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Restoring anorectal sensitivity

To preserve life-long colorectal health and prevent colon cancer,  a healthy person should move the bowels after each major meal, or at least twice daily. Because circumstances are rarely ideal, many people tend to suppress urges and skip stools. This leads to hardening of stools, straining, enlarged hemorrhoids, and anorectal nerve damage — the primary conditions behind  irritable bowel syndrome and chronic constipation. Finally, one day,  fiber or laxatives are needed to initiate bowel movements because the urge sensation has gone for good. This guide will help you to restore anorectal sensitivity without resorting to fiber and/or laxatives.

When you are hungry, you eat — or die from malnourishment. When you are thirsty, you drink — or die from dehydration. When your bladder gets full, you go to the bathroom — or wet all over yourself. And when you feel the defecation urge, you just tense up your pelvic muscles and pull-in the external anal sphincter — and wait until the next call.

You can tell Mother Nature to wait because unlike with food, drink, and urination, suppressing defecation doesn‘t make anyone dead or soiled right away. And if you practice this long enough, the urge becomes less and less urgent — until one day a “scream” turns into a “whisper,” and renders you irregular or constipated.

So you add some fiber to make the urge louder. But it is still getting quieter because this time around, bulked up stools are causing anorectal nerve damage. So you add a bit more fiber, then more, and more, and more. Not surprisingly, at some point the urge becomes barely audible or completely mute, and you are the expert suppressor turned into the expert strainer with all of the related accouterments — hemorrhoidal disease, irritable bowel syndrome, inflammatory bowel disease, diverticular disease, colorectal polyps, and on, and on, and on.

Can you crank up the “volume” without fiber? Yes, with awareness and retraining, you absolutely can! In fact, turning up the volume isn‘t even that critical — you just need to learn to listen, that‘s all.

Can you turn the mute off? Unlikely. The damage has probably gone too far. Can you still attain normalcy and regularity without fiber or laxatives? Absolutely. If I didn‘t know how to accomplish it, I wouldn‘t have touched this kamikaze subject.

So, to help you along, here is an unabridged reprint of the “Restoring the Sixth Sense” chapter from my forthcoming book Gut Sense: How To Eat Without Harm, How To Fix What You‘ve Already Harmed.

I am that generous because a satisfied customer is always a repeat customer. There are so many digestive organs left to protect and fix above the anus that you‘ll have plenty of interest left to read my next book.

Restoring the Sixth Sense

The rectum and anus: life-long heroics, but little glory

When the input/output organs break down, our health and quality of life decline along with them. On the input side there are the eyes, ears, nose, and oral cavity. On the output side are the genitourinary organs and rectum and anus. Despite their critical importance, the rectum and anus are the least appreciated, understood, or cared for organs — and the most abused by fiber, or more precisely, by the hard stools caused by fiber.

Alas, what‘s taken for granted gets broken first. By the age of fifty, most Westerners still enjoy nearly all of their teeth, only slightly diminished vision, close to normal hearing, unimpeded urination, and the ability to enjoy reasonable intercourse.

But the rectum and anus is an altogether different story. Close to half of all Americans over fifty already suffer from hemorrhoidal disease, and most of this group suffers also from irregularity or constipation. Some of them may have distended rectums. Almost all of them have diminished anorectal sensitivity, or what can be aptly called the loss of the “sixth sense.” The first five senses are, of course, sight, hearing, touch, smell, and taste.

Since defecation is in part a voluntary act, and in part involuntary, this complex issue has yet another dimension. Just as most people can ignore the discomfort caused from wearing tight clothing or hearing loud music, they can also learn to ignore and suppress the voluntary segment of the defecation process. Although anorectal sensitivity may remain intact, the signal to visit the bathroom (sensitivity threshold) is no longer “heard.” In such cases irregularity and dependence on fiber commence much earlier in life than either age- or disease-related constipation.

This excerpt from Fiber Menace explains the functions of rectum and anus in the digestive process:

The rectum: All‘s well that ends well

The rectum is very much like an exit dock in a space station — it separates the rest of the “ship” from the perils of harsh outer space. Hence, the rectum of a healthy person is empty at all times. Its brief contact with stools and gases happens only on their final journey out to the sewer.

Unlike the colon‘s circular musculature, the rectum‘s is longitudinal, with strands of muscles running from top to bottom, very much like the drawings of biceps that hang in medical offices. The rectum‘s muscles stretch out to accommodate the feces as they move down from the colon, and they contract back to initiate defecation. The rectum‘s contraction completes an elaborate sequence of preceding events:

A final, and most crucial participant in this process is the nerve plexus along the anorectal line—the juncture of rectum and anal canal. When the stools reach this intersection, the final signal is sent to the autonomous nervous system to complete elimination. All of the same factors that compromise the rectum‘s ability to react and contract, desensitize the anal nerve plexus: large stools, nerve damage, hemorrhoids, anal fissures, medication, and others. Alas, as we age, these factors grow more and more pronounced.

Fortunately, improving anorectal sensitivity is easier than reversing nerve damage or shrinking a distended rectum. So let‘s begin with the easy part.

Anal control: Virtue turned torture

Domesticated cats and dogs can suffer from irregularity and constipation for the same reasons that humans do — captivity and dependence. In the pets‘ case it‘s a dependence on their masters, and in ours a dependence on social mores.

Once out of diapers, our bowels become captive to an endless variety of circumstances incompatible with health — we simply can‘t respond immediately to an urge to defecate while in the middle of the highway, halfway through the meeting, presentation, concert, date, and similar circumstances. Inevitably, we learn to suppress and defer involuntary reflexes for considerable stretches of time until the circumstances are just right — and that‘s dependence.

Alas, that valuable social asset (the ability to hold in one‘s gases or stools) eventually becomes a liability, and a precursor to irregularity and an inevitable dependence on fiber to fix it, for the same reasons other repetitive deeds turn into a predictable fate — diminished anorectal sensitivity.

Civilization comes with a price: a disruption of the rhythm and harmony of natural living. Some circumstances are more harmful than others:

The list isn‘t complete, but it‘s a representative one. Once you know how to prevent or eliminate irregularity related to a business trip or a weekend getaway, you‘ll know exactly what to do during a honeymoon, or during the emergency that plucked you out of bed in the middle of the night.

Although each life and destinfy is unique, the large intestine and its ills are fundamentally the same, whether in the lowly vagrant or the president of the United States. This is why when it comes to irregularity or constipation, what works great for one, works well for all. By the same token, what hurts just one, also hurts the rest. And nothing causes as much hurt as one‘s own mind?

The mind-behind connection

As much as irregularity impacts the mind, the mind impacts stools even more. Yes, it means exactly what you may be thinking: irregularity, literally and figuratively, may indeed commence in your head. And not a thing is going to relieve it, unless you “treat” your head first. Here are some of the most common precursors of this kind of irregularity:

Can you think your way “out” of irregularity and constipation the way you can think your way “in”? Absolutely. If your mind can control you, you can control your mind as well. This, in part, is what this information is about: helping you to reprogram your conscious and subconscious mind in order to replace old paradigms with new ones, erase scripts that don‘t work, and write new ones that do.

Don‘t laugh. Plenty of research points out that an expertly performed hypnosis is as effective for the relief of chronic constipation as laxatives . When it comes to irregularity, mind over fecal matter is indeed a viable reality.

Avoiding urge suppression: nine rules to prevent peril

Normal defecation — regular, complete, effortless, and without any straining — is an involuntary act with some degree of voluntary control exercised when the act commences, but not how or why it is initiated. That‘s why irregularity wasn‘t an issue for savages, who, always went al fresco (outdoors) and au natural (nude), didn‘t have to make any conscious decisions whether to defecate or not. They just did it whenever they wanted to, period, just like diapered toddlers do. This is why evolution hasn‘t endowed us with the skill of voluntary, on-demand defecation.

The voluntary control of one‘s bowel in civilized settings is, of course, essential. There is, however, a fine line separating voluntary control from stool suppression, and just where this fine line resides is hard to describe in words, or establish in quantitative terms when you cross that line.

While voluntary control helps you to get from point A to the bathroom without embarrassment, suppression helps you get from point A to point B without going to the bathroom. Voluntary control is an instinctive trait, passed along with genes, and well-mastered in time for preschool. Suppression, however, is an acquired skill, learned from parents or guardians, who permit or suggest “to hold it.”

By the teenage years, the ability to control the anal muscles without crossing one‘s legs becomes stronger, the nerve plexus less sensitive, and the anal muscles more tense. Unfortunately, the seemingly harmless habit of suppressing defecation eventually creates gut-wrenching problems that are the hallmark of irregularity and chronic constipation: increased size, mass, and weight of stools, fecal impaction, nerve damage, colorectal distention, and hemorrhoidal disease, caused by muscular tension inside the anal canal, which is applied to suppress defecation.

Because the defecation urge is as innate as thirst or hunger, there‘s really no “healthy” way of dealing with suppression, except avoiding and preventing situations when you actually need to suppress the urge. And the only way to do it — tactically as well as strategically — is by following these straightforward and logical rules:

Rule #1: Don‘t teach thy children wrong

Up to a certain age, defecation is as natural as playing or eating. Children don‘t associate defecation with shame, they don‘t get embarrassed by the noise or smell, and they aren‘t too squeamish about hygiene or toilet cleanliness. They just drop their little pants and do it, unless, of course, they hear: “Johnny, don‘t let your pants touch that dirty floor,” or “Mary, real ladies don‘t use public restrooms,” and so on. That‘s when little Johnnies and Marys begin mastering the art of suppression, pulling the pants back up as per mother‘s orders, or waiting to get back home to go to the bathroom.

Some of these unfortunate kids develop irregularity early on, some may get away with it until adulthood, and almost all of them will make up a contingent of future irritable bowel syndrome victims, simply because casual suppression leads to an accumulation of large stools in the large intestine. This in turn leads to a continuous pressure on the intestinal walls, and a ceaseless irritation of the mucosal membrane. There is really no way around this problem — i.e. needing a potty outside the house, unless you follow Rule #2.

Rule #2: Establish a regular elimination routine

Early on in basic training, young conscripts are taught to have a daily stool as part of their morning hygienic routine, because, once in the tank or trench, there‘s no room, time or chance to move the bowels. True, the soldiers‘ tender age, young intact guts, vigorous daily activity, and a military diet, usually rich in fat, quickly help to season these rookies into Rambos, but all of this shouldn‘t stop you from learning to relieve yourself on-the-clock at any age. Because you aren‘t in basic training, the techniques may be different, but the objectives are the same: make scheduled defecation as predictable as clockwork. And this is easiest to master when you follow the next rule.

Rule #3. Create thy urge

Doctors don‘t like hearing from their patients “But Monastyrsky said ...”, but they love to discuss their own problems with me for the same reasons you‘re reading this: they experience pain and discomfort as much as mere mortals do. In fact, one doctor approached me with the following question:

—Konstantin, he said, I understand the importance of relieving myself before leaving the house, but how do I do it, if I don‘t eat breakfast?

—Relax for a moment, and slowly drink a glass of warm water. Soon, you‘ll do it.

A few weeks later he called to thank me for this simple, practical piece of advice, which made such a difference to him. When you juggle patients all day long, there often isn‘t much time to get to the bathroom.

So how come a glass of warm water helped this doctor? Well, the physiology of drinking isn‘t much different from eating:

This is the point where you still have two options: hold it until you get to the bathroom, or suppress it. The second option may not be viable when the volume of stool exceeds your ability to suppress the urge.

All other things being equal, our internal organs prefer as little stress as possible, because a light workload limits organs‘ wear-and-tear, preserves energy, and causes no lasting damage. And that brings us to the next rule.

Rule #4: Keep stools small

Unlike large and hard stools, small and soft ones are easy to propel toward the rectum. A large stool hurts while it creeps along. Children and adults cringe with discomfort when they have to relieve themselves of dry, hard, and impacted stools (type 1 to 3 on BSF scale). Confronted with pain, they often suppress defecation to avoid it, causing themselves even more harm. Small stools “depart” quickly, and more or less unnoticeably. When this happens, there‘s no fear, no need to suppress anything, and little chance of needing to go to the bathroom while away from the house.

There‘s only one way to assure small stools (type 4 to 6 on BSF scale): through the avoidance of indigestible fiber and with timely, regular defecation. Small stools are less likely to stimulate a strong defecation urge in the wrong place at the wrong time. Small stools maintain a perception of complete elimination, and don‘t stimulate the defecation urge throughout the day. Besides all other benefits, small stools — size and weight-wise — are easier to hold in without damaging the colon, rectum or anus. But you aren‘t likely to need to hold anything in, if you follow the next rule.

Rule #5: Eliminate completely

Accomplishing completeness is a bit tricky, because there is no such thing as the “complete elimination” of feces from the large intestine — a healthy gut is never completely empty. Thus, completeness is a perception, not a physical reality, and that perception stems from actual fullness. There is only one way to create the perception of completeness, and that is to get rid of the factors that continue to “nag” the large intestine even after a bowel movement: a pressure on the intestinal walls by the remaining large stools, irritation of the mucosa, retention of compacted feces in the rectum, and excessive flatus (gases). Let‘s expand on that:

Secondary factors, more typical for irregularity and chronic constipation, such as scar tissue from surgery, internal hemorrhoids, anal canal inflammation, tightness of anal muscles, tumors, and other pathologies may affect the perception of completeness. If the problems continue to persist after the elimination of primary factors, you should undergo a complete colorectal examination to seek out and exclude other causes.

Following all of the suggestions here — improving digestion, excluding dietary fiber, restoring intestinal flora, reducing stool size, eliminating flatus, healing the intestinal mucosa, and excising hardened stools — will bring back gradual relief, and the welcome perception of complete elimination.

Rule #6: Minimize flatus

Intestinal gases are the byproduct of healthy bacterial activity, and are always present in the healthy bowel. Most of them escape during defecation, some absorb back through the intestinal walls, and some are let go voluntarily when the discomfort is palpable. Excessive gases stretch out the colon and rectal walls, and stimulate the defecation urge irrespective of all other physiological factors. The suppression of gases requires as much strength as the suppression of stool, and with the same unpleasant results — hemorrhoids, distention, and noticeable pain. There are many ways to reduce gases, some reasonable, some not:

These simple steps will help you reduce — never eliminate — the creation of gases. Not having any gas — a sign of severe dysbacteriosis — is much worse than having some.

Some people, even if they‘re in the same family, eating the same food, may experience more gases than others. This variance has to do with the peculiarities of individual digestive systems, such as the quality of chewing, volume of saliva, length of maceration, consumption of liquids, speed of digestion, gastric acidity, pancreatic sufficiency, enzymatic activity, level and composition of intestinal flora, and some other factors. Obviously, younger people produce less gases than older people simply because all the above function better and faster in the young than in the old.

Alas, only champagne gets better with age, not the gut. And this brings us to the next rule, which helps keep the gut young and healthy, and also helps eliminate the unnecessary stimulation of the gastrocolic reflex.

Rule #7: No snacking or eating

Any time you eat or drink, or even chew gum, the large intestine goes into motion with a gastrocolic reflex and mass peristaltic movement potent enough to stimulate even a strong defecation urge. Thus, it‘s best to avoid eating or drinking in places where you can‘t access an acceptable toilet. Of course, you won‘t have to deal with this problem if you follow all the previous rules, and relieve yourself before leaving home. If all else has failed, then follow the next rule.

Rule #8: Expect the unexpected

When the urge strikes, knowing where to find an acceptable bathroom is as important as noting in advance the location of a fire exit. But finding a bathroom isn‘t enough. Many people are reluctant to use public bathrooms because they lack essential niceties such as a clean seat, deodorant, soft toilet paper, or a flexible shower or bidet frequently found in Europe but not in the United States. Here‘s a common sense strategy that always works:

When traveling, I always carry around a small Ziplock bag that contains all of the above. My wife aptly calls it an “ass-saver.” I realize that the above suggestions might not be news to women, so this information is primarily intended for men. And that brings us to the final rule.

Rule #9. If it no longer works naturally, help yourself

There is no magic wand that can undo years of colorectal damage caused by hard stools. The stem cells that can re-grow anal and rectal nerves haven‘t been harvested yet. Until that time comes, rely on the least harmful “unnatural” means to accomplish the same result (see Practical Considerations). If you don‘t, the situation will only grow worse, and worse, and worse.

Along with everything else you‘ve learned here, observe these nine rules, and your anus will respond with uninterrupted service (little appreciated until it fails). Even when it fails for the very first time, it isn‘t too late to reverse back to normal. And indigestible fiber is the least appropriate means of fixing up anal sensitivity, because the small anus and bulky stools are as compatible as fire and ice.

The invisible stool-breakers: Nerve damage

Besides all the things you can do to avoid suppressing the urge-sensation, or causing one in the wrong place, there are more external and internal perils capable of desensitizing anal sensitivity. To break down their insidious destructive powers, you must act on many fronts, often unrelated to the digestion process itself, because, just like with muscles, blood circulation, or mucosal integrity, nerve damage is a body-wide, systemic problem.

Here are some of the major factors and conditions behind the nerve damage phenomenon, some of them already discussed in other chapters. As expected, the majority of them are caused by a diet high in fiber and processed carbohydrates, and low in essential fats and primary proteins.

First, here are the systemic causes, unrelated to the large intestine and stools:

In addition to the systemic causes just listed, internal disorders of the large intestine diminish anorectal sensitivity as well. Their impact is cumulative, and no age group is immune. Anal sensitivity may be reduced in toddlers, teens, and young adults — a tender age doesn‘t bestow any immunity against the mechanical and chemical damage caused by fiber, large stools, or diarrhea. Obviously, the older you get, the higher the vulnerability. Here are the major internal causes and disorders that affect anorectal sensitivity:

Since aging is inevitable, taking good care of your anus from birth is the only viable strategy for not experiencing problems in the most vulnerable “golden” years. This means applying all of the strategies outlined here and in Fiber Menace, and protecting children from the harm caused by processed fiber, excess carbohydrates, lifestyle drugs, poor toilet training, and bad parenting.

Practical considerations

So what do you do to overcome a partial loss of anorectal sensitivity?

Step 1. Normalize stool and restore intestinal flora using the Hydro-CM program. For as long as stools remains large, hard, or dry, you won't be able to restore anorectal sensitivity because these conditions compromise the physiology of defecation.

Step 2. Maintain proper stool morphology and regularity. If the damage hasn't gone far, don't suppress stools, and you'll be fine. If, on the other hand, your rectal sensitivity is diminished , or descending and sigmoid colons are too stretched to propel smaller stools, or the nerve damage is no longer reversible, continue using the Hydro-CM program to  moisturize stools and stimulate colonic peristalsis. As the fluids move into the rectum, stretch it out, and reach the anal plexus, the urge becomes much more pronounced.

In addition to the Hydro-C program, you can use rectal glycerin suppositories to stimulate a bowel movement. There are two distinct mechanisms of action for glycerin suppositories:

Glycerin suppositories should be used only after normalizing stools with the Hydro-CM program, otherwise you‘ll be stimulating a painful and traumatic expulsion of hard or large stools.

In general, using both — the Hydro-CM program and glycerin suppositories — works best. While the first softens, break downs, and moisturizes stools, the second stimulates defecation. Just make sure to take the Hydro-CM program an hour or two before inserting the suppositories.

If you need to rely on the hyperosmotic effect of glycerin suppositories on a regular basis, you are better off using the Hydro-CM program. That‘s because glycerin is a mild irritant. As such, it is contraindicated for people with inflammatory bowel disease, irritable bowel disease, anal fissures, acute hemorrhoids, and similar conditions. The Hydro-CM program has none of these contraindications, and offers additional anti-inflammatory and healing properties. 

Moreover, its delivery into the rectum is slow and inefficient, and it may also cause rectal discomfort and a burning sensation — especially pronounced among children and young adults, who are normally much more sensitive to all outside stimuli.

For the same reasons, you shouldn‘t use mini-enemas containing glycerin, deceptively sold as “Liquid Glycerin Suppositories.” These are more expensive, difficult to self-administer, a hassle to administer to others, uncomfortable to hold, irritating — and impractical for people with adequate anorectal sensitivity, who can use suppositories with rapid effect and less trouble.

Just as with any laxative, do not use glycerin suppositories if you are experiencing rectal bleeding, abdominal pain, nausea, vomiting, a sudden change in bowel habits, or haven‘t had a bowel movement in the past three days. Glycerin suppositories aren‘t effective for fecal impaction, and are undesirable for large stools, because strong peristalsis and vigorous propulsion through the anal canal may cause further anorectal damage. Always normalize stools first using the Hydro-CM program.

You may find that using two suppositories, inserted one after the other, may be more effective than using one. The reasons are: (1) the anus is about the same length as a single suppository (3 cm), and a single suppository is apparently not long enough to come into full contact with the nerve plexus region; (2) once pushed further inside by the second suppository, the first one stimulates defecation much faster and with more strength; (3) the faster you expel both suppositories along with stools, the less likely it is that the glycerin will cause an additional hyperosmotic reaction or irritation. Obviously, when just one suppository works fast and well, there is no reason to use a second one.

You may use glycerin suppositories to establish, quite reliably, the fact of anal (not rectal) nerve damage. If, during the first five to ten minutes or so after inserting two suppositories, you don‘t experience any defecation urge, then the damage is quite complete.

For those with little or no damage at all, the response is strong and vigorous, to the point where a numbing sensation in the legs might occur. Anything between these two reactions — from none to a strong urge — is a subjective measure of how much anal sensitivity you have left.

Just keep in mind that numerous external factors, such as medication, narcotics, and alcohol, can reduce or nullify the reaction to glycerin suppositories in the same way that these factors “turn off” the normal defecation urge and intestinal peristalsis. In the presence of these obstacles, this test isn‘t objective or meaningful. In this case, using them is pointless. Use only the Hydro-CM program instead.

Whenever you miss a bowel movement, the stools closest to the rectum harden up and dry out, making consecutive elimination much more difficult. That‘s why not missing bowel movements is key to a healthy large intestine and regular effort-free defecation. This “rule” was easily observed when life was simple: same village, same shack, same chores day in and day out. Well, life isn‘t like that anymore.

Finally, for best results and zero harm, make sure to use glycerin suppositories properly. Here are several tips:

As you can see, not all is lost — and lots can be gained. With minimal effort and a little practice, you can maintain regularity without fiber, harsh laxatives, and addiction. True, it‘s not the same as it was when you were in your teens, but neither is everything else — you don‘t have the same teeth, or the same hair, or the same vision, or the same hearing, or the same sex drive. But none of those facts are as bothersome as colorectal disorders.

And it‘s much more economical — your annual expenses from the Hydro-CM program and occasional glycerin suppositories will always be significantly less than what you are spending on laxatives, occasional colonics, co-pays, fiber-laden serials, prune juice, “cleansing” kits, and other archaic means of managing the absence of the sixth sense.