# what should i do? suggestions for slow transit constipation please!



## xxfakeasmile

im taking MoM for almost 2 months now, every 2-3 days, otherwise the bloating is horrible. i took senakot for maybe 6 months, everynight 4 pills. im glad i stopped that but, i know MoM isnt great either.what do you guys suggest i do? ive tried zelnorm & miralax & fibre, etc. etc. and they all don't helpi've heard of many different "natural" stuff but which one do you think would be good for me, someone that most likely has slow transit? -triphala-rhubarb supplementsim on probiotics now and i still dont notice much of a difference after a month and ive been trying hard to drink lots of water now. i know MoM brings more water in the stool so i must have a difficulty with keeping the water in or having slow transit and the stool drying up after a couple of days of sitting in my colon. is MoM non-habit forming or will i have to take more & more like stimulant laxatives? never gotten a clear answer on this... it doesnt say anywhere, but i know stimulants are bad. i live in canada as well... is there any way to get rhubarb?


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## Kathleen M.

If you have been diagnosed with "slow transit" you would be put on a LOW fiber diet and osmotic laxatives (MOM is one, miralax is another)Osmotics do not damage the colon like stimulatory laxatives, but if you need them to go, and you stop you may be constipated again.What tests have you had?You can be VERY constipated without having "slow transit" constipation. So frequency of stool is not a measure of this (however if "slow transit" is severe you may have much less than one BM a week when you eat and take nothing to make you go).Do you feel you are over any problems you may have caused by the Sennakot? IE you are back to what you were like when you decided to start taking that every day?K.


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## xxfakeasmile

i was very badly constipated when i started taking the senakot. i took barely no medicine before the senakot and was struggling to have a bowel movement. i had one long bm, the constipated type, if i squatted. do i have to take more & more of milk of magnesia as time goes by or will the dosage keep working? i tried miralax when i was still on senakot and i was up to 3 cups a day without a change at all. if that's the same as MoM why didn't it work for me?


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## xxfakeasmile

oh and i am seeing gastroenteroligist in 2 weeks and another one in 4 weeks, the later one said he will give the sitz marker test if the fibre diet doesn't work....


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## 5069

KMottus is right. You probably need Insoluble Fiber which will speed things up but don't overdo it. In the morning can you eat an apple with the skin on it? Leaving the skin on is very important as it is pectin and that is healthy for us all. This is really good for your problem. If you can eat cereal, try Raisin Bran 1/2 to 1 Cup should really get things going,but space this out throughout the day. Don't do it all at once. Drinks lots and lots of plain water. No colas or tea. At night, also eat 2 stalks of celery. This should greatly improve things. If you have Slippery Elm capsules take two but you more than likely won't need a laxative. Let us know. Good luck. Annem


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## xxfakeasmile

i still dont know the difference between insoluble and soluble fiber. can you list some insoluble fiber stuff?also doesnt anyone have any suggestions about what other natural supps to take? im trying to take magnesium supplements but they aren't totally magnesium oxide. they are a mix of citrate and something else so i was wondering if that is helpful or no. the brand is jamieson.


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## boomboomroom

Why would you be told to be on a LOW fiber diet? My GI doc said to be on high fiber, w/zelnorm, and miralax. Lots of water, which still doesn't make alot of sense, because water makes the food harden up. I drink alot of water, but the concept isn't computing. Water hardens the stool, but drink extra water for constipation.


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## elvesrock

um, water does NOT harden stool. it does the exact opposite. where are YOU getting your information from? that's laughable. are you slow transit? if not, YOU should be on a high fiber diet, if it's runofthemill stuff..


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## boomboomroom

Hey elvsrock, why don't you do some research before you run your smart mouth!Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish. Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others. At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief. Who Gets Constipated? According to the 1991 National Health Interview Survey, about 4 1/2 million people in the United States say they are constipated most or all of the time. Those reporting constipation most often are women, children, and adults age 65 and over. Pregnant women also complain of constipation, and it is a common problem following childbirth or surgery. Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. However, most people treat themselves without seeking medical help, as is evident from the $725 million Americans spend on laxatives each year. What Causes Constipation? To understand constipation, it helps to know how the colon (large intestine) works. As food moves through it, the colon absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed. (See figure 1.) The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Figure 2 lists the most common causes of constipation.


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## xxfakeasmile

Boom Boom, you're wrong. Water doesn't cause stool to harden, the water keeps it soft. The only reason why it is hard is because as stool stays longer in the colon, more water is absorbed and the harder it gets. Water staying IN the stool is helpful for it to soften. Please do YOUR research first, rather than getting it from a website.


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## boomboomroom

Than why did my GI doc(the one with an md license) tell me that food is liquid after digestion, and water makes the food hard in the colon? What about the information I provided from the internet? It was writen by a professional as well? If I'm wrong, and the doctors are wrong, who's right?You said "the longer it stays in the colon, the more the water is absorbed, so how is that making it hard, if water softens?


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## boomboomroom

The hard and dry stools of constipation occur when the colon absorbs too much water. What exactly does this sentence mean, if not water in the colon makes the stool hard?


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## elvesrock

your G.I. doctors were probably NOT wrong. neither is the information you provided. you MISUNDERSTOOD the information. water makes stool soft. the longer stool STAYS in the colon, the water is ABSORBED by the COLON which in turn makes the stools HARD. when food is digested, it is first liquid, due to the water in it and as it moves along it gets harder because of the colon absorbing the water in it. when we are constipated, the stool stays in the colon for a longer amount of time than is normal or healthy and the stool gets hard. you are misunderstanding things. please ask anyone on this forum and they will tell you you are wrong.


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## boomboomroom

I get it now. I had to get past the defensive wall from being critisized and laughed at, to see the whole picture.I WAS WRONG!!!I MISUNDERSTOOD.I'll go eat my crow pie now............


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## sadone

boom boom,don't feel bad--i'm always wrong!


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## boomboomroom

Thanks for your sympathy.I'm new to this IBS-C w/poor motility thing. Just when I think I understand it, I learn something new.I drink 3/4 of a gallon of water, take all my vitamins, exercise 3-4 times a week, yet I can't over come this problem. My GI Doc. said it's got partly to do with with the nerve damage I have from my 2 c-sections, and the way my Perineum closes part of my exit off. All of this causes my colon to hold on to everything for 8-10 days without meds.I'm going to buy some slippery elm to use with my zelnorm, miralx, and mag. supps..


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## Tricis56

I am still totally confused by soluble fibre insoluble fibre, high fibre low fibre, no fibre!!! I have slow transit constipation. I had IBS for 20 years but they have diagnosed slow transit. I am on prucalopride 2 mg, bisocodyl one day and picolax.The high fibre definitely blocked me up so the specialist has said dont take extra fibre and told me to try Fod map. I would love to know if any particular food helps anyone as I dont think it does and I am drinking 2 litres water day but does this make it worse?


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## annie7

i've had slow transit constipation for most of my life--50 years. you are right--when the colon moves so slowly, fiber is not our friend. i've learned i do best on a diet that is low in fiber.

drinking water does help. it helps keep the stool in the colon moist.

also i have found that the low FODMAP diet helps reduce gas and bloating.

there are a lot of good diet tips here on the constipation board as well as on the diet board. Tummyrumbles has posted on both boards with a lot of good advice. and there are lots of helpful posts from others as well.

diet is a lot of trial and error. we're all different; we have to find our what works best for us..

here is a good food chart listing both the soluble and insoluble fiber content of various foods:

http://www.digestivehealthconsultants.org/patient_education/fiberchart.html


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## Dreamcatcher32

First of all.. do you know why you have slow transit constipation? Sometimes old age is a cause but if you're younger this needs to be looked into. Sometimes autoimmune diseases, endometriosis, thyroid problems, etc can cause slow transit. I think the most common cause for slow transit (though I could be wrong) is pelvic floor dysfunction. Also, one can not 'assume' that they have slow transit. They need to have a GI transit study to confirm that feces does not move through the colon at a normal rate. It's less common to have slow transit constipation.

Pelvic Floor dysfunction can be diagnosed by a pelvic floor therapist. GI specialists do not properly diagnosis this. Bu some pelvic floor therapists are not qualified to diagnose or treat pelvic floor dyssynergia/anismus specifically. I went to Mayo Clinic in Rochester, MN. That's how I got my diagnosis. I also have thyroid problems and endometriosis, which cause some trouble. But the pelvic floor was the main problem. Took me months to train myself to relax my pelvic floor in certain positions. I had also come to a point where nothing seemed to work for me.

I will say that there are many things you can try. Like Schulze's intestinal formula #1, Constipation Stop! by Renew Life, Senna, Dulcolax, Oxypowder, Swiss Kriss, etc. Remember you will need to periodically switch these around, as your body may get used to one thing. You can also get Amitiza and Linzess from a GI doc. I would be sure that you have had the proper testing and have a good motility doc on your side. If you simply can not go without using these things and they don't seem to be effective, you're going to have to have all your options open. I will say taking something every 3 days is right on target with what you should be doing. Mayo instructed me that anymore than this is not advisable or really necessary.

What is your diet like? You may need to take a closer look at this. Cut out all carbs (pastas, rice, breads, etc) insoluble fiber, add in solueable fibers, eat a lot of fish, protein, avocado, veggies, and fruits. I would also advise that you start juicing regularly. Juice greens mixed with fruits (spinache and apples or spinache and pineapple) and drink that every morning. You can also try smoothies in the morning - spinache, yogurt, coconut water, pineapple, etc. You can do a whole host of delicious smoothies! Also be sure to drink a lot of coffee if you can tolerate it. Do not snack or graze and eat 3 large meals a day. Peristalsis will kick in after each meal.


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## Tricis56

Hi
Thanks for your reply. I have only just seen it. Yes I have had all the tests. I had Ibs 20 years. Now I have slow transit constipation. RECTAL EVACUATORY DYSFUN ctio n.
RECTCELE. GI dysmotility with gastroparesis.
Sorry i do nt even know what it means!


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## Tricis56

Hi
Thanks for your reply. I have only just seen it. Yes I have had all the tests. I had Ibs 20 years. Now I have slow transit constipation. RECTAL EVACUATORY DYSFUN ctio n.
RECTCELE. GI dysmotility with gastroparesis.
Sorry i do nt even know what it means!


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## annie7

Tricis

rectal evacuatory dysfunction refers to problems with passing a bowel movement--problems such as pelvic floor dysfunction or other outlet problems like a rectocele, rectal prolapse etc.

about pelvic floor dysfunction (PFD):

with pfd, the pelvic floor muscles don't coordinate and/or relax properly to allow easy passage of stool. ineffective pelvic floor muscle coordination results in inadequate relaxation of the pelvic floor while attempting to have a BM. the puborectalis muscle tightens and contracts when it is supposed to relax to allow passage of stool. so you can't get it all out (incomplete) and keep having that "have to go " feeling all day.

a defecatory proctogram (defecography) test will show if you have pfd as well as reveal if you have any other outlet problems like a rectocele, vaginal prolapse, rectal prolapse, etc. an anal manometry also helps diagnose pelvic floor problems. it sounds like you've had these tests, since you have the diagnosis.

biofeedback and physical therapy can be effective in correcting pfd. it has helped me. i have pelvic floor dysfunction as well as slow transit constipation, rectal hyposensitivity and megarectum. there are many good places--clinics, hospitals etc-- in the UK where you can go for biofeedback treatment for pfd. the doctor who diagnosed you can refer you to one of these places for help. i know from reading other posts in the past that St Mark's Hospital in London has an excellent biofeedback program.

also elevating your feet on something like a footstool, shoebox etc while sitting on a toilet can help straighten out the anorectal angle and allow for a more complete evacuation. so can using a squatty potty. you can order a squatty potty on amazon as well as other places online.

here is a good link explaining pelvic floor dysfunction:

http://www.fascrs.org/patients/conditions/pelvic_floor_dysfunction/

here is a link explaing biofeedback for pfd:

http://ibs.about.com/od/constipation/a/biofeedbackconstipation.htm

i also have a rectocele. here is a good link explaining that:

http://www.fascrs.org/patients/conditions/rectocele/expanded_information/

there are treatments for gastroparesis. you can discuss this as well as your other diagnoses with your doctor. there is lots of help out there for you.

wishing you all the best.


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## Tricis56

Thanks for the links. I have recently been sent for autonomic testing linkef to the constipation and waiting for the results

The specialists have not mentioned bio feedback. Only surgery to remove the whole large bowel. 
They were talking before about removal of the top part only but now are not willing to consider this.


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## annie7

did the specialist tell you that you have pelvic floor dysfunction? you mentioned that they said you had rectal evacuatory dysfunction, so that's why i mentioned pfd and biofeedback. i would ask them about this--pfd and biofeedback-- specifically, if i were you.

because i have slow transit, i desperately wanted my whole colon removed since it doesn't work. the surgery for this is called a total colectomy with ileoerectal anastomosis. but because i have pfd (pelvic floor dysfunction) my colorectal surgeon and both my gastro docs told me i could not have this surgery--that removing colon would not help me because i still would not be able to get stool out due to the tight pelvic floor muscles and lack of proper coordination. the only surgery i can because i have pfd is an ileostomy--a bag. if my constipation problems become worse, then i might have to have this surgery but for now all the docs are saying no. so this is my situation.

like mine, your situation is complex. especially since you have gastroparesis as well. hopefully you can discuss all this very thoroughly with your doctors. and it helps to do a lot of research online beforehand. that's what i did.

take care.


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## Tricis56

HI

The specialists have not mentioned pelvic floor dysfunction.

This is what they have told me:

1. Likely Pan dysmotility

2. An element of gastroparesis

3. Slow transit constipation

4. Rectal evacuatory dysfunction

5. Rectocele

6. Possible autonomic dysfunction

7. Fibromyalgia

8. CFS

9. Depression

I asked my GP to put it in terms I could understand and he said I don't evacuate, my transit time is very slow and I have a wonky colon.

When you say the whole colon removed do you mean the large intestine?

I haven't been in to discuss the surgery as they told me this was a last resort and with the resilor, bisocodyl, picolax, and the peristene I am having bowel movements but still keep getting flare ups, but at least am not being hospitalised, as I was before.


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## annie7

yes, by "whole colon" i meant the large intestine...the large bowel.


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## Jill41

I stumbled onto this conversation after searching for "Slow Transit Constipation Support". I have been diagnosed with the condition, but the only information the GI doctor gave me was to take Miralax.

Does anyone have suggestions for about how to find a doctor who might be more informative about the condition and how to cope with it? I live near Seattle, which has a medical school. Would the medical school be a good source of information?

Many thanks for any thoughts!


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## annie7

Yes, often a gastroenterologist who works at a university hospital will be more knowledgeable,proactive and up to date about treating constipation Than a regular gastroenterologist.


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## Michael J Famoso

annie7 said:


> Tricis
> 
> rectal evacuatory dysfunction refers to problems with passing a bowel movement--problems such as pelvic floor dysfunction or other outlet problems like a rectocele, rectal prolapse etc.
> 
> about pelvic floor dysfunction (PFD):
> 
> with pfd, the pelvic floor muscles don't coordinate and/or relax properly to allow easy passage of stool. ineffective pelvic floor muscle coordination results in inadequate relaxation of the pelvic floor while attempting to have a BM. the puborectalis muscle tightens and contracts when it is supposed to relax to allow passage of stool. so you can't get it all out (incomplete) and keep having that "have to go " feeling all day.
> 
> a defecatory proctogram (defecography) test will show if you have pfd as well as reveal if you have any other outlet problems like a rectocele, vaginal prolapse, rectal prolapse, etc. an anal manometry also helps diagnose pelvic floor problems. it sounds like you've had these tests, since you have the diagnosis.
> 
> biofeedback and physical therapy can be effective in correcting pfd. it has helped me. i have pelvic floor dysfunction as well as slow transit constipation, rectal hyposensitivity and megarectum. there are many good places--clinics, hospitals etc-- in the UK where you can go for biofeedback treatment for pfd. the doctor who diagnosed you can refer you to one of these places for help. i know from reading other posts in the past that St Mark's Hospital in London has an excellent biofeedback program.
> 
> also elevating your feet on something like a footstool, shoebox etc while sitting on a toilet can help straighten out the anorectal angle and allow for a more complete evacuation. so can using a squatty potty. you can order a squatty potty on amazon as well as other places online.
> 
> here is a good link explaining pelvic floor dysfunction:
> 
> http://www.fascrs.org/patients/conditions/pelvic_floor_dysfunction/
> 
> here is a link explaing biofeedback for pfd:
> 
> http://ibs.about.com/od/constipation/a/biofeedbackconstipation.htm
> 
> i also have a rectocele. here is a good link explaining that:
> 
> http://www.fascrs.org/patients/conditions/rectocele/expanded_information/
> 
> there are treatments for gastroparesis. you can discuss this as well as your other diagnoses with your doctor. there is lots of help out there for you.
> 
> wishing you all the best.


I can't believe how much I release using a Squatty Potty. It really works for me.

I got one here http://squattypotty....esolutions.com/


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