"You are what you eat."

This isn't quite true - you are what you eat and don't eliminate. And if you're not eliminating, you're constipated. 41/2 million Americans say they're constipated most or all of the time. Poor diet and/or lack of exercise is a common cause, which sounds like me on some of my motorcycle trips.

Other factors contribute to constipation. If you're rushing to get an early start, you might ignore your gut telling you to take a bathroom break. This is bad, because the longer that stool stays in your gut, the drier and harder it becomes. The end result (sorry) can be painful. If you understand your gut, it's easy to prevent and treat its problems. Here's how the gut works.

People are basically donuts. We're a hollow tube, topologically. Food and drink enter the north end, and stool (and urine) exit from down south. What happens to the food in between is digestion and excretion.

When you chew, you mix food with saliva, which has several enzymes. These start breaking down some of your food even before it reaches the stomach. Here's an example of how these enzymes work: chew a piece of bread for about a minute, and note how it starts tasting sweet. An enzyme in your saliva is breaking the starch in the bread down into sugar. Your saliva also contains mucus, which lubricates the food and holds it together, making it easier to swallow.

When you swallow, food is propelled down the esophagus, which connects the mouth to the stomach. Once it gets to your stomach, food is churned up and mixed it with other digestive enzymes, and the stomach lining adds acid. The resultant liquid is called "chyme." Later, bile that's made in the liver and stored in the gall bladder, and digestive enzymes from the pancreas is added to this mix.

After leaving the stomach, the chyme enters the small intestine where the nutrients are absorbed. When the chyme finally arrives at the beginning of the large bowel, or colon, there are still several quarts of liquid remaining, along with the fiber and whatever else your body couldn't take in. The walls of the colon are designed to absorb the liquid in the chyme, so you don't end up losing quarts of water each day. Not only would this be inconvenient, but also it could rapidly lead to dehydration. In fact, death from dehydration due to diarrhea is one of the world's leading cause of death in children and infants. The gut's goal is stool with a proper consistency: dense enough to stick together, but soft enough that your gut can move it along, and eventually eliminate it.

The contents of the gut move by peristalsis, or rhythmic contractions of the muscles in the gut wall. Some medications slow or stop this movement, which is needed to push the chyme and stool along. Medicines that slow the gut include narcotics, like codeine, hydrocodone (found in Vicodin) and narcotic analogues like Imodium and Lomotil. The latter two are made to treat diarrhea, but they can be stronger than you want. I suggest taking half the recommended dose of them. If you absolutely must use them, start taking psyllium (as in Metamucil) right away, to prevent really bad constipation. Psyllium also encourages regrowth of normal gut germs. Other medications causing constipation include iron supplements, some antacids, antidepressants, antispasmodics, diuretics, and anticonvulsants for epilepsy.

The slower the passage of the gut's contents, the more time the colon has to remove the water. If too much water is removed, the result is hard, dry stool, which can be painful - or in some cases impossible - to eliminate. A relative lack of physical activity can slow the transit of material through the gut, too. If you're normally fairly active but spend all day sitting while traveling, you might slow down your gut's contents enough to produce constipation.

So, how do you treat constipation? There are lots of preparations on the drugstore's shelves, but they fall into five major classes. All have their use.

First come bulk laxatives, like psyllium (i.e., Metamucil(r) and in PerDiem Plain(r)). These prevent constipation by adding bulk. They're not good if you're already constipated and can't eliminate. I take PerDiem Plain on road trips where my diet's often poor and my exercise is minimal.

Next are stool softeners like Colace(r) and Surfak(r). These add moisture, which can prevent stool from getting too hard. However, once you're bound up, these may not help.

The third class are stimulant laxatives, like Dulcolax(r), Correctol(r), Feen-A-Mint(r), and Senokot(r). This make the large bowel contract, which can get things moving again. Prunes fall into the same category. These can be helpful to relieve constipation after it occurs, but shouldn't be used too often, since chronic use can lead to dependence.

Lubricants act like, well, lubricants. Mineral oil is the most common used one. It works by greasing the outside of the stool, allowing it to pass down (and hopefully out of) your gut. These can be helpful in relieving constipation, too.

Saline laxatives (also called "osmotic" laxatives) are the most powerful. These act by bringing liquid through the walls of the gut into its inside, which moistens hard dry stool and can help tremendously. Haley's M-O(r), milk of magnesia, and Citrate of Magnesia(r) are all effective, though Citrate of Magnesia(r) is the most effective. If you use these, make sure you have access to the bathroom when they start working.

Some of these medications are available in suppository form. Glycerin is a lubricant, which can help with very hard, dry stool. Dulcolax(r) contains biscodyl, which stimulates the colon and rectum (the last bit of colon before the anus). Other useful preparations are available as small, disposable enema kits. These include phospho-soda and mineral oil. Remember, if using an enema, lay on your left side. If this thought's unpleasant, just remember that an ounce of prevention's worth a pound of cure.

(c)flash gordon md 2003

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