[incompleteguy]

Hi everyone -I'm a 31 yr old male that has been suffering with the same problem for years now. Basically, I used to be a once-per-day kind of guy. Now, it's 3-4 times a day, feels more urgent than normal, and it comes out fairly loose (but not diarrhea), and at the end, it gets stuck in my rectum. I can strain and bounce and shift side to side and sometimes get another tiny piece out, but I can't get it all out, even if I strain, and then it hurts like you wouldn't believe when I walk around or even adjust in my seat. Been to a variety of doctors...--Had a colonoscopy 5 years ago when this first started, didn't show anything. Still, I'm scared to death of colon cancer (I have had a change in bowel habits that results in going more frequently, sometimes later in the day they can be pencil thin, etc.), so I'm going to get another one soon.--Don't have hemorrhoids--Positive for bacterial overgrowth on two different hydrogen breath tests. Taken rifaximin twice with no improvement or change during or after treatment.--Positive for yeast on Metemetrix test. No improvement after 3 weeks of nystatin. Got re-tested, still positive for yeast. --Positive for hookworm - treated with mebendazole and no improvement or change in symptoms. --Positive for rapid transitNot lactose intolerant, don't have celiac disease. Don't have rectocele. No blood in stool. Any ideas on what else I can do? I feel like I have all of these problems that have been diagnosed, but the standard "solutions" have had no effect whatsoever. Should I try Vivonex to see if I can get rid of the bacterial overgrowth? My GI says that wouldn't help because I wasn't any better on the rifaximin. The only thing that helps is to do an enema to clear out the "stuck" stool. Then I feel ok until the next bowel movement. Thanks for any help anyone can offer. Please, anything, I'm at my wits end.

 

[ziggy7]

http://www.ibsgroup.org/forums/index.php?showtopic=112669this diet should help alot cause by the sounds of it your eating way to much fiber that would explain why it gets stuck alot and also too much fiber is food for nasty gut bactriai like to eat a low fiber & low carbohydrate diethttp://www.biblelife.org/bowel.htmthis link should help alot

 

[incompleteguy]

Thanks, I'll take a look at it. Any other suggestions? Has anyone ever heard of someone that is positive for SIBO not havign ANY response to antibiotics? Is this Candida thing for real (most GI's will say it is not)? Is it possible I have "dumping syndrome"? I do have to have a BM often right after eating. However, I've never had any kind of stomach surgery, so...Thanks!

 

[Kathleen M.]

Dumping syndrome is not just having a BM right after a meal (that is a common IBS symptom as eating sets off the "move it along" signal).Dumping syndrome usually has nausea and vomiting and some other symptoms with it.Now if you've tried 5 different antibiotcs and your breath test is the exact same amount of high after each and every time I would maybe try to get tested at another lab as maybe that lab isn't good, and everyone always comes up positive because they can't do it right.Some people do need to try 3 or more completely different brands of antibiotics. Also I think some people can get rid of the SIBO and still have symptoms from OTHER conditions.Just if you aren't retested after the antibiotics and you didn't try more than one brand it is really hard to say what is going on.The breath test tells you NOTHING about what species you have so it is a random draw if one brand of antibiotics happens to kill the bacteria causing your problems. Taking the same brand 2 times is NOT the same as trying rifaximin and then cipro and then Flagyl.

 

[incompleteguy]

Thanks so much Kathleen. I have done the breath test twice at two different, highly reputable hospitals (one being the Mayo Clinic) and tested positive both times. I have not done Cipro nor Flagyl. Should I encourage my GI to let me try those? He might raise the C. Diff risk as being a reason not to do so. A typical day for me goes like this...9am - modest breakfast (oatmeal and banana)9:30am - BM, fairly well formed but a bit loose and long. There is a bit at the end that doesn't come out (not just the *sensation*, it's actually stuck in there)9:30-11am - Moderate anal discomfort. Feels like a cut, kind of itches and burns. Doesn't hurt too much when seated, but can still feel it. 11am - Another BM. Keep in mind I haven't eaten lunch yet. A bit thinner than the first one and not as big. There is still stool at the end that doesn't come out, and again, it's not just the senation. 11am-2pm (with lunch at 1pm) - Pretty severe anal discomfort. Hurts quite a bit to walk. I can barely do it and not grimace, but it is a major impediment to walking anywhere, even for a short walk. 2pm - Sit down at toilet to try to go again. After some straining and bouncing and rocking side to side, able to get 2-3 very thin (pencil-sized) pieces that are 1-2 inches long. Still have severe anal discomfort due to there still being stool stuck in there that won't come out. 2pm to 2:10 pm - get in shower, turn handheld shower on to "jet" setting, point at anus and get enough water in there that I feel the need to expel it (takes about 10-15 seconds). Basically, a mini-enema. Get on toilet and expel water as well as another very thin 4-5 inch long piece of stool as well as some small bits and shards. 2:15pm - within 5 minutes after expelling stool via shower method, pain and discomfort is completely gone 2:15pm to rest of the day - sometimes another BM, sometimes not. If there is, it's usually in the late evening and all of it comes out, or enough of it not to cause severe discomfort. No pain while sleeping.Forgive my graphic description, but what the heck is this??? It completely ruins every day, makes it extraordinarily difficult and painful to travel since there isn't always a handheld shower nearby. Some days I'm literally in tears until I can get home at 5pm and use the shower to get the stool out. My stool gets thinner and thinner and the pain more and more severe until I essentially perform a mini-enema with the shower, then the pain is totally gone. I have been checked for hemorroids and was told there weren't any, but then again, I was checked when it didn't hurt. Maybe I should get it checked when it does hurt, like at around 1:30pm in my day described above. I feel like regardless of SIBO, candida, etc...I shouldn't be experiencing this much anal pain from unexpelled stool. But maybe I'm wrong? I know I sound crazy, but this is ruining my life. I have a lovely wife and a young healthy baby boy, and I want to make something of myself. This is completely holding me back, making me very depressed at times. I know there has to be a cure...I wasn't always like this...and I'll do whatever it takes to find it.

 

[Kathleen M.]

If the one antibioitic doesn't kill off your bacteria using one of the other antibiotics used for years for other reasons for SIBO long before Rifaximin was ever on the market might be worth doing.http://www.medicinenet.com/small_intestina...rowth/page6.htmIncomplete evacuation is a pretty common IBS experience. It isn't a major symptom of something else. Not sure if that is specific to SIBO or not. If you think you might have rectal hypersensitivity (which is the rectum sends inappropriate signals rather than you have discomfort from excess gas and bloating up higher which seems to be more of an SIBO thing) it may be worth looking at one of the treatments for the enteric nervous system.Rectal hypersensitivity can mean you get severe urgency symptoms even when you aren't full enough to really need to go.You might also need to have the pelvic floor tested, but usually that is strain for an hour for all BM's not so much the incomplete after you go thing.No pain while sleeping is typical of IBS as the colon is less active during sleep.

 

[incompleteguy]

Thank you again, Kathleen. A few follow-up questions to your post:1) What is the C. Diff risk in trying all the different antibiotics?2) Isn't the *sensation* of incomplete evacuation more an IBS thing, not actual incomplete evacuation? 3) Since there is always a fair amount of stool, I wouldn't suspect rectal hypersensitivity. Nevertheless, what sort of treatments are there for the enteric nervous system?4) Why do you think the stool gets thinner as the day (and the pain) progresses?5) Do you believe in the whole "yeast" thing? As in, are you on the side of the Doctors who think it's not true that you can have enteric yeast overgrowth?Thank you again so much!

 

[Kathleen M.]

1) see if this answers your questionhttp://www.medicinenet.com/clostridium_dif...litis/page3.htm2) Sometimes it is the huge gotta go NOOOWWWWW sensation at fill levels that are so small they shouldn't be noticed. If you can eventually force a small amount out there may be a small amount in there (or you just keep working it until soemthing finally gets to the end.When they do anal manometry with IBSers often they feel like they are full to bursting with all the pain and urgency of holding it for hours or days past when you first needed to go. But there is barely anything in the balloon and it is a fill level no normal person will notice. So it isn't just you feel it when you are completely empty, but you may feel it when there isn't really enough in there to go, but you feel every little bit in there like it was a huge amount and you are full to bursting and if you don't go now it will be really bad.3) Doesn't sound like a normal stool amount, just some amount or eventually some amount will show up in there if you work at it long enough.4) Because if you go and go and go and go the stool normally gets thinner and thinner and probably the more you try to force it the more the nerves report more and more that they need to go. It can be a vicious cycle. The more you try to force every last bit out, the more sensitive you are to every last bit.5) If you have HIV, or some other severe immune problem and are seriously ill. If you are among the "worried well" and your blood work is always pretty darn normal and all that, then I don't believe in it. Most of what they treat "worried well" Candida with may have effects for lots of reasons that have nothing at all to do with Candida.

 

[incompleteguy]

Thank you again. My responses:1) Sounds like a round of Flagyl followed by Cipro might be worth a shot2) I have actually had an anal manometry done, and it came out normal. It's as though there's something "sticky" about the stool itself. 3) It's never "gotta go now" it's more "man, this hurts, maybe if I go I can get the stool out." It's like having a thorn in the anus more than anything. It's not a huge stool amount, no. Sometimes it's a reasonable size, sometimes not. But whatever is there causes pain, and when it is excreted, the pain subsides immediately. 4) It seems like whatever is causing my severe rectal pain is the same thing that's causing the stool to become thin and not want to come out. There's something going on that is causing rapid transit. I never used to have to have a BM shortly after waking up. I had a rapid transit test that came back positive. Any idea on what could cause rapid transit? SIBO? Usually when I take Immodium, I feel pretty good for a few days because I'm only having 1 BM during the day and it's usually not sticky. However, that's a band aid not a cure, and sometimes it makes me too constipated. Thank you again so much, this is very helpful and gives me some hope.

 

[Kathleen M.]

Rectal hypersensitivity can be either pain or urgency. Often it is both. They find with IBSers they often end up in extreme pain from amounts of rectal fullness that normally isn't a big deal. Don't know why your test was normal if you seem to be over reacting so much to every bit of stool in the rectum.A BM shortly after waking is pretty normal for healthy people. Not a sign of disease. Not sure about rapid transit. Have you tried something that isn't quite as constipating as Imodium like Calcium Carbonate (caltrate dietary supplement) or Pepto Bismol.?If you have several BM's a day it is pretty normal for the later ones to be thinner and thinner is more common with softer and stickier stools. There is no evidence that something other than consistency effects stool width. The "it has to be cancer or other obstruction" was made up in the 1800s with no data and has never been verified. Stool consistency and width has been proven and many people find a stickiness to softer stools and as I said the more you have per day the softer the stools will become. Even in healthy people.

 

[incompleteguy]

Is the anal manometry the "gold standard" for testing rectal hypersensitivity? Are there any other tests I should consider?Tried Caltrate, didn't seem to have any effect whatsoever. Pepto-Bismol I have not tried.I just don't understand why it goes from somewhat normal urgency in the morning (not diarrhea urgency by any means, but more urgent than when I was "normal") to outright pain a few hours later until it all comes out via the enema. Having a BM upon waking may be normal for some people, but it has never been normal for me. Thank you again Kathleen for providing a light in an otherwise very dark tunnel.

 

[Kathleen M.]

Other than IBS does all kind of crazy things with all sorts of pains.Why couldn't I walk to the mail box without doubling over and crying out in pain where I didn't have the issues you have with pain.I don't know if anyone really knows other than it depends on which parts of the nervous system are twigged.I don't know that they do a lot of diagnosing for rectal hypersensitivity specifically, but in the research I think manometry is one of the places they can tell who seems to have it (where the thing that many IBSers have it, but not all). I don't know of anything else that really explains your severe reactions to even a small amount of stool anywhere near the rectum that goes away after you force it out.Pooping in the morning rather than later in the day is just not a symptom of any particular disease and I pooped right when I got up from when I was very little and long before I ever had IBS, and it is a pretty normal thing for healthy people so while it changed, it isn't a good sign of what is wrong with you other than IBS and IBS tends to act up when the colon is more active and the colon in all normal healthy people every tested s most active in the morning around the time they get up whether they poop or not.I do worry the amount of effort you go to have the poop later in the day may be setting you up for more problem the next time you have to poop. I know just ignoring it for a couple of weeks to see if it fades a bit when you don't go through all that all the time isn't easy. Just it always seems people start with something small and then the whole thing gets more and more elaborate and it never seems to make anything better.