Hi guys! As advised by the gastroenterologist, I got anorectal manometry done. The doctor who did the procedure told me that I contract the anal muscles instead of relaxing while having bowel movement, this causes incomplete evacuation & that is why I have to pass the stools several (usually 4-5) times a day.
Below are the findings of the report:
1. Anal sphincter length is approximately 4 cm (shorter than the normal length I guess)
2. Rectoanal inhibitory reflex [RAIR] is present.
3. On bearing down he paradoxically contracts his anal sphincter instead of relaxing it and has poor rectal propulsive forces [<40mmHg] which is suggestive of "Dyssynergic defecation". He is unable to expel a 50cc balloon in 60 secs. Biofeedback sessions for anal sphincter relaxation exercises maybe beneficial.
The doctor has advised me to go for biofeedback. I googled a bit & found that biofeedback is the most effective treatment method for dyssynergic defecation but from a survey on patientslikeme I found that this treatment method isn't that effective instead people got benefited from a method like physical therapy.
Have got a few questions now:
I. Is it only the dyssynergic defecation which causes me to have 4-5 bowel movements daily, poor apetite etc or something else like IBS as well is present (I don't have symptoms of any kind of pain)?
II. What is the reason of blood being seen stuck to the stool (sometimes)? Is it Infectious colitis (I had got colonoscopy & biopsy done a few months back as I used to get to see blood stuck to the stools on regular basis, infectious colitis was the diagnosis. The doctor prescribed me anti-biotics for a period of two weeks & since then I rarely get to see the blood but it hasn't disappeared completely) or dyssynergic defection or something mild like anal fissure?
III. Shall I go for biofeedback or try something else like physical therapy?
Kindly guide me. Thanks in advance.
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Aryan11111
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I can relate. I am nervous because I just saw a new Gastroenterologist. He wants me to have Anorectal Mammotry (sorry for spelling errors). Done. Mine is being done with a catheter with a baloon they fill with air. Is that how yours was done? I have had chronic, severe constipation for as long as I remember, and nothing seems to work..Linzess, Probiotics, Fiber, at home remedies. Only things that helps me is Senna which I take once a week. I even struggle taking "stool softeners (Colace) every day. I strain to the point that now I messed my shoulder up, and having pain in my upper spine area. It's pretty concerning. I'm nervous about possible surgery of Sphincter muscle. The gastro who ordered the test for me said, I would have to do exercises to strengthen pelvic floor muscles. You can pm me if you want, but please keep us informed about possible solution.
A friend of mine has just told me she had this test. She seemed reluctant to get into any details, so I wasn't able to really ask her any detailed questions. I did get the impression, though, that it was not a "big deal" and not painful. I think it is good that you are having it done, as it is just one more bridge to cross. Even though you weren't crazy about the new gastro, he does seem to be a little more interested in figuring out what is going on. Also, I wouldn't assume you have to have surgery. Even if you did I think it would not be major surgery. I understand that ANY surgery is scary, though. I am now waiting for hip replacement surgery and am very scared.
I'm sorry to hear about your hip surgery. Please keep us posted. My dad had it, and he was scared too..but he said it went better than expected, and his recovery was very fast. They are doing the surgery's a lot better then they did in the past. But I know it can be quite frightening. You have us here to talk to..I wonder if there is a hip or joint forum on here, as I think I have a torn rotator cuff from straining. My own fault, but I am having so much pain by my upper spine, and it radiates into my shoulder, collarbone then I have pins and needless going down my right arm. Have to make an appt for an orthopedic surgeon. I feel my life revolves around specialists and Doctors, just Never ending. The transportation company won't take me to the location. They say that going to Cincinnati where the Anorectal mamnotry is being performed is out of their zone limits. I don't think my case manager will take me that far either...she has not returned any of my calls. They have nothing closer..I may have to cancel it. Not sure what to do, but I really need this test..so I am anxious.
Thanks for your thoughts about the hip surgery. Yes, I agree - too many doctors and specialists. Can you take a train to Cincinnati? I am not familiar with the area as I am on the east coast. Nothing is ever very easy.
No. Unfortunately not. They have a cable car system in Cincinnati..like San Francisco..but it just goes around downtown Cincinnati. I love 30 miles north in a small city. We only even have one taxi cab service. Thank you though..☺
Hi Eliana! Sorry for the late reply first as I was quite busy since a couple of days.
Yes, the manometry was done using the catheter with a balloon.
If nothing seems to work for you then I would suggest you to go for it, I would explain the reason behind it. Muscles in our abdomen, pelvic floor, rectum & anus work in a coordinated way for the passage of stools, due to some reasons (like trauma, stress, depression & a few others) this coordination gets lost & that is why the stool isn't passed the way it should be. The doctor told me that I contract the anal muscles at the time of passing stools instead of relaxing & that is why I can't empty the bowels properly.
I would suggest you not to strain as it can cause other complications like hemorrhoids.
No need to be nervous. You should be happy if the test comes out to be positive because now you will know the reason behind your constipation which is treatable. The gastro who advised me to get this test done, told me that it usually takes 4 sittings of biofeedback to see remarkable improvements. 4 sittings means only a couple of months (duration depends on your therapist though) & yes you will have to practice it the way taught by your therapist.
Once again, I would advice you not to be worried at all & go for the procedure ASAP (My gastro had advised me to get this test done around 4-5 months ago but I ignored). The procedure is not at all painful & takes only half an hour. Quite expensive but is worth. You can reach me whenever you want. Would be happy to help
Thank you. I'm so scared I might need surgery. I live alone in housing where we have to attend groups. Pretty strict here. I wonder what the surgery entails and is it painful..long recovery time. Its all a bit overwhelming. Thank you for being there. If surgery is needed, I hope it won't hurt to use the bathroom, and I am sure I can be excused for groups.
If the condition is "dyssynergic defecation" then I don't think you would need a surgery. Its just that the muscles have lost the coordination & you need to get that coordination back by practice. Just let me know once you get the test done. If the test is positive I can be of your help
I have been through a number of tests for chonic bloating due to what feels like trapped gas every day. It's been for the past 4 years. I move my bowels everyday but my doctor says it's incomplete evacuation as well
I haven't even been asked by my gastro to take this test you have spoken of. I live in New England in the US. Anyway try have prescribed celexa an antidepressant but I can't take it due to the side effects so now they want me to try biofeed back. They feel my problem is being caused because of a brain to gut issue. Apparently my brains alarm is telling my gut something is wrong for no reason. I also take vit C, probiotics and
Nature thyroid. My integrative Dr thinks it might be due to a low but normal thyroid.
I am on bioidentical hormones as well
The bloating seemed to start when I started on them. Hope this info helps.
I neither have the symptom of bloating nor have the feeling of trapped gas. Do you get that feeling of incomplete evacuation or its just that the doctor thinks?
Even my gastro had prescribed me an antidepressant (Tryptomer). I took it for a couple of months. He had prescribed me the same this time as well but I didn't take it due to the possible side effects.
As far as I know biofeedback is for improper working of muscles in the anus & rectum area. Don't know whether the brain to gut issue has any connection with it. Stress, depression etc can cause the improper working of muscles but I have no idea about whether biofeedback can have impact on the signals that the brain sends to the gut. Might be I am talking about different type of biofeedback (which targets anal area) & you are talking about different one (which targets brain). Kindly let us know if this treatment method works for you. Best wishes
I hate the feeling of incomplete movements. Then I gulp down water and only sometimes, the remaining comes out. But only sometimes..then I have to make coffee, and sometimes the caffeine in it (usually the instant kind with six packs of Stevia..not healthy, I know, but it makes the remainder come out. I never know if it is stool still stuck there or a hemmorhoid, a difficult way to live.
Even I have to do same things. I do simple exercises which sometimes help or I drink tea, sometimes I eat heavy breakfast etc to get the bowel emptied completely. It used to work for me before but lately all these efforts seem to go in vein.
Your gastro can insert a camera & look for the presence of hemmorhoid in case if you want to assured of its presence.
I have large internal..sometimes prolapsed. Went to see a Colon surgeon who have me a digital rectal exam. She was a bit rude. Said "nothing she could do for me". Something about folds..
Hi! If you have similar symptoms as me then it is mostly the same condition. This procedure is not at all invasive & isn't painful as well.
The doctor who performed this procedure told me that initially I will have to take sittings biweekly (once in every two weeks) then depending on my progress he will increase the time period between two sittings. He said it usually takes around 6-10 sittings to get optimum results but the gastro who had advised me to get this test done said it usually takes only 4 sittings.
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Please help me.
Colon transit bowel motility test/study for chronic constipation/ biofeedback therapy/anorectal physiology investigation 
IBS C/D or something else? 
Is it safe to take mesalazine/octasa long term for ulcerative colitis?
