# why I always have to poop three times in the morning



## dlqc (May 17, 2018)

I have been diagnosed to have dyssynergic defecation, or pelvic floor dysfunction (pdf), and posterior prolapse.

But there is still one problem that confuses me: why do I always have to poop three times in the morning?

All the physicians I saw think it is just because I am too nervous. However, I have tried not to always worry about constipation in the morning, or do not drink too much water to trigger my stomach, just let it go and go to toilet when I really feel the need. However, I discovered that if I poop less than 'I should' in the morning, my rectum and anus would always start to develop a significant sensation of heaviness and distention in the afternoon, plus frequency of urine, and this feeling would last for the rest of the day.

This is really a burden because it forces me to stay home every morning, praying for 'enough' amounts of stools can be evacuated today so that I can focus on work in the afternoon. It steals every morning from me.

I am 25, male, graduate student. The pdf problem really ruins my everything, self confidence, study, concentration, relationships.


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## annie7 (Aug 16, 2002)

sorry, i can't answer your question about having to poop three times... but as far as the pfd is concerned, i really do hope you can get biofeedback--that can really help a lot with pfd. did you get in yet to see that other doctor you mentioned in one of your earlier posts? was he/she at all helpful about getting you into a biofeedback program? i do hope so.... i do hope that you can find a doc who will listen to you and who will help you. take care..


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## dlqc (May 17, 2018)

annie7 said:


> sorry, i can't answer your question about having to poop three times... but as far as the pfd is concerned, i really do hope you can get biofeedback--that can really help a lot with pfd. did you get in yet to see that other doctor you mentioned in one of your earlier posts? was he/she at all helpful about getting you into a biofeedback program? i do hope so.... i do hope that you can find a doc who will listen to you and who will help you. take care..


Thank you Annie that you still remember me, which is really a surprise.

Does the physiotherapist's experience matter in biofeedback program? I am still waiting in the queue for biofeedback therapy at a public hospital, as my doctor said the physiotherapist team at that hospital is stronger in terms of their biofeedback program quality, they have more experience in providing this therapy to pfd patients. However, the waiting list of public hospital is very long, so I am still waiting (I'm in Hong Kong where the healthcare system imitates that in the UK).

If you think the experience of therapists is not a major factor, then I will go try other private clinics.

I am not sure. At present I tend to believe therapists' experience does matter, for maybe the way that the muscles get disordered differ from person to person. Insofar as I understand, the therapy contains two parts, one about adjusting our muscle movement using a machine, so we need to go to the clinic once/twice a week, while the other part is to do some particular muscle exercises everyday at home. So perhaps a more experienced therapist will assign more personalized home exercises to us, based on our individual situation (like somebody may need to focus on muscle relaxation, while others on muscle squeeze)?

I do hear about the effect of biofeedback at another 'low-tier' hospital. The patients complaint that in the first few weeks the therapy does have significant effect, but sooner or later the effect declines and finally not effective at all.


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## annie7 (Aug 16, 2002)

Hi--so sorry the wait time is so terribly long. that makes it hard. and yes, i agree with you--i do think that the therapiist's experience does matter quite a bit--different patients have different problems and needs so a therapist with lots of experience helps. and yes, you're right--the therapists do not have a one-size-fits-all, cookie-cutter approach to treatment. everything is modified to fit the patient's particular needs,

one important thing about biofeedback and PT for pfd is that is is very important for the patient to do their own homework --the exercises and advice etc that the therapist gives them--daily or even two or three times a day--whatever the therapist recommends. people who don't do this sometimes find that therapy has a waning effect. i found it extremely helpful to try work at being aware of my pelvic floor muscles as much as possible during the day. i would check my muscles frequently to see if they were tense and if so, relax them--using a quick tense and release exercise (as described below). and i would monitor myself like this sitting, standing, lying down etc. all day long. this really does help. constantly be aware of what your pelvic floor muscles are doing. plus i bought a home biofeedback machine so i could work with that daily. and all this did finally teach me to how relax all the way down to the lowest point.

also-another thing my gastro doc recommended to me and i've heard other people say this too--is that periodic refresher biofeedback courses can help. as well as going to a different biofeedback PT if you find you are not making progress as you would like with your current PT. a new therapist--a different pair of eyes--can really be helpful.

is it possible for you to get in for treatment at a private clinic while you are waiting for biofeedback at the public hospital. at least you could get started that way. and hopefully the PT there would be knowledgeable enough... and then once the hospital finally has an opening, start PT there.

in case it helps any--here are the exercises my biofeedback PT had me doing. they might be helpful for you although of course nothing beats having a trained therapist giving their own recommendation based on your needs and personal instruction:

pfd exercises my PT told me to do:

one simple exercise to do for this is to gently squeeze your pelvic floor muscles--the muscles around your anus-and then relax them. squeeze just enough so that you can "get the release" as my pelvic floor PT puts it--- get the relaxed feeling. this helps you identify your pelvic floor muscles and also helps you to relax them.

here are two other exercises she told me to do:

1) slow contractions: contract your pelvic floor muscles for 5 seconds (gently) then relax them for 5 seconds. 10-15 times in row, twice a day. always relax for at least as long as you squeeze.

2) quick contractions: contract your pelvic floor muscles gently for 1 second and then relax for 1 second. again, never hold your breath while doing this.


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## flossy (Dec 8, 2012)

Same with me, syf08678, incomplete evacuation. Usually 3 times, give or take.


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## dlqc (May 17, 2018)

annie7 said:


> Hi--so sorry the wait time is so terribly long. that makes it hard. and yes, i agree with you--i do think that the therapiist's experience does matter quite a bit--different patients have different problems and needs so a therapist with lots of experience helps. and yes, you're right--the therapists do not have a one-size-fits-all, cookie-cutter approach to treatment. everything is modified to fit the patient's particular needs,
> 
> one important thing about biofeedback and PT for pfd is that is is very important for the patient to do their own homework --the exercises and advice etc that the therapist gives them--daily or even two or three times a day--whatever the therapist recommends. people who don't do this sometimes find that therapy has a waning effect. i found it extremely helpful to try work at being aware of my pelvic floor muscles as much as possible during the day. i would check my muscles frequently to see if they were tense and if so, relax them--using a quick tense and release exercise (as described below). and i would monitor myself like this sitting, standing, lying down etc. all day long. this really does help. constantly be aware of what your pelvic floor muscles are doing. plus i bought a home biofeedback machine so i could work with that daily. and all this did finally teach me to how relax all the way down to the lowest point.
> 
> ...


Dear Annie7, thank you so much. You are always so helpful. And it is new information to me that periodic refresher bf courses help, and we may try new PT if little progress is made with the current one, for I heard a lot of complaints from other patients that they think bf only have short-term effect, after a few weeks the effect diminishes.

You mean in your country there are bf courses provided by private clinics? that is fantastic. I kind of remember that this May when I was traveling in San Diego, I came across an institution with an ad board outside their entrance saying they provide pelvic floor training courses and bf programs. This is also a new knowledge to me because I read one academic journal article by a famous US professor saying that in the US bf is provided in only a few medical centers. Maybe most institutions that offer bf courses are targeted at women after delivery.


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## dlqc (May 17, 2018)

flossy said:


> Same with me, syf08678, incomplete evacuation. Usually 3 times, give or take.


Hey flossy, I have read your story in an earlier thread. But I do not understand one thing: since you have IBS-D, which means that you do not have constipation, and it is easy (perhaps too easy) for you to poop. Then why do you still have feeling of incomplete evacuation? Where does your ick get stuck? in your tommy (bloating), or rectum?


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## flossy (Dec 8, 2012)

syf08678 said:


> Hey flossy, I have read your story in an earlier thread. But I do not understand one thing: since you have IBS-D, which means that you do not have constipation, and it is easy (perhaps too easy) for you to poop. Then why do you still have feeling of incomplete evacuation? Where does your ick get stuck? in your tommy (bloating), or rectum?


Unless there was a typo somewhere I think you are confusing me with someone else, as I definitely have IBS-C; chronic constipation.


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## dlqc (May 17, 2018)

flossy said:


> Unless there was a typo somewhere I think you are confusing me with someone else, as I definitely have IBS-C; chronic constipation.


sorry, because you mentioned that on that very night when you for the first time tried a new diet, you had bowel movements 3-4 times that night, and "I'd go and IMMEDIATELY have to go again", so I thought you were suffering diarrhea.

Now I guess what you mean you have to go to toilet frequently is that you always feel sth in your rectum so that you want to empty it and therefore need to go to toilet, rather than due to diarrhea. And you go to toilet frequently because although you feel something in rectum, you just cannot completely push it out, so you want to go and try from time to time, sometimes it works while sometimes it does not. In addition, because you have the sensation of heaviness and distention of rectum, maybe sth affects your prostate.

This is exactly my symptoms. I used to see urologist, and was told to have chronic prostatis (CP). I took pills for CP for half a year, but there was no improvement at all. Later on I came to know a new disease name called pelvic floor dysfunction, and am now officially diagnosed to have that. Have you received anorectal manomatry, or defecography? Or have you ever thought about trying biofeedback therapy (so that your muscles can be trained to become able to empty your rectum again)?


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## annie7 (Aug 16, 2002)

Hi syf-- thanks so much for all your kind words.

yes, here biofeedback for pfd is offered in various clinics and physical therapy centers as well as by hospitals. as you mentioned, some of it is geared to women but a lot of it is not because it is widely recognized that men suffer from pfd too--it's not just a woman's problem nor is it limited to just women who have had children (i've never had kids).

probably one of the best places to go for biofeedback here in the usa is the mayo clinic. they have a very intense two week, in-house biofeedback program for pfd which is for both men and women and it also includes balloon retraining therapy which is also very helpful and can help with rectal hyposensitivity too.


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## flossy (Dec 8, 2012)

syf08678 said:


> sorry, because you mentioned that on that very night when you for the first time tried a new diet, you had bowel movements 3-4 times that night, and "I'd go and IMMEDIATELY have to go again", so I thought you were suffering diarrhea.
> 
> Now I guess what you mean you have to go to toilet frequently is that you always feel sth in your rectum so that you want to empty it and therefore need to go to toilet, rather than due to diarrhea. And you go to toilet frequently because although you feel something in rectum, you just cannot completely push it out, so you want to go and try from time to time, sometimes it works while sometimes it does not. In addition, because you have the sensation of heaviness and distention of rectum, maybe sth affects your prostate.
> 
> This is exactly my symptoms. I used to see urologist, and was told to have chronic prostatis (CP). I took pills for CP for half a year, but there was no improvement at all. Later on I came to know a new disease name called pelvic floor dysfunction, and am now officially diagnosed to have that. Have you received anorectal manomatry, or defecography? Or have you ever thought about trying biofeedback therapy (so that your muscles can be trained to become able to empty your rectum again)?


Personally? I only go to the bathroom if I HAVE TO go.

I don't push. (I have bad enough hemorrhoids!) Pushing doesn't help me go anyhow.

I never "try from time to time" to go. I go whenever I get the sensation I need to go, which is usually about 3 times a day, sometimes more, sometimes less ( when I'm lucky).

I've never had any testing done, besides a colonoscopy.

It seems like a lot of people get all sorts of tests done here, but for what reason? What is the purpose if they can't fix you? Then they come back here and are still chronically constipated. And when all the testing in done, their doctor will write them a prescription for Lizness or Amitiza, which doesn't get very good reviews here at all, and that seems to be that.

-I really don't think there is any way to train your rectum to be able to empty normally if you have chronic constipation. *The problem starts WAY before the rectum,* at least for me. The reason I can't go normally is because there is something off, something not normal with the insides of my intestines. Until that is fixed I could try to train my rectum all day and all night, but I'd bet the farm it wouldn't make a bit of difference. The problem doesn't start with my rectum, it ends with my rectum.

The problem may even start in my stomach and not my intestines, but I don't think that is true.

P.S.

I've been on Dr. Schulze Intestinal Formula Number 1 for about 8 months now, it definitely helps.

More info:

http://www.ibsgroup.org/forums/topic/239065-finally-a-product-i-can-recommend/

-Also, I'm finally going to see a colon/rectal surgeon today (unless I get lost) about my hemorrhoids and possible rectal prolapse. Did you ever get a procedure done on your posterior prolapse, or no?

P.P.S.

Thanks for replying! A lot of people post messages here but never seem to follow up/come back. (((Odd.)))


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## dlqc (May 17, 2018)

flossy said:


> Personally? I only go to the bathroom if I HAVE TO go.
> 
> I don't push. (I have bad enough hemorrhoids!) Pushing doesn't help me go anyhow.
> 
> ...


Flossy, thank you very much for your sharing. I do not know where you derive your insight that the problem starts way before the rectum. Anyway, it makes me reflect on my own problem.

I also have hemorrhoids, but it is not as serious as yours, insofar as I read from your story. But I do know that it is very difficult to get it completely cured, although some procedures can help you get rid of it temporarily. You may have to avoid spicy food.

I do not get any procedure done on my posterior prolapse. My physician said I do not need a surgery, perhaps because it is still not that serious. I've heard that kegel exercise is helpful to naturally recover from rectocele, although very serious rectocele definitely need a surgery.


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## dlqc (May 17, 2018)

annie7 said:


> Hi syf-- thanks so much for all your kind words.
> 
> yes, here biofeedback for pfd is offered in various clinics and physical therapy centers as well as by hospitals. as you mentioned, some of it is geared to women but a lot of it is not because it is widely recognized that men suffer from pfd too--it's not just a woman's problem nor is it limited to just women who have had children (i've never had kids).
> 
> probably one of the best places to go for biofeedback here in the usa is the mayo clinic. they have a very intense two week, in-house biofeedback program for pfd which is for both men and women and it also includes balloon retraining therapy which is also very helpful and can help with rectal hyposensitivity too.


I just realized that in many posts people tend to tell their stories, misery, depression, and get comfort and encouragement from other people and leave. Very few are like you, who stay here and keep encouraging other people. Thank you!


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## flossy (Dec 8, 2012)

syf08678 said:


> Flossy, thank you very much for your sharing. I do not know where you derive your insight that the problem starts way before the rectum. Anyway, it makes me reflect on my own problem.
> 
> I also have hemorrhoids, but it is not as serious as yours, insofar as I read from your story. But I do know that it is very difficult to get it completely cured, although some procedures can help you get rid of it temporarily. You may have to avoid spicy food.
> 
> I do not get any procedure done on my posterior prolapse. My physician said I do not need a surgery, perhaps because it is still not that serious. I've heard that kegel exercise is helpful to naturally recover from rectocele, although very serious rectocele definitely need a surgery.


I am getting a Ferguson hemorrhoidectomy next week, on the 15th. The surgeon said it is a 95% success rate, long term. I certainly hope I'm part of that positive percentage! Thanks for replying and take care.


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