Unordinary Constipation

[Nogodsnomasters]

Background: I've had IBS for 15yrs, with varying changing symptoms over the years.

This year I've become constipated but it took months to work out that that was what it is as I don't have the obvious traditional constipation symptoms of not going to the loo or hard stools. It took myself and my GP a while to come to the conclusion that it is constipation. I have a bowel movement every day, sometimes several times per day, and the more constipated I become the more frequently I go to the bathroom?! The movements are not hard themselves they're actually soft/fluffy (not sausage shaped at all but rather in pieces) but they are difficult to pass, I have to squeeze and push to get them moving and they are incomplete movements, small amounts each time but I have the urge to go several times per day with each stool getting smaller as the day goes on.

My GP prescribed fybogel which I've been using on/off for about 6 months now. It works to a varying degree, as in after a few days usage I will have more complete and full bowel movements and therefore less trips to the toilet per day and this will remain the case for a week or two and then the symptoms come back and I take the fybogel again for a few days and round and round we go.

I have tried upping my fibre intake through diet, fruit, veg, shredded wheat, chia seeds and flaxseeds in yogurts and on the cereal etc, I drink plenty of water. I don't do a great deal of high intensity exercise but I walk a lot and do yoga.

Has anyone else had this kind of constipation that I'm describing? If so what do they do about it? I'm getting really tired of it. Other symptoms of it when it's flaring up are nausea, some mild tummy pain, excess wind but those have always been the case with my IBS anyway.

sounds to me like a bowel prolapse rather than constipation

Are you on a low FODMAP diet?

How would I know that's the case?

Kwasi - no, I did all that years ago when I first started with bowel problems and also did gluten free it never had any affect on my IBS. I am on a restricted diet due to GERD though so I don't have chocolate, caffeine, spicy foods, citrus foods, no alcohol etc

I’m thinking you need a colonoscopy to find out if you have a bowel prolapse, gastroparesis or an impaction cooking up. Either way, you’re not wrong when you state that this is not normal. I would definitely add water as much as possible and start writing a diary that includes times and symptoms.

Never had a colonoscopy. Recently had a barium swallow test for my GERD with showed no structural problems but that only goes as far as your upper bowel I believe (duodenum).
Gastroparesis is definitely something I've heard about but don't know much about. Had a quick Google on the prolapse and I don't think it's that as I've no bleeding, rectum pain?

My daughter had encopresis when she was a baby. She held on because she was scared to poo. She stretched her bowel and lost sensation. I had to give her an enema to release the bowel contents and then medicate her to encourage bowel motility and function. Without that, she would have had an impacted bowel and the function would never have been normal. When your bowel is impacted, the solids build up and up and allow only fluid leakage around it all. It often requires surgery to sort of left for too long.

I always thought that an impacted bowel would cause proper diarrhea? My stools are definitely not watery or loose. Nothing comes out without me forcing it really.

You could have a rectocele- a prolapse of the wall between your bowel and vagina. If your GP did an internal (vaginal) examination they could find out. You could also put your thumb in your vagina while you are trying to have a bowel movement, press it against the bowel wall and if you feel a bulge, this would be the rectocele. A lot of women have this.

It sounds exactly like a rectocele. I have one but because it isn't apparent when I lay down, the GP thought I must be mistaken. In my case, it all blocks and goes past the outlet, so I have to push back against it to allow the movement to pass.

On the topic of adding more fibre to the diet can I recommned this video?

I've never heard of this, is there any other symptoms? I've never had a rectal or vaginal examination just smears.

a rectocele is a prolapse

A classic symptom is feeling like you need to go, but when you go to the toilet, nothing comes out despite feeling like you need to go.

I have that sensation frequently. But if I raise my feet up higher (the squat position) I can usually get some poo out so there is always poo there.
Not to be crude but I've just tried putting my thumb in as you suggested and I'm not sure if I can feel a bulge or not it's hard to tell - sorry if that sounds stupid.

Can I ask though, the fybogel I take seems to work for a short time then I return to as described above so if it was a prolapse would the fybogel work? Is it possible that it's just making it bulkier and therefore big enough to bypass the prolapse? Secondly would it come and go or be the same problem every day for you?

Just giving this a bump, anyone else experienced this? I wanted to add that the stool type im having is number 5 on the bristol stool chart, which is blobs and soft, they describe this as needing more fibre which is what I'm doing! Yet even with this soft type stool I need to push and squeeze to get it out.

You’ve had some good thoughts on this thread but I wanted to expand on @Fraaahnces point about stretching the bowel. Talk to your GP about trying a longer course of something like movicol or laxido (both available over the counter so the GP would be for advice on how to schedule this and whether it’s a good idea overall).

incidentally, and I must stress I am not hcp but worked in a relevant department for a long time, a lot of people who had colonoscopies found their issues resolved afterwards with out further interventions. The consultants very much put this down to the efficacy of the bowel
prep.

I see what you mean like a full clear out and start again? Yeah I'm wondering if fybogel long term is actually the right thing to do or whether something like laxido would be better to see what happens. I mean today I've been to the toilet 4 times already, all soft blobby type poo's but I'm straining to get them out it's like there no force in my rectum for them naturally even though I know I need to go. Even passing wind is difficult without straining a lot. I get so nauseous when I'm like this.
Maybe another GP call is needed. I've had the usual blood test and stool tests done, fit test h-pylori test and the inflammation test back in August, all clear.

When you take the fybogel it softens your stool so it can squeeze out of whatever space you have available (think of a tube of toothpaste). If you have a rectocele, the stool is moving up/down/sideways (depending on position) instead of travelling smoothly down the rectum and out. When you've taken the fybogel, whatever stool is filling the rectocele will fill it, and the remainder will come out, which is why you still feel 'full' and like you need to go.

I can strain for a long time and get nowhere. Unless my rectocele (that the GP didn't believe I have) is given some resistance, everything gets trapped and I can't pass it.

It might be area specific but it might be worth asking your GP if you can have a direct referral to a continence nurse. I feel like this would fall under their remit.

Fybogel is great if your diet isn’t high enough in fibre. If you have a faecal impaction, it can be like adding glue on top of cement. I would actually try speaking to the chemist about getting a bisocodyl enema. (Comes in a little tube or a suppository). It works to both soften the impaction on the “dry” side and promote contraction of the bowel. I would be certain to have had lots of water and make sure that you have time to be near the loo as once the dam is broken you can sometimes be quite… productive.

The fybogel does seem to help bulk the stool, the larger it is the easier it comes out, when it's not solid and in fluffy pieces that's when I struggle to get it out. I've spoke to GP today as I just can't carry on like this, she wants to swap me to laxido and for me to come in at 4pm for my first rectal exam. Dreading that.

My daughter had overflow from constipation. It wasn't watery. Soft and gritty. Difficult to wash off

Good luck with the exam. I had one too. Then a colonoscopy. Worth it to know all is OK.