Wilderness Evacuations

2022, July/August Adirondac

Trigger warning: Some readers may find this content gross.
Lots has been written, very importantly, on the safe and proper handling of human waste in the backcountry. That won’t be the subject here. We will discuss the mechanics of passing said human waste, or more to the point, difficulty in passing-constipation.

Constipation is defined as infrequent bowel movements (typically less than three per week). More important, it is associated with stools that are sometimes hard to pass, often with the sensation that the bowels did not empty completely. Severe constipation may be accompanied by abdominal pain and can lead to additional problems such as worsening hemorrhoids. According to a study from over a decade ago, constipation in the U.S. accounted for nearly six million physician visits and about $235 million in direct costs in a year. These figures have likely grown significantly since the study was published.

Why would this be a topic for a column on backcountry health and safety? There are a few reasons. First, the person with constipation at home can at least sit in relative comfort in a warm, dry room, reading a magazine such as this one. Squatting over a cathole in the rain or in black fly season, however, is a whole other experience. More serious constipation can result in abdominal pain that can be severe enough to be confused with appendicitis; there are documented wilderness evacuations from this problem. Finally, three major contributors to constipation (diet, hydration, and exercise) may be significantly affected by backpacking. This may result in a significant change in bowel habits for someone who ventures into the backcountry for a few days.

The substance in our diet that most helps to maintain the bulk and softness of our stools is fiber. Fiber content is listed in the nutrition information panel on most foods. Although the data are not firm, thirty grams per day represents a good fiber intake for most adults; this is not likely achieved by most Americans. Good sources of fiber include whole grains, oatmeal, dried fruits, nuts, and brown rice.

For many people, the backpacking diet may differ considerably from that at home. Some folks, for example, like to subsist with the relative simplicity of boxed “mac and cheese,” instant white rice, hard white rolls, and similar meals on the trail. While this may simplify meal preparation, it is a recipe for constipation-especially on a trek of more than a couple of days. As readers may ]mow from my other writings, I am a big proponent of healthier eating on the trail, like that described in resources such as NOLS Cookery. I have had students in my wilderness courses whose usual diets were low in fiber think that something was wrong after a few days of healthy trail eating upon finding that they were having one or two soft stools daily.

Hydration is the second factor impacting constipation. When one is dehydrated, the body absorbs as much water as possible from the gut, making stools drier and harder. Yet another reason to stay well hydrated in the backcountry! Remember, there is no “one size fits all” rule for liquid intake; one should drink as much as necessary to keep urine from being dark yellow.

Exercise is the final important factor in preventing constipation. Sedentary folks are at much greater risk, so maintaining bowel health is another good reason to hit the trail.

The backpacker with normal bowel habits at home who consumes a healthy trail diet and plenty of water should have no difficulty with constipation on the trail. Folks prone to constipation, or those with less fiber-rich diets, may want to bring along some medication for constipation. There are many types of these; the most common are stool softeners (such as Colace) and stimulants (such as Dulcolax). Stool softeners are less likely to result in a “quick need” to have a bowel movement, and are therefore a better choice on a trek.

The American Gastroenterological Association has a very helpful online resource with additional information about constipation, including warning signs of more serious problems. It can be accessed at patient.gastro.org/ constipation.

Tom Welch, M.D., is a physician at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. He is a licensed professional guide and certifying instructor for the Wilderness Education Association, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available at his website and blog, adirondoc.com. Bill Balistreri, M.D., an internationally known expert in constipation and other gastroenterological disorders, reviewed this column and provided helpful advice.

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Topics: Diet & Nutrition