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• I am 58 years old patientold.
• Very healthy, no complains of any type of health issue other than what I will be stating below:
• No work stress
• Eat normal, light breakfast, lunch, and moderate diner.
• Two years old patientago, and all of a sudden, I started not to feel the urge to go to the bathroom, for #2, for almost 2 to 3 weeks.
• No indigestion issues at all.
• No pain whatsoever other than the pressure of the accumulating stuff inside the intestine and colon.
• I (feel) it is like the ascending, transverse, and descending colons are full stuffed, as my stomach tends to increase on the right and left sides and as well on the upper side.
• The lower part of the stomach (the sigmoid colon and rectum) is always completely empty, if not shrinking inward.
• To easy the situation, I started to use laxatives once or twice a week. it empty my stomach completely, with complete ease.
• I did a endoscopy inspection and the doctor did not find any issue that may likely to cause my situation. He advised me to drink lots of water, eat more vegetables and high-fiber food. I am doing all of that for the last 2 years old patientto no avail.

  • If not using a laxative, I will not be able to go to the toilet for up to two or three weeks. Thereafter, small pieces of feces start to come out once a day, after I exert lots of pressure on my lower abdominal muscles. The quantity of feces that comes out is hardly more than approximately one ounce. I suspect the amount of feces that come out is due to the pressure of the stuff behind it and not because of natural colon contraction.

  • Again, I never feel any kind of pain in the stomach at anytime during the 2 to 3 weeks that I don't go to the toilet. Still, I feel normal hanger and I eat my daily 3 meals as normal.

Any advice please.

Category: Gastroenterologist, Medical

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Category: Hepatologist
Dr. Ratnakar Kini is online now

Expert:  Dr. Ratnakar Kini replied 4 Days.

Thanks for posting your query at DoctorSpring.com
I am Dr.R.K and I am pleased to assist you.
You are obviously constipated.
Since there are risk factors or precipitating factors, you probably are having functional constipation.
It can be a normal transit or a slow transit constipation.
To know what type of constipation you have which will help to plan the treatment, you need to undergo a colon transit study.
You can consult a gastroenterologist for this test.
Meanwhile you can take fiber supplements like metamucil.
I hope that answers your question.
Let me know if I can assist you further.

Patient replied :

Dear Dr. R. K. If constipation is defined as “Accumulation of hard feces in the descending colon and all the way down to the rectum”, then I may say “I am not constipated. You may be right if my definition ifor constipation s not correct. I mentioned in my earlier message that the lower part of my stomach is always empty, and shrinking inward. After a prolonged period of no use of laxative, the small amount of feces that comes out is quite soft, and unlike the hardness that characterize constipation. I found the following defenition on functional constipation, and only item #6 that may apply for my case:
Rome III Diagnostic Criteria for Functional Constipation (http://www.aafp.org/afp/2011/0801/p299.html)
Must include two or more of the following:
1. Straining during at least 25 percent of defecations
2. Lumpy or hard stools in at least 25 percent of defecations
3. Sensation of incomplete evacuation for at least 25 percent of defecations
4. Sensation of anorectal obstruction/blockage for at least 25 percent of defecations
5. Manual maneuvers to facilitate at least 25 percent of defecations (e.g., digital evacuation, support of the pelvic floor)
6. Fewer than three defecations per week
7. Loose stools are rarely present without the use of laxatives
8. There are insufficient criteria for irritable bowel syndrome (IBS)
Please let me know if you still believe it is a case of “Functional Constipation” Thank you, Sir.

Expert:  Dr. Ratnakar Kini replied 3 Days.

Your definition of constipation is not correct. Constipation is not having bowel movements, difficulty in having bowel movements, passing hard stool, straining during defecation, feeling of in complete evacuation, ( Any one of these). Since you have relief with laxative, what you have is constipation. And since you do not have risk factors, what you have is functional constipation.
And suggested earlier, the next step is to get a colon transit study done.
Feel free to discuss further,

Patient replied :

Thank you very much Dr. R. K.
Your advise is truely of great help to me. I will follow your recommendation and I shall see a gastroenterologist for a test, and take forward from there.

Best Regards.

Dr. Ratnakar Kini
Category: Hepatologist
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
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