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Colorectal Diseases

Severe constipation

05/14/2008

Question:

I was diagnosed with IBS about 20 years ago and although I didn`t have frequent bowel movements, I did have them and they were normal. About a year ago, my movements changed. It`s like everything stopped and I could hardly even have a movement. I`ve had the bloating, gas, and discomfort before, but its much much worse now. I`ve tried almost everything. Even an enema I did once almost didn`t work and that scared me. All I would get was alot of pain with nothing coming out. I tried probiotics and for 2 weeks suddenly had normal movements almost daily and I felt great; but then it just stopped working and all the symptoms came back. I `ve been to 3 gastro. doctors in 2 years; who of course tell me I`m constipated. I`ve tried all the stool softners, mirolax, and I`ve been increasing my water. Nothing is working and I`m getting scared. There is no colon disease in my family. I`m 49; had my first colonoscopy just 2 years ago; was normal. I`ve had an complete ultrasound done, CT scan of abdomen (which only showed alot of fecal matter), Gastric Emptying Study (normal), and am scheduled for a small bowel study. My present doctor doesn`t seem to have any answer and just told me do a clease, which I did a week ago and was unbelieveably painful, terrible cramping; and now no movement since the cleanse. The 2nd day after the cleanse, I woke up with terrible pain in the abdomen all day for 2 days straight. I started psyllium once a day a week ago and increasing my water. Still no movement in 7 days. I feel the need, but won`t come out. I have no clue what is going on. I`m doing everything right and nothing seems to be working. My doctor is frustrated and says she doesn`t know what I want! I have other physical symptoms that began a couple years ago including fatigue; sleeping alot; unintentional weight gain (20lbs) and continuing with no change in diet or exercise; dry skin and then the severe constipation. I started to think I might have an underactive thyroid, but they keep telling me my TSH is normal. I keep going to doctors but no answers. I`m scared I`ll end up in the ER being compacted. I just don`t know what else I can try or what might be going on. Any thoughts would be appreciated.

Answer:

If you have not done it already, consider seeing a specialist in motility disorders, or a colon and rectal surgeon with an interest in pelvic floor dysfunction. There is a methodic way to evaluate constipation, and it is not clear that you have had it.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati