Feeling Pooped: Breaking Open Constipation at the Mayo Clinic

We spend so much time here talking about what we put into our bodies, but today I’m shifting to what comes out. Ladies and gents, take a bow(el movement)!

Everybody does it, hopefully on the regular. Maybe there was a time that you remember when things didn’t go as smoothly. Your body had a hard time letting go. In the field we call that constipation. Otherwise known as what I’ve been dealing with for the last 5 years.

In various posts discussing the nutritional value of fiber and healthy fats and gut-friendly foods, I’ve mentioned “stomach problems.” Never more than a vague hint dropped here and there, since I didn’t really know how to explain it. Besides, other than my family, who’d want to hear about whether or not I went to the bathroom that day? It feels like being potty trained all over again. “So, did you go? Yes? Hooray! Good job Sara!”

After 5 years I’m much more open about it, whether you’re into that or not. It amazes me how many times I found another person dealing with similar,  if not the same, dilemma day in and day out. It’s my turn to pay it forward and help someone else searching for relief.

Hi ho, hi ho, it’s off to Mayo we go.

With an appointment set for the end of June, my hopes rose. I didn’t care if the conclusion was still PFD and they sent me right back to my physical therapist. All I wanted was a more concrete diagnosis, based on the best tests the medical world can perform right now.

As my week at the Mayo Clinic drew nearer, I wavered between nervous and excited anticipation. Could they solve the puzzle? Are the tests going to hurt? What if they don’t have an answer? Will this belly bloat ever go away?

Friends couldn’t believe I was flying all the way to Minnesota for a doctor appointment. Some thought the Mayo Clinic only existed in the movies. Others took inordinate pleasure in making jokes, asking me if I’d be tasting a lot of mayonnaise or whether I’d like some ketchup with that.

But I’m getting ahead of myself.

It all started at the end.

The end of high school, that is. About halfway through senior year I inexplicably developed constipation, worse than after a week of eating matzah. The running joke became “Sara’s full of sh*t.”

For the remainder of the year I saw a host of GIs and even an endocrinologist. Time ticked by while I swung my feet from a deceptively uncomfortable chair in countless waiting rooms that quickly began to look identical. Each appointment followed the same routine. Doc’ walks in, asks why I’m there, and I methodically tick off the symptoms, a list that grew faster than your adolescent growth spurt.

Several of them were shocked at how informed I was. But hey, wouldn’t you want to know what’s happening in your own skin? Nevertheless, after more poking and prodding, it always ended in one of two ways. Either A) Doc’ takes a stab at a diagnosis and prescribes something or B) Doc’ scratches his/her head and shuttles me off to so-and-so who they know/heard deals with “this kind of thing.”

Despite copious amounts of supplements and laxatives– you name it, I’ve probably tried it– the constipation, bloating, abdominal discomfort, and consequent bad mood continued.

I took to calling myself a medical anomaly.

Finally one GI gave a credible diagnosis– pelvic floor dysfunction (PFD, from here on out). You’ve probably only heard of it if you have it.

Imagine your pelvic muscles as a woven basket. Better yet, picture them as a tube, accepting waste from digestion in one end and controlling when it leaves. People on one extreme have relaxing PFD, where their muscles are too relaxed and cause things like incontinence or pelvic organ prolapse. My GI said I had the polar opposite, non-relaxing PFD, the lesser known case of too tight pelvic floor muscles preventing you from doing your duty.

For the next few months I went twice a week to a PFD physical therapist, praying that it would work and I could go to Israel for my gap year come August.

Fast forward 4 years.

The physical therapy helped. I jetted off for the year, charged with increasing my fiber intake, drinking more water, and focusing on my breathing to relax the muscles. Unfortunately, the constipation soon reared its head again. I sporadically went back to my physical therapist for tune-ups whenever I was home from college, but the problem didn’t feel resolved, at least not to the point of satisfaction.

Cue visits to more waiting rooms and doctors, until eventually one gave me a choice. She could send me to yet another GI, who would likely repeat the process, or I could go to the Mayo Clinic, the world’s biggest medical center with the top motility specialists.

Well, when you put it like that….

Renown aside, I didn’t know what to expect. The facility seems like the center of Rochester, Minnesota, although technically it’s downtown. I rambled around between appointments, in awe of the sheer size and also the beauty of the facility and its campus, filled with grassy areas, colorful flowers, and benches. You could almost forget that you’re at a hospital, until you see the people sporting all manner of medical apparatus.

But it’s not all rainbows and sunshine.

That week was hard, both mentally and physically. My mood constantly hovered somewhere on a scale of anxious to upset. Each night I fell into bed exhausted, only to wake up early the next morning to check back into the office by 7:15. The numerous scans of my stomach and colon, an EKG, and anorectal manometry all led up to the Mayo Clinic’s colonic motility test, consisting of a flexible sigmoidoscopy and colonic manometry.

I knew before coming that my diet for the week would need to change, although I didn’t fully wrap my mind around what that would look like. No fruits, vegetables, whole grains, nuts, or anything high fiber. I ate Wonder Bread for the first time. Drank real milk (and realized I liked it).

Then, on Thursday, it was time for a clear liquid diet before 4 liters of Go Lytely to choke down, a cup every 10 minutes. With my mom as my witness, I admit that I didn’t exactly follow the rules, but at least swallowed enough between Thursday night and Friday morning to be sufficiently prepped for the sigmoidoscopy.

We’ve reached the grand finale.

Once all the necessary equipment was in place for the flex sig to begin, I simply lay on my back in a hospital bed for the next 6-7 hours. Add in numerous Friends reruns and it doesn’t sound so bad. Minus the fact that I couldn’t move at all, in case I forced my colon muscles to contract when they wouldn’t have naturally.

Halfway through the day, you have to consume a meal so that they can monitor how your colon responds. This isn’t just any meal though. No, this is a 1,000-calories-in-10-minutes meal. The Mayo Clinic provides a non-dairy fruit shake specially made for this; alas, it wasn’t kosher, so my mom and I scrambled around in the grocery store on Thursday, adding calories and trying to think what I could swallow fast enough.

For anyone who’s curious, 16 ounces of whole milk kefir (first time having kefir, won’t be the last) and two Perfect Bars are the way to go.

So what’s the final score?

Like I thought, PFD is no longer the right diagnosis for me. An occasional refresher visit to the physical therapist if I need it, but my new doc’ says it’s not my final answer. I’m one of the 15-30% of constipated patients with slow transit constipation. Next time you’re crawling in traffic on the highway, you’ll know what it feels like in my colon.

There are various forms of treatment, which you should discuss with your doctor if you experience this too. For me, it means finding the right balance of magnesium (need more) and fiber (need less), to keep water in my colon and not over-consume a nutrient I can’t digest. Talk about a huge diet shift. It’ll take some time to figure out exactly, but I’m (cautiously) optimistic.

If you, or anyone you know, suffers from something similar, then I hope this was helpful! I’m happy to answer any questions that I can. Otherwise, I hope you found this interesting, since you’ve read for so long. Thanks for sticking it out 🙂