- peristalsis again). When this normal movement is interrupted, the bowel can’t empty and there may be bloating, pain, spasm or constipation. (Ed -I wonder if this why stimulant users always feel like they need to go to the loo whenever they have just scored or are about to use -due to the brain forcing a quick rush of serotonin like it does when you use coke or other drugs?)

Absorption: large intestine Once food has passed through the small intestine, it is mostly undigestible material and water. It enters the colon (large intestine), named for its wide diameter. The large intestine has six parts: the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

Absorption: large intestine
Once food has passed through the small intestine, it is mostly undigestible material and water. It enters the colon (large intestine), named for its wide diameter. The large intestine has six parts: the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

For various reasons, the drugs we take, stress, vitamin and mineral deficiencies, the intestinal muscles slow down and then bacteria from the waste gets absorbed into the bloodstream leaving your system toxic.
The degree of firmness of your faeces depends on its length of time passing though the gut – the longer the journey, the more water is absorbed back into the bloodstream, leaving your stools dried out. You end up which a pooh that takes longer to move along its passage – becoming constipating. (Charming!!)
Generally, the more sluggish the gut, the firmer the stools. Headaches, oily skin and hair, bloating and congestion of the nose, throat and lungs result as well as dried out stools. Methadone user’s will know all about dried up, sheep style pooh! Although constipation may be considered trivial, each year around one tenth of the population of the UK take laxatives regularly with over 7 million visiting their GPs.

Basically, you want to be able to pass a stool with minimal effort -ideally, almost no effort. It should be regular -from once-twice a day to 3 – 4 times a week. It should look like number 4 on the Bristol Stool Chart here, smooth and long like a sausage.

The Bristol Stool Chart

The Bristol Stool Chart -the medical standard as to how our pooh should look. Click here to see more about what each one means.

Bloating

They aren’t really sure what bloating actually is but they do know that constipation causes bloating – fix the constipation and the bloating goes away.  Bloating could be from when the tone of the bowel is decreased, causing it to ‘spread out’, and increase in diameter. Remember that there are at least six metres of intestine wrapped up in every adult body cavity. When that whole length is expanded, it is very uncomfortable! In addition, gas trapped in the bowel can distend it and can cause discomfort.

Intestinal Flora

After bacteria inside the gut are killed by antibiotics, laxatives, heavy metals, surgeries, and colonoscopies, fiber is broadly recommended to replace bacteria and form stools, otherwise they turn into grayish rock-hard pebbles, and turn a routine trip to the bathroom into a torture. This condition is called disbacteriosis or disbiosis.

Healthy intestinal flora is also vital for prevention of constipation, for maintaining your primary immunity (phagocytosis), for shielding your large intestine from colon cancer, and for averting yeast infections.

Constipation can result, especially when the stools are dry or hard. means there is too little bacteria to loosen up the formed feces and keep them moist, because, unlike other stool components, bacterial cells retain moisture.

Eliminating disbacteriosis literally means “infecting,” or, as a microbiologist might say, reinoculating your large intestine with synergistic bacterial strains. In practical terms, it means that you need to take a quality pre- and probiotics, available from health practitioners and good health food shops.

Supplemental probiotics are the most accessible, inexpensive, and easiest form of oral bacterial therapy. You can take these supplements continuously, periodically, or on an as-needed basis, relying on your observations of stools and other symptoms of disbacteriosis.

Tried and Tested Tips (for moving that tom tit!)

OK, so here’s what you can do. Many of these methods have been tried and tested by fellow users, so give them a go.

1. Drink a glass of warm water every morning before eating any food- this is great for your bowels and really helps things along. Especially good if you can squeeze a bit of lemon in it to really cleanse/detox your digestive system.

2 Live yogurt- full of live bacteria. If eaten often it destroys the gas, disease and odour producing bacteria in your shit. Greek yogurt is creamier (much nicer I think -ed!)  than normal plain yogurt and has lots of good bacteria in it. So does Keffir -a yogurt drink.  Just adding touch of honey and some nuts and seeds -and you have a seriously yummy breakfast / snack that is really good for you. eating this daily will help you become regular. Tried and tested by BP!

3. Potassium- (found in almonds, fruit, especially bananas, green leafy vegetables such as spinach. Papaya is particularly good -and the seeds are excellent for dealing with parasites in the gut. Potassium keeps the intestinal muscles moving. NOTE-if you suffer from DVT check with your doctor before consuming extra potassium.

4. Wholemeal bread, brown rice, wheat germ?? These high fibre foods were believed to speed up the transit time of waste through the colon. Sprinkling bran or wheat germ on your cereal is thought to be beneficial but some now say that the big focus on bran was just a food industry drive (it was all started by Kelloggs’ so…). and there is a big backlash against high fibre nowadays -fibre is thought necessary, but easily digestable fibre that dosnt build up in the body. Click this link from Gutsense.org and have a read. Remember though, to drink extra water when eating bran or fibre as it expands absorbing intestinal liquids. Psycillum husks are thought to be one of the best natural substances to help you become regular. Google it!

5. Vegetable juices -especially green vegies -or at least 70% of your vegetable juice being green,  and the rest apple which has its own gelatinous fibre, even when juiced, be green – and you will be going regularly, no to ways about it! Wholemeal or wholewheat bread (not ‘brown’) with marmalade, fruit salads are all helpful when eaten regularly, or even a banana with or without a bit of bran on your cereal. Seeds, like sunflower, sesame, pumpkin, linseed, flax seeds -buy organic whenever possible, have them at home, ground up and toasted slightly if you prefer, ready to sprinkle on everything from yogurt to salads, to meat and fish.

6. B complex vitamins that are yeast-free are good for healthy intestinal muscles. PS Don’t get into overdoing multi vitamin and mineral supplements if you have liver disease or symptomatic  Hepatitis C. It just gives your liver more work to do.

7. Another really good tip is to buy a bag of fresh carrots, chop them up into little bite sized sticks, and munch away a couple of carrots worth. By the next day, the wheels will be in ‘motion’ and you should be able to go to the loo. Be sure to try and drink a lot of water with it so things aren’t to ‘dry’ or painful.

8. Major tip – Positioning – the SQUAT:  When your actually trying to pooh, and it’s starting to feel like

Buy a 'Squatty Potty' or put a small stool under the loo seat -and you will be shocked at the difference! Its much better for us!

Buy a ‘Squatty Potty’ or put a small stool under the loo seat -and you will be shocked at the difference! Its much better for us!

something to big to manage is on it’s way, lean back on the toilet, with your back against the cistern. You will find leaning back at this slight angle will help a lot as your stool makes its way out, no kidding!  But the best way for sure is to elevate the feet -so you can basically squat on the toilet. (see pic ). Sitting is not the natural way to pass a stool, squatting, with the knees to the chest, is. This way actually straightens out the intestinal area to allow for easier evacuation.  It really helps to relax the pelvic floor as you pass a stool, you can use a short foot stool for this, about 7 inches high, to place your feet on while you go to the bathroom.

EMERGENCY TIPS

No. 1: Yoga: If you find yourself really constipated -watch this video which shows a few yoga moves which can really, seriously help things start moving -and by moving, we mean in minutes of doing the poses.  It helps the intestines stretch and relax -and, again being tried and tested by drug users, we can say this really does work and is definitley worth learning for anytime you have problems going to the toilet or to use regularly.

 

(I) Massage your stomach in a clockwise direction for 5-10 minutes and if you can, go for a brisk walk (you’ll be amazed how a good walk can help things along -long periods lying down and your bowel gets ‘lazy’). There are some excellent yoga moves that honestly, really help get you moving and are definatly worth a try. Click here.

(ii) Drink as much liquid -(water seems to work the best – warm if you can bear it) as you can handle. NOTE: If you have severe liver disease, it isn’t wise to drink too much water so take note and combine ordinary water intake with other methods we’ve noted.

(iii) Try squatting on the floor or on the toilet seat -or as pic above, get a small stool for your feet to be placed on, which instantly changes your position overall, on the toilet and should help significantly.  This is the natural position for passing waste and it encourages the movement of the bowels. Straining too hard is ill advised as this can cause broken blood vessels and haemarrhoids (piles). Instead, try pushing out gently for a few seconds and then squeeze the muscles in for a similar length of time (works better if you’re squatting, either on loo seat or normally). Repeat slowly till things start moving – but don’t push hard. This really helps a lot -actually, this tip has been handed down through a couple of generations of opiate users as has stood the test of time……

(iv) Drug Users Fix: OK, so we better mention the old tried and tested coffee and a cigarette, it is true to say it does ‘get you going’ and can be the most palatable thing for some of us first thing in the morning. Coffee is a diuretic which gets the metabolism moving, nicotine is also a stimulant, and it seems both of them together in the morning, especially the coffee, can make you go. If you are very constipated though, you might want to try something that SOFTENS your poo first (drink lots of water and prune juice the day before) so when things do move, it is soft and not painful to pass.

Either individually or in combination -those emergency tips should get you going. Remember, if you are very constipated and you are going to go ‘evacuate’ -the tried and tested use of vasoline around your anus (and just inside) will help any stool pass with a lot more ease. Ask a nurse! It works!

(v) Don’t panic if you don’t go everyday. Every two/three days is ok -but daily is ideal. It is possible to ‘train’ your bowels to produce a motion at certain times of the day – so if you tend to score around lunch time, try to get that time for a pony in the mornings when you can relax a bit, before you go out.

(vi) Don’t put it off – we appreciate this is easier said than done (many BP staff hold masters degrees in ‘hanging on til you score’ – by then, of course, it’s too late!) but constant constipation can lead to some bad shit happening. Excuse pun, but it is usually just down to bad habits and habits can be changed.

Methadone, Opiates and Constipation

Methadone Users may find they have, what is regarded in the trade as ‘sheep shit’. Small hard golf ball type stools. Increasing your fluid intake here is very important as is more fibre in your diet. Morphine (amps and MST’s) can be even more constipating than gear (heroin) or methadone and often white heroin is considered more constipating than brown heroin. Have a word with your chemist or GP if you think you need laxatives as there are different kinds for different problems (e.g, you don’t want a laxative that just speeds up the poohing process because if your already suffering from dry /hard stools, you’ll end up a really huge, hard, dried out stool on its way! No, you want something that will soften your stool, and engage peristalsis as well to make it easier to pass as it moves out. (Lovely subject!)

Other Constipation Considerations

There are also many medicines that can cause constipation. They include:

  • Vitamins, and often Calcium supplements as well as Iron supplements (try slow release iron) are known constipators. It is recommended using prenatal vitamins and minerals as they are absorbed much better by the body.
  •  Codeine, Morphine, Anticholinergics (opiate based meds are famous for being constipating)
  • Blood pressure medicines

DANGER SIGNS

What is important here, is to note any changes in bowel habit or faecal appearance.

* Bleeding from the stomach (or a burst ulcer), oesophagus or duodenum produces black, sticky or ‘tarry’ stools. If there is less blood, the stools may still be black or very dark. Not all black stools are the result of internal bleeding but it would certainly mean seeing a doctor at once.

* Bleeding from the colon (as happens with bowel cancer), shows as obvious blood. The blood may be clearly mixed with the stools and leach out into the water in the loo, or it may only colour the stools so that they a magenta hue, like the Red Cross red. If a tumour is lodged high in the rectum, the bleeding may be a very dark blood; its quantity is very variable. BUT, all to often, bleeding is mistaken as that from piles or an anal spilt (ouch!) so make sure the doctor dosen’t fob you off when you are still worried and don’t always assume that bleeding is just. Haemarrhoids. Be sure to visit a sympathetic GP.

A tumour constricting the colon may produce thinner stools than normal. Some patients may notice an increase in wind or the presence of mucous.

Bulky, pale faeces the colour of porridge or clay with a fatty consistency and a gross smell are associated with gall bladder, liver, or pancreatic disease. An urgent call to a GP is a must.

Click here for a useful article on constipation and further helpful ones below.

Related Articles  we have researched and we think are good

This is an unmissable programme about intestinal flora -good bacteria in the gut -and how crucial understanding it is to overall health, especially brain health.

Leave a comment

12 Comments

  1. This is a great, informative article. Having all this information in one place is very helpful – especially the Bristol Stool Chart!

    I’ve been on a high-dose of opioids for some time now, and several daily servings of yogurt works the best for me. I went from once-a-week (if lucky) to once-a-day BMs. Fage and Greek Gods work the best. You want something natural, with lots of live cultures.

    Fiber definitely helps add bulk, but sometimes, I found it made things worse. if you use it, you must drink a ton of water! Ex-Lax induces pretty hefty cramping, and has around a five minute window so if you can’t get to the restroom, you’re out of luck. Senokot is great and feels very natural, but it is habit-forming. You can end up much more constipated in the long term! Miralax did nothing for me. Magnesium Citrate definitely works as an occasional emergency laxative (hospitals use this to clean you out before a prostate exam) but it can wreak havoc on your electrolyte balance, and can even kill you if overdone!

    Thanks again for the information!

    Reply
  2. Mo

     /  March 12, 2014

    Strange. I read this exact same blog just moments ago, but on another site. I mean….it’s the exact same article, word for word. The other one cited the Authur and her credentials at the bottom though. So, someone is stealing here, and it’s one of the two sites. Anyways, good informative article, although the auther assumes that the reader is a active drug user. I’m goin to say the majority of people reading this are prescribed opiates for chronic pain, or are people in recovery on methadone therapy.

    Reply
    • Wow -that is weird coz this was written for our user magazine -written and researched by users -in this case me -and I know because I wrote it straight out of my head! The only part I might have re-used was the scientific bit about how the digestion actually works. Id like to see the other site to be honest as they must have nicked ours! Not that that is an issue but a credit would be nice! Thanks for letting us know. PS re the majority of people who read this -it is actually the average illicit drug user, or the person who has had dealings with a range of drugs -through whatever reason -but are essentially a criminalised population. It is this that defines us -wrongly -because many of us are on opiate substitution treatment, like methadone or suboxone etc. This website is to gives space for people who never usually get a space to speak in their own language, about their own concerns. I hope you like the update -the article was old and things have moved on in terms of gut health -especially re probiotics. Thanks for your comment. BP

      Reply
      • Oh -just noticed you said they did credit us! Thats ok then!

      • Wow that is a terrific comment, thanks for all that excellent info. And I would like to say u are right about the fibre issue- you do have to drink a tonne of water with it and actually research these days is saying that fibre is not that useful for constipation, and it can make things worse, in fact it also states out there on the internet that the whole fibre discussion was brought about by the first big cooperation advertising campaign that cloaked itself in spurious research to look official – guess who?? Kellogg’s of course! And all bran! So cut back on any excessive fibre use and I agree, think more about a healthy and balanced gut flora, using good bacteria like yogurt -and wow I agree again with you that FAGE GREEK YOGURT is wonderful for regularity!! I have also found it to be a super good yogurt -add some crushed, toasted nuts (no oil) and bit of a chosen fruit, or prunes or figs, supplement with a few yoga poses as above – and everyone is good to go! I have noticed more
        People on long term opiates like methadone finding bowel problems occurring later in life IF they are not trying to eat well and counter balance things. It seems peristalis – the movement of the intestines that pushes along a bowel movement, can get floppy, sleepy, or intestine that are stretched out which causes bulges (painful). We are not Drs here remember, just research drug related health and lifestyle issues all the time -and we always learn of our readers! Brilliant! Thanks so much for writing in BigBarney!

  3. I used to suffer from constipation; so bad sometimes I thought I was going to die. I went thru a phase more than 10 yrs ago taking a lot of pills & opiates. Then I found the answer; enemas / douching with rectal bulb syringe i.e. squirting water into my anus. This has always worked, and enabled me to eliminate the stool.
    Given all the pain and worry I had prior to that, finding this cheap & simple method was a moment of sartori (illumination).
    Here is a wiki link so u can check this isn’t a cranky trick http://en.wikipedia.org/wiki/Enema

    The best method of all colon hydrotherapy; however this has the downside of being expensive. Not for bankers costs at least £100 a session. I strongly recommend this though if you have the money. A tube is used to inject water; a second narrow tube is for the outflow. Lying on one’s side one can see the faecal matter flowing out.
    Here is the wiki link http://en.wikipedia.org/wiki/Colonic_irrigation

    I had tried some other ways; trying to get little bits out with fingers etc; chemical laxatives. Etc. The latter are the worst are definitely to be avoided IMO.
    That is one of the virtues of the douche method. Furthermore the costs of an enema syringe is low eg £3 new f/ Ebay incl. postage); it doesn’t involve chemicals so no side affects. Like most things with unhealthy bacteria, water can do no harm.
    The more water you put in the better. Lukewarm or cold water;p but definitely hot water. for some reason this only worsens prurience (itching); and we all know how bad that can be.
    There’s even a German best-seller ‘Wetlands’ (made into a film) by British writer Charlotte Roche foregrounded anal prurience – the female protagonists’s main problem – as well as masturbation techniques. http://en.wikipedia.org/wiki/Charlotte_Roche

    Reply
  4. Danial Sroczynski

     /  February 28, 2013

    Almost everyone gets constipated at some time during his or her life. It affects approximately 2% of the population in the U.S. Women and the elderly are more commonly affected. Though not usually serious, constipation can be a concern.:

    Look over our very own online site as well
    <.http://www.foodsupplementcenter.com/benefits-of-bitter-melon/

    Reply
  5. Greg Fedderly

     /  November 3, 2012

    there are many ways to remedy constipation. the best way is still to take high fiber foods and take lots of fluids. ‘

    Freshest blog post on our personal internet page
    http://www.healthmedicinelab.com/uti-treatment/

    Reply
  6. hippycat

     /  December 24, 2011

    This is not a topic I would love to blog about. Well done! One tiny problem – there’s no sympathetic GP anywhere in this part of Cambridge.

    Reply
    • And how right you are! It can be very hard 2 find a ‘sympathetic gp’, that is, one free from ignorance and/or incorrect attitudes about people who use drugs, and indeed, the subject of constipation itself! It rarely gets the hearing it deserves when one has taken the trouble 2 raise it with a gp things r usually pretty bad…however, the advice in this article is, as I mentioned, tried and tested by drug users far and wide and heavily researched as well. The info about relaxing ur pelvis when going 2 the loo (wen constipated) is actually gr8 advice, as is a few yoga positions (incredibly helpful) and the info about needing the DUAL action for laxatives – the mover – AND the softener, not often given in the one substance. The drug info is the interesting addition here tho, anything one can add to this we wud be most appreciative; as in wot other drugs constipate or opposite and why? Thuts welcome! Can’t help with the gp in cambridgeshire…any empathetic docs out there wanna step forward???
      Thanx for ur comment hippycat

      Reply
  7. Properly put from a terrific blogger

    Reply
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