# Unexpected Cure? - Slow Transit / Colonic Inertia



## partytown (Aug 5, 2018)

Hi all

I first posted here earlier in the year - I'd been suffering from severe, unremitting constipation that was finally diagnosed as "IBS-C with slow transit constipation / colonic inertia", and nothing was working. Below is a list of things that I tried:

• Movicol / Miralax (2 sachets a day for 3 weeks)

• Lactulose

• Glycerin suppositories

• Fleet enemas

• FODMAP diet

• Low-fibre diet

• "Intestinal Formula #1"

• Movicol / Miralax (regime of 4-6-8 sachets, increasing dosage for 3 days)

• Movicol / Miralax (8 sachets a day for 3 days)

• Dulcolax (2 tablets)

None of the above worked, until I tried:

• Dulcolax (2 tablets), combined with Movicol / Miralax (8 sachets) - commonly used as half of a colonoscopy prep in the U.S., but made me feel very lethargic / nauseous / crampy

• MoviPrep colonoscopy prep - worked well with none of the Dulcolax side-effects, but requires you to drink 2 litres of disgusting fluid in a short amount of time

The problem with those solutions was that it would only last a week or two. Slowly, I'd slip through the Bristol stool chart until everything stopped moving again...so frustrating.

Finally, I went to my gastroenterologist and begged him to give me something for it. He prescribed Prucalopride and said that if the side-effects were unreasonable, he'd be able to look into ordering the Peristeen irrigation system. He also said "I'm not really supposed to recommend this - but Magnesium Citrate / CitraMag prep is much easier to drink, and works just as well as MoviPrep or Dulcolax. You could try using that every week or two, if you have to". Since I'd done a MoviPrep session a few days prior to the appointment, I decided to give it a week or so before starting the Prucalopride, just to give my body some time to recover from the prep.

Around this time I also started taking L-Arginine supplements (2000mg a day), since I'd read it was a decent booster of nitric oxide (lowers blood pressure, improves blood flow / circulation). I'm not really a great believer in supplements / vitamins / natural cures, so I was pretty skeptical, but I thought it couldn't hurt.

Anyway...the day after taking the L-Arginine, I suddenly had an urge to "use the facilities". This was very unusual, since I hardly ever "feel the urge", even when taking colonoscopy-prep-strength laxatives. It was a healthy, normal baby stool. 2 hours after that, I had to go again! 2 hours after that, in the words of the famous Daft Punk song, "One More Time"! Probably just a fluke or my body reacting weirdly to the MoviPrep, I thought.

I didn't make the L-Arginine connection for a few days, but I kept taking 2000mg p/d. Each day, no less than 3 healthy, normal bowel movements. For *3 weeks* now, I've been going 2 or 3 times per day - no straining, no pellets, no discomfort, no "overflow diarrhoea". It's insane. Since I was a kid, my bowel habits were once every 3-7 days, even before I was diagnosed with IBS-C / slow transit.

No idea if there's any problems with taking it long-term - I'll ask my gastroenterologist in a couple of weeks, but for now - wheeeee!

Apologies if this was too long or seems like an advert...for those of you going through the same thing, you know how exciting it is when you find something that works


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## flossy (Dec 8, 2012)

Good to hear! Are you taking anything else to help with your BM's besides L-Arginine or no?


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## partytown (Aug 5, 2018)

Absolutely nothing else. Even came off the FODMAP / low fibre diet without any problems (although to be honest, it didn't seem like it was doing much anyway).

It's quite amazing - if I hadn't tried it for myself I would have 100% ignored something like this. Hopefully it continues to work


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## bungeedog (Mar 24, 2014)

Here's why:https://www.hindawi.com/journals/mi/2012/318087/

Nitric oxide is over-represented in the colon's of people with CIC....


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## Stevect06 (Jun 20, 2014)

Interesting - I believe I have slow colonic transit.

I'm going to look up L-Arginine.


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## bungeedog (Mar 24, 2014)

Apparently it is critical for small intestinal motility and affects the response of sphincter muscles and smooth muscle. When you don't have enough you get slow transit constipation - there are several articles. I'm not good enough at chemistry to understand all the enzyme reactions. But what you're doing with the L-arginine is putting a precursor into your body and it creates more NO molecules. The one article discussed an overall difference in the type of ennervation of the guts of people with CIC vs normal. Here's another quote from another article - (I went out and got some today can't wait to see...) - A question for you, does it make you flush at all? L-arginine is a blood vessel dilator...or are you taking it at night?

Intestinal motility and motor disorders

Studies from animal models have shown a role for NO as an inhibitor of small bowel motility. In humans, NOS blockade results in an increase in fasting motor activity.42 As a corollary, postoperative ileus may be a result of increased intestinal NO production because urinary nitrate levels are raised postoperatively,43 perhaps in response to surgical manipulation of the intestine. Indeed, iNOS−/− mice exhibit less phagocyte infiltration than controls, and are protected from the reduction in contractility that occurs in response to surgical manipulation.44Furthermore, NOS inhibitors, when used in combination with adrenergic agents, normalize intestinal transit time in animal models of the postoperative gut.45 However, the link between NO generation and postoperative ileus in humans is not as well established at this juncture.43

Deficient NO generation has also been linked to other small and large intestinal transit disorders including diabetic enteropathy and slow-transit constipation. For example, loss of NOS expression has been described in a patient with long-standing diabetes, together with loss of immunoreactivity for VIP and a decrease in the volume of ICC.46 Based on these and other studies, the role of NO-cGMP supplementation in the treatment of diabetic GI symptoms is currently under investigation. Although the role of NO in colonic motility in humans is not well studied, some studies show reduced NOS expression in slow-transit constipation. However, the selective contribution of NO deficiency to the pathogenic basis of these disorders remains unestablished as other cellular defects are present as well.


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## bungeedog (Mar 24, 2014)

3 weeks! I'd be delirious with joy...thanks for posting this. There's a ton of research on NO and the gut, and articles in Gastroenterology but true to form none of the physicians I've seen even mentioned it as a possible cause. I was told "You have colonic inertia, go get pelvic floor biofeedback.." Well what does the pelvic floor have to do with colonic inertia? Oh well another story...

https://www.gastrojournal.org/article/S0016-5085(03)01919-X/fulltext


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## Stevect06 (Jun 20, 2014)

Occasionally there will be news about a medication being beneficial for something it wasn't intended for. One way we'll find out about them is from information provided such as this, thanks to technology, the internet and those who contribute.

The side effect of technology and the internet is after I looked up L-Arginine I started seeing ads for it on Facebook. I wasn't on Facebook when I looked it up - Google must share browsing information with FB


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## wgbutler (Mar 15, 2018)

When I saw this I ordered an L-arginine supplement from Amazon. So far nothing. It's been about a week. I'll go ahead and finish up the bottle, but it looks like this isn't the magic bullet for me.


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## wigglesmom (Dec 12, 2002)

I've tried everything as well. I'm curious if this is still helping you. Can you let us know? Thanks!


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