# A different approach. Please let me know if you have tried this.



## wigglesmom (Dec 12, 2002)

I have anismus, and I feel as if I have tried nearly everything to help myself. In order to go to the bathroom each morning, I take a number of supplements/aides each night including but not limited to magnesium in various forms, malva tea, and triphala. For years now, I have had to resort to taking things that make my bowel movements very soft and liquidy.

I am now wondering what might happen if I stopped in hope to again produce solid bowel movements and pass them naturally. Might the anismus correct itself and be less of a problem?

I eat very healthy, so I do not think that my issues are diet based.

Has anyone tried doing this? I'm a bit scared to as I need to get myself into work each day and can't really deal with what might happen if I'm not able to go to the bathroom.

As a guide-my main issue is the fact that it takes me over an hour of sitting to go to the bathroom (I use a Squatty Potty). I have very little feeling of urgency. What I do have is an intense pain and pressure (I almost feel like a plug is in me, and I am about to pop from pressure) over my right eye when I need to go to the bathroom or when I am impacted.


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## annie7 (Aug 16, 2002)

you know, that's a very good question and one that i've been wondering a lot about lately.

because i also have slow transit in addition to anismus i've been taking --as advised by my gastros--dulcolax and milk of mag to move things along. this combo also makes my stools very loose/liquidy. i also have a grade 2 rectocele and this type laxative combo helps me evacuate past the rectocele so it doesn't get all caught up in there. splinting never worked for me for some reason.

anyway--more and more lately i have been finding it harder to move out even this liquid stool. it seems to stay caught up there in the descending and transverse colon and just sloshes around in there and won't move down and out, producing lots of painful and very uncomfortable bloating.

so i've been wondering about cutting back on the laxatives a bit as an experiment but like you am afraid that then i won't be able to go much if at all and just feel worse. i do very well remember the days before i started taking laxatives. without laxatives i could only go a little bit each day and lots of stool would remain stuck in my rectum, sigmoid and beyond. with all the same bloating, pain and discomfort. when i took the sitz marker test a couple years ago i had to go off laxatives and didn't have a bm or even the urge for the duration of the test and became severely impacted.

without laxatives i get very little or no urge at all to go.

i have just started biofeedback/physical therapy in the hopes on helping anismus. my next visit is friday and i'll ask my pt about all this--hopefully she can provide some helpful feedback.i'll post here and let you know if she has any helpful advice. and i know you went through bio/pt also. did your therapist have anything to say about this?


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## annie7 (Aug 16, 2002)

i should add that about ten days ago i did try cutting back some on the milk of magnesia i take--from the full cap to a three quarters full cap--but that made it harder for me to "go" completely. it definitely did not seem to help with the anismus. everyday day i kept backing up more and more until i started feeling like an impaction was developing. had to do a clean out with mag citrate and dulcolax yesterday. and even then it was hard for me to get rid of all that liquidy stool.

but we're all so different in how we react to things. maybe it would work for you if you tried a way to firm up your stools somewhat.

but oh yes i sure do understand how hard that is to do when you're working and only have the weekends to experiment--and then risk ruining your weekend at that.


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## wigglesmom (Dec 12, 2002)

Thanks, Annie. This is helpful. I also take mag. citrate when I feel an impaction developing. Please let me know what your therapist says in relation to this. I didn't ask my biofeedack therapist. Also, let me know how the therapy goes. I don't think it helped me at all, bit I hope it works for you!


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## annie7 (Aug 16, 2002)

yes, thanks--i'll let you know on both.

realistically speaking i don't think the bio/pfd therapy will help me much if at all. although of course i'm trying to think positive about it all.

from what i've read and heard from others it really isn't too successful for people with long standing and/or severe problems and mine are both. plus i have slow transit and of course it won't help with that. according to the gastro and the pt the hope is that the therapy will help the laxatives work better.

in regards to your original question as i think back over my long history with all this it seems no matter what i try or do i'm always full of stool. before i started taking laxatives whenever the docs felt my belly they always said i was full of hard stool (which i felt too) then i started eating fiber and taking stool softeners (on their advice) and i was always full of soft stool. now on the gastros advice i'm taking laxatives and i'm full of semi-soft liquid stool. all three kinds of stool are hard for me to fully evacuate.


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## annie7 (Aug 16, 2002)

i asked my pt today about what kind of stool--soft, firm or liquidy--is easiest for people with anismus--pfd --to pass but she really wasn't too much help with that. she just said people have to experiment with it all to see what works best for them. which i've been doing over the years to no avail.

so i told her i have found all types of stool--even the liquidy ones--hard to pass. she really didn't have anything more to say about that other than to ask my gastro. did that already with both of them. they both told me bio/pt should help with that. going round in circles?

i did notice one of the instruction sheets in her notebook advised 25-40 grams of fiber a day--mostly vegetables --not grains or wheat.

years ago when i had my "spastic colon" --ibs-c diagnosis --and this was long before i finally got to see a gastro and have all my tests--my various primary docs all told me eat 40 grams of fiber, drink lots of water, exercise, learn to live with it. ugh-- that was miserable. after doing lots (years) of reading here and elsewhere--reading about slow transit (as well as pfd) and how people said their gastros said to deal with slow transit, i started lowering my fiber--and got rid of those wheat bran cereals! and i found i do much better on less fiber--about 21-23 grams a day, mostly from well cooked vegetables and a little fruit. still not great but better than 40 grams!!!!

it really does take a lot of experimenting. and i know you've done that--you've tried everything...i do hope you can find something that helps.

it looks like i have four more bio/pt sessions left. haven't started the biofeedback part yet. i'll let you know if she has any more helpful instructions...

take care..


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## wigglesmom (Dec 12, 2002)

Thanks for the information and for asking her. I feel like no one knows. If there were someone who knew, believe me-I'd find them!


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## annie7 (Aug 16, 2002)

you're right--i agree--i feel like no one knows...

were you looking into botox at one time to see if that helps? i can't remember exactly. i asked my pt about that, too--about botox possibly helping with anismus-- but she didn't know anything about it.

i do know that it doesn't always work, usually wears off after several months and requires repeat injections, sometimes is not covered by insurance and also it sounds like there can be a problem-- in some areas at least-- of finding a surgeon who can/ will do it.


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## AIRPLANE (Mar 15, 2004)

I've been to 3 PTs over the past several years and they didn't have anything to offer for this problem either. Pretty much the same advice as everywhere else for things like rectoceles and PFD- keep things soft so they will be easy to pass but as you know that isn't necessarily the case. I feel like the softer stuff is actually more likely to get stuck and just sit in the sigmoid and/or rectum as the more solid stuff. We don't want the granite type stuff either as it could cause more harm besides the pain they cause.

It seems like there should be a way to regulate things but like both of you, I've tried many different things but so far have come up empty. Fruits- except for berries- don't agree with me and I think I'm sensitive to fructose which is in fruits and also maple syrup and honey- there is also fructans in wheat which I hear is similar. My first PT recommended eating applesauce- maybe because it has pectin in it?_ but that doesn't agree with me. I'm experimenting with fiber supplements (first psyllium, now Citrucel which I wish didn't have citric acid and sweetening in it) again along with magnesium for the past two weeks but still no luck- either too slow or too fast, sometimes very urgent and still usually incomplete. I also take marshmallow with the fiber and meals- supposedly it can help provide a coating to make things move easier.My system must be too sensitive and over-reacts to anything I try.And it is difficult to stick with anything that makes things worse for very long when you have to go to a job.

Keep us posted on your Pt, Annie. I'd like to try going back to the one I saw last year- before the weather got so bad- but it is too difficult with my current work schedule as it is in an out-of-the-way location. I wouldn't mind having some more internal work done but it seems like it only helped temporarily. Does your PT do any internal work? Out of the 3 PTs I went to, only the one I saw last year really did any internal work. However, after I went for awhile, she didn't do very much of it and had me doing things that I could have done at home like I mentioned to you.

I also have wondered sometimes if I could manage it to stop taking so many supplements and meds, what would happen. It seems like such a waste of money and takes up so much shelf space besides!


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## Gooby (May 11, 2013)

This is what I do to keep my stools from getting too dry and compacted...

1. I eat a few prunes with each meal, and drink a small glass of prune juice with each meal. Depending upon my bowel movements each day, I adjust the quantity of prunes and prune juice to take just enough so that I have a bowel movement each day, but not so much that I end up having diarrhea. I am a type 2 diabetic, so in theory, I am not supposed to eat prunes and prune juice because of the sugar content, but I figure that having constipation is actually worse for me than the sugar spike it causes. I now take extra Metformin each day and exercise more to burn off the extra sugar found in prunes and prune juice. I also have reduced the amount of other carbohydrates I would have otherwise eaten to make up for some of the extra sugars found in prune juice and prunes.

2. To reduce the amount of prunes and prune juice I need to stay regular, I swallow a 250 mg tablet of magnesium oxide (found in the vitamin section of grocery stores) with each meal.

3. The combination of magnesium, prunes, and prune juice have been very effective for me, to stop constipation and stay regular. I tested this by not eating any prunes, not drinking any prune juice, and not taking any magnesium pills for one day. The next day I did not have a bowel movement. I went right back to constipation again.

4. For probiotics, I drink a small glass of kombucha with each meal. It is full of good bacteria and good yeast, without the binding dairy products found in kefir. 

5. The only fiber supplement that I have found to work for me is inulin. You can find it various forms-- capsules and powders, etc. I mix up the powder into a glass of water and drink it down. It is clear and doesn't taste like anything. Supposedly, it is also food for the good bacteria.


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## annie7 (Aug 16, 2002)

Airplane---my pt hasn't done any internal work yet. not sure if she will later or not? i have four more visits scheduled. insurance finally agreed to pay for it--for a little while at least. yes i'll keep you posted.

and good luck to you with everything you are trying and yes hope you can somehow get to see that pt you mentioned. oh yes i remember how very hard it was to make appointments with that difficult work schedule, inflexible supervisors etc.

and yes i do so agree with you about all the meds, supplements, shelf space etc!!! i've got tons of stuff that didn't work but ate up my money and and my shelf space....


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## screeb (Jul 25, 2001)

What I do to keep my stools from getting too dry and compacted is to take garcinia cambogia, which has a citric acid extract.

A redox reaction in citric acid is the first step of the electron transport chain (Kreb's Cycle) in the mitochondria of the cytoplasm of a cell. When one takes a Garcinica Cambogia (GC) pill, which consists of 60% Hydroxycitric acid (HCA), there is a "left shift " or "turning on" of the mitochondria of the endoplasmic reticulum. Garcinia cambogia causes HIF-1 reduction.

I belive G. Cambogia is helping prevent stools from drying out by reducing Hypoxia Factor Inducible 1 (HIF-1) genes. Hypoxia-inducible factor-1 alpha (HIF-1alpha) functions as a master regulator of cellular and systemic homeostatic response to hypoxia by activating transcription of many genes whose protein products increase oxygen delivery. The carotid body, a peripheral chemosensor no bigger than a grain of rice, is the most perfused organ per gram weight in the body and receives blood via an arterial branch arising from internal or external carotid artery. A proposed underlying mechanism for hyperactivity of the chemoreceptors is the relative activity of HIF-1 alpha._ Increased HIF-1 alpha-dependent NOX2 mRNA expression, triggers glomus cell depolarization (type of cell in Carotid Body), leading to sympathetic activation.[ii]

However, Garcinia Cambogia causes decreased activation of HIF-1 causing decreased sympathetic activation such that less pain projects from gut pathway causing decreased Locus coeruleus firing causing decreased perception of visceral pain. The less intense the pain pathway "whispers down the lane", the less the level of norepinephrine in the brain and therefore G. Cambogia which produces decreased HIF-1 is decreasing norepinephrine where the major effect is a decrease in perception of visceral pain . Combining these two sub-programs into a super program , the G. Cambogia decreases HIF-1, causing increased sugar causing decreased LHA/OX-A, causing reduced peristalsis via decreased dorsal motor nucleus of the vagus activation. The vagal or parasympathetic system balances out the norepinephrine/sympathetic system. Remember, we are dealing in long term overactivity of the proximal colon, so reducing peristalsis (proximal colon activity) is a good thing. It makes the stools less compressed and dryed out._


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## Queeniebee (Jun 3, 2013)

I too suffer from anismus and a moderate to severe rectocele and struggle with achieving the best consistency to pass the stool. Too watery and loose, and I can feel the rectocele filling up. Not loose enough, and it won't pass at all. Splinting doesn't help me.

I've found the best combination to be some form of magnesium (right now it's Milk of Magnesia, but magnesium citrate capsules and Natural Calm have also worked in the past) and Citrucel capsules.

One of the most effective things I've found is climbing up on the toilet and squatting. I have a squatty potty, but I still find the natural squat position to be most effective, since it seems to straighten out the angle and allow the stool to pass without getting trapped in the rectocele. If you're agile enough, you might want to try it.


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## annie7 (Aug 16, 2002)

Queenie--oh yes--you're right--squatting or at least elevating the feet on a footstool or shoe box, waste bin etc does help many of us.

and yes i am agile so i actually did try squatting on the toilet---lol--what an experience! i'm agile but i have arthritic knees and it was all a bit of a wobbly, painful thing for me. plus i found i could not relax properly in that position. but yes, those squatty potties sure can be helpful, too.

i find the shoe box works best for me--love it!.


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