# Incomplete Evacuation



## Regina Filangie (Apr 9, 2014)

Hi everyone, I'm new here and am hoping to find some help. My primary symptom is incomplete bowel evacuation, but I also have bloating, lower back pain, & frequent urination. I've had every test imaginable: various blood tests for celiacs and even ovarian cancer, colonoscopy, Xray, CAT scan, MRI, ultrasound, gastric emptying, sitz marker and they all came back fine. I've tried high fiber diets, low fiber, dairy free, gluten free, meat free and nothing has made a difference. As of today, I eat a diet high in fiber (incl. fruit, whole grains, and veggies), exercise 4-5 days a week, drink about 85 ounces of water a day, take a probiotic (Pearls Complete), 2 Fiber gummies and an 8 oz glass of Plum Smart juice at night. I can't say I don't eat some processed food, but I try to keep it to a minimum. I apologize if this is too graphic, but I'm able to have a well formed, large BM every morning with no straining and it always looks like more than enough to feel relieved - but I don't feel relieved. Maybe twice a week I'll go and feel like I actually accomplished something, but every other day I end up feeling as bad as if I hadn't gone at all. The strange thing is on the few days that I do feel like I completely emptied my bowels, the BMs aren't any bigger than on the days I feel like nothing came out. I've also tried squatting, as well as Triphala to no avail. I'm in my early 40s but this is making me feel like an old woman. I'm depressed and tired and find it hard to enjoy what is otherwise a very blessed life. This started about ten years ago - but not nearly as bad. In the early stages - I might have one or two bad days a month, but now I'm lucky if I get 7 or 8 good days a month. I'm at my wits end and just don't know what else to do. Has anyone else experienced something similar ? Were you able to find ways to alleviate your symptoms ? The one thing I haven't tried is laxatives. Even Milk of Magnesia and Miralax scare me, as I'm terrified of becoming dependent on something and I don't know if what I have would even be considered constipation - given the size, frequency, and ease of BMs. I have some interest in Magnesium supplements, but I'm confused about whether it should be Oxide, Citrate, how much and for how long. Any advice would be appreciated. Thanks.


----------



## tinoryls (Feb 22, 2013)

I had the same "incomplete evacuation feeling" a few years ago and my sigmoidoscopy revealed Proctitis. It was inflammation of the rectum and my doctor said that it made me feel that there was more, where there was none. It was successfully treated with Mesalamine Suppositories.

Are you sure that it's not just a feeling? These days when I feel I have not completely evacuated, I can generally have some tea/coffee and that does the deed. You can try an enema only once and see if there's actually any stool left.

Not sure of the magnesium, never took them.


----------



## Regina Filangie (Apr 9, 2014)

tinoryls said:


> I had the same "incomplete evacuation feeling" a few years ago and my sigmoidoscopy revealed Proctitis. It was inflammation of the rectum and my doctor said that it made me feel that there was more, where there was none. It was successfully treated with Mesalamine Suppositories.
> 
> Are you sure that it's not just a feeling? These days when I feel I have not completely evacuated, I can generally have some tea/coffee and that does the deed. You can try an enema only once and see if there's actually any stool left.
> 
> Not sure of the magnesium, never took them.


I'm not sure, but I don't think it's just a feeling. Mainly because of the back pain, bloating, and always having to pee. I appreciate your feedback and I'll do some research on Proctitis. Thanks


----------



## annie7 (Aug 16, 2002)

Regina

so sorry for all your problems. it's all very difficult, isn't it.

have you been tested for pelvic floor dysfunction? pelvic floor dysfunction occurs when the pelvic floor muscles don't coordinate properly to allow easy passage of stool. they tense instead of relax. the symptoms of pelvic floor dysfunction include constipation and the feeling of incomplete evacuation. and back pain, bloating and frequent urination also can be symptoms of it.

the test to dx this is a defecating proctogram . often an anorectal manometry is done as well.

a rectocele can also cause feelings of incomplete evacuation. the defecating proctogram will also dx a rectocele as well as any other outlet problems such as a rectal prolapse (internal or external).

here's an article about pfd. there's a lot of info online about it. a program of biofeedback and physical therapy often helps people with this problem.

http://www.fascrs.org/patients/conditions/pelvic_floor_dysfunction/

good luck to you. i do hope you can find a solution to all this and feel better soon. take care.


----------



## tummyrumbles (Aug 14, 2005)

Do you get up as soon as you've had your BM in the morning? What happens if you stay there longer? Sometimes stool can be higher up as well. If you don't evacuate this, and it's gassy stool, this can cause bloating / gas throughout the day. Usually the extra bits that don't come out aren't big enough to cause faecal incontinence for IBS-C people, but the gas content can cause gas incontinence for some people (leaky gas) or bloating if you can hold it in.

I have a sluggish colon but I go every morning. I used to have incomplete evacuation all my life. I only started to completely evacuate when I found this board about 10 years ago. I think the reason for my incomplete evacuation is that that the stool is in sections throughout the colon, not just collected in the lower bowel so this is why I don't think pelvic floor dysfunction applies in my case. I actually feel clear between BMs but then after some time I release gas and can feel a BM "shooting down" diarrhea-like so I'm guessing the stool is coming from higher up.

I think the 2 biggest mechanical factors in complete evacuation are digestion time and evacuation time. Most people with incomplete evacuation probably just don't sit there long enough. It can be deceptive because after the first BM you usually feel clear. But then there's a gradual sense of heaviness which I think is the remainder of the BM moving down. This would be a totally different feeling to a sudden relaxing of pelvic floor muscles and sphincter where you would probably feel that you want to go but just couldn't move it out.

Another factor is eating dinner too late. A sluggish colon, as opposed to constipation where you're blocked up for over a day, is possibly more due to gassy stool that is not only segmented but is hard to budge because it's not solid. The earlier you eat dinner, the more time peristalsis has to move the stool down. I've never taken any medication for this problem. Diet plays a huge role in this because a lot of foods can cause constipation like high FODMAPs, all grains, refined flour - in fact anything that causes gas. Gas has a direct affect on neuromuscular signaling in the colon. In your case the high fibre diet, especially the whole grains, could be causing problems if they're high FODMAPs.

There's a good thread on pelvic floor dysfunction here:

http://www.ibsgroup.org/forums/topic/155622-pelvic-floor-dysfunction/

Airplane's answer is very interesting regarding blame being put on the patient if there's no improvement.

If you have a sitz test and all the markers are say, lower in the colon and you actually feel that you have to go all the time but nothing happens then you could possibly have pelvic floor dysfunction.

I'm not sure that the issue is non-relaxing muscles or sphincter in my case because once the BM has moved its way down there's no problem getting it out. The problem for me is why the BMs seem to be so high up and not collected in the low bowel as they would be for most people. I go every morning though so the food is basically digesting properly every 24 hours although I am a late night snacker.

I rest my feet on big heavy books and that helps a lot. A u-shaped cushion can help with extra padding for the long wait.


----------



## annie7 (Aug 16, 2002)

just as an update to the thread that Tummyrumbles posted the link for..

i have been dx'd with pelvic floor dysfunction as well as slow transit constipation. last summer my insurance company did agree to pay for a program of biofeedback and physical therapy for me. my physical therapist was terrific! so understanding, supportive, knowledgeable and helpful. and the program has helped me learn to relax my muscles and go better. i do have slow transit constipation as well and biofeedback does not help with that of course but it did help me some with my pfd. i definitely think it's a program that is worth a try if one is dx'd with pfd and if your insurance will pay for it.

here is a recent post about someone's success with biofeedback for pfd:

http://www.ibsgroup.org/forums/topic/169925-bowel-retraining-mayo-clinic/#entry911576


----------



## Regina Filangie (Apr 9, 2014)

Thanks to everyone who took the time to answer. I haven't been tested for Pelvic Floor Dysfunction, but will definitely ask my doctor about it.


----------

