Lost on Journey: The Secret

During the Golden Week holiday in autumn, everyone is probably out and about, right? However, while looking for poetry and distant places, there always seems to be something that is difficult to explain...

Netizens discuss the unspeakable problem during travel - constipation

Image source: Xiaohongshu @脆皮青年自救指南 As netizens have discussed, constipation often occurs during travel. As early as 2003, a study from abroad showed that 46% of travelers experienced digestive problems during a week-long cross-border trip, of which 38% were constipation [1]. Many netizens self-deprecatingly said that traveling is about "seeing the most beautiful scenery and taking the hardest shit." If you can't poop, you won't feel comfortable anywhere, which especially affects the efficiency of "special forces" when checking in during travel.

01I can’t poop when I go out traveling. What’s wrong?

I believe that many people's first reaction must be: not acclimatizing! Looking through the "Chinese Idiom Dictionary", the concept of not acclimatizing first came from "The Three Kingdoms·Wu Zhi·Zhou Yu Biography": "Not accustomed to the local climate and water, will inevitably develop diseases." Therefore, 1,800 years ago, our ancestors would have felt unwell because of "moving". However, the main reasons for defecation difficulties when traveling are as follows:

1. Identify the toilet

You wouldn’t have thought that this would be the number one reason. Some people are obsessed with their beds, some are obsessed with their pillows, and of course some are obsessed with their toilets! In fact, the cause of constipation is primarily a “functional” problem [2]. In simple terms, “there is no disease, it’s just a mental problem.” Depression, anxiety, and adverse psychological events are also clear risk factors for constipation in the expert consensus , and we J people may have been accompanied by anxiety since we started making the strategy.

Image source: zuomeme.com

There are several ways to recognize toilets: you are used to sitting on the toilet at ordinary times, but you can only squat on the toilet when traveling; you can usually step on the ground to gain strength, but the toilets you encounter when traveling do not have the ground to step on; you usually like to flush your butt, but this is not possible when traveling; the toilet is too dirty, the smell is too bad, the cubicle door cannot be closed tightly, and you are nervous because there are people walking around outside, afraid that you will make too much noise and stink others... These may lead to dysfunction of the nerves and smooth muscles near the anus, commonly known as "the intestines are also nervous", causing constipation.

Image source: www.zcool.com.cn @凤兮520

If you are constipated because you are using the toilet, it is recommended that you try squatting to defecate. Studies have shown that squatting can shorten defecation time and improve defecation difficulty [2]. You can also massage your abdomen gently in a clockwise direction with your navel as the center to promote intestinal peristalsis and relieve "intestinal tension."

The effect of posture on defecation, the ease of defecation is A＞D＞C＞B
Image source: Shenzhen People's Hospital @Dr. Wang Dong

2. Changes in diet content and structure

Food is the most important thing for Chinese people to do when traveling. One of the most important things for us Chinese people is to taste the local specialties, but if we are not careful, we can easily develop serious picky eating habits. For example, in Sichuan and Chongqing, we eat hot pot in turn, in the Northwest, we love meat, and in the Northeast, we are bombarded with carbohydrates... Special foods that make people sigh that "you can't finish them even if you eat ten meals a day", which really leaves people with less stomach capacity to eat vegetables and fruits.

Image source: Photo Network In order to defecate smoothly, we should consciously eat more vegetables and fruits during the trip to increase dietary fiber intake. The latest expert consensus recommends that at least 20-35g/d of dietary fiber should be consumed every day (approximately equivalent to 1 kg of lettuce), and soluble dietary fiber [2] (vegetables, fruits, etc., prunes and dragon fruit are recommended). The laxative effect of insoluble dietary fiber (such as roots, whole grains, etc.) is controversial, and it is not recommended to deliberately eat more to relieve constipation. It is worth mentioning that the expert consensus does not clearly define the effect of spicy food on defecation. If you happen to love spicy food, you can choose food according to your actual situation.

Image source: Photo Network

3. Not drinking enough water

When traveling, it is inevitable to be tired from traveling. Sometimes, the distance between scenic spots is very far, and the transition time is long. Or we are always afraid of "looking for a toilet as soon as we enter the scenic spot", which will delay our travel efficiency. In addition, the mineral water in the scenic spot is always sold at double the price, which leads us to intentionally or unintentionally reduce the frequency and amount of water we drink. As a result, the stool becomes dry and hard, leading to constipation. To avoid this situation, it is recommended to ensure at least 1.5~2L of water per day [2] (approximately equivalent to 3~4 bottles of the most common size of mineral water) to allow the stool to be fully "lubricated" and "leave" smoothly.

Image source: Photo Network

4. Changes in daily routine

Research has confirmed that intestinal movement is closely related to the circadian rhythm [3]. Everyone has their own fixed bowel habits. Some people defecate as soon as they wake up, some defecate after breakfast, some like to "take a paid shit", and some like to squat before going to bed at night to let themselves fall asleep. In our thousands of years of traditional Chinese medicine culture, it is mentioned that "the hand yangming large intestine meridian is paired with the hour of Mao", which means that the best time to defecate is between 5 and 7 in the morning , which coincides with the view of modern medicine [4]. But! When traveling, unless you are rushing to a certain tourist attraction, no one will get up so early for no reason! This leads to not defecate when you should, and what is the result? You hold it back! Everyone must have experienced that once the regularity is broken, it is not so easy to let the shit that has been held back come out.

Image source: The Paper @栗子阿孙, 张思凡

02 The poop that is held back "rubs and rubs, like the devil's steps"

The poop you hold back is not as obedient as you might think. It is not willing to wait until the next day at your usual time to open the door and excrete. It stays in the colon, constantly absorbed by the intestinal mucosa, and repeatedly rubbed in the intestinal cavity as the intestines move, becoming dry and hard , slowly turning from "banana poop" to "sheep poop", and the difficulty of pooping instantly increases by several levels. At this time, drinking a lot of water can no longer replenish its water and reverse the transformation.

Image source: Xiaohongshu

If you don’t defecate for several days in a row, the accumulated feces will become more and more, and thicker and thicker. The intestines will expand like a balloon, and the pressure on the anus will increase. At this time, the feces have become a devil. You can’t defecate without force, and if you force it, it will easily cause anal fissures. In the elderly, it will also induce cardiovascular and cerebrovascular diseases, which is life-threatening. In clinical practice, I have also encountered patients who have not defecated for two or three weeks. When they took an X-ray, their stomachs were full of feces, which was extremely shocking. In fact, the human intestine cannot store feces endlessly. Just like a balloon will definitely burst, when the pressure on the intestines is high, either the food can only come out of the mouth (intestinal obstruction[5], massive vomiting), or it will be "exploded" (acute peritonitis[6]). These situations are not uncommon.

Abdominal upright radiograph of a patient with constipation

Image source: Internet

Of course, some friends say that there is really no way, there is really no place to defecate regularly outdoors, and sometimes they hold it in for a week. In fact, generally speaking, it is not a big problem for normal people not to defecate for a short period of about a week, and there is no need to worry too much . The intestines can still hold this amount of feces. However, it is still recommended that friends who are worried about constipation can prepare some probiotics that do not need to be refrigerated (such as Clostridium butyricum, and in an emergency, you can also take a lot of yogurt to supplement probiotics) and acute laxatives (such as enema, lactulose, polyethylene glycol, etc.) during the trip, in case of emergency.

Image source: Photo Network

Finally, in order to better immerse yourself in the poetry and the distance when traveling, here is a special guide for you: "Travel to the Toilet"
Drink a cup of warm water in the morning to moisten the intestines and detoxify without feeling tired. Drink fruits and vegetables regularly to enjoy the fiber-rich digestion. Develop a habit of going to the toilet regularly, and don't wait until you are in a hurry to regret it. There are some tricks for defecation posture, squatting is really good. Keep a calm mind and worry less, and stress makes it difficult to defecate. Gently massage the abdomen in time to promote peristalsis and facilitate defecation. Prepare good bacteria and good medicine, and don't worry about the hidden troubles of constipation.
Shanghai Health Science Popularization Special Plan, Project No.: JKPXZX-2024-A07

Recommended level for popular science reading: entry level

References

[1]Mearin F, Zárate N, Sardi JA, Moreno-Osset E, Salis G. Traveler's constipation. Am J Gastroenterol. 2003;98(2):507-509.

[2] Gastrointestinal Motility Group of the Chinese Society of Gastroenterology, Chinese Medical Association, Functional Gastrointestinal Disease Collaborative Group. Chinese expert consensus on chronic constipation (2019, Guangzhou) [J]. Chinese Journal of Gastroenterology, 2019, 39(9): 577-598.

[3] Duboc H, Coffin B, Siproudhis L. Disruption of Circadian Rhythms and Gut Motility: An Overview of Underlying Mechanisms and Associated Pathologies. J Clin Gastroenterol. 2020 May/Jun;54(5):405-414.

[4] Narducci F, Bassotti G, Gaburri M, Morelli A. Twenty four hour manometric recording of colonic motor activity in healthy man. Gut. 1987 Jan;28(1):17-25.

[5] O'Donnell MT, Haviland SM. Functional Constipation and Obstructed Defecation. Surg Clin North Am. 2024 Jun;104(3):565-578.

[6] Alburakan A, Alshunaifi A, AlRabah R, Alshammari S, Alnasser S, Nouh T. Chronic constipation that resulted in fecal impaction and colon perforation: A case report. Medicine (Baltimore). 2022 Aug 26;101(34):e30206.

Author: Ding Hui, attending physician of the Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine

Editor: rain