# Pelvic Floor, Outlet Obstruction, and Slow Transit..Suggestions



## Jinky (May 23, 2014)

I am new to this forum and new to the problem of chronic constipation. It's been almost 2 years since I developed my pelvic problems but constipation as a result of this disorder has only become an issue in the past 6 months. I've had 8 months of physical therapy with a highly regarded specialist, trigger point injections and botox injections, but chronic muscle spasm is still an issue. I cannot defecate without the use of a laxative. I don't experience much of an urge to go. I've had to change my diet substantially to avoid being hugely bloated, although I still experience some bloating even with a very restrictive diet. I eat chicken and fish, including fatty fishes like sardines and salmon, yams, potatos, and butternut squash (no bread or grains) and carrots, spinach, zucchini, and green beans as my veggies, sauteed in olive oil.

I used to use Miralax but it always made me feel bloated and stopped working pretty quickly. MOM doesn't seem

to do much either. What good does it do, filling a sluggish bowel full of water? I've taken Sennakot a few times, but

I've heard it's bad to take stimulant laxatives. I feel I have no choice. I read on one thread someone taking MOM

along with a stimulant. I wouldn't do it daily, but would doing something like that twice a week do me harm? Would

I become a laxative addict if I did something like that twice a week? So far I've used Sennakot 3 times, on a weekly

basis, but I don't feel good only having a bowel movement once a week

I need to find a way to manage this long-term that is not going to harm my body.

Training the rectum to relax results in extreme vaginal and lower abdominal pain and horrible feelings of urgency. I don't want to go there. Besides, with a stimulant laxative I am able to defecate. Even with Miralax and a squatty potty I did pretty OK for awhile. The issue is not making stool soft enough so it can pass, It's making the intestine do it's job. And I know how to "squat on the pot" as well. Coffee doesn't make me "go" anymore.Ingesting spoonfuls of oil doesn't do much for making things move faster either, just more comfortable to pass.

I don't know what to do for myself, and I don't want to hurt myself.


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## annie7 (Aug 16, 2002)

Hi---sorry for all your problems. it's miserable isn't it.

sounds like you may have read at least one of the threads i've posted on. tests show i have pfd, slow transit, rectal hyposensitivity and megarectum. i don't get the urge either --probably has to do with rectal hyposensitivity in my case--and yes i take milk of mag and a stimulant daily on the advice of both my gastros and my surgeons.

trying not to be too repetitive here







--or pushy either--as i've mentioned this on other threads--including today on an another thread--my docs have all told me and i've read many studies etc that say that all the older type stimulant laxatives that harmed the colon have been removed from the market.

it's always best to get your doctor's advice before starting to take any otc meds. so you probably would want to do that first. in my case after trying everything my doctors all told me to take what i need to go, that stimulants when taken as directed and not abused will not harm my colon, and that it is ok for me to take milk of mag and a stimulant daily.

good luck with everything. i do hope you can find some relief. take care.


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## annie7 (Aug 16, 2002)

here are a some links--i've read more-- regarding the safety of stimulant laxatives. the first link also mentions: " While laxatives may be misused, there is no potential for addiction."

http://www.ncbi.nlm.nih.gov/pubmed/15654804

http://www.ncbi.nlm.nih.gov/pubmed/12702977

http://www.ncbi.nlm.nih.gov/pubmed/8234421


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## Jinky (May 23, 2014)

Thanks for the info. I will show these to my MD and ask for his advice.


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## annie7 (Aug 16, 2002)

thanks--yes--good idea to discuss it all with your doc.


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## annie7 (Aug 16, 2002)

since you're taking senokot (which my gastros specifically told me is safe to take) here is a pubmed article on the safety of senna laxatives. it says in part:

"This analysis establishes that (1) there is no convincing evidence that the chronic use of senna has, as a consequence, a structural and/or functional alteration of the enteric nerves or the smooth intestinal muscle, (2) there is no relation between long-term administration of a senna extract and the appearance of gastrointestinal tumors or any other type in rats, (3) senna is not carcinogenic in rats even after a two-year daily dose of up to 300 mg/kg/day, and (4) the current evidence does not show that there is a genotoxic risk for patients who take laxatives containing senna extracts or sennosides."

http://www.ncbi.nlm.nih.gov/pubmed/20107583

i was as concerned as you are regarding the safety of taking stimulant laxatives. years and years ago when the old style laxatives were on the market i was always told they were not safe to take regularly. so when my gastro first recommended taking them--after nothing else would work--i asked a lot of questions and did a lot of research.


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## Jinky (May 23, 2014)

This has been a bad morning for me. Last night I had to do a second round of Sennekot and MOM because the first time it didn't work. This got me really worried. It is incredibly painful for me when I defecate in any case and the pain lingers a long long while (a result of my pelvic floor tension myalgia, I continue to work with a pain management doctor who is a neurologist to help get a handle on this thing. this is the reason why I am not enthusiastic about having a daily bowel movement at this time). Since I got up this morning, it's been ongoing trips to the bathroom with complete brown-water liquid in the toilet and horrible stomach pain. It was 2 tablets of senna + 4 capfuls of MOM. The first night I took it...... next day, I had no response, no bowel movement. Last night I did a second round.....Now this. :-(

I agree with what you said about talking with my doctor, but I haven't had a bowel movement in a week, been feeling really uncomfortable, and had to go. ;-(


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## annie7 (Aug 16, 2002)

oh so sorry. it's all so hard, isn't it, managing all this, getting the right laxative combo to work right--or at least not cause more pain--and especially hard when we have pelvic floor problems on top of it all. i struggle with it--have good days and bad. and you've got all that pain on top of everything else too which makes it all worse.

and it sounds like you've tried everything to relieve it and nothing works to relieve the muscle spams and the pain. as you said, you've worked with a knowledgeable specialist and tried trigger point injections and botox. do valium suppositories help at all? or oral valium? i know one woman with PFTM who said that helped her. although we're all so different--what helps one may not help another.

i do not have PFTM --just pfd.

i do hope you can find some relief at least to the point where you can have a BM without such pain. and i hope that the pain doc can help you...


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## Jinky (May 23, 2014)

I do have Baclofen suppositories, let me they you, they have been the most useful things! They don't provide a huge amount of pain relief but they help to some degree and I can use them both vaginally and rectally. I've found

them far superior to valium suppositories. However, they do cause an incredible amount of sedation. I'm thinking of asking my pain management doctor to try to lower the dose from 40mg to 30mg to see if I can still can get decent pain relief but not be in a stupor. I usually use them only at night because of the sedation, and right after a BM, to try to quiet things down.

I'll bounce back from this..........The day is still early............EDIT: Feeling better now, ready to leave the house and resume the rest of my day........


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## Dreamcatcher32 (Nov 12, 2013)

I'm so sorry to hear of your troubles! I have very similar issues and was diagnosed with Pelvic Floor Dyssnergia. You said you've had physical therapy - what kind was this? Did you do biofeedback to relax the tightened muscles? What about balloon expulsion? What is most important is 'dropping' your pelvic floor on a daily basis. You need to be sure your pelvic floor is loose at all times and this is going to mean using biofeedback to see where you're at and then replicating that relaxation on a daily basis. I find you have to try to replicate it in ALL positions - standing, laying, sitting, etc. I have found that nothing will really 'cure' this, but you can do a lot to help it. Do you find your PFD tends to ebb and flow? Mine does... thankfully. Sometimes I do great and other times not so great.

Mayo Clinic said laxatives are not addicting in any way and you can use them as much as I need to. Though I avoid them as much as I can! Their suggestion that is most effective is to use 4 capfulls of Miralax and then follow-up with a suppository or enema. So mouth to anus works best with PFD. Enema's are a little trickier because the water can get 'trapped' up there. Using a suppository might be best. Have you tried the Dulcolax ones are the 'magic bullet' suppositories? I have also heard of Enameez but have not tried them yet. They're supposed to be crazy powerful! I would use MOM before any other laxative. What you can do is pop a linzess (you need these prescribed) and then do 5 capfulls of MOM. That usually gets me going for the rest of the night. I've had a few times where it didn't work but that's because I didn't have much in there. You might also need to 'rotate' laxatives so they don't loose their effectiveness.

I would not wait a week to have a bowel movement. Only go every 3 days (also recomended by Mayo Clinic) So on that 3rd day, be sure to take whatever you have to. Perhaps you could do 1 enema a week and take a laxative the next time? You could probably also do a suppository that week also. That might rotate things out enough to where you won't get any sort of addiction. (not physical, more mental)


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## annie7 (Aug 16, 2002)

Jinky--oh so relieved to hear you are feeling better! fingers crossed that will continue!


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## rita41 (Oct 8, 2012)

I really sympathise with your problem. I also have this problem and had it for as long as I remember. I have just started taking coconut oil after breakfast and after dinner. Just started so I am keeping my fingers crossed that it works. Actually I did go to the bathroom the other day without taking laxitives. It is only a suggestion. Good luck and stay strong.........


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## annie7 (Aug 16, 2002)

Rita--so glad coconut oil is helping you! and yes--fingers crossed it continues.


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## rita41 (Oct 8, 2012)

Thanks Annie 7 . I will try almost anything heeeheee


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## annie7 (Aug 16, 2002)

oh yes---me too!


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## Jinky (May 23, 2014)

Dreamcatcher, I've read your posts..... My problem is more complex than yours in that there is a centralized pain component that is maintaining a chronic spasm of the levator ani group, and the treatments I've utilized thus far have had limited effectiveness. I know it is centralized pain because I've had two nerve blocks: a pudendal block and a sympathetic nerve block, and I had zero relief from either one of them. I was working with a therapist that is one of the most knowledgable and highly educated in the field of pelvic pain in the United States. We both agreed at the end that pain was maintaining the spasm and until I got the pain under control it would be impossible to break the spasm. She had no explanation (and neither did my pain management doctor) why the problem shifted from vaginal pain and feelings of urgency to rectal pain and chronic constipation. My problem is not just muscoskeletal dysfunction but chronic neuropathic pain. When I "drop the pelvic floor" I get extreme vaginal pain and urgency. My pelvic floor hates being relaxed, when I try to relax it my brain sends down pain signals letting me know that this is not where I should be. Thus, my pain management doctor and I are working on tackling the centralized pain, through medication, and then, hopefully, I can try to work on the muscoskeletal problem - which, at this point, seems to be chronic puborectalius spasm, causing outlet obstruction/chronic constipation/bloating and triggering a tsunami of pain every time I have a bowel movement.

At first I thought I'd let myself have a bowel movement once a week but I'm finding that I'm uncomfortable unless I have one twice a week. My quest is to find the combo that works for me, so I can take a bowel movement twice a week, a normal BM without loose stool/cramping. BTW I RE-READ THE LABEL ON THE MILK OF MAGNESIA AND IT TURNED OUT I TOOK A QUADRUPLE DOSE OF WHAT IS RECOMMENDED ON THE LABEL.The label said 2-4 Tbspns for an adult in a 24 hour period and I took FOUR CAPFULS IN A ROW! OOPS! Next time, I'm going to try the senna with 2 Tbspns of MOM and see what happens. My bad! *ouch* :-(

Well it did work, just a little too well!


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## Dreamcatcher32 (Nov 12, 2013)

I'm really sorry to hear of your struggles. It sounds like once you get the pain under control, you'll be in a lot better shape. I also have PFTM and know how irritating it is. I always have to pee and that tenses my pelvic floor and I can't get an urge to have a BM! Though sometimes I do even when I have to pee. It just kinda depends. I knew someone else who kinda had a similar problem to you but no constipation. They had CHRONIC pain when sitting but really didn't know why. Have you tried Nuerontin at all? I also used to have vulvodynia and that went away over time. I did also have a PN diagnosis but these last time at Mayo they said it was wrong. I remember having a nerve block, which helped with my vaginal pain at the time. But what helped most of all was just learning to... let it go. I know that sounds hokey but it's true.

I don't think doctors would think it's okay to have a BM once a week. That can cause obstruction and other difficulties. I would go for having at least 2 a week! I know how miserable it is taking laxatives all the time though. WOW! I can't believe you took four capfuls of MOM. I think that would give me diahrrea for a good few weeks. Ahh! Even now, if I take 6 or so tbs, I have diahrrea for 4 days. I'd rather just take something that helps the BM to 'slip' out - like liquid magnesium. That's far preferable to me. Also be SURE to shake the bottle of MOM before using it. Everything settles to the bottom.


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## Dreamcatcher32 (Nov 12, 2013)

Jinky said:


> Dreamcatcher, I've read your posts..... My problem is more complex than yours in that there is a centralized pain component that is maintaining a chronic spasm of the levator ani group, and the treatments I've utilized thus far have had limited effectiveness. I know it is centralized pain because I've had two nerve blocks: a pudendal block and a sympathetic nerve block, and I had zero relief from either one of them. I was working with a therapist that is one of the most knowledgable and highly educated in the field of pelvic pain in the United States. We both agreed at the end that pain was maintaining the spasm and until I got the pain under control it would be impossible to break the spasm. She had no explanation (and neither did my pain management doctor) why the problem shifted from vaginal pain and feelings of urgency to rectal pain and chronic constipation. My problem is not just muscoskeletal dysfunction but chronic neuropathic pain. When I "drop the pelvic floor" I get extreme vaginal pain and urgency. My pelvic floor hates being relaxed, when I try to relax it my brain sends down pain signals letting me know that this is not where I should be. Thus, my pain management doctor and I are working on tackling the centralized pain, through medication, and then, hopefully, I can try to work on the muscoskeletal problem - which, at this point, seems to be chronic puborectalius spasm, causing outlet obstruction/chronic constipation/bloating and triggering a tsunami of pain every time I have a bowel movement.
> 
> At first I thought I'd let myself have a bowel movement once a week but I'm finding that I'm uncomfortable unless I have one twice a week. My quest is to find the combo that works for me, so I can take a bowel movement twice a week, a normal BM without loose stool/cramping. BTW I RE-READ THE LABEL ON THE MILK OF MAGNESIA AND IT TURNED OUT I TOOK A QUADRUPLE DOSE OF WHAT IS RECOMMENDED ON THE LABEL.The label said 2-4 Tbspns for an adult in a 24 hour period and I took FOUR CAPFULS IN A ROW! OOPS! Next time, I'm going to try the senna with 2 Tbspns of MOM and see what happens. My bad! *ouch* :-(
> 
> Well it did work, just a little too well!


Also I am wondering... could you possibly have Endometriosis?


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## Jinky (May 23, 2014)

No, I had a hysterectomy 3 years ago, which I believe is the root cause of all of these troubles.

I had chronic pain with sitting for a LONG while and I thought I would be living with that nightmare forever, but when the vaginal pain got switched over to rectal problems the sitting problems ended.

I got stuck with THIS instead..... outlet obstruction/slow transit constipation/painful defection. And the awful chronic urgency ended. I used to sleep with ice packs over my bladder some nights.

I tried Neurontin early on. It had terrible side effects for me, made me incredibly dizzy, spaced out, my head felt liked it was going to explode. I take 2 other anticonvulsants (Topamax and Lamictal)

so adding a third one was probably overkill to my system. I can't take tricyclics for pain relief either because I take Wellbutrin plus an SSRI (Zoloft). Currently my pain management doctor is trying me on

low dose Naltrexone and Neudextra. Both have been investigated for treatment of neuropathic pain. My doctor is familiar with a lot of out-of-the-box things. He's board certified in pain management,

is a neurologist, a treats pudendal disorders....... something a lot of pain management doctors don't know much about.

I know what you mean about letting it go. The most rehabilitative thing I ever did was stop waiting and wishing for the time when it would be "all better" and living my life the best I can, making the most of every day.

Realizing there are going to be good days and days that are not-so-good. For the first time in a long time, I'm starting to exercise again.


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## Dreamcatcher32 (Nov 12, 2013)

A lot of women do have bowel problems after hysto's. Some of them feel better too, though. I guess it sort of depends. A hysto doesn't mean you don't have endometriosis, though. Endo can form anywhere.. usually it centers around the reproductive organs but it can very easily be on the bladder, bowels, organs, etc. I have it and am not sure if it's one of the sources of my problems. But I am sure not having surgery to find out.

Sounds like you're in good hands with your pain management. It really would be great if you could get to the root cause of your pain. I don't think the gastro's at Mayo Clinic would be able to help you, they tend to focus entirely on the bowel and don't really coordinate with other offices. At least that is what I have found.

I agree with you, a persons mental state is so important. I often let all of this consume me and that seems to be more trouble than the physical problem at hand. A person really has to learn to live with what they've got and stay positive. What else can you do?


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## Dreamcatcher32 (Nov 12, 2013)

Jinky said:


> No, I had a hysterectomy 3 years ago, which I believe is the root cause of all of these troubles.
> 
> I had chronic pain with sitting for a LONG while and I thought I would be living with that nightmare forever, but when the vaginal pain got switched over to rectal problems the sitting problems ended.
> 
> ...


Hysterectomy's don't get rid of Endometriosis. It grows outside of the reproductive organs as welll. If the surgeon wasn't skilled at finding Endo, then it could still be there. Do you have IC? Endo wouldn't really account for the sitting pain, I don't think. But I'd be sure to buy some of you rown memory foam and build your own cushion so as not to put pressure on thse 'hot spots' when you sit.

I wish someone would put your last paragraph here on the front page of this forum. It is so true. I find myself doing this all the time, "Oh, I'll do that tomorrow when I feel better..." But you can't sit around not living your life. That's not healthy. Did you hear about the 122 year old woman who basically says she's lived this long because if she can't control something, she's not going to worry about it! In fact, she lived an unhealthy lifestyle and didn't do her physical body any favors but she just said "Eh" And went on with life. She's a positive person and researchers are finding that sort of attitude is what results in longevity and overall quality of life. Congrats to you!


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