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by
Konstantin Monastyrsky
To preserve life-long
colorectal health and prevent colon cancer, a healthy
person should move the bowels after each major meal, or at least twice daily. Because circumstances are rarely ideal, many people tend to suppress
urges and skip stools. This leads to hardening of stools,
straining, enlarged hemorrhoids, and anorectal nerve damage — the
primary
conditions behind irritable
bowel syndrome and chronic constipation. Finally, one day, fiber or laxatives
are needed to initiate bowel
movements because the urge sensation has gone for good. This guide will help you to restore anorectal sensitivity without resorting to fiber and/or laxatives.
When you are hungry, you eat — or die from
malnourishment. When you are thirsty, you drink — or die from
dehydration. When your bladder gets full, you go to the bathroom — or
wet all over yourself. And when you feel the defecation urge, you just tense up
your pelvic muscles and pull-in the external anal sphincter — and wait until
the next call.
You can tell Mother Nature to wait because unlike with food, drink,
and urination, suppressing defecation doesn‘t make anyone dead or soiled
right away. And if you practice this long enough, the urge becomes
less and less urgent — until one day a “scream” turns into a “whisper,”
and renders you irregular or constipated.
So you add some fiber to make the urge louder. But it is still
getting quieter because this time around, bulked up stools are causing
anorectal nerve damage. So you add a bit more fiber, then more, and
more, and more. Not surprisingly, at some point the urge becomes barely
audible or completely mute, and you are the expert suppressor turned
into the expert strainer with all of the related accouterments —
hemorrhoidal disease, irritable bowel syndrome, inflammatory bowel
disease, diverticular disease, colorectal polyps, and on, and on, and
on.
Can you crank up the “volume” without fiber? Yes, with awareness
and retraining, you absolutely can! In fact, turning up the volume isn‘t
even that critical — you just need to learn to listen, that‘s all.
Can you turn the mute off? Unlikely. The damage has
probably gone too far. Can you
still attain normalcy and regularity without fiber or laxatives?
Absolutely. If I didn‘t know how to accomplish it, I wouldn‘t have
touched this kamikaze subject.
So, to help you along, here is an unabridged reprint of the
“Restoring the Sixth Sense” chapter from my forthcoming book Gut Sense:
How To Eat Without Harm, How To Fix What You‘ve Already Harmed.
I am that generous because a satisfied customer is always a repeat
customer. There are so many digestive organs left to protect and fix
above the anus that you‘ll have plenty of interest left to read my next
book.
Restoring the Sixth Sense
The rectum and anus: life-long heroics, but little glory
When the input/output organs break down, our health and quality of
life decline along with them. On the input side there are the eyes, ears,
nose, and oral cavity. On the output side are the genitourinary organs
and rectum and anus. Despite their critical importance, the rectum and
anus are the least appreciated, understood, or cared for organs — and
the most abused by fiber, or more precisely, by the hard stools caused
by fiber.
Alas, what‘s taken for granted gets broken first. By the age of
fifty, most Westerners still enjoy nearly all of their teeth, only
slightly diminished vision, close to normal hearing, unimpeded
urination, and the ability to enjoy reasonable intercourse.
But the rectum and anus is an altogether different story. Close to
half of all Americans over fifty already suffer from hemorrhoidal
disease, and most of this group suffers also from irregularity or
constipation. Some of them may have distended rectums. Almost all of
them have diminished anorectal sensitivity, or what can be aptly called
the loss of the “sixth sense.” The first five senses are, of course,
sight, hearing, touch, smell, and taste.
Since defecation is in part a voluntary act, and in part involuntary,
this complex issue has yet another dimension. Just as most people can
ignore the discomfort caused from wearing tight clothing or hearing loud
music, they can also learn to ignore and suppress the voluntary segment
of the defecation process. Although anorectal sensitivity may remain
intact, the signal to visit the bathroom (sensitivity threshold) is no
longer “heard.” In such cases irregularity and dependence on fiber
commence much earlier in life than either age- or disease-related
constipation.
This excerpt from Fiber Menace explains the functions of rectum and
anus in the digestive process:
The rectum: All‘s well that ends well
The rectum is very much like an exit dock in a space station — it
separates the rest of the “ship” from the perils of harsh outer space.
Hence, the rectum of a healthy person is empty at all times. Its brief
contact with stools and gases happens only on their final journey out to
the sewer.
Unlike the colon‘s circular musculature, the rectum‘s is
longitudinal, with strands of muscles running from top to bottom, very
much like the drawings of biceps that hang in medical offices. The
rectum‘s muscles stretch out to accommodate the feces as they move down
from the colon, and they contract back to initiate defecation. The
rectum‘s contraction completes an elaborate sequence of preceding
events:
The gastrocolic reflex, stimulated by eating and/or drinking, is
the
perceptible prologue of this process. Alas, it‘s an easy reflex to
suppress directly (consciously), or indirectly, through stress, lack of
attention, habit, and similar factors. The more often you suppress it,
the greater your chances of developing a life-long dependence on fiber
to move your bowels. The gastrocolic reflex actuates the next step.
The colonic mass peristaltic movement occurs without conscious
control. It‘s impossible to suppress by will, but stress, age,
laxatives, and systemic muscular relaxants (such as narcoleptics,
antidepressants, blood pressure and cholesterol-lowering medication) can
diminish it significantly, and bring on fiber dependence. (This
particular side effect is always stated on the prescription information
circular for each medication.) The mass peristaltic movement propels
feces into the rectum.
The stretching of the rectum by incoming stools is, by far, the
most important condition for regularity. Not surprisingly, the long-term
stretching of the rectum, common among individuals who consume a great
deal of fiber, eventually leads to the loss of rectal sensitivity, and
inhibits natural defecation. The stretching of the rectum stimulates
contraction, and?
At the very end of this process, following your explicit
instruction to relax the external sphincter, the rectum contracts to
begin the elimination of stools that are now inside the rectal ampoule.
Again, the rectum‘s ability to contract diminishes with age, from
medication, from nerve damage related to diabetes and inadequate
nutrition, muscular disorders, and also from extended periods of
stretching by stool enlarged (bulked up) by fiber.
A final, and most crucial participant in this process is the nerve
plexus along the anorectal line—the juncture of rectum and anal canal.
When the stools reach this intersection, the final signal is sent to the
autonomous nervous system to complete elimination. All of the same
factors that compromise the rectum‘s ability to react and contract,
desensitize the anal nerve plexus: large stools, nerve damage,
hemorrhoids, anal fissures, medication, and others. Alas, as we age,
these factors grow more and more pronounced.
Fortunately, improving anorectal sensitivity is easier than reversing
nerve damage or shrinking a distended rectum. So let‘s begin with the
easy part.
Anal control: Virtue turned torture
Domesticated cats and dogs can suffer from irregularity and
constipation for the same reasons that humans do — captivity and
dependence. In the pets‘ case it‘s a dependence on their masters, and in
ours a dependence on social mores.
Once out of diapers, our bowels become captive to an endless variety
of circumstances incompatible with health — we simply can‘t respond
immediately to an urge to defecate while in the middle of the highway,
halfway through the meeting, presentation, concert, date, and similar
circumstances. Inevitably, we learn to suppress and defer involuntary
reflexes for considerable stretches of time until the circumstances are
just right — and that‘s dependence.
Alas, that valuable social asset (the ability to hold in one‘s gases
or stools) eventually becomes a liability, and a precursor to
irregularity and an inevitable dependence on fiber to fix it, for the
same reasons other repetitive deeds turn into a predictable fate —
diminished anorectal sensitivity.
Civilization comes with a price: a disruption of the rhythm and
harmony of natural living. Some circumstances are more harmful than
others:
Occupation: Certain occupations predispose people to constipation
more than others, because they encourage or require a suppression of the
urge to defecate for prolonged periods of time. Surgeons, drivers (bus,
truck, cab, etc.), pilots, and policeman are among the list of
contemporary professions without immediate bathroom “privileges,” and
it‘s a list that‘s pretty long.
Scheduling: Alternating shifts at work interfere with
the natural
physiological pattern of elimination, and often lead to irregularity,
especially in the case of occupations like the ones listed above.
Jet lag: Intercontinental travel shifts the cycle of eating,
digesting and eliminating backwards or forward many hours.
Unfortunately, your body, accustomed to a different schedule, can‘t
adapt to time zone changes as fast as jets can fly over them — it can
take up to two weeks for your body to readjust its inner clock.
Inevitably, eating at the wrong time, and not having access to the
toilet at the right time, causes digestive disorders ranging from
indigestion and vomiting to diarrhea and constipation.
Mobility: A brief business trip or a weekend skiing sojourn can be
as disruptive for the digestive system as a flyover abroad — you get up
too early, eat at the wrong time, don‘t have access to the toilet when
nature calls, and are often embarrassed to use a toilet in the wrong
place or at the wrong time. All of the “ingredients” needed to “welcome”
in irregularity.
The list isn‘t complete, but it‘s a representative one. Once you know
how to prevent or eliminate irregularity related to a business trip or a
weekend getaway, you‘ll know exactly what to do during a honeymoon, or
during the emergency that plucked you out of bed in the middle of the
night.
Although each life and destiny is unique, the large intestine and its
ills are fundamentally the same, whether in the lowly vagrant or the
president of the United States. This is why when it comes to
irregularity or constipation, what works great for one, works well for
all. By the same token, what hurts just one, also hurts the rest. And
nothing causes as much hurt as one‘s own mind?
The mind-behind connection
As much as irregularity impacts the mind, the mind impacts stools
even more. Yes, it means exactly what you may be thinking: irregularity,
literally and figuratively, may indeed commence in your head. And not a
thing is going to relieve it, unless you “treat” your head first. Here
are some of the most common precursors of this kind of irregularity:
Lack of privacy. Shame isn‘t a physical affliction, but a mental
one. In Japan, for example, there‘s an epidemic of defecation-related
shame among women so acute that the stalls in most public bathrooms
feature an electronic device called the Sound Princess. This gizmo
imitates the loud sound of a toilet being flushed at the push of a
button. It‘s not the embarrassment in itself that causes irregularity,
but suppressing the urge to avoid public bathrooms (because others can
hear you). The suppression of stools related to lack of privacy is one
of the major causes of irregularity and eventual fiber dependence.
Fastidiousness. Howard Hughes went nuts worrying about bugs, but he
died anyway. Many people won‘t go near a public bathroom that isn‘t tidy
or that smells bad. Unfortunately, habitually waiting for too long to
get to a clean one causes irregularity. In this sense, the problem
begins in your head.
Depression and anxiety. Irregularity follows your moods. A tense,
wound-up state of mind stimulates the release of stress hormones, which
in turn causes muscular tensions, constricts blood vessels, causes poor
circulation, inhibits digestion, and disrupts normal neurological
processes. Each of these factors alone is sufficient to cause
irregularity — just imagine how strong their combined “punch” must be.
(Unlike depression or anxiety, strong stress is more likely to cause
diarrhea than irregularity for reasons explained here?)
Parental conditioning. Behind each constipated youngster there is
usually a constipated parent. No, constipation isn‘t genetic, but bad
habits, bad examples, and bad judgment are as contagious as the bubonic
plaque, and at first, so is constipation.
Can you think your way “out” of irregularity and constipation the way
you can think your way “in”? Absolutely. If your mind can control you,
you can control your mind as well. This, in part, is what this
information is about: helping you to reprogram your conscious and
subconscious mind in order to replace old paradigms with new ones, erase
scripts that don‘t work, and write new ones that do.
Don‘t laugh. Plenty of research points out that an expertly performed
hypnosis is as effective for the relief of chronic constipation as
laxatives . When it comes to irregularity, mind over fecal matter is
indeed a viable reality.
Avoiding urge suppression: nine rules to prevent peril
Normal defecation — regular, complete, effortless, and without any
straining — is an involuntary act with some degree of voluntary control
exercised when the act commences, but not how or why it is initiated.
That‘s why irregularity wasn‘t an issue for savages, who, always went al
fresco (outdoors) and au natural (nude), didn‘t have to make any
conscious decisions whether to defecate or not. They just did it
whenever they wanted to, period, just like diapered toddlers do. This is
why evolution hasn‘t endowed us with the skill of voluntary, on-demand
defecation.
The voluntary control of one‘s bowel in civilized settings is, of
course, essential. There is, however, a fine line separating voluntary
control from stool suppression, and just where this fine line resides
is hard to describe in words, or establish in quantitative terms when
you cross that line.
While voluntary control helps you to get from point A to the bathroom
without embarrassment, suppression helps you get from point A to point B
without going to the bathroom. Voluntary control is an instinctive
trait, passed along with genes, and well-mastered in time for preschool.
Suppression, however, is an acquired skill, learned from parents or
guardians, who permit or suggest “to hold it.”
By the teenage years, the ability to control the anal muscles without
crossing one‘s legs becomes stronger, the nerve plexus less sensitive,
and the anal muscles more tense. Unfortunately, the seemingly harmless
habit of suppressing defecation eventually creates gut-wrenching
problems that are the hallmark of irregularity and chronic constipation:
increased size, mass, and weight of stools, fecal impaction, nerve
damage, colorectal distention, and hemorrhoidal disease, caused by
muscular tension inside the anal canal, which is applied to suppress
defecation.
Because the defecation urge is as innate as thirst or hunger, there‘s
really no “healthy” way of dealing with suppression, except avoiding and
preventing situations when you actually need to suppress the urge. And
the only way to do it — tactically as well as strategically — is by
following these straightforward and logical rules:
Rule #1: Don‘t teach thy children wrong
Up to a certain age, defecation is as natural as playing or eating.
Children don‘t associate defecation with shame, they don‘t get
embarrassed by the noise or smell, and they aren‘t too squeamish about
hygiene or toilet cleanliness. They just drop their little pants and do
it, unless, of course, they hear: “Johnny, don‘t let your pants touch
that dirty floor,” or “Mary, real ladies don‘t use public restrooms,”
and so on. That‘s when little Johnnies and Marys begin mastering the
art of suppression, pulling the pants back up as per mother‘s orders, or
waiting to get back home to go to the bathroom.
Some of these unfortunate kids develop irregularity early on, some
may get away with it until adulthood, and almost all of them will make
up a contingent of future irritable bowel syndrome victims, simply
because casual suppression leads to an accumulation of large stools in
the large intestine. This in turn leads to a continuous pressure on the
intestinal walls, and a ceaseless irritation of the mucosal membrane.
There is really no way around this problem — i.e. needing a potty
outside the house, unless you follow Rule #2.
Rule #2: Establish a regular elimination routine
Early on in basic training, young conscripts are taught to have a
daily stool as part of their morning hygienic routine, because, once in
the tank or trench, there‘s no room, time or chance to move the bowels.
True, the soldiers‘ tender age, young intact guts, vigorous daily
activity, and a military diet, usually rich in fat, quickly help to season
these rookies into Rambos, but all of this shouldn‘t stop you from
learning to relieve yourself on-the-clock at any age. Because you aren‘t
in basic training, the techniques may be different, but the objectives
are the same: make scheduled defecation as predictable as clockwork. And
this is easiest to master when you follow the next rule.
Rule #3. Create thy urge
Doctors don‘t like hearing from their patients “But Monastyrsky said
?”, but they love to discuss their own problems with me for the same
reasons you‘re reading this: they experience pain and discomfort as much
as mere mortals do. In fact, one doctor approached me with the following
question:
? Konstantin, he said, I understand the importance of relieving
myself before leaving the house, but how do I do it, if I don‘t eat
breakfast?
? Relax for a moment, and slowly drink a glass of warm water. Soon,
you‘ll do it.
A few weeks later he called to thank me for this simple, practical
piece of advice, which made such a difference to him. When you juggle
patients all day long, there often isn‘t much time to get to the
bathroom.
So how come a glass of warm water helped this doctor? Well, the
physiology of drinking isn‘t much different from eating:
Eating stimulates the gastrocolic
reflex — a wave of peristaltic activity that propels chyme through the
small intestines and feces — through the large.
Swallowing and stretching the stomach
are the same, whether it‘s through food or water — the gastrocolic
reflex and ensuing chain of events begins anyway. In fact, some people
can experience the gastrocolic reflex just by thinking about food.
In turn, the gastrocolic reflex
stimulates a mass peristaltic movement — an even stronger peristaltic wave
that propels stools toward the rectum.
In turn, the stretching of the rectum from incoming feces
stimulates defecation.
This is the point where you still have two options: hold it until you
get to the bathroom, or suppress it. The second option may not be viable
when the volume of stool exceeds your ability to suppress the urge.
All other things being equal, our internal organs prefer as little
stress as possible, because a light workload limits organs‘
wear-and-tear, preserves energy, and causes no lasting damage. And that
brings us to the next rule.
Rule #4: Keep stools small
Unlike large and hard stools, small and soft ones are easy to propel
toward the rectum. A large stool hurts while it creeps along. Children
and adults cringe with discomfort when they have to relieve themselves
of dry, hard, and impacted stools (type 1 to 3 on BSF scale). Confronted
with pain, they often suppress defecation to avoid it, causing
themselves even more harm. Small stools “depart” quickly, and more or
less unnoticeably. When this happens, there‘s no fear, no need to
suppress anything, and little chance of needing to go to the bathroom
while away from the house.
There‘s only one way to assure small stools (type 4 to 6 on BSF
scale): through the avoidance of indigestible fiber and with timely,
regular defecation. Small stools are less likely to stimulate a strong
defecation urge in the wrong place at the wrong time. Small stools
maintain a perception of complete elimination, and don‘t stimulate the
defecation urge throughout the day. Besides all other benefits, small
stools — size and weight-wise — are easier to hold in without damaging
the colon, rectum or anus. But you aren‘t likely to need to hold
anything in, if you follow the next rule.
Rule #5: Eliminate completely
Accomplishing completeness is a bit tricky, because there is no such
thing as the “complete elimination” of feces from the large intestine —
a healthy gut is never completely empty. Thus, completeness is a perception, not a
physical reality, and that perception stems from actual fullness. There
is only one way to create the perception of completeness, and that is to
get rid of the factors that continue to “nag” the large intestine even
after a bowel movement: a pressure on the intestinal walls by the remaining
large stools, irritation of the mucosa, retention of compacted feces in
the rectum, and excessive flatus (gases). Let‘s expand on that:
Large stool stems from two primary factors — indigestible fiber and
the suppression that allows newly arriving feces to pile up on top of
the unexpelled, “suppressed” ones.
Irritated mucosal membrane — a hallmark of irritable bowel syndrome
and a precursor of colitis, results from the accumulation of large,
impacted, and formed feces from the cecum to rectum. Other factors
include laxatives, disbacteriosis, excessive acidity resulting from
fiber fermentation, and digestive disorders in the upper (small)
intestines, which allow still active enzymes, acids, and bile to sip
down into the unprotected large intestine.
The retention of compacted feces in the rectum results from
hardened, compressed stool. This problem is especially acute among older
adults, whose distended, stretched out, insensitive rectums no longer
respond to fecal stimulation, and lack the strength to contract and
eliminate accumulated stools. There is only one way to deal with this
problem: starting out early, guard your own rectum from harm and
distention by following all the other rules.
Excessive flatus is deciphered in the next rule.
Secondary factors, more typical for irregularity and chronic
constipation, such as scar tissue from surgery, internal hemorrhoids,
anal canal inflammation, tightness of anal muscles, tumors, and other
pathologies may affect the perception of completeness. If the problems
continue to persist after the elimination of primary factors, you should
undergo a complete colorectal examination to seek out and exclude other
causes.
Following all of the suggestions here — improving digestion,
excluding dietary fiber, restoring intestinal flora, reducing stool
size, eliminating flatus, healing the intestinal mucosa, and excising
hardened stools — will bring back gradual relief, and the welcome
perception of complete elimination.
Rule #6: Minimize flatus
Intestinal gases are the byproduct of healthy bacterial activity, and
are always present in the healthy bowel. Most of them escape during
defecation, some absorb back through the intestinal walls, and some are
let go voluntarily when the discomfort is palpable. Excessive gases
stretch out the colon and rectal walls, and stimulate the defecation
urge irrespective of all other physiological factors. The suppression of
gases requires as much strength as the suppression of stool, and with
the same unpleasant results — hemorrhoids, distention, and noticeable
pain. There are many ways to reduce gases, some reasonable, some not:
Sanitize the gut. Kill off all the bacteria with antibiotics, but
this is akin to throwing out the baby with the bath water. Ensuing
disbacteriosis is a deadly disease, as described in depth here.
Take digestive enzymes. Enzymes, like Beano, break down fiber
before it reaches the gut. But enzymes aren‘t always effective, and can
contribute to weight gain and diabetes from all that extra broken-down
sugar.
Reduce consumption of indigestible carbohydrates. Cut out dietary
fiber (a major source of bacteria feed), unfermented diary (a source of
lactose), and processed food, all of which add fillers from fiber, such
as pectin, inulin, guar gum, cellulose gum, or agar-agar, that pass to
the large intestine indigested, and provide ample feed for enteric
bacteria, which in turn creates so much gas.
Avoid sugar alcohols. Do not consume any foods that contain
indigestible (to enzymes, but not gas-making bacteria) sugar alcohols
(hexitols), such as sorbitol and mannitol, commonly found in bananas,
apples, pears, berries, prunes, sugarless gum, and also as sugar
substitutes in most low-carb products that call for a lot of sweetness,
such as cookies, ice cream, snack bars, and cakes.
Cut out gluten. Foods that contains gluten (a hyper-allergic plant
protein) affects intestinal permeability — the ability of the mucosal
membranes to absorb not just water, electrolytes, nutrients, and
vitamins, but also gases. Cereals, especially from wheat, are loaded
with gluten, sugar, and fiber. Commercially baked goods such as pizza,
bread, pasta, and pastry also contain a lot of gluten, especially when
made from whole wheat, which is considered, ironically, a health food.
Chicken nuggets and similarly-processed meats are shaped and bound with
gluten. Over 300,000 tons of gluten goes into food. It‘s omnipresent and
harmful, unless you read the labels.
Restore beneficial flora. The body‘s symbiotic bacteria reduce
gases by controlling the population and feeding habits of the
undesirable strains that are the most prolific “gas-producers.”
Seek out privacy. Taking a brief private walk, especially after a
meal, is good therapy for this problem. Gases are especially prominent
after meals, because eating stimulates intestinal peristalsis, and their
forward propulsion. Fortunately, this is also the best time to let the
gases go.
Use glycerin suppositories. They
stimulate the anal sphincter, initiate
peristalsis, and speed up gas elimination. (For that, you must have
privacy. More at the end of the page.)
These simple steps will help you reduce — never eliminate — the
creation of gases. Not having any gas — a sign of severe disbacteriosis
— is much worse than having some.
Some people, even if they‘re in the same family, eating the same
food, may experience more gases than others. This variance has to do
with the peculiarities of individual digestive systems, such as the
quality of chewing, volume of saliva, length of maceration, consumption
of liquids, speed of digestion, gastric acidity, pancreatic sufficiency,
enzymatic activity, level and composition of intestinal flora, and some
other factors. Obviously, younger people produce less gases than older
people simply because all the above function better and faster in the
young than in the old.
Alas, only champagne gets better with age, not the gut. And this
brings us to the next rule, which helps keep the gut young and healthy,
and also helps eliminate the unnecessary stimulation of the gastrocolic
reflex.
Rule #7: No snacking or eating
Any time you eat or drink, or even chew gum, the large intestine goes
into motion with a gastrocolic reflex and mass peristaltic movement
potent enough to stimulate even a strong defecation urge. Thus, it‘s
best to avoid eating or drinking in places where you can‘t access an
acceptable toilet. Of course, you won‘t have to deal with this problem
if you follow all the previous rules, and relieve yourself
before leaving home. If all else has failed, then follow the next rule.
Rule #8: Expect the unexpected
When the urge strikes, knowing where to find an acceptable bathroom is
as important as noting in advance the location of a fire exit. But
finding a bathroom isn‘t enough. Many people are reluctant to use public
bathrooms because they lack essential niceties such as a clean seat,
deodorant, soft toilet paper, or a flexible shower or bidet frequently
found in Europe but not in the United States. Here‘s a common sense
strategy that always works:
You can always squat over the toilet seat, but this depends on your
clothing, agility, and strength. You‘d be better off to always keep
several disposable toilet covers in your briefcase or bag, or use paper
towels or toilet paper to drape over the seat.
If you‘re uncomfortable with your
clothing touching the bathroom floor, put a newspaper down on the floor
in front of you.
Carry a small deodorant can in your
purse. There is really no other way around it, unless you happen to have
some spray perfume.
For proper hygiene away from home, always carry with you a portable
dispenser with pre-moistened hemorrhoidal tissues or baby wipes,
available at any drugstore. You can also presoak several paper towels
before entering the stall. Just don‘t flush them, because they may clog
the toilet.
When traveling, I always carry around a small Ziplock bag that
contains all of the above. My wife aptly calls it an “ass-saver.” I
realize that the above suggestions might not be news to women, so this
information is primarily intended for men. And that brings us to the
final rule.
Rule #9. If it no longer works naturally, help yourself
There is no magic wand that can undo years of
colorectal damage caused by hard stools. The stem cells that can
re-grow anal and rectal nerves haven‘t been harvested yet. Until that
time comes, rely on the least harmful “unnatural” means to accomplish
the same result (see Practical
Considerations). If you
don‘t, the situation will only grow worse, and worse, and worse.
Along with everything else you‘ve learned here, observe these nine
rules, and your anus will respond with uninterrupted service (little
appreciated until it fails). Even when it fails for the very first time,
it isn‘t too late to reverse back to normal. And indigestible
fiber is the least appropriate means of fixing up anal sensitivity,
because the small anus and bulky stools are as compatible as fire and
ice.
The invisible stool-breakers: Nerve damage
Besides all the things you can do to avoid suppressing the
urge-sensation, or causing one in the wrong place, there are more
external and internal perils capable of desensitizing anal sensitivity.
To break down their insidious destructive powers, you must act on many
fronts, often unrelated to the digestion process itself, because, just
like with muscles, blood circulation, or mucosal integrity, nerve damage
is a body-wide, systemic problem.
Here are some of the major factors and conditions
behind the nerve
damage phenomenon, some of them already discussed in other chapters. As
expected, the majority of them are caused by a diet high in fiber and
processed carbohydrates, and low in essential fats and primary proteins.
First, here are the systemic causes, unrelated to the large intestine
and stools:
Diabetic neuropathy. Over 50% of diabetics, millions of whom are
undiagnosed, experience some form of nerve damage. It leads to numbness,
loss of sensitivity in the extremities, sometimes pain. The same nerve
damage extends to gastrointestinal enervation, and diminishes anorectal
sensitivity. A diet high in carbohydrates and fiber is the one and only
factor behind elevated blood sugar and hyperinsulinemia — two primary
causes of sugar diabetes. The reduction of carbohydrates and exclusion
of fiber from the diet is the only viable strategy to prevent further
anorectal nerve damage, and to restore (however partially) nerve
damage.
Disorders of the peripheral nervous system. This term covers a
broad number of systemic conditions, such as nerve root disorders,
peripheral neuropathy unrelated to diabetes, disorders of neuromuscular
transmission, and some others. Anything that affects nerve fibers and
sensors system-wide, affects anorectal sensitivity, and its recovery is
contingent upon the successful treatment of underlying disorders.
Spinal cord disorders and injury. Sensory and motor nerve fibers
descend and ascend from the spinal cord. Pathologies or trauma to the
spinal cord may diminish or turn off anorectal sensitivity in ways
specific to each condition. Anorectal sensitivity can be restored only
if the underlying condition can be effectively treated.
Demyelinating diseases. This term covers a number of degenerative
(age related), toxic, infective, nutritional, and metabolic disorders
that cause demyelination — damage to the myelin sheaths, which cover
nerve fibers. Multiple sclerosis is one of the better known
demyelinating diseases. Because myelin sheaths are composed of
lipoprotein layers, nutritional and metabolic disorders are the primary
causative factors of myelin damage. For the same reason, the degree of
recovery from these diseases is high, once the underlying digestive
disorders, such as celiac disease or indigestion are resolved, and
proper supplementation of essential fats, protein, vitamins, and
minerals are provided.
Malnutrition. For most people the term malnutrition means not
enough nutrients — a rarity in wealthy developed countries. Still, more
people today are malnourished in the West than in primitive, poor
cultures, because underlying digestive disorders and poorly conceived
weight-loss diets preclude proper digestion of plentiful nutrients,
especially among children and older adults. Just like with the demyelinating diseases, malnutrition, regardless of its origins, causes
body-wide nerve damage. Fortunately, in many instances the nerve damage
is reversible once the underlying digestive disorders are treated, and
proper nutrients, including supplements, can get assimilated.
Drugs that affect the central nervous system. Many prescription,
over-the-counter, and illicit drugs affect the central or peripheral
nervous system, numb or turn off anorectal sensitivity completely, and
cause irregularity or constipation, even when all other organs and
systems are healthy and functional. The thorough review and exclusion of
offending medicines is the only viable strategy to prevent further nerve
damage and loss of anal sensitivity from the ravages of hard stools
bulked up by fiber.
In addition to the systemic causes just listed, internal disorders of
the large intestine diminish anorectal sensitivity as well. Their impact
is cumulative, and no age group is immune. Anal sensitivity may be
reduced in toddlers, teens, and young adults — a tender age doesn‘t
bestow any immunity against the mechanical and chemical damage caused by
fiber, large stools, or diarrhea. Obviously, the older you get, the
higher the vulnerability. Here are the major internal causes and
disorders that affect anorectal sensitivity:
Large stools and irregularity. As amply described in preceding
chapters, the stools that correspond to the Bristol Stool Form Scale
type 1 to 3 cause mechanical damage and desensitize the rectum and anus.
Large stools are symptomatic of irregularity and are caused
primarily by dietary fiber. The reduction of dietary fiber, along with
other steps outlined in Fiber Menace, may help to restore anorectal
sensitivity to its proper level.
Chronic constipation. Large stools, straining, and
the on-going use of
laxatives are symptomatic of the organic stage of constipation, and
long-term exposure to fiber. The partial restoration of anorectal
sensitivity is possible, but not complete restoration, because of all
the accrued anorectal damage. At this stage regular and normal stools
are best accomplished following the pertinent information provided on
these pages.
Chronic diarrhea is likely to accompany celiac disease, acute
disbacteriosis, ulcerative colitis, Crohn‘s disease, and irritable bowel
syndrome — all of the conditions caused directly or contributed to by
fiber. Sporadic diarrhea may result from excessive consumption of
soluble and insoluble fiber as well, and may become chronic. Diarrhea is
even more treacherous than large stools and constipation, because a
continuous irritation of the anal mucosa, and severe straining to
restrain diarrhea-related urges, severely desensitize anorectal
sensitivity.
Hemorrhoidal disease. The enlarged hemorrhoids caused by straining
and large stools perpetuate more straining, because the passage of
stools is restricted by the hemorrhoidal enlargement. The inevitable
high pressure on nervous receptors along the anal canal, and painful
defecation, decreases the anal sensitivity threshold and potentially
causes nerve damage. Since hemorrhoidal disease is irreversible (other
than by surgical means), excluding fiber and reducing stool size is the
most viable strategy to prevent further damage.
Inflammatory disease of the anal canal. The anal canal is lined by
mucosa just like the rest of the digestive organs. The chemical and
mechanical damage caused by fiber, large stools, or diarrhea may cause
inflammation of the mucosa and nerve damage. The prevention and
treatment strategies are the same as for hemorrhoidal disease.
Tissue damage. The complications from inflammatory disease and
severe mechanical damage from large stools may cause ulceration,
laceration, prolapse, fistulas, or abscesses inside the anal canal.
These painful conditions diminish or cancel out anorectal sensitivity
altogether until they are either healed or surgically repaired. The
prevention and treatment strategies are the same as for hemorrhoidal
disease.
Anorectal surgeries. No matter how skilled the surgeon, the removal
of affected tissues or the plastic restoration of the anal canal leaves
scars, which may diminish or halt the sensitivity of the anal canal.
There is only one way to prevent this from happening — take all the
steps outlined here to prevent the need for surgery in the first
place.
Pruritus Ani. Anal and perianal (around the anus) itching caused by
excessive acidity from fiber fermentation significantly diminishes anal
sensitivity. The removal of fiber from the diet is the only viable
option. Poor hygiene, infections, skin disorders, and similar causes may
cause chronic anal itching too, which may also diminish anal
sensitivity. These underlying conditions must be diagnosed and treated
first.
Anal intercourse. The anus wasn‘t meant by nature to be penetrated by a
penis or any other object. The continuous throbbing of an erect penis or
vibrator against the narrow opening of the anal canal causes all of the
disorders listed above, and then some. Anal sensitivity is usually the
first to go. The only practical advice is to abstain from anal
intercourse.
Since aging is inevitable, taking good care of your anus from birth
is the only viable strategy for not experiencing problems in the most
vulnerable “golden” years. This means applying all of the strategies
outlined here and in Fiber Menace, and protecting children from the harm
caused by processed fiber, excess carbohydrates, lifestyle drugs, poor
toilet training, and bad parenting.
So what do you do to overcome a partial loss of anorectal
sensitivity?
Step 1. Normalize stool and restore intestinal
flora using Colorectal
Recovery Program. For as long as stools remains large, hard, or
dry, you won't be able to restore anorectal sensitivity because these
conditions compromise the physiology of defecation.
Step 2. Maintain proper stool morphology and
regularity. If the damage hasn't gone far, don't suppress stools,
and you'll be fine. If, on the other hand, your rectal sensitivity is
diminished , or descending and sigmoid colons are too stretched to
propel smaller stools, or the nerve damage is no longer reversible,
continue using Hydro-C (a
component of Colorectal Recovery Program). Hydro-C moisturizes stools and
stimulates peristalsis. As the fluids move into the rectum, stretch
it out, and reach the anal plexus, the urge becomes much more
pronounced.
In addition to Hydro-C, you can use rectal glycerin
suppositories to stimulate a bowel movement. There are two distinct
mechanisms of action for glycerin suppositories:
Stimulant effect. This is for people with
a relatively intact
anorectal sensitivity. As soon as the suppository contacts the extremely
sensitive nerve plexus situated along the anorectal line, the rectum
starts contracting. This action imitates normal defecation. The rectal
contraction stimulates the mass peristaltic movement, and the colon
advances stools into the rectum for immediate expulsion.
Hyperosmotic effect. This is for people with significantly
diminished sensitivity, when the mechanism of action is different
and delayed. After about 30 to 60 minutes — the time it takes for the
suppository to melt — you must either lay down or assume a more
effective knee-to-chest position (knees and elbows support the body,
buttocks up, head down) to let the glycerin drip down into the colon.
Without this “positioning,” the suppositories may still work, but it will
take hours. Once inside the colon, the glycerin starts the hyperosmotic
action, attracts water, and acts just like a conventional osmotic
laxative.
Glycerin suppositories should be used only after normalizing stools
with Colorectal Recovery Program, otherwise you‘ll be stimulating
a painful and traumatic
expulsion of hard or large stools.
In general, using both — Hydro-C and glycerin suppositories — works
best. While the first softens, break downs, and moisturizes stools, the
second stimulates defecation. Just make sure to take Hydro-C an hour or
two before inserting the suppositories.
If you need to rely on the hyperosmotic effect of glycerin
suppositories on a regular basis, you are better off using Hydro-C.
That‘s because glycerin is a mild irritant. As such, it is
contraindicated for people with inflammatory bowel disease, irritable
bowel disease, anal
fissures, acute hemorrhoids, and similar conditions. Hydro-C has
none of these contraindications, and offers additional anti-inflammatory
and healing properties.
Moreover, its delivery into the rectum is slow and inefficient, and
it may also cause rectal discomfort and a burning sensation — especially
pronounced among children and young adults, who are normally much more
sensitive to all outside stimuli.
For the same reasons, you shouldn‘t use mini-enemas containing
glycerin, deceptively sold as “Liquid Glycerin Suppositories.” These are
more expensive, difficult to self-administer, a hassle to administer to
others, uncomfortable to hold, irritating — and impractical for people
with adequate anorectal sensitivity, who can use suppositories with
rapid effect and less trouble.
Just as with any laxative, do not use glycerin suppositories if you
are experiencing rectal bleeding, abdominal pain, nausea, vomiting, a
sudden change in bowel habits, or haven‘t had a bowel movement in the
past three days. Glycerin suppositories aren‘t effective for fecal
impaction, and are undesirable for large stools, because strong
peristalsis and vigorous propulsion through the anal canal may cause
further anorectal damage. Always normalize stools first using
Colorectal Recovery Program.
You may find that using two suppositories, inserted one after the
other, may be more effective than using one. The reasons are: (1) the
anus is about the same length as a single suppository (3 cm), and a
single suppository is apparently not long enough to come into full
contact with the nerve plexus region; (2) once pushed further inside by
the second suppository, the first one stimulates defecation much faster
and with more strength; (3) the faster you expel both suppositories
along with stools, the less likely it is that the glycerin will cause
an additional hyperosmotic reaction or irritation. Obviously, when just one
suppository works fast and well, there is no reason to use a second
one.
You may use glycerin suppositories to establish, quite reliably, the
fact of anal (not rectal) nerve damage. If, during the first five to ten
minutes or so after inserting two suppositories, you don‘t experience
any defecation urge, then the damage is quite complete.
For those with little or no damage at all, the response is strong and
vigorous, to the point where a numbing sensation in the legs might
occur. Anything between these two reactions — from none to a strong urge
— is a subjective measure of how much anal sensitivity you have left.
Just keep in mind that numerous external factors, such as medication,
narcotics, and alcohol, can reduce or nullify the reaction to glycerin
suppositories in the same way that these factors “turn off” the normal
defecation urge and intestinal peristalsis. In the presence of these
obstacles, this test isn‘t objective or meaningful. In this case, using
them is pointless. Use only Hydro-C instead.
Whenever you miss a bowel movement, the stools closest to the rectum
harden up and dry out, making consecutive elimination much more
difficult. That‘s why not missing bowel movements is key to a healthy
large intestine and regular effort-free defecation. This “rule” was
easily observed when life was simple: same village, same shack, same
chores day in and day out. Well, life isn‘t like that anymore.
Finally, for best results and zero harm, make sure to use glycerin
suppositories properly. Here are several tips:
Always take Hydro-C first on an empty stomach. It takes time to act.
After you establish your personal response time, you‘ll have some good
guidance for when to use suppositories. The idea is not to use them too
soon. If the urge sensation from Hydro-C kicks in before, that‘s great —
then you don‘t need to use suppositories.
Once you establish your individual response reaction, allow enough
time for the suppositories to act after insertion. You don‘t want to be
caught with one inside you while away from the home or office.
Glycerin suppositories are made from similar components, using
similar size molds, and all of them work pretty much the same. Buy any
brand you feel comfortable with. Don‘t buy any with the word “medicated”
on the label. You don‘t need medication, just stimulation.
When traveling or using glycerin suppositories outside the house,
buy them prepackaged in individual foils or blister packs. This way they
are discreet and take up little space.
Store suppositories at normal room temperature. Do not refrigerate,
unless you live in the tropics. Don‘t insert them chilled, since cold
will anesthetize the nerve endings. Also, at normal room temperature
suppositories are slightly slippery, and are easier to insert than when
dry and cold.
Always wash the hands thoroughly before handling suppositories.
First, you don‘t want to contaminate the contents of the jar. Secondly,
you don‘t want to introduce any infectious agent inside the anal canal.
Close the lid before inserting suppositories, while your hands are still
clean.
Trim your nails. You don‘t want to scratch the area around the
anus. After inserting the suppository, wash hands even more thoroughly,
particularly under the nails, because fecal matter may get into contact
with your hands.
For people with diminished anorectal sensitivity, insert the
suppositories immediately before a meal. This is the best way to combine
the stimulating effect of suppositories with the gastrocolic reflex
caused by eating. Be ready to interrupt the meal. Don‘t suppress or wait
for another urge. It may not come, or may not be as vigorous and
effective.
You can use suppositories to stimulate defecation the next day or
two after taking Hydro-C. This way you allow your large intestine to
propulse stools down to the rectum, rather then “washing” them out
daily.
If you run out of Hydro-C, and you can‘t attain defecation
naturally, use suppositories to stimulate defecation and prevent the
hardening and enlargement of stools until you receive it.
As you can see, not all is lost — and lots can be gained. With
minimal effort and a little practice, you can maintain regularity without
fiber, harsh laxatives, and addiction. True, it‘s not the same as it was
when you were in your teens, but neither is everything else — you don‘t
have the same teeth, or the same hair, or the same vision, or the same
hearing, or the same sex drive. But none of those facts are as
bothersome as colorectal disorders.
And it‘s much more economical — your annual expenses from Hydro-C and
occasional glycerin suppositories will always be significantly less than
what you are spending on laxatives, occasional colonics, co-pays,
fiber-laden serials, prune juice, “cleansing” kits, and other archaic
means of managing the absence of the sixth sense.
Summary
The anus and rectum terminate the alimentary canal. Both organs are
as important to complete the digestion process, as strong teeth are
important to start it.
Because the functionality of the anus and rectum isn‘t
well-understood or appreciated, both organs are usually ignored until
serious anorectal damage is detected.
Anorectal disorders interfere with defecation — the final stage of
the digestive process. A bottleneck at the end affects other digestive
organs just as a single stalled car slows down an entire multi-lane
highway.
Constipation and diarrhea are the side effects of compromised
defecation. Both conditions exacerbate anorectal disorders even more,
which, in turn causes more severe forms of diarrhea and constipation.
Dietary fiber is routinely recommended to alleviate diarrhea and
constipation. Because of its physical and biochemical properties, fiber
causes more damage, not less, by affecting the already impaired anus and
rectum with large, hard stools and acidity, which in turn results in
even more injury.
Systemic medicines that affect the central and peripheral nervous
system, such as drugs used to control convulsions, depression,
hyperactivity, pain, psychoses, schizophrenia, colitis, irritable bowel
syndrome, and many other conditions, cause constipation, and in turn
call for laxatives, including fiber.
The modern lifestyle interferes with natural, uninhibited
defecation. The need to retain stools leads to the eventual loss of anal
sensitivity, and causes irregularity or constipation, which is then
treated with more fiber or laxatives.
The habit of suppressing the defecation urge leads to diminished
anorectal sensitivity, irregularity, constipation, and fiber dependence.
This chapter outlines a set of simple-to-follow rules intended to avoid
situations when stools needs to be retained.
Nerve damage in any area of the body invariably affects the anus,
rectum, and defecation. The number of diseases and conditions that may
cause nerve damage is immense, ranging from infections to malnutrition,
and from surgeries to anal sex.
Anorectal sensitivity can be damaged by systemic causes, such as
diabetic nerve damage, spinal cord injuries, infectious diseases, and
other conditions. It can also be affected by internal causes, such as
hard stools, irregularity, constipation, diarrhea, hemorrhoids, and
others.
In many cases nerves damage and diminished anorectal sensitivity
can be overcome by removing fiber, restoring normal stools, and paying
attention to bodily needs.
In these cases, where nerve damage can no longer be overcome, the
techniques and tools described here and in Fiber Menace should help in
achieving normal defecation, and result in the gradual recovery of
anorectal sensitivity.
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