[16430]

I have had a bunch of diagnostic tests done to discover the cause of constipation.The tests area) colonoscopy - clean anal manometry - revealead paradoxical contraction of puborectalis musclec) defecography - cleand) gastric motility - cleane) capsule endoscopy - cleanf) small bowel manometry - revealed less contractions than expectedBased on the tests, I have been told my by doctor that the root cause of my constipation issue is that nerve endings in the stomach are damaged. Since zelnorm has been helping me he said that I should continue on it and that the nerve endings will have to recover on their own. It is a process that may take several years or may never happen at all :-(.I have been taking zelnorm for past 3 months while this problem is present for the past 2 years.Has anyone else been diagnosed with similar issues.Any inputs on trying alternative therapies? The doctor has given me permission to investigate other treatments since there is really no cure in western medicine except wait.

 

[SpAsMaN*]

quote:Based on the tests, I have been told my by doctor that the root cause of my constipation issue is that nerve endings in the stomach are damaged.

WOW.That's new to me.

 

[flux]

quote:

anal manometry - revealead paradoxical contraction of puborectalis muscle

This suggest you have pelvic floor dysfunction. That implies you could benefit from biofeedback. Incidentally, this problem does not involve the nerves of the intestine per se.

quote:f) small bowel manometry - revealed less contractions than expected

There's insufficient information here to know what that means exactly. Does it mean that you don't convert to fed or fasting states or that you don't have phase IIIs or that you do, but the contraction amplitude is lower than normal.

quote:Based on the tests, I have been told my by doctor that the root cause of my constipation issue is that nerve endings in the stomach are damaged.

The information you presented suggests there is a problem and perhaps two problems, but this conclusion is actually not supported by it. It doesn't seem that you had any studies of colonic motility, either colonic manometry or colonic scintigraphy (or any study of bowel transit). So while it may be true, the evidence doesn't actually support it. You can be "helped" by Zelnorm even though the conclusion is not true, so that doesn't necessarily tell us much. It seems a bit strange that you could have gotten all these sophisticated studies, but somehow did not get any kind of transit study for the colon.

quote:WOW.That's new to me.

On the other hand, it is certainly reasonable to assume that some percentage of the people on this board have to one degree or another some form of enteric neuropathy. So that's not at all new. In fact, what would be new is that were actually not the case.

 

[16430]

Thanks for a comprehensive responseI am appending my small bowel manometyr report for more details at the end of this post. No abnormality was seen except low amplited waves in the antrum and small intestine after I was fed the meal. Am not sure what it means exactly. Am hoping you would be able to throw some light on this.As for colon transit - am not sure why it was not done. One possible reason is that I have incomplete evacuation - not complete constipation. Also , a rough experiment possibly is that when I eat beetroot I can see the color of the stool changed the next day so hopefully the transit time is good. I do have daily bowel movements except they are *always* incomplete(until I started taking zelnorm)Thanks for any answers.Small bowel manometry report appendedProcedureUnder a combined endoscopic and radiographic guidance, the small bowel motility catheter was placed in the jejunum beyond the ligament of the Treitz. The catheter was then connected to a special recording device and a continuous recording of the gastro duodenal pressure profile was obtained over a 5 hr period. During the first 3 hours the patient remained fasting(fasting state); Patient then ate a standardized meal and recording was continued for additional 30 minuts instead of 2 hours (fed state)fasting state:measurementa) mean cycle duration(period between phase III complexes): Not applicable. Only one phase III seen Initiation of phase III (gastric or ectopic): GastricAbnormalitiesa) Bursts of phasic activity of abnormal duration (> 2 min), amplitude (>20 mmHg) and frequencey (10 - 12 / min) which are non propagating and distinct from phase III activity of IMMC: NO Sustained (>30 min) poorly coordinated phasic activity, isolated to one or more sengments of the intestine: NOc) Low amplitude contractions: NOd) Absent, incomplete or retrograde propagation of phase III complexes covering a distance of at least 30 cm: NOe) Prolonged (>3 min) increase in basal tone (>30 mmHg) during phase III activity:NOf) Retrograde contractions:NOg) Lack of phase sequence : NOFed stateAbnormalities:a)Persistance of fasting pattern after a small meal:NO Low amplitude waves in the antrum and small intestine: YESc) Bursts of non propagating phasic contractions: NOd) Premature return of phase III within 90 min of the meal: NOe) Broad based contractions occuring in the presence of increased tone (minute contractions): NOImpressionThis is an abnormal study that reveals evidence of postprandial gastric hypomotility during the 2 hour post prandial recording period and may explain patient's symptoms.

 

[SpAsMaN*]

Perhaps you have slow gastric emptying or dumping syndrom.I seriously doubt that a stomack problem could creat constipation.The colon has is own brain.

 

[SpAsMaN*]

In other hand,the digestive system may act like a drain.If a part is semi-obstructed it can creat numbing of the stomack(the gas isn't moving freely).

 

[SpAsMaN*]

Perhaps your doctor do the rigth testing.At least he seems to investigate your condition.That's a step in the rigth direction.

 

[flux]

So the report says

quote:and recording was continued for additional 30 minuts instead of 2 hours (fed state)

So that seems to imply that after you were fed, the study was stopped after 30 minutes and that they didn't record for the full 2 hours.But the conclusion says

quoteostprandial gastric hypomotility during the 2 hour post prandial recording period

Well, that seems to imply that they did record for 2 hours after the meal, so I'm confused.Also, it appears that sole abnormality is

quote:

Low amplitude waves in the antrum and small intestine: YES

So let's assume they really did record for 2 hours. Seeing this I wonder whether it was during the entire time or near the end. Near the end could imply delayed gastric emptying, but you previously noted

quote:d) gastric motility - clean

which to me, was a gastric emptying scan and that abnormality wasn't observed. So in that sense the two studies are somewhat contradictory.What I would ask is whether during the manometry and after eating, did you feel symptoms, like feelings of fullness, indigestion, nausea. That would correlate to the finding, but based on all what I see here and your complaint of constipation, I don't think it's a clinically significant finding.

quote:I do have daily bowel movements except they are *always* incomplete

It seems that your real problem is pelvic floor dysfunction and it is interesting that Zelnorm is helping with that. I could only guess for whatever odd reason, the defecography didn't show it.