Constipation question

This post is likely to contain TMI; you have been warned in advance :-/

Basically I've gone from diarrhoea to constipation in a few weeks. I'm on steroids and Remicade; currently at 25mg on the steroids, tapering down 5mg a week. Initially I thought the steroids were having no effect because there was still evidence of a stricture whenever I ate. But now I think they they have been doing something because my bowels have slowed right down, almost to the point of catatonia.

The thing I don't get is that my stools are not hard; in fact sometimes they are still liquid. But even when they are not, they are soft and fairly thin. And yet I have the opposite problem of urgency: I rarely feel the signal to 'go' and when I do it disappears as quickly as it comes; I then sit there for several minutes on the toilet, trying to coax a stool out that simply doesn't want to leave. (I don't strain hard; that makes things worse.) I managed to go once today, after having not been able to go for the previous 3 days, and it was a bit of a nightmare to be honest. My stomach is still really bloated and I'm sure my colon must be backed up with stool by now.

Has my bowel simply become lazy after years of chronic diarrhoea? Long-term use of laxatives can result in the bowel becoming lazy and in rebound constipation apparently, so I was wondering if something similar could happen with long-term diarrhoea in general. Also, I'm not sure how to manage this type of constipation. Stool softeners don't seem right as I don't think the stool needs to be any softer.

Oops, how did I forget to mention it? I'm on a very low-fibre diet at the moment, which I don't think is helping. This cutting out veggies and fruit is a relatively new part of my diet, and I don't think my body likes it. However, for the moment, that isn't changeable. I'm due to start an all-liquid elemental diet soon, so that might change things again.

I wonder if the urge to go and the contractions and spasming are more symptoms of the disease, and where it is, than an indication that you do actually need to empty your bowel.

Did they find any indication of perianal disease, or of CD low in your colon? I'm wondering if it might help to add some sort of topical med to your treatment.

Ivy.

Hi NCOT,
My Crohn's disease is located in my ileum, and my colon is completely healthy, but like Kazbern described, I have a motility issue. I am constipated with "soft" stool all the time. Miralax sometimes makes it too soft, but it helps and so does senna. I try to take fiber pills and stool softener, and only use the Senna or Miralax a couple times a week. Maybe it's a good sign that the Pred is working.

NCOT this sounds exactly like me!! I thought the NP at the doc's office was out of her mind. She insisted I was constipated. Well, I guess I was, because I added Miralax and it helped tremendously. But I was still having many problems. I guess I was in denial and didn't want to listen to them, but I didn't pay much attention to my diet. Well, now I have and am feeling much better. I also asked around as I work in a hospital and a nurse suggested I take Mineral Oil 2 tbsp at bed time. I have been doing this for a week now and it's really helped to keep things moving. I did NOT tell my doc about this yet, I'm scheduled for another scope in March. I'll let him know then and see what he says. Maybe it's worth a try.

Tess

I really resist calling this constipation - at least when I hear that word I think of hard stool, which is totally not the issue. But whatever, a rose is by any other name would smell as sweet.

To everybody thus far who has said they find it hard to think of it as constipation when they have soft/liquid stools, I feel the same :/

Got this from the NHS website:

Clinical definition

Doctors define constipation in a number of ways:

opening the bowels less than three times a week
needing to strain to open your bowels on more than a quarter of occasions
passing a hard or pellet-like stool on more than a quarter of occasions

So, by that definition, we are all constipated. Yay... :-/

@keepingfaith - I suspect I have all three of those things: scar tissue, slow transit time and rectal inflammation. Something's going on, that's for sure. This is not remotely like the constipation I used to suffer from as a child and teenager. That early constipation, I suspect, was psychological in origin, whereas this, I'm equally sure, isn't. By the way, if you do speak to your GI, feel free to post what he or she says, as I'd be interested in knowing.

Okay, I'd better go to bed... starting to fall nod off at the laptop and once again I've let time slip past until it's unconscionably late. That's brain fog for you :-/

Goodnight folks; thanks for the help :p

@mg12061 - I'm glad your daughter has had a diagnosis and found something which seems to be working. I don't think doctors take constipation seriously enough; it may not tend to signify disease as often as diarrhoea does, but I think it is a more horrible experience than diarrhoea.

Interesting to hear that motility issues exist in Crohn's patients. I'm starting to suscept that constipation may actually be fairly common to Crohn's disease patients. Not as common as diarrhoea, but far from rare either...