Reason for Suden Colonic Inertia

[alexandria]

I am a 35-year old female with a history of constipation predominant IBS, gastritis, and a redundant sigmoid colon. I also had laproscopic surgery in October of 2002 for endrometriosis, ovarian drilling (for fertility), and removal of a fibroid tumor. I've been struggling with severe IBS ever since the surgery, and ever since December ( have had sudden chronic constipation). Although, I've always struggled with bouts of constipation, it has been easily resolved with an increase in fiber and Equalactin. My GI doctor placed me on Zelnorm which gave me bouts of diarrhea and abdominal pain. After stopping the drug (after 6 weeks), I began having chronic constipation. This was followed by abdominal distension/bloating around the sigmoid region, cramping after eating, and a slight bulge in the colon after eating. I am now unable to move my bowels without the assistance of Zelnorm (which I am on again). I have never experienced chronic constipation. My doctor has run the following tests which have all come back normal: stool culture, blood tests, abdominal xrays (for blockage determ), pelvic ultrasound, colonoscopy, small bowel series, and abdominal CT scan. MY GI doc tells me I am struggling with colonic inertia and that my sigmoid colon has become sluggish. I'm confused as to why this has happened so suddenly. My GYN doctor sees no evidence of abdominal adhesions and nothing has turned up on the tests. Is there something that we are missing? The pain and motility problems are affecting my quality of life and I would like to understand the cause so I may stop worrying and resolve. Any other suggestions? I am fearful that I will need to have my colon removed to resolve this problem.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There are many causes of chronic constipation.  Diseases associated with constipation include neurologic and metabolic disorders, obstructing lesions of the gastrointestinal tract, including colorectal cancer, and endocrine disorders such as diabetes mellitus.  Other abnormalities leading to impairment of defecation include aganglionosis (Hirschsprung's disease) and acquired functional outlet disorder (pelvic floor dyssynergia). In addition, patients with irritable bowel syndrome often complain of periods of constipation, which may alternate with periods of diarrhea or normal bowel function.

However I will focus on colonic intertia as your GI doctor has suggested.  The majority of patients with severe constipation with abnormal colonic transit are said to have colonic inertia, defined as the delayed passage of radiopaque markers through the proximal colon.

Unfortunately, the use of drugs to promote colonic transit by increasing colonic motor activity has generally been disappointing.  Reglan and cisapride have not consistently worked in trials.  Some patients with severe constipation have been treated successfully with misoprostol or regular doses of polyethylene glycol electrolyte solutions.  You are already taking Zelnorm, which is another, recent option.  

You may want to try misoprostol or regular polyethylene glycol solutions if you haven't already.  The last resort would be surgical options (i.e. subtotal colectomy).  In general, the patient satisfaction has been good, with studies showing over 90% of patients having an improved quality of life after surgery.  You may want to discuss this option 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.

Thanks,
Kevin, M.D.

Bibliography:
Wald.  Treatment of chronic constipation.  UptoDate, 2002.

[JAJA03]

I understand what you are going through I too had severe colonic inertia. It got to the point when I couldn't use the bathroom with the five-gallon enemas. So on 8/30/2001 I had a complete colectomy. Which they removed my whole colon and rectum. The only problem is you have to be very careful of what you eat and most important is you have to drink atleast 8 glasses of water because since you no longer have a colon majority of your water is gone.Another thing your very volnerable to catching any kind of infection dealing with your stomach. last but not least YOU CAN'T EAT NUT, LETTUCE, CHIPS, UNCOOKED VEG, NO SEEDS, CABBAGE, NOT ALOT OF BREAD. That's all folks!!

[eak1969]

I am 34 years old and have had severe constipation since I was a three-month-old baby.  About five years ago, I was given transit-time measurement tests and diagnosed with colonic inertia.  The doctor recommended surgery to remove the colon.  I was terrified of ramifications and so continued to take laxatives, finally settling on magnesium oxide, which gave me great relief with very few of the side effects other laxatives caused.  However, I began experiencing increasing fatigue and muscle weakness and learned they were symptoms of magnesium toxicity.  I stopped taking the magnesium and now find myself in the position of having to find another alternative.  

I went online to investigate surgical options again.  During my research, I learned of an experimental procedure to insert pacemakers into the colon in order to stimulate colonic motility.  This work was written about in the May 2003 edition of Medical Science Monitor.  

Do you know anything about this procedure?  Is it anywhere close to being put into practice with patients suffering from colonic inertia?  Alternately, are there other viable options (or potential options) besides surgery to relieve this problem?

Thank you.

[Still 40something]

Hi, I have been diagnoses with colonic inertia for almost 3 years now.  I have always been constipated as a child.  It got worse as I got older.  I went to a gastreanologist and he diagnoses me with a "lazy colon" (colonic inertia). I told him I would try eating more fiber and fruit, etc. and nothing seemed to help.  

He prescribed a miracle laxative called MIRALAX.  I have been taking it every single morning for almost 3 years now and have had an elimination almost every single day since! Before that, I eliminated once or twice a week and they were not very productive. Still was constipated.  

Now I know what it feels like to have a "healthy" bowel movement without any straining involved!  So see your doctor about prescribing Miralax as you need a prescription for this "miracle!"  

Just be sure to take it every day and don't stop just because you have a bowel movement.  You will have to take it every day for the rest of your life as your colon goes back to being "lazy" if you don't.  If you find your stools are being too soft, then cut back a little on the dosage and vise versa if they are too hard.  You will find a happy medium, believe me!

I am so happy to share my "cure" for colonic inertia!

Vicki

[Pcaino]

A related discussion, Colonic Inertia was started.

[Mikie007]

A related discussion, Dr Pho, please advise was started.

[vangirl]

A related discussion, colonic inertia was started.