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- - That large plate of spaghetti bolognese from 5 days ago is swimming around in your bowels,fighting for space alongside 7 bowls of cornflakes, a packet of custard creams, 60 vinegar-soaked chips, 2 cheeseburgers,  various chocolate bars,  and a massive Indian curry. Your stomach's swelling by the hour and you feel like you're just about to give birth -  but you have just swallowed 5 laxatives and plugged in a suppository and still nothing.   What do you do?

 -  -  -Those of us who have taken a bite out of the 'drug misuse' apple know that it  doesn't  always come out at the other end in a quiet or comfortable fashion.

Some heavy users can go two-three weeks, some even four weeks without a trip to the loo and if you're a working girl (or boy) having sex with a chock-a-block bowel can be most unpleasant. We've all heard of the advice, 'fresh air, plenty of exercise and lots of fresh fruit an' vegetables'.

 Well you might get the exercise running around chasing your gear  (- it still is exercise), but the fresh air - fruit and  vegetable stuff isn't always so easy and besides, a big enough smack or methadone habit can constipate the healthiest person.

Prevention is the best cure, particularly, for those who are susceptible to bowel troubles.  -  Using the odd laxative or
suppository  is okay, just don't go mad.  Using them over a long period of time is seriously bad news,eventually your
sewage system will pack up altogether. ....It helps to know a bit about your bodily functions in order for you to receive the right attention. 

(There are no particularly palatable words for feces, shit, excreta, pooh, stools, waste pony, tom tit  so we will mix and match, okay? )

When your food reaches its final stage of digestion in the small intestine, it has become a thick, watery liquid.    - - - It is moved along its way by the continuous contraction and relaxation of the intestinal muscles (peristalsis). The surrounding large intestine or colon absorbs this liquid into its walls, feeding blood vessels,  and is still maintaining peristalsis. Whatever waste remains will then become your shit.   For various reasons, the drugs we take, stress, vitamin and mineral deficiencies, the intestinal muscles slow down and bacteria from the waste gets absorbed into the bloodstream leaving your system toxic.

The degree of firmness of your feces depends on its length of time passing though the gut - the longer the journey, the more water is absorbed back into the blood-stream, leaving your stools dried out. You end up which a pooh that takes longer to move along its passage - becoming constipating.  (Charming!!)

The more sluggish the gut, the firmer the stools.    - - -  Headaches, oily skin and hair, bloating and congestion of the nose, throat and lungs result as well as dried out stools. Methadone user's will know all about dried up,sheep style pooh!  Although,methadone constipation may be considered trivial, each year around one tenth of the population of the United States take laxatives regularly with over seven million visiting their Primary Care Physicians.

OK, so here's what you can do.  Many of these methods have been tried and tested by fellow users, so give them a try. 

1. Drink a glass of warm water every morning before eating any food- this is great for your bowels and really helps things along.

2. Live yogurt- full of live bacteria. If eaten often it destroys the gas, disease and odor producing bacteria in your shit.

3. Potassium-  (found in almonds, fruit, especially bananas, green leafy vegetables such as spinach. Papaya is particularly good.  - -  These keep the intestinal muscles moving.

If you suffer from Diverticulitis check with your doctor before consuming extra potassium.

4. Bran, wholemeal bread, brown rice, wheat germ.  - -  -These high fibre foods will speed up the transit time of waste through the colon. Sprinkling bran or wheat germ on your cereal is really beneficial. Remember, though, - - - to drink extra water when eating bran as it expands absorbing intestinal liquids. A teaspoon or two skinned and ready to eat salad stuff from any Sainsburys or Tescos, often for less than a pound.

5. Weetabix, shredded wheat, sultana bran, wholemeal bread with marmalade, fruit salads are all helpful when eaten regularly, or even a banana with or with-out a bit of bran on your cereal.

6. B complex vitamins that are yeast-free are good for healthy intestinal muscles.

P. S. Don't get into multi- vitamins and mineral supplements if you have problems with Hepatitis C.    It just gives your liver more work to do.

7.  Another really good tip is to buy a bag of  fresh carrots, chop them up into little bite sized sticks, and munch away a couple of carrots worth. - By the next day, the wheels will be in 'motion' and you should be able to go to the loo. - Be sure to try   and drink a lot of water with it so things aren't to 'dry' or painful.

(i)  Massage your stomach in a clockwise direction for 5-10 minutes and if you can, go  for a brisk walk.

(ii)  Drink as much liquid -(water seems to work the best - warm if you can bear it) as you can handle. 

(iii) Try squatting on the floor or on the toilet seat.  This is the natural position for passing waste and it encourages the movement of the bowels. Straining too hard is ill advised as this can cause broken blood vessels and hemorrhoids (piles).

Instead, try pushing out gently for a few seconds and then squeeze the muscles in for a similar length of time (works better if you're squatting, either on loo seat or normally).  Repeat slowly till things start moving but don't push hard. This can really help a lot  actually,  - - this tip has been handed down through a couple of generations of opiate users as has stood the test of time

Don't panic if you don't go everyday.  Every two/three days is ok.   It is possible to 'train' your bowels to produce a motion at certain times of the day -  -  - so if you tend to score around lunch time, try to get that time for a pony in the mornings when you can relax a bit, before you go out.

Don't put it off - we appreciate this is easier said than, but constant constipation can lead to some bad shit happening.   Excuse pun.

Methadone Users may find they have, what is regarded in the trade as 'sheep shit'. Small hard golf ball type stools. Increasing your fluid intake is very important as is more fibre in your diet.

Morphine can be even more constipating than gear or methadone. - - Have a word with your chemist or Primary Physician if you think you need laxatives as there are different kinds for different problems.  -  ( You don't want a laxative that speeds up the process and dries it out ending up with a huge,hard, dried out stool on its way, do you? No.  - - You want something that will soften your stool to make it easier to pass.

What is important here, is to note any changes in bowel habit or fecal appearance.

Bleeding from the stomach (or a burst ulcer), esophagus or duodenum produces black, sticky or 'tarry' stools. If there is less blood, the stools may still be black or very dark.  - - - Not all black stools are the result of internal bleeding but it would certainly mean seeing a doctor at once.

Bleeding from the colon (as happens with bowel cancer), shows as obvious blood. The blood may be clearly mixed with the stools and leach out into the water in the loo, or it may only color the stools so that they a magenta hue, like the Red Cross red.

If a tumor is lodged high in the rectum, the bleeding may be a very dark blood; its quantity is very variable.  BUT, all to often, bleeding is mistaken as that from piles or an anal spilt  (ouch!) so make sure the doctor doesn't fob you off when you are still worried and don't always assume that bleeding is just  hemorrhoids. Be sure to visit a sympathetic General Practitioner. (If there are any left!) (LOL)

A tumor constricting the colon may produce thinner stools than normal.   - -Some patients may notice an increase in wind or the presence of mucous.

Bulky, pale feces the colour of porridge or clay with a fatty consistency and a gross smell are associated with gall bladder, liver, or pancreatic disease.

An urgent call to a GP is a must!!!  

Reference:  Black Poppy Issue 3  A-Z Health Issues    Constipation 
                  Editor:   Erin O' Mara

Painful, difficult bowel movements and feeling gassy or bloated are well-known    characteristics of constipation. Other signs include hard, dry stools or excessive straining to pass a bowel movement. 

It's important to keep in mind that infrequent bowel movements alone do not nec-essarily indicate constipation. It depends on what is "normal" for you.  In medical terms, constipation is diagnosed when a patient has fewer than three bowel movements a week, and/or stools are hard and dry.

Constipation occurs when the normal muscle actions in the colon (large intestine) fail to work properly, meaning the contents cannot be eliminated normally. The causes of constipation are complex and for most people with long-standing constipation there is no identifiable cause.

Recent review of available evidence has shown many previously held beliefs as to the causes of constipation, are unfounded. However, causes can include some of the following:

         *Certain diseases
         *Certain medications, (opioids)
         *Unsuitable diet
         *Changes in routine,such as holidays or travel
         *Changes in metabolism
         *Suppressing the urge to go to the bathroom
         *Hormonal changes
         *Recovery from surgery in some places
         *In some cases, not getting enough exercise

When it comes to bowel movements, what is normal varies from person to person. Some healthy people have one bowel movement a day, some have more than one, and others have just three or four a week.

It all depends on your individual digestive system, - what you eat,  -  and your own lifestyle. But if you have fewer than three bowel movements a week, or if having a bowel movement involves excessive straining and/or pain, or if your routine is less often than is usual for you, you may be suffering from constipation. 

References:1. Kamm MA. Constipation and its management. British Medical Journal 2003;327:460-462.
2. Tramonte SM, et al. The treatment of chronic constipation: a systematic review. Journal of General Internal Medicine 1997;12:15-24.
3. Müller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and Misconceptions About Chronic Constipation. American Journal of Gastroenterology 2005;

I highly recommend Colace® which the generic name is Docusate Sodium if you feel you need help. Laxatives can be used occasionally but your body will become dependent on them.  If it happens, then you will not be able to have a bowel move-ment without taking a laxative. 

Docusate sodium belongs to the family of laxatives known as stool softeners.

These medications work by allowing liquids to mix with hard stools.  These medications do not cause bowel movements, but allow for passage of the stool without straining.

This is especially important in conditions such as heart disease and any circumstances where passage of stools could be potentially painful.

Compiled by: Deborah Shrira RPH,CMA                     Date:  25 July 2006