# Fecal material remains in rectum after several BM's



## ira (Jun 26, 2003)

Hello:I have primarily C-related IBS, though I have at least one BM daily. It's the sensation of having incompletely evacuated that is the most basic source of my discomfort.After several bowel movements upon awakening--generally induced by a strong cup of coffee-- I always feel that sensation of incomplete evacuation.It feels as if I'm tightening up some muscles that ought to be relaxing. This leads to an appreciable sense of pressure/pain in the lower GI/rectal area.When I insert my finger up the rectum, I often can actually palpate fecal material---either in small pellets or poorly formed. If ,and when, I'm able to digitally remove these, I get some measure of relief, though it does seem that it's still not all out, and that some of the feces is still lying there in the rectum but a bit further up.Questions :1) Is the presence of palpable fecal material in the rectum after a bowel movement part and parcel of the IBS syndrome? Or is this normal and common in the general non-IBS population , and they simply don't bother to poke around there?2) Are there non-medicinal approaches which can help with this type of incomplete evacuation, such as exercises, diet, etc?Thanks:-Ira================================[Please excuse the graphic nature of what I'm trying to describe, but I can't think of a more delicate way to put this]


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## Nanobug (Nov 7, 2006)

> quote:Are there non-medicinal approaches which can help with this type of incomplete evacuation, such as exercises, diet, etc?


Something like (pure) psyllium fiber comes to mind. Have you tried it? Just don't forget to drink lots of water with that fiber, though.


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## eric (Jul 8, 1999)

You might ask your doc about"Outlet obstruction type constipation (pelvic floor dyssynergia)The external anal sphincter, which is part of the pelvic floor normally stays tightly closed to prevent leakage. When you try to have a bowel movement, however, this sphincter has to open to allow the fecal material to come out. Some people have trouble relaxing the sphincter muscle when they are straining to have a bowel movement, or they may actually squeeze the sphincter more tightly shut when straining. This produces symptoms of constipation. "http://www.iffgd.org/GIDisorders/GIAdults.htmlThey also use biofeedback for some of these issues as well as certain excersises.The "sensation of in complete evacuation" is a sensation that more needs to come out, when basically there is not much or nothing left to come out, but you still have a sensation. This has to do with nerves signals going from the rectum to the brain.


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## ira (Jun 26, 2003)

> quote:They also use biofeedback for some of these issues as well as certain excersises.


Hi Eric.Thank you kindly for your response.I doubt my medical insurance would cover something like biofeedback. But can you tell me something more about those exercises you mention?Thanks again:Ira


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## 14998 (Jan 5, 2007)

My problem is similar at times. Sometimes I cannot go at all, but often I go a little in the morning and still feel like I have to go all day.


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## 16229 (Jan 28, 2006)

http://www.continence-foundation.org.uk/pu...ercises%209.PDFOnce you have strength and control of the muscles then you need to work on relaxing them. If I see an article more specific to the relaxation part I'll post it. But strengthening the muscles will make relaxing them more easy as you will have greater control over the muscles.


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## ira (Jun 26, 2003)

Thanks Eric, Artjunky, etc.I spoke to my physician today. She's a generalist, not a GI specialist, but is quite familiar with IBS. Described symptoms in brief. She seemed to recognize the syndrome, though didn't name it. She explained that some muscles are apparently tightening when they ought to be relaxing. Somewhat akin to what is described here...She recommended deep breathing exercises and said biofeedback is often used for this.I inquired as to whether general biofeedback--rather than a biofeedback which is focussed on that particular sphincter muscle--would be the way to go. She felt that the more generalized biofeedback approach was called for, but couldn't recommend any practitioner for this. Any ideas as to how to go about this in NYS?I do recall her recommending similar exercises to what Artjunky had posted for a urinary condition--which does occasionally continue to act up-- which seemed to be along the same lines. Something about strengthening control over the puborectalis muscle. While acupuncture and those exercises did help the urinary urgency and other urinary aspects of this syndrome, it seems somewhat more obstinate in the case of the IBS-related dyssynergy. Eric: I vaguely recall a post of yours about non-GI or extra-GI manifestations of IBS from several years ago which was quite relevant to some of the symptoms I have. I might post another question on this elsewhere on this board so as not to confuse everything...ArtJunky: If you're able to find that article about the relaxation component for those muscles you made reference to in your Jan 11 post, it might of help to me. It seems to be the "ballpark" I'm in.Thanks in advance:-Ira


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## Brian0003 (Nov 5, 2006)

I have the exact same thing....I'm a college student, 19 male:I'm not sure if its really constipation, because I rarely have hard stools anymore but the incomplete evacuation is a major pain in the ass. I go about 2-3 times a day.Nothing has worked- I've tried fiber, Soluble and Insoluble, the Insoluble just made it worse, and the soluble didn't seem to do anything at all.Next I tried Glycolax/Miralax. Not strong enough so no affect.Next I tried Steriods, then Zelnorm, Amitza and many other things...still not helping.The only relief I get is hwen the stool is completely liquidfied. I know, its almost as gross, I use milk of magnesia about 3 times a week. But hey, its better than having incomplete evacuation. I think Incomplete Evacuation is the worst bowel syndrome you can possibly have, seriously, its worst than the worst constipation/diahierriah.By the way, don't use cofee. Its bad in the long run and its probably not relieving the incomplete evacuation anyway(It didnt work for me :/).


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## Mary2001 (Aug 25, 2006)

Ira I have the exact same thing i.e. feel I am tightening muscles that should be relaxing, and I termed that as constipation because I thought that is what it was, had all the tests at the hospital (but I told them it was constipation I had as I thought that is what the problem was when I had such difficulty with incomplete evacuation), but its exactly the same problem you have and I am so keen to get an answer for this. My tests were all clear so they said it was ibs I had and I haven;t found any solution to help so far. Thanks to everyone for posting on the boards, and also to Brian. I wonder if milk of magnesia is okay to take long term. I have not tried that. What I was taking was fybogel, but it doesn't help with incomplete evacuation either. It is good to know we don't suffer alone. Thanks. Mary


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## 16636 (Sep 29, 2006)

I know that the idea behind incomplete evacaution is that it's often a "sensation" rather than the real thing. But in my personal experience, having fuller bowel movements was necessary to get rid of that feeling. When I added Activia to my Zelnorm, it really helped push out more stool. How much more? It was noticeable in that it *felt* like a lot more but visually it doesn't appear to be a huge amount. So IMO a really big part of this horrible incomplete evacuation is not being able to efficiently push out all the stool, even a small quantity. Often I would have a 2nd cramp after the initial bowel movement but somehow the muscles felt uncoordinated and everything would pull back up into the colon instead of pushing outwards. Sorry for the details. Over a period of a month of juggling Zelnorm, the Activia & fiber consumption I feel like I'm learning what works best, but it did improve things from the standpoint of incomplete evauation right away. While things still aren't completely consistent, it's definitely much better. I think using the Activia for at least a month is worth a shot, for men and women (even if it's marketed mainly to women!) It can take a while to see the effect and the changes can be subtle at first.Dana


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## 22521 (Oct 2, 2006)

Hi Im so glad I found this question, as i thought i was the only one who suffered this symptom so bad, I used to think that it was not IBS and that i had somehow damaged the muscles by not going the toilet when i was in school all the time....i have asked the doctor on a number of occassions on how to combat this and all they ever prescribe me is colofac which seems to worsen the problem. Last week though i watched a televison programme on diets and it showed how bad bread was....i decided to cut it out of my diet and the IE seemed to improve around 25%!!!! its not perfect but certainly a step in the right direction...i also started eating bran which felt like the paristaltic (???Spelling???) movements of the bowel where working right down to the sphincter. I know this might not help but im just happy im not alone.


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## 19048 (Jan 10, 2006)

I started doing tightning and releasing of the anal muscles. It took a long time to help but I am seeing progress. I really dread that feeling of having to go but can't. I have to really use all my self-control not to strain. I just keep telling myself it will come when it is ready and take some deep breaths. Most times it will. I have 2 sensations one is after a bowel movement it feels like if only I could get the rest out I could get relief. the second is what I call the "icky" feeling....it is almost like a twitching in the anal area that feels like I have to go but I know I can't. Since doing the tightning and releasing it has improved those awful sensations a great deal.


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## ira (Jun 26, 2003)

> quote:I started doing tightning and releasing of the anal muscles. It took a long time to help but I am seeing progress. I really dread that feeling of having to go but can't.


****************************H Trailrunner:Would you kindly tell me if you coordinate the above anal muscle tightening /releasing exercises with deep breathing exercises? If so, precisely how do you coordinate them?I was once taught a technique such as this, but I forget the precise mode of coordination of contracting the abdomen/expanding the abdomen with contracting/releasing anal muscles...Thanks in advance:-Ira


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## 21078 (Oct 1, 2005)

Number One - I'm not new to this board - despite the "new member" - been around for YEARS - just don't post that often. In the bathroom too much.Number Two (pardon the expression) - This thread is ME. My story. THANK YOU Ira for posting.I have had several defograms (people complain about colonoscopies, imagine sh****ing in front of a crowd), balloon tests, etc. which show some dysfunction, but these tests don't replicate real life. I am sure I have major pelvic floor dysfunction. I have to consciously relax my muscles to evacuate what I can, and then there is always a sensation of incomplete evacuation. I do sit-ups to move stool along. It takes hours.I have had some biofeedback training, but it didn't help very much. I'm sorry to say that at this point I have a partial rectal prolapse, which will require surgery to correct. With the recent news that laxitives don't really cause dependence, my GI Doc has asked me to try Senna - with some good results. I'd like to know more about the specificly targeted relaxation exercises mentioned above!


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## ira (Jun 26, 2003)

No Go writes:"I'd like to know more about the specificly targeted relaxation exercises mentioned above!"=====================================Seems like an important enough question to merit a new post. My apologies if this isn't the usual procedure.-Ira


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## 21198 (Dec 10, 2006)

To Ira and others with incomplete BM syndrome ,blame Mr.Crapper for this dilemma(inventor of modern toilet)I know of one tequnique no one has mentioned here I learned of at my colonic therapist clinic that may help. I forget the exact name of the device ,so Ill have to describe it instead ,its basically a footstool that is put where your feet go when sitting on the toilet.The idea is to raise the feet up at least 2-3 feet up off the ground,to make the body get into more of a squatting position than a sitting one .Which makes the stomach muscles press the colon forward more that then presses on the rectum to push everything out that is in the bowels .Most of the time after a large stool the sphincter is fooled intro thinking no more stools are in the bowels , because the sitting position is not the most effective position to move our bowels ,the toilet was designed with sitting comfort in mind,we are not aware 2 or 3 more stools are waiting to drop into place to exit but the internal sphincter muscle has sealed off too early and we think all its clear when its not. When I tried this leg postioning foot stool I was amazed to go 3 times more volume than ever before,Ill try to find its name and post it here


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## annie7 (Aug 16, 2002)

thanks, Pat, for mentioning squatting and explaining it so well. there was quite a thread on this last summer and Adelaide mentioned a device called nature's platform that's supposed to help with the squatting position. some of us have had success with just using an overturned waste basket or laundry hamper. and if you're small and agile, you might just be able to put your feet on the toilet seat and squat like that. here's the link to that thread:http://ibsgroup.org/groupee/forums/a/tpc/f...08252#436108252


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## 19048 (Jan 10, 2006)

It is a move where you stand with legs at shoulder width and slightly bent. You put your hands in a praying position with elbows out. You open your hands and breath in, filling your lungs and tighten your anal muscles. You bring your hands together in the prayer position, breath out and relax your anal muscles. I also do some positive thinking.


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## ira (Jun 26, 2003)

Hi Trailrunner:Thanks for the info....It seems quite difficult to *expand* the abdomen by deep breathing while tightening the pelvic floor muscles. It come much more naturally *to draw the abdomen in * while tightening those muscles, and let it expand on the _outbreath _. I vaguely recall this being referred to as: "Reverse Abdominal Breathing".I can do it the way you seem to be describing, but it is trickier and seems less relaxing...Would you happen to have a link to the exercise you describe?Thanks again;-Ira


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## 19048 (Jan 10, 2006)

actually my son who is a black belt in karate told me about it and I may have the breath reversed but it still helped me. I don't think the breathing was so important as the tightning and releasing....using those muscles I guess. the exercise did help me but the fresh coconut water I drink at night has been the most helpful. Please read my post "this really helps me".


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## 21198 (Dec 10, 2006)

Tailrunner.......its not the breathing part that helps its the squatting position thats most important as it presses on the abdominal /colon/retcum walls and pushes out stools stacked up in the colon,down into the rectum like dominos. Mr. Crapper ( inventor of toilets)made it more comfortable to sit longer for our BMs ,than squatting was before,but it isnt the best way to fully evacuate all the stools in our guts.The inner sphincter muscle strains to open so wide,that we want ot snap it shut as soon as the first stool exits the outer sphincter,instead if we humans relaxed it after that first stool and let other stools drop down and follow right behind that first one,like cars of train linked together.


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