constipation: feeling of obstruction (fecal impaction or just a "lazy colon?")

I've read through many of the posts on here and found them pretty helpful, so I figured I'd post up my specific situation to see if anyone out there can give more specific feedback regarding my condition.

I went to the doctor, suspecting fecal impaction. The doctor said I have a mild case of constipation and have a "lazy colon." They took an x-ray and saw lots of stool in my colon, as well as pockets of gas that could not come out until the stool ahead of it was released. Based on the x-rays, the doctor told me there was no impacted stool, but the stool was just taking a long time in moving through my colon, possibly because the colon was stretched out so that sensation of "having to go" was not as constant. The doctor also initially did a manual test by sticking a lubricated finger into my rectum and first noted that he did not feel any impacted stool but also noted that my sphincter was very tight. I was basically prescribed Colace and told to maintain a healthy fiber diet and drink lots of water.

Now, about my condition. I've never really had constipation in the sense that I've passed hard, painful stool. From time to time, they have been that way, but most of the time the problem was straining and a feeling of obstruction. I've read that constipation, by itself, without impacted stool, can cause a feeling of obstruction and the sensation that the bowel is not empty. But since my stool is not little lumps, per se, and not dry and hard like the kind of stool one would expect from constipation, I am wondering if my condition is in fact fecal impaction or a problem with my rectal muscles.

The stool: when it comes out, most of the time it comes out like a paste. Almost like squeezing out toothpaste. It's not pencil thin, but usually not round but somewhat flat-looking, light-brown to medium-brown in color, relatively soft, but thick like paste and sinks right to the bottom. When I feel the urge to go, it's often because I have to release gas, and then once the gas is released, I sort of feel the urge to release stool, and after a while, the paste-like stool is released. Afterwards, I still sort of feel the urge to go, but my butt feels plugged. Every once in a while, when it feels plugged, I strain a little bit (not hard, but more try to move the rectal muscles to get movement without holding my breath), and a small "clump" of stool will pop out (the clump is not as paste-like but more like hard stool, but not painful), but the sensation of obstruction will still be there, and I always feel like my bowels are not empty when I am done.

For many weeks now, I've done just about everything I've read that helps with constipation. I've dramatically increased my fiber intake (broccoli, carrots, wheat everything, peas, bran cereal, etc), drank more water, cut back on most other foods and any kind of caffeine, added Citrucel to my diet, dried Apricots and raisins (although I've heard they can cause gas so I've cut back a little lately just in case. Anyone know if this is true?). I've taken juice from lemons, eaten prunes (although haven't tried prune juice yet), and continue to make my fruit smoothies, which basically consists of frozen strawberries, a banana, strawberry yogurt, and a little bit of milk or soy milk to make it more drinkable. And I've taken a Colace tablet every day for about a week now. Despite all this, my condition seems about the same. Although I guess it has only been a few weeks and it might take longer if it is a muscle issue to see results.

In terms of my physical condition, I'm fairly in shape, lift weights, exercise from time to time, but obviously, as a student, there have been many times I've not taken care of myself the way I should. But like I said, my bouts with constipation were never that serious up until now. However, I have had symptoms of constipation dating as far back as perhaps 5-6 years ago, but not continuously.

I'm thinking a lot of it may be due to stress, even though I don't necessarily "feel" stressed, since I'm studying for the bar right now, and 3 years of law school wasn't really a relaxing walk in the park. I'm one of those people who tends to deal with problems on my own, and I've heard that even if you don't "stress out" in an obvious way, there can still be a strong affect on your body. So perhaps that's what's causing a lot of this?

As my condition stands now, I normally don't feel a serious urge to go, but do have bowel movements, oftentimes after releasing gas, and the stool is not always paste like but sometimes bigger but crumbly when it hits the water, so it's not like it's always squeezing out. But in general, that's how it is, and I always feel like there's more that can't come out. Usually, a few hours later, I sit down and can make it come out, but never all at once. There are times where I feel like something wants to come out, but it can't, perhaps because it's too big (impaction). Again, I'm not sure if it is in fact impacted stool or perhaps just the "sensation" of obstruction, but many times I'll feel the strong urge to release it and it'll feel like something's stuck. But based on the doctor's x-ray, he said there was no impacted stool. Could the x-ray be wrong?

This post got pretty long. Any comments would be much appreciated.

you need to speed up your transit time and get the stool all out at once,if you tried the food protocol.insoluble fiber is what speeds it up and soluble
fiber is the bulk up your stools.i recommend miralax untill you get your system
running again ,its over the counter now.stay on your colace and take one
scoop in the morning or night and see if it works and regulate it after that
for as a normal bm.miralax is not a stimulant laxative and can be taken for
a long period of time and will not be habit forming,it does not interfere with
electrolytes and is very gentle,compared to moms and other osmotic laxatives, most doctors wiil put you on these after test with your similar
conditions.try it for two weeks and you will find that fiber plus miralax will
get you the kick start you need.some people fiber alone does not help
and you need a additional additive to help , having IBS is one example
and no matter what kind of fiber you eat there is always bm problems.
this will save you a lot of stress try it ,i use it and know people since 1993
who use it daily without any side effects.

Thanks Lodgen for the advice! I'll try miralax and see how it goes. I do agree that one of my problems is the need to speed up the movement through my colon so that I don't have only small chunks getting through. My only concern is the sensation of obstruction I sometimes have, because sometimes when the stool comes out it feels like it's really squeezing out as if there's impaction. But maybe that's more due to my rectal muscles? Since I don't always feel like it's impacted, I'm hoping maybe it's just the muscles. Anyway, will see how miralax works out and hopefully I can post up some good news soon!

A quick update:

I've been taking Miralax along with Colace for the past few days, and it does seem to be helping. In fact, the day after I first took Miralax, I got a little more relief than usual. However, the feelings of incomplete evacuation does still persist.

I'm wondering if my symptoms actually indicate IBS? I'm not constipated in the sense that I have hard stool, so the Miralax and Colace aren't helping with making my stool more passable, but just in drawing water in to my colon to make the "urge" to go stronger, I think. Even without it, I do feel the urge, but not that strongly that after some stool comes out, my rectal muscles close up and nothing more comes out. That's the feeling of "incomplete evacuation" I have. I don't think it's impaction since the shape and texture of my stool does not indicate I have impacted stool. I think it's just my rectal muscles aren't as controlled as they should be and don't facilitate the movement of stool like it should. Is that IBS? The stool itself is soft and of a medium brown color, so I think I'm just suffering from the inability to control my rectal muscles. Any suggestions?

And for anyone considering Miralax, Colace, or Citrucel:

I take all three and do find them helpful. Citrucel is actually quite tasty, and although I'm not lactose intolerant, I take it with vanilla soy milk, which makes it all the more tastier. And it does help bulk up the stool. For me, I end up taking 2-4 scoopfuls throughout the day, and I think that's an OK amount, depending on how much other stuff you eat.

Miralax with orange juice is good. It has no taste and you don't even notice it. I think the Miralax has helped more than the Colace, which is more a relief for hard stool, which I don't have. Miralax draws water into the colon somehow, which I think speeds up stuff through the colon and creating that urge to go. Otherwise, you'd just have clay-like stool sitting in your colon (hence, constipation), slowly moving along until it comes out hard and painful. For me, since I don't have constipation, the Miralax helps to just move the stool along and create that urge, which seems to make my rectal muscles more likely to open up.

Just thought I'd share my experiences in case anyone finds them helpful. But if anyone else has any thoughts about my condition, please let me know. Thanks!

Hey Mike,

I have the same issue almost perfectly to your description. I've had it for atleast the last 9-10 months. Unfortunately, this issue continually aggrevates my anal fissure.

It seems no matter what I do, I can't get the front part of my stool to be soft. It's not hard, just clay like and seems to have a texture of clay-like pellets lumped together. Usually the following 4/5ths of my stool are mushy and fine. I was having a feeling of not fully passing all the stool for a while, but even now I feel like I am passing 99% of it and still get the clay-like front.

A GI doctor told me it was IBS without any tests, but I think they use that diagonsis a lot. Before this, I never had a problem with any food or my stomach. I do think it has to do with stress. I can describe my stress the same as yours...it's there, but not to a degree beyond what I thought was normal.

I've been drinking plenty of water, I exercise regularly, and I know I'm passing my stools contain on a daily basis. Usually, I tried to eat a "marker" food, like corn one day and then peas the next and see if it shows up in my stool and it usually does show up the next day.

I cannot have a colonoscopy at this time due to my anal fissure, but I would probably get one just to be safe after it heals. Ironically, a lot of the people I've spoken to about anal fissures describe there bowl movements in the same way as we have. The anal fissure is the result of constipation, not the cause however.

If you find out any other information, please let me know!

You might have pelvic floor problems. That's when the muscles aren't working properly and constipation or slow transit is happening. I have this problem. I don't have hard bms but I have to strain to go. Unfortunately it caused me to get an anal fissure and that's a whole other pain (literally) in the butt. I now take miralax before I go to bed at night and it's help with the feeling of fullness in the colon. All my doctors tell me it's safe to use daily and for the rest of my life. I hope you find some relief soon Suzy.

I have the same problem I strain & strain maybe one or two hard balls come out but I have lower stomache pain & the feeling that my bowel is not empty. I too drink a lot of water.

I am going to try colace or miralax.But do any of tou experience lower stomache pain also