Post colonoscopy/ IBS?

Dr.Pho:
One week ago today, I had a colonoscopy with a rectal surgeon to confirm his diagnosis and treatment of internal bleeding hemorrhoids. They had been treated in Feb after a flexible sigmoid and anoscope, with banding and infra-red coagulation. The colonoscopy was negative, no findings or polyps, and in fact the hemorrhoids improved to the point that no other banding was needed. My initial symptoms of bleeding starting in Jan of this year, and I began using fiber supplements(Unifiber--which is similar to Citrucel--1 tablespoon a day) increasing fruits/vegetables, more water and taking 100mg of Colace (2 50mg a day). Since going on this regime, my bowel movements and habits have improved considerably. Now, with the exam being negative, I was going to reduce and stop the Colace, but still maintain the other aspects of the regime. I try to get 25-30 mg of fiber a day. For more history, I was also diagnosed about 20 years ago with what was then called a spastic colon. Symptoms would mainly be some upper left quadrant discomfort, right under my ribcage. I was prescribed Donnatal back then, which worked pretty well. I still get some discomfort in that area, with occasional bloating and gas, but I have not taken any meds for several years. I am 45 year old mail in good general health.

Today, and yesterday, my bowel movements were different than the last 2 months. Hard, small pebbles and initially difficult to pass. I'm concerned that this might re-aggravate the hemorrhoids if it continues, and also is this a symptom of irritable bowel syndrome? I don't understand how this would occur with the amount of fiber and water, along with the Colace. Also, is there any concern in continuing to take the Colace long term? I still plan to eliminate it, but not until my movements are "back to normal". Would going back to Donnatal help (or a related drug). What would be the cause of this, considering all tests were negative? Any information that you could provide would be greatly appreciated.
Thank you.

[Kevin Pho, MD]

With a normal colonoscopy, it is unlikely that an anatomical abnormality or mass is causing the symptoms.  Irritable bowel syndrome can lead to your symptoms.  You can try medications like  a different type of antispasmodic agents or consider Zelnorm if you GI doc feels that this is constipation-predominant IBS.

Generally, long-term use of colace is not advised, as it can lead your body to be dependent on the stool softener for bowel movements.  

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:
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