June 13, 2024 • 35 mins
Ever been caught off-guard by the silent but deadly post-op enemy, constipation? We're cracking open a dialogue on this hushed subject, revealing why that first post-surgery toot matters more than you might think! Join us as we dissect the ins and outs of keeping things moving smoothly after surgery. With a blend of our own tales from the trenches and expert clinical advice, we've revamped the typical pre- and post-op playbook to tackle constipation head-on, discussing everything from the mysterious ileus to the impact of stress on your gut.
Sip along with us as we spill the beans on staying hydrated with more than just plain old H2O—think flavored waters, shakes, and high-water content snacks. We're serving up a full course of wisdom on the crucial balance of proteins, fats, and carbs, and why your Keto diet might be backing you up, literally. Our chat meanders through the interplay of a varied diet, the importance of sleep, and even how your meds could be messing with your movements. So, grab your favorite drink, and let's get to the bottom of what keeps your digestive tract on track!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, Maria.
I know, talking shit is usuallybad, but we're talking shit
today.
Speaker 2 (00:04):
Yes, we are, because it's the shit.
We had to mark this episodeexplicit because of our desire
to say that word five times in arow.
Okay, and why are we going tobe talking about?
Why are we going to be talkingabout it?
Speaker 1 (00:18):
Why are we talking shit?
Because sometimes you justcan't, I can't.
I need to know all the why'sand how to manage it, and yes,
yes, I'm going to ask you foryour expert opinion or knowledge
.
Speaker 2 (00:31):
Thank you.
I'm going to ask you for yourexpert opinion too, as a person
who has dealt with this firsthand, or maybe second hand as
well.
But no yes, a lot of people arereally surprised when they come
to the hospital.
That, like when I round onpeople every day, I'm like, have
you passed gas, have you pooped?
And people get really freakedout about it the first time we
do it, but then we celebratewhen they pass gas and celebrate
(00:54):
when they poop, and then peoplereally get it.
Speaker 1 (00:56):
So it's not a problem if you're going.
Speaker 2 (00:58):
It is a very big problem if you are not
Absolutely.
That's why we're going to talkabout it.
Actually, also, interestinglyenough, this was the number one
reason that people were callingour office after surgery is
because you do four or five daysright and they wouldn't have a
bowel movement and they wouldhave pain and they would have
issues to the point wheresometimes people were going to
(01:20):
the hospital to be seen and allthey really needed to do was
have a big bowel movement.
So I think it's important thatactually led us to revamp our
entire how we managed themedications around helping
people poop and actually evenmade it so that they were taking
a medication starting a weekbefore surgery.
We actually changed our entireprotocol and studied it to see
(01:42):
if people would do better ifthey started taking Colase, a
stool softener, a week beforesurgery.
And guess what those phonecalls went to?
I believe zero afterwards.
Speaker 1 (01:50):
There wasn't a whole lot of them, yeah.
No yeah which is kind ofinteresting.
Speaker 2 (01:53):
So not that I have enough data to really prove that
was the one, and only I didn'thave enough patients for that,
but that is yeah, that's pretty.
It's pretty remarkable thatthis is a really important thing
to address around surgery.
Speaker 1 (02:05):
Yes, so why can't I?
Why?
Speaker 2 (02:07):
can't I shit, so why can't you poop?
There's a couple of factors.
Basically, there's there maynot be enough in the tank.
Speaker 1 (02:14):
We'll talk about that Especially right after surgery.
Speaker 2 (02:16):
Yeah Right, there may not be enough helping things
get through, which is also anissue with surgery and sometimes
there's things physicallystopping you, like stopping you
up, and we will talk about, yeah, those three things.
Basically, surgery is thespecial situation in general.
Anytime people have surgery orhave a trauma or have anything
(02:37):
that can impact how their gutswork, those can slow down and
that is actually called an Ilias, where your guts are paralyzed.
There's not a real likeblockage and there's not a real
thing blocking them from workingbut they don't work properly.
Your guts still produce leadersof fluid a day.
So if you think about, like howmuch math saliva your mouth
(02:59):
produces the rest of your gut,the rest of your GI tract,
stomach, esophagus, smallintestines all produce fluid too
.
So if you get backed up becauseyour guts not working properly,
things aren't going from startto finish in the right direction
, you can get really miserable,and that can happen even just
from having a trauma or surgery,whether it's very much.
Speaker 1 (03:21):
Remind me what's that called.
Again, it's actually called anIlias Ilias.
I thought that was like anorgan.
Speaker 2 (03:28):
I love it.
You're probably thinking Iliam,which is the last part of the
small intestine, but anyway, yes, we've now gone to zero
listeners for this episode.
Oh, stop.
But no so even just literallythe trauma of surgery itself or
being in it, quite literally atrauma like a motor vehicle
collision or something like thatcan cause that problem too
Patient, because it's not justthe fact that you're having
(03:50):
bariatric surgery.
It may just literally be thefact that you had surgery that
is causing some of that slowdown, but then after surgery,
everyone recovers from that andthat's not the reason that, long
term, people have issues withconstipation.
So that is something that we'regoing to talk about too.
So yeah, so one.
I want to ask you actually haveyou dealt with this problem?
Speaker 1 (04:13):
Absolutely Still do for sure For sure especially
going back into the hospital.
I had bariatric surgery while Iwas in the clinic or in a
clinic, and so I had more timeto focus on my water.
I'm in the hospital now where,sometimes 12 hour days, I am not
sitting down at all, grantedthe activity helps, but lack of
(04:35):
water yeah.
Speaker 2 (04:36):
And I think a lot of people notice this if they're
traveling or if they're often,you're more routine, for
whatever reason holidays or,like you said, working long
shifts or working overnight youstop eating and drinking the way
you normally do.
You may be moving differently,you may be sleeping differently,
and those things can absolutelycontribute to constipation.
Even if you've got enough inthe tank, even if everything
(04:57):
else is working, you may begetting constipated because you
don't have enough water enoughfiber.
And we'll talk about some ofthose things.
Speaker 1 (05:03):
Can your body just not want to do the right thing
because of stress?
Speaker 2 (05:09):
Oh yeah, Okay, yeah, absolutely, and actually there's
even in literature.
I think we've seen somepatients too that are affected
by this.
Definitely.
You see that this in surgeryclinics in general, where people
have fear of going to thebathroom, and sometimes it's
because like for me, forinstance, when I was a resident
and a fellow there were timesthat you're working or even now,
(05:31):
sometimes when I'm on call,you're working and there's not a
reliable time for you to beable to go to the bathroom.
So it can be very challengingin that situation to have a
regularly scheduled BM everymorning with your coffee or
something like that.
That's exactly right.
Speaker 1 (05:47):
That's where I'm at yeah.
Speaker 2 (05:48):
And so for some folks it can be really difficult to
know when to safely go, if thatmakes sense, and that can
contribute to that, and otherstressors can definitely
contribute to people gettingthrown out of whack with a
regular routine and then itsnowballs, just like anything
else related to stress, whereyou can't properly go to the
bathroom for a day or two andthen all of a sudden it's day
(06:10):
three or four, and this ishappening over and over again
and it becomes an increasinglystressful situation that feeds
forward into itself.
Yes, stress can definitelyaffect how we boot, but in
general, I think it's reallyimportant if you're having this
problem One, let's figure outwhat is constipation.
Speaker 1 (06:28):
Yeah, when is it?
Speaker 2 (06:29):
considered constipation.
When is it like not good andwhen is it a real problem.
So basically, people shouldhave a BM every day or two.
You're not everybody poops thesame way.
Not everybody poops the sameway.
So I do want to say this is oneof those things where there is
a range of normal, and justbecause you don't poop every
morning with your coffee, thatdoes not mean you have
constipation at all.
(06:50):
Some people quite literallytake a day or two in order for
that to happen.
So that's part one.
And then part two is consistencyof your bowel movements.
We're really getting into ittoday.
But if it's really watery,that's a problem.
If it's really hard, that's aproblem.
And both of those things canactually happen.
Even if you're only going tothe bathroom once or twice a day
(07:10):
, or if you're going multipletimes a day, you can still be
having little pellet, rabbitpellets that you're pooping up
multiple times a day.
So consistency is important too.
It becomes a problem if you'regoing more than two or three
days without a bowel movementand if the consistency is really
hard to pass, because withconstipation you can form
hemorrhoids Anytime.
(07:30):
You're straining a lot, you canget the royal rage Not fun.
You can get fissures, which islittle tears.
Yeah, super painful, super notfun.
You can actually getdiverticulosis from this problem
, so that's little outpouchingsof your colon that can sometimes
get infected and inflamed andcause problems down the road,
(07:51):
and in general, it's just notgreat for your gut not to be
working on a regular basis.
It seems to change even some ofthe bacteria, the microbiome of
the gut, for people who havechronic constipation and this is
crazy, but constipation andstraining can also contribute to
hernia.
Yeah, so if you think about it,people are more likely to
develop hernias when they havepregnancy or when they gain a
(08:13):
lot of weight or if they'redoing a lot of heavy lifting.
But even constipation andstraining can contribute to that
risk too.
So, yeah, so not being able togo on a regular basis and have
good bowel movements can be avery big deal.
Speaker 1 (08:27):
I just want to be able to sit in the bathroom as
long as my husband does everysingle day.
Speaker 2 (08:31):
And actually so.
Yeah, so sitting for prolongedperiods of time and doing that
on the toilet actually is acontributing risk factor for
constipation.
Yeah, and a lot of folks don'tnecessarily know that either.
And how you had BMs as a kidsometimes affects how you have
BMs as an adult.
And if you were used to likesitting on the toilet and
reading or playing video gamesor something like that as a kid
(08:52):
and you carry that into youradulthood and you have time to
do that, which is remarkable butfine, that can actually train
your body to also strain and toalso not pass on movements as
regularly as it could.
So a lot of different factorsthere.
Speaker 1 (09:08):
So take away the magazines and stuff from your
body.
Speaker 2 (09:11):
Yes, yes, I know.
So I know we're supposed tohave a little bathroom reading
materials and things, butactually not a great way to
encourage efficient and good BMs.
But in general, like if you'rehaving problems with
constipation, assess first.
That is a really importantthing to do and there's a couple
of things to assess.
Are you drinking enough waterand how much water?
(09:31):
How much water is enough water,tammy, you think?
Speaker 1 (09:34):
Supposed to be 64 ounces a day.
Speaker 2 (09:36):
Yeah, that's right.
So basically eight glasses ofeight ounces a day, is that?
Speaker 1 (09:41):
water Not just coffee ?
Speaker 2 (09:43):
Yes, of water, like things that contain water, yes,
yeah, and not dehydrating andnot dehydrating.
But I will debunk somethinghere real quick, because if it's
coffee or tea and that's whatyou're used to drinking
especially do that.
That is better than nothing.
And there are some studies thathave come out recently that
actually indicate we thoughtthat caffeine was dehydrating
(10:04):
for a really long time.
So drinking caffeine isbasically like negative to your
water intake.
It's not.
No, it's not.
You're going to need to linkthat article.
There's a few, there's a few,but basically so.
The reason why is becausecaffeine can have a diuretic
effect.
It can cause your kidneys toexude more fluids, right, and it
can cause more essentially.
(10:25):
But one is that effect ispretty weak and two, your body
gets used to the caffeine thatyou drink.
If you're drinking caffeineover and over again I'm a person
who drinks a lot of coffee anda lot of tea and things like
that- yeah, I was proud to seeyou drinking water here while
we're recording.
Hey, that's right.
But you know me as well.
I am a camel.
I go to the bathroom like twoor three times a day period and
(10:46):
that's it, because my body is soused to retaining that water
and a lot of that is just howbodies self-regulate.
So if what you're drinking iscoffee and tea and that's what
gets your fluids in, do not stopdoing that and pretend like
you're going to be able to justswitch that all to a glass of
water a day.
Right, that is not going tohappen.
Sounds torture, that is torture.
(11:06):
The other thing to think aboutis this is not an all or nothing
.
If you're trying to guzzle likea gallon in the morning and get
yourself through your entireday that way, that's probably
not going to happen, and then,especially with bariatric
surgery, you can't really dothat anyway because your tank is
so little and, being inhealthcare, tammy, I know this
for you.
You've mentioned that this isreally challenging.
How do you actually go aboutgetting your water in over the
(11:29):
course of a day?
Speaker 1 (11:31):
Insert Stanley here.
No, but seriously, my cup isalways full.
I always have multiple cups,like I always have ice water in
a separate cup.
So yeah, I can keep refillingmy Stanley, because I usually
have like crystal light orsomething in it.
I do need flavor of some sort,but literally I've just made a
habit of every time I sit downat my desk which sometimes isn't
(11:53):
always.
Very often, I make sure I drink,I make sure I drink.
So it's just.
Yeah, I feel lost when I don'thave my Stanley next to me, just
because it has become a habitof having it with me and drink
and drink.
Yeah.
Speaker 2 (12:11):
Good for you, and I honestly think a lot of us are
not super honest about our waterintake.
We think we're doing a reallygood job, we think we're
drinking throughout the day, butI personally come from a
culture, so I'm a Russianimmigrant here when I was a kid
and so our family culture wasvery much don't drink while
you're eating, don't drink onthe go.
We still have this like my momis very anti-Stanley Big jug
(12:33):
yeah jugs and things like that.
They brought that toThanksgiving Exactly.
So there are certain culturesor certain workplaces or certain
in general that don't lookfavorably upon constantly having
some water or something todrink with you.
But get over it.
I'm sorry.
That just made me think.
If you're post bariatricsurgery, it's not really
optional because, again, youcannot guzzle that 16 ounce
(12:57):
container or that bottle ofwater when you feel like it
later or earlier and not beenough to keep you going for the
rest of the day.
Speaker 1 (13:04):
And I've seen you or I've helped you do or faxed off
a letter to patients that saysthis patient is required.
You need to make an exceptionfor this person to have water
next to them.
Yes, no matter what.
Speaker 2 (13:19):
Yes.
So even if you're a surgeon,even if you're a nurse, even if
you're an airline pilot, even ifwhat other principle?
Even if you're someone who justyour butt does not hit a seat
all day long, at any time, thereare ways, and certainly you can
even ask your bariatric surgeryprogram to write you an
exception.
In fact, I think we wereworking on some cards for people
(13:40):
that say I've had bariatricsurgery before.
I need these certain meal sizerestrictions and things like
that.
And I think one of theimportant things there is that
it indicates I need to bedrinking six to four ounces of
water a day and that needs to bethroughout the day.
There are ways to engineer theworkplace and your life around
it, but don't be afraid ofcarrying that jug, that water,
whatever you need, because it'sjust it's so important, so
(14:04):
important, absolutely.
It's so important you don'twant to be backed up because of
it.
Oh and, by the way, people doask if flavoring is okay.
Flavoring is totally fine.
So if it's a mix of women, ororange or cucumber or whatever
it is that makes the water tastegood for you, or crystal light
or something like that, go forit.
Again, the benefit to havingthe fluids is so much higher
(14:24):
than any of the risk, and therisk is not.
There's no science behindthinking that there's a risk
associated with flavored wateror things like that, so just do
it.
Fake sugars the body perceivesthem a lot like real sugars, so
I'm not super pro fake sugar.
If you're going to havesomething with some sugar, just
lower sugars, probably better.
If no, sugar is not an option,so that's.
(14:46):
But in general that's justthat's what I believe.
Speaker 1 (14:49):
Right, Absolutely no.
And fake sugars sometimes don'tagree with us.
And so one crystal light packetis in my whole.
Usually it's for 16 ounce waterbottle.
Right, it's in my whole 40ounce Stanley and I continue to
actually water it downthroughout the day because that
initial sip is like too sweet.
But I do need something and itworks for me.
(15:11):
And, as you said, water is moreimportant than, or getting that
fluid in is more important thanit just being plain water.
Speaker 2 (15:19):
Exactly and think about it too that one you can
water down drinks.
A lot of people after bariatricsurgery have sort of texture
issues sometimes or flavorissues that weren't there before
for things especially that aresweet.
So if that's the case, water itdown just to half a cup with
water and then that makes it alot more palatable and it cuts
down on sugar if that's what'sin it.
(15:39):
So that's a good approach.
And oh, yes, don't forget that,like your shakes and your
smoothies have fluids in them.
Those count.
Fruits and vegetables havefluids in them.
So it's yeah, those are alsogreat ways to get your fluids in
and yeah, so there's a lot ofways to make sure that you're
getting enough fluid in the tankto help things go.
Another one is whenever we'retalking about constipation.
(16:01):
So one is are you gettingenough fluids to is?
Are you getting an effectivity?
Speaker 1 (16:05):
I realized, if I am more active, if I do an angry
one mile sprint, my bowels getmoving, so something happening?
Speaker 2 (16:15):
They sure do, and there is some fun science behind
that, which is basically yourguts need to know where gravity
is, and if you are laying downor sitting in a reclined
position, your guts have areally hard time pushing things
down where they need to go.
In fact, when we have peoplewho have that Ilias state that
we talked about earlier, wheretheir bowels are paralyzed and
(16:35):
they're not really working, thebest way to treat that is
actually walking upright, beingupright and moving.
But it's the same forconstipation too.
You need to get going in themorning, and more ways than one
working out can help.
But the more time you spendlaying, sitting, not moving,
being in one position without,without that, the harder time
your body has actually havingbow movements and pushing things
(16:57):
through.
So activity really important.
Speaker 1 (17:00):
Absolutely.
I have experienced thatfirsthand, for sure.
Speaker 2 (17:05):
Yeah, okay.
We've talked about fluids,we've talked about activity.
What about fiber?
Speaker 1 (17:11):
Insert deer head lights here.
Speaker 2 (17:14):
So fiber is actually complicated and we will not go
into all of the complexityassociated with it, we're just
going to make it super simple.
We probably should have a wholeepisode on fiber, but for the
purpose of this podcast and thisepisode, fiber is something
that's in a lot of differentfoods, and the best way I've
ever heard fiber described Iwill never forget, by another
surgeon is like toilet paperfrom the inside Elaborate.
(17:37):
Yeah, you're like I know,should I be eating toilet paper?
Wait, what is this?
So think about it this way it'slike the scrub brush that your
GI tract gets, that yourintestines and your colon get,
and it's really important inhelping draw water into your gut
, so that water that we talkedabout a couple minutes ago being
really important.
It helps to pull that waterinto your gut so that your
(17:59):
stools aren't rocks and thatthey have enough oof to them to
be able to pass through.
It also creates some bulk to it.
So think about it this way it'slike creating some Amazon
packaging around what's there.
So it helps to create somepackaging, for it to have some
substance and for it to be ableto move, which is important,
(18:19):
yeah, and it creates that sortof scrub brush effect, as it
goes.
So it's really important howfiber.
So what kinds of things havefiber?
What kinds of things work foryou that have fiber?
Speaker 1 (18:30):
Ta-da-da.
Timmy, I'm really bad at thispart.
Yeah, fruit veggies, it'sgreens.
Speaker 2 (18:40):
Dried fruit, lots of things that are in soups, for
instance.
So if you have soup withvegetables in them oh, she's in
the background, I'm waiting fora sec.
Yeah, so fruits and vegetables,whole grains.
There's actually a lot ofthings that now have added fiber
in them.
So if you look at packaging, alot of whole grain products have
fiber in them, whether that belike pasta or whether that be
(19:02):
bread or whether that be evenprotein powder, sometimes have
added fiber in them, and then,definitely.
You can also do supplements forfiber.
So there's powder of that,there's tablets of that.
There's so many differentversions that you can take and
again there's a little bitbeyond the scope of this.
But there's soluble fiber,there's insoluble fiber.
Both are important, but thebiggest takeaway here is make
(19:24):
sure you're eating fruits andvegetables or whole grains or
that you're using a dailysupplement for fiber.
Maybe both.
Yeah, absolutely, absolutely.
Speaker 1 (19:32):
No dude.
Speaker 2 (19:34):
Yeah, so especially if you're having problems with
constipation, it's really hardto consider.
One other thing I'm going tothrow out there and people don't
necessarily think about it isdried fruit, and so I'm thinking
like you told me this yeah,dried apricots.
This is a very greatnon-medication way to help your
body have some fiber and havesome fruit sugar, which is also
(19:55):
something that can help peoplehave some balance and is good
and it really helps withconstipation.
So, if you're eating a handfulof that, probably too much,
because, remember, the size of aprune is teeny, tiny, but the
size of a plum is not, and thewater is gone from the prune so
you don't want to eat like youwouldn't eat 10 plums, so maybe
you wouldn't eat 10 prunes.
Yeah, raisins are good, allthat, so just moderation in
(20:20):
terms of how much you're eatingof it, but it's actually a
really great way to get fiberand to help yourself not be
constipated.
Speaker 1 (20:26):
Yeah, that definitely has helped me.
I have used that tool.
Speaker 2 (20:31):
Yeah, dried fruits, and they go in the mouth, they
are eaten.
I didn't have somebody ask meif you put it in your butt and I
said you should eat, but notfor this purpose.
Yeah, please don't.
Please don't do that, At leastfor the purpose of having bowel
movements.
That is not helpful.
And then, okay.
So we talked about fluids, wetalked about activity, we talked
(20:52):
about fiber.
What about your diet varietyand what's in your diet?
You had mentioned some reallygood stuff about eating too much
protein and how that affectedyou early on.
Can you tell me a little bitabout that?
Speaker 1 (21:04):
Oh, yes, I was saying that, or to one of our
dieticians, that I'm focusing onmy protein.
That's what everybody tells usto do.
Focus on your protein and,excuse me, cheese.
Are you eating any carbs?
How many are you eating fruit?
And I'm like no fruit has sugarin it and carbs are carbs.
So, yeah, she challenged me tomix up my diet a little bit, so
(21:27):
I actually started eatingoatmeal with some raisins in it
and, yeah, my bowel movementswere much better and I lost
actually a significant amount ofweight that first week.
Just something about my itshocked my body of some sort and
I got past the plateau.
For sure.
(21:47):
I love it.
Speaker 2 (21:48):
Yeah, because our bodies do need proteins, fats
and carbs.
Low carb diets usually makepeople really constipated and
also your body does absolutelyneed those things in balance.
So if you're eating too muchprotein, it's a great way to
have poop that's like bricks andthat comes only every several
days.
It's a great way to not have acolon that's getting a lot of
(22:10):
fiber, because you're probablynot eating things that have
carbs and that have some fiberin them, which your body needs.
Fat is also really important indiet too, because fat also
helps your body have good bowelmovements and things move
through.
And again, we're not talkingabout either or for any of this.
It's quite literally incombination and oftentimes yeah,
(22:30):
oftentimes if we're eating alot of processed food or if
we're eating just one kind offood, we're probably depriving
our bodies of a balanced dietthat has everything in it that
helps us be able to have healthyskin, healthy bones, healthy
joints, healthy brain, healthyeyes and also healthy poops.
Yes, absolutely yeah, reallyimportant.
(22:51):
Alcohol, caffeine, can have animpact, so smoking certainly can
have an impact, which I don'tknow a lot of people realize
either.
So the more you drink alcohol,the more erratic your bowel
movements are going to be notnecessarily constipation, but
could be diarrhea, could be amix.
And then same thing withcaffeine, too much caffeine.
So again, cup of coffee a day,a couple cups of coffee even, or
(23:12):
tea, not a big deal, but ifyou're drinking like 10 red bowl
a day, maybe that is too much.
Oh, yeah, that's going to bediarrhea straight up Could be at
the same time that muchcaffeine actually can be
dehydrating Right, so you mayactually end up being
constipated if you do that.
Speaker 1 (23:30):
Yeah, obviously everybody's body is different.
Speaker 2 (23:32):
But that fake sugar, whatever is in the caffeine in
there and all of that Reallyimportant to actually take a
look at what you're eating andmaybe you're excluding foods
from your diet that you reallyneed and you're not getting
enough diversity and variety inyour diet and that's having its
impact on your gut.
Speaker 1 (23:47):
Absolutely Just like exercise if you're doing one
exercise for a really longperiod of time.
So if you're eating the samething for a long period of time.
Speaker 2 (23:55):
Your body just gets used to it mixing stuff up
changing things up Exactly and Ithink we notice this a lot.
This one especially when wetravel.
So traveling and being stressedand things like that can have a
huge impact on our diet variety.
I know I go to Slim Jim's realfast in a pinch, right, exactly.
Yeah, beef jerky, yeah, beefjerky and nuts and things like
(24:18):
that, because I know those aregoing to have a consistent
quality at least, even thoughthey may not be the best thing
for my body and they may not bethe highest quality of food.
They're super processed usually.
At least what you're getting inairports and what you're
getting in gas stations may notbe the healthiest.
Being mindful, especially whenyou're stressed, especially when
you're busy, especially whenyou're traveling, that the
variety in your diet, makingsure there's grains and fruits
(24:40):
and vegetables, and that yourfluids are staying high all of
that's really important,especially when there's active
change or stress going on inyour life.
Yeah, absolutely Same thing forsleep.
So we've talked about fluids,activity, fiber, diet, variety,
travel.
What about sleep?
This?
Speaker 1 (24:58):
is, I think, one of the clear ones.
Yeah, Sleep is important justall around for our energy, for
our health in general, our hearthealth and but it helps bowel
movements huh, it does, and it'snot like a direct.
Speaker 2 (25:12):
we don't have a study that says we've eight hours a
day and all of a sudden, yourpoops are great.
By the way, sleep, and we willhave an entire episode on this.
At least once we have someonewho we're interviewing actually
coming up tomorrow yeah, thesleep medicine doctor and really
great expert on this.
But enough sleep is veryimportant for your body again to
regulate properly, and thataffects how your body treats
(25:35):
food.
That affects how your bodytreats fluids.
It affects how your body isable to go to the bathroom.
So important to be gettingenough sleep, whatever that is
for your body, and that may be arace.
You may be a person who's greaton four hours of sleep.
You may be somebody who needseight or nine, so be mindful of
that.
That is a really big factor,especially if you have shift
(25:55):
work that goes overnight or achange in your schedule or
you're moving or traveling.
Again, don't scrimp out on thesleep Very important even for
this aspect.
Speaker 1 (26:05):
Yes, very much.
So why do medications?
Oh, no-transcript yeah.
I realize that some medicationswill cause me to be motivated.
Speaker 2 (26:14):
Oh yes, why, yes, right after surgery.
Actually, many people willnotice that they're taking
narcotics which they get duringsurgery, even as pain control,
potentially during surgery, butthey may be taking it afterwards
.
So that class of medicationoxycodone, hydrocodone, all of
those things, fentanyl dilated,all of those things have a
natural effect on slowing downthe gut and so they can
(26:35):
contribute to constipationpretty badly, which is again one
of the reasons why sometimesit's important to use other
medications, like stool softeneror some things like that, to
combat, to counteractessentially those medications
Others not have.
Like, for instance, if you havea thyroid problem where your
body is not creating enoughthyroid hormone and you have
supplements for that, and if you, if, for whatever reason, your
(26:56):
level of that is low, that canalso be contributing to
constipation.
But there are many differentkinds of medications that can
contribute to constipation.
So if, if your water's on point, your activity's on point, your
fiber's great, your diet'sgreat, you're getting enough
sleep, you're really notstressed or you're really trying
to take care of everything, butyou're still having problems
with constipation, it's a greatidea to see your doctor about
(27:19):
medications that you're takingand medical conditions.
So, like we talked about, thatlow thyroid state,
hypothyroidism, can impactconstipation.
A lot of different hormonalchanges can impact constipation,
certainly GI function.
So if you have any kind ofproblems with your stomach or
intestines or colon, that canaffect your ability to have
(27:40):
bowel movements too.
So if everything else you'redoing well, it's a great time to
talk to your doctor about yourspecific situation.
Speaker 1 (27:47):
Yeah, the difference between stool softeners and
laxatives.
Speaker 2 (27:56):
Aha, I love it.
What's the difference?
Speaker 1 (27:58):
And when and what order.
Speaker 2 (28:01):
Yes, yeah, that's a great question.
So we're let's talk about somefixes for constipation.
Right, we feed the dead horse,Okay, what are the things that
can cause this?
Now let's talk about some waysto fix it.
So one I will say before tryingmedications, make sure you've
got the rest of these thingsgoing on in your life too.
You're increasing your fluidintake.
You're having physical activityon a regular basis and you're
trying fiber, good diet, all ofthat stuff.
(28:23):
If that's not working for you,try stool softeners.
Stool softeners are greatbecause they make your stools
soft.
I'm brilliant, right, I can'tput my hand on that, but how?
But how?
This includes, by the way,things like Kolei, stokelaxen
and, like we talked about, evendried fruit and fiber can be
considered stool softeners too.
Typically, they work by helpingyour gut draw water into what's
(28:45):
inside of it.
That's one of them.
That's called an osmotic agent,osmotic being the term that
means that it's drawing water in.
So, again, that helps to bulkyour stool up.
It helps to soften it so itactually can move.
Right.
If you have a canoe in a river,if the riverbed is dry, you
ain't going nowhere, but if thatriverbed has water in it, guess
(29:06):
what?
Your canoe can move, yeah, orlike a slide, right.
If you're on a water slide orsomething.
You don't want to go down awater slide without any water.
That's not fun so you've got toone, have the water in your body
for it to be able to pull in.
But once you do, the stoolsofteners can really help to
create stools that can move.
So be the canoe, don't be thedry bed Creek.
Yeah, there we go.
(29:28):
Yeah, that's really what stoolsofteners do.
There are also laxatives, whichis one level of more action than
stool softeners.
So laxatives like mero lax,milk of magnesium, lactulose,
there are lots and lots ofothers, magsitrate, which is no
longer on the market but used tobe, these things actually help
to push things forward.
So stool softeners don't havethat kind of action, but
(29:51):
laxatives do.
And there are some things thatare both stool softeners and
laxatives.
So mero lax, technically, isconsidered both because it helps
to draw water into the stooland it also helps to make your
gut push things forward.
But laxatives are one stepabove stool softeners.
So I would say start with astool softener once or twice a
day until you get to the pointwhere you want your bell
(30:11):
movements to be, and if that'sstill not helping, then that's
when to add laxatives.
Right, and again, stoolsofteners and laxatives will not
work if there's not enough inthe tank.
If the water isn't there.
No amount of stool softeners orlaxatives are going to help the
situation.
In fact, they can make it worse.
So be careful.
It's also something to becareful using, because you can
(30:35):
become dependent on stoolsofteners and laxatives.
You can train your body to bedependent on these medications,
so they are not meant foreveryday use for forever.
Yeah, for folks that havebariatric surgery, you are
taking vitamins, including iron,that can also cause
constipation, so important insome situations to talk to your
doctor about one.
(30:56):
Do you need to be taking theiron pill every day?
Or you may be taking too muchiron because your multivitamin
may include iron and you may betaking a supplement in addition
and kind of overdoing it.
Should you be using food thatcontains iron to supplement your
iron intake If that'scontributing to your
constipation, and then shouldyou be balancing that out with a
stool softener and or alaxative at least a couple times
(31:17):
a week?
Those are all things to thinkabout.
So for our berry folks, you'remuch more likely to have
problems with not having enoughwater in your body, not enough
fluid in the tank and havingsome medications that that don't
help you out either, like yourvitamins and minerals you're
taking.
So sometimes for our folks thestool softener and laxatives
really become important as aconsideration in a more long
(31:40):
term picture too.
Speaker 1 (31:43):
Okay, at what point do you go to the ER or?
Speaker 2 (31:47):
doctor.
Yes, so one.
I would say really thereshouldn't be any visits about
constipation to the twoemergency settings, because it's
at the same time.
If you're having a lot of painand you don't know what is
causing that, then yeah,obviously you're going to have
an inpatient care or emergencydepartment.
But if you know, you haven'tpooped in a lot of days
(32:08):
emergency usually right and it'snot an emergency and otherwise
things are going okay.
It's probably a great time tocall your doctor and definitely
to call your bariatric team,because we've all been there and
we can help you work throughthe steps to get back on track.
And then the other thing issometimes there may actually be
something more going on.
There may be a medicalcondition that's cropped up,
(32:29):
there may actually be an issuewith your gut or your blood for
us to evaluate.
So it really is important, ifthis is an ongoing issue for you
, especially once you've workedthrough a treatment path and
it's still not getting better,then it's very important to go
see your doctor, yeah, andconsider also if there's
medication changes that haveoccurred or new medical
conditions that you have onboard that can definitely be
(32:50):
affecting your gut and yourconstipation too, causing
constipation.
Speaker 1 (32:55):
Absolutely Talking shit today.
Speaker 2 (32:59):
We got all serious.
We started off all night andthen we got all serious about
poop.
Speaker 1 (33:04):
But it is.
It's a topic that we all needto talk about.
Nobody wants to talk about, butit's a huge issue.
I have a bunch of bariatricfriends.
I'm having more with thispodcast and this is a.
It's an issue.
Speaker 2 (33:19):
Yeah, and I'm glad because constipation technically
doesn't kill people and it'sless of a problem than maybe
some of the other complications,but in terms of being affecting
quality of life it's a massiveone, because if you're not
comfortable, it's uncomfortable,it can cause bloating, it can
cause you to not eat rightbecause you don't feel good
enough to eat.
It can stop you from drinkingenough fluid because you already
(33:40):
feel driven in full.
So it just it really worksagainst you.
So the best is prevention.
The best is drink in a fluidstate active, eat a good, varied
diet and keep in touch withyour team and your friends and
your people.
But if that's not possible, ifthat's not working, then start
to tweak things.
Start to consider more fluids,fiber stool, softeners, maybe
(34:02):
laxatives, and then definitelyget help if you're needing to
figure out what's going on andyou've tried things and things
are just not working for you.
Speaker 1 (34:11):
Absolutely.
I know it's a boring topic, butthank you for talking about it
and thank you for explaining it,because I clearly learned a few
things, especially like when totake a stool softener, when to
use a laxative, all of thatstuff.
Speaker 2 (34:23):
So thank you, yeah, go.
Yeah.
By the way, just real quick onthe stool softener versus
laxative, that's something thatyou can look up.
Typically on the box it willsay if it's a stool softener or
a laxative on both.
So if you have questions aboutthat's a good way to know which
one is which.
And you can also always askyour pharmacist.
So, as long as you're notbuying this, like at midnight on
a Tuesday or something, whatpharmacist even open at midnight
(34:44):
on a Tuesday anymore?
But, yeah, you can always askyour pharmacist, or, honestly,
this is always a good questionto be chatting with your
surgical team about, because wedeal with poop so much more than
you think we do and wedefinitely enjoy people having
good BMs and, yeah, notstruggling with this problem.
So don't be afraid to ask.
Speaker 1 (35:04):
Absolutely so.
Thank you everybody forlistening.
Don't forget to go over toInstagram and follow us.
We do have a Facebook group nowCorb bariatrix community.
Ask to join.
There's just a few questions.
Otherwise, thank you, maria,for talking shit today.
Speaker 2 (35:20):
Every day Thank you Bye, bye.
Bye.
All right, Maria.
I know, talking shit is usuallybad, but we're talking shit
today.
Speaker 2 (00:04):
Yes, we are, because it's the shit.
We had to mark this episodeexplicit because of our desire
to say that word five times in arow.
Okay, and why are we going tobe talking about?
Why are we going to be talkingabout it?
Speaker 1 (00:18):
Why are we talking shit?
Because sometimes you justcan't, I can't.
I need to know all the why'sand how to manage it, and yes,
yes, I'm going to ask you foryour expert opinion or knowledge
.
Speaker 2 (00:31):
Thank you.
I'm going to ask you for yourexpert opinion too, as a person
who has dealt with this firsthand, or maybe second hand as
well.
But no yes, a lot of people arereally surprised when they come
to the hospital.
That, like when I round onpeople every day, I'm like, have
you passed gas, have you pooped?
And people get really freakedout about it the first time we
do it, but then we celebratewhen they pass gas and celebrate
(00:54):
when they poop, and then peoplereally get it.
Speaker 1 (00:56):
So it's not a problem if you're going.
Speaker 2 (00:58):
It is a very big problem if you are not
Absolutely.
That's why we're going to talkabout it.
Actually, also, interestinglyenough, this was the number one
reason that people were callingour office after surgery is
because you do four or five daysright and they wouldn't have a
bowel movement and they wouldhave pain and they would have
issues to the point wheresometimes people were going to
(01:20):
the hospital to be seen and allthey really needed to do was
have a big bowel movement.
So I think it's important thatactually led us to revamp our
entire how we managed themedications around helping
people poop and actually evenmade it so that they were taking
a medication starting a weekbefore surgery.
We actually changed our entireprotocol and studied it to see
(01:42):
if people would do better ifthey started taking Colase, a
stool softener, a week beforesurgery.
And guess what those phonecalls went to?
I believe zero afterwards.
Speaker 1 (01:50):
There wasn't a whole lot of them, yeah.
No yeah which is kind ofinteresting.
Speaker 2 (01:53):
So not that I have enough data to really prove that
was the one, and only I didn'thave enough patients for that,
but that is yeah, that's pretty.
It's pretty remarkable thatthis is a really important thing
to address around surgery.
Speaker 1 (02:05):
Yes, so why can't I?
Why?
Speaker 2 (02:07):
can't I shit, so why can't you poop?
There's a couple of factors.
Basically, there's there maynot be enough in the tank.
Speaker 1 (02:14):
We'll talk about that Especially right after surgery.
Speaker 2 (02:16):
Yeah Right, there may not be enough helping things
get through, which is also anissue with surgery and sometimes
there's things physicallystopping you, like stopping you
up, and we will talk about, yeah, those three things.
Basically, surgery is thespecial situation in general.
Anytime people have surgery orhave a trauma or have anything
(02:37):
that can impact how their gutswork, those can slow down and
that is actually called an Ilias, where your guts are paralyzed.
There's not a real likeblockage and there's not a real
thing blocking them from workingbut they don't work properly.
Your guts still produce leadersof fluid a day.
So if you think about, like howmuch math saliva your mouth
(02:59):
produces the rest of your gut,the rest of your GI tract,
stomach, esophagus, smallintestines all produce fluid too
.
So if you get backed up becauseyour guts not working properly,
things aren't going from startto finish in the right direction
, you can get really miserable,and that can happen even just
from having a trauma or surgery,whether it's very much.
Speaker 1 (03:21):
Remind me what's that called.
Again, it's actually called anIlias Ilias.
I thought that was like anorgan.
Speaker 2 (03:28):
I love it.
You're probably thinking Iliam,which is the last part of the
small intestine, but anyway, yes, we've now gone to zero
listeners for this episode.
Oh, stop.
But no so even just literallythe trauma of surgery itself or
being in it, quite literally atrauma like a motor vehicle
collision or something like thatcan cause that problem too
Patient, because it's not justthe fact that you're having
(03:50):
bariatric surgery.
It may just literally be thefact that you had surgery that
is causing some of that slowdown, but then after surgery,
everyone recovers from that andthat's not the reason that, long
term, people have issues withconstipation.
So that is something that we'regoing to talk about too.
So yeah, so one.
I want to ask you actually haveyou dealt with this problem?
Speaker 1 (04:13):
Absolutely Still do for sure For sure especially
going back into the hospital.
I had bariatric surgery while Iwas in the clinic or in a
clinic, and so I had more timeto focus on my water.
I'm in the hospital now where,sometimes 12 hour days, I am not
sitting down at all, grantedthe activity helps, but lack of
(04:35):
water yeah.
Speaker 2 (04:36):
And I think a lot of people notice this if they're
traveling or if they're often,you're more routine, for
whatever reason holidays or,like you said, working long
shifts or working overnight youstop eating and drinking the way
you normally do.
You may be moving differently,you may be sleeping differently,
and those things can absolutelycontribute to constipation.
Even if you've got enough inthe tank, even if everything
(04:57):
else is working, you may begetting constipated because you
don't have enough water enoughfiber.
And we'll talk about some ofthose things.
Speaker 1 (05:03):
Can your body just not want to do the right thing
because of stress?
Speaker 2 (05:09):
Oh yeah, Okay, yeah, absolutely, and actually there's
even in literature.
I think we've seen somepatients too that are affected
by this.
Definitely.
You see that this in surgeryclinics in general, where people
have fear of going to thebathroom, and sometimes it's
because like for me, forinstance, when I was a resident
and a fellow there were timesthat you're working or even now,
(05:31):
sometimes when I'm on call,you're working and there's not a
reliable time for you to beable to go to the bathroom.
So it can be very challengingin that situation to have a
regularly scheduled BM everymorning with your coffee or
something like that.
That's exactly right.
Speaker 1 (05:47):
That's where I'm at yeah.
Speaker 2 (05:48):
And so for some folks it can be really difficult to
know when to safely go, if thatmakes sense, and that can
contribute to that, and otherstressors can definitely
contribute to people gettingthrown out of whack with a
regular routine and then itsnowballs, just like anything
else related to stress, whereyou can't properly go to the
bathroom for a day or two andthen all of a sudden it's day
(06:10):
three or four, and this ishappening over and over again
and it becomes an increasinglystressful situation that feeds
forward into itself.
Yes, stress can definitelyaffect how we boot, but in
general, I think it's reallyimportant if you're having this
problem One, let's figure outwhat is constipation.
Speaker 1 (06:28):
Yeah, when is it?
Speaker 2 (06:29):
considered constipation.
When is it like not good andwhen is it a real problem.
So basically, people shouldhave a BM every day or two.
You're not everybody poops thesame way.
Not everybody poops the sameway.
So I do want to say this is oneof those things where there is
a range of normal, and justbecause you don't poop every
morning with your coffee, thatdoes not mean you have
constipation at all.
(06:50):
Some people quite literallytake a day or two in order for
that to happen.
So that's part one.
And then part two is consistencyof your bowel movements.
We're really getting into ittoday.
But if it's really watery,that's a problem.
If it's really hard, that's aproblem.
And both of those things canactually happen.
Even if you're only going tothe bathroom once or twice a day
(07:10):
, or if you're going multipletimes a day, you can still be
having little pellet, rabbitpellets that you're pooping up
multiple times a day.
So consistency is important too.
It becomes a problem if you'regoing more than two or three
days without a bowel movementand if the consistency is really
hard to pass, because withconstipation you can form
hemorrhoids Anytime.
(07:30):
You're straining a lot, you canget the royal rage Not fun.
You can get fissures, which islittle tears.
Yeah, super painful, super notfun.
You can actually getdiverticulosis from this problem
, so that's little outpouchingsof your colon that can sometimes
get infected and inflamed andcause problems down the road,
(07:51):
and in general, it's just notgreat for your gut not to be
working on a regular basis.
It seems to change even some ofthe bacteria, the microbiome of
the gut, for people who havechronic constipation and this is
crazy, but constipation andstraining can also contribute to
hernia.
Yeah, so if you think about it,people are more likely to
develop hernias when they havepregnancy or when they gain a
(08:13):
lot of weight or if they'redoing a lot of heavy lifting.
But even constipation andstraining can contribute to that
risk too.
So, yeah, so not being able togo on a regular basis and have
good bowel movements can be avery big deal.
Speaker 1 (08:27):
I just want to be able to sit in the bathroom as
long as my husband does everysingle day.
Speaker 2 (08:31):
And actually so.
Yeah, so sitting for prolongedperiods of time and doing that
on the toilet actually is acontributing risk factor for
constipation.
Yeah, and a lot of folks don'tnecessarily know that either.
And how you had BMs as a kidsometimes affects how you have
BMs as an adult.
And if you were used to likesitting on the toilet and
reading or playing video gamesor something like that as a kid
(08:52):
and you carry that into youradulthood and you have time to
do that, which is remarkable butfine, that can actually train
your body to also strain and toalso not pass on movements as
regularly as it could.
So a lot of different factorsthere.
Speaker 1 (09:08):
So take away the magazines and stuff from your
body.
Speaker 2 (09:11):
Yes, yes, I know.
So I know we're supposed tohave a little bathroom reading
materials and things, butactually not a great way to
encourage efficient and good BMs.
But in general, like if you'rehaving problems with
constipation, assess first.
That is a really importantthing to do and there's a couple
of things to assess.
Are you drinking enough waterand how much water?
(09:31):
How much water is enough water,tammy, you think?
Speaker 1 (09:34):
Supposed to be 64 ounces a day.
Speaker 2 (09:36):
Yeah, that's right.
So basically eight glasses ofeight ounces a day, is that?
Speaker 1 (09:41):
water Not just coffee ?
Speaker 2 (09:43):
Yes, of water, like things that contain water, yes,
yeah, and not dehydrating andnot dehydrating.
But I will debunk somethinghere real quick, because if it's
coffee or tea and that's whatyou're used to drinking
especially do that.
That is better than nothing.
And there are some studies thathave come out recently that
actually indicate we thoughtthat caffeine was dehydrating
(10:04):
for a really long time.
So drinking caffeine isbasically like negative to your
water intake.
It's not.
No, it's not.
You're going to need to linkthat article.
There's a few, there's a few,but basically so.
The reason why is becausecaffeine can have a diuretic
effect.
It can cause your kidneys toexude more fluids, right, and it
can cause more essentially.
(10:25):
But one is that effect ispretty weak and two, your body
gets used to the caffeine thatyou drink.
If you're drinking caffeineover and over again I'm a person
who drinks a lot of coffee anda lot of tea and things like
that- yeah, I was proud to seeyou drinking water here while
we're recording.
Hey, that's right.
But you know me as well.
I am a camel.
I go to the bathroom like twoor three times a day period and
(10:46):
that's it, because my body is soused to retaining that water
and a lot of that is just howbodies self-regulate.
So if what you're drinking iscoffee and tea and that's what
gets your fluids in, do not stopdoing that and pretend like
you're going to be able to justswitch that all to a glass of
water a day.
Right, that is not going tohappen.
Sounds torture, that is torture.
(11:06):
The other thing to think aboutis this is not an all or nothing
.
If you're trying to guzzle likea gallon in the morning and get
yourself through your entireday that way, that's probably
not going to happen, and then,especially with bariatric
surgery, you can't really dothat anyway because your tank is
so little and, being inhealthcare, tammy, I know this
for you.
You've mentioned that this isreally challenging.
How do you actually go aboutgetting your water in over the
(11:29):
course of a day?
Speaker 1 (11:31):
Insert Stanley here.
No, but seriously, my cup isalways full.
I always have multiple cups,like I always have ice water in
a separate cup.
So yeah, I can keep refillingmy Stanley, because I usually
have like crystal light orsomething in it.
I do need flavor of some sort,but literally I've just made a
habit of every time I sit downat my desk which sometimes isn't
(11:53):
always.
Very often, I make sure I drink,I make sure I drink.
So it's just.
Yeah, I feel lost when I don'thave my Stanley next to me, just
because it has become a habitof having it with me and drink
and drink.
Yeah.
Speaker 2 (12:11):
Good for you, and I honestly think a lot of us are
not super honest about our waterintake.
We think we're doing a reallygood job, we think we're
drinking throughout the day, butI personally come from a
culture, so I'm a Russianimmigrant here when I was a kid
and so our family culture wasvery much don't drink while
you're eating, don't drink onthe go.
We still have this like my momis very anti-Stanley Big jug
(12:33):
yeah jugs and things like that.
They brought that toThanksgiving Exactly.
So there are certain culturesor certain workplaces or certain
in general that don't lookfavorably upon constantly having
some water or something todrink with you.
But get over it.
I'm sorry.
That just made me think.
If you're post bariatricsurgery, it's not really
optional because, again, youcannot guzzle that 16 ounce
(12:57):
container or that bottle ofwater when you feel like it
later or earlier and not beenough to keep you going for the
rest of the day.
Speaker 1 (13:04):
And I've seen you or I've helped you do or faxed off
a letter to patients that saysthis patient is required.
You need to make an exceptionfor this person to have water
next to them.
Yes, no matter what.
Speaker 2 (13:19):
Yes.
So even if you're a surgeon,even if you're a nurse, even if
you're an airline pilot, even ifwhat other principle?
Even if you're someone who justyour butt does not hit a seat
all day long, at any time, thereare ways, and certainly you can
even ask your bariatric surgeryprogram to write you an
exception.
In fact, I think we wereworking on some cards for people
(13:40):
that say I've had bariatricsurgery before.
I need these certain meal sizerestrictions and things like
that.
And I think one of theimportant things there is that
it indicates I need to bedrinking six to four ounces of
water a day and that needs to bethroughout the day.
There are ways to engineer theworkplace and your life around
it, but don't be afraid ofcarrying that jug, that water,
whatever you need, because it'sjust it's so important, so
(14:04):
important, absolutely.
It's so important you don'twant to be backed up because of
it.
Oh and, by the way, people doask if flavoring is okay.
Flavoring is totally fine.
So if it's a mix of women, ororange or cucumber or whatever
it is that makes the water tastegood for you, or crystal light
or something like that, go forit.
Again, the benefit to havingthe fluids is so much higher
(14:24):
than any of the risk, and therisk is not.
There's no science behindthinking that there's a risk
associated with flavored wateror things like that, so just do
it.
Fake sugars the body perceivesthem a lot like real sugars, so
I'm not super pro fake sugar.
If you're going to havesomething with some sugar, just
lower sugars, probably better.
If no, sugar is not an option,so that's.
(14:46):
But in general that's justthat's what I believe.
Speaker 1 (14:49):
Right, Absolutely no.
And fake sugars sometimes don'tagree with us.
And so one crystal light packetis in my whole.
Usually it's for 16 ounce waterbottle.
Right, it's in my whole 40ounce Stanley and I continue to
actually water it downthroughout the day because that
initial sip is like too sweet.
But I do need something and itworks for me.
(15:11):
And, as you said, water is moreimportant than, or getting that
fluid in is more important thanit just being plain water.
Speaker 2 (15:19):
Exactly and think about it too that one you can
water down drinks.
A lot of people after bariatricsurgery have sort of texture
issues sometimes or flavorissues that weren't there before
for things especially that aresweet.
So if that's the case, water itdown just to half a cup with
water and then that makes it alot more palatable and it cuts
down on sugar if that's what'sin it.
(15:39):
So that's a good approach.
And oh, yes, don't forget that,like your shakes and your
smoothies have fluids in them.
Those count.
Fruits and vegetables havefluids in them.
So it's yeah, those are alsogreat ways to get your fluids in
and yeah, so there's a lot ofways to make sure that you're
getting enough fluid in the tankto help things go.
Another one is whenever we'retalking about constipation.
(16:01):
So one is are you gettingenough fluids to is?
Are you getting an effectivity?
Speaker 1 (16:05):
I realized, if I am more active, if I do an angry
one mile sprint, my bowels getmoving, so something happening?
Speaker 2 (16:15):
They sure do, and there is some fun science behind
that, which is basically yourguts need to know where gravity
is, and if you are laying downor sitting in a reclined
position, your guts have areally hard time pushing things
down where they need to go.
In fact, when we have peoplewho have that Ilias state that
we talked about earlier, wheretheir bowels are paralyzed and
(16:35):
they're not really working, thebest way to treat that is
actually walking upright, beingupright and moving.
But it's the same forconstipation too.
You need to get going in themorning, and more ways than one
working out can help.
But the more time you spendlaying, sitting, not moving,
being in one position without,without that, the harder time
your body has actually havingbow movements and pushing things
(16:57):
through.
So activity really important.
Speaker 1 (17:00):
Absolutely.
I have experienced thatfirsthand, for sure.
Speaker 2 (17:05):
Yeah, okay.
We've talked about fluids,we've talked about activity.
What about fiber?
Speaker 1 (17:11):
Insert deer head lights here.
Speaker 2 (17:14):
So fiber is actually complicated and we will not go
into all of the complexityassociated with it, we're just
going to make it super simple.
We probably should have a wholeepisode on fiber, but for the
purpose of this podcast and thisepisode, fiber is something
that's in a lot of differentfoods, and the best way I've
ever heard fiber described Iwill never forget, by another
surgeon is like toilet paperfrom the inside Elaborate.
(17:37):
Yeah, you're like I know,should I be eating toilet paper?
Wait, what is this?
So think about it this way it'slike the scrub brush that your
GI tract gets, that yourintestines and your colon get,
and it's really important inhelping draw water into your gut
, so that water that we talkedabout a couple minutes ago being
really important.
It helps to pull that waterinto your gut so that your
(17:59):
stools aren't rocks and thatthey have enough oof to them to
be able to pass through.
It also creates some bulk to it.
So think about it this way it'slike creating some Amazon
packaging around what's there.
So it helps to create somepackaging, for it to have some
substance and for it to be ableto move, which is important,
(18:19):
yeah, and it creates that sortof scrub brush effect, as it
goes.
So it's really important howfiber.
So what kinds of things havefiber?
What kinds of things work foryou that have fiber?
Speaker 1 (18:30):
Ta-da-da.
Timmy, I'm really bad at thispart.
Yeah, fruit veggies, it'sgreens.
Speaker 2 (18:40):
Dried fruit, lots of things that are in soups, for
instance.
So if you have soup withvegetables in them oh, she's in
the background, I'm waiting fora sec.
Yeah, so fruits and vegetables,whole grains.
There's actually a lot ofthings that now have added fiber
in them.
So if you look at packaging, alot of whole grain products have
fiber in them, whether that belike pasta or whether that be
(19:02):
bread or whether that be evenprotein powder, sometimes have
added fiber in them, and then,definitely.
You can also do supplements forfiber.
So there's powder of that,there's tablets of that.
There's so many differentversions that you can take and
again there's a little bitbeyond the scope of this.
But there's soluble fiber,there's insoluble fiber.
Both are important, but thebiggest takeaway here is make
(19:24):
sure you're eating fruits andvegetables or whole grains or
that you're using a dailysupplement for fiber.
Maybe both.
Yeah, absolutely, absolutely.
Speaker 1 (19:32):
No dude.
Speaker 2 (19:34):
Yeah, so especially if you're having problems with
constipation, it's really hardto consider.
One other thing I'm going tothrow out there and people don't
necessarily think about it isdried fruit, and so I'm thinking
like you told me this yeah,dried apricots.
This is a very greatnon-medication way to help your
body have some fiber and havesome fruit sugar, which is also
(19:55):
something that can help peoplehave some balance and is good
and it really helps withconstipation.
So, if you're eating a handfulof that, probably too much,
because, remember, the size of aprune is teeny, tiny, but the
size of a plum is not, and thewater is gone from the prune so
you don't want to eat like youwouldn't eat 10 plums, so maybe
you wouldn't eat 10 prunes.
Yeah, raisins are good, allthat, so just moderation in
(20:20):
terms of how much you're eatingof it, but it's actually a
really great way to get fiberand to help yourself not be
constipated.
Speaker 1 (20:26):
Yeah, that definitely has helped me.
I have used that tool.
Speaker 2 (20:31):
Yeah, dried fruits, and they go in the mouth, they
are eaten.
I didn't have somebody ask meif you put it in your butt and I
said you should eat, but notfor this purpose.
Yeah, please don't.
Please don't do that, At leastfor the purpose of having bowel
movements.
That is not helpful.
And then, okay.
So we talked about fluids, wetalked about activity, we talked
(20:52):
about fiber.
What about your diet varietyand what's in your diet?
You had mentioned some reallygood stuff about eating too much
protein and how that affectedyou early on.
Can you tell me a little bitabout that?
Speaker 1 (21:04):
Oh, yes, I was saying that, or to one of our
dieticians, that I'm focusing onmy protein.
That's what everybody tells usto do.
Focus on your protein and,excuse me, cheese.
Are you eating any carbs?
How many are you eating fruit?
And I'm like no fruit has sugarin it and carbs are carbs.
So, yeah, she challenged me tomix up my diet a little bit, so
(21:27):
I actually started eatingoatmeal with some raisins in it
and, yeah, my bowel movementswere much better and I lost
actually a significant amount ofweight that first week.
Just something about my itshocked my body of some sort and
I got past the plateau.
For sure.
(21:47):
I love it.
Speaker 2 (21:48):
Yeah, because our bodies do need proteins, fats
and carbs.
Low carb diets usually makepeople really constipated and
also your body does absolutelyneed those things in balance.
So if you're eating too muchprotein, it's a great way to
have poop that's like bricks andthat comes only every several
days.
It's a great way to not have acolon that's getting a lot of
(22:10):
fiber, because you're probablynot eating things that have
carbs and that have some fiberin them, which your body needs.
Fat is also really important indiet too, because fat also
helps your body have good bowelmovements and things move
through.
And again, we're not talkingabout either or for any of this.
It's quite literally incombination and oftentimes yeah,
(22:30):
oftentimes if we're eating alot of processed food or if
we're eating just one kind offood, we're probably depriving
our bodies of a balanced dietthat has everything in it that
helps us be able to have healthyskin, healthy bones, healthy
joints, healthy brain, healthyeyes and also healthy poops.
Yes, absolutely yeah, reallyimportant.
(22:51):
Alcohol, caffeine, can have animpact, so smoking certainly can
have an impact, which I don'tknow a lot of people realize
either.
So the more you drink alcohol,the more erratic your bowel
movements are going to be notnecessarily constipation, but
could be diarrhea, could be amix.
And then same thing withcaffeine, too much caffeine.
So again, cup of coffee a day,a couple cups of coffee even, or
(23:12):
tea, not a big deal, but ifyou're drinking like 10 red bowl
a day, maybe that is too much.
Oh, yeah, that's going to bediarrhea straight up Could be at
the same time that muchcaffeine actually can be
dehydrating Right, so you mayactually end up being
constipated if you do that.
Speaker 1 (23:30):
Yeah, obviously everybody's body is different.
Speaker 2 (23:32):
But that fake sugar, whatever is in the caffeine in
there and all of that Reallyimportant to actually take a
look at what you're eating andmaybe you're excluding foods
from your diet that you reallyneed and you're not getting
enough diversity and variety inyour diet and that's having its
impact on your gut.
Speaker 1 (23:47):
Absolutely Just like exercise if you're doing one
exercise for a really longperiod of time.
So if you're eating the samething for a long period of time.
Speaker 2 (23:55):
Your body just gets used to it mixing stuff up
changing things up Exactly and Ithink we notice this a lot.
This one especially when wetravel.
So traveling and being stressedand things like that can have a
huge impact on our diet variety.
I know I go to Slim Jim's realfast in a pinch, right, exactly.
Yeah, beef jerky, yeah, beefjerky and nuts and things like
(24:18):
that, because I know those aregoing to have a consistent
quality at least, even thoughthey may not be the best thing
for my body and they may not bethe highest quality of food.
They're super processed usually.
At least what you're getting inairports and what you're
getting in gas stations may notbe the healthiest.
Being mindful, especially whenyou're stressed, especially when
you're busy, especially whenyou're traveling, that the
variety in your diet, makingsure there's grains and fruits
(24:40):
and vegetables, and that yourfluids are staying high all of
that's really important,especially when there's active
change or stress going on inyour life.
Yeah, absolutely Same thing forsleep.
So we've talked about fluids,activity, fiber, diet, variety,
travel.
What about sleep?
This?
Speaker 1 (24:58):
is, I think, one of the clear ones.
Yeah, Sleep is important justall around for our energy, for
our health in general, our hearthealth and but it helps bowel
movements huh, it does, and it'snot like a direct.
Speaker 2 (25:12):
we don't have a study that says we've eight hours a
day and all of a sudden, yourpoops are great.
By the way, sleep, and we willhave an entire episode on this.
At least once we have someonewho we're interviewing actually
coming up tomorrow yeah, thesleep medicine doctor and really
great expert on this.
But enough sleep is veryimportant for your body again to
regulate properly, and thataffects how your body treats
(25:35):
food.
That affects how your bodytreats fluids.
It affects how your body isable to go to the bathroom.
So important to be gettingenough sleep, whatever that is
for your body, and that may be arace.
You may be a person who's greaton four hours of sleep.
You may be somebody who needseight or nine, so be mindful of
that.
That is a really big factor,especially if you have shift
(25:55):
work that goes overnight or achange in your schedule or
you're moving or traveling.
Again, don't scrimp out on thesleep Very important even for
this aspect.
Speaker 1 (26:05):
Yes, very much.
So why do medications?
Oh, no-transcript yeah.
I realize that some medicationswill cause me to be motivated.
Speaker 2 (26:14):
Oh yes, why, yes, right after surgery.
Actually, many people willnotice that they're taking
narcotics which they get duringsurgery, even as pain control,
potentially during surgery, butthey may be taking it afterwards
.
So that class of medicationoxycodone, hydrocodone, all of
those things, fentanyl dilated,all of those things have a
natural effect on slowing downthe gut and so they can
(26:35):
contribute to constipationpretty badly, which is again one
of the reasons why sometimesit's important to use other
medications, like stool softeneror some things like that, to
combat, to counteractessentially those medications
Others not have.
Like, for instance, if you havea thyroid problem where your
body is not creating enoughthyroid hormone and you have
supplements for that, and if you, if, for whatever reason, your
(26:56):
level of that is low, that canalso be contributing to
constipation.
But there are many differentkinds of medications that can
contribute to constipation.
So if, if your water's on point, your activity's on point, your
fiber's great, your diet'sgreat, you're getting enough
sleep, you're really notstressed or you're really trying
to take care of everything, butyou're still having problems
with constipation, it's a greatidea to see your doctor about
(27:19):
medications that you're takingand medical conditions.
So, like we talked about, thatlow thyroid state,
hypothyroidism, can impactconstipation.
A lot of different hormonalchanges can impact constipation,
certainly GI function.
So if you have any kind ofproblems with your stomach or
intestines or colon, that canaffect your ability to have
(27:40):
bowel movements too.
So if everything else you'redoing well, it's a great time to
talk to your doctor about yourspecific situation.
Speaker 1 (27:47):
Yeah, the difference between stool softeners and
laxatives.
Speaker 2 (27:56):
Aha, I love it.
What's the difference?
Speaker 1 (27:58):
And when and what order.
Speaker 2 (28:01):
Yes, yeah, that's a great question.
So we're let's talk about somefixes for constipation.
Right, we feed the dead horse,Okay, what are the things that
can cause this?
Now let's talk about some waysto fix it.
So one I will say before tryingmedications, make sure you've
got the rest of these thingsgoing on in your life too.
You're increasing your fluidintake.
You're having physical activityon a regular basis and you're
trying fiber, good diet, all ofthat stuff.
(28:23):
If that's not working for you,try stool softeners.
Stool softeners are greatbecause they make your stools
soft.
I'm brilliant, right, I can'tput my hand on that, but how?
But how?
This includes, by the way,things like Kolei, stokelaxen
and, like we talked about, evendried fruit and fiber can be
considered stool softeners too.
Typically, they work by helpingyour gut draw water into what's
(28:45):
inside of it.
That's one of them.
That's called an osmotic agent,osmotic being the term that
means that it's drawing water in.
So, again, that helps to bulkyour stool up.
It helps to soften it so itactually can move.
Right.
If you have a canoe in a river,if the riverbed is dry, you
ain't going nowhere, but if thatriverbed has water in it, guess
(29:06):
what?
Your canoe can move, yeah, orlike a slide, right.
If you're on a water slide orsomething.
You don't want to go down awater slide without any water.
That's not fun so you've got toone, have the water in your body
for it to be able to pull in.
But once you do, the stoolsofteners can really help to
create stools that can move.
So be the canoe, don't be thedry bed Creek.
Yeah, there we go.
(29:28):
Yeah, that's really what stoolsofteners do.
There are also laxatives, whichis one level of more action than
stool softeners.
So laxatives like mero lax,milk of magnesium, lactulose,
there are lots and lots ofothers, magsitrate, which is no
longer on the market but used tobe, these things actually help
to push things forward.
So stool softeners don't havethat kind of action, but
(29:51):
laxatives do.
And there are some things thatare both stool softeners and
laxatives.
So mero lax, technically, isconsidered both because it helps
to draw water into the stooland it also helps to make your
gut push things forward.
But laxatives are one stepabove stool softeners.
So I would say start with astool softener once or twice a
day until you get to the pointwhere you want your bell
(30:11):
movements to be, and if that'sstill not helping, then that's
when to add laxatives.
Right, and again, stoolsofteners and laxatives will not
work if there's not enough inthe tank.
If the water isn't there.
No amount of stool softeners orlaxatives are going to help the
situation.
In fact, they can make it worse.
So be careful.
It's also something to becareful using, because you can
(30:35):
become dependent on stoolsofteners and laxatives.
You can train your body to bedependent on these medications,
so they are not meant foreveryday use for forever.
Yeah, for folks that havebariatric surgery, you are
taking vitamins, including iron,that can also cause
constipation, so important insome situations to talk to your
doctor about one.
(30:56):
Do you need to be taking theiron pill every day?
Or you may be taking too muchiron because your multivitamin
may include iron and you may betaking a supplement in addition
and kind of overdoing it.
Should you be using food thatcontains iron to supplement your
iron intake If that'scontributing to your
constipation, and then shouldyou be balancing that out with a
stool softener and or alaxative at least a couple times
(31:17):
a week?
Those are all things to thinkabout.
So for our berry folks, you'remuch more likely to have
problems with not having enoughwater in your body, not enough
fluid in the tank and havingsome medications that that don't
help you out either, like yourvitamins and minerals you're
taking.
So sometimes for our folks thestool softener and laxatives
really become important as aconsideration in a more long
(31:40):
term picture too.
Speaker 1 (31:43):
Okay, at what point do you go to the ER or?
Speaker 2 (31:47):
doctor.
Yes, so one.
I would say really thereshouldn't be any visits about
constipation to the twoemergency settings, because it's
at the same time.
If you're having a lot of painand you don't know what is
causing that, then yeah,obviously you're going to have
an inpatient care or emergencydepartment.
But if you know, you haven'tpooped in a lot of days
(32:08):
emergency usually right and it'snot an emergency and otherwise
things are going okay.
It's probably a great time tocall your doctor and definitely
to call your bariatric team,because we've all been there and
we can help you work throughthe steps to get back on track.
And then the other thing issometimes there may actually be
something more going on.
There may be a medicalcondition that's cropped up,
(32:29):
there may actually be an issuewith your gut or your blood for
us to evaluate.
So it really is important, ifthis is an ongoing issue for you
, especially once you've workedthrough a treatment path and
it's still not getting better,then it's very important to go
see your doctor, yeah, andconsider also if there's
medication changes that haveoccurred or new medical
conditions that you have onboard that can definitely be
(32:50):
affecting your gut and yourconstipation too, causing
constipation.
Speaker 1 (32:55):
Absolutely Talking shit today.
Speaker 2 (32:59):
We got all serious.
We started off all night andthen we got all serious about
poop.
Speaker 1 (33:04):
But it is.
It's a topic that we all needto talk about.
Nobody wants to talk about, butit's a huge issue.
I have a bunch of bariatricfriends.
I'm having more with thispodcast and this is a.
It's an issue.
Speaker 2 (33:19):
Yeah, and I'm glad because constipation technically
doesn't kill people and it'sless of a problem than maybe
some of the other complications,but in terms of being affecting
quality of life it's a massiveone, because if you're not
comfortable, it's uncomfortable,it can cause bloating, it can
cause you to not eat rightbecause you don't feel good
enough to eat.
It can stop you from drinkingenough fluid because you already
(33:40):
feel driven in full.
So it just it really worksagainst you.
So the best is prevention.
The best is drink in a fluidstate active, eat a good, varied
diet and keep in touch withyour team and your friends and
your people.
But if that's not possible, ifthat's not working, then start
to tweak things.
Start to consider more fluids,fiber stool, softeners, maybe
(34:02):
laxatives, and then definitelyget help if you're needing to
figure out what's going on andyou've tried things and things
are just not working for you.
Speaker 1 (34:11):
Absolutely.
I know it's a boring topic, butthank you for talking about it
and thank you for explaining it,because I clearly learned a few
things, especially like when totake a stool softener, when to
use a laxative, all of thatstuff.
Speaker 2 (34:23):
So thank you, yeah, go.
Yeah.
By the way, just real quick onthe stool softener versus
laxative, that's something thatyou can look up.
Typically on the box it willsay if it's a stool softener or
a laxative on both.
So if you have questions aboutthat's a good way to know which
one is which.
And you can also always askyour pharmacist.
So, as long as you're notbuying this, like at midnight on
a Tuesday or something, whatpharmacist even open at midnight
(34:44):
on a Tuesday anymore?
But, yeah, you can always askyour pharmacist, or, honestly,
this is always a good questionto be chatting with your
surgical team about, because wedeal with poop so much more than
you think we do and wedefinitely enjoy people having
good BMs and, yeah, notstruggling with this problem.
So don't be afraid to ask.
Speaker 1 (35:04):
Absolutely so.
Thank you everybody forlistening.
Don't forget to go over toInstagram and follow us.
We do have a Facebook group nowCorb bariatrix community.
Ask to join.
There's just a few questions.
Otherwise, thank you, maria,for talking shit today.
Speaker 2 (35:20):
Every day Thank you Bye, bye.
Bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.