How Bowel Health Can Affect Your Substance Use

Don't self-medicate bowel problems—see your doctor instead


Bowel health is one of the most stigmatized health problems. It seems that, although everyone has bowel problems from time to time (more than three bowel movements a day is considered diarrhea, less than three bowel movements a week is considered constipation), they cause more embarrassment than much more serious problems. Even people who use substances, who are constantly living with the stigma of drug use, can sometimes feel greater embarrassment about their bowel problems than their drug use, and be even more reluctant to discuss these issues with the person who is most likely to be able to help them—their doctor or healthcare provider.

If you have an addiction, there are specific ways that bowel issues may be affecting your chances of recovery. In addition, concurrent conditions, including those you may not even be aware of, are also important for you to know about. Your substance use might even be worsened by attempts to self-medicate bowel issues which could be addressed by simple dietary or behavioral changes. But if you don't discuss them with your healthcare provider, you may continue to suffer unnecessarily, and delay getting the help you need for your addiction and potentially for treatable bowel problems.

So, how do bowel issues affect your addiction? Here are some possibilities:

Using a Substance to Get You 'Going'

Over the years, the use of drugs to get a bowel movement started has been confided to me in hushed tones. Whether it is your ongoing addiction to caffeine, which starts with a morning caffeine or tea to wake up your bowels, a cigarette, or even a stiff drink or a joint, so many people with addictions feel this is the "only" way to go.

However, they may not have tried the many simple behavioral changes that can improve bowel health.

Constipation is a common problem, particularly among people who suffer from stress. And the physiological and psychological effects of certain drugs can help relax the bowels. But there are much healthier, and overall more effective ways of regulating your bowel movements, for example, ensuring that you are properly hydrated, you are taking enough exercise, and that your diet contains adequate fiber.

If you want to try and tackle your constipation on your own, there is plenty of advice in our chronic constipation treatment guide.

If following this advice isn't enough and after trying everything you are still having problems with constipation, don't despair. Your doctor can help with exploring the cause of the problem and can give you healthier options for improving your bowel health. And although medical marijuana may be used to treat irritable bowel syndrome, it is much safer to use the substance under the guidance of a physician than it is to self-medicate.

Your doctor will also be able to guide you on the use of laxatives, if they are even appropriate in your situation. Again, this is something best done in collaboration with your physician, as over time, use of laxatives can be damaging to the digestive tract and the body can form a dependence on laxatives in order to function. And some people with eating disorders, including various food addictions, get hooked on laxatives as a way of purging after bingeing. Enough said.

Smoking to Cope With Gas

Passing gas is normal. In fact, most perfectly healthy adults pass gas up to 20 times a day. However. some people are extremely embarrassed about flatulence, to the point where they will smoke, simply to cover up the odor of gas.

Given the high cost of smoking, both financially and in terms of the negative impact on health, this is a self-defeating strategy that nonetheless keeps some smokers hooked.

I've worked with a number of smokers who can't seem to manage to quit smoking, who have admitted that, particularly in social situations, smoking cigarettes or marijuana masks the embarrassment of gas. Offering cigarettes to others covers up the embarrassing odor of flatulence even more effectively, because cigarette smoking interferes with their companion's sense of smell. People suffering from the discomfort of trapped gas may also use cigarettes or marijuana to relax their bowels and help them to release gas.

And they may even feel too embarrassed to discuss it with their doctor.

Yet, as with constipation, there are other, much less deadly ways of dealing with the causes of gas, detailed here in our tips on gas and bloating. There are also many relaxation and breathing techniques that can help you to safely relax your bowels, as well as your whole body. If none of these approaches are enough, see your doctor for more advice on your specific situation.

Letting Diarrhea or Fecal Incontinence Put You Off Detox

One of the most serious effects of the embarrassment that some people feel about bowel problems is their avoidance of life-saving detoxification treatment for substance use disorders. Some drug users have the opposite problem to the constipation described above. Surprising thought it may seem, some people are so anxious about diarrhea, and possible incontinence, if they quit drugs, that it puts them off getting proper medication management for detox.

People who have been using heroin might feel so disgusted with the process of withdrawal, particularly the diarrhea that typically occurs, that they want to avoid other people while they are going through withdrawal, both medical staff and other patients. This is a serious safety issue, as severe withdrawal symptoms, including those associated with dehydration, which can occur after severe diarrhea, can be life threatening. It is also a flawed way of thinking about the problem—if anyone can help to alleviate your withdrawal symptoms, it is the addiction specialists who work in detox facilities.

It is true that diarrhea, as well as nausea and vomiting, are symptoms of heroin withdrawal and withdrawal from other opiates, including opiate-based pain killers. Some people even use the constipating effects of these drugs to control recurrent diarrhea. But as with other bowel symptoms, there are other, much more healthy and effective ways of controlling diarrhea

Many of us experienced shameful experiences of "toilet accidents" during childhood, and the idea of having one as a adult can be the ultimate in social shaming for adults. The fear of fecal incontinence can be enough to cause people to delay quitting opioids for years. But maybe you should ask yourself whether the potential embarrassment of a few days of diarrhea among people who are either going through the same thing themselves, or who are professionals who are well aware of the symptoms, and deal with them every day, is really as bad as staying addicted to drugs. Detox is by far the best place to be if you are withdrawing from alcohol or opiates.

Warning: Bowel Symptoms May Be Caused by Another Condition

Perhaps the best reason to face up to your bowel symptoms, rather than try to cover them up with substance use or avoid getting appropriate treatment, is that they may actually be caused by an underlying health condition. These other conditions could be potentially serious and very harmful if left untreated.

Staying silent about your bowel symptoms and using drugs to cope with the problem may prevent you from identifying the real cause of your bowel symptoms. For example, there are a number of different causes of diarrhea, as well as flatulence and constipation. If the cause is addressed directly, whether through diet, behavior, such as exercise or eating patterns, or treatment for an underlying condition, it can eradicate the distress that can keep you in a harmful pattern of substance use that is based on social stigma and embarrassment.

Incontinence is often a symptom of or co-occurs with Alzheimer's disease and dementia, which can be triggered by long-term alcohol or drug abuse. Because alcohol or drug intoxication can mimic dementia, and can, for some people, occasionally result in incontinence, it can be hard to know whether someone with an active addiction is intoxicated or suffering from dementia. Don't assume that they are, even if they seem affected when you do not think they are intoxicated. I have personally seen people who seemed extremely impaired by dementia become surprisingly coherent after just a few weeks of abstinence.

If you or someone you care about is experiencing symptoms of dementia, an assessment and diagnosis is your best bet for getting the right kind of help. It makes sense to talk to your doctor about it.


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