Returning to the soil.

Two weeks ago, we delved into the bowels of our roleplaying characters and discovered how even simple diarrhoea can provide interesting story experiences. Today, we continue our theme by discovering more hidden nuggets of narrative joy buried in our lower gastrointestinal tracts (and that's a sentence I never thought I'd write...).

You shall not pass!

Having covered diarrhoea, we now naturally move onto constipation.

Constipation is defined as the "infrequent or difficult evacuation of faeces". It can be caused by organic obstruction (for example due to a bowel tumour), drugs (such as codeine, heroin and other opiates), a non-functioning bowel, perianal problems and by biochemical imbalances (for example, lead poisoning).

Before all you hypochondriac and motion-challenged readers run to your family doctors to say that Dr. Aesclupius thinks you have cancer, bear in mind that the most common cause of constipation is none of the above, but rather changes in diet and lifestyle.

Telling the player of Thrugg the Mighty that last night's feast of venison has left him bound up internally may not be appropriate for every heroic fantasy game, but it does show a certain level of attention to story detail.

Constipation can become painful after a while, with cramping discomfort starting in the lower left abdomen and eventually spreading over the bowel as a whole. The elderly and the very young are especially prone to coming to harm from constipation. For example, a child who stops opening his bowels because of soreness will find that when he finally does go to the toilet the stool is so hard that it hurts even more, and the pattern can get reinforced. In fact, if the child maintains an infrequent habit for half a year or so, permanent bowel damage can be caused through stretching of the gut wall.

Paradoxically constipation can also present as "overflow diarrhoea" where the hard stool itself doesn't shift but watery stool leaks around the outside.

Is it meant to look like that?

Aside from not enough faeces and too much faeces, there can be problems with the quality and contents of the bowel motions. Consider the following...

Blood

Bright red blood in the motions is usually (but not always) nothing to worry about, as it is often due to haemorrhoids or anal fissures (cracks in the anal skin that are as painful as they sound).

Dark red blood is more serious, as it tends to come from higher in the bowel. In fact, if you bleed from your stomach or duodenum (as ulcers sometimes do) then by the time the blood reaches the other end it has been digested and converted into a substance called melaena. Melaena is black, tarry, sticky stool with a characteristic smell (that a colleague of mine once described as "vomit mixed with sawdust and iron filings").

Now, I don't know if it is true of other people's RP groups, but I used to find that whenever we start a new campaign at least half the players will generate alcoholic or hard-drinking characters. A malicious GM (like myself) sees this as an opportunity to wreak havoc on the player character's bowels! Afflicted characters could start bleeding from their gastric ulcers after an evening in the tavern, with all the cramping abdominal pains and melaena-laden stool that goes with it. I'd encourage you to do the same to your players if only to see the priceless look of terror on their faces.

I will, of course, return to alcohol in more detail in a later article.

Fat and oil

Loose fatty stools (known as steatorrhoea) are characteristic of gut malabsorption syndromes (like coeliac disease). Motions will be bulky, foul smelling and with oily globules in them. They will float on water, and are far smellier than normal.

The roleplaying potential of complex conditions like coeliac disease is admittedly somewhat limited. On the other hand bearing in mind that changing the contents of stool can dramatically change its characteristics will open doorways to a whole host of ideas and images.

Imagine a character (literally) stumbling across a heap of oily red dung, that has a terrifyingly offensive stench and is semi-liquid. The ranger of the party can step forward, and explain that this is the classic appearance of orc-dung, as it reflects their entirely carnivorous diets. If you have a taste for the macabre, you can even add in a few human fingers, and explain that orcs gulp down their food in large chunks, and that their inefficient digestion means that meat often passes through in a largely unprocessed state. Of course, this would also explain why they belch and expel gas all the time, and are always hungry...

Parasites

The idea of parasites swimming around bowels is sure to put the "ick factor" into any roleplaying horror game, and is an ideal tool for grossing out jaded players.

Helminthic diseases such as cestodes (tapeworms), nematodes (roundworms) and trematodes (flukes) can be found in the bowels of a significant proportion of the world population - an estimated 1.8 billion carry parasitic bowel infections in one form or another. Parasitic infections are far more common where there is no clean water supply.

Presentation is normally by itching around the anal area, and sometimes from migration of the worms to other areas, for example the genitalia or even the abdominal cavity. Most parasitic infections have no symptoms, however.

Parasites are generally invisible to the naked eye, but visible under a microscope examination of the stool.

Of course, in a fantasy, horror or scifi world parasites might be larger or more exotic. Imagine a Call of Cthulu investigator looking into the toilet bowl and seeing - in amongst his daily evacuations - dozens of swimming fingernail sized toads... SAN check please!

Slime

Slimy stools are full of mucus, and are due to overproduction of mucus in the large bowel. Your bowel normally produces mucus (which is mostly lubricating protein) to help smooth things along, but overproduction generally represents significant bowel problems.

"Aluminium paint"

The brown colour of stool is introduced early on in the gut, via the bile duct. Essentially it is the waste product of broken down blood, which the body dumps into the bowels. In obstructive jaundices the stool will often appear pale because of the blocking of this drainage by gallstones or cancer.

"China clay" or "Aluminium paint" stools are the same process taken to an extreme. These stools are pale and cream-coloured, and are associated with absolute obstruction of the enterohepatic biliary circulation, normally by pancreatic cancer. Its worth noting that pancreatic cancer is a real silent killer, as by the time symptoms like "china clay stool" occur, its often too late to do anything about the underlying cancer.

Dramatic changes in stool colour are a good way to throw jaded players off balance. With its associations with pancreatic cancer "china clay" stool would be a good way to launch into a "dying slowly" story (as explored in an earlier article).

Other changes

The above pretty much covers the majority of bowel habit changes that can occur in real life, but in a roleplaying setting the possibilities are far greater. Forget gigeresque aliens with acid for blood... why not have an alien that has super-corrosive stools? And if humans can have parasite and bacteria-laden stools, who is to say that goblins don't have baby goblin spores in their motions? It would certainly explain why there are so many of them, and why they are so unsanitary...

Summary

As you can see, your bowel motions are far more interesting than you might have thought!

Hopefully I've provided something useful to your games, and hopefully you've not regretted reading about the grisly fundamentals of this pleasant topic...

Next time, I'll be stepping away from disease and illness, and instead looking at accurate depiction of medical environments and medical day to day life. Till then, have fun playing with poo!