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Dr. Andrew Rynne

Family Physician

Exp 50 years

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How can hard stools and constipation be treated despite taking Prune juice?

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1973 Questions

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Posted on Wed, 2 Jan 2019 in Digestion and Bowels
Question: I have been an IBS sufferer for many years. About 2 weeks ago, I had a bout (1 day and about 4 motions) of soft bowels/diarrhea, and since my stomach has been off. A week later, I had soft bowel movements, and in between days of hard bowels or no bowel movements at all. I predominantly suffer from IBS-C, but do have flare ups of diarrhea that typically last only a day. I take Prune juice on occasion that helps to get my stomach moving, but often result in cramps and a lot of gas. My stomach feels colicky and unpredictable. The pain seems to move around my abdomen, but predominantly on the left side and middle. I do not have any noticeable blood in my stools.
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Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:

Need few more details.

Detailed Answer:

Hello,

Have gone through your details and i appreciate your concerns.
Every patient is a unique case when we deal with IBS.

In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome.

The structure of the intestines is normal, only functional abnormality occurs in this condition.

So frankly speaking (IBS) represents a functional disorder of the gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction.

The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important

So in lay man's language till date, we are not sure what the exact cause of this problem. So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc).

Some patients have symptoms of unformed stools some have to bloat and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.

So as seen above every patient is different. The intensity of symptoms in every patient is different as so is the response to medicines and lifestyle change. A patient may respond well to one medication while another patient is totally unresponsive to the same.

Our goal-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.

Please mention doses and name of all the medications tried by you for further suggestion. Was a colonoscopy ever done?

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Ramesh Kumar 1 hour later
I have tried Bentyl, but no longer use the medication. I have never had a colonoscopy. I absolutely believe stress is a factor but even times I don’t feel stressed I experience the symptoms and issues.
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Answered by Dr. Ramesh Kumar 3 hours later
Brief Answer:

Follow up.

Detailed Answer:

Hello,

Again my respected patient, see irritable bowel syndrome is a diagnosis of exclusion which means that when there is nothing wrong with your intestinal system despite all possible medications but the patient is having symptoms then we use an umbrella term called irritable bowel syndrome.

The first thing to be done before labelling a patient is having IBS is a colonoscopy. This is the baseline test for any problem involving intestines.

Secondly, these symptoms could be due to inflammatory bowel disease or polyp or any either benign pathology also. So a colonoscopy has to be done.

Lastly, Bentyl dicyclomine is just initial therapy for a patient of IBS.

Mebeverine, Loperamide, Fybogel and lifestyle modification if tried in conjugation to control symptoms.

Intially go for a coloscopy sir and then follow up with repports
Ask your Gastro to start you on medications like Cibis (with a composition(formula) of Chlordiazepoxide 5 MG+Clidinium bromide 2.5 MG) along with an anti-anxiety medication.

This would help to control symptoms. Symptoms can be controlled very well in most patients by proper therapy.

Hope I have answered your query.

Take care

Regards,
Dr Ramesh Kumar, Gastroenterologist

Above answer was peer-reviewed by : Dr. Kampana
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