# incomplete evacuation



## Mary2001 (Aug 25, 2006)

Hi all, I see some messages posted on the boards about incomplete evacuation (stools remaining in the rectum) and I would like to know if this problem only accompanied by trapped gas means that someone has ibs, or is it a seperate problem (not ibs) or is it part and parcel of ibs. If it is ibs does it mean ibs d or ibs c. Would be grateful for clarification on this. Thanks.


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## 16963 (Dec 5, 2006)

People with both C and D have mentioned it. I have IBS-D, and I get it sometimes. It's the most annoying thing ever







I had never heard of it until I had IBS, and I also never had a problem with it until I developed IBS. Although I'm confused as to how it would be exclusively linked...


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## overitnow (Nov 25, 2001)

I had active IBS D for about 10 years. IE was certainly apart of that--why else would I have gone 4+ times most mornings? I am sure that was related to the solid to liquid ratio coming through. It probably became even more irritating during the recovery period, as that liquid was reincorporated into the poop. I would seem to get just so much push on the soft stool, leaving the rest behind. While I was never C, there did seem to be some motility problem in getting it all through.Mark


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## 16963 (Dec 5, 2006)

I have found, though, that my IE is a whole lot better since I've been treating my IBS. Before, I'd go to the bathroom a zillion times after 1 "real" BM. Now, I go once, and about 10 minutes later I go again, and then I'm usually "empty" for the time being.


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## Mary2001 (Aug 25, 2006)

> quote:Originally posted by lynnie:I have found, though, that my IE is a whole lot better since I've been treating my IBS. Before, I'd go to the bathroom a zillion times after 1 "real" BM. Now, I go once, and about 10 minutes later I go again, and then I'm usually "empty" for the time being.


 Thanks for the replies about this and I wonder what is good treatment to help with this, as I have a daily problem with it. Thanks again.


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## 16331 (Dec 14, 2005)

I also have the incomplete evacuation. I have C IBS, sometimes D as well.Sometimes my stools are hard, and sometimes they are not. I take a multivitamin with Calcium , and try to eat fiber foods, but I think the Calcium may make it more difficult. I hate still having stool, and I can't go. I've resorted to suppositories at times, I push, but are afraid of pushing too much, because my lower abdomen starts to bother me, and is tender, when I push too much or hard, plus I think I have internal hemmorhoids, it hurts and is sore at times, almost like a cutting feeling. Not sure what to do .


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## 17947 (Feb 3, 2007)

I'll go to the bathroom. After a couple of minutes, I'll think I'm done. I wipe, pull up my pants, wash my hands, etc. I put my shoes and coat on. Walk down the street to meet up with my girlfriend. Halfway down the street I'll realize that, "oh, balls... I'm not done yet." (I hope she never sees me running away...







) Well, not really. Usually I can tell that I haven't completed the job, but I can't do anything about it. So I will leave the house and then, once I'm just out of range of my house it'll be back for more. I've come to expect it now. It's one of the more annoying parts of IBS. I have C and D with lots of pain.


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## Mary2001 (Aug 25, 2006)

> quote:Originally posted by Catalyst:I'll go to the bathroom. After a couple of minutes, I'll think I'm done. I wipe, pull up my pants, wash my hands, etc. I put my shoes and coat on. Walk down the street to meet up with my girlfriend. Halfway down the street I'll realize that, "oh, balls... I'm not done yet." (I hope she never sees me running away...
> 
> 
> 
> ...


 Thanks for your replies, but is there no cure or treatment to help with this, as I also find it very frustrating that when I think I am finished in the bathroom and away from the house about my business, I will have a feeling that I need to go again. I spend ages trying to prevent that from happening as I stay so long in the bathroom, but it looks like its something that cannot be conquered unless someone know about some treatment that would help. I take fibogel and colpermin capsules. The colperhim helps a bit with trapped gas, but incomplete evacuation just doesnt go away as these treatments do not help. Thanks for all replies and help offered.


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## overitnow (Nov 25, 2001)

If you have D, then the flavonoids I use might work as well for you. Mark


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## evulienka (Jan 12, 2007)

these are my symptoms : i have had trapped gas for many years and IE time to time. I have BM regularly every day so I donÂ´t actually have C or D but the stool is almost always either loose or hard - never normal. my doctor told me it was IBS . (all my tests were negative)


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## 17947 (Feb 3, 2007)

I haven't found a cure, no. Sorry. The only thing that works for me is to stay on the toilet for an hour. And hopefully you'll catch the "second wave." Unfortunately, this is not possible for most people, as some do have lives.


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## eric (Jul 8, 1999)

You have to realize this is in big part sensation, its the "sensation of incomplete evacuation" do to sensitive nerves in the rectum.The SENSATION of Incomplete evacuation" The rectum is more elastic than the rest of the bowel so it can stretch to store fecal material. It is surrounded by nerves that detect expansion of the rectum and signal a sensation of urgency to let us know when it is time to have a bowel movement."http://www.aboutincontinence.org/causes.html In IBS the nerves in the rectum that signal urgency can be very sensitive so it feel like you have to go when the colon is empty.Hypnotherapy helped me greatly with this, biofeedback might also help a person with this as well.There maybe other issues for this to to be tested for."Dyssynergia of the pelvic floor: the term, defined by the Rome Criteria, provides as a symptomatologic expression of the entity characterized by straining during evacuation, a sensation of incomplete evacuation, or the recourse to fingering in at least 25 percent of evacuation actions. It has also been defined as abdomino-pelvic dyssynergia and can be identified through manometry, electromyography, or defecography as the incapacity of the muscles of the pelvic floor to relax during the act of defecation14,17."http://www.anemgi.org/html/anost.htm FYII asked one of the experts in chat about biofeedback and Incomplete evacuation, which sometimes may lead to fecal incotinence."Eric. Yes. Incomplete evacuation can lead to FI. This is often a result of unintentional contraction of the anal canal during BMs, like we see in constipation patients. So we train proper relaxation during defecation attempts in the same manner. "a bb search will come up with quite a bit of info on this.


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## 21857 (Aug 15, 2006)

I have D, but when i take to much immodium, I can get C, and i experience the incomplete evac, and it is horrible, im sorry your going through this. Wish I knew more about it to help you out, but i can sympathise!


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## Mary2001 (Aug 25, 2006)

Hi all Thanks for all replies, and sharing hints and information. Thanks to Eric for all info and you mentioned hypnotherapy. I am doing Mike's tapes for the second go. (I did the programme last year in late 2005 early 2006, but it did not work for me, so I decided to give it another go. It is certainly making me more relaxed and confident this time, but I am puzzled at the bit about the wheel that spins, as I see the wheel spinning fast, but I do not have D, its C I have, so I was never sure which pedal to use. I used the right hand pedal for C.but hard to visualise a wheel spinning slowly. Anyway I am going to keep going with Mike's programme (even if I need to do it 4 or 5 times) as I think it is marvellous for stress relief, and I would hope that might help with the incomplete evacuation, if it has helped you. You said it was a Sensation more than anything, so I am beginning to see that now, but its just trying to get rid of that sensation that is the problem as it is very frustrating indeed. Thanks for all your research.


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## eric (Jul 8, 1999)

Mary hang in there and don't worry to much about the wheel at the moment, because the subconcious will sort it out for you. You can visulize a stream and the water flowing, instead of damned up.







Sometimes it takes a couple rounds so glad it is helping more this time. The subconcious doesn't like change, so it may take a bit for that to happen. Let me know how its going for you after a bit.I didn't even notice to much when the sensation thing basically stopped for the most part, every once in a great while sometimes I feel it kindof.


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## Arnie W (Oct 22, 2003)

What if it is not a sensation, but is IE for real? I have had it for years and years and am no closer to finding an answer for it.


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## Kathleen M. (Nov 16, 1999)

What happens if you use a glycerin suppository or do a small enema? The stool left in the rectum should come out and end the problem for awhile.Does the stool come out when you do that.Do you think you need to have your pelvic floor tested to make sure it relaxes enough to let all the stool out?K.


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## Arnie W (Oct 22, 2003)

Hi, Kath. Thanks for the reply. Yes, a small enema works well, but I don't like to get too dependant on that. The suppositories have not normally been helpful.I have been thinking about checking out the pelvic floor for a while.


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## Mary2001 (Aug 25, 2006)

Hi Eric Thanks for your reply, but I wonder which pedal I should use as I am stuck at that and am thinking maybe that is why the hynotherapy isn't working for me. It is incomplete evacuation that is my problem, so I wonder is that ibs D or ibs C. I am at session 2 of the hypnotherapy now for the second time around and I had been using the right hand pedal, but its not working out, so I have 2 questions that you might be able to answer. (1) What is hynotherapy addressing to help? is it incomplete evacuation it helps or does it make you go to the bathroom more for C or less for D? and the other question I have is Do you know what is in the subconscious that the tapes are addressingi.e. stress, or depression or what? Thanks Eric. I am not having a very good day today, but I am so glad to have the support of people like you and all the others on the ibs boards. Thanks to all who replied, and gave their thoughts and views. You all make the world a brighter place. Thanks again.


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## Kathleen M. (Nov 16, 1999)

Incomplete evacuation seems to be seen in both IBS-C and IBS-D types.As for the pedals, I'd just play with it and see what seems to work for you. I don't know if you can analyze it ahead of time to arrive at the right answer.I think hypnotherapy like CBT is more general. It has to do with your response to your GI tract. You can respond in ways that keep a symptom going (any symptom) or repspond in a way that cause a inappropriate body response to become more appropriate.It is going to be kind of individual as it depends on how you are responding and how your own response needs to adjust. I know for the CBT it wasn't working by making depressed people less depressed as it worked best in the clinical trial I was in on the non-depressed people. I think it can work on how your own depressions or stress feeds the IBS, but it doesn't just make stress go away and the symptoms follow. Not sure if that makes sense. It may not change how much stress you have, but it can change how your stress effects the IBS. If your stress reaction is making things worse you can rechannel it so you aren't using it to send the IBS signals that ramp up the symptoms.K.


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## eric (Jul 8, 1999)

Mary Sorry to hear your having a rough spot.I would email Mike for some advise on the pedal issue.Have you ever heard of? "Outlet obstruction type constipation (pelvic floor dyssynergia)The external anal sphincter, which is part of the pelvic floor normally stays tightly closed to prevent leakage. When you try to have a bowel movement, however, this sphincter has to open to allow the fecal material to come out. Some people have trouble relaxing the sphincter muscle when they are straining to have a bowel movement, or they may actually squeeze the sphincter more tightly shut when straining. This produces symptoms of constipation. "You might ask your doctor about this?The exact mechanisms on how HT works for IBS is still be looked into, however there are things they have found out and some have to do with a psychophysiological reponse.Thoughts produce chemical and electrical reactions, both good and bad.However the digestive system is autonomic. It runs without conciously thinking about it. So basically the subconcious is connected to the autonomic control. So its working on the brain gut axis. When your in the 'trance state' which is a "heightened state of focus" you can slow digestion down, heartbeat and breathing, which are all autonomic nervous system functions. Even gastric acid.The reduction of stress and anxiety is basically a side effect of the hypnotic state. HT works on many levels of IBS. It can boost the immune system, there is evidence of it working on the Anteior Cinculate Cortex a problem found in IBS in regards to pain and pain and emotions and viceral hypersensivity. On the symptoms of d and c and d/c. Which you have to remember are symptoms of IBS and a larger bigger picture of IBS.Our thoughts also produce chemical and electrical signals that effect the body. Negtive thoughts and emotions create negative reponces from the body and positive thoughts and emotions create positive chemical and electrical reponces in the body. There is even a lot more to it all, but suffice it to say HT for IBS works on both the gut and brain aspects of IBS. The top down and the bottom up.Hope that helps some. That is one good thing about it for IBS, as a lot of treatments, especially meds, work on a specific symptom or two. HT works on the whole person and on many symptoms and levels. Even non gi symptoms IBSers can have like, muscle tension, back ache and nausea and others. Its helping to calm the brain gut axis and give your brain which already has a lot of control in digestion even more control. A better connection between the "brain in the gut" or entric nervous system and the brain.Its also important that this is a coping tool.


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## Mary2001 (Aug 25, 2006)

Thanks to Kathleen and Eric for info and I have an appointment with my doctor for 2 weeks time and I will ask about the outlet obstruction constipation to see if he thinks that may be my problem. Is that the same thing though as ibs, as I did get diagnosed with ibs 2yrs ago approx, as all my tests were negative but it seems very much like outlet obstruction instead. If it is outlet dsfunction do you know if Mike's hypnotherapy would help with that or what other type of treatment works for that. Thanks and sorry to bother you both so much with this.


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## Kathleen M. (Nov 16, 1999)

Outlet obstruction is not the same as IBS.I think the main treatment for that is biofeedback so you learn to relax the muscles when you want to have a BM. Some people tense them up when they should be relaxing them.The tapes might help, but aren't as targetted as biofeedback where you would get information about what you were doing as you did it.I did biofeedback for migraines.K.


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## Mary2001 (Aug 25, 2006)

Kathleen, Thanks for your reply and for taking the time out to help me. It is a bit of a drawback that there is not a one single test that would diagnose ibs; as the reason why I am unsure about it is because all my other tests I had were negative (colonoscopy, barium enema, sigmoidscope etc) so I am thinking that if there is other conditions like outlet dsyfunction or pelvic floor dsyfunction (which would have similar symptoms to ibs) and I have not been tested for any of those conditions that maybe it could be one of those conditions is the cause. If I knew for definite what the exact problem was I think I would be much better able to deal with it, but maybe I will find out when I visit my doctor. Thanks for all help.


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## eric (Jul 8, 1999)

Mary you can have more then one problem at a time."Pelvic Floor DyssynergiaAn example of anorectal dysfunction that can contribute to constipation is a condition called Pelvic Floor Dyssynergia (also referred to as anismus). It is marked by the failure of pelvic floor muscles to relax, or a paradoxical contraction of the pelvic floor muscles, with defecation. The pelvic floor is composed of a group of muscles that span the underlying surface of the bony pelvis, which function to allow voluntary urination and defecation. "Paradoxical contraction" refers to an abnormal increase of pelvic floor muscle activity with defecation-rather than the normal decrease in muscle activity that is necessary in order to have a normal bowel movement. This condition can contribute to some forms of constipation, complaints of incomplete evacuation, and straining with stool. Because pelvic floor muscles are controlled voluntarily, their function can be improved through various learning procedures - such as biofeedback. For more information on Disorders Related to Excessive Pelvic Floor Muscle Tension, see IFFGD Fact Sheet No. 109. For more information on constipation, visit IFFGD's web site at www.aboutConstipation.orgI am not sure how chronic pain fits into Pelvic Floor Dyssynergia.It might be the pain defines you have IBS. But its possible to have both.


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## 14529 (Feb 1, 2007)

Gosh, IE is my biggest problem. If I don't really go one day, I get anxious if I'll be able to go the next day. When the next day comes, I'm even more anxious and feel like my sphincter or something just shuts. I know what that means. Even more constipation and dicomfort. And the anxiety remains for quite sometime, and just perpetuates the problem. But even without anxiety, my IE problem always remains. It gives me gas, bloating, and what not. I'm thinking of hypnotherapy as well...


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## tummyrumbles (Aug 14, 2005)

*EDIT: I've had a lot of luck with the SIBO Specific Diet - a combination of the Specific Carbohydrate diet and the low FODMAP diet. (2016)*

I think itâ€™s helpful identifying what kind of incomplete evacuation you have. In my case, I go every day, several times in the morning. So I think my colonic transit from the stomach to the traverse colon is normal. My diet is pretty good, with probably 20 grams of fibre a day. My problem area seems to be the descending colon. The first BM in the morning is easy to void, but Iâ€™m waiting ages for the others. If I donâ€™t wait it out, Iâ€™d get bad gas at work, so I donâ€™t have a choice in the matter. I have to wait it out, and this takes an hour and a half. My life revolves around my colon, but at least I can have a normal life if I do this. I donâ€™t recommend anyone using enemas, IBS drugs, or any other artificial means to evacuate, because it just leads to more problems in the long run. Iâ€™ve been doing this for a year, and honestly donâ€™t think anyone is going to come up with a cure for this condition, which I call a sluggish descending colon, but the proper term may be chronic intestinal pseudo obstruction. I donâ€™t strain or anything; Iâ€™m completely relaxed, and just let it happen. I have to allow 2 Â½ hours from when I get up, till I leave for work, because the first BM isnâ€™t until an hour after I get up. Itâ€™s annoying but itâ€™s definitely worth getting up early for.


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## 14529 (Feb 1, 2007)

omg, tummyrumbles, that's exactly my problem! I go everyday, no strain, pretty much relaxed, and the first two minutes are great. Then something just happens and it takes forever to let the rest out.It gets really slow. I get tired after thirty minutes of sitting, so come back for another 'session.' I have three to four sessions in the morning, but no matter how much I try, I still can't let it all out. There's something that is still stuck. And whatever that is stuck gives me gas and bloating, and lots of discomfort. But yeah, I usually have to wake up 2 1/2 to 3 hours early from the time I have to leave the house. It's frustrating. But in your case, you said the first bowel movement comes after an hour you wake up. Coffee or black tea can help speed things up...


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## 16636 (Sep 29, 2006)

I'm also up 3 hours before I even leave the house in the morning for work. In my case, I need medication to go regularly at all because I have IBS-C. I can recommend medication for people with this condition as long as it's helpful. I need to wait an hour before eating after taking the Zelnorm.For me, Amizita and Zelnorm combined help me go at all, and after sitting down a few times after breakfast and diner I can go enough to eliminate IE. This is for the moment. Things generally stop working eventually (unfortunately).My IE is also relieved by insoluble fiber and stool softeners. Soluble fiber doesn't do much for IE (for me). If my medication is working, I need at least 20-25mg a day of insoluble fiber. If the meds aren't working, fiber doesn't seem to do much other than give me gas.Dana


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## 14529 (Feb 1, 2007)

Yeah, I need some sort of laxative to help me go as well. Zelnorm made me more constipated. I do take in lots of fiber. But what's the difference between insoluble and soluble?And the thing for me is that my bowels can only move in the morning. So even though it's incomplete and I feel I have to go throughout the day, I can't. I have to wait another twenty fours to actually go again. It's a darn long process...


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## 15178 (Feb 17, 2007)

I'm new to the website and have some questions about IBS.....and I hope some of you can advise me.....I read through a lot of the mtyerial and the only big concern I have is the symptom that concerns the issue of awakening during sleep or not being able to get to sleep.....I find that only after I awake do I begin to have the uncomfortableness.......i.e. lower abdominal pain, new to go, runny stools......all the symptons I see on this website.....it does not awaken me from sleep but as soon as I awake it starts.I have had regular colonoscopies (one witin the last year) and they are always clear......I have recently had a complete blood panel done and it was excellent.....and in the last month I had a complete physical with everything okay including a negative occult blood test.....So........does it sound like IBS?I'm going to another doctor soon, just to check it out to be certain but any advice or assistance you can offer will be appreciated.Sam


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## 14139 (May 13, 2005)

Boy oh Boy glad to hear that I am not the only one who deals with IE. That is the worst part of IBS for me. I have posted in other blogs about going to the bathrom before leaving home and than having to turn around and run home because I have to go again. It makes me so mad and nervous that I am not going to make it to the toilet that the sensation gets stronger and stronger. I started taking fiber (2 pills per day ### dinner time) and TUMS (for the calcium). Its seems to help give more complete BM's, but I am struggling with not being able to go on the weekends. Something about being more relaxed-knowing I have no where to be puts the IBS aside. But I feel bloated and want to go and can't.I do know now that I would be in control more if I remained calm. Obviously I have some control if I am able to put it aside when home. I think we have IE because (possibly) we think about it more than non-IBSer's. Thus we can bring on the sensation easier and faster than others. I think we have these urgencies because we are afraid of losing control in public. I don't want to assume that every IBS person is the same just majority of us have the same thoughts, habits, and fears. I hope that there is some medical breakthrough SOON! I still believe that IBS is more involved in the nervous then research is looking at. Good luck to all!


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## 20341 (Jan 28, 2007)

I have the same feeling and my doc told me it was IBS along with other symptoms I described. He did a colonoscopy and eliminated other culprits. I hate it really. Nothing like feeling like your not quite done. I feel bloated most of the day that it is constantly on my mind. I really would like to feel more calm and not "obsess" about the bloated, full feeling in my gut.


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## tummyrumbles (Aug 14, 2005)

Karma, maybe you have the same problem as me. In the past I drank too much, and probably got a bit lazy with bowel habits, so Iâ€™m paying the price now. I do have plenty of tea at breakfast to speed things up, 3 mugs. Itâ€™s a good thing that your bowels only move in the morning, as you want to train the colon to go completely after breakfast. Iâ€™m really against the use of enemas, suppositories, IBS drugs because you need to be able to listen to your body. If you try a new diet, or an exclusion diet to see if any existing foods are causing intolerances, you need to be in tune with how your body reacts. You want to get to the stage where your colon is voiding as efficiently as it can, without outside help. Itâ€™s a brain-colon thing too, and if you rely on these things your colon probably gets a bit lax from this, and wonâ€™t try as hard. I had to give up alcohol. If youâ€™ve got IBS and youâ€™re a regular drinker, youâ€™ll always have IBS. It retards digestion, which means evacuation takes even longer. I was over-eating a bit too, so I eat better now, and try not to eat after 8.00 pm, which seems to help too.


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## 14529 (Feb 1, 2007)

hmmm...I'm 20, and my IBS started when I was 16. My IBS is due to an overuse of laxatives. But the laxative use started due to an all of a sudden feeling of being 'incomplete.' I never seemed to get that complete feeling, and kept increasing my laxative dose until the point where I couldn't go at all..and it hasn't been the same since. Since then, I've been consuming lots of insoluble fiber. I just read on this .. site that I need less insoluble and more soluble fiber! So I actually have to reduce my whole wheat and bran consumption. Oh my! This means I have to completely turn my diet around...But along with what Brandeegirl said, I'm constantly bloated and it's always on my mind. I wish I could think less of it, but I guess it's hard when you feel so uncomfortable...


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## tummyrumbles (Aug 14, 2005)

Itâ€™s probably moderation in all things. You need a bit of insoluble fibre, to help bulk things up. Too much can be irritating. If you can have a bowl of Sultana Bran a day, maybe a small bowl to start with, that might be enough insoluble fibre. The first time I had it, it caused diahhroaoa, so go easy at first. Iâ€™d just try a sensible diet, and as youâ€™re doing, give it as much time in the morning as you can. I have Weet-Bix at breakfast, wholemeal sandwiches for lunch at work, a banana and apple, and regular dinners at home with veges most of the time. I donâ€™t eat red meat anymore. On week-ends I have fish and chips, but thatâ€™s really my own junk food.


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## SpAsMaN* (May 11, 2002)

Welcome Sam,Even before you enter the office of a gastroenterologist,i think they know another IBSers is coming.


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## Mary2001 (Aug 25, 2006)

> quote:Originally posted by Karma:Gosh, IE is my biggest problem. If I don't really go one day, I get anxious if I'll be able to go the next day. When the next day comes, I'm even more anxious and feel like my sphincter or something just shuts. I know what that means. Even more constipation and dicomfort. And the anxiety remains for quite sometime, and just perpetuates the problem. But even without anxiety, my IE problem always remains. It gives me gas, bloating, and what not. I'm thinking of hypnotherapy as well...


 I think your symptoms seem much like mine. But there is another thing that;s happening me too and that is about every 7 to 10 days I have a whole lot of stool (please excuse graphic) and I don't know where its coming from as I do not eat such an awful lot sometimes like the last day I was out all day and hardly ate much so that is how I wonder where is this "backlog" or whatever it is coming from every 7 to 10 days approx. When that happens I feel weak and sweaty and generally unwell for a day or two before it happens and I have extra trouble evacuating when its going to happen and I wonder if you also get that. I don't know if its part of IBS or a food intolerance or a viral infection or maybe something in the air, but it keeps happening, and its so annoying. I am hoping the hynotherapy will help me, it is good for the stress anyway. Thanks for input about incomplete evacuation. Mary


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## eric (Jul 8, 1999)

There is another part to this as well. IT has been noted that a lot , I believe almost 80% of IBS patients have rectal hypersensivity. Gastroenterol. 2006 Mar;41(3):217-22. Related Articles, Links Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome.Nozu T, Kudaira M, Kitamori S, Uehara A.Department of Comprehensive Medicine, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648, Japan.BACKGROUND: A reduced rectal perceptual threshold has been reported in patients with irritable bowel syndrome (IBS), but this phenomenon may be induced by a comorbid psychological state. We evaluated the rectal pain threshold at baseline and after conditioning (repetitive rectal painful distention: RRD) in patients with IBS or functional abdominal pain syndrome (FAPS), which is an abdominal pain disorder, and in healthy controls, and determined whether rectal hypersensitivity is a reliable marker for IBS. METHODS: The rectal sensory threshold was assessed by a barostat. First, a ramp distention of 40 ml/min was induced, and the threshold of pain and the maximum tolerable pressure (mmHg) were measured. Next, RRD (phasic distentions of 60-s duration separated by 30-s intervals) was given with a tracking method until the subjects had complained of pain six times. Finally, ramp distention was induced again, and the same parameters were measured. The normal value was defined by calculating the 95% confidence intervals of controls. RESULTS: Five or six of the seven IBS patients showed a reduced rectal pain threshold or maximum tolerable pressure, respectively, at baseline. In all patients with IBS, both thresholds were reduced after RRD load, but they were reduced in none of the patients with FAPS. RRD significantly reduced both thresholds in the IBS group (P < 0.05), but it had no effect in the control or FAPS groups. CONCLUSIONS: Rectal hypersensitivity induced by RRD may be a reliable marker for IBS. Conditioning-induced visceral hypersensitivity may play a pathophysiologic role in IBS.http://ibsgroup.org/groupee/forums/a/tpc/f...06105832/inc/-1A person shouldn't really feel their rectum all the time. Those signals should not really be reaching the brain.


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## 14529 (Feb 1, 2007)

Hi Mary...sorry to hear about your situation...I don't have that problem, and I heavn't really heard that from other IBS-C sufferers on this site. But since you do suffer from constipation and IE, it seems reasonable that there could be some 'backlog.' Are you able to fully evacuate after the loose stools?


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## Mary2001 (Aug 25, 2006)

> quote:Originally posted by Karma:Hi Mary...sorry to hear about your situation...I don't have that problem, and I heavn't really heard that from other IBS-C sufferers on this site. But since you do suffer from constipation and IE, it seems reasonable that there could be some 'backlog.' Are you able to fully evacuate after the loose stools?


 Thanks for your reply Karma and yes well I think everyday that I am evacuating properly because I go everyday, but its always very difficult to get it out (or feels that way) and I am left with a feeling of incomplete emptying and trapped gas everyday. I try to go every morning, but spend about half an hour and maybe some days have to go again (which maddens me as I try to get the whole thing done in the morning so I can get peace then)! but it never works out for me the way I want it. I tried not going to see what happens, and If I don;t go I get a discomfort in my stomach, but feel if I could conquer that discomfort I would not need to be going to the bathroom to solve it and make it go away, so whatever is causing that is the main problem. I try to get rid of it by going to the bathroom, but I am beginning to think it might not be a proper call to the bathroom atal. This would drive you crazy this problem, and without the help of all you good people who help on the boards, I don't know how I would manage, so thanks for help offered. Sometimes when I have something written down, it helps me get a better prospective of things, and now when I am reading this what I wrote it appears to me that I am trying to "control" my bowel actions, and I think that might be wrong, as I think in the past before I got ibs as far as I remember if I needed the bathroom it was an automatic thing, like 5 minutes, - job finished, so with this ibs it appears to take over my thinking, and I wish I could get back to normality, and maybe that's what I am trying to control. There must be an answer somewhere for this ibs and hopefully the more people share their experiences it might turn something up hopefully. God Bless


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## Mary2001 (Aug 25, 2006)

> quote:Originally posted by eric:There is another part to this as well. IT has been noted that a lot , I believe almost 80% of IBS patients have rectal hypersensivity. Gastroenterol. 2006 Mar;41(3):217-22. Related Articles, Links Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome.Nozu T, Kudaira M, Kitamori S, Uehara A.Department of Comprehensive Medicine, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648, Japan.BACKGROUND: A reduced rectal perceptual threshold has been reported in patients with irritable bowel syndrome (IBS), but this phenomenon may be induced by a comorbid psychological state. We evaluated the rectal pain threshold at baseline and after conditioning (repetitive rectal painful distention: RRD) in patients with IBS or functional abdominal pain syndrome (FAPS), which is an abdominal pain disorder, and in healthy controls, and determined whether rectal hypersensitivity is a reliable marker for IBS. METHODS: The rectal sensory threshold was assessed by a barostat. First, a ramp distention of 40 ml/min was induced, and the threshold of pain and the maximum tolerable pressure (mmHg) were measured. Next, RRD (phasic distentions of 60-s duration separated by 30-s intervals) was given with a tracking method until the subjects had complained of pain six times. Finally, ramp distention was induced again, and the same parameters were measured. The normal value was defined by calculating the 95% confidence intervals of controls. RESULTS: Five or six of the seven IBS patients showed a reduced rectal pain threshold or maximum tolerable pressure, respectively, at baseline. In all patients with IBS, both thresholds were reduced after RRD load, but they were reduced in none of the patients with FAPS. RRD significantly reduced both thresholds in the IBS group (P < 0.05), but it had no effect in the control or FAPS groups. CONCLUSIONS: Rectal hypersensitivity induced by RRD may be a reliable marker for IBS. Conditioning-induced visceral hypersensitivity may play a pathophysiologic role in IBS.http://ibsgroup.org/groupee/forums/a/tpc/f...06105832/inc/-1A person shouldn't really feel their rectum all the time. Those signals should not really be reaching the brain.


 Thanks for reply, and yes I agree those singals should not always be reaching the brain. I am sorry I took up so much of the board about my problem and wish to thank you for all help received, but I am getting a bit worried about this because I cannot get rid of it and am glad I had someone to turn to. I am going to my doctor next week to see if there is anything else like pelvic floor tests that could help me. I am still also hoping the hypnotherapy might help, and will keep you posted.


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## eric (Jul 8, 1999)

Can't remember where I saw it but I thought I saw a study where they use some kind of topical anesthesia cream on the rectum to help.I think I might have also seen a study where they used neurotonin for the "sensation" signals. But someone would have to look it all up or ask a doc.Visceral Sensations and Brain-Gut MechanismsBy: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA"The most common symptoms of IBS patients are related to altered perception of sensations arising from the GI tract, and frequently from sites outside the GI tract, such as the genitourinary system or the musculoskeletal system. Sensations of bloating, fullness, gas, incomplete rectal evacuation and crampy abdominal pain are the most common symptoms patients experience. Numerous reports have demonstrated that a significant percentage of FBD patients (about 60%) rate experimental distensions of the colon as uncomfortable at lower distension volumes or pressures when compared to healthy control subjects. This finding of an increased perception of visceral signals ("visceral hypersensitivity") has been demonstrated during balloon distension tests of the respective part of the GI tract regardless of where their primary symptoms are â€" the esophagus, the stomach, or the lower abdomen. In contrast to the current emphasis on mechanisms that may result in sensitization of visceral afferent pathways in the gut, it may well be that alterations in the way the nervous system normally suppresses the perception of the great majority of sensory activity arising from our viscera are essential for the typical symptom constellation of IBS and other functional GI disorders to develop."http://www.aboutibs.org/Publications/VisceralSensations.html


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## tummyrumbles (Aug 14, 2005)

If you just have a sensation of incomplete evacuation, this means that you feel you have to go, but no matter how long you sit there, you canâ€™t evacuate any more.I think for most of us incomplete evacuation is real, and anesthetising your rectum is probably not a good idea. Thereâ€™s enough fiddling around there as it is. Incomplete evacuation means that you havenâ€™t completely evacuated. You would know by now whether this relates to you. It might be an idea to time yourself if you suffer from incomplete evacuation, because the colon is usually consistent with regards to timing. If you time yourself on the week-end, and donâ€™t leave your home until youâ€™re completely done, however long this takes until you canâ€™t go any more is your evacuation time. This is the time you need to allow every morning before you go to work.


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## eric (Jul 8, 1999)

That might depend on what kind of IBSers you are really. C people might have material in the rectum. Tests for Outlet obstruction type constipation (pelvic floor dyssynergia) might be helpful because it causes an inability to expel stool from the anorectum. Also tests for motility problems.With d and Cers, it can be the 'sensation' as pect as a person switches from d to c basically while going. Some comes out fast and some doesn't. This has to do with motility.With d, there maybe nothing there but the signals are still going omn and being reported to the brain.as for the cream is pretty much like using Preperation H really. It is also why I said ask your doctor.Some people including myself have rectal hypersensivity as do up to 80 % of Ibsers where I can pretty much feel it there basically all time, even regardless if I have to go. I should not be getting those signals however, the system is not designed to get that information to the concious level.Some consitpation or IBS medications have also worked for some people when it comes to the "sensation of incomplete evacuation." Incomplete evacuation itself is more a motility problem. Some might have fecal incontinence. About Incontinencehttp://www.aboutincontinence.org/About Constipationhttp://www.aboutconstipation.org/and this site actually has some good info on some of this.for example"What Is The Defecation Reflex? Just prior to elimination, muscular activity in the colon pushes feces down into the flexible rectal sack which expands to accommodate the stools. Nerve endings, stimulated by the expansion, activate the defecation reflex indicating to the body that it is time to move the bowel. This is the urge to â€œgoâ€."How Does The Rectal Sac Become Enlarged? Ignoring, (withholding) stools enlarges (stretches out) the rectal sack. Stools that are withheld, remain in the rectal sac becoming dried out and hard. These dried stools keep the rectal sack expanded. Over time, if stools are repeatedly with held, therectal sack looses its ability to spring back to normal size and looses its sensitivity to activate the defecation reflex as it normally would. The result is an enlarged rectal sack. When the sac becomes enlarged, more and more stools are required to fill the rectal sack before the pressure sensitive nerve endings are able to activate the defecation reflex. The problem is that new stools, that could otherwise be promptly eliminated, collect behind the retained stools only to become dried out instead of being eliminated. This process continues until enough stools gather, in the enlarged rectal sac, to provide adequate pressure to trigger the defecation reflex."http://www.fruiteze.com/education/constipa...ring_reflex.htm


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## eric (Jul 8, 1999)

Dr Wald is an expert in IBS as well as an expert with a focus on rectum problems."Arnold Wald, University of Pittsburgh Medical Center ended this session by addressing Anorectal Assessment and Treatment. Assessment is used to suggest appropriate treatment and help predict chances of success. In recent years ultrasound (an imaging method in which high-frequency sound waves are used to outline a part of the body) of the anal canal and anal sphincter muscles (anal endosonography) has enhanced our understanding and evaluation of fecal incontinence. It is particularly helpful in detecting defects in sphincter muscles. Pelvic MRI is a more recent method of examination that can recognize diminished anorectal muscle tone (atrophy) and can provide more information about the structure and function of these muscles.[4] Treatment approaches to incontinence including biofeedback, surgery, and a new method of sacral stimulation were also discussed. While biofeedback has been reported to be effective in many patients, its use remains controversial because of flaws in existing studies. Surgery appears to benefit some but not all patients with fecal incontinence, depending on the underlying defect." http://www.iffgd.org/symposium2003techniques.html" Constipation â€" The constipation of IBS can last from days to months. Stools are often hard and pellet-shaped. Sometimes people experience a sensation of incomplete evacuation, even when the rectum is empty. This faulty sensation can lead to straining, sitting on the toilet for prolonged periods of time, and the use of enemas and laxatives for relief. (See "Patient information: Constipation").http://patients.uptodate.com/topic.asp?file=digestiv/8576


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## eric (Jul 8, 1999)

Subtypes of constipation predominant irritable bowel syndrome based on rectal perception http://gut.bmj.com/cgi/content/abstract/43/3/388


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## tummyrumbles (Aug 14, 2005)

Eric, have you come across anything about weak descending colon muscles? And whether thereâ€™s a natural management? Iâ€™ve read some of the info on pseudo obstruction sites, but none of it seems to describe what I have. I donâ€™t think I have problems with pelvic floor dyssynergia, rectal sac enlargement, nor the sphincter muscles themselves, simply because when the stool is there, itâ€™s voided easily. My problem is the long delay between evacuations, which means that the stool isnâ€™t being efficiently pushed down to the rectum by the descending colon. I think itâ€™s more of a descending colon muscle inefficiency because I can actually sense the stool moving down gradually between BMs; itâ€™s an increasingly heavy, full feeling. Is there a more accurate term for this particular problem? I think some of us may have messed up the nerves/muscles in our descending colon by laxative or alcohol abuse in the past, or maybe just by ignoring the urge to go. My belief is that by sitting there and waiting it out, youâ€™re re-training your colon. This works, but obviously Iâ€™d be a lot happier if it was quicker.


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## 14529 (Feb 1, 2007)

Mary, I know what you mean. I've tried before to not go and just wait until my body has the urge, too. But boy is that bad. I'm in complete discomfort. And if I don't try to go, my body is such that it won't care to go. So, yeah, got to set apart that 3 hour time limit before going to class, or anywhere.I have a question Eric. You're quite an advocate for hypnotherapy. I'm guessing you've tried hypnotherapy, and if you have, are you still having major problems with IBS, especially the IE part? Because I want to try hypnotherapy for this symptom especially...


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## eric (Jul 8, 1999)

First and ask your doctor about this, but I think sitting there and waiting it out might not be such a good idea. It might be better to get up for a bit and let the urge feeling come again, then try to go again.I think I remeber sitting there to long is problematic actually. Although more comfortable. LOL







"My problem is the long delay between evacuations, which means that the stool isnâ€™t being efficiently pushed down to the rectum by the descending colon. I think itâ€™s more of a descending colon muscle inefficiency because I can actually sense the stool moving down gradually between BMs; itâ€™s an increasingly heavy, full feeling. Is there a more accurate term for this particular problem? "This sounds like different things. A person can have slow motility problms.But this is the thing, you shouldn't really be feeling anything down there fore the most part. Normal don't feel food moving through them chronically. So part of that in IBS at least is what's called viceral hypersensivity of the colon. The nerves are more sensitve to distension. another part of this at least in IBS is the contraction can be abnormal in the entrie lenght of the colon, as opposed to the normal pushing out contractions.














So higher up in the colon stool gets held up behind these contraction, then released. Gas builds up behind them as well. The new IBS drugs zelnorm and lotronex are to speed up or slow down the colon, depending. OF course if your an alternator they are not for that really.Some antidepressants as a side effect will do that also and some of those even help sensory info to the brain. The thing here is the problem hopefully can be identified for the right treatment.


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## Mary2001 (Aug 25, 2006)

Thank you very much Eric for all that information, and I will re-read it and get back to you on it. Also thanks to the others who wrote about IE and its good to compare notes and symptoms. I certainly agree that one should not always feel sensation from the rectum i.e needing to go and I wonder what ever sets that off in the first place. Thanks for replies and will post later.


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## annie7 (Aug 16, 2002)

thanks, Mary for starting this thread and thanks to everyone, especially Eric, for all your contributions. there has been so much helpful info posted here. I've had ibs-c and incomplete evacuation for years. that IE feeling is so hard to cope with--sometimes almost impossible. but it certainly does help to read about it and learn the causes. that knowledge helps me deal with it and learn to try to accept it as much as possible. thank you!


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## eric (Jul 8, 1999)

Karma, Mike's HT CD's have helped me tremedously and I personally highly recommend them. I am not cured but they have worked on almost every symptom I have had with IBS, including the sensation of IE and even non gi symptoms. Where I use to get it all the time, I very very rarely get it now. The tapes helped me about 80 to 85 percent.Importantly they also broke the vicious cycle for me and put me in control more then the IBS had control of me as well. They greatly helped me with severe pain. I was the first person to do them on here. Ponderings of an IBSerhttp://ibsgroup.org/groupee/forums/a/tpc/f...0173/m/67910046


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## eric (Jul 8, 1999)

another treatment for animus is biofeedbackFYIPelvic Floor DyssynergiaAn example of anorectal dysfunction that can contribute to constipation is a condition called Pelvic Floor Dyssynergia (also referred to as anismus). It is marked by the failure of pelvic floor muscles to relax, or a paradoxical contraction of the pelvic floor muscles, with defecation. The pelvic floor is composed of a group of muscles that span the underlying surface of the bony pelvis, which function to allow voluntary urination and defecation. "Paradoxical contraction" refers to an abnormal increase of pelvic floor muscle activity with defecation-rather than the normal decrease in muscle activity that is necessary in order to have a normal bowel movement. This condition can contribute to some forms of constipation, complaints of incomplete evacuation, and straining with stool. Because pelvic floor muscles are controlled voluntarily, their function can be improved through various learning procedures - such as biofeedback. For more information on Disorders Related to Excessive Pelvic Floor Muscle Tension, see IFFGD Fact Sheet No. 109. http://www.aboutibs.org/Publications/PelvicFloorDys.htmlPelvic Floor Dyssynergia(Pelvic Floor Dysfunction)http://www.aboutgimotility.org/dyssynergia.htmlBiofeedback & Bowel Disorders: Teaching Yourself to Live without the Problem By: Jeannette Tries, Ph.D., and Mary K. Plummer, O.T.R., Wisconsin http://www.aboutconstipation.org/biofeedback.html


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