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Suggest treatment for incomplete bowel movement and stomach cramps

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Posted on Fri, 28 Nov 2014
Question: I have been a chornic suffer of mild IBS symptoms. Have consulted medicine doctors, gastro specialist and my own uncle who is a colo-rectal surgeon. When i was initially diagonised i underwent tests like occult blood stool test, rectal examinations, procto-sigmoidoscopy. My IBS symptoms have changed over a period of time. I do not have IBS-D or IBS-C either types, however i have the symptom of incomplete evacuation with different stool passage. I have managed to control this by eating more fiber , adding (15 billion+) probiotics and changing my toilet posture and habbit. I take Isabgol fiber 3 tea spoons with drink every night which really keeps bowels soft and easy to pass. In the morning i wake up , the sense of urgency is there but less (as compared to other IBS sufferers) but in order to do away with the unpleasant IBS symptoms like incomplete evacuation i usually go twice in the morning almost back to back after drinking water and green tea. This has become a habbit in order to ensure satisfation for all throughout the day. I usually do not go for the rest of the day however sometimes i do visit once post lunch if need be (usually if i have a heavy dinner the night before). I try and have light meals multiple times rather than having heavy meals thrice. My main issue is post lunch stomach cramps which are in the sigmoid region (lower left abdomen) and the flatus. Recently, after a visit to another gastroenterologist , he advised me to take duspatalin retard 200 mg twice daily, but since my previous doctors had indicated it might just cause constipation mildly, i started with 135 mg duspatalin twice per day. The Flatus is less and so is the sigmoid sensation , its been just 6 days i have been taking this medication and the advise was to continue for 6 weeks ? Shall i continue to do the same ? Also, he indicated that in case post 6 weeks of Duspatalin (retard, which he suggested) if my condition doesn't improve he would be keen to do a full colonoscopy, (which of course i am not keen, as all my previous physicians thought i do not need it) to ensure i do not have mild ulcers at the right end of the colon. Though, i am not a doctor i do not think that going to the toilet 2-3 times per day and having mild flatus requires a colonoscopy, since i have had this for a while i am aware of the disease myself and its symptoms and precautions. Please do advise whether i should continue with Duspatalin or Duspatalin retard and the next steps ? Sorry for the long note, but i thought it would be pertinent for you to reply accurately. I am presently continuing with Duspatalin and my Isabgol fiber drink at night. Waiting for your reply, many thanks.
doctor
Answered by Dr. Klerida Shehu (56 minutes later)
Brief Answer:
Butifar and Anxiolytic to start as therapy..

Detailed Answer:
Hi,

I have gone through your medical history carefully and can say as following:

1. I need to have the results of your previous procto-sigmoido-scopy:
- to know if it was a full colonoscopy or examination was run until sigmoid?
- if nothing was found, then, you should run coloscopy after 3 years (5 years after the last procto-sigmoido-scopy)
- if certain lesions were noted, then, you should schedule another colonoscopy now.

2. The pain you are feeling on the left lower abdominal quadrant is due to IBS.

3. Duspatalin is the best option to treat IBS. You should continue taking it up to 6 weeks and see the improvement.

4. If after 6 weeks, your IBS problems would be the same, then, I advise to start taking:
- Butifar
- anxiolytic

and to culture feces to exclude candida infection.

Hope it answered to your queries!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu (9 minutes later)
The results showed grade 1 or 2 internal hemorrhoids along with a mild fissure which has healed over a period of time. I am not keen to do a colonoscopy unnecessarily for the symptoms i have which presently. I am based in UAE , can you pls provide me the medicine brands which are available here. I have heard of Librax , is it the same which you have written ?I would like to know whether i should take Duspatalin 135 mg twice a day or i increase the dose to Duspatalin retard twice per day ? Will there by any side effect like constipation ?

Thanks.
XXXX
doctor
Answered by Dr. Klerida Shehu (26 hours later)
Brief Answer:
Librax contains the anxiolytic I suggested..

Detailed Answer:
Hi back XXXX

Thank you for following up.

1. Librax is the brand name for generic chlordiazepoxide and clidinium). Chlordiazepoxide is an anxiolytic. Earlier I have advised to start an anxiolytic agent.
Clidinium will relax the muscles of GI tract including stomach and intestines, thus, reducing your actual symptoms.

2. You can start wit Duspatalin 135 mg, twice a day, and can adjust the dose according to your actual GI symptoms.

You can increase to Duspatalin retard twice a day if symptoms won't improve.

3. Yes, constipation is one of the side effects of spasmodics like Duspatalin. However, their benefit will overcome its side effects.

4. Butifar is the trade name for generic Butirric Acid. It will help reduce the symptoms of IBS and improve the sensation of full bowel movements.

You can ask at your local pharmacy for Butirric acid as active ingredient.

Hope it answered to your queries!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu (8 hours later)
Just as a follow up note , wanted to tell you this that the proctoscopy was done until sigmoid region but of course no lesion or anything had been suspected at all...neither do i have symptoms apart from mild cramps and flatulence at the present. I would not be keen to do any invasive procedures at present with the present symptoms.
doctor
Answered by Dr. Klerida Shehu (13 hours later)
Brief Answer:
If this is your case,then do not run colonoscopy

Detailed Answer:
Hi back XXXX

Thank you for your follow up note.

In such cases, I usually advise to run a full colonoscopy to evaluate all segments of the colon. As you are not keen to run it and your symptoms are mild and no history of bleeding is present, then, it's ok not to run colonoscopy.

Hope it helped!
Dr.Klerida
If no more queries, do not forget to close this discussion!
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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Suggest treatment for incomplete bowel movement and stomach cramps

Brief Answer: Butifar and Anxiolytic to start as therapy.. Detailed Answer: Hi, I have gone through your medical history carefully and can say as following: 1. I need to have the results of your previous procto-sigmoido-scopy: - to know if it was a full colonoscopy or examination was run until sigmoid? - if nothing was found, then, you should run coloscopy after 3 years (5 years after the last procto-sigmoido-scopy) - if certain lesions were noted, then, you should schedule another colonoscopy now. 2. The pain you are feeling on the left lower abdominal quadrant is due to IBS. 3. Duspatalin is the best option to treat IBS. You should continue taking it up to 6 weeks and see the improvement. 4. If after 6 weeks, your IBS problems would be the same, then, I advise to start taking: - Butifar - anxiolytic and to culture feces to exclude candida infection. Hope it answered to your queries! Dr.Klerida