Scared about Sudden Motility Problem

I am a 35 year old female and have been struggling with sudden, severe constipation, and abdominal bloating/bulging - and am frustrated that my doctors have not been able to find out what's wrong. I have a history of constipation predominant IBS, a redundant sigmoid colon, gastritis, asthma, high BP, mild endometriosis and recently diagnosed Generalized Anxiety. Although I have a history of IBS, I've never experienced chronic constipation. Any episodes have been easily resolved with Equalactin. In October 2002, I underwent a laporoscopy for fertility. In the process, my doctor identified and removed a fibroid tumor from my uterus (3 hour surgery). I began experiencing GI problems shortly after surgery. GI doctor put me on Zelnorm for motility. Ironically, constipation was worse on Zelnorm. Went off drug and had no bowel function (without medication). Was put back on Zelnorm after a few weeks (for another trial). Motility got increasingly worse and normal meds such as Equalactin did not work. GI doctor ran following tests: blood work, urine, abdominal xray, pelvic ultrasound, colonoscopy, small bowel series and abdominal CT scan. All normal. 1 week after colonoscopy, pain began getting worse. Bulging/distension after eating (left colon around hip), area of distension has increased to upper belly (around waist),painful BMs (feels like pulling and pinching), mucus when bearing down, mild chills after eating, mild backache, and extremely tired. Starting to show in my complexion (pale and dark circles under the eyes). This has been going on for 8 weeks. Not knowing what's wrong is contributing to anxiety and making symptoms worse. Had follow-up with GI doc and was told he had no idea what was wrong, or what to do for me. He originally diagnosed me with sluggish colon. Upon hearing of the anxiety, he decided to try the antidepressant, Lexapro (for anxiety and motilty). Was told to return in 6 weeks. I'm concerned that the doctor is treating my symptoms instead of trying to find the cause of the problem. Is there anything he should be doing, or should I consider a second opinion? Worried about bulging and abdominal pain getting worse and not knowing the cause. Is there anything that can cause sudden colonic inertia and abdominal bulging when eating? Can severe stress cause severe bowel disfuction such as this? Any suggestions would be greatly appreciated.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note chronic constipation, distension after eating, painful BMs.  

Blood work, urine, abdominal xray, pelvic ultrasound, colonoscopy, small bowel series and abdominal CT scan are all normal.  These normal tests argue against a serious cause that is causing your constipation (i.e. bowel obstruction or mass).  

That's a pretty good initial workup for chronic constipation.  Here are some other specialized tests you may want to consider discussing with your personal physician.  

One consideration would be colonic interia - patients with colonic inertia have a resting colonic motility that is similar to normal controls but have little or no increase in motor activity after meals.  The cause of this is nerve-based dysfunction.

A colonic marker study may be considered to test for colonic intertia.  Radiopaque markers are swallowed, and their passage through the colon is monitored by abdominal radiographs. Markers are counted in the right, left, and rectosigmoid colons (defined by certain anatomical landmarks), and are followed as they move distally until expelled.  

Other causes of chronic constipation can include anotomical abnormalities, or problems with the pelvic floor.

Defecography is a test that can assess the anatomy including anorectal structures and the anorectal angle are evaluated during this study.

Anorectal manometry and an anal sphincter EMG can evaluate the anal sphincter muscle.  Any dysfunction in this muscle can lead to chronic constipation.

If every single of these tests are negative, then the cause may be attributable to irritable bowel syndrome - stress can definitely play a role in the worsening of the constipation.  

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.

Thanks,
Kevin, M.D.