Bowel Issues – Part 2, by Dr. Bob

Mechanical bowel problems
Mechanical bowel problems can include gallstones, bezoars, malrotation, ileus, foreign bodies, food impaction, stool impaction, tumors both cancerous and benign, and intussusception.  Then there is the mechanical problem we can actually do something about in a TEOTWAWKI environment:  constipation.  First, we will review the list and talk a little bit about prevention and conservative treatments of the list above; then we can spend some time reviewing the prevention, treatment, and management of constipation.  We will also talk a little about constipation’s frequent sidekick:  hemorrhoids.  Fun topics, to be sure, but a little knowledge in these areas may one day really help your overall peace and comfort in a survival situation.
Gallstones form in the gall bladder and can obstruct the cystic duct, the common bile duct, or worse at the opening of the small intestine causing a painful and potentially deadly condition called pancreatitis.  Gallstones most often pass on their own without problems.  They can be encouraged to pass with a simple home remedy that Docswife herself has used successfully:  3 tablespoons of olive oil with 3 tablespoons of lemon juice.  This remedy encourages gall bladder spasm and emptying, and it seems to work for those stones that are “on the line” of being big enough to cause problems but just need a little shove.  It is worth a try if you have no surgical options in the future.  If you know that you have had gall bladder problems before and still do on occasion, now would be the time for an elective surgery to remove it.  Don’t wait until it is not an option.
A bezoar is a collection of compacted indigestible material that accumulates in your digestive tract, and can sometimes block the intestine (large or small) and is synonymous with a food impaction.  Bezoars usually form in the stomach, though they may also occur in the intestines.  Bezoars can be made of fibrous vegetables (celery, etc.),  hair, fibers or medications that don’t digest properly.  Usually it is the “rolling” feature of digestion that continues to “ball up” whatever is starting the bezoar into a larger problem.  Bezoars may cause lack of appetite, nausea, vomiting, weight loss and a feeling of fullness after eating small amounts.  Bezoars most often occur in people with certain risk factors; like those with delayed stomach emptying, people with diabetes, or end-stage kidney disease.  Without one of the risk factors for bezoars, you’re not likely to develop them.  If you are high risk, reduce your intake of foods with higher indigestible cellulose to reduce your risk.
Malrotation, intussusception, and ileus are all mechanical bowel problems caused by the wave-like muscle contractions of the intestines.  Malrotation is just what it sounds like, the bowel “twists up” in the wrong way and pinches off the flow “downriver” and causes a backup.  This leads to pain, cramping, vomiting, and eventually death as the bowel will die of at the site of the twist.  Intussusception is a “tunneling” problem where the bowel slips inside another section of bowel and sometimes gets stuck.  It most often is a problem of children 3 to 5 months old and rarely it is a problem of older adults.  If an adult suffers from intussusception, it is nearly always from another cause (like cancer).  Intussusception is a very serious problem as the intestine will begin to swell and then the problem worsens and then can cause perforation which will lead to abdominal infection and death without surgery.  Ileus is the lack thereof of such contractions, almost always after a surgery.  Ileus is very common in hospitals now, as when a person wakes from surgery the bowels sometimes take longer to “wake up” and this is why nurses ask incessantly about passing gas and your bowels if you have ever had a surgery before.
Foreign bodies are self-explanatory.  Most often children and psychiatric patients will swallow things they should not and it can cause obvious bowel trouble.  Amazingly, coins smaller than a quarter will almost always pass through a child without problems.  Single coins, buttons, and other non-pointy objects will usually pass through the bowel without problem.  Lots of things that are eaten that you would think may cause problems like straight pins, needles, and other metal objects can often be digested by our stomach acid and are rendered fairly harmless.  Obviously, if you swallow something that cuts into your bowel or blocks it entirely, bad things will happen post-collapse.  Don’t do that, and keep others in your group (like kids) from doing it too.
Tumors can cause many of the above secondary circumstances, due to the mass itself.  Malrotation and impaction are common due to tumors, both benign and cancerous.  Bleeding can occur with any larger tumor that is eroding the bowel wall.  If erosive or large enough, the tumor can cause perforation leading to unhappy non-survivor syndrome.  There is nothing you can do about a tumor once you have it post-grid, so make sure to get your colonoscopy if you are over 50 and see your doctor for any tumor concerns now.
Food impaction was discussed just a bit ago, because bezoars are sometimes food.  Other times, food gets far enough digested to become a fecal impaction.  Impaction is related to, but different from constipation itself.  Impaction is due to the “rolling” action of the bowels previously mentioned.  In some instances, this rolling can cause large “balls” or “rolls” of stool to harden into nearly rock-like stools.  These can get large enough to need to be removed surgically at times.  Children that often avoid bowel movements are at high risk.  Once, I helped coach a child suffering from impaction to birth an impaction ball that was literally the size of a baseball.  Amazing, and it must have hurt to be sure.  Impaction can cause severe pain, diarrhea as the stool blocks other stool behind it but lets liquid pass around it, and ultimately vomiting as the stool backs up all the way to the source.  Perforation of the bowel can occur, which again leads to bad outcomes at TEOTWAWKI.
Long before impaction comes constipation.  Constipation should and probably will have its own article in the future.  The short version of the story is prevention.  Prevent constipation before it starts, or treat it early to clear it before it worsens and bad things happen.  Prevention starts with being informed.  Regular bowel movements are important, bowel health is essential to survival long-term and comfort short-term.  Fluid and fiber, fluid and fiber, fluid and fiber.  Repeat.  No one should ever take fiber without thinking consciously about increasing their fluid intake.  It’s that simple a rule.  Fiber goes with fluid, and visa verse.  Another that I stress for patients is regular exercise.  Moving around seems to help move around your bowels.  This is another reason nurses get you up and moving after surgery to encourage your bowels and prevent ileus.  Darn, those nurses are smart!  Laxatives should be used as a last resort for management of constipation, but again waiting too long can cause more of a problem to solve.  There is a fine line in using laxatives too much, but in TEOTWAWKI laxatives will be scarce and should be used sparingly.  After all these have failed to produce results, mineral oil enemas and disimpaction are the final options.
With constipation or with simple diet changes can come hemorrhoids.  Hemorrhoids are more common with protein-heavy diets, and with increased physical activity.  Hemorrhoids can be miserable, and sometimes internal hemorrhoidal bleeding can be severe, even life-threatening at times.  Prevention and early treatment are the best approaches.  Prevention of hemorrhoids is accomplished with the same general recommendations as constipation; but also witch hazel wipes, anti-hemorrhoidal medications and plain old ice used early can really help nip the bud in this situation.  Diet changes often will cause constipation and hemorrhoids, sometimes both, sometimes one then the other.  Weight control, regularity in diet, regular exercise, and sweat control can all help prevent or reverse hemorrhoids quicker.  All preppers should have a good supply of witch hazel wipes and hemorrhoid suppositories for treatment.  Ice may not be available, but if it is, ice is a much better treatment plan than topical gels or creams.  Good hygiene can also help treat hemorrhoids once they start, keeping everything nice and clean and dry down there is essential.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: