Humans and Gorillas Have This Complaint In Common-- Any Guesses?

By Jamie Wells, M.D. — Aug 17, 2017
Given the political morass consuming all of the oxygen in the room on social media and every news outlet, a pivot to human and gorilla medical commonalities seemed a worthwhile departure.
Credit: Graphicstock

Given the political morass consuming all of the oxygen in the room on social media and it seems every news outlet, I must admit writing another in-depth thought piece on current health policy or innovation seems a bit disconnected from the events of the day and week.

So, I was glad to discover a development that could catapult me out of this transient paralysis-- or writer's block. The unlikely source for this spurt of creativity? A Kansas zoo. Entitled "Constipated gorilla in Kansas zoo recovering after surgery," the Associated Press piece delivers an apropos topic that affects humans too.

Tiffany, the 49-year old lowland gorilla, wasn't acting like herself which initially was attributed to a storm, but as the days went on she ate less and less prompting greater concern. From reports, it appears she underwent exploratory surgery to assess the problem and, thankfully, is doing well. In humans it would be described as FOS --or full of stool versus full of another "s" that is not such a nice word so use your imagination, but in her the disclosures detail large amounts of stool in her colon that required removal and flushing. Hopefully, once all the testing is concluded it will be readily determined how to treat her constipation and learn why it occurred. 

Being one of the oldest gorillas in a global database, it will be interesting to discover if age was a contributing factor. In humans as in animals, constipation is a universal symptom. The etiologies and acuity tend to vary depending on the specific population and clinical history. Whereas Tiffany's case would be more acute with a surgical course out of concern for likely bowel obstruction, other scenarios are more chronic in nature and can be less worrisome. 

It is a common occurrence in the post-surgical human patient who is on pain medications to have the side effect of reduced gut motility. The sooner a person is off of those drugs (e.g. opioid narcotics), the better it is for them to avoid worsening, unpleasant constipation. This is why being assured an individual passes gas and has moved their bowels is essential to being cleared for hospital discharge. But, balancing pain, the disease states and origin of the surgery itself as well as the individual's clinical status all play a role in optimizing what can be a delicate dance. In a young child, ingestion of a foreign object or defiant stool-withholding behaviors can be a cause for obstructing bowel progress. The latter emotional issue can contribute to a physical one. 

Chronic constipation can be when the individual goes less frequently and when he does it is hard or dry and likely accompanied with belly distension and discomfort. It can result in pain on defecation or yield a sensation of inadequate, small or incomplete evacuation. The symptoms can be highly variable. In fact, a person can experience what they believe to be diarrhea, when in reality it is constipation. The loose, watery excretion can be from leakage around the area of impaction. Frequent straining and more sustained constipation can lead to rectal prolapse, fecal blockages, hemorrhoids and blood on the toilet tissue as a consequence. Fortunately for many with more mild forms (which is very common), increasing hydration, avoiding certain more binding foods and enhancing a fiber-rich diet can keep this under control and serve to soften stools. For others in the more severe set, more aggressive interventions are necessary inclusive of a wide range of medications administered from above and below-- or, orally and rectally-- to manual, even surgical disimpaction. Long-term use of laxatives and the like also warrants continuous monitoring to ensure electrolyte imbalances don't occur which can lead to a cascade of medical problems. 

Like most medical issues, determining why whenever possible best contributes to directing therapies and efforts toward resolution. Being that constipation is likely the most frequent complaint with respect to digestion, it is interesting to note that it genuinely can impact every stage of the life cycle. Though dietary scope tends to be a routine culprit in the very young, increased immobility can be a common trigger as we age. The pregnant woman is often troubled by it as well.

According to the National Institutes of Health (NIH), this universal problem affects about 42 million people in the United States. Thankfully, it is often a temporary issue for the majority. However, there are medical conditions and drugs that can exacerbate and contribute to protracted constipation, including but not limited to: hypothyroidism, spinal cord or brain disorders, tumors, anatomical anomalies, anti-seizure medicines or iron supplements, to name a few.

As Tiffany continues her anticipated speedy recovery, I hope her remedy will merely be to increase her activity level and tweak her diet. She has much joy to experience and records to break for her longevity.