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Ask Internist Your Own Question

Internist
Internist, Doctor (MD)
Category: Health
Satisfied Customers: 4761
Experience:  Board Certified in 2 Specialties, VERIFIED,American, trained and located in United States
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For approx 5 years I have been suffering from severe constipati&#

Customer Question

For approx 5 years I have been suffering from severe constipation and have been taking 6No movicol a day that help but are erratic and are of variable assistance coupled to this is a severe pain in/around the rectum that I think is associated with the constipation each morning I also have terrible aches in my sides -I have seen several consultants that have not solved the problem-they think the stinging pain is neuropathy as I have diabetes???-overall this is ruling my life and preventing me from having a normal one
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Brims replied 3 years ago.
Chat Conversation Started
Dr B :

Hello, is your stool hard?

Customer :

Difficult to say as I have been taking movicol for about 5years and until recently senna(2No per day) that I stopped about a month ago and increased the movicol to 6 sachets per day-sometimes it is the consistancy of mud other times it seems like hard lumps in a liquid-as I said I have been diagnosed with neuropathy(autonomic)that previous doctors believe has gone through/into my digestive system???-thus creating mixed or wrong nerve signals

Dr B :

have you had a colonoscopy?

Customer :

Yes

Dr B :

Why did you stop senna?

Customer :

I was advised to by 2No consultants as they both thought it was creating futher problems and a dependancy and that Movicol on its own at a higher lever ie 6No sachets per day is a better/safer option-unfortunately nobody has been able to solve the pains on/around my rectum that as I said are frequently very severe-at present I'm taking 2No Tramadol,3600 gabapentin plus recently a 5mg morphine patch a day this latter can be increased although I am advised it will acentuate the bowl/constipation problems-I realy am at my wits end as it has gone on for so long-I have got other health issues that my be contributary

Dr B :

Did they do a biopsy when they did the colonoscopy?

Customer :

Yes -and had more since and I was found to have prostrate cancer for which I have had treatment that appears to have been successful-also I have sleep aponea and have had a heart by pass(nearly 6years ago)-it wasn't that successful-during my time in hospital for this I contracted MRSA also it was at that time the severe constipation started with the rectal pains approx 5-6 months later.as you will realise I am diabetic hence the neuropathy-I also have an anurism that is at about 2.5 to 3mm they won't operate until it reaches 5mm-I have arthhritis and persistant bronchial and sinus problems

Dr B :

Sorry to hear that. What question would you like me to answer?

Customer :

As per the very start- why am I suffering from rectal pains and continual constipation & bowel pains-what is it ?-I mentioned the other problems in case they have a bearing

Dr B :

After everything you have told me I think your problems are from the neuropathy you have that is from diabetes

Customer :

This is it-I'm not confident with this analysis-its what I've been told several times but also that nobody/no doctor has come across it in the rectal area as is the case with me-and it does seem to be linked to the continual constipation viz:- its worse when the constipation is worse- also I have been taking gabapentin and/or pentagablin for over three years with no appreciable effect-which if it is neuropathy why has there been hardly any relief ???-I'm convinced something has been missed

Expert:  Dr. Brims replied 3 years ago.
I will opt out and allow another expert to help you
Expert:  Internist replied 3 years ago.
This situation is obviously difficult. You are correct in stating that the constipation is made worse by some of your medications especially morphine. However if you must continue these medications all therapies for constipation must be explored. The pain that you experience around the rectum is definitely unusual for pain associated diabetic neuropathy although since you state that it correlates with the neuropathy it is definitely a possibility. If that is the case I know nothing other than the medications you are taking that would be helpful. One possibility that usually occurs in younger men is called proctalgia fugax which is a spasm of the perianal muscles that occurs intermittently. I will attach a link. In addition to the polyethylene glycol you may want to try bulk forming agents and you may also want to ask your doctor I doubt a relatively new medication called Amitiza ( lubiprostone). In the meantime try the following and avoid senna as the bowel becomes dependent.

You must try to avoid stimulant laxatives. Give this regimen a chance. It takes time.

I will recommend a regimen for you to try to get you to have one or two normal bowel movements a day. The first approach is to increase fiber and bulk in your stool. If this fails, then you must go on to stimulant laxatives or other agents.

First, to increase the bulk in the stool, you must take fiber every am. ie. bran, bran cereal, bran muffin. Also 2 salads a day and ample fruits and vegetables. (avoid gas forming vegetables such as beans or broccoli, cabbage) Psyllium agents such as Metamucil, Citrocel, Konsyl, Hydrocil, Perdiem 2-4 heaping tablespoons a day should help increase the bulk in your stool. You may instead want to try Fibercon, 6-8 capsules a day.Also try Colace (stool moisturizer). Start slowly and increase the amount every day to avoid side effects of gas or bloating.

Try to train yourself to have one or two movements a day by sitting on the toilet the same time every day.

Probiotics, like Activia, will help.

Make sure you don't have hypothyroidism as this can affect bowel movements.

I have found this works for most of my patients after minor adjustments you must make yourself. Let me know how you make out after a few weeks. This takes time and does not work overnight.

You can use Miralax on a short term basis or an enema if you are really
uncomfortable.

http://menshealth.about.com/cs/embarrassments/g/proctalgia.htm

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Customer: replied 3 years ago.

Hi

Thanks for the reply-are there some typing errors? viz:-I don't understand sentence No3 - if it correlates with the "neuropathy?" did you mean something else and sentence No7 "doubt ?" again was this meant to be something else.

One final point that I should have mentioned previously is that I do already suffer from severe bloating and severe wind and my stools are very soft sometimes liquid presumably from the Movicol.

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