Bollywood’s Constipation Comedy and the Mind-Gut Connection

From constipation to diarrhea and anything in between, there is no dearth of pop culture allusions to the impact of bowel movements on day-to-day life. Sit down to watch just about anything on television, and you’ll be hard pressed to go without seeing Jamie Lee Curtis encouraging you to take the Activia challenge, or Ben Stiller’s bowel issues in Along Came Polly destroying loofahs and overflowing toilets. And now, a Bollywood movie called Piku spun “motions” and emotions into a 2.5-hour long box office phenomenon.

Piku focuses on the unique relationship between the title character and her aging father, Bhaskor. As her constipated father’s primary caregiver, Piku is always on the receiving end of any and all bowel movement discussions regardless of whether she’s at work or on a date. And the highlight of the movie? A Delhi to Calcutta road trip that includes endless poo pit stops and Bhaskor’s special toilet seat in the cargo.

All bathroom humor and pop culture aside, the gut-brain axis and the bowel movements of patients have always been of legitimate interest in the medical world.

In the hospital, bowel movements and stool characteristics are of the utmost importance. Post abdominal surgeries, for example, stunned bowels take their sweet time recovering, so discharges are often delayed simply to ensure that a patient has an adequate movement before they go home.

For patients on powerful antibiotics, the mention of diarrhea particularly piques our interest because of the possibility of dreaded clostridium difficile (C. diff) infections. So between praying for bowel movements and praying to keep diarrhea at bay, there are a lot of in-hospital emotions in regards to motions.

When there is concern for bleeding in the gastrointestinal system, we get up close and personal with our patient’s bowel movements. Color, texture, amount, and frequency are just a few of the key features we’re interested in. Sometimes color can be tricky, but thankfully, as an Indian doctor with black hair, I can always ask my patients if their stools are closer to the color of my hair or more like the color of my skin. You do what you can to get the facts!

In the clinic, things are a little more laidback, but clinic visits are often filled with discussions surrounding bowel movements—or lack thereof. Often times these discussions in the outpatient setting come to points involving dietary habits, food intolerances, and sometimes emotional stressors that can trigger changes within even the most regular of bowel movers.

And this is where the gut-brain axis comes to play. From the impact of gut microbes on mood and personality to the proposed neural connections between the central nervous system (CNS) and the enteric nervous system (ENS), the future possibilities for studies about the gut-brain axis are endless.

Originally, theories proposed that depression and anxiety can affect the gastrointestinal system and contribute to symptoms such as bloating, diarrhea, and constipation; but experts at the Johns Hopkins Center for Neurogastroenterology propose that an irritated stomach—and thus an irritated ENS—can actually trigger mood changes through signals sent to the CNS.

This theory can be further validated by the fact that up to 95 percent of the body’s serotonin is found in the gastrointestinal system, and almost all of the serotonin in the blood stream comes from this source. The role of this important neurotransmitter in the underlying processes at play with depression and anxiety has been well established for years, so this information only further supports the ENS-CNS connection involved in the gut-brain axis.

Today, some of the hottest research involving the gut-brain axis revolves around the influence of gut microbes on cognition and mood. These recent studies are looking at the idea that many of us—literally—think with our stomachs, and in fact, there are proposals that perhaps modifying gut microorganisms could treat certain CNS disorders. Given the growing role of fecal transplants for the treatment of recurrent C. diff infections, it goes without saying that the link between the gut microbiota and the CNS needs to be better explored and better understood. Because, after all, stool has now become a treatment for a disease process, and as with all treatments, the risks and benefits must be weighed.

It goes without saying that for medical practitioners and researchers alike, the gut-brain axis has provided plenty of food for thought. Puns aside, the impact of emotions on our motions and vice versa is slowly proving to be a matter that we all need to take seriously. Unlike the unfortunately nicknamed—and subsequently shunned—“Gasser” from an episode of How I Met Your Mother, we should all better embrace a willingness to understand our gastrointestinal system and all of its byproducts. There is a lot more that needs to be understood, so let the conversations about your motions flow freely.