how bad can constipation get maybe you've heard people say things like you've got 20 pounds of toxic poop just brewing in your colon or maybe you've heard stories of people not having a bowel movement for days or even months well in today's video we're going to actually talk about one of the most extreme cases of constipation but also focus on what most of us will experience with constipation and how we can prevent it and even treat it with home remedies or lifestyle changes and even some of the medical interventions if it gets worse we'll also talk about situations where people try to take matters into their own hands when they actually can't pass a stool or have a bowel movement it's going to be quite interesting and a little bit crazy in some situations so let's jump right into this anatomical awesomeness foreign the first thing that we're going to talk about that has a major influence on constipation is Transit time and what do I mean by transit time I'm talking about the time it takes for the stool to move from the beginning of the large intestine all the way to the end or in other words you could kind of think of it like how long is a stool going to be in there before it's evacuated out during a bowel movement now the reason this is important is because that when the stool or fecal Mass first enters into the large intestine it's softer and has more fluid and that fluid or the water is going to be absorbed as it passes through the large intestine into the body and that stool become more solid and the more water that's absorbed the more solid it becomes and you can kind of think of if I absorb too much water it could potentially get too hard and make it difficult to pass during a bowel movement another thing to consider is that as the stool or fecal Mass moves down into the rectum that's going to actually stretch the wall of the rectum and that will send a signal back to the brain and it says to you huh I need to go to the bathroom now we pretty much have one of two choices in this situation you can choose to clench down on that external anal sphincter and hold it or you can choose to find a bathroom and relax the external anal sphincter and possibly have an epic bowel movement now if we go back to holding it because we've all had to do that maybe even have a bathroom or sometimes people do it habitually which can cause some problems because you could imagine if this stool is spending more time in here because we choose to hold it it could be absorbing more and more water and get harder and harder furthermore if you are continuing to eat the leftover stuff from that last meal is going to continue to pile on into that stool that you're holding there so often times with patients we'll say hey we want to make sure that we have consistent bowel habits that you're not frequently just holding this and ignoring that signal to go have an epic bowel movement So based on everything we've talked about you've probably guessed that fluid intake is something that you can control to help with constipation again that idea being if there's more fluid in that stool as it's passing through it can retain more water and therefore be softer and easier to pass during a bowel movement and that's exactly what we'll talk to patients about yes we'll say hey let's control those bowel habits and if you're purposely holding things or habitually holding things quit it and also increase that fluid intake and of course you can't have a conversation about constipation without talking about fiber fiber can increase the bulk of your stool and you might be thinking do I really want a bulk stool to help me with constipation and it turns out the answer is yes because these bulky fibrous stools tend to help push things along through the intestinal tract and the reason being is they help to stimulate the contractions within the intestinal wall and increases the transit time so things can pass on through and push on out the body now it's not just about the size of this bulky fibrous stool it's also about the consistency and this consistency tends to be softer and more ideal for passing through the body and this is because a lot of the fibers that you eat tend to actually retain water so that means that the stool will hold on to more water as it's passing through again keeping that nice ideal consistency to make it easier to pass out during a bowel movement the daily recommended amount of fiber is about 20 to 35 grams per day now if people are having a hard time getting that amount there are fiber supplements available but you can see that there is a range there 20 to 35 and what works for one might not be the ideal for another person so there is a little bit of experimentation that goes on here and when I'm talking to patients about increasing their fiber and constipation I'm not just saying hey let's jump you all the way to 35 grams per day to that Max because sometimes that jump can be too quick and they can have things like bloating gas and abdominal discomfort and so we look at what are you taking in now as far as fiber unless you slowly increase from there until we get the desired response another really cool thing that we know about fiber is that it stimulates the growth of the gut flora and as we know the gut Flora is the bacteria that lives within the intestine and there's some data that suggests that a healthy well-balanced gut Flora can help improve the bulk of the stool as well as help improve that Transit time and that's possibly one of the reasons why you'll hear some people report that they have improvements in their constipation and bowel Habits by taking things like a Prebiotic and a probiotic and speaking of prebiotics and probiotics yes you all knew it was coming it's time for me to say thank you to the sponsor of today's video seed seed makes a daily symbiotic which is a pre free and probiotic two in one capsule designed to support your gut health skin health and much more this cool little two in one capsule protects against stomach acid and digestive enzymes so that the probiotics these bacterial strains actually make it to the colon where they belong and with seeds you get 24 clinically and scientifically studied strains the first of its kind which is pretty amazing from a scientific perspective because we need to continue to increase our knowledge of the gut microbiome and how it affects our health and seed is definitely dedicated to this see it is also dedicated to sustainability with your first purchase you'll get a glass jar that is infinitely refillable and the monthly refills will come in packaging that is compostable biodegradable and recyclable now recently Justin and I have been having more frequent conversations about our bowel function because that's a normal thing to do and not to give you too many graphic details but since taking these wonderful probiotic strains we've both noticed improvement in our gut motility gut regularity and our overall bowel habits if you you will so get 15 off your first month's supply of seeds daily symbiotic by clicking the link in the description and using our code Anatomy at checkout activity level also influences constipation as exercise has been shown to improve it because exercise will help to stimulate gut motility and improve the frequency of contractions within the wall of the gut that stool pass through more quickly certain drugs can also cause constipation and this can be quite the list but some of the most common drugs that you hear about are certain antihistamines certain antidepressants even iron supplementation can do it and certain pain medications like opiates or opioids I even actually had a professor during my medical training say to us the one of you that prescribes the opiate or opioid and does not pair it with a laxative will be the one to do the disimpaction now if you've never heard of a disimpaction that's probably a good thing because that probably means that you haven't had to perform a disimpaction or even be the one receiving the disimpaction and obviously it's not going to be comfortable for either their party involved and I'll explain why a disimpaction is a manual procedure that's used to help someone who has fecal impaction fecal impaction is when the stool becomes so hard and so built up in the rectum and the anus that the person cannot pass the stool at all so it's kind of like constipation gone wrong and what happens is is a person will perform this manual procedure usually it's a student doing their medical clinical rotation that is picked for this who had nothing to do with prescribing the pain medication causing this in the first place but nonetheless the student must Don the glove put Lube on the finger and insert said finger into the anus and perform the scissor motion this is Then followed up with an enema that contains mineral oil this will help to soften the stool as well as lubricate it so hopefully the rest of it can pass through on its own now again obviously this disimpaction is not comfortable for the person receiving it and so how can we avoid getting to this point especially if we've already tried or exhausted all those lifestyle modifications like increased fiber increase fluid take exercise and proper bowel habits well in that case we'll likely have to step up to the laxatives now there are different types or classifications of laxatives one of the first ones we tend to reach for are the bulk forming laxatives because these tend to behave similar to fiber as they increase the bulk of the stool as well as cause the stool to bring in or retain that water and one of the most common bulk forming laxatives that you've probably heard about is Metamucil there's also the surfactants or the stool softener laxatives one of the common ones you'll hear about is docusate sodium or Colace which again the name implies they're supposed to soften the stool there's also the osmotic laxatives which help to bring in water into the large intestine and therefore into the stool most common one you've probably heard about is Miralax and then there's the stimulatory laxatives if you've ever heard of something like Dulcolax that's a stimulatory laxative and the idea is that it will stimulate the contractions within the large intestine to help Propel that stool along now there are also suppositories that can be used when one is knocking on the door of fecal impaction and it's supposed issue some medication that is manually inserted into the anus but whenever I think about suppositories I'm just reminded of this story that a person told me when they try to do their own disimpaction when they were fecally impacted if you will this person used a nail to do their own disimpaction yes hammer and nail that kind of a nail and luckily they used the blunt end of the nail they inserted this in the anus this person is actually telling me this he will remain anonymous it's not Justin even though it would be hilarious if it was Justin but this person inserted into the anus broke up that fecal impaction and it actually worked for them but this is definitely not recommended or something you should participate in I mean you think reach for the suppository before reaching for the nail that's just my thoughts on it so let's finish up with one of the most extreme cases of constipation this occurred in a 22 year old male from China and he'd been dealing with constipation for pretty much his entire life and he had such a huge buildup of stool that they ended up removing 76 centimeters or about 30 inches of his colon now keep in mind the colon makes up the majority of the large intestine and we have seen what a normal large intestine is supposed to look like throughout this video but the very beginning of the large intestine is called the cecum in the very ends called the rectum but the rest is referred to as the colon but of that segment of the colon that they removed from this person it weighed 13 kilograms which is about 28.6 pounds imagine carrying nearly 30 pounds of stool inside your abdominal cavity that's crazy and trust me the majority of that weight that they pulled out was the stool because the colon doesn't weigh very much I've held lots of colons in my hands which sounds a little bit weird but they don't weigh that much now again important to note that this was an extreme case and wasn't technically that run-of-the-mill or idiopathic constipation that I mentioned earlier this was secondary to a condition that this particular person had and he was actually born with something called Hirschsprung's disease hirschsprung disease is when certain nerve cells that innervate or control the smooth muscle in the wall of the large intestine don't develop properly and so then the intestinal wall that muscle in the intestinal wall can't contract properly and Propel that feces along through the large intestine and so because of that he just constantly was just building up stool and having constipation throughout his life now one thing that's interesting about that is most the time hirschsprung disease is diagnosed in infancy or early childhood rarely doesn't make it or take as long as adulthood to deal with some like that thanks for watching everyone hopefully you learned something new and useful about constipation if you're interested in checking out seeds that link and the information is in the description below go ahead and comment below I'm really excited about this because you guys tend to make hilarious comments when it comes to videos about bodily functions so I'm very excited about that and if you also feel the need like And subscribe and we'll see in the next video [Music] [Music] foreign