Brief Answer:
Following data are needed for a more specific opinion.

Detailed Answer:
Hi,

1. You are saying to have block outs with immediate fainting/falling. Can you please tell if the block outs might happen suddenly or there is something that triggers: stress? emotions? when doing an activity (watching TV? eating? passing the motion?when standing up or getting out of bed all of sudden (immediately)?

2. You are also saying that you are having constipation problems, and currently taking Dulcolax and Epsom salt to alleviate constipation.

To my opinion, this is not enough. You should also consider changing your diet too:
- increase water intake although it might fastidious as you are having enlarged prostate. You can have your fluids during the days up to 6 p.m., so you won't get up to toilet during nighttime
- eat more foods high in fiber: plums, pear, kiwi, figs, etc.
- avoid foods that would aggravate constipation: banana, yogurt, etc.

3. Constipation is often associated with too much straining. That will put pressure on vagal nerve with block outs episodes. This is true if you have these block outs when having your difficult bowel movements.

4. If not related to bm, then, other neurological issues are to rule out together with oscillations in blood pressure.

Hope it was of help!
Dr.Albana

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Brief Answer:
Following testing advised...

Detailed Answer:
Hi back,

Thank you for providing additional information.

If there is nothing that might trigger the block outs, I advise to:
- measure your blood pressure at the moment when you have such episodes
- measure your blood sugar levels
- avoid standing up quickly; take your time instead
- further tests are needed such as abdominal ultrasound (focusing on abdominal aorta); ECG; echocardiogram and doppler echo of the neck blood vessels.

You can discuss it further with your physician.

I still think that the block outs are related to constipation problems you are having. The long staying of the stool inside the bowels lead to distended bowels that would put pressure into vagal nerve resulting in block outs.

Hope it was of help!
Dr.Albana

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Brief Answer:
Following answers to your queries...

Detailed Answer:
Hi back,

1. Enlarged prostate is a normal process through aging. If problems are present such as :
- incontinence
- difficulty in passing urine; cannot empty bladder totally
- urine retention,

then, we advise to start treatment.

Otherwise, changes in lifestyle and diet regimen is advised only.

In your case, if you have an untreated enlarged prostate, I need to know if:
- you are having such problems too?
- do you have any recent abdominal ultrasound? what was the size of your prostate? what about residual urine in the bladder?

Usually, enlarged prostate won't give such problems, unless the urine retention is so severe that would also cause pressure on vagal nerve as distended bowels.

2. Yes, this is what I was emphasizing since the beginning: if you correct/ease your constipation problems, I think you won't have such block outs.

However,if I was your caring doctor would also like to ensure that you are not having other organic issues as mentioned earlier; and would recommend the above-mentioned tests.

3. Diet changes are very important in managing constipation.
Can continue taking Dulcolax. Instead of epsom salt, I advise to take sena supplement together with psyllium.
Next, if I was your caring doctor would also go deeper and investigate to identify why you are having constipation:
- is it from the diet? then the suggested changes can help a lot
- is it from medications? if yes, once you stop taking them, constipation will improve
- is it from any internal problem? colonoscopy and anal manometry study can help

To my opinion, based on what you are reporting, the constant use of dulcolax and epsom salt has turned your bowels lazy; they cannot work without their help. So, we must help your bowels become more active through diet and lifestyle changes as medications are used for only a short period because of this side effect.

Hope it was of help!
Dr.Albana

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Brief Answer:
Still thinking over distended bowels putting pressure to vagal nerve...

Detailed Answer:
Hi back,

From your new reports, it seems that your prostate is normally/physiologically enlarged without causing any problem. This makes me think that you are not having problems with urine retention.

Now, I am wondering: if you have not done any ultrasound so far or any digital examination; how do we know that you have enlarged prostate?

That's why I recommend to run abdominal ultrasound as it will help:
- determine the size of your prostate and residual urine in bladder
- identify other abdominal problems you might have with abdominal organs including abdominal aorta
- observer if gas is present in your bowels and how distended they are?

However, barium examination and ct-scan can also identify why you are having constipation problems.

If we exclude other organic problems, then, everything is again related to distended bowels pressing on the vagal nerve and causing block outs. Once again, other issues should be ruled out first.

All the best!
Dr.Albana

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Brief Answer:
Happy to be assisting you...

Detailed Answer:
You're most welcomed!

Please do not forget to leave an excellent feedback when you close this discussion!

Thank you!
Dr.Albana

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