A common case of ‘matzahpation’

Mrs. J has been a patient of mine for several months after she had her screening colonoscopy done earlier this year. In general she is in excellent health and tends to stay on top of her regular health screenings for herself, her husband, and her 2 children. I was a little concerned when she contacted my office this morning and said that she was having abdominal discomfort, and my staff got her on the schedule for a Telemedicine Visit that afternoon.

When she connected to the visit, we briefly chatted about how the Passover holiday had been, and especially how this Passover was different than all others. She told me about her Zoom Seder with family members from all over the world, and how she actually enjoys Passover because it gives her an excuse to eat Matzah which she not-so-secretly loves.

A lightbulb went off in my head. “I’m so happy that you enjoyed your Seder and got to connect with so many family members. Why don’t you tell me a bit about your abdominal discomfort?” She went on to relay details about how she was bloated and cramping, but felt better after using the restroom. Even more curious was the fact that she normally had very regular bowel habits – but now noticed more difficulty.

This is a conversation replicated annually in doctors’ offices worldwide. I assured her that with some simple interventions we would be able to reverse course and she would feel much better. As a matter of fact, within a few days time she may notice the problem rectifying itself. I explained that she likely was dealing with “Matzahpation” – a term coined on the internet, but sums up the issue succinctly – constipation which tends to occur over the Passover holiday in relation to a sharp increase in Matzah ingestion, as we forgo bread and flour and instead avail ourselves of matzah and matzah meal for all of our favorite recipes.

Constipation and its associated symptoms are a year round reality, and a very common reason for patients to see me as a gastroenterologist. It is often a sensitive topic and makes many uncomfortable to discuss, but know that you are far from alone in this struggle. Per a report from the American Gastroenterological Association (AGA), it is estimated the prevalence of constipation to be 16% of adults in the US, and in those over age 60 the number increases to 33%.

I do think it is important to understand the various definitions surrounding constipation. What is considered “regular”? This actually may surprise you. I think many of us are conditioned from birth to think “regular” means having a bowel movement every day, like clockwork. Wake up, have my coffee, go to the bathroom, go through the rest of my day, go to sleep. Rinse and Repeat. How surprised would you be if I told you it could be normal to go every 2 or 3 days? The truth is that there is a range of normal – anywhere from 3 times a day to 3 times a week.

What is important to me, and what I stress to my patients, is consistency – both in frequency and in form. If you are someone who goes every other day, then that may be your norm. I want to make sure that not only are you going regularly, but that it is easy and complete – you feel empty after you have gone, you don’t have to return too quickly to the bathroom, and that it didn’t take much time. If you didn’t click off all 3 of those checkboxes you may actually have a mild form of constipation commonly referred to as fecal retention.

What can you do to fix this at home? 

• Drink water and hydrate – drink 64 ounces a day or more unless you are otherwise on a fluid restriction
• Eat Fiber containing foods and consider a fiber supplement
• Whole Grains (Whole Grain Matzah is an excellent option over Passover!)
• Green Vegetables
• Fruits with skin
• Laxatives

I am more a fan of a docusate-type stool softener or a water based laxative like Miralax for an initial trial at home.

If these steps aren’t enough to get you going, it may be time to discuss with a professional.

So how did Mrs. J fare? Glad you asked! After our visit she increased her water intake and started taking a fiber supplement. We had a quick followup phone conversation before the end of the holiday, and with more bowel regularity all of her bloating and cramping had resolved as well. While constipation affects many of us all year round, don’t forget about its visiting relative – matzahpation – so that you can avoid its restricting embrace and get back to enjoying all your favorite matzah recipes.