“The Business of Number Two”

I always joke with my patients and their parents about poop. I mean, after all, it is funny that I talk about poop for a living. Usually, when I tell my patients poop jokes, it lightens the mood and everyone relaxes…which is in and of itself, part of my medical treatment plan.

Most people come to their first feeding team appointment knowing little about recommendations that will be made. They are often tired from repeated referrals and treatment plans that have not worked. They are frustrated, they are tired, they are at their “wits end”. So, humor is one tactic I use to break through the tension, to lighten the mood and to let my patients and their parents let go a bit.

In reality, pooping is a main part of successful eating. Most people look at me a bit cross-eyed when I start asking the details about their “business”. How often, what does it look like (usually compared to some type of food), how big is it, does it hurt to push it out, does your stomach hurt before or after, do you poop at night, do you know when you need to poop? Why all these questions?

Constipation is a common problem in children, occurring in approximately 3% of children worldwide. In up to 40% of these children, constipation starts in the first year of life. Constipation is not just “hard poop”, but can manifest itself by infrequent and/or painful stooling, leaking of stool that can be confused with diarrhea (encopresis), abdominal pain, difficulty eating, vomiting and bloating. Imagine dealing with any of these symptoms and how that might impact one’s desire to eat.

Getting a very detailed history of each patient’s stooling history from birth is paramount to our success as a feeding team. Of course, we want to rule out more organic causes of constipation, such as Hirschprung’s disease, celiac disease and hypothyroidism, to name a few. We also will often use radiology, not because we need it to diagnose constipation, but often it is helpful in educating families objectively. If we get an xray that shows a large volume of stool throughout the intestines, it is often easier to justify the need for a clean out in a patient who may stool every day…though those stools may be hard little “rabbit pellets”.

Most often, constipation is “functional” or something that has occurred over time, without identifiable associated disease process. However, we, as a team, view it as a REAL problem, one that is worth the time and effort to investigate fully in order to allow each patient the best case scenario in GI comfort. We absolutely see a connection between ease and regularity of stooling with each and regularity of eating.

So, when your feeding team visit starts and ends with poop talk, don’t be alarmed. Treating constipation is a large part of what we start with in establishing “gut comfort”.   We have to address and aggressively manage constipation before we can move forward with our team goals. As my colleague says, “We strive to be number one in the business of number two…”