I have chronic constipation. I think it is casued by various muscles not relaxing as the symptoms fit what I have read online. There are vaious names for this, anismus, dysssergenic defaecation and obstruced defaecation. I looked on this site and this is one of the groups that seems appropriate to post in. Any help appreciated and if you think any other group would be relevent please let me know.
This has gone on for about a year and a half and is getting worse. The GP prescribed various laxatives, they help but do not cure. I am now spending about 3 hours a day on the toilet. Sometimes it interrupts my sleep as I think I have emptied my bowel, go to bed and then 10 minutes later want to go again. What comes out is small soft pellets, or liqued as I take 3 laxido a day. The GP also prescribed senna but that didn't help.
I have an apppointment with gasterenterology on the 1st of May and I had a colonoscopy a year ago which found two polyps that were removed but that didn't help. I think it is likely that I need a definite diagnosis to get effective treatement.
I saw a private pelvic floor physio who gave me some exercises which take 20 minutes and I try to do them twice a day. I do not think they are helping but will keep trying.
I hardly have time to clean the house or anything else after I have gone to work and some days I take the day off if I have not slept well. As a self employed gardener this is effecting my income and I had 7 months off work last year recoving from a heart condition.
I don't think I am dehydrated but I guess I can try drinking more water.
If anyone has any suggestions as what might help or if they have had this and had effective treatement please let me know.
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Grassmower
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I so sympathize. Perhaps you have an internal rectal prolapse as I've had similar symptoms with that. One thing occurs to me, Laxido softens stool and at three doses a day it can make it too runny to have the bulk needed to be pushed out. Herbal laxatives no gain for constipation. Occasional doses of milk of magnesia often works when constipated. I hope that your appointment is with a colorectal surgeon, that's the sort of person you need to see in my opinion. I wish you well.
There is certainly some kind of blockage. If i don't take the laxido things get harder and then I am on the loo in the middle of the night for about 20 minutes and then can't get to sleep for an hour afterwards.
I had a colonoscopy last year and my private phsysio thinks that would have picked up any physical blockage which is why he thinks it is, "Functional," ie how the muscles are functioning. He could be wrong which is why I want the hospital apppointment.
On recommendation I have just begun eating Chia seeds. They are a superfood packed with nutrients and fibre. So far they have transformed my bowel movements as previously passed small pellets during the day as you’ve described. They bulk the stool and are readily available in supermarkets. I noticed yesterday they are a really good price in Tesco and come in a resealable bag.
It might be best to seek some advice from your specialists and my usual advice for constipation may not apply to you at all or make things worse, but I'll put it here for you anyway to discuss with them:
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:
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.
Dear Grassmower, I know exactly what yonly ou are experiencing. I had identical symptoms 4 years ago. Was definitively diagnosed with dysynergic defecation via ano-rectal manometry with BET (Balloon Expulsion Test) and Defecography. Unfortunately there is no treatment for it other than aggressive laxatives (which you are on) and pelvic floor therapy with biofeedback. The laxatives, as you know from your experience, only work up to a certain point, and the they have serious side effects like dehydration and electrolyte imbalance. Pelvic floor therapy with biofeedback, in my view and experience, is a diversion GI's use to shift responsibility for dealing with a condition that "modern medicine" has not developed a treatment. This allows them to claim that they are doing something to treat the condition. I did extensive research on the efficacy of pelvic floor therapy with biofeedback and found that it may help about 50-60% of patients who try it diligently. That means that the odds are no better than pure chance. In any case, I tried laxatives and diligent PFT with biofeedback with worsening symptoms. At that point, one colo-rectal surgeon suggested that I have a diversion colostomy to bypass the pelvic floor muscles and expel feces via the stoma. Since this is a last resort measure that is rarely used it is not performed by most colo-rectal surgeons. In any case, in desperation, I agreed to the colostomy 2 years ago. Initially, even though I started to have severe rectal pain right after the surgery, I was somewhat relieved to be able to expel my feces. To make a very long story short, my pain has continued to get worse and I have developed other complications from the surgery that has rendered me completely homebound and mostly bedridden. So, bottom line, I don't have a positive suggestion for you, but, I would definitely not go for the colostomy surgery if I could do it over again.
Thanks. Do you think that biofeedback has the same outcome as no treatment? Did you find evidence for that and if so can you point me towards that?
I found a youtube video on anismus by Leicester Hospitals Pelvic Floor Service a couple of days ago. I found it informative and useful. It helped me be less stressed when going to the toilet, whether it will help in the long run I don't know but I will keep trying along with the exercises a private pelvic floor phsyio gave me.
Another alternative is transanal irrigation. I read that can take half an hour each time. As I have a reduced volume in my large bowel due to an earlier bowel resection that would still be an hour and a half but that might be an improvement on what is happening at the moment.
The answer to your first question is yes. I know in my case it didn't work even though I tried it diligently for over two years with four of the "best" Pelvic Rehabilitation Therapists. I think that for those that see an improvement it's more of a placebo effect than the "treatment". I couldn't find any definitive evidence that it doesn't work, but, I didn't find any that proves it does. I'm an Ivy League trained Ph.D., statistician.
Thanks for your reply. I have looked into antidepressants, widely prescribed, but only slightly better than placebo, so I can understand your point of view.
The other treatments are botulin injections in the tense muscles and irrigation. At the moment I am loosing so much sleep, and then work, I am despairing so I hope I get some answers from the hospital appointment.
on reading your response again I realise that this has had a catastrophic effect on your life. You have my sympathy. I wouldn't be surprised if I end up in a similar situation as this is steadily getting worse.
I sincerely hope that you do find something that works for you. Please don't let my experience dampen your optimism about your situation. Every individual is different. I wouldn't wish what has happened to me on my worst enemy. You seem to be a very nice person. Good luck to you.
Thankyou. I will keep doing my PV exercises and research more. I hope to see my GP tomorrow as I am getting less and less sleep and this is impacting my life considerable. I am wondering if a few days of sleeping pills would help restore my sanity, if not my bowels.
If this is a chronic stress reaction, which some research indicates it could be, I was wondering about psychotherpy (although I also know that is overegged too) but have not found anything online except perhaps hypnotherapy, which is really targetted relaxation, much like some of the PV exercises. Those exercises did help, espcially the relaxation and Kegels, but are doing so less at the moment. I suspect as you say, no one knows much about why this happens or maybe what is actaully going on at a physical level, never mind an emotional one but I shall carry on and see what happens. More relaxation and meditation and moving towards a plan on what I need to do to survive which probably means cut back work drastically and try to find friends to help do practical things.
I voluntarily got admitted to an in-patient chronic disease treatment program run by the department of psychiatry at the "world renowned "Johns Hopkins Hospital to test out the theory that any ailment of the digestive system that modern medicine cannot diagnose is due to the malfunctioning of the gut-brain axis. The mainstay of their treatment approach is to try out a series of psychotropic drugs (SSRI, SNRI, Tricyclic antidepressants, Lithium, etc.) I am skeptical of the use of these drugs, but I decided to give them an honest try. After three weeks and tying three different drugs I decided to give discharged because I got none of the intended benefit but all of the very severe side effects. Also, while there I got to know some of the other patients in the program who also didn't get much relief but we're afraid to leave the program because they had become dependent on it; it was their security blanket. I definitely don't want to lose control of my mind which thankfully is working well even though my body is not.
A wise decicion in my opion. I regularly read up on these drugs, at the moment they are often hard to come off and create more problems than they solve in many people. The Mad In America website is a good source on a lot of the critiques of these drugs. My guess is Big Pharma would be looking to create a new market for there drugs. There may still be a psychological element but I would expect that to show up in studies that show a correlation between traumatic events and bad gut health, similar studies show a deffinite correlation for psychosis but I know of no such study for physical aimments apart from general ones that show the harder your life the more likely you are to have health problems.
I got sleeping pills and more laxative from my GP yesterday which meant I slept well but am wiped out today. The GP also gave an alternative possible diagnosis of a blockage caused by some tissue from my bowel resection 20 years ago slipping and causeing a partial blockage, it might be or it might be tight muscles or both but it definitly needs investigation which I hope the hospital on the 1st of May will initiate.
Make sure they do all the imaging that can be done;- CT scan, MRI, Ultrasound - to rule out any anatomical blockages. Also, if you haven't already had ano-rectal manometry with BET and Defecography done, they absolutely need to be done to determine dysynergic defecation. Good luck on your May 1 visit.
consultant said stop all laxatives, low fibre diet, hold it in, poo once a or once every other day and use glycerine suppositories. No tests, maybe becauase colonoscopy showed nowt. He said they have very few tools at there disposal which was honest. I quite liked him, I'd invite him round for tea if he was in the area. We discussed the emotional side and although he didn't probe he wasn't dismissive.
My problems got a fair bit better, as in I could sleep, after talking to the GP I liked about up and coming family therapy with my half brother. The family therapy happened and it was in some ways useful, he agreed my step mother was a drunk, but in other ways dissapointing and I am thinking how to proceed now. Using a poetic metaphor the phrase wanting to shit on someone from a great height comes to mind, and then not doing so because it would be too scary - so a physical experession of holding things in to an extreme degree. I am reading Gabor Mate's book "The Body Says No" which has a chapter on IBS and other gut problems related to stress and it seems relevent to me. I think you maybe right about the pelvic floor exercises, mainly placebo as when I think about the family situation the same muscles were contracting as the physio gave me, so prob same muscles involved but he was not identifying why I wasn't using them correctly.
Holding it in has helped and has not stopped me sleeping which was horrible and has given me back some of my time. I started trying the glycerine suppositories today and that reduced the time on the loo quite a lot. I think the consultant is suggesting drying things out and then retraining the bowel. I will give it a try and see him again in a month or so. It seems to be working so far better than what the GP's were prescribing which was just increasing ammounts of laxatives.
I am not being too hopeful but I am not being dismissive about the consultants suggestions. I'll give it a good try, record results and review.
I’ve suffered with constipation for years which led to bad prolapse of bladder and bowel due to straining I read about Mag 07 tablets and I swear by these for relief of constipation Once you get dosage right it’s a miracle No purging of stomach no griping pains Taken them for years Finchley Clinic online do them Not cheap but well worth the cost for the relief
I recently found a gastroenterologist and psychotherapist who has written about this. He is called Nick Read. He has retired but has published a book which I have ordered called Sick and Tired, healing illness doctors cannot cure.
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