Whenever an elderly gentleman comes with constipation I get worried about cancer colon being the cause. This man was no exception. He is past seventy and I have known him for some years now, I knew his fetish about daily bowel movement and I suspect that he abused laxatives to achieve this objective. Therefore when he came with complaining of constipation of two days, I got a bit worried and told him to try some isobgul powder [which bulks and softens the stool] that night. He gave me a sheepish look and told.’ But doc, I have already taken tablet of dulcolax and it has not helped’. It was with difficulty that I could control my irritation. This is because I do not like any one taking an irritant purgative like dulcolax as it can cause problems when used routinely, and when the habit gets a patient it is difficult to get him off. But I held myself back as I felt it was more important to know why of his constipation than worry about his misuse of dulcolax at that moment.
I told him to get an enema done and gave a note for getting this done at a nearby polyclinic and asked him to come for a proctoscopy [an examination of the lower end of the colon by a small metal tube] later. I also told him to be prepared for a possible colonoscopy [longer version of the proctoscope] and sent him with a worried frown [revealed on his face and not mine].
He did not come back for over a month and when he did come it was for an entirely different reason. Curious to know, I asked him about his constipation. He laughed and said it was due to the news paperboy not delivering the daily newspaper to him on three successive mornings. You are justified in wondering what newspaper has to do with constipation. Let me tell you. Our friend has read his morning newspaper sitting on the commode for the past 40 years and would not move the bowels unless this ritual is followed! Arrived the newspaper and went the constipation!