For years, one of the first things I did when I walked into a new place was look for the toilet. It could be a restaurant, a meeting, a grocery store, a party.
I wanted to know where it was and how quickly I could get there if I needed it.
My wife noticed because I kept asking her everywhere we went.
What makes this strange in retrospect is that I was going to the bathroom most days.
That probably explains part of why it took me so long to understand that I was constipated. My definition was simple: constipation meant you could not poop.
I could poop, so I did not think the word fully applied to me.
What I did not count was everything required to make that bowel movement happen.
I could sit on the toilet for fifteen or twenty minutes. I strained. I waited.
Eventually something would come out, and I would stand up still feeling as though there was more left. None of this seemed remarkable to me. I had been doing it for long enough that I thought this was simply what bowel movements felt like.
If something came out, I counted it as “I pooped.” That was the measurement.
Looking back, I was throwing away most of the useful information.
My body knew before I did
About six months after my wife and I moved to the United States, I saw bright red blood on the toilet paper for the first time.
It shocked me for a few seconds. Then it disappeared after a day or two, and I did something I think a lot of people do when an uncomfortable symptom goes away: I decided the disappearance meant the problem was gone.
Two years later, the blood came back. Then came hemorrhoids, fissures, appointments with a specialist, and eventually a colonoscopy at age thirty-five. The procedure itself came back fine. The bills came to roughly $3,700.
There is a much longer story inside those years, but the part that interests me now happened before the specialist and before the colonoscopy.
My body had already been giving me information.
I did not know how to read it.
I was asking one question over and over: How often am I going?
Frequency matters, but eventually I realized it was answering only one small part of what I needed to know.
Imagine three people.
One person has not had a bowel movement in four days.
Another goes every morning, but spends twenty minutes straining and still does not feel empty afterward.
A third has stool that is relatively soft and still struggles to get it out.
All three may describe themselves with exactly the same sentence: “I’m constipated.”
The label is the same. Their experience is not.
That distinction changed the way I started looking at my own constipation.
The questions I wish I had known to ask
If I could go back, I would pay attention to seven things much earlier:
How often am I going, and has that changed from what is normal for me? Going three times a week for ten years is different from suddenly dropping to three times a week since March.
What is the stool actually like? Hard, dry, lumpy, pellet-like, or relatively soft but still difficult to pass all tell you something different.
What happens to the urge? Do I normally feel it, barely feel it, or keep feeling that I need to go without getting relief?
Can I actually get started? Or do I spend a long time waiting and then pushing, trying to make something happen?
How much am I straining, and what am I straining against? Straining against very hard stool is one experience. Straining heavily when the stool is already relatively soft is another detail worth noticing.
Does it feel blocked? I mean the specific sensation that the stool is there, but getting it out seems to be the problem.
When I am done, do I actually feel done?
That last question was particularly important for me.
For years I would have a bowel movement, stand up, and still feel as though I needed to go again. I kept thinking I needed to poop more often. A much better question for me was why I still felt unfinished after I had already gone.
None of these questions diagnoses the cause of constipation. That is not what they are for. They turn “I’m constipated” into a more useful description of what is actually happening.
Compare those two statements:
“I’m constipated.”
And:
“I go almost every day. I strain a lot. Sometimes the stool is not even very hard, and afterward I still do not feel empty.”
The second statement does not give you a diagnosis. It does give you, and your clinician, something much more specific to work with.
Once I could see the details, I started seeing sequences
Another thing changed when I began paying attention this way. Some of my worst episodes stopped looking completely random.
For me, there was often a sequence.
Less stool would come out in the morning. Then it would take longer to get that smaller amount out. Sometimes the stool would become wider with cracks. Later I might see small pellets. If things kept getting worse, bleeding sometimes followed.
That was my pattern. I would not turn it into anybody else’s rule.
Your pattern may look nothing like mine. You may not have a clean sequence at all.
What mattered was not the exact sequence. It was the realization that my worst day sometimes had information leading up to it.
Before I understood that, I mostly reacted to whatever was happening in the moment. Once I could see a pattern, I sometimes knew something was changing before I reached the worst part.
That was useful, but it created another problem.
I started changing everything
When symptoms got worse, I would change my food, increase my water, walk more, change my exercise, adjust my routine, take supplements, and sometimes do several of those things at once.
Then I would get better.
At first, that felt like success.
The problem was that I could not explain why I had improved.
Was it the food? The water? The exercise? The routine? Some combination of them? Would the same thing work next time?
I had changed so many variables that the improvement taught me surprisingly little.
This bothered me because the next time constipation came back, I was nearly starting over. I had done a lot of work, but I had not preserved much of what the work had taught me.
Eventually I slowed the process down. I started paying more attention to what had changed, being more deliberate about what I was trying, watching what happened afterward, and keeping that information when I made the next decision.
I am an engineer, so this way of thinking came naturally once I finally got there. But I also took it much too far.
For years, I treated my own body like a research project. I thought about fiber while I ate. I wondered about water while I drank it. I evaluated whether every walk counted as enough exercise. I read research constantly and paid attention to almost everything my body did.
It worked well enough that I eventually got my constipation under control.
For a long time, I thought the lesson was that everyone should become a scientist of their own body.
I do not think that anymore.
It worked for me partly because I am an engineer who builds healthcare software, I enjoy reading research, and I was willing to spend an unreasonable amount of time on the problem. Even with those advantages, it was exhausting.
An answer that requires somebody to spend thousands of hours doing what I did is not a very good answer for most people.
What I want instead
Today, I do not normally walk into a restaurant and immediately look for the toilet.
Most mornings I wake up, drink water, have a bowel movement, and continue with my day.
It is automatic. It is boring.
Boring is the point.
I can still have a bad day. I can still get constipated. The difference is that a bad day does not automatically feel like a mystery anymore. I understand my own pattern better. I have context from what happened before. I know more about what deserves my attention and what I need help with.
That is also part of why I eventually built Gutsphere.
I did not want another tracker whose job ended once I entered the information. I wanted something that could keep what happened, what I tried, what changed, and what I had already learned together, so the next decision did not have to start from zero again.
And I wanted that system to reduce the amount of work digestive health took from my life, not give me another job to do.
If I could give the earlier version of myself one place to start, I would not give him a food list or another remedy.
I would tell him to ask a better question.
Not only:
“How often am I going?”
But:
“What actually happens when I try to go?”
I wish I had started there.
One caution I would add now that I did not take seriously enough myself: the first time I saw blood, I ignored it because it disappeared. I would not make that decision again. Rectal bleeding or blood in the stool, constant abdominal pain, vomiting, fever, unexplained weight loss, or being unable to pass gas deserve medical attention rather than more self-experimentation.
If you want help keeping your digestive-health story, what you have tried, and what you learn connected over time, you can learn more about Gutsphere here:
iOS: https://apps.apple.com/us/app/gutsphere-your-gut-companion/id6560105851
Android: https://play.google.com/store/apps/details?id=com.gutsphere.androidapp
And I am curious about something because I suspect many of us have one.
What part of your constipation did you live with for years before realizing it might actually be useful information?
For me, it was never feeling finished.