Why does travel make me constipated? A gastroenterologist explains.

Washington Post

14 hours ago

Adapted from an online discussion.
I have to travel for work sometimes and may be gone a week or more. I end up not having a bowel movement the entire time I'm gone. By the end, I'm bloated and miserable. Any suggestions?
Here's a fact: We all poop weirdly on vacation.
That goes for any kind of travel, whether for work or pleasure.
Our bowel movements love a routine. We're wired to optimally poop at certain times: within the first one or two hours upon waking, soon after eating meals, after a cup of coffee and after exercise. These classic triggers tell our colon to start contracting — propelling our poop forward and helping us feel the 'urgency' to go.
When we travel, everything about our routine goes awry. We're running around and become easily stressed, which greatly alters our poop patterns, and we're often left with no choice but a public bathroom when we feel the call. That alone creates so much poop anxiety that people are just unable to go.
Furthermore, when we travel, we tend to drink less water, eat more processed, carb-rich foods either on the go or indulging at restaurants, and we rarely get to drink coffee and exercise the same ways we do in the comfort of our home routines (sitting for hours on a plane isn't helping your bowels one bit).
Because of all this, traveler's constipation is quite common.
I strongly recommend you start taking something that will help at the start of the trip — even a day or two before leaving. It's always easier to get ahead of a problem than to chase after it when it becomes a crisis. Start with something easy like an extra fiber supplement or MiraLax, which is a mild laxative that pulls water into your intestine. If that doesn't do the trick and you find you're seriously backed up, go for a stimulant laxative like senna, which you can pick up over the counter.
My brother has watery, loose stools, four or more times a day. He does admit that it would be nice not to go so often, so what OTC remedy could he try?
You don't need to poop once a day to be healthy. The number of times we poop depends on a multitude of individual factors — our diets, our exercise patterns, how stressed we are and our circadian rhythm to name a few (did you know that, unlike many other organs, your colon rises and shines just like you do — it's why having a bowel movement in the first hours after waking is easier than later in the day!)
So I tell my patients that 'normal' is what's comfortable for you. In general, Americans think that anywhere from three bowel movements per week to three bowel movements per day is 'normal.'
It sounds like, for the most part, your brother is pleased with his habits. Four stools a day is on the higher end of typical, and I can't comment specifically on his situation without knowing his whole history. But assuming all else is stable, and he's perfectly content, I might let someone like this be. If he finds that the frequent call of nature is interfering with his ability to socialize, or leading to discomfort, he should absolutely talk to his physician. 'Change' is definitely possible ('improvement,' however, depends on your perspective here).
Perhaps the thing I love most about your asking this is that you and your brother seem to have a healthy open dialogue about poop! In so many families, this is not the case. In my own poop-friendly family, my father is also a gastroenterologist, so you can imagine what a delight the pair of us are at dinner parties.
After being as regular and predictable as Old Faithful until the age of roughly 48 (I'm a 51 year-old male), I find that I rarely have the sort of satisfying, bowel-emptying events that typified my 30s and 40s. Is this normal for a man of my age?
Dear Poopless,
Lord Tennyson once wrote: ''Tis better to have loved and lost than never to have loved at all.'
The same could be said of a great poop. Much like love, those who have known a life of effortless bowel movements suffer dearly when it's lost, but I'm happy to hear that you were able to experience that sheer joy for so many years. And I'm optimistic we can get you back on track!
Our bodies are constantly changing. Sure, some of it is age — constipation, after all, comes for us all and is more common among older Americans. But it's often other factors for which we may not be connecting the dots: Has your exercise routine shifted? Did you start any new medications or supplements? Has stress from your job, relationships or family shifted? For women, are you entering menopause?
I love starting with old-fashioned psyllium husk when things first begin slowing down. Fiber is a powerful, shape-shifting ally — it can bulk up loose stool and also soften hard stools.
Here's a pro tip: Try taking two kiwis a day — a 2021 study found that consuming two kiwis per day was just as effective in increasing stool frequency and reducing straining as prunes. But unlike prunes, eating kiwis helped with bloating too.
Since being on Ozempic, I'm always constipated. Without laxatives, I get severely impacted. Softeners and fiber were not effective. Any suggestions?
GLP-1 agonists, like semaglutide (brand name Ozempic), slow down our gastrointestinal motility, or in other words, how quickly our guts can propel contents forward. I know this comes as no surprise to anyone on these medications: the GI side effects are a huge reason many people can't stick with them in the long-term. This delay can affect our GI tracts from our stomachs all the way down to our colons.
In a much-discussed randomized-controlled trial of semaglutide for weight loss published in 2021, about 23 percent of people on semaglutide experienced constipation and 44 percent experienced nausea.
So what you're experiencing is common — and as more people get access to GLP-1 agonists, we're going to have to start being more preemptive in addressing these concerns.
Everyone's bodies and lifestyle is different — for some, increasing fiber or using the occasional over-the-counter laxative may be sufficient to keep things moving smoothly. But I'd explore options with your physician about what else you can try if you feel you've exhausted your options. We have many ways we can treat constipation, including safe but strong prescription medications at our disposal.
It could also be that you warrant other tests to see whether there may be any other issues contributing to your symptoms. For me, the main thing is not to suffer silently. If you let your doctor know how bad things are, we can work together on possible solutions.