Good on you, Deanna Cesario. The 39-year-old Calgary mom has gone public about her constipation. She's not embarrassed about toilet talk, she recently told me, and she hopes other women will learn not to be, too.
A recent survey on women and bowel health in Canada revealed a disconnect between women's knowledge about bowel health and their own behaviours. While 97 per cent of the 1,002 adult women surveyed agreed that bowel health was an important part of overall health, almost half of them said they avoided public bathrooms because of embarrassment. Forty-three per cent agreed that they did not openly discuss their bowel habits even though 69 per cent have experienced constipation.
Cesario, who participated in the survey, is not surprised about its results. It's her view that women don't prioritize bowel health the same way we do healthy weight, skin care and stress management. "I ignored my problem for a long time," says Cesario. "I shouldn't have."
Her condition became chronic after the birth of her first child. "Things seemed to slow down, and it was downhill from there," she says. Her constipation would go on for days; she would become more anxious as the gas and bloating made her increasingly uncomfortable. After ruling out medical issues such as thyroid disease, her doctor told her she just had a lazy colon.
The Canadian Society of Intestinal Research tells us that "normal" bowel behaviour is going anywhere from three times a day to three times a week, as long as it's comfortable. Chronic constipation affects up to 30 per cent of Canadians and occurs more frequently in women; one in five Canadian women live with chronic constipation. Assuming there's no irritable bowel syndrome, intestinal obstruction or disease, chronic constipation can result in hemorrhoids, anal fissures, and diverticular disease.
Dr. Mani Kareemi, a gastroenterologist and clinical associate professor at the University of Calgary says that this is a women's issue mostly because women are less likely than men to discuss their bowel habits. "Talking about bowel health is not taboo and raising the issue of constipation should be part of the discussion you have with your doctor," he says.
About one-fifth of women surveyed have a long-standing problem with constipation, he says. "Maybe half of them have a colon that doesn't contract properly. Why isn't entirely clear. But while ideally we talk about having a movement every day, it is rather narrow-minded to think that way."
The causes of constipation are many and include lack of fibre and not drinking enough water. But there are other factors that may surprise you: Medication side-effects for example; anti-depressants, some narcotics, calcium or iron supplements and medications that affect the nervous system can contribute to it. So can insufficient exercise. There is much more information on women and constipation.
Ironically, an overdependence on the laxative that may help relieve you will eventually contribute to your constipation. Dr. Kareemi says there are many categories of laxatives and women and men should learn their differences.
Bulk-forming agents such as Metamucil are considered safe, as are stool softeners such as Colacel. Stimulants such as Dulcolax increase muscle contractions to move food along and hyperosmotics such as Phillips Milk of Magnesia draw water into the bowel from nearby tissue. An enterokinetic agent such as Resotran, available by prescription for women who have tried other remedies, targets the serotonin receptors in the gut which then stimulate the colon to contract.
"The whole issue of the bowel is still alien to many of us," says Dr. Kareemi. "We need to start accepting that the colon is just like any other part of the body and is no more dirty than any other part of the body. It needs to be paid attention to."