# Pelvic floor dysfunction?Read that and comment please



## SpAsMaN* (May 11, 2002)

Over the past ten to fifteen years, clinicians treating urological, gynecological, and gastroenterological disorders have gained a significant respect for the muscles of the pelvic floor. As has been noted in previous issues of the ICA Update, this complex group of muscles is involved in sexual intercourse, the maintenance of urinary continence, and bowel function. Abnormal function of these muscles can be seen in as many as 70% of IC patients and can be responsible for complaints as varied as pelvic pain, urinary urgency and frequency, or lower back pain. This short discussion will focus on the relationship between pelvic floor dysfunction and two common bowel problems, constipation and irritable bowel syndrome. Constipation and Pelvic Floor Dysfunction Constipation is one of the more common conditions associated with interstitial cystitis. There are lots of reasons for constipation to occur. Some of these factors include:1. Dehydration. Many IC patients believe that limiting their fluid intake will result in less frequent bathroom visits. Unfortunately, this strategy usually backfires. The result is a more concentrated urine that causes more pelvic discomfort. It also tends to worsen constipation.2. Use of Certain Medications. Medications such as opioids are notorious for causing chronic constipation. Other medications that can cause similar problems include tricyclic antidepressants (like Elavil ï¿½), calcium channel blockers (usually used to treat high blood pressure and abnormal heartbeats), aluminum and calcium-based antacids, and anticholinergic agents (like Ditropan ï¿½, Detrol ï¿½, or Levsin ï¿½). Diuretics can also cause dehydration. Dehydration, as noted in #1, can cause constipation. 3. Inactivity. Bowel function is stimulated by physical activity. People who lead sedentary lives and rarely exercise are more likely to have problems with constipation.4. Hormonal and neurological disturbances. Diabetes and thyroid disorders can lead to constipation. Multiple sclerosis, spinal cord injury, and scleroderma are other medical problems that may be associated with constipation.5. Intestinal Blockage. Blockages within the intestines from cancer to inflammatory bowel disease can slow down bowel transit and thereby cause constipation.Finally, we come to the pelvic floor muscles and how they might participate in the development and maintenance of constipation. As in the urinary tract, the pelvic floor muscles are responsible for relaxing and contracting at appropriate times and with appropriate force. In the case of bowel function, these muscles are responsible for maintaining some tightnessï¿½just enough to allow stool to accumulate in the rectum without allowing the stool to escape at inappropriate times. The frequent problem seen in the IC patient is that the pelvic floor muscles contract too tightly in the region around the anus. This often leads to complaints of lower back pain, pain in the perineum (the region between the vagina or scrotum and anus), pain in the region around the anus, and constipation. The question arises, "How then, does muscle tightness in this area cause constipation?" Itï¿½s actually quite simple: the act of defecation involves a contraction of the rectum. People often push a little bit to aid this process (remember, too much pushing can worsen these problems). At the same time, the muscles of the pelvic floor (in the region of the anus and rectum) should relaxï¿½just as the pelvic floor muscles should relax when one wishes to urinate. Unfortunately, instead of relaxing, many people unconsciously tighten those muscles even more. The result is that the stool doesnï¿½t empty effectively because the muscles are blocking its exit. Once you are constipated, the natural tendency is to push that stool out. This results in more pelvic floor muscle spasm, which then causes more blockage. You can readily see how this can become a rather nasty vicious cycle! If you couple this problem with any of the factors listed in #ï¿½s 1-5, youï¿½ve got even more of a dilemma. In order to get rid of constipation, itï¿½s important to treat not only the pelvic floor spasm but also all of the other factors that might be involved. Irritable Bowel Syndrome and Pelvic Floor Dysfunction Irritable bowel syndrome is characterized by intermittent bouts of diarrhea and constipation. It is often accompanied by episodes of severe abdominal cramping, the sensation of "bloating" or out-right knife-like abdominal pain. IBS seems to occur as the result of abnormal contractions of the intestines, but pelvic floor dysfunction and increased rectal sensitivity may also play a very important role in the development and maintenance of symptoms. The association of pelvic floor dysfunction and IBS is probably best exemplified by the frequent comments from patients that their IBS symptoms have significantly improved when their PFD was treated.Although, therapy for pelvic floor dysfunction has been discussed in past ICA Updates, the basic methods of care merit repeating. These are: 1. Donï¿½t make it a habit to strain when urinating or having a bowel movement.2. Frequent warm baths are often helpful to relax the pelvic floor muscles. We usually recommend baths twice daily (15 minutes) when PFD is acting up.3. Muscle relaxants can be helpful as recommended by your doctor.4. Transvaginal or transanal biofeedback and/or electrical stimulation may help (transanal biofeedback is the preferred method of therapy for constipation or IBS).5. Treat constipation aggressively. Stool softeners and various laxatives are very important in the management of constipation. Your doctor may have specific brands that he/she believes are best suited for you.6. Avoid other associated causes of constipation. This means going back to points 1-5. Watch out for medications that might worsen constipation and discuss the issue with your doctor. The dosage might be lowered or the medication discontinued if the problem is severe enough. Make certain to drink enough fluids. Becoming dehydrated will only get or keep you constipated or worsen the symptoms of IC. Many IC patients live extremely sedentary lives because of chronic pain or constant fatigue. This inactivity is a sure-fire way to perpetuate constipation. Itï¿½s extremely important to get some exercise in during the day. It doesnï¿½t have to be overly strenuous physical activity. Just taking a short walk periodically during the day is usually just fine. In fact, exercises that promote a great deal of bearing down sometimes worsen PFD.In summary, pelvic floor dysfunction can have a profound negative impact on both constipation and irritable bowel syndrome. Therapy directed towards PFD can result in significant improvement of bowel function, however, only when other causes of bowel problems are addressed. Additionally, please remember that other therapies for the treatment of constipation and IBS exist. These therapies are beyond the scope of this discussion. Questions regarding these issues should be addressed to your primary care doctor or gastroenterologist.


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## jaimellllrrrr no go (Apr 9, 2004)

That's my problem for sure. I wish it said more about treating it. I need some way to relax my muscles. I already excercise and take baths. Has anyone heard of any products for this that aren't bad for you? I'm going to get those hypnosis tapes and I'm doing that Ibs diet. Is that sort of the same thing as that reflex that when you eat, your colon contracts?


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## SpAsMaN* (May 11, 2002)

In Wisconsin,there is a good center,here the link,they offering treatments options at least.I wish i could have one center like that in the province of Quebec.







http://www.healthreachrehab.com/pages/continencecare.html


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## jaimellllrrrr no go (Apr 9, 2004)

Yeah, there's no way I can afford to go that far. I'm on a 5 month waiting list for osteopathy. I don't know much about that yet. Sorta sounds like the same feild of treatment.


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## SpAsMaN* (May 11, 2002)

I don't think that is the "same treatment".They seems to have devellop a special treatment for pelvic floor dysfunction(Specialist center).But osteopathy is good.Far more than the chiropractor who lies.I can see an osteopath in few days here in Quebec city.


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## SpAsMaN* (May 11, 2002)

Here a link from a serious scientist group.That is good to understand what is going on. http://www.guideline.gov/summary/summary.aspx?doc_id=3061


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## gisele44 (Apr 14, 2004)

Spasman, there is a clinic in Quebec. It's in Sherbrooke. I've been there to see Dr. Ghislain Devroede (spelling ?). Please go see the following site. http://chus.qc.ca/Fr/general/gen_bienvenue.asp The treatment that he mentioned for me was biofeedback. The problem that I have with this treatment is that I live in New Brunswick and I would have to spend at least 2 weeks in Sherbrooke to go through a series of tests to start with. After I would need to go back for biofeedback treatments. I would need to go as often as it takes for the treatment to work. If you live close or you have relatives in the area you might be able to get in to see him. I was refered to him by a surgeon in N.B.. After my appointment with him last fall I've since tried something else that works really well. You can check out my post "Cape Aloe is a miracle" for more information.


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## meribaibs (Jan 18, 2004)

Does the facility in Sherbrooke function like the Mayo Clinic? In other words, can I make an appointment to see a specialist without having to take part in a clinical trial? I'm looking for a diagnosis of my symptoms with tests to back it up. It seems to be too much to ask here in Montreal.


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## gisele44 (Apr 14, 2004)

Unfortunately, in Canada, we can't just pick up the phone and make an appointment to see a specialist. The process that I had to go through was first to see my family doctor who then issued a request for me to either see a gastro doctor or surgeon (whichever came first). I waited at least 6 months when I got the call to see a surgeon. She's the one that told me about "anismus", which is this pelvic floor muscles disorder. She told me that the only treatment for this disorder is biofeedback and that the only clinic on the east coast which is familiar with this treatment is this clinic in Sherbrooke. This Dr. Devroede is known worldwide for his work regarding "Anismus", he wrote a book (Dr Ghislain Devroede, MD : Ce que les maux du ventre disent de notre passï¿½, 311 pages, ï¿½ditions Payot). He was her professor when she was in medical school. She arranged for me to see him. The whole process took a good year and a half.


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## SpAsMaN* (May 11, 2002)

Gisele,how many times have you seen Ghyslain and for which problems and what is the results you felt?My altered motility come from over the pelvic floor muscle.It may help me but some testimonials would be great.Trained specialist seems very usefull in these "holistics" treatments.


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## Tiss (Aug 22, 2000)

Looks like this doctor promotes the use of laxatives--thought we were supposed to stay away from those if possible.


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## SpAsMaN* (May 11, 2002)

I have tried Aloe gel and others aloe product with no results and often worst.I'm sceptical that Cape aloe can help me.


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## gisele44 (Apr 14, 2004)

Spasman, I only saw Dr. Devroede once for a consultation. After our one hour consultation, he seemed to believe that Anismus might be my problem. To enable him to contiue treating me for Anismus he needed me to go through a myriad of tests to rule out other possible problems. I was able to go through a few tests here in New Brunswick before my visit with him in Sherbrooke. I suppose he had already ruled out a few possibilities with these tests. The problem that I had last year was that if I continued to see him, I would've needed to be in Sherbrooke for at least 2 weeks and probably keep going a number of times after this for the treatments. For me, with a family and a job, etc., it wasn't possible at the time. I've been through barium enemas a couple of times and doctors keep telling me that everything is normal in my intestines. I really do believe that I have Anismus. Since I've been taking Cape Aloe (not Aloe gel), I'm 90% better. I have one to two bowel movements a day. The homeopatic doctor that I am now seeing is really helping me. All I can give you is my experience. I have always been very constipated. I've gone through different diets, colonics, special exercises, etc. and out of years of researching and experimenting, this treatment of Cape Aloe and homeopatic medicine works for me. The other 10% is there only because most times I still need suppositories. I think that it's only a matter of time and I won't need them anymore. As for Tiss's comment of this doctor promoting laxatives, I don't know where he got that. Dr. Devroede never mentioned to me that it was good to keep taking laxatives. I think if I would've kept seeing him we would've gone the route of biofeedback and this does not promote laxatives.


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## Tiss (Aug 22, 2000)

gesele44, I was referring to #5 under IBS and Pelvic Floor Dysfunction. It states that "constipation should be treated aggressively.Stool softeners and laxatives are very important in the management of constipation". A little confusing to me as I've always heard to try and stay away from them. It's not always possible for me.


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## SpAsMaN* (May 11, 2002)

Gisele have you tried Others form of Aloe before and what was your results?I have visit your link for it and i never found anything.Don't know what is Anismus.It sound like a martian name.


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## SpAsMaN* (May 11, 2002)

Ok,anismus is pelvic floor dysfunction,here a link who help for anismus and constipation. ConstipationOn this page:Who gets constipated? What causes constipation? What diagnostic tests are used? How is constipation treated? Can constipation be serious? Hope Through Research Points to Remember For More Information The lower digestive tract 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. Also, 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 its causes, prevention, and treatment will help most people find relief.[Top] Who gets constipated?According to the 1996 National Health Interview Survey, about 3 million people in the United States have frequent constipation. Those reporting constipation most often are women and adults age 65 and over. Pregnant women may have constipation, and it is a common problem following childbirth or surgery.Constipation is one of the most common gastrointestinal complaints in the United States, resulting in about 2 million doctor visits annually. However, most people treat themselves without seeking medical help, as is evident from the millions of dollars Americans spend on laxatives each year.[Top] What causes constipation?To understand constipation, it helps to know how the colon (large intestine) works. As food moves through the colon, it 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.The hard and dry stools of constipation occur when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Common causes of constipation arenot enough fiber in the diet not enough liquids lack of exercise medications irritable bowel syndrome changes in life or routine such as pregnancy, older age, and travel abuse of laxatives ignoring the urge to have a bowel movement specific diseases such as stroke (by far the most common) problems with the colon and rectum problems with intestinal function (chronic idiopathic constipation) Not Enough Fiber in the DietThe most common cause of constipation is a diet low in fiber found in vegetables, fruits, and whole grains and high in fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods are less likely to become constipated.Fiber--both soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.According to the National Center for Health Statistics, Americans eat an average of 5 to 14 grams of fiber daily,* short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods from which the natural fiber has been removed.A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose convenience foods low in fiber. In addition, difficulties with chewing or swallowing may force older people to eat soft foods that are processed and low in fiber.*National Center for Health Statistics. Dietary Intake of Macronutrients, Micronutrients, and Other Dietary Constituents: United States, 1988-94. Vital and Health Statistics, Series 11, number 245. July 2002.Not Enough LiquidsLiquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8-ounce glasses. Liquids that contain caffeine, like coffee and cola drinks, and alcohol have a dehydrating effect.Lack of ExerciseLack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.MedicationsSome medications can cause constipation. They includepain medications (especially narcotics) antacids that contain aluminum and calcium blood pressure medications (calcium channel blockers) antiparkinson drugs antispasmodics antidepressants iron supplements diuretics anticonvulsants Irritable Bowel Syndrome (IBS)Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but there is no specific cause or anything unusual that the doctor can see in the colon.Changes in Life or RoutineDuring pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.Abuse of LaxativesMyths about constipation have led to a serious abuse of laxatives. This is common among people who are preoccupied with having a daily bowel movement.Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.Ignoring the Urge to Have a Bowel MovementPeople who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.Specific DiseasesDiseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus.Several kinds of diseases can cause constipation:Neurological disordersmultiple sclerosis Parkinson's disease chronic idiopathic intestinal pseudo-obstruction stroke spinal cord injuries Metabolic and endocrine conditions diabetes underactive or overactive thyroid gland uremia hypercalcemia Systemic disorders amyloidosis lupus scleroderma Problems with the Colon and RectumIntestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.Problems with Intestinal Function (Chronic Idiopathic Constipation)Some people have chronic constipation that does not respond to standard treatment. This rare condition, known as idiopathic (of unknown origin) chronic constipation may be related to problems with intestinal function such as problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women.Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower or sigmoid colon.Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.[Top] What diagnostic tests are used?Most people with constipation do not need extensive testing and can be treated with changes in diet and exercise. For example, in young people with mild symptoms, a medical history and physical examination may be all the doctor needs to suggest successful treatment. The tests the doctor performs depend on the duration and severity of the constipation, the person's age, and whether blood in stools, recent changes in bowel movements, or weight loss have occurred.Medical HistoryThe doctor may ask a patient to describe his or her constipation, including duration of symptoms, frequency of bowel movements, consistency of stools, presence of blood in the stool, and toilet habits (how often and where one has bowel movements). A record of eating habits, medication, and level of physical activity or exercise will also help the doctor determine the cause of constipation.The clinical definition of constipation is any two of the following symptoms for at least 12 weeks (not necessarily consecutive) in the previous 12 months:straining during bowel movements lumpy or hard stool sensation of incomplete evacuation sensation of anorectal blockage/obstruction fewer than three bowel movements per week Physical ExaminationA physical exam may include a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anus (anal sphincter) and to detect tenderness, obstruction, or blood. In some cases, blood and thyroid tests may be necessary to look for thyroid disease and serum calcium or to rule out inflammatory, neoplastic, metabolic, and other systemic disorders.Extensive testing usually is reserved for people with severe symptoms, for those with sudden changes in number and consistency of bowel movements or blood in the stool, and for older adults. Additional tests that may be used to evaluate constipation includecolorectal transit study anorectal function tests Because of an increased risk of colorectal cancer in older adults, the doctor may use tests to rule out a diagnosis of cancer, includingbarium enema x ray sigmoidoscopy or colonoscopy Colorectal transit study. This test, reserved for those with chronic constipation, shows how well food moves through the colon. The patient swallows capsules containing small markers that are visible on an x ray. The movement of the markers through the colon is monitored with abdominal x rays taken several times 3 to 7 days after the capsule is swallowed. The patient follows a high-fiber diet during the course of this test.Anorectal function tests. These tests diagnose constipation caused by abnormal functioning of the anus or rectum (anorectal function). Anorectal manometry evaluates anal sphincter muscle function. For this test, a catheter or air-filled balloon inserted into the anus is slowly pulled back through the sphincter muscle to measure muscle tone and contractions.Defecography is an x ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the exam, the doctor fills the rectum with a soft paste that is the same consistency as stool. The patient sits on a toilet positioned inside an x ray machine and then relaxes and squeezes the anus to expel the paste. The doctor studies the x rays for anorectal problems that occurred as the paste was expelled.Barium enema x ray.This exam involves viewing the rectum, colon, and lower part of the small intestine to locate any problems. This part of the digestive tract is known as the bowel. This test may show intestinal obstruction and Hirschsprung's disease, a lack of nerves within the colon.The night before the test, bowel cleansing, also called bowel prep, is necessary to clear the lower digestive tract. The patient drinks a special liquid to flush out the bowel. A clean bowel is important, because even a small amount of stool in the colon can hide details and result in an incomplete exam.Because the colon does not show up well on x rays, the doctor fills it with barium, a chalky liquid that makes the area visible. Once the mixture coats the inside of colon and rectum, x rays are taken that reveal their shape and condition. The patient may feel some abdominal cramping when the barium fills the colon, but usually feels little discomfort after the procedure. Stools may be a whitish color for a few days after the exam.Sigmoidoscopy or colonoscopy. An examination of the rectum and lower (sigmoid) colon is called a sigmoidoscopy. An examination of the rectum and entire colon is called a colonoscopy.The patient usually has a liquid dinner the night before a sigmoidoscopy and takes an enema early the next morning. A light breakfast and a cleansing enema an hour before the test may also be necessary.To perform a sigmoidoscopy, the doctor uses a long, flexible tube with a light on the end called a sigmoidoscope to view the rectum and lower colon. First, the doctor examines the rectum with a gloved, lubricated finger. Then, the sigmoidoscope is inserted through the anus into the rectum and lower colon. The procedure may cause a mild sensation of wanting to move the bowels and abdominal pressure. Sometimes the doctor fills the colon with air to get a better view. The air may cause mild cramping.To perform a colonoscopy, the doctor uses a flexible tube with a light on the end called a colonoscope to view the entire colon. This tube is longer than a sigmoidoscope. The same bowel cleansing used for the barium x ray is needed to clear the bowel of waste. The patient is lightly sedated before the exam. During the exam, the patient lies on his or her side and the doctor inserts the tube through the anus and rectum into the colon. If an abnormality is seen, the doctor can use the colonoscope to remove a small piece of tissue for examination (biopsy). The patient may feel gassy and bloated after the procedure.[Top] How is constipation treated?Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms of constipation and help prevent it.DietA diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.Lifestyle ChangesOther changes that can help treat and prevent constipation include drinking enough water and other liquids such as fruit and vegetable juices and clear soups, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.LaxativesMost people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, doctors may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, also helps prevent constipation.A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum, powder, and granule forms. They work in various ways:Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil, Citrucel, Konsyl, and Serutan.Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person's risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced or plan to replace phenolphthalein with a safer ingredient.Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Products include Colace and Surfak.Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common example.Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Laxatives in this group include Milk of Magnesia and Haley's M-O.People who are dependent on laxatives need to slowly stop using them. A doctor can assist in this process. In most people, this restores the colon's natural ability to contract.Other TreatmentsTreatment may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse.People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control release of bowel movements. Biofeedback involves using a sensor to monitor muscle activity that at the same time can be displayed on a computer screen, allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to use these muscles.Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.[Top] Can constipation be serious?Sometimes constipation can lead to complications. These complications include hemorrhoids caused by straining to have a bowel movement or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool. Treatment for hemorrhoids may include warm tub baths, ice packs, and application of a special cream to the affected area. Treatment for anal fissure may include stretching the sphincter muscle or surgical removal of tissue or skin in the affected area.Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition, known as rectal prolapse, may lead to secretion of mucus from the anus. Usually eliminating the cause of the prolapse, such as straining or coughing, is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and by an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers into the anus.[Top] Hope Through ResearchNIDDK's Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal conditions, including constipation. Among other areas, researchers are studying the anatomical and physiological characteristics of rectoanal motility and the use of new medications and behavioral techniques, such as biofeedback, to treat constipation.[Top] Points to RememberConstipation affects almost everyone at one time or another.Many people think they are constipated when, in fact, their bowel movements are regular.The most common causes of constipation are poor diet and lack of exercise.Additional causes of constipation include medications, irritable bowel syndrome, abuse of laxatives, and specific diseases.A medical history and physical examination may be the only diagnostic tests needed before the doctor suggests treatment.In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation:Eat a well-balanced, high-fiber diet that includes beans, bran, whole grains, fresh fruits, and vegetables. Drink plenty of liquids. Exercise regularly. Set aside time after breakfast or dinner for undisturbed visits to the toilet. Do not ignore the urge to have a bowel movement. Understand that normal bowel habits vary. Whenever a significant or prolonged change in bowel habits occurs, check with a doctor.Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation. [Top] For More InformationInternational Foundation for Functional Gastrointestinal Disorders Inc.P.O. Box 170864Milwaukee, WI 53217Phone: 1-888-964-2001 or (414) 964-1799Fax: (414) 964-7176Email: iffgd###iffgd.orgInternet: www.iffgd.orgAmerican Gastroenterological AssociationNational Office4930 Del Ray AvenueBethesda, MD 20814Phone: (301) 654-2055Fax: (301) 654-5920Email: info###gastro.org or webmaster###gastro.orgInternet: www.gastro.org[Top]--------------------------------------------------------------------------------The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.--------------------------------------------------------------------------------National Digestive Diseases Information Clearinghouse2 Information WayBethesda, MD 20892-3570Email: nddic###info.niddk.nih.govThe National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.--------------------------------------------------------------------------------NIH Publication No. 03-2754June 2003


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## I'll B Snookered (Apr 9, 2004)

Thanks for the good post, spasman. I will be looking into this. I think I might have a problem with anorectal dysfunction. I am especially excited about someone possibly x-raying me while sitting on the pot--and I was mad at my parents for taking baby pictures of me in the bathtub!


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## SpAsMaN* (May 11, 2002)

AnismusThis is constipation caused by the person having learned incorrect muscle action . It can be effectively treated using an anal probe and EMG to relearn the correct muscle action i.e. to relax the anal muscles. As with all biofeedback the more often the practice is done the quicker the results. Who have tried that?


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## SpAsMaN* (May 11, 2002)

Many researchs on C there. http://www.bedwetting.org/html/references.htm


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## hognfrog (Sep 12, 2002)

Hi:I have been trying for months to get my insurance to approve visits to a Pelvic Floor Dysfunction Clinic. It was refused because they claim it is "experimental" and therefore, not covered. I spoke with someone at the clinic and she wrote a letter to the insurance company. They have agreed to cover 8 visits. We have a 70%/30% co-pay when I go out of network. So at $300 a session, this is going to cost me $90 a session. I just had a colonoscopy this morning and everything is fine. I just have no motility! I have a terrible problem having bowel movements when I'm not at home and since I leave at 7:00 am for work and don't return until around 6:00 pm, I don't have the opportunity to go when I need to. I have caused my own problem! I also don't go if I'm staying at someone's home while on vacation. We now always stay at a hotel and don't share a room with anyone. I am hoping this will work. I am now living on 4 Senokot with Colace daily. I either can't go or I cramp badly and explode, which leaves me very weak. If you like, I will keep you updated on my progress.


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## SpAsMaN* (May 11, 2002)

Yeah post.I think they will give you a rectal manometry to see if they can find a sensitivity or pelvic floor muscle problem.


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## Tiss (Aug 22, 2000)

Josephine, you are most definetly not alone. Most of us C'ers have trouble going at home much less anywhere else. I have trouble traveling, sharing rooms (won't do it), all the stuff you mentioned. WHen I was working I'd have to get up 3-4 hours before work. I was so exhausted. It is better now that I'm not working (so grateful I had a choice) but still have many rituals around going to the loo. It's such a drag and so limiting. Just wanted you to know you aren't alone in this 'crappy' business.


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## hognfrog (Sep 12, 2002)

Spasman:I have had ano-rectal manometry which showed paradoxycal constipation and anismus (you know I work for a neurologist, so the GI terms sometimes are difficult to spell). The rectal muscles begin to spasm when I am having a bowel movement and pretty much close down. The pain is unbelievable. I am sure part of it is a learned process since I have never really been able to relax enough to take time to go. I am waiting for my stomach biopsy to get back (I had an endoscopy and colonoscopy on Tuesday). Once we are sure everything is ok (I have lost 11# in 2 months), I will begin the going to the Pelvic Floor Dysfunction Clinic. I will probably only have to sell my first born to pay for it!!!!


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## bonniei (Jan 25, 2001)

I am currently doing biofeedback to improve pelvic floor dusfunction as well as to control gas. I find Beyond Kegels found at http://www.phoenixpub.com/store/merchant.m...ersonalProducts very useful and targetS the same muscles, if you sit at the right angle so that your anorectal rather than your bladder muscles are being exercised. It is cheaper than than biofeedback and done in the privacy of your house. However a couple of biofeedback sessins might be good to make sure you are targeting the right muscles.


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## StillHoping (Sep 16, 2002)

I wish i could have one center like that in the province of Quebec. Spasman?







I hope I am not being too nosey but are you currently seeing a motility specialist?I can totally relate to being a victim of where I live.In Massachusetts there aren't too many GI motility specialists.I have what I believe from reading posts on this board,functional dyspepsia.The GI I saw in Boston suggested biofeedback & behavior modification and basically said I had aerophagia.Then it was "c-ya".At Temple the doctor I saw and spoke to me and reviewed my symptoms,diet,lifestyle,etc.,for a over an hour & put the kabosh on that "theory" right away.I had to go to Pennsylvania to find a good doctor.It's pretty sad.I hope you can find a good doctor spasman.







I enjoy reading your always informative posts.


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## SpAsMaN* (May 11, 2002)

Well,i have found one clinic from 2 hours drive from here.Not sure about the rate of sucess with the "treatment".But rectal manometry should be use in ALL ibser i think.That seems to really help to understand the hell we live.


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## StillHoping (Sep 16, 2002)

Well,i have found one clinic from 2 hours drive from here.Not sure about the rate of sucess with the "treatment".But rectal manometry should be use in ALL ibser i think.That seems to really help to understand the hell we live.Im glad to here that you found a clinic.







There really should have more clinics for people with motility disorders with competent doctors.We shouldn't have to trek off to another state or country for help.


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## SpAsMaN* (May 11, 2002)

I'm still asking me what is the rate of the sucess who can be reach with PFD clinics in IBS.


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## StillHoping (Sep 16, 2002)

I'm still asking me what is the rate of the sucess who can be reach with PFD clinics in IBS.I wonder if they would give you a percentage of success with the patients they treated if you asked them?


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## SpAsMaN* (May 11, 2002)

I told to the nurse who was involved in the PFC that i have doubt in her "treatment" because she was never clear about the sucess.But i was happy about the interest she have in rectal manometry.


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## bonniei (Jan 25, 2001)

Note that PFD is not IBS.


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## SpAsMaN* (May 11, 2002)

IS THERE AN IRRITABLE BLADDER IN THE IRRITABLE BOWEL SYNDROME?A group of 16 premenopausal women with irritable bowel syndrome and 16 controls answered a standardised bowel and urinary symptom questionnaire and underwent twin channel subtracted cystometry. The irritable bowel patients also underwent oesophageal balloon distension studies for perception and pain. Urinary frequency and urgency and the urodynamic finding of detrusor instability were significantly more common in women with irritable bowel syndrome. There was no relationship between first sensation of bladder fullness and oesophageal perception or between maximum bladder capacity and oesophageal pain thresholds. These findings suggest that there is an irritable bladder in the irritable bowel syndrome and support the concept that irritable bowel syndrome is part of a generalised disorder of smooth muscle.Monga, A.K. et al.BRIT. J. OBSTET. GYNAECOL. 1997, 104 (12) 1409-12


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## SpAsMaN* (May 11, 2002)

Smooth muscle,never heard.


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## bonniei (Jan 25, 2001)

"The gastrointestinal tract muscle is composed of a type of muscle called smooth muscle. (By contrast, skeletal muscles, such as the biceps, are composed of a type of muscle called striated muscle.) Smooth muscle relaxant drugs reduce the strength of contraction of the smooth muscles but do not affect the contraction of other types of muscles. They are used in IBS with the assumption (not proved) that strong or prolonged contractions of smooth muscles in the intestine-spasms-are the cause of pain in IBS. There are even smooth muscle relaxants that are placed under the tongue, like nitroglycerin for angina, so that they may be absorbed rapidly. Smooth muscle relaxants are approximately 20% more effective than a placebo in reducing abdominal pain. It is not clear if smooth muscle relaxants have a beneficial effect on constipation or diarrhea.Commonly used smooth muscle relaxants are hyoscyamine (e.g., Levsin) and methscopolamine (e.g., Pamine). Other drugs combine smooth muscle relaxants with a sedative (e.g., Donnatal), but there is no evidence that the addition of sedatives adds to the efficacy (effectiveness) of the treatment." http://www.medicinenet.com/Irritable_Bowel...drome/page6.htm


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## SpAsMaN* (May 11, 2002)

They give a rate of the sucess who can be achievewith Boifeedback,maybe that is a little high what do you think?Biofeedback & Bowel Disorders: Teaching Yourself to Live without the Problem By: Jeannette Tries, Ph.D., and Mary K. Plummer, O.T.R., Wisconsin What is biofeedback? Biofeedback is a neuromuscular reeducation tool we can use to tell if certain processes in our bodies are working correctly. It is a painless process that uses a computer and a video monitor to display bodily functions that we usually are not aware of. Special sensors measure these functions, which are displayed as sounds we can hear, or as linegraphs we can see on a computer screen. In this way, we receive more information on how our bodies work. A therapist helps us use this displayed information to modify or change abnormal responses to more normal patterns. That may mean increasing a response, decreasing a response, or learning to coordinate two responses more effectively. How can biofeedback help? Bowel control is a bodily function that can be shaped by biofeedback. Bowel control is something most of us master in our early childhood years. Once control is established we think very little about these processes. That is, until something goes wrong. Disease, trauma, or age-related changes in the body may interrupt our ability to command this crucial body function. Biofeedback techniques help us reestablish these learned patterns. The technology allows us to retrain defective processes, and to restore more normal function. Does biofeedback work for everyone? Biofeedback and home strengthening exercises are a nonsurgical, non-invasive therapy option that have been shown to reduce symptoms in a large percentage of people. However, the benefits of biofeedback will vary from person to person. Participating in this therapy can help restore a sense of personal control which may have been lost as a result of dealing with a functional bowel disorder. What disorders may be treated by biofeedback? Biofeedback therapy may be used to treat a variety of bowel disorders including incontinence, constipation, painful spasms of the pelvic floor muscles and symptoms associated with the irritable bowel syndrome. When should biofeedback therapy be used? It is important to consult a qualified physician when considering treatment options. One or more of a variety of diagnostic tests may be suggested. Before treatment for incontinence is implemented, a thorough assessment of the muscles and nerves in the pelvic floor should be carried out. In order to implement a neuromuscular reeducation program that best fits your needs, detailed information relating to your symptoms needs to be given to your physician and therapist. Once an evaluation has been made the correct treatment option can be implemented. Who administers biofeedback therapy? Biofeedback may be administered by a well trained and qualified physician, nurse, or physical or occupational therapist. How long does biofeedback therapy last? Therapy sessions may vary. A person with a non-neurological problem may be seen an average of six to eight treatment sessions over a three month period. Treatment sessions may be scheduled weekly and decrease in frequency as improvements occur. Home practice is the key to improvement. It is important to take what is learned in therapy sessions and apply these same exercises and strategies at home. Repetition of the correct patterns and application of these patterns to everyday situations is critical to reestablishing bowel control. This specific treatment is based on extensive research done at the National Institutes of Health. Research shows that an average symptom reduction of 75% to 80% is possible with this type of therapy. Biofeedback offers an important treatment alternative for people affected by bowel disorders.


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## bonniei (Jan 25, 2001)

it would be high if they were saying that 75% to 80% improved. They are saying that on the average a person experienced 75%to 80% improvement of symptoms


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