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Anal Sphincter Muscle & MS

Hi, Everyone.

   I am undergoing evaluation for MS. One problem I have is loss of bowel function. A proctography revealed I have no function, at all. My GI doc says I have a tight anal sphincter muscle and feels it is nerve related, and to finish my evaluation.
  Does anyone know how MS affects the anal sphincter muscle?
  I attempted to do some rectal kegel exercises, but they only make the nerves in my spine sting more.
  Thanks in advance.
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Avatar universal
Hi, Jazzy.

   Glad I could make you laugh! :) Sometimes a good laugh is better than a pill. Thanks, my Yorkies really are adorable. I feel so blessed to have them they're real characters. The care of the coat is a tremendous amount of work, but oh-so-worth it! I get so many compliments.

   I had a Sheltie years ago when I was single. She was a tiny one and gorgeous! I love the breed! Lots of coat care, there, as well.

    Jazzy, thank you, I wish none of us were suffering, but I am so glad to have found a 'home' here where I feel safe. Good people here.

    XXX
   Sheila

  
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251222 tn?1270936117
LOL OK  the won't let us say c r a p  but we can say suck! Rock on!
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251222 tn?1270936117

Oh my goodness I was laughing my A O here with the Tight *** thing! HAAAA   Your yorkies sound adorable! I have watched them at dog shows and am amazed at their owners combing each and every hair just so. Such patience!! We always thought the boys should get some manly hair accessories instead of the bows also! LOL

I am a sheltie fanatic. :)  Its a complete and total obession for me also.

I wish you were not suffering. And bathroom problems suck!  (I'm sure that one will be bleeped out!)

Hang in there
Jazzy
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Avatar universal
Hi, Shelly. I'm so sorry you're dealing with this, too. Yes, a racoon is a better choice, my Yorkies just won't accept the blame for me.  Wish I hadn't had my hysterectomy, it's made it that much more uncomfortable. Sheila
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Avatar universal
OMG, I have the same "no feeling" thing, and inability to "go" The lack of feeling seems to be relatively new, but really odd!  If I have the gas thing going on, my boyfriend has been kind enough not to mention it, but just in case, I'm gonna get me a raccoon!

Shelly
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Avatar universal
Quix, thank you for taking time to think about my problem. The specialist that ran the proctography said "You have no bowel function. Everything just falls to the bottom". (He was so kind, and took the time to put me at ease beforehand.) The G.I. doc read the report last week and said "You have no bowel function. You have a tight anal sphincter". (I guess I'm a real tight A** LOL) He advised me to complete my MS evaluation. He said he could send me for biofeedback, if the tight anal sphincter is not nerve related. If it is nerve related, he said biofeedback wouldn't help.  Now, I am thinking it is nerve related, because I have done the rectal kegel exercises and they cause the nerves in my spine to sting more. I am seeing the Neuro on Tuesday afternoon to hear the results of the spinal tap and evoked potentials. I hope it is 'D' day for me. May I get back to you then, about info about Botox treatments?

I don't think my insurance would cover biofeedback anyway, I'd have to go back to one of the university hospitals, and I am very concerned about being referred back to one of the university hospitals because of the way they bill. Somehow they are able to avoid the agreement they have with my PPO. And the bottom line is, when I incur the bill,  I must pay it. I need to learn more about why they are able to bill in such a manner.

Quix, thank you so much for helping me. You are a Guardian Angel to all of us here. My husband commented last night that I seemed in much better spirits after coming here. I told him that I don't feel so alone in undergoing my evaluation.

Helpful - 0
147426 tn?1317265632
I have been thinking about your problem.  I didn't realize that you have two opposite problems compounding each other.  The first is loss of bowel function and I'm assuming that means loss of normal peristalsis (the muscular waves that move everything through.)  On top of that you have a "spasmed" sphincter.  Is that right?  Then, there are treatments for other parts of the body that cause painful localized spasm.  Now - be clear that I am making this up as a go along, but it certainly is something you could discuss with the proctologist - They have had huge success using Botox (yes, Botox) in relaxing isolated spasmed muscles.  Now this might not be the exact answer, but, it is a temporary (weeks to months) treatment so if it was too successful it wouldn't be relaxed forever.  But, it is a thought, or a direction, to investigate.

If you are at all interested I could find some articles or cites for the neurologic uses of Botox to take to him.

Quix
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Avatar universal
Hi, Doni.

   Thank you for the welcome. I never imagined the love and support I would find here, when I posted. I am just awestruck by the kindness and compassion.  I already do love all of you. Last night, as I lay down to sleep, I thanked the Lord for guiding me to this forum, to a group of loving people that understand.

    How long have you been waiting for a dx? Tuesday may be 'D' day for me, as the Neuro will have all my test results. Frankly, I am afraid to believe he has an answer. But hopeful...I am.

   Yes, these Yorkies are too prissy to accept blame for my gas. LOL Just cause they're beautiful and have that long luscious hair, they think they're 'all that'. (Who I am to argue?)

    I know what it's like to have no control...was hospitalized for that 18 years ago. I suspect it has caused you to lose weight.  I'm so sorry you have that problem. Are you familiar with the saying, "She has her head up her butt?" Sorry, very crude. Well, that's what I feel like. My days consist of thinking about how to make it happen.

    Fart contests....with Bradley...now, I'm going to have to tell my 'girls' that dogs DO fart. My girls do just what Sadie does...sniff, give me a look of disgust, roll their eyes...... I understand completely how you regard Bradley as your four-legged grandson...my 'girls' are my kids.  They won't grow up, get married and move 7 hours away.

   Sheila
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Avatar universal
Hi, Jazzy.

   Thanks so much for the welcome. Sorry you are having a bowel problem, too.

    Yes, I'm a YOYO~Yorkie Owned-Yorkie Obsessed. Seriously, these girls get me through the day, and many a night. So much love & comfort in tiny little packages.

   What breed are you owned by?

   Sheila
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Avatar universal
Wow what a great thread.  Welcome yorkieville!  Sorry for the problems you are having, but you have  come to the right place for knowledge, support and always great laughs.  I am one of the undx, and totally whining.  These people on this board are sent from God to lighten our life and make all our problems much easier to live with, they are just the greatest and I know you will love them all.

Carol, I laughed til I hurt, you are hilarious!!!  You know how down I've been lately, really needed a good laugh, so glad I read this thread!!!  Too bad we can't put pictures on this site, sure would like to see you in those shorts!  Might have to get me some of those, though I'm sure you will always be the reining "Hot Legs" for all of us!!!!  Walking farts?.......you are just tooooo much!

Sheila- that's pretty bad when your dogs won't take the blame..........ha

Zilla, what are we gonna do with Quix and her racoons? Boy, if we all ever met in the same place homeland security might bust us for setting off a stink bomb!!!!!!!!!!!!!  And it's for sure we couldn't run away...................man, what a visual....ha

I have the opposite problem, just started happening this year.  Won't think I have to go, then boom! I will have to make a mad dash for the old pottie! Sometimes I make it, sometimes the outcome is not so pretty.  Mostly happens to me in the mornings after I'm awake an hour or so.  Don't know what I will do if it gets worse.  I already pee a thousand times a day and all night, now this...........oh well!

My son couldn't take his dog "Bradley" to college with him so he is considered my 4 legged grandson.  He and I lay in bed at night and have fart contests.............sometimes he wins............sometimes I win!!!!  My bloodhound Sadie will just look at us....sniff...give us both a look of total disgust....and jump off the bed...ha ha ha ha

I love you all and am forever grateful for your friendship, compassion, love, support and for todays laughter. All of you mean so much to me, hope you all have a wonderful and pain free day.

doni
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251222 tn?1270936117
Hi Yorkie and welcome, from a fellow dog lover! I dont' have any advice as I have the complete opposite problem, but just wanted to say hey!

Everyone was giving me a kick with the farts and racoons. LOL

Jazzy


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Avatar universal
Hi, Quix.

   Aha! So, your the one that holds the title to the World's Indoor Endurance Reclining! :)

    Racoons, huh? LOL

   Yes, I think seeing a spinal rehab specialist is wise. Wish my sphincter would relax a bit...might help, but the exercises only make my spine sting more. You know the irony in this....18 years ago, I was hospitalized for diarrhea so severe, I lost 17#s in 2 months.

   Sheila
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147426 tn?1317265632
I have two families of racoons under the front porch right behind my famous recliner - Yes it was this very chair in which I set the World's Indoor Endurance Reclining record!.  Racoons have a whole range of growls, yips, chortles and trills to communicate, but their growls sound like rumbly farts.  Whenever any passes gas in my house, everyone looks at each other and says, nodding wisely, "Racoons."

Sheila, I would still talk to a spinal rehab specialist.  Yes, my cocktail works perfectly for me, but I still have fair function.  My sphincter, however, has lost tone and there better be nothing in my way when the urge stikes, because I can't hold it and wait for a better moment.

Q
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Avatar universal
Kristin,

    My dogs won't let me blame my farts on them. They rat me out!  They get up, give me a look, as if to say, "What did you do?!" or one of them will roll her eyes at me, and they get up and move.

    If I could feel the pressure of the fart coming...maybe I'd have a chance of blaming it on one of them and being the one to walk away. LOL

    Sheila
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Avatar universal
Hi, Quix.

    Thank you so much for the warm welcome. Speaking indelicate-not a problem, I'm afraid my health claimed my dignity awhile ago. :)  After the proctography, I said, "Dignity? What is dignity?"

    Other than the proctography, am I facing any other tests to determine if I have any nerve function in the colon? The specialist that did the p. told me I have no bowel function at all. (Gee, I could have told them that without the test.)

   With your 'colon cocktail', are you able to empty? Rectal suppositories do not do anything for me. I cannot feel anything. The build up really is uncomfortable since I had a hysterectomy. I'm really worried that it will weaken further, my already weakened pelvic floor.

   I checked on a site for spinal cord injury and they discussed manual extraction. What fun, huh?

   Quix, I've read many of your posts, and I have to tell you that I am touched that a doctor would donate her time to helping so many, and trust me, while I am new, it has not escaped my notice how many people you have helped. With that said, I am sorry you have MS. I'm sorry anyone has MS.

   My thread did grow long fast, didn't it? I am amazed at how wonderful people have been to me. They (and now, you) have treated me like I belong here. Every now & then, I have a teary day...this started as one of them...you know, the tears of frustration? Well, those tears turned to a different kind...tears of gratitude.

   Can you just imagine all of us and our problems, on stage? Gosh, if we didn't make people laugh, nothing would!

   Again, thank you so much for the warm welcome.

   Sheila
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228463 tn?1216761521
You will be Hot Legs in the Hot Pants with those new shorts of yours!!

Your story of the walking farts is hillarious and I am so glad Sheila brought this up!  I have been noticing the pressure of a fart coming lately but totally unable to do anything to control it getting out.  My husband usually blames his on the dogs so I guess I will have to bring one with me wherever I go from now on!!  Maybe that's why Paris Hilton brings her dog with her!!

You guys are hillarious!
Kristin

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147426 tn?1317265632
Hi, there!!!  A big welcome to our home.  MS is an indelicate disease and we often need to speak indelicately.  I'm a former pediatrician, and I KNOW indelicate.  Try discussing,  uh...self-stimulation with a 15 year old boy., lol.

I have MS, but I also use a narcotic med daily and am on clonazepam, and come from the faimily with the slowest transit time in the world, so severe constipation is a part of my daily life, too.  I solve it with a DAILY (if I miss one day I'm in trouble, 2 days - does the word "epoxy" real a bell?) 25 to 30 grams of fiber, 300mg sodium docusate (generic Colace stool softener) and senna 6.8 mg tabs, I use 3 to 4 daily.  This works well for me, but I still have some intact function.  

If your nerve input to the colon is really absent or very weak, you are in the same situation as a quadriplegic or high paraplegic.  There are specialists that can give you a program that they use to ensure proper elimination without causing diarrhea.  The build up is actually somewhat dangerous and it will increase discomfort and thus, increased spasticity and spasm in people with MS.  There are rectal suppositories that act locally and can be used, but I don't know what the current recommendations are.

You could look on the sites which deal with living with spinal cord injury to see some of this or contact a spinal injury rehab center to discuss the problem with their specialist - often a Clinical RN.  It may be indelicate, but dealing with it is mandatory for your health.

Your thread got so long so fast!  I want to go back and read everything carefully and respond to your whole story as soon as I can.  Welcome again.  We're here to help solve all these little/big conundrums, have fun and enjoy the walking farts (I can't believe someone with such sexy legs said that!!!).  That would make a great Monty Python routine!!  Maybe we all should go on the stage.  "Zilla, Lace up your toe-shoes!!"

Quix
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Avatar universal
Hi, Carol.

    You made me laugh so hard! Thank you, I really needed to laugh. Funny thing, I can't tell when I pass gas either. The other night, DH was rubbing my back. I'm laying there, and all of a sudden, I smell the most awful odor. Laying there thinking, "Gee, what did he eat?!"  Then, I realized it was me! Sweet hubby, never said a word.

   I vote you buy the really short, shorts with the really low waist. I figure, if people are going to be looking at you, give them something nice to look at, right? :)

    At the campground the other day, I was a little off balance one day, and I thought, "Now, if I had a beer in my hand, nobody would wonder why I'm stumbling around".

   XXX
   Sheila
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Avatar universal
Hi, Zilla.

    "Funned out" is a good thing sometimes. :) Enjoy your boys...as you know, they grow up way too fast. This, from a mom of a 33 year old...but it seems like only yesterday......he was a little guy.

    This is confusing. The services took place at The Center for Advanced Medicine, which I 'think' is considered part of the hospital. And the docs office is there.  The nurse requested a urine sample from me. The only other procedure I had was in the exam room, where the gyne did a pelvic & rectal exam, then she said "Lets go to my office & talk". Her office was a tiny little room right down the hall from the exam room.

    This is what they billed me on that date:
    Service Code 1640414 GYNU-EVALUATION & Management 124 99214  $719.00

                        68445    FAOB-UA DIP STICK; NON-AUTO WO MICRO81002  $51.00  

    They submitted it as 3 separate things though. And one of the reps at BCBS told my DH that $210.00 was "use of the office", and $509.00 was the doctors fee. BCBS "allowed" $21.58 for the FAOB-DIP STICK, and and the provider agreed to accept the allowance as payment in full.

    Regarding the claim for the $210.00 it says "This service is not a covered benefit at this place of service."

    Regarding the claim for the $509.00 it says, "This service is not a contract benefit when performed in this setting. You are responsible for the provider's charge."

    So, I am not sure how this Gyne is in our PPO.

    Zilla, thanks for taking the time to sort through this with me. Even if you cannot help me with it, I am so touched by your willingness to try. That alone, means more to me than if I have to pay the bill.

    Sheila
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199882 tn?1310184542
Thanks Sheila, I will try them.  We are the exact same with our problem.  Not having any feeling.  I too only feel the pressure but I don't know when it passes.

I'll tell you a funny story:  I also have a really bad gas problem.  That's another thing that I just don't know is happening until it happens.  One day my 23 year old son and his wife where walking in walmart and every step I took I farted.  We laughed so hard.  I was using my walker and I finally set down.  When I got back up it was the same thing.  A true case of the walking farts.lol

Come on guys, you gotta laugh at that!! hahahaha

Zilla,  Your right, the only thing that keeps me going is the fact that I do have the sexiest legs on earth.  Now that I'm walking again I'm thinking about getting me some of those real short shorts with the real low waist. What do you think?

Have a great night all,
Carol
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220917 tn?1309784481
Hi, Sheila~  Oktoberfest was great fun!  I'm funned out, tho!  My boys were so cute, if I do say so myself...

Where did the services take place?  At the hospital or doc's office?  This is so confusing.  But for me confusing happens all the time.  It's true, the doctor is ultimately responsible for coding.  He/she has a biller who should know exactly what to bill for.  Blue Cross is NOT going to tell you what it will pay for.  Ever.  "Use of office" sounds hokey.   It sounds like "double dipping," almost.  That's not allowed.  I work for a surgeon, and we use a different section of the coding book, but I don't think there's anything comparable to that.  Coding always surprises me, though!

If something's not a covered benefit, and the doc is in your PPO, they shouldn't charge it.  They know not to bill your company for it.  They should have gotten pre-approval before doing the procedure.  "Use of office?"  What does that mean?  It sounds fraudulent, kind of.  That's why it's not a covered benefit.  DO NOT pay it yet until they explain what it is.  

Get back to me about where the procedure was done, OK?  What exactly was done?  What did they do and what ALL did they bill for on that date?  Interesting as the plot thickens.....

Later, Sheila,

Zilla*

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Avatar universal
Hi, Carol.

    Thank you for the welcome. This is a very nice place. Such kind, caring people here. I don't feel so alone anymore. But I am sorry so many others are going through it.

    Carol, I have no feeling either. I feel the pressure of stool. I do not feel it when I pass stool. If I don't use vitamins and minerals to go, then, nothing happens. No urge.

    Have you tried the Poise Ultimate Coverage Protection Supreme pads? I bought some for after my proctography, was afraid I might have problems after, on the long drive home from Chicago, IL to NW IN  Joke was on me, nothing came out. Not even during the test when it was supposed to.

   I'm sorry this is happening to you, too. Yes, you are much too young to have this problem.

    Carol, God Bless you, too. I'll keep you in my prayers, as well.

    Chris is right, you do have a wonderful attitude.

    (((BIG gentle HUG)))

    Sheila
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Avatar universal
Hi, Zilla.

    Oktoberfest, what fun! My goodness, we don't live that far away from each other...I'm in NW IN.

    I agree, this forum is wonderful To find people that actually understand.

    Interrupting? My goodness, you are not interrupting! I believe it's called 'chatting' :) I appreciate the advice about the bill. Would it be an imposition to ask you how I can get the doctor to submit the bill with the code the insurance company requires? The office call with the Gyne was at University of Chicago Hospital, Center for Advanced Medicine, this past July 18th. When we received the Explanation of Benefits from our insurance company, Blue Cross Blue Shield of Michigan, the claim was submitted as two things; $210.00 for hospital services and $509.00 for Medical Care. My DH went round and round with phone calls to BCBS who kept insisting the claim was denied because of the way it was submitted, and the billing dept. at U of C kept insisting they couldn't submit it any other way.  We've since found out that $210.00 was a charge for "use of the office" and the $509.00 was the doctors fee. (the actual bill we received says GYNU-EVALUATION & Management 124 99214 719.00) We've never heard of a charge for use of the office, and apparently it's not a covered benefit. Our plan does not pay office calls, but if we use a doctor in our PPO, they have an "amount allowed' so we pay a reduced amount. This Gyne is in our PPO. We are not sure how she is allowed to get around that fact. Last week, I told my GI doc about the bill and he said it was ridiculous and said DH should go see the Benefits Rep at the plant. Well, the Rep agreed, called the BCBS hotline number and they wouldn't even discuss it with him. The Rep said the doctor is responsible for the codes and suggested DH call the doctors head nurse and ask her to discuss it with the doctor. DH called and left a message on the voice-mail. He also called the Gynes finance person when we first got the bill and left a voice-mail but she didn't return his call either. We wrote to the Physicians Board, no response. We sent a written letter to BCBS last week. DH spoke to billing when we got the bill and said he would pay what he could on it each month, and explained that he is retired and we live on a fixed income. (we made a payment when the 1st statement arrived, and on the 2nd statement, they said the bill is over-due.)

    I apologize this is so long. It may end up we have to bite the bullet and pay the bill, but the thing that really worries me, is, if this Gyne can avoid submitting the bill in a manner that we get the "amount allowed", how do I know what doctor in my PPO is safe to go to? I have not run into this problem before.

    Back on track, yes, my DH is great, and I don't know how I would manage being sick without him. When I give in to tears of frustration and hopelessness, and I admit that I do, (today was a teary day) he reassures me that I will be diagnosed and back on my feet.

   You are so blessed to have 5 boys! Just imagine how many grandchildren they will give you someday......:)

    I pray we all find some answers oon....

    XXX
    Sheila
Helpful - 0
220917 tn?1309784481
Oh, Carol,

Does it ever stop with you?  I just want to reach through the computer and hug you!  You have been through SO much, and you have the absolute BEST attitude.  It' is just such a dagnab good thing you have such HOT legs, or I don't know where you'd be, Girlfriend, really and truthfully.

'Zilla Twinkle Toes*
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