# Only symptom is" regular Incomplete evacuation sensation - Discomfort"



## NickwithHope (Apr 8, 2009)

Hi , I face extreme discomfort everyday because of the sensation of incomplete evacuation. There is no real incomplete evacuation, its just the feeling that is there. I have pretty good bowel movements and have no problems while evacuating. It is the only symptom and I have no constipation or diarrhea. Everyday toward the evening my discomfort kind of goes away, only to return and follow the same pattern the next day.So is this still IBS ? I was wondering if anyone has the same problem. My only symptom is incomplete evacuation sensation. Please reply.-Nick


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## Kathleen M. (Nov 16, 1999)

Less symptoms than IBS is not something more dangerous and deadly than IBS.There are a whole bunch of functional bowel problems, most are "not quite enough symptoms for IBS".Now if every single stool is in your normal range of consistency and frequency and nothing at all on that front has changed at all it is not technically IBS.I'm not sure if it is enough for something like functional chronic abdominal pain (which is all the discomfort of IBS with normal stools) or where they may parse you out.However which specific one of the functional bowels diseases you have it doesn't matter much what they label it. They treat based on symptoms and the symptoms indicating something non-functional are the same whether it is functional diarrhea or functional bloating. If you have blood mixed in the stools, inexplicable weight loss (eat way more than you need and still drop weight), or abnormalities on blood work, then you need to have some tests run to rule various things in, or out. It may still be functional with red flags, or something short term in the case of bleeding, but what is a functional symptom vs a may be something else is the same for all the functional bowel diseases.There are a couple of pelvic floor issues, and levator ani syndrome might fit, but people usually don't describe that as incomplete evacuation (unless you do have that kinda like sitting on a ball sensation that happens to translate into I still need to go). They are also functional and usually they don't treat them other than make sure the discomfort isn't from something serious.http://en.wikipedia.org/wiki/Levator_ani has some info on that.Strangely a lot of the really serious things (i.e. life threatening) have very little discomfort even when your blood work goes wacky or other noticeable things happen (like lumps). I do know this sort of discomfort is very annoying and very distracting. If it is interfering with your life it may be worth seeing if something antispasmodic (peppermint or prescription) helps. Those can be taken as needed. If you have this most of the time and those don't help it may be worth trying something like a low dose antidepressant to turn the volume down on the bad signals the nerves are sending.If it is mostly just annoying trying some mind-body stuff may be all you need. Various distraction and relaxation techniques can reduce the sensation for awhile or make you less anxious about it when it happens.


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## NickwithHope (Apr 8, 2009)

Thanks Kathleen for the very informative response. By the way, I have been experiencing some blood loss after every stool (just a couple of drops at the very end), which is also described as "blood on toilet paper" symptom.I had a colonoscopy around three years ago, internal hemorrhoids were detected. So, I guess my symptom combination of incomplete evacuation sensation and blood in stool is only caused by IBS and internal hemorrhoids. I hope there is no rectal cancer or anything life threatening,but it has been a while since I got my colonoscopy done and I wish to go for it again just to be sure and safe.So, is there no one here who has my condition? That is only incomplete evacuation sensation and nothing else. Please tell me, I am trying to find a kindered soul who can be of immense mental help.-Nick


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## grits91058 (Jul 13, 2007)

I believe you should be tested for pelvic floor dysfunction (PFD). There are several forms of dysfunction, but if your puborectalis muscle is spasming instead of staying in a relaxed state; or if your puborectalis contracts rather than relaxes when you defecate (so you can actually empty yourself) it can be a result of of some form of PFD. Speaking from lots of experience, I would suggest that you seek out a physical therapist who specializes in PFD to give you an exam (it will be a rectal exam). A PT with Pelvic Floor experience can give you a good read on what is going on. Sometimes it can be helped by various exercises, biofeedback, rectal valium suppositories, or a combination of these and other things.


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## NickwithHope (Apr 8, 2009)

Kathleen M. said:


> Now if every single stool is in your normal range of consistency and frequency and nothing at all on that front has changed at all it is not technically IBS.


It is not IBS then. I have a single stool everyday in the morning. There is no change in consistency/frequency on any given day. But the incomplete evacuation sensation and the way it kicks in after a meal (breakfast or lunch) and the way it gradually goes away in the evening are consistent with other IBS-C patients. I am trying to make some sense of my condition. Any help will be greatly appreciated.


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## Kathleen M. (Nov 16, 1999)

Sounds like the rectal hypersensitivity of IBS without the stool consistency issues, so the same treatments used for that in IBS like antispasmodics or low dose antidepressants.Unless your symptoms match the levator ani syndrome, but I don't think they treat that any differently other than things like a warm sitz bath might help.But beyond that I don't have any other help to offer.


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## alwayshappy (Mar 11, 2009)

hi Nick, a defecography test is the best test to show what exactly happens on real time when you evacuate to see if there's an obstruction within the rectum, like: rectal prolapse, rectocele, enterocele or anismus. ask your gi to reffer you to this test. good luck!!


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## NickwithHope (Apr 8, 2009)

Thank you alwayshappy and Kathleen for your wonderful input. I will talk to my doctor about levator ani and defecography and ask him if they would be helpful in my case.*I forgot to add this most important information that might help me.Here it is.*I had this condition of regular discomfort due to incomplete evacuation sensation for four years and then went for a colonoscopy to determine its cause, miraculously it stopped right after the colonoscopy and gave me a 3 year break.And when I least suspected, it struck back and this is my second straight month of regular discomfort.The colonoscopy revealed that I did not have any problem except for internal hemorrhoids, and the cause of my discomfort was diagnosed as IBS. I do not know if they got the diagnosis right. But that colonoscopy procedure helped me get rid of the discomfort for three straight years.I believe that the colon prep that I had to do before the colonoscopy procedure of drinking a solution that helped me completely clean my colon was instrumental in providing me with the 3 year relief. And also that the colonoscopy procedure itself was very helpful in cleaning/de-toxifying/correcting my colon.I spoke to my doctor and he said that colonscopy prep or colonoscopy procedure do not have a role to play in any relief or cure of my condition. But it seems my only hope and want to go for it again.Any idea/comments people ? Did anyone feel/experience the same ?


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## grits91058 (Jul 13, 2007)

In my earlier post I suggested getting tested for PFD. As another poster suggested, getting a defecography MRI would be useful information I did have that test done. It gives your doc realtime info as to what is happening, and the hospital can give you a cd of it to provide to other docs who may see you. My GI doc referred me to a colo-rectal surgeon who was the one who actually ordered the test. The MRI will rule in or out PFD.


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## NickwithHope (Apr 8, 2009)

Yes as you said, I have now started to suspect Pelvic Floor Dysfunction too. I have started doing some exercises, but I guess its not helping much. I have defecography MRI lined my in my to-do tests as it would reveal the whole picture. I will try talking to my doctor about it. Thanks a lot for your valuable suugestion and showing some empathy toward my suffering.


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## alwayshappy (Mar 11, 2009)

good luck nick







, and please keep us posted on the defecography results.


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## libran (Aug 9, 2006)

I experience this symptom too but unlike you Nick I have other symptoms of IBS: bloating and constipation. I feel good on the rare occasions that i have a normal BM.Could it be that your internal heamarrhoids are causing the feeling you are having?


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## grits91058 (Jul 13, 2007)

A pelvic floor dysfunction that does not allow you to evacuate completely will cause bloating and constipation because you are not cleaning your system out. Yes, you do feel better when you have a complete bm because you are emptied out. I speak from 50 years of experience. I was only diagnosed with PFD two years ago through the MRI. Then it all made sense. I am addressing the PFD now, then will deal with the digestive problems as the digestive problems are the sympton of PFD, not the cause. I am in the midst of getting a series of botox injections into the puborectalis. I have shown some improvement and am working with the doctor to figure out how much I will need to achieve satisfaction. I do feel that botox is a viable treatment for PFD. The problem is finding a doctor or medical center who administers this treatment as it is only now starting to gain attention for this problem.


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