If you are a medical professional or a caregiver I hope you stick with me. You are important players in this subject.

Diarrhea is so common as a symptom and as a drug side effect that it is often minimized as an issue.  We have all had experiences with it in our lives and we also tend to avoid discussing those bodily functions so it slides below the radar.

I had no appreciation for the power of these gastro events until my hospitalization last year. Diarrhea was just an occasional annoyance. There is something very primal in finding yourself in a hospital bed with a couple of very young nurses trying to clean up a pint or so of very foul, noxious, repulsive liquid that you are laying in. We really don't pay those people enough.  Poop juice is like blood, a little goes a long way. A gusher seems to consume everything for yards around.

Patients know that there are plenty of indignities involved with managing disease but basic body processes like pooping rise high in the list. During my recovery the drug warning about possible side effects has been true.  Not a big deal just something we put up with.  I didn't realize that it had affected me until I took a recent trip.

I don't have any particular OCD tendencies but I found myself checking into restrooms at the airport and other stops whenever possible.  Not because I needed to but to check whether I might soon. The thought that I might have an attack on an airplane or in a meeting weighed on me far more than was appropriate.

As I think about how that pressure affects people I'm reminded of one of our members.  She had NASH F4 and had been decompensated.  She had improved a lot and her doc had been very positive about her situation as she recompensated. Her husband wanted to go out to dinner to celebrate their anniversary and the fact that she had improved so much.

They were very happy to be going out for the first time in a long time.  She wore her best dress but took the precaution of wearing her diaper. (I'll get guff for saying that, it is an adult incontinence garment), but I'm old and its a diaper to me. 

Part way through the meal she had a sudden uncontrollable episode of diarrhea. It quickly overwhelmed the diaper. There was nothing for her to do but walk out with her soiled dress and diarrhea running down her leg. She went home and never left the house again, not even to go to her doctor. She was housebound for several years until an ambulance took her away following a stroke.

If you are a medical professional, be aware that this common problem can cause more disruption to a patient's life than it is commonly given credit for. It alters how a person reacts to ordinary situations and reduces social contact for many. Withdrawal and social isolation are serious problems for these patients and should not be overlooked.

If you are a caregiver wanting to help patients be more active plan events with toilet facilities in mind. For example, if you are going to a park choose one with restrooms and parking nearby.  If going to a mall find out in advance where restrooms are located and communicate this planning with your patient. Going to a restaurant, get a table near the rest rooms. Acknowledge the challenge with your patient and plan accordingly.

If you a patient, don't let a social reluctance keep you from communicating fully with your care team and people around you about the challenge. We have learned from childhood that these are private subjects but in the presence of disease they intrude on how one lives and the stress involved isn't healthy.

OK, more than anyone wants to think about I suppose, but disease and drug management are important to living as full a life as we are able. Minimizing challenges isn't the best way to win the game.