I keep thinking about this in the context of caring for my ageing patients. No one TELLS them, before they’re old, how things are going to change, or why. No one talks about the loss of elastin, and how that doesn’t just affect your skin looking old, but also how it heals. No one warns them that their skin will become paper-thin if they live long enough, incredibly fragile and easy to tear. Just “hurr dur wrinkly!!!”
No one tells them their bowels are going to lose strength and coordination, so it gets more and more difficult to have bowel movements. No one warns them about obstipation, much less bowel obstructions. I have a saying I repeat often in clinic: “Proper pooping prevents problems!” I say it because it makes people chuckle, because it destigmatizes needing to poop. Everyone poops. And it turns out pooping requires both a complex network of nerves to create peristalsis, and stools soft enough to move through the bowels, and I have watched more than one elderly patient die because their bowels stopped working right.
No one talks about hemorrhoids, so I have patients coming in terrified by blood in their stools–and listen, blood in your poop is definitely a good reason to see a doctor; if you’re over 50 and you haven’t had a colonoscopy, get one. It’s the best health screening we have evidence for, in my opinion. Colon cancer is a bitch. But more commonly, people have bloody stools because they have either hemorrhoids that are bleeding or because they have an anal fissure after straining on a hard bowel movement. Do you know what a hemorrhoid is? I didn’t, until I was well into medical school. Everyone has them. They’re venous columns that surround the rectum and anus. Internal ones can bleed; external ones can itch. Most people will get them eventually. Be kind about them.
Everyone is going to have trouble peeing if they live long enough. Men can’t start, women can’t stop. Because people with prostates will often have benign enlargement of the prostate–it’s not cancer, but it gets bigger–and the urethra, the tube that lets urine leave the bladder, goes through the prostate. Bigger prostate = compressed tube, less flow. Meanwhile, people with uteruses have much shorter urethras, which means that when we lose that beautiful collagen and elastic, we also lose it in the two sphincters that help us keep from leaking urine, and so we leak urine. Especially when something triggers an increase in intra-abdominal pressure, like a sneeze or a cough or a laugh.
All these things people are taught to be ashamed of and embarrassed about–they are so common. They’re normal parts of having a human body and doing the things one does with a human body. Poop trouble? Welcome to the club! People have been writing about their cures for constipation for as long as written language has existed. Listen, you are not alone. You are not alone. You are not alone. And that means that when someone else has a gross problem, you must be kind to them, because that is going to be you. There will be a day when you have diarrhea, because viral gastroenteritis spreads like wildfire every winter. There will be a day when you cough a huge glob of mucus comes out, because mucus is a natural defense mechanism and kind of miraculous but also nasty. Every gross thing a body can do, yours is likely to do, if not now then later.
