Unspeakable messes: How ADHD might be messing with your sh*t
It was around the point that the Peking Duck arrived that my uncle pulled out the cards.
We were crammed around the largest table in an upscale Chinese Fusion restaurant, celebrating my cousin’s birthday. The place was full, and the chatter of the surrounding tables meant there was no chance for a conversation to cross the growing mounds of food. But I had seen my uncle reach into his pocket and pull out a small card, placing it in front of my dad in triumph.
My uncle is an anaesthetist, and from what I had managed to pick up from the tiny snippets I could catch, he’d spent the week at some sort of medical conference. That didn’t explain the look of amusement on my dad’s face. Or the outrage on my mum’s.
My uncle, fuelled by the child-like joy of getting a reaction from his younger sister, pulled out an entire stack of the cards and began passing them around the table to a mixed reaction of confusion, amusement, and general embarrassment.
The cards were about healthy faeces- yeah, you read that right. Each one had a detailed coloured scale, with illustrations of poo ranging from swampy green liquid to tough pebbles, with a wide variety of stool in the middle. With a devious glint in his eyes, my uncle asked me loudly across the table: “So, what does yours look like?”
At this point, my mum finally shut it down. Apparently, yelling questions about her youngest daughter's bowel movements in the middle of a crowded restaurant finally crossed the line. Or maybe it was that the card had finally reached their 80-year-old mother, who seemed to be considering it carefully. It didn’t really matter.
I had already begun to realize that beyond the humour and sibling jibing, the information on this card was incredibly important. It was the first hint that maybe something was wrong with my body.
Okay, I know you’re probably thinking, “Wasn’t this meant to be about ADHD? What’s all this sh*t?” So, I’m going to cut to the chase. Chronic Constipation (CC) is an extremely common problem for people with ADHD, and it can be way more dangerous than you might think.
I actually first came across the connection in an article criticizing the rise in adult diagnosis of ADHD. I had been diagnosed at age 24, two years ago from writing, and was reading it with some mix of self-flagellation and intent to write a rebuttal. But any half form intentions I had were entirely derailed with a single line.
“I even had someone claim that their ADHD made them constipated.”
This made me pause. I’ve been suffering from… let’s call it defecation difficulties, for basically my whole life. I hadn’t even noticed until my uncle’s card in that Chinese Fusion restaurant. We don’t often talk about bowel function, and we definitely don’t talk about what’s normal or healthy. But by this time I knew I suffered from both CC and ADHD.
As it turns out, the link between ADHD and CC is pretty well clinically documented. Organizations like CHADD, a prominent ADHD advocacy group, have even begun screening for CC specifically in it’s patients.
According to a 2018 clinical review, 23% of ADHD patients have a history of CC symptoms, or are currently being treated for CC (Attention Magazine, 2018). This is 50% higher than the general population.
Another study found that children with ADHD were almost three times more likely to suffer from constipation versus those without ADHD (McKeown, 2013).
Something definitely seems to be going (or not going) on in the guts of people with ADHD. But does a mental health issue that stops you from doing sh*t actually stop you from doing sh*t?
It’s not quite that straightforward. ADHD is characterized by difficulty in holding attention and issues with executive functioning. As weird as it sounds, you need both to maintain a regular bowel movement. Almost universally, the consensus is that it’s a behavioural link.
How did I get this far into life without realizing that “bathroom habits” were an actual habit I was meant to maintain?
How can ADHD cause Chronic Constipation?
A lot of the typical behaviours which characterize ADHD can predispose people to developing CC in quite surprising ways. Here are a few behaviours you might want to keep an eye on if you have ADHD, summarized from the CHADD website.
You don’t pay attention to your body
Either you don’t notice that you need to go, or you’re so absorbed in your current task that you ignore the signals your body is sending you. Who hasn’t come out of a hyperfixation marathon with the realization that you haven’t drunk water in six hours and you totally skipped lunch. Routinely ignoring that your body needs to go to the bathroom can result in the bowel walls stretching, and the signals from your bowels end up weakening. Stool that sits in your gut for too long becomes drier, and harder to pass.
You get bored waiting
Maybe you’re frustrated about stupid body functions stopping you from getting back to what you care about, or maybe you just struggle to sit still for that long. Either way, it’s common for people with ADHD not to let the pelvic muscles relax enough to pass a bowel movement, or to impulsively get up off the loo because there’s no immediate action. Incomplete bowel movements become larger, firmer, and harder to pass.
On the other hand, straining to pass stool quickly can be extremely unhealthy. I’m going to be honest, I had thought straining was just part of the process. Apparently not. Straining whilst defecating can cause anal fissures, haemorrhoids, and in severe cases, pelvic organ prolapse. I people like me, who have a family history of colon cancer, it can be especially dangerous.
You don’t maintain a gut-friendly diet, hydration, and exercise schedule
Ah. The trifecta of self-care. I was once so absorbed in a project I was working on that I ended up in the hospital for dehydration. Sometimes it’s hard enough to manage more than cheesy pasta for dinner, let alone thinking about balanced diets and fibre intake.
But obviously, what you put into your body affects the way it comes out. There are two types of fibre in food: soluble and insoluble. Both are required for a healthy gut function, and without them (and proper hydration) the path food takes through your body is going to be slow and dry.
Exercise can also help a lot with digestion. Getting your body moving, surprise surprise, gets your gut moving, and helps you pass bowel movements more efficiently. Spending four hours hunched over a desk painting a figuring with a single horse hair apparently does not.
You have difficulty with a schedule
I missed the memo that bowel movements were meant to be on a routine. One of the long term treatments for CC is regular training of the pelvic muscles, ie. going to the bathroom for a set time, at the same time, daily. For someone with ADHD, it can be difficult to comply with the routines required to correct the problem, or prevent reoccurence.
You don’t know what’s normal
This point wasn’t in any of the papers I read, but it was the key takeaway from my entire little sh*tty research project. I didn’t know what’s normal, and you probably don’t either.
For instance, constipation can be a lot more than just not passing bowel movements for days on end. I had what doctors refer to as “difficulty passing bowel movements”, that is, needing to strain or experiencing pain when passing stool. The little pebbles on my uncles card? Not normal.
Similarly, I kept ending up on articles about how long people are meant to sit there before their body works its waste management magic. What I learnt? I had been waaaaay too impatient with my body. I was bored with waiting, but more importantly, I didn’t know how long I was meant to wait for. FYI, people tend to take up to five or ten minutes to fully complete a bowel movement. Doctors suggest spending no longer than 15 minutes on the loo, as this might result in some of the straining issues I talked about earlier.
Had I not been paying attention when someone was explaining all this to me? Or was this a case of taboos getting in the way of important medical knowledge? I couldn’t help but think about the way my mum had reacted to that card ending up in front of me during dinner.
If you’re wondering, that diagram is called the Bristol Stool Chart. Now you can answer the question yourself: what does yours look like?
Obviously, I’m not a doctor. I’m not qualified to tell you how your body should behave, and I’m definitely not qualified to tell you how to fix it. But I was shocked about how under-informed I was about my bathroom habits, or how serious some of the consequences could be. If you think you suffer from Chronic Constipation, or have any other bathroom-related health concerns, please seek help from a medical professional.
And from one person with ADHD to another: get interested in your health however you can. It might be the hyperfixation that saves your life.
Lilian Robson is an Australian writer living in Berlin. This is the first in her series Unspeakable Messes, in which she delves into the ways ADHD interacts invisibly with the gross or taboo parts of life. Follow her for more, and if you found this helpful, please share it with others!
