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    transit study & colonic inertia

    I just did a sitzmark transit study while on laxatives (Daily use of enemeez and nightly dose of MoM). This was what my doc emailed me with:

    "So we have demonstrated very slow transit thru the colon - it has been 7 days and there are still markers in the colon
    Of the original 25 markers within the capsule, i can see in today's film, 2 remaining ones in the vicinity of the rectum
    On the first day, 9/21/2016 , half were at the beginning of the colon and half were in the lowest part of colon - this suggests the biggest obstacle to evacuation will be at rectum a/o just above?

    PLUS there is Probably an increased amount of stool as the week progressed.
    You have colonic inertia - the suspicion is that the accumulated mass of stool provides some set of symptoms for you

    The best way to know whether symptoms are due to anything other than constipation, is to not be constipated and see what symptoms persist?"

    I haven't pooped pebbles in over a year, how can I still have such bad GI symptoms with soft stool? Basically every once and a while I will have a few days of feeling so sick that I cant function. I will vomit, be nauseous, have no appetite and have stomach cramps. So bad I do end up in the ER cause of it. I've had almost every GI test done since 2014. My ultrasound of my Gallbladder was clear last Wednesday. What options am I looking at here? How much softer can I possibly make my stool without having an accident. I've been on every laxative in the book, so far the MoM is the only one to give me results on time, in the AM. I have no rectal control, T12 incomplete for 13 years now. I have had 2 kids and do suffer from pelvic organ prolapse. Would surgery for that help? I am at a loss here. Not sure what else to try nor do I full understand how having stool so low in the rectum can cause such upper GI problems.

    #2
    This is a classic presentation of early obstructive megacolon in a person with SCI. You may get by for a few years using stronger and stronger stimulants such as senna, bisacodyl tablets, and multiple suppositories for evacuation. Increased use of softeners and osmotic laxatives are rarely helpful in managing this condition. Many people go on to elective colostomy, with a more proximal (rather than distal) stoma to manage a problem such as this.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Originally posted by SCI-Nurse View Post
      This is a classic presentation of early obstructive megacolon in a person with SCI. You may get by for a few years using stronger and stronger stimulants such as senna, bisacodyl tablets, and multiple suppositories for evacuation. Increased use of softeners and osmotic laxatives are rarely helpful in managing this condition. Many people go on to elective colostomy, with a more proximal (rather than distal) stoma to manage a problem such as this.

      (KLD)

      I have soft stool currently (MoM, Fiber is 25g daily, enemeez) so adding back in Senna or something stronger will get me by for now? Proximal meaning closer to the small intestine's? Where you have to have a bag 24/7? Is it possible a distal colostomy with irrigation would be suffice?

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        #4
        I had a colostomy surgery around 3 months ago for very similar symptoms. Unfortunately, my intestinal cramping and pain are not any better. Only upside is not having to do bp. Good luck to you... And let me know if you find any solutions! I'm at a complete loss too (
        "He gives strength to the weary and increases the power of the weak. Even youths grow tired and weary, and young men stumble and fall; but those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will RUN and not grow weary, they will WALK and not be faint."
        Isaiah 40:29-31

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          #5
          Originally posted by SurfCat View Post
          I had a colostomy surgery around 3 months ago for very similar symptoms. Unfortunately, my intestinal cramping and pain are not any better. Only upside is not having to do bp. Good luck to you... And let me know if you find any solutions! I'm at a complete loss too (
          What is the location of your colostomy (ascending, transverse, descending, sigmoid)? Was the location based on a transit study such as the one described by Chelley above? If yours is too distal vs. proximal of the area of colon most effected by the loss of colon transit, a colostomy may not resolve the problem.

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #6
            Originally posted by SurfCat View Post
            I had a colostomy surgery around 3 months ago for very similar symptoms. Unfortunately, my intestinal cramping and pain are not any better. Only upside is not having to do bp. Good luck to you... And let me know if you find any solutions! I'm at a complete loss too (
            My current GI symptoms are not daily. They suspect that as the colon fills & stretches with stool, thats when I start getting all the upper GI symptoms. I dont feel like this daily, it happens for a few days then will go away. Is your pain daily or does it happen in spurts? I dont have much of an appetite either, has your appetite increased at all? I was just referred to the GI motility clinic in UCSF. They are wanting to run more tests before I make any surgical decisions. If this is indeed the cause, Im praying its just my rectum in trouble. Id prefer a colostomy over an illiostomy.

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              #7
              I went to hospital today and discovered I was really backed up, have pretty good diet, hydrate well & exercise so am pretty pissed off this has happened. Only been taking laxatives for 18 months (61 yrs old, T9 Para & 40 years in chair) Was taking 2 Laxsol to begin with & switched to Normacol Plus (Started with 2 teaspoons & reduced to 1) then went to Senna same thing. Must be me mucking around with doses. The hospital gave me 2 Movicol sachets to take there & then, I also took 2 Senna tonight with MB tomorrow morning. Although still going it is very soft & must be from above where the mass is sitting. Hope for a good BM in morning as tummy feels bloated and want it to go away. Doctor did say my tummy was soft on examination & not vomiting or anything like that (just spasm kicking up) You try and do everything right and things still go pear shaped, being SCI is just wonderful sometimes

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                #8
                I think that the Senna may have stopped working which was why things backed up, has anyone on the forum had a similar experience ? Not sure what to do about this and was hoping forum members had any ideas, been off and on Senna for about 18 months & wonder if it is possible to kick the habit as I see some Spinal Unit websites warning against stimulant use. Was not on before surgery and now kick myself for making the decision to continue and want to know if there is something milder I could use but still make things move through until my own peristalsis is restored. Really freaks me out having all that poo stuck up there and no way to get it down except stronger and stronger laxatives. I have seen a number of posts of members saying that the senna stopped working

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                  #9
                  Do you do your bowel program every day? Slow transit time is the main issue in SCI for most.. Using laxatives makes you dependent on laxatives but they don't do anything for the slow transit time. You must evacuate from below.
                  CWO
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                    #10
                    Have not had transit time checked officially, but did my own test eating some silver beet, Lunch Tuesday, still no sign Friday. SCI - Nurse, do you know if it possible if I could get back to my pre operation no laxative state ? Or after 18 months am I stuck with using some form of stimulant laxative? Do SCI have any sort of program for this sort of thing ? All the advice I was given by GP & specialist was just keep using senna if it is working (which does not appear to be now) SCI - Nurse are you aware of others in the community who have had problems with senna after a while ?
                    And yes I do my BP every day, maybe a good time to kick senna if it not working, is there any other mild laxative I could use to fill the gap ??

                    Comment


                      #11
                      I don't know if this is relevant but there an article about probiotics may help recover after SCI. I will take one probiotic they mention VSL#3 and see if it helps.

                      https://www.christopherreeve.org/blog/gut-health-and-sci-probiotics-as-treatments

                      Gut Health and SCI: Probiotics as Treatments?

                      This is a cool paper, just out in the Journal of Experimental Medicine, from the Phil Popovich lab at Ohio State: "Gut dysbiosis impairs recovery after spinal cord injury.” They found that SCI greatly changes the community of bacteria living in the intestines; the microbiome, as it is called, is significantly disrupted by damage in the nervous system. This results in dysbiosis and it messes with all sorts of body functions, including recovery from injury.

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                        #12
                        It is pretty scary this talk of megacolon hope I do not have the beginnings of this, want a normal colostomy when I was ready

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                          #13
                          I just read that interferential electrical stimulation therapy can help a slow transit bowel, has anyone been on senna for a long time and managed to cease ?

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                            #14
                            Low dose Senna is ok. It is a mild stool softener and laxative. Stool softeners and mild laxative are usually necessary to keep the stool firm- but not lump so it can move- albeit slowly- through the intestine. Other laxatives such as milk of magnesia taken routinely tend to make the bowel dependent on laxatives and the causes accidents and incontinence. Daily suppository or enemeez will keep the colon cleared so even though it is moving slowly it will get there. If you have problems-i.e. AD, distended abdomen and it gets stuck then you need some type of change. Miralax is used and helps. Others decide on a colostomy.
                            cwo
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                              #15
                              Thanks SCI Nurse I am most grateful, tried Enemeez this morning as MB did not seem to be giving the same kick, worked well but afterwards my butt felt like I had given birth to a basketball. Found an interesting article online written by a women who titled her story "Get Your Bowels working again after Laxative addiction & Bulimia" She started taking laxatives aged 11 & started recovery at 20. Her top tips to get bowels working again 1. Increase fiber intake 2. Have hot drink in the morning 2 or 3 cups of Peppermint or Green tea about 30 minutes before eating to stimulate the digestive system 3. Eat healthy wholesome breakfast 4. Aim at eating about 5 small meals a day which makes you feel less bloated 5. Exercise 6. Positive reinforcement 7.Keep food diary 8. Decide 100% you want to recover. And if you cannot go cold turkey it is OK to have the occasional laxative.
                              Also on another site with similar subject the advice was in part, to avoid Gluten & Casein as both have been proven to prevent peristalsis. Eat fat, vegetables & take probiotics. Is not Senna only a stimulant, Laxsol has Senna & Softener ? I have been on Senna for just under year & half and want to kick the habit, was given Movicol at hospital when the x ray determined had a lot of poo to come down. I thought Senna being a stimulant was habit forming that is why they say on the packet to only take for short duration
                              Last edited by gommer; 23 Oct 2016, 7:55 PM.

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