Hi Marc. I recognise these symptoms very well. I've had exactly the same problems over many years but have now been free of them for nearly a year.
What follows is a bit of an essay, but then it's a complicated problem.
GPs here in Britain (MDs in US? - first-line, non-specialist doctors) often prescribe fibre as a first resort for constipation. If it works, fine, but it isn't always appropriate. I was prescribed 15 different types of medication - Normacol, Normacol Special, lactulose, natural senna etc until it was coming out of my ears. They simply gave me diarrhoea for several years. I was also prescribed glycerin suppositories, phosphate enemas and many others, but none of them worked either.
Read the following, and if it doesn't work, see a gut expert - either a gastroenterologist [orthodox medicine] or colonic hydrotherapist [complementary medicine].
Don't be put off by people telling you that "constipation isn't really a problem"/"you don't have to go every day you know"/"go away and try not to worry about it" - these people have never had severe constipation! If it's anything like mine was, your constipation won't be life-threatening in itself, but the feelings of sluggishness and despondency associated with it can be hugely disruptive and demoralising.
What's probably happening with you is this:
As your waste matter is making is way through your system and gets into the colon - the large intestine - it's starting to dry out much more quickly than it should do as it turns into a formed stool. The large intestine starts above your right trouser pocket, goes upwards roughly to the level of your navel, then goes across your front to your left-hand side before dropping down again to the rectum & anus. It's whilst going along this part of the gut that waste matter which isn't able to stay moist, will instead turn hard and go dark in colour in the process.
As this dried-out stool approaches your anal canal/rectum, instead of just popping out within a few hours it'll slow right down and will often break up into lumps as it dries out. If it doesn't break up whilst still inside the colon, it'll probably do this as you're straining to defecate and only parts of it - lumps or balls - will get through.
As this happens the colon wall, which normally forces the stool along the gut towards the rectum using a movement called perestalsis, starts to lose its grip on the dry stool, which is another reason the stool won't keep moving. Perestalsis is a series of 'Mexican wave'-like contractions with which the colon forces its contents towards the rectum. (If you've ever seen a worm moving over soil, this is roughly the movement your bowel is making to try and empty itself; unfortunately this doesn't work very well with stools once they've become dry and hard and wide). These hard, dry stools are known by gastroenterologists as 'impacted stools'.
By this stage you'll be feeling very full and sluggish each day, possibly unable to concentrate.
What you need for this is a stool softener rather than a laxative, so that the stool remains moist inside the bowel - though not too soft and certainly not liquid - so that by the time it reaches the rectum it hasn't completely dried out and also so that the colon wall can grip it and eject it more easily.
Ask a gastroenterologist for advice on stool softeners, or just go straight to a colonic hydrotherapist.
Colonic hydrotherapy (also called colonic irrigation) helped me. I turned to it in desperation last year and was very sceptical but it's worked extremely well for me - 90% of the time, going to the loo is now bliss.
A hydrotherapist will probably firstly clean out the inside lining of your large intestine (this could take 3or4 sessions), and then put you on a herbal or other preparation to i) help you go and ii)improve the water-retaining ability of your colon.
The hydrotherapy also helps the colon massage itself as the process involves remove (by using a jet of water) the thick, lining of black matter that cakes up the inside of the colon. With luck you should then slowly start to go more regularly and even get a signal to 'go' - something that disappears during severe constipation.
My own stool softener is a homoeopathic (herbal) preparation recommended by my hydrotherapist here and made locally.
If there's no improvement for 2-3 weeks after your final visit to have your colon dredged out in this way, read on.
Other factors which might be causing your constipation:
* The muscle around the anus/rectum may be tightening up so that 'nothing shall pass'. This muscle is known as the 'anal sphincter'. Normally it's shut tight: if it wasn't, we'd all be incontinent. When you're opening your bowel it needs to relax properly to let all the waste matter out so that you feel properly emptied.
Unfortunately, if you have impacted stools it has to relax even more to let these (wider) stools out. If it can't, instead the hard stool stays lodged inside the rectum and more recent, softer waste matter from higher up in the colon squeezes its way past the stool and coming out through the rectum, while the hard stool stays lodged in the colon. This is known (I think) as enforced diarrhoea, but isn't really diarrhoea - it's your colon knowing that it's supposed to expel something, and expelling whatever it can.
You then have a burning sensation around the anus and a strong feeling of not having emptied yourself (because you haven't), usually accompanied by soreness.
You're also more likely to develop piles (haemorrhoids) when you're constipated, partly because when you're having to force dry, knobbly stools out through the anus, they can drag haemorrhoids out with them. A softer, smoother stool is less likely to.
It's important to be as relaxed as you possibly can be when emptying the bowel. Try reading a magazine and not worrying about whether you'll go or not, and controlling the muscle so that anything that comes out, does so in as controlled (by you) a way as possible. After all, it's got to come out sooner or later, so tell yourself you can wait as long as it can!
Biofeedback devices can help here: they sense whether the sphincter is contracting at the right time, and give you feedback to help improve your defecating & bowel relaxation technique. I'm thinking of getting one myself. Try a medical equipment supplier or search the web for 'biofeedback'.
If the above doesn't help, ask a gastroenterologist about factors - both physical and psychological - which might be affecting the sphincter.
* Physical factors include:
- poor diet
- poor sleep
- lack of exercise
- side-effects of drugs
* Psychological ones might include:
- stress
- depression
- sluggishness
- worries
- general anxiety or
- being unduly self-conscious when going to the toilet.
Could any of these apply?
* Another cause of constipation can be 'spastic pelvic floor syndrome', also known as 'anismus'. This involves the muscles around the anus coordinating wrongly and inadvertently closing the anal canal when you're straining to defecate.
* Other, less likely causes of your severe constipation might be the following types of rectal obstruction:
- a 'rectal intussusception'
- a 'rectal prolapse'
- a 'rectocele'
I don't know anything at all about these except that they involve a change in the physical shape of the rectum. A gastroenterologist should be able to help if your problem hasn't corrected itself by this stage.
See also the letter from Gabby posted in Bowel Disorders (old section) in October - she has a very similar problem to yours.
That's it! I hope this is of help.
John (UK)
chronic constipation help!!!!
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