Neuropathy/Constipation

[yorkieville]

I have Neuropathy and back pain & presssure, & am undergoing tests to determine the cause. Recently had a Sigmoidoscopy in hopes of determining the cause of my constipation. My Gastroenterologist said everything was normal, felt the constipation is related to the Neuropathy. How does Neuopathy cause it, and am I am danger of losing bowel function permanently?

[Forum-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   Bowel motility is controlled by the autonomic nervous system.  The Vagus nerve is the major player in providing parasympathetic output that produces GI motility.  In patients with generalized neuropathy (most common cause is diabetes, but there are many others) or a specific neuropathy of the autonomic nervous system (such as pure autonomic failure) the nerve supply to the gut can be disturbed.  A gastric emptying study will be helpful in determining if you have slow transit (likely due to decreased nerve supply).  If this is the case, then promotility agents such as reglan or erthyromicin.  I would also suggest a tilt table test and a battery of autonomiIc tests including heart rate response to deep breathing and pupillary response to light.  I would also make sure you are not taking any narcotics for neuropathy related pain, narcotics are very constipating and not very effective on neuropathy pain.  I would not expect you to loose bowel function completely, but I would expect that you will need to alter you diet to include more fiber/fiber supplements and may need promotility agents.  
I hope this has been helpful.

[Gracygirl]

I have had perhipral neuropathy for almost a full year with fluctations in pain, as well as constipation....my suggestion, try eating popcorn and a lot more roughage.  The signals are all screwed up with neuropathy, however they do get through. I also noticed that taking a strong multivitamin everyday with iron has cause constipation as well, so I have started to take them every other day. You may want to check the vitamin bottle for iron content too. Hope this helps.  May I ask how long you have been suffering with neuropathy and does your pain wax and wane?

[yorkieville]

The Neuropathy began in my legs, 3 years ago. Then, in 11/05, 5 months after a car accident, I began having low back pain and rectal pressure, constipation, etc. The back pain progressed to the point that I am unable to sit up for more than a few minutes without making the pain unbearable. Walking and standing also cause pain, and pressure on my lower spin. Then, in 12/06, the Neuopathy spread to my spine. In the past few months, I have lost the sensation to have a BM.  My Gastroenterologist said my fiber intake is excellent, and I don't take a multivitamin. I am, however, taking 50 mg. of Lyrica twice a day now, and I am wondering if it could be causing the loss of sensation. The Lyrica has eased some of the back pain, so, that makes me think the pain is caused by the nerves. Tomorrow, I am scheduled to have a Lumbar Epidural Steroid Injection, as a diagnositc measure, to enable my Pain Management Doctor to determine what direction he should take. Thank you for taking the time to reply. It is all very scary, isn't it?

[Gracygirl]

What caused your neuropathy?

[yorkieville]

The doctors do not know, yet, what caused my Neuropathy. My new Pain Management Doctor is beginning tests and procedures, to hopefully, determine the cause. Tomorrow, I am having the Lumbar Epidural Steroid Injection, and he thinks that may reveal something. My D.O., whom I have been seeing once a month, for 3 years, has not been very serious about finding the cause, until I went in for my January appointment and told him that the nerves in my spine, began stinging in December. Then, he ordered an MRI, and in February, ordered an EMG, and with the results of both, referred me to the Pain Management Doctor, who is very concerned about getting me a diagnosis. He actually sat down in front of me, looked me in the eyes, and promised me that he would hold my hand and walk this path with me until I am diagnosed.

[Gracygirl]

Have you been able to walk the whole time? Did you ever lose your muscle strength in your legs completely? I would find a doctor that stays with you and helps you find a diagnosis. Three years is a long time to go without answers.

[yorkieville]

Yes, I have been able to walk, however, not for very long, because the back pain would become unbearable. I have lost muscle strength in my legs, and cannot feel the vibration in my feet and legs, when tested.  I have lost 7#s and now weigh, 87#s at 5'2. Most of the weaght loss is along my spine. This afternoon, I had the Lumbar Epidural Steroid Injection. The Pain Management Doctor seemed a little doubtful that it will help, and will re-check me in two weeks. He injected dye and took an xray, so, I am curious to hear what he has to say.They say it takes time to see if the steroids ease the pain.

[jcverive]

For a relatively simple biological function, bowel elimination is surprisingly complex. Absolutely everything that you swallow affects your bowels (even air, such as when chewing on gum).  Drugs - prescription or not - can affect many of the physical factors (water balance, muscle tone,  sensation, etc.), excercise affects metabolism, muscle tone, and certain physiological triggers (reflexes), and of course diet (what/when/how, and even where/why/how often you eat) has a great deal to do with bowel function. Even hormone balance and the physical layout and condition of your "plumbing" has much to do with bowel function. Healthy bowel function depends on many factors, but it is luckily not overly difficult in most cases to establish and maintain reasonably effective and comfortable bowel function.  

In your case, your inability to sense bowel movement readiness is a considerable problem to have to overcome, and you may well have to accept an outcome that is sub-optimal. Nonetheless, you owe it to yourself to do what you can.

Let's start with the "poop" on poop, stool, or whatever you want to call it.  To move freely in the large intestine, stool needs to be soft and flexible. Stool starts out largely of undigestable fibers and sediments, in a slurry of water and a small amount of undigestable fats. Bacteria in the colon break down some of these components, and excess water is removed by the colon walls. Soluble fibers help protect against excessively dry stools, and insoluble fibers provide structure to keep the stool from becoming overly compact.  Starchy foods provide soluble fibers, and fresh fruits and vegetables provide the insoluble fibers. Therefore, it's not enough to get plenty of fiber, but rather it is desirable to get a balance of both forms of fiber.  This is perhaps the least well understood aspects of diet as regards colonic health!

Next, let's consider some physiological factors of your bowels. For example, let's assume you ate a reasonable meal a few to several hours ago. If all other factors are normal, you've got some poop to get rid of. However, you're probably unaware of this unless your meal was unusually large. For many reasons (some well understood, many others still a mystery), your body won't try to eliminate your stool unless you provide additional stimulus.  Start eating or drinking (or just moving after a period of rest), and things start "happening". Many of these triggers or reflexes are given special names, but there are too many to justify listing here. It's enough to know that these triggers exist.  

Finally (for otherwise healthy individuals), there is one more thing to do: attend to your bowels when your body signals that it is ready to eliminate some solid waste.  The triggers/reflexes discussed earlier are often easy to ignore, especially if the first urges to poop hit at an inconvenient time or place.  However, ignoring these urges too often can lead to irregular bowel function, and your body may even learn to ignore some of the signals on its own. In this case, there can be such a thing as too much "self-control".

Therefore, if you eat reasonable, well-balanced meals at consistent intervals, include equally reasonable periods of rest and movement (or exercise), maintain adequate fluid intake, and sten to your body when it's trying to communicate with you, you've done just about all you can to ensure proper bowel function.

Obviously, things don't always work as well as would be ideal. Some health problems can lead directly to constipation, though more often it's the medications themselves that mess up the various aspects of bowel function.  And the medications for nerve pain are notorious for causing constipation, either by reducing the body's ability to signal when it is time to eliminate, or by interfering with the muscles responsible for moving the stool along.

There are so many remedies for constipation that it is probably best to advise you to speak to a pharmacist and/or dietician/nutritionist for best advice.  Don't expect your doctor to help (except good pediatricians, doctors of internal medicine, or exceptional general practitioners or geriatric doctors); most doctors don't spend enough time treating constipation.

Best of luck, and please let us know how you are doing!

[yorkieville]

While I always appreciate a reply, I don't think you read my original post very thoroughly.  Bottom line, my Gastroenterolgist had concluded, that the constipation was neurological, we've been all through diet, medications, etc. etc. and until they find the cause of my Neuropathy, numbness, extreme back pain, etc. the lack of sensation will remain an issue. I had posted in hopes of hearing from a Neurologist, or someone else that has experienced the same thing; neuropathy related. But thanks, anyway.

[que03]

constipation is major problem for me.  I am/was extremely active and have learned a lot of tricks for dealing with constipation.  I too have been dealing with it for over 3 years and for most of that time have been considered a clinical case of MS.  Major constipation was first sign, like 2 weeks intervals requiring duplicate enemas and bowel preps.  Never b/f have I had to deal with this stuff!  Anyway, just in the last month, neurologist is wondering if I have a ca channel autoantibody that could be complicating things.  The gut is regulated by nerves that have a high number of calcium channels.  Some medicines work via ca channels i.e. Lyrica.  I had things somewhat under control with a daily regimen of Miralax and Fibersure until I was put on Lyrica.  My response was a pseudoileus--everything stopped again.  Went off Lyrica and after a month things started working a little better.  Now my frustration is though if I am not constipated and I jog I cannot feel if I have stool escaping.  You can only imagine the embarrassment.  What more can I deal with???  I would suggest bringing up Lyrica to your doc.  Obviously, narcotics are out of the question.  My neuro said this has not been a complaint from other patients.

[yorkieville]

I suspect that you are correct; the Lyrica is just complicating matters, further, for me. Hopefully, I won't need to take it too much longer. Tomorrow, I am having a "Sympathetic Lumbar Block" to "turn off the nerves". Hopefully, the doctors will diagnose the nerve problem soon.  Yes, I truly can imagine your embarrassment over "stool slippage". What did your Neuro say avoiding it happening again?

[Maddogcanada]

Hello All From Brantford Canada. I am supposed to have a operation soon as i was diagnosed with the following.. C5-C6 This is the severley affected Level. There is an annuar disk buldge with a focal left paracentral protrusion that herniated both superiorly and inferorly almost to the level of the adjacent disk spaces. There is Severe acquired centra canal Stenosis and abnormal hihg T2 signal within the spinal cord extending from the level of the superior endplate of C5 to the Level of the midportion of the vertebral body of C6. There is Bilateral moderate to severe exiting neural foraminal stenosis as well at this level secondary to a combination of disc and uncovertebral degenaritive change. <-- This is from the Doctors MRI note. The Opinion is as follows. The Most Severe Level is C5/6 where there is a diffuse annular buldge with a left paracentral protrusion, as described above, that reults in severe acquired central canal stenosis with abnormal high T2 Cord signal indicative of myelopathic change at this level. There is bilateral moderate to severe neural foraminal stenosis at this level as well. "The Myelopathic change merits urgent referal"

Now my Symptoms are as follows..
1 - Numbness in my left and right hands
2 - Numbness in my lower body from the Mid-Section to under my Toes.
3 - I have to hold on the things in order to move around - example to go to the bathroom I have to pull and drag my feet up the stairs.
4 - Loss of sudden Bowel Trouble ie: Not knowing i have to go as per the NO feeling or ability to push to relieve myself as there is No pressure i can get to that area.
5- Un-balanced, walking like i have drank 100 Beers or the likes.

Now for the weird part - "I have NO NECK pain at ALL??. Why?? I am also a Type 2 Diabetic... Anyone have or had simular situation please reply ASAP as my surgery is for Tommorow at 10:30am at Hamilton Health Sciences here in Canada.

Thanks and for all of you i wish you all a brisk and speedy recovery...

God Bless You All.

[yorkieville]

You need to post your own question, under your own thread to get a better response.

[hilda614]

A related discussion, neuropathy/constipation was started.