# First appointment, GI doc does nothing but schedule colonoscopy



## melmcc224 (May 31, 2014)

Hi, I am new to the forum, and I had some questions about how Gastro doctors usually treat someone. I should probably give a brief description of my problems first..

I am 32 years old, and I have been suffering from chronic constipation since around 23 years of age.. I have had 2 vaginal births, which have definitely made my constipation much worse. Since my first child, I have suffered with external and internal hemorrhoids. The internal one definitely seems to be getting worse. I can feel it hang out when I force on the toilet. My constipation also got much worse due to the fact that I would starve myself. I was never fully anorexic, but I would go a long stretches of just eating one tiny meal a day. Obviously this slowed my system down tremendously. The starving came from the fear of being so "backed up" so I was afraid to eating anything else.. (I know.. It makes no sense) I would never take laxatives out of fear of the horrible cramping they cause. So I mostly used psyllium fiber, and soapy enemas to help clean myself out..

I also know that I must suffer from pelvic floor disorder after having children as well. I have problems emptying my bladder. Sometimes I need to push on my lower abdomen to get the urine to come out. I also have times when it leaks out.. All of my problems have seemed to get much worse after I had a Tubal Ligation done in Oct. 2013.. I have these "episodes" where I start feeling a needle poking me inside my vagina, and I have to urinate frequently.. Then I start to have horrible back pain and abdominal pain which feels like labor contractions, and I start passing liquid and hard stool. These "episodes" can last for a few hours at a time, and seem to be worse each time I experience it.. I was always scared of going to the doctor because I was afraid of what they would tell me, but I finally have been scared into going..

I had my first Gastro appointment last week, and after reading through this forum, I figured he would've did a full exam, where they push down on your whole abdominal area, maybe did an ultrasound,etc, but this doctor barely even touched my stomach. I gave them an extensive history of all my issues, and he pretty much told me to take Miralax twice a day, and wants me to have a Colonoscopy as soon as possible. I was under the impression that there were other tests that could be done before resorting to the Colonoscopy. Am I wrong? I know I will probably need one, but I rather have other tests done first..

Should I just try to find a different doctor?


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## Kathleen M. (Nov 16, 1999)

Ultrasounds really tell you nothing at all about constipation, other than maybe you are constipated with more stool than non-constipated people. If you had pain consistent with gall bladder problems they might do it for that.

Usually the pre-colonoscopy tests are blood work (if you haven't had any recently) to see if you are anemic or your inflammation markers are up (but usually you see that more with diarrhea than chronic constipation). They may also do a stool sample, but again that tends to be more for IBS symptoms with diarrhea not constipation.

The other tests for constipation usually are a sitz marker test and pelvic floor testing but he may want the colonoscopy first. If he won't do any of that testing after the scope then I'd think about another doctor.

But usually they like to take a look see if your symptoms are disruptive enough.

FWIW taking a good medical history is doing something, and often tells you as much or more than poking around at the abdomen or random medical tests just to do medical tests.


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## melmcc224 (May 31, 2014)

Thank you for your explanation.. He didn't do any bloodwork, which I had forgot to mention in my previous post. I found that the most surprising because I told him I have hypothyroidism, and I know I am anemic (which I forgot to mention to the doctor). It seems like this doctor's standard practice to automatically send patients for colonoscopies because I overheard people stating they were new patients, and then confirming their appointment dates for a colonoscopy.. He told me to take Miralax twice a day, and I am starting to think he may be right, because I have taken it 3 days in a row, and only had a small hard bowel movement. Is twice a day a normal dosage for chronic constipation?


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## Kathleen M. (Nov 16, 1999)

Yea seems reasonable, that way you get more of the osmotic into more of the stool than taking it once a day. It mixes into the stool, and while stool from meal one will mix some with meal two taking it more often makes it more mixed in than if you take it less often.

Some GI doctors do like to scope most everyone with symptoms (and usually you end up at the GI because you have symptoms bad enough your GP feels you need to see someone), and if you already have recent blood work (or chronic problems) redoing that may not be likely to do anything that confirm the same result for the last however many years you had that exact same result.

I'd be more worried if the family doc scoped everyone no matter what they came in for. Most people are in the GI clinic for things a scope will help rule in or rule out.

FWIW most people seem more worried about doctors that do not want to scope them. Much depends on how that doctor reads the risk benefit ratio and if they would rather err on the side of missing something every once in a while, or the harm from stressing out patients with the prep and then being told the test was normal.


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## Dreamcatcher32 (Nov 12, 2013)

Sounds like most GI docs. The last thing they want to do is check your pelvic floor. It's ridiculous given that 50% of those with chronic constipation have pelvic floor problems and this directly causes constipation. I also want to warn you that you need a physical therapist to test your pelvic floor to be 100% sure that you don't have dysfunction. The testing (anorectal manometry) can miss it.

You may have other issues going on but you definitely have pelvic floor problems by the sound of it. I would go to a GI doc that specializes in motility for the 'episodes' you're having. I would also get the colonoscopy done to rule anything out. It's a breeze compared to most testing.

Ask your local GP if they know of any place that specializes specifically in WOMENS pelvic floor problems. It's important that you get the right diagnosis and treat this now. Btw, starving yourself is VERY common with pelvic floor problems. Almost everyone who has it does this exact thing. But like you said, it's really the worst thing you can do. If you don't have enough 'in there,' then you're definitely not going to get an urge to go. You also want to be sure to eat large meals to stimulate peristalsis. If you eat half of your food, you might not get one. If you eat the entire meal, that'll get things moving! You have to have a relaxed pelvic floor, though.

Psyllium fiber can constipate you, as it draws water out of the colon. You want to hydrate it with the proper diet. Use Magnesium Citrate to soften your stool or MOM if you get really backed up. Regular magnesium can relax the smooth muscle quite well. Be sure you're drinking at least 64oz of water a day and a glass of water after each meal. You can also use Aloe (inner filler ONLY) to get things moving. Rotate that with the magnesium for now. Most of all, be sure to 'relax' your pelvic floor. Take warm baths and concentrate on it as much as you can.


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## Aidara (May 9, 2014)

Dreamcatcher, why people with pelvic floor dysfunction tend to starve themselves? What is it to do with pelvic floor? I also agree that it is important to eat large meals rather then small ones. It helps a bit with peristalsis. Does anybody knows what to do if stools are soft, but there is no urge to go?


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## melmcc224 (May 31, 2014)

Kathleen M. said:


> FWIW most people seem more worried about doctors that do not want to scope them. Much depends on how that doctor reads the risk benefit ratio and if they would rather err on the side of missing something every once in a while, or the harm from stressing out patients with the prep and then being told the test was normal.


Yea, that would be the "normal" way to approach the situation. Unfortunately, I have many phobias and anxiety issues, so I am far from normal.. I haven't had any bloodwork done in a long time. I just recently acquired health insurance, and my issues were so severe that going to a GP just wouldn't make sense..

Dreamcatcher 32, thank you for your response. I live in Northwest Alabama, so I'm sure to find some type of specialist I would have to probably go to Birmingham, but I will definitely see what I can find.. I have also read about biofeedback helping the pelvic floor and constipation, but from what I have read is that it isn't covered by health insurance.. Would it be worth looking into purchasing my own machine? I know a good one is pretty expensive, but it may be worth it in the long run.

I have heard of the supplements you listed working pretty well, so I will take your advice and buy them.. I definitely don't drink enough water. That is probably another major cause of my issues, but with my bladder feeling so low, and drinking so much fluid, I will get extreme pressure to almost pain, plus I will have to urinate every 10 minutes.. It is insane.. Some days I struggle to get any urine out, then other days I am urinating what seems like gallons of fluid every 15 minutes..


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## Dreamcatcher32 (Nov 12, 2013)

Aidara said:


> Dreamcatcher, why people with pelvic floor dysfunction tend to starve themselves? What is it to do with pelvic floor? I also agree that it is important to eat large meals rather then small ones. It helps a bit with peristalsis. Does anybody knows what to do if stools are soft, but there is no urge to go?


Aidara, the reason those with pelvic floor dysfunction typically starve themselves is because 1) they can have trouble getting an urge to have a BM and 2) they figure if they eat half as much they'll only be half as 'backed up.' It makes sense if you're struggling to pass things, to be honest. At the same time, it's one way to ensure you won't get an urge to have a bowel movement in a given day. The rectum will only decide to 'empty' when it's full enough and the more you have 'in there,' the stronger your urge will be. The bigger of a meal you eat, the stronger peristalsis will be.

If you have soft stools but there is no urge to go, you could have motility problems or pelvic floor problems. A combination of both is quite common. You could also be dealing with something as simple as not having 'enough' in there to go every day. But you should go every other or third day, unless you're starving yourself.


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## Dreamcatcher32 (Nov 12, 2013)

melmcc224 said:


> Yea, that would be the "normal" way to approach the situation. Unfortunately, I have many phobias and anxiety issues, so I am far from normal.. I haven't had any bloodwork done in a long time. I just recently acquired health insurance, and my issues were so severe that going to a GP just wouldn't make sense..
> 
> Dreamcatcher 32, thank you for your response. I live in Northwest Alabama, so I'm sure to find some type of specialist I would have to probably go to Birmingham, but I will definitely see what I can find.. I have also read about biofeedback helping the pelvic floor and constipation, but from what I have read is that it isn't covered by health insurance.. Would it be worth looking into purchasing my own machine? I know a good one is pretty expensive, but it may be worth it in the long run.
> 
> I have heard of the supplements you listed working pretty well, so I will take your advice and buy them.. I definitely don't drink enough water. That is probably another major cause of my issues, but with my bladder feeling so low, and drinking so much fluid, I will get extreme pressure to almost pain, plus I will have to urinate every 10 minutes.. It is insane.. Some days I struggle to get any urine out, then other days I am urinating what seems like gallons of fluid every 15 minutes..


I can certainly relate, as I have extreme anxiety and obsessive compulsive issues. This is very common in those with pelvic floor problems, as we're 'tensing' those muscles constantly when in stressful situations or when using the restroom. Please don't stress out about a colonoscopy. It's so easy you'll laugh at yourself afterwards. I didn't even really mind the prep too much. Watch Katie Couric's experience. You can find that on youtube, it's pretty funny. I also want to assure you that 90% of the time, colonoscopy's find nothing. But they are a necessary tool to rule out the very small chance you could have something.

If you're in Alabama, it looks like you're going to have to either make a trip to Mayo Clinic in Jacksonville, FL or Cleveland Clinic in Ohio. I say that because Mayo or Cleveland are going to be the two places in your proximity that will actually successfully diagnose GI, urinary and pelvic floor problems. I would be sure to research doctors at these two facilities and make sure you get in with the best ones.

It might be worth a shot to purchase your own U-control machine. But I think it would be best to first get diagnosed. It never works to self-diagnose. You can 'guess' at what you might have but there could be other underlying problems that need to be looked into and then you'd never know. Now, if you WERE diagnosed at Mayo Clinic and didn't want to do their 2 week bowel retraining, then you could attempt to purchase the u-control device on your own. Biofeedback is covered by most insurances these days, though. The bowel retraining program will also help your bladder but it won't cure it. I would recommend going to Mayo Clinic and also getting your bladder checked out. If you have other underlying issues going on (prolapsed bladder maybe?), they will send you to different departments and get things figured out for you. That's the beauty of Mayo Clinic.

Water is very important for the bowels. You need to get your bladder issues helped so you can drink as much water as necessary to soften your stool. For now, I would eat things that are 'moisture-rich.' For instance, veggies and fruits. IF you are eating a lot of fiber and not drinking water, that food is going to sit in you like a brick. I don't know if your bowels seem like a dangerous situation but your bladder definitely does. That can cause long-term health problems if left untreated. I really can't stress to you how important it is for you to see someone. And not just 'a doctor,' but someone who specializes in these problems and will leave no stone un-turned. That's why I am recommending Mayo or Cleveland to you.

Also look into Endometriosis, as it sounds like you could possibly have this on your bladder. A vaginal ultrasound would find any cysts that could be 'blocking' things for you. It's really important you get all of these things looked into and treated. I really wish you all the best of luck, message me if you need to.


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## melmcc224 (May 31, 2014)

Wow, Florida and Ohio are the only choices? I would have to save money to travel, so it would probably be a while before I can go to either place. I do have an appointment for my Gyno this week so hopefully they will be able to help me with the Endo issue. I had also thought it could be a possibility.. I think the person who performed my Tubal Ligation has caused some damage, and I told the nurse about it when I scheduled my appointment. She acted as if I was crazy for thinking that pelvic floor issues would cause constipation.. She actually told me "Well, as far as your bowel issues, we can't help that at all" I told her that I did extensive reading about it being caused from pelvic floor issues, and you know most doctors can't stand when patients actually do research on their own.. Thankfully, the doctors there are very good, so I won't worry about the nurses.. I figure I should go to them first, and get whatever I can diagnosed, then have the colonoscopy..

I wish I could be as fearless about the colonoscopy, but I have felt horrible for so many years, so I am always convinced that I am suffering from some random illness at any given time.. I am more scared of not being able to fully empty my bowels, and they end up having to reschedule it.. How does that work? Do they do an ultrasound to see if it's empty before they go in?


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## Kathleen M. (Nov 16, 1999)

They ask what is still coming out, from an FAQ found here.

http://www.ahni.com/Practices/getmycolonoscopy/FAQ.html



> How do I know if the colon prep worked well enough?
> 
> Regardless of the colon clean-out that you choose, the end goal is a clean colon. The day of the procedure a lot of patients will pass yellow liquid and be concerned that they area not cleaned out. If the yellow liquid is clear then they are cleaned out and they are just passing digestive juices. The stomach and small intestine think any minute that you are going to come to your senses and feed them. So they are making juices in overtime mode hoping to get lucky. Since your digestive tract is clean the juices fall down into your colon and pass out your rectum as clear yellow liquid. If you are passing cloudy or brown liquid then you probably are not well cleaned out and you should tell your nurse as you are being admitted. Tell them the first thing so that they can inform the doctor to see if any further clean out is required. Remember the quality of your exam depends on 2 things: #1 How good your doctor is. #2 How clean your colon is. You could have the best doctor in the country but if your colon is not well cleaned out you will have a substandard exam.


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## Aidara (May 9, 2014)

Thanks a lot, Dreamcather. I am still learning about pelvic floor disorders. That is so true, what you said about eating. I am not starving when I am constipated. I am still eating food. But I want to eat less. Eating makes me feel worse. I will do my best to eat larger meals even though I am constipated, because I noticed myself that small frequent meals doesn't help in my case.


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## annie7 (Aug 16, 2002)

melmcc244---so sorry for all your problems. struggling with multiple health problems as well as pelvic floor dysfunction is very difficult, isn't it.

if you're looking for a good treatment center for pelvic floor problems and don't have the money to travel right now you could first try looking around locally. gastro doctors affiliated with university hospitals are very knowledgeable about pelvic floor problems and are very proactive about treating them. i'm not familiar with your area but for starters you could try the University of Alabama at Birmingham hospital (UAB). their website says they treat all types of pelvic floor disorders. you could call them and check into it. if it turns out they don't offer a biofeedback/PT program right there at the hospital their gastro docs should be able to refer you to a physical therapist nearby who specializes in this:

http://www.uabmedicine.org/conditions-and-services/incontinence-why-uab

also--the university of michigan bowel control website has a list of physical therapists specializing in pfd. it's a pdf file. it has mostly PT's in michigan but you can scroll down to alabama and it shows Thomas Hospital in Fairhope, AL specializing in Women's Health and constipation and gives the therapist's name. here is the hospital website and the U of M pdf file link:

http://www.infirmaryhealth.org/hospitals/thomas-hospital

http://www.med.umich.edu/PT-Staff/PTContactList.pdf

and i imagine there are other university hospitals close to you as well. i have pfd and am  retired and cannot afford to travel out of state for treatment. i live in michigan and have been taking an excellent program of biofeedback/physical therapy for pfd through the univeristy of michigan hospital. one of my gastro docs works at the hospital and is the head of the program. i've been very very happy with both my doctor and the program. so hopefully you can find something closer to home.

wishing you all the best. take care.


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## melmcc224 (May 31, 2014)

annie7 said:


> melmcc244---so sorry for all your problems. struggling with multiple health problems as well as pelvic floor dysfunction is very difficult, isn't it.
> 
> if you're looking for a good treatment center for pelvic floor problems and don't have the money to travel right now you could first try looking around locally. gastro doctors affiliated with university hospitals are very knowledgeable about pelvic floor problems and are very proactive about treating them. i'm not familiar with your area but for starters you could try the University of Alabama at Birmingham hospital (UAB). their website says they treat all types of pelvic floor disorders. you could call them and check into it. if it turns out they don't offer a biofeedback/PT program right there at the hospital their gastro docs should be able to refer you to a physical therapist nearby who specializes in this:
> 
> ...


Thank you so much for looking into this for me! I did notice that Birmingham may be my best option for the moment. I can't believe there isn't more help for those of us who suffer from such a common problem. I remember laughing at my father a few years back when he told me I am so constipated because of my anxiety causing me to be constantly tense on the inside.. I thought he was crazy, but the more I read about the possible factors that can cause constipation, being constantly stressed and anxious is definitely a big one..

I was also wondering if anyone thinks that scoliosis could have a connection with constipation? I have read that your brain sends signals through your spinal cord, and down into your bowels, but if you have a spinal injury, or scoliosis, that it can cause your bowels to not receive the signals being sent to it? My scoliosis has gotten worse the past few years, so who knows..


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## Kathleen M. (Nov 16, 1999)

There is one case report, but that doesn't always generalize but at least it sounds like one person's experience might relate to yours (but I couldn't tell from the snippet available on-line what kind of pelvic floor dysfunction).


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## annie7 (Aug 16, 2002)

melmcc--thanks-you're more than welcome. i do hope you can get tested and get started on a program of biofeedback near you.

i have mild scoliosis. you can tell from looking at me that my back is curved and--one hip is higher than the other, plus i'm thin enough that you can sort of see it... and x-rays confirmed this. i also have a hypermobile sacrum and sacroiliac joint dysfunction--have to wear a sacroiliac belt 24/7 to keep my sacrum from shifting out of place. i never thought about scoliosis contributing toward my constipation problems though. interesting thought. sorry your is getting worse. and thanks, Kathleen, for your input on this!


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