Page 44 - Summer2018

Reading Between the Lines

By Merinda Teller

Uptight and Out of Sight: The Global Constipation Epidemic

Although In the penultimate volume of J.K. Rowling’s $1099 annually per child). In a study in British
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constipation famed Harry Potter series, when the dark forces Columbia, 2.1 percent of visits to a pediatric
led by “you-know-who” (aka Lord Voldemort) emergency department (ED) over a one-year
rarely makes seem to be unstoppable in their takeover of period were constipation-related, and the ED
the front the magical world, visitors to the mischievous visits often led to overutilization of tests and
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page, its Weasley twins’ joke shop get a little comic re- invasive treatments.
lief. In an otherwise somber neighborhood, the
prevalence shop window prominently features “a gigantic NORMAL VERSUS DYSFUNCTIONAL
levels rival poster…emblazoned with flashing yellow let- Defecation is a “sophisticated” process
or exceed ters” that asks, “Why are you worrying about that requires “rectal filling, awareness of rectal
you-know-who? You should be worrying about filling and the ability to propel the stool and
the levels of u-no-poo—the constipation sensation that’s relax the pelvic floor muscles in a coordinated
more highly gripping the nation!” 1 fashion.” Normal bowel function depends on
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Intentionally or not, Rowling had her finger both sensory perception and physiological coor-
publicized on the pulse of the “constipation sensation” dination; if the need to defecate happens to arise
chronic that is gripping many nations around the (non- at an inconvenient time, the rectum will relax
conditions magical) world, including the United States. and “allow more stool to be accommodated”
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such as Chronic constipation affects up to 27 percent until a more opportune moment. Disregard-
of Americans (sixty-three million as of 2004), ing the body’s signals is not an advisable habit,
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diabetes and with prevalence apparently higher in women and however, because “when the urge to defecate is
asthma. the elderly. Although constipation rarely makes ignored, stool gets dehydrated and small, the
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the front page, these prevalence levels rival or rectum gets used to being stretched and fails to
exceed the levels of more highly publicized respond normally, and feces then back up into
chronic conditions such as diabetes and asthma. the colon, causing discomfort.” 12
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Older adults may suffer disproportionately When the basic process continually goes
from constipation, but the condition is also awry and an individual chronically experi-
common in children. Two recent systematic ences infrequent stools, difficult stool passage
reviews of studies from around the world found or other symptoms indicative of “a sufferer’s
that the prevalence of functional constipation difficulty with the act of defecation,” conven-
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ranged from 0.5 to 87 percent of children and tional gastroenterologists classify the problem
adolescents and 1 to 31 percent of infants and in one of two ways. If the clinician is unable to
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toddlers. Moreover, pediatric bowel problems identify any known causes or detectable abnor-
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frequently are underdiagnosed. Children with malities, the chronic constipation is “idiopathic”
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chronic constipation may go on to develop en- or “functional.” Researchers have identified
copresis, a negative cycle of impaction, disten- various risk factors associated with this type
tion, pain and fecal incontinence. of constipation—including low socioeconomic
Pediatric constipation also has an economic status, low education, stressful life events and
impact. U.S.-based studies report that children low levels of physical activity—but they caution
with constipation use more health services and that there is no guarantee that addressing these
generate three times more health care costs than risk factors will improve bowel function.
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children without constipation ($3430 versus The colon is physiologically complex—

42 Wise Traditions SUMMER 2018