# How many think they have Slow Transit Const., not IBS??



## atrain (Jun 22, 2001)

Slow Transit Constipation is a chronic problem where stool does not move through the colon at a regular speed. It moves through slower therefore people have constipation at all times. How many of you would think that this is your problem, not IBS, although i guess they can intertwine in their own way. My doctor just sent me out with "IBS" but I doubt that is it, I know i have slow transit but wonder what difference it really makes.


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## giggles05 (Feb 1, 2002)

i think i have the same thing too, because i have constipation all the time and nothing else!!


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## flux (Dec 13, 1998)

> quote:I know i have slow transit but wonder what difference it really makes.


It makes a big difference.Anyway, the first order of business is to get yourself diagnosed properly. I think it is amazing that so few members of the BB have been tested.







Admittedly, there are very places in the country that can do all the various tests.These tests includemanometry: esophageal, antroduodenal, colonic and anorectal.x-rays: flat plate, sitz marker, and defacographyelectronic: electrogastrogram, pelvic electromyographynuclear med: scintigraphyIt is amusing to hear one states that they have had *all the tests*, when in fact, in reality, they have probably not had any tests whatseover.If one can distinguish between IBS and slow or delayed transit then treatment is *very different.* With a transit problem, one would probably want to dramatically reduce or eliminate fiber altogether. The next step would be Miralax. And of course, the new drugs do look promising. Depending on the severity, more drastic measures may be needed including removing the colon.


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## Tiss (Aug 22, 2000)

Flux, I agree that people should be properly tested. However, in my case and probably many others, HMO's are deciding what are 'necessary' tests. I was diagnosed and my doctor just said, try this fiber and water and if you're still having problems maybe your insurance will pay for the other tests. End of story. I can't even get an appointment to go back to see him (colorectal surgeon and gastrointerologist) because my problems aren't 'severe' enough. It is true my symptoms are greatly diminished because of the things I do everyday to decrease the problem, but it's not entirely gone and I really don't know exactly what my main problems are and as long as I have an HMO I don't think I'll find out.


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## Sean (Feb 8, 1999)

I have been definitively diagnosed with slow transit constipation which is also known as colonic inertia. The diagnosis was confirmed with a sitz marker test. After 5 days, all of the markers were still in my colon, basically because I had no bowel movement at all during the 5 day period over which the test was conducted. I also had a rectal mannometry, which was normal, indicating that I don't have outlet problems. All of the standard invasive tests, such as barium enema, sigmoidoscopy and colonoscopy have been normal for the 14 years I have had this problem. That is why you need to get at least some of the specialty testing that Flux described. I am lucky to live in a place with a large medical center with several medical schools and state of the art teaching and research centers. Still, this had been a difficult problem to deal with. My case is bad enough that prokinetic drugs have little or no effect. I have been taking Miralax daily for about 14 months now, but it started to lose its effectiveness after the first three months. I have to also rely on other measures. Hopefully, Zelnorm will work for me if the FDA ever approves its use. If not, then my doctor tells me that I may eventually have to have most of my colon removed. I am only 30, so that is not an exciting prospect.


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## Paula J. (Nov 23, 2001)

It's true there are a lot of tests that can be done, but cost is an important factor, and also necessity. I have an HMO and feel like we here in the US have the best medical care in the world. Where does everyone come when they need very special treatment. Right here. My doctor gave me a colonoscopy as his first diagnostic tool. I have terrible gas, and constipation. I call it irregularity because the movements are normal just Many days between them. My doctor said that I will not have a bad outcome just from gas. I already knew this because I've had it for 9 years and I'm still here and otherwise healthy. I also think that many people go to the doctor but are probably embarrassed to tell the whole story, or the doctor is incompetent. If someone complains enough the proper tests can be done even with HMO's. They are hoping you're not real sick I'm sure, but I haven't had that many problems really when I need specialists care. I'm sure years ago before all this science, people had to figure some things out for themselves, and that seems to be what many on this board are trying to do.


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## metoo (Dec 26, 2001)

Atrain,Have you ever had a sitzmarker test to determine if you do have colonic inertia?. It just involves swallowing a capsule that contains 25 radioactive rings and they take an x-rays 3 days later followed by another on the 5th day. If all the rings are still in your colon ... then that would determine you do have colonic inertia.This is very different to constipation and more serious. It's certainly worth checking it out and can be done in any state and isn't too expensive ... the main cost is 2 single x-rays and the capsule ($20) which is even worth paying out of pocket just to find out.







You cannot take any form of laxatives or enema's during the 5 days or a week prior.


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## atrain (Jun 22, 2001)

metoo-i did go to a doctor and have that test done but the idiot told me that i could keep taking these stool softeners "with laxative" that i was taking at that time so the test was bogus. what difference does it make?? are there different treatments??


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## Paula J. (Nov 23, 2001)

I don't really know if it makes a difference. To me not being a doctor ,slow transit, and constipation seem like they'd be similar, or related, or you could have both. I use suppositories to go. They don't work for everyone. Fiber, water, herbs, molasses, graham cracker w/fudge, acidopholus, you name it I've tried it, and no go. But some people can't use the suppositories so your guess is as good as mine.


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## bethesda (Oct 22, 2001)

What really is the definition of IBS C ?Half asleep bowel? Confused bowel? Hyperactive bowel? Sluggish bowel? Slow transit bowel? If you ask me it all fits in the same category because the symptoms one suffers are similar. I know I have extremely slow transit time without sitz marker test because my doctor has diagnosed it using good old fashioned listening to the patients symptoms. I have all the symptoms of cramping, bloating, noisy bowel, irritable bladder, feeling of incomplete emptying etc etc. The whole thing is still a matter of experimenting and working out what is best for you as an individual. I would much rather tell people I have IBS than slow transit bowel problem.


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## flux (Dec 13, 1998)

> quote:What really is the definition of IBS C ?


First there is IBS and there is constipation. They are actually separate and there really is no IBS-C per se.IBS is defined generically by having abnormal bowel movements and pain. In constipation, there must be abnormal bowel movements that are infrequent or there is straining, but there is *no* pain.Many things things can cause constipation. For example, having little fiber in the diet will cause constipation but there is no intrinsic defect with the colon in this case. Many cases of constipation are probably the result of this.In slow-transit, there is something wrong with nerves of the colon.In outlet obstruction, there is something wrong in how the pelvic muscle work to produce defecation that results in straining and incomplete evacuation.The treatment for these entities is very different. For example, it wouldn't make sense to have one's colon removed for IBS but it would for slow-transit constipation.


> quote:I would much rather tell people I have IBS than slow transit bowel problem


But what if it that isn't the case?


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## Jan8 (Nov 5, 1999)

FluxI believe you said much the same thing to me ages ago. That I do not have IBS. I suffer C & D with much very bad gas but little pain. Are you saying unless you have pain you do not have IBS? How is it that the Medical profession don't think like wise. They, it seems to me class cronic constipation (when one has a good diet) and cronic gas, with or without pain as IBS.How is it that you know better than the medical professionals?Jan8


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## bethesda (Oct 22, 2001)

Flux.I cannot find slow transit constipation in any of my medical encyclopaedias but only IBS and it includes the description of slow transit C. I have seen people on TV talking about having their bowels removed and they said they had IBS.Slow transit IBS runs in our family and no family member has yet had their bowel removed.


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## flux (Dec 13, 1998)

IBS is *not* slow transit constipation. You are not likely to find information like this in a medical encyclopedia yet because it is relatively new information.


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## jo-jo (Aug 19, 2001)

Lets say someone has slow transit, what can be done to correct this problem? Flux?


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## flux (Dec 13, 1998)

> quote:Lets say someone has slow transit, what can be done to correct this problem? Flux?


Atrain has brought up the colectomy option and that although drastic is probably the closest thing to a cure. However, whether one chooses option depends upon the severity and extent of the problem.Other solutions (obviously to be tried before resorting to that option), include: limiting one's fiber intake drastically, miralax and water, more miralax and water, even more miralax and water. Some drugs mentioned but not commonly tried include:neostigminemisoprostolcolchicineand last, but not least, upcoming prokinetic drugs (e.g, Zelmac/tegaserod)


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## Ty (Mar 8, 1999)

Nope







Since this IBS thing showed up, I've been a D/C type, a D type and now a C type.


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## Paula J. (Nov 23, 2001)

Flux seems much more knowledgable than our doctors. I got levbid from mine and that's it. No other tests, but a colonoscopy which was negative. He doesn't want to see me unless I need to see him he said. It would seem like I need him if I still have the problem. I've read different stuff, and it mostly says diet, and what foods are gassy as a means of control. That is not my problem. I have gas even when I don't eat. I personally think from my doctor, and other peoples doctors that they don't care to be bothered with this problem. Thank you Flux for all your generous asnwers, I trully appreciate all your knowledge. I just wish I could find a doctor that would be more interested.


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## jo-jo (Aug 19, 2001)

Totally agree with you Paulo.


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## metoo (Dec 26, 2001)

Ok Flux,I really agree with you. What if one's tried all the options you suggested and they haven't worked? How do they test for colonic inertia other than a sitzmarker test which is not all that reliable. There must be some other tests to show that the colon does not function.No doctor will perform such major surgery unless they have documented proof that such a test is warranted. I've had the sitzmarker test, but did 2 things wrong which messed up the whole test. Also are there any tests to show nerve damage to the colon? I would have the surgery performed if it could restore some quality back to my life instead of it causing me to be completely debilitated. It's also deteriorating very quickly. Having the surgery is definately worth it, because the option would mean continuing not to be able to function or have a life. There has to be another alternative to living like an invalid with chronic pain 24/7!


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## kyestar (Nov 26, 2001)

> quote: In constipation, there must be abnormal bowel movements that are infrequent or there is straining, but there is no pain.


Sorry, but that is WRONG! If someone is constipated, be it through IBS or slow colon transit, they will have pain. Try telling someone with slow colon transit, who hasn't had a BM in weeks, that they have no pain, and see what they say!!


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## atrain (Jun 22, 2001)

kyestar-I had constipation for a year where i would not go for weeks and i had no pain. then i started getting really emotional about it and then the pain started. i now have almost a daily BM but now I have pain whereas when i was constipated and didn't think anything of it I had no pain?? I know from my experience and others on the board it is very possible to be constipated beyond beleif but have no pain


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## Paula J. (Nov 23, 2001)

I'm very confused about what I have. I labeled it IBS because that sounded logical. I do not have painful constipation, but I never let my self not go. I don't give it time to build up. I do have the gas also, and feel like it would be worse (which is hard to believe) if I didn't make myself go. I like reading all the suggestions on this site, but I may not really be an IBSer. I wonder if any of us really knows for sure what we have.


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## flux (Dec 13, 1998)

> quote:a sitzmarker test which is not all that reliable. There must be some other tests to show that the colon does not function.


I don't think I would call the sitzmarker unreliable. However, it's probably nonspecific. It may not tell you details about *how* colonic transit is slow. The scintigraphy is similar, however, it looks at the entire digestive tract and in that fashion can give a better picture of overall gut dysmotility. Colonic manometry is probably the most specific an accurate test for the state of colonic motility.


> quote:Also are there any tests to show nerve damage to the colon?


Biopsies are possible but very difficult as 1) they require surgery and 2) there aren't many people who know how to study the sections.


> quote:but that is WRONG! If someone is constipated, be it through IBS or slow colon transit, they will have pain


While there is no pain in *pure* functional constipation, there is nothing preventing a person from having both IBS and constipation simultaneously.This is definition of *pure* functional constipation..


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## Tracey Heynes (Nov 5, 2001)

Aaaaaargh ! This is all SO depressing!For ages,friends suggested I might have IBS but I said no because my symptoms didn't seem to fit the ones I most often heard described(including pain !)When I asked my gastroenterologist,he put "The Rome Criteria For IBS" in front of me.His attitude was rather disinterested though-"take this stool softener and go away" sort of thing.I'd love to give him a print out of this thread but I'm sure he wouldn't bother to read it.If I mentioned all these tests you've talked about I'm sure he'd not be interested either.I feel so powerless in this situation,and I'm sure I'm not alone in this.I suppose the answer might be to change docs. but,in my experience,when it comes to specialists,they rarely seem interested once it's clear the problem is going to be difficult to treat(ie when initial drugs don't have the desired effect).They seem then to regard me as a nuisance when I keep turning up at the surgery seeking help.How on earth,in these circumstances,could I ever find out whether my problem is "slow transit" or IBS?I despair.


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## Jgarton244 (Jan 2, 2002)

I have had slow colon transit for over 10 years, due to long term diabetes causing nerve damage in the colon, and severely limiting the motility. I used cisapride for a few years, with some success, but then it was pulled off the market. I have used perdiem, prune juice, miralax, milk of magnesia, all with limited success. I recently bought some zelmac from an online pharmacy from Mexico ( they do not require a prescription) and it has helped quite a bit, although I still need to drink 2 glasses of prune juice each day. It has eliminated the bloating and pain, and has improved my regularity. I also took ethromyacin for a while, and that also helped, but lost it's effectiveness after several months.Jim


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## flux (Dec 13, 1998)

Oops, I forgot all about erythromycin.


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## bonniei (Jan 25, 2001)

Biofeedback for slow transit. Try Jan 2002. The article is numbered 9 http://www-east.elsevier.com/ajg/frames/rec_iss.htm


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## admflo (Dec 1, 2001)

Flux: unfortunately most of the tests you list in your post are not covered by the larger insurance companies and are listed as investigational. The manometry tests, defography(sp.?) just draw a chuckle from them. Unfortunately, the medical community has no cure until the person becomes obstructed and it's time for the old NG tube, decompression and hopefully not surgery but unfortunately, all too often, it happens. I think the majority of docs are apathetic simply because they know there is nothing they can do until it reaches the above mentioned point. That's why boards like these are so important. It's left up to us to flounder around trying to find out whatkicks up our individual gastrocolic reflexes.


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