You’ve Been Pooping All Wrong!

Summary

Podcast Summary – "You’ve Been Pooping All Wrong!"

Podcast: This Is So Awkward
Hosts: Dr. Cara Natterson & Vanessa Kroll Bennett
Guest: Dr. Trisha Pasricha, Gastroenterologist & Assistant Professor, Harvard Medical School
Date: May 12, 2026

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Episode Overview

This engaging, science-backed, and delightfully candid episode explores a taboo yet universal subject: pooping. Hosts Dr. Cara Natterson and Vanessa Kroll Bennett welcome gastroenterologist Dr. Trisha Pasricha, author of You’ve Been Pooping All Wrong, to answer all the questions we’re too embarrassed to ask—how to poop properly, what “normal” really means, the brain-gut connection, and how social, cultural, and hormonal factors shape our digestive experiences. With humor, honest personal stories, and the latest medical science, the conversation tackles everything from period poops to why smartphones in the bathroom might be ruining our butts.

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Main Discussion Points & Insights

1. Why Are We Pooping Wrong? (04:05–11:45)

• Public Confusion About Normal Pooping:
  Dr. Pasricha describes how even as a trained gastroenterologist, she was shocked to discover most people don’t know what “normal” pooping looks like. Patients embarrassingly “linger at the door” to ask if their habits are okay.
  • “People would come into my clinic… but what they really wanted to talk about… they would like, linger by the door… ask, is my poop normal?” (04:37, Dr. Pasricha)
• We Don’t Talk About It Enough:
  Cultural taboos mean people don’t discuss bowel habits, leading to confusion and unnecessary suffering. Shared family anecdotes highlight the wide variety in attitudes about talking poop.

2. What Is Normal? (09:36–11:45)

• No One-Size-Fits-All Frequency:
  Dr. Pasricha notes “once a day” is a myth—what matters is comfort and that pooping doesn’t interfere with your life:
  • “The two rules… it should be comfortable, it should be effortless, and two, it shouldn’t disrupt your social life.” (10:38)
• Early Detection and Health:
  Normalizing bowel conversations can save lives, as early colorectal cancer is treatable—but “one in three people avoid talking to their doctor about their bowel habits because they’re so embarrassed.” (11:46)

3. The Social Life of Pooping (13:07–14:31)

• Individual Differences:
  The “pooportunity” concept: some people have a set daily window, others can “go” anywhere. Culture, upbringing, and location shape bathroom behavior.

4. The Concept of “Poopforia” (16:36–20:03)

• More Than Regularity:
  Dr. Pasricha introduces “poopforia”—not just being regular, but pooping being “the least of your daily concerns. It’s quick, it’s effortless, you move on.”
  (17:22, Dr. Pasricha)
• Stress and Social Life:
  She distinguishes between “relief poops” (ahh!) and having a healthy, predictable, easy routine.

5. Brain-Gut Axis & Mood Impact (21:10–25:27)

• It’s Not All “In Your Head”:
  Modern science recognizes the gut has its own nervous system. Gut-brain miscommunication can cause real physical symptoms.
  • “There are very few organs… that can change on a dime based on your thoughts.” (22:22)
• IBS as “Gut Neurodiversity”?
  IBS involves “a lower threshold” for pain signalling—sometimes triggered by nerves, inflammation, or microbiome imbalances.

6. Hormones, Pain, and Gender Differences (25:27–29:07)

• Estrogen’s Role:
  Recent research (citing Nobel laureate David Julius) shows estrogen increases gut pain signaling:
  • “Women… have a lot more estrogen… responsible for pain signaling… directly responsible for the pain signaling from our guts to our brains.” (27:09, Dr. Pasricha)
• Implications for Puberty, Perimenopause, Endometriosis:
  GI pain may diminish post-menopause as estrogen levels fall—helping explain shifting prevalence by age.

7. Cultural Normalization and Suffering (29:18–33:50)

• Don’t Normalize Suffering:
  Shared family patterns can perpetuate silent suffering (“Jewish Bowel Syndrome,” normalizing severe symptoms).
• Medical Empathy:
  “We should never normalize suffering… for them, this is 10 out of 10 pain, and that’s what matters.” (30:16–32:00, Dr. Pasricha)

8. Pooping and Performance: Stress, Athletes, and “Almost Home” Syndrome (35:24–39:40)

• Why Athletes (& Performers) Poop Before Competition:
  Stress hormones both stop stomach function and activate the colon—“Let’s get everything out!”
  • Box breathing and vagal maneuvers can help manage pre-event bathroom emergencies.
• “Almost Home” Effect:
  Approach to home triggers the brain to relax sphincters—sometimes a little too soon:
  • “Once you start to arrive in a safe space… subconsciously your sphincters… give up the fight… you have very much not arrived!” (38:13–39:40)

9. Smartphones on the Toilet: A Hidden Menace (50:31–54:07)

• Hemorrhoid Risk:
  Bringing phones into the bathroom increases risk of hemorrhoids by 46% (lab data).
  • “When you’re sitting on this open toilet bowl… the hemorrhoids become more and more engorged… that connective tissue… is going to start to weaken.” (50:47, Dr. Pasricha)
• What to Do:
  She recommends returning to low-engagement reading (e.g., out of date catalogs) and limiting device use to “two TikToks” max.

10. The Truth About Laxatives (46:57–48:42)

• Demonizing Laxatives is Harmful:
  No evidence they cause “dependence” or “damage”—using them appropriately for constipation, even chronically, is okay and preferable to unnecessary suffering.
• Important Distinction:
  Laxative use for medical purposes ≠ laxative abuse in the context of disordered eating.

11. Period Poops and Hormonal Cycles (43:11–46:57)

• Why Periods Change Your Poop:
  Progesterone slows digestion before the period; prostaglandins during menstruation trigger both uterine cramps and bowel contractions, causing diarrhea.
  • “Prostaglandins don’t discriminate… they contract your uterus, but also your bowels.” (43:57)
• Treatment Tips:
  NSAIDs & loperamide can help if needed; heating pads may help by dulling pain signals and relaxing muscles (46:12).

12. Kids and Teens: Endless Toilet Time (54:07–56:12)

• Smartphones Prolong Toilet Sitting:
  The longer you linger, the greater the hemorrhoid risk and possible future pelvic floor problems.
• Setting Limits:
  Aim for 1–5 minutes per poop session. “Speed pooping” is lauded in Dr. Cara’s family.

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Practical Advice & Memorable Strategies

Five Ways Tweens/Teens Can Optimize Pooping (56:12–58:07)

1. Use a Stool: Elevate your knees above hips for better pelvic angle—“Your knees should be elevated.” (56:24)
2. Go When You Feel the Urge: Ignoring urges leads to constipation and drier, harder poops.
   • “You teach your body not to send that signal later.” (56:40)
3. Eat More Fiber: Modern diets lack enough—prioritize “high-value” veggies (e.g., brussels sprouts, peas, broccoli), kiwis, and nuts.
4. Talk About It: Normalize conversations about poop beyond your family—don’t suffer in silence.
5. (Implied) Limit Phone/Device Use: Set brief time limits or avoid entirely.

Top Fiber Picks (58:13–59:50)

• Kiwis (“two a day increase bowel movements without causing bloating”)
• Nuts (“great snack, bursting with fiber”)
• High-yield vegetables (brussels sprouts, peas, broccoli; iceberg lettuce is low-yield)

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Notable Quotes & Moments

• “Poop can be used as a lie detector.” – Dr. Cara (09:36), recounting how her daughter’s green poop unveiled a hidden gelato snack
• “Pooforia is when pooping is the absolute least of your daily concerns.” – Dr. Pasricha (17:22)
• “Never normalize suffering.” – Dr. Pasricha (32:00), on family attitudes to chronic digestive pain
• On Period Poops: “Prostaglandins don’t discriminate… they contract your uterus, but also your bowels.” – Dr. Pasricha (43:57)
• On Device Use: “You should not bring your smartphone to the bathroom.” – Dr. Pasricha (50:47)

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Timestamps for Key Segments

• Poop Talk and Normality: 04:05–11:45
• Family Stories & Social Life: 13:07–14:31
• Pooforia vs. Regular: 16:36–20:03
• Brain-Gut Axis Explained: 21:10–25:27
• Hormones & Gut Pain: 25:27–29:07
• Mental Health and Suffering: 29:18–33:50
• Athletes, Stress, and Pooping: 35:24–39:40
• “Almost Home” Urgency: 38:13–39:40
• Period Poops & Hormonal Cycles: 43:11–46:57
• Laxative Myths: 46:57–48:42
• Smartphones, Hemorrhoids, and Time Limits: 50:31–54:07
• Practical Tips & Food Recommendations: 56:12–59:50

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Final Thoughts

This episode dispels embarrassment and misinformation with humor, empathy, and expertise. Dr. Trisha Pasricha and the hosts provide invaluable, practical advice for families navigating puberty and gut health, while challenging taboos and encouraging proactive, shame-free self-care and conversation. If you’ve ever felt alone, confused, or awkward about pooping—you’re in good company and there’s real science to help.

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Recommended Resource:
You’ve Been Pooping All Wrong by Dr. Trisha Pasricha

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Contact & Resources:

• Podcast: awkwardpodcast.com
• Book: “You’ve Been Pooping All Wrong”
• Further info, community, and puberty resources: lessawkward.com

Transcript

[A]

Kara. At Great Wolf Lodge, there's adventure for the whole family. I'm excited to check out the lodge in the Poconos, which is close to me. And with 23 lodges across the country, there's probably one near all of you, too. You and your pack can splash away in the indoor water park where it's always a toasty 84 degrees. There's a wave pool, a lazy river and a bottle. Bunch of massive water slides, including ones your family can enjoy all together.

[B]

They even have adventure packed attractions from Magi Quest, a live action game that kids can play throughout the lodge, to the Northern Lights Arcade. And there's also a bunch of great dining options and complimentary daily events like nightly dance parties, all under one roof. So bring your pack together at a lodge near you. Learn [e-mail] that's G-R E A T W O L F.com and strengthen the pack the urge to poop when you are in a bookstore.

[A]

Yes, that thing is. That was fascinating.

[B]

So wild. And I mean, I'm just gonna say, like, because we're way oversharing in this episode. Like, yes.

[C]

Yeah.

[A]

But I feel like the next generation isn't gonna have that urge because they didn't sit and read in the actual sore. They're gonna.

[B]

Hi, Vanessa.

[A]

Hi, Cara. You are a giddy, giddy lady this morning.

[B]

The topic of today's podcast is one we've never covered. And I literally can't believe it because it's astounding.

[A]

Shocking.

[B]

Not only is it astounding, it is something you and I talk about all the time. So many poop origin stories in our families, so much about our daily routines. We are on zoom for so many hours a day. These are conversations we have. And now we get to have these conversations with the whole wide world because we have Trisha Pasricha here, who is a. She's a physician. She's a gastroenterologist. She's an assistant professor of medicine at Harvard Medical School. And she's going to tell us all why we've been pooping all wrong, which is the name of her book. And I will say, I have never been stopped. So many times when walking down the street with a book, like, literally, I was carrying it in my hand for some, and strangers from out of nowhere were like, where can I get that book? That's my story. I feel seen. So, Tricia, welcome. We are so happy to have you here.

[C]

Oh, my gosh. Thank you guys for having me. And can I just say that I think this is the sign of a real friendship right here that you're having these conversations with each other. That's. That's something deep.

[A]

And we didn't even get to what our dinner table conversations are like. I mean, it only goes from there. Trisha, so the title of your book, which literally, we got the request for you to come onto the podcast, and I saw the title of the book. I did not even look any further because the book is called you'd've been pooping all wrong. And I was like, done. Like, she has to. Come on. I don't even care. I don't even care if the book is any. Because anyone who can come up with that title, it's like, you deserve to hang out with us amazing cool, poop talking women. So we're so happy to have you here. You also happen to be, like, eminently qualified and very brilliant. So, like, win that I didn't just take a shot in the dark. So, Tricia, we're going to start here with. With the lead. We can't bury the lead. And you say most of us have been pooping all wrong. I am almost 50, and I cannot believe that I'm about to hear this. So how did we not learn this basic life skill?

[C]

Yeah. You know, that is something that I have been sitting with and mulling on for years and years. And so I'll take you back in time when I started my GI training. This was back in 2019. The Before Times, before COVID Covid made things way worse, as you guys know. But even before COVID people were not pooping correctly. And what was so bizarre to me is that people would come into my clinic and they'd have some specific reason they had made their way into my room. Like, maybe they saw a little blood in their stool. Yikes, we have to talk about that. Or maybe they need a colonoscopy. We're going to talk about that. But what they really wanted to talk about, the thing that they would, like, linger by the door. When I was like, all right, let's. We'll see you next time. They would be lingering to ask, is my poop normal? Or like, hey, by the way, like, my husband spends 30 minutes every time he chooses to poop. Like, that's weird, right? I can. I should go home and tell him you said that was weird. And I'd be like, hmm. And I'd start to hear this pattern of questions as, like, that lingering by the door question over and over, which just betrayed the fact that people have no idea what normal Looks like How to poop. And the whole book, the title of this book came from what I just found myself either saying in my head or on occasion out loud to people in my clinic when they would explain what they were doing and how they were going, what their lifestyle was like. And it was. It just blew my mind that we were all pooping wrong. However, I do see how we got into this situation. Right? Because, you know, you said you're almost 50, that how many times? Except with your best friend, which I think is actually a rare and beautiful thing. I'm not kidding about that. How many times do you have a conversation with another living soul about pooping?

[A]

Well, I'm a bad person to ask that question to because I grew up in a house where we talked about everything that no one else talks about. And we talked about it, like, ad nauseam. Like my mom.

[B]

Your mom. Your mom told me her pooping history.

[A]

My mom has her pooping history. And then she. Not only did she, but when my parents were first married, in their first year of marriage. This is a story I've heard many, many times in my childhood. Trisha.

[C]

Oh, yeah, I'm so excited.

[A]

Came to her and like, he came home from work and he said, I think I'm constipated. And she said, because in my mom's book, being constipated is literally the biggest nightmare in the entire world. So she's like, oh, my God. When was the last time you had a bowel movement? Yes, my mother uses the phrase bowel movement. Like, she's very precise. When was the last time you had a bowel movement? And he said to her, this morning. And she said, I almost divorced him right then. I couldn't believe that it had been eight hours since he last pooped and he thought he was constipated. Like, he does not deserve my sympathy at all. So that's all to say, pooping is not just in my. The family I've created with my husband, but my family of origin. Cara, I feel like, I don't know. Was your family a poop talking family before?

[B]

No, but medical school changes a person.

[C]

Oh, my gosh.

[B]

And so my kids were born to two doctor parents who as soon as they pooped in toilets, taught them to look at the poop in their toilet. And.

[C]

Oh, my God, I mean, right?

[B]

And Tricia, when you write about this in your book and you talk about the importance of actually looking at what's coming out of your body, I will tell you, my kids, they. At first they didn't really think anything of it. And then they sort of started to realize no one else reported back

[A]

except the Bennett's except.

[B]

Exactly. And. And then eventually, I will say it was a remarkable thing. I got a call from one of my kids in college who said, after years of looking, I have a question based upon what I've seen. And that was really an amazing moment. But my favorite poop story is my daughter used to go to a preschool that was next door to a gelato store, and her favorite gelato was the blue one. I don't even think it had a flavor that. Like a name or flavor. It was just the blue one. And it would turn her poops electric green. And just because of the dyes and all that. And.

[C]

Party trick, right?

[B]

And one day she came home from preschool, and I said, oh, you know, you were in carpal, so. And so did you have your gelato today? And she being the daughter of a pediatrician who was like, let's pick our tree today. Enjoy it. And then that's your treat today. It was like, nope, nope, I did not. And I said, great. And after dinner, whatever. She got her treat that we had at home. And then she goes to the bathroom and looks and calls me in and says, why is my bright green? And I was like, because you lied. And it was just a moment. So, yeah, we are. We are big poop investigators. But I think that the beauty of the comment you just made is that it is a very intimate topic that doesn't need to be. It's really a yardstick for so many things that are happening inside the body. What do you want people who don't talk about it freely, like Vanessa and me? What do you want them to know?

[C]

First of all, I'm like, I'm not over the fact that poop can be used as a lie detector that way. That's an amazing story. Come sit by me, Trisha.

[A]

Speaking of brain gut health, I know

[C]

I think about this a lot, and that is like, an application that hadn't even occurred to you. So. Amazing. Well, one, I think the first step, like you said, is to look and understand your own normal, because what you consider normal is actually not usually what your best friend considers normal. There is often this problem in which what you think is normal is also what maybe your mom thinks is normal. And then, you know, like, IBS runs and families, and then everyone's normalizing a problem that happens. But often what you described, which is what happened with your parents, it's when you partner up for the first time or maybe you go to college and you're living in this group environment that you realize everyone else's pattern is really different than yours. And then there's this domestic spat about, like, who's right about what constipation means, who's right about how many times you're supposed to go. So the first thing I want you to do is understand what is normal for you. And that is not just as simple as what is a normal frequency, which everybody thinks the answer to that is, I should go once a day. I want people to know you don't have to go once a day to be godlike. You can go as many times a day as is comfortable for you. So the two rules that you should stick to in my books are one, it should be comfortable, it should be effortless, and two, it shouldn't disrupt your social life if you're meeting those two things and you're able to go out, walk the dog, meet your friends for brunch. You're not worried about the bathroom situation all the time. But yeah, you poop every time you have a meal, which is like three or four times a day. I can live with that if you can live with that. But on the other hand, if it's like, you know, yeah, I poop once a day, but I'm straining my eyeballs out for 25 minutes and my partner's always annoyed with me because we're late wherever we have to go and I'm hogging the bathroom, I don't know. I don't know if that's quite normal. So I think you need to understand and recalibrate according to yourself. That's the first step. I think if I were to take like an even bigger step back and say, why does any of this matter? It's not really just about societal comfort. You know, one thing we think about in GI a lot is the rise of early onset colorectal cancer these days. Right. And I'm sure, Kara, you're hearing a lot of parents think about this and talk about it.

[B]

Yes.

[C]

And there's this statistic that comes out of the uk, which is that one in three people will avoid talking to their doctor about their bowel habits because they're so embarrassed by them. And the whole thing about early on to colorectal cancer is that if we catch it early, your survival rate in the early stages is greater than 90%. If we catch it late, that can plummet to less than 20%. So talking about your poop, looking at it, understanding when there has been subtle Changes or big changes can have a big impact on your health. That's even a bigger deal sometimes than just your day to day quality of life.

[B]

You know, I just want to add that we have an invented word in our family. It's called pooportunity. And that's true. And there are two people. We are a nuclear family of four. And two are like, you can set a clock by the pattern of pooping. And two, if they have a poopportunity and they miss it, they are miserable because they don't know when it's coming back around. And when you talk about, is it interfering with your social life? It's so fascinating to me because that is the case for that half of my nuclear family. If they miss their window, it does a little bit interfere with their social life.

[A]

I have people in my family who will poop anywhere. Like, literally moving trains.

[C]

Good for them.

[A]

Porta potties on, like, at music festivals.

[B]

Gastroenterologists. Oh, I love it.

[C]

The moving. I once was getting into this. I was trying to. I was in this competition with my dad, and we were like, what is the worst place to poop? He's also a gastroenterologist, and moving train was my number one worst place.

[A]

And I don't only have one child. I have at least two children who will do that. But then I also have members of my family, one of whom is English, who's like, he didn't go to the bathroom in any way, shape or form when he was in school as a kid. Nothing. Like, I don't even think he peed at school during the day. Like, it was like everything just, like crawled back up and he, like, held onto it until he could get home. So I must be uncommon.

[B]

No, but you know what? It's not uncommon. And in the pediatric office, you hear all the time from young kids, especially entering kindergarten, where if you ask the question, will you use the bathroom? Or how many times a day do you go to the bathroom? You get back answers about what? Not just why the answer is no, but what's in the bathroom that terrifies them. I saw spiders in the bathroom.

[C]

Oh, my.

[B]

There are, you know, this, that, and the other happened in the bathroom. So this is so common. We'll be right back. But first, a word from our sponsors.

[A]

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[B]

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[E]

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[B]

Yeah.

[E]

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[A]

So Trisha, I want to Cara loves wordplay. It's like her favorite punning is like her absolute favorite. So I started reading the book before she I was like, oh my God, Cara, you were going to love this book so much because poop is used in any number of contractions.

[C]

Have to.

[A]

Sorry, even that I just did contract word verbal contractions, not bowel contractions. So you have a phrase poop foria. And I want to know like we always talk about like regular. Are you regular? What's the difference between poop foria, which I assume is a contraction between poop and euphoria and just being regular. And we're going to use this as a way to go down the path of like the diversity of experiences and how we can do better with our pooping.

[C]

Yeah. I think a lot of people think healthy pooping is as simple as being regular. And by regular, again, people cling to this, number one. And pooforia is so much more than that. First of all, pooforia is this state of living, state of mind that I really think everyone should have. I want everyone to reach that state. And some people, I think, can get to it from learning some of the basics. Some people do need medicines. Like, there's real pathology in the gut that will need to be treated. But everyone should have that as the goal, not just being regular is the goal. And the difference is that being regular could mean that I'm able to have a predictable bowel movement. Maybe that's once a day, maybe it's twice a day. And I know it's coming. That is maybe like the foundation of things. And so, like, that can be very helpful. But again, I know a lot of people who are. Would be technically regular, but they have so much pain and straining and discomfort associated with that bowel movement to make it happen. Because they're like, I have to go. Or. Or I'm weird, I'm off. And that's not porphyria. And you might also be regular. Like, there are a lot of people who will struggle, but they'll get some bowel movements out in the morning and then it'll just be weighing on them the rest of the day. Because they wouldn't have felt that they completely emptied, truly. Yeah. It'll just be like on the back of their mind, like, I need to go again, but it's not coming out. It's kind of like what your kids are describing, like this feeling like, I missed this window, this opportunity, and now how am I going to get through the rest of my day? And that's not pooforia. Pooforia is actually, to me, in the simplest way, I tell my patients about this. It is when pooping is the absolute least of your daily concerns. It's when you poop, it's quick, it's effortless, you move on. You're not obsessed with the toilet, you're not obsessed with the next time you're going to need to use it. You just. You're able to go. And for everybody, the frequency, like, the consistency, how fluffy, how soft it is, it's going to be a little bit different for everyone.

[B]

Just a quick clarifying question. So poopforia is not the sensation of, I have to go, I have to go, I have to go. Ah, I went. And it was Great.

[A]

It was glorious.

[B]

I've got energy and I can go run a marathon. It is not that. It is the sort of chronicity of having a really healthy pattern where it's a nothing burger for you.

[C]

Totally. And it's a. I will say, like, a lot of people, we all know it. There are a lot of people who report, like, there are some poops that are euphoric. Happens to us all. That's a separate thing. That may not happen every day for you, but I do want you to every day be living in a state of euphoria.

[A]

So I want to tie this to your research, which is about the brain, gut health. And I'm sort of curious. You know, we talk about mental health, and part of mental health is like everyday functioning, that you're out doing the things that you want to do, that you're feeling connected, that your mood is more regularly good than not good. Right. Like, I'm thinking about that and I want to tie it to. Is the sort of poop opportunity. What is it?

[C]

Poop.

[A]

Pooportunity. What do you call it, Kara?

[B]

Pooportunity Pooper tunity. Which is just, you know, it's very beautifully described in the book. The waves of peristalsis that make you feel this urgency. And there's an acronym in there that I'd never heard before. That was amazing.

[A]

But I'm. What I'm curious about, Trisha, is like, is the sort of disappointment or frustration or like, social retreat? Like, is that tied? I want to talk about the brain, gut health, and I want to explain, explore the mood impact and how much of that is physiological and how much of that is just like, ugh, my day is now unpredictable. It's annoying.

[C]

Like, can we.

[A]

Can we explore that a little bit?

[C]

Yeah, I mean, this is most of what my lab studies at Harvard Medical School. And so I, as a neurogest neutrologist, I study the gut brain connection. And when it comes to GI symptoms, things like constipation, vague abdominal pain, for some people, diarrhea. It has been long known that a lot of your gut symptoms are closely tied to your brain. And I think the problem is that we've sort of misunderstood the gut brain connection for, like, 100 years, in which we've framed a lot of our gut symptoms as being caused by our depression and anxiety. And it's almost turned into this narrative that I see all the time in my clinic, where people who have what I would consider the quintessential disorder of gut brain interaction, which is irritable bowel syndrome. They will have been told by lots of doctors, this is stress. This is all in your head. And physiologically, you know, parts of that are not wrong, though, when you say it like that. It's incredibly dismissive and it misses the other half of the picture. But, you know, if you think about it, there are very few organs in your body that can change on a dime based on your thoughts. They'll change entirely what they're doing. Like right now, if we were to start thinking about our favorite dessert, that blue gelato, and how cool it would feel on a hot summer day, like, I might start salivating, My pancreas will start to secrete insulin, and there's no food in front of me. I'm just thinking about it, right? Or if I'm stressed, which I, you know, like, if I was about to give a big presentation or go on stage. We all know what it feels like to suddenly have to poop right before you're on, and that's horrible, and it's miserable, and it happens so quickly. And of course, the problem with all this is that because these things are real physiological phenomena, that we then start to say, okay, well, maybe your gut symptoms exist because you are thinking about them so much, when what's really happening is what we've learned in the last maybe two or three decades is that there usually is some trigger, some abnormality in the gut that then, you know, reminder. The gut has its own nervous system. We call it the enteric nervous system. It's got millions of neurons that are communicating with each other very similar to the central nervous system, which is the brain. And those neurons, often, in the example of irritable bowel syndrome, they operate at a lower threshold. They'll become triggered at a lower threshold than someone who doesn't have that. So if somebody with IBS or irritable bowel syndrome eats, say, just a regular meal, and they get a little bit of gas and bloating, as all of us do, they will perceive that as very painful, where someone without that is not because those neurons are firing. And then those neurons go to the spinal cord, they synapse, they go again up to the brain. And. And if that's happening to you every day, multiple times a day, that you're perceiving pain from just everyday triggers. Yeah, of course you're going to start to become anxious, you're going to start to become a little bit hypersensitive and anticipate more pain will be coming. And it fuels a very vicious cycle

[A]

so is IBS like gut neurodiversity?

[C]

Huh? You could. You could. I mean, that is an interesting way of framing it. I think you could think about it that way. I mean, I think we think about neurodiversity in general. There's often a link with GI symptoms that we don't think is a coincidence. Like, for example, in autism, autism spectrum, a lot of GI symptoms go hand in hand with that. And I think that there's one abnormality. Well, there's multiple abnormalities that are related to the nerve cells in ibs. And a lot of that have to do with, like, kind of the threshold at which they get triggered. But the tricky thing about IBS and a lot of other disorders in this category is that it's really not ever just one thing. IBS is this, like, big category that we put a lot of people with really kind of different symptoms into this bucket, which I think is partially why it's very misunderstood. But sometimes the problem is in the nerves. Sometimes the problem has nothing to do with the nerves, but has to do with, like, these inflammatory cells that live around the nerves. So the nerves may not be the problem, but they're just becoming triggered by these inflammators. And then, of course, the microbiome is often altered and plays a big role. So there's a lot of different reasons why this happens. All of it does eventually certainly reach the brain. There's no pain, there's no discomfort, unless the brain decides that there is. But, you know, we have to be very careful, I think, in 2026, about saying the brain is the cause. This is in your head. We need to treat the stress.

[B]

On a sort of related but tangential note, there is so much overlap between IBS symptoms and endometriosis symptoms, with the endometriosis symptoms that impact the gut, being bloating and abdominal pain. And sometimes your stool is impacted or your patterns are impacted. And I'm wondering if there's a hormonal component to the neuroendocrine system. A, is there, and B, if there is, how does it shift? Whether it's with things like endometriosis or frankly, just things like puberty and perimenopause

[A]

and periods and period poops.

[B]

Well, we'll get to period poops.

[C]

Yeah. All my favorite topics. But, yes, this is actually like, an incredibly exciting area. So my lab, we've actually been recently studying endometriosis, because, just from the outside, somebody with endometriosis has a lot of the same symptoms as someone with ibs. And how do you know what it is? And this is one of those things that we cannot keep missing. Endometriosis, especially in younger people. It's like there's a statistic where women will see an average of seven doctors before they get diagnosed with endometriosis. That's how you know, it's nutty. We are doing a bad job of diagnosing it, partly because we don't have a great non invasive test yet. So we're trying to figure that out. But the pathophysiology of both is really interesting. So this is some data that has come out of the lab of David Julius and his team. And if you don't know, he won the Nobel Prize in 2021 in Medicine and physiology and he really studies nerve signaling and pain signaling. And, and what he basically discovered was a mechanism that really explains why women tend to get IBS more than men.

[A]

Right.

[C]

And the reason is estrogen. We know a lot about what estrogen does as a hormone in the rest of our bodies. What I think we didn't know until recently is that estrogen is responsible for pain signaling the gut. And so of course women, we have a lot more estrogen, we have a lot more estrogen receptors. Those are directly responsible. And he proved this at some big recent studies. Those are directly responsible for the pain signaling and from our guts to our brains. And so it's interesting because before this data came out, and this is literally within the last one year or two years, a lot of gastroenterologists in my field noticed this like really odd phenomena of like, you know, we see a lot of younger women with ibs, we see a lot of teenagers, we see a lot of people in their 20s and 30s. And then they, what happens to them? Like we, when they become 50, 60, they're not really coming in for IBS anymore. And it felt really odd when we couldn't quite explain it. We just know, like if you look at the population data that seems to be true, that as you get older, you still might have constipation, you might still have diarrhea and bloating, but that specific type of pain starts to get a little better. Of course we'll talk about the other problems that come with perimenopause and menopause. But this is probably why. It's probably because the estrogen levels are changing naturally. And estrogen is a big part of the story of IBS and actually a lot of other diseases, of course, in endometriosis.

[A]

So higher levels of estrogen mean higher Perception of pain at, like, I don't even know how one measures pain. That's in a way that's not subjective. Right. Like, isn't it. Isn't it always self reporting the whole thing?

[B]

Vanessa?

[C]

Oh, you hit on it, haven't you?

[A]

So you were talking earlier, Trisha, about like, kind of generationally, people accepting their realities. And we've covered that on other episodes around endometriosis. But since you're our poop pioneer, you're welcome.

[C]

Thank you. I haven't heard that one before.

[A]

I know. I was like, this is going to be a new one. She's never had this one before.

[B]

The poop master general.

[A]

That's also very good. And it's kind of like the instruction to kind of suck it up or deal with it or like, this is just how our family is or.

[C]

Yes.

[A]

You know, if you come from my lineage, which is Eastern European Jews, like, you know, everything gives us diarrhea and it's just like, okay, sure, like fettuccine Alfredo. Like, I haven't eaten it in. And it's like, so you sort of.

[B]

It's called jbs, Jewish Bowel Syndrome.

[A]

Jewish Bowel Syndrome.

[B]

It's a thing.

[A]

So I guess I'm wondering, like, when we think about pain and listen, women go through childbirth and if you give men the mimicking of childbirth, they're. They can't function. They're an excruciating or even the mimicking of, you know, menstrual cramps, they can't function. So one could imagine that it's not just perceived. It is actually like the estrogen is actually playing that role. I'm wondering how do we change the conversation around it? As we're thinking about the intersection of endometriosis and pooping and all those things, how do we begin to, like, rewrite the stories in our families around this stuff?

[C]

Oh, my gosh. I love and think about these questions every single day. Because you are absolutely right that we don't have an objective measurement of pain. And that's because pain, you can objectively create some noxious stimuli. In 10 women, that is the same stimuli. But once those signals reach the brain and hit our amygdala, it's going to start to change based on a lot of other factors that are a little bit separate from that trigger. It's going to be based on our prior experiences with pain and before there's going to be a lot of emotions that get brought in. And I think that's the key difference between pain and suffering. Someone can experience pain, but not feel that they're suffering. Once the brain is involved, the suffering can be what amplifies that perception of pain because you're bringing in your prior history and your emotions into it. And that's the reason why I think, in medicine, I'm sure you've seen this car. We struggle to be empathetic to patients who we say, wait, you're telling me that you're experiencing 10 out of 10 pain, but you're sitting there talking to me. You're sitting there sipping your water. It's probably not that bad. Or it might be like you'll find somebody who is really crying their eyeballs out and, and it'll. It'll look like they're suffering a lot. And you might say, okay, this is what I think pain is supposed to look like. And maybe the. The stimuli is not something that you would have otherwise said. This is like, you know, really, really bad. But they're crying, so. So this must be real. And all of these measures are not correct. And the thing that I tell when I teach residents and med students is to throw out these sort of ideas about what you think pain looks like. Forget about how you think you would feel. If the patient is telling you they feel 10 out of 10 pain, that's it. Because for them, this is 10 out of 10 pain. And that's what matters. And the second thing I teach them, which I think is the part that changes minds tragically, even more than just me saying, you have to believe your patients and is to simply show them the data. The data like the kinds I'm sharing with you about the estrogen receptors, which is that most of the tests that we can do in GI are surface level tests. They are not tests that are going to get to the enteric nervous system where the pathology lies. Because to do that, you'd have to poke a hole into your stomach to get to that deep muscle layer. But if I show residents these surgical studies where you. You actually can get that tissue, and you say, look how different the nerves look. Look at the inflammation that is reaping all over their entire nervous system. You just would never see it. If you just looked at a colonoscopy, it'll look normal. Suddenly, people are horrified because they'll say, oh, my God, this woman is living with so much inflammation. We just couldn't see it on a CT scan. We're not going to see it on a. On an endoscopy. And once, you know, that's there, and this is, you know, like the scary Part is that most women are not going to get a test in endometriosis that shows an abnormality unless they do an invasive surgical test. Most people with IBS are never going to get a test that shows the abnormality, but in both cases, it's there. And then I think the last bit, just to get to the question about, what do I do if my whole family is living this way? I see this all the time in endometriosis and in ibs, which does cluster in families. We should never normalize suffering. And I think that's something that we just do. Because you grow up with these horrible periods and you're like, well, that's why my sister had it. And that's the only person you talk to. That's the other reason why I think it's so important to normalize conversations with people who are outside your immediate circle. Even if that's just your doctor. Right. Don't be embarrassed to tell your doctor about these things because you might realize not everybody else's pain is so bad that they miss school over it. You know, these kinds of things.

[B]

I want to get to what you can do about it. But before we go there, a quick conversation around people who have episodes of frequent pooping. And I'm thinking sort of situational. So the first group I'm thinking about are athletes or performers who are about to go on stage, and I want to talk about that. And then period pooping and the sort of prostaglandins of it all. And let's start with athletes, because I have a rower who, when we go watch his rowing races, it's kind of unbelievable. The most central feature of the viewing area is the line of porta potties. Okay, you cannot make this up. And there are rowers in and out of those porta potties. Like, it's. That's. The central meeting area is the porta potty station. And they are all in and out constantly to the point where I don't think I would have understood that concept of the connection of performance, athletic or otherwise, and pooping without this visual. But now, like, it's really not the boats on the water I think of when I think of rowing races. It's really like the line when I can't find my kid.

[C]

Other floating objects.

[B]

Seriously, when I can't find my kid, I literally go stand outside the porta potties and I'm like, I'll find him. And I do, you know, so can you talk about that a little? Like, what about performance causes us to poop?

[C]

Okay, let's talk about. We'll break it down. So there's. When an athlete situation, there's the performance part of it, and then there's the movement and the exercise part of it. So the first part, which would apply to anybody, like I was a theater kid, deeply, heavily experienced this when you feel stressed, that part of the brain that I mentioned, the amygdala, which is kind of the emotional. We think of it as the fear processing hub, but it's really responsible for a lot of emotions. And it ends up releasing a hormone called corticotrophin. Releasing hormone that acts very quickly on your stomach and your colon. And it does two different things, which I think explains a lot of our symptoms. On the stomach, it serves to basically grind activity to a full stop. So the stomach stops emptying, which is why a lot of people suddenly feel really nauseated because everything stopped moving from like here upwards in your stomach. But then ironically, at the same time, that hormone speeds up the last part of your colon because your colon's like, all right, let's. Let's get everything out where it's got to go. Time. Let's get it all out. And so you're feeling really nauseated and you have to poop at the same time. And what I tell people to do here is something called a vagal maneuver. And vagal maneuvers are so lovely because they will certainly bring your heart rate down, which is also a separate problem, but they're also going to calm your gut down. And vagal maneuvers can be as simple as box breathing, which are like. Actually, you know, it's funny, I had. So I have a two year old and a three year old. I teach my three year old. It's a lot going on. I teach my 3 year old box breathing. Just when we're having a moment, having a big emotional moment, like unrelated to the poop, stress. But it's really, anyone can do it. You don't need any extra utensils or thoughts. You just imagine drawing a box the size of a box. So you inhale up. 1, 2, 3, 4. Hold it. 1, 2, 3, four. Exhale for the third side. 1, 2, 3, Four. And then you close the box and you do that three times. And it will really activate the, the vagus nerve, which does help to calm the activity of the gut. There are other things you can do which may or may not be relevant to a rower. Like you could activate your diving reflex too, which is very effective. Like if you dunk your face in cold water. If you have an ice Bag, and you put it on your sinuses. That'll help kind of calm the gut. But this is something that we all experience in real life, but under kind of moments of stress. Right.

[A]

So my question was much less elevated, which is, like, you know, you have to poop. Like, you know, you have to. Like, you're gonna have diarrhea or something, and you're, like, holding it, holding it. And then you're, like, two minutes from home, and all of a sudden you're like, I'm not gonna make it. Like, somehow the br. Like, what is happening in the brain gut situation that all of us. And the same thing also kind of happens with having to pee. But mostly it's like, the anticipation. Vanessa.

[E]

I don't know.

[A]

Like, is there something where the brain is. Knows you're, like, close to home and sort of like, all right, time.

[C]

Yeah. So what happens is two things, like. And I just. We're going to talk about the anatomy involved here. Okay. So you have your colon. Your colon is often under a lot of influence from your brain through your vagus and through your sacral nerves. And you don't have control, really, over your colon directly. Indirectly, if you control your thoughts, and you can. You can maybe secondarily influence it. But what you do have control over are your sphincters. You actually have an internal and an external anal sphincter. And your job when your colon is spasming and you don't want to go, is to tighten that external anal sphincter. That's your. That's all you can do to kind of be this, like, final bastion of hope against the incoming flood. And in most cases, if you compress and you tighten long enough and hard enough for, like, a couple minutes, those waves of contractions will say, whoa, okay, sorry. And they'll stop, and they'll calm down. And sometimes you even get, like, a little bit of retrograde flow, which you don't really perceive, and that's okay, but sometimes you cannot. And the problem is that once you start to arrive in a safe space, which is what our home bathroom environment is like, or even if you're desperate, like anything that looks like a socially appropriate. Yeah. Then your. Your sphincters are a little bit subconsciously going to start to give up the fight, because they're like, we have arrived. We are here. And actually, you have very much not arrived. You are inches away from arriving, but you have not ARR. And that's what has.

[A]

So you promised.

[C]

You're so close, but it's really this is like such a common thing because I of course I see patients with fecal incontinence all the time. And that's the, that's the classic experience is that I made it so close. But then why right before I was there did I lose it? And it's because your brain is like, wait, we're here. We got here. That's the moment you got to clench harder than you ever clenched in your life.

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[B]

You know that is an incredible explanation that does not explain the phenomenon you touched on in your book, which is so fascinating and so real, is the urge to poop when you are in a bookstore.

[A]

Yes.

[C]

That thing is.

[A]

That was fascinating.

[B]

So wild. And, I mean, I'm just gonna say, like, because we're way over sharing in this episode. Like, yes. It's bizarre. Yes.

[C]

Yeah.

[A]

But I feel like the next generation isn't gonna have that urge because they didn't sit and read down the toilet.

[B]

They're gonna feel right, and we're gonna get there.

[A]

Cause I know the burning question people have is about how long kids be on the toilet. But I don't want to forget about period poops because it's so, so, so important. Trisha, will you talk about what's happening? First of all, let's myth bust. They are a thing. Period poops are a thing. Will you talk about the physiology behind that thing?

[C]

Yeah. At least a quarter, if not up to 50% of people, young women, women, anyone who's on their period will notice that their poop is off. They poop weirdly when they're on their period. And two things usually happen. One is people often describe a little bit of constipation, a lot of bloating, sluggishness leading up to the periods. And then at the time when you want it least, when you're already bleeding, then you have a lot of loose stool, too, and you get diarrhea. And that's the thing that, like, horrifies most teenage girls is that there's just a lot going on every time they're on their period. And it's the worst. And there's two reasons for that. One is that, you know, during your period, during the cycle, there's this rise and fall of progesterone. This is probably at least explains part of why you get a little sluggish and bloated leading up to the event. Right. Like, women get really, really constipated for a lot of reasons. Part of it is just kind of the mechanics of the baby being there. But progesterone, as those levels rise during pregnancy, women get more and more constipated. So we see that every month there's going to be a cycle. But then think about why we have period cramps and what the uterus is doing. So the uterus is shedding its lining, and it is contracting. And the reason it's contracting is because of this compound called prostaglandins, which are produced by almost every cell in the body. And that's what's responsible for these, like, really dreaded, loathed period cramps. And of course, the problem is that prostaglandins don't discriminate. They will, of course, contract your uterus, but they're also going to contract your bowels at the same time. So just when you were having cramps of your uterus, you. You're also going to get cramps in your colon, in your small intestine. It's going to push things forward, so it sucks. There is a kind of relatively simple way to treat it, and there's two. One is take loperamide, which is Imodium, you know, and take it within the recommended dose. That usually stops things, at least from the poop side of it. It doesn't do much for the cramps. The thing that will help with both are NSAIDs. Right? NSAIDs like ibuprofen or Motrin. The thing about NSAIDs is that I, as a gastroenterologist, really don't love them because they can damage the lining of the gut. And I, of course, every, like, GI fellow has seen way too many ulcers because of NSAIDs than they, they ever want to see again. However, my trick about this is that I'm actually, I'm like this too. Like when I have a migraine coming on or if I'm having cramps, I usually, like, I feel it and I'm like, hmm, let me see if it gets worse, then I'll, then I'll maybe take a medicine. I, I can, I can probably get through the next couple hours. Let's just see where it goes. And then by the time it' raging, I'm in severe pain. I can't function. I'm like, oh, let me. Why Let me grab some Motrin. And then it takes me like a while to like, get everything under control as opposed to if I had just taken the Motrin or the ibuprofen when I had that whiff that, that migraine that those period was about to start, then I actually could have staved off the problem and taken fewer tablets and pills if I just, like, shut off the faucet at the beginning.

[B]

Tricia, why do heating pads work?

[C]

There's a couple different explanations for it. I think probably the most obvious is that the heat can cause a little bit of local relaxation of those muscles, but also heat. This is the, like, more indirect method, is that we think about heat as causing pain, as being painful, but when it's used in low therapeutic levels, it actually can dull the nerve Endings, just temporarily, so that pain is actually no longer being as rapidly sent up to the brain. And so when you have, you know, like, they have these, like, icy hot, like, creams and things, like, the whole mechanism behind that is that the, like, endings of those nerve cells, little filaments, start to retreat with heat. And so if you use them in a certain area, it can kind of help with the perception of the pain at least. But it's. It's temporary like everything else.

[A]

Yeah. So let's talk for a second before we get to teenagers sitting on the toilet for endless periods of time. You talk pretty emphatically in the book about our culture's abhorrence of laxatives and the myths around laxative use. And we're a little bit off topic, but it's so fascinating and you're so emphatic about it that I. I don't want to not touch on it. First of all, I want everybody to read your book because I swear to God, it is so eye opening. Can you just give us, like, a quick overview on your perspective on laxatives and why they're so. Shouldn't be so demonized?

[C]

Yeah. I have found a lot of people when they are dealing with constipation, they would rather do something natural. Like, they find the idea of taking a medicine for constipation so embarrassing, so mortifying, so unnatural, and they're looking for natural solutions. And, like, it's actually great because we have a lot of natural solutions. You could exercise more. You could do my favorite, which is eat two kiwis a day. There are things you can do, but you. But you hit a point at some point, right, that, like, some of these solutions are just not going to reverse the tide depending on what's going on. I think we should change that culture of how we feel embarrassed to treat this really important part of our bodies that just might need a little bit of help. And people often worry, well, if I take alexative, I'm going to become dependent on it. I'm somehow fundamentally changing my gut and how it will respond to future therapies or future signals. And that's not the case at all. There's never been any studies that show that. But that myth has persisted over decades. It's been passed on from your parents. So I don't want people to feel embarrassed if you are constipated, if you are suffering, let's treat the suffering. Let's get you feeling better. And then we'll. We'll take a step back and say, like, what can we change in our lifestyle about it? But let's get you out of this hole that we're in first.

[B]

Yeah. I mean, I think in the world of tweens and teens, the real worry around laxative use is laxative abuse. It's laxative use in association with body image issues and disordered eating and eating disorders. And those are very real concerns. And I think there's no one who wants to ignore that bucket. But I agree with you. Like, it's been conflated at this point to demonize laxative use. Your description of how laxatives work was so clear, and one very short paragraph frankly explained why it. It is not actually an addiction. It is not. Right. It's not a dependence. Because these substances are sitting in the intestine, they're actually not even getting absorbed into your bloodstream. So they go nowhere near the brain. So these brain dependencies, these brain pieces of addiction and dependence do not exist when it comes to laxative use. But laxative abuse, different story. And, you know, we could go deep down that rabbit hole, but we will not. Let's switch over to kids sitting on the toilets endlessly. And then let's land with what can people do to optimize their pooping. Let's give them some strategies. But first, our kids and their toilet perching, particularly with devices. I've got one suggestion, which is no devices in the bathroom. Easy.

[C]

Right.

[B]

But can you explain what the issue is? Like, why should you get there with that solution or other solutions?

[A]

And that also assumes kids will listen to that rule.

[C]

Correct? Right. First of all, like, we have to start with ourselves. Are we gonna listen to that rule?

[B]

Right, you guys, it's like, Trisha, do you wanna talk about what they find on phones?

[C]

Yeah. There's two reasons that you should not bring your smartphone to the bathroom. One is just the amount of bacteria that's living on there. I will say there hasn't been a study that has linked, like, an infectious outbreak to a contaminated phone. But they have found, obviously, fecal bacteria is on top of all of our phones at all time. And how do we think it got there? But the other reason is one that my lab studied last year, which is that people who bring their smartphones into their bathroom, they have a 46% increased risk. Risk of having hemorrhoids. The reason that this happens is that when you're sitting on this open toilet bowl, we think that the hemorrhoids, which, by the way, are just. We all have them. Hemorrhoids are just these, like, Cushions of veins that are living there, they become more and more engorged when you don't have that pelvic floor support the way we do right now sitting on a chair because it's just an open bowl. If you repeat that pattern day after day, week after week, year after year, that connective tissue around those hemorrhoids is going to start to weaken. They're going to fill up. One of these days they're going to pop out. One of these days they're going to burst. And we saw that when we did colonoscopies on older adults, where even among older adults like 45 and older, most of them were bringing their smartphones in. We have since replicated parts of that study in college students. It's like upward of 80% are bringing their smartphones in. And so every generation, I imagine, is bringing this in more and more. I do think it's hard. I mean, I think the ideal thing is, yeah, don't bring your smartphone in. Like, we don't want to bring it to our bedside, we don't want to bring it to the dinner table. Don't bring it to the bathroom if that's not gonna realistically happen for you. Like, some people are like, I have to just lightly scroll something in order to like feel comfortable and go. I would say at least set yourself like a two TikTok limit. That's the goal. And after two TikToks, just check in with yourself and say, did I do the thing that I came in to do? And if you didn't do the thing, then say, why don't I get up and try again later? Like I can watch the pit outside. I don't have to do it in this situation with my pants, hands down. But I do think like having a conversation even about that is important because I, we're all bringing it in. It's hard to let go of it. And there is this phenomena like we hinted at earlier, where like, what I really think we should do is bring back the old fashioned bathroom reader. Like, you know, where you have like this like discreet stand of like two week old magazines that you can't really get that engrossed. Like you just, you just kind of flip the pages of some like old L.L. bean catalog and you're like, oh, that would look nice like last season. And then you're done and you move on with your life. That's what I think we should do. Because you don't want these like social media apps that are like fully hijacking your mind and then it's like 45 minutes later, you're still. You're still caught up.

[A]

So essentially give up on trying to get our kids to read, but fill their bathrooms with, like, out of date catalogs and magazines so they have something to look at, but are not so engrossed that they actually, like, sit on the toilet forever.

[C]

I don't think it's reading that's the problem. Like, I think it's the smartphone, the social media, and that's what we found in our studies, that people are by far and away using social media and they're accidentally spending more time than they intend. When you have something that you're reading that cannot, like yesterday's sports section of the newspaper, you're gonna want to get out of there in a couple minutes.

[A]

Is there a. Is there a maximum time? Like, if you were gonna come to my house and be like, okay, guys, let's have a tough conversation. Five minutes.

[C]

Okay, Five minutes. And I'm going to be so honest with you guys, I think you should do it in one minute. Like, in an ideal world, you get in, you get out. You, like, know when your colon is contracting. Yeah. Thank you for raising your hands.

[B]

You're able to go in my family speed pooping.

[C]

Oh, my God, Cara, your family is amazing.

[B]

Well, I mean, no, we're just all medical all the time. But. But it's like, that's the goal. It's.

[C]

Yeah, you're in.

[A]

But let's. Let's use some kid friendly, teen friendly incentives terminology explanation. And I think we can close with this. Like, what is to car's point? Something practical. Like, what do we say to tweens and teens as to why it makes sense? Like, is it like, well, do you want hemorrhoids that are going to explode and give you bloody poop? No. Okay, well, then don't spend 30 minutes on the toilet. Like, what's the rationale that we can offer them?

[F]

Them?

[C]

Well, the rationale we know about is hemorrhoids, which when they burst open and there's like a bright red toilet bowl, you will hear a scream from the bathroom. Nobody wants that. But hemorrhoids are more than that. They're actually, like, uncomfortable. They're itchy, they're embarrassing. It feels like there's this lump when you're trying to sit. That's like, even the worst part than just seeing a bunch of blood, which usually usually doesn't kill you. Although, you know, you might need to get some help. It's the, like, horrible uncomfortableness of the hemorrhoids that, that's, that's the big problem. So people don't want that. That's the part that we've studied. The part that I think we're going to find out is a bigger problem is that, but we're trying to look at this in my lab right now, is that I think it's changing the dynamics of your pelvic floor when you sit there in that position. And I think over time we're going to find that the longer you sit in that position, you're changing the dynamics of your sphincters just slightly so that you are going to cause more problems for yourself down the line. If you're trying to poop again in your 30s and 40s, it's going to be harder if you had just never put that strain, put that pressure. So it is like a your future self will thank you kind of thing. But it's like all the other, like, small things we do for our health now that pay off later.

[B]

Tricia, can you give us five things that kids can do, tweens and teens can do to make pooping head towards poop for you. Like, I love that these are right.

[C]

Like, okay, one, put a stool under your feet. And I, like, I teach my 2 and 3 year old to do that because when they're potty training and they're

[A]

like, little legs are dangling, I know

[C]

that's the time you guys need a stool. Why do we teach our kids to sit on the big kid potty with, like, their feet? Your knees should be elevated. There you go. Indeed. Use a stool or use a box. Use like whatever you got going on. Stack of books. Okay, so that's one. You talked about this earlier and this is a big problem, of course, in schools. But if you feel the urge to go, do not resist the urge. Like, do not say, this is a bad time for me. I think we can solve a lot of our teenage constipation and even younger constipation problems by just saying, I feel the urge. That's my body sign. The problem is that if you suppress that urge over and over again, you teach your body not to send that signal to you later. And 12 hours later where you're like, I'm home. I'm in my happy place. This is a good time for me to poop. Guess what? Your colon's not playing ball anymore. It's not contracting. So now you, at 7:00pm, 8:00pm at night, have to do all the work by generating this really intense valsalva to get this now Much more dry, much more pebbly poop out of there than if you had just gone 12 hours ago and it was nice and soft and flush. So go when it's time to go. 3. This is a big problem for the younger ones. You gotta eat more fiber. There's like no way around this. This is a problem for us, our age, the parents age. This is like a big problem for kids because every generation are eating more and more ultra processed foods. It's not just about the kind of chemicals and emulsifiers that are in it. It's about what do they not have. And what they don't have is fiber. Your poop thrives on fiber, so you have to eat more of that. And then I think having conversations with your friends, like, just check in with everybody. Like again, don't like, just hide your, your symptoms with your own family. Talk to other people.

[A]

That's so great. Three things that have lots of fiber in them. And then we're going to let you go.

[C]

Ooh. Okay, well, kiwis. I mentioned earlier, I love a kiwi. And I don't just, I'm not just making this up because there were two really nice big randomized control trials that were published like in our great gastroenterology journal, American Journal of Gastroenterology, that showed two kiwis a day will increase how many bowel movements you have. But also they don't cause bloating. So if someone's like, I just want something that's not a, like a medication laxative, what can I eat? You don't have to eat the peel, although you could tons of fiber, but you can just eat the inside. So kiwis are really, really good. I like to eat nuts as a snack. That's my secret. Go to like, and so I don't even keep chips and crackers in my office. I only keep nuts so that I force myself to only eat nuts. That's all I have access to. But they're great, they're bursting with fiber. And then I think my one that is under appreciated is I feel like a lot of people will be like, well, I'm eating fiber cause I had a vegetable at dinner, right? And then there's there's high value vegetable and there's like low value vegetables, right? Like, and if you're gonna just say like, like I'm gonna have this iceberg lettuce, like romaine Caesar salad on the side, that's not gonna do for you what it would if you had had a side of brussels sprouts. Or even a side of peas. I love a pea. Or maybe even broccoli. Those have a lot more fiber and they pack a lot more bang for your buck than like, you know, I have a lot of teenage patients who are like, well, I don't say this explicitly, but they'll be going through their routine and like the only vegetable they have will be like that, like, like little thin slice of lettuce on their hamburger. And it's like, come on, that's like not giving you anything, like for your day. So if you're. We can only eat so much. We're only gonna do so much. If you're gonna cook a vegetable, cook a high yield vegetable.

[B]

Love it. In pediatrics, we used to tell parents when their little babies were constipated to feed them fruits that start with pea, peaches, pears, plums, prunes, and mangoes. Because mango really gets things moving. Trisha, what a joy to have you on. You've been pooping all Wrong is the least judgmental, most fascinating read. You will love it. Go out, get it. This book is making the rounds in my family. I'm just telling you right now. It is amazing. Thank you for sharing your wisdom.

[C]

Oh my gosh, thanks for having me guys. I learned a lot. I got some good words from today.

[A]

Thank you so much for listening. You can email us with questions, feedback or episode [e-mail] if you want to

[B]

learn more about what we do to make this whole stage of life less awkward for everyone involved. Our parent membership, our school health ed curriculum, our keynote talks, and more are all atlessawkward awkward.com and if you want

[A]

products that make puberty so much more comfortable, visit myumla.com.

[H]

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