# IBS-C, incomplete evacuation - who has this symptom?



## Naomi889 (Sep 11, 2005)

Hi -I have a question about a specific symptom of IBS-CI've had very very severe IBS-C for six years, and a particular problem - incomplete evacuation - is my main symptom - indeed my only symptom really. I understand that IBS is very very common, but in all my thousands of conversations with doctors and on internet boards for sufferers such as this I have never come across anyone else who had this as their main symptom.I am basically trying to find out as much as I can about others with this symptom so I can try to make sense of it all and potentially find a treatment that would help. I have been in constant, severe physical discomfort for years now and my quality of life is very bad, and I am really getting desperate. I am SURE that one of the reasons that people like us are not getting treatment is that not enough is understood about what is actually going wrong in our bodies - IBS is really an unhelpful catch-all term in my opinion.Anyway - my questions. Does anyone else here suffer from incomplete evacuation after a bowel movement? And, if so, have you found that your IBS has got periodically and progressively worse over the years that you have had it???Mine have. My symptoms (the incomplete evacuation, constipation and physical discomfort) go along at a certain level, and then (after some minor stress event) will worsen, permanently. Many doctors have simply not believed me when I have told them this, and have certainly not heard of it happening to anyone else. Well, I believe me, and that's all that matters, but I do find it odd that I have never even come across anyone on one of these boards with my particular symptom (the IE and the periodic steady worsening), when one in 10 people are supposed to have IBSHowever, I recently saw a gastroenterologist who made some sense of this for me - she told me that the lower bowel has a certain capacity - I think she said 40mls or something - but what happens with IE is that the capacity becomes enlarged at a certain point (through e.g. stress induced IBS-constipation), to say 100mls, and then the body's sort of baseline for stopping going to the toilet is changed - it sort of "thinks it has finished" even when it has not. So even though the "stressor" has disappeared, the bowel remains distended and the body continues to "stop" going to the toilet at the wrong point. Then, the next time you are stressed, the capacity enlarges again (i.e. the constipation and discomfort gets worse) and it stays that way, even when the stress is gone. This fits my experience of IBS so exactly that I know it must be true. The way to treat the problem (she says) is to gradually reduce the capacity of the bowel - persuade it back to normal - there were other complicating factors that I won't bother going into now.But anyway, could you some of you let me know more about your experiences of IBS and particularly of incomplete evacuation, and also whether your IBS has got worse over the years? I really would be very grateful, as I think trying to understand what is going on with this particular symptom could help people like us find treatment.


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## grits91058 (Jul 13, 2007)

Naomi - I believe you should be tested for Pelvic Floor Dysfunction. I have been diagnosed as IBS-C for many years now with IE being the symptom that continued to worsen. I have been diagnosed with a non-relaxing puborectalis (also known as anismus, levator ani syndrome). Personally, I think this has been my main problem all along. Ask your GI doc to set you up with another doc who can test for this (an MRI). I was referred to a colo-rectal surgeon who found this. Am also seeing a physical therapist, and am awaiting an upcoming appt with a urogynecologist who specializes in pelvic floor disorders. Typically a pelvic floor disorder is what causes urinary incontinence, however, its the same muscle that controls the rectal area. I am hopeful that my upcoming appt with the urogynecologist will open some new doors for treatment. Currently, I try to keep the stool soft/liquidy for ease of evacuation. I also am back on the Zelnorm, also MOM. Also, hot baths help to relax the muscle.


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## Rose (Mar 25, 1999)

I totally relate to everything you said. I take a product called Fiber Plus every night, and I do have a BM every morning....some mornings I go more than others. Guess that depends on what I have eaten the day before, how much exercise I have gotten and how much water I drink....but it really doesn't matter, because I never feel like I am empty...still feel the need to go more, but nothing will come, which leaves me with a constant discomfort and sometimes pain on my lower left side. It feels like there is stool in either my sigmoid or descending colon that simply sits there and won't move. It is extremely uncomfortable. I have had some extremely stressful things happening in my life over the past few months, which has only made the problem worse. It seems all my stress goes to my bowels. I almost feel like when I am stressed, my colon sort of knots or twists up not allowing the stool to pass. Sometimes it is so knotted up, that I can't even pass gas, let alone stool!!!In answer to your question, yes it gets worse the older you get. Constipation has been a part of my life since childhood, and it has only gotten worse over the years. Of course, I have to admit my stress level has gotten worse also, which in turn just compounds the problem. Another problem I have is that I have an extremely stressful job and I work in an office envirornment where about 20 women share a two stall bathroom. Sometimes, at work, if I am not having a too stressful day, I will feel the need to "go", but if I visit the bathroom and somebody else is in there or using one of the stalls, which unfortunately for me happens more times than not...then I simply cannot go. If the bathroom is empty, I have no problem, but CANNOT go if somebody else is in there....so I hold it back trying to wait until it is empty, but usually by then, I've lost the urge...only making me feel worse. Weekends are a little easier, but not much.


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## Naomi889 (Sep 11, 2005)

Oh my goodness! Two people with the same chronic symptoms as me!!To grits91058 - I have indeed been tested for Pelvic Floor Dysfunction, and was also diagnosed with non-relaxing puborectalis. As you exhibit exactly the same symptoms as me, that corroborates my theory (gastros are quite vague about the specifics of the problems they see in others). What do you mean by an MRI? As in an actual Magnetic resonance imaging scan? Are you US or UK based?? - when I was tested 6 months or so ago, it involved some probes and a ballon, basically, but they made that same diagnosis. Zelnorm? Does that really help? I read about it back in 2001 when it was in trial but it was not licenced for use in the UK as it was not thought to be effective enough.OK, herein lies the rub. Basically, as I said earlier, I have had IBS for 6 years and have spoken to many many docs and people on internet boards and not found anyone with my specific symptoms. I have not used the boards for a few years and suspect that they are much more widely used now, hence immediately being able to find two others with the same symptom. * My opinion, based on the scientific literature, conversations with gastroenterologist and my own experiences, is that this non-relaxing puborectalis/anismus with associated self-perpetuating incomplete evacuation is actually a very, very specific disorder, and one that is perhaps relatively rare compared to the frequency of "IBS" as a whole. * For this reason relatively little is known about it, but alot more has been theorised just in the past few years (I mean the original gastro I saw back in 2002 did not even believe my symptoms could possibly be true and he would have seen hundreds of people with IBS every week). It's a growth field. *I think potentially this particular disorder could be quite treatable and here's why.* Now we all know the "mind-gut" connection is very complicated and that's why they can't treat IBS and blah blah blah. BUT - and here's the but- the gastro I am see at the moment told me told me that incomplete evac and the non-relaxing muscle are basically a self perpetuating, vicious circle sort of thing. As in - you get stressed, your IBS causes you to suffer from incomplete evac via this poorly functioning muscle. But then, instead of going away in the absence of the stress, like most people IBS, the distended bowel from the IE actually *CAUSES THE MUSCLE TO CONTINUE TO MALFUNCTION*. Do you see what I mean? The muscle clamps up in response to stress, causing IE. The IE then stop the muscle from going back to working normally in the absence of stress! *One causes the other!* And this is why this particular symptom is so intractable and frequently worsens over time. Part of the evidence the GI doc has for this is that when she treats patients for the IE over a period of time using non-stim laxatives, and reduces the severity of the IE and constipation, the muscle frequently starts to function normally all by itself, without any need for the Biofeedback machine therapy that she otherwise uses to treat this muscle problem. And so, in theory, while people like us may never be able to stop our symptoms happening in times of high stress, the key point is that it seems likely that we CAN STOP THEM OCCURING ALL THE TIME.Do you understand? It all makes such sense to me that part of me really believes that if just a little more were known about this specific disorder it may well turn out to be very treatable. GI docs are only helpful to an extent - you have to wait over 6 months between appointments here in the UK, and there are only a few treatments available so far (botox is one in trials at the moment). _ *So I think the key thing is to gather together as many people as possible with this particular symptom so we can share our experiences and what medicines are working on the problem. I think that would be really helpful and I do believe that potentially even a new treatment could be worked out this way[/*i] So far I have been corresponding with girl who's symptoms are quite similar to mine and I believe we both have been able to help each other and both understand a little more about how this disorder works. I work in scientific research and truly believe that the way to solve this is to gather together common experiences of this specific problem in order to test theories and work out potential solutions. I truly believe that this could work. I could even see the way forward into organising some sort of clinical trial for this specific disorder.To this end, I've copied this post into a message to both of you with my email address. If you want to email me more about the your experiences of IBS, that would really be great. Even if you just let me know what meds have worked for you and I'll do the same I think that could be really helpful._


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## Joan Mack (May 20, 2007)

My male gastro guy told me that I was not trying hard enough. When I have a stuck poop in me, I use my finger to cut it. Went through 2 weeks of debilitating "trying"...which I kept a "log" (get it) on my results. Will use my zelnorm up and make an investment in underwear. Luckily I live near a dollar store with irregular fruit of the loom undies. You would have to take a microscope to find the "irregular" section in the undies. I doubt the FDA IND people will help me. My regular doc said he would put through the paper work. Let me tell you one thing, a bad bowel cramp can cause reflux symptoms.


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## mrnnthd (Nov 16, 2007)

You most likely have thyroid problems. This condition is not tested or treated until it is very advanced. research this condition. I have been researching it for 3 yrs, both on the net and in medical books. It causes allmost everything that happens to us from chronic fattigue to cancer. Kids need to be tested at puberty., then follow their TSH levels every 5 yrs or so. If it starts to rise it should be retested in 6mos (some infections can cause a rise). Normal is most likely 1 or under, some people feel the best when theirs is near 0.What has helped me. First get your thyroid tested. In 2003 the AACE-endocrinologist recommended lowering the upper level to 3.You can have symptoms at 1.5 maybe even lower. Treatement takes a long time to adjust. The quicker you catch this condition the better. Have your B12 level checked. Thyoid causes malabsorption of this causeing anemia which can lead to heart attacks. probiotics appear to have helped me. Antibiotics kill the natural flora and fauna in the intestinal tract. These replace them. They really helped my allergiess that used to knock me flat in the summer(75% of histamine is produced in the intestinal tract),I took 6-8 a day for about 8 mos and currently try to take about 4 a day after 1and a half yrs. This has helped with my food allergies which were getting very bad. Anything thyroid related can take a long time yrs to correct. Also have vit D checked as this causes osteoporosis. Maybe all vitamins are malabsorbed. Thyroid causes everythiong from fibromyalgia to cancer. I cant stress how important it is for people to become knowledgable about this disease. Read mary shomans book "How to Line Well With Hypothyroidism" and "Solved the Riddle of Illness". These are only the beginning I recommend reading medical books also. You have to wade through a lot of the chemistry to find pertinent info and they spread it out so only one or two symptoms, such as lung cancer, are found. You may have to go to an alternative practioner to get tested and treated and pay for it yourself. Make sure you have the TPO done. This test for autoimmune thyroid the most common kind. Hope this helps.


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## 16275 (Sep 23, 2006)

All this info is very interesting as I feel like I could have written some of it myself ! It is very frustrating to try and go and then not only not feel like you have not completed your "mission" after all your effort, but to add insult to injury, yes it is extremely uncomfortable as well. Many times I feel this way, but after reading the later post by "Teach", I can also say that I have days like that also. I just know certain days that I will end up going all day long, not straining in this case, but going in little increments all day long, and knowing the day is shot as I can not stray too far from a restroom. Usually in this case the urge hits very qiuckly and I need to hustle to make to the restroom. So I find it interesting that at times I have episodes of both.... Not sure what it is exactly... stress/food eaten/emotions, that decides what type of episode I may have on a particular day. I feel like I'm sitting on both sides of the fence on this one!


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## 23620 (Jan 25, 2006)

I have also had this as my primary symptom for many years. I also have been diagnosed as gluten intolerant and according to the gastroenterologist this is a contributing factor. I'm not sure that I can see the relationship. Anyway I have found that if my stool is fairly solid, almost to the point of being hard, this seems to help. It makes the movement easier to evacuate. Softer stool always leaves me incompletely evacuated. I take amatezia (I think that is what it is called), 1 triphalia and 1 laxative (morning and night), as well as cod liver oil and calcium/magnesium. I think the calcium helps achieve the more solid stool. Of course I am quite careful about my diet, lots of pears and veggies. This has been a difficult situation for me for a long time but I am definitely much better than I have been in the past. I have mostly good days now but I do relate very much with the symptoms you describe. With an incomplete evacuation comes pain and I would describe a burning sensation. My sense is that the residual material in my colon is causing this extremem discomfort. Please hang in there because I am living proof that this condition does not have to progressively worsen and that it can be turned around but not without lots of attention and personal care. I forgot to mention that I took wellbutrin for a while and believe it or not it seemed to help. I'm guessing because of the constipating effect which caused the more solid evacuation. Ok, enough for now. good luck to everyone.


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## Naomi889 (Sep 11, 2005)

I actually posted this same thread some time ago on the "General" board and the discussion there has turned to what is variously called pelvic floor dysfunction/anismus/non-relaxing puborectalis as a cause of IE. Does anyone here have any knowledge or experience of this condition, or of it's most popular treatment, biofeedback therapy? If so, do share your experiences on the main thread on the general board as this type of info is very useful in building up common threads in our symptoms and working towards cures.


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## jman2008 (Jun 22, 2007)

I have this,so far I found a combination of amitiza, super seed (garden of life) and ultra inflamX seems to help greatly.


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## SKZ (Dec 1, 2007)

Are you positive you don't have something very common called a "rectocele"? It is a prolapse of the rectum (basically a herniation) into the vagina. I have had this for a long long time. It usually from h aving babies. It causes incomplete evacuation. I had mine fixed 2 times, but my chronic constipation keeps ruining the surgery.


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## SpAsMaN* (May 11, 2002)

Strainers should use a "step" or do squatting to help evacuate:http://www.healthstep.com/resources/constipation.html







Look this patent:http://www.freepatentsonline.com/20030019020.html


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## annie7 (Aug 16, 2002)

hey Spasman--thanks for posting the health step info. are you going to try it? $64.99 is a little high for me--i think i'll try using my bathroom wastebasket again. it's 8 1/2 inches wide so when i lay it on it's side it's the same height as the health step--and luckily i have two identical wastebaskets--one for each bathroom--so i can put one on each side of the toilet. . i've used that wastebasket in the past--sometimes sideways, sometimes turned upside down for more height. sometimes it helped, sometimes it didn't but it's worth a try. from what i've read, squatting really can be helpful.


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## SpAsMaN* (May 11, 2002)

Yes squatting promote evacuation.I bougth a cheap step at the 1 $ store.Thanks for your concern lol


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## kc99 (Jun 7, 2007)

Hi Naomi, I know I'm kind of late in replying to this, but I found your post very interesting, and I share some of the general symptoms that you and the others here have discussed.


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## Naomi889 (Sep 11, 2005)

To SZ - you said "Are you positive you don't have something very common called a "rectocele"? It is a prolapse of the rectum (basically a herniation) into the vagina. I have had this for a long long time. It usually from h aving babies. It causes incomplete evacuation. I had mine fixed 2 times, but my chronic constipation keeps ruining the surgery"Is this really common? I've never given birth - is this the only way it can happen? Did you get yours from giving birth - is that when your IBS-C started?Does anyone else have experience of these?To kc99 - What are your symptoms - do you find that you are discomfort all the time, and have your symptoms worsened over time at all?


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## SKZ (Dec 1, 2007)

HI Naomi,My rectocele from having 2 large babies. I don't think that is the ONLY way it can happen though. I did a search on RECTOCELE on this forum and they all say the same thing.....incomplete evacuation. It a pain in the ass, no pun intended! I dont think I am going to have mine fixed again. i think I give up. I have had enough surgeries already. Have you done a google search on the subject? There is a TON of info on it. Also do a search on this forum, if you havent already.Sue


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## kc99 (Jun 7, 2007)

Hi Naomi,Well, let's see, to answer your two specific questions:I experience discomfort every day, though it is not every single hour of the day. Interestingly, I tend to feel better as it gets later in the evening, which I think has to do with the relaxation of all those smooth muscles in the gut. Also, I am a coffee drinker, and that is about the time when the coffee wears off. (Yes, I have tried cutting down on caffeine, and that definitely did not help).I have been in denial of this, but yes, I think my symptoms are getting worse over time. Though I think that has been a gradual change, and not linked to specific events. Also, I am in graduate school and so there is this confounding effect of accumulated fatigue, which I think is a huge factor.As for the symptoms -- I especially sympathized with Rose's complaint about having to share the bathroom with 20 co-workers. I also have trouble if there are people around.But anyways, more specifically -- I tend towards constipation but that has never seemed to be the right term for it. I only take an extremely small amount of fiber supplement and that is plenty. I do have the "IE" problem, in that I am not necessarily completely constipated, but I just have to make multiple trips to the bathroom before things are done. Until then, I typically experience some degree of discomfort and/or pain. This is exacerbated if I am around other people, or in a situation where I can't access a bathroom. Interestingly, my symptoms all started in college with some nasty GERD, which actually got much better over time (though I still take Prilosec). It was after the GERD that I developed IBS....I've never really had the two problems co-occur. My (relatively uninformed) hypothesis is that in both cases, there's been a problem with muscles just being too weak or otherwise screwed up to do their jobs correctly, either in the esophagus or the gut. But how to fix that, I don't know. I've tried anticholinergics (Bentyl) and Zelnorm and both made me feel worse, not better. So for now I do what I can with diet, but I wish I could do a lot more.


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## Joan Mack (May 20, 2007)

Glad I have read this site again. I will definitely try squatting. It might help. Hope I do not fall down...lol.


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## annie7 (Aug 16, 2002)

yes, squatting--thanks Spasman, for bringing that up again. we've have previous threads about squatting and from what i remember it seems like the ideal squatting height was always mentioned as being about 12 inches or so (elevating your feet to 12 inches off the floor) or even (ideally) placing one's feet on the toilet seat itself and squatting on the seat like that. now that position is a bit (!) difficult for me with my arthritic knees but i kept practicing and finally was able to do it although it was a bit hard to relax in that position. so i had more success with turning over a small wastebasket--other people mentioned using other things like a suitcase, etc-- and putting my feet that--about 10" high. sometimes that helped--sometimes not. the health step you posted about is 8 1/2 inches high so this past week i've been experimenting with a lower height and for me that lower height really does seem to work much better! i took two thick old bath towels and rolled them up tightly so they are about 7+ inches high and put my feet on those and yes, that really is the best height for me. it does seem to help most of the time at least--not always. it pays to experiment with different heights. so don't give up if one particular height doesn't work for you--keep trying different ones.


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## postmortem (Nov 11, 2006)

how did it all start for you guys? i mean we don't just randomly develop a problem with relaxing our pelvic muscles right? some mentioned having a baby but what about others?


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## eric (Jul 8, 1999)

this whole thread is about sorting it all out and has a lot of information and linksThere were conditions being talked about with constipation that are not IBS but functional disorders of the anal rectal canal. These disorders can overlap in the same person and frequently do overlap, some one can have animus and IBS for example. But these conditions effect different parts of the anatomy. Animus is not IBS.http://www.ibsgroup.org/forums/index.php?showtopic=91738I also took notes form the UNC chat with the experts about a year or so ago. Dr Whitehead is a leading expert on constipation as well as IBS. Just for the info*"Whitehead:* The internal anal sphincter is a smooth muscle the surrounds the anal canal and that normally stays contracted to prevent leakage from the rectum. Damage to this muscle can cause leakage without awareness. *Whitehead: *The muscles of the pelvic floor that we use to hold back a bowel movement until we can find a convenient place are the external anal sphincter (which surrounds the anal canal) and the puborectalis muscle which can pinch off the rectum and prevent fecal material from entering the anal canal. *Whitehead:* This slide shows the anatomy of the rectum and the pelvic floor muscles that are important to continence. The rectum is a place to store fecal material before a bowel movement, and when the rectum becomes stiff and non-compliant because of diseases like ulcerative colitis, bowel accidents are more likely. The sensation of fullness that tells us when we have to squeeze pelvic floor muscles to avoid having an accident also comes from the rectum.*Whitehead:* Treatments for bowel accidents can include drugs (for diarrhea or constipation), biofeedback or pelvic floor exercises to improve our ability to sense rectal fullness and squeeze the pelvic floor muscles more effectively, and surgery to repair pelvic floor muscles damaged by childbirth or other trauma. Treatment is successful in about ¾ of patients, so it is always worthwhile to report the symptom to your doctor and to request treatment. Whitehead: The causes of major incontinence are summarized here. They include severe diarrhea, injuries to the pelvic floor muscles that result, for example, from the birth of a large child, and injuries to the nerves that go to the pelvic floor muscles. Whitehead: This slide summarizes the ways our bodies protect against accidents: We have to be able to perceive when there is fecal material in the rectum, and we have to be able to squeeze the pelvic floor muscles with enough strength to prevent leakage until we can reach the bathroom. We also need the internal anal sphincter to provide a passive barrier to leakage, and we need enough elasticity in the rectum to store fecal material for a few minutes. *Whitehead:* The internal anal sphincter is a smooth muscle the surrounds the anal canal and that normally stays contracted to prevent leakage from the rectum. Damage to this muscle can cause leakage without awareness. Whitehead: The muscles of the pelvic floor that we use to hold back a bowel movement until we can find a convenient place are the external anal sphincter (which surrounds the anal canal) and the puborectalis muscle which can pinch off the rectum and prevent fecal material from entering the anal canal. *Whitehead: *This slide shows the anatomy of the rectum and the pelvic floor muscles that are important to continence. The rectum is a place to store fecal material before a bowel movement, and when the rectum becomes stiff and non-compliant because of diseases like ulcerative colitis, bowel accidents are more likely. The sensation of fullness that tells us when we have to squeeze pelvic floor muscles to avoid having an accident also comes from the rectum. Whitehead: Minor accidents are usually related to diarrhea. About 20% of people with IBS report occasional soiling of their clothes, and many of them are afraid to go out of their homes because of this. Another common cause of minor incontinence is hemorrhoids. Heymen: Yes.Patients are trained to tightly contract the anal canal muscles closed, while keeping abdominal muscles relaxed. Feedback is provided using intra-anal EMG or manometry pressure measurements. Heymen: Eric. Yes. Incomplete evacuation can lead to FI. This is often a result of unintentional contraction of the anal canal during BMs, like we see in constipation patients. So we train proper relaxation during defecation attempts in the same manner. --------------------------------------------------It really makes a difference if you what kind of c you have an why."Constipation can be broadly divided into 3 classes based upon the underlying physiologic cause: Normal-transit constipation Slow-transit constipation Pelvic floor dysfunction In normal-transit constipation, colonic motility (the way muscles contract and relax to move contents through the colon) is unaltered; stool moves through the colon at a normal rate. However, patients with normal-transit may experience more difficulties in stool passage, for example due to harder stools. In contrast, in slow-transit constipation colonic motility is decreased and bowel movements are infrequent, leading to more severe symptoms of straining and harder stools.Persons with pelvic floor dysfunction have a functional outlet obstruction, a defect in the coordination necessary for stool evacuation. This usually occurs due to the failure of the pelvic floor muscles (including the anal sphincter) to relax appropriately during evacuation efforts, thus making stool passage much more difficult regardless of whether stool transit in the colon is normal or delayed. In some cases, individuals contract their pelvic muscles instead of relaxing them (pelvic floor dyssynergia).The majority of persons seen by a doctor have normal-transit constipation, followed by pelvic floor dysfunction, and slow-transit constipation. Some patients can have a combination of slow transit and pelvic floor dysfunction (functional outlet obstruction)."http://www.aboutconstipation.org/site/abou...haracteristics/


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## Lee (Oct 30, 2004)

I also have these symptoms. I have a BM most mornings with the help of Colgout, Tazac and Benefibre. However, every day at about 4pm I need to go again, but can't. If I do manage to go then it is ALWAYS hard 'pebbles'. Usually I can feel it there but I just can't get it out.If I drink a large quantity of iced water, slowly, and sit and relax (can only do this on my days off work), then sometimes it gives me the urge to go, and I can pass these pebbles. That is, if I fill up my bladder and then urinate, I am obviously relaxing the pelvic floor muscle so therefore I can evacuate more easily.I don't understand why I can go in the morning (large, well formed), but at night it changes, it is baffling. I cannot go out , at night because I am so uncomfortable. No movies, parent/teacher nights, committee meetings, book clubs, restaurants, for me.Currently seeing a Gastro guy. He has diagnosed a rectocele (had colonoscopy) but he is so far only treating me with above meds. By the way, I have a rectocele, but I did not have my children naturally, so childbirth is not the cause. I have had manometry ( the balloon thing) which showed that I am missing one third of my external sphincter muscle. The doc who did this test said I wouldn't have the same "drive" as a normal person. So I guess that is the cause of the pelvic floor dysfunction.If I could get rid of the 'pebbles' I might have some chance of feeling ok each evening. Fibre is not the cause because according to my doc I am having a reasonable amount, and I drink 2 litres of water a day.So in my case I have a rectocele, pelvic floor dysfunction, incomplete evac at night, fructose intolerance, and IBS too.


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## postmortem (Nov 11, 2006)

now that i read eric's post more thoroughly...it reminds me, my ibs + IE started after i chased down a bus after breakfast and developed an upset stomach. ugh i still remember it. i was RIGHT in front of the bus but the lady closed the door and there was a GREEN LIGHT so i kept running for 10 blocks to catch my 2nd bus. i was almost at school before i turned around to take the bus home. there weren't any bathrooms in sight so i had to take the bus back a good 45 minutes before i got home to use the bathroom. that was a lot of butt scrunching. maybe if i went straight to school for the bathroom it would have been different, though there were a lot of snobby girls that liked to hang out at the school bathroom before class started. one bathroom in the entire school and our school had a thousand or two. i got diarrhea for a whole week after that and then took antibiotics. after that i noticed i constantly felt an incomplete feeling like there's stool sitting in the rectum. i wasn't really constipated at first, and i was starving myself then so i wasn't expecting major poops. however, eventually it turned into slow transit. and i understand how you feel Lee because its similar in my case except I don't always have a big BM in the morning but often times i feel like i have to go really bad but i get hard pebbles. biofeedback is not covered by insurance?so what triggered the IE or did you wake up one morning and your pelvic muscles decided to have a bitchfit and never recovered.you guys get that little bulge in your perineum as well right?


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## Naomi889 (Sep 11, 2005)

Postmortem"So what triggered the IE or did you wake up one morning and your pelvic muscles decided to have a bitchfit and never recovered?"Ha ha ha! Class. That's pretty much what happened to me. I was studying for Uni exams, putting myself under a ludicrous amount of pressure, taking stupid amounts of caffeine and pepto bismel. After that I developed "IBS" - but "IBS" that comprised only mild bloating that happened 3 or 4 times a week. Annoying, but not that big a deal. Then, on Nov 21st 2001, studying for another set of exams, the IE/ muscle dysfunction began, and has never, ever, not for one second of one hour of one day of the last 6 years, let up. My 20 year old self would never have thought it was possible to suffer like this.N.B. This is why I get so irritated at alot of people's and doctors' concepts of "IBS" - the large majority of those diagnosed with "IBS" only have it mildly, and having had both mild and severe IBS I know that you just CANNOT compare the two in terms of the impact they have on your life. You absolutely cannot. It's like comparing someone with the occasional mild headache to someone with a constant migraine. If more doctors appreciated this I am sure that our suffering would be taken more seriously and that there would be more and better treatments available. I am sure that "Airplane" and "Annie7" can appreciate what I mean here."You guys get that little bulge in your perineum as well right?”I am not exactly sure where you are feeling this bulge. Externally or, er, internally? Internally, (as in the vagina) , I can certainly feel a large bulge which has got worse as my IE/IBS has got worse and seemed to coincide in severity with the pain during sex. I think it's to do with the distension of your bowels putting pressure on your cervix. Oh, the joys of IBS.How old are you "Postmortem"? You sound like maybe just a teenager as you mention school? You poor, poor little thing if so.


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## Mistral (Jan 17, 2008)

I'm only just now piecing together that my IBS was probably triggered by cosmetic surgery 15 years ago. I was given an antibiotic as a precautionary measure.Three months later I had excruciating abdominal pain for days. I get to the doctor and he says... did you have surgery recently?... I hadn't even made the connection, but he told me it was the antibiotics. So he gives me Flagyl... another antibiotic... which I now know wipes out all gut flora, good and bad.Nothing was right after that, and I constantly struggled with abdominal pain, but never quite as severe as from that incident.But by three years after the surgery, I was completely bound up with constipation... dry pebbles and strings. Then the slippery slope started.... thyroid problems, anxiety problems, weight problems, mood problems... and IBS-C eventually changed to IBS-C/D and possibly leaky gut syndrome since I have thyroid antibodies.And in the course of the last 10 years, I've had at least 4 more rounds of antibiotics. If it wasn't for the Internet, I would never have found out about the problems they cause. I always thought antibiotics were the miracle of modern medicine.


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## postmortem (Nov 11, 2006)

when did you notice the incomplete bms?


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## guenever (Jan 21, 2008)

I go a large amount and then i find myself straining and straining to go little bits. it's like i could be in the BR for a half an hour just passing little bits. i don't know what to do. i just feel like crying some days. especially when i am at school teaching and having another teacher cover a class and i know i have to get back.


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## postmortem (Nov 11, 2006)

me too i get what you mean. just passing little bits trying to finish it off. its torture. oh and naomi, i'm 16.5, ibs since a month or so after i turned 14.


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## Naomi889 (Sep 11, 2005)

Postmortem, do you find that with the "just passing little bits trying to finish it off" you are left feeling very bloated and uncomfortable, all of the time? If you have it as badly as me then I think I'd like to shoot the doctors who'd let a little 14 year suffer like this. Yes, I know they don't have a cure or anything, but I know how badly they refuse to listen to or sympathise with people with severe IBS. In fact, in my opinion, I think that this may well be worse with regard to young women, who are often classified as over anxious and not taken seriously enough.Incidently the GI I'm seeing who specialises in our sort of incomplete evacuation/rectal muscle dsyfunction type IBS says that the vast majority of her patients are women, and for the most part young women. I've read articles on the "incomplete evacuation/rectal msucle dsyfunction" type IBS/ constipation that also point this out and suggest that it is because, to paraphrase "young women can be anxious and this translates to their guts ". I do not credit that at all - it does not adequately explain the markedly high proportion of young women. What, one loses one's anxiety when one becomes middle aged? Men are never anxious? There is far more likely to be some sort of hormonal link, say. You also said"you know... i took a lot of pepto bismol as well because of the week long diarrhea... i read that pepto has bismuth in it, which is a toxic metal and can cause constipation in high amounts"That's not unlikely at all. Many medications work differently on different people, especially in combination with other factors.And:"anything is possible, so i feel we should be kind to ourselves and just look everything possible despite how absurd or simple. get better or die trying. as immature as that may sound, i don't care. "There is nothing immature about that. That is a mature and determined response to a horrible, intractable problem. I feel sad that you have this at such a young age but clearly your maturity helps you to cope, or the illness had taught you wisdom. Hey, it must be good for something, right?


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## barelycoping (Jan 23, 2008)

this is my first visit to this site. Frankly I can't believe it took me so long to find it and I am unbelievably happy that I have! Finally, people to talk to! It is so tiring to listen to my friends just shake their heads at me and tell me how easily they 'go to the bathroom', and all of their 'helpful hints'. I know they mean well, but unless you have IBS, you really do not know what it's like and that you have tried EVERYTHING there is to try. Really, do you think I enjoy being constipated all the time??? Think about it.Anyhow, apart from my tirade, yes, I also suffer from incomplete evacuation, and yes, it is one of my main symptoms. I hope we are speaking of the same feeling, like you have to go all the time, even if you have just been, or you feel the need 'to go', and nothing comes out. Nothing, yet you know there is something in there.My IBS-C came on about 3 years ago now. I am not sure if it has gotten worse, but it certainly is not getting better. It is stress related. I am on anti-depressants and blood pressure meds too. I do not feel like adding another med to my ever growing pill diet but I am ready to try the medication that is supposed to help the constipation and see if it improves my condition. It is exhausting being bloated all the time.


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## postmortem (Nov 11, 2006)

does anybody else feel like the heaviness of the stool is doing all the pushing? it seems like once half of the stool has gotten out it suddenly won't go any more... with half the stool out there isnt anything heavy to push the rest of it out... idk does anybody else feel like that?


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## Colina (Jan 2, 2008)

Hi all. I do not have ibs myself but found this interesting as I did have a rectocele that was caused by a prolapsed uterus. When your uterus prolapses(starts to slide down) it pulls along with it your rectum and/or your bladder. I can now have regular and complete bowel movements. Deffinetly worth reading up on.


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## Naomi889 (Sep 11, 2005)

I don't quite understand - do you mean that you had a rectocele and got it fixed, and you can now have complete bowel movements, whereas you could not before?


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## Colina (Jan 2, 2008)

Hi Naomi. Sorry for not making that post clearer. I had a second degree uterus prolapse which caused my rectum to be pulled down causing a rectocele. I had a vaginal hysterectomy and they repaired the rectocele. Before this I could not complete a bowel movement much less even have one. I went about 3 weeks once without, it was a nightmare, however I have always had boughts of constipation so just tried the usual. Now I have no trouble at all unless i do not drink lots of water or skip my two morning granola bars.


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## grits91058 (Jul 13, 2007)

I haven't posted for a while, but wanted to give this update. I was diagnosed last year with non-relaxing puborectalis and, frankly, have had this problem all of my life. Long story short - am being treated also for years for IBS-C but have found some help with the pubo problem. My GI doc referred me to a local urogynecologist who works a lot with women with pelvic floor disorders. Although most of her patients have problems with interstitial cystitis (inability to empty the bladder due to tight pubo) she felt that the treatment she was giving them may be beneficial to me because the pubo muscle regulates all of lower female orifices. I have been using for over a month now specially-compounded suppositories (inserted vaginally - sorry guys) that are a mixture of diazapam (valium) and amitryptilline (a tricyclic antidepressant). This combination of drugs, when inserted vaginally, are right up next to the pubo and act as a local muscle relaxant. I have shown some improvement - my muscle can still tighten up but this drug does seem to alleviate the spasms that I was having. My understanding is that this is a new treatment developed by another local doctor here in Denver. The dosage of the suppository is a very low dosage (either 5mg of one and 10mg of the other - can't remember which). I use 3 to 4 of them each day. I would urge any female with a non-relaxing pubo problem to visit with a urogynecologist and explore other treatments. There may be other urogynecologists out there using this treatment and perhaps other treatments.


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## alan4815 (Feb 21, 2008)

Just found this forum, and this thread seems to have my symptoms exactly, thought I'd share my experience. I'm a 23 year old male in graduate school with all the accompanying stress. I started having mild symptoms in high school, and they've gotten progressively worse over the years.I usually am able to have a medium bm in the morning, followed by discomfort and anywhere from 2-5 more smaller bms throughout the day. Many times I have the urge to go with no results when I get there. I believe the problem started either due to a long dose of antibiotics I took for pneumonia when I was 13, or possibly because of some uncomfortableness about going in public when I was younger, I'd hold it longer than I should.I've been to a few doctors about the issue, and here's what I've tried so far:1. High fiber intake. This mostly gave me D. 2. Antispasmatic. No effect on bms, and made me a little woozy.3. Went to a naturalist. Spent about $200 on supplements for "cleaning" me out supposedly. The major one was a very high amount of oregano. At the same time I went on a no dairy, no wheat, no sugar diet. I spent about 4 weeks on the diet and taking the supplements. After about a week I noticed a huge difference. Was having surprisingly large bms, and no discomfort afterwards. I would still go 2 or sometimes 3 times a day, but never the discomfort I normally feel. Felt incredible.Then I got very sick. High fever, upper right abdominal pain. Went to the doc, and blood work showed I had elevated liver enzymes. I immediately stopped the supplements and was out for about a month feeling very sluggish getting over the liver issues. During this month I continued on the diet, but went back to my old bowel habits.That was about a year ago, and since then I've given up the diet (it made no difference), and haven't tried the supplements again. The liver issues scared me, and the docs I went to regarding the liver stuff seemed to think the supplements could have caused the problem. Anyway, this post is getting very long. I just wanted to say I'm in the IE bandwagon, and let you know what I've tried. Anyone else been to a naturalist before? Best month of my life, followed by one of the worst months


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