Core Bariatrics

Episode 22: We're Talking S**T

• Dr. Maria Iliakova & Tammie Lakose

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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!

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Speaker 1:

All right, Maria. I know, talking shit is usually bad, but we're talking shit today.

Speaker 2:

Yes, we are, because it's the shit. We had to mark this episode explicit because of our desire to say that word five times in a row. Okay, and why are we going to be talking about? Why are we going to be talking about it?

Speaker 1:

Why are we talking shit? Because sometimes you just can't, I can't. I need to know all the why's and how to manage it, and yes, yes, I'm going to ask you for your expert opinion or knowledge.

Speaker 2:

Thank you. I'm going to ask you for your expert opinion too, as a person who has dealt with this first hand, or maybe second hand as well. But no yes, a lot of people are really surprised when they come to the hospital. That, like when I round on people every day, I'm like, have you passed gas, have you pooped? And people get really freaked out about it the first time we do it, but then we celebrate when they pass gas and celebrate when they poop, and then people really get it.

Speaker 1:

So it's not a problem if you're going.

Speaker 2:

It is a very big problem if you are not Absolutely. That's why we're going to talk about it. Actually, also, interestingly enough, this was the number one reason that people were calling our office after surgery is because you do four or five days right and they wouldn't have a bowel movement and they would have pain and they would have issues to the point where sometimes people were going to the hospital to be seen and all they really needed to do was have a big bowel movement. So I think it's important that actually led us to revamp our entire how we managed the medications around helping people poop and actually even made it so that they were taking a medication starting a week before surgery. We actually changed our entire protocol and studied it to see if people would do better if they started taking Colase, a stool softener, a week before surgery. And guess what those phone calls went to? I believe zero afterwards.

Speaker 1:

There wasn't a whole lot of them, yeah. No yeah which is kind of interesting.

Speaker 2:

So not that I have enough data to really prove that was the one, and only I didn't have enough patients for that, but that is yeah, that's pretty. It's pretty remarkable that this is a really important thing to address around surgery.

Speaker 1:

Yes, so why can't I? Why?

Speaker 2:

can't I shit, so why can't you poop? There's a couple of factors. Basically, there's there may not be enough in the tank.

Speaker 1:

We'll talk about that Especially right after surgery.

Speaker 2:

Yeah Right, there may not be enough helping things get through, which is also an issue with surgery and sometimes there's things physically stopping you, like stopping you up, and we will talk about, yeah, those three things. Basically, surgery is the special situation in general. Anytime people have surgery or have a trauma or have anything that can impact how their guts work, those can slow down and that is actually called an Ilias, where your guts are paralyzed. There's not a real like blockage and there's not a real thing blocking them from working but they don't work properly. Your guts still produce leaders of fluid a day. So if you think about, like how much math saliva your mouth produces the rest of your gut, the rest of your GI tract, stomach, esophagus, small intestines all produce fluid too.

Speaker 2:

So if you get backed up because your guts not working properly, things aren't going from start to 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:

Remind me what's that called. Again, it's actually called an Ilias Ilias. I thought that was like an organ.

Speaker 2:

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 literally the trauma of surgery itself or being in it, quite literally a trauma like a motor vehicle collision or something like that can cause that problem too Patient, because it's not just the fact that you're having bariatric surgery.

Speaker 2:

It may just literally be the fact that you had surgery that is causing some of that slow down, but then after surgery, everyone recovers from that and that's not the reason that, long term, people have issues with constipation. So that is something that we're going to talk about too. So yeah, so one. I want to ask you actually have you dealt with this problem?

Speaker 1:

Absolutely Still do for sure For sure especially going back into the hospital. I had bariatric surgery while I was in the clinic or in a clinic, and so I had more time to focus on my water. I'm in the hospital now where, sometimes 12 hour days, I am not sitting down at all, granted the activity helps, but lack of water yeah.

Speaker 2:

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 you stop eating and drinking the way you normally do. You may be moving differently, you may be sleeping differently, and those things can absolutely contribute to constipation. Even if you've got enough in the tank, even if everything else is working, you may be getting constipated because you don't have enough water enough fiber. And we'll talk about some of those things.

Speaker 1:

Can your body just not want to do the right thing because of stress?

Speaker 2:

Oh yeah, Okay, yeah, absolutely, and actually there's even in literature. I think we've seen some patients too that are affected by this. Definitely. You see that this in surgery clinics in general, where people have fear of going to the bathroom, and sometimes it's because like for me, for instance, when I was a resident and a fellow there were times that you're working or even now, sometimes when I'm on call, you're working and there's not a reliable time for you to be able to go to the bathroom. So it can be very challenging in that situation to have a regularly scheduled BM every morning with your coffee or something like that. That's exactly right.

Speaker 1:

That's where I'm at yeah.

Speaker 2:

And so for some folks it can be really difficult to know when to safely go, if that makes sense, and that can contribute to that, and other stressors can definitely contribute to people getting thrown out of whack with a regular routine and then it snowballs, just like anything else related to stress, where you can't properly go to the bathroom for a day or two and then all of a sudden it's day three or four, and this is happening over and over again and it becomes an increasingly stressful situation that feeds forward into itself. Yes, stress can definitely affect how we boot, but in general, I think it's really important if you're having this problem One, let's figure out what is constipation.

Speaker 1:

Yeah, when is it?

Speaker 2:

considered constipation. When is it like not good and when is it a real problem. So basically, people should have a BM every day or two. You're not everybody poops the same way. Not everybody poops the same way. So I do want to say this is one of those things where there is a range of normal, and just because you don't poop every morning with your coffee, that does not mean you have constipation at all. Some people quite literally take a day or two in order for that to happen. So that's part one.

Speaker 2:

And then part two is consistency of your bowel movements. We're really getting into it today. But if it's really watery, that's a problem. If it's really hard, that's a problem. And both of those things can actually happen. Even if you're only going to the bathroom once or twice a day, or if you're going multiple times a day, you can still be having little pellet, rabbit pellets that you're pooping up multiple times a day. So consistency is important too.

Speaker 2:

It becomes a problem if you're going more than two or three days without a bowel movement and if the consistency is really hard to pass, because with constipation you can form hemorrhoids Anytime. You're straining a lot, you can get the royal rage Not fun. You can get fissures, which is little tears. Yeah, super painful, super not fun.

Speaker 2:

You can actually get diverticulosis from this problem, so that's little outpouchings of your colon that can sometimes get infected and inflamed and cause problems down the road, and in general, it's just not great for your gut not to be working on a regular basis. It seems to change even some of the bacteria, the microbiome of the gut, for people who have chronic constipation and this is crazy, but constipation and straining can also contribute to hernia. Yeah, so if you think about it, people are more likely to develop hernias when they have pregnancy or when they gain a lot of weight or if they're doing a lot of heavy lifting. But even constipation and straining can contribute to that risk too. So, yeah, so not being able to go on a regular basis and have good bowel movements can be a very big deal.

Speaker 1:

I just want to be able to sit in the bathroom as long as my husband does every single day.

Speaker 2:

And actually so. Yeah, so sitting for prolonged periods of time and doing that on the toilet actually is a contributing risk factor for constipation. Yeah, and a lot of folks don't necessarily know that either. And how you had BMs as a kid sometimes affects how you have BMs as an adult. And if you were used to like sitting on the toilet and reading or playing video games or something like that as a kid and you carry that into your adulthood and you have time to do that, which is remarkable but fine, that can actually train your body to also strain and to also not pass on movements as regularly as it could. So a lot of different factors there.

Speaker 1:

So take away the magazines and stuff from your body.

Speaker 2:

Yes, yes, I know. So I know we're supposed to have a little bathroom reading materials and things, but actually not a great way to encourage efficient and good BMs. But in general, like if you're having problems with constipation, assess first. That is a really important thing to do and there's a couple of things to assess. Are you drinking enough water and how much water? How much water is enough water, tammy, you think?

Speaker 1:

Supposed to be 64 ounces a day.

Speaker 2:

Yeah, that's right. So basically eight glasses of eight ounces a day, is that?

Speaker 1:

water Not just coffee?

Speaker 2:

Yes, of water, like things that contain water, yes, yeah, and not dehydrating and not dehydrating. But I will debunk something here real quick, because if it's coffee or tea and that's what you're used to drinking especially do that. That is better than nothing. And there are some studies that have come out recently that actually indicate we thought that caffeine was dehydrating for a really long time. So drinking caffeine is basically like negative to your water intake. It's not. No, it's not.

Speaker 2:

You're going to need to link that article. There's a few, there's a few, but basically so. The reason why is because caffeine can have a diuretic effect. It can cause your kidneys to exude more fluids, right, and it can cause more essentially. But one is that effect is pretty weak and two, your body gets used to the caffeine that you drink. If you're drinking caffeine over and over again I'm a person who drinks a lot of coffee and a lot of tea and things like that- yeah, I was proud to see you drinking water here while we're recording.

Speaker 2:

Hey, that's right. But you know me as well. I am a camel. I go to the bathroom like two or three times a day period and that's it, because my body is so used to retaining that water and a lot of that is just how bodies self-regulate. So if what you're drinking is coffee and tea and that's what gets your fluids in, do not stop doing that and pretend like you're going to be able to just switch that all to a glass of water a day. Right, that is not going to happen.

Speaker 2:

Sounds torture, that is torture. The other thing to think about is this is not an all or nothing. If you're trying to guzzle like a gallon in the morning and get yourself through your entire day that way, that's probably not going to happen, and then, especially with bariatric surgery, you can't really do that anyway because your tank is so little and, being in healthcare, tammy, I know this for you. You've mentioned that this is really challenging. How do you actually go about getting your water in over the course of a day?

Speaker 1:

Insert Stanley here. No, but seriously, my cup is always full. I always have multiple cups, like I always have ice water in a separate cup. So yeah, I can keep refilling my Stanley, because I usually have like crystal light or something in it. I do need flavor of some sort, but literally I've just made a habit of every time I sit down at my desk which sometimes isn't always.

Speaker 1:

Very often, I make sure I drink, I make sure I drink. So it's just. Yeah, I feel lost when I don't have my Stanley next to me, just because it has become a habit of having it with me and drink and drink. Yeah.

Speaker 2:

Good for you, and I honestly think a lot of us are not super honest about our water intake. We think we're doing a really good job, we think we're drinking throughout the day, but I personally come from a culture, so I'm a Russian immigrant here when I was a kid and so our family culture was very much don't drink while you're eating, don't drink on the go. We still have this like my mom is very anti-Stanley Big jug yeah jugs and things like that. They brought that to Thanksgiving Exactly. So there are certain cultures or certain workplaces or certain in general that don't look favorably upon constantly having some water or something to drink with you. But get over it. I'm sorry. That just made me think. If you're post bariatric surgery, it's not really optional because, again, you cannot guzzle that 16 ounce container or that bottle of water when you feel like it later or earlier and not be enough to keep you going for the rest of the day.

Speaker 1:

And I've seen you or I've helped you do or faxed off a letter to patients that says this patient is required. You need to make an exception for this person to have water next to them. Yes, no matter what.

Speaker 2:

Yes. So even if you're a surgeon, even if you're a nurse, even if you're an airline pilot, even if what other principle? Even if you're someone who just your butt does not hit a seat all day long, at any time, there are ways, and certainly you can even ask your bariatric surgery program to write you an exception. In fact, I think we were working on some cards for people that say I've had bariatric surgery before. I need these certain meal size restrictions and things like that. And I think one of the important things there is that it indicates I need to be drinking six to four ounces of water a day and that needs to be throughout the day. There are ways to engineer the workplace and your life around it, but don't be afraid of carrying that jug, that water, whatever you need, because it's just it's so important, so important, absolutely. It's so important you don't want to be backed up because of it.

Speaker 2:

Oh and, by the way, people do ask if flavoring is okay. Flavoring is totally fine. So if it's a mix of women, or orange or cucumber or whatever it is that makes the water taste good for you, or crystal light or something like that, go for it. Again, the benefit to having the fluids is so much higher than any of the risk, and the risk is not. There's no science behind thinking that there's a risk associated with flavored water or things like that, so just do it. Fake sugars the body perceives them a lot like real sugars, so I'm not super pro fake sugar. If you're going to have something with some sugar, just lower sugars, probably better. If no, sugar is not an option, so that's. But in general that's just that's what I believe.

Speaker 1:

Right, Absolutely no. And fake sugars sometimes don't agree with us. And so one crystal light packet is in my whole. Usually it's for 16 ounce water bottle. Right, it's in my whole 40 ounce Stanley and I continue to actually water it down throughout the day because that initial sip is like too sweet. But I do need something and it works for me. And, as you said, water is more important than, or getting that fluid in is more important than it just being plain water.

Speaker 2:

Exactly and think about it too that one you can water down drinks. A lot of people after bariatric surgery have sort of texture issues sometimes or flavor issues that weren't there before for things especially that are sweet. So if that's the case, water it down just to half a cup with water and then that makes it a lot more palatable and it cuts down on sugar if that's what's in it. 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 have fluids in them. So it's yeah, those are also great ways to get your fluids in and yeah, so there's a lot of ways to make sure that you're getting enough fluid in the tank to help things go. Another one is whenever we're talking about constipation. So one is are you getting enough fluids to is? Are you getting an effectivity?

Speaker 1:

I realized, if I am more active, if I do an angry one mile sprint, my bowels get moving, so something happening?

Speaker 2:

They sure do, and there is some fun science behind that, which is basically your guts need to know where gravity is, and if you are laying down or sitting in a reclined position, your guts have a really hard time pushing things down where they need to go. In fact, when we have people who have that Ilias state that we talked about earlier, where their bowels are paralyzed and they're not really working, the best way to treat that is actually walking upright, being upright and moving. But it's the same for constipation too. You need to get going in the morning, and more ways than one working out can help. But the more time you spend laying, sitting, not moving, being in one position without, without that, the harder time your body has actually having bow movements and pushing things through. So activity really important.

Speaker 1:

Absolutely. I have experienced that firsthand, for sure.

Speaker 2:

Yeah, okay. We've talked about fluids, we've talked about activity. What about fiber?

Speaker 1:

Insert deer head lights here.

Speaker 2:

So fiber is actually complicated and we will not go into all of the complexity associated with it, we're just going to make it super simple. We probably should have a whole episode on fiber, but for the purpose of this podcast and this episode, fiber is something that's in a lot of different foods, and the best way I've ever heard fiber described I will never forget, by another surgeon is like toilet paper from the inside Elaborate. Yeah, you're like I know, should I be eating toilet paper? Wait, what is this?

Speaker 2:

So think about it this way it's like the scrub brush that your GI tract gets, that your intestines and your colon get, and it's really important in helping draw water into your gut, so that water that we talked about a couple minutes ago being really important. It helps to pull that water into your gut so that your stools aren't rocks and that they 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's like creating some Amazon packaging around what's there. So it helps to create some packaging, for it to have some substance and for it to be able to move, which is important, yeah, and it creates that sort of scrub brush effect, as it goes. So it's really important how fiber. So what kinds of things have fiber? What kinds of things work for you that have fiber?

Speaker 1:

Ta-da-da. Timmy, I'm really bad at this part. Yeah, fruit veggies, it's greens.

Speaker 2:

Dried fruit, lots of things that are in soups, for instance. So if you have soup with vegetables in them oh, she's in the background, I'm waiting for a sec. Yeah, so fruits and vegetables, whole grains. There's actually a lot of things that now have added fiber in them. So if you look at packaging, a lot of whole grain products have fiber in them, whether that be like pasta or whether that be bread or whether that be even protein powder, sometimes have added fiber in them, and then, definitely.

Speaker 2:

You can also do supplements for fiber. So there's powder of that, there's tablets of that. There's so many different versions that you can take and again there's a little bit beyond the scope of this. But there's soluble fiber, there's insoluble fiber. Both are important, but the biggest takeaway here is make sure you're eating fruits and vegetables or whole grains or that you're using a daily supplement for fiber. Maybe both. Yeah, absolutely, absolutely.

Speaker 1:

No dude.

Speaker 2:

Yeah, so especially if you're having problems with constipation, it's really hard to consider. One other thing I'm going to throw out there and people don't necessarily think about it is dried fruit, and so I'm thinking like you told me this yeah, dried apricots.

Speaker 2:

This is a very great non-medication way to help your body have some fiber and have some fruit sugar, which is also something that can help people have some balance and is good and it really helps with constipation. So, if you're eating a handful of that, probably too much, because, remember, the size of a prune is teeny, tiny, but the size of a plum is not, and the water is gone from the prune so you don't want to eat like you wouldn't eat 10 plums, so maybe you wouldn't eat 10 prunes. Yeah, raisins are good, all that, so just moderation in terms of how much you're eating of it, but it's actually a really great way to get fiber and to help yourself not be constipated.

Speaker 1:

Yeah, that definitely has helped me. I have used that tool.

Speaker 2:

Yeah, dried fruits, and they go in the mouth, they are eaten. I didn't have somebody ask me if you put it in your butt and I said you should eat, but not for this purpose. Yeah, please don't. Please don't do that, At least for the purpose of having bowel movements. That is not helpful. And then, okay. So we talked about fluids, we talked about activity, we talked about fiber. What about your diet variety and what's in your diet? You had mentioned some really good stuff about eating too much protein and how that affected you early on. Can you tell me a little bit about that?

Speaker 1:

Oh, yes, I was saying that, or to one of our dieticians, that I'm focusing on my protein.

Speaker 1:

That's what everybody tells us to 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 sugar in it and carbs are carbs. So, yeah, she challenged me to mix up my diet a little bit, so I actually started eating oatmeal with some raisins in it and, yeah, my bowel movements were much better and I lost actually a significant amount of weight that first week. Just something about my it shocked my body of some sort and I got past the plateau. For sure. I love it.

Speaker 2:

Yeah, because our bodies do need proteins, fats and carbs. Low carb diets usually make people really constipated and also your body does absolutely need those things in balance. So if you're eating too much protein, it's a great way to have poop that's like bricks and that comes only every several days. It's a great way to not have a colon that's getting a lot of fiber, because you're probably not eating things that have carbs and that have some fiber in them, which your body needs. Fat is also really important in diet too, because fat also helps your body have good bowel movements and things move through. And again, we're not talking about either or for any of this. It's quite literally in combination and oftentimes yeah, oftentimes if we're eating a lot of processed food or if we're eating just one kind of food, we're probably depriving our bodies of a balanced diet that has everything in it that helps us be able to have healthy skin, healthy bones, healthy joints, healthy brain, healthy eyes and also healthy poops. Yes, absolutely yeah, really important.

Speaker 2:

Alcohol, caffeine, can have an impact, so smoking certainly can have an impact, which I don't know a lot of people realize either. So the more you drink alcohol, the more erratic your bowel movements are going to be not necessarily constipation, but could be diarrhea, could be a mix. And then same thing with caffeine, too much caffeine. So again, cup of coffee a day, a couple cups of coffee even, or tea, not a big deal, but if you're drinking like 10 red bowl a day, maybe that is too much.

Speaker 2:

Oh, yeah, that's going to be diarrhea straight up Could be at the same time that much caffeine actually can be dehydrating Right, so you may actually end up being constipated if you do that.

Speaker 1:

Yeah, obviously everybody's body is different.

Speaker 2:

But that fake sugar, whatever is in the caffeine in there and all of that Really important to actually take a look at what you're eating and maybe you're excluding foods from your diet that you really need and you're not getting enough diversity and variety in your diet and that's having its impact on your gut.

Speaker 1:

Absolutely Just like exercise if you're doing one exercise for a really long period of time. So if you're eating the same thing for a long period of time.

Speaker 2:

Your body just gets used to it mixing stuff up changing things up Exactly and I think we notice this a lot. This one especially when we travel. So traveling and being stressed and things like that can have a huge impact on our diet variety. I know I go to Slim Jim's real fast in a pinch, right, exactly. Yeah, beef jerky, yeah, beef jerky and nuts and things like that, because I know those are going to have a consistent quality at least, even though they may not be the best thing for my body and they may not be the highest quality of food. They're super processed usually. At least what you're getting in airports and what you're getting in gas stations may not be the healthiest.

Speaker 2:

Being mindful, especially when you're stressed, especially when you're busy, especially when you're traveling, that the variety in your diet, making sure there's grains and fruits and vegetables, and that your fluids are staying high all of that's really important, especially when there's active change or stress going on in your life. Yeah, absolutely Same thing for sleep. So we've talked about fluids, activity, fiber, diet, variety, travel. What about sleep? This?

Speaker 1:

is, I think, one of the clear ones. Yeah, Sleep is important just all around for our energy, for our health in general, our heart health and but it helps bowel movements huh, it does, and it's not like a direct.

Speaker 2:

we don't have a study that says we've eight hours a day and all of a sudden, your poops are great. By the way, sleep, and we will have an entire episode on this. At least once we have someone who we're interviewing actually coming up tomorrow yeah, the sleep medicine doctor and really great expert on this. But enough sleep is very important for your body again to regulate properly, and that affects how your body treats food. That affects how your body treats fluids. It affects how your body is able to go to the bathroom. So important to be getting enough sleep, whatever that is for your body, and that may be a race. You may be a person who's great on four hours of sleep. You may be somebody who needs eight or nine, so be mindful of that. That is a really big factor, especially if you have shift work that goes overnight or a change in your schedule or you're moving or traveling. Again, don't scrimp out on the sleep Very important even for this aspect.

Speaker 1:

Yes, very much. So why do medications? Oh, no-transcript yeah. I realize that some medications will cause me to be motivated.

Speaker 2:

Oh yes, why, yes, right after surgery. Actually, many people will notice that they're taking narcotics which they get during surgery, even as pain control, potentially during surgery, but they may be taking it afterwards. So that class of medication oxycodone, hydrocodone, all of those things, fentanyl dilated, all of those things have a natural effect on slowing down the gut and so they can contribute to constipation pretty badly, which is again one of the reasons why sometimes it's important to use other medications, like stool softener or some things like that, to combat, to counteract essentially those medications Others not have. Like, for instance, if you have a thyroid problem where your body is not creating enough thyroid hormone and you have supplements for that, and if you, if, for whatever reason, your level of that is low, that can also be contributing to constipation.

Speaker 2:

But there are many different kinds 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's great, you're getting enough sleep, you're really not stressed or you're really trying to take care of everything, but you're still having problems with constipation, it's a great idea to see your doctor about medications that you're taking and medical conditions. So, like we talked about, that low thyroid state, hypothyroidism, can impact constipation. A lot of different hormonal changes can impact constipation, certainly GI function. So if you have any kind of problems with your stomach or intestines or colon, that can affect your ability to have bowel movements too. So if everything else you're doing well, it's a great time to talk to your doctor about your specific situation.

Speaker 1:

Yeah, the difference between stool softeners and laxatives.

Speaker 2:

Aha, I love it. What's the difference?

Speaker 1:

And when and what order.

Speaker 2:

Yes, yeah, that's a great question. So we're let's talk about some fixes for constipation. Right, we feed the dead horse, Okay, what are the things that can cause this? Now let's talk about some ways to fix it. So one I will say before trying medications, make sure you've got the rest of these things going on in your life too.

Speaker 2:

You're increasing your fluid intake. You're having physical activity on a regular basis and you're trying fiber, good diet, all of that stuff. If that's not working for you, try stool softeners. Stool softeners are great because they make your stools soft. I'm brilliant, right, I can't put my hand on that, but how? But how? This includes, by the way, things like Kolei, stokelaxen and, like we talked about, even dried fruit and fiber can be considered stool softeners too. Typically, they work by helping your gut draw water into what's 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 bulk your stool up. It helps to soften it so it actually can move. Right. If you have a canoe in a river, if the riverbed is dry, you ain't going nowhere, but if that riverbed has water in it, guess what? Your canoe can move, yeah, or like a slide, right. If you're on a water slide or something. You don't want to go down a water slide without any water.

Speaker 2:

That's not fun so you've got to one, have the water in your body for it to be able to pull in. But once you do, the stool softeners can really help to create stools that can move. So be the canoe, don't be the dry bed Creek. Yeah, there we go. Yeah, that's really what stool softeners do.

Speaker 2:

There are also laxatives, which is one level of more action than stool softeners. So laxatives like mero lax, milk of magnesium, lactulose, there are lots and lots of others, magsitrate, which is no longer on the market but used to be, these things actually help to push things forward. So stool softeners don't have that kind of action, but laxatives do. And there are some things that are both stool softeners and laxatives. So mero lax, technically, is considered both because it helps to draw water into the stool and it also helps to make your gut push things forward. But laxatives are one step above stool softeners. So I would say start with a stool softener once or twice a day until you get to the point where you want your bell movements to be, and if that's still not helping, then that's when to add laxatives. Right, and again, stool softeners and laxatives will not work if there's not enough in the tank. If the water isn't there. No amount of stool softeners or laxatives are going to help the situation. In fact, they can make it worse. So be careful. It's also something to be careful using, because you can become dependent on stool softeners and laxatives. You can train your body to be dependent on these medications, so they are not meant for everyday use for forever.

Speaker 2:

Yeah, for folks that have bariatric surgery, you are taking vitamins, including iron, that can also cause constipation, so important in some situations to talk to your doctor about one. Do you need to be taking the iron pill every day? Or you may be taking too much iron because your multivitamin may include iron and you may be taking a supplement in addition and kind of overdoing it. Should you be using food that contains iron to supplement your iron intake If that's contributing to your constipation, and then should you be balancing that out with a stool softener and or a laxative at least a couple times a week? Those are all things to think about. So for our berry folks, you're much more likely to have problems with not having enough water in your body, not enough fluid in the tank and having some medications that that don't help you out either, like your vitamins and minerals you're taking. So sometimes for our folks the stool softener and laxatives really become important as a consideration in a more long term picture too.

Speaker 1:

Okay, at what point do you go to the ER or?

Speaker 2:

doctor. Yes, so one. I would say really there shouldn't be any visits about constipation to the two emergency settings, because it's at the same time. If you're having a lot of pain and you don't know what is causing that, then yeah, obviously you're going to have an inpatient care or emergency department.

Speaker 2:

But if you know, you haven't pooped in a lot of days emergency usually right and it's not an emergency and otherwise things are going okay. It's probably a great time to call your doctor and definitely to call your bariatric team, because we've all been there and we can help you work through the steps to get back on track. And then the other thing is sometimes there may actually be something more going on. There may be a medical condition that's cropped up, there may actually be an issue with your gut or your blood for us to evaluate. So it really is important, if this is an ongoing issue for you, especially once you've worked through a treatment path and it's still not getting better, then it's very important to go see your doctor, yeah, and consider also if there's medication changes that have occurred or new medical conditions that you have on board that can definitely be affecting your gut and your constipation too, causing constipation.

Speaker 1:

Absolutely Talking shit today.

Speaker 2:

We got all serious. We started off all night and then we got all serious about poop.

Speaker 1:

But it is. It's a topic that we all need to talk about. Nobody wants to talk about, but it's a huge issue. I have a bunch of bariatric friends. I'm having more with this podcast and this is a. It's an issue.

Speaker 2:

Yeah, and I'm glad because constipation technically doesn't kill people and it's less of a problem than maybe some of the other complications, but in terms of being affecting quality of life it's a massive one, because if you're not comfortable, it's uncomfortable, it can cause bloating, it can cause you to not eat right because you don't feel good enough to eat.

Speaker 2:

It can stop you from drinking enough fluid because you already feel driven in full. So it just it really works against you. So the best is prevention. The best is drink in a fluid state active, eat a good, varied diet and keep in touch with your team and your friends and your people. But if that's not possible, if that's not working, then start to tweak things.

Speaker 2:

Start to consider more fluids, fiber stool, softeners, maybe laxatives, and then definitely get help if you're needing to figure out what's going on and you've tried things and things are just not working for you.

Speaker 1:

Absolutely. I know it's a boring topic, but thank you for talking about it and thank you for explaining it, because I clearly learned a few things, especially like when to take a stool softener, when to use a laxative, all of that stuff.

Speaker 2:

So thank you, yeah, go. Yeah. By the way, just real quick on the stool softener versus laxative, that's something that you can look up. Typically on the box it will say if it's a stool softener or a laxative on both. So if you have questions about that's a good way to know which one is which. And you can also always ask your pharmacist. So, as long as you're not buying this, like at midnight on a Tuesday or something, what pharmacist even open at midnight on a Tuesday anymore? But, yeah, you can always ask your pharmacist, or, honestly, this is always a good question to be chatting with your surgical team about, because we deal with poop so much more than you think we do and we definitely enjoy people having good BMs and, yeah, not struggling with this problem. So don't be afraid to ask.

Speaker 1:

Absolutely so. Thank you everybody for listening. Don't forget to go over to Instagram and follow us. We do have a Facebook group now Corb bariatrix community. Ask to join. There's just a few questions. Otherwise, thank you, maria, for talking shit today.

Speaker 2:

Every day Thank you Bye, bye. Bye.