# From Chronic Constipation to Fecal Impaction



## maxell

Looks like I've finally graduated from chronic constipation to fecal impaction. Last night, I was on the toilet from 8pm until 6am, trying to pass stool. It wouldn't come out. Well, it almost came out but it wouldn't expectorate. So for about 7 hours, I was in a state of emergency, stuck between a rock and a hard place. Literally a rock, since my bowel movement these days is like giving birth to jagged pieces of rocks. While sitting for 7 hours, I drank about a gallon of water, a 1/4 bottle of Milk of Magnesia, 1 bottle of magnesium citrate, 2 glasses of Miralax, 2 Colaces, and some additional magnesium supplements. Still, nothing came out and I was stuck, I mean, my feces were stuck. My lower buttocks were inflamed from the stool that was lodged there and was trying to come out but couldn't, because of lack of moisture and movement. My sphincter was basically dilated and stayed that way the whole time, because I couldn't defecate. So I downed 3 tablets of Metformin (Glucophage), my diabetes medication which induces diarrhea when I take more than 2 in 8 hours. Nothing. I waited for diarrhea to hit but no, not a movement. Then, I figured that I need an enema. I had never done it before. By this time, my undies were soiled so I made make-shift adult diapers, put on my pants and drove to where CVS has a 24-hour pharmacy, 5 miles away. Bought some mineral oil and regular enemas, some Preparation H, suppositories, and more magnesium citrate bottles.Did an enema with mineral oil. I had never done it before so I didn't know you have to do it in a kind of doggie-style position. So finally did it the right way and waited. Nothing. Waited another 2 hours. Nothing. Then I did a regular enema. Waited for another hour. Nothing. At this point, I was tired and had stayed up all night due to my constipation, and the night before, I only had 4 hours of sleep, because, during the day, I had to take a day off from work and drive my 70-year old aunt and her son, my cousin, to their doctors and labs. I was driving most of the day and I could not go to the bathroom since I was constantly late for appointments. And the traffic was horrendous. So I sat in my car the whole day and I was becoming very uncomfortable; I had some abdominal discomfort. Plus I hadn't gone to the bathroom for the last 2 days. Finally drove back home and I was ready to hit the sack. But then I realized, wait, I should try to take care of bidness right now, because previously, whenever I procrastinated my bowel movement, I ended up with really horrendous constipation! Well, this time, I not only ended up with constipation. This ended up becoming the most stressful moment in my life! Around 5 am, I debated whether I should call 911. Then I thought, what can these guys do? All they'll do is maybe an enema. If they still can't get the impacted feces out, then they'll do rock, scissors, paper, and will manually remove the hard stool with their fingers. Do I want this embarrassment, for crying out loud? I was getting tired, hadn't slept a wink day and night, it was getting hot, the bathroom radiator was overheating. I brought a fan in because I was getting overheated. I got worried at this point because I started having a fever. I measured my BP: it's 160/110. I never hit 130 since I lost 50 pounds. Measured my blood sugar: 115. Stress elevates everything.I suppressed the urge to call 911 again. Anyway, even after my second enema, nothing came out. By this time, I was so tired. I just put my adult diaper on and went to sleep. Woke up after 3 hours, felt the urge. Wow, that was still one of the most painful bowel movement I ever had. It was severely impacted. But not all came out. I mean, this has been an ongoing story: my inability to completely defecate, only a majority portion of it. But what the heck: downed another bottle of magnesium citrate, went back to bed. Another BM in 3 hours upon waking. But it's still not completely out. So now what? My PCP is a GI and I had a colonoscopy done in December and nothing was found. I also have T2 diabetes and Sjogren's Syndrome, an autoimmune disease which can make bodily organs really dry, especially your mouth, throat and eyes. Constipation, though, is not a frequent occurrence with Sjogren's. And my diabetes is well under control, though it was out of control for at most 2 years prior: I'm only 45 years old.I've tried everything: Brazilian nuts, figs, filberts, high fiber, Metamucel, Miralax, Citrucel, Colace, Docusium Sulfate, Milk of Magnesia, mineral oil, other stool softeners. High fiber and increased fluid intake. Actually, I ended up with one of the worst constipation ever when I increased my fiber to 50g per day. The stool balloons, and it's even harder to get it out. After having undergone the most stressful event in my 45 years of life (both physically and mentally), I'm trying to seek some help. I think I finally came to the right place. I'm 5-10/160 lbs. Over the last 4 months, I lost 45 lbs. on a low-carb, high-fat diet. I've had constipation since about 2004. It was occasional at first but is now the norm. It was annoying until last night, when I experienced for the first time the horrors of impacted feces. I know that the outside world may laugh at my plight. Now I fully understand just how painful and stressful constipation is.


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## BQ

MaxI see you say you have tried everything... have you considered doing some of these things simultaneously? In other words, most folks find a combination of several treatment methods working in concert is best for managing symptoms. For you the point would be to avoid the impaction. You may need to take/eat/do something _every_day to avoid impaction. I know for some IBS C'ers Fiber supplements, especially those heavy with soluble fiber ( like Metamucil & Citracel) can make things worse so, yes, if you have found that.. I would avoid them. What you described happening ("stool balloons" ) is probably because you were increasing soluble fiber.. not insoluble.(There is a difference between insoluble & soluble fiber. See this for more info:http://www.myfooddiary.com/resources/ask_t...insoluble_fiber Perhaps you need to attempt to increase your *IN*soluble fiber and maybe that might help?)I would opt for more natural dietary fiber instead of any of the supplements on the market. Increase your veggies (maybe raw or blanched.. etc??), insoluble fiber.And/or perhaps adding like a glass of prune juice a day .. etc. Perhaps making those dietary changes combined with using an osmotic daily and/or perhaps a stool softener daily.. might make a difference. (You see I am saying "and/or"?? You might need to employ several strategies at once ... _daily_.)Doing what you did drinking all of that while on the toliet is, as you found out, too late. You need to be doing something everyday to avoid impaction. If you know you are going to have a day like you had.. loads of driving aorund and not much physical exercise... you may need to take or do or eat something more or different to compensate for that inactivity and stress.There is NEVER a time when sitting on the toliet that long is good. If you had the thought that all that would happen at the ER is digital removal... perhaps trying that right away at home once you know you are dealing with impaction is the thing to do next time. So get yourselves some gloves, mineral oil, perhaps another enema kit etc in preparation for that. I sincerely hope the day never comesthat you need them, but it is good to have what you need IN the house and ready for you should the need for them arise. If you cannot figure out what to do balancing the Diabetes, the Sjorgen's and the constipation... seek your Dr's advice or a dietician's. (Or ask for a referral to a nuitritionist/dietician etc.)Now I must offer you Congratulations on your weightloss and your overall lifestyle changes to improve your health! You are an inspiration! Wish you all the best.


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## Dooby

Hi, MaxI've just looked up Sjogren's Syndrome on Wikipedia and it says "Many patients also have IBS symptoms due to slow gastric transit" - there are threads on the forum discussing the difference between constipation and slow transit. Should be worth discussing with your doctor.


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## maxell

Thanks for you suggestions. I'm currently taking 100mg of Docusate Sodium daily. Unfortunately, I can't try prune juice since it contains too much carbs and sugar, and my BG will spike. So far, I've cut out hard cheese from my diet and my bowel movement the last 4 days have been okay. Perhaps that was the problem all along. I'm still consuming some Ricotta cheese, however, as well as cream cheese. Not a lot but I haven't given these up yet and my BM seems ok. I've also limited my Joseph's lavash to no more than 1 a day; before I ate up to 3 slices of Lavash, which have mega doses of either soluble or insoluble fiber, whichever worsens constipation. I'm also limiting coffee to 1 cup in the morning and tea to 1 in the afternoon. I used to drink 2 cups of coffee and up to 5 cups of green tea before. I think what happened last week was caused by a confluence of things: high fiber intake; eating on the run and in my car; eating loads of Cheddar, Swiss and Pepperjack cheese; procrastinating BM due to running late; and dehydrating myself by drinking 8 cups of coffee and tea during the day.I also stopped taking my Vitamin D supplements because of fear that I may have OD'd on it. At last check, my level was in the 80s, upper normal, yet I still kept taking 2,000 IUs per day. This may or may not be related, but I'm not taking any more until my next blood test.Now I seem okay. But I'm walking on eggshells now for fear it will return. Trust me, I will never foget what happened that night for the rest of my life! It was an incredibly traumatic experience, both physically and psychologically.


BQ said:


> If you cannot figure out what to do balancing the Diabetes, the Sjorgen's and the constipation... seek your Dr's advice or a dietician's. (Or ask for a referral to a nuitritionist/dietician etc.) Now I must offer you Congratulations on your weightloss and your overall lifestyle changes to improve your health Wish you all the best.


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## maxell

I definitely have constipation. I may have slow transit as well. My stool looks either like (1) rabbit droppings or (2) lumpy, sausage-shaped. Both are hard to pass and I spend an enormous time trying, often yielding nothing. At this point, I have either hemorrhoids or fissures. Let's see if it was my hard cheese consumption and diuretics.


Dooby said:


> I've just looked up Sjogren's Syndrome on Wikipedia and it says "Many patients also have IBS symptoms due to slow gastric transit" - there are threads on the forum discussing the difference between constipation and slow transit. Should be worth discussing with your doctor.


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## BQ

Well I would stop walking on egg shells as tension like that can bring on problems. Just observe how your stools are and if they start seeming very hard.. do something riight away.. don't wait a few days to see if it clears up. Stay on top of it more or less daily.If you can't drink prune juice... try eating a few prunes. If you were to see a dietician they would tell you that you can have fruit.Here some info:http://www.ehow.com/about_5230648_can-diab...;utm_source=askSo glad you are seeing some improvement and I hope it continues.All the best


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## bardos

Hello Everyone,Fecal Impaction revisited: Hope This Helps I found this thread (and forum) doing a google search for "high fat diet + fecal impaction." I was diagnosed with Type II diabetes a few weeks ago and I am successfully treating this with a switchover to a low carb high fat diet. Just the other day I suffered fecal impaction beginning at 11AM. Lasted for about 5 hours when, using her intuition, my wife suggested a Hot Bath. I drew the bath and sat in it for about 30 minutes. I got out, peristaltic action began, this time with success. Amazing!It is a problem, the high fat diets. I have found information which leads me to believe that adding Insoluble fiber to the diet will help this condition. After googling I come up with good BG foods like cocoa powder, coconut and linseed among others.Check it out here: http://www.dietaryfiberfood.com/dietary-fiber/insoluble-fiber-sources.php


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