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Severely Constipated....


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Hi all,

I have been severely constipated for that last couple months........as some of you have read, I am currently on track for surgical procedure for GI pacer (stomach). I am questioning whether or not I should get this pacer, for various reasons as posted earlier, but also because I wonder if there is more than just HYPOmotility of the stomach........I have had a hard time swallowing the past couple months, and now, severely constipated as well.......

....Interestingly enough, a couple weeks ago when i was in the ER for the nausea, they did an abdominal x-ray on me and saw what the radiologist dictated as "a moderate amount of stool in the descending colon and rectal vault".....i was shocked by that considering I didnt even "feel" like i had to go to the bathroom until two days after that x-ray was taken -- and if there was THAT much stool sitting RIGHT there (sorry, i know this is gross) to be eliminated, I wonder why the sensation to go to the bathroom wasnt there until two days later???

Do any of you have problems with constipation?? is there is test to show/prove neuropathy or hypomotility of the small and/or large intestine and not just with the stomach?

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Hi, Cardiactec.

I am so sorry you are going through so much. There are different issues which can be involved, of course, like not feeling the urge, or slow peristalsis, or hard stool, etc. Have you had a stool test (for dysbiosis, parasites, short-chain fatty acids, etc.)?

I have read in a number of places that extra stool in the transverse and descending colon can aggravate tachycardia. This is due to of pooling or extra cardiac workload to move blood in spite of abdominal fullness. I wonder if your GI issues are one reason for your very high heart rates in spite of BBs. I tend to have more episodes if I am constipated or gassy.

I expect you have tried all the usual healthy laxative foods and products, but if not, I will suggest what works for me.

OLL

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it's actually not all that unusual for those with gastroparesis to have motility issues elsewhere in the GI tract. obviously it's not the case for everyone, and it's often not the same degree as the gastroparesis (can be more or less of an issue), but i'm actually surprised that you haven't been required to get more testing before being scheduled for a pacer. since the pacer only deals with the stomach, severe problems elsewhere can be a deal braker in terms of whether the pacer is even worth a try (as is the case for me). this doesn't mean that things have to be perfect elsewhere b/c there are meds to take and the like, but it's something that many doctors test to some degree, particularly if there are "red flags", i.e. constipation. my understanding though - in a general sense - is that problems in the small intestines are more problematic than problems in the large intestine/ colon (probably b/c they're harder to treat). but as a not particularly relavent side note/ FYI, there is some testing in the works (very initial stages) for pacing that involves the small intestines as well.

in terms of what testing is available, there are several options. some are more readily available than others and some give better info; there's probably a balance to be struck (that could vary depending on the situation, results, etc) in terms of how many tests it makes sense to pursue. some include manometry of the stomach & small intestines (not done many places, very long, gives great info), lower GI/ anorectal manometry (more common but still not everywhere), upper GI series (done pretty much everywhere, will show severe problems but not as specific as info from a manometry, time varies depending on your body), and colonic transit test ("in between" in terms of availability, despite the name can give some info about motility throughout the GI tract, requires multiple x-rays over about a week but otherwise not uncomfortable or time consuming). i have a feeling i'm forgetting something but that's at least a good start...

constipation can certainly be a motility issue but isn't always. sometimes it's more about hydration, foods being eaten, etc. in this way, sometimes it's an issue for those with gastroparesis b/c the dietary restrictions imposed by the GP can be a recipe for constipation.

hope this helps,

:D melissa

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Interesting enough, when I was about 6 years old, I was rushed in to the ER because I was vomiting up bile due to the fact that I was severely constipated, couldnt go to the bathroom at all.........my parents tell me that when i was an infant, they used to have to do various thing to help me go to the bathroom as well............off and on throughout adolescent years, i had some bathroom problems, but not as severe as when i was younger..............and now lately, i have been having these problems again, along with the stomach trouble, and swallowing trouble........

i have mentioned several times to the GI doc about the swallowing problems............he told the GI surgeon about this and when I met with the surgeon, he brought it up, and at that point, i thought he would start discussing his hesitation for pacing me due to the fact that if there are other GI areas involved displaying possible dysmotility, so that the pacer would be less effective to truly "treat" the overall underlying problem..............he never said anything about it..............and proceeded to discuss GI pacing...........

as for the constipation, i have only mentioned that to my PCP.......he thinks it's linked to the dysmotility of my stomach.........

...I told my GI doc that i didnt want to have an esophageal manometry for the swallowing trouble because essentially there is no treatment for that anyway, so i didnt want to go through the torture of such an unpleasant test if they couldnt treat the problem..................as for the lower manometry testing, nobody has recommended that to me..........

as for the diet that helps with constipation, it tends to aggravate my gastroparesis......

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I had a full GI series which diagnosed slow motility along my entire GI system (drank so much contrast I get chills thinking about it...and it includes a barium enema, which was not painful but was embarassing). Unfortunately, I've had an ongoing struggle to keep things "moving". Glycolax helps (aka Miralax which is now OTC), but is an incomplete answer. Dulcolax sometimes works for me, but inconsistently. I can have as many as 10 days without a significant bowel movement.

All I can offer is wht helps me most: exercise, good fluid intake, glycolax and a diet rich in fibrous veggies and fruits...as well as fibrous grains like oats, flax seeds (I have ceoliac so i can't have wheat, barley or rye). One of my docs wanted me to take several teaspoons of extra virgin olive oil every day, but I didn't find it useful and it tasted disgusting.

Nina

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Angela,

I remember you mentioning taking Zofran for nausea. Just wanted to let you know that constipation can be a side effect of Zofran. Regarding the X-ray interpretation, it's not uncommon to see stool in the colon and rectal vault on the X-ray without actually having the urge to go. You've got some excellent suggestions for treatment of constipation from others. One other thing that I want to mention is that Mestinon can be helpful with improving swallowing as well as promoting peristalsis of the bowels - i.e. a side effect of Mestinon usually is diarrhea.

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What is the defining symptom of constipation? I have bouts of slow motility--been worse in the past year. I have been able to address it with increased fluid and fiber (fruit and veggie) intake.

I am just wondering at what point slower motility is actually "constipation"?

Angela so sorry for your continued discomfort. I hope it can be resolved soon.

Katherine

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Yeah, I've had problems with constipation and slow motility for as long as I can remember. I never realized it was abnormal. I'm not even going to tell you how old I was when I finally realized that some people can "go" more than once or twice a week!

Over the years things have gotten worse for me. Fruits, vegetables, and other forms of fiber have never made a difference. Sometimes I can use a strong cup of coffee or black tea to get things moving. But when the problem gets bad those don't work. Maybe that's the line between slow motility and constipation?

I've recently discovered a tea that helps greatly. Yogi tea makes a tea called "Get Regular" that really works. It has senna leaf as well as other herbs that help with digestion and motility. Drinking a cup of that tea should help in 6-8 hours. If not then it is safe to drink another cup. I thought the tea would taste bad, but it really doesn't. Now, it isn't chai tea by any stretch of the imagination, but it isn't bad either!

We also need to keep in mind what medications we're taking because many of them have constipatoin as a side effect. This can cause a problem with constipation or exacerbate a problem that's already present.

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just wanted to add - for anyone reading, as those with GP likely already know this - that lots of fiber, fresh fruits & veggies, etc. can not only cause problems in terms of symptoms but can actually be dangerous for some with GP as it can encourage the formation of something called bezoers. this isn't true for all GPers as it depends on the severity, but it's a reality for some that is worth keeping in mind.

my funniest GI testing memory (not to be confused with the worst memory) was the time they had to keep the place open late to try to get the test finished...b/c my system was so slow. eventually they gave in at "almost". and that was when things were TONS better than they are now. now i can't do most of the testing b/c it's simply not possible.

for those asking about what is actually considered constipation, there are technical definitions, but i think that most apt physicians would consider it more of an individual thing. people are different, so as long as your body has a pattern that's healthy for you it's probably okay, even if a bit slower than the "norm". i guess what i'm getting at is that it might be normal for one person to have a bowel movement weekly, whereas if someone typically goes daily & then doesn't go for a week it might be problematic. pbviously there are extremes that should never be "normal" for anyone, but i also think that strict lines between normal & abnormal aren't always helpful. other signs of more of an issue could be pain, or as rachel mentioned, when typical "fixes" don't help. i've actually - with my doc's instruction - had to use enemas and/or suppositories occassionally to get things moving.

doctorguest et al, mestinon was a huge help to me in the past with GI motility from top to bottom...in fact i credit it with keeping me off any artificial nutrition for at least a year longer than would have otherwise been possible. i laud it almost every time conversations about gastroparesis come up!

rachel, like many other wacky things in my body, for many years i too had no idea that some people went to the bathroom more often than once or twice a week! i too had issues with constipation long before i knew it was an issue or before other autonomic issues - GI or otherwise - were something that really caused me issues, one time even landing me in the ER with an impaction.

cardiactec, have you had a small bowel follow through at some point since your GP diagnosis? usually it's routine to make sure there's not something more anatomical causing the stomach problem. and i've honestly not heard of someone getting a pacer without it being a prerequisite...unless for some reason it's physically impossible.

:D melissa

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Hi,

I sympathize with your issues. My doctor is looking further into whether nerve damage could be causing my GI symptoms (constipation, nausea & vomiting) I'm actually have a specialized test to check for this in the morning - an antroduodenal manometry motility study. It doesn't sound like fun but it basically measures the pressure in the stomach for 4-6 hours under certain circumstances and can diagnose nerve damage. I suppose after tomorrow I will know more...

~Elle

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elle -

good luck with your testing. the testing you're having is what i included in my list as stomach/ small intestine manometry. and - if you need something to help get you through the test - you can try to be glad you're not having it done at one of the many places that does it for 8 hours or more?! perhaps a small comfort, i know, but hopefully it will give you & your docs helpful info. i was actually supposed to have it done a few months ago but deemed too unstable at the time (was in the hospital) for the test. we may pursue it again if i can manage to stay out of the hospital & off of antibiotics for decent length of time.

let us know how it goes for you,

B) melissa

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Hi all,

thanks for all your comments/suggestions.....

first off, doctorguest, why would that be, to have a moderate amount of stool in your rectum, and not be able to sense a need to defecate until two days following that x-ray? you would think with that much pressure right in the rectum, that there would be some receptor activity occuring? when I was 6 and had to go into the ER because i was vomiting bile, so sick from not being able to go to the bathroom, that is precisely where a large amount of stool was sitting - in the descending colon and the rectal vault........no "true" obstruction was found, just nothing was moving.........also doctorguest, if you could answer a question, can SSRI also cause hypomotility/constipation problems? my neuro is currently trying me on SSRI as a last dig attempt before going to surgery, to help with my GP (yes, i gave in to my hesitation with the stigma SSRI's can/seem to have in order to see if this will bring relief - so far, 6 days into it, it hasnt done a thing to help my tummy)......ah yes, good suggestion regarding zofran - forgot that a side effect of that was constipation - that could definitely be enhancing the troubles i have been having with the constipation, but i was having problems with constipation before starting to take zofran -- interestingly enough, the constipation has been much worse lately -- perhaps due to the large amounts of zofran i am taking to try and combat the nausea.....

sunfish, i have never had any small bowel follow through testing, no manometry tests - the only GI tests i have had include colonoscopy, sigmoidoscopy, upper GI barium, endoscopy, and the gastric emptying study.........everything but the GES was done 3 or 4 years ago when they were trying to get to the root cause of my nausea.....

elle, good luck with your procedure, i hope it goes smoothly and that they find some answers as to what is going on......my doc told me that neuropathy of the GI tract could only be diagnosed through surgical procedure????? not sure what he meant by that, he said something about a biopsy........i thought it could be diagnosed through manometry??

rachel, thanks for the suggestion of the tea. i will definitely look into it.

OLL, interesting about the HR coinciding with stool/constipation in the colon.....I'll have to look into that....any websites/links you can give me that talk about this?

momtoguiliana, thank you for your sympathy..............i know that fiber is generally a recommended treatment for constipation, but as sunfish stated, and as i have unfortunately found out over the past couple years, anything high fiber makes my nausea 10X worse....

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First of all, I am proud of you that you are giving SSRIs a try despite your initial reservations, and I hope that it does help you symptomatically. After 2-4 weeks, you should be able to see whether there is any benefit, but the good thing already is that you seem to report no side effects, and that's great! Constipation is not something that is routinely reported with SSRIs, although I suppose it's possible. I think the worsening of constipation is probably from Zofran, however. I've taken this medication a few times myself, and it had this effect on me too.

With respect to why you're not feeling the urge to go from having stool in the rectal vault, I would not worry about this too much: it is so easy to "see" things on an X-ray, and that doesn't necessarily translate into "sensing" it. It may be due to smooth muscle relaxation and position of the stool so that it doesn't cause the urge. This may be secondary to the constipation problem. I am fairly certain that once you discontinue Zofran, it will improve. Hopefully, the SSRIs would improve your motility problems.

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Congrats Angela on trying an SSRI, I know you had strong feelings about them (as did I, I only agreed to try one when I was getting much more symptomatic because I was worried about the stigma) - hopefully you'll soon be seeing the the beneficial effects that many of us POTSies find from SSRIs.

Flop

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I have been having some side effects from the SSRI, feeling like my head is in the clouds and also some dry mouth, but I think it's getting better........

I still have my opinions about SSRI's, -- B):lol: :lol: :P :P :P but at this point, if I can avoid GI pacer surgery, I am willing to try just about anything, including SSRI, to get my nausea under control.......

...having tried just about every med known to man BUT SSRI, I figured since the medical field is mainly one big game of process of elimination, we can either now eliminate SSRI as being helpful or it not........my doc said if THIS doesnt help, he'll take me off of it and try some form of med they give to stroke patients????? starts with a B??? cant remember the name....and if THAT doesnt work, then he'd be in favor -- and so would I -- for trying the GI pacer......

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Angela - I made the mistake of taking my first SSRI tablet on a monday morning before going to work (Paroxetine 20mg). By 11am I felt drunk / drugged (well I was drugged just that I'd taken the tablet intentionally). I had such bad vertigo that the walls and floor were moving and people seemed to be zooming in and out getting closer then further away from me. It was really scary, I bumped and bounced my way down the corridor to the administrators office to sheepishly explain that I'd have to go home sick and could they call me a taxi? Also had huge huge dilated pupils.

I cut the dose in half and still felt horrid for about 10 days, after 2 weeks I bravely put the dose back up to 20mg. That was months ago - now I tolerate it just fine without any noticable side-effects.

I know this isn't exactly constipation related but wanted to reassure you that the wobblyness doesn't usually last beyond the first few weeks.

Good luck,

Flop

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i'll add myself to the cheering section that hopes the SSRI brings some relief after a bit more time. do make sure you give it enough time. that was one thought i had (and never got back to mentioning) with your trial of domperidone as well; some people don't notice a benefit until four weeks or more at the maximum dose so i'm wondering if you gave it a long enough go??

i do know that for some SSRIs can really help motility-wise, and have never heard of them causing constipation (though of course nothing is impossible). i know that an SSRI helps nina/ mightymouse in terms of GP/motility (i'm assuming/hoping she's okay with me passing this on b/c she's shared it on various occassions in other posts!).

ah yes, and the small bowel follow through i mentioned is actually the same as the upper GI barium study, or at least it can be. so you probably have had that done, just under a different name. though it does still surprise me that since it was years back that it wouldn't be repeated, particularly before proceding with surgery.

hang in there with the extra symptoms from the SSRI...hopefully it will be worth it.

B) melissa

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