# Rectal Descent vs Colonic Inertia



## JayCatGuy (Aug 12, 2007)

Having several what I felt at the time were full BM's, just a few days back, I thought 4 sure that I would have some relief...but even that night, I realized "it wasn't over", in that, that constant "round the clock urge to go" was still there. And the BM's were trials of combo's of the Oils (mineral, Castor) and drinking Caffeine via Energy Drink, in addition using the "squat position"...and so on...all that work...or rather suffering...and I feel just as I did before hand (now, prior to this, I was all ready for colostomy as I nothing else worked that used to anymore). And I haven't used any Stim. Laxatives before or after the Castor Oil.So with all this pressure/pain down their and huge Hemmorhoids-use PrepH and or Hydrocort. oint. (blocking gas too)...I did some research. And I found about Rectal Descent as well as this statement regarding Colonic Inertia: http://128.23.252.175/public/problems/dise...ctalDescent.cfm"If they don't have colonic inertia, they will have the usual amounts of stool getting down to the rectum daily. They will feel the urge to move their bowels; but, even with straining, the rectum will not empty. This differs from someone with colonic inertia. Someone with colonic inertia may not feel the need to move his bowels for a week or more at a time. Someone with rectal descent without colonic inertia will feel the need to move his bowels every day."Basically that people colonic inertia will "not feel the need move his bowels every day"...as opposed to those w/"rectal descent". My question is to people with JUST "colonic inertia" do you feel the strong urge to have a BM everyday, and throughout the day, even if you have a BM? Or you rarely even notice it?Now, I'm sure there are those who may have both colonic inertia and rectal descent...but I don't want make it even, I don't know...more complex as it is. Even when just about all Laxatives worked, I always had to place myself in the most unusual positions and rarely if ever, did I just have to "sit on toilet" (not the normal person) and just go, once this whole problem for started a couple years back. One leg up on wall, arm pressuring belly, rocking and finding just the right position and mostly...espeially during the Zelnorm days, I had to lean my forehead against the wall in front of me...and literally put myself in like a 45% angle...at around this time I developed "urinary retention" and went through the whole foley cath, self cath...to this day, I still have problems with. Sorry for the graphics...but it's all real and I'm suffering. And I have to figure a way to explain this to GI MD's so that they do not think I"m crazy, because, prior to all of this happening to me...and I hate to say it, perhaps I may have thought the same thing (if not gone through the same experience). I feel as though, "i'm the only one that has to go through BATHROOM GYMNASTICS" just to attempt at having a BM...and or the "Squat Position". I'm so confused, however, the pain trumps it all.If anybody has any thoughts or understands the article above that I quoted from...as well as for those w/Colonic Inertia, do you feel after a full BM (if and when that ever comes), do you find relief for at least a day or 2? Sorry for the length....Jay


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## Sean (Feb 8, 1999)

I have "just colonic inertia." I almost never feel any kind of urge to have a bm unless I have taken a laxative or enema, either of which create urgency. Without something to make me go, I wonder if I would ever have an urge. What I do have is tremendous bloating, cramping and gas. After a full bm (almost always enema or laxative induced), I do feel amazing relief which lasts for several days.


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## Kathleen M. (Nov 16, 1999)

You might consider getting the pelvic floor tested.If you are going at least 2X a week it probably isn't colonic inertia. Usually with that your transit time is so long that people will go more than a week to even a month without a BM.People with pelvic floor problems often cannot relax the anus properly (or have other problems) so even then they have an urge they cannot go easily.The constantly feeling like you need to go can be the sort of rectal hypersensitivity you see in IBS.http://www.aboutgimotility.org/site/about-...e-pelvic-floor/ is some info about pelvic floor dysfunciton.http://www.aboutgimotility.org/site/about-...ng/pelvic-floor discusses the various tests.K.


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## JayCatGuy (Aug 12, 2007)

To Sean and Kathleen, Perhaps, maybe it's somewhat symantecs, in that, when I say, "still have urge to"....I mean sorta mean what you wrote "What I do have is tremendous bloating, cramping and gas". In particular the cramping (isn't cramping a feeling like painful feeling of that isn't relieved...that even passing some gas would temporiarily relieve it?). The other think re:Gas, is that I have it, I just can't release...either do to these large Hemmorhoids on both sides, that sorta seal off everything...often need to roll on belly, and manually separate so that there is space for gas to pass. When I first had the first BM last week or so after not having a BM for 23 days, I found that...and it's already now happening just today...which is the 5th day (no bm), is that, in time, I begin to feel "nothing". But I know I don't have the luxury of "just letting it go"...because then I get a different kind of pain...rocks piercing my lower abdomen and can't twist my hips, and so on. PERHAPS, it's the leftover Castor Oil... mineral oil...as I used daily phosphate enemas for 6 months...until they completely stopped working; may have done some severe damage. MY MD at the time though made light of it, even though I told him that most of the time, I was unable to expel even 1/2 of the enema...sometimes...the entire enema was somehow "lost within me" (talk about cramping pain all day long). Maybe, my insides are just so messed up...dried out...takes days to leave body. So confused. My GI never called since I started seeing him, only his secretary...have a new appt. w/a new GI Feb 5th, if I can hang on until then. And those two hyperlinks were great Kathleen...reelvic Floor and I think it's got something to do with this, I just hope I'm not at the point of where the article wrote, about normal pelvic floor vs. Rectal Descent. "The normal rectum lies against the sacrum (lower backbone) in a gentle curve down to the anal opening. When a person moves his bowels, the muscles of the pelvic floor relax and the rectum swings down and straightens so it is almost straight up and down (vertical) over the anal opening. In this way the rectal contents can move straight out. Another comparison might be to a pair of pants. They are easy to put on if you lift them up with your hands on the waistline. It is more difficult to put them on if they are lying crumpled on the floor and you can't grab the waist band with your hands. It is easier to push something through a soft pliable tube if it is supported at the top and hanging vertically then if it is lying flat horizontally."Bottom line...I need a GI that will do those Tests that are indicated for the pelvic floor, whether it's re-training or physical/surgical matter. Thanks Sean and Kathleen, JayPS Boggles my mind why I feel better 5 days after the BM induced Cast Oil, Mineral and Caffeine...and suffered all day, cause, there was more and more until it turned liquod (that's when I thought I was "done and done" and would be okay for at least few days.


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## eric (Jul 8, 1999)

For constipation you also might want to get a sitz marker test done, as well as pelvic floor testing Kathleen is mentioning here.also this whole thread is about sorting it all out and has a lot of information and linkshttp://www.ibsgroup.org/forums/index.php?showtopic=91738


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## JayCatGuy (Aug 12, 2007)

Hi Eric, Yes, I agree about Colonic Inertia (sitz marker) testing...finally got the RX in the mail for the correct Radiologist...as well, as Pelvic Floor. I read your link leading to a thread to what unfortunately, seemed to turn into a sparring match, at some points, when we're all here to support eachother...because this IBS w/C or w/D or mixed...causes, as we all know, severe human suffering and destroys lives, even breaks up families...but, we're all human and frustrations can sometimes run high, I mean it's hard enough at times to communicate one on one, in person...and with the addition of writing our experiences, pains, knowledge, hope, encouragement...at times, can easily be misconstrued. But I think I deciphered ultimately, that "Incomplete Evacuation" is an issue to examined. Thanks Eric, Jay


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## Nomie (Mar 22, 2000)

Jay,just to let you know.you are not the only one who goes through the BATHROOM GYMNASTICS. I thought I was the only one. I have not tried the leg up on wall trick though







I have to lie on floor and press in different spots until I feel something. That is after doing fleet enema. It usually takes me 2 or 3 fleets and many trips to bathroom and floor.I do have pelic floor disfunction and I have an appointment on Feb 14 for botox to relax the mussel. I also have a prolaspe. I do feel like I have to "go" all the time and feel like I never finish. Gas is always trapped and has to be released by the same lying on floor method(without the fleet).Let's keep in touch to see how we make out.


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## JayCatGuy (Aug 12, 2007)

To Nomie, Yes, definately will stay in touch...you're one of those I completely relate too. Unfortunately, I used enemas too long on a daily basis (6-8 months) and don't matter how many, and all the little tricks (did 'em too, w/the belly presssue points/rub), digital manueveurs, oh what else, drinking a pint of warm water just before the enema...and at the beginning I'd get full bm's...but, towards the end, nothing but "salty mouth" "dehydration" "cramps" and no BM....and more often than not, I retained at least half of the enema (which was the worst=keeping the cramps/dry mouth going all day)... I think I sorta messed myself w/those things...but, "they worked at the time and it always felt desperate"...now, I"m in a completely new desperation and well, I'm still awake cause can't decide what to (take) or leave things alone...for it seems that if I take a liquod stim...some way, some how, even if I have a good BM or more...I end up in severe pain for, well, it's beeen 5 going on 6 days now and just tonight the cramping has stopped. But of course, the sharp edge in belly and distended lower belly has grown marketedly. So fed up witih all this...I've come to loathe it all............................anyway, thanks for your reply and we'lll continue to compare notes......................Jay


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## Nomie (Mar 22, 2000)

Jay,you sound so much like me. I wish I could say that was a good thing. I have been doing the enemas for years and most of the time they do not work to good if at all. Lots of times they get stuck. Wonder where it goes







I still do this bathroom torture because I still feel better by doing this then nothing at all. Have you tried smooth move tea. That worked for a while but now leaves terrible gas.


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## eric (Jul 8, 1999)

Jay, yes there was some issues on that thread, because there are different functional disorders that effect different areas of the body. Functional disorders of the rectum are different then functional IBS, which effects the large colon. Some people have overlapping conditions. But animus is not IBS. They are classified in different parts of the body in the ROME criteria.IBS is a distint entity and some people use the term too broadly.Believe me when I say I know all about sufffering.


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## Mistral (Jan 17, 2008)

Without the senna/cascara sagrada/turkey rhubarb fiber supplement, four or five days go by before I have the urge to go. When I finally do it's a struggle just to get out rabbit pellets and strings. Everything is completely dried out. I think the solution for me is to figure out why the normal fluid balance has been lost.The research I've done seems to indicate that histamines are responsible for triggering perilstalsis. The histamine release seems to be connected to fermentation, which is apparently tied to "good" bacteria. Fluid balance is involved somewhere in there. I'm not sure if it's before or after the histamine release. The iFlora probiotics I am taking worked really well at getting everything totally back to normal for the first week, but for the past two weeks I've gone right back to where I was. Senna and cascara sagrada are both connected with histamine release, but the results are unpredictable and sometimes too urgent and watery.Supposedly, fermented foods like sauerkraut, kimchi, and prunes can help a great deal... but first I'll have to deal with my complete distaste for those foods.


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## eric (Jul 8, 1999)

Actually its not histimine, but"Serotonin and the Peristaltic ReflexSerotonin is directly involved in initiating the ENS-mediated peristaltic reflex"http://www.ibsgroup.org/forums/index.php?showtopic=80198However mast cells are involved in IBS and the release of histimine.http://www.ibsgroup.org/forums/index.php?showtopic=93117Normal Function of the Colon and Anorectal Areahttp://www.aboutconstipation.org/site/abou...normal-functionThis page can help a lot.Constipation can be broadly divided into 3 classes based upon the underlying physiologic cause: Normal-transit constipation Slow-transit constipation Pelvic floor dysfunction http://www.aboutconstipation.org/site/abou...haracteristics/


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## Kathleen M. (Nov 16, 1999)

You might try adding an osmotic as well as the stimulatory laxatives to help with the water balance.They help hold water in the stool, so if it tends to be in there longer than it takes your body to get the water out the osmotics will help hold onto it until it gets to the end.Fiber helps a bit with that, but magnesium oxide is the main dietary supplement people use for that (250-750 mgs a day). Miralax has gone over the counter and it works as an osmotic as well.K.


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## Mistral (Jan 17, 2008)

This is interesting.From:http://en.wikipedia.org/wiki/Gut_floraCarbohydrate fermentation and absorptionWithout gut flora, the human body would be unable to utilize some of the undigested carbohydrates it consumes, because some types of gut flora have enzymes that human cells lack for breaking down certain polysaccharides.[3] Rodents raised in a sterile environment and lacking in gut flora need to eat 30% more calories just to remain the same weight as their normal counterparts.[3] Carbohydrates that humans cannot digest without bacterial help include certain starches; fiber; oligosaccharides and sugars that the body failed to digest and absorb[6][2][7] like lactose and sugar alcohols, mucus produced by the gut, and proteins.[6]Bacteria turn carbohydrates they ferment into short chain fatty acids, or SCFAs.[6][5][7] These materials can be used by host cells, providing a major source of useful energy and nutrients for humans.[6] They increase the gut's absorption of water, reduce counts of damaging bacteria, increase growth of human gut cells,[5] and are also used for the growth of indigenous bacteria.[2] The SCFAs are produced by a form of fermentation called saccharolytic fermentation[6] and include acetic acid, propionic acid, and butyric acid.[6][5][7] Gases and organic acids like lactic acid are also produced by saccahrolytic fermentation.[7] Acetic acid is used by muscle, propionic acid helps the liver produce ATP, and butyric acid provides energy to gut cells and may prevent cancer.[6]Another, less favorable type of fermentation, proteolytic fermentation, breaks down proteins like enzymes, dead host and bacterial cells, and collagen and elastin found in food, and can produce toxins and carcinogens in addition to SCFAs. Thus a diet lower in protein lowers exposure to toxins.[2][5]Evidence also suggests that bacteria enhance the absorption and storage of lipids.[3] Bacteria also produce and help the body absorb needed vitamins like vitamin K. In addition, the SCFAs they produce help the body absorb nutrients such as calcium, magnesium, and iron.[2]


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## Mistral (Jan 17, 2008)

Histamine role in smooth muscle contractionshttp://www.bio.davidson.edu/Courses/Immuno...Super/home.html"Smooth Muscle Effects: Histamine causes contraction of the smooth muscle of the ileum, bronchi and bronchioles, and uterus by acting on H1-receptors. It may be involved in increased peristalsis associated with food allergies (Abbas et al., 1994). Histamine-induced bronchiolar constriction has been implicated in the first phase of bronchial asthma (Rang et al., 1995). In asthmatics, histamine was found to increase airway smooth muscle tone and cause mucosal edema and glandular secretion, resulting in the narrowing of the airways and limited air flow. In nonasthmatics, bronchial activity to histamine was limited, most likely due to fewer H1-receptors in airway smooth muscle (Goldie, 1990)." http://www.pharmacology2000.com/Autacoids/...oids/hist1b.htmGastrointestinal tract:-Intestinal smooth muscle contraction -H1 receptor mediated effect http://www.vef.hr/vetarhiv/papers/2005-75-5-7.pdf"Histamine (P-imidazolyl-ethylamine) is a powerful and consistent stimulant of smooth muscles (GADDUM and PICARELLI, 1957; EGHIANRUWA, 2002). It is also a powerful gastric secretagogue (GANONG, 1999) and induces the contraction of the smooth muscle of the gastrointestinal tract (EYRE and CHAND, 1979)."Manual of Allergy and Immunologyhttp://books.google.com/books?id=8qMWoy1OM...ZHlnWtNKSJy1T2o[page 31]"Histamine binding to H1-receptors is linked to contraction of airway and gastro-intestintal smooth muscle, vascular permeability, mucus production in the nose, pruritis, and cutaneous vasodilation."[page 32] "In the gastrointestinal tract, histamine secretion stimulates both gastric and mucosal cells, leading to increased gastric acid and fluid secretion as well as smooth muscle contraction, resulting in increased peristalsis, hypermotility, and diarrhea."Immunology, Immunopathology, and Immunityhttp://books.google.com/books?id=s62zl56GZ...KpV_9R7Ps34w_2Y"On one hand, the smooth muscle of arterioles is stimulated to dilate by reaction of histamine with H2 receptors (blocked by cimetidine), causing increased blood flow (erythema). On the other hand, the smooth muscle of pulmonary bronchi, gastrointestinal tract (asthma), and the genitourinary system (cramps and diarrhea), as well as endothelial cells (edema), are stimulated to contract by action of histamine on H1 receptors (blocked by anti-histamines)."


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