thoughts on urgency

Hi people! SO, my favorite subject, the urgency... Honestly, for the past year or so that has been my biggest problem. My stools are usually formed- when I'm doing poorly, they're soft, slimy, bloody, mucousy. When I'm doing well, they're more solid, no blood or mucous. But with either type, when I have to go, I have about a 30 second window, max, to get to the toilet. It got me thinking about this- I'm fairly sure my urgency is from lack of muscle control, not necessarily inflammation in the rectum. There is another poster on here, I think pb4???, who claims urgency as their only symptom- I know there are others who claim the same thing. If urgency is the only symptom, isn't it possible it's just your muscles? After years of flaring badly & constantly straining/pushing with tenesmus, I think my muscles just aren't toned enough to hold it anymore. I am able to differentiate tenesmus from actually going- when it's just tenesmus, I'm able to talk myself thru it, deep breaths, etc. If it's stool, I NEED to find somewhere to go. Do any of you know if long-term lack of rectal muscle control is a side effect of IBD? Regardless of how many or what types of probiotics I try, if I use rectal meds or not, the urgency is still the same, every morning, like clockwork.  Another reason I think it's not inflammation is my 70 year-old mother has lack of bowel control at times- she's had numerous colonoscopies over the yeras which have showed nothing, so..... it can't just be inflammation that causes urgency, right??? Any feedback?

yeah, sort of- re. talking with my GI. He knows that's my biggest issue, & last time he suggested a high bifido probiotic, & we talked about stopping Remicade & starting Humira. I'm not so much comparing myself to my mother, but just pointing out that there have got to be other reasons aside from inflammation for urgency! It's bizarre- I could expect the urgency when I was passing bloody mucous & not much else, but to actually poop your pants is another thing! Especially when you're feeling pretty good, day to day. I haven't actually had an accident in awhile, but I have had to use my DIY port-a-potty fairly recently. If I didn't have that in my car, there'd be trouble. I guess my thing is this- I can see tenesmus resulting from rectal inflammation, but why would actual urgency, the inability to hold it, result from inflammation? Or maybe it's just the timing- you feel the urge, & just happen to have something to pass at that specific time??? You're right, who knows???

Urgency was my biggest problem. I had frequency, loose stools, and bleeding, too, but the urgency was what pushed me to get surgery because, like you, I would not even have a minute to get to the bathroom when I had to go. My rectum was not inflamed at all actually. My surgeon said the urgency was because of colon spasms. I had an anal monametry to test the muscle strength and it did not seem good, which made the surgeon uncertain that the j-pouch was a good option for me. However, after surgery until my pouch failed because of leakage because we did the second surgery too soon, I had great muscle control at all. No leaking inthe first week when it was all watery! The surgeon was very impressed and said that he could hardly even do a rectal exam because my muscles had tightened up considerably.

I just began Humira and my bleeding has stopped.  My stools are getting more formed.  But I still have the urgency and some mucous.  When I have to "go, I really have to have a bathroom nearby.  Evalou, you have given me some things to talk to my GI about.  I am hoping the Humira will help with the urgency soon.

This may sound WAY off to some but I actually think my pregnancies may have played a role in why my urgency has become so much worse. Since my colitis really has not moved much in the 5 years I have had it (first 2 were proctitis) how is it that the urgency issue seems to be the thing that's increasing so much?? Lead me to think...within that same timeframe I had both of my pregnancies at which in the 6-7 month range Flared & the urgency was off the charts... & it's been like that ever since. I have read about the connections between colitis & bladder control and links to certain other gender specific internal malfunctions so maybe it's not that far off? It would be interesting to see the ratio of male to female on this one. PLEASE don't think I am downplaying male urgency issues, I would never do that. We all have very different triggers. Thoughts?

I think it might have something to do with the nerves in the area, too.  I think that it is also related to inflammation, which effects the nerve endings, which in turn become totally confused on the degree of urgency.  I attended a seminar on IBD in November, and it seems that was what the doctor/speaker was saying.  That would also explain a colon spasm.  

Nice theory but I don't think muscle control has anything to do with it.  Normally when you have to go to the bathroom a message to your brain tells you hey you need to go.  In most cases those without UC for example can sort of say not now and you tell your brain that you will go later.  With UC when that message to the brain is triggered there's no way to reverse it.  I think the inflamation is bothered and it's impossible not to pass what's in the bowel.  I've noticed that when not flaring I can hold it or wait a lot longer then when in a major flare.   

I use to crap in my pants with UC; even when having relatively minor symptoms of UC. It was horribly embarrassing. I had surgery for UC and ended up with a jpouch. I have never crapped in my pants again and I have the same sphincter muscles as before. So, I think accidents are related to the disease, not to control.

Sue

Hi Eva Lou, Urgency and frequency are still my issues (not surprised since I still have active crohn's colitis and IBS as well), I still feel better than I did before I started my regime (listed in my sig) that's for sure...I was already told by a second colon and rectom surgeon (not the one that performed the banding on what they thought was hemmies, but a surgeon I saw after that) that chances are with the mess my anus is in I may never see full remission...but I'm still glad I've altered my diet and so on cuz I feel it's all helping me feel somewhat better but the urgency is still the same as it always has been, hopefully it won't get any worse like it did after I had my second natural child birth.

There's mind-gut connection control which I think the disease distrupts and then there's physical muscle damage control (like from having natural child births and diseased anus), so there are grey areas when it comes to control, nothing is black and white when it comes to this DD.


:)

My "urges" don't feel like menstral cramping at all, just like normal bowel urges...I was doing kegal exercises for a long time (months) and noticed I started getting vaginal/rectal cramps from them, I stopped doing kegals and the cramps stopped, I did kegals again and soon after doing them the cramping in that area returned again...very bizarre but my conclusion is that me and kegals don't mix or I end up getting random cramping (not just when going poop but when the cramps hit during those times it was soooo painful and not worth it) which would come and go at anytime and sometimes lasted what felt like forever. So kegals cause me discomfort down in that whole area.

:)