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Cannot Have A Bowel Movement Without Laxative. Colonoscopy Showed Polyps. Have Healthy Diet. Need Some Advice
Question: Hi,
I haven't been able to go to the toilet (number 2) for six months without the assistance of a laxative (movicol sachets and microlax enimas). I've had a CT scan of my chest, abdomen and pelvis that revealed no obstruction (except moderate faecal matter in the colon), and endoscopy and colonoscopy that was normal however some large polyps that I'm told in future could become cancerous if I don't have them removed (which they were). I've been prescribed resotrans (for six months) which I take daily. My diet has been extremely restricted (mainly boiled vegetables for dinner and cereals/breads for breakfast and small steaks for proteins). It's the most healthy diet anyone could have. After doing the colonoscopy preparation I was completely clear and after resuming eating (without resotrans) I waited 5 days without a bowel movement until I started drinking bottles of prune juice and taking the resotrans so I could get some relief. It seems no matter how clear my gastrointestinal track I can't have a bowel movement. Two years prior I had similar symptoms which resulted in keyhole surgery to remove a 5-6 centimeter hematoma from my lymph nodes. There was no cause found. I'm 26 years old and extremely depressed because of this.
I need some advice, this is controlling my life and I believe my specialist has given up as he now prescribes me an antibiotic that contracts the stomach muscle any is cheaper than resotrans. I don't feel this is a solution to my problem and it's not being investigated further. I just don't know what to do.
XXXXXXX
Brisbane, Australia.
I haven't been able to go to the toilet (number 2) for six months without the assistance of a laxative (movicol sachets and microlax enimas). I've had a CT scan of my chest, abdomen and pelvis that revealed no obstruction (except moderate faecal matter in the colon), and endoscopy and colonoscopy that was normal however some large polyps that I'm told in future could become cancerous if I don't have them removed (which they were). I've been prescribed resotrans (for six months) which I take daily. My diet has been extremely restricted (mainly boiled vegetables for dinner and cereals/breads for breakfast and small steaks for proteins). It's the most healthy diet anyone could have. After doing the colonoscopy preparation I was completely clear and after resuming eating (without resotrans) I waited 5 days without a bowel movement until I started drinking bottles of prune juice and taking the resotrans so I could get some relief. It seems no matter how clear my gastrointestinal track I can't have a bowel movement. Two years prior I had similar symptoms which resulted in keyhole surgery to remove a 5-6 centimeter hematoma from my lymph nodes. There was no cause found. I'm 26 years old and extremely depressed because of this.
I need some advice, this is controlling my life and I believe my specialist has given up as he now prescribes me an antibiotic that contracts the stomach muscle any is cheaper than resotrans. I don't feel this is a solution to my problem and it's not being investigated further. I just don't know what to do.
XXXXXXX
Brisbane, Australia.
Hi XXXXXXX
Thanks for writing in.
Constipation is one of the commonest problems worldwide. Often there is no cause and it is known as functional constipation. You need to answer a few questions first :
1. Ask which the most distressing symptom you have ? Is it reduced stool frequency per se, straining, hard stools, unsatisfied defecation, or symptoms that occur between infrequent bowel movements (bloating, pain, malaise)?
2. How often is a “call to stool” noted? Is the call always answered?
3. What laxatives are being used, how often, and at what dosage?
4. Are suppositories or enemas used in addition?
5. How often are the bowels moved, and what is the consistency of the stools?
6. Are you using any other medications at present ? (like anti depressants ?)
Sometimes certain medications cause reduced stool output. If need to do the following tests to rule out other causes of constipation
1. anorectal manometry - to rule out if there is some dysfunction of your pelvic muscles that is reducing the stool frequency ?
2. Colonic transit study - to see how fast and frequently you bowels are moving
3. Balloon expulsion test- to see if you are generating enough pressure in your pelvic muscles to expel the stool
4. Thyroid function test
If there is no organic cause found for the constipation, the best solution is increasing fiber- have lots and lots of fibers. Artificial fiber preparations are also available like methylcellulose and pysllium husk which are beneficial on a long run. Taking laxatives for a long time causing dependence to it and it becomes difficult to leave them after that. A newer drug called lubiprostone is safer and more effective without much dependence. Resotrans is not bad as well. You need to have patience with is as there is no miracle solution to the constipation, however a little insight into your condition and small steps at a time would help us reach our goal of good, laxative free bowel movements !
Hope I have answered your query. If you have any further questions I will be happy to help
Regards
Dr. Om Lakhani
Thanks for writing in.
Constipation is one of the commonest problems worldwide. Often there is no cause and it is known as functional constipation. You need to answer a few questions first :
1. Ask which the most distressing symptom you have ? Is it reduced stool frequency per se, straining, hard stools, unsatisfied defecation, or symptoms that occur between infrequent bowel movements (bloating, pain, malaise)?
2. How often is a “call to stool” noted? Is the call always answered?
3. What laxatives are being used, how often, and at what dosage?
4. Are suppositories or enemas used in addition?
5. How often are the bowels moved, and what is the consistency of the stools?
6. Are you using any other medications at present ? (like anti depressants ?)
Sometimes certain medications cause reduced stool output. If need to do the following tests to rule out other causes of constipation
1. anorectal manometry - to rule out if there is some dysfunction of your pelvic muscles that is reducing the stool frequency ?
2. Colonic transit study - to see how fast and frequently you bowels are moving
3. Balloon expulsion test- to see if you are generating enough pressure in your pelvic muscles to expel the stool
4. Thyroid function test
If there is no organic cause found for the constipation, the best solution is increasing fiber- have lots and lots of fibers. Artificial fiber preparations are also available like methylcellulose and pysllium husk which are beneficial on a long run. Taking laxatives for a long time causing dependence to it and it becomes difficult to leave them after that. A newer drug called lubiprostone is safer and more effective without much dependence. Resotrans is not bad as well. You need to have patience with is as there is no miracle solution to the constipation, however a little insight into your condition and small steps at a time would help us reach our goal of good, laxative free bowel movements !
Hope I have answered your query. If you have any further questions I will be happy to help
Regards
Dr. Om Lakhani
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Thank you Dr Lakhani. To answer your questions (to the best of my ability, over six months there have been variables)
1. The most distressing symptom is the lack of a satisfactory bowel movement. It's quite depressing to the point that I have severely lacked sexual function also. There is bloating but rarely abdominal pain. I do suffer from severe headaches when medication fails to force a movement beyond two days.
2. The only "call to stool" is in the morning after breakfast (80% of the time) and this is only after I take resotrans which is always after dinner the night before, to avoid some of the side-effects.
3. If I was unable to have a satisfactory bowel movement after 3 days (generally 9 meals) without the resotrans I have been taking "Movicol" for faecal impaction (that is all 8 sachets over 3-4 hours.) At times the movical took a lot of time to work so I would combine it with prune juice. I haven't had to do this since May/June.
4. I have used enimas with the movicol however beyond this evening, I haven't used an enima since May/June.
5. On the very restricted diet, and smaller-sized meals with resotrans, I can have a bowel movement 3-4 times a week. However I'm only human, and consider chocolate once a week as a cheat day (even though, most people would consider my cheat day as barely nothing). They are generally soft stools. I've often had the "string stools" as well.
6. I was on lovan in 2009 however ceased use by September 2011. I take ipburofen for headaches. I no longer take codeine as I had history of abusing them and they also appear to cause further constipation after a prolonged use.
When having the hematoma removed in 2010 when I had the same symptoms, various scans were done (I believe CT scans) and blood in the urine was also identified, that's when the mass was found on a follow up scan.
Do you think it would be worth getting an MRI? Is there significant range of areas that a CT scan wouldn't see in the chest, abdomen and pelvis?
For the six months that I've been enduring these problems I've maintained a suspicion of another mass however scans do not confirm this. I've also had a discomfort in my throat, basically a feeling of food not moving through. At times I feel like my bowel movements (however small) are only a result of further food pushing through my system (look a toothpaste tube) It's physically uncomfortable.
I understand that there is no easy solution. I've only ever had constipation twice in my whole life (at 24 and 26). I've always had a fast metabolism. From the ages of 18-23 I've always weighed in between 77-79 kgs and no matter how much exercise have struggled to gain weight. During this year I've weighed in at 90 kgs (April) and now I weight 83 kgs which is very unlike my build (I'm 6.1" tall)
Appreciate your response.
XXXXXXX
1. The most distressing symptom is the lack of a satisfactory bowel movement. It's quite depressing to the point that I have severely lacked sexual function also. There is bloating but rarely abdominal pain. I do suffer from severe headaches when medication fails to force a movement beyond two days.
2. The only "call to stool" is in the morning after breakfast (80% of the time) and this is only after I take resotrans which is always after dinner the night before, to avoid some of the side-effects.
3. If I was unable to have a satisfactory bowel movement after 3 days (generally 9 meals) without the resotrans I have been taking "Movicol" for faecal impaction (that is all 8 sachets over 3-4 hours.) At times the movical took a lot of time to work so I would combine it with prune juice. I haven't had to do this since May/June.
4. I have used enimas with the movicol however beyond this evening, I haven't used an enima since May/June.
5. On the very restricted diet, and smaller-sized meals with resotrans, I can have a bowel movement 3-4 times a week. However I'm only human, and consider chocolate once a week as a cheat day (even though, most people would consider my cheat day as barely nothing). They are generally soft stools. I've often had the "string stools" as well.
6. I was on lovan in 2009 however ceased use by September 2011. I take ipburofen for headaches. I no longer take codeine as I had history of abusing them and they also appear to cause further constipation after a prolonged use.
When having the hematoma removed in 2010 when I had the same symptoms, various scans were done (I believe CT scans) and blood in the urine was also identified, that's when the mass was found on a follow up scan.
Do you think it would be worth getting an MRI? Is there significant range of areas that a CT scan wouldn't see in the chest, abdomen and pelvis?
For the six months that I've been enduring these problems I've maintained a suspicion of another mass however scans do not confirm this. I've also had a discomfort in my throat, basically a feeling of food not moving through. At times I feel like my bowel movements (however small) are only a result of further food pushing through my system (look a toothpaste tube) It's physically uncomfortable.
I understand that there is no easy solution. I've only ever had constipation twice in my whole life (at 24 and 26). I've always had a fast metabolism. From the ages of 18-23 I've always weighed in between 77-79 kgs and no matter how much exercise have struggled to gain weight. During this year I've weighed in at 90 kgs (April) and now I weight 83 kgs which is very unlike my build (I'm 6.1" tall)
Appreciate your response.
XXXXXXX
Hi XXXXXXX
Good to hear from you again.
I have taken a note of the history you have given. Since you have already undergone a colonoscopy , the chance of finding anything sinister beyond that is less likely. However a colonoscopy can only see the large bowel and part of the small bowel and the endoscopy can only seen upto the stomach and first part of the small intestine. The remaining small bowel is beyond the reach of these tests. To evaluate the small bowel the we can start with a CT electrolysis. You can discuss with your doctor regarding small bowel evaluation.
Having said that, my judgement and experience says that it is unlikely we will find anything in the small bowel as well. As I said your history gives a picture of "functional constipation" , which is difficult to treat. Some of your features also suggest an underlying depression and I would suggest you have a relook with your psychiatrist and if he prescribes an antidepressant ask him to give one that doesn't cause constipation
Apart from that you can get done the tests I have suggested above. Sometimes a 'pelvic floor dysfunction' causes such symptoms which may be missed by other tests. there are specific treatment and remedies like biofeedback for 'Pelvic floor dysfunction' causing constipation.
Finally you need to remember that we are often coached wrongly from our childhood that we need to pass bowels everyday. Modern thinking is that some people have a slow transit system or the systems slows down and have less bowel movements. Infact modern definition of constipation is <3 bowel movements in a week is defined as constipation. As long as you have 3 or more bowel movements in a week - there is nothing to be concerned about .
Hope this helps
Regards
Dr. Om Lakhani
Good to hear from you again.
I have taken a note of the history you have given. Since you have already undergone a colonoscopy , the chance of finding anything sinister beyond that is less likely. However a colonoscopy can only see the large bowel and part of the small bowel and the endoscopy can only seen upto the stomach and first part of the small intestine. The remaining small bowel is beyond the reach of these tests. To evaluate the small bowel the we can start with a CT electrolysis. You can discuss with your doctor regarding small bowel evaluation.
Having said that, my judgement and experience says that it is unlikely we will find anything in the small bowel as well. As I said your history gives a picture of "functional constipation" , which is difficult to treat. Some of your features also suggest an underlying depression and I would suggest you have a relook with your psychiatrist and if he prescribes an antidepressant ask him to give one that doesn't cause constipation
Apart from that you can get done the tests I have suggested above. Sometimes a 'pelvic floor dysfunction' causes such symptoms which may be missed by other tests. there are specific treatment and remedies like biofeedback for 'Pelvic floor dysfunction' causing constipation.
Finally you need to remember that we are often coached wrongly from our childhood that we need to pass bowels everyday. Modern thinking is that some people have a slow transit system or the systems slows down and have less bowel movements. Infact modern definition of constipation is <3 bowel movements in a week is defined as constipation. As long as you have 3 or more bowel movements in a week - there is nothing to be concerned about .
Hope this helps
Regards
Dr. Om Lakhani
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Above answer was peer-reviewed by :
Dr. Aparna Kohli
Answered by
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