This week, I interviewed my friend and GP, Dr Dan Sherlock on all things poo-related. As many of you know, this is a subject close to my heart, metaphorically speaking anyway. See how many double entendres you can find. It’s like a faecal Where’s Wally.
ANDI: So, Hi Dr. Dan.
DR DAN: Hello
ANDI: Let’s just jump straight in. As a percentage, how many of your patients come in with problems related to the bowels or digestion?
DR DAN: It’s fairly common. There are two groups. People who have a sudden problem with poo...
DR DAN: ...Like they've picked up infections or eaten something dodgy and they've got bit of diarrhoea and vomiting. They come in because they reckon they might need antibiotics. So that’s one group, the sudden poo problems. Then there’s people with long-standing problems but I guess everyday I would see at least two of what we’re calling ‘poo problems’.
ANDI: (LAUGHS) Sorry I'm going to laugh every time you say it but I’ll get over it eventually
DR DAN: OK, alright...
ANDI: What should people expect their poo to look like and what does it look like when its gone Pete Tong?
DR DAN: There’s actually a classification of poo...
ANDI: The Bristol Stool Chart. I know it well (I have since discovered you can buy Bristol Stool Chart t-shirts, mugs and iPhone covers WTF?!)
DR DAN: That's the one. It’s a very useful tool. The perfect poo should be somewhere between 3 and 4 on the chart. You know when you've done a good poo, don’t you? You've got that sense of pride. It’s not too soft, it’s not too hard, bang in the middle with slight indentation but not cracked. I think it’s quite a clean poo in a way oddly.... There are pictures
ANDI: Yes, I’ve seen pictures. Do you refer to it or are you completely familiar with it now?
DR DAN: When I was in the hospital people were more obsessive about poo. Every time a person went to the toilet the nurses had to record it on the Bristol Stool Chart and kept it in the patient’s file, particularly if they had a poo problem. They’d log their movements until they returned to normal poo. You don’t need to do this with every patient. Like with a chest infection it’s probably not that vital.
ANDI: Are you guys as squeamish as the rest of us or is it just part of the job?
DR DAN: It is part of the job, as it were. I don’t particularly have any strong feelings about it. It’s just another symptom. It just gives you an idea of what’s going on with someone's body that helps find what the problem might be.
ANDI: How often do you have to look at people's bums?
DR DAN: That’s less often. I wouldn't say that happens every day
DR DAN: Couple of times a week, you get a bum, on average. It’s a bit like buses. You get some days it’s just like bum morning. Everyone’s showing you their bum. That's just the way it goes some times. It’s funny like that. Things do come in clusters. You get 2 or 3 in a row.
ANDI: Which reminds me, piles, how common are they? Are all age groups susceptible to them?
DR DAN: Yeah it is actually. You see it from the age of 20 - 30 and sometimes as people get older but it’s not particularly restricted to any group. I’d say I’d see it once every couple of weeks. Piles are always there, in the background.
ANDI: Out of all the people that come in to see you, how much is brought on by their own life style choices and how much is them catching something or developing something that’s in the body already?
DR DAN: That’s a big question. That’s a very big question. If you ate something dodgy and then the next day you're shitting through the eye of a needle, you’d probably say it was down to picking up a bug. People who tend to have chronic problems, it’s more likely to be down to lifestyle and diet.... but it’s a little... controversial
ANDI: I suppose you don’t want to get into the thing of blaming people for their symptoms but you can see how sometimes if they’d made different lifestyle choices, maybe they wouldn't have had that ailment. Would that be true?
DR DAN: Yeah, I think certainly from what I've seen, people who are really busy, stressed out, working really hard, tend to be prone to picking things up but I think when it comes to it, if you've had problems with your bowel, certainly looking at your life style, what you’re eating, what you’re drinking, your exercise is definitely part of an assessment for a poo problem.
ANDI: (GIGGLES) Sorry.... So in terms of things we consume, it’s probably an obvious question but what sort of things cause problems?
DR DAN: Well, if you’re eating a lot of fatty foods, like McDonald's every day, you’d have a pretty loose stool as your body would be processing a lot of fat. That can lead to looser stools, diarrhoea but it’s not an exact science. That’s why people struggle with this. They say “ I'm looking at my diet and I'm trying to eat these things but I'm still having the problem”.
ANDI: Because some people can manage certain foods better than others. Like some people are better with foreign foods.
DR DAN: Yeah
ANDI: Does alcohol have any impact on what happens to your digestion?
DR DAN: Yeah definitely. It varies from person to person but, for example, I had a friend at uni and after we'd go out on a bender, he'd always get diarrhoea.
ANDI: Wow, didn't stop him though, right?
DR DAN: No, didn't stop him
DR DAN: He used to feel really shit. People know which foods upset them but you still may find yourself having that kebab on a Saturday night.
ANDI: and to hell with the consequences
DR DAN: exactly and you'll pay for it tomorrow
ANDI: I find Guinness has quite a spectacular effect on the body
DR DAN: Guinness?
ANDI: Yeah. Really. It’s one of those things where you have to remind yourself later on that you had it, like beetroot. You forget and then you panic when you’re on the loo
DR DAN: Like asparagus. You’re like, “What’s going on!?” and then you remember, I had asparagus for dinner
ANDI: “ I'm rotting from the insides! Oh.... no”. If you could tell people to do one thing or include more of something in their diet what would it be?
DR DAN: a food?
DR DAN: Oat biscuits. They’re good
DR DAN: Yeah. I think they’re good for keeping you regular.
DR DAN: No, I just made that up
ANDI: have you??
DR DAN: Yeah
ANDI: Dr Dan, you can’t do stuff like that!
DR DAN: OK, OK. Well, you get a lot of fibre in your green veg. (THINKS) It’s difficult to say one thing because it really does come down to how your own body handles the foods
ANDI: You can say more than one thing then
DR DAN: Greens. Spinach.... oat biscuits
ANDI: (SIGHS) is that true?
DR DAN: Oat biscuits are very good! Peppermint is good, especially if you’re prone to a bit of cramping or you get a bit of a jippy tummy from time to time. If you get stressed then peppermint can help sooth things
ANDI: Do you ever say this sort of stuff in surgery or do you think they'll [the patients would] be thinking, what the hell is he talking about, peppermint tea? I need antibiotics
DR DAN: No, I do say peppermint tea. Peppermint capsules work as an antispasmodic. It’s not something where I’d say you've got to do this but it’s certainly worth trying if you do get a bit of cramping or irritation or pains.
ANDI: What about wind? What’s the cause and is it an indication that something’s up or is it a normal part of being a human being with a digestive system?
DR DAN: Yeah it is really. The food gets broken down in the large intestine so that the last bits of water and nutrients can be absorbed from the digested food products then gas is produced and that gas just... comes out. I've had people come to me and say, ” I've got really bad wind. It smells terrible”. This woman was really stressed about it but there’s not much you can do. I suggest looking at your diet. I recommend keeping a food diary. If you are wondering what’s causing your bowel to behave in a certain way, keep a food diary. Note down what you've eaten, your symptoms, your daily activities, were you busy, did you drink and see if you can find any patterns. There are no tests really for bad wind as far as medical science is concerned. There are certain allergies tests but the best place to start is your diet.
ANDI: Do certain life style choices influence how effectively your digestive system operates?
DR DAN: It’s a huge factor. There’s conditions like Irritable Bowel Syndrome, where people suffer from chronic ongoing problems like cramps, diarrhoea , constipation, bloating, it’s not fully understood but certainly there’s a very strong association between levels of stress, anxiety, overworking and the onset of the symptoms
ANDI: So really, your advice would be for people to relax with some oat biscuits
DR DAN: Yeah, just chill out. Have an oat biscuit, man. Don’t stress. Have a peppermint tea and listen to some whale music. That's pretty much all bases covered
ANDI: And you can just scribble that on a prescription. I'll just ask you a couple more questions. What about probiotic yoghurt coz there’s part of me that thinks, is this a load of bollocks or does it actually do any good?
DR DAN: I'm not familiar with the up to date evidence on their effectiveness but the reasoning behind them is they replace the good bacteria in your stomach. The large bowel has a colony of ‘good’ bacteria or natural flora which is very important in breaking down food and plays an important role in maintaining health and if for any reason you’re a bit deficient in these natural bacteria then these drinks will replace it. That’s the theory behind it. When I was working in the hospital, they did a trial of patients who were taking antibiotics. Because they can kill the good bacteria in your bowel, they were giving Yakult but the trial results didn't prove that it made much difference.
ANDI: oh really?
DR DAN: hmmm
ANDI: Under what circumstances should people go to their GP, when it comes to bum problems?
DR DAN: If people are concerned, they should come in. If they've had a bit of one off bleeding and you know you've got, say, piles then you don’t have to come in but if you've got bleeding and you don’t know why and you’re concerned then you should. I encourage people to come in. Like if you’re having things like loose stool for more than a month and you’re over the age of 55 then you should get it checked out.
ANDI: The Government are doing these really terrifying ads at the moment. The person on the ad says “oh, I've got a bit of bleeding” or “my stools are looser than normal” and then the voice over goes, “come in, it could be bowel cancer!”. Yeah but couldn't it just be that I've caught a bug or something?!
DR DAN: It can be but the reason for that campaign is because in Britain we have a very poor five year survival rate for lots of cancers and bowel cancers is one of them so we’re trying to improve that and pick up cases early
ANDI: I see
DR DAN: If you’re a bit concerned then just get down to the doctor because it may be embarrassing for you but for me it’s really just another day at the office
ANDI: that just involves other people’s bums. Any final nuggets of advice?
DR DAN: There’s a website that’s good for patients. www.patient.co.uk and that gives you lots of helpful information
ANDI: Is that a government sanctioned website
DR DAN: Yeah, it is. It’s run by the government and doctors use it to give out patient information leaflets
ANDI: Oh good. Do you get a lot people coming in going,” I've goggled my symptoms and I think I've got such and such”?
DR DAN: People do but often they feel like they shouldn't but I don’t mind. I think it’s good for people to take on a bit of responsibility for their own health because I'm not just here to tell people what to do. I'm here to help them take responsibility for their own health.
ANDI: That’s a nice way of looking at it, taking responsibility for your own health and helping us be more self sufficient, more self reliant. Well, thanks Dr Dan. That’s been very interesting
DR DAN: We've covered poo
ANDI: Yes, we've definitely covered poo.