Help me find to find relief

[stillina]

I am a 33 year male from Illinois. Approximately 7 months ago I found myself in an emergency room due to severe back and abdminal pains caused by constipation.  The ER took x-rays, and what I believe was a cat scan to rule out any possible obstructions.  I was given a laxative and released.  Since then I have been plagued with recurring digestive problems.  My symptoms include feelings of chronic constipation that persistes even after I have a bowel movement, constant bloating and cramps. I have relied on laxitives to relieve some of the pressure, however, even after the use of laxatives I experience the excessive build up gas and pressure with the inability to pass it for long periods of time.

My physician referred me to a GI specialist for a colonoscopy.  To my suprise the results from that test as well as various blood tests came back normal. The GI Dr diagnosed me with IBS and advised to treat my condition with an antidepressant. I tried the antidepressants for over a month and found no relief for my symptoms.  Moreover, I was experiencing some minor side effects from the treatment that only complicated my miserable situation.  The doctor recently suggested another type of anti-depressant which may be more effective along with a medication called hyomacine to help me pass gas and librax to minimize the bloating I experiance.  I've become reluctant to take any of them because of the side effects....for example hyomacine and librax can aggravate constipation which is what I'm trying to avoid. More importantly, I'm becoming increasingly concerned that maybe the doctors missed something along the way and there may be a more serious underlying problem.  Is it possible something else is going on besides IBS?  What causes my intestines to get all knotted up in such a way that the simple passage of gas is a miracle?  Does IBS hit you abrublty and persist for this long?  any refreshing insights you could provide is greatly appreciated.  This condition has screwed up my life and has affected all those close to me.

Thank You

[Kevin Pho, MD]

A colonoscopy would likely rule out any anatomical abnormality that may be causing the symptoms.  Other possibilites other than IBS would include colonic inertia or pelvic floor dysfunction.

A normal imaging study should lead to a search for problems causing abnormal transit and pelvic floor dysfunction. Marker studies are useful for this purpose; an abnormal test should lead to defecography or manometry to test the pelvic floor. A diagnosis of pelvic floor dysfunction should not be made unless at least two of the following studies are positive: anorectal manometry; anal sphincter EMG; defecography; and impaired balloon expulsion from the rectum.

You may want to discuss these tests with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Wald.  Etiology and evaluation of chronic constipation.  UptoDate, 2004.

[yoshi]

if alcoholic drinks help your problem,see what happens when you take alka selzer or gas x ??
both will neutralise gas in your system.

[stillina]

Thanks for the feedback vegas1.  The facts you mention are very disturbing.  I've heard similar horror stories from others that combined with my own initial experience have prevented me from attempting further treatment with antidepressants.  Unfortunately, the only "relief" I'm currently finding is when I drink a few alcoholic beverages.  Go figure.

[Vegas1]

Hey The md's perscribe antidepresents when never they can't find the problem . Unfortunatly they put me on Paxil 20 mg's per day now if i try to stop ,  I have electrical shocks that drop me t the ground europe's FDA has band the drug from the market go to paxil lawsuits and man you will wee what they are talking about PLEASE DON'T TAKE THE MEDS Thanks good luck .