# Incomplete Evacuation



## 22395 (Apr 16, 2007)

Yes, this topic has been discussed a lot.But, I still would like to know how common is this sypmtom with IBS?And, how does everyone finish evacuating remaining stool?This topic is not meant to address the problem of "feeling like you still have more", but rather actually having remaining stool remaining if you were to do a manual check with, say, a vinyl glove.I'm getting ready to have a manogram, after having had a defectogram, etc., to help evaluate the problem.But, for time being, I am miserable from trying and straining to empty - whether diarrhea or constipation.I use a combination of laxatives to try and flush everything out (not too successively), manual gloved evacuation (I hate this, and it's not complete), and an occasional enema.So, please, if you have this problem, how on earth do you finish the job??Thanks for any information anyone can help me with.Evelyn (P.S. And, yes, I do use Miralax several times a week, and hate the stuff. More constant going and not completely emptying misery.)


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## 22395 (Apr 16, 2007)

Still hoping someone can tell me what works for them in empying out the I.E.Also, with urgency and I.E., I can never tell if I really have to go or not. I'm constantly in the bathroom feeling like I have to go.Sometimes something comes out, and sometimes not.I'm feeling extremely miserable with this.My favorite time has become bedtime when I can take some Ambien and hope that tonight will be a good night of sleep. Unfortunately, I haven't slept well at all in about 5-6 months.Evelyn


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## overitnow (Nov 25, 2001)

Since I was never C, I cannot say that this would help you or not; but the flavonoids I take took me from D to Mud to IE to normal. Fiber helped some at the end to give the stools more compression.When I quit taking them for a time, I went from normal back to IE and then full out D. It seemed pretty conclusive to me.Mark


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## AIRPLANE (Mar 15, 2004)

I was trying to remember SeekingHope...did you say that you had a small rectocele? If so, that could be a part of the problem. I also have a small one and don't want to risk surgery for it as there can always be complications that make it worse than it was before. I am currently using hemorrhoid treatments to see if I can improve circulation in that area and maybe shrink the rectocele. I'm experimenting with Zenmed Ziro cream which I use to coat a moisturizing suppository with and then insert it at night before bed. I'm also ordering Venapro- an oral supplement. While I only occasionally have stool stuck in the rectocele- which is at the very bottom- I think the whole incomplete evacuation problem I have is definitely related to this as well as the PFD I've mentioned before. Just a thought. I know how frustrating it is to not know what to do especially while you're waiting for test results and follow-up appointments. My physical therapy isn't until August 7 which is a 4-week wait since I made the appointment. ( I also don't hesitate to use Dulcolax suppositories and also enemas which sometimes work well and sometimes don't.)


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## Arnie W (Oct 22, 2003)

SeekingHope, every word that you have written describes me perfectly, especially the second paragraph. Yes, it is definitely not just a sensation, as digital checking will confirm. I've experimented with laxatives and suppositories, but they don't make enough difference to warrant using them on a longterm basis.I am ever so interested in learning of the results of your tests.I am wondering if IE could have something to do with the sacral nerve or something along those lines.


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## 22395 (Apr 16, 2007)

Airplane, I have supposedly a 'slight' rectocele, which both my colon/rectal surgeon (who ordered and evaluated my defectogram test) and my gynecologoist both say should not be causing a problem. The damndest thing about the defectogram is that I emptied almost normally. But, then the gynecologist said that I had very little spinchter muscle tone when he did my annual recently. Regardless, I have extreme IE which continues to be miserable. I did a enema Monday, after taking Miralax Sunday night, and had 'constipated' diarrhea most of yesterday, Tuesday. I had to go out with folks for the afternoon, so had to take a Bentyl. (The Bentyl, for me, is for the urgency and also helps stop the horrible, continual flatulence for a while.) That didn't hold the constant semi-productive diarrhea, so I resorted to taking some Pepto Bismal. And, around it goes as I sit here miserably blocked this morning.I can't remember if you are predominantly C or D? I alternate back and forth, with a lot doing with the blasted meds.About how often do you use the Dulcolax suppositories and enemas? Also, do you use Fleet or warm water enemas? The small 'fleet size', or a larger quart enema bag? Right now I'm using the Fleet, usually followed up with an additional bottle of warm water. Then I end up wearing a Depends for most of the rest of the day because I still have messy mucous problems, etc. At other times, I also use vinyl goved evacuation, but am simply not able to remove everything this way. And, I do play around with using Miralax, which I find unsatisfactory to say the least.Arnie, yes I probably do have some nerve damage. I also have MS, which is an over riding factor in all of this misery. What do you do to completely empty? Are you relying solely on manaul evacuation or do you also use enemas?Thanks to everyone for being there. I will be posting another topic concerning analrectal manomentry and biofeedback results. Airplane, plus other therapy. I want to know who's had what and if it has worked.Evelyn


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## AIRPLANE (Mar 15, 2004)

SeekingHope-I too had a normal defecography test but then I felt that the stool consistency was much firmer and also larger than what I produce on my own so I'm not surprised it was more easily and completely passed than what is normal for me. They did make note of my straining though. I was thinking the test might show more prolapse issues as I have heard that if you have one issue, such as a rectocele, you usually have more prolapses but it only showed a very small cystocele in addtion to the rectocele. Over the 23 years I have had this I have tried fiber many times as well as probiotics and Florastor and nothing will give me a normal stool size and consistency. The doctor said PFD could cause a problem with poor stool formation although I have not read this anywhere else so don't know.I did fail the anal manometry- they filled the balloon up as far as it would go and I never felt the urgent need to evacuate. I also could not expel the balloon. So in other words, the two tests did not exactly agree with each other but nevertheless the 'unaffordable' biofeedback program was recommended. Wish I'd asked the doctor if he had an alternative in mind if insurance wouldn't pay but will try the physical therapy near my home first.I still suspect that the rectocele is a contributing factor regarding the IE even though it is supposedly a 'small' one. My regular gynecologist had me try hormone cream with a pessary which did not help-she had said I should no longer have incomplete evacuation while using them yet when I was wearing the pessary I could not have a movement at all and I tended to be backed up worse than usual for awhile even after removing it. At first the gynecologist thought that the hormone cream alone would even eliminate the rectocele but no such luck- would have tried the cream longer but it became too irritating although I still have some left so may try again. I think the rectocele somehow changes the angle of the rectum, making it difficult to get a grip on things, and also feel that the circulation throughout the veins in the area is poor- just like it is with hemorrhoids or varicose veins so that is why my current experiment is to use creams and oral supplements that supposedly address this circulation issue. I search the web and Ebay for possible products. It will probably be futile but I'm willing to try anything. Interestingly, my regular gynecologist thought I should have surgery for the rectocele while the doctors at Mayo downplayed the issue even though I know it causes discomfort besides IE- I can feel the annoying bulge 24-7 and it even bugs me while trying to go to sleep. However, after having a hysterectomy 9 years ago which only caused me more problems, I am reluctant to go under the knife again so I flip-flop a lot as to whether I should have surgery for it. Will see what the physical therapist has to say about it, if anything.For the past couple of days I have been using either a Fleet-type enema or a Dulcolax suppository. If the enema doesn't work well, I follow up with one or two warm enemas-using the same bottle. If I use a Dulcolax suppository, I won't do anything more if I feel it is effective except for a moisturizing-type suppository with the hemorrhoid cream afterwards. Depending on how I feel, I may use a warm water enema afterwards.With the IE I always have internal and external irritation and the enemas and especially the suppositories can make it worse so I always have to treat the irritation once or twice a day or I will be sorry the next day even if the evacuation is fairly satisfactory which of course it still sometimes is not! I've been using Calmol moisturizing suppositories for internal irritation with a little hemorrhoidal cream on it and then I put some more cream on the exterior. I got the Calmol on Ebay but you could try other brands if you have irritation issues. I personally don't care for Preparation H products but will use if I have nothing else.Will be interested to see how your anal manometry test goes. At least it was a pretty quick and painless procedure. Of course, with my issues I wasn't able to feel very much anyway! Also, I consider myself 'alternating"- my stool is usually softer than I'd like, and sometimes it can be hard-especially if I take fiber (which I sometimes use to stop the never-ending effect of oral laxatives for test preparation), and also either one can be followed or preceeded by a bit of watery stuff. In other words, I can have it all- IBS-A.Or, better yet, maybe I'll say I have IBS-AA- ALTERNATING and ALWAYS more to come (when it will)!


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## 22395 (Apr 16, 2007)

Airplane, thank you so very much for your useful and timely information. It helped me set my course of action over the next several days until I have the test on Tuesday morning. Unfortunately, the blasted test is at 6:30 AM - the only time that they perform them where I am. So, I have to get up at 4:00 AM to do a pre-test enema that morning. And, because I have such IE problems, I'm also supposed to do an enema the evening before. I'm hoping that I will have the energy and stamina to perform the test. (With MS, I have extreme fatigue most of the time to begin with. I am practicing getting up at 4:00 AM and going to bed earlier the next several days.)I've also tried probiotics and adding more fiber. The additional fiber just seems to block me up more. I did purchase some enteric coated peppermint with ginger & fennel oil capsules yesterday. Took one and it helped for a couple of hours with the bloating and stomach discomfort. Another problem I have is extreme flatulence. And, almost constant urgency because of the IE and many small IE bowel movements. Do you also have these problem? If so, what do you do for them? One of the meds I take very sparingly for this is bentyl. After clearing out with enemas or Miralax, or a combination, etc., I also end up with more diarrhea. (I'm also alternating C & D.) So, the bentyl will also help ease that for 2-3 hrs. when I try to be with friends. Unfortunately, about once a week I find myself also taking some pepto bismal or even Imodium something to help stop the diarrhea when I'm with my boyfriend. Horrible cycle of events.I currently use a vaginal hormonal suppository (similiar to Estrace), and also use Estrace cream to apply to the outer urethal area. (I also have bladder issues because of MS.)Airplane, I appreciate your information. Please let me hear from you again. Especially regarding any urgency and flatulence issue.Evelyn


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## 22395 (Apr 16, 2007)

P.S. Airplane, what type of physical therapy are you getting ready to take?


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## AIRPLANE (Mar 15, 2004)

SeekingHope-I will have to write about the physical therapy after I've been there for evaluation. My appointment is August 7. I searched on the internet for locations. This place has different types of therapists who specialize in different problems- they treat sports-type injuries, for example and have 2 different specialists for men and women who have pelvic floor issues. The site said they may even do a brief pelvic exam. Will be curious to see if they also recommend doing biofeedback as they have it available at some locations. I am fairly skeptical about the biofeedback being effective in my case but then I have read on this bulletin board a time or two that some people felt it did help them although I am not sure if they also did other things at the same time. If it is part of a larger approach then I could understand. Will have to wait and see. I just know that in the past I was constantly told to do Kegels which I have tried to do over the years but it absolutely has not helped any issues. I have read that Kegels are actually NOT a good idea to do in some cases although when you have GI issues, especially urgency and gas, you are in effect doing Kegels every time you attempt to contain things so in a sense you can't avoid doing them! If I indeed have tight, non-relaxing muscles this could be one cause but as you know there is no way a person with urgency, LG and gas issues is going to just ignore them and let them come out without an effort to contain them. Will have to wait and see what they suggest.As far as the urgency and gas goes, I vary from day to day. If the enemas and or suppositories work well, I may have a 'fair' day. A couple of days ago, for the first couple of hours at work I felt not too bad but then I felt a small amount of stool enter the rectum and it just hung there for the rest of the day. When this happens, I may have a bit of flatulence but mostly it is the LG problem where others can smell it even when I'm not passing gas. It makes for a very long workday. I generally do not eat anything until after work when I get home around 4 PM. I leave for work at 5:30 AM and have a 50-minute commute. On my days off I will usually get up around 10:00 AM and have cereal or toast and then my symptoms, which I still say are at least partly due to the rectocele, kick in. I will have a movement usually within an hour. Sometimes it feels like I'm done, sometimes it feels like I'm not but usually in either case I will have urgency sometimes as soon as I leave the bathroom and need to return right away or will have it every 1-2 hours a few times throughout the day. From what I've read, these are typical rectocele symptoms. As in your case, I was told mine was small and should not matter by some people but then someone else told me I should have it fixed. I was also told that rectoceles shouldn't cause any pain but in a brochure I obtained from IFFGD on this issue it stated that they can. If they do, I would think the referred pain could be a cause of urgency and feeling like you need to go when you otherwise wouldn't, and then in addition you could also have the pelvic floor issues which contribute to lack of control. I have tried many things for flatulence but nothing really stands out.I think the gas/odor I have now is pretty much strictly due to the IE rather than from higher up in the GI tract. I will occasionally take peppermint on my days off which will relieve abdominal bloating a bit when I do have it but I feel that it makes the gas slide right on out and causes more of a control problem so I seldom take it when I have to work the next day. If I'm going to have gas, nothing will reduce the amount produced. I don't have nearly as much as I did when I had severe diarrhea for several years when I'd pass large amounts every 2-4 minutes. I did try Bentyl at the time but it had the same effect as the peppermint. I've never been in a relationship due to this problem so have mainly only had to deal with people at work with this issue. They complain but not directly to me.For the IE, while I was using the pessary, I had more difficulty evacuating and did try 'splinting'- which is manual evacuation which you've mentioned but I ended up with a horrible bladder infection and had to take antibiotics which always make GI symptoms worse so I do not even try to do it. I'm just not good at it but have heard of other people, especialy women with rectoceles, doing it on a routine basis.Hope your manometry provides some clues. When you talk to your doctor, maybe try asking him/her why you can't seem to form normal-sized stools even though you've tried fiber, etc. As I said in my last post, my doctor thought it was due to PFD but again I've never heard this idea before as I always thought stool was formed higher up in the colon. As long as everything is in bits and pieces or narrow strips, I think IE will always be a problem no matter what else is or isn't going on. I had kind of hoped to go through the motility department at Mayo where they test things such as transit through the entire GI system to maybe find the cause of the poor stool formation but was not offered it. I remember as a teenager, I had a big problem with constipation and had huge stools but now am just the opposite.I also can relate to the fatigue. While I don't have MS, I am always tired and often have difficulty sleeping and have a hard time finding a comfortable position when in bed. Again, this is partly due to the bulge from the rectocele which surprisingly bothers me more when I sit or lie down than when I'm standing.


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## eric (Jul 8, 1999)

seeking hope, this is a pretty copmmon symptom with ibsers.you also have to take into account the sensation, because either way its still part of the picture, just in how the body works.also quite a few IBSers have rectal hypersensivity. The nerves in the rectum are hypersensive to pressure. You actually wouldn't know you had remaining stool really if it weren't for the sensation feeling, however in IBS the nerves there can be sensivite, hence a small amount or just pressure or even a bigger amount can send the signal.FYI"there is real incomplete evacuation and the "sensation of incomplete evacuation." "Continence depends on functioning muscles and nerves in and around the rectum and anal canal. At the lower part of the bowels, the sigmoid colon helps to slow the passage of fecal material before it moves into the rectum. The rectum is more elastic than the rest of the bowel so it can stretch to store fecal material. It is surrounded by nerves that detect expansion of the rectum and signal a sensation of urgency to let us know when it is time to have a bowel movement." http://www.aboutincontinence.org/causes.html Visceral Sensations and Brain-Gut Mechanisms By: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA "The most common symptoms of IBS patients are related to altered perception of sensations arising from the GI tract, and frequently from sites outside the GI tract, such as the genitourinary system or the musculoskeletal system. Sensations of bloating, fullness, gas, incomplete rectal evacuation and crampy abdominal pain are the most common symptoms patients experience. Numerous reports have demonstrated that a significant percentage of FBD patients (about 60%) rate experimental distensions of the colon as uncomfortable at lower distension volumes or pressures when compared to healthy control subjects. This finding of an increased perception of visceral signals ("visceral hypersensitivity") has been demonstrated during balloon distension tests of the respective part of the GI tract regardless of where their primary symptoms are â€" the esophagus, the stomach, or the lower abdomen. http://www.aboutibs.org/Publications/VisceralSensations.html FYIAno-Rectal Manometry"Ano-rectal manometry measures pressures of the anal sphincter muscles. It also measures how well a person feels different sensations of fullness in the rectum. "http://www.ddc.musc.edu/ddc_pub/patientInf.../ano-rectal.htm I think this may also be more confusing with MS perhaps. Also what your mentioning that they said, "little spinchter muscle tone" along with possible hypersensivity and IBS and the sensation aspect to all this maybe all part of the issues.


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