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Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ?

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Practicing since : 1997
Answered : 65 Questions
I'm a 48 years old male . I need to go to toilet several times , between 6 to 8 times a day but still the complete evacution is not there. My stool generally a rather loose paste type ; sometimes it is a thick liquid.
My main problem , however , is that I suffer from halitosis whenever I fail to have a clear bowel and its severity decreases as soon as I have it clear.
I have no dental or gums problem.
I had endoscopy and colonoscopy done in 2009 which were normal.
I was treated with medicines to increase the movement and power of intestines(as the doctor told me- do not remember the name of the medicine) for 4 months which showed good results but it never disappeared altogather .
It is back again. Now I am being treated with VIBACT DS ( 2 TABLETS DAILY FOR 4 WEEKS).

Is it curable?
How could the gases escape through the mouth?
Posted Sun, 22 Apr 2012 in Abdominal Pain
Answered by Dr. Vaibhav Banait 27 hours later

Thank you for posting your query.

Based on your symptoms, it suggests the possibility of Irritable Bowel Syndrome.

It would be great if you answer some more questions in details to guide you better.

1. How long you are having these symptoms?
2. How many times in last 3 months did you wake up due to motions?
3. Is there any associated abdominal pain? If yes, what is the effect of bowel movement on pain?increase/ decrease/remains same?
4. Did you notice any blood in motion any time?
5. Is there any fever?
6. How is your appetite?
7. Is there any weight loss in last 6 months?
8. In any way, can you associate onset of symptoms with starting any medication?
9. What exactly does your laboratory report say?
10. What is your diet? How much is the milk intake?

I will be able to comment precisely only after getting answers from you.

Waiting for your reply.

Dr Vaibhav Banait.
MD (Medicine), DNB (Medicine), DM (Gastro-Enterology)
Consultant Gastro-Enterologist and Hepatologist.
Therapeutic Endoscopist..

Above answer was peer-reviewed by
Follow-up: Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ? 19 hours later
1.I have been sufferring with this since 1985; on and off I went for some treatment between 1985 and 1994- after that I gave up in despair. Also because the symptoms somewhat reduced. In 2009 I again tried with the results that I have already written about.

2. No waking up during the nights.

3. No pain.

4.There was some blood for a few days but it disappeard. This was about 5 years back.

5.No fever.

6. Good appetite. I'm 5'10.5'' and weigh 102 kg. I'm trying to reduce.




No ulcer, stricture, growth, polyp or any other lesion in the entire length colon.

normal colonoscopy

Bx for histopathology- nil

Complication - nil.





Bx for histopathology.-nil
Bx for rapid urease test - nil
complication - nil.

10.I'm a vegetarian. a large cup of milkshake in the morning; 4 cups of tea with milk
normal breakfast , lunch , dinner .

My problem is the halitosis- how could the constipation or IBS cause the halitosis?

As soon as I have had the motions it would reduce dramatically.

In 2009 I was given coolospa, rozo, cremadiet with good results.

My stool does not come out in cylindrical form; a loose paste coming out in very small diameters and it is sticky.

Answered by Dr. Vaibhav Banait 7 hours later

Thanks for answering my questions.

From symptoms you mentioned, I could deduce few things.

You have chronic diarrhea which is not associated with abdominal pain. It is reassuring that it has not resulted in any complication or major lab abnormality. That simply indicate that the disease may have functional origin (abnormal gastrointestinal and psychological function) or may be related to milk intolerance, or bacterial overgrowth if you also get abdominal Bloating.

It would be prudent to abstain from milk and milk products for a month and observe the effect. With Gastroenterologist's advice if he agrees, you can try Rifaximin for few days.

Abdominal discomfort relieved by motion is an important part of definition of irritable bowel disease which is absent in your case.

As far as halitosis is concerned you should get Ear, Nose and Throat and dental examination done. It is important to know whether you or the person standing near you notice bad breath. Good oral hygiene and absence of nasal disease should give you fresh breath. Occasionally belch is perceived as halitosis.

belching is a normal phenomena and only if excessively there should investigations be considered. Common causes include aerophagia which has psychological basis and GERD (Gastroesophageal reflux Disease). Treatment of the conditions should help you.

I would suggest consulting a good Gastroenterologist to get to the root cause of your problem. You may consider discussing these possibilities with him.

I hope I have answered your queries.

Wish you good health.

Dr Vaibhav Banait
Above answer was peer-reviewed by
Follow-up: Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ? 17 hours later
Thanks Dr XXXXXXX for your kind answers.

However I would like to point out that I always feel that my bowels are not fully evacuated and I need to visit the restroom many times a day. I do have loose motions but they are much less frequent ; I would rather say I have chronic constipation .

Since I would not be able to submit any further questions as per the this web site's rules , I would request you to kindly bear with me a little more this time.

First you have to believe me when I say that the source of halitosis is the undigested or digested food in my stomach and guts. If ,for example, I somehow ,have my bowels clear ( once in a blue moon) I would be completely fine.

It's quite noticable by my colleagues ; I don't want to elaborate because that makes me miserable.

Since I have been living with for such a long time I have this feeling that my food remains in the guts much longer than normal and it leads to its putrefaction producing too much gases which then rise give me that terrible halitosis.

My stool types are mostly 5 and sometimes 6 or 1.

I Have this feel;ing that something obstructs the movement of the feaces may be near the end ; the feaces therefore have to be either of the types that I have. The stool has to make its way around that obstruction.if I did have solid stool sometime it would me more like a tape ; too thin.

How would I know?

If its make you rather irritated (you expect me to tell the symptoms , wouldn't you?) , imagine how difficult it is for me to tell all this to a XXXXXXX doctor face to face.

I would like you to tell me what I should do about this obstruction thing.


Answered by Dr. Vaibhav Banait 7 hours later
Hi and thanks again,

I understand your symptoms and yes, it does not irritate me. Your symptoms are real and is not a mind game definitely.

What you might have is 'obstructed defecation' or ''evacuation disorder' due probably to pelvic floor weakness. Pelvic muscles can be strengthened by exercises, you will have to seek help from physiotherapist.

Some patients have heightened rectal sensation. These patients feel small amount of liquid/feces in rectum as urge to defecate . Hence sense of incomplete defecation and obstructed defecation is common among them. You seem to have similar problem. Rectal balloon expulsion exercises and behavior therapy do help, but not widely available. You may seek help at a center which provide these facilities.

You may attempt 'rifaximin' treatment to treat halitosis under good guidance though such use is not very well documented and recommended. Considering low risk of toxicity, and chance that bacterial overgrowth might be the cause of this symptom, I am suggesting this drug but I would advise you to take second opinion on this.

Use of healthy, high fiber XXXXXXX diet to minimize the chances of indigestions, which might also benefit you.

Hope this is helpful to you.

Wish you good health

Best wishes
Above answer was peer-reviewed by
Follow-up: Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ? 17 hours later
Thanks so much.

I am already under this bacterial treatment - VIBACT DS , 2 CAPSULES A DAY FOR 4 WEEKS as I had written in my first mail. I have completed one week and it seems to be working. I would say I am feeling about 60% better. Is it a good enough substitute for rifaximin?

I would stop consuming milk as you have suggested.

I have also started about 30 minutes of brisk walking daily

Regarding that obstruction thing, could it be fecal impaction? Will it show in an x-ray or ct scan?

And finally , if you don't mind, my original query- Is it possible for the intestinal gases to cause halitosis?

Answered by Dr. Vaibhav Banait 22 hours later
Thanks again.

1. I am happy that you are benefited by vibact which contains billions of useful bacteria. The concept is to replace harmful bacteria in your intestines by useful bacteria. In your case, it seems to be working. So continue it.

2. Obstructed defecation is caused by weakness of muscles in and around anorectum which maintain regulation of rectum and sigmoid, such that the person maintain continence when he does not want to defecate, and align organs during defecation to allow easy passage. If the muscles are weak, the process is disturbed leading to inability to pass even liquid/feces.
This can be documented by balloon expulsion test and by defecography at radiology centers.

3. Halitosis can be noted in patient with advanced liver, kidney disease and those with obstructions to intestines such as occurs in patients with narrowing of esophagus or duodenum due to purification of residual food and bacterial overgrowth, but in otherwise normal person, in my opinion, this is seldom observed.

I hope I have answered your queries to your satisfaction . Feel free to write back.

Dr Vaibhav Banait
MD (Medicine), DNB (Medicine), DM (Gastro-Enterology)
Consultant Gastro-Enterologist and Hepatologist
Therapeutic Endoscopist

Above answer was peer-reviewed by
Follow-up: Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ? 3 days later

Regarding that narrowing of duodenum point, is it possible that it was missed in my endoscopy and colonoscopy ?

I would hate to go through again these two procedures, is it possible to detect this narrowing by some other method?

Could this narrowing also cause thin or pasty stool?

I was feeling dizzy and experienced light-headedness during the past two days.Could it have been caused by VIBACT DS? Today I am feeling OK though.These billions of bacteria being downed through my throat - is it completely safe? Would it have been better to try and eleminate the bad bacteria rather than reducing them to minority? After all, if they remained they could create trouble again.

We could for the time being the continence and pelvic muscle things. I didn't really mean I had thoce kind of problems.

From all that I have been able able to tell you, would you think the VIBACT DS is the best thing ? I mean do you believe the overgrowth of bacteria is the most probable cause? Or would you suggest something else?

Thanks for your patience and regards;
Answered by Dr. Vaibhav Banait 4 hours later

Thanks for the follow up query.

It is extremely uncommon to miss duodenal narrowing on routine endoscopy done by an expert. so if it is not there, it is not there. that is the best available investigation to rule out Duodenal narrowing.

Duodenal narrowing will not cause thin and pasty stools.

Vibact DS is unlikely to cause lightheadedness. It is probiotic nutritional supplement, it is used to restore the natural balance of your body. So, it is safe and you would be benefited with it.

Bacterial overgrowth might be the cause. It is difficult to be sure of it only based on history.

You can consult your Gastroenterologist for further evaluation and physical examination.

I hope I have answered your query.

Wish you speedy recovery.

Above answer was peer-reviewed by
Follow-up: Incomplete bowel evacuation, halitosis, taking VIBACT DS, done endoscopy, colonoscopy. Treatment ? 21 hours later
Our stomach , I understand, is hermetically sealed. If the smell is coming out of the stomach or intestines, what became of this seal?

I will mention some more symptoms; may be somrthing definite would come out of it.

I have tried, or rather have been forced , to skip meals in case my bowels have not emptied in the morning. It has helped. Tolerable level of halitosis, and what's more, it vanishes in say 8 to 10 hours even if my bowels remain uncleared provided I have desisted from eating.

A kind of fermentation , I have often felt , taking place in my stomach and intestines. If I have my meals when this is happenning, the halitosis turns most virulent. Spicy, oily , rotten kind of halitosis. Mercifully, it settles in about 2 to 3 hours .

Immediately after I have had my motions, the thing is noticably less strong.

Sometimes it( the halitosis) is like feces itself ; at other times it's like something is burning. People often ask me to check the insulations in my cabin.

The last time I was treated ( in 2009 ) Iwas given the medicines to help my guts move the matter ( as I was told) and it had helped me quite a bit. But even then, I remember, the doctor had looked worried. ' Your halitosis remains unexplained" this is exactly what he said.

This vibact ds is also giving me good results. But far from complete cure. I'm desperate because today again the thing returned.

What would like to know is the cause for this thing. People have constipation and IBS and all other kinds of problems but they they DON'T have to endure this . That hermetic seal is there to protect them. Why is that not happening in my case?
Answered by Dr. Vaibhav Banait 15 minutes later

Thanks for follow up again.

The stomach is considered by most researchers as a very uncommon source of bad breath except in belching. If there is some problem, it would demonstrate more serious manifestations than just foul odor. As you mentioned, your endoscopies are normal, there is no reason to be worried about the hermetic seal.

I think, you should continue with Vibact DS.

Accompanied by good oral hygiene, mouth wash and Vibact should take care of your problem. Be patient. Things seem to be taking time but gradually responding.

hope I have answered your queries adequately.

Wish you speedy recovery.


Above answer was peer-reviewed by
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