# Currently having a sitz market test, what is the definition of colonic inertia?



## oceannir (Mar 6, 2012)

So i'm coming up to day 5 of my sitz marker test.Its been very difficult to go without taking anything for the constipation, I feel incredibly full and in quite some discomfort all day.Instead of using markers, they gave me a drink with radioactive material to take so they could measure the movement. I'm just curious, how bad does it have to be to get the 'colonic inertia' rating. If most of its gone after day 5 is that colonic inertia?The man said that after day 3 there was still quite alot inside me, he said by that mark a normal person would have cleared everything. Also is the treatment any different once you are defined as slow transit?


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## BQ (May 22, 2000)

Have you seen this?http://www.rightdiagnosis.com/c/colonic_inertia/basics.htm


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## oceannir (Mar 6, 2012)

BQ said:


> Have you seen this?http://www.rightdiagnosis.com/c/colonic_inertia/basics.htm


Ive googled it quite extensively.I'm struggling to work out were the cross over period from normal range slow bowel is to colonic inertia.That site is a huge mess of information btw.


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## BQ (May 22, 2000)

Well if they already told you:


> The man said that after day 3 there was still quite alot inside me, he said by that mark a normal person would have cleared everything.


My guess is you are definitely tending toward that. Have you read this: http://www.usagiedu.com/articles/constip2/constip2.pdf It seems to use the term Colonic Inertia and Slow Transit interchangeably. Treatment would probably be based on the severity of symptoms. Hopefully you will have definitive answers from your Dr soon.All the best


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## Kathleen M. (Nov 16, 1999)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271260/From what I can tell from this they found that in general the upper limit for the normal healthy control population would be 70 hours (about 3 days) so probably anything much longer than that would be in the slow transit realm.From there it can range from mild to severe. So are you in the 4-5 day range rather than less than 3 or are in the more than 10 day range.The slower it is the more aggressive they may need to treat things. Generally from what I have seen the slower it is the less fiber you take and the more you rely on osmotics. But if you are close to normal limiting fiber may not be the recommendation (and finding the right amount for you rather than just avoid it as much as possible may be more what they are looking for).If it is severe enough and the osmotics aren't helping nearly enough then they talk surgery. It isn't 71 hours and we do surgery first. Usually that is a only when osmotics are not helping anymore.


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## oceannir (Mar 6, 2012)

Kathleen M. said:


> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271260/From what I can tell from this they found that in general the upper limit for the normal healthy control population would be 70 hours (about 3 days) so probably anything much longer than that would be in the slow transit realm.From there it can range from mild to severe. So are you in the 4-5 day range rather than less than 3 or are in the more than 10 day range.The slower it is the more aggressive they may need to treat things. Generally from what I have seen the slower it is the less fiber you take and the more you rely on osmotics. But if you are close to normal limiting fiber may not be the recommendation (and finding the right amount for you rather than just avoid it as much as possible may be more what they are looking for).If it is severe enough and the osmotics aren't helping nearly enough then they talk surgery. It isn't 71 hours and we do surgery first. Usually that is a only when osmotics are not helping anymore.


The thing that I don't understand is wouldn't everyone with IBS-C have slow transit? Because when my IBS used to flare up I would often go 3 days without going fairly regularly, if I went daily it was a miracle. However no one mentioned slow transit, that was just IBS.Even when for some reason it got far far worse (literally in one day) and the GI doctor gave me osmotics because I was barely passing anything he still said it was IBS. You hear of people saying they have "IBS" going once a week and the like. I guess what i'm getting at is there is no real perceivable difference between IBS-C and slow transit in the fact that IBS-C is probably the milder end of severe slow transit if you get what i'm saying. But thankyou, thats very good information. Thats kind of what I was after, now I realize there is no real 'crossover point'.


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## Kathleen M. (Nov 16, 1999)

Generally if you fall in the normal range of stool frequency without a lot of laxatives (3 a day to 3 a week) you are still in the less than 72 hours of transit time, and I wouldn't call that pre-slow transit constipation as many people never have this progressive it gets worse aspect that seems to be more the slow transit thing than the IBS-C thing)ANDConstipation has two aspects.1. Stool consistency2. Stool frequency.You can go every other day and have really hard, dry, hard to pass stools. If you are going every other day you are likely in the normal range for transit time. That still counts as constipation. You do not have to have to miss 5 days of BM's to have hard stools, heck some people can have constipated stool type and go nearly every single day. While my IBS is under control I still tend to vary from slightly too soft stools to slightly too hard stools and you wouldn't think you could pass a constipated stool type when you normally go 2 times a day, but I do that probably once every week or so.Also constipation predominate doesn't mean severe constipation only. A lot of people on the more C side may still occasionally alternate so they back up for 2-3 days then flush out with several BMs on that day, maybe even have a few normal days then back up again. So they may when backed up have a moment of over 70 hours but most of the time the transit time is normal. Slow tranist is when it is always slow, all the time, generally no several days in a row of spontaneous normal BMs daily. IBS-C can be back up for 3 days, then poop normal for 4 then back up for 3 days again. It does not have to be severe constipation every single day.But I agree there isn't a solid sharp distinct line, but then there isn't really that for most medical conditions. There is normal. A wide range of not quite normal, and then some outliers who are really out of normal range that have a serious problem. So no it isn't if your transit is 69 hours you are totally normal with perfect stool constancy that passes easy and at 71 hours you have severe unrelenting constipation that doesn't respond to the usual things that help most people. But if you haven't passed the whatever it is after 5 days when it should be all gone by 3, that is generally the line where they call it slow transit constipation rather than any other kind of constipation.And some people have outlet problems so that even if they can get the markers to the end in 30 hours like a normal person things may not be able to get out and so may back up just at the end. That is why, I think, they were distinguishing in the article between people who still have a lot of the markers in the first 3rd of the colon from those who all the markers get moved to the end relatively normally, but may not have been released when they should be.


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## em_t (Jun 8, 2010)

I've had this test done, twice actually and I was told if there was 20% or more of the markers left after 5 days, that was considered an abnormal result and indicative of slow transit constipation. In the UK they don't really use the term inertia because even in slow transit constipation there can be some movement, but just not enough to propel it through the bowel quick enough. Now I know you didn't have the markers test but I'm sure they could quantify or at least take a rough estimate of how much of the radioactive material was still left inside your bowel. Also what's important is the position of the markers - if they are all situated in the rectum or close to it, it might be a problem with obstructed defecation which causes constipation in some people whereas if it's slow transit constipation the markers will generally be randomly distributed and you may have some remaining in the ascending colon. For me, out of 60 markers, I had 59 remaining in my bowel after 5 days, where the other one went I had no idea because I didn't go to the toilet during that time, which is considered very severe. I know the protocol is different in different countries but just because you've been diagnosed with slow transit constipation / colonic inertia doesn't mean that surgery will be suggested immediately. Since my diagnosis of slow transit constipation I've been pushing for this because my life has been so badly effected by it, and even though my transit study is the worst my gastro has seen in 20 years, they will still try to do anything to avoid surgery, because the outcome isn't certain. For some people it works very well, other people are still left with a lot of pain and others may require a permanent ileostomy bag. So it is something you have to be very certain about if you want to go down that route. I've tried various laxatives and combination of laxatives without much success but am now trying a new system called Peristeen, which is an anal irrigation system that is currently working really well for me. I still need to take my laxatives but I don't have that feeling of still needing to go after it or incomplete BMs, it's also helped with the bloating a lot. From start to finish, including setting the system up it takes me roughly 20-30 minutes every other day, so you do need to invest time into it, but if you're struggling with constipation you're probably used to spending a long time in the bathroom anyway. Anyway sorry for the long rambling message, hope that helped a bit!


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## Sean (Feb 8, 1999)

I had 100% of the markers left in me after 5 days, so I was definitely over the line and well into the range for colonic inertia. I seem to remember that normal transit time ranges from 24 hours to 72 hours. My doctors have used the terms colonic inertia and slow-transit constipation interchangeably, so I have assumed they are describing the same thing.


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## pukka (Nov 28, 2004)

oceannir said:


> So i'm coming up to day 5 of my sitz marker test.Its been very difficult to go without taking anything for the constipation, I feel incredibly full and in quite some discomfort all day.Instead of using markers, they gave me a drink with radioactive material to take so they could measure the movement. I'm just curious, how bad does it have to be to get the 'colonic inertia' rating. If most of its gone after day 5 is that colonic inertia?The man said that after day 3 there was still quite alot inside me, he said by that mark a normal person would have cleared everything. Also is the treatment any different once you are defined as slow transit?


I tried to do this test and failed. I was at the hospital and said no way and walked out. I dont need a test to tell me I have a motility problem, I know I have a motility problem. I told my GI, I will never do a sitz marker. You are brave.


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## pukka (Nov 28, 2004)

Sean said:


> I had 100% of the markers left in me after 5 days, so I was definitely over the line and well into the range for colonic inertia. I seem to remember that normal transit time ranges from 24 hours to 72 hours. My doctors have used the terms colonic inertia and slow-transit constipation interchangeably, so I have assumed they are describing the same thing.


So what happened next? Did they give you medication?


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## Sean (Feb 8, 1999)

The first sitzmark test was almost 15 years ago. In that time, my doctors have prescribed Zelnorm, Amitiza, stimulant laxatives, sorbitol, lactulose, citrate of magnesia, phospho soda and various types of enemas. Nothing has really resolved the problem. I have just learned how to cope, mostly with the use of dulcolax twice a week to empty my colon and give me some relief.


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