While I was a student dietitian there were certainly moments that I caught myself reflecting, as all good students do, on how unprepared I was for certain situations on placement. On how I never realized that I would spend so much time learning or talking about certain topics and just how much you can learn from a person based on one or two parameters.
Now, I could spend my words going over each of these topics, but honestly I spent so much time talking about one topic that I’m going to just concentrate on that. So today’s topic is all about…
Poop. Poo. The sausage making factory. The, ahem, butt of all good jokes and the thing was all do but don’t talk about.
While on placement, I asked every single patient about their bowels. I carried around a bowel chart and made many patients giggle when I asked them what their movements looked like. And I also made plenty of patients uncomfortable by asking about bowels. None other than an eight-year-old boy who I had to have the “everyone poos, including me”. In front of his mother. And in front of my supervisor. Talk about awkward. But it shouldn’t be! I persevered because it was important to get that information. Why? Well because a person’s bowel habits (and more importantly, any recent changes in habits) can tell me so much about them.
Constipation can leave a person feeling full and uncomfortable which could mean their appetite is reduced. Diarrhoea and associated stomach cramps (pain) can also make a person eat less, and hydration needs to be considered at both ends of the spectrum.
When I had a patient who complained of “loose” or liquid-like bowels, it was important to me to ask what they looked like and how many times they go in a day. To do this I used the Bristol stool chart, which allows health professionals to objectively assess patient’s bowel movements so that problems, at either end, can be quickly and accurately managed. Going twice a day and producing type 4 motions is a very different to producing 10+ watery motions. Although both might warrant further investigation if 2 motions a day is considerably different to normal bowel habits.
Am I normal?
“Normal” bowel habits actually vary widely between people – as such what is considered “normal” ranges from 3 motions per day to a motion every 3 days.
In the case of healthy people, bowel habits are generally stable. People generally fit somewhere on this scale of one every three days to three times a day and don’t deviate too much. In times of illness or stress, bowel habits can change and this is where I step in. Changes in bowel habits can tell me so much about what is going on with your health – in some cases changes are temporary but sometimes they might need further investigation. Having some loose motions after a bout of gastro is not normally cause for concern, but if it persists, and there is blood or mucus in the stool that’s when I’ll work with the medical team to work out what’s going on.
What’s affecting your bowels?
It’s just not your medical history that your bowels affects. It could be your social history too.
In the case of my eight-year-old patient, who tended towards constipation, asking about bowels allowed me to focus in on fibre and hydration when I took a diet history. If that didn’t give me the answer (it did, in this case) there’s so many other aspects of his social history that might tell me why he has constipation. Is it that pooping is a taboo subject at home or at school and there has been some teasing around it in the past? Will my patient alter his eating/drinking habits to “hang on” until he gets home? Are there issues of privacy at home or school – kids ducking their heads under the stalls for example?
Are you cottoning on to the fact that I find bowel habits and the things that can influence them fascinating yet? And yet, aside from dirty jokes, bowel habits are not talked about often enough, in my opinion. I always remember my lecturer Tim Crowe asking why there is such a public campaign behind breast cancer, but not bowel? His answer: no one wants to wear the poo colored ribbon. I think he’s bang on the money.
It’s embarrassing for people to talk about their bowels. And yet it’s so important for people to talk about it, especially if there are changes. I remember having toilet trouble after a bout of gastro and when I finally got the courage to go to my GP the response was “Hmm, that’s weird, you just must be stressed. Go do something relaxing” The problem turned out not to be stress, but bowel habits can be affected by stress, so I’m sure it was made worse by the stress of continually going to the doctor to be told, essentially, it’s in my head and I’m stressed. Around and around we go.
Maybe that’s why I’m such an advocate for good bowel health and why I’ll always encourage open and honest discussion around this tricky topic. At the end of the day, I’m a professional, and when I ask about bowel habits, I’m not trying to embarrass you and I’m certainly not silently comparing my habits to yours. I’m doing my best to to help you achieve good health, and your intestinal health is no exception to this.
photo by flare