Pelvic Nerves and Defecation - Flux, K or Anyone?
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I too would like input from Flux and others.I have been researching the Defecation Reflex. I found many definitions and explanations. The one below seems the most complete to me. I have an appointment with my GI Specialist next week. I have been told by my Neurologist (I have Multiple Sclerosis) that my problem with defecation may not be with pelvic floor muscles. There are tests, I believe from my research, for this to be determined. I will know next week! Unless Flux or someone knows which tests would be appropriate to determine whether my problem is muscle related, nerve related or both.Process of Defecation.1. Rectum distended by entrance of feces or voluntary increase in abdominal pressure. a. Internal sphincter relaxes. b. External sphincter transient constriction due to voluntary removal of excitatory input to sphincter. 2. Increased rectal pressure moves stool through anal orifice when both sphincters relaxed. 3. Defecation reflex reinforced by parasympathetic reflex. a. Activation of pelvic nerves by rectal receptors causes contractions of descending and sigmoid colon. b. Enhances intrinsic inhibitory influence on internal sphincter. c. Releases VIP. (1) Increases mucous secretion in distal colon. (2) Facilitate feces movement. d. Can empty descending colon, sigmoid colon, and rectum. 4. Sympathetic nerves do not contribute to defecation act. 5. Valsalva maneuver. a. Increases intra-abdominal pressure. b. Forces pelvic floor downward. (1) Straightens anorectal angle. (2) Reduces resistance to fecal movement. 6. Squatting position flexes hip to align anorectal angle.------------------Take care, Forever Vikee[This message has been edited by vikee (edited 06-21-2001).]
Huh? I don't get it. What's with the down thumb?There are two main studies of defecation: defecography, which is an X-ray procedure and anorectal manometry, which involves measuring the actual pressures.See the thread where I discuss incomplete evacuation... http://www.ibsgroup.org/ubb/Forum1/HTML/017497.html ------------------I am not a doctor, nor do I work for profit in the medical/pharmacological field, but I have read scientific and medical texts, and have access to numerous sources of medical information that are not readily available to others. One should always consult a medical professional regarding advice received.
Thanks Flux,I appreciate the info and will review that thread. I am so grateful you are here!You were fast with this! I just called out your name and you were there!!! That�s sorta the first line to a song that I can�t remember now.I love to sing happy songs, even on a BB!! That�s why I am, Forever Vikee
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·Is it possible to damage these nerves and muscles somehow? There was a big study on nerves in the pelvic area and bikeriding, is there a possible link to IBS with nerve or muscle damage anywhere? Is it possible to damage these nerves/muscles by bad habits or injuries?...Like sitting at a computer for 12 hours a day for years? I've heard people here say sitting at the 'puter causes problems for them.Or, possibly bikeriding? Bike-riding has recently been blamed for a serious risk of impotence problems with many men. Apparently sitting on a bike seat puts pressure on the nerves that run through there and can cause serious problems. I don't know much about these issues but, I was wondering if there were any physical changes/injuries etc, associated with IBS, especially people who don't show symptoms till later on in life, 20's, 30's, etc. Sorry if I'm way off topic, this just reminded me of the biking study and I got to thinking.
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Some people have problems with the pelvic floor (not sure how much is muscle problems or how much is nerve problems).Bike riding could be a problem because you are putting weight on areas not really designed for carrying your weight. In a normal chair you are sitting on the part of the bones that normally support your weight while sitting and that shouldn't be as much of a problem as narrow bike seats.Sitting for hours on end can be a problem with constipation simply from the inactivity. Movement tends to help move things along in the colon.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html
Ooops sorry, was rather excited reading the earlier post on this and rushed it - meant to add the Blue Q
Hey vikee, could it be that uhhhh, "You've Got A Friend" maybe ? It's either you've got a friend in James Taylor or Flux. Anyway, just call out his name and you know wherever he is, he'll come runnin', cause you've got a friend.(I love JT, just a singin' his songs).Now if you don't mind, I think I'll go "Up On The Roof" (not).
Hi Moldie,I remember, "Up On The Roof" and again can't think of the rest of the words now. That's my memory problem with the Cognitive Deficits of MS! I hate that!! But the memory comes back. As do memories of debate and Candida!Yes, I remember now, James Taylor.... "Just call out my name and remember wherever I am, I'll come running....."And I consider Flux, James Taylor and You all as Friends. As different as each of you are, I respect all of you!! And consider each a Friend! That's just the way I am and have been Forever! Even when I was a little girl![This message has been edited by vikee (edited 07-06-2001).]
I think there's other variables though, like how formed the stool is. If your colon didn't move the stool properly and it was overly formed in the sigmoid area for example ("rabbit pellets" as one example) then the defecation process seems to get messed up. So I think you could be normal in the rectal area but have problems because of stool formation.
I think there's other variables though, like how formed the stool is. If your colon didn't move the stool properly and it was overly formed in the sigmoid area for example ("rabbit pellets" as one example) then the defecation process seems to get messed up. So I think you could be normal in the rectal area but have problems because of stool formation.
vikee and the fluxster thanks for the info.Please keep us posted on how u go on with the doc next week.jorok my GP tells me that some women experience the big C after hysterectomy and he thinks this could be due to injury to the pelvic nerves. He says it produces IBS like symptoms.
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KKat
vikee and the fluxster thanks for the info.Please keep us posted on how u go on with the doc next week.jorok my GP tells me that some women experience the big C after hysterectomy and he thinks this could be due to injury to the pelvic nerves. He says it produces IBS like symptoms.
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KKat
KKat, This gives you an description of my problem with defecation. I gave this to my GI Specialist as I explained my problem and what I was doing. I have cut out parts that are even more detailed! �I use Metamucil and lots of water daily. I learned to wait till I have a strong urge for a BM and then relax and wait for contractions of the defecation reflex. The contractions don�t come....... I use my stomach muscles and breath holding to expel feces (Valsalva maneuver). I can not feel the feces move from my rectum to the toilet. I don�t know when I�m finished or how much has come out. There are very very long formed stools that comes out without any contractions to let me know know when to stop pushing, so I take breaths and push with my stomach muscles and stop when I get tired. .....Then this process repeats itself a few times. Eventually I can push no more out. The feeling of incomplete evacuation stays with me for close to an hour and then goes away.�He agreed that what I�m doing is the Valsalva maneuver. �I learned this way to have a BM as suggested by the Paralyzed Veterans Association regarding Neurogenic Bowel Management for Spinal Cord Injuries....As long as one doesn�t have a heart problem this procedure is safe...... This process is not pleasant since I have to use my stomach muscles and push and sometimes strain. The process does not take a long time.� We spoke and a student MD was there to observe. He asked me many questions. He was surprised to know that my Neurologist didn�t know what the problem was and referred me to him. He told me to continue using the method I was using and that it was similar to the process of giving birth!! I have never given birth to a child!! But I have to BMs!!!!!He prescribed Miralax to make my BMs comfortable so I wouldn�t have to strain. This has worked but I have to adjust the dose and need time to experiment with this.He did not suggest testing (except for a routine colonoscopy) and I wonder if this has to do with the mental (depression etc.) and physical problems (MS etc.) I have. He has referred me to an MD who works in Rehabilitation and with patients with spinal cord injuries. This will be sometime in August.This GI Doctor is sending copies of the exam to all my other Doctors. I was too nervous to remember what he said and dictated into his tape, but know he said my problem was neurological in nature and that his office did biofeedback for pelvic muscle retraining but that wouldn�t help me. I think he said this. If my recollection is incorrect I will post again.I have a feeling he was puzzled by what I said. He was very kind and considerate and somehow I have the feeling he was handing me to another Doctor cause he didn�t really know what to do.If I were younger (I�m 59) and didn�t have so many mental and physical problems I would seek a second opinion from someone in a large city. My PCP who had to refer me to this GI Specialist said he thought I would have to see a Specialist in Philly or NYC.I wonder what this Doctor of Rehabilitation will say. To be continued......I suspect that Medical Science is just beginning to understand the process of digestion and elimination. Since I do not live in a big city I doubt that more can be done to help me. I have read how people with spinal cord injuries have daily BMs. Some of this is gross to me. I think I have figured out what works for me!!This site explains Disorders of the anus, rectum and pelvic floor and test to determine the problem. The information may be useful for you.: http://ics.toya.net.pl/19.htm ------------------Take care, Forever Vikee
KKat, This gives you an description of my problem with defecation. I gave this to my GI Specialist as I explained my problem and what I was doing. I have cut out parts that are even more detailed! �I use Metamucil and lots of water daily. I learned to wait till I have a strong urge for a BM and then relax and wait for contractions of the defecation reflex. The contractions don�t come....... I use my stomach muscles and breath holding to expel feces (Valsalva maneuver). I can not feel the feces move from my rectum to the toilet. I don�t know when I�m finished or how much has come out. There are very very long formed stools that comes out without any contractions to let me know know when to stop pushing, so I take breaths and push with my stomach muscles and stop when I get tired. .....Then this process repeats itself a few times. Eventually I can push no more out. The feeling of incomplete evacuation stays with me for close to an hour and then goes away.�He agreed that what I�m doing is the Valsalva maneuver. �I learned this way to have a BM as suggested by the Paralyzed Veterans Association regarding Neurogenic Bowel Management for Spinal Cord Injuries....As long as one doesn�t have a heart problem this procedure is safe...... This process is not pleasant since I have to use my stomach muscles and push and sometimes strain. The process does not take a long time.� We spoke and a student MD was there to observe. He asked me many questions. He was surprised to know that my Neurologist didn�t know what the problem was and referred me to him. He told me to continue using the method I was using and that it was similar to the process of giving birth!! I have never given birth to a child!! But I have to BMs!!!!!He prescribed Miralax to make my BMs comfortable so I wouldn�t have to strain. This has worked but I have to adjust the dose and need time to experiment with this.He did not suggest testing (except for a routine colonoscopy) and I wonder if this has to do with the mental (depression etc.) and physical problems (MS etc.) I have. He has referred me to an MD who works in Rehabilitation and with patients with spinal cord injuries. This will be sometime in August.This GI Doctor is sending copies of the exam to all my other Doctors. I was too nervous to remember what he said and dictated into his tape, but know he said my problem was neurological in nature and that his office did biofeedback for pelvic muscle retraining but that wouldn�t help me. I think he said this. If my recollection is incorrect I will post again.I have a feeling he was puzzled by what I said. He was very kind and considerate and somehow I have the feeling he was handing me to another Doctor cause he didn�t really know what to do.If I were younger (I�m 59) and didn�t have so many mental and physical problems I would seek a second opinion from someone in a large city. My PCP who had to refer me to this GI Specialist said he thought I would have to see a Specialist in Philly or NYC.I wonder what this Doctor of Rehabilitation will say. To be continued......I suspect that Medical Science is just beginning to understand the process of digestion and elimination. Since I do not live in a big city I doubt that more can be done to help me. I have read how people with spinal cord injuries have daily BMs. Some of this is gross to me. I think I have figured out what works for me!!This site explains Disorders of the anus, rectum and pelvic floor and test to determine the problem. The information may be useful for you.: http://ics.toya.net.pl/19.htm ------------------Take care, Forever Vikee
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