Incomplete evacuation

[Ella59]

Does anyone have the answer to incomplete evacuation? I can manage the other symptoms of IBS but this is a real nuisance and I’ve never seen any remedies for it. I would be grateful to hear how other people manage this problem.

[winfong]

There are a number of possible causes - pelvic floor dyssynergia, for example - outside of IBS. What does your gastro say?

It is, of course, also part of IBS as well. I find a large bowel movement can really clean things out and stop the incomplete evacuation feeling. To accomplish that, I'd probably take extra laxatives or perhaps an enema. I must admit, though, I don't have that problem very often.

[Ella59 in reply to winfong]

Thanks for your reply, winfong

To be honest I last saw a Gastro about 35 years ago when I was first diagnosed, after a really bad first year everything settled down for years but about 6 years ago I developed food intolerances. I had to drastically change my diet to a lot of bland foods and reduce my fruit and veg intake which I think is the problem. I now only take laxatives when I really need to and rely on flax and chia seeds and kiwis. I realise that it isn’t a big problem compared to what others have to endure but it is annoying at times.

[Hidden in reply to winfong]

Hey winfrog, we're a lot alike. I was DX with GPA Vasculitis in 2017. When I looked at the health interests in your profile, I saw that we have a lot in common. I've been reading quite a few posts on here about constipation and several times I've replied suggesting an enema and it's crickets. I take Hydrocodone every day for back pain among other things and it causes a bit of constipation. Rather than putting harsh chemicals in the upper part of my digestive tract, my wife puts a couple quarts of warm water in my lower half and all is good. I know there are those that suggest eating natural foods high in fiber instead of taking laxatives but that just might compound the issue in some cases. Take care young man!

[ItchyGirl]

Chia seeds really help me with this, I make my own muesli with chia, flaxseed, nuts, grains and dried fruit, if I have that each day then I generally have a good experience when going to the loo!

[Ella59 in reply to ItchyGirl]

Thanks for your suggestion. I think I will try upping my seed and dried fruit intake and see if it improves things.

[Teen1960]

Hi Ella, do you have a prolapse? I suffer with ibs but I also have a rectocele where poo collects in a pocket inside my bottom, also a tense muscle in there too 🙈 x

[Ella59 in reply to Teen1960]

No, I don’t think I do, thankfully Teen1960. I know what difficulties rectoceles can present though as my daughter has one and does have problems. I think my problem is due primarily to not being able to increase my fibre intake substantially and if I take laxatives regularly I’m ok for the first few days but then the laxatives cause other problems.

Thanks for your reply.

[Teen1960 in reply to Ella59]

I understand Ella and my heart goes out to your daughter too because rectoceles are debilitating 😢 mines a grade 2. I hope you find some answers from the lovely people on here 😍

[xjrs]

What is your fibre intake like? To improve constipation in the short term you can try ground flaxseed on your breakfast, starting at 1 teaspoon and increasing at 1 teaspoon every 2-3 days - you'll need to consume extra water with it.

These foods are also high fibre:

8-9 Prunes

2 tablespoon chia seeds (soaked for 10-15 mins in milk or non dairy milk with cereal or water)

Shredded wheat (or if GF: Nutribrex)

60g Quinoa

Wholewheat bread

75g Whole grain pastas (if GF: Buckwheat)

2 Hard pears

5 Dried apricots

90g Raspberries

1 orange (contain a natural laxative)

2 kiwi.

I find that I need to have 1 orange or 2 kiwi a day and then another high fibre fruit later in the day to help with BMs. Introduce new foods and any fibre increases slowly, starting with one new thing at a time, waiting for 2-3 days for a response and keep a food diary. You may not need to consume as much fibre as I do.

For breakfast I make a porridge of 4 tablespoon of oat bran and 4 tablespoon all bran (wheat bran), 2.5 small cups of water and microwave for 10 mins. I then mix in 2 tablespoon of chia seeds and 1 tablespoon ground flaxseed and leave to stand for 15-20 mins since the chia seeds need to form a gel. On top of that I place 8 prunes and eat. The best thing to do is to start with normal oats in similar quantities and, if needed, replace one of the tablespoons of oats with oat bran for a couple of days, carrying on doing this every couple of days until you get to 4 tablespoon of oat bran and 4 tablespoon of oats. Then start replacing with wheat bran in the same manner. You can then add the other ingredients one at a time. You might find you do not need the complete 'recipe' to have a BM. All these individual components are down to tolerance e.g. you may not tolerate wheat (see later about Alflorex), so it is best to keep a food diary (I do this on a spreadsheet) recording symptoms for up to 2-3 days after each change.

I also take 30 drops of ginger extract before bedtime to aid motility. You may need to work up the dose to say 7 drop increments each night.

Exercise can help with BMs. The government recommends 150 mins of moderate exercise (e.g. walking as if you are late for an appointment) or 75 of intense exercise (e.g. jogging) per week. I also have a bit of a walk around straight after breakfast to get things moving.

You need to ensure that you are drinking enough fluids (2 litres of fluid per day).

There is some good advice about constipation here:

theibsnetwork.org/constipat...

theibsnetwork.org/constipat...

There are also medications that help IBS-C (constipation dominant IBS). I suffer from IBS-C and have been prescribed Linaclotide for it. I also take Alflorex probiotic which has made me more tolerant to taking in the extra fibre I need for a BM.

Failing dietary measures, you can try Optifibre, which needs to be worked up to a dose according to instructions. You may not need the full dose - watch out for gas and increment to a level that is acceptable for you.

Some people are more prone to constipation due to their intestinal anatomy. Through colonoscopies I have been told that I have a long loopy (redundant) colon. This means that food takes longer to pass through and in the mean time the intestines have more time to suck out water from the stool, drying them out and causing constipation. I have found that I need to consume much more fibre than other people to have regular BMs.

I have also found useful having most of my food at meal times, leaving 4-5 hours of not eating between meals, eating my fruit snack before a meal. This means that your digestive system has time to process each meal. It also allows something called the MMC (migrating motor complex) to run which sweeps food waste from your small intestine into your large intestine. This only happens when you have an empty stomach. When people snack regularly, it prevents the MMC from working properly. I also find the larger meals help to push things along better than drip feeding through snacking.

[Ella59 in reply to xjrs]

I think that’s the problem that I can’t tolerate high fibre foods, even increasing fibre gradually and trying different types of fibre causes problems. If I take laxatives regularly I’m fine for the first few times but then I get awful stomach cramps.

[xjrs in reply to Ella59]

With IBS-C, the only way I managed to increase my fibre intake was by taking Alflorex probiotic, which not only helps to fight off bad bugs that can cause symptoms such as pain, but the Bifdobacterium in it helps to digest complex carbs (i.e. fibre). I also take Linaclotide that helps to calm intestinal nerves. Prior to taking those, I could barely eat anything without being in pain. I can now eat wholewheat bread, oat bran, all bran, other wholegrains and high fibre fruits.

[MyStar86 in reply to xjrs]

When do you take the Alflorex do you take it first thing in the morning on an empty stomach or later in the day? I have heard good things about this but I found it increased my gas and slowed my bowels so I wondered if there was a right way to take it. Many thanks

[xjrs in reply to MyStar86]

I take mine 1 a day on an empty stomach right before breakfast with water. Apparently probiotics work best within half an hour of a fat containing meal. For instance, my breakfast contains ground nuts and seeds which contain fats. Presumably if you have milk that would have an element of fat in it.

[MyStar86 in reply to xjrs]

Brilliant thank you 🙏🏻

[bungi1961]

I can sit on the loo for what appears to be a life time straining to go and it can hurt things inside that I didn't know that I had and yes I do know that I will only end up having to go again in about an hours time and that fills me with even more fear and dread when I do and all ways scared it will go from solid ones to really water like stuff that I can't control and never getting to the loo in time and in fear of pooping myself and wearing these paper pants all the time and it appears that I don't have a normal poop and been like this for 3/4 years OH it's just a vicious circle!!!!!

[Ella59 in reply to bungi1961]

I do sympathise with you, thankfully I don’t have diarrhoea so it’s more controllable but it does resonate with me having to go back in an hour’s time.

[Dollymae06 in reply to bungi1961]

I am exactly the same it is so depressing and disabilitating . I get anxious too frightened to go out any where or plan anything. Have to wear Tenna pants incase of accident as I can't control my bowels at times. I am taking Mebeverine and Loperamide also Alflorex but still get episodes.

[Gardenlover2020]

I have incomplete evacuation too, it’s very annoying & painful too . I’ve added Optifibre to my diet , one scoop with my yoghurt or cereals in the morning & it’s a big help ! It’s a white sugar like consistency , it’s tasteless & not like fibre as you imagine it to be . Worth a try 🙏

[Ella59 in reply to Gardenlover2020]

Thanks for your suggestion, I have just had a look at Optifibre and it’s definitely worth a try. Fingers crossed that it works.

[Gardenlover2020 in reply to Ella59]

I also take Prucalopride, which is a prescription medication , ask your doctor about it ,it’s very effective too

[trace55]

yes nearly every day I also have IBS and take mebeverine tablets.

[Gizmo6]

I have ibs c but a few years ago I took up yoga and my ibs c symptoms flared up less. I have recently been adding exercises for a tight pelvic floor, kegels and reverse kegels. I have found I'm more regular and less wind. It's early days but I have high hopes. I take simethicone if I'm having a bad windy day which is much less. I'm sharing a link , I hope you don't take offence with the topic. I find this particular exercise good for the pelvic floor support, all round.youtu.be/Jh6XLYu84Xo?si=xaE...(Not working as expected?)

[Ella59 in reply to Gizmo6]

I did yoga for many years when I was younger and I have always said it was a mistake giving it up as I think I would have benefited from it much more as I’ve got older. No offence taken whatsoever with the topic, in fact I am going to add some of those exercises to the pelvic floor exercises I already do.

Thank you for replying.

[Gizmo6]

Just to add I bought a squatting toilet stool. It's early days but I feel it's making things easier. That's really good you're already doing pelvic exercises. The exercises are good for your body even if they don't really help with constipation much for you. Good luck hope you find some relief 🥰