Dr Hive - What do you think about this? (gross factor)

[Night Elf]

I know someone who has exceptionally large stools. They frequently clog the toilet. I'm trying to help with some research and I've come across celiac could cause this problem. Something about malabsorption of food. He is nervous about going to the doctor because he suspects the solution will be to just eat more fiber. That didn't help in the past. This is not a new development. This has been going on since he was a little kid. He's just gotten used to it. He passes a bowel movement every 2-3 days. He has sat on the toilet waiting for something to happen daily but he doesn't feel he has to go so he sees it as a waste of time. 

I was going to suggest a gluten-free diet but my research says it takes about a month to see effects. Is this true? Is this worth a try? He is now extremely upset about it and wants to fix it. We just don't know how to handle it. I still think he should go to the doctor but is his regular doctor the person to see or should he see a specialist?

[Pawz4me]

Despite popular belief more fiber isn't always the solution for constipation. It can make some people worse rather than better.

Has he tried Miralax for a few days to see what happens? Or prune juice?

IME before seeing a doctor it's best to try a thing or two at home and see how or if it works. If nothing else it gives the doc a little more info to go on. Plus unfortunately it seems that many doctors don't really take you seriously if you haven't tried a few self help measures before coming in.

But to me this just sounds like a fairly typical case of constipation. I wouldn't assume anything else unless/until I found out that trying a few common remedies doesn't help.

[Bluegoat]

Well, I think one thing is that some people just have larger stools.  It doesn't necessarily indicate there is anything wrong with diet.

I'd try a more practical approach, like flushing half way through.

[sbgrace]

I think this is part of only going every 2-3 days--constipation likely. Stools get larger before he feels the need to go. 

[Night Elf]

I'm thinking it's constipation too but don't know what to suggest to him except what Bluegoat suggested, to flush after going a little bit. 

[lavender's green]

Our pediatrician always recommends a week on Miralax for anything related to constipation. I think that helps the colon get back to a proper size, get used to the feeling of needing to go with smaller stools, etc, etc. There's no reason not to try this before running to the doctor, assuming the person is otherwise relatively healthy. I've never seen it give anyone in my family explosive diarrhea, for example.

[Reefgazer]

You know what gets things moving?  All-bran cereal; it’s like super colon blow.  Maybe he could try that.

[Selkie]

Does he eat many fruits and veggies? Because eating a diet rich in fruits and veggies will do the trick. Have him try eating at least one big salad a day and plentiful produce at every meal, and he'll be going much more often than once every few days.

[Bluegoat]

So - it's considered normal to not poop every day.  People vary considerably.  If the stools are healthy, the problem isn't likely constipation.  If they are hard and cracked, thats a sign its constipation.

 

[BeachGal]

On 6/9/2018 at 10:49 AM, Night Elf said:

I know someone who has exceptionally large stools. They frequently clog the toilet. I'm trying to help with some research and I've come across celiac could cause this problem. Something about malabsorption of food. He is nervous about going to the doctor because he suspects the solution will be to just eat more fiber. That didn't help in the past. This is not a new development. This has been going on since he was a little kid. He's just gotten used to it. He passes a bowel movement every 2-3 days. He has sat on the toilet waiting for something to happen daily but he doesn't feel he has to go so he sees it as a waste of time. 

I was going to suggest a gluten-free diet but my research says it takes about a month to see effects. Is this true? Is this worth a try? He is now extremely upset about it and wants to fix it. We just don't know how to handle it. I still think he should go to the doctor but is his regular doctor the person to see or should he see a specialist?

 

His colon may be desensitized to the signals that nerves send telling him to go. Very common in kids with encopresis; kids with encopresis will often “squeeze shut” their sphincter when they get the urge to go. After years of not responding and nerve signaling problems, the colon enlarges which would explain the cloggers.

Daily practice sits after meals can help. After eating, maybe 15-30” after, go sit on the toilet for 15”. No need to produce anything. Generally, stronger urge to go in morning after coffee and/or breakfast. Sometimes after a warm bath.. Key is to establish habit of sitting on toilet.

Keep food and ? diary. Note foods that help and foods that don’t. Make sure he’s getting enough water. Give this time to correct. Could take months.

[alisoncooks]

I also have a kiddo for which daily Miralax is needed. It certainly wouldn't hurt to try it for a week, just to see if it resolves the problem. 

[Jean in Newcastle]

If you really think that it moght be Celiac then do NOT have him go off of gluten. He needs a blood test and it will not be accurate if the person is off of gluten. That said, I have not heard of that being a symptom of Celiac disease. 

[barnwife]

I'd also suggest making sure the person is getting plenty of water. If I increase my fiber intake without increasing water as well, my stools get very, very large. Water seems to lubricate things and keep them moving and loose. My suggestion would be to add a prune a day and at least 2 more glasses of water than currently consuming.

[catz]

Has he tried pro-biotics?  I have IBS and daily probiotics and a SMALL amount of ground flax into a smoothie, oatmeal, or yogurt is super helpful for me.  Pro-biotics can take 4-6 weeks to build in the system.  

[ashfern]

I used to only go every 3-4 days and then go 3-4 times that day. I started eating prunes every day. That usually does the trick. I also try to remember to take my fiber drink. It has probiotics & other stuff in there.

[Night Elf]

Tell me about pro-biotics. What do I buy? Where do I find it? 

What about the fiber drink? Doesn't that increase the amount of stool?

[marbel]

I used to  have the same problem - infrequent huge stools.  I tried a lot of different things but what has worked for me long-term is Dextrin fiber mixed with water - a brand  name is Benefiber but I use generic from Walmart, way cheaper - lots of liquid every day,and magnesium citrate supplements at night (400 mg).    Magnesium is considered pretty safe but I would research it if the person is taking any medications or has any health conditions, or ask the doc. 

Psyllium fiber is popular but it made me feel slightly ill when I used it.

If fiber is taken without enough water, it is going to make things worse.  I agree with those who suggest starting with miralax.  I've used it and both of my kids have too, no ill effects at all when used properly. 

How are this person's exercise habits?  That can make a big difference too.  

[Supertechmom]

Constipation is a sign of Celiac. 

https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms/

And in my experience, adults who have had life long issues take much longer than a month to heal and change from Celiac.  Especially those not in the classical presentation.   

However your insurance handles it but he should end up at a GI specialist for evaluation.  A blood test can be done to see if he has any antibodies and the GI will recommend a small bowel biopsy  which depending on presentation and the skill/knowledge of the physician and pathologist and lab tech who prepares the slides may or may not be positive.  Doesn't mean you don't have it just means the patch of intestine taken at that point didn't have enough damage to qualify.   it truly is a hit and miss type of procedure since damage is not usually available to the eye during exam.  There might be areas that look different because the damage is so bad but Celiac can often look normal until under the microscope.

IF you do test and get a negative,  a gluten free diet trial of a year  is recommended and then reintroduction of gluten products is what i was told to do.  Symptoms return, then you have  gluten issue. Now at least they are admitting there is Non celiac related gluten issue for people. Even 12 years ago, drs were reluctant to say that

 

 

 

[marbel]

I don't think I would jump to a gluten-free diet based just on constipation.  A gluten-free diet isn't the best for people who don't have gluten issues.  There are lots of causes of constipation.  Beth, what caused you to think of gluten?  Are there other issues that point to it?

[Bluegoat]

Are larger than average stool really a sign of celiac with no other indications?

I'd be surprised if a doctor investigated on just that basis.

[Bluegoat]

I'm still not sure why people think he is constipated.  Normal frequency is from more than once per day to something like every 10 days - it's really very broad.

[marbel]

3 minutes ago, Bluegoat said:

I'm still not sure why people think he is constipated.  Normal frequency is from more than once per day to something like every 10 days - it's really very broad.

When I saw "clogging the toilet" I assumed hard stools.  Unless the person is using a lot of toilet paper and that's what's clogging it.  

[Pawz4me]

12 minutes ago, Bluegoat said:

I'm still not sure why people think he is constipated.  Normal frequency is from more than once per day to something like every 10 days - it's really very broad.

I'd like to see your source that says going as infrequently as every ten days is considered normal. Everything I've ever read and my GI doc says that normal is anywhere from three times a day to three times a week. So going every other day is normal. Going every third day is not. And stools that are large enough to clog the toilet are also not likely to be considered normal.

Really, this is a rather simple situation. Try Miralax for a few days. See what happens. Proceed from there.

[ashfern]

1 hour ago, Night Elf said:

Tell me about pro-biotics. What do I buy? Where do I find it? 

What about the fiber drink? Doesn't that increase the amount of stool?

Probiotics can be found in your normal grocery store. I think they're over near the vitamins. 

I use  Melaleuca Fiberwise (that links to the product label). If I go daily then the volume is less. Also, drink plenty of water to help move things along. Exercise, even walking, helps move things along.

Personally, we don't use Miralax in our house. We did for one dd and it was a horrible experience for her. It's not a natural product. You can do a google search for some of the issues it causes.

[Bluegoat]

24 minutes ago, Pawz4me said:

I'd like to see your source that says going as infrequently as every ten days is considered normal. Everything I've ever read and my GI doc says that normal is anywhere from three times a day to three times a week. So going every other day is normal. Going every third day is not. And stools that are large enough to clog the toilet are also not likely to be considered normal.

Really, this is a rather simple situation. Try Miralax for a few days. See what happens. Proceed from there.

 

I'm just going by my memory of what is the point when you are supposed to start considering there is an issue.

But in any case, this giy is going three or more times a week it sounds like, so not abnormally infrequently.

Edited June 11, 2018 by Bluegoat

[Bluegoat]

26 minutes ago, marbel said:

When I saw "clogging the toilet" I assumed hard stools.  Unless the person is using a lot of toilet paper and that's what's clogging it.  

 

I think just large can cause clogs though - after all, toilet paper is soft too.

That being said, lots of people have harder stool than they might.  Combined with less frequent elimination than some, and maybe he has a big colon too, that might all contribute.  If he can up his water and fibre some, it might help and would be healthy.  

But I'd be less sure about doing something involving more intervention or especially any medications.  

[Pawz4me]

13 minutes ago, Bluegoat said:

 

I'm just going by my memory of what is the point when you are supposed to start considering there is an issue.

But in any case, this gig is going three or more times a week it sounds like, so not abnormally infrequently.

Every three days is NOT three times a week.

Three times a week = three times in seven days.

Every third day = three times in nine days.

This is not hard stuff. This is not at all an unusual or uncommon problem. Quite the contrary. Constipation is incredibly, incredibly common. There is zero reason to assume Celiac or anything else unless there are other symptoms. There is no reason to seek out a specialist or even a primary care doctor until one tries a few common sense home/OTC treatments and see if they help or not.

Plus it really doesn't matter whether technically it's constipation or not. She says the person is upset about it and wants a solution. If I were only going every third day I'd want a solution too. Because I'd feel awful.

[EmseB]

58 minutes ago, Bluegoat said:

I'm still not sure why people think he is constipated.  Normal frequency is from more than once per day to something like every 10 days - it's really very broad.

This might sound silly, but I think this is the standard for an exclusively breastfed infant. Just saying that's where you might have heard those numbers.

My kids' peds have always said at least every other day once they're fully weaned.

[rjand6more]

How old is he?

Does he drink coffee?  If not, try that.  

[Bluegoat]

2 minutes ago, EmseB said:

This might sound silly, but I think this is the standard for an exclusively breastfed infant. Just saying that's where you might have heard those numbers.

My kids' peds have always said at least every other day once they're fully weaned.

 

You know what, I think you might be right, that may be why that number is in m mind.

I think every other day is a bit anal (ha ha.)  Some people seem a little less frequent than that.  But medical opinions on this seem to be affected  by culture - I read a book about medical culture a number of years ago, comparing different countries, and one of the things they noticed about Germany was the doctors were very concerned with daily bowel movements.  

 

[wintermom]

16 hours ago, BeachGal said:

 

His colon may be desensitized to the signals that nerves send telling him to go. Very common in kids with encopresis; kids with encopresis will often “squeeze shut” their sphincter when they get the urge to go. After years of not responding and nerve signaling problems, the colon enlarges which would explain the cloggers.

Daily practice sits after meals can help. After eating, maybe 15-30” after, go sit on the toilet for 15”. No need to produce anything. Generally, stronger urge to go in morning after coffee and/or breakfast. Sometimes after a warm bath.. Key is to establish habit of sitting on toilet.

Keep food and ? diary. Note foods that help and foods that don’t. Make sure he’s getting enough water. Give this time to correct. Could take months.

With encopresis there is that tell-tale leaking stool which stains the underwear. Not clear whether this is happening in the OP's case.  Keeping a stool diary is a really good idea, and knowing the rating of stools and what is ideal. Working toward type 4 stools is the goal. 

[wintermom]

1 hour ago, marbel said:

I used to  have the same problem - infrequent huge stools.  I tried a lot of different things but what has worked for me long-term is Dextrin fiber mixed with water - a brand  name is Benefiber but I use generic from Walmart, way cheaper - lots of liquid every day,and magnesium citrate supplements at night (400 mg).    Magnesium is considered pretty safe but I would research it if the person is taking any medications or has any health conditions, or ask the doc. 

Psyllium fiber is popular but it made me feel slightly ill when I used it.

If fiber is taken without enough water, it is going to make things worse.  I agree with those who suggest starting with miralax.  I've used it and both of my kids have too, no ill effects at all when used properly. 

How are this person's exercise habits?  That can make a big difference too.  

There is an ingredient in Benefiber that can cause gas build-up, which can be very painful. My GI specialist warned me about this fiber supplement for my situation.

[catz]

1 hour ago, ashfern said:

Probiotics can be found in your normal grocery store. I think they're over near the vitamins. 

I use  Melaleuca Fiberwise (that links to the product label). If I go daily then the volume is less. Also, drink plenty of water to help move things along. Exercise, even walking, helps move things along.

Personally, we don't use Miralax in our house. We did for one dd and it was a horrible experience for her. It's not a natural product. You can do a google search for some of the issues it causes.

We don't use Miralax either.  I had awful side affects from it and I'd be uncomfortable using it more than very short term without direction from a doctor.  If this a chronic issue, I'd try more natural solutions first and/or talk to a doctor.

I use this probiotic daily.  There are a number of good brands though.  

https://www.amazon.com/dp/B000XSF0P4/ref=sspa_dk_detail_2?psc=1&pd_rd_i=B000XSF0P4&pd_rd_wg=cuC4f&pd_rd_r=T53TZ6J9MR7ZZ4NCY7M8&pd_rd_w=PEVAw

I just buy ground flax at natural food stores to mix into smoothies or a small amount of juice.  I much prefer using flax to anything labelled fiber out of the store.  I find it is much more gentle.  I'm talking like 1-2 TBSP a day and you can start with less.   The other thing I do is carry a water bottle.  It really helps to have an insulated stainless bottle, I drink a ton more water.  If this is someone who is very sedentary, getting on a walking plan is a good idea too.  

[Supertechmom]

I must work with some hyper anal mds then LOL!..  ('m fairly certain a few of them studied in Europe so maybe there is a cultural thing as mentioned earlier) The GIs and general surgeons I work with basically are of the opinion one shouldn't have to work to have a bowel movement.  It's much like urination. one feels the urge, goes to the bathroom, and relaxes.  Stuff comes out. and you should be able to control it.  If not something is wrong...diet, hydration, medicines,  mechanical issues  - something along the intestinal tract isn't working quite right -obstruction, narrowing of intestine, enzymes, and diseases of the bowel.  But people shouldn't have to worry about having a movement.   They do agree with probiotics  daily though preferably in a non artificially sweetened high protein yogurt. and flax seed due to the typical diet of Americans. Fast food/processed box food is hard on the intestines.  

The stand out points to me is 1) the clogging the toilet - too much at one time or too hard  2) since he was a little kid - diet, mechanical issues, disease 3) he thinks it is an issue - If he's been this way since he can remember then something changed recently that has made him feel something needs to be done. IME, when people who have  "gotten used to it" or  "it's always been this way"  suddenly get upset about it, something has changed even if they can't explain what has changed. So I would get things checked out.  A lot of times, they can do an xray or scan and see what the stool burden is and if there are dilated loops or free air along the way.

[Bluegoat]

12 minutes ago, Supertechmom said:

I must work with some hyper anal mds then LOL!..  ('m fairly certain a few of them studied in Europe so maybe there is a cultural thing as mentioned earlier) The GIs and general surgeons I work with basically are of the opinion one shouldn't have to work to have a bowel movement.  It's much like urination. one feels the urge, goes to the bathroom, and relaxes.  Stuff comes out. and you should be able to control it.  If not something is wrong...diet, hydration, medicines,  mechanical issues  - something along the intestinal tract isn't working quite right -obstruction, narrowing of intestine, enzymes, and diseases of the bowel.  But people shouldn't have to worry about having a movement.   They do agree with probiotics  daily though preferably in a non artificially sweetened high protein yogurt. and flax seed due to the typical diet of Americans. Fast food/processed box food is hard on the intestines.  

The stand out points to me is 1) the clogging the toilet - too much at one time or too hard  2) since he was a little kid - diet, mechanical issues, disease 3) he thinks it is an issue - If he's been this way since he can remember then something changed recently that has made him feel something needs to be done. IME, when people who have  "gotten used to it" or  "it's always been this way"  suddenly get upset about it, something has changed even if they can't explain what has changed. So I would get things checked out.  A lot of times, they can do an xray or scan and see what the stool burden is and if there are dilated loops or free air along the way.

 

I wondered about this.  I thought maybe he had some sort of incident where he clogged a toilet in a public place or someone's house.  That could make one rather paranoid I suspect.

But it could be something like you mention as well.

[BarbecueMom]

21 minutes ago, Supertechmom said:

I must work with some hyper anal mds then LOL!..  ('m fairly certain a few of them studied in Europe so maybe there is a cultural thing as mentioned earlier) The GIs and general surgeons I work with basically are of the opinion one shouldn't have to work to have a bowel movement.  It's much like urination. one feels the urge, goes to the bathroom, and relaxes.  Stuff comes out. and you should be able to control it.  If not something is wrong...diet, hydration, medicines,  mechanical issues  - something along the intestinal tract isn't working quite right -obstruction, narrowing of intestine, enzymes, and diseases of the bowel.  But people shouldn't have to worry about having a movement.   They do agree with probiotics  daily though preferably in a non artificially sweetened high protein yogurt. and flax seed due to the typical diet of Americans. Fast food/processed box food is hard on the intestines.  

The stand out points to me is 1) the clogging the toilet - too much at one time or too hard  2) since he was a little kid - diet, mechanical issues, disease 3) he thinks it is an issue - If he's been this way since he can remember then something changed recently that has made him feel something needs to be done. IME, when people who have  "gotten used to it" or  "it's always been this way"  suddenly get upset about it, something has changed even if they can't explain what has changed. So I would get things checked out.  A lot of times, they can do an xray or scan and see what the stool burden is and if there are dilated loops or free air along the way.

This was my first thought.  Or too much meat (portion-wise or relative to other food categories).

[Mary in VA]

Is he having pain or is he uncomfortable?  If there is no pain or discomfort I wouldn't call it constipation. People have different body schedules and there is a wide range for normal.  My dh would go every day, multiple times a day, at the same times every day.  I'm like the case here. I can go every 2-3-4 days, quite a bit at a time, and multiple times on that day.  No pain or discomfort at all.  I wouldn't worry about it or mess about trying to change things if he's not uncomfortable. Just flush several times when going and make sure to flush before using the toilet paper.  I never have a problem clogging things up if I do that.

[BeachGal]

2 hours ago, wintermom said:

With encopresis there is that tell-tale leaking stool which stains the underwear. Not clear whether this is happening in the OP's case.  Keeping a stool diary is a really good idea, and knowing the rating of stools and what is ideal. Working toward type 4 stools is the goal. 

 

That’s often true but in some cases of encopresis there is no leakage or bunny droppings but large, impacted clay-like stools. Children will sometimes pass these in the tub when their sphincters relax. They can be dense and as large as cans of soda and have to be broken up before flushing.

Fiber acts like a sponge and takes waste, toxins and other material out of the body. Some waste can be reabsorbed if not absorbed by fiber and not eliminated timely (constipated) leading to mitochondrial damage in the body.

Probiotics are loosely regulated in the US. Many tested products have shown to have few to no strains of good bacteria or they don’t have all the strains they claim to have. Visbiome and VSL#3 are pretty dependable probiotics and are often used in research. Amazon sells both, IIRC.

Prebiotics found in food like Jerusalem artichokes (eat only a slice or so with food) feeds your gut bacteria which helps them colonize in the gut.

The Good Gut by Justin and Erica Sonnenburg (Stanford researchers) discusses how important the microbiota is to many aspects of health. It’s a good book for anyone wanting to learn more.

[Bluegoat]

Just now, BeachGal said:

 

That’s often true but in some cases of encopresis there is no leakage or bunny droppings but large, impacted clay-like stools. Children will sometimes pass these in the tub when their sphincters relax. They can be dense and as large as cans of soda and have to be broken up before flushing.

Fiber acts like a sponge and takes waste, toxins and other material out of the body. Some waste can be reabsorbed if not absorbed by fiber and not eliminated timely (constipated) leading to mitochondrial damage in the body.

Probiotics are loosely regulated in the US. Many tested products have shown to have few to no strains of good bacteria or they don’t have all the strains they claim to have. Visbiome and VSL#3 are pretty dependable probiotics and are often used in research. Amazon sells both, IIRC.

Prebiotics found in food like Jerusalem artichokes (eat only a slice or so with food) feeds your gut bacteria which helps them colonize in the gut.

The Good Gut by Justin and Erica Sonnenburg (Stanford researchers) discusses how important the microbiota is to many aspects of health. It’s a good book for anyone wanting to learn more.

 

So, is it likely this is the issue if it has been a problem since he was a child?

[BeachGal]

Hard to say for sure but some children with encopresis do grow up without fully resolving it.

[Night Elf]

Nothing specific happened, he just clogged the toilet yet again and it upset him. He had to deal with the clog before he could properly clean himself and that's got to be uncomfortable. 

He does not eat boxed foods, but does eat a lot of meat.

I don't think I could get him to use flax. He doesn't eat any type of food that it could be mixed into. Well, he hasn't had yogurt in a very long time. Maybe he'd be willing to try that? Where do I find flax?

He was on Miralax for 5 years as a child. He's no stranger to it. He'd probably use it again if it would mean smaller bowel movements which I guess would happen because he'd be going more frequently?

[Pawz4me]

28 minutes ago, Night Elf said:

 

He was on Miralax for 5 years as a child. He's no stranger to it. He'd probably use it again if it would mean smaller bowel movements which I guess would happen because he'd be going more frequently?

Yes, it should make him go more frequently. There's a lot of room to play around with Miralax. I'd take the recommended dosage for a few days and see what happens. If he has good results then you can tinker with it if necessary -- maybe try a dose every other day, or half a dose once a day, etc. Over the years I've had two gastroenterologists, an internal medicine doctor, a pediatrician and a general practice PA all say that it's fine to take Miralax every day if needed. Forever.

IMO there's nothing "wrong" with trying flax or other fiber sources or probiotics or prebiotics. But those things can take a long time to figure out and may or may not help. Most of them either do nothing for me or worsen my IBS symptoms. And they can get very expensive if you go for the really good probiotics or prebiotics. If it were me and I wanted to experiment with any of those things I'd do it in conjunction with Miralax.

[catz]

Ground flax can be found at many grocery stores.  I always buy Bob's Red Mill.  It doesn't need to be golden flax.  Could be brown.  You can also grind in a coffee grinder

https://www.amazon.com/Bobs-Red-Mill-Flaxseed-32-ounce/dp/B000EDDSE8/ref=sr_1_1_a_it?ie=UTF8&qid=1528814993&sr=8-1&keywords=amazon+bob's+ground+flax

This is a flax and probiotic based supplement.  I use this when I'm travelling.  Could be something to try with someone hesitant to try mixing in a fiber with a smoothie, etc.   

https://thrivemarket.com/p/renew-life-fibersmart?utm_source=google&utm_medium=pla&utm_medium=pla&utm_source=google&utm_campaign=Shopping_Health_Beauty&utm_content=631257534095&utm_term=google-pla_na&gclid=Cj0KCQjw3v3YBRCOARIsAPkLbK66bFetYAckUReoo6J9-x1nCuFGNQc2reQt-0ru04ffFW4Zz724OTkaAjKAEALw_wcB

[BeachGal]

The Ayurvedic medicine triphala could help. Triphala is a powder made from three fruits. One of them helps with motility issues. Haritaki, I think. You'd want to get the powder from a reputable source.