An American Journey: From Constipation to Colorectal Cancer

An American Journey: From Constipation to Colorectal Cancer

In my work as a radiologist, every day I see a whole lot of poop, well, actually images of poop. One of the most common emergency room patient complaints is abdominal pain and, too often, particularly in children, the cause is simply constipation. This is evident on imaging studies, and I believe this is a symptom of a much larger problem, our Standard American Diet, which is generally very high in animal-based foods and processed foods, and quite low in plant-based whole foods (e.g., fruits, leafy vegetables, and whole grains). 

toilet paper

Unfortunately, constipation is just the beginning for many of these youngsters. Here are just a few of the problems they are likely to encounter later in life without significant dietary changes:

Hemorrhoids. These are vascular structures in the anal canal that help with stool control. They become pathological when swollen. They are composed of arterio-venous channels and connective tissue. Internal hemorrhoids usually present with painless rectal bleeding, whereas external hemorrhoids may be asymptomatic or, if thrombosed, may cause significant pain and swelling related to the anus region. Factors that increase intra-abdominal pressure (e.g., chronic constipation) contribute to hemorrhoids.

Diverticulosis/Diverticulitis. Diverticulosis refers to diverticula in the colon, which are outpocketings of the colonic mucosa and submucosal, through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure (e.g., chronic constipation) and are uncommon before the age of 40. Diverticulosis often results in painless rectal bleeding. Diverticulitis results when one of these diverticula becomes inflamed, may cause pain and fever, and can be complicated by abscesses, which occasionally require drainage procedures or surgery.

Colorectal Cancer. Cancer is an uncontrolled cell growth, which in this case occurs in the colon or rectum. Symptoms of colorectal cancer typically include rectal bleeding and anemia, which are sometimes associated with weight loss, pain, and changes in bowel habits. Results of The China Study showed that high fiber intake (e.g., plant-based whole foods) was consistently associated with lower rates of cancers of the rectum and colon.1,2

Constipation and hemorrhoids used to be personal issues for me. However, since adopting a whole food, plant-based diet, neither has been a problem and I sincerely doubt they ever will be. I consider myself fortunate that I did not progress to diverticulitis or colorectal cancer before making my dietary changes.

It is noteworthy that recent studies seem to suggest that the environment within our colon may be a predictor of our risk of many chronic diseases. A chronic failure to expeditiously eliminate waste/toxins through our bowel seems to have reverberating consequences throughout our body. Furthermore, it has been my anecdotal observation over the last 15 years as a practicing radiologist that adults in whom I diagnose constipation on imaging studies are much more likely to have cancers (e.g., breast, prostate, and colorectal) and visible atherosclerotic disease.

Yet, relatively few dollars are spent on research and education related to the benefits of a plant-based diet to promote colon health. Instead, like other cancers—including breast and prostate—most expenditure in the United States is toward screenings for early detection and implementing treatment regimens following diagnosis. Why do we not place more value on nutritional prevention in our US health system? Why do we generally prefer only to diagnose/screen and to treat?

As health care professionals, we can and should educate our patients and encourage them with regard to plant-based foods as the most comprehensive and effective way to prevent the diseases that result in most American deaths. By starting with our children, we can give them each an opportunity for a healthier, longer, and more productive life, free of many chronic diseases.


1. Li JY, Liu BQ, Li GY, et al. Atlas of cancer mortality in the People’s Republic of China. An aid for cancer control and research. Int J Epidemiol. 1981 Jun;10(2):127-33.

2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; Peoples’s Medical Publishing House; 1990.