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I will try and keep this short, but I need to know how to continue to find out what is wrong with me.
Last June (2008) I had an emergency appendectomy.  When they pulled the appendix out, they realized it wasn't as bad as it should have been from my WBC count, so the surgeon (thankfully) looked back in and saw that I had a foot of intestine scarred and twisted. They did surgery to get that out.  My symptoms before that were extreme bloating (look pregnant), early satiety (eat very little and felt like I had eaten a Thanksgiving meal), constipation and weight gain. As soon as I started eating solid food again, I started right back with the same symptoms, gained the weight back instantly, and I am basically back at the same situation I was before the surgery.

My gastro doc basically asked me to eat more fiber, drink water and go on Senokot-S and Miralax. I have done all that. If I don't take a dose of the Miralax, I don't have a bowel movement.  Since there has been no improvement, he did an endoscopy, which showed inflammation, but he did a biopsy, which was negative.  I just recently had a SIBO test and it came back positive. I have taken all my anti-biotics and still feel the same.  Last week I had a gastric emptying study which came back normal, 96% emptying after 4 hours.  When I took the SIBO test, the nurse said I would have diarrhea from the drink and it should happen in about 30 minutes. I didn't have diarrhea until 7 1/2 hours later.

In addition, I have had two colonoscopies. The first in 12/2005, came back with polyps removed. and again I had a colonoscopy in 2/2008, nothing found but internal hemmerrhoids. In 2005, when I had the colonoscopy, I also had an endoscopy and it showed a hiatel hernia. This time around, the doctor said the hernia was unchanged.

I would like to know from you, please, what other tests should be done and what questions should I ask my doctor?  I hope that I have given you all the information you need. Thank you!

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation, which would have excluded most of the major causes.

The normal colonoscopies would rule many of the structural issues, and the gastric emptying scan would make gastroparesis less likely.

At this time, I would consider more specialized tests to look for constipation, including anorectal manometry, anal sphincter EMG, defecography; and impaired balloon expulsion from the rectum.

If two of these tests are positive, you can consider the diagnosis of "colonic inertia," which is a controversial term suggesting neurological dysfunction of the colon.

These options should be discussed with a GI physician, preferably at a major academic medical center.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd