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Unable to have a bowel movement without enema including diarrhoea. Take miralax for bowel incontinence. Suggest?

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Gastroenterologist
Practicing since : 1996
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I am unable to have a bowel movement without the use of enema's. This includes diarrhea. I treat my bowel incontinence with constant use of laxatives such as Miralax and Phillips Magnesia.

Although I have seen numerous GI doctors they fail to explain what prevents me from having a movement without enemas.

Thank You In Advance
XXXXXXX XXXXXX
Posted Mon, 17 Jun 2013 in Digestion and Bowels
 
 
Answered by Dr. Ratnakar Kini 39 minutes later
Hi,
Thanks for posting your query.
I am Dr.Ratnakar Kini and I am pleased to answer your query.

How long have you been constipated?
Are you a diabetic?
What are all the tests that have been done to evaluate this issue of constipation?
Above answer was peer-reviewed by
 
Follow-up: Unable to have a bowel movement without enema including diarrhoea. Take miralax for bowel incontinence. Suggest? 3 hours later
& years constpated. Not a dabetic see below for the tests mess.
I saw a great colorectal Doc. Dr. Wexner/Cleveland Clinic,Westin,FL. This was an out of network visit by my HMO. He ordered 7 tests, Manometry Anorectal,XR ColonicTransit,Gastric Emptying Scan,Defecogram,XR gastrgraffin Enema and XR Abdomen.
However only two tests XR abdomen & Gastric Emptying Scan have been performed. While I'm certain these tests are needed the 5 undone tests are not available outside of Cleve. Clinic. My primary tells me that local hospitals do not perform the tests except for the Defecogram which requires me to drive 30 mies per day. Cleveland Clinic is 50 miles so even if my HMO authorized it I am unable to drive these distances due to atrophy and hand shaking issues. You would not want me on the road.
So I'm in a puzzle and although I have tried to get a GI Doc. in my area to accept me, NONE will due to that spinal cord patients are difficult. Welcome to capitalistic medicine.
So my question was to understand what is not functioning most likely due to brain to nerve signaling issues. I'm on my own when it comes to trying to manage my GI issues. I've experienced constipation and evacuation issues since my cord injury.
I've managed the evacuation issues for 6 years using hot raw Senna tea leaves every 3 days. However last fall (Stenisis?) the tea stopped working and I've been thrown into the land of laxatives/fiber and there is no consistency in the use of these products. In addition bedwetting was added to my menu.
Sorry for all the letters but it helps explain why I can't get proper medical GI care.
 
 
Answered by Dr. Ratnakar Kini 11 hours later
Hi,
Thanks for giving additional information.
What type of spinal injury you have and how did that happen?
Above answer was peer-reviewed by
 
Follow-up: Unable to have a bowel movement without enema including diarrhoea. Take miralax for bowel incontinence. Suggest? 6 hours later
My profile has this info but I'm a C3 to C7 incomplete of 7 years.
Sorry for all the content in my question. I realize that my brain is nor communicating with the so called instruction nerves in my colon system. I'm really trying to just understand which part of my colon system accounts for me having to use enemas even with diarrhea.
Once identified is there a surgical fix or am I headed towards having to wear a colonoscopy bag? Sorry for my time consuming response but I sleep a lot due to being chronically ill with many other medical issues.
 
 
Answered by Dr. Ratnakar Kini 26 hours later
Hi,
Since there are multiple issues, it is essential to undergo the tests mentioned by your doctor.
Of these, the evaluation of colon transit and defecography at least should be done before we would know what actually is the cause.
Discuss with your doctor about getting at least these two tests done.

I hope that answers your question.
If you have no more questions, kindly rate this service.
Regards,
Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Unable to have a bowel movement without enema including diarrhoea. Take miralax for bowel incontinence. Suggest? 2 hours later
Thank you for your response and I am pursuing trying to find places that will perform these tests.
I realize that my injury is accountable for not communicating with the functional nerve endings in my GI tract. I would like to know what part of my colon is not functioning to require enemas even when I have diarrhea due to overuse of laxatives?
Thank You In Advance
 
 
Answered by Dr. Ratnakar Kini 13 hours later
Hi,
It is difficult to say without the tests whether the issue is transit related or evacuation related.
The diarrhea/incontinence could be overflow incontinence with constipation.


I hope that answers your question.
If you have no more questions, kindly rate this service.
Regards,
Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
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