# Incomplete evacuation as a symptom



## Naomi889 (Sep 11, 2005)

I've had very very severe IBS-C for six years, and a particular problem - incomplete evacuation - is my main symptom - indeed my only symptom really. I understand that IBS is very very common, but in all my thousands of conversations with doctors and on internet boards for sufferers such as this I have never come across anyone else who had this as their main symptom.I am basically trying to find out as much as I can about others with this symptom so I can try to make sense of it all and potentially find a treatment that would help. I have been in constant, severe physical discomfort for years now and my quality of life is very bad, and I am really getting desperate. I am SURE that one of the reasons that people like us are not getting treatment is that not enough is understood about what is actually going wrong in our bodies - IBS is really an unhelpful catch-all term in my opinion.Anyway - my questions. Does anyone else here suffer from incomplete evacuation after a bowel movement? And, if so, have you found that your IBS has got periodically and progressively worse over the years that you have had it???Mine have. My symptoms (the incomplete evacuation, constipation and physical discomfort) go along at a certain level, and then (after some minor stress event) will worsen, permanently. Many doctors have simply not believed me when I have told them this, and have certainly not heard of it happening to anyone else. Well, I believe me, and that's all that matters, but I do find it odd that I have never even come across anyone on one of these boards with my particular symptom (the IE and the periodic steady worsening), when one in 10 people are supposed to have IBSHowever, I recently saw a gastroenterologist who made some sense of this for me - she told me that the lower bowel has a certain capacity - I think she said 40mls or something - but what happens with IE is that the capacity becomes enlarged at a certain point (through e.g. stress induced IBS-constipation), to say 100mls, and then the body's sort of baseline for stopping going to the toilet is changed - it sort of "thinks it has finished" even when it has not. So even though the "stressor" has disappeared, the bowel remains distended and the body continues to "stop" going to the toilet at the wrong point. Then, the next time you are stressed, the capacity enlarges again (i.e. the constipation and discomfort gets worse) and it stays that way, even when the stress is gone. This fits my experience of IBS so exactly that I know it must be true. The way to treat the problem (she says) is to gradually reduce the capacity of the bowel - persuade it back to normal - there were other complicating factors that I won't bother going into now.But anyway, could you some of you let me know more about your experiences of IBS and particularly of incomplete evacuation, and also whether your IBS has got worse over the years? I really would be very grateful, as I think trying to understand what is going on with this particular symptom could help people like us find treatment.


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## SpAsMaN* (May 11, 2002)

Naomi in responce to your PM,i urge you to contact Dr.Palmer(UK).I spoke to him by e-mail few years ago.He's very confident that IE is cause by rectal mucosa prolapse.I cannot confirm anyone who have saw him but perhaps it may help.Again i take no responsability if it failed.Here the link:http://www.springerlink.com/content/2p1f91yk4l2l9ay3/


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## eric (Jul 8, 1999)

Naomi, when you say physical discomfort, do you mean physical discomfort of the abdomen?Have you ever had pelvic floor testing?This is a good website on constipation.Functional constipation is the presence of two or more of the following:Straining during at least 25% of bowel movements, Lumpy or hard stools in at least 25% of bowel movements, Sensation of incomplete evacuation for at least 25% of bowel movements, Sensation of anorectal obstruction or blockage for 25% of bowel movements, Manual maneuvers to facilitate at least 25% of bowel movements and/or, Infrequent (fewer than 3) bowel movements per week. http://www.aboutconstipation.org/Its worth reading this pagehttp://www.aboutconstipation.org/site/abou...haracteristics/There is a lot in the IBS and consitpation literature on the "sensation of incomplete evacuation." which is in part a neurologic process. Basically the neves in the rectum are hypersensitive and even when there is almost no matter in the rectum there after going, it can still sends a signal to the brain 'sensory feedback' there is still stuff there. That's put really simply however.This is more complex on it allNeurophysiological evaluation of healthy human anorectal sensation http://ajpgi.physiology.org/cgi/content/full/291/5/G950There are other issues with IE however to consider.I am also not sure what you mean exactly by your IBS getting physically worse. What physical symptoms are getting worse?


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## Naomi889 (Sep 11, 2005)

Spasman, thank you so much for the doctor's name. Sharing info like that is the most useful function of this board. And no sir, of course I would not hold you responsible if it did not work!Eric - I have indeed had pelvic floor testing and been diagnosed with a non-relaxing puborectalis muscle (also known as anismus, etc. etc.). Thank you for the links. I am aware of the Rome criteria for constipation and have in fact read many times of rectal hypersensitivity and so on. Listen, if my symtoms are due to rectal hypersensitivity and not actual constipation, then I'm the Pope. Believe me, I suffer from pretty severe constipation. And I am able to go every day. Somehow a concept that is occasionally difficult for doctor and even poor fellow IBS sufferers to grasp, as it is unusual, but it is not too complicated. If your bowel muscle closes up before you are able to fully evacuate your bowels, EVERY DAY, then you will be constipated. My upper abdomen measures about 25 or 26 inches and my lower abdomen as much as 40 inches - to say I look pregnant is an understatement. When I say physical discomfort, I mean constant dementing physical discomfort resulting from constipation. The constipation and physical discomfort resulting from the constipation gets worse every year - it is a self perputuating thing, no doubt in my mind. Do you ever suffer from constipation, Eric?


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## SpAsMaN* (May 11, 2002)

Constipation is a plague.If you feel constipated you probably are.You're welcome.


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## eric (Jul 8, 1999)

Naomi,I have IBS d/c which leans more to d. Very occasionally C and yes I have had the "sensation of incomplete evacuation after a bowel movement.' Many times. However not as much anymore.It kind of sounds like you have IBS c/d and leans to C.Altered segmental and other contractions in IBS can cause some weird feelings and symptoms.You go everyday? "rectal hypersensitivity and not actual constipation"These are two different things that can happen.In IBS there can be say d or c or d/c AND rectal and sigmoid colon hypersensitvity or even in other areas such as the esphogus in functional dyspepsia.A person can have animus and IBS.Has anyone ever suggested biofeedback for the Pelvic Floor Dysfunction (Dyssynergia)?There is also information on actual distension and bloating in IBS which is common and might have to do with issues with the abdominal wall muscles in actual distension as well as altered gas transit from altered contractions. Do you know about the defication reflex?


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## EarnestAccord (Dec 11, 2001)

It's nice to see this topic being talked about. I've had IBS C/D for a decade. My predominate symptoms are bloating, gas and lower left qudrant pressure and weight. But yes almost every BM that I have feels incomplete. But to broaden this I have different sensations associated with that word. Some incompletes feel like there is literaly a nug stuck half way out and while it is uncomfortable it usually subsides after an hour. My other incomplete is what I think was described above as nueral. I know I haven't eaten for twelve hours, my BM is banana shaped and it feels like the totality of what's in my rectum but then minutes later I'll get this indescribable feeling of wanting to push and get more stuff out. Now I know by experience that there is no more "stuff" because I've given myself enemas following what I thought for sure was a fractional BM but nothing else was flushed out and the sensation increased. So I now know to get off the toilet and move on. My list of things that increase the sensationCaffeineBM's within the first couple of hours after wakingHigh Fiber diets ( some of the least IE BM's have been after eating only protiens)Hope this helps.


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## Naomi889 (Sep 11, 2005)

Eric - thanks again for taking the time to comment, you're obviously very knowledgeable about the various minute of this condition, but I assure that I am correct in my belief that constipation from IE (even when one can go everyday) is tangible and clear cut symptom - and "weird feelings" have nothing to do without - I really am suffering from severe constipation, I promise you! Not every facet of IBS symptoms will be detailed on these IBS sites on the web. I don't have "IBS c/d " 'cos I never get the D! I really am IBS-C! I'm taking the time to clarify this because I think this (the IE) is a poorly understood symptom and it would be great if these major IBS sites (the ones where you get your info - and even scientific papers!) could cover it more accurately. As it is not only the doctors but apparently my fellow sufferers are somewhat unwilling to believe that I can really be suffering from C!Thanks once again for your info though. Much appreciate your time, and you're obviously very knowledgeable


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## Naomi889 (Sep 11, 2005)

Actually in the interest of increasing general knowledge of IBS as a whole here is one of my posts from a different thread on my opinion of the specifics of my type of IBS. If anyone can be bothered to read it all, I'd love to know what you think!To grits91058 - I have indeed been tested for Pelvic Floor Dysfunction, and was also diagnosed with non-relaxing puborectalis. As you exhibit exactly the same symptoms as me, that corroborates my theory (gastros are quite vague about the specifics of the problems they see in others). What do you mean by an MRI? As in an actual Magnetic resonance imaging scan? Are you US or UK based?? - when I was tested 6 months or so ago, it involved some probes and a ballon, basically, but they made that same diagnosis. Zelnorm? Does that really help? I read about it back in 2001 when it was in trial but it was not licenced for use in the UK as it was not thought to be effective enough.OK, herein lies the rub. Basically, as I said earlier, I have had IBS for 6 years and have spoken to many many docs and people on internet boards and not found anyone with my specific symptoms. I have not used the boards for a few years and suspect that they are much more widely used now, hence immediately being able to find two others with the same symptom. My opinion, based on the scientific literature, conversations with gastroenterologist and my own experiences, is that this non-relaxing puborectalis/anismus with associated self-perpetuating incomplete evacuation is actually a very, very specific disorder, and one that is perhaps relatively rare compared to the frequency of "IBS" as a whole. For this reason relatively little is known about it, but alot more has been theorised just in the past few years (I mean the original gastro I saw back in 2002 did not even believe my symptoms could possibly be true and he would have seen hundreds of people with IBS every week). It's a growth field. I think potentially this particular disorder could be quite treatable and here's why. Now we all know the "mind-gut" connection is very complicated and that's why they can't treat IBS and blah blah blah. BUT - and here's the but- the gastro I am see at the moment told me told me that incomplete evac and the non-relaxing muscle are basically a self perpetuating, vicious circle sort of thing. As in - you get stressed, your IBS causes you to suffer from incomplete evac via this poorly functioning muscle. But then, instead of going away in the absence of the stress, like most people IBS, the distended bowel from the IE actually CAUSES THE MUSCLE TO CONTINUE TO MALFUNCTION. Do you see what I mean? The muscle clamps up in response to stress, causing IE. The IE then stop the muscle from going back to working normally in the absence of stress! One causes the other! And this is why this particular symptom is so intractable and frequently worsens over time. Part of the evidence the GI doc has for this is that when she treats patients for the IE over a period of time using non-stim laxatives, and reduces the severity of the IE and constipation, the muscle frequently starts to function normally all by itself, without any need for the Biofeedback machine therapy that she otherwise uses to treat this muscle problem. And so, in theory, while people like us may never be able to stop our symptoms happening in times of high stress, the key point is that it seems likely that we CAN STOP THEM OCCURING ALL THE TIME.Do you understand? It all makes such sense to me that part of me really believes that if just a little more were known about this specific disorder it may well turn out to be very treatable. GI docs are only helpful to an extent - you have to wait over 6 months between appointments here in the UK, and there are only a few treatments available so far (botox is one in trials at the moment). _ So I think the key thing is to gather together as many people as possible with this particular symptom so we can share our experiences and what medicines are working on the problem. I think that would be really helpful and I do believe that potentially even a new treatment could be worked out this way_ So far I have been corresponding with girl who's symptoms are quite similar to mine and I believe we both have been able to help each other and both understand a little more about how this disorder works. I work in scientific research and truly believe that the way to solve this is to gather together common experiences of this specific problem in order to test theories and work out potential solutions. I truly believe that this could work. I could even see the way forward into organising some sort of clinical trial for this specific disorder.To this end, I've copied this post into a message to both of you with my email address. If you want to email me more about the your experiences of IBS, that would really be great. Even if you just let me know what meds have worked for you and I'll do the same I think that could be really helpful.


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## eric (Jul 8, 1999)

I want to ask one more time do you know about the defication reflex works?Consitpation from animus is different then consitpation from IBS.The reason you know to have a bowel movement is the rectum signals the brain, it is in part a neurological process. If they scoped you when you felt the IE they could see if material was in there.For many IBSers there is not and a sensation of incomplete evacuation is a realitivly common problem. Where the nerves there are hypersensitive and sends the signals there is still material there even when there might not be, even a very very minute amount of material could cause the signal to be sent. There is different issues going on here in regards to c and IBS and c and animus.For example motility in IBS does not explain pain, you have have d or c or d/c attacks and not have pain at that time. Or you can have pain and not d or c or d/c attacks. They don't always correlate together. Motility alone does not fully explain IBS.Have you watched all these new videos?http://www.ibsgroup.org/forums/index.php?showtopic=91754I will also as soon as I can see if I can get an expert to comment on IE.


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## Naomi889 (Sep 11, 2005)

Eric - I think you mean the "defecation reflex ", and yes, I know what it is, as I also have an internet connection as well as a degree in biology. Quote - "If they scoped you when you felt the IE they could see if material was in there. For many IBSers there is not and a sensation of incomplete evacuation is a realitivly common problem. Where the nerves there are hypersensitive and sends the signals there is still material there even when there might not be, even a very very minute amount of material could cause the signal to be sent. "For the third time, Eric, there is no "if" about whether my symptoms result from "hypersensitive nerves" or actual constipation. They result from actual constipation, regardless of whether I can "go" every day. You will not find completely comprehensive information about a multi-faceted and complex disorder on the internet, and it would be much more sensible and logical to increase your knowledge of this disorder by basing it not only on your reading but also on the direct testimony of your fellow sufferers. I don't mean to be rude, but as I said, this is the third time! As I said in my first two replies, I have very severe, constant abdominal distension due to the extreme swelling of my bowels, I am in extreme discomfort, and I have other nasty symptoms of severe constipation such as pain during sex. It is also perfectly logical that one would suffer from constipation if the relevant muscle had been diagnosed as non-functional and one was never able to fully complete a bowel movement over a period of years! There is no doubt that I am constipated.I am now not surprised that the occasional doctor has been incredulous of my symptoms - the "I've not read about it, therefore it does not exist" school of thought, but I never would have thought a fellow IBS sufferer would think that way!Having said that, for the third time I would like to re-iterate that I am grateful for your time and help. Please just bear in mind what I said! I am sure you would also find it frustrating to not only be unable to find treatment for one's symptoms but also to not be believed about their tangible existence!


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## SpAsMaN* (May 11, 2002)

Naomi i understand how you feel.The PRESSURE from the lack of sigmoid motility is pushing on your sexual organ giving you pain.The releif after a defecation is normal but often temporarly.As soon as the inner pressure in the sigmoid build again,the disconfort continue.So there is a REAL motility problem in the lower gut.IT'S NOT NORMAL TO SEE THE WHOLE COLON SWELLED BY GAS.Thanks


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## SpAsMaN* (May 11, 2002)

I wonder if people with IBS-D feel that type of inner bowel pressure.Probably not to the extend of IBS-C sufferers.I think it's mostly a IBS-C type of symptoms.The test to confirm sigmoid spasm/motility problem is kinda simple to me.You do an enema and IF water get stuck in the sigmoid AND SIT THERE then there is a problem.


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## eric (Jul 8, 1999)

Sorry yes it was a typo/sp. Listen I am not the enemy I am trying to help."constant abdominal distension due to the extreme swelling of my bowels, I am in extreme discomfort, and I have other nasty symptoms of severe constipation such as pain during sex. It is also perfectly logical that one would suffer from constipation if the relevant muscle had been diagnosed as non-functional and one was never able to fully complete a bowel movement over a period of years! There is no doubt that I am constipated.""I've not read about it, therefore it does not exist" school of thought,I have never doubted you right from the begining. Nor do I doubt your missery from all this either. I know its very real. If fact I think the two different problems compound each other probably.I think were just not on the same page even though were talking about some of the same issues.I am trying to understand fully what you are actually saying as well. 80 percent or so of IBSers have a hypersensivite rectum just to know.Again consitipation is a symptom not a disease. Animus is a distint problem and IBS is a distint problem.Pain or discommfort in IBS is generated from hypersensitive nerves that line the colon in "classic IBS." This is called viceral hypersensivity. They also very frequently have rectal hypersensvity as well and in functional dyspepsia esphogal hypersensivity.You seem to have been diagnosed with two problems coexsisting. I think that's important.Anismus: a marker of multi-site functional disorders?Medscape NewslettersMedscape Best Evidence Key journal articles ranked for newsworthiness and clinical relevance in each specialty, linked to Medline abstracts. Int J Colorectal Dis. 2004; 19(4):374-9 (ISSN: 0179-1958)Bouchoucha M; Devroede G; Arsac MLaboratory of Digestive Physiology, Hôpital Broussais, 96, rue Didot, 75014 Paris, France.PURPOSE: This study was undertaken to assess the clinical significance of anismus in patients who complain of constipation. PATIENTS AND METHODS: Thirty control subjects and 93 consecutive patients complaining of functional constipation took part in the study. Colonic transit time study and anorectal manometry were performed. Questions about depression and urinary and sexual diseases were added to a questionnaire based on the Rome II criteria, and visual analog scales about four items (constipation, diarrhoea, abdominal bloating and abdominal pain). RESULTS: Constipated patients have lower threshold sensation volume, lower constant sensation volume, and lower maximum tolerable volume than controls. Thirty-seven patients (40%) were found to have anismus, based on anorectal manometry. No significant difference was found between constipated patients with anismus and constipated patients without anismus, using anorectal manometry. Constipated patients had longer colorectal transit time than controls, but neither total nor segmental colonic transit time was correlated with the presence or absence of anismus. *In patients with anismus, a higher frequency of *oesophageal symptoms, dysmotility-like dyspepsia, aerophagia, *functional bowel disorders,* functional abdominal pain, soiling, and dyschezia was found. In addition, a higher frequency of urinary complaints, sexual complaints, and depression was found. Anismus was associated with increased awareness of constipation, abdominal bloating, and abdominal pain, but not with diarrhoea.PreMedline Identifier: 15034727http://www.medscape.com/medline/abstract/15034727Approach to the IBS Patient With Significant Persistent Abdominal Distension?http://www.medscape.com/viewarticle/478403Medscape: Several studies presented during this year's meeting explored the relationship between bloating, abdominal distension, and visceral sensitivity. What were some of the key findings from these studies, and how do you think they set the therapeutic stage for the path forward in this fieldhttp://www.medscape.com/viewarticle/477464What treatments are they offering you for the Animus? See what I am saying here is the very real constipation problem and animus and then the very real problem that causes C in IBS. Different mechanisms causing two problems both can cause C. One a problem with the non-relaxing puborectalis muscle and the other a problem with the sigmoid colon. Its very much more complicated then that even.


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## eric (Jul 8, 1999)

Spasman,IBS d patients and c patients and c/d patients with IBS can have the sensation of incomplete evacuation.Motility problems can occur in different parts of the digestive tract and there are different tests.


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## eric (Jul 8, 1999)

FYIFirst Principles of Gastroenterology3.6.3 PELVIC FLOOR DYSSYNERGIA  The majority of patients with constipation have a form of irritable bowel syndrome, but there is a small subgroup of patients who may have a specific disorder in colonic and/or anorectal function that produces constipation. These patients are almost all female, may have delayed colonic transit or present with anorectal dysfunction with impaired awareness to rectal distention (without a megarectum), or may demonstrate a phenomenon of rectal outlet obstruction due to inappropriate contraction of the voluntary anal sphincters during defecation. This has been termed pelvic floor dyssynergia or anismus. These patients can present major therapeutic dilemmas and warrant further investigation in specialized coloproctology units involved in the care of such patients.http://gastroresource.com/GITextbook/en/index.htmHave you ever been to a "specialized coloproctology unit" ?


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## SpAsMaN* (May 11, 2002)

Eric,Irritable bowel and sigmoid contractions:http://www.ncbi.nlm.nih.gov/sites/entrez?c...pt=AbstractPlus*Department of Radiology, St Clara Hospital, Rotterdam, The Netherlands.Fifteen patients with abdominal pain compatible with the irritable bowel syndrome (IBS) were examined by barium enema and pressure recording. Strong circular contractions of the sigmoid colon and pressure recordings correlated with the characteristic pain in 13 of the 15 patients. In 15 control patients no pain occurred. It is concluded that pain and high pressure are caused by strong circular sigmoidal contractions. Such findings enable the radiologist to contribute to the diagnosis of IBS.*


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## SpAsMaN* (May 11, 2002)

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSumSensitivity and distensibility of the rectum and sigmoid colon in patients with irritable bowel syndrome.Drewes AM, Petersen P, Rössel P, Gao C, Hansen JB, Arendt-Nielsen L.Dept. of Medical Gastroenterology, Aalborg Hospital, Denmark. [email protected]: Hyperalgesia to visceral stimuli is a biological marker of the irritable bowel syndrome (IBS). Abnormal pain processing is probably of most importance, but biomechanical abnormalities of the gut wall may also contribute to the findings. In the current study, we investigated the sensation of the gut to electrical stimuli as well as the distensibility of the rectum and sigmoid colon in IBS patients and a control group. METHODS: Nine patients with IBS and 11 controls entered the study. The pain threshold to electrical stimuli at the rectosigmoid junction was determined with bipolar electrodes integrated on the biopsy forceps for the endoscope. Subsequently, controlled distensions of the sigmoid colon and rectum were performed with a balloon integrated on a probe for impedance planimetry, providing the possibility to measure the cross-sectional area (CSA), wall tension and strain to different pressures together with the sensation ratings. RESULTS: The pain detection thresholds to electrical stimuli at the rectosigmoid junction were 12.5 (range 7-39) mA in controls and 7.5 (range 0.75-12) mA in IBS patients (P = 0.03). The calculated pressures at the pain detection threshold in the sigmoid colon were lower in the IBS patients (31.5 (range 5-58) versus 5 cm (range 5-25) water; P = 0.03), otherwise no differences were seen in sensation rating to the different distension pressures. The CSA was slightly higher in controls to the different pressures, whereas no differences between the groups were seen in strain and tension of the rectum and sigmoid colon. CONCLUSION: The visceral hypersensitivity in IBS seems to be related to alterations in the nervous system rather than biomechanical parameters such as the tension and strain of the gut wall. Treatment of pain in IBS should therefore be based on drugs with documented action on the nociceptive pathways in the central nervous system.


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## eric (Jul 8, 1999)

Spasman, the first study you posted is from 1991.Contractions, especially after eating or even when stressed can contribute to pain. But since the late 90's motility alone does not fully explain pain in IBS. So this is now out of date.In the second post, there is no biological marker in IBS. Again, this is an older study from 2001. I am not sure if you realize what that is saying either, that the pain in IBS is from the central nerous system and the brain, not the gut.But this too is out of date. Gut abnormalities have been found."While abnormal motility plays a vital role in understanding many of the functional GI disorders and their symptoms, it is not sufficient to explain reports of chronic or recurrent abdominal pain. VISCERAL HYPERSENSITIVITYVisceral hypersensitivity helps to account for disorders associated with chronic or recurrent pain, which are not well correlated with changes in gastrointestinal motility, and in some cases, where motility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lower pain threshold with balloon distension of the bowel or have increased sensitivity to even normal intestinal function. Additionally, there may be an increased or unusual area of somatic referral of visceral pain. Recently it has been concluded that visceral hypersensitivity may be induced in response to rectal or colonic distension in normal subjects, and to a greater degree, in persons with IBS. Therefore, it is possible that the pain of functional GI disorders may relate to sensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injury to the viscera. "Spasman, you recently asked me abnout new sensivity studies and that thread is more up to date then these old studies.For Naomi, it is really possible the IBS C caused by a different mechanism then the pelvic floor dysfunction is adding more pressure to anal/rectal and defecation reflex. " IBS is really an unhelpful catch-all term in my opinion."Again a lot has been learned recenlty and IBS is a distint entity and anismus is another problem, many times functional disorders can overlap.Most people with IBS also don't have anismus on top of there IBS, some do however and this is one reason when someone has c to do pelvic floor testing. Its also possible there is viceral hypersensvity with the IBS compounding the animus issues and the IE. That there is fecal matter in the analrectal canal and viceral issues. Both perhaps. If it was just animus I don't think that would happen really. But animus is NOT the cause of IBS C. The sigmoid colon is a problem in IBS C and what the strong evidence on 5ht receptors and serotonin and c and the animus is another problem, not caused by the same mechanisms.The pressure from IBS c would then make the animus even more problematic and debilitating.Spasman, with IBS d and d/c sometimes a person can go like 5 to ten times and still after every bowel movement feel a sensation of incomplete evacuation. This is pretty common. In would be important say in Naomi's case that she also mentions she was diagnosed with animus, because that would not be the same case for IBSers with the senseation incomplete evacuation. You can't make comparisions because of the two sperate problems going on.


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## Arnie W (Oct 22, 2003)

Naomi, I share your frustration. It is disparaging and disheartening when what we know to be true is brushed off by others as being pure figments of the imagination.Now what exactly is IE? Is it a term which has been coined by IBSGroupers, but not recognised by the medical world? I am getting the impression that it is a term mainly used by C IBSers. My case is different, but in my eyes I suffer from IE. I am neither C nor D as such. I have several bms every day and each one is never completely evacuated. I have argued before that it is much more than just a sensation - it is for real - but it has fallen on deaf ears. How do I know it is IE? Well, I always have to do lots of wiping after a bm and it is not uncommon to have to use a damp cloth or wet wipes to finish cleaning up. And investigation with a finger (covered in toilet paper or a glove) after bms leaves me with no doubt that I do not completely evacuate.But where to from here? Why does it sit in the anus as well as further up and not want to budge? What can I take to push it along? Could it be a pelvic floor issue or is it because of a stressed-out body? I am sure that if I could solve this problem, I could make headway with my other major complaint, ie frequent gas.


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## eric (Jul 8, 1999)

"It is disparaging and disheartening when what we know to be true is brushed off by others as being pure figments of the imagination."Not one person has said that at all here, thats a misinterpretation. It is well known in science that sensory nerves can fire when they are not suppose too. If there were no sensory nerves there you would not know when to go to the bathroom. This is a majorally complex system. Connected to the gastro colonic responce and defecation reflex and bidirectional signaling from sensory nerves and motor nerves and the brain some concious signals some not.The sensation of incomplete evacuation is part of the medical community and part of ibs. It is not just c people either.The sensation is a VERY REAL SENSATION and how the body physically actually works to send a signal to the brain for a in part voluntary responce and in IBS out of whack, but it is a very real issue. This in no way implies people make it up. That is not the case at all, in fact it seems to be more about people not knowing how the system physically works and problems found. The body signals to eat, does that mean we make that up? No its a physical process that reaches our conciousness.Some people with IBS or dyspepsia eat a very small amount of food and feel full. That is another example of abnormal sensation issue. It too is real.The reason why you may think its real is because IT IS real.Arnie, have you had pelvic floor testing?There can still be material there and still get a sensation. It does not have to be totally empty and clean. The thing is it should turn off after a bowel movement preferably, but that doesn't always happen.This is one of the reasons."*The nervous system that controls the gastrointestinal organs, as with most other organs, contains both sensory and motor nerves. The sensory nerves continuously sense what is happening within the organ and relay this information to nerves in the organ's wall. From there, information can be relayed to the spinal cord and brain. The information is received and processed in the organ's wall, the spinal cord, or the brain. Then, based on this sensory input and the way the input is processed, commands (responses) are sent to the organ over the motor nerves. *Two of the most common motor responses in the intestine are contraction or relaxation of the muscle of the organ and secretion of fluid and/or mucus into the organ. As already mentioned, abnormal function of the nerves of the gastrointestinal organs, at least theoretically, might occur in the organ, spinal cord, or brain. Moreover, the abnormalities might occur in the sensory nerves, the motor nerves, or at processing centers in the intestine, spinal cord, or brain. Some researchers argue that the cause of functional diseases is abnormalities in the function of the sensory nerves. For example, normal activities, such as stretching of the small intestine by food, may give rise to abnormal sensory signals that are sent to the spinal cord and brain, where they are perceived as pain. Other researchers argue that the cause of functional diseases is abnormalities in the function of the motor nerves. For example, abnormal commands through the motor nerves might produce a painful spasm (contraction) of the muscles. Still others argue that abnormally functioning processing centers are responsible for functional diseases because they misinterpret normal sensations or send abnormal commands to the organ. In fact, some functional diseases may be due to sensory dysfunction, motor dysfunction, or both sensory and motor dysfunction. Still others may be due to abnormalities within the processing centers."http://www.medicineonline.com/encyclopedia...-Bowel-SyndromeThe main issue here though is two functional disorders going on at once, one literally on top of another.


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## eric (Jul 8, 1999)

Management of Bladder, Prostatic and Pelvic Floor Disorders withBotulinum NeurotoxinCurrent Medicinal Chemistry, 2005, 12, 247-265"CONSTIPATION DUE TO PELVIC FLOORDYSFUNCTIONPelvic floor dysfunction is characterized by a failure of the puborectalis muscle to relax during efforts to defecate, or by its paradoxical contraction. With an effort to evacuate the rectum, the puborectalis and the EAS normally relax to straighten the anorectal angle and open the anal canal. The diagnosis is suggested by the demonstration of a persistent impression of the puborectalis on the posterior surface of the anal canal during attempted evacuation of barium paste and, more reliably, by EMG evidence of increased electrical activity in the puborectalis muscle during straining."Pelvic floor dissynergia Failure of coordinated relaxation of the striated muscles (puborectalis muscles, external anal sphincter) during attempted expulsion of rectal contents. Studies suggests that this is a learned but unconscious act that often can be corrected by biofeedback techniques."New discussion on rome 111 and Functional Anorectal Disorders.F3a. Diagnostic Criteria for DyssynergicDefecation Inappropriate contraction of the pelvic ﬂooror less than 20% relaxation of basal restingsphincter pressure with adequate propulsive forces during attempted defecationF3b. Diagnostic Criteria for Inadequate Defecatory PropulsionInadequate propulsive forces with or with-out inappropriate contraction or less than 20% relaxation of the anal sphincter during attempteddefecation"Physiologic and Psychological FactorsFunctional defecation disorders are probably ac-quired behavioral disorders because at least two thirds of patients learn to relax the external anal sphincter and puborectalis muscles appropriately when provided with biofeedback training. It has been peculated that pain associated with repeated attempts to defecate large, hard stools may lead to inadvertent anal sphincter contraction, to minimize discomfort during defecation. However, rectal discomfort is not more common in pelvic ﬂoor dysfunction compared to normal or slow-transit consti-pation.57Anxiety and/or psychological stress may also contribute to dyssynergic defecation by increasing skel-etal muscle tension. Uncontrolled studies have reported sexual abuse in 22% of women with functional defecation disorders, and 40% of women with functional lowergut disorders, including functional defecation disorders.39,58 Treatment Functional defecation disorders are managed bypelvic ﬂoor training using (1) biofeedback techniques in which patients receive feedback on striated muscle activity recorded by anal or perianal EMG or pressure sen-sors59 - 62; or (2) simulated defecation in which the patient practices evacuating an artiﬁcial stool surrogate,perhaps combined with diaphragmatic muscle training.62 Controlled and uncontrolled studies suggest anoverall success rate of 67% to 80% after pelvic ﬂoor retraining for functional defecation disorders."http://216.109.125.130/search/cache?ei=UTF...=1&.intl=usYou said stress makes it worse."psychological stress may also contribute to dyssynergic defecation by increasing skeletal muscle tension."IF you have this on top of IBS C I can certainly understand.


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## Arnie W (Oct 22, 2003)

I can give an example about how I was not taken seriously at my last GI visit, Eric.I told the GI that I had got into the habit of manually removing leftover stool after my bms, this being because I assumed that I would otherwise be passing too much odorous gas, as well as to try to cut back on the number of toilet trips that I might make during the course of the day. In the written report I sighted later, I saw that he had written I was obsessive-compulsive and could benefit from perhaps visiting a psychologist. I do not have OCD - I have a problem of stool sitting in the rectum and the inability to empty it all out. Am I to assume that that is not considered a problem or, more likely, that there is no medical solution for this problem, so learn to live with it. BTW, I have drastically reduced the incidence of manual removing, but am still left with the problem of having a bowel that won't empty itself.But, Eric, I hope you will at least acknowledge that, for some of us, IE goes far beyond being just a mere sensation.


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## annie7 (Aug 16, 2002)

i have been following this thread with great interest since i've suffered from ie for almost 40 years. thanks, Naomi, for starting it and for all the info you shared and thanks Eric for all your time and information--i really do appreciate all your info. it really has helped me a lot to understand the mechanisms behind it all. understanding sometimes helps me to cope with the pain.and Arnie--i've had the same situation too where i could digitally feel stool still up there in the rectum although i had never been real successful with manual evac b/c i always tried to keep my stools soft which then made them hard to pull out so i had to give up on that (manual evac). and i think that's horrible what your dr wrote in your file. and so typical of uncaring uninformed docs who are not up-to-date on ibs, have no idea what we are going through and how it so adversely impacts our quality of life. plus, as someone mentioned in another thread about gastro docs on the ibs-c board, if one should decide to go to another doc, this kind of negative opinionated and false info in our file gets passed on to the new doc and often will negatively influence the new doc to typecast us.


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## eric (Jul 8, 1999)

Arnie, This thread is about a couple of different things. One was Naomi has more then IBS going on, she also has another functional disorder on top of IBS or that is the problem itself. I don't know. I know docs don't always take us as seriously as we want all the time or understand or don't get somethings wrong. Again there are good ones and bad ones. I had a doctor tell me my IBS was from abuse about 15 years ago or more when they thought abuse might lead to IBS, but I was never abused and now they know it doesn't cause IBS, but can make it worse.I here stories all the time about GI visits. Part of why I am trying to help here is really for that reason and to help.One thing here is type in sensation of incomplete evacuation and ibs and see how many things come up, a lot do from serious medical websites. It is even in the symptoms for IBS and I know its pretty common.When I was looking up somethings I found this, which is why he might have wrote that in the chart without really knowing you better.This is info from 2006APPROACH TO THE PATIENT WITH CHRONIC FUNCTIONALCONSTIPATION"Some patients report a distressing need to evacuate repeatedly for anyminimal amount of faeces retained in the rectum.This type of problemis usually associated with an obsessive-compulsive behaviour and isinterpreted by the patients as constipation. "I am just pointing it out. So for some out there it must be an issue. I would personally confront him/her on it.Its important here again, there is IBS and there are pelvic floor disorders and they can sometimes overlap.I looked up some studies also to look more into it. One thing here also is fasting and then looking at the problem. If there is no food in the system.this is just IBSColorectal Dis. 2006 Jul;8(6):488-93. LinksRectal sensation, pelvic floor function and symptom severity in Hispanic population with irritable bowel syndrome with constipation.Awad RA, Camacho S, Martín J, Ríos N.Colon and Rectum Physiological Section, Experimental Medicine and Motility Unit, Gastroenterology Service, Mexico City General Hospital, Mexico City, Mexico. [email protected]: In patients with irritable bowel syndrome with constipation (IBS-C, Rome II) we determined if pelvic floor function correlates with rectal sensitivity and tone, and if the pelvic and rectal measurements correlate with symptoms. PATIENTS AND METHODS: Sensory thresholds and tone in fasting and postprandial states were evaluated with an electronic barostat in 34 patients and 10 normal controls. The pelvic floor was assessed by defaecography. RESULTS: Pain threshold to rectal distension was lower in IBS-C patients (P = 0.007). Postprandially, IBS-C patients showed lower values for sensation of gas, perception of urge, and pain threshold compared with controls. In IBS-C the anorectal angle widened less and showed less perineal mobility during defecation; the rectal tone in fasting IBS-C patients correlated with the angle at rest (P = 0.04) and with the perineal descent at rest (P = 0.01). The severity of abdominal discomfort or pain, and abdominal fullness correlated with the anorectal angle. The duration of symptoms and frequency of bowel movements correlated with perineal descent. Straining, mucus expulsion, and the feeling of incomplete evacuation correlated with rectal sensitivity variables. CONCLUSION: Patients with IBS-C have lowered sensory thresholds for noxious and non-noxious stimuli, increased visceral sensitivity after food, less perineal mobility during defecation, and symptoms that correlate with rectal sensitivity and pelvic floor parameters.PMID: 16784468If you go into pubmed and type in irritable bowel syndrome and sensation of incomplete evacuation there is some info.This is NOT IBS but pelvic floor dyssynergia. Swiss Med Wkly. 2001 Mar 24;131(11-12):152-6. LinksPatient satisfaction after biofeedback for constipation and pelvic floor dyssynergia.Wiesel PH, Dorta G, Cuypers P, Herranz M, Kreis ME, Schnegg JF, Jornod P.Division of Gastroenterology, CHUV/PMU, Lausanne, Switerland. [email protected]: Patients referred for chronic constipation frequently report symptoms of straining, feeling of incomplete evacuation, or the need to facilitate defecation digitally (dyschezia). When such patients show manometric evidence of inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate, they are diagnosed as having pelvic floor dyssynergia (Rome I). AIMS: To evaluate long-term satisfaction of patients with pelvic floor dyssynergia after biofeedback. PATIENTS: Forty-one consecutive patients referred for chronic constipation at an outpatient gastrointestinal unit and diagnosed as having pelvic floor dyssynergia who completed a full course of biofeedback. METHODS: Data have been collected using a standardised questionnaire. A questionnaire survey of patients' satisfaction rate and requirement of aperients was undertaken. RESULTS: Mean age and symptom duration were respectively 41 and 20 years. Half of patients reported fewer than 3 bowel motions per week. Patients were treated with a mean of 5 biofeedback sessions. At the end of the therapy pelvic floor dyssynergia was alleviated in 85% of patients and 49% were able to stop all aperients. Satisfaction was maintained at follow-up telephone interviews undertaken after a mean period of 2 years, as biofeedback was helpful for 79% of patients and 47% still abstained from intake of aperients. CONCLUSIONS: Satisfaction after biofeedback is high for patients referred for chronic constipation and diagnosed with pelvic floor dyssynergia. Biofeedback improves symptoms related to dyschezia and reduces use of aperients.PMID: 11416888This is something also"Fecal impaction, in which stool in the last part of the large intestine and rectum hardens and blocks the passage of other stool, sometimes develops in people with constipation. This condition is particularly common among older people, pregnant women, and people with an inactive colon (colonic inertia). Fecal impaction leads to cramps, rectal pain, and strong but futile efforts to defecate. Often, watery mucus or liquid stool oozes around the blockage, sometimes giving the false impression of diarrhea. Fecal impaction can aggravate or further worsen constipation."This in part goes back to Naomi's issues"Dyschezia: Dyschezia is difficulty in defecating caused by an inability to control the pelvic and anal muscles. Having a normal bowel movement requires relaxing the pelvic floor muscles (the muscles that support the bladder, uterus, and rectum) and the circular muscles (sphincters) that keep the anus closed. Otherwise, efforts to defecate are futile, even with severe straining. People with dyschezia sense the need to have a bowel movement but cannot. Even stool that is not hard may be difficult to pass.Conditions that can cause dyschezia include pelvic floor dyssynergia (a disturbance of muscle coordination), anismus (a failure of the sphincter muscles to relax during defecation), rectocele (hernia of the rectum into the vagina), enterocele (bulging of the small intestine and the lining of the abdominal cavity between the uterus and the rectum or between the bladder and the rectum), rectal ulcer, and rectal prolapse (protrusion of the rectal lining through the anus).http://www.merck.com/mmhe/sec09/ch119/ch119b.htmlI am working soon on getting some expert info on all this, but like I was pointing out do a search on just the sensation of incomplete evacuation and IBS, it comes up a lot. This also doesn't mean anyone makes it up in there heads. That's NOT was this is all about. Some people may have other problems and others a sensation of incomplete evacuation while nothing is really there, which can and does happen. Those people are important too, yes?


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## Naomi889 (Sep 11, 2005)

Subject of threadLook, Eric, I’m the one who started this thread, and this thread was meant to be about only one thing, the collection of the experiences of people with the symptom of actual incomplete evacuation, i.e. constipation, after a bowel movement. My reason for doing this is I believe that it is a very poorly understood symptom and it is therefore extremely helpful for those of us suffering from this condition to share our direct experiences of it. I am not denying that perceived IE due to rectal hypersensitivity also exists, I am sure you are correct. But the very fact of it’s existence is doubtless part of the reason that Arnie, Annie and I have had occasional difficultly in being taken seriously about the physical reality of our constipation symptoms and subsequently treated by the medical profession, and therefore if we could please just drop the subject of rectal hypersensitivity and all mentions of “sensation” for now, I think that would be far more helpful to the intended purpose of this thread.Incidentally you also assert to Arnie that “Naomi has more then IBS going on, she also has another functional disorder on top of IBS” – well that’s one opinion. As I stated, I believe anismus/non-relaxing pub/pelvic floor dyssynergia (all terms that are more or less being used to describe the same phenomenon) is still quite a new area of investigation, but I believe that there is some newish evidence that around 40% of people with IBS-C may be experiencing this problem. Now as I assume you of course would know, IBS is a “functional disorder”, i.e. if you comply with a certain set of criteria (the Rome criteria in this case), you have IBS. It is not a “positive/negative” diagnosis like ulcerative colitis or diabetes etc. etc. Therefore, I do have IBS, and I’m trying to share my experiences of IBS with others with a similar type of IBS.Biofeedback therapy – interested in the opinions of others’Towards a solution!!! – now I am interested in the experiences (not just Pubmed abstracts) of those with actual IE (maybe we should just call it that) of biofeedback therapy. Has anyone with IE or other IBS-C spoken to or heard from their doctors about this? I have just started this, or am just about to – the original machine I received turned out to be broken! Now Eric has helpfully already brought this one up via the literature, but just to cover it once again – the idea is that in people with the anismus etc problem, the body has “forgotten” how to make this muscle function properly, and via a probe with a sensor one can attempt a series of exercises in order to try to “retrain” this muscle into proper functioning. And it does have a fairly good success rate!!! Now as someone with this problem, to a certain extent this has always sounded a bit hairy to me – I mean I didn’t just wake up one day six years ago and “forget” how to go to the toilet properly, and I don’t really see what it is I’m missing in trying to get the darn thing to function properly! The idea is that healthy people can contract or relax this muscle, and people with anismus etc are contracting this muscle when they tell it to relax! There is a pressure sensor on the probe, so you set a baseline, and there’s a wee light that should go up when you contract and down when you relax. Now I was diagnosed via a series of contraction/ballon hospital tests with this anismus thing, but my faith in the validly of these gastros’ theories was shaken somewhat yesterday when I was back at the hospital being taught how to use this machine and found that actually, I can make the light sensor go up and down!!! (I should only be able to make it go up if I really cannot relax that muscle!) However, the nurse assured me that in fact some people with my diagnosis could still register contractions and relaxations with this probe, but still found the exercises you do with this machine to help greatly with their symptoms. I believe her, as she sees a lot of patients with this problem, but it does not entirely make sense to me. I theorised that perhaps I and some others with this problem can relax the muscle but not for long enough to “complete” a bowel movement and she said perhaps that was likely. The “defecation programme” and the understanding and treatment of IE and anismusNow there is a second problem with this theory, and I’m still trying to work this one out myself so any suggestions/other people’s experiences would be greatly appreciated. Now the GI nurse yesterday told me that this muscle is ENTIRELY VOLUNTARY as in you are in COMPLETE potential control of it. As in, if I just did the right muscle action and didn’t “fret” and “tense up”, I could control this, and would be able to fully complete a bowel movement. But I’m now starting to lose faith in her knowledge a bit as this contradicts my own experiences of IBS, and also what her boss, the gastroenterologist, said. Stick with me here, cos I’d really like others’ opinions on this. My only symptom really is incomplete evacuation after every bowel movement even though I am able to “go” ever day. As I mentioned at the start of this thread, the severity of this constipation from IE has periodically got worse over the years for me. As in, I’ll be in a certain level of discomfort and constipation after every bowel movement, i.e. the same level of constipation, day after day after day, for say, 9 months or so. That is to say, I’m going to the bathroom every morning, and the relevant muscle is “stopping” or “contracting” at the SAME point every day. Then, after mild stress or whatever, one day, all of a sudden that level of constipation gets worse, as in, to be gruesome, the amount of stuff in there has gone up. And even though I’m still going to the toilet every day IT STAYS AT THAT SAME LEVEL, every day. Now the ONLY explanation for this is that, in line with the gastroenterologist’s theory that I posted earlier, is that the body runs a “program” for going to the toilet. Even a healthy person has a significant amount of stool in their bowels after they have finished going to the toilet, and it is likely that at a certain point the body says “stop, there’s 40 mls in there now, we’re finished”. But for me and probably others with IE that “stop” baseline has CHANGED to e.g. 400mls, and it my case the baseline keeps on changing periodically i.e. its 400mls every day for 10 months, then I get a bit stressed and it permanently changes to 440 mls! With me, anyone?? There is a point to all this I promise!! So what I’m saying is, you go to the toilet, and if you’re a healthy person the relevant muscle contracts – stops relaxing – when there is e.g. 40 mls left in your bowel. For me and others with IE maybe that muscle isn’t generally working very well, but it definitely contracts and just won’t relax again when there is e.g. 400mls left. AS IN, THIS IS NOT A COMPLETELY VOLUNTARY ACTION – the body is running a sort of “defecation programme” in parallel with your voluntary control of this muscle. So the nurse cannot be totally correct, which makes me lose faith in this treatment a bit!!!!Thanks to anyone who stuck with me through that. I know I put it in quite a convoluted way, but I actually think it’s a really sound theory and was confirmed for me by the gastroenterologist. Unhelpful health professionalsThe nurse just did not understand what I meant at all, and I thought she could at leas have tried! I mean my direct experiences tell me this “defecation programme” and “stop” theory is correct, and if a GI nurse is just completely incapable of understanding what I mean, how much hope is there of successful treatment for people like us? If more researchers and doctors had IBS-C, anismus or IE as their “research interest” and were genuinely interested in EXACTLY what was going on in people with these problems, there would better treatments. I’m afraid I lost my temper and said this to the nurse yesterday. I know she’s probably the only one who can help me but…arrgh!..back to the topic of unhelpful medics, Arnie, the nurse said “IBS can really affect the quality of your life you know, people start thinking about it alot”. I said, look, I’m in constant severe, physical discomfort, OF COURSE my IBS is all I think about (so bad that sex has even become too painful, I’m dam*ed lucky not to have been dumped by my lovely boyfriend by now, though I didn’t tell her that bit.) “Oh well I think that’s the problem then” says the nurse “You’re thinking about it so much that you just can’t relax properly every time you go to the bathroom”. Oh God, sometimes I just want to force feed these people their own entrails, and to think that they’re the only ones who can help me…….Anyway, sorry for the mammoth post. To return to the point and to get the thread back on track, I would be really, really interested in 1) The experiences of other people with actual IE 2) People’s opinions of biofeedback therapy as a treatment for IBS 3) People’s opinions of and experiences of the “Defecation programme”/“Stop” theory that I mentioned earlier.I would particularly love to hear from Arnie and Annie again.


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## SpAsMaN* (May 11, 2002)

Naomi,this week i post this research on IE from UK:The research is available on-line.Save it on your computer and print it:http://www.springerlink.com/content/2p1f91...y3/fulltext.pdf In the meantime if you want to promote evacuation,look at my avatar and put your butt in the air.I swear this position promote movement of stuff.Gas and stools.


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## annie7 (Aug 16, 2002)

Spasman--so that's what your avtar is doing! great idea--i do this a lot to release trapped gas although it's never helped with trapped stools. thanks for posting the link but i couldn't get it to come up--keep getting the page not found screen. i'll keep trying.Naomi -- i've never had biofeedback for ie. my insurance won't pay for it and no way can i afford to pay out of pocket for it or even switch to a better but much more expensive insurance company right now. i do remember a thread on this board this past summer where a couple people were discussing their experiences with biofeedback and also physical therapy if i remember correctly.I currently do not have a gastro doc. couldn't find a good one (long story). for the past year and a half i've been trying to manage my ie by keeping my stools almost liquid with nightly milk of magnesia b/c for me it's easier to go more completely this way. i've been experimenting with stool consistency for quite a long time and medium hard as well as soft stools are harder for me to completely evacuate. but the mom alone isn't enough. i also need the peristalic push to evacuate completely. zelnorm works great for this but unfortunately zelnorm does not work if i take it every day so i take it every two or three days with periodic holidays. i seem to build up a resistance to drugs pretty quickly. on the days when i do not take zelnorm i alternative various stimuant laxatives like senna, cascara sagrada, triphala, ducolax--i rotate them and i take a weekly two day break from all of this so as not to over do things and to give my body a rest. i also take longer breaks from the stimulants for about a week or so periodically.during these "break" times, when i feel incomplete and really bad i use a plain glycerin suppository and sometimes that helps. if it doesn't help by getting stool out, i may try an enema and sometimes that helps. when the supp or the enema do help that indicates to me that my ie feeling was indeed caused by stool stuck in the rectum--or maybe even higher up in the colon--that's when the enema helps, when it's higher up. other times, when i try the supp or the enema, nothing comes out but i still feeling that icky ie feeling of fullness, bloated crampiness. very uncomfortable, painful--- hate being that way all day but what else to do..i'm guessing then that this is caused by the hypersensitivity that some of Eric's articles mention. or else maybe ?? stool stuck way up there b/c sometimes the crampy stuck feeling is really quite a bit higher up, more like across the abdomen--is that the transverse colon?--not in the rectum or even in the lower colon. i don't know...maybe it's the hypersensitivity but whatver the cause, ie is miserable. just trying to cope with it anyway i can.so anyway, these are my experiences. and i suppose i should add a disclaimer here and say that i am not necessarily advocating this routine for others--it's just what i personally have chosen to do after suffering for 40 years with ibs-c and ie--predominately ie. i'm just sick and beyond tired of it --all the pain and the misery--and what it has done to my life.


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## eric (Jul 8, 1999)

Naomi, This thread can help all people you and others. "Incidentally you also assert to Arnie that "Naomi has more then IBS going on, she also has another functional disorder on top of IBS" - well that's one opinion."No that is what you have posted. It is also very important. Which is in part why your intial post wasn't clear until you also posted about the Functional Anorectal Disorder on top of IBS.It is EXTREMELY important to understand they are two sperate conditions.The cause of IBS C is NOT anismus. IBS C has to do with the functioning of the sigmoid colon. They have a lot of evidence on why there is a malfunction in the sigmoid colon that leads to d or c or d/c and it has to do with the release of serotonin from specific cells in the gut called EC (enterochromaffin cells.) altered serotonin signaling and ibs compilationhttp://www.ibsgroup.org/forums/index.php?showtopic=80198Its important then to get people's experiences that they share both problems like you do IBS C and anismus. Because the experiences with just IBS cers is not the same as your problems. Although they can have issues with evacuation. They also know people with IBS C can have viceral hypersensivity of the colon and rectum. This is already known and it to is important for those with IBS to talk about and understand in regards to IBS.If you don''t talk about this and seperate the issues, other people without anismus will be confused about there own symptoms as they relate to yours. There are also others like you with Functional Anorectal Disorders and IBS because functional gi disorders can overlap. IBS and functional dyspepsia frequently overlaps.IBS is a "functional disorder"Yes with a "specific cluster" of symptoms and it is a distint entity and it is a secure diagnoses.anismus is a Functional Anorectal Disorder.They are not the same problem!!! Which is why they have there own rome classifications.IF you have IBS you have a functional problem of the sigmoid colon.If you have anismus you have a functional problem where there is "failure of the puborectalis muscle to relax during efforts to defecate."Arnie or Annie, were either of you diagnosesd with IBS and a pelvic floor disorder?These are experts on biofeedback for Functional Anorectal Disorders.BiofeedbackBiofeedback treatment for functional anorectal disorders: A comprehensive efficacy review. Applied Psychophysiology and Biofeedback. Treatment of Functional Anorectal Disorders: Biofeedback Is Proving Its Value Like Never BeforeOlafur S. Palsson, PsyD, and Steve Heymen, MSCenter for Functional Gastrointestinal and Motility Disorders, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NCKeywords: anorectal disorders, biofeedback, fecal incontinence, functional anorectal pain, pelvic floor dyssynergia"Biofeedback for functional anorectal disorders is a specialized biofeedback application with a 30-year history. This article summarizes the nature of the disorders that are responsive to this treatment, the techniques used, current status of the evidence of efficacy, and some of the latest research work that is rapidly strengthening the empirical case for the value of anorectal biofeedback."I have to come back and post the link here on this.alsoBiofeedback therapy for dyssynergic defecationGiuseppe Chiarioni, Steve Heymen, William E Whitehead"AbstractDyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because there are no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining (increasing intra-abdominal pressure) and having the patient practice defecating a water filled balloon. In adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises (described as sham biofeedback), and drugs to relax skeletal muscles. *Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation.* However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults."Diagnostic criteria for functional defecation disorders[4] include those for functional constipation[5], namely two or more of 6 symptoms present for the last 3 mo with an onset more than 6 mo in the past; the symptoms are straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction/blockage, or manual maneuvers to facilitate defecation on more than 1/4 of bowel movements, or less than 3 bowel movements per week. To meet criteria for functional defecation disorders, the patient must also undergo objective diagnostic testing and demonstrate at least two of three abnormalities: impaired evacuation of the rectum, inappropriate contraction or less than 20% relaxation of the pelvic floor muscles, and inadequate propulsive forces during defecation[4]. "http://www.wjgnet.com/1007-9327/12/7069.asp


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## annie7 (Aug 16, 2002)

Eric- i have only been dx'd with ibs-c. i have not been through the testing for any pelvic floor disorders. my previous doctors never even brought up the subject of pelvic floor dysfunction. i had been thinking of trying to get a gastro doc next year and asking for the tests for pfd but my insurance company told me they will not pay for bio feedback and in fact the rep i talked to said they wouldn't even pay for physical therapy for ibs which sounds kind of restrictive to me but then again i had to battle and battle with these guys to get them to pay for zelnorm for me way back when it first came out and even then they would only pay for six months of it and then cut me off completely and forever. so anyway, i'm not really sure going through the pfd tests would help a lot in the long run b/c even if it turns out that pfd is part of my problem, it doesn't look like my insurance company will help me pay for a solution to it.thanks again, Eric, for all your informative posts. it helps to try to learn as much about this as possible.


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## eric (Jul 8, 1999)

Annie, there are somethings I want to post about your post here, but I have to get to work. Some of the treatments that work for IBS C don't work for pelvic floor disorders and vice versa.This is from 99 even and they have made a lot more progress then when this was written on IBS.ButFrom our improved appreciation of the role of the pelvic floor and anal sphincter muscles in the process of evacuation (Figure 2) and of disturbances in the dynamics of defecation,[10] *it is clear that pelvic floor disorders may produce a syndrome virtually identical to the so-called constipation-predominant IBS. Therefore, a history of excessive straining, a sense of incomplete evacuation, or the need to digitate the rectum or vagina to facilitate emptying of the rectum are all features associated with pelvic floor or anal sphincter dysfunction.[8,10,25] In patients with constipation, it is essential to perform a careful rectal examination that includes assessments of the anal sphincter tone at rest, the ability of the puborectalis to relax during straining,[10] and the descent of the perineum during straining.[25] Simple screening tests, such as the balloon expulsion test and measurement of perineal descent, are available to confirm the clinical diagnosis. * Figure 2. (click image to zoom) Pelvic floor and anal sphincter functions involved in continence and defecation. Continence requires: contraction of puborectalis, maintenance of anorectal angle, normal rectal sensation, and contraction of sphincter. Defecation requires: relaxation of puborectalis, straightening of anorectal angle, and relaxation of sphincter. Reprinted with permission from Camilleri et al.[8] *The differentiation between evacuation disorders and IBS-constipation has important practical implications. For example, a prokinetic agent for constipation is unlikely to work in patients with evacuation disorders. Much direct and indirect expenditure attributable to IBS might be avoided then if more attention were placed on the rectal examination of these patients. **Colonic and rectal hypersensitivity are very relevant in IBS patients with diarrhea and urgency.[26-28] Hypersensitivity has been proposed as a biologic marker of the condition[28]; however, the lack of responsiveness of rectal hypersensitivity in clinical trials[29] and its poor correlation with clinical responses challenge whether this symptom can be used as a biologic marker.[*30] Anxiety, psychosensory function, and limbic system activation may contribute to the increased rectocolonic sensitivity.[31-33] In summary, the evidence for hypersensitivity in IBS is considerable, but the proof of its clinical relevance will depend on the development of effective therapies and documentation of clinical benefit by restoring normal sensation.[34]"http://www.medscape.com/viewarticle/407938_4Its been esimated some 80% percent of IBSers have rectal hypersensitivity. They know longer view it as a possible biological marker anymore though. But it can help to support the diagnoses for IBS. What I am posting here has significant relavance to this thread and effective ways for people to manage different functional disorders here.


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## Arnie W (Oct 22, 2003)

This has become a very intersting and helpful thread and I will need to come back again to digest more of it. Thankyou all for contributing.Spas, I couldn't open your link either.As for the symptoms for functional defecation disorder which eric tabled, they fit me perfectly, more so than symptoms for IBS. Though, as I said earlier, I was diagnosed by my last GI as having a functional disorder rather than IBS. And in reply to eric's question, I have never had pelvic floor testing or biofeedback, despite having been through the whole spectrum of therapists. I am now convinced that it is worth considering, though I need to do some research to make sure I get a genuine practitioner.I noted the reference to obsessive-compulsive behaviour in regard to IE and can see where my GI was coming from, but my IE is usually not minimal. I also have a fairly constant feeling of fulness in the rectum, which can be uncomfortable, but does not get to the level of requiring pain relief. If I'm by myself I'll often ignore the urge to defecate created by that fulness and let out gas if I have to. When I'm at work, I respond to the urge a lot more.I don't know what others feel, but from my research I believe that it is normal for the rectal area to be clean after a bm. That's what I am aiming towards, anyway.


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## SpAsMaN* (May 11, 2002)

Here the link again:IE:http://www.springerlink.com/content/2p1f91...y3/fulltext.pdf


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## annie7 (Aug 16, 2002)

Eric--thanks for the link to that medscape article. i read the whole thing--very helpful and informative.Spasman--that link you posted still won't come up. is it because you have to be registered at the site to read it?


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## SpAsMaN* (May 11, 2002)

OK HERE THE LINK.SAVE IT ON YOUR PC.ON THE RIGTH SIDE OF THE PAGE,YOU *CLICK ON PDF *TO GET THE ENTIRE RESEARCH:http://www.springerlink.com/content/2p1f91yk4l2l9ay3/YOU HAVE TO -RIGTH CLICK- ON THE LINK TO SAVE IT I THINK...


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## eric (Jul 8, 1999)

Annie, I am still at work so I will post tomorrow somethings for you.Arnie, if your weren't diagnosed with IBS what did they say/ There is also functional C or functional d or functional abdominal pain. There is some thirty functional disorders.Perhaps it was functional C.Functional d or c is kindof like IBS without the pain.Pain or discomfort is a must for an IBS diagnoses. Functional disorders can effect the entire digestive tract. Functional despepsia is a problem with the esphogus. IBS a problem with the large intestines.Both IBS and dyspepsia shared altered motility, viceral hypersensitivity and brain gut axis dysregulation.In IBS the strongest evidence is from the release of serotonin in the gut from those ec cells is impaired, so the release can cause d or c or d/c.Those cells are pressure sensivitve to stimuli, theact of eating, stress, hormones and other issues. Serotonin is also the neurotransmitter that sends signals to the brain in regards to sensations arising from the gut. Normal people don't feel their gut functioning all the time. IN IBS there is an issue with the information the brain receives from the gut. The brain has mechanisms that keep it from getting regular signals from the gut unless there is a problem. In IBS the "gate" that keeps the signals from entering the concious mind is out of whack so we receive signals we shouldn't from the vicera.Another very important cell in regards top IBS is the mast cell embedded in the gut wall close to the ec cells. The mast cells have been implicated in IBS now for years along with the ec cells. I will come back to those though.I have rectal hypersensvity even to the point where I can feel my rectum, without any urge to deficate, the feeling is just there sometimes. Of course other things can conribute to feelings there like hemmie ect... Although the HT did a number on that as well as all my other symptoms. There is actuially a study showing HT helps rectal hypersensivity in IBS.Part of my points here is the treatments for these disorders can be different. Zelnorm may work for IBS C because its a drug that works on the 5ht receptors and serotonin release, but not for pelvic floor disorders. They may use biofeedback in some IBS patients, but its more for pelvic floor disorders then IBS. These are some of the reasons its important to talk about these things.I will find a graph though on the anal rectal canal and point some important things out there. The rectum is one of the most sensivitve parts of the body. If the cells there were not sensitive and signal to the person conciouly you would poop your pants and not know it until is was to late. The mechanism or defecation reflex is very very complex. Its also NOT a good idea to regularly ignore the Defecation Reflex. That can create problems as well.This is putting it simply really. Also as you can see here the brain is involved.Defecation is the process by which faeces (stools) are ejected from the rectum. This is a co-ordinated *neuro*muscular process involving relaxation of the muscles that normally maintain continence at other times.When sufficient faecal material has entered the rectum, the 'call to stool' is evoked. Distension of the rectum by inflating a balloon can reproduce this sensation and invoke the relaxation of the sphincters which allow defecation to proceed. Providing the continence mechanisms are intact the relaxation can be voluntarily overridden-the 'call to stool' can be delayed until it is socially convenient to defecate.The most common physiological stimulus to defecation is eating. This initiates the 'gastro-colonic reflex' which results in increased motor activity in the colon and the passage of faeces from the colon into the rectum. Sitting or squatting straightens the angle between the rectum and the short anal canal, and contractions in the colon force additional stool into the rectum to initiate a defecation reflex and sphincter relaxation. Although many individuals 'strain' (perform a Valsalva manoeuvre: see blood pressure), which increases intra-abdominal pressure and facilitates movement of faeces into the rectum, this is not strictly necessary since the process will proceed automatically.There are two major - and opposite - disorders of defecation, namely faecal incontinence and obstructed defecation.Faecal incontinence results when the anal sphincter is no longer competent to prevent the unscheduled evacuation of faeces. This may occur as a result of injury to the local nerves serving the sphincters or as a result of disease of the central nervous system, notably dementia, mental retardation, stroke, brain tumours, and spinal cord lesions. Local nerves may be affected as part of widespread nerve damage (polyneuropathy) in conditions such as as diabetes mellitus, although perhaps the most common situation is that of sacral nerve damage associated with pregnancy and delivery. Incontinence may also occur as a result of primary muscle disorders or as a result of direct sphincter damage following surgery, radiation, or inflammatory disorders. Incontinence can also occur in the irritable bowel syndrome and in situations of extreme anxiety.Obstructed defecation. Recently it has become apparent that some individuals with constipation have a problem with co-ordination of the process of defecation, and a failure to relax pelvic and sphincter muscles to allow the evacuation of faeces. This may be part of the spectrum of sacral nerve damage, although there is also evidence that there may be a psychological component in addition.Management of defecation disordersDegenerative neuromuscular disorders which affect the defecatory process are extremely difficult to treat and in some instances a colostomy is the only socially acceptable intervention. However, when there is evidence of traumatic damage to the anal sphincter, surgical repair is a possibility. In individuals with only partially impaired sphincter function, continence can be maintained for some time with the use of simple anti-diarrhoeal drugs and possibly bulking agents. There is no universally accepted treatment for obstructed defecation, although psychotherapy and behaviour therapy, particularly using biofeedback techniques, have been successful.- Michael Farthing, Anne Ballingerhttp://www.answers.com/topic/defecation?cat=healthalso for IBS D this is why the act of eating and not the food itself can trigger d. There is also more serotonin released right after eating in d patients."The most common physiological stimulus to defecation is eating. This initiates the 'gastro-colonic reflex' which results in increased motor activity in the colon and the passage of faeces from the colon into the rectum."'The sigmoid colon over reacts to eating and food in the colon moves to the rectum to make room for more food coming and the over reaction causes d.


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## annie7 (Aug 16, 2002)

Spasman --thanks for the link--got it this time.


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## Naomi889 (Sep 11, 2005)

Annie – you say “I had been thinking of trying to get a gastro doc next year and asking for the tests for pfd but my insurance company told me they will not pay for bio feedback and in fact the rep i talked to said they wouldn't even pay for physical therapy for ibs which sounds kind of restrictive to me but then again i had to battle and battle with these guys to get them to pay for zelnorm”I have been flabbergasted at some of the prices for biofeedback therapy quoted by some of the U.S. based posters on this forum. And your insurance company won’t pay??? That’s outrageous! I thought that Michael Moore film was a bit exaggerated till I read some of the stuff on this forum! The waiting list in here in the UK for biofeedback therapy is over 2 years, but you can also opt to pay £100 (about $200) for a biofeedback machine ordered over the internet and they will train you to use it which is what I have done! Bear in mind that I don’t know whether it has worked for me yet, but if I were you I’d try to get all the tests possible!Eric – with regard to IBS-C and what is variously know as anismus/non-relaxing pub, you say that :“It is EXTREMELY important to understand they are two sperate conditions.The cause of IBS C is NOT anismus. IBS C has to do with the functioning of the sigmoid colon. They have a lot of evidence on why there is a malfunction in the sigmoid colon that leads to d or c or d/c and it has to do with the release of serotonin from specific cells in the gut”I think it is quite misleading to say this. I have never asserted that the cause of ALL IBS-C is anismus, just that there have been quite a lot of suggestions in the literature lately that this condition (anismus) may well be very under-recognised and involved in quite a significant no. of cases of “IBS-C”. Many (most?) doctors would not take this to mean, however, that these people do not have IBS! As in, this may well be an under-recognised facet of IBS (which is, in the case of both C and D, a multi-faceted disorder!). Which is why I’m throwing out there the suggestion of it’s linkage in particular to IE. For example, here in the UK (are you other posters all US based?) there are only two gastroenterologists specialising in these “obstructed defecation/anismus” problems, one in Edinburgh who I see and one in London who a girl I email sees. We have both been diagnosed with the “Non-relaxing.pub.” thing, but both these HIGHLY experienced specialists still consider our diagnoses to be “IBS” (even though they think that our IBS is caused by the malfunctioning muscle thing, it’s still a stress induced disorder of the gut). Incidentally I have in fact tried a prokinetic drug, and it did indeed help me!Your familiarity with academic literature (and you clearly are very well read) has surely demonstrated to you that these sorts of things are NOT always accepted, definitive facts, especially with a multi-faceted and complex disorder such as IBS! I.e. one paper which asserts or accepts that IBS and non relaxing pub/anismus are completely separate disorders will certainly be contradicted by a good many others, as too little is know about this to be definitive!! Do you know what I mean? A google or Pubmed (www.ncbi.nlm.nih.gov/sites/entrez ) will show any posters that many in the medical profession do indeed include anismus/obstructive defecation under the umbrella spectrum of IBS.Additionally a wee anecdote about serotonin. “In IBS the strongest evidence is from the release of serotonin in the gut from those ec cells is impaired”, when in fact the history of this issue is I think a little suss (no doubt it is involved in some cases, but it is not necessarily definitive for IBS-C), and has to do with the drug know in the States as “Zelnorm”. The reason Zelnorm was licensed for use as a drug for treatment of IBS-C was that the tegaserod maleate (the chemical name for Zelnorm) was being used in a study of something completely unrelated on rats (sorry, I’ve forgotten what now), and someone happened to notice that the tegaserod was speeding up the rats’ gut transit times. Cue clinical trials for tegaserod for IBS-C, and THEN the plethora of research into serotonin signalling! As Zelnorm does not help everyone, it would seem to me that it is more likely that this is an aspect of some and not necessarily all IBS-C.


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## eric (Jul 8, 1999)

Annie, yours sound like IBS. Especially if they gave yo8u zelnorm and it helped. When you take that do some of the other symptoms get better, bloating, feeling full, pain ect..?Its still worth having them check for pelvic floor issues though perhaps, or at least asking.The sigmoid colon usally works by contractions that push the stool out, but in IBS those contractions can happen anywhere along the length of the large colon and trap stool or gas, altered transit. IN IBS this can cause pain or weird feeling, in part because of the pressure sensitive cells there that release serotonin. They just released miralax OTC also so you know.I am still looking for a certain graph on all this in regards to anal rectal functioning.The above link Spasman posted is when they find people with anal rectal problems, not just operating on IBS. Also a slight issues with the statement virtually identical to IBS with the pelvic floor issues, that is not exactly totally accurate, very similar would be better.


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## annie7 (Aug 16, 2002)

thanks, Eric. oh yes, when i take zelnorm i feel great--complete evacuation, no pain, no bloating--absolutely terrific. i only wish it would work like that for me when i take it every day but it doesn't--guess i build up a resistance to it quickly. so i take 6 mg every other day with periodic holidays and then i get great results from it. thanks again for all your hard work in providing all this info. i've bookmarked this page and printed out a lot of the stuff too for future reference.oh yes, Naomi--i was tempted to contact Moore about my insurance company during the time he was soliciting info from people for his movie. the insurance guys told me they consider biofeedback an alternative treatment and they don't cover those...


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## Naomi889 (Sep 11, 2005)

Eric, now your information might just be misleading other posters and this is NOT fair. As I said in my last post, the two main gastroenterlogists in the UK who specialise in pelvic floor dysfuntion STILL consider those who are diagnosed with this to have IBS if IBS is what they are already considered to have!!!!!!!!!! So just because Zelnorm works for Annie or she has IBS does not also mean there is not a chance she has a pelvic floor dysfunction as part of this IBS. Zelnorm is a prokinetic agent, and a prokineic agent working on the same principles as Zelnorm helped me bit, even though if we went with your definition I have a pelvic floor dysfunction and NOT IBS!!


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## AIRPLANE (Mar 15, 2004)

Naomi,I too have had incomplete evacuation as a very bothersome symptom the entire time I have had this so-called 'IBS' for over 23 years now. The first several years I had violent diarrhea several times a day, pelvic pain 24 hours a day. As time went on, it became pretty much both D & C. In either case, I very rarely seem to feel as though I have finished, and even when I do, it turns out that I wasn't. And I do believe that as time goes by that the problem can get worse because this is not how the body is supposed to function. For example, how can you NOT strain? Who wants to leave the house knowing they will be carrying this around with them the rest of the day? Yet straining definitely can lead to more problems- such as a rectocele- which can cause even worse IE.I went to the Mayo Clinic in Minnesota earlier this year to get advice for a rectocele. I was hoping to go through the extensive IBS program they tout on their website but no such luck. I did see a gastroenterologist who ordered an anal manometry and a defecography test. For the manometry test, they blew up a balloon and I was to evacuate it and I failed to do so. On the defecography test, they had me clean everything out starting the day before, then fill you with a substance to 'duplicate stool' and watch you evacuate it.They said I strained too much to get it out and therefore must have non-relaxing pelvic floor muscles. Although I strained, I did get everything out but then I feel that that provides limited information in regard to IE because 1) I was otherwise totally cleaned out before the test and therefore had nothing more to evacuate and 2) the substance they put in to duplicate BM was much firmer and larger than what I myself normally produce. Whether or not I take fiber, whether I have constipation or diarrhea, I cannot form "normal' sized stool. As a result, I feel the information from the defecography was somewhat limited as far as reproducing what I normally deal with- however, I was willing to try the recommended treatment of biofeedback.The doctor put me on a waiting list to have two weeks of biofeedback at their clinic which was scheduled for this past October (which was 4 months away at the time). However, my insurance company wouldn't cover biofeedback so it would have cost me between $6,000.00 and $7000.00 which was out of the question. The doctor didn't tell me this was a possibility and I figure he'd have nothing more to tell me so I haven't gone back. Unbelievable that a doctor at a major clinic would prescribe something at their very own place and my insurance- a fairly big, reputable company- wouldn't oblige!However, I did see a urogynecologist before I saw the gastroenterologist and he gave me his card to use as a referral for either biofeedback or physical therapy closer to my home. Finding someone who specializes in this type of thing wasn't easy but I finally managed to locate one not too far away. The physical therapist's opinion was not the same as the doctors' though. She said my pelvic tone was good and that biofeedback wouldn't help. She did however try it out on me in the office and she concluded that everything was fine in that regard. She said that as a physical therapist she had the luxury of coding it differently- instead of reporting it as biofeedback she could call it muscle therapy- and therefore insurance would cover the cost. Again though, she said it wouldn't help in my case. Her conclusion was that I have scar tissue, which is something I initially used to bring up with doctors but eventually I got tired of their ignorance on the subject. She recommended a firm massage of the abdomen, also exhaling completely and sucking my abdomen in. I will be seeing her tomorrow again for the first time in a few weeks as she moved to a new location and was not available for a month or so. Whether it helps or not we'll see but at least I feel she is TRYING to help, and I only have a $15.00 co-pay per visit. I'll give you some of my history, it may get a bit long-winded but then I've had this a LONG time! This is basically to demonstrate my agreement with some statements that you made- like the "catch-all" aspect of the term IBS, and that if doctors were really interested in what you have to say and would work with you, many sufferers probably COULD find relief! I mean, tests and x-rays are good for some things, but shouldn't the best source of information be you, the sufferer? And where does the knowledge in the medical books get discovered in the first place- didn't it come from actual patients? Don't any of these doctors want to be the first to discover 'ground-breaking' information that could maybe help others as well as their own patients? I think the term IBS was a newly-coined term back in 1984 when the problem for me first started and I think it was on the tip of many doctors' tongues- my first doctor diagnosed it without even coming into the room- he just stood in the doorway, chuckled and said 'You have irritable bowel syndrome. Eat lots of fruits and vegetables. I'll have the nurse give you a copy of a bland diet' and that was it. No examination, no NOTHING! My big problem began 23 years ago after a lifting injury on the job. Something in my lower right quadrant gave way and I developed several symptoms after that- a tight and suddenly bloated abdomen, a twisted feeling in my right abdomen, a constant noisy sound like fluids were trying to get through a tight area,a falling-out feeling in my pelvis, pelvic pain, went suddenly from years of constipation to violent diarrhea, a feeling of lack of circulation, particularly along basically my entire right side, generalized edema (water-weight gain)., a feeling of things being 'glued together' .When I would describe all of this to the doctors, in particular the lifting incident, they would turn off almost immediately. The harder I would try to explain things, the more detailed I got, the angrier they would get and it became clear that none of these people really wanted to help me get to the bottom of this- very frustrating and I hear this same feeling in your posts. When I would try to describe how it was destroying my life and my dignity, many of them would actually laugh! I think they probably type-cast me as a young, vain woman who was exaggerating about a bloated abdomen and some gas and maybe thought it was 'ruining' my dates (even though I wasn't dating at the time and due to this condition never would). One doctor did consider endometriosis but ruled it out. However, scar tissue can pretty much do the same thing- sort of glue things together but they would not listen to me and couldn't wait for me to leave.What was interesting was when I had exploratory surgery back in 1990. They went in through my navel with a laparoscope just to look around. They concluded that my uterus was enlarged and distorted, there was a large fibroid and that I should have a hysterectomy which I decided against because I was still hoping I might find an answer to this and maybe would eventually feel well enough to have a relationship and maybe have children. I also wondered, 'OK, why is the uterus enlarged and distorted? It seems like it would fit in with what I'd been trying to say all along- that I had an on-the-job injury which messed up my insides and caused things to prolapse. Also, interestingly, I experienced a total but brief respite from my symptoms. After the exploratory, the tightness went away, and all of the other symptoms- even the violent diarrhea.I was able to form 'normal' sized stool once again. I went down 3 clothes sizes in one week. My suspicion is that they might have inadvertently broken up the scar tissue that had formed from the injury. However, after a couple of weeks, it all came back- probably because of more scar tissue. But again, when I tried to discuss this with any doctor, they said it was 'psychological'- I just THOUGHT I was better because I'd had a form of surgery! Amazing- even the sudden weight loss didn't make them blink!I did come across a website the other day, similar to this one for scar-tissue. I read a few posts there and discovered that it is a subject much like IBS- not easily diagnosed, not a subject doctors like to deal with, it does NOT always show up on CT-scans (which I've had a few of) and IBS is one of the symptoms it can cause. Also read about a supplement called SerraPeptase which is touted as a possible solution, that it might break up scar tissue so have ordered some but will not hold out hope. Man, the money we waste on this IBS!Mostly, Naomi, I want to tell you that I admire your efforts to figure out what is causing your symptoms and that I can relate to the frustration regarding the lack of open-minded , cooperative people in the medical community, the doctors, researchers, etc. And like you mentioned, the longer a person has these issues, it can't be good and probably can get worse as you said yours had gotten. I feel that the last 23 years of my life have been wasted unnecessarily- that this is NOT the way things have to be! That one-week respite I experienced back in 1990 proved it to me without a doubt. I realize that doctors' first concern are conditions that kill people completely- such as cancer- but isn't quality of life pretty important too? Seems not. I understand that these symptoms don't have answers in the textbooks yet- so why are our efforts to try to change this fact being met with such hostility and resistance?I currently have no plans to see a physician and won't until I have to- such as for a bladder infection which I began to get occasionally after this started.In fact when I finally went to a doctor last year about a tumor on my right adrenal gland- which was found on an MRI ordered by a chiroprator- she couldn't understand why I hadn't been to a doctor for so long and I told her how I felt and she wrote in my file that I was a 'disgruntled' person. I don't feel like giving them a penny of my or even my insurance company's money. I've often wondered how much impact it would have on the medical community if all of us sent away with the 'lazy' diagnosis of IBS boycotted them- even for just a week!AIRPLANE


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## SpAsMaN* (May 11, 2002)

Airplane,what you describe as "scar tissue" is interesting but this term is confusing to me.Perhaps it is your way to describe something weird inside your belly?Do you think scar tissue is the same as adhesions?As far as i know adhesions is something you can only get from surgery.


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## eric (Jul 8, 1999)

I just got off the phone to Dr William Whitehead at the UNC Center for Functional GI & Motility Disorders. A world recognized center on Functional disorders. A training center for other doctors from around the world as well on functional disorders.The Chairman for the Rome committee is also at the UNC Center, Dr Douglas Drossman. DR Whitehead is cochair of the UNC center.Dr William Whitehead is a world recognized expert also on constipation and many other aspects of IBS and functional GI disorders.*"He chaired the Rome I working team on Anorectal Disorders in 1990-1994, the Rome II working team on Anorectal Disorders in 1995-2000, and co-chaired the working team on Design of Treatment Trials from 2001-2006. He also chaired the International Resource Committee for the Rome Foundation and led a multisite study to validate the Rome III diagnostic questionnaire in 2006. "*http://www.med.unc.edu/wrkunits/2depts/med...c/whitehead.htm*IBS Constipation and anismus are two seperate functional disorders.* One the function of the large intestines and the other a Functional Anorectal Disorder.Which is why they have there own classification defintions.IMPORTANTLY functional disorders can frequently overlap. Which is why its also important to do pelvic floor testing in people with constipation. This is also why there is some confusion on this, because they are recognizing more people with overlapping function disorders.There are different mechanisms in regards to IBS C and Pelvic floor disorders and different parts of the anatomy effected. One a functional BOWEL disorder and the other a functional Pelvic floor disorder.http://www.romecriteria.org/rome_III_gastro/I asked him about your case Naomi and he said "*its possible *there are two seperate issues going on."He also wanted to know what Dr you see in the UK "gastroenterlogists in the UK who specialise in pelvic floor dysfuntion." He mentioned an expert in the UK, Dr Michael Kamm on Pelvic floor disorders and functional disorders at the St Mark's Hospital and Academic Institute."This unit offers a multidisciplinary specialist approach to diagnosis and treatment of patients with functional bowel disorders. Each year we receive over 2000 referrals for oesophageal motility disorders, intestinal motility problems like pseudo-obstruction, IBS, diarrhoea and constipation and faecal incontinence. The latest diagnostic test are offered and supported by our diagnostic services with imaging and endoscopy procedures. All diagnostic tests are reviewed once a week by the specialist team to generate a full report with management suggestions. Medical therapy for IBS is offered in conjunction with the Unit of psychological medicine. Other therapies are biofeedback training exercises, or surgical treatment. In addition to patient care, the team participates in patient-orientated education, medical education and clinical research. When appropriate, patients can participate in new treatment trials conducted (click link)The unit is staffed byrofessor Michael Kamm, Professor Christine Norton, Dr Naila Arebi, Ms Carolynne Vaizey, Biofeedback Nurses Clinical Physiologists, Technicians, Receptionists, Secretaries, Research Fellows and Nurses.""http://www.stmarkshospital.org.uk/index.php?page=physiologyalsoFYIAt IFFGD's 7th International Symposium on Functional Gastrointestinal Disorders in April 2007, we had the opportunity to talk to some of the international experts in functional GI disorders. Our discussions covered some of the most recent developments in this field. Click the topic titles below to go to the video interviews!http://www.aboutibs.org/site/learning-center/video-corner/ Increasingly our understanding of IBS is that it is a heterogeneous disorder - that is, multiple factors contribute to the well defined symptoms of the disorder. One of these suspected underlying dysfunctions involves serotonin, which is a neurotransmitter or messenger to nerves. Most serotonin in the body is in cells that line the gut where it senses what is going on and through receptors signals nerves that stimulate a response. The serotonin must then be reabsorbed (a process called re-uptake) into cells. This process appears to be disrupted in people with IBS.SerotoninHow does serotonin affect gut function? An interview with Gary M. Mawe, PhD, Professor of Anatomy and Neurobiology, University of Vermont, Burlington, VT. Dr. Mawe is a basic scientist.http://www.aboutibs.org/site/learning-cent...orner/serotoninThe case for serotonin in the generation of IBS symptoms, as well as other issues has grown stronger over the last five or more years, not weeker.I am also very aware about all the research on IBS in regards to serotonin and other mechanisms that are associated with the syndrome, like mast cells for one. It was Dr. Gershon who was majorally invovled in all this and still is involved.The Other Brain Also Deals With Many Woes "In each situation, the gut must assess conditions, decide on a course of action and initiate a reflex. "The gut monitors pressure," Dr. Gershon said. "It monitors the progress of digestion. It detects nutrients, and it measures acid and salts. It's a little chemical lab."The enteric system does all this on its own, with little help from the central nervous system. The enteric nervous system was first described in 1921 by Dr. J. N. Langley, a British physician who believed that it was one of three parts - along with the parasympathetic and sympathetic nervous systems - of the autonomic nervous system, which controls involuntary behaviors like breathing and circulation. In this triad, the enteric nervous system was seen as something of a tag-along to the other two. After Langley died, scientists more or less forgot about the enteric nervous system. Years later, when Dr. Gershon reintroduced the concept and suggested that the gut might use some of the same neurotransmitters as the brain, his theory was widely ridiculed.The Brain in Your Gut "It was like saying that New York taxi drivers never miss a showing of 'Tosca' at the Met," he recalled.By the early 80's, scientists had accepted the idea of the enteric nervous system and the role of neurotransmitters like serotonin in the gut. http://www.nytimes.com/2005/08/23/health/2...nyt&emc=rssThere are many research center studying serotonin and IBS as well as a host of other extremely complex issues.


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## Naomi889 (Sep 11, 2005)

Thanks, Airplane, for your post, I really found it very moving. I feel for you so much and can identify with almost all you are saying. I think the one of the things with the treatment of severe IBS is that I don’t believe that even gastroenterologists really understand what a severe thing it can be and just how badly it destroys your life. Secondly, as you say, it is not "dangerous", and is it is a condition which is often most strongly marked by discomfort and inconvenience rather than by pain. So it is not taken as seriously even as some other non-"dangerous" chronic disorders such as spinal problems etc. As I say, I just do not think the medical profession generally has any idea of how much chronic, constant discomfort can affect your life. Thirdly many of the terms one uses to describe one's symptoms "bloating" "constipation" "diarrhoea" are things that almost everyone can get at SOME time or another so they underestimate how devastating they can be if they occur all the time and do not respond to treatment. And fourthly, too few doctors and researchers have "IBS" as a "research interest", because it's just icky, non-fatal and therefore just not that interesting - I work in science and I personally have never come across a lab doing basic fundamental research into how the gut works, with one of the aims being to help those with IBS, though I've seen a few looking into ulcerative colitis (more seriously, technically, though I personally know two people with this disease and I swear to God that they have a much better quality of life that me and no doubt you). Do you agree with these reasons?However, I do not see this as a reason to give up on doctors. I went through a phase of hating them all, in fact I kind of still do, but the way I see it is that doctors are weak humans just like the rest of us, only their profession (naturally enough) generally makes them a little too impatient, dismissive and arrogant to give good help to a severe IBS sufferer. I would probably act in the same way if I had chosen to be a medical doctor and had never developed IBS! However this does not mean that there is not a specialist out there who might have some knowledge about what could have happened in your case or have some way to treat you. I do not know much about the potential role of scar tissue in IBS, but the marked co-incidence of your symptoms and accident would seem to be a giant clue to me. But do most doctors care? No! I can just picture them now, barely listening to you and not caring! The other thing I always tell myself is as long as you are alive there is always hope. Medical knowledge expands all the time (even if it is at a snail's pace in the case of gastroenterology). I’m 26 years old and I’ll probably live for another 50, and I’ll spend all of those fighting to get better. I have a vague memory of reading of a doctor who mentions some things relevant to you, but it was in a book and I would have to go and hunt it down - I will definitely do this, but I really have to go and read some (non IBS) papers now! I will get back with the doctor's name -it would be great if we could communicate again - you are clearly intelligent, articulate and your experiences and reflections of this horrible disease are so similar to mine, so I would find it really cathartic.ERIC - that's great that you got in touch with the doc. Now the specialist I have seen here in the UK is Dr Maria Eugenicos. The girl I have communicated with in London who has been diagnosed with the same thing as me says she was treated in "Northwick Park, London" which PubMed would indicate means that she potentially just might have been treated by this Dr Kamm. She still seems to have been told that she is being treated for "IBS" i.e. her diagnosis of the muscle problem had not preclude her diagnosis of IBS. My doctor is still also treating me for IBS despite my diagnosis. Incidentally my view is not that they are not technically separate things with different diagnostic criteria but that the muscle thing may be an under -recognised facet of SOME people's IBS, when one takes into account that "IBS" is a syndrome and there is NO positive marker of it's diagnosis.


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## AIRPLANE (Mar 15, 2004)

Spasman-Yes, adhesions is another way of saying scar tissue, which can form from ' trauma'- which could be from surgery or a type of accident, such as from on-the-job injury,auto accident, sports, exercise. Forming scar tissue, or adhesions, is the body's response to inflammation, according to what I've read. I believe I have heard of it being an issue for people with Crohn's disease and that is why they sometimes use steroids but I'm not 100% on that.Naomi, what I've always wished for was that I could find a place that has what is called 'integrated medicine'- which means you are seen by doctors from different types of practices in one place-and I don't mean only the usual 'specialists' such as GI, urinary or gynecologic. It would include them too, in other words, the usual type of doctors we see which are referred to as 'allopathic'- which means they essentially look for pathological issues such as cancer or other things that can be seen with a microscope, and x-rays, etc. But also maybe a chiropractor. And maybe a naturopath. And also people who perform alternative treatments like accupuncture, herbal medicine, and others. These different types of doctors have different perspectives and I think combining them could be worthwhile- take the best of each. I hear the term ' integrated medicine' all the time but so far it is a fairly new idea and not mainstream enough to be available to most of us yet. (I have also heard of 'functional' medicine and read a bit on it but it's also not widely available and I haven't really grasped the concept but heck maybe include them too) Of course there would be the usual insurance issues but hopefully they would eventually 'see the light'. It would be nice if these people were willing to work together and discuss their different perspectives instead of us going from one and then to the other on our own, if they could interact with each other to coordinate the best approaches for our individual cases. However, it is obvious from my visits with these different types of doctors that often these people do not like each other. My 'primary' allopathic doctor made it pretty clear that she thought little of chiropractors( even though it was a chiropractor who finally allowed me to have an MRI which found an unrelated issue, a rare type of tumor on the adrenal gland which I had removed last year at Mayo. The surgeon at Mayo was amazed it was discovered- I said it was thanks to my chiropractor!) She is from India and thinks IBS is strictly a result of the western diet. While the chiropractor advised me to eat 'whole' foods, which was along the same line of thinking as hers, he did not dismiss the fact that there was something structurally wrong as he said he could feel a 'tightness' in the area. He also did refer me to someone for pelvic floor issues but unfortunately they were not taking any new patients. I saw him for about a year but am now going to a physical therapist. (Years ago I was referred to a Doctor of Osteopathy by a co-worker but he turned out to be the same as my regular doctors- same attitude, everything). At any rate, these different types of doctors look at things differently and can find things that the others may miss, as I'll demonstrate below. Nevertheless, the treatment might require the help of more than one type of doctor, or of a doctor other than the one who first found the probable or possible source of the issue.An interesting thing that happened to me was back in 1998 when I first went to a chiropractor for a shoulder issue. I did not mention any of my other problems- the on-the-job incident, the lower-right side business or the subsequent IBS. It was standard operating procedure for this chiropractor's office to do a full-body x-ray of new patients. When I went into the room for the consultation, the chiropractor was sitting there looking at my x-rays with a puzzled look on his face. When I asked him what he was looking at, he said 'Something in your lower-right side is jutting out to the right'. I asked him what it was. He said 'I don't know what it is but it should be straightened out'. I then told him about my issues and the original on-the-job incident, and told him I had tried to tell the doctors there was something wrong down there,and that they said they had seen nothing on x-rays, to which he replied, 'They don't know what they're looking for'. Since I had had a hysterectomy (a totally useless surgery in my case) a few weeks prior we decided not to do much with the issue for the moment and pretty much dealt with the shoulder. We had an issue over the payments and I had to stop going to him. Unfortunately, when I saw another chiropractor a couple of years later, the pertinent x-ray was gone when I went to retrieve it and the new chiropractor was against excessive x-rays so I hit a dead end.Eventually I may have to see more doctors but I just hate picking someone's name out of thin air and then wondering if my time and money will be well spent. There is a need for more useful resources for finding help for people who have difficult-to-treat conditions such as this. It would be nice if the internet had a site to help patients find the appropriate doctors- just a reference for all gastroenterologists in general is not sufficient, and some places require a referral from a primary doctor which I always fail to get because as they say 'It's ONLY IBS' and 'learn to live with it'. A 'center' specifically for IBS and related conditions would be nice, a place that you could refer yourself to. As I said, I had hoped to go through the extensive IBS program at Mayo but apparently I didn't qualify- even after 23 years. I believe that there is more than one thing going on- like the pelvic floor issues, the rectocele, scar tissue, possible fistula from the hysterectomy or a fissure, and of course the right side issue, maybe also involving something called the illiopsoas muscle which my physical therapist and I are mainly working on now, who, by the way I saw today and she had a bit of a change of mind and suggested that maybe I SHOULD consider renting a biofeedback machine but we would just think about it for now.My issues require more time and input than the standard office visit allows and I'm sure many people on this board can relate. But again, I like the sound of integrated medicine the best but am afraid I won't see it widely available in my lifetime.Yes, I agree that GI issues are very common and it is difficult for people to relate to the degree of problems other people can have, including physicians. Before this incident, I suffered pretty extreme constipation, particularly in early adolescence but once fiber became big news in the 1970s and I started eating whole wheat bread instead of white bread and maybe a bowl of granola before school I was able to somewhat manage the condition- unlike later, when I developed violent D and now both C & D. How I was back then, to me, is how I primarily view IBS. To me, it is pretty much a single GI issue that you have but can manage if you do the right things. If it is unmanageable no matter what you as an individual try-diet, fiber, probiotics, etc. then I personally think it is not IBS unless you use the term IBS as a 'symptom' of something else, such as Multiple Sclerosis which I have read about. Same with scar tissue- I read a report by a physician saying that IBS was one of the possible 'symptoms' so, in other words, IBS is not always a condition in and of itself although my impression has always been that the original coining of the term was intended to be exactly that. That is why the recommended treatment is the usual fiber and diet advice which makes it sound so trivial if in fact IBS is just one symptom of something else. I think this adds to many doctors' and peoples confusion when the term IBS is used. Many people think it is just a minor annoyance much like they themselves have but if the term IBS is used for all these other scenarios which create multiple symptoms- the cause for which just hasn't been diagnosed yet- then it gives a totally wrong impression of the person's condition and no wonder being treated with sympathy and being taken seriously is so hard to come by, from doctors, friends, family, co-workers. As an attorney on this board mentioned awhile back, this condition should really qualify as a disability for some of us but doctors won't believe how many problems it can cause a person on the job or in other areas of life if it is supposedly 'just IBS'. Although I would say that even 'just IBS' could certainly be a problem for some people- like if I still just had the severe constipation I had as an adolescent, would it still respond to whole grains, granola, etc. like it did when I was a teen? I don't know. Anyway, I'm not saying we won't work but we should be entiltled to exercise benefits like what my employer calls 'FMLA' (Family Medical Leave Act) which is documentation from a physician that I give to my boss which would make it easier for me to take off work for the appointments themselves, and also if I needed to call in sick or go home early due to the condition on my worst days so I could do so without fear of being fired or disciplined. I know of many employees who use this benefit who I seriously doubt have issues as bad as mine, certainly no worse. But as I said in my first post, when I describe the problems I have due to this condition some doctors have actually laughed and don't think IBS is a valid reason for receiving this benefit and apparently I can't force them to oblige. IBS is a vicious label to bear. I would definitely get more consideration and understanding if I had a deadly condition like cancer or AIDS, and even a lesser problem like back issues which seems to be the most common reason for using FMLA at my place of employment.As much as we like to think we've advanced, IBS makes me feel like I'm living in the dark ages- having to fight for my basic rights as a human being. I think being labeled with IBS has definitely helped me understand what it feels like to be discriminated against for something I have no control over. Sure I can always write my congressman (like that ever helps)!AIRPLANE


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## eric (Jul 8, 1999)

Naomi,"Incidentally my view is not that they are not technically separate things with different diagnostic criteria but that the muscle thing may be an under -recognised facet of SOME people's IBS, when one takes into account that "IBS" is a syndrome and there is NO positive marker of it's diagnosis."This is something I am trying to get across here. They *are* *"technically separate things with different diagnostic criteria"* and *they are different conditions.* This can be explained, which is something I am trying to do here.You cannot use the terms interchangeably to mean the same thing ie IBS. Both conditions can and probably really compound each other.It sounds like from what your posting here you have IBS AND the pelvic floor disorder. This is two different muscles that are being effected. IBS is a syndrome with a "specific cluster of symptoms."Pelvic floor disorders also have specific symptoms."under -recognised facet of SOME people's IBS,"Its the overlap that is being more recognized. Its not that anismus is being more recognized as a form of IBS. It is not a form of IBS C, but a seperate functional disorder.Somethings to read.Characteristics of Chronic Constipation"Constipation can be broadly divided into 3 classes based upon the underlying physiologic cause: Normal-transit constipation Slow-transit constipation Pelvic floor dysfunction In normal-transit constipation, colonic motility (the way muscles contract and relax to move contents through the colon) is unaltered; stool moves through the colon at a normal rate. However, patients with normal-transit may experience more difficulties in stool passage, for example due to harder stools. In contrast, in slow-transit constipation colonic motility is decreased and bowel movements are infrequent, leading to more severe symptoms of straining and harder stools.Persons with pelvic floor dysfunction have a functional outlet obstruction, a defect in the coordination necessary for stool evacuation. This usually occurs due to the failure of the pelvic floor muscles (including the anal sphincter) to relax appropriately during evacuation efforts, thus making stool passage much more difficult regardless of whether stool transit in the colon is normal or delayed. In some cases, individuals contract their pelvic muscles instead of relaxing them (pelvic floor dyssynergia).The majority of persons seen by a doctor have normal-transit constipation, followed by pelvic floor dysfunction, and slow-transit constipation. Some patients can have a combination of slow transit and pelvic floor dysfunction (functional outlet obstruction).""Pelvic Floor Dysfunction (Dyssynergia)*Defecatory disorders, such as pelvic floor dyssynergia, are thought to contribute to about 25% of occurrences of chronic constipation.(2) Pelvic floor dyssynergia (also referred to as anismus) is a functional disorder marked by the failure of pelvic floor muscles to relax, or a paradoxical contraction of the pelvic floor muscles, with defecation. *The pelvic floor is composed of a group of muscles that span the underlying surface of the bony pelvis, which function to allow voluntary urination and defecation. "Paradoxical contraction" refers to an abnormal increase of pelvic floor muscle activity with defecation, rather than the normal decrease in muscle activity that is necessary in order to have a normal bowel movement. This condition is uncommon. Its diagnosis requires specialized investigations that will require referral to a medical center.Noteefecatory disorders are most commonly due to dysfunction of the pelvic floor or anal sphincter. In addition to pelvic floor dyssynergia, other terms used to describe defecatory disorders include anismus, paradoxical pelvic-floor contraction, obstructed constipation, functional rectosigmoid obstruction, the spastic pelvic floor syndrome, and functional fecal retention in childhood.[2]Referral is necessary only if the constipation fails to respond to the usual treatment measures. Because pelvic floor muscles can be controlled voluntarily, their function can be improved through various learning procedures - such as biofeedback."http://www.aboutconstipation.org/site/abou...haracteristics/Normal Function of the Colon and Anorectal Areahttp://www.aboutconstipation.org/site/abou...normal-function"If the transit time is prolonged, patients may undergo further testing at highly specialized centers. *Defecography uses x-rays to look at the behavior of the rectum and anus during attempts to defecate. It evaluates completeness of rectal expulsion and puborectalis muscle relaxation, and identifies structural problems (such as rectocele)*Anorectal manometry can be used to measure resting and squeezing anal sphincter pressures, rectal sensation and compliance, and sphincter response. With manometry, balloons are positioned in the rectum and anal canal. Doctors inflate the balloons and then measure the response. Hirschsprung's disease and other disorders are detected this way."http://www.aboutconstipation.org/site/abou...tion/treatment/"Patients with IBS with diarrhea (IBS-D) have been reported to exhibit an increase in high-amplitude propagating contractions (HAPCs) and transit in the colon,[18,19] whereas those with IBS with constipation (IBS-C) may have reduced numbers of HAPCs and reduced transit"This is reduced transit of the sigmoid colon in IBS C. There is a lot of IBS research in regards to the generation of IBS symptoms, that are not on this thread.The below article is pretty good.Treating Chronic Constipation: How Should We Interpret the Recommendations?Clin Drug Invest. 2006;26(10):547-557. "DiagnosisA specific cause for constipation symptoms can be identified in some patients. Commonly referred to as secondary causes, these may include underlying organic disease (metabolic, neurological), structural abnormalities (as a result of previous surgery), use of select medications (e.g. opioids), and lifestyle habits (e.g. poor eating habits, lack of exercise).[21,22]Other patients, however, have no diagnostic markers, structural abnormalities or physical findings to explain the presence of constipation-associated symptoms. This is known as primary or idiopathic constipation and is typically subcategorised into three groups: normal transit - the rate of transit of stool through the colon is normal, but patients experience difficult stool passage or have hard stools;23 slow transit - colonic stool transit is delayed;23,24 and pelvic floor dysfunction (also known as pelvic floor dyssynergia and obstructed defecation).23,24 Pelvic floor dysfunction is characterised by a failure to coordinate actions of the puborectalis muscle and anal sphincter during defecation. Feelings of incomplete evacuation and straining are key features. Structural or functional abnormalities (e.g. rectal prolapse, rectocoele, anismus) contribute to the presence of pelvic floor dysfunction in many patients.25,26 *Importantly, at any given time, one or more of these three mechanisms may contribute to a patient's symptoms.23"*http://www.medscape.com/viewarticle/546268?rssThere is a difference in IBS and how stool moves through the large colon and pelvic floor dyssynergia where there is "failure to coordinate actions of the puborectalis muscle and anal sphincter during defecation."We are talking about two seperate issues here IBS c and anismus, but there are even others like functional C and still other issues.When a person m9ght have different functional disorders going on at the same time it might require different treatment approaches to EACH problem.For example IBS can frequently over lap with functional dyspepsia, a upper gi functional disorder of the esphogus. Just like IBS functional dyspepsia encompasses altered motility, viceral hypersensitivity and brain gut axis dysfunction of the esphogus. Here its important to treat both the dyspepsia and the IBS, even though some of the mechanisms that generate the symptoms might be the same, there can be other symptoms associated with each disorder.For the record also there has been a huge amount of IBS research and functional disorders research over the last 20 years all over the world, especially the last five years. This is also in conjuntion with other GI Diseases that are being researched as well as the entire body.They have made substandial gains in understanding super complex issues. As a biology major I am sure you can also appreciate how complex the human body really is and how complex just the digestive system is itself. IBS is already recognized as a brain gut axis disorder. However this hasn't completely filtered down to the general public and IBSers fully yet.I have had IBS for over thrity five years. I too have certainly gone through doctors who believe it was psychological for many years in my youth. We now know, that is not the case, it is not purely psychological, but as I mentioned the interaction of physiological interactions in the bidirectional communication between the brain gut axis. Airplane, I am going to have to read your entire situation here. However, the HPA axis and IBS have been implicated. That is part of that system of course.I also have to mention here a naturopath or a chiropractor, in all probablities would not have the expertise to evaluate and treat the differences in IBS and pelvic floor disorders. There is some issues with the spinal cord though and transimission to the brain in regards to analrectal disorders as well as IBS ect.. So perhaps spinal manipulation might help some people who have issues with the spinal cord. But I would personally be extremely wary of either a naturopath or a chiropractor actually diagnosing functional bowel disorders. Airplane, have you given up on pelvic floor testing?


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## Naomi889 (Sep 11, 2005)

Eric - Maybe we're talking at cross purposes here. Again, these are not just my random theories; this is from a gastroenterologist who must see hundreds of patients with this problem every week!!! Let's say that all my symptoms are caused by this non-relaxing muscle thing. By your definition I would then not have IBS but have ONLY "anismus/pelvic floor disorder ". However, as I said, this is not the view of the specialist I am seeing at the moment - and you'd think she would know. If you read my earlier posts on this thread I explained that Dr Eugenicos's theory is thus: Stress happens, this muscle malfunctions, IE/constipation results. The enlarged bowel is then "re-programmed"- the body "thinks it has finished" even when it has not. So you see that this IS a malfunction of the BOWEL - in that (she says) the gut's signal programs become disordered in response to the increased bowel capacity - however it ALL originates from the malfunctioning muscle. Do you see? So I DO have BOTH IBS (in that I have a malfunctioning bowel with disordered signal programs AND the muscle pelvic floor thing but they are BOTH caused by the ONE thing - the muscle problem. Do you follow what I am saying? So IBS-C really can in some cases be entirely caused by this malfunctioning muscle, according to her, and I really think she should know!Airplane - so what do you think they saw on the X-ray? I don't fully understand. I do agree with you about the image in people's - particularly doctors' - minds when the term "IBS" is used. It is quite, quite ridiculous how little is known of the utter devastation this disease can cause. You might have read my whinging earlier in the thread about the specialist GI nurse who was saying things to me the other week like "You need to stop thinking about this disease all the time" - akin to telling someone with a migraine to forget they have it - a technical impossibility! If you have a physical sensation all the time you cannot ever be unaware of it! It just demonstrated to me her utter lack of understanding of the full potential impact of this disease, and she is a bloody GI nurse who sees people with severe IBS day in, day out! But what can we do to change this, and would it help if we did? I think so, as part of the reason severe IBS is not well treated clearly because the suffering it causes is wildly underestimated.


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## eric (Jul 8, 1999)

Listen, who would really know is the doctor I posted who helps write the diagnotic criteria for functional disorders. Ask your doctor about them. Print and take this thread with you and see what they say."Let's say that all my symptoms are caused by this non-relaxing muscle thing. By your definition I would then not have IBS but have ONLY "anismus/pelvic floor disorder ". Exactly and this is NOT IBS by anyones defintion, although it can cause similar symptoms. Or you have IBS C and non-relaxing muscle thing, which is what it really sounds like. The thing is they are two different kinds of muscles with different reasons they can malfunction. I am also pointing this out to help you figure it out and to be able to treat it all better. IBS has a more defined defintion then I think you might be aware of here for one."malfunctioning bowel with disordered signal programs" that is pretty true though for IBS and the large colon. But it is way way more complex then we are even mentioning here. Stress does not actually cause IBS, but modifies it and can trigger symptoms. But its not the cause, other things are going on. They have found structural abnormalities in subgroups of IBSers as well as a host of other targets of interest and abnormalities, not completely understood yet. I am not sure you are aware of all of them.I actually think what is happening here is your doctor does believe you have two conditions going on, first ask and then tell me what they say about it, before we go back and forth some more. I have spent a lot of time hours on all this here, looking this all up and going through it all. One of the leading Rome experts in all of this which I posted has stated they are seperate conditions.All you need to do is talk to the doctor and ask them and see what they say.


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## Naomi889 (Sep 11, 2005)

Eric, it is great that you've spent time looking into this, but at least try to appreciate what I'm saying before you post. I am not saying that they are not technically different conditions and I agree - and my gastroenterologist would agree - that I have both. The WHOLE point of what I have been saying - what she says - is that *my* IBS IS caused by the muscle condition - and it is still IBS! The whole system is linked - the IE caused by the malfunctioning muscle is causing disordered signalling in the bowel - that was specifically and definitely what she was saying. If you don't demonstrate that you understand this - counter it if you like - maybe we should just give up.It is not unheard of for different scientists to have different views as I'm sure you are aware - but this woman treats hundreds with this disease.


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## eric (Jul 8, 1999)

Some of this I am doing for you and some for others reading the thread and some for myself and my own personal knowledge."my IBS IS caused by the muscle condition - and it is still IBS!"Your actually saying anismus causes IBS.I am saying this is incorrect. IBS is not caused by anismus. Anismus is another functional disorder. So you either have both or one or the other and it matters greatly.The criteria for IBS is not the same criteria for functional constipation or the same criteria for functional disorders of the anus and rectum. They can however overlap.You might also notice the doctor here is the doctor I asked. This isn't about researcher differences, becase this is a "Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders "Your doctor probably follows, or hopefully follows these recomendations. "Chair, Committee on Functional Anorectal Disorders,Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome II),Professor of Medicine, University of NorthCarolina,Chapel Hill, NC, USA W E WhiteheadThis is from rome ll and I would have to look at rome lll, butFunctional disorders of the anus and rectum"F3.Pelvic ﬂoor dyssynergiaPelvic ﬂoor dyssynergia is characterized by paradoxical contraction or failure to relax the pelvic ﬂoor during attempts to defecate.16 17It isfrequently associated with symptoms of diY-cult defecation including straining, feeling of incomplete evacuation after defecation, and digital facilitation of defecation.The prevalence of pelvic ﬂoor dyssynergia inthe population is unknown, because thediagnosis requires physiological testing. How-ever, in patients referred for evaluation ofchronic constipation, pelvic ﬂoor dyssynergia isfound in 25-50% of both children and adults.18This may be an overestimation due to the highfalse-positive rates seen in some studies.19Noinformation is available on gender diVerences.DIAGNOSTIC CRITERIA(1) The patient must satisfy diagnostic cri-teria for functional constipation inDiagnostic Criteria C3;(2) There must be manometric, EMG, orradiologic evidence for inappropriate contraction or failure to relax the pelvic ﬂoor muscles during repeated attempts to defecate;(3) There must be evidence of adequatepropulsive forces during attempts to defecate; and(4) There must be evidence of incomplete evacuation.Diagnostic criteria for functional constipa-tion are: at least 12 weeks (which need not beconsecutive) in the preceding 12 months of twoor more of: (1) straining in >1/4 defecations;(2) lumpy or hard stools in >1/4 defecations;(3) sensation of incomplete evacuation in >1/4defecations;(4)sensationofanorectalobstruction/blockage in >1/4 defecations; (5)manual maneuvers to facilitate >1/4 defeca-tions (e.g., digital evacuation, support of thepelvic ﬂoor); and/or (6) <3 defecations/week.Loose stools are not present, *and there is insuf-ﬁcient evidence for irritable bowel syndrome."*" Diagnostic criteria for pelvic ﬂoor dyssyner-gia must be validated and should includedeﬁnite changes in anal canal pressure dur-ing straining, propulsive forces, and per centevacuation of the rectum."But they are using rome lll now.*This is not the same diagnotic criteria to diagnose IBS and there are very important reasons for that.*Altered motility alone does not explain IBS either."What Causes Irritable Bowel Syndrome? The exact cause of irritable bowel syndrome is not known. However, tremendous advances in our understanding of this common and disabling disorder have been made in the last 10 years. Abnormal motility in terms of the bowel moving too fast (which causes diarrhea) or too slow (which causes constipation) is certainly part of this syndrome. However, this represents only one part of a complicated disease. The symptoms of pain, incomplete emptying of the bowels, and bloating cannot be blamed only on abnormal GI motility. Over the last 20 years a number of very well done scientific studies have demonstrated that individuals with IBS tend to have higher levels of *sensitivity in the intestines* compared to individuals who do not have IBS. ""Abnormal motility in terms of the bowel moving too fast (which causes diarrhea) or too slow (which causes constipation) is certainly part of this syndrome. "http://216.109.125.130/search/cache?ei=UTF...=1&.intl=usThere are pathological observations of why the SIGMOID colon malfunctions in IBS, which are different mechanisms (although they may possible share some issues like neurotransmitters) of why a person has Pelvic ﬂoor dyssynergia. Doctors do not use the terms IBS and anismus, or Pelvic ﬂoor dyssynergia or other functional disorders of the anus and rectum and IBS to mean the same conditions or interchangeably.


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## AIRPLANE (Mar 15, 2004)

Naomi889 said:


> Eric, it is great that you've spent time looking into this, but at least try to appreciate what I'm saying before you post. I am not saying that they are not technically different conditions and I agree - and my gastroenterologist would agree - that I have both. The WHOLE point of what I have been saying - what she says - is that *my* IBS IS caused by the muscle condition - and it is still IBS! The whole system is linked - the IE caused by the malfunctioning muscle is causing disordered signalling in the bowel - that was specifically and definitely what she was saying. If you don't demonstrate that you understand this - counter it if you like - maybe we should just give up.It is not unheard of for different scientists to have different views as I'm sure you are aware - but this woman treats hundreds with this disease.


Naomi,If I understand what you are trying to get at, it is that while yes, the pelvic floor dysfunction and the GI issues (constipation) are two separate issues, they still probably share the same 'root' cause. If so, I definitely agree with this because as I mentioned before, I had several different issues begin at the same time as the so-called IBS. Symptoms I didn't mention before, along with the 'falling-out' sensation include urinary urgency when there is very little to get rid of. I tend to retain urine the same way I retain stool and also have had blood found in urine tests- had a negative kidney x-ray. It also changed my menstrual flow at the time. And my outside appearance changed as well. I went from having a fairly small waist to looking like I was pregnant virtually overnight. When I first went to doctors I described it as feeling like I had a hernia- both in a downward sense (the falling-out sensation along with the severe, constant pelvic pain and throbbing, plus the distorted feeling in my lower right abdomen), and that my blood circulation felt like it was being severely restricted throughout the area. I would get nasty, arrogant responses, the one I mainly remember is a doctor who sarcastically said, 'If you had a hernia, I could see it just by standing in front of you and looking at you'. Well, maybe he couldn't see it but I sure could see the difference and so could my clothes! (By the way, a rectocele is considered a type of hernia too) I was constantly told to do Kegels, which I did so much I probably did them in my sleep. It was futile as I felt like when I did them I wasn't just trying to strengthen my pelvic floor but also that in the process I was also having to virtually lift the weight of my entire upper adomen, which felt like it was prolapsed down onto the pelvic area. So I would definitely not be surprised if I had non-relaxing muscles down there. Also, I have read that when you try to not pass wind that you are essentially doing Kegels and I have definitely done my share of that (albeit unsuccessfully).Also, I mentioned about how when this first happened I described it as feeling like a hernia. My impression is that many doctors still do not believe that women actually can get hernias. I have also read stories of women who, after a pregnancy, could not get rid of their 'extra' abdomen after giving birth no matter what they did. I have read of some of these women getting cosmetic surgery for this issue and some of them have mentioned an unexpected bonus of 'improved' digestion after having this done. What this tells me is that what these women really have IS a type of hernia yet it is considered merely a cosmetic issue and as such they have to go to a cosmetic surgeon and of course pay out-of-pocket for what really should be a medical issue!The way I look at it in my own case, however, is that I do NOT have IBS. I view that what I had as a teenager- severe constipation which DID respond to increased fiber- as IBS. Once this incident occurred, it was altogether something else and I furiously fought with my first several doctors back in the 1980s over being given this label but they would not give it up. Again, I question the use of the term IBS as a symptom of other conditions- like Multiple Sclerosis. If MS affects the digestive system, I think it should simply be described as constipation or diarrhea or digestive problems. However, I frequently read of IBS as a 'symptom' of other conditions. But then, if I did not have this 'other' condition which remains undiagnosed, I have no way of knowing how my GI tract would be behaving today.(Except for the miraculous one-week respite back in 1990 after the exploratory when everything worked great!)As far as what the chiropractor saw on the x-ray, it's anyone's guess. He did not seem to know what it was either, just that something was amiss. The pelvic floor is very complex. Don't know if it could have been the illiopsoas muscle that both the chiropractor and physical therapist have mentioned or what. And since none of my other chiropractors did x-rays I did not have another similar experience (I saw two different ones after that).Eric, I have been begging for pelvic floor testing from Day 1 back in 1984 with little success. The response I got from doctors was pretty much 'do Kegels' and that was it. I am convinced I have had a rectocele from the beginning (as just one of the many symptoms)and until a gynecologist diagnosed it last year, none of the countless GIs and gynecologists I'd seen noticed it even though I pretty much described its symptoms many times. This gynecologist wanted to do surgery but the prospect is not good. It will probably just return because I feel that the 'root' cause of all of these issues is the same and until it is addressed just treating one thing will not help. The doctors I saw at Mayo, a urogynecologist and a GI, said that the surgery would probably not help and could even make it worse. I agree that a chiropractor cannot address all these issues- and the chiropractor I was seeing felt the same- that is why he tried to refer me to a physician he knew who dealt with these issues but unfortunately she was not taking any new patients. But I do agree with his opinion that most doctors just want to use a 'band-aid' approach and not try to find or deal with the actual 'cause' of many issues, that they don't take the whole body into account. As I mentioned, I have the sense that my blood circulation is severely impacted through a large area which most likely has a negative impact on the whole structural support system as well as nerve sensation which you have alluded to frequently. I took Paxil for a couple of years and mostly it made me into a zombie along with the other well known side effects. After I saw the urogynecologist at Mayo, I had asked to be referred to the GI department so I could go through the IBS program they tout on their website but instead was just referred to the gastroenterologist who wanted me to do the biofeedback program which I was willing to try but do not feel that I should have to pay $6,000.00- $7,000.00 out-of-pocket. It may be partly my fault that I assumed insurance would cover this recommended treatment at their clinic and therefore I never discussed this possibility with the doctor. So why haven't I gone back? Because of past experiences with doctors. He'd probably say that there was nothing more he could do, and if I wasn't willing to pay the exhorbitant cost out-of-pocket, it was my problem.The urogynecologist, the first doctor I saw at Mayo, gave me his card to use as a referral for physical therapy. So that is who I am going to now per his advice. She specializes in 'women's issues'- incontinence, etc. and works in a urology clinic. Most of the things we have done so far are similar to what my last chiropractor did- different types of exercises and manipulations. I went to her yesterday and had a good 1 1/2 hour session. Today I can feel my body trying to correct itself but something is preventing it from doing so. I felt like this quite often after chiropractic adjustments too. This is why when the physical therapist mentioned scar tissue it made sense- well 'possibly' anyway and I feel it is worth considering. However, it is apparently a 'sore' subject with doctors-maybe because some of the things they do- i.e. surgery, even the so-called laparoscopic kind- causes it, besides other types of trauma. Plus, from what I've read, they don't really know how to deal with it. When I mentioned some of the issues I've had to the physical therapist, some of which required surgery- such as a large uterine fibroid on the lower right side, the removal of the right adrenal gland due to a rare tumor, plus the fact that I have nodules on my liver she commented 'It's interesting that all of these problems seem to be located on your right side'. Just a coincidence? No common bond?AIRPLANE


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## SpAsMaN* (May 11, 2002)

Check this out,there is clinicals trials on a surgery for obstructed defecation:http://www.clinicaltrials.gov/ct2/show/NCT...TARR&rank=1


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## Naomi889 (Sep 11, 2005)

Eric, I think we’re just going to have to agree to differ now. I’ve made my point repeatedly, I’m going with Dr Eugenicos’s opinion and if you actually read carefully what I’ve written you’ll see it doesn’t necessarily contradict anything that the doctor you mentioned definitively said.Airplane, yes, you understand me correctly. And indeed, with the diverse set of localised symptoms which followed on from your accident it does sound rather like there may well be something very specific going on that you should keep chasing up - the best would perhaps been to find a sympathetic and interested specialist via google/pubmed etc.? Most of these people are probably in the States so you're lucky in that respect. The British health care system, the "NHS", is considered (by us Brits) to be pretty poor for a rich Western country but I've been quite shocked at the insurance stories I've seen on this board (we don't have insurance, we pay via tax and then everything is free at the point of use, but I'm sure you all know that). An ex-NHS nurse, the only medic I've ever met truly sympathetic to my health probs, told me that with regard to chronic, difficult to treat conditions on the NHS "Help is given to those who shout the loudest" and it sounds rather like that may also apply in the States. Incidently like you I also have a slightly altered menstrual cycle and also a slight difficulty fully evacuating urine but I've read that these are both strongly linked to chronic constipation - makes sense really - so I just assumed that it was the cause. Let me know if you find anything that helps you and if you like I'll get back in touch with you if I find the name of that doctor I mentioned earlier


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## SpAsMaN* (May 11, 2002)

> Eric, now your information might just be misleading other posters and this is NOT fair. As I said in my last post, the two main gastroenterlogists in the UK who specialise in pelvic floor dysfuntion STILL consider those who are diagnosed with this to have IBS if IBS is what they are already considered to have!!!!!!!!!!


Wow this is interesting and controversial issue!!!Systemic IBS or anismus?!?!?!?!


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## eric (Jul 8, 1999)

This is more a misunderstanding of different conditions and different parts of the anatomy then a controversial issue of is Anismus as a subtype of IBS C. It is a subtype of constipation.ITs not, it can cause simliar symptoms, but that does not make it IBS C. People can have this and also have IBS or not have IBS at all.I have posted enough now from multiple expert sources on this discussing they are different disorders. Regardless of what some want to believe. But that is up to them, personally I would be finding out from my doctor their actual position, because it matters greatly.ACP: Causes of Constipation and Tips for Office Evaluation Satish Rao, M.D., Ph.D., a professor of medicine and director of neurogastroenterology and GI motility at the University of Iowa Carver College of Medicine in Iowa City"He said that by the Rome II Criteria *constipation-predominant irritable bowel syndrome (IBS-C) and chronic constipation have many symptoms in common, such as fewer than three bowel movements per week; hard, lumpy stools; straining; and a feeling of incomplete defecation. But IBS-C requires symptoms of abdominal pain/discomfort, which are not a primary symptom of chronic constipation. Furthermore, bloating/distension are prominent in IBS-C whereas a sense of anorectal obstruction and sometimes manual maneuvers to defecate are features of chronic constipation. *Chronic constipation can be classified as primary or secondary. Secondary constipation can result from drugs, anal fissure, or colonic obstruction from cancer, among other causes. *Once secondary causes are excluded, one is left with primary constipation "which is a neuromuscular disorder of the gut," according to Dr. Rao. Three main subtypes exist, based on physiological tests. **The first subtype is dyssynergic defecation, a relatively new term meaning that defecation mechanisms are uncoordinated or "dyssynergic." Stool comes into the rectum but cannot be expelled fully or at all. Anorectal manometry shows that the rectum and the anus are not working in harmony. In normal defecation the rectum contracts and the anus relaxes to allow stool expulsion. Several patterns of dyssynergia occur: a rise in both rectal and anal pressure; a rise in anal pressure but poor pushing effort in the rectum; and good rectal pressure but with a failure to relax the anal canal. **The second type of primary constipation is slow transit constipation (STC), which occurs when there is neuropathy in the colon and the colon muscle is "too lazy" to push the stool residues along, Dr. Rao said. The pathophysiology of STC is secondary to dyssynergia, neuropathy, myopathy, or a mixed motor/sensory dysfunction. The neuropathic etiology can result from loss of myenteric plexi and of the intestinal pacemaker cells, the interstitial cells of Cajal. The third type of primary constipation is irritable bowel syndromic constipation with pain or discomfort in the presence of normal pelvic floor function and normal transit. *Dr. Rao then focused *on IBS-C, the major dysfunction of which is now thought to be a visceral hypersensitivity. As an example, he said if a balloon is inflated in the rectum, IBS-C patients will perceive it at a much lower threshold than control subjects. The problem resides at the receptor level in the gut, in the afferent tract sending the message to the spinal cord, in the relay of the message to the brain, or in the brain's perception of the signal. A study has shown that a major dysfunction may be in the primary somatosensory cortex. Also, descending pathways that modulate sensory perception may be abnormal. "*The physical examination should involve a detailed abdominal exam to exclude a mass and to detect stool loading, particularly in the left lower quadrant to exclude a mass. After examining the anorectal area for fissures, hemorrhoids, bleeding, and skin excoriation/tags, the physician needs to stroke the anus with a cotton swab in all four quadrants to evoke the ano-cutaneous reflex. If present, it indicates that the sacral neuronal circuitry is intact. A digital rectal exam can help diagnose pelvic floor dysfunction or dyssynergia. With one finger in the rectum, the physician places the left hand on the patient's abdomen, then instructs the patient to attempt defecation. "Typically, you should feel tightening of the belly muscles under your left hand, which tells you that they're generating good pushing force," Dr. Rao said. "Then you will feel your finger being ejected, which is good perineal descent and rectal pushing forces. And third and most importantly, you should feel relaxation of the anal sphincter." If all these signs occur, it is unlikely that the patient has pelvic floor dysfunction or dyssynergia. Otherwise, dyssynergia should be suspected, and manometric evaluation can be used to confirm it. Dr. Rao warned that some coaxing of the patient may be required because the physician is somewhat of a stranger, and patients may be reluctant to attempt defecation lying down or in the bed. *Colonic function can now be easily evaluated using a Sitzmark capsule. *This commercially available capsule is filled with 24 radiopaque marker rings. The patient swallows the capsule on day one, and a plane film x-ray is performed on day six (about 120 hours later). Five or fewer markers remaining in the field indicates normal transit; more rings mean slow transit. "This gives you an objective verification of your patient's symptoms because patients' recall of bowel habits is often very poor," he said. Another test is to place a balloon filled with 50 mL of water in the rectum. Most normal individuals can expel it in less than one minute. "http://www.medpagetoday.com/Gastroenterolo...yndrome/tb/3052They don't diagnose IBS by inserting a finger up the rectum for pelvic floor muscles issues.They use sitz marker tests to find out how fast or slow feces moves through the COLON and possible malfunctions in how the colon is operating.A person can have COLON malfunction and pelvic floor disorders, thats part of the point. They may reqiure different treatments in combination for a person who may have both to get the best results to feel better. Therapies for dyssynergic defecation consist of biofeedback mainly, because of the type of problem and because its been shown to work for a good percentage of people. Also in testing is botox injections and scaral nerve stimulation for pelvic floor disorders. These are not regularly used for c IBS patients, because of different problems in different parts of anatomy and different mechansims that cause symptoms.These are cell mechanisms in the sigmoid colon that are believed (with substantial research) to effect COLON function in IBS.







The 5ht 3 receptors are associated with IBS d and the 5ht 4 receptors are associated with IBS C.It is to a persons benefit to talk closely with their doctors and ask if they might have more then one functional disoder going on and what that may mean to the person and treatments. As I mentioned before, quite a few people have an upper gi diorder, like functional dyspepsia along with a lower gi disorder of the colon like IBS or an even a lower functional disorder of the Functional Anorectal Disorders.


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## eric (Jul 8, 1999)

I want to highlight this"The third type of primary constipation is irritable bowel syndromic constipation with pain or discomfort *in the presence of normal pelvic floor function and normal transit. *"


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## Naomi889 (Sep 11, 2005)

Eric, I know my doctor's actual position on this and have quoted it repeatedly - I'm not a complete idiot. If you're incapable of understanding exactly what Dr Eugenicos's point was then there's not a lot of point in re-iterating it - things that I have said before address the points you re-made. I'd advise any other IBSers interested in this issue to read both Eric and I's previous posts on this issue and make up their own minds.


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## SpAsMaN* (May 11, 2002)

I think we need to realize that the bowel is a sensitive organ.The point i want to adress is sensitivity.We,as IBSers,can probably all agree that we have sensitivity at different places in the belly.Sensitivity has many form.You can feel irritated or have severe intermittent pain.Perhaps the pain sensor can cause constipation or spasms...See,when i've had hydrotherapy,my colon react by spasming.Some of the water got trapped in my sigmoid causing me a obstruction and terrible discomfort for hours afterward.This event makes me wonder about pain modulation at the mucosa level.Why the water cause such a spasms?Is it pain processing gone wrong or a weird reaction to water in contact with the mucosa?


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## annie7 (Aug 16, 2002)

Spasman i've never had colonic hydrotherapy but usually when i do an enema i get the same problem you mentioned--not all the water comes out. some seems to be trapped in the colon, usually further up. i can feel it sloshing around in my abdomen-is that the transverse colon? anyway, it's definitely trapped up there--like there's a spasm or something holding it back--rather uncomfortable---but it always comes out the next day and then i feel much better.Eric--great articles. thanks for the info. i've bookmarked this thread and also printed most of the articles for future reference.


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## eric (Jul 8, 1999)

Spasman, it really helps to understand how the colon actually works in healthy people.I have mentioned this many times in regards to pressure sensitive cells that line the gi tract. When stimulated by eating and for other reasons, the pressure sensitive cells releases chemicals to carry out digestion. Some of those chemicals importaly serotonin is involved in signaling to the brain sensations that arise from the digestive tract. Annie, glad the information helps.This is also new Gastroenterol Clin North Am. 2007 Sep;36(3):687-711. LinksConstipation: Evaluation and Treatment of Colonic and Anorectal Motility Disorders.Rao SS.Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Division of Gastroenterology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 4612 JCP, Iowa City, IA-52242, USA.This article focuses on the colonic and anorectal motility disturbances that are associated with chronic constipation and their management. Functional chronic constipation consists of three overlapping subtypes: slow transit constipation, dyssynergic defecation, and irritable bowel syndrome with constipation. The Rome criteria may serve as a useful guide for making a clinical diagnosis of functional constipation. Today, an evidence-based approach can be used to treat patients with chronic constipation. The availability of specific drugs for the treatment of chronic constipation, such as tegaserod and lubiprostone, has enhanced the therapeutic armamentarium for managing these patients. Randomized controlled trials have also established the efficacy of biofeedback therapy in the treatment of dyssynergic defecation.PMID: 17950444


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## eric (Jul 8, 1999)

FYIComprehensive Overview of ConstipationW. Whitehead http://www.med.unc.edu/medicine/fgidc/comp...onstipation.pdfConstipation Causes and Treatments - D. Maier http://www.med.unc.edu/medicine/fgidc/cons...d_treatment.pdfNaomi889With all due respect, when you make comments like this here. I am trying to explain to you and others that biofeedback is much more a treatment for pelvic floor disorders and its not a standard medical treatment for IBS C. There are reasons for this approach in people with functional pelvic floor disorders."People's opinions of biofeedback therapy as a treatment for IBS" and on thisFirst Principles of GastroenterologyPELVIC FLOOR DYSSYNERGIA *The majority of patients with constipation have a form of irritable bowel syndrome, but there is a small subgroup of patients who may have a specific disorder in colonic and/or anorectal function that produces constipation. These patients are almost all female, may have delayed colonic transit or present with anorectal dysfunction with impaired awareness to rectal distention (without a megarectum), or may demonstrate a phenomenon of rectal outlet obstruction due to inappropriate contraction of the voluntary anal sphincters during defecation. This has been termed pelvic floor dyssynergia or anismus. These patients can present major therapeutic dilemmas and warrant further investigation in specialized coloproctology units involved in the care of such patients.*http://gastroresource.com/GITextbook/en/index.htmHas anyone with PELVIC FLOOR DYSSYNERGIA or Anismus on the bb here ever been refered to a *"specialized coloproctology unit" ?*


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## eric (Jul 8, 1999)

Spasman"I think we need to realize that the bowel is a sensitive organ.The point i want to adress is sensitivity.We,as IBSers,can probably all agree that we have sensitivity at different places in the belly.Sensitivity has many form.You can feel irritated or have severe intermittent pain.Perhaps the pain sensor can cause constipation or spasms...See,when i've had hydrotherapy,my colon react by spasming.Some of the water got trapped in my sigmoid causing me a obstruction and terrible discomfort for hours afterward.This event makes me wonder about pain modulation at the mucosa level.Why the water cause such a spasms?Is it pain processing gone wrong or a weird reaction to water in contact with the mucosa? "Review article: intestinal serotonin signalling in irritable bowelsyndrome""SUMMARY Alterations in motility, secretion and visceral sensation are hallmarks of irritable bowel syndrome. As all of these aspects of gastrointestinal function involve serotonin signalling between enterochromafﬁn cells and sensory nerve ﬁbres in the mucosal layer of the gut, potential alter-ations in mucosal erotonin signalling have been explored as a possible mechanism of altered function and sensation in irritable bowel syndrome. Literature related to intestinal serotonin signalling in normal and pathophysiological conditions has been searched and summarized.Elements of serotonin signalling that are altered in irritable bowelsyndrome include: enterochromafﬁn cell numbers, serotonin content,tryptophan hydroxylase message levels, 5-hydroxyindoleacedic acid levels, serum serotonin levels and expression of the serotonin-selective reuptake transporter. Both genetic and epigenetic factors could contribute to decreased serotonin-selective reuptake transporter in irritable bowel syndrome. A serotonin-selective reuptake transporter gene promoter polymorphism may cause a genetic predisposition, and inﬂammatory mediators can induce serotonin-selective reuptake transporterdownregulation.While a psychiatric co-morbidity exists with IBS, changes in mucosalserotonin handling support the concept that there is a gastrointestinal component to the aetiology of irritable bowel syndrome. Additional studies will be required to gain a more complete understanding of chan-ges in serotonin signalling that are occurring, their cause and effect relationship, and which of these changes have pathophysiological consequences."There is a lot more herehttp://216.109.125.130/search/cache?ei=UTF...=1&.intl=us


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## 16579 (Apr 1, 2006)

Wow, Naomi………I have so much the same and being new here almost don’t know where to begin. I have ALL the same symptoms for three years. The IE after a bowel movement is debilitating. I have had three sphincterotomy surgeries, endless procedures and drugs, had my GI doctor die unexpectedly and another one get quarantined for bringing whooping cough into the hospital and this is all just the tip of the iceberg,Last spring, I saw a psychologist that teaches at Harvard who espouses the theory that stress/ anxiety/tension = tight muscles = pain. He got me to read and absorb his book and since I’ve been doing these funky meditation exercises and I have been a lot better and I’m the naturally hyper type and sitting still for long periods isn’t really my thing but to get over this, I would drink turpentine. In any event, I have been better until about a month ago and it came back.I read that Neurontin as an anti-spasmatic drug can help and I have been taking that for about a week and have felt better some. I had two consecutive days where I felt as normal as I had been in three years and then the pain was back the last two days. I saw the colo-rectal guy who thinks for sure I have non-relaxing puborectalis (levator syndrome) and he wants me to do biofeedback. I did one session of that a year ago and it was so humiliating and uncomfortable I blew off the rest of the sessions. I guess if I’m not better in a few weeks when it is scheduled, I’ll do it. I guess you gotta do what your doctor tells you, right? Maybe.My questions – I think in these posts we established pretty much what causes this misery but can anyone weigh in that has gotten over this and how and has anyone had biofeedback and how was that and anyone get help with Neurontin and did that take time. Let’s hear from people who got better (hopefully there are some).


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## Naomi889 (Sep 11, 2005)

Hello John. So have you also found that your symptoms (i.e. the incomplete evac., cons. etc) have actually got periodically worse over time?Regarding the biofeedback, we don't seem to hear that often from people who have found really successful treatments on this board! Either successful treatments aren't that common, or - perhaps more likely? - most of the people posting on the board are those who are really battling with their symptoms rather than those who have found some resolution! Anyway, as I may have said in an earlier post on this thread, there is a girl who I sometimes email who has the same symptom pattern as me (and presumably you), and she found massive improvement with the biofeedback therapy. She wasn't totally cured, but she said she really did feel so much better. I really wouldn’t let the embarrassment factor put you off - I know it's embarrassing, I've done it in front of a nurse - but I just don't care. You know, it wasn't your fault you got this horrible disease, and, like that girl Sophie who runs the IBSTales website says, bowels are amusing or embarrassing and not to be mentioned-until the day IBS happens to you or to someone you love!


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## Naomi889 (Sep 11, 2005)

Also, what did they tell you about the reasons for you having the sphincterotomy surgery? Do you have anal fissure caused by the IE that just need to be fixed, or are they hypothesising that the fissures themselves are now causing or making worse your levator ani muscle problem?


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## SpAsMaN* (May 11, 2002)

Bioffeedback is worth trying.It help to push the stool.I just have been to them few times tho.Hi Naomi.The thing i like is when they inflate a balloon and you try to evacuate it.I have been looking to buy one of these but i cannot find any.


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## SpAsMaN* (May 11, 2002)

I did a defecography also.The surgeon told me i have non-relaxing puborectalis and say the defecography was worthed.Remember in I.E. there is the ano-rectal angle that play a role in straithening the rectum.It migth be important.


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## 16579 (Apr 1, 2006)

Hi Naomi – I have found that relaxation techniques like meditation do help but mostly I have spurts when OK and not so bad and then I get clobbered again. It is very unpredictable. I may go through the biofeedback. I am lucky that I have insurance so I guess what do I have to lose? I run a lot and find that when I go for a run 4 miles or more it gets better fast. Figure that out?!I don’t have constipation but a year or so ago they said I had an anal fissure and that was the problem. Hooray. One surgery and all better. Who could ask for more? But the first surgery didn’t work so I went back for another. Then the surgeon went on military reserve and brought back whooping cough to the hospital and he was gone and another surgeon said it wasn’t all the way healed and so back again! None of that did anything and I almost jumped off a bridge (figuratively). It’s been a long and frustrating road and sometimes there is real depression but I gotta hang tough like all of you. Do you have good medical care in the UK to get treated? Did you have biofeedback or physical therapy or whatever they call it?


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## eric (Jul 8, 1999)

JohnO,You were literally drinking turpentine?" I would drink turpentine"Wow, not sure if that is a good idea?If you feel deepressed or have high anxiety its important to work on that also if you have IBS. Are you still working on that?"espouses the theory that stress/ anxiety/tension = tight muscles = pain."This is very true. There has been much work done on this and the systems involved in IBS.alsoLevator Ani SyndromeLevator Ani Syndrome (also known as levator syndrome and proctodynia) is episodic rectal pain, caused by spasm of the levator ani muscle. The etiology is unknown.Symptoms include a dull ache high in the rectum and a feeling of constant rectal pressure or burning. The pain may also be felt in the low pelvis or perineum.The discomfort may be relieved by walking or pelvic tightening exercises similar to Kegel exercises. Other treatments include massage of the muscle, warm baths, muscle relaxant medications, and biofeedback. Electrical stimulation of the levator ani muscle has been used to try to break the spastic cycle. Injection of botulinum toxin A has also been used.Variants of levator ani syndrome include proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region). Proctalgia fugax and levator ani syndrome have not been found to be of psychosomatic origin, although stressful events may trigger attacks.Digestive Disease Week is considered the largest and most prestigious meeting in the world for the GI professional. Every year it attracts more than 16,000 physicians, researchers and academics from around the world who desire to stay up-to-date in their respective fields. The meeting is the year's best opportunity to learn about the latest advances in gastroenterology, hepatology, endoscopy and gastrointestinal surgery; prevention, diagnosis and treatment of digestive disorders; and cutting-edge technological advances.http://www.ddw.org/wmspage.cfm?parm1=175DDW: Anorectal Biofeedback Benefits Some IBS Patients By Jeff Minerd , Contributing Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Earn CME/CE creditfor reading medical news WASHINGTON, May 25 -- A common treatment for constipation may also be effective in patients with irritable bowel syndrome (IBS) *who have constipation-like symptoms caused by pelvic floor dyssynergia,* researchers said here. Action Points --------------------------------------------------------------------------------This study suggests that biofeedback therapy may be effective in *certain patients with IBS.* This report is based on abstracts presented at a meeting. These data and conclusions should be considered preliminary until they have been reviewed and published in a peer-reviewed publication. After three months of weekly anorectal biofeedback therapy, women with the condition experienced significant improvement in bowel satisfaction, bowel function, and quality of life, reported Vid Suttor, M.D., of the Royal North Shore Hospital in Sydney, Australia, at the Digestive Disease Week meetings. Pelvic floor dyssynergia is a condition in which the muscles and ligaments at the base of the abdomen that support the uterus, bladder, urethra, and rectum-the pelvic floor-don't work in a coordinated fashion, Dr. Suttor said. *Significant numbers of patients with IBS also suffer from this condition. *It causes many of the symptoms of constipation, including straining, a sense of incomplete evacuation, sensation of a blocked anus, and pain, Dr. Suttor said. There is no satisfactory treatment, and patients' quality of life is seriously affected, she added. Dr. Suttor and colleagues enrolled 25 women *with IBS and pelvic floor dyssynergia* to undergo weekly sessions of biofeedback therapy. During the sessions, a gastroenterologist and a nurse worked together to train patients in how to use their abdominal muscles and how to breathe properly in order to help have a bowel movement. A biofeedback monitor allowed patients to see and react to their rectal pressure. The therapy also included simulated defection with a water-filled balloon. *The researchers also enrolled 25 women with constipation. They underwent the same biofeedback sessions, so the researchers could directly compare the effectiveness of biofeedback therapy for the two conditions*. Global bowel satisfaction, as measured by a 10-cm visual analog scale, improved by about 5 cm in both groups (P<0.0001). In addition, about 75% of all patients rated themselves as "improved" or "very improved." Quality of life, as measured on a 10-point scale, also improved by more than three points in both groups (P<0.0001). All of the six women with IBS and initial paradoxical anal contraction on strain normalized with therapy, as did six of the nine women with constipation and this condition (P not significant between the groups). For those with abnormal balloon expulsion at baseline, eight of the 10 women with IBS and both of the women with constipation were able to expel the balloon normally by the sixth therapy session. The study included only women because they are more likely to be affected by IBS, but the results would apply equally well to men, Dr. Suttor said. *"The efficacy of anorectal biofeedback therapy in non-diarrhea predominant IBS with pelvic floor dyssynergia is similar to that in functional constipation with pelvic floor dyssynergia," the researchers said. **"Biofeedback therapy should be utilized in the management of IBS patients with features of pelvic floor dyssynergia," they concluded. Clinicians should ask patients with IBS about symptoms of pelvic floor dyssynergia and refer then for a course of anorectal biofeedback therapy if necessary, Dr. Suttor said. *The authors reported no financial disclosures. Primary source: Digestive Disease Week 2007Source reference:Vid Suttor et al. "Anorectal biofeedback therapy is effective for non-dairrhea predominant irritable bowel syndrome as for functional constipation." Abstract T1350. Presented at Digestive Disease Week 2007, Washington, D.C., May 19-23. Complete DDW Coverage http://www.medpagetoday.com/MeetingCoverag...Meeting/tb/5773If a person lives in the US The UNC Center for Functional GI & Motility Disorders highly specializes in all these things and have some of the top researchers in Biofeedback for Anorectal Disorders and for other reasons.


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## 16579 (Apr 1, 2006)

I would drink turpentine to get over this. A whole bottle.


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## SpAsMaN* (May 11, 2002)

> The discomfort may be relieved by walking or pelvic tightening exercises similar to Kegel exercises.


Nope,trying to strengtening a muscle already tense won't help.


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## Naomi889 (Sep 11, 2005)

You don't have constipation but you do feel like you have incomplete evacuation? How does that work - is it just quite a mild sensation? I hope you get to have a go at the biofeedback thing. Many people think that medical care in the UK is quite poor for one of the world's richest countires - there are two problems; people can and do die on waiting lists for treatment, and doctors can be very strapped for time. So with regard to a chronic intractable condition like IBS, it is very hard to find treatment or even be listened to - I've never seen a GP who's actually fully listened to what I've said about this condition in all the years I've had it. But I don't know that that's something that's so very different in the US after reading this board for a while - plus there's all the insurance stories! Nobody refered me for biofeedback therapy/non-relax pub. testing - I had to ask for it myself - no GP ever made a single helpful suggestion to me in all the time I've had this - all the things that have helped me I looked up on PubMed myself. The waiting list for use of a biofeedback machine on the NHS here in Scotland is two years! However, if you are willing to pay for one yourself (around £100 which is $200), which I did, they will train you to use it.Mate, to get rid of this, I'd drink turpentine, french kiss Gordon Brown and walk down Princes Street naked during rush hour. I'd cut off my right hand to get rid of this.


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## 16579 (Apr 1, 2006)

Naomi -- wow, the walking down Princess Street naked is really radical but kissing Gordon Brown -- wow -- that's over the top. YuckI'm lucky that I have probbaly the best insurance in the US and just about evrything is covered. In about an hour I see this really top GI woman doctor and I'll let you know what she thinks since it seems like our symptoms are similar. I bet she recommends biofeedback too but I'm not going to reveal what the other doctors have diagnosed to get a blind opinion.No, no constipation just IE. Some days good-- some days not so.


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## Naomi889 (Sep 11, 2005)

Are you kidding? I'd do a lot worse that GB- I think I'd sell my soul to be rid of this. I dream about it every day and every night and I'll never give up hope of a cure. Maybe it's worse for those who have IBS-C with C all the time?.. we're always in discomfort - there's never been a moment of the last 6 years where I have not felt in discomfort, and there's never been an hour that I haven't wished to be well again.....


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## 16579 (Apr 1, 2006)

It’s easy for me to say but maybe the fixation with this adds some to the problem. I know, I know – easy for me to say but I went through all this relaxation training and tried to take my mind off it as much as possible and I was really good for many months. I’m not sure why it’s back the way it is but even now I try some of the relaxation techniques like meditation and I’m convinced that that helps. You are too young to suffer with something as debilitating as this. No one should have to but especially someone your age who I perceive to be a lot younger than me. I’m 55 and wish this would go away because I wonder how long I have before the really bad health stuff kicks in.Does your misery ever abate? Mine is anywhere from nothing some days to an hour to six to 8 hours others with IE. It usually goes away and for that I should be thankful. If yours is constant, oh my God, Naomi, you have to get this fixed. I saw this GI woman doctor this morning and she thinks I should do the feedback. I probably asked you this before but did you have that or did you tell me your insurance in Scotland won’t pay and it’s wicked (New England popular adjective for emphasis) expensive?


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## Naomi889 (Sep 11, 2005)

The nurse I saw last week said as much to me and I could have cheerfully strangled her, really I could. (I don't mean to be rude - I'm so sorry! - it's just so, so frustrating I could cry - I'll try to explain myself). Even my own father, who has always rated my intelligence very highly, takes this view. Please understand, it is not acutally unnatural or a "fixation" to think contstantly of your severe physical discomfort if you are always in that discomfort..I tend to use a headache analogy to those who do not understand. My symptoms occur constantly - I get no remittance from them. Imagine you have a severe headache - all the time. You would not be able to stop thinking about it, ever, because one cannot ignore physical pain or discomfort - it is an impossibility. I tend to use a headache analogy to those who do not understand. My symptoms occur constantly - I get no remittance from them. Therefore it is not at all unnatural for me to think constantly of them. I think only those whose symptoms occur 24 hrs a day can understand this.I think the stress thing with IBS is a very difficult and subtle paradox. Yes, stress can make it worse, but that does not mean that *everyone* can control their symptoms via control of their mental state. For me, yes, stress has made my symptoms worse, but by God, the absence of stress does not make them better. You name it, I tried it, in the first sorry year I had this- hypnotherapy, cognitive behaviour therapy, ... it did not help one bit. I cannot override my personality and I have come to realise that I have done all I can do with regard to stress control. It is probably to do with my particular type of self-worsening IBS via the IE- read my earlier posts if interested.And yes, I am too young to suffer like this - thank you so much for your sympathy. I got this six years ago and then had everything going for me. I'm now 26 - don't know how you managed to perceive I was young - I can spell! From most people's perspective my life experience would be very cruel - I have suffered so much since I was only 20, and (I'll be frank) am now in so much physical discomfort that sex has become too painful. What sort of life prospect is that for a young women? How can I ever hope of getting married, of having children? But in a way, it is a load of rubbish- NO ONE should have to suffer like this, not just the young! And suffering like this opens up your eyes to all the suffering that exists in the world - do you know how many innocent young people are infected with HIV through no fault of their own in sub-saharan Africa these days, how many suffer from bowel prolapse diseases in Africa without hope of treatment, or how many have lost their whole families in Iraq? What I'm trying to say is that severe illness changes your perspective - who am I to say that I should not suffer like this? Alas, we are all the victims of monsterous and impersonal forces and there is no right or wrong, fair or unfair about it! It's not a great comfort to me that I have come to realise this....


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## 16579 (Apr 1, 2006)

Naomi, there is way too much unfairness and injustice in the world as you accurately point out but the one thing that has to keep us all going is some sort of hope to get beyond all this. Without hope, it is almost impossible to push on. I guess I am lucky that my misery does abate some. I can’t fathom 24/7 of this. I hope that there is hope for you. There has to be. Whatever they have diagnosed you as having, there has to be some treatment, no? Did you do the biofeedback? Honestly, it breaks my heart to read your last post. You are so young. I have kids that age. Actually, my son’s band does tons of concerts in UK (Dropkick Murphys) and I can’t imagine them being so young going through this. I wish I could switch places with you and you get some relief so you can live a normal life free from all this. I mean that. I had my years of good health and God don’t we take good health for granted until it’s shattered. There just has to be some hope for you. I know I’m not giving up and neither should you. Easy for me to say, I know.


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## Naomi889 (Sep 11, 2005)

Ah yes John, Pandora's box. We always have hope. I'll be dead when I give up hoping for a cure for this thing. It's just as you say - if one's illness really does have a tangible cause, theoretically there can be a cure even if it has not yet been invented - I'm sure this applies to your IBS as well as mine. Deep down I think it unlikely, but I dream about it every day. To be able to wake up in the morning and not feel ill, to not spend every day in exhaustion and despair, to have, er.. a normal love life.. it is always a theoretical possibility. I am so very touched by your sympathy - you are a kind man. I just think we in the West don't really conceive of the sheer unfairness of life - especially young people from comfortable backgrounds like me and no doubt your young son (I have vaguely heard of that band I think!). It is simply not normal for a young person from a rich country to suffer so very much- doesn't mean there is any fair or unfair about it, alas - illness is no arbiter of fairness..Incidentally I have indeed started biofeedback therapy- no change yet but it's only been a week - we don't tend to have insurance here in the UK - almost everyone uses the "NHS" which is paid for via our higher taxes.


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## annie7 (Aug 16, 2002)

i like your headache analogy, Naomi. personally i've found it impossible to ignore pain especially when it's 24/7. i've suffered from ibs-c and ie for the last forty years and have practiced meditation daily for the last 30 years. meditation is wonderful and has helped me in many ways and i've read that it can help people with their pain however for me that's not been the case--it has done nothing for mine. and i've also tried stress reduction exercises and cbt. but everybody's different--what works for one may not work for another. hopefully biofeedback will help both of you--please keep us posted.


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## Naomi889 (Sep 11, 2005)

Forty years, Annie, that's really terrible. I will certainly come back and let people with this symptom know if the biofeedback therapy or anything else works.


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## annie7 (Aug 16, 2002)

well yes and what's really sad about the 40 years is the medical profession's ongoing lack of interest in ibs as well as chronic constipation, pfd, etc --lack of care and concern and aggressive treatment plans on the part of the doctors i've seen over the years. for years i was told that ibs-c was "my fault" and all i needed to do was eat more fiber, drink more water and exercise more and "stop obsessing over it" and when i told the drs i was already following that plan, i was actually told to just get over it and live with it--that it wasn't as bad as some things (like cancer) were. what--pain 24/7 isn't bad? granted it's not going to kill me but on the other hand, unless we get some better treatments for it, i'll have it til i die. it devastates one's quality of life. only recently has there finally (!!!!) been more interest and research done on ibs as well as chronic constipation and pfd and other pelvic and rectal problems. and drug options too have been so limited. zelnorm and amitiza are the only drugs that come to my mind that were developed to help those with ibs-c and chronic constipation --and of course we all know what's happened with zelnorm. i know there are some drugs in the pipeline and i hope and pray they become available soon.we need the entire healthcare industry---the doctors, the pharmaceutical companies, the insurance companies-- to take us seriously! as well as our families, friends and employers.


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## eric (Jul 8, 1999)

You can still get zelnorm under the "Zelnorm available to U.S. patients under restricted access program"http://iffgd.org/site/news-events/news/industry-news/zelnormOne of the things also I was trying to get across is like John O where he has the sensation of incomplete evacuation, but not constipation. There are different factors in incomplete evacuation. For some especially IBS, and it can happen in D or c or D?C IBS, IT IS the sensation of incomplete evacuation after a bowel movement."Video Corner: Overcoming Challenges There is growing recognition of the seriousness and the complexity of the functional GI disorders. Yet individuals affected by these disorders still face challenges in finding adequate care. Many physicians remain unprepared to diagnose and treat patients with functional GI disorders. Moreover, the burden of illness resulting from chronic pain or discomfort and other symptoms associated with functional GI disorders remains underappreciated by everyone it seems - except those who experience it, or those who are truly dedicated to finding solutions. "http://www.iffgd.org/site/learning-center/...rner/challenges


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## eric (Jul 8, 1999)

also in regards to IBS itself.This used specific gut directed HT. Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42. LinksGut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J, Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Academic Department of Medicine, University Hospital of South Manchester, UK.BACKGROUND: We have previously shown that hypnotherapy alters rectal sensitivity in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition, the study group was symptomatically rather than physiologically defined. AIM: To assess the effect of hypnotherapy on rectal sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique (barostat) that addresses these technical issues. METHODS: Twenty-three irritable bowel syndrome (Rome I) patients (aged 24-72 years) were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and depression. Normal values for sensitivity were established in 17 healthy volunteers (aged 20-55 years). RESULTS: Compared with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group (P = 0.04) and decreased in the hyposensitive group, although the latter failed to reach statistical significance (P = 0.19). Normal sensory perception was unchanged. Sensory improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain (r = 0.714, P = 0.07). CONCLUSION: Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.PMID: 12641511


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## Naomi889 (Sep 11, 2005)

You're damn*d right in all you say Annie. But Nil Illegitimi Carborundum with regard to the medical profession, that's what I say. Keep fighting, doesn't matter how long you've had it, I sure as h*ll will and I will definitely let those who've posted here know if I find anything that works.


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## 16579 (Apr 1, 2006)

Keep fighting, Naomi. You are young, smart, pretty and have determination. You have all things going for you. Me on the other hand.......never mind ........LOL.......I start biofeedback next Friday and maybe we can compare how it goes. The woman doing this already told me something on the phone that has helped. I "can't wait" to have a woman doing this to me. Check humility at the door.


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## Naomi889 (Sep 11, 2005)

Why thank you, John, how kind. But I am afraid that all life has taught me that the saying is so very very true; you don't have anything if you don't have your health. It doesn't make any difference if you are young or clever - not sure I'll agree with the last one - if you are always in terrible discomfort and can barely function. We are all brought to humility before the vagrancies of Fate with regard to health - did it matter that Christopher Reeve was a rich and successful film star when he became a paraplegic? No, he died, despite his efforts to cure himself and faith that he would, because that was simply the lot that fate had decreed for him. But what all of us, including Annie who's had this for forty years, do have, is hope. As long as a treatment or even a cure is within the realms of possibility, we must be persistent with the medical profession.Screw the humility with the biofeedback - who cares? I hope it helps you.


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## 16579 (Apr 1, 2006)

Yea -- I used to have a wise old friend who would say "misery shines on the just and the unjust alike". How true. I feel so horrible that you have no relief. At least mine goes away after a while. I actually just had two good days but today kind of bad again. I wish the same would happen to you in terms of some relief.This is probably repetitve, but have you done meditation? I have for about six months and I think the relaxation takes the edge off.


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## Naomi889 (Sep 11, 2005)

John - I tried a very wide variety of stress reducing techniques in the first and second years I had this, including meditation. I was also purposely unemployed for 4 months to test the elimination of all external stresses, and I have chosen not to start a PhD as I would otherwise have done as being too stressful, foregoing the chance of a successful career. Nothing helped, at all, but as I said earlier in the thread I think that's more to do with my particular type of IBS - it worsens very markedly and intractably. I can believe stress reducing techniques help others but sadly that absolutely does not seem to be the case for me.Incidentally with regard to your biofeedback therapy - have you not been given your own machine? I can see why it would be embarrassing to the point of uselessness if you had to do every session in front of a nurse. People on this board in the U.S. have quoted massive fees for biofeedback therapy, but here in Scotland I was just told to buy my own machine online- it has "Not for sale in the US" written all over it, interestingly enough - can you not buy your own machine in the U.S.? It would be better, surely.


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## 16579 (Apr 1, 2006)

Naomi – I don’t start until next Friday so I am not sure. I’m glad you brought it up because I didn’t know that such a thing existed as one having one’s own machine. I’d way rather do that than have to go get tortured by a nurse for a bunch of visits. I’ll ask. Thanks. I can imagine explaining a take-home machine to my wife. Oh, hi honey, look at my Christmas present I got from the biofeedback lab – my own butt muscle toning machine. I’d have to pick her off the floor from hysterics. Oh well………you gotta do what you gotta do. Has it helped you yet? E-mail me off the thread if you want if this thread is getting too long. I think you can do that.


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## Naomi889 (Sep 11, 2005)

Regarding the machine, well it's like we were saying earlier - who cares about the embarrassment factor if it turns out it really does help! I'm just being a bit vague with the people I've told about this thing about what it actually is......







. To John, and anyone else being over-quoted for biofeedback therapy, the machine I'm using is called the NeuroTrac Simplex and it was bought from a company called Oakfield instruments. John, I'm sending you a message with my email address if you need to share/ask for any info about our specific symptoms and the biofeedback therapy in general - I'm very happy to correspond with anyone suffering from the symptoms we have been discussing on this thread, as I've found prior correspondence with a girl with identical symptoms to me to be extremely useful.


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## SpAsMaN* (May 11, 2002)

I just wanna warn people to not spend more than 1000-2000$ on Biofeedback stuff.This thing may just be....well,overated.Honestly,i went only 1 or 2 times but i don't get the idea of it.*Sure now i use my muscle better when i evacuate.I push from the pubic area and then let it go \!/*Again,this pubic pushing really help to evacuate.My biofeedback clinic is very far away so i don't even bother to return.BTW,i doubt this has an impact on general constipation.I don't want to discourage people from trying it,it has help me.


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## SpAsMaN* (May 11, 2002)

I know these perineal rehab center are rare and probably far away from your home BUT i think it is better to have the physiotherapist to guide you with the electronic and the evacuation manouvers.The balloon expulsion test is interesting.I would like to buy one.You pump it and try to evacuate it.HAVE FUN!


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## eric (Jul 8, 1999)

Spasman, on another thread you mentioned your were also diagnosed with anismus as well?Is this correct?


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## SpAsMaN* (May 11, 2002)

Eric,anismus i beleive,is the old term for non-relaxing puborectalis(with push).Having said that,i beleive in my case i have both n-r pubo and IBS.


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## Johnny D. and C. (Feb 21, 2002)

Hi all! I had chronic constipation and had all the symptoms you guys mention, incomplete evacuation, for months,etc. Decided I'd rather have the D back. Stopped eating regular yogurt and milk products, they make the large bowel sticky with mucus. For me this was very constipating, feeling full all the time etc. The mucus in my opinion interferes with the colon's ability/sensitivity to the stool and affects its movement through the bowel. Plus it's hard for the peristalsis sp, the squeezing action of the bowel to physically move stool through this sticky environment. The bowel may use constipation as a method of removing mucus plaque from it's walls. Notice bowel movements in toilet bowl usually accompanied with mucus in and on cracks of hardened stool. Sorry to be graphic. I also used salt water enemas to rid myself of mucus plaque. Didn't take long to become IBS D again. I was afraid of developing diverticulitis. Anyway hope this helps.


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## eric (Jul 8, 1999)

How many people with Consitpation on this thread have had a sitz marker test done?Johnny,The bowels natural shed cells from the bowel walls. It also works as a lubricant."The mucus in my opinion interferes with the colon's ability/sensitivity to the stool and affects its movement through the bowel. Plus it's hard for the peristalsis sp, the squeezing action of the bowel to physically move stool through this sticky environment. The bowel may use constipation as a method of removing mucus plaque from it's walls. Notice bowel movements in toilet bowl usually accompanied with mucus in and on cracks of hardened stool. Sorry to be graphic. I also used salt water enemas to rid myself of mucus plaque. "This is actually not the case.Jackson Siegelbaum Gastroenterology"Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. IBS patients sometimes produce large amounts of mucous, but this is not a serious problem. "http://www.gicare.com/pated/ecdgs03.htmmucous is common in IBS and is not serious.The bowel wall constantly sheds its cells, especially during a bad flare when contractions can be stornger."Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. IBS patients sometimes produce large amounts of mucous, but this is not a serious problem. "Merck manual IBS"Excess mucus production, which often occurs in IBS, is not related to mucosal injury. Its cause is unclear but may be related to cholinergic hyperactivity."http://www.merck.com/mmpe/sec02/ch008/ch008e.html


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## eric (Jul 8, 1999)

These are a couple centers in the US that deal with pelvic floor disorders.One in Southern Californiahttp://www.surgery.usc.edu/divisions/cr/pe...rdisorders.htmland one in Minneapolis, MN http://www.pelvicfloorcenter.org/National Digestive Diseases Information Clearinghouse"Problems with Intestinal FunctionThe two types of constipation are idiopathic constipation and functional constipation. *Irritable bowel syndrome (IBS) with predominant symptoms of constipation is categorized separately.*Idiopathic-of unknown origin-constipation does not respond to standard treatment.Functional constipation means that the bowel is healthy but not working properly. Functional constipation is often the result of poor dietary habits and lifestyle. It occurs in both children and adults and is most common in women. *Colonic inertia, delayed transit, and pelvic floor dysfunction are three types of functional constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower, or sigmoid, colon.**Pelvic floor dysfunction is caused by a weakness of the muscles in the pelvis surrounding the anus and rectum. However, because this group of muscles is voluntarily controlled to some extent, biofeedback training is somewhat successful in retraining the muscles to function normally and improving the ability to have a bowel movement.**Functional constipation that stems from problems in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.**People with IBS having predominantly constipation also have pain and bloating as part of their symptoms."*http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/


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## Johnny D. and C. (Feb 21, 2002)

With all due respect Eric, when the medical field namely the ones telling me about my disorder and the complicated symptoms, cure me, then I'll listen to their elaborate assumptions! They should inoculate themselves with this disease, in order to understand how we feel and this would better motivate them to find a cure. Instead of concentrating on making this a manageable condition, reliant on there little daily pill. We all suffer due to greed! I haven't had the sitz marker test done and I am through with tests and specialists. I was a factory worker for twenty-five years. I have had no academic training, only self taught. My advice is for the people who do not understand medical language, people like me. You are a very prolific member with thousands of posts, you know much more than me. I have only a few posts, check the dates. There was a period I stopped posting, a period were I was much better, no symptoms. I speak from my own personal experiences. You disagree with me, that is your right. I disagree with you and many others on this board as well. I would not even be here, if I hadn't got a chest infection in my lung and required antibiotics again. I was planning on coming back when I was absolutely positive, I cured myself. But well I'm back for now, but maybe not for long. By the way that's a good idea you have....about making a place on the forum for people to post, that have cured themselves, why not contact them, since they moved on with their lives. Send them a pm, it shows up in their email and ask them how they are doing. During a search for an unrelated topic I came across member "day" who claims to be getting much better, he has not posted since, has he moved on? Good luck to all!


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## Naomi889 (Sep 11, 2005)

"When the medical field namely the ones telling me about my disorder and the complicated symptoms, cure me, then I'll listen to their elaborate assumptions! They should inoculate themselves with this disease, in order to understand how we feel and this would better motivate them to find a cure"Right on, Johnny my brother! Well, I do understand academic language and have been trained to dissect academic papers, and I can tell you now that some of what appears in the scientific literature regarding IBS is indeed bollocks. That is one of the reasons that I maintain (and expressed previously to Eric) that a more useful thing that quoting random sections of it verbatim (although this can be helpful) would be if those of us with severe IBS grouped ourselves together according to our specific symptoms, recounted our specific experiences, and proceeded from that point on a very scientific basis towards successful treatments. I can tell you now that if that were more widespread then there would be more effective treatments for the various types of IBS (always remember that it is a diagnosis of exclusion and not a tangible positive/negative diagnosis like e.g. ulcerative colitis, but this does not mean that the various facets of it are not potentially treatable). Personally I feel that I may have the training analyse what is physically happening to me and suggest some experiments or trials that could potentially be done that may well prove more useful that some that are currently running, but does this mean I can even get a doctor to listen to me for long enough to provide a basic medical assessment of what my specific experiences have been. Hell, no! No, they’ll carry on with their myriad “IBS is significantly detrimental to quality of life” studies. Mmm, useful.I wonder if this board would be amenable to the creation of more specific groups that just "C" or "D" and "anxiety", or we could get ourselves more directly involved in the creation of clinical trials somehow? Hmmm.Thoughts? Posters? Moderators?


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## eric (Jul 8, 1999)

Johnny,Out of curiosity where did you get this information from? Did you read this somewhere or just your own speculation?"The mucus in my opinion interferes with the colon's ability/sensitivity to the stool and affects its movement through the bowel. Plus it's hard for the peristalsis sp, the squeezing action of the bowel to physically move stool through this sticky environment. The bowel may use constipation as a method of removing mucus plaque from it's walls. Notice bowel movements in toilet bowl usually accompanied with mucus in and on cracks of hardened stool."On this""When the medical field namely the ones telling me about my disorder and the complicated symptoms, cure me, then I'll listen to their elaborate assumptions! They should inoculate themselves with this disease, in order to understand how we feel and this would better motivate them to find a cure"First there are many disorder and diseases in the world they don't fully understand or can cure, so treating the symtoms and possible remission is the next best option.Also the leading cause of misdiganoses is self diagnoses. I am not saying that is the case here, but its almost impossible for a lay person to actually figure out how their body physically works on the molecular level.They cannot cure IBS at this time. For one because they don't fully understand it and the complexties of it all. That doesn't mean they don't have any clue however and a lot of research has been done lately within the last ten years and speciafially the last five.Mucous has nothing to do with pain and IBS. Mucous is secreted from the bowel wall naturally.The actual term for sensitvity is called visceral hypersensitivity. This is a major part of IBS research right now. There is a lot of information on it all out there and on this bb.The altered contractions which can sometimes be pretty violent cause the bowel walls to shed the cells in IBS.There are good and bad doctors out there. They are excellent extremely knowledgable people working in IBS research that are actually trying to help all of us. This is not about a person having a bad doctor relationship with a single person.Also on the flip side there can be problematic patients, we don't hear about that to much of course.It is well know in IBS a good doctor patient relationship is very helpful. I know this doesn't always happen however, and there is some responsiblity on the patients part as well.I can also tell you from having IBS for more then thrity five years constantly looking for and wanting a cure is counterproductive. Some people find treatments that really work and work well, some about 10% go into remission and doctors don't know exactly why that is really.For the majority of IBSers wioth moderate to severe symptoms it is a chronic condition for now at least.The sitz marker test shows if you have slow transit through the digestive tract and the colon. This is a different problem then pelvic floor disorders. Its even different then IBS. On thing a lot of negative coomments here on IBS and IBS research is from shear frustration and perhaps some bad doctor experiences. I have had them numerous times myself. Now if I go to the doctor for IBS, which is rare, I have learn so much about IBS I can talk to them pretty well. I also am in touch with some of the leading researcher on IBS as well. These are not bad people or people witholding a cure or any of that, its that it taskes time to figure things out and money for research can be a problem as well. As stated on another thread the person who figures this all ut will win a nobel prize just like the one doctor and HyP and ulcers.On this I don't know where you got this from."By the way that's a good idea you have....about making a place on the forum for people to post, that have cured themselves, why not contact them, since they moved on with their lives. Send them a pm, it shows up in their email and ask them how they are doing. During a search for an unrelated topic I came across member "day" who claims to be getting much better, he has not posted since, has he moved on?"I do talk to a few people no longer on the bb here. I don't believe off hand I know one person who has cured themselves, a lot of people who have treated themselves successfully however. In order to understand cure in IBS you have to understand the problems and they are seriously complex. They have not figured out the hiuman digestive system or the brain yet and they work togehter. IBS as it stands right now is a brain gut axis disorder, did you know that?Naomi889,"Well, I do understand academic language and have been trained to dissect academic papers, and I can tell you now that some of what appears in the scientific literature regarding IBS is indeed bollocks."Yes and some is already well known. For example that there are different kinds of constipation and IBS is not a pelvic floor disorder. That is not up for debate, they are seperate conditions.Also where does a person get good information then? Not form a single study or two, but from basic science done on functional disorders. ITs not just IBS these doctors study either but functional disorders and disease. There has been an enormous amount of research done lately and very well carried out research.Most times people don't know who all these researchers really are and what they are really doing. One thing is for sure a lot of them have total dedication to helping us, yet we bash the entire medical field. Or a person can learn ways to have better doctor patient relationships and get more out of a doctors visit. Or fire the bad ones. This"That is one of the reasons that I maintain (and expressed previously to Eric) that a more useful thing that quoting random sections of it verbatim (although this can be helpful) would be if those of us with severe IBS grouped ourselves together according to our specific symptoms, recounted our specific experiences, and proceeded from that point on a very scientific basis towards successful treatments."Is what research really is about. However people are not good at this and this thread is a case in point really. They may know how they feel, but they cannot diagnose themselves. Already on here we see people calling different disorders all IBS and that is false.Different disorders may require different treatments.This also is no longer the case. IBS diagnoses is based on a SPECIFIC CLUSTER OF SYMPTOMS. Using the Rome Criteria is is a SECURE diagnoses."(always remember that it is a diagnosis of exclusion and not a tangible positive/negative diagnosis""Current Approach to the Diagnosis of Irritable Bowel Syndrome* In the past two decades, medical opinion has changed regarding how to diagnose IBS. The older view emphasized that IBS should be regarded primarily as a "diagnosis of exclusion;" that is, diagnosed only after diagnostic testing excludes many disorders that could possibly cause the symptoms. *Fortunately, physicians can now diagnose IBS in most patients by recognizing certain symptom details, performing a physical examination, and undertaking limited diagnostic testing. This simpler approach is grounded on recent knowledge...and it leads to a reliable diagnosis in most cases."http://www.iffgd.org/store/viewproduct/163for more on diagnosing IBShttp://www.ibsgroup.org/forums/index.php?showtopic=65559Knowledge about a medical condition empowers the person and can make a major difference to finding successful treatments, reducing anxiety, reducing worry and a lot of other reasons. These things can contribute to IBS..I can also say after over thirty five years of having IBS, blaming or bitching about things rarely helps anything, except to blow off steam. Learning is another story completely.


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## Johnny D. and C. (Feb 21, 2002)

Hi Eric In answer to your first question, a bit of both. Mucus plaque is mentioned in the "The Yeast Syndrome" book. First published in 1986. You are right I am speculating with regards to pelvic floor dysfunction. If the large bowel is sticky due to milk consumption, and using digital exploration to verify, how hard is it on the muscles to try and push a mass of stool through this tube. I would say very hard, how long before diverticulitis, pouch like pockets form, or muscle stretch and become useless, under this stress? I'm not knocking all Dr's and I certainly would like to believe there are some good ones out there. But why is medical malpractice the fife or sixth leading cause of death in North America. I have certainly run into my share of incompetence. The new forum you wanted to Jeffery to set up. http://www.ibsgroup.org/forums/index.php?showtopic=92199 or did I mistake your intentions. Anyway hope I answered some of your questions.


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## eric (Jul 8, 1999)

PS sorry for the typo's in the last post, I was at work typing very fast. This is an expert in Canada on constipationCan J Gastroenterol. 2000 Nov;14 Suppl D:155D-162D.LinksConstipation: a physiological approach.Thompson WG.University of Ottawa, Ottawa, Canada. [email protected] first step in managing a patient with constipation is to understand the precise nature of the complaint. Is the onset recent? What are the frequency and form of the stools, and how much effort is required to defecate? Is constipation steady or alternating as in irritable bowel syndrome? Are there structural, metabolic or pharmacological confounders? Is the patient depressed? Has dietary fibre been tried at a sufficient dose? What are the patient's understanding and beliefs about the symptoms? Has there been sufficient and appropriate investigation? Armed with the answers to these questions, physicians can help most patients through lifestyle, dietary and pharmacological adjustments, along with supplementary fibre. Some patients may require regular doses of an osmotic laxative. Those few that fail these measures should have their transit time estimated while on a high fibre diet; if it is normal, further testing is unlikely to help. The above efforts should be re-emphasized, and reassurance should be offered. Some patients may require a psychological assessment. If transit time is prolonged and the patient may benefit from surgery for colonic inertia or biofeedback for anismus, then colon and anorectal function should be assessed. The decision to perform further tests should be made carefully, and unrealistic expectations should be discouraged. Before surgery is offered, the patient should have the benefit of receiving an expert opinion. Biofeedback helps some patients with isolated anorectal dysfunction.also and the below conditions are not IBS but other medical diagnoses.Pain in the buttThere are several patterns of pain in the rectum, anus and perineum that have been described.They may be due to elevated muscle activity or tension in the pelvic floor musclesProctalgia fugax Severe and sudden attacks of a sharp pain in the rectumdescribed as stabbing, burning or grinding pain in the anal canal or rectum Attacks may follow defaecation, sexual activity or stress may awake in the middle of the night with severe rectal pain Levator ani syndrome Continual discomfort on parts of the anal canal or rectum. Described as having the anal canal pulled in knots or feeling like there is a hard object like a golf ball in the anal canal. Women with this problem may have pain on sexual intercourse. Some people report extension of pain across the buttocks and down the legs CoccydyniaThis is a condition marked by pain in the coccyx or tailbone. Described as the tailbone "being on fire'Paradoxical contraction of the pelvic floor muscles (anismus). This an abnormal increase in the pelvic floor muscle activity with defecation (rather than a decrease).This can contribute to constipation or complaints of incomplete evacuation or excessive straining. Excessive pelvic floor activity may be associated with voiding hesitancy, interrupted stream, urinary urge and painful urination. Pelvic floor muscle function can be improved by relearning (through biofeedback)available through specialist colorectal clinics. Several sessions over a few months may be required. Medication does not seem to be effective http://www.gastro-info.co.nz/IBS.htmA person might notice lastly there with anismus "Medication does not seem to be effective" but for IBS C predominate people some medications do work. Again different treatments for different problems. Even the different problems above, which can and do overlap with IBS frequently."Part 2: What causes constipation?What causes constipation? (continued from page 1)Irritable Bowel Syndrome (IBS) Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress,* but there is no specific cause or anything unusual that the doctor can see in the colon."*"Problems with the Colon and Rectum Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.Problems with Intestinal Function (Chronic Idiopathic Constipation) Some people have chronic constipation that does not respond to standard treatment. This rare condition, known as idiopathic (of unknown origin) chronic constipation may be related to problems with intestinal function such as problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women.*Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower or sigmoid colon.*Functional constipation that stems *from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit."*http://ibdcrohns.about.com/cs/otherdisease...stipation_2.htmThis part on IBS however"but there is no specific cause or anything unusual that the doctor can see in the colon."Using standard medical tests the colon appears normal, but with powerful microscopes now researchers are finding different abnormalities at the molecluar level in the colon walls.


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## Naomi889 (Sep 11, 2005)

I'd give you more credit Eric, if you hadn't appeared to fail to understand the basis of my point when were debating the specifics of anismus/IBS-C, and if you articulated yourself better. So I'm not going to bother to go into it yet again. My basic point now is simply that my direct experience tells me it is likely that a range of more specific and useful studies into IBS could be done if there was greater communication between patients and doctors. I am not dismissing an entire body of scientifc research at all. I am merely telling you as someone who works in academia not to always take all papers as gospel and that it can sometimes be useful to debate things out for ourselves - we are the ones with the direct experience of this disorder. I also am talking more of a hope of a range of more successful treatments than a cure


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## eric (Jul 8, 1999)

Johnny"In answer to your first question, a bit of both. Mucus plaque is mentioned in the "The Yeast Syndrome" book. First published in 1986. You are right I am speculating with regards to pelvic floor dysfunction. If the large bowel is sticky due to milk consumption, and using digital exploration to verify, how hard is it on the muscles to try and push a mass of stool through this tube. I would say very hard, how long before diverticulitis, pouch like pockets form, or muscle stretch and become useless, under this stress? """In answer to your first question, a bit of both. Mucus plaque is mentioned in the "The Yeast Syndrome" book. First published in 1986. "This book is out of date for one and inaccurate on mucous and IBS. Also yeast does not cause IBS.IBS is not an infection.Importantly serotonin released from cells embedded in the colon wall are the neurotransmitter responsible for signaling sensation to the brain. This is majorally implicated in IBS and pain and IBS and d or c or d/c symptoms, as well as nausea and other issues. Do you know about all that research?"If the large bowel is sticky due to milk consumption, and using digital exploration to verify, how hard is it on the muscles to try and push a mass of stool through this tube."Diary can slow the gut down due to fats in it. But the bowel is not sticky due to milk consuption.Have you been tested for lactose intolerence?Not all people with IBS C develop diverticulitis. This is a seperate issue."using digital exploration to verify, how hard is it on the muscles to try and push a mass of stool through this tube."You can't reach far enough up into the colon. Also in IBS there is a mnalfunctioning of the sigmoid colon, which is different then problems in anal rectal functioning.Another major issue here is still altered perception of normal digestion in IBS. This isn't being talked about here and it is very important to the big picture of IBS."I'm not knocking all Dr's and I certainly would like to believe there are some good ones out there. But why is medical malpractice the fife or sixth leading cause of death in North America. I have certainly run into my share of incompetence."I have had my share as well, now I know how to talk to them and help myself when I see one.This isn't about malpractice. Of course there are all kinds of problems with the medical community, granted, but this is about actual research on IBS. People can have a bad doctor then ignore what the good reseach doctors are finding out, because they have had bad experiences with doctors so then they don't trust any of them. In reality this is a problem. I went and learned who a lot of these doctors are and what their credentials are even. There is a group who does research and does not see patients even. There is a large body of inaccurate IBS information on the web and there is also a large body of excellent information on the web. I lean towards sources you can actually trust, like the UNC or IFFGD or John Hopkins or UCLA or Cleveland clinic or Medscape ect..Naomi889 I have taught IBS at two hospitals and over the last five years I have been here, read over I'd say tens of thousands of research papers on IBS. I also have access to most of the top centers in the US on IBS and help from world leading experts on functional gi disorders.One of the Drs that helps me with questions is Dr Drossman the chairman of the Rome committee and a world expert on functional disorders. They train researchers from around the world.I believe expert advise is a good thing personally. You can check out the accuracy and credability of the resources I have already posted on the different types of C or IBS even. "I'd give you more credit Eric, if you hadn't appeared to fail to understand the basis of my point when were debating the specifics of anismus/IBS-C, and if you articulated yourself better."You have called IBS C and anismus the same thing and that is incorrect. So you either have one or the other or both. You have been very vague about basis of your point really.Do you have both yes or know and then we can move on from that aspect. We have been debating here for many years. I can also tell you they are investigating an extremely wide array of IBS research into all kinds of things, bacteria, molecular cell transmission, the brain the enteric nervous system, hormones, neurotransmitters and a ton of other research. They have found abnormilties as well and were not discussing that on this thread, what they already know about IBS. I know also a lot of negative comments come from sheer frustration with having symptoms that greatly effect a person. Especially a chronic conditions that are extremely complex and not totally understood. But the researchers actually know more about it all then a lot of people realize. IBS research is advancing steadily, with experts in all kinds of different fields looking into it. Neurogastroenterology, gastroenterology, cell biology, neuroimmunology, and many more and some of these researchers are experts in their fileds.A lot of people don't realize or even know the enteric nervous system, or "brain in the gut" is as complex as it is and the gutbrain to brain connection is all the same system working together. There is a malfunction in how the two talk to each other bidirectionally. Two very important cells implicated in IBS are EC or enterochromaffin cells that line the gut wall and mast cells which are also embedded in the gut wall.


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## eric (Jul 8, 1999)

Johnny"The new forum you wanted to Jeffery to set up. http://www.ibsgroup.org/forums/index.php?showtopic=92199 or did I mistake your intentions."Yes that was not a forum about people being cured, but about people with Post Infectious IBS, which is a subgroup of IBS, whcih may develop into "calssic" IBS.About thirty percent and maybe more develop PI IBS after a bout of gastroenteritist.The intial infection resolves and people are left with cell changes in their digestive system. This is a type of model for studying IBS as well.One of the leading experts in Post Infectious IBS is Dr Robin Spiller in the UK. He has done a substatial amount of research on PI IBS and IBS."Post-infectious Irritable Bowel SyndromeRobin Spiller; Eugene CampbellCurr Opin Gastroenterol. 2006;22(1):13-17. ©2006 Lippincott Williams & WilkinsPosted 12/08/2005Abstract and IntroductionAbstractPurpose of Review: Irritable bowel syndrome patients form a heterogeneous group with a variable contribution of central and peripheral components. The peripheral component is prominent in irritable bowel syndrome developing after infection (post-infectious irritable bowel syndrome) and this has proved a profitable area of research.Recent Findings: Recent studies have overthrown the dogma that irritable bowel syndrome is characterized by no abnormality of structure by demonstrating low-grade lymphocytic infiltration in the gut mucosa, increased permeability and increases in other inflammatory components including enterochromaffin and mast cells. Furthermore, increased inflammatory cytokines in both mucosa and blood have been demonstrated in irritable bowel syndrome. While steroid treatment has proved ineffective, preliminary studies with probiotics exerting an anti-inflammatory effect have shown benefit.Summary: The study of post-infectious irritable bowel syndrome has revealed the importance of low-grade inflammation in causing irritable bowel syndrome symptoms. It has suggested novel approaches to irritable bowel syndrome including studies of serotonin and histamine metabolism which may be relevant to other subtypes of of the disease.IntroductionAlthough the idea of irritable bowel syndrome (IBS) developing after infection is not new, being first clearly described in 1962,1 scientific study of mechanisms is relatively recent. The demonstration of mucosal abnormalities, overthrowing years of dogma that IBS is characterized by no abnormality of structure, has stimulated others to re-examine the IBS gut. Post-infective IBS (PI-IBS) develops in 3-30% of individuals with bacterial gastroenteritis. Known risk factors include female sex, severity of initial illness, bacterial toxigenicity and adverse psychological factors, including neuroticism, hypochondriasis, anxiety and depression, as reviewed in 2003.2 The purpose of the current review is to update the literature since 2003, during which time there has been an explosion of interest and many productive new approaches with implications for novel treatments."http://216.109.125.130/search/cache?ei=UTF...=1&.intl=us


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## postmortem (Nov 11, 2006)

i dont know about you guys but when i have incomplete evacuation i can feel that bulge in my perineum. i showed it to my gynecologist once and she felt it too. i don't always feel that bulge also. i wonder if its a prolapse though, but i can't get doctors to take me seriously because of my age. it's like "wth do you know? you're a kid."


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## Naomi889 (Sep 11, 2005)

Postmortem"So what triggered the IE or did you wake up one morning and your pelvic muscles decided to have a bitchfit and never recovered?"Ha ha ha! Class. That's pretty much what happened to me. I was studying for Uni exams, putting myself under a ludicrous amount of pressure, taking stupid amounts of caffeine and pepto bismel. After that I developed "IBS" - but "IBS" that comprised only mild bloating that happened 3 or 4 times a week. Annoying, but not that big a deal. Then, on Nov 21st 2001, studying for another set of exams, the IE/ muscle dysfunction began, and has never, ever, not for one second of one hour of one day of the last 6 years, let up. My 20 year old self would never have thought it was possible to suffer like this.N.B. This is why I get so irritated at alot of people's and doctors' concepts of "IBS" - the large majority of those diagnosed with "IBS" only have it mildly, and having had both mild and severe IBS I know that you just CANNOT compare the two in terms of the impact they have on your life. You absolutely cannot. It's like comparing someone with the occasional mild headache to someone with a constant migraine. If more doctors appreciated this I am sure that our suffering would be taken more seriously and that there would be more and better treatments available. I am sure that "Airplane" and "Annie7" can appreciate what I mean here."You guys get that little bulge in your perineum as well right?”I am not exactly sure where you are feeling this bulge. Externally or, er, internally? Internally, (as in the vagina) , I can certainly feel a large bulge which has got worse as my IE/IBS has got worse and seemed to coincide in severity with the pain during sex. I think it's to do with the distension of your bowels putting pressure on your cervix. Oh, the joys of IBS.How old are you "Postmortem"? You sound like maybe just a teenager as you mention school? You poor, poor little thing if so.


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## eric (Jul 8, 1999)

This is very new on the Pathophysiology of IBS.http://www.ibsgroup.org/forums/index.php?showtopic=92806


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## postmortem (Nov 11, 2006)

Naomi889 said:


> Postmortem"So what triggered the IE or did you wake up one morning and your pelvic muscles decided to have a bitchfit and never recovered?"Ha ha ha! Class. That's pretty much what happened to me. I was studying for Uni exams, putting myself under a ludicrous amount of pressure, taking stupid amounts of caffeine and pepto bismel. After that I developed "IBS" - but "IBS" that comprised only mild bloating that happened 3 or 4 times a week. Annoying, but not that big a deal. Then, on Nov 21st 2001, studying for another set of exams, the IE/ muscle dysfunction began, and has never, ever, not for one second of one hour of one day of the last 6 years, let up. My 20 year old self would never have thought it was possible to suffer like this.N.B. This is why I get so irritated at alot of people's and doctors' concepts of "IBS" - the large majority of those diagnosed with "IBS" only have it mildly, and having had both mild and severe IBS I know that you just CANNOT compare the two in terms of the impact they have on your life. You absolutely cannot. It's like comparing someone with the occasional mild headache to someone with a constant migraine. If more doctors appreciated this I am sure that our suffering would be taken more seriously and that there would be more and better treatments available. I am sure that "Airplane" and "Annie7" can appreciate what I mean here."You guys get that little bulge in your perineum as well right?"I am not exactly sure where you are feeling this bulge. Externally or, er, internally? Internally, (as in the vagina) , I can certainly feel a large bulge which has got worse as my IE/IBS has got worse and seemed to coincide in severity with the pain during sex. I think it's to do with the distension of your bowels putting pressure on your cervix. Oh, the joys of IBS.How old are you "Postmortem"? You sound like maybe just a teenager as you mention school? You poor, poor little thing if so.


i was 14 years old when i got sick. the last thing on my mind was that i wouldn't be able to poop like a regular person at least not for another 50 years. i'm currently 16.5.for me, my ibs started after i got diarrhea for a whole week. i took otc stuff for a whole week and it still wouldn't stop, so i took antibiotics and when it finally stopped i wasn't evacuating fully and it felt like my muscles weren't pushing out, like there's a bunch of stool sitting somewhere above the rectum or that it just cut off the exit of the feces. i usually get stopped halfway so then i get flushed with this nasty feeling of nausea and maybe toxicity? like #### is rebounding into my system. not sure if that's how to describe it.how my diarrhea started: not long after i had breakfast i chased after a bus that closed right in front of my face. i was running after it for 10 blocks because i didn't want to be late for school. this wasn't a school bus, just the avg mass transport kind. my stomach was upset, but i got on the bus anyway. then i decided i was feeling too sick so i took the bus home. i was clenching my butt to hold in the diarrhea for about an hour or more. so that could have done some damage. of course the antibiotics could have done the damage as well as a number of things. i was also severely depressed and stressed out at the time i got sick because my dad was unhappy with the fact that i didn't get into the "top school" and my classmates weren't that nice about it as well. school is now one of my biggest stressors. i also developed an eating disorder at that same time. i had so many things going on at that time i really cant even try to pinpoint what went wrong except for everything.for me the bulge is like something protruding out from the perineum. i believe its wrapped around a sack of skin. it goes in sometimes and then back out. i should go to a colorectal surgeon to make sure i don't have a prolapse or something like that i guess. i don't get taken seriously because doctors assume i'm a hypochondriac teen that thinks everything is wrong because of something i read on the internet. but really, i'm just trying to cover all angles instead. i want to make sure it's not something other than their "IBS" and "sorry we can't help you" ####. also, yeah, doctors give out the diagnosis ibs so ambiguously. there really are different severities and there's the impression that it's such an easy to manage while there are those with fairly manageable symptoms while others have more distressful ones. it's mostly those with more extreme symptoms that end up on forums looking for help. those that can have it under control often go on with their lives and not worry about it until they're under unbearable discomfort. yet we're all categorized under ibs, excruciating or manageable hassle. it doesn't do justice to our suffering.you know... i took a lot of pepto bismol as well because of the week long diarrhea... i read that pepto has bismuth in it, which is a toxic metal and can cause constipation in high amounts. may be relevant but may not. i'm sure there will be posts with all medical blahblah about its unlikeliness and how that's not ibs or whatever. but really does it matter if it goes with ibs or not? i'm sure none of us wants ibs and would be more than happy to find it's something else that's at least treatable. that's one of the few things that give me hope.anything is possible, so i feel we should be kind to ourselves and just look everything possible despite how absurd or simple. get better or die trying. as immature as that may sound, i don't care.


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## Naomi889 (Sep 11, 2005)

Postmortem, do you find that with the "just passing little bits trying to finish it off" you are left feeling very bloated and uncomfortable, all of the time? If you have it as badly as me then I think I'd like to shoot the doctors who'd let a little 14 year suffer like this. Yes, I know they don't have a cure or anything, but I know how badly they refuse to listen to or sympathise with people with severe IBS. In fact, in my opinion, I think that this may well be worse with regard to young women, who are often classified as over anxious and not taken seriously enough.Incidently the GI I'm seeing who specialises in our sort of incomplete evacuation/rectal muscle dsyfunction type IBS says that the vast majority of her patients are women, and for the most part young women. I've read articles on the "incomplete evacuation/rectal msucle dsyfunction" type IBS/ constipation that also point this out and suggest that it is because, to paraphrase "young women can be anxious and this translates to their guts ". I do not credit that at all - it does not adequately explain the markedly high proportion of young women. What, one loses one's anxiety when one becomes middle aged? Men are never anxious? There is far more likely to be some sort of hormonal link, say. You also said"you know... i took a lot of pepto bismol as well because of the week long diarrhea... i read that pepto has bismuth in it, which is a toxic metal and can cause constipation in high amounts"That's not unlikely at all. Many medications work differently on different people, especially in combination with other factors.And:"anything is possible, so i feel we should be kind to ourselves and just look everything possible despite how absurd or simple. get better or die trying. as immature as that may sound, i don't care. "There is nothing immature about that. That is a mature and determined response to a horrible, intractable problem. I feel sad that you have this at such a young age but clearly your maturity helps you to cope, or the illness had taught you wisdom. Hey, it must be good for something, right?


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## thickthighs (Dec 10, 2007)

i also believe i have incomplete evacuation and i have proof..i recently gave myself an enema after a bm and there was more left in me..also i have hemorroids from starining even though i have been ibs-d for YEARS..so far the d has stopped


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## postmortem (Nov 11, 2006)

Naomi889 said:


> Postmortem, do you find that with the "just passing little bits trying to finish it off" you are left feeling very bloated and uncomfortable, all of the time? If you have it as badly as me then I think I'd like to shoot the doctors who'd let a little 14 year suffer like this. Yes, I know they don't have a cure or anything, but I know how badly they refuse to listen to or sympathise with people with severe IBS. In fact, in my opinion, I think that this may well be worse with regard to young women, who are often classified as over anxious and not taken seriously enough.Incidently the GI I'm seeing who specialises in our sort of incomplete evacuation/rectal muscle dsyfunction type IBS says that the vast majority of her patients are women, and for the most part young women. I've read articles on the "incomplete evacuation/rectal msucle dsyfunction" type IBS/ constipation that also point this out and suggest that it is because, to paraphrase "young women can be anxious and this translates to their guts ". I do not credit that at all - it does not adequately explain the markedly high proportion of young women. What, one loses one's anxiety when one becomes middle aged? Men are never anxious? There is far more likely to be some sort of hormonal link, say. You also said"you know... i took a lot of pepto bismol as well because of the week long diarrhea... i read that pepto has bismuth in it, which is a toxic metal and can cause constipation in high amounts"That's not unlikely at all. Many medications work differently on different people, especially in combination with other factors.And:"anything is possible, so i feel we should be kind to ourselves and just look everything possible despite how absurd or simple. get better or die trying. as immature as that may sound, i don't care. "There is nothing immature about that. That is a mature and determined response to a horrible, intractable problem. I feel sad that you have this at such a young age but clearly your maturity helps you to cope, or the illness had taught you wisdom. Hey, it must be good for something, right?


thank you. yes i do feel bloated and uncomfortable after trying to pass those tiny pieces. i feel nauseous/dizzy and sick to my stomach. it's extremely hard for me to concentrate as well. the hormonal link is interesting. i was found to be on the high side for testosterone, but of course the doctors do not want to address it because of the age factor as well. supposedly it'd ease itself into balance, but thing is i started menstruating at 9, which is way early. my period is very irregular as well. i was prone to digestive problems in the past, frequent diarrhea. i searched around and believe i've found a clinic willing to address hormone problems despite the age, but it's far away from me and not covered by insurance. the site says they believe there's something called hormone allergy, but i haven't found much info aside from what's on their site. ibs has been a big strain financially so i don't think my parents' bank account can take it. i wish ibs is being addressed more holistically rather than just managing symptoms.my hormone problem is genetic and in my family a lot of the females have stomach problems as well, just that none of them have problems have problems with their rectal muscles like i do.how are your hormones and your period?i found this on something about rectoceles:"This is because estrogen, which helps keep pelvic muscles strong, decreases after menopause. "


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## TECKNINE (Feb 28, 2008)

have any of you guys had this symptom since childhood? do you guys have any other (chronic) illnesses besides IBS??


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## eric (Jul 8, 1999)

I have had the symptom of incomplete evacuation since childhood. It is 90% less after doing HT for IBS.I have no other chronic illnesses per see, although some genetic anxiety perhaps.TECKNINE, have you been evaluated for functional pelvic floor disorders?


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## postmortem (Nov 11, 2006)

TECKNINE said:


> have any of you guys had this symptom since childhood? do you guys have any other (chronic) illnesses besides IBS??


what do you mean by childhood? under 13? mine started at 14. i also have slight hormone problems, but thats more genetic.


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## tummyrumbles (Aug 14, 2005)

Incomplete Evacuation is a very real complaint and in my case is caused by a sluggish colon. What the GI said in the opening post made sense. If there's less than say 100ml or if it's not bulky enough then the urge to go won't be as strong. Mine are very loose, and I would agree that maybe the small, loose volumes aren't sending strong enough signals. I have to allow 3 hours from when I get up till I go to work, and then I'm completely clear - and there's usually about 3 or 4 lots, all about 1/2 hour apart. So it's definately not all in the mind. In Australia up to 80% of mature aged women claim to have problems with a sluggish colon, so it's not just an IBS problem. The only cure to the gas that I used to get at work from IE is to spend the time in the morning evacuating. I changed to part-time work starting later so that I can do this. This isn't a cure for the underlying IBS, as I'll always have a sluggish colon, but it's a cure for the embarressment that comes with not fully evacuating.


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## runner23 (Jan 12, 2009)

Is there anything you do or take in particular to ensure that you are completely clear within those three hours in the morning?


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## tummyrumbles (Aug 14, 2005)

I always have 3 cups of tea. I think this helps to stimulate things. I used to have "leaky gas" which was gas from retained stool building up in the colon. Whoever you live with is going to make fun of you if you spend 2 hours in the toilet. Luckily it's just me and my children but someone with a partner or housemates will find it hard. It's what you have to do though if you suffer from leaky gas.I don't know why my colon is the way it is but it may have been bad habits in the past. You just have to do whatever works.


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## escabar70 (Apr 27, 2009)

Incomplete Evacuation used to be a huge problem for me and the most annoying part of having IBS, they have some good information about it on Cures for IBS and a few medical websites.


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## Naomi889 (Sep 11, 2005)

Just to say that after being contacted by many people about this thread I have set up an incomplete evacuation email group.If anyone who has incomplete evacuation as a primary or bothersome symptom wishes to join they can do so here -http://uk.groups.yahoo.com/group/IE/


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## tummyrumbles (Aug 14, 2005)

Just bumping this to see if anyone has successfully sped things up naturally (no meds). In my case it seems to be a problem with the colonic muscles just operating inefficiently. I've never been tested for anything as no-one here seems to have had any real help there. I keep to a normal diet. I made the mistake early on thinking if I increase my fibre it would speed things up but that just irritates the colon. I try to have veges every day and 2 pieces of fruit, but whatever I have the whole process still takes hours so diet doesn't seem to make any difference.What physically seems to happen is that the stool is there in the lower colon (I evacuate every morning) but not all together. I get an urge and a smallish BM, but then I can feel the muscles just suddenly relax, as though the process has all finished. I have to wait it out until I gradually get a fuller feeling and the contraction starts all over again. This happens quite a few times.I know there is feedback therapy but no-one here on these boards seems to have any luck with it. I would be interested to know though if anyone here has successfully reduced their evacuation time by natural means only, i.e. diet, exercise etc.


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