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Suffering from Constipation for 7 months?(long post)

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Posted 10/30/2012 8:13 AM (GMT 0)
Hi, I'm a 21 year old male. So back in April, I went to the doctor to complain about my mild abdominal pain occurring 5 minutes after eating certain food(gastritis?) and less frequent stool(hard and round) I was having. The doctor told me "it's nothing" and he put me on Buscopan Forte for 2 weeks.

Within 2 weeks I started getting severe abdominal pain and constipation. So I went back to the doctor to tell him that my symptoms had worsened. The doctor told me to take 3 day worth of stool sample to the pathologist for testing.

While I was been told do this, he was STILL not prescribing me any laxatives. And by this time, I was constantly going to the bathroom but failing to excrete any faeces. During this time, I felt my lower abdomen dropping down and my anus popping out a little when I was straining on the toilet. Once I finished taking Buscopan Forte, this stopped happening.

3 weeks later, the result of the stool came back as negative so the doctor told me get an X-ray of my stomach. 1 week later, he saw that I had a Impacted Colon on the X-ray film and finally prescribed me with 200 tablets of Bisalax and told me to take 2 tablets every night. I asked him how long I should take it for and he said "until you stop been constipated" and quickly dismissed me.

So it took the doctor almost 2 months to find out that I actually DID have constipation even though I've been telling him the symptoms all this time. By the time he finally prescribed me laxatives, I had already developed Impacted Colon which I did not have in the beginning.

After using Bisalax for 3 weeks, I was still experiencing occasional constipation, tenesmus and severe abdominal pain occurring 5 minutes after eating certain food. But when I told the doctor about these symptoms, he just said "your bowel is probably still recovering" and put me on Coloxyl and Sena(2 tablets a day) and told me to "come back in 3 weeks and see how you go".

For the next 4 months no matter how many times I went back to the doctors to complain about my abdominal pain, all they would do is put me on stimulant laxatives tell me to "come back in 3 weeks and see how you go". I tried switching doctors but they all said the same thing. I even asked the doctor "is it safe to take stimulant laxatives for a long time?" and he told me "yes" which I found hard to believe.

After 4 months I realized that the doctors are just going to keep prescribing me stimulant laxatives and not do anything about my recurring constipation, tenesmus and abdominal pain. So I stopped going to the 24hr Medical Center and decided to go to a daytime Medical Centre instead.

And I was surprised by how much more professional and caring the doctor was. On the first day, the new doctor suspected that I had gastritis and immediately put me on Nexium and Psyllium Husk. Thanks to him, my stomach pain and constipation was gone in just a month. But for some reason, I was still experiencing tenesmus, mucous discharge and occasional constipation that occurs whenever I eat certain food which is usually any form of sweets or snacks.

So on 24th of October, I had a Colonoscopy and the Gastroenterologist wanted me to get a CT scan because they thought that I have a Partial Sigmoid Vulvulus. Luckily, the CT scan showed no sign of structural problem. But if that's the case, then why I'm still experiencing tenesmus, mucous discharge and occasional constipation? When I asked the "better" doctor what I could have, he thinks I have a colon that's not functioning any more for some reason.

So now I'm worried that my colon is damaged and not functioning any more because I was over-prescribed stimulant laxatives from the 24hr Medical Center doctor(s) during the first 4 months.

Could this be the case? If so, can a damaged colon heal or am I going to have a dysfunctional colon for the rest of my life?

I strongly believe that my constipation wouldn't have gotten this bad if I was given a gentle laxative and Nexium much sooner. It's been 7 months now since I've been suffering from constipation and I have already spent over $2500 for colonoscopy, X-ray, medications and appointments with the specialist.

I'm going to talk to a gastroenterologist again on 20th of November but I would also like to hear your thoughts on what you think I have.

Thanks in advance.

Additional Details-------------------------------------------

This is how much stimulant laxatives I've taken:
Bisalax 5MG(200 tablets)
Amount taken: 52 tablets
When:
- 42 tablets in 3 weeks(2 tablets at night) when I was first prescribed
- 10 tablets(1 - 2 tablets at night) occasionally when I became incompetent.

Coloxyl and Sena(8mg Senoside B)(30 tablets)
Amount taken: 40 tablets
When:
- 30 tablets in 2 1/2 weeks(2 tablets in the morning and at night) which is how much I was told to take when I stopped defecating for 3 days straight.
- 10 tablets(2 - 4 tablets a day) used occasionally after been prescribed a second bottle.
Posted 10/30/2012 3:00 PM (GMT 0)
Try and remove Fibre from your diet and take metamucil
Posted 10/31/2012 8:24 AM (GMT 0)
I received the results from the Colonoscopy and CT Scan:

CT Abdomen

Findings:
There is a relatively homogeneous density in the pelvis above the urinary bladder presumed to be bowel but it is difficult to assess due to the absence of intra mesenteric fat.

Conclusion:
No definite intra-abdominal pathology can be identified to account for patient's symptoms.


Random Colonic Biopsies

Microscopic:
The sections show fragments of colonic mucosa which show a few neutrophils focally in the lamina propria.
Three scattered lymphoid aggregates are also present in the lamina propria.

Summary:
Minor mucosal inflammation possibly representing a resolving self-limiting colitis.
However, correlation with clinical and colonoscopic findings is essential.


The doctor told me that according to the results, I might have a autoimmune disease. He also said that my colon was moving very slowly for some reason.

I don't have a significant family history of autoimmune disorder other than my great grandmother and my grandfather's sister who both had diabetes. So I think it's environmental.

Does anyone know what type of autoimmune disease the doctor was talking about?

Post Edited (Heinstein) : 10/31/2012 4:02:54 AM (GMT-6)

Posted 10/31/2012 1:46 PM (GMT 0)
Probably an inflammatory bowel disease like UC or Crohn's. But the symptoms don't seem critical (except for the quality of life issue that you're having with motility).

Look, it seems that you are very anxious that you damaged your colon by taking stimulant laxatives. I realize that there are risks to taking these things, but it doesn't seem (to me) that you have taken too many of them. And to ask a DR to figure out exactly how to move YOUR bowels seems misplaced.  You started your original post by describing small hard stool.  This is not the kind of stool that you want - it signifies constipation.  You want long, formed stool that does not have a pebbly look.  Do a web search for the bristol stool scale and see if you can find a description of the "right" kind of stool.

You are the one who knows what it takes to get your bowels moving. There are lifestyle issues here that only you control - how much water are you drinking, do you get enough fiber in your diet, do you do enough exercise? There are certainly motility issues that have pathology behind them - a tethered cord, for example, or hirschprung's disease - but that would probably have been resolved already. You might ask your DR to do a sitzmarker study to identify what part(s) of your colon is the problem.

Senna is a great stimulant laxative that moves bowels and probably does no long-term damage. Although it will discolor the lining of the colon and make future scopes "interesting." In a pinch, you could take some senna and get things going, without having to use it daily.

Miralax is a non-stimulant stool softener that a lot of docs like these days because it is pretty effective. I've been using a little bit every other day for a while now and it works alright.

Also yoga is a good way to massage the bowel and get things moving.

Posted 11/3/2012 5:54 AM (GMT 0)
Between Crohn's Disease and Ulcerative Colitis, it seems like I have the latter disease. But for some reason I don't get frequent bloody stools, all I get is occasional small amount of blood on toilet paper. I also never get diarrhea.

The main problem I have is a lot of food like chocolate, ice cream, milk, yogurt, cookies, crackers, cereals, soft drinks, tea and coffee causing abdominal pain and fatigue which then leads to constipation. I also get frequent tenesmus, mucous discharge and occasional small amount of blood on toilet paper.

I think I already had gastritis back in April because eating certain food gave me severe abdominal pain in less than 10 minutes. But it wasn't until August that I got treated for it.

Do you think my untreated gastritis caused Ulcerative Colitis? Or did I already have both of them from the beginning?
Posted 11/3/2012 12:54 PM (GMT 0)
Maybe you have hemorrhoids with your constipation and this is causing the bleeding? Internal hemorrhoids can be completely painless while external hemorrhoids hurt.

It sounds like you have something weird going on. The biopsy report: few neutrophils focally in the lamina propria and lymphoid aggregates make it sound like you do have colitis. Colitis could, however, be caused by a myriad of things and could be causing your colonic dysmotility. Did you doctor ever give you any antibiotics or do any stool samples?
Posted 11/3/2012 3:45 PM (GMT 0)
Gastritis does not cause inflammatory bowel disease.

Investigating GI disorders is a long process for most of us, and getting to the bottom of complaints can be expensive and invasive and unpleasant. Most people will not pursue a diagnosis until they are really suffering - weight loss, joint pain, terrible gastric distress, uncontrollable diarrhea....things that you don't seem to be having (yet). I'm sorry that you're struggling with constipation. It may be simply that you should avoid the foods that bother you.
Posted 11/5/2012 6:05 AM (GMT 0)
I drank instant coffee today even though it caused severe constipation last time because I really need coffee to exercise at the gym.

Unfortunately, although I didn't get any abdominal pain, my lower abdomen(particularly the left side) became swollen. So I'm almost certain that I have Ulcerative Colitis now.

I've been researching the cause of UC and although it's not known yet, it's speculated to be triggered from diet and lifestyle changes or viral/bacterial infection. I personally think one of following probably triggered my UC.

1.) food poisoning(vomiting) after eating sushi packs which also had salmon roe which was off.
2.) sudden change in sleep pattern(sleeping at 5 - 8 am and waking up at 12 - 3pm) after working at a new job.
3.) eating past mid night due to change in sleep pattern.
4.) Exercising less due to random shift calls.

So am I going to have to give up 99% of my favourite food/drink from now on? Or will I be able to eat normally after the gastroenterologist prescribes me the anti-inflammatory medication?

Post Edited (Heinstein) : 11/4/2012 11:43:14 PM (GMT-7)

Posted 11/5/2012 1:05 PM (GMT 0)

kazbern said...
Gastritis does not cause inflammatory bowel disease.

Investigating GI disorders is a long process for most of us, and getting to the bottom of complaints can be expensive and invasive and unpleasant. Most people will not pursue a diagnosis until they are really suffering - weight loss, joint pain, terrible gastric distress, uncontrollable diarrhea....things that you don't seem to be having (yet). I'm sorry that you're struggling with constipation. It may be simply that you should avoid the foods that bother you.

OP: this post gets to the heart of what you have asked.

I would add that you seem to be very pro-active so if you start investigating and modifying your diet to relieve your constipation you may slow down or even prevent your symptoms from getting worse. My suggestion: eliminate all wheat products and most dairy. Eliminate a lot of insoluble fiber but keep soluble fiber in your diet such as cooked spinach and other leafy greens and cooked carrots. Skip raw fiber until your constipation lets up.

I agree that gastritis doesn't "cause" IBD but your body is telling you there are things going on it isn't happy with so listen to it and try and figure it out before things get worse and you need medical intervention in the way of Rx meds.

In my opinion your constipation is showing that your colon is pre-inflamed and sluggish. Why? Who knows. Just try and get your diet and your colon in a happy place.

Best of luck.
Posted 11/5/2012 1:44 PM (GMT 0)
Heinstein,

Welcome to the forum.

Glad you've found us.

Sounds like you need a new GI to me.

Chronic constipation can be very problematic, as you are experiencing.

And like kazbern and imagardener both said, it can be handled through lifestyle: exercise, diet modification, supplements.

You may be lacking magnesium, and I would suggest you try something natural called Natural Calm - a powdered supplement of Magnesium, which added to water becomes "fizzy" and you drink it down. It works great for constipation, and used daily will enhance regularity, which you certainly need. Here's the info on the product: http://www.calmnatural.com/natural-calm-raspberry-lemon-8oz

You can buy it cheaper through amazon.com

But start at a lower dose and work your way up, because if you use too much of it, it will cause diarrhea.

As was already pointed out to you:  Are you drinking enough good water?

As far as diet is concerned, your diet as stated sounded rich in grains and dairy - which are generally not the greatest for the stomach and intestinal tract. I would suggest your trying to cut out dairy and gluten for 2 weeks and see how you feel.

Just as Natural Calm helps you go, there are other healthy things you can add to your diet:  chia seeds, healthy steamed veggies like broccoli and cauliflower (well known as the intestinal broom).

Also, sounds to me like you could also benefit from some good probiotics, and omega 3's ( all helpful in stool formation).

I had years ago suffered from the tenesmus you describe, it is very uncomfortable and difficult to handle, because you always feel like you have to go, sit on the toilet and nothing comes out, so you end up by running to the toilet every few minutes... yea, it's not fun.

The only thing that fixed that for me was a homeopathic remedy you can buy online called: Mercurius Corr (potency 30C). You only need to take a few pellets, and you'll find it will resolve within a few minutes.

In those days, I used to carry this remedy wherever I went, as I never knew when this tenesmus would strike.

If you need any other info, let me know.

 

Posted 11/5/2012 2:26 PM (GMT 0)
Heinstein,
this is what I would do:
-drink about 8 glasses of water per day
-take a good probiotic like VSL3, Benebiotic...3 times per day
-Take min 2000IU of natural form of vitamin E (mixed tocopherols) per day in the divided doses
-take vitamin C minimum 3,000mg per day (1,000mg after each meal). The best if you can take the regular ascorbic acid if you can tolerate it , if not take the sodium ascorbate form. Do not get Ester-C, it is useless.
-Try to eat some cooked/raw vegetable with each meal

All these simple supplements should help you a lot. If you still constipated after 1 week and there is no improvement, I would add magnesium supplement. The best of the best is Natural Calm by Natural Vitality. It is a magnesium citrate in a powder form that you put in some warm water, it will fizz for a few seconds and you drink it. I would start with about 1/3 of a teaspoon in 1/2 glass of water. Take it 2-3 times per day and see if this will do the trick. If not increase the dose to 1/2 or 1 teaspoon.
This is a very effective magnesium supplement that doubles as the laxative for many people and the good thing is it is not habit forming comparing to the rest laxative. This just a mineral in citrate form.
I hope it will help.
Posted 11/6/2012 1:45 PM (GMT 0)
Sorry, I actually left out a lot of the important information from the results, but this time I've included everything:

CT Abdomen ( I had to get one because after the colonoscopy, they thought there was a twist in my sigmoid colon)

Clinical Information: Worsening constipation. Unusual twist in the sigmoid colon reminiscent of a Volvulus/extrinsic compression? Extra colonic mass or compression in abdomen. No previous films however are available for comparison.

Technique: Post contrast axial scans obtained through the abdomen and pelvis.

Findings: No focal abnormality identified in the liver or spleen. The kidneys are concentrating contrast normally, no evidence of obstruction. Pancreas is normal. Gallbladder is well distended. No para-aortic lymphadenopathy. There is a relatively homogeneous density in the pelvis above the urinary bladder presumed to be bowel but it is difficult to assess due to the absence of intra mesenteric fat. No evidence of bowel obstruction. No free fluid in the abdomen or pelvis. No para-aortic lymphadenopathy. Bones are normal.

Conclusion: No definite intra-abdominal pathology can be identified to account for patient's symptoms. In particular no evidence of colonic volvulus or obstruction.


Specimen: RANDOM COLOIC BIOPIES

Macroscopic: (JM/PC)

The specimen consists of multiple mucosal biopsies ranging in size from 2 to 6mm. All embedded.

Microscopic:

The sections show fragments of colonic mucosa which show a few neutrophils focally in the lamina propria.
Three scattered lymphoid aggregates are also present in the lamina propria.
The other cellular components of the lamina propria are normal.
The surface and crypt morphologies are normal with a normal goblet cell population.
There is no deposition of collagen in the subepithelial stroma nor an increase in intraepithelial lymphocytes.
Parasties, ova and cysts are not found.
There is no evidence of inflammation or neoplasia

SUMMARY: BIOPSY, RANDOM COLON
MINOR MUCOSAL INFLAMMATION POSSIBLY REPRESENTING A RESOLVING SELF-LIMITING COLITIS.
However, correlation with clinical and colonoscopic findings is essential.

So are the results telling that I have Ulcerative Colitis? If so, what kind of UC?
And how come they thought there was a twist in my sigmoid colon but the CT Scan showed no evidence?
Posted 11/6/2012 2:21 PM (GMT 0)
You do not have ulcerative colitis. You have "MINOR MUCOSAL INFLAMMATION POSSIBLY REPRESENTING A RESOLVING SELF-LIMITING COLITIS", it does not mean you actually ever had colitis.
Right now you have some minor mucosal inflammtion which could be caused by many different things.
This is very good news for you.
Eat a gentle good diet and take some good probiotics.
Posted 11/6/2012 4:53 PM (GMT 0)
So if I don't have Ulcerative Colitis, why did the doctor say I may have autoimmune disease? It's unlikely that I have Crohn's because I don't get diarrhea.

You mentioned that I should eat a gentle diet and take probiotics. I have been doing that for the past 3 months by taking psyllium husk, eating healthy and avoiding food that worsen mucous discharge and tenesmus. But even when I'm doing this, I sometimes still get very narrow thin stool which is harder to come out. Other times, the stool is round and small.

Could I possibly have IBS? If so, why do I sometimes get small amount of blood on my toilet paper?
Posted 11/6/2012 5:35 PM (GMT 0)
You could have IBS because there is inflammation in your colon. The blood probably caused by some rough food scraping the inflammed colon walls. I would not eat anything raw like salads, peelall the vegetables before cooking them, do not eat any citrus fruits or tomatoes. Do not drink any soft drinks or coffee. I am not sure about psyllium husk, it is rough and can irritate your colon too. Slippery elm bark is more gentle, if you are trying to get everything moving better. I would highly recommend you to take natural vitamin E (mixed tocopherols) after each meal, to help to heal your colon and take some beta-carotene also. It is very important to get the natural form of the vitamin E.
I would stay away from anything fried, at least till you get better.
I do not think you have Chron's either. Belive me, you would know it: a lot of pain, multiple trips to the bathroom, blood, cramps...
If you do everything possible to calm the inflammation and irritation in your colon now, it will not develop into the ulcerative colitis. Stay away from taking antibiotics or you will end up with colitis for sure. This is how many of us, on this forum, got the colitis.
Good luck to you!
Posted 11/7/2012 12:32 AM (GMT 0)
Small round stool is indicative of constipation. When your stool moves too slowly through your colon a lot of water is absorbed, making the stool hard and small. Hard stool can sometimes cause minor tearing at the rectum and leave blood on the tissue.
Posted 11/8/2012 2:40 PM (GMT 0)
So I'm still wondering what triggered my Gastritis and IBS/IBD. These are the things that happened before I started getting the symptoms.

End of February:
Food poisoing(vomitting) after eating takeaway salmon roe and other sushi

Mid March:
Work accident, high stress for 1 hour

21st of April:
Started having bad sleep wake cycle, mild anxiety

30th of April:
Travelled to Sydney. Accidentally scratched my rectum in the public toilet. My stomach was fine, I could eat anything I wanted to like Oreo.

1st of May:
After I got back from Sydney, I went back to bad sleep wake cycle again and eating past midnight.

Before 10th of May:
I drank 30 ml to 70 ml of 6 - 10 month old opened bottle of unrefrigerated Red wine which was placed side ways in a way that the liquid was touching the aluminium cap. 5 minutes after drinking it, I was in acute abdominal pain for 10 minutes. I either had gastritis already but wasn't aware of it or the old Red wine somehow caused gastritis.

13th of May:
Started experiencing abdominal pain and tenesmus. I couldn't eat regular foods any longer.

So it seems like either my bad sleeping habit or the Red wine triggered my symptoms. I heard that old Red wine just turns into vinegar so I'm not sure if that's harmful.

What do you think?
Posted 11/8/2012 3:07 PM (GMT 0)
Red wine is a stomach irritant and if you already had gastritis (sometimes it can be asymptomatic) red wine will bother you. Same with coffee, tea, cola and chocolate. Gastritis can be a result of too much stomach acid production, which is easily remedied by taking an over-the-counter antacid like Tums as needed, and/or taking a proton pump inhibitor like prilosec for a few weeks. Avoiding high acid foods is a good idea if you are prone to this problem. It doesn't mean you have a terrible illness.

From your posts you seem very anxious about your health. Have you considered talking to someone about your worries (like a psychologist)?
Posted 11/21/2012 7:59 AM (GMT 0)
Thanks guys. I really appreciate your help.

I had a appointment with the Gastroenterologist today. The good news is that he told me I don't have IBD.

But the bad news is that he said I have IBS-C and a Slow Colonic Transit. He said for some reason my colon is unusually long and floppy for my age. Which is the reason why he thought I had sigmoid vulvulus because during the colonoscopy, my colon had flopped to one side which caused it look like it was twisted. He said my colon's was comparable to the one an of elderly because it was floppy and long.

I asked him if this was caused from me straining in the toilet too hard. I explained to him that one day when I was straining, I heard my stomach gurgle and felt my lower abdomen physically drop. But he told me that typically it's something you're born with and happens after child birth complication.

But I find it odd that I suddenly get this now. Because I didn't have any complication during birth and I never had any problem with constipation until this year.

Also, when I was first constipated back in April, I don't think my bowel movement was this slow either. So I think something happened after my first visit to the doctor which caused my colon to become elongated and floppy. I have a few theories:

1.) When I went to the doctor saying that I think I have IBS after telling him the symptoms of constipation and abdominal pain, he denied it straight away and prescribed me with Buscopan Forte for 3 weeks.

So I asked him if I should change my diet or stop drinking coffee and he said I don't have to change anything and quickly dismissed me.

The medication only temporary treated my abdominal pain but I was still getting constipation and tenesmus. Few weeks after using the medication, I was straining in the toilet in a squatting position as usual. But this time, I heard my stomach gurgle and felt my lower abdomen physically drop. At the same time, the head of my rectum popped out(about 3 cm). It wouldn't go back in so I had to push it back in with my finger.

After this had happened, I started getting mucous discharge for the first time and other symptoms like constipation and abdominal pain worsened significantly in less than 2 weeks. I think what contributed to this was me continuing to drink coffee which caused me to strain excessively and buscopan forte which relaxed my colon.

2.) While I was working I accidentally drank a sip of soft drink which caused my abdomen to become suddenly bloated like a balloon. It happened very quickly and it was so painful that I thought my colon was going to explode. But my colon only expanded for few minutes until all of the gas escaped somewhere else.

Out of the two theories I think it's the first one is more likely. I wouldn't be surprised if I was right because we know our own body better than anyone else. I was right about thinking I had IBS 8 months ago. And I finally got diagnosed with IBS yesterday. I'm hoping I'm not right again this time but I feel like I could be.

The gastroenterologist said that at this point he doesn't want to do anything and suggested me to wait and see if I get better over time.

So even if I was able to put my IBS-C into remission, wouldn't I still be prone to constipation if my colon is floppy and long? Are there any cure for this like surgery to shorten the colon?

I wish my first doctor took my stomach complaint seriously and not leave me straining in the toilet for 3 months. I don't think this would have happened if I was treated earlier.

Do you guys think my first theory is a feasible explanation? Or do you think it's something else?

Post Edited (Heinstein) : 11/21/2012 7:41:30 AM (GMT-7)

Posted 11/22/2012 2:52 AM (GMT 0)
Also if I drink coffee, my rectum easily pops out even if I don't apply much pressure. So I know for sure that coffee causes your body to strain excessively.

So my theory is caffeine causing excessive straining + Buscopan Forte relaxing the colon + tenesmus causing me to strain frequently = elongated and weakened colon.

Ever since I felt my lower abdomen drop and my rectum had popped out for the first time, my rectum would easily pop out whenever I was straining in the toilet. Before that incident, my rectum never popped out. This also explains why my symptoms suddenly worsened significantly after I was on Buscopan Forte.

If my colon wall is elongated and weakened due to excessive straining, can it heal back to normal over time like a muscle? Or is it going to stay like that permanently?
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