Weird bowel problem

[spastigirl]

(well, it's probably more like 'constipation' than the other options)

My bowels have been consistently not-normal since I was born premature with mild diplegic cerebral palsy. When I was about 10 I became continent of bladder, but not of bowel, and suspect this had something to do with constipation/poor diet (i.e. with the bladder I had enough daily 'throughput' to get used to normal function, but because I would rather not eat than eat something I didn't like, I had a tendency to chronic constipation). Until I was in my mid-20s I had a tendency to get 'caught short' with unexpected bowel movements, but this no longer seems to happen in later life. Medical experts told me that if my bladder worked properly I would be able to get my bowels to work properly (and didn't have major nerve damage), but I never got quite sorted out (largely because their suggestions largely involved enemas, which don't seem to work well for me).

My tendency towards constipation is, with reasonably-good diet, not immediately affected by diet and laxatives, but directly affected by exercise (to the extent that several times in my life when I've been constipated I've taken medicine and it might take about 4 or 5 days to work, but exercise seems to work far more directly). The phrases 'slow-transit constipation' and 'low bowel motility' do seem to describe my condition rather well.

My most consistent problem is slight anal leakage (not formed stool but damp staining), and this has been constant. Enemas or having healthy/regular bowel movements do not seem to clear the problem. I've generally had this described by doctors as overflow constipation, and there have been periods in my life when this was a fair description, but it doesn't necessarily seem to work that way. The odd thing about it is that the healthier/better-behaved my bowels are the more noticeable the flow is, and exercise always increases it. For example, the week before I saw my Continence Advisor, I happened to be taking more exercise than usual, and I was passing well-formed stool once or twice a day (as compared to my normal average of once every three days, which is borderline-constipated), but this did not affect the leakage apart from making it slightly more noticeable.

My CA said she'd never happened to come across a case like mine, but when I went into that much detail she agreed with me that the problem didn't seem to be precisely constipation.

The way the 'flow' generally works is that it's more noticeable when I take exercise and for the few hours either side of having a bowel movement -- tailing off consistently the next time I sit or lie down for a few hours. I wouldn't be surprised if it's traces of stool that somehow don't get 'bound up' into the proper bowel movement, mixing with anal mucus to cause the flow that is meant to ease the passage of the bowel movement, but comes out in a less-acceptable manner.

Enemas scare me because I'm afraid of having the Spastic Panic Flinch, but also because they consistently haven't worked well for me. Nurses expect enemas to clear you out properly, and this never seems to happen for me (my most-recent experience of an enema 3 years ago involved heavy uncontrollable anal flow for the next three days, as opposed to my normal slight annoying staining).

I found somebody online who discovered she had 'incomplete bowel evacuation' from having a hospital MRI of her rectal function. Hers isn't the same because it was caused post-childbirth as opposed to being a lifelong condition, but 'leakage', 'poor sphincter control', 'embarrassing response to enemas' and especially 'the more I walk the more it leaks' seem quite familiar to me from my own experience.

I'm still at the stage of trying to understand myself better. I'll consider having Horrible Invasive Tests done in a hospital if somebody convinces me this is a good idea, but understanding the way I work (or don't) is a good start.

Remember, this is an oddity because it hasn't quite ruined my life and/or health -- I just seem to have functioned this way since I was born, consistently.

[ggreg]

I would be interested in hearing what your doc appointment reveals.  I think you may have an anal muscle problem, particularly since you've had this since you were a girl, and could be an operation might help you.  Quit drinking the coffee during the day... only drink it when you usually go to the bathroom IF you go in the morning or after work... if you drink coffee after the evening meal, it'll keep you up at night.

[waffenamp]

You might want to try a tablespoon or two of olive oil everyday to lubricate your intestines if you are feeling constipated. Stay away from corn, soy, and other oils. Id stick with the olive oil

[spastigirl]

Alas, I ate noticeably more-than-usual wholegrain fibre yesterday, and what it seems to have done is give me urge incontinence in uncontrollably passing small amounts of *solid* waste, which doesn't really improve things from my point of view (less hygienic than tiny amounts of liquid waste which get pulled into a pad). I haven't had that problem noticeably in years, although I had it frequently when I was a child. My childhood diet probably included a very high amount of grain fibre, as I hated fruit and veg, so my mother did her best to improve things with wholegrain bread/pasta/rice, which I didn't object to.

My current diet doesn't happen to include much grain fibre (bread every few days), just veg every day and fruit smoothies every so often (because I still detest fruit apart from bananas which don't contain dietary fibre).

I suspect what I may have to do is avoid all non-meal snacks, which is a b*****r as I love coffee with a chocolate biscuit in the daytime as a small treat, and carefully try grain-style fibre as part of a meal containing other stuff (possibly eggs or bananas to counteract the effect slightly).

Am going to see dr next week, and see if I can get referred to someone who knows (consultant or bigger continence practice), because my digestive arrangements don't fit readily into the average range and I'd like to understand more about what I've got and what can be done.

[ggreg]

Well, I cannot speak to possible inadequate muscular control of the exit area, but I can tell you a tip that might help "bind," to use your word, the waste in your digestive tract.  If you aren't already, whole grains might help that leakage thing, like 100 percent whole wheat bread, if you'll eat a slice every day, might do the trick.  I think what you're dealing with is kind of a diarrhea issue, which often accompanies constipation, so could also be smallish amounts of anti-diarrhea type medicines might help you.  Of course, you risk more constipation, but it wouldn't hurt to try it, if the whole grains thing doesn't work.