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Have colonic inertia. Started taking linzess. Do I need surgery?

Dec 2014
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Practicing since : 2007
Answered : 4791 Questions
I have colonic enertia for many many years. I was never diagnosed because at the time I took the marker
tests, physicians knew little about it. I am on Linzess now, with little relief. I was thinking of taking it
every twelve hours for a little while. The dosage is to be every 24 hours. I took it after twelve hours, last
night. I wouild like to do that again. I am considering surgery, but don't want to if I can advoid it.
Any suggestions. Thankyou
Posted Fri, 5 Apr 2013 in Digestion and Bowels
Answered by Dr. Seikhoo Bishnoi 40 minutes later
Welcome to Health Care Magic

Usually Irritable Bowel Syndrome presents with altered bowel habits like continuous abdominal pain, diarrhea alternating with constipation, fullness of abdomen etc. In a lot of people who present with colonic inertia or chronic constipation usually no definitive pathological cause found. Most of marker tests come normal. As you are 60, so possibility of any congenital disorder is ruled out. You have mentioned your medical history is normal so I assume there is no history of Diabetes, Significant Hypertension or Hyperlipedemia etc.

Linzess or Linaclotide is a newer drug. In recent studies it has shown significant results. As you are getting relief with this so continue with this drug, but as the recommended dosing is once a day, there is no much benefit in doubling the dose.

Surgery will not do much in this condition. Usually irritable bowel syndrome is a condition in which due to some unconscious anxiety bowel motility of individual got altered. Although individual fails to find any cause behind his/her condition but even just relaxation of anxiety and stress helps.

What can be done in your condition-
- Medicines like Librax, which contains Clinidium and Chlordiazepoxide. This drug has been found to be very beneficial in irritable bowel syndrome. Usual dosing is once after meals in night. It tend to improve motility of intestines.

- Other medicines like SSRIs in low doses especially Paroxetine are very helpful. Paroxetine tend to treat anxiety also. It also has effect in intestinal motility. Amitryptilline is also a good drug useful in such conditions.

- Low dose benzodiazepines like clonazepam are also helpful

- And one of most important thing is high fibre diet, low fat diet. You can take Isabgol husk for some time.

- Relaxation exercises, yoga also help a lot.

So I advise you to visit a Psychiatrist for evaluation of the problem as all other tests are coming normal. Hope I cleared your doubt, If you have some more doubt then you can ask again. I will be happy to answer you again and don't forget to mention the results of investigations if any.


Dr. Seikhoo Bishnoi MD
Above answer was peer-reviewed by
Follow-up: Have colonic inertia. Started taking linzess. Do I need surgery? 54 minutes later
There have been many doctors who disagree with your view that this is condition
is caused by psychological factors. Fiber of many types is very damaging to
IBS with constipation. It has been advised by caregivers in this field to
use Chia as a fiber. Chia fresh by Gaia is recommended. People with colonic
inertia fail the marker test because the markers barely move. Since I was
a girl, I did yoga and meditation. I am also a vegetarian. Physicians have
given lectures on the hormones that regulate body functions. Nature is not fair.
Hemophiliacs do not clot because their bodies do not make one blood factor.
When they receive it from a transfusion, they clot. It seems that there is
something not being produced in my body, which does not allow the proper
chemicals to be produced. I went to Rockefeller University Hospital as an
in-patient. They told me I was producing a great amount of opiates in my gut.
They explained that this meant I was not producing something else. But they
did not know what it was. They gave me a drug that removes the opiates from
the gut receptors. I went to the bathroom. My body worked. The drug had
serious side effects as it was continued. So I had to stop the meds.
It is wrong to think that the medical field knows everything now. And that since
they don't have a physical answer to something, they chalk it up as mental.
I am glad that there are doctors that don't agree with you.
Answered by Dr. Seikhoo Bishnoi 13 minutes later
Hello again,

I am not definitely saying that it is due to stress. But, as physical causes has been ruled out, you have mentioned in your last question, so, possibly stress may be a cause. Sorry that I sounded otherwise.

Secondly another possibility may be Colonic Pseudobstruction. It is a disease of elderly but in some people it may occur at earlier age. Features of constipation, fullness of abdomen after meals and slight pain are features. There is no vomiting in it. All of diagnostic tests come normal. Diagnosis is made by proper clinical evaluation. This syndrome can be checked if it is behind the colonic inertia in you. In that case, treatment by an expert doctor with Cholinergic drugs as Neostigmine, laxatives etc can be done.

Hope I tried to clear your doubt. I will be happy to answer you again.


Above answer was peer-reviewed by
Follow-up: Have colonic inertia. Started taking linzess. Do I need surgery? 43 minutes later

I just googled colonic pseudo obstruction. Yes, the description of this condition
is the same description given to colonic inertia. Or at least, it is the description
I read on colonic inertia from a medical article. This is exactly what happens.
I am exhausted by it. And my life has become one of seclusion because I can
barely function in my days. I need to look into a medical center that specializes
in this. I have heard nightmares from people that have had major surgery
with their intestines. Complication, pain, long recovery times. I hope I can
advoid some of this. I must begin walking around my apartment now, due to
the tight swelling of the upper right side of my transverse colon. If you email
me back, can I respond later in the day? I must walk now. Thankyou
Answered by Dr. Seikhoo Bishnoi 11 minutes later
Hello again,

Sure. You can reply anytime. I will be available maybe after a few hours.

Since you have the symptoms similar to Pseudo Obstruction, I would advise you to visit a Gastroenterologist near to you. Medicines can correct the symptoms. Please don't remain worried of surgery as the worry itself may cause stress.

If you have any other doubts you can ask again at any time. If you are satisfied with the conversation you can review me.


Wish you good health.

Above answer was peer-reviewed by
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