# Is there anything else I could try?



## Nuffa (Sep 12, 2014)

Hi there!

i am a 31 year old female and I have been suffering from severe Ibs-c for four years now. Every possible test came back perfectly normal. Yet, I am having severe motility problems. Without laxatives, I wouldn't have a bowel movement at all. therefore, my gastro told me to take two movicol (miralax) daily. which by and large worked fine for about 2,5 years until movicol lost its effectiveness almost entirely. I tried Linzess-to no avail. Resolor-nada. enemas don't do much since I am constipated higher up.i need to take up to 6 doses of movicol to get me going, which then gives me horrible d, makes me vomit and i am sometimes even passing out. I cant function at all.II had to go to hospital because of fecal impaction three times already. is there nothing else I can do except for taking another sitzmarker-test( i had one before) and maybe having part of my intestines removed?Sorry for possible mistakes. English is not my mother tongue.

I appreciate your support.kind regards, Nuffa


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## annie7 (Aug 16, 2002)

so sorry for all your problems. it's hard, isn't it, struggling with chronic constipation.

your English is excellent 

when you say all your tests came back normal--does that mean you passed your sitz marker test and it showed normal transit?

i imagine you've tried this but do stimulant laxatives--senna or bisacodyl (dulcolax) help you at all?

or suppositories--glycerin suppositories or dulcolax suppositories?

like you, i have severe motility problems. i have slow transit constipation, as diagnosed by the sitz marker test (no BM the entire time. did not pass any markers) and i have pelvic floor dysfunction as well as rectal hyposensitivity and megarectum.

and like you, my colon does not work at all without laxatives.

because i develop impactions very easily, both of my gastro docs as well as my surgeons have told me to take laxatives daily to keep things moving so i don't become impacted. i take 15 mg dulcolax and well as 4 TBL milk of magnesia every night. i take the dulcolax a few hours before drinking the milk of mag. i have found that taking an osmotic laxative as well as a stimulant laxative works better for me than taking either one of them alone. but that's me--we're all different in how our bodies react to meds. miralax (movicol) never worked well for me which i why i use milk of magnesia instead. i also use suppositories as needed, again with the approval of my doctors.

some people find the peristeen irrigation system is very effective for constipation. it's not available here in the usa, so i haven't tried it. it is available in the UK--not sure if it is in germany. it's a bit similar to an enema but much more effective. it sends the water higher up.

also--using a enema with the big quart (or liter) size bag is more effective and goes higher up than the smaller. prepackaged enemas. you can buy these large enema bags--enema kits-- in the drugstore or online.

have you been tested for pelvic floor dysfunction? with pfd, the pelvic floor muscles don't coordinate and/or relax properly to allow easy passage of stool. ineffective pelvic floor muscle coordination results in inadequate relaxation of the pelvic floor while attempting to have a BM. the puborectalis muscle tightens and contracts when it is supposed to relax to allow passage of stool. so the stool backs up in the rectum and beyond. this kind of back up can cause your colon to slow down, thus causing chronic constipation.

a defecatory proctogram test (defecography) will show if you have pfd as well as reveal if you have any other outlet problems like a rectocele, vaginal prolapse, rectal prolapse, etc. an anal manometry also helps diagnose pelvic floor problems. both tests are usually needed to make sure.

biofeedback and physical therapy can be effective in correcting pfd. i've read they have centers that treat pelvic floor dysfunction in germany.

have you tried elevating your feet on a foot stool or shoebox, etc or squatty potty? elevating the feet while on the toilet helps straighten out the anorectal angle and allows for a more complete evacuation.

i do hope you can find some relief. wishing you all the best.


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## Dreamcatcher32 (Nov 12, 2013)

When you say 'all tests' what do you mean? Besides Sitz Marker - what kind of testing have you had done? In order to know if your actual colon is functioning properly, you need a GI transit study. This also tests your small intestine and stomach. I went to Rochester, MN and had this done. Mine turned out normal. So did in my Anorectal Manometry and recent defecography. Despite passing these, I was still diagnosed with pelvic floor dyssynergia by their biofeedback nurses. They used a u-control biofeedback sensor to see that my pelvic floor muscles were tense and I was also having paradoxical contractions. That means that you are 'tensing' versus relaxing when having a BM. I also tense my muscles throughout the day which leads to constant tension and spasms. 50% of those with chronic constipation have this so I think it's possible you may as well. Though getting a diagnosis would need to be done by a good womens urology clinic that specifically deals in pelvic floor dyssynergia (tension)/anismus. I did Mayo Clinic's bowel retraining program and while it didn't solve my problems, it has helped more than laxatives ever did. If you have pelvic floor problems, removing your colon is not an option. Unfortunately, only an ostomy would work as far as a surgical approach is concerned. Though if this is the majority of your problem, biofeedback will help IF you stick with it and do it at home for many months. It has taken me around 7 months to learn how to relax things enough to have a BM.

Everyone seems to go through the struggle of finding a product that will 100% work for them. It's really important to get to the 'root' of the problem and figure out why you're having such troubles. Finding a motility doctor is important but given the severity of your issues, it sounds like Mayo Clinic would be your best bet. A lot of things can cause constipation and so many things can make it worse. Some have food sensitivities, thyroid problems, autoimmune disorders, nerve damage, depression, psychological problems, low blood pressure, etc.

STOP with the movical. Your body is obviously rejecting it at this point. Mayo Clinic told me that having a BM every 2-3 days is perfectly fine. It won't harm you. You shouldn't take something daily to make things move. It sounds like a change in diet is in order here (removing ALL processed foods and having a strict diet of chicken, fish, veggies & fruits). Up the water intake to 64oz a day and esp after fiber-filled meals. You need to find out what you are sensitive to and what you aren't. But I promise you that if you remove the carbs, you'll be in a lot better shape. Also try Bluebonnet Chelated Magnesium at 800mg a day. This stuff is potent! It will soften your stool like the Miralax does but in a more natural way. Also buy some Bluebonnet or Lifetime liquid magnesium to help on the days that you're really having trouble. Enemas will work once you get things down to your rectum. But I would only use these once a week at most. Try suppositories before enemas. You can also try Aloe Vera Inner Filler (not whole leaf). Only use this every 2-3 days though. Try oils (coconut, olive oil) inbetween meals. Also try mollasses in the morning (2 tbs) along with a large caffeinated beverage. If this doesn't work, take a 30 min walk. Exercise is great for peristalsis. Though nothing will work better than having a LARGE meal and a relaxed pelvic floor to get things moving! I literally have to 'meditate' and relax down my pelvic floor nearly all day to get things going. I have realized if you have tension there of any kind you can not get an urge to have a BM. Nothing will budge.


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## Nuffa (Sep 12, 2014)

Thanks a lot for your answers. With all tests i meant colonoscopy,gastroscopy and food allergies. All came back normal. Yet, i also have slow transit constipation. And digestion hurts. You know what i mean? Kinda difficult to explain. No manometry or defocography done so far as several doctors refused to test me. I mean, are they kidding me? I feel like i have pfd. My muscle feels very tense indeed. I will send my test results to some clinics here in germany. Additionally, i will see a nutrition doctor. Annie,do you use dulcolax on a daily basis?doesn't that make matters worse in the long run? Does any of you take probiotics? I believe they help me a bit. Not sure which ones to take though on a regular basis. I will give the shoebox a try☺ Is milk of magnesia really good?maybe i should try to get it either from the us or here in germany. Annie, u have slow transit. Is it more or less fiber for us? Less,right?take care. I am sooo happy that you guys replied to my post.


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## annie7 (Aug 16, 2002)

so sorry doctors have refused to test you--that's not good patient care at all! yes if you feel your muscles are tense down there, that does sound like you have pelvic floor dysfunction. yes, do send your test results to some more clinics--that's a great idea.

yes i do use dulcolax every day. this is what my gastro doctors and surgeons have all told me to do because i develop impactions very easily. they have all told me to "take what i need to go". daily. for me, with my situation, taking dulcolax--and milk of mag-- daily does not make things worse because my colon does not work at all by itself. it needs help. but again--this is my own personal situation. i always tell people to check with their doctors first before going to daily stimulant use. it is a last resort but that's where i'm at--the last resort.

about fiber--for me, i have found that a low fiber diet works best. eating lots of fiber just made me worse. when you have slow motility, a high fiber diet can just slow things down all the more. and the longer the stool is in the colon, the more it dries out, no matter how much water you drink. you have to experiment to find just how much fiber works for you--we're all different. but for me and for many others with slow transit, fiber is not our friend. my doctors have also told me this.

seeing a nutritionist is a great idea!

i do hope you can find a good, knowledgeable, caring and proactive gastro doc who will help you get the tests and treatment you need.


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## annie7 (Aug 16, 2002)

just an important note about dulcolax and milk of mag. don't take these two together because that can cause cramping from the dulcolax. the instructions on the dulcolax package--as well as on their website--say not to take dulcolax within an hour of drinking milk or taking any acid reducers (such as milk of mag, prilosec etc) that way you don't get cramping.

here is an excellent u-tube video on how to have a bowel movement without straining. it shows you how to push from your diaphragm--by gently pooching out your belly-- and not from your rectum--no straining. it's really helpful especially for those of us with pelvic floor dysfunction. the woman in the video, Michelle Kenway, is a pelvic floor physiotherapist. she also has lots of good information on her website:






my biofeedback physical therapist told me to do these exercises daily to help me learn to relax my pelvic floor muscles:

one simple exercise to do for this is to gently squeeze your pelvic floor muscles--the muscles around your anus-and then relax them. squeeze just enough so that you can "get the release" as my pelvic floor PT puts it--- get the relaxed feeling. this helps you identify your pelvic floor muscles and also helps you to relax them.

here are two other exercises she told me to do:

1) slow contractions: contract your pelvic floor muscles for 5 seconds (gently) then relax them for 5 seconds. 10-15 times in row, twice a day. always relax for at least as long as you squeeze.

2) quick contractions: contract your pelvic floor muscles gently for 1 second and then relax for 1 second.

never hold your breath while doing any of these exercises. always remember to breathe.


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## Nuffa (Sep 12, 2014)

Annie,when did u develop chronic inertia? I wonder what the cause might be. To be honest,i am disabled since birth. So maybe i should also consider changing all my medication. Before 2010, i went to the bathroom up to 4 times daily and led a normal life. (For me,since
I dont know how
It is to be "completely healthy". )but ibs is whats really disabling me and whats causing additional health problems. Did u suffer from constipation all your life? I hope
It's ok to ask u so many questions.


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## annie7 (Aug 16, 2002)

oh yes, Questions are fine

I have had constipation since childhood. For 50 years. I'm old lol...

So sorry you are disabled. That really complicates things, doesn't it.

im on my tablet here in the car. (Not driving of course  )

Will write more when I get home.take care


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## annie7 (Aug 16, 2002)

just wanted to add (silly tablet doesn't work too well in the car...) was that there are many different things that can cause chronic constipation. sometimes it's because the colon is overly long and twisted. sometimes it's because the pacemaker cells in the colon--the interstitial cells of cajal--are damaged or even missing. some diseases can also cause constipation, etc.

and there are other things-we had a thread here going on about all that a while ago :

http://www.ibsgroup.org/forums/topic/168214-list-of-all-possible-causes-for-constipation/


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## Dreamcatcher32 (Nov 12, 2013)

Nuffa said:


> Thanks a lot for your answers. With all tests i meant colonoscopy,gastroscopy and food allergies. All came back normal. Yet, i also have slow transit constipation. And digestion hurts. You know what i mean? Kinda difficult to explain. No manometry or defocography done so far as several doctors refused to test me. I mean, are they kidding me? I feel like i have pfd. My muscle feels very tense indeed. I will send my test results to some clinics here in germany. Additionally, i will see a nutrition doctor. Annie,do you use dulcolax on a daily basis?doesn't that make matters worse in the long run? Does any of you take probiotics? I believe they help me a bit. Not sure which ones to take though on a regular basis. I will give the shoebox a try☺ Is milk of magnesia really good?maybe i should try to get it either from the us or here in germany. Annie, u have slow transit. Is it more or less fiber for us? Less,right?take care. I am sooo happy that you guys replied to my post.


If they have only done a colonoscopy and gastroscopy, this is not enough to diagnose slow transit constipation. This is not a 'common' problem though it isn't unusual in the elderly. If you do have pelvic floor dysfunction, often the slow transit can be corrected if the pelvic floor is fixed with biofeedback. I will say that a manometry and defecography might not even show that you have it... that's the tough part. You might want to just jump right in and try biofeedback anyway, if your insurance covers it. If probiotics helped you then you should stay on those. I would make sure you're buying a high quality brand with live cultures - meaning you have to put it in the fridge. My naturopath recommended Culturelle for me, haven't tried it yet. Stomach pain can also really tense your pelvic floor muscles if you're constantly 'bracing' when it happens.


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## Nuffa (Sep 12, 2014)

The sitzmarker test showed slow transit. Dreamcatcher,i read some reviews of culturelle. They say it makes stool more solid?i guess that's unfortunately not what we are looking for.


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## Nuffa (Sep 12, 2014)

Forgot to say i ordered milk of magnesia. Let's see how it works.


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## Nuffa (Sep 12, 2014)

Thanks for suggesting the shoebox. It seems to help!yay!


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## annie7 (Aug 16, 2002)

oh wow--that's terrific! 

isn't it a relief to find something that helps.

i love my shoebox. sometimes you have to experiment a bit with which height works best--a low footstool or a higher one, etc. some people actually squat on the toilet but i have bad knees so that didn't work too well--was pretty funny actually--almost broke the toilet ..lol...

my biofeedback physical therapist suggested using two shoe boxes (or footstools, etc) --one for each foot so you can spread your knees further apart and get a wider stance. some people find it's helpful to have their legs spread out so they are more in line with their hips and not close together. again, the distance that works varies from person to person.

also you can order a squatty potty.

http://www.squattypotty.com/?Click=11813

http://wellnessmama.com/7013/squatty-potty-review/

they also sell those on amazon. and elsewhere. lots of great reviews for it.


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## Nuffa (Sep 12, 2014)

Another question: i still unfortunately didnt have a complete bowel movement and i am in pain now. What would u do if you were in my place? Maybe tomorrow is gonna be better with another try with the shoebox or do i have to take even more laxatives. Yesterday, i took 1 movicol,290mg linzess,800 mg magnesium and 2 dulcolax. Should i continue this way?or try to take a little less. In the past,i took as much as i needed in order to get a full bowel movement,but i believe that is why my bowels have become even more lazy and my situation took a turn for the worse,esp. When it comes to pain. Tomorrow,i will talk to my doctor. I am so afraid of whats next.you have been a blessing. Thanks a lot.


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## annie7 (Aug 16, 2002)

oh so sorry--that's miserable isn't it. especially with all the pain.

if you want to try getting more stool out now, you could try a glycerin suppository or even a dulcolax suppository if those work for you. the suppositories will get stool out that's still in the rectum or even the sigmoid colon. sometimes they even help me get out stool that is a bit higher up.

as far as tomorrow--yes, that's a hard one to figure. i really don't know how to advise--it's a decision best up to you. a doctor's advice is best.

maybe you've already read the recent threads we have here discussing laxative use. the laxatives currently on the market--at least, here in the usa, are safer to take than they were years ago because the ones thought to cause damage have been removed from the market. i remember when they did that with the old formula exlax and replaced it with a safer, new version of exlax. for many of us with slow colons, using laxatives did/does not make them worse. if the colon gets slower, it's because it would have anyway, not because of laxative use. at least, that what studies have shown, what my gastros and surgeons have told me and what the current feeling is here in the usa about all this. and here i'm talking about regular laxative use, of course. laxative abuse--taking more than recommended--is not good and could cause damage.

but really-it's up to you. i definitely do not want you to do anything that you don't feel is safe for you to do. and if you of course it's always best to have a doctor's advice.

some of us found that linzess gave us pain although i know it's supposed to actually help with pain, not hurt. yes do ask your doctor about the pain.

i do hope tomorrow is a better day for you....and i hope your doctor has some answers for you...


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## annie7 (Aug 16, 2002)

....cute picture, btw...


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## Nuffa (Sep 12, 2014)

Thanks a lot.everyday,i thank god for my sweetheart. He is the reason for me to keep on fighting. 😊


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## annie7 (Aug 16, 2002)

that's wonderful he is so loving and supportive! you two look terrific together!

and you're right--we keep on fighting--we never give up!!


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