“No organ of the body is so misunderstood, so slandered, and so maltreated as the colon. No wonder that the colon is unhappy.” These words by Arthur F Hurst are still as true as they were in 1935. Most of the bathrooms in the developed world will have a book. We read in bathrooms. Magazines, newspaper, books and we even have bathroom libraries. Why? Why do we read in bathrooms, pleasure or a necessity? The reason is very simple. We are in there a long time, a very long time. So we have to look at the underlying reason as to why we have to be in there for so long. It turns out, many and most of us are suffering from bowel disorders. Constipation is a common problem in adults and it is one of the most common causes of general suffering. Chronic Recurrent Abdominal Pain, though not fatal, is debilitating, in both adults and children alike. It can present itself in various ways starting from occasional hard stools to severe abdominal pain.
Most of the patients will respond by saying that they suffer with constipation “just like a normal person”, yet when were the last time bowel habits were discussed with a normal person; in other words, who taught us what a normal bowel habit is? What needs to be understood with constipation is that it creeps upon us very slowly. Just as we are never able to pinpoint the exact day that our kids grew and only notice the growth when we compare pictures after a while, incremental progression of constipation manifests in a similar fashion. The problem is that we do not have a picture of our health to compare it to. We do not have a picture that shows our energy levels and how well we feel over weeks, months, and years, as we do not record it and cannot comprehensibly measure it. The way we feel this week will become the baseline picture of our health for the next week. Hence, when people develop constipation over years, it usually goes unnoticed.
To understand the purpose of this book you will first need to understand how scientific literature works and how research papers are written. A question by a researcher leads to generation of a hypothesis based on which an experiment is designed. The results are then assembled, context and the surrounding thought processes are layered with the results based on our current understanding of the topic, and finally, conclusions are drawn to advance our learning. In this entire process the only hard fact is the result of the experiment; the discussion and conclusions are based on our current understanding of the topic and are just a figment of our imagination. Several things in our environment such as current thought processes, prior experience, and other factors may influence the interpretation of results making our conclusions biased. If we find additional evidence, facts may be interpreted very differently due to new evidence. A simple example will illustrate this point better. In the dark, a round long thing is the rope but add to that information a fang, a tail, slime, movement and a bite: it is a snake. Depending on what we see routinely and what makes up the current wisdom, will allow us to interpret whether the round long thing is a snake or a rope. If we see a movie about snakes just before being blindfolded, we determine it is a snake, even if we were actually handed a rope. Chronic recurrent abdominal pain with negative workup and other unexplained digestive track symptoms are all twisted shoots of our faulty understanding of physiology. Today’s research is replacing and modifying yesterday’s theories as new evidence becomes available and this journey of discovery and refinement is eternal.
This book is written for patients and parents who want to understand the symptoms and discomfort associated with these conditions in scientific terms. Doctors now-a-days become far too entangled in numerical percentages and abbreviation jargon. Add to this the time pressures created by our health care system this leaves a normal person confused as to what he might have.
Another complicating factor is the widespread state of denial in acknowledging constipation. Laxative is a taboo and people do not want to talk about what comes out of “the other end.” The classic image we have of a person with constipation is that of an old lady who shouts at anyone and everyone. This image, coupled with the fact that most people don’t want to acknowledge that they are getting older, cause people to deny constipation as a problem. They subconsciously ignore the transitory state of bowel dysfunction, which they assume will get better on its own.