October 9, 2025 • 39 mins
Centered on Health 10-9-25 - Diarrhea and Constipation with Dr. Jeff Tuvlin and Dr. Lindsey Snow.
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Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Health
on use Radio. Wait forty wyjs now, here's doctor Jeff Tumbler.
Speaker 2 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news Radio eight
forty whas. I'm your host, doctor Jeff Tublin. We're joined
in the studio by mister Jim Fenn, who's here to
take your calls tonight. Our phone number five oh two,
five seven one, eight four eighty four if you want
to call in and be a part of the show.
(00:31):
Tonight is an exciting night because we have a very
special guest. Tonight we are joined in the studio with
doctor Lindsey Snow. Welcome doctor Snow, thank you so much.
And doctor Snow is starting a new series on our
show with us that we're going to be doing about
once a month. I'm going to let her introduce herself
in just a moment, but we are starting a series
called Chief Complaint and the doctors doctor is in so
(00:54):
Chief Complaint. We're gonna take a complaint that somebody might have.
For example, tonight we're going to be talking about diary
and constipation and we're going to kind of go through
what you as the listener might want to think about
or when you might need to see a doctor and
answer some of those questions the doctor is in. We're
going to ask you to submit questions to us that
we can answer for you here live and on the air.
(01:15):
So doctor Snow, welcome. I'm gonna let you introduce yourself.
We're excited to get this series kicked off.
Speaker 3 (01:21):
Thank you so much. I'm so excited. My name is
doctor Lindsay Snow. I'm a Board certified family medicine physician.
I practice a Baptist Health on Chamberlain Lane by the
Ford Plant.
Speaker 4 (01:32):
Yeah.
Speaker 1 (01:33):
I'm really excited for this series.
Speaker 3 (01:34):
I feel like, you know, something I hear all the
time in primary care clinic is there's so much information
out there that a lot of times people don't know
what they should trust or believe, you know, like what do.
Speaker 2 (01:48):
I do with this right? There's so much information?
Speaker 3 (01:51):
Yeah, and so I think that providing educational opportunities is
really good. But one thing that I'm really excited about
this particular series is that we're going to go into
how things work. Because I think for me, if I
understand how something works, then when something's going wrong, I
understand it better.
Speaker 1 (02:08):
I don't know if you feel that way, you know, I.
Speaker 2 (02:10):
Think that makes perfect sense. And I also, like, you know,
usually we have a specialist on the show, either a
primary care specialist or a subspecialist, And I think what's
nice about what we're planning on doing is sort of
helping the listener understand when is it something I need
to see my primary care about, When is it something
they might send me to a specialist for. So, you know,
the more they know, and the more we all know
(02:31):
of what we're doing and planning, I think that the
better the outcomes. So we are obviously starting with something
near and dear to my heart in the GI world.
So the chief complaint that we're talking about tonight is
going to be about diarrhea and constipation, which is obviously
a very common problem. But I'm going to let you
take the lead because I'm sure you'll want to pick
(02:51):
my brain about that.
Speaker 3 (02:53):
So first off, we're gonna kind of start with how
does digestion work? You know, food goes in and stuff
comes out the other end and everything in between.
Speaker 1 (03:05):
So let's imagine, you know.
Speaker 3 (03:06):
If there was fairytale music right now, Look, This is
the story of digestion. So if someone takes a bite
of an apple, you chew the apple up, and there's
enzymes in your saliva that start breaking down the sugars
in the apple. Digestion actually starts there, so.
Speaker 1 (03:22):
Then you swallow it.
Speaker 3 (03:25):
You swallow it, it goes down your esophagus and into
the stomach. So then in the stomach there is acid
is produced by the stomach cells, and that continues to
break things down. The stomach shakes it around. I imagine
the stomach is like a big angry bag, and then
it goes into the small intestine, which, as doctor Tublin
will tell us, is not so small where food is
(03:47):
actually absorbed. So that's where the nutrients and all the
things that your body needs is taken from the food,
and then what's left goes into the large intestine and
is eventually excreted as poop.
Speaker 2 (04:00):
I think that was very well said, and I think
what you said is great, which is that if you
understand how it's supposed to work, then when we talk
about what may not be normal, people will be able
to understand that a little bit more. So, you touched
on digestion, and I just want to mention that with
the GI tract, we have digestion, which is the breakdown
of these complex molecules into more absorbable components, and then
(04:23):
there's absorption, which is the actual coming of these nutrients
from the GI tract into the bloodstream through our lymphatic system,
and then they go to the cells where they provide
nutrients and energy and all the things that we need
from our nutrition. And we actually do have a caller
on the line already. His name is David, So, David,
are you there. You're on with doctor Lindsay Snow and myself.
Speaker 4 (04:49):
My question is I have had back issues through the years.
Lately and I also bettle with sciatica, and the last
month or so it's been pretty intense pain, and I
noticed that I have a difficult time going, you know,
the bathroom. So there's been days where it's been two
thy days without a bowel movement, and sometimes when I
(05:11):
do I do, it's either constantation or it's diarrhea. And
I'm wondering what kind of doctor would I see to
kind of figure out where to go from this, because
it's some people think it's a pinch nerve. It's causing
the problem that I need to see an orthopedic, but
I'm not really sure. But it's it's you know, it's
(05:33):
it's not very healthy. I need to do something because,
like I say, sometimes it's two or three days before
I have a bowel movement, so I need to figure
out a where to go from from here.
Speaker 2 (05:44):
Well, I think you summarize very nicely a lot of
what we were hoping to cover tonight, So I would
I would say, just to start that one of the
things that I think you bring up is what it
sounds like is that there's been a change for you,
and I think that's always something we want to point
out to our list of you know, the people have
very different regimens of their bowel movements that can be
(06:05):
very healthy, but when something is different or changed for
your particular routine, that's something to pay attention to, which
you are clearly doing. I think to answer your question,
I would say, and you know, doctor Snow, if you
feel differently, you would probably start with your primary care physician.
They would probably be aware of the surgery that you
just had. They would be able to review the medications
that you might be on from the surgery, and instead
(06:28):
of jumping right to sort of that mechanical problem of
the nerve, which certainly would be something we would consider.
We'd want to kind of look at those triggers that
might be happening just from the situational aspect of having
had surgery and maybe not being as mobile the water intake,
the medicines you might be on. But of course then
looking into anything mechanical, Doctor Snow, would you add anything
(06:50):
to that?
Speaker 1 (06:51):
Yeah, I think that's great.
Speaker 3 (06:52):
And also this brings up kind of the next thing
we were going to talk about with is what is
a normal bowel movement?
Speaker 2 (06:59):
Yeah, so, like I was saying, those can be very different,
you know, and the characteristics of normal and I'll go
over that in just a minute, but David, I just
want to make sure that that answers your question. So
I think to answer that, we would have you start
with your primary care make sure you bring your list
of medications, even anything over the counter or supplements that
you might be taking, and let them go through that
(07:20):
with you extensively to help figure out what might be
going on.
Speaker 4 (07:24):
Okay, well, thank you very much, appreciate you taking a call.
Speaker 2 (07:26):
Yeah, thanks for calling in. So doctors know you were
asking about normal and so what I would like to
say is that healthy can mean different things to different
different people. So what we do know is that the
typical would be, you know, a brown formed movement that
is relatively easy to pass, that isn't straining or uncomfortable,
(07:47):
it's not associated with any pain, and you know, but
the frequency can be very different, and it can be
normal to go to the bathroom only a couple times
a week. But what's not normal is to be uncomfortable
because of that in between. And I also want to
point out, as we sort of get ready to talk
about diarrhea and constipation, that some occasional diarrhea and constipation
(08:10):
is normal. It's normal to have small bouts of changes
here or there, but they should be relatively short lived
and not very severe. So I think we're going to
take our first break. I want to let everybody know
that you are listening to Centered on Health with Baptist
Health here on News Radio eight forty whas your hosts
tonight are myself, doctor Jeff Tavlan and doctor Lindsay Snow.
(08:32):
We're doing our Chief Complaint tonight. Our phone number five
seven one eight four eight four if you want to
call in and be a part of the show. We'll
be right back. Welcome back to Center on Health with
(08:55):
Baptist Health here on news radio eight forty whas. I'm
your doctor, Jeff Tumlin, and we have doctor Lindsley Snow
with us tonight as our co host. We're talking about
diarrhea in our new series that we're talking about called
Chief Complaint. And our phone number is five seven one
eight four eighty four and our producer, mister Jim Fenn
is here to take your calls if you want to
(09:16):
ask a question. So doctor Snow, welcome back. And right
before the break, we were starting to talk about normal anatomy,
a little bit about what to expect as normal and
what a normal bowel movement is.
Speaker 3 (09:30):
So I always think about bowel movements kind of as
like goldilocks, right, you've got too hard, just right, too soft,
So starting with you know, the too soft end of
the spectrum.
Speaker 1 (09:44):
So diarrhea. Can does diarrhea have to.
Speaker 3 (09:48):
Be just like straight water? Or can it be softer
or more frequent?
Speaker 2 (09:54):
All of the above, I think all of the above.
So diarrhea, you know, pet, someone will come to you,
you know, first stop. As a primary care physician with diarrhea,
and so you'll ask them, you know, what does that mean,
and a lot of times you'll get just what you said,
it's like water running through me. But other people just
mean they're going more than they were going before, and
to them that's diarrhea, or they're unable to hold it,
(10:17):
and they may be confusing something called incontinence with diarrhea.
And then just sort of a different in the consistency
that it used to be these solid stools and now
they're not. And then the other part that some people
think of as diarrhea is urgency. So that really that
kind of like, oh my gosh, if I don't find
a bathroom now, I'm going to be in trouble.
Speaker 3 (10:38):
So when I think about the causes of diarrhea, I
kind of imagine them as like buckets. So when we
were talking about the role of the intestines, it's to
absorb the small intestine, and that's I feel like where
most diarrhea happens. It's to absorb nutrients, stuff like that.
But sometimes when things aren't going right these it can
(11:01):
be reversed kind of like a pump, and instead of
absorbing things, the small intestines are pushing water into the
small intestine, right, So that would be I would think
more like a infection, like a maybe food poisoning is
one people are pretty familiar with.
Speaker 1 (11:17):
Certain if you're drinking.
Speaker 3 (11:19):
Creek water stuff like that, right plane in a cow pasture.
Speaker 1 (11:24):
Then there's also other causes. So what would be some
of those other ones?
Speaker 2 (11:28):
So the buckets is a great analogy because that's also
you know, we assume by the time somebody comes to us,
you know, with diarrhea, that they've already seen a primary
care or had an e our visitor or something. But
we need to start thinking about what is causing this diarrhea.
Is it something that we call functional diarrhea where it's
(11:48):
a hyper sensitivity of the gut. I think most people
listening are probably familiar with the term irritable bowel syndrome
that's oftentimes associated with diarrhea, but you're alluding to other
things like infectious diarrhea. And so what can happen is
if you have like a toxin, anything that's causing irritation
to the lining of the gut, it's going to cause
(12:10):
the gut to secrete more fluid and that is what
that diarrhea becomes.
Speaker 1 (12:14):
So it's trying to like rinse the demons.
Speaker 2 (12:16):
Kind of flush it out, and our body is actually
pretty exquisitely built, so it wants to get rid of it.
So but there's another kind called osmotic. So people are
probably familiar with artificial sweeteners, and sometimes they'll say that
gives me diarrhea. And you know, if I eat you know, sucrose,
or if I have something with a lot of fructose
in it, And so that's caused by the fact that
(12:37):
these molecules are not supposed to be there and they're
drawing water out of the body into the gut and
it's causing diarrhea.
Speaker 1 (12:43):
And is that how lactose intolerance?
Speaker 2 (12:45):
It is yep, yep. Similar, And so they are the
only other two kind of main categories. There's one called inflammatory,
so I treat a lot of conditions of the inflammatory bow,
which is Crone's disease or al sort of clitis. So
an inflamed gut can lead to diarrhea. And then there
are times when the body just isn't able to absorb
things properly. That's called malabsorption. So those are kind of
(13:07):
the buckets that we think about.
Speaker 3 (13:09):
So what would be before we kind of go into
how could someone maybe treat things at home things like that.
You know, we always want to make sure we give
good guidance on what's kind of a quote unquote red
flag symptom. So I always tell people, you know, blood anywhere,
it's not.
Speaker 2 (13:25):
Supposed to be right.
Speaker 1 (13:26):
Symptoms lasting more than a week is kind of my threshold.
Speaker 3 (13:31):
And then any associated you know, fever, weakness, because I
feel like the big risk with diarrhea can be dehydration.
I mean it used to be a huge killer before
antibiotics and modern medical treatment.
Speaker 2 (13:42):
So I mean that's exactly right. So I think, well,
and one thing to point out is, you know, with
our caller Dave, like he is noticing a change, so
I would throw a change in as a red flag.
So I think what you said was was really right
on the money. I mean, we don't. We started off
my saying it is normal occasionally to have a little
(14:02):
diarrhea or to have a little constipation. The problem is
if it's persistent. So somebody could go on a trip
with their family, they may come back from Mexico and
have some travelers diarrhea and it might last three to
five days and they'll get better and again during that
time frame, the main thing, as you pointed out, would
be hydration and making sure that you don't get dehydrated.
But if it persists, that's not normal. And if there's pain, fever, blood,
(14:27):
or it's a big change for you, then I think
those are warning signs, red flags.
Speaker 3 (14:32):
So assuming someone doesn't have any of the warning signs,
what would be something they may consider trying at home
for diarrhea.
Speaker 2 (14:41):
So the first thing is hydration, right, just to replenish.
So we've talked about that. But I do think it's
okay to use over the counter products like emodium. I mean,
they're there for a reason. Now it's going to say
on the box not to use it for a very
long period of time because we don't want you masking
something at home that should be treated. But for the
short term use of diarrhea medicine, emodium works really, really well.
Speaker 3 (15:06):
There was a really fun study that compared diluted apple
juice to pedlite, which is much more expensive, and the
diluted apple juice group actually had better outcomes. So yeah,
whenever I have somebody with diarrhea, and I always tell
you know a lot of times there's also naug of
vomiting with diarrhea, especially with a stomach bug.
Speaker 1 (15:23):
So I always tell.
Speaker 3 (15:24):
People, you know, you're thirsty because you're dehydrated, and you
want to chug all this fluid, but that can actually
trigger more nausee and vomiting.
Speaker 1 (15:31):
So I tell people to do like a shot glass.
Speaker 3 (15:33):
Every few minutes, maybe every five minutes, because you want
to do those small volumes.
Speaker 1 (15:39):
That will add up as time goes on.
Speaker 3 (15:40):
And then I usually recommend, you know, straight water is good,
but again we want to make sure we were replenishing
our salts because if you have diarrhea, a lot of
that's coming out. So usually I recommend diluted gatorade is
Do you have a preference?
Speaker 2 (15:53):
No, I think that those are great, great so long
as it's not red. Yeah, we don't like the reg
because that might be a confusing. And also if you're
prepping for a colon ascapy, just why so the emodium
works really well. So those work on the receptors in
the gut that will slow the motility down in the gut.
And that's the reason that that works is because it
gives your body more time to absorb the water that's
(16:15):
kind of naturally trying to come out too fast. So narcotics,
you know, work the same way. That's why they cause constipation.
I know we'll probably talk about that later, but it's
the same receptors. So emodium works on those receptors to
slow the motility of the gut down intentionally. Some people
use probiotics over the counter. I think that's okay to
do that question a lot. Yeah, I think that's certainly
(16:38):
not going to interfere with anything that you know, to
mask anything, and it might be symptomatic. So there's several
probiotics over the counter. And I will say, we have
a wonderful pharmacist, Angela Sallin who's always on the show,
and I just want to put a plug in for
pharmacy because they are really really helpful. So if you
are looking at this aisle of product after product after
(17:00):
product and you have a question of what's the right thing,
ask your pharmacists. They're they're there to help.
Speaker 3 (17:05):
I always tell folks I love I always recommend getting
things from food if possible, so fermented food, so kim chi, kafir, yogurt, kombucha,
any fermented food, sour kraut, My dad loves soaur kraut.
It was just October fresh right, So hey dad, So
that's where I recommend getting probiotics if at all possible.
(17:27):
But yeah, taking probiotics scummies or a capsule or something
like that isn't wrong either.
Speaker 2 (17:31):
So they're probably a patient's probably gonna call you before
they're gonna call me, although not always, but if you're
going about your day and you get a message from
a patient I'm having diarrhea, like, how do you think
about how long to let them know? Say, hey, try
these things we just mentioned, but call back if.
Speaker 3 (17:53):
Yeah, So that's usually what I do, especially if someone says,
you know, my you know, our kids are carriers of
disease and pestilence. Once school gets back in session, we
start having you know, diarrhea season. So a lot of
times if someone says, oh, you know, my kid brought
home a stomach bug. You know, I've had diarrhea for
four days and I'm puking, I'll say, okay, well let's
stop the puking, so that way you can keep some
(18:14):
fluids down and not get dehydrated. But like you said,
the body's trying to flush whatever toxin is there out
for a reason. So usually I recommend against amodium for
probably what's infectious diarrhea as far as the what you
describe more functional. Usually, again we recommend dietary changes. Increasing
fiber can definitely be a big one. A lot of
(18:35):
Americans do not eat enough fiber.
Speaker 2 (18:36):
Absolutely, it's really hard.
Speaker 3 (18:38):
And we're going to talk about sources of fiber, yes,
coming out because I definitely am eager to hear that,
because I've always get that question.
Speaker 1 (18:46):
Like what fiber should I eat?
Speaker 3 (18:48):
And then increasing hydration, looking at medications, that sort of thing,
and then usually yeah, I'll say, hey, come in and.
Speaker 1 (18:53):
See me within a week or so if things aren't better.
Speaker 2 (18:55):
And sort of that first evaluation, you know, for us
looks like oftentimes getting stool samples just to make sure
that there's no infection while you know, diarrhea we kind
of classify as sort of subacute, which is like super
super right away and not very fast acute, which has
been going on for a little while, and then chronic,
(19:16):
which has been going on for a long time. So
even though you can have an infection for a very
long time that hasn't been picked up, that's not the norm.
So if somebody's having this acute diarrhea that's not going away,
then ruling out an affection is probably like the first thing. Yeah,
which all they want to do. All right, well, let's
take one break here, we'll jump right back in when
(19:37):
we come back. I want to remind everybody that you
are listening to Centered on Health with Baptist Health here
on news radio eight forty whas. We're talking tonight about
our Chief Complaint of diarrhea and constipation with doctor Lindsey
Snow and myself. Our phone number five oh two, five
seven one eight four eighty four. If you want to
call in and be a part of the show, we'll
be right back. Welcome back to Center It on Health
(20:10):
with Baptist Health here on news radio eight forty whas.
I'm doctor Jeff Tulvlin and we're joined by my co
host tonight, doctor Lindsay Snow. We're talking in our new
series of Chief Complaint about diarrhea and constipation. Please call
us if you have any questions you want to ask.
Five oh two, five seven one eight four eight four.
So doctor Snow, right before we went to break, we
(20:31):
were talking about the different causes of diarrhea, and I
just want to point out that I think if you
look by sort of codes of billing, the probably the
most common reason for diarrhea that we see in GI
and probably in primary care is irritable bowel syndrome. So
IBS is irritable bow syndrome. It's oftentimes either diarrhea or
(20:52):
constipation predominant. But a lot of people probably will see
you first with IBS.
Speaker 1 (20:57):
Yeah, we'll get that a lot.
Speaker 3 (20:59):
So, like you said, kind of chronic person who's like,
you know, I've always had either diarrhea or constipation.
Speaker 1 (21:04):
I've tried all these things, nothing seems to help.
Speaker 3 (21:08):
And I feel like IBS is kind of a tricky.
Speaker 1 (21:11):
One a lot of the time because you know, we'll.
Speaker 3 (21:14):
Rule up the scary stuff first obviously, but then you're
kind of like, okay, your gut it just hates everything.
So treatment can be kind of challenging, right, So, I know, pharmacologically,
what sort of medications do we normally use for IBS
or is it more non pharmacologic stuff.
Speaker 2 (21:34):
Well, I think it's both. I think as far as medicines,
pharma pharmacological treatments, we have things that slow the gut down.
We have things that people may be familiar with, like
bental or dicyclamine or levsin or hyoskymine. These are anticholinergic.
That means that they work on the nerves in the
gut to slow it down, just like we talked about earlier,
(21:54):
but they also decreased that sensation of discomfort. So you know,
one thing that I think is really important for people
that are listening that may have IBS is that it
is it's not just a diagnosis of exclusion. There are
actual criteria. So when you're a provider, either your primary
care or your GI physician is talking to when they
haven't been able to find something, it doesn't mean that
(22:17):
we're saying it's not real. It's just it's the hypersensitivity
of the gut and there's not a lot of ways
to test that overtly. So I just I think for
IBS patients it can get very, very frustrating. But I
do think there's a lot of people that like to
try things naturally. So what do you talk to them
about in the primary care.
Speaker 3 (22:36):
So usually when I start with primary care, and this
is for diarrhea as well as dietary changes and so
the low fodmap diet and I always what it stands
for is like fermento, oligo die sc or he's looking
at your squirming.
Speaker 2 (22:53):
Yes, you're doing so.
Speaker 3 (22:55):
It's molecules that are in foods that are getting are
not bad. But yeah, I liked how you describe it
as hypersensitivity, where the gut is just very irritable. I
guess that, yess sense, that's a good name there, And
so typically IBS guts do not like those molecules, and
so eliminating foods that are high in those molecules is
(23:16):
usually where I recommend starting. Because if we can manage
things without medication and all that stuff, I think that's
great because there's a lot of IBS folks who are
able to not everybody, but some folks.
Speaker 2 (23:25):
And there are studies that support that the fodmap diet
does work, so it's not just sort of picking something
out of the air and hoping that it works. And
you know, a lot a lot of times IBS patients
they get this when they're pretty young, so to be
on medications for the rest of their life, I think
if you can do it through lifestyle changes, I think
that's amazing.
Speaker 3 (23:43):
There's also peppermint oil, there's acupuncture shout out and I
read something about CBT, so cognitive behavioral therapy. What other
non pharmacolture therapies do you recommendo? Are the usually the
top three I do is dietary changes, peppermint oil, and
then considering acupuncture and or CBT.
Speaker 2 (24:06):
Yeah, I think that's right. I think that's how we
would approach it to that we oftentimes will use the
thodmap diet to begin with. Now, there's an overlap with
lactose intolerance, so sometimes you know, we confuse IBS with
lactose intolerance. There can be bacterial overgrowth, which is another
condition that can be similar to symptom wise to IBS.
So I do think that those are going to be
(24:26):
the kinds of things. You know, when we talk about
what happens in the primary care world and then what
happens in the GI world. You're going to do all
those things. First, You're going to treat them with dietary changes,
You're going to try some of these non pharmacological things.
You might even prescribe some of the pharmacological things. But
at some point there is going to be the desire
to rule out other things that might require more testing
(24:47):
through a GI doctor, like a colonoscopy. But ultimately there
are other medications that we might escalate to that work
on the brain gut, and that would be done through
through specialty.
Speaker 4 (24:58):
Yeah.
Speaker 3 (24:58):
Always described it as my sandbox in primary care. I'm
very comfortable within the confines of my sandbox.
Speaker 1 (25:03):
But if somebody's.
Speaker 3 (25:04):
Needs are are outside, I got a definitely phone a friend,
rely on our specialist colleagues. Another thing that I just
had a thought of was a lot of times people
who menstraight can will say they notice they have diarrhea
around their cycle. That's very common because so your period
is the uter is contracting to get rid of the
(25:25):
indometrial lining. That's what the blood is, and it can
irritate the structures around it, which are the bladder and
the end of the large intestine. So that's also kind
of another common cause of diarrhea that would fall within
the range.
Speaker 1 (25:41):
The realm of normal.
Speaker 2 (25:42):
Yeah. I think that it's very common for us to
hear that there's sort of a cyclical nature. And that's
also true with the with the irritable bow that we've
been we've been talking about as well.
Speaker 3 (25:51):
So while we're on irritable bows, so again with goldilocks,
too hard, too soft, Yes, So.
Speaker 1 (25:57):
Now going into constipation.
Speaker 3 (25:58):
Right, So, just like diarrhea can kind of have many forms,
when you think of constipation, is it just someone who's
maybe straining to have a bowel movement. It is those
hard little rabbit turn that people sometimes describe.
Speaker 2 (26:12):
So yeah, So again, one of the things with constipation
that I want to point out is number one, it
can be normal to not go to the bathroom every
single day.
Speaker 1 (26:21):
That was mind blowing when you told me that.
Speaker 2 (26:23):
I mean, that's great, and most people do. But if
you're not having other symptoms of pain or discomfort and
you go naturally three times a week, that's really okay,
especially if it's not a change for you. Again, I
know I've said that a couple of times, but that's
really important because you know, you know your body, and
(26:43):
if something isn't the same as it's always been, it's
worth mentioning. But with constipation, by the time somebody gets
to us, we need to start thinking about, you know,
what does constipation really mean. Just like we talked about,
diarrhea could mean different things to different people, constipation can
mean different things. So constant can be the inability for
(27:03):
the stool to move around the colon, so the large
intestine getting around might be slow, so the motility might
be slow. We call that slow transit constipation. But constipation
can also be you know, the stools getting around okay,
but it's really hard to get the stool out. So
that's oftentimes very common in people who have pelvic floor abnormality.
(27:25):
So straining or feeling like you need to disimpact yourself
because it won't come out, those are signs of an
outlet problem and not necessarily a transit problem. So we
need to know, you know, we know we're on the
highway of constipation. We need to know what lane we're in.
Speaker 3 (27:41):
Yes, And I always think of kind of the gears
of constipation using a car analogy of mush and push,
because to make a bowel movement, it has to be
mushy because the colon. What was it that you said,
One of your instructors told you the purpose of the colon.
Speaker 2 (27:56):
Was to absorb water and to have a reason to
read the paper.
Speaker 1 (27:59):
Yes, we're going to say, now reason they're like, scroll
on your.
Speaker 2 (28:01):
Scroll on your right. Yeah. I'm aging myself there with
that quote.
Speaker 1 (28:06):
Yes, read the shampoo bottles.
Speaker 2 (28:07):
Yeah. So, and the corollary to that is that you
can live your entire life without a large intestine, because
the two functions of the large intestine the colon are
to reabsorb water and to package waste, and you can
eliminate the waste through an ostomy if need be. And
the small intestine takes over the job of absorption and
can actually absorb more water than it normally does when
(28:30):
the body doesn't have a colon.
Speaker 1 (28:31):
That's amazing.
Speaker 2 (28:32):
Yeah, it's pretty amazing.
Speaker 1 (28:33):
And then push, Like you said, there's the motility.
Speaker 3 (28:35):
So thinking like of your large intestine is like a
toothpaste tube. You know, we got to squeeze it and
get it all through there. So a lot of times
when someone tells me that they're having constipation, kind of
the first questions I ask thinking about mush and push
are are you drinking enough water? Because if someone's dehydrated,
the colon's going to absorb more water from the waste
(28:56):
to try and give the body what it needs.
Speaker 1 (28:58):
And then push.
Speaker 3 (28:59):
If someone isn't enough fiber, then there's not enough to
actually push to really make a bowel movement, so it
takes a lot longer to kind of accumulate what is needed.
Speaker 2 (29:09):
Yeah, and the fiber issue, I get asked all the time,
you know, So what type of fiber you know, because
if you look in the grocery store, you're going to
see aisles of different types of fiber. So, just as
a very brief statement, there's soluble fiber and there's insoluble fibers,
and so soluble obviously means it'll work with water, it'll
(29:29):
absorb with water. That's how we get sort of that
gel and the ease of the passage, whereas the insoluble
fibers are bulking and that's what gives you the bulk
to the stool. We prefer to get our fiber through diets,
whole grain oats, fruits, vegetables, legomes. Those are the kinds
of ways we'd like you to get your fiber. Beans, yes,
(29:50):
but so the if you can't reach it with just
dietary fiber, we would would recommend over the counterfiber, you know,
like metamucol or things.
Speaker 1 (30:01):
Like now they make it in a gummy, they do
make it a gummy a gummy.
Speaker 2 (30:04):
Yeah. So you're looking for about twenty to forty total
grams of fiber per day, the most of that you
would want to get through your diet, and maybe ten
grams if you need to through through over the counter stuff.
So let's stop there. We'll take our final break, and
we will come back and we'll talk more about constipation
and maybe some of the medications that can cause it.
So you are listening to Centered on Health with Baptist
(30:27):
Health here on news radio eight forty whas. I'm your host,
doctor Jeff Tublin. We're talking tonight about our chief complaint
of diarrhea and constipation. Don't forget to download the iHeartRadio app.
It'll give you access to all of the show and
all the other features that the app has to offer.
We'll be right back. Welcome back to Center It on
(30:55):
Health with Baptist Health here on news radio eight forty whas.
I'm your host, doctor Jeff Tuvlin, and we're joined by
our co host tonight, doctor Lindsey Snow. We're doing our
chief Complaint episode about diarrhea and constipation. I want to
remind everybody to download the iHeartRadio app. You can use
it to listen to this show and its entirety, or
have access to all the features that the app has
(31:16):
to offer. So doctor Snow, right before we went to break,
we broke into constipation and we're diving in. And just
like we talked about with diarrhea, somebody calls your office
with constipation, how do you guide them over the phone
or through the my chart or what's the process.
Speaker 3 (31:35):
Yeah. Usually, again, I kind of just provide those general
recommendations on increasing fiber and drinking water is really hard.
I have my giant forty cup right in front of
me because I'm trying so hard to get my water.
Speaker 1 (31:47):
It's thirty two to sixty four ounces a day minimum.
Speaker 2 (31:51):
Yeah, that's a lot, It's a lot.
Speaker 3 (31:53):
Yeah, So counsel them on fiber.
Speaker 1 (31:55):
Again.
Speaker 3 (31:55):
I love the twenty gram was did you say twenty
to forty twenty to forty gram? I think that's great,
kind of giving people a number, just sort of just
more right.
Speaker 2 (32:04):
More more.
Speaker 3 (32:07):
Then again, usually I'll say if things aren't getting better
within a week or so, come back and see me.
I have a question. Is constepation just the opposite of diarrhea.
So of diarrhea is the intestines just secreting. Constipation is
the just the intestines absorbing. Would you say that's accurate
or do you think there's a little more nuance to it? So?
Speaker 2 (32:28):
I love that, but I think so we don't approach
them the same, but opposite, if that makes sense. It's
not like the way we treat diarrhea. We untreat it
with constipation. So and the reason I say that is
because there are some very important things for each of
those diagnoses that have nothing to do with the other one. So,
for example, with constipation, there could be a mass something
(32:52):
that's causing the reason that that thing that has nothing
to do with the diarrhea side of things. Right, it's
not the opposite, but it's something we have to think
about with constant patient. So even though it sounds opposite,
we would take each symptom as its own entity and
do its own work up kind of, you know, from
beginning to end.
Speaker 3 (33:10):
So for constipation, I think also maybe even more with diarrhea,
I feel.
Speaker 1 (33:16):
Like a lot of medications are the cause of it.
Speaker 2 (33:19):
We could we could have mentioned that earlier, for sure. Yeah.
Speaker 3 (33:22):
So, but my medications can affect the gut both ways,
you know. I know a lot of anxiety and depression
medications can cause diarrhea or constipation because they're serotonin receptors
in the gut, and those medications work on serotonin receptors.
A lot of diabetes, medications can cause diarrhea or constipation,
(33:44):
depending on how their.
Speaker 1 (33:45):
Mechanism of action.
Speaker 3 (33:48):
You think you said, nonsteroidals like i'd be profile, can
cause diarrhea absolutely, Yeah. What are some other common medical
medication culprits?
Speaker 2 (33:56):
So I'll just start by saying that oftentimes I don't
think people consider supplements as medications. So I feel I
think we're doing a better job when we talk to
patients and we ask them what they're taking that we
as providers remember to ask them about supplements. But as
(34:19):
a patient, you should also be aware that when you're
asked about your medications, your provider wants to know if
you're taking over the counter things or supplements too. And
the reason I say that is because things we think
that are super healthy, Like people may be taking magnesium
for their heart or for whatever reason, and they may
be having diarrhea and may be so confused why do
I have diarrhea? And it's because they're taking magnesium. There's
a reason it's called milk of magnesia because that magnesium
(34:41):
helps stimulate bowel movements. So that's a very important first
place to look. So I do want to encourage our
patient population and our providers to consider supplements, herbals and
over the counters as medications when it's coming to taking
the history. But as far as diarrhea is concerned, antibiotics
are a big one. They can cause it. You mentioned
met foreman or diabetes medication, the antidepressants, anything with magnesium
(35:07):
in it, and then just these over the counter stuff.
So I think that's the diarrhea side of things. I
think with constipation, you know, I'm just going to jump
right in. I think that one of the biggest things
we're seeing now are the GLP ones. I mean, they
are very very common. People are taking a lot of them,
and that the way that they work is on motility
and one of the places that gets affected is the
(35:28):
motility of the colon. So it is not uncommon. It's
actually a fairly significant constipation that can happen with with
the GLP ones.
Speaker 1 (35:38):
You mentioned earlier.
Speaker 4 (35:39):
Yep.
Speaker 2 (35:39):
So you know they're there for a reason and people
need them and we understand that, but they do cause constipation.
They work on those receptors we talked about earlier that
can slow the motility of the gut. But people take
iron supplementation that causes constipation. Blood pressure medications, even antacids
that you you know, common ones that you think of of,
(36:00):
like you know the prilo sexiomeprazol or you know those
acid reflex medicines. So it's really important that both the
patient bring a list and the provider ask for the
list of the things that patients are taking, because you
could undergo a very extensive work up for either diarrhea
or constipation when that answer might have been right in
(36:22):
front of you.
Speaker 1 (36:23):
Yes, and we definitely do not want that. No, no,
thank you.
Speaker 3 (36:27):
So what are some red flag symptoms for constipation? I
don't think we touched on that like we did for diarrhea.
Is it just kind of the exact same so blood
where there shouldn't be Definitely fever. I feel like people
don't usually get a fever with constipation the way they
might with diarrhea.
Speaker 4 (36:45):
No.
Speaker 2 (36:45):
I think pain, you know, bloating, that's not normal when.
Speaker 1 (36:49):
You have a bowel movement. It's not supposed to.
Speaker 2 (36:51):
Pain with the bowel movement or pain in the in
the abdomen. Weight loss certainly, that is a definite alarm symptom.
Change in color, So that is so variable, and that
can be medication related. It can be diet related. I
don't know that you have to go seek immediate medical
(37:12):
attention just for a change in color, But if there's
a change in color associated with other things we've been mentioning,
then for sure, and I think, you know, rather than
changing color, if there's if they're totally pale, I think
that may be something to ask about.
Speaker 3 (37:27):
When I was in residency in Saint Louis, there was
an absolutely terrifying pediatric gansture in Oledge, just like the
scariest person I still.
Speaker 1 (37:34):
Think about, Like, we're very nice and GM he's under
my bed.
Speaker 3 (37:39):
And he would tell people he did not care what
color the poop was, as long as it wasn't red, white,
or black.
Speaker 2 (37:45):
Fair enough, those are three colors we definitely pay attention to.
Speaker 1 (37:49):
All the colors of the rainbow are feat.
Speaker 2 (37:50):
So I think, yeah, with constipation, I think the pain
is a bigger one weight loss certainly, and then the
bleak for sure.
Speaker 3 (38:00):
And one thing that I learned that was interesting is
sometimes someone can get so constipated that they actually have
diarrhea where there's this big stool ball for lack of
a better term, and then there's just liquid poop kind
of going around it so one can lead to the other.
Speaker 1 (38:17):
You can have both at the same time.
Speaker 2 (38:18):
Yeah, you can. That's called overflowing continents, usually from a
fecal impaction. So another story for another time. Well, that's
going to wrap it up. I can't believe this was
our first chief complaint episode. I hope overflowing with stuff overflowing.
I hope that the audience is enjoying this and listening
to this. We're going to try and use different chief complaints.
(38:39):
It won't always be diarrhea, but we're going to try
and hit the major one so that you, our listener,
can understand when to seek medical attention. That's going to
do it for tonight's episode of Centered on Health. I
want to thank our producer, mister Jim Fenn, doctor Snow,
thank you for joining us, and our caller Dave, and
I hope everybody has a really wonderful rest of your
week and a great weekend file. This program is for
(39:06):
informational purposes only and should not be relied upon as
medical advice. The content of this program is not intended
to be a substitute for professional medical advice, diagnosis, or treatment.
This show is not designed to replace the physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
(39:27):
to your personal health or regarding specific medical conditions.
Speaker 1 (39:30):
To find a Baptist health provider, please visit baptistealth dot com.
It's now time for Centered on Health with Baptists Health
on use Radio. Wait forty wyjs now, here's doctor Jeff Tumbler.
Speaker 2 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news Radio eight
forty whas. I'm your host, doctor Jeff Tublin. We're joined
in the studio by mister Jim Fenn, who's here to
take your calls tonight. Our phone number five oh two,
five seven one, eight four eighty four if you want
to call in and be a part of the show.
(00:31):
Tonight is an exciting night because we have a very
special guest. Tonight we are joined in the studio with
doctor Lindsey Snow. Welcome doctor Snow, thank you so much.
And doctor Snow is starting a new series on our
show with us that we're going to be doing about
once a month. I'm going to let her introduce herself
in just a moment, but we are starting a series
called Chief Complaint and the doctors doctor is in so
(00:54):
Chief Complaint. We're gonna take a complaint that somebody might have.
For example, tonight we're going to be talking about diary
and constipation and we're going to kind of go through
what you as the listener might want to think about
or when you might need to see a doctor and
answer some of those questions the doctor is in. We're
going to ask you to submit questions to us that
we can answer for you here live and on the air.
(01:15):
So doctor Snow, welcome. I'm gonna let you introduce yourself.
We're excited to get this series kicked off.
Speaker 3 (01:21):
Thank you so much. I'm so excited. My name is
doctor Lindsay Snow. I'm a Board certified family medicine physician.
I practice a Baptist Health on Chamberlain Lane by the
Ford Plant.
Speaker 4 (01:32):
Yeah.
Speaker 1 (01:33):
I'm really excited for this series.
Speaker 3 (01:34):
I feel like, you know, something I hear all the
time in primary care clinic is there's so much information
out there that a lot of times people don't know
what they should trust or believe, you know, like what do.
Speaker 2 (01:48):
I do with this right? There's so much information?
Speaker 3 (01:51):
Yeah, and so I think that providing educational opportunities is
really good. But one thing that I'm really excited about
this particular series is that we're going to go into
how things work. Because I think for me, if I
understand how something works, then when something's going wrong, I
understand it better.
Speaker 1 (02:08):
I don't know if you feel that way, you know, I.
Speaker 2 (02:10):
Think that makes perfect sense. And I also, like, you know,
usually we have a specialist on the show, either a
primary care specialist or a subspecialist, And I think what's
nice about what we're planning on doing is sort of
helping the listener understand when is it something I need
to see my primary care about, When is it something
they might send me to a specialist for. So, you know,
the more they know, and the more we all know
(02:31):
of what we're doing and planning, I think that the
better the outcomes. So we are obviously starting with something
near and dear to my heart in the GI world.
So the chief complaint that we're talking about tonight is
going to be about diarrhea and constipation, which is obviously
a very common problem. But I'm going to let you
take the lead because I'm sure you'll want to pick
(02:51):
my brain about that.
Speaker 3 (02:53):
So first off, we're gonna kind of start with how
does digestion work? You know, food goes in and stuff
comes out the other end and everything in between.
Speaker 1 (03:05):
So let's imagine, you know.
Speaker 3 (03:06):
If there was fairytale music right now, Look, This is
the story of digestion. So if someone takes a bite
of an apple, you chew the apple up, and there's
enzymes in your saliva that start breaking down the sugars
in the apple. Digestion actually starts there, so.
Speaker 1 (03:22):
Then you swallow it.
Speaker 3 (03:25):
You swallow it, it goes down your esophagus and into
the stomach. So then in the stomach there is acid
is produced by the stomach cells, and that continues to
break things down. The stomach shakes it around. I imagine
the stomach is like a big angry bag, and then
it goes into the small intestine, which, as doctor Tublin
will tell us, is not so small where food is
(03:47):
actually absorbed. So that's where the nutrients and all the
things that your body needs is taken from the food,
and then what's left goes into the large intestine and
is eventually excreted as poop.
Speaker 2 (04:00):
I think that was very well said, and I think
what you said is great, which is that if you
understand how it's supposed to work, then when we talk
about what may not be normal, people will be able
to understand that a little bit more. So, you touched
on digestion, and I just want to mention that with
the GI tract, we have digestion, which is the breakdown
of these complex molecules into more absorbable components, and then
(04:23):
there's absorption, which is the actual coming of these nutrients
from the GI tract into the bloodstream through our lymphatic system,
and then they go to the cells where they provide
nutrients and energy and all the things that we need
from our nutrition. And we actually do have a caller
on the line already. His name is David, So, David,
are you there. You're on with doctor Lindsay Snow and myself.
Speaker 4 (04:49):
My question is I have had back issues through the years.
Lately and I also bettle with sciatica, and the last
month or so it's been pretty intense pain, and I
noticed that I have a difficult time going, you know,
the bathroom. So there's been days where it's been two
thy days without a bowel movement, and sometimes when I
(05:11):
do I do, it's either constantation or it's diarrhea. And
I'm wondering what kind of doctor would I see to
kind of figure out where to go from this, because
it's some people think it's a pinch nerve. It's causing
the problem that I need to see an orthopedic, but
I'm not really sure. But it's it's you know, it's
(05:33):
it's not very healthy. I need to do something because,
like I say, sometimes it's two or three days before
I have a bowel movement, so I need to figure
out a where to go from from here.
Speaker 2 (05:44):
Well, I think you summarize very nicely a lot of
what we were hoping to cover tonight, So I would
I would say, just to start that one of the
things that I think you bring up is what it
sounds like is that there's been a change for you,
and I think that's always something we want to point
out to our list of you know, the people have
very different regimens of their bowel movements that can be
(06:05):
very healthy, but when something is different or changed for
your particular routine, that's something to pay attention to, which
you are clearly doing. I think to answer your question,
I would say, and you know, doctor Snow, if you
feel differently, you would probably start with your primary care physician.
They would probably be aware of the surgery that you
just had. They would be able to review the medications
that you might be on from the surgery, and instead
(06:28):
of jumping right to sort of that mechanical problem of
the nerve, which certainly would be something we would consider.
We'd want to kind of look at those triggers that
might be happening just from the situational aspect of having
had surgery and maybe not being as mobile the water intake,
the medicines you might be on. But of course then
looking into anything mechanical, Doctor Snow, would you add anything
(06:50):
to that?
Speaker 1 (06:51):
Yeah, I think that's great.
Speaker 3 (06:52):
And also this brings up kind of the next thing
we were going to talk about with is what is
a normal bowel movement?
Speaker 2 (06:59):
Yeah, so, like I was saying, those can be very different,
you know, and the characteristics of normal and I'll go
over that in just a minute, but David, I just
want to make sure that that answers your question. So
I think to answer that, we would have you start
with your primary care make sure you bring your list
of medications, even anything over the counter or supplements that
you might be taking, and let them go through that
(07:20):
with you extensively to help figure out what might be
going on.
Speaker 4 (07:24):
Okay, well, thank you very much, appreciate you taking a call.
Speaker 2 (07:26):
Yeah, thanks for calling in. So doctors know you were
asking about normal and so what I would like to
say is that healthy can mean different things to different
different people. So what we do know is that the
typical would be, you know, a brown formed movement that
is relatively easy to pass, that isn't straining or uncomfortable,
(07:47):
it's not associated with any pain, and you know, but
the frequency can be very different, and it can be
normal to go to the bathroom only a couple times
a week. But what's not normal is to be uncomfortable
because of that in between. And I also want to
point out, as we sort of get ready to talk
about diarrhea and constipation, that some occasional diarrhea and constipation
(08:10):
is normal. It's normal to have small bouts of changes
here or there, but they should be relatively short lived
and not very severe. So I think we're going to
take our first break. I want to let everybody know
that you are listening to Centered on Health with Baptist
Health here on News Radio eight forty whas your hosts
tonight are myself, doctor Jeff Tavlan and doctor Lindsay Snow.
(08:32):
We're doing our Chief Complaint tonight. Our phone number five
seven one eight four eight four if you want to
call in and be a part of the show. We'll
be right back. Welcome back to Center on Health with
(08:55):
Baptist Health here on news radio eight forty whas. I'm
your doctor, Jeff Tumlin, and we have doctor Lindsley Snow
with us tonight as our co host. We're talking about
diarrhea in our new series that we're talking about called
Chief Complaint. And our phone number is five seven one
eight four eighty four and our producer, mister Jim Fenn
is here to take your calls if you want to
(09:16):
ask a question. So doctor Snow, welcome back. And right
before the break, we were starting to talk about normal anatomy,
a little bit about what to expect as normal and
what a normal bowel movement is.
Speaker 3 (09:30):
So I always think about bowel movements kind of as
like goldilocks, right, you've got too hard, just right, too soft,
So starting with you know, the too soft end of
the spectrum.
Speaker 1 (09:44):
So diarrhea. Can does diarrhea have to.
Speaker 3 (09:48):
Be just like straight water? Or can it be softer
or more frequent?
Speaker 2 (09:54):
All of the above, I think all of the above.
So diarrhea, you know, pet, someone will come to you,
you know, first stop. As a primary care physician with diarrhea,
and so you'll ask them, you know, what does that mean,
and a lot of times you'll get just what you said,
it's like water running through me. But other people just
mean they're going more than they were going before, and
to them that's diarrhea, or they're unable to hold it,
(10:17):
and they may be confusing something called incontinence with diarrhea.
And then just sort of a different in the consistency
that it used to be these solid stools and now
they're not. And then the other part that some people
think of as diarrhea is urgency. So that really that
kind of like, oh my gosh, if I don't find
a bathroom now, I'm going to be in trouble.
Speaker 3 (10:38):
So when I think about the causes of diarrhea, I
kind of imagine them as like buckets. So when we
were talking about the role of the intestines, it's to
absorb the small intestine, and that's I feel like where
most diarrhea happens. It's to absorb nutrients, stuff like that.
But sometimes when things aren't going right these it can
(11:01):
be reversed kind of like a pump, and instead of
absorbing things, the small intestines are pushing water into the
small intestine, right, So that would be I would think
more like a infection, like a maybe food poisoning is
one people are pretty familiar with.
Speaker 1 (11:17):
Certain if you're drinking.
Speaker 3 (11:19):
Creek water stuff like that, right plane in a cow pasture.
Speaker 1 (11:24):
Then there's also other causes. So what would be some
of those other ones?
Speaker 2 (11:28):
So the buckets is a great analogy because that's also
you know, we assume by the time somebody comes to us,
you know, with diarrhea, that they've already seen a primary
care or had an e our visitor or something. But
we need to start thinking about what is causing this diarrhea.
Is it something that we call functional diarrhea where it's
(11:48):
a hyper sensitivity of the gut. I think most people
listening are probably familiar with the term irritable bowel syndrome
that's oftentimes associated with diarrhea, but you're alluding to other
things like infectious diarrhea. And so what can happen is
if you have like a toxin, anything that's causing irritation
to the lining of the gut, it's going to cause
(12:10):
the gut to secrete more fluid and that is what
that diarrhea becomes.
Speaker 1 (12:14):
So it's trying to like rinse the demons.
Speaker 2 (12:16):
Kind of flush it out, and our body is actually
pretty exquisitely built, so it wants to get rid of it.
So but there's another kind called osmotic. So people are
probably familiar with artificial sweeteners, and sometimes they'll say that
gives me diarrhea. And you know, if I eat you know, sucrose,
or if I have something with a lot of fructose
in it, And so that's caused by the fact that
(12:37):
these molecules are not supposed to be there and they're
drawing water out of the body into the gut and
it's causing diarrhea.
Speaker 1 (12:43):
And is that how lactose intolerance?
Speaker 2 (12:45):
It is yep, yep. Similar, And so they are the
only other two kind of main categories. There's one called inflammatory,
so I treat a lot of conditions of the inflammatory bow,
which is Crone's disease or al sort of clitis. So
an inflamed gut can lead to diarrhea. And then there
are times when the body just isn't able to absorb
things properly. That's called malabsorption. So those are kind of
(13:07):
the buckets that we think about.
Speaker 3 (13:09):
So what would be before we kind of go into
how could someone maybe treat things at home things like that.
You know, we always want to make sure we give
good guidance on what's kind of a quote unquote red
flag symptom. So I always tell people, you know, blood anywhere,
it's not.
Speaker 2 (13:25):
Supposed to be right.
Speaker 1 (13:26):
Symptoms lasting more than a week is kind of my threshold.
Speaker 3 (13:31):
And then any associated you know, fever, weakness, because I
feel like the big risk with diarrhea can be dehydration.
I mean it used to be a huge killer before
antibiotics and modern medical treatment.
Speaker 2 (13:42):
So I mean that's exactly right. So I think, well,
and one thing to point out is, you know, with
our caller Dave, like he is noticing a change, so
I would throw a change in as a red flag.
So I think what you said was was really right
on the money. I mean, we don't. We started off
my saying it is normal occasionally to have a little
(14:02):
diarrhea or to have a little constipation. The problem is
if it's persistent. So somebody could go on a trip
with their family, they may come back from Mexico and
have some travelers diarrhea and it might last three to
five days and they'll get better and again during that
time frame, the main thing, as you pointed out, would
be hydration and making sure that you don't get dehydrated.
But if it persists, that's not normal. And if there's pain, fever, blood,
(14:27):
or it's a big change for you, then I think
those are warning signs, red flags.
Speaker 3 (14:32):
So assuming someone doesn't have any of the warning signs,
what would be something they may consider trying at home
for diarrhea.
Speaker 2 (14:41):
So the first thing is hydration, right, just to replenish.
So we've talked about that. But I do think it's
okay to use over the counter products like emodium. I mean,
they're there for a reason. Now it's going to say
on the box not to use it for a very
long period of time because we don't want you masking
something at home that should be treated. But for the
short term use of diarrhea medicine, emodium works really, really well.
Speaker 3 (15:06):
There was a really fun study that compared diluted apple
juice to pedlite, which is much more expensive, and the
diluted apple juice group actually had better outcomes. So yeah,
whenever I have somebody with diarrhea, and I always tell
you know a lot of times there's also naug of
vomiting with diarrhea, especially with a stomach bug.
Speaker 1 (15:23):
So I always tell.
Speaker 3 (15:24):
People, you know, you're thirsty because you're dehydrated, and you
want to chug all this fluid, but that can actually
trigger more nausee and vomiting.
Speaker 1 (15:31):
So I tell people to do like a shot glass.
Speaker 3 (15:33):
Every few minutes, maybe every five minutes, because you want
to do those small volumes.
Speaker 1 (15:39):
That will add up as time goes on.
Speaker 3 (15:40):
And then I usually recommend, you know, straight water is good,
but again we want to make sure we were replenishing
our salts because if you have diarrhea, a lot of
that's coming out. So usually I recommend diluted gatorade is
Do you have a preference?
Speaker 2 (15:53):
No, I think that those are great, great so long
as it's not red. Yeah, we don't like the reg
because that might be a confusing. And also if you're
prepping for a colon ascapy, just why so the emodium
works really well. So those work on the receptors in
the gut that will slow the motility down in the gut.
And that's the reason that that works is because it
gives your body more time to absorb the water that's
(16:15):
kind of naturally trying to come out too fast. So narcotics,
you know, work the same way. That's why they cause constipation.
I know we'll probably talk about that later, but it's
the same receptors. So emodium works on those receptors to
slow the motility of the gut down intentionally. Some people
use probiotics over the counter. I think that's okay to
do that question a lot. Yeah, I think that's certainly
(16:38):
not going to interfere with anything that you know, to
mask anything, and it might be symptomatic. So there's several
probiotics over the counter. And I will say, we have
a wonderful pharmacist, Angela Sallin who's always on the show,
and I just want to put a plug in for
pharmacy because they are really really helpful. So if you
are looking at this aisle of product after product after
(17:00):
product and you have a question of what's the right thing,
ask your pharmacists. They're they're there to help.
Speaker 3 (17:05):
I always tell folks I love I always recommend getting
things from food if possible, so fermented food, so kim chi, kafir, yogurt, kombucha,
any fermented food, sour kraut, My dad loves soaur kraut.
It was just October fresh right, So hey dad, So
that's where I recommend getting probiotics if at all possible.
(17:27):
But yeah, taking probiotics scummies or a capsule or something
like that isn't wrong either.
Speaker 2 (17:31):
So they're probably a patient's probably gonna call you before
they're gonna call me, although not always, but if you're
going about your day and you get a message from
a patient I'm having diarrhea, like, how do you think
about how long to let them know? Say, hey, try
these things we just mentioned, but call back if.
Speaker 3 (17:53):
Yeah, So that's usually what I do, especially if someone says,
you know, my you know, our kids are carriers of
disease and pestilence. Once school gets back in session, we
start having you know, diarrhea season. So a lot of
times if someone says, oh, you know, my kid brought
home a stomach bug. You know, I've had diarrhea for
four days and I'm puking, I'll say, okay, well let's
stop the puking, so that way you can keep some
(18:14):
fluids down and not get dehydrated. But like you said,
the body's trying to flush whatever toxin is there out
for a reason. So usually I recommend against amodium for
probably what's infectious diarrhea as far as the what you
describe more functional. Usually, again we recommend dietary changes. Increasing
fiber can definitely be a big one. A lot of
(18:35):
Americans do not eat enough fiber.
Speaker 2 (18:36):
Absolutely, it's really hard.
Speaker 3 (18:38):
And we're going to talk about sources of fiber, yes,
coming out because I definitely am eager to hear that,
because I've always get that question.
Speaker 1 (18:46):
Like what fiber should I eat?
Speaker 3 (18:48):
And then increasing hydration, looking at medications, that sort of thing,
and then usually yeah, I'll say, hey, come in and.
Speaker 1 (18:53):
See me within a week or so if things aren't better.
Speaker 2 (18:55):
And sort of that first evaluation, you know, for us
looks like oftentimes getting stool samples just to make sure
that there's no infection while you know, diarrhea we kind
of classify as sort of subacute, which is like super
super right away and not very fast acute, which has
been going on for a little while, and then chronic,
(19:16):
which has been going on for a long time. So
even though you can have an infection for a very
long time that hasn't been picked up, that's not the norm.
So if somebody's having this acute diarrhea that's not going away,
then ruling out an affection is probably like the first thing. Yeah,
which all they want to do. All right, well, let's
take one break here, we'll jump right back in when
(19:37):
we come back. I want to remind everybody that you
are listening to Centered on Health with Baptist Health here
on news radio eight forty whas. We're talking tonight about
our Chief Complaint of diarrhea and constipation with doctor Lindsey
Snow and myself. Our phone number five oh two, five
seven one eight four eighty four. If you want to
call in and be a part of the show, we'll
be right back. Welcome back to Center It on Health
(20:10):
with Baptist Health here on news radio eight forty whas.
I'm doctor Jeff Tulvlin and we're joined by my co
host tonight, doctor Lindsay Snow. We're talking in our new
series of Chief Complaint about diarrhea and constipation. Please call
us if you have any questions you want to ask.
Five oh two, five seven one eight four eight four.
So doctor Snow, right before we went to break, we
(20:31):
were talking about the different causes of diarrhea, and I
just want to point out that I think if you
look by sort of codes of billing, the probably the
most common reason for diarrhea that we see in GI
and probably in primary care is irritable bowel syndrome. So
IBS is irritable bow syndrome. It's oftentimes either diarrhea or
(20:52):
constipation predominant. But a lot of people probably will see
you first with IBS.
Speaker 1 (20:57):
Yeah, we'll get that a lot.
Speaker 3 (20:59):
So, like you said, kind of chronic person who's like,
you know, I've always had either diarrhea or constipation.
Speaker 1 (21:04):
I've tried all these things, nothing seems to help.
Speaker 3 (21:08):
And I feel like IBS is kind of a tricky.
Speaker 1 (21:11):
One a lot of the time because you know, we'll.
Speaker 3 (21:14):
Rule up the scary stuff first obviously, but then you're
kind of like, okay, your gut it just hates everything.
So treatment can be kind of challenging, right, So, I know, pharmacologically,
what sort of medications do we normally use for IBS
or is it more non pharmacologic stuff.
Speaker 2 (21:34):
Well, I think it's both. I think as far as medicines,
pharma pharmacological treatments, we have things that slow the gut down.
We have things that people may be familiar with, like
bental or dicyclamine or levsin or hyoskymine. These are anticholinergic.
That means that they work on the nerves in the
gut to slow it down, just like we talked about earlier,
(21:54):
but they also decreased that sensation of discomfort. So you know,
one thing that I think is really important for people
that are listening that may have IBS is that it
is it's not just a diagnosis of exclusion. There are
actual criteria. So when you're a provider, either your primary
care or your GI physician is talking to when they
haven't been able to find something, it doesn't mean that
(22:17):
we're saying it's not real. It's just it's the hypersensitivity
of the gut and there's not a lot of ways
to test that overtly. So I just I think for
IBS patients it can get very, very frustrating. But I
do think there's a lot of people that like to
try things naturally. So what do you talk to them
about in the primary care.
Speaker 3 (22:36):
So usually when I start with primary care, and this
is for diarrhea as well as dietary changes and so
the low fodmap diet and I always what it stands
for is like fermento, oligo die sc or he's looking
at your squirming.
Speaker 2 (22:53):
Yes, you're doing so.
Speaker 3 (22:55):
It's molecules that are in foods that are getting are
not bad. But yeah, I liked how you describe it
as hypersensitivity, where the gut is just very irritable. I
guess that, yess sense, that's a good name there, And
so typically IBS guts do not like those molecules, and
so eliminating foods that are high in those molecules is
(23:16):
usually where I recommend starting. Because if we can manage
things without medication and all that stuff, I think that's
great because there's a lot of IBS folks who are
able to not everybody, but some folks.
Speaker 2 (23:25):
And there are studies that support that the fodmap diet
does work, so it's not just sort of picking something
out of the air and hoping that it works. And
you know, a lot a lot of times IBS patients
they get this when they're pretty young, so to be
on medications for the rest of their life, I think
if you can do it through lifestyle changes, I think
that's amazing.
Speaker 3 (23:43):
There's also peppermint oil, there's acupuncture shout out and I
read something about CBT, so cognitive behavioral therapy. What other
non pharmacolture therapies do you recommendo? Are the usually the
top three I do is dietary changes, peppermint oil, and
then considering acupuncture and or CBT.
Speaker 2 (24:06):
Yeah, I think that's right. I think that's how we
would approach it to that we oftentimes will use the
thodmap diet to begin with. Now, there's an overlap with
lactose intolerance, so sometimes you know, we confuse IBS with
lactose intolerance. There can be bacterial overgrowth, which is another
condition that can be similar to symptom wise to IBS.
So I do think that those are going to be
(24:26):
the kinds of things. You know, when we talk about
what happens in the primary care world and then what
happens in the GI world. You're going to do all
those things. First, You're going to treat them with dietary changes,
You're going to try some of these non pharmacological things.
You might even prescribe some of the pharmacological things. But
at some point there is going to be the desire
to rule out other things that might require more testing
(24:47):
through a GI doctor, like a colonoscopy. But ultimately there
are other medications that we might escalate to that work
on the brain gut, and that would be done through
through specialty.
Speaker 4 (24:58):
Yeah.
Speaker 3 (24:58):
Always described it as my sandbox in primary care. I'm
very comfortable within the confines of my sandbox.
Speaker 1 (25:03):
But if somebody's.
Speaker 3 (25:04):
Needs are are outside, I got a definitely phone a friend,
rely on our specialist colleagues. Another thing that I just
had a thought of was a lot of times people
who menstraight can will say they notice they have diarrhea
around their cycle. That's very common because so your period
is the uter is contracting to get rid of the
(25:25):
indometrial lining. That's what the blood is, and it can
irritate the structures around it, which are the bladder and
the end of the large intestine. So that's also kind
of another common cause of diarrhea that would fall within
the range.
Speaker 1 (25:41):
The realm of normal.
Speaker 2 (25:42):
Yeah. I think that it's very common for us to
hear that there's sort of a cyclical nature. And that's
also true with the with the irritable bow that we've
been we've been talking about as well.
Speaker 3 (25:51):
So while we're on irritable bows, so again with goldilocks,
too hard, too soft, Yes, So.
Speaker 1 (25:57):
Now going into constipation.
Speaker 3 (25:58):
Right, So, just like diarrhea can kind of have many forms,
when you think of constipation, is it just someone who's
maybe straining to have a bowel movement. It is those
hard little rabbit turn that people sometimes describe.
Speaker 2 (26:12):
So yeah, So again, one of the things with constipation
that I want to point out is number one, it
can be normal to not go to the bathroom every
single day.
Speaker 1 (26:21):
That was mind blowing when you told me that.
Speaker 2 (26:23):
I mean, that's great, and most people do. But if
you're not having other symptoms of pain or discomfort and
you go naturally three times a week, that's really okay,
especially if it's not a change for you. Again, I
know I've said that a couple of times, but that's
really important because you know, you know your body, and
(26:43):
if something isn't the same as it's always been, it's
worth mentioning. But with constipation, by the time somebody gets
to us, we need to start thinking about, you know,
what does constipation really mean. Just like we talked about,
diarrhea could mean different things to different people, constipation can
mean different things. So constant can be the inability for
(27:03):
the stool to move around the colon, so the large
intestine getting around might be slow, so the motility might
be slow. We call that slow transit constipation. But constipation
can also be you know, the stools getting around okay,
but it's really hard to get the stool out. So
that's oftentimes very common in people who have pelvic floor abnormality.
(27:25):
So straining or feeling like you need to disimpact yourself
because it won't come out, those are signs of an
outlet problem and not necessarily a transit problem. So we
need to know, you know, we know we're on the
highway of constipation. We need to know what lane we're in.
Speaker 3 (27:41):
Yes, And I always think of kind of the gears
of constipation using a car analogy of mush and push,
because to make a bowel movement, it has to be
mushy because the colon. What was it that you said,
One of your instructors told you the purpose of the colon.
Speaker 2 (27:56):
Was to absorb water and to have a reason to
read the paper.
Speaker 1 (27:59):
Yes, we're going to say, now reason they're like, scroll
on your.
Speaker 2 (28:01):
Scroll on your right. Yeah. I'm aging myself there with
that quote.
Speaker 1 (28:06):
Yes, read the shampoo bottles.
Speaker 2 (28:07):
Yeah. So, and the corollary to that is that you
can live your entire life without a large intestine, because
the two functions of the large intestine the colon are
to reabsorb water and to package waste, and you can
eliminate the waste through an ostomy if need be. And
the small intestine takes over the job of absorption and
can actually absorb more water than it normally does when
(28:30):
the body doesn't have a colon.
Speaker 1 (28:31):
That's amazing.
Speaker 2 (28:32):
Yeah, it's pretty amazing.
Speaker 1 (28:33):
And then push, Like you said, there's the motility.
Speaker 3 (28:35):
So thinking like of your large intestine is like a
toothpaste tube. You know, we got to squeeze it and
get it all through there. So a lot of times
when someone tells me that they're having constipation, kind of
the first questions I ask thinking about mush and push
are are you drinking enough water? Because if someone's dehydrated,
the colon's going to absorb more water from the waste
(28:56):
to try and give the body what it needs.
Speaker 1 (28:58):
And then push.
Speaker 3 (28:59):
If someone isn't enough fiber, then there's not enough to
actually push to really make a bowel movement, so it
takes a lot longer to kind of accumulate what is needed.
Speaker 2 (29:09):
Yeah, and the fiber issue, I get asked all the time,
you know, So what type of fiber you know, because
if you look in the grocery store, you're going to
see aisles of different types of fiber. So, just as
a very brief statement, there's soluble fiber and there's insoluble fibers,
and so soluble obviously means it'll work with water, it'll
(29:29):
absorb with water. That's how we get sort of that
gel and the ease of the passage, whereas the insoluble
fibers are bulking and that's what gives you the bulk
to the stool. We prefer to get our fiber through diets,
whole grain oats, fruits, vegetables, legomes. Those are the kinds
of ways we'd like you to get your fiber. Beans, yes,
(29:50):
but so the if you can't reach it with just
dietary fiber, we would would recommend over the counterfiber, you know,
like metamucol or things.
Speaker 1 (30:01):
Like now they make it in a gummy, they do
make it a gummy a gummy.
Speaker 2 (30:04):
Yeah. So you're looking for about twenty to forty total
grams of fiber per day, the most of that you
would want to get through your diet, and maybe ten
grams if you need to through through over the counter stuff.
So let's stop there. We'll take our final break, and
we will come back and we'll talk more about constipation
and maybe some of the medications that can cause it.
So you are listening to Centered on Health with Baptist
(30:27):
Health here on news radio eight forty whas. I'm your host,
doctor Jeff Tublin. We're talking tonight about our chief complaint
of diarrhea and constipation. Don't forget to download the iHeartRadio app.
It'll give you access to all of the show and
all the other features that the app has to offer.
We'll be right back. Welcome back to Center It on
(30:55):
Health with Baptist Health here on news radio eight forty whas.
I'm your host, doctor Jeff Tuvlin, and we're joined by
our co host tonight, doctor Lindsey Snow. We're doing our
chief Complaint episode about diarrhea and constipation. I want to
remind everybody to download the iHeartRadio app. You can use
it to listen to this show and its entirety, or
have access to all the features that the app has
(31:16):
to offer. So doctor Snow, right before we went to break,
we broke into constipation and we're diving in. And just
like we talked about with diarrhea, somebody calls your office
with constipation, how do you guide them over the phone
or through the my chart or what's the process.
Speaker 3 (31:35):
Yeah. Usually, again, I kind of just provide those general
recommendations on increasing fiber and drinking water is really hard.
I have my giant forty cup right in front of
me because I'm trying so hard to get my water.
Speaker 1 (31:47):
It's thirty two to sixty four ounces a day minimum.
Speaker 2 (31:51):
Yeah, that's a lot, It's a lot.
Speaker 3 (31:53):
Yeah, So counsel them on fiber.
Speaker 1 (31:55):
Again.
Speaker 3 (31:55):
I love the twenty gram was did you say twenty
to forty twenty to forty gram? I think that's great,
kind of giving people a number, just sort of just
more right.
Speaker 2 (32:04):
More more.
Speaker 3 (32:07):
Then again, usually I'll say if things aren't getting better
within a week or so, come back and see me.
I have a question. Is constepation just the opposite of diarrhea.
So of diarrhea is the intestines just secreting. Constipation is
the just the intestines absorbing. Would you say that's accurate
or do you think there's a little more nuance to it? So?
Speaker 2 (32:28):
I love that, but I think so we don't approach
them the same, but opposite, if that makes sense. It's
not like the way we treat diarrhea. We untreat it
with constipation. So and the reason I say that is
because there are some very important things for each of
those diagnoses that have nothing to do with the other one. So,
for example, with constipation, there could be a mass something
(32:52):
that's causing the reason that that thing that has nothing
to do with the diarrhea side of things. Right, it's
not the opposite, but it's something we have to think
about with constant patient. So even though it sounds opposite,
we would take each symptom as its own entity and
do its own work up kind of, you know, from
beginning to end.
Speaker 3 (33:10):
So for constipation, I think also maybe even more with diarrhea,
I feel.
Speaker 1 (33:16):
Like a lot of medications are the cause of it.
Speaker 2 (33:19):
We could we could have mentioned that earlier, for sure. Yeah.
Speaker 3 (33:22):
So, but my medications can affect the gut both ways,
you know. I know a lot of anxiety and depression
medications can cause diarrhea or constipation because they're serotonin receptors
in the gut, and those medications work on serotonin receptors.
A lot of diabetes, medications can cause diarrhea or constipation,
(33:44):
depending on how their.
Speaker 1 (33:45):
Mechanism of action.
Speaker 3 (33:48):
You think you said, nonsteroidals like i'd be profile, can
cause diarrhea absolutely, Yeah. What are some other common medical
medication culprits?
Speaker 2 (33:56):
So I'll just start by saying that oftentimes I don't
think people consider supplements as medications. So I feel I
think we're doing a better job when we talk to
patients and we ask them what they're taking that we
as providers remember to ask them about supplements. But as
(34:19):
a patient, you should also be aware that when you're
asked about your medications, your provider wants to know if
you're taking over the counter things or supplements too. And
the reason I say that is because things we think
that are super healthy, Like people may be taking magnesium
for their heart or for whatever reason, and they may
be having diarrhea and may be so confused why do
I have diarrhea? And it's because they're taking magnesium. There's
a reason it's called milk of magnesia because that magnesium
(34:41):
helps stimulate bowel movements. So that's a very important first
place to look. So I do want to encourage our
patient population and our providers to consider supplements, herbals and
over the counters as medications when it's coming to taking
the history. But as far as diarrhea is concerned, antibiotics
are a big one. They can cause it. You mentioned
met foreman or diabetes medication, the antidepressants, anything with magnesium
(35:07):
in it, and then just these over the counter stuff.
So I think that's the diarrhea side of things. I
think with constipation, you know, I'm just going to jump
right in. I think that one of the biggest things
we're seeing now are the GLP ones. I mean, they
are very very common. People are taking a lot of them,
and that the way that they work is on motility
and one of the places that gets affected is the
(35:28):
motility of the colon. So it is not uncommon. It's
actually a fairly significant constipation that can happen with with
the GLP ones.
Speaker 1 (35:38):
You mentioned earlier.
Speaker 4 (35:39):
Yep.
Speaker 2 (35:39):
So you know they're there for a reason and people
need them and we understand that, but they do cause constipation.
They work on those receptors we talked about earlier that
can slow the motility of the gut. But people take
iron supplementation that causes constipation. Blood pressure medications, even antacids
that you you know, common ones that you think of of,
(36:00):
like you know the prilo sexiomeprazol or you know those
acid reflex medicines. So it's really important that both the
patient bring a list and the provider ask for the
list of the things that patients are taking, because you
could undergo a very extensive work up for either diarrhea
or constipation when that answer might have been right in
(36:22):
front of you.
Speaker 1 (36:23):
Yes, and we definitely do not want that. No, no,
thank you.
Speaker 3 (36:27):
So what are some red flag symptoms for constipation? I
don't think we touched on that like we did for diarrhea.
Is it just kind of the exact same so blood
where there shouldn't be Definitely fever. I feel like people
don't usually get a fever with constipation the way they
might with diarrhea.
Speaker 4 (36:45):
No.
Speaker 2 (36:45):
I think pain, you know, bloating, that's not normal when.
Speaker 1 (36:49):
You have a bowel movement. It's not supposed to.
Speaker 2 (36:51):
Pain with the bowel movement or pain in the in
the abdomen. Weight loss certainly, that is a definite alarm symptom.
Change in color, So that is so variable, and that
can be medication related. It can be diet related. I
don't know that you have to go seek immediate medical
(37:12):
attention just for a change in color, But if there's
a change in color associated with other things we've been mentioning,
then for sure, and I think, you know, rather than
changing color, if there's if they're totally pale, I think
that may be something to ask about.
Speaker 3 (37:27):
When I was in residency in Saint Louis, there was
an absolutely terrifying pediatric gansture in Oledge, just like the
scariest person I still.
Speaker 1 (37:34):
Think about, Like, we're very nice and GM he's under
my bed.
Speaker 3 (37:39):
And he would tell people he did not care what
color the poop was, as long as it wasn't red, white,
or black.
Speaker 2 (37:45):
Fair enough, those are three colors we definitely pay attention to.
Speaker 1 (37:49):
All the colors of the rainbow are feat.
Speaker 2 (37:50):
So I think, yeah, with constipation, I think the pain
is a bigger one weight loss certainly, and then the
bleak for sure.
Speaker 3 (38:00):
And one thing that I learned that was interesting is
sometimes someone can get so constipated that they actually have
diarrhea where there's this big stool ball for lack of
a better term, and then there's just liquid poop kind
of going around it so one can lead to the other.
Speaker 1 (38:17):
You can have both at the same time.
Speaker 2 (38:18):
Yeah, you can. That's called overflowing continents, usually from a
fecal impaction. So another story for another time. Well, that's
going to wrap it up. I can't believe this was
our first chief complaint episode. I hope overflowing with stuff overflowing.
I hope that the audience is enjoying this and listening
to this. We're going to try and use different chief complaints.
(38:39):
It won't always be diarrhea, but we're going to try
and hit the major one so that you, our listener,
can understand when to seek medical attention. That's going to
do it for tonight's episode of Centered on Health. I
want to thank our producer, mister Jim Fenn, doctor Snow,
thank you for joining us, and our caller Dave, and
I hope everybody has a really wonderful rest of your
week and a great weekend file. This program is for
(39:06):
informational purposes only and should not be relied upon as
medical advice. The content of this program is not intended
to be a substitute for professional medical advice, diagnosis, or treatment.
This show is not designed to replace the physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
(39:27):
to your personal health or regarding specific medical conditions.
Speaker 1 (39:30):
To find a Baptist health provider, please visit baptistealth dot com.
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