# latest consultation did not go well



## westr (Jan 27, 2012)

this is after the ultrasound, I thought they would be saying "ok, no idea what it is, yes we will give you a proctogram on faith due to the amount of people you have found who ended up being diagnosed with stuff etc"

what they ended up saying is "your internal sphincter is loose and irregular, its quite thin to the left. this is what is causing the odour, there is nothing we can do, we dont want to give you a proctogram"

could it still be intussusception/rectocele? does this sound quite definitive and and internal sphincter being weak is most likely the issue? has anyone been told they had a thin sphincter to go on to be diagnosed with something functional like rectocele?

I kept on at them and they agreed to give me the proctogram in the end. but now I'm thinking they are more likely going to be right...but then doesnt everyone with functional problems have a problem getting a doctor to diagnose it?


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## JMH91 (Apr 16, 2014)

westr said:


> this is after the ultrasound, I thought they would be saying "ok, no idea what it is, yes we will give you a proctogram on faith due to the amount of people you have found who ended up being diagnosed with stuff etc"
> 
> what they ended up saying is "your internal sphincter is loose and irregular, its quite thin to the left. this is what is causing the odour, there is nothing we can do, we dont want to give you a proctogram"
> 
> ...


Internal sphincter is the involuntary one, the one which gives resting continence. So weak on one side (I also have left side conincedence) would give pretty much normal ability to resist urge to pass stool, and normal strength (from external, voluntary sphincter), but minor disruption to resting seal ... translation is manifested to intermittent mucous discharge, maybe with odor if feces is present in rectum.

I understand where your Doctors are coming from on this, they have found an issue, so reluctance to spend money and look for more issues when one is already found which explains cause.

I disagree that nothing can be done. What is cause of thin muscle? Atrophy - because maybe of nerve damage? This is what I do=

- TENS to make sphincter muscles more bulky and strong

- Avoid straining to prevent further nerve damage (water enemas, squatting posture, psyllium)

- Try to get complete evacuations (same measures as above) so no feces is ready to leak out

I am researching treatments for nerve damage like *sacral nerve stimulation* and* tibial nerve stimulation*. To just say nothing can be done is a lie. I think they either lack the knowledge or lack the desire to do something. Of course, it does not mean much to them because they get to continue with their life, and will never see this person again whose life is ruined.


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## westr (Jan 27, 2012)

they didnt exactly say nothing can be done, they talked about the thing where they mess with the ankle and stimulate the sacral nerve. sounded interesting.

i have a cold at the moment, when i have a cold my breath goes bad, the doctor told me he could actually smell me, thats a first. I think he smelt my breath and thats what turned things and made him order the proctogram.

does tens stimulate the internal sphincter? my external one is great apparently.


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## QuietDesperation (Jan 17, 2014)

That's terrible news. Sorry to hear this, you just went through my biggest fear. Rectal prolapse / intussusception often results in weakend sphincter. If you are having trouble with bowel movements you should have a proctogram. There is no good cure for internal sphincter weakness from what I understand, but there are things you can do which may improve it. Personally I have had issues with odor, mucus/wetness and it has been much less of an issue lately. I've been doing pelvic floor exercises and taxing laxatives. The issues became much less of a concern shortly after beginning with the laxatives so I suspect stool consistency may play a part. The odor went away on it's own and I don't have that any more. I think that could be due to my pelvic floor exercises, I'm pretty sure my prolapse has retracted a little.


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## JMH91 (Apr 16, 2014)

Yes, the nerves run inside the walls of the gut, so when walls fold, in prolapse and intussusception, nerves are abnormally stretched and nerve damage may occur also. Another way to think is that nerve damage was first, which caused body to start compensation of straining, which in turn caused problems like intussusception.

The ankle thing sounds like tibial nerve stimulation. It is supposed to have similar benefits to sacral nerve stimulation but without morbidity of implanted surgical stimulator device.

For TENS and internal sphincter, honestly I am not sure. The device I brought (TENSCARE) has both urge incontinence and passive incontinence programs, so that suggests that internal is also triggered to contract with the electrical stimulation.

It is also worth thinking that resting tone of anal canal, which is what is problem presumably, is made up of force contribution from =

55% Internal sphincter

15% hemorrhoid vascular cushions

And also contribution from external sphincter (source did not give %ge ... maybe is 30%)

So it is my belief that if external sphincter is trained, like body building muscles to make them bigger and stronger, external sphincter can partially compensate for weak internal sphincter. This is certainly how it feels. After a few weeks of TENS, at rest without conscious contraction, the whole anal canal feels much stronger, and when I felt, the sphincter muslces felt much more bulk and obvious.

EDIT: westr, also please ask about perianal injectable bulking agents (e.g. PTQ/SOLESTA)


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## Maria Slan (Jul 16, 2013)

try to look at the two theories, can it explain every of your symptoms and other cases on the site, compare them? if they have more logic then you go with them


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## horizonzero (Nov 17, 2013)

If they can't do anything for you get a reference for Oxford Pelvic Floor


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## yzz (Jun 23, 2011)

If you're not feeling progress with kegels, try weighted squats and lunges. Also, do crunches lifting your legs towards your head and not vice versa which could potentially make the situation worse. You can also strengthen your core through running consistantly if somehow you could get a hold of a treadmill (I'm guessing going to the gym is not an option).


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## JMH91 (Apr 16, 2014)

Running is great if done in moderation. But, long distance running can also be a cause of constipation. I am not sure if this is the high complex carb diet they need to eat which is slow moving through the gut, or something else, but that is a known cause


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