Question Title: Colorectal Problems

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Constipation

Posted by HFHS-MD/rf on January 02, 1998 at 14:38:11:

In Reply to: Colorectal Problems posted by Mr. K.T. Lee on December 22, 1997 at 07:57:34:

: Dear Sir/Mdm,

I am glad there is a site on the internet for questions on colorectal disorders.

Let me give you a quick profile:

I have been experiencing severe constipation problems since early 1995.
I have difficulty in clearing stools or only at times manage to clear
partially on each toilet visit. The latter leaves me a great discomfort.
Sometimes, my stools comes in 3 continuous phases: small stone-line and
hard, longer and softer and watery in a session. Very often, this session
is accompanied with excrutiating pain probably due to the problems as
follows (All my hospital visits are to the Singapore General Hospital):

1995 (Sept) First referral to the specialist. Doctor suggested I go for colonscopy - Report shows that I was alright.
1995-1996 Went for manometry - I was given the chance to look at the x-ray
screen real-time on how my muscles were reacting when defeacting - I
realise they were acting in opposite directions. The doctor confirmed
that the condition is a "Paradox" where the part of the intestinal muscles
did not relax which it should resulting in creating an abnormal condition.
I went for biofeedback lessons subsequently which I did not find it useful
as well as the lack of consistency to practice at home.

Late 1996 - Late 1997 Constipation problem still exist but did not seek
medical assistance. In mid August to mid Oct 1997, this period is very
unusual as my bowels is regular with toilet visits daily in the mornings.
Coincidentally, I started a new job on mid August 1997. I have not much
problem 99% of the time to clear all stools each toilet visit. Notably,
the stools were also softer and there is not much waiting time to clear my
stools as compared previously.

1997 Went back to the doctor recently as I had another experience of the 3
part stool evacuation syndrome which was quite an ordeal. The doctor
said there's nothing they can do except to continue with biofeedback
lessions.

I sincerely hope that you would be able to advice accordingly to the best of your ability.

Thank you.

Mr Lee Kin Thong
Singapore

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Difficulty with defecation is a common clinical problem. The first responsibility of the physician is to exclude conditions that can block the bowel e.g. colon polyps or cancer. Your normal colonoscopy eliminates these possible diagnoses. I am uncertain regarding the "manometry test" that you underwent. In general, biofeedback is used to retrain the lower sphincter. Often it is used to train individuals to voluntarily relax the muscle to allow defecation.

When we see patients who have difficulty with defecation and in whom a mechanical obstruction has been excluded, we often recommend that they increase the amount of fiber in their diet. This can be done by increasing the quantity of vegetables eaten or by using medical over-the-counter products such as Metamucil. The beneficial result of increased fiber intake is large soft stool that are easy to pass. The untoward side effect may be a sensation of gas and bloating. With continued fiber use, however, individuals often become accustomed to this sensation.

Good luck

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