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**SCI-Nurse** · 29 May 2022, 5:19 PM

Your questions are two-fold
1. The hemorrhoids could be causing problems if you sit for a lengthy period of time and vigorous dig stim is performed for a bowel program the incidence of internal and hemorrhoids can be a big problem. I’ve seen veterans actually have such swollen hemorrhoids that it difficult for the stool to be expelled. Re-education on dig stim techniques can help or switching to a mini enema can help replace the dig stim to reduce hemorrhoid size.

2. Your bowel program being off with occasional diarrhea or accidents can be an indication that you could be constipated. Sometimes doing your bowel program daily can get your bowel program back on track.

Keep us posted
SCI-Nursepbr

**HACKNSACK44** · 30 May 2022, 8:08 AM

Have you thought about a colostomy? Best decision I have ever made!

**SCI-Nurse** · 30 May 2022, 11:39 AM

Your bowels can slow down (less peristalsis) due to aging or other medical conditions such as diabetes, or drug side effects (such as anti-hypertensive drugs).

Hemorrhoids do not change the rate of peristalsis, although in people with sensation and bowel control they may add to constipation by them deliberately avoiding having a bowel movement (holding it in), which is painful.

Is the "second wave" you are having mostly dark brown mucous, and not actual stool? If so, this may be what is affectionately called by my people with SCI "butt snot" or "afterburn". It indicates too strong of a suppository, the wrong kind of suppository, or too much and prolonged digital stimulation (I assume this is what you mean by "touching").

What type of suppository are you using? If it is bisacodyl, is it generic or Dulcolax, or is it a Magic Bullet? Have you tried either Enemeez or a glycerine suppository?

What laxatives have you been taking on a regular basis, and for how long?

Are your hemorrhoids bleeding a lot? Witch-hazel may temporarily reduce their size, but will not prevent them from bleeding or swelling again. I would suggest you see a good colo-rectal surgeon and discuss a procedure to remove or sclerois those hemorrhoids.

At the same time, you could discuss a colon transit time study, as with your long history, and long use of laxatives, you may be on your way to developing an obstructive megacolon.

(KLD)

**RJC** · 7 Jun 2022, 8:56 AM

Originally posted by SCI-Nurse View Post

Your bowels can slow down (less peristalsis) due to aging or other medical conditions such as diabetes, or drug side effects (such as anti-hypertensive drugs).

Hemorrhoids do not change the rate of peristalsis, although in people with sensation and bowel control they may add to constipation by them deliberately avoiding having a bowel movement (holding it in), which is painful.

Is the "second wave" you are having mostly dark brown mucous, and not actual stool? If so, this may be what is affectionately called by my people with SCI "butt snot" or "afterburn". It indicates too strong of a suppository, the wrong kind of suppository, or too much and prolonged digital stimulation (I assume this is what you mean by "touching").

What type of suppository are you using? If it is bisacodyl, is it generic or Dulcolax, or is it a Magic Bullet? Have you tried either Enemeez or a glycerine suppository?

What laxatives have you been taking on a regular basis, and for how long?

Are your hemorrhoids bleeding a lot? Witch-hazel may temporarily reduce their size, but will not prevent them from bleeding or swelling again. I would suggest you see a good colo-rectal surgeon and discuss a procedure to remove or sclerois those hemorrhoids.

At the same time, you could discuss a colon transit time study, as with your long history, and long use of laxatives, you may be on your way to developing an obstructive megacolon.

(KLD)

My PSW is very knowledgable in general and he’s been with me over 2 stints pretty much 20 years… He’s as careful as he can be during the routines and always tells me if he’s feeling extra irritation and tries to stay away from the internal haemorrhoids when stimulating if he can as much as possible. We are doing our best to limit the amount of digital Stimulation required each routine.

I did go to a colorectal surgeon about three months ago to get sclero therapy… Unfortunately when he inserted the probe to look around he was not gentle enough and ended up popping the main haemorrhoid that was the one I needed to get injected… He ended up still injecting it but there was a lot of bleeding at the time and I’m not sure how much of the solution actually stayed within it… And he wasn’t able to apply the solution to any others. I think at the time it did help for a little while but it didn’t really have an opportunity to fix the situation as much as it should have. My PSW tells me he still feels it notably internally when doing a touch. I may have to go have that redone again in the future hopefully with the doctor being more careful this time so I can see if it gets better results.

I don’t get bleeding as often as I was before I went to see a colorectal surgeon. Maybe every fifth time there’s a small little bit of blood… But I’m pretty careful and aware now given that I know I have internal haemorrhoids about not irritating them too much so I can usually avoid bleeding… Plus I have sensation that’s almost fully intact so I can tell when things are getting irritated. I did try Anusol suppositories once for internal relief and they did work well… it’s just when I sat up during the day and all of the excess basically leaked out which was pretty fucking gross. So I haven’t really use them that much.

It’s been so long I don’t think about it but I’m pretty sure it’s a 10 mg bisacodyl suppository. I’ll have to double check. The second wave I’m referring to is just some loose diarrhoea that seems to come down later on instead of initially… I’m not sure if it’s just the last bit of food in my system ending up looser because of the laxatives I’m taking and/or potentially because sometimes I have to get up a little quicker because my bowels start moving that I’m not getting an opportunity to lay on my side with a suppository as long as I should sometimes for everything to stage lower. It’s not all the time but sometimes. Kind of depends how things fall down early on once I get up. I can usually feel the pressure across my upper belly if there’s still stuff in there that hasn’t come down.

I’ve always use the same suppositories over the years. Never tried anything different. Though I have thought about getting enemeez but they are really expensive for me to ship here into Canada it seems like.

For laxatives on Tuesday Thursday I take 3 1/2 milk of mag tablets and one 5 mg bisacodyl tablet… On Sunday I’ve been taking 4 milk of mag tablets. Not sure why exactly but that had always been the combination that worked for me for the longest time.

As I said I’m not getting up and having diarrhoea or anything in the morning… It’s more like probably what your average person would consider a normal bowel routine… Getting up and there’s formed stool in the lower area or the very lower bowel and just ready to come out. So I sit there for a little bit and generally comes out and then I do maybe one or two checks hopefully at worse three to make sure whatever residue was there comes out so it doesn’t fall out during the day. But it’s weird because I never had that problem before. I would always be able to get to the next day without any problem. The only times I ever ran into some problem like I said is if I ate something that didn’t sit well with me, if I was upset about something heavily, or on the three day weekend stretch which is a long time to push not going to the bathroom… But I usually tried to mitigate the pressure by eating very lightly on Friday and Saturday and usually stuff that was predominantly meat or bread or cheese that wasn’t easy to process. That’s kind of why I’m wondering if maybe when things calm down now that I have more irritated internal haemorrhoids it’s making me feel like I got to go instead of maybe just being able to sit there for the extra time that I used to wait.

I’ve started to wonder if I have a little bit of IBS potentially because I noticed a lot more foods leave me burping… And I find I’ll be burping several hours after eating… So I’ve tried to go back and see what foods don’t make me burp after eating them. I’ve narrowed down a couple which I’m good with… But I haven’t completely filtered out everything and it’s a little difficult with having to have a balanced meal at supper. Plus I’m trying not to make it too hard for my fiancé to manage her meals. But I’m trying to start getting her to pick up low fodmap foods from the grocery store for me so I can try more of those to see if I feel better which is more of an IBS diet.

I’m not exactly sure what an obstructive megacolon is… I don’t feel like I’m not fully emptying on my routines… I just feel like when I eat something it’s coming through me quicker than before.

The only other major change is that I’m living with my fiancé now and she tends to cook richer foods. She likes things that have sauces on them, she likes to use the slow cooker, where as when I was living with my parents my mom cooked predominantly dryer blander foods that rarely had sauces on them and she never used a slow cooker, it was always cook them in the oven. I may have to have that conversation with my fiancé to see if I can try her to just cook blandly like my mom used to for a week or two and see if that affects my routines. She’s not making things that are super spicy but I could see something in a slow cooker that’s keeping more of the grease potentially around the meat or even more things with barbeque sauces etc. on them possibly maybe playing apart because I’m not used to eating like that and sometimes my tummy is sensitive.

Can a long-term use of laxatives cause your system to start going more frequently? Like can some of the laxatives be hanging around in your system whereas before they used to flush out? I was wondering about that and maybe trying to lessen the amount that I take as well as trying to pay attention to what I eat and how my routines go.

Oh and to answer the other question asked, NO a colostomy is not on the table, that’s not something I want to consider. I know some people feel it was a great decision for themselves but it’s not a direction I want to go with myself.

**SCI-Nurse** · 7 Jun 2022, 12:21 PM

Suggest you do a "poor man's" transit time study. Eat a cup of canned or frozen corn, then see when you see the hulls come out in stool. It should be 72 hours or less. If it is longer, you could be developing an obstructive megacolon. You have used strong laxatives for a long time, which is a significant risk factor for this condition long term with SCI.

No, laxatives don't "hang around" in your body, nor do they cause diarrhea (which is technically 3 or more loose stools in a 24 period) in low doses.

Obstructive megacolon is a condition that some with SCI can develop where the large intestine gets stretched out and looses it's muscle tone and peristalsis. The bowel becomes a huge floppy bag of stool. Stool may still move but slowly, and primarily by gravity. It is found most often in people with SCI who have used strong laxatives for a long period of time. Not all GI physicians know about it.

You may need regular hemorrhoid surgery for your internal hemorrhoids rather than sclerosing injections or banding, which work best for external hemorrhoids.

(KLD)

**RJC** · 8 Jun 2022, 6:34 AM

Originally posted by SCI-Nurse View Post

Suggest you do a "poor man's" transit time study. Eat a cup of canned or frozen corn, then see when you see the hulls come out in stool. It should be 72 hours or less. If it is longer, you could be developing an obstructive megacolon. You have used strong laxatives for a long time, which is a significant risk factor for this condition long term with SCI.

No, laxatives don't "hang around" in your body, nor do they cause diarrhea (which is technically 3 or more loose stools in a 24 period) in low doses.

Obstructive megacolon is a condition that some with SCI can develop where the large intestine gets stretched out and looses it's muscle tone and peristalsis. The bowel becomes a huge floppy bag of stool. Stool may still move but slowly, and primarily by gravity. It is found most often in people with SCI who have used strong laxatives for a long period of time. Not all GI physicians know about it.

You may need regular hemorrhoid surgery for your internal hemorrhoids rather than sclerosing injections or banding, which work best for external hemorrhoids.

(KLD)

I forgot to mention about two or three months ago I had a colonoscopy and my Doctor Who is a colorectal surgeon said everything looked normal and fine. So I assume was a developing in obstructive megacolon he would’ve seen that during the scope. But thank you for the explanation.

I figured it would be difficult with the bar routines to actually have a haemorrhoid surgery. That’s why he wanted to try the sclerotherapy. Like I said I may opt to try it again. I think for the first little while it did work but he had traumatized the site quite a bit so it was unfortunate.

**beckman** · 9 Jun 2022, 2:52 PM

Originally posted by SCI-Nurse View Post

At the same time, you could discuss a colon transit time study, as with your long history, and long use of laxatives, you may be on your way to developing an obstructive megacolon.

(KLD)

What are the signs of obstructive mega colon? Could long term use of, dicyclomine cause an obstruction ?

**SCI-Nurse** · 9 Jun 2022, 7:26 PM

I've never seen any literature relating dicyclomine to obstructive megacolon, but you should discuss it with your GI physician.
Signs and symptoms include prolonged time for evacuation (3-4 hours or more), significantly decreased transit time (much longer than 72 hours) as well as X-ray or CT showing a large grossly stretched out colon with few normal indentations, that is full of stool.

(KLD)

**RJC** · 16 Jun 2022, 5:47 AM

Originally posted by SCI-Nurse View Post

I've never seen any literature relating dicyclomine to obstructive megacolon, but you should discuss it with your GI physician.
Signs and symptoms include prolonged time for evacuation (3-4 hours or more), significantly decreased transit time (much longer than 72 hours) as well as X-ray or CT showing a large grossly stretched out colon with few normal indentations, that is full of stool.

(KLD)

I have always been on condom drainage. I know my bladder doesn’t empty easily 100%. Sometimes there’s a small residual. I’ve always had a small chronic bladder infection that’s been nonsymptomatic. Every year I get an ultrasound of my kidneys and my bladder. I know I have a couple diverticuli on my bladder. I don’t have any Hydro nephrosis on my kidneys which is good. But I noticed sometimes over the winter when I’m stuck inside, especially if I haven’t been drinking a lot of liquids, mostly clear liquids that is, that sometimes that bladder infection gets a little more irritated and angry and it’s a bit more difficult for me to empty my bladder. Usually I continue taking vitamin C Cran max and drinking a lot of clear fluids to try to flush it. But what I’m wondering is could irritation from your bladder affect your bowel routine? Not necessarily being sick from infection per se but perhaps the bladder getting irritated during the day, maybe at night from being over full, would that cause some irritating properties on the digestive tract?

**SCI-Nurse** · 19 Jun 2022, 8:27 PM

they are located next to each other. Chronic constiptation has shown More irritation of the bladder, UTI’s and a full bladder can contribute to bok problems. No symptoms of bladder infection-then we consider this “colonization”, not an infection. I explain it this way- colonization is similiar to when the Native Americans and Pulgrims lived near other and worked together peacefully as organisms are in the bladder but getting along. UTI- when the Native Americans and pilgrims started killing each other etc… not getting along. UTI is like this-the organisms have increased abd/or changed and now symptoms occur-more bladder spasms, other muscle spasms increased also, low grade fever, feeling more tired than usual, pressure over bladder, blood in urine-some symptom -can try drinking more water, other interventions but don’t wait to long as it can get in bloodstream and sepsis occur. CWO

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Bowels – having to go every day lately

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