# Possible IBS-C, Would like Some Opinions



## needhelp2121 (Apr 4, 2015)

Hi Everyone,

Like many of you I have been on the doctor merry-go-round. I finally settled on my current gi doctor and he has been quite thorough. However I still cannot seem to figure out what is causing my symptoms. If someone could read on and offer an ideas I would really appreciate it.

Here it goes: Currently, my symptoms are constipation, distension, and gas. I do have a bowel movement everyday, sometimes twice a day or even three, but each time its hard w/ cracks and sometimes pellets. I have that sensation of incomplete evacuation. Not the worst, but certainly annoying. My main issue though is my stomach. No matter what time of day it is, my stomach is moderately to severely distended. Its not painful exactly but definitely very uncomfortable. It is in the lower abdomen. I am 6' 2'', early 20s male, and weigh 140 pounds and so it couldn't be excess fat. I can still see my hip bones and there is a very large bulge. I wake up in the morning with it and go to bed with it. If I fast, it is still there. Eating can sometimes cause it to increase for an hour or so but doesn't add much size overall.

Treatment: I have been gluten and dairy free for 6 months, with minimal to no change in symptoms. For many months i subsisted on a diet of oats, rice, chicken, carrot juice, corn flakes, and not much else. I have had blood tests for parasites, candida, lyme disease, mold, fungus, etc. all come up normal. I had a hydrogen breath test that came back with possible sibo, (hydrogen levels peaked at about 28 ppm) although he said the results were not following a typical sibo pattern, they were abnormal. So, I was treated with a 14 day course of rifaximin just in case, which surprisingly did absolutely nothing. I have taken all sorts of supplements, literally everything. Every B vitamin, magnesium, various homeopathic and herbal remedies. I've tried fiber supplements: metamucil, oats, even acacia (which actually has helped the most). I have also taken ox bile, betaine hcl, and enzymes with slight improvement. I've been on many different ssris. Some for the gi symptoms, others to control chronic migraines which have just recently completely stopped. No medication I have taken has ever helped my gi symptoms.

I was on an antibiotic for acne (doxcycline) on and off for about 4 years, I probably took it 2-3 years total. I stopped about two years ago, im sure that didnt help.

Important: I had a mostly flat belly until I started getting heartburn in 2013. A different gi doctor gave me prilosec which didnt help, and a few months into treatment I started to get the bloating/distension. I eventually stopped the prilosec but it continued to escalate into the problem I have now. The constipation was around even before that, but not as bad as it is now. I was probably on it a total of 4 months (in addition to 2 months of zantac before that). That may have contributed it.

Anyone have ideas? I am stumped and my doctor appears to be as well. I feel like maybe the constipation is worse than I think, could it be sort of built up in there, causing the distension? Not to be gross but I'm desperate at this point, nothing I do helps.

I can't help but think I still have sibo and maybe rifaximin was the wrong drug. Anyone with SIBO have an opinion on this?


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## annie7 (Aug 16, 2002)

HI and welcome to the board.

so sorry for all your problems. and yes, it can be hard to get all this figured out.

all i can think of is that quite possibly the gas and bloating is caused by the incomplete evacuation--the stool that is still inside. that certainly happens with me.

you mentioned that your stools were quite hard. does softening them up--with magnesium supplements, stool softeners or miralax--help at all? maybe if they were softer, you could get more of them out.

have you tried elevating your feet on a footstool, shoe box, etc or squatty potty while sitting on the toilet? elevating the feet helps straighten out the anorectal angle and allows a more complete evacuation.

perhaps trying amitiza or linzess (linaclotide) would help with your constipation. these meds have helped quite a few people.

if you think you might have a build up of stool causing the problems, you could try doing a cleanout--maybe with miralax--not a full out colonoscopy prep, maybe just half of that-- and see if that helps. be sure and stay well hydrated if you do this. drink gatorade or pedilyte to keep your electrolytes up.

hopefully someone else here on the board will have some more ideas for you.

good luck. hope you can find some relief. take care.


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## needhelp2121 (Apr 4, 2015)

Thanks for the tips Annie. Magnesium helps a bit, I just started miralax a few days ago and it appears to be helping a ton. I went quite a bit this morning but I still feel bloated and my belly is still sticking out quite a bit. Nothing I eat or don't eat seems to change it. I will try the foot elevation thing. I have tried linzess but surprisingly the lowest dose gives me diarrhea.

I can't help but think I still have sibo and maybe rifaximin was the wrong drug. Anyone with SIBO have an opinion on this?


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## annie7 (Aug 16, 2002)

yes it could be you still have SIBO, despite rifaximin.

I have SIBO. i'm not a SIBO expert like many here on the board but i've done some reading on it. i've read that there is a type (or maybe types) of bacteria that rifaximin doesn't kill off-- not sure which one(s). someone else on the board would know.

if you have constipation and you had methane show up on your HBT, a combo of rifaximin and neomycin is often successful, rather than rifaximin alone.

there are other antibiotics and combos used as well if rifaximin didn't help.

sometimes you need more than one round of antibiotics. and often SIBO comes back, especially if the cause of it isn't addressed and corrected.

hopefully some of the SIBO experts will chime in here..we also have a lot of very informative threads here on SIBO. lots of helpful information.

you might want to post a new topic over on the general discussion board asking about SIBO and rifaximin etc. a lot of people here with SIBO also have ibs-d so a post on the general discussion board will be more noticeable.


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## AIRPLANE (Mar 15, 2004)

I noticed that you had a SIBO test that showed some hydrogen. Did they say anything about methane? I know that there are different tests being used, and supposedly the best one uses lactulose as the test solution, while others use glucose or D Xylose, which are not as good. There is also work being done to develop testing for a third type of gas, hydrogen sulfide, in addition to hydrogen and methane. Being that you are constipation-predominant, I would guess that you might have high methane. I wonder if the test that you had checked for both hydrogen and methane.

Also, if you have high methane, Rifaximin/Xifaxan alone isn't enough. It is better for hydrogen than methane. They usually recommend something like neomycin along with the Rifaximin for methane, as Annie mentioned. The best herbal for methane is the allicin supplement called Allimed. Only bad thing about Allimed is the cost- it is quite spendy but naturopathic expert Dr Allison Siebecker seems to think quite highly of it for reducing methane.

Here are some good links on SIBO.

http://chriskresser.com/sibo-and-methane-whats-the-connection

http://radicatamedicine.com/2015/02/25/beating-sibo-naturally-with-herbal-antimicrobials


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## needhelp2121 (Apr 4, 2015)

I will check out those links thanks. Hydrogen appeared to be the only thing that showed up. methane never went over 3ppm, I have a copy of the results so I know that for sure. I know that a high level of methane usually goes with constipation in sibo cases but not in my case. Its very strange. The test used lactulose and my doctor is very reputable and well known in my city, so I think the equipment is reliable. Also, i should add I don't get diahrea, ever. Only under special situations like severe flu or when I was on Linzess.


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## annie7 (Aug 16, 2002)

i was originally diagnosed with ibs-c years ago. i never had D either--just chronic C.

after finding this board and reading a lot here, i began to think my problems were a bit more complicated than ibs so i went to a good gastro doc and had some tests--a sitz marker test (colonic transit study), a defecatory proctogram, an anal manometry and another colonoscopy, which showed a long twisted colon. these tests changed my diagnosis from ibs-c to pelvic floor dysfunction, megarectum and rectal hyposensitivity. and now sibo.

so at least all these tests gave me and my docs a better idea of what's going on..

my HBT results showed hydrogen peaked at 43 ppm and methane 4 ppm. so i didn't have high methane either but i keep my constipation under control (more or less) with laxatives so maybe that's why.

yes, figuring all this out can really be a challenge. it helps a lot to have good doctor, like you do. he sounds quite knowledgeable and thorough.

about bloating--i found this article about bloating and distension quite helpful:

http://www.iffgd.org/site/manage-your-health/symptoms-causes/bloating-distension


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## needhelp2121 (Apr 4, 2015)

Thank you for the insight. I have read that article many times, its been helpful. Its interesting you should mention the pelvic floor and twisted colon issues. My doctor told me my colon was spasming based on a physical exam. I feel like we may have similar pathology going on. Do you just take laxatives to deal with those conditions or are there other things? I have a strong suspicion i may have a pelvic floor issue going on. Also I should add that miralax seems to be moving things really well for me at the moment and I feel like the bloating has decreased. Any idea if I can use it long term? Thanks again.


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## annie7 (Aug 16, 2002)

oh good--so glad that miralax is helping. and yes, it is safe to use long term. all my doctors--my pcp, gastros and surgeons have told me that plus i've read that as well. i know people who have been on it for years.

yes, it could be you have pelvic floor dysfunction. it's not just something that affects only women--men can develop it too.

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 you can't get it all out (incomplete) and often you keep having that "have to go " feeling all day.

biofeedback can be very effective in training people how to relax those muscles. it has helped me.

a couple links;

http://my.clevelandclinic.org/health/diseases_conditions/hic_pelvic_floor_dysfunction

this one shows a diagram of the male pelvic floor and discusses pfd in men and how pelvic floor exercises can help men:

http://www.mccc.edu/~behrensb/documents/pelvicfloordisorderpresentation.pdf

because i also have colonic inertia, i have to take laxatives in order to go. otherwise nothing moves at all.


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## needhelp2121 (Apr 4, 2015)

Interesting. Do you find that you still are bloated? I feel much more cleaned out but I am still pretty bloated now, especially since its the end of the day.


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## annie7 (Aug 16, 2002)

oh yes, i have bloating problems.

mine has several causes. osmotic laxatives--miralax and milk of magnesia--can cause bloating. miralax doesn't work as well for me so i take milk of magnesia (as well as dulcolax) . so i get bloating from the milk of mag. and SIBO makes me bloat, too. my colon not working (due to inertia and abdominal adhesions) makes me bloat also since, despite all the laxatives, i don't go very well.

if your bloating is due to gas from food, you might want to give the low FODMAP diet a try, if you haven't already done so.


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