# Chronic Bloating/Constipation Help



## axapak (Jan 9, 2014)

Hi everyone,

I'm an 18 year old male living in Toronto. As a student, I tend to live a relatively sedentary lifestyle.

For as long as I can remember, I've had problems with constipation. In my youth, I had frequent stomach aches (which I outgrew) and took laxatives for extended periods of time. Up until about a year ago, the constipation didn't really bother me. However, in December of 2012, I visited Bulk Barn and ate a whole bag of gummy candy. I was extremely bloated and constipated for the following week. I took laxatives to clear myself out. Two weeks later, things had returned to normal, and I eventually ended up making another visit to Bulk Barn for more candy. The bloating and constipation returned, and since then, have not gone away.

I've been bloated and constipated for over a year now. My diet and lifestyle patterns are the same then as they were before the bloating occurred, which I find odd. The bloating is very noticeable; sometimes so much that my stomach physically can't stretch any further out. It's also extremely uncomfortable, leaving me feeling lethargic but restless. For the first few months, I found eating prunes helped. The bloating would "fully" disappear after relieving myself in the washroom, only to return almost immediately. Eventually, the prunes stopped being effective, never "fully" relieving the bloating, only "halfway". I've also tried Metamucil, which got me regular, but only relieved bloating "halfway". I've also tried gluten- and diary-free diets to no avail.

I've been tested for celiac disease, lactose intolerance, and stool cultures. All fine. I've had an ultrasound of my GI tract, all fine. I've had an upper GI inspection, which showed food passing through me slower than usual. As such, my doctor prescribed domperidone maleate (Motilium) to speed things up. It helped my constipation a little, but not the bloating. After seeing a gastroenterologist, she's diagnosed my with Irritable Bowel Syndrome, and has put me on RestoraLAX, Metamucil, and prucalopride succin (Resotran). She also suggested exercising 3 times a weekly, and eating smaller, more frequent meals full of fibre and fruits/vegetables. The first day of using all these medications, I went to the washroom three times, and the bloat was gone. However, the bloating return after the next meal, and despite using the medication and exercising for three weeks now, the bloating has not receded.

This bloating has really hurt my self-esteem, lowered my sex drive, and has left me miserable and uncomfortable in my own body. Does anyone who has faced/is facing this problem have any suggestions for me? I'm all ears.


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## annie7 (Aug 16, 2002)

yes, lots of constant bloating like that is miserable. sorry you're going through all this.

so it sounds like bloating is the main problem---are the medications taking care of your constipation?

from your experience with the gummy bears (sound like they should call that place the "Bloat Barn") and prunes it sounds like you are sensitive to sorbitol--found in both of those and other foods as well. sorbitol can promote a BM but it can also cause bloating in susceptible people.

have you tried the FODMAP diet? there's a lot of info on that on the Diet board here. a low FODMAP diet can be very helpful with bloating although the breads and pastas listed on it can be a bit heavy and constipating. a very strict FODMAP diet can make constipation a bit worse although the meds you are on may offset that effect. it's all in experimenting and finding a balance.

have you been tested for SIBO--small intestinal bacterial overgrowth? that can also cause a lot of bloating as well as constipation.

also--if food moves slowly through you, a lot of fiber--particularly insoluble fiber--can slow it down even more and cause bloating and more constipation. you might want to trying reducing your fiber and see if that helps. some people find metamucil very bloating and find citrucel less so. or try no fiber supplements at all--try getting it from non-FODMAP fruits and vegetables (well cooked, not raw)

diet, fiber can take a lot of experimenting with but it's worth it.

and yes, exercising and drinking enough water does help moves things through the digestive tract.

it does sound like you have a good gastro doc--that really helps. good luck. hope you can find some relief.


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## axapak (Jan 9, 2014)

Hi annie7,

Yes, the main problem is bloating and constipation. The medication is helping with the constipation a little, but not as much as I had hoped. Instead a small bowel movement every three to four days, I now have them every one to two days. However, many of them are small movements, and don't leave me feeling like I've completely evacuated my bowels.

Is there any way to get tested for sorbitol? Would a broad food allergy test help?

I haven't heard of the low FODMAP diet before, but some quick reading suggests it might be difficult. I'm living at university now, so I don't have a whole lot of options when it comes to the foods I eat.

No, I haven't been tested for SIBO. Frankly, I haven't even heard of it. Where would I get this test done? At a gastroenterologist?

How can I tell foods with insoluble fibre apart from foods with soluble fibre? I could try going off the Metamucil for a while, but I feel my bowel movements would suffer, which do partially contribute to the distension of my midsection.

I've been exercising regularly for three weeks now, and aim to continue.


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## annie7 (Aug 16, 2002)

sorry, i don't know much about food and allergy testing etc but i would imagine there is a way to test for sorbitol sensitivity. you could ask your gastro doc. and hopefully someone on the board here can answer that question too.

the test for SIBO is the hydrogen breath test (HBT) ask your gastro about where to get tested for it. around here where i live the gastro testing unit at the local university hospital does it. there are a lot of SIBO experts here on the board, too...hopefully they will chime in...









here's one chart listing the soluble and insoluble fiber content in food. they do start out by saying that insoluble fiber helps with constipation and it does for some people but if your colon moves slowly too much insoluble fiber just sits in there too long and slows it down all the more.

http://huhs.harvard.edu/assets/File/OurServices/Service_Nutrition_Fiber.pdf

have you had either of the following tests to get to the possible cause of your constipation--you can ask your gastro for them if you haven't:

the sitz marker test (colonic transit study) measures colonic transit times and shows if you have slow transit constipation. also placement of the markers can reveal other problems--ie if they end up with all or most of them collected in the rectum it could indicate pelvic floor dysfunction or an outlet problem.

and then there's the defogram--defecatory proctogram. this test will show if you have pelvic floor dysfunction --where the pelvic floor muscles don't coordinate properly to allow stool to pass-- or an outlet obstruction like a rectal prolapse or intussusception or a rectocele, etc. both men and women can have these problems. sometimes people have an internal rectal intussusception that they are not aware of until they take this test. if the defogram indicates pfd, an anal manometry is used to confirm this dx.

if you have pelvic floor dysfunction, biofeedback/physical therapy can help with that.

i've found that when sitting on the toilet elevating my feet on a footstool (shoebox actually, in my case) so that my knees are higher than my hips really helps. it straightens out the anorectal angle and allows for a more complete evacuation.

good luck--hope you can find some relief.


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