Everybody Poops, So Please, Can We Have an Honest Discussion about Constipation and Brain Injury?

In one lecture I gave at the Hershey Medical Center in Pennsylvania, I met a man who pushed so hard to make the poop come out, he got a hemorrhagic stroke right after. Coincidence? Maybe not. 

The Cleveland Clinic has a test to determine how strong is the muscle activity in the anus. It’s called Anorectal Manometry. This test measures how well your muscles and nerves work together to push poop out. A catheter with a balloon attached is inserted into your rectum and the balloon is inflated with warm water. The other end of the catheter is attached to a machine that will measure your muscle activity.

If the man I met took and failed the test, there’s proof. If I took it, which I didn’t, I don’t know whether I’d laugh or cry. A balloon? C’mon!

Anyway, getting down to business, there is a strong connection between brain injuries—such as strokes, traumatic brain injuries (TBI), or other neurological damage—and constipation. This occurs due to several factors related to how the brain masterminds the bowel function, digestion, and mobility. The reason why constipation is common after a brain injury:

• Many medications prescribed after a brain injury, such as pain relievers called opioids, muscle relaxants, and certain antidepressants, can slow down bowel function and lead to constipation.

• The brain and nervous system play an important role in regulating bowel movements. The damaged brain can disrupt signals that control the muscles in the intestines, leading to difficulty passing the stool.

• Brain injuries can affect the body’s ability to recognize the urge to have a bowel movement, making the constipation worse.

• Anxiety, depression, and stress can also contribute to digestive problems, including constipation.

• Exercise and movement help stimulate the intestines to keep bowel movements like clockwork. After a brain injury, especially if mobility is reduced or one side of the body is weaker (as with stroke survivors), physical activity often decreases, contributing to constipation.

• Some people with brain injuries experience difficulty eating or drinking enough fluids due to swallowing problems (dysphagia) or reduced appetite. A lack of fiber and hydration can worsen constipation.

Ways to Manage Constipation After a Brain Injury

• Stay Hydrated: Drink plenty of water throughout the day.

• Establish a Routine: Try to have a bowel movement at the same time each day.

• Increase Fiber Intake: Eat more whole grains, vegetables, fruits, and legumes.

• Stay Active: Engage in as much movement as possible, such as walking or stretching.

Tom Robbins, an American novelist, once said, ” Our greatest human adventure is the evolution of consciousness. We are in this life to enlarge the soul, liberate the spirit, and light up the brain.”

And one more thing, Tom: to poop regularly. You can do it if you follow my recommendations! There! You got through the discussion on constipation. Congrats!