If you have a thoracic aortic aneurysm, you may be worrying every time you have a bowel movement if pushing and straining could rupture it.
Even if your aneurysm doesn’t qualify for surgical repair, you know that there’s still a bigger risk – when compared to a healthy aorta – of a dissection if intrathoracic pressure quickly rises.
Straining with a bowel movement due to constipation causes an increase in intrathoracic pressure.
What makes this worse for a TAA is if you hold your breath while “bearing down” to expel your poops. This really loads up the pressure within the thoracic cavity.
It’s similar to the act of holding one’s breath while straining to lift a very heavy weight, such as with a bench press or barbell deadlift.
So then, just how potentially dangerous can the mere act of sitting on a toilet be for someone with a thoracic aortic aneurysm?
“This comes down to increased blood pressure during straining, leading to aortic wall stress,” explains Alexandra Kharazi, MD, a cardiothoracic surgeon with the Sharp HealthCare system in CA.
In a TAA, the aortic wall in the bulging part of this great blood vessel is thinner than it should be, due to the expansion of the aneurysm.
Think of a balloon that gets bigger and bigger as air fills it. Its skin gets thinner, and the risk of popping goes up.
As blood pressure rises, there is increased force against that too-thin inner wall of the aneurysm, which could lead to a tear or dissection.
“This varies greatly by patient factors,” says Dr. Kharazi.
“For example, someone with a connective tissue disorder such as Marfan syndrome is much more susceptible to rupture and dissection during sudden increases in blood pressure like straining for a bowel movement.
“In someone who does not have a connective tissue disorder (that they know of), this varies by aneurysm size and location.
“For example, someone with a 5.5 cm ascending aneurysm is at greater risk of rupture during straining than someone with a 4.5 cm descending thoracic aortic aneurysm.”
A larger aneurysm has a thinner, weaker wall. Plus, if it’s close to the heart, as is the case with ascending dilatations, the blood flow is more turbulent.
How to Reduce Anxiety Over Having an Aortic Dissection During a Bowel Movement
“I had a patient come in with an ascending aortic dissection after straining for a bowel movement,” says Dr. Kharazi.
Thus, it’s entirely possible for this to happen; it isn’t just the stuff of hypotheticals in medical literature.
How likely is it to happen, though? Nobody knows, as far as a percentage.
But think of it this way: Nobody knows how likely, in terms of percentage, you’d get flattened by a giant truck if you walked across a random highway while looking only straight ahead of yourself.
But the danger is overwhelmingly present. You may make it across 200 times and never come within a hundred feet of an 18-wheeler.
But you may also get squashed the very first time you take that walk.
“I would recommend an over-the-counter stool softener and increasing fiber in the diet to avoid constipation, as the first factor,” says Dr. Kharazi.
“Being hydrated is also important. If this doesn’t work and you are still straining, seeing your primary doctor to evaluate for underlying causes of your constipation is the next step”
Finally, avoid the Valsalva maneuver: holding one’s breath while straining against resistance.
This means next time you’re finding it difficult to pass your poops, DO NOT hold your breath as you bear down.
Instead, exhale continuously. Do not pause this letting your breath out.
Loudly blow out the air if you must, but make every effort to avoid taking a pause to hold your breath.
If at the bottom of the blowing out, the stool is only partially expelled, then take another deep breath and start exhaling again as you resume pushing. Repeat as necessary.
Yes, it’s easier to just hold one’s breath and push like mad to get out stubborn BMs.
However, you can get in the habit of a steady exhalation whenever you’re on the toilet.
In fact, don’t wait till you have constipation. Start this practice the next time you have a bowel movement – even if it’s soft and comes out super easy.
This way, should you eventually have constipation or hard stools, you will already be used to blowing out air — without pausing — while straining.
Dr. Kharazi has many areas of surgical expertise including the following: aortic aneurysm repair, aortic valve repair and replacement, and CABG. Other areas of focus include arrhythmia, bloodless medicine, lung cancer and resection, septal defect repair and thoracic surgery.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.