A first rate discussion of #2s

There are few things worse for people than discussing their bowel movements.  After having our diapers changed and then going through toilet training, we are then left to our own devices to sort out what is normal when it comes to, ahem, eliminating solid bodily waste.  A sign society is not comfortable with a topic is the number of euphemisms that exist, and there are a LOT for pooping.  Spending a penny, sitting on the throne, going to the potty, doing a #2, and on and on. A variety of authors have tackled the subject in some form- see Bill Bryson’s book “At Home”, for a terrific historical perspective, or “How to Shit in the Woods” by Kathleen Meyer as another, albeit the latter only applying when you are in the backcountry.  While there are piles of books related to what goes into our mouths, there is a distinct paucity when it comes to what is going to be discharged out the other end.  We all do it, but nobody wants to talk about it.  How we often form our opinions about normal behaviour is by bouncing ideas off other people and absorbing the media information that is out there.  But you can’t on this topic, ‘cause nobody wants to go there (pun intended).  Until now.  Yay me!

Aside from the fact that modern toilets and plumbing have led to increasing our life expectancy more than virtually any other public health initiative, the less public pooping has become, the more we don’t talk about it.  UNTIL THERE IS A PROBLEM.  Then you get to discuss it in excruciating detail with your family doctor, a gastroenterologist, or me, your local general surgeon.  General surgery encompasses the practice of proctology, at least in Canada, and I am a general surgeon.  The reluctant expert. “This is SOOOOO embarrassing!!!” is the cry from  patients. Aside from brief references in a few often tasteless comedy movies or TV shows,(Along Came Polly, The Interview, Bad Teacher, Slumdog Millionaire, Sex and the City, and multiple instances in Two and a Half Men for a few examples) pooping is just not something we discuss.  Put a group of post partum women in a room and tales of urinary incontinence are discussed with ease.  Nobody talks about problems with pooping after having a baby.  Sex is easier to discuss and at least that is taught in schools.  Even the TV commercials for laxatives are very, um,  shall we say, oblique in their message.

I have had people bring in pictures of their poop, and even once or twice, the real thing.  The problem with having patients describe their bowel movements is often that people don’t realize what is normal.  Or the fact that there is a wide range of normal.  The North American or Western ideal of one bowel movement a day, always first thing in the morning is, quite frankly, ridiculous.  Our pooping schedule and stool consistency are dependent on so many factors, including but not limited to, fluid and fibre consumption, antibiotic use, hormonal factors (as every constipated pregnant woman knows), caffeine intake, genetics, gender, and a myriad of psychological factors which includes the availability (or perceived lack of availability) of a toilet.  I am not going to go into specific bowel or perianal disorders here but they could include hemorrhoids, fissures, abscesses and fistulas, Crohn’s, rectal prolapse, colon or rectal cancer, or diverticular disease.   All that goes wrong down there is not hemorrhoids.  This is not meant to be a substitute in any way, shape, or form for concerns you have.  Those should be addressed to your doctor.

So here is my extremely general advice about pooping.

  1. Let it go (I had to get the Frozen reference in here somewhere).    If it’s not coming, let it go, walk away, and come back later. Along with this, when you do need to go, excuse yourself and GO! This is what your body is trying to tell you. The gastrocolic reflex is where you eat, then you poop. Use this information wisely. Get the library, magazines and your phone/tablet/ipad out of the bathroom. You should not have enough time to read anything while pooping. It shouldn’t take that much longer to do a #2 than a #1.
  2. If you are over 50 get screened for colorectal cancer. Roughly 6% of the population will develop bowel cancer in their lifetime. It is easily treatable or even preventable if caught early, and it can be as easy as sending some of your poop away in the mail.
  3. Eat fibre, lots of it. From plants, not out of a jar of Metamucil. Less than half of North Americans are getting enough fibre and this is leading to some very unhappy bums. And not surprisingly, when your bum isn’t happy, neither are you!
  4. Nobody cares what your bum looks like. By bum I mean anus. And if they do care, maybe that’s a warning sign. A lot of ladies after pregnancy (and men with stupid, idiotic, what the #$% are you DOING in there?  bowel habits) and the joy that is thrombosed external hemorrhoids want their bums to look like before the pregnancy and/or ridiculous amount of straining. Not happening. Get used to it. There is no such thing as a plastic surgeon for your bum, not to mention the cure would be worse than the disease.
  5. Ignore the TV commercials. A certain company is trying to make North Americans believe they won’t really be “clean” down there unless they use both toilet paper and some sort of baby wipe type product. This is ridiculous for anyone not in diapers. Hopefully it will go the way of douching, meaning the way of the dinosaurs. In fact, toilet paper is likely the cause of a lot of bum problems. In cultures where bidets are used, perianal complaints drop dramatically.   But of course this does not sell a lot of unnecessary wiping product to please the shareholders. Not to mention the environmental cost of these things is HUGE. New subdivisions have to plan for larger plumbing pipes as more and more of these wipes are flushed down the toilet. You SHOULD NOT flush anything solid down your toilet but poop and toilet paper.  And go easy on the toilet paper, would ya?
  6. Know your normal. Do not get into the vicious cycle of laxative, anti-diarrheal, repeat. Some patients colons’ are so confused they don’t know whether to contract or relax. If you are concerned, see your doctor. There will likely be a colonoscopy in your future.

I hope the above is helpful.  This does not mean I want to discuss pooping in detail if I happen to meet you at a dinner party.  That is the joy of internet anonymity.  If this prevents one person from suffering because of a sore backside, or some reassurance to those who have always wondered, then it will be mission accomplished.  Instead of spending a penny, I have put my two cents in on the subject.

2 thoughts on “A first rate discussion of #2s

  1. Hey Lesley, do you remember a lecturer in med school who summed up the difference in bowel movements among developed and developing nations by saying, “Large hospitals — small poops. Small hospitals — large poops.”? Also, I still shake my head at the fact that we were never asked to consider Lactose Intolerance as a differential diagnosis for chronically loose stools. Unbelievable.

    Liked by 1 person

    1. No I don’t remember that, but it’s certainly true. I could go on about this topic for a good while longer, since I spend most of my clinic time talking to people about this stuff. But I am trying to keep the blogs short (like my attention span)


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