Expert: Heather Van Vorous - 1/2/2009

Question
QUESTION: Hello,
I have always had a weak bladder and am often woken at night by the need to urinate. In recent weeks every night when I wake up to unrinate I also have to open my bowels, this will happen 1 to 3 times a night. It does not appear to be diarrhea just normal movements and there is no pain. If I wake up and open my bowels the next time I wake up to unrinate I also start to get the feeling to open my bowels which may die down or I may actually open them. I also get pains in my upper left abdomen just below the left side of my rib cage when I sit down in the evening. I have had a blood test,an ultrasound scan and a gastroscopy which all came back as normal. I am waiting for the results of a colonoscopy and a CT scan. In the meantime could it be IBS, what do you think?

ANSWER: Hi Steve - I cannot diagnose you, but I can send you to the diagnostic criteria for IBS, which are here http://www.helpforibs.com/footer/ibs.asp  

I do not think your symptoms match those of IBS, but a good GI doc will be able to properly diagnose you. The tests you might need run are on the same page above.

Best,
Heather

---------- FOLLOW-UP ----------

QUESTION: Dear Heather
Thanks for you answer. Things have now moved on because today I saw the GI Doctor and he told me that all of my tests including blood, CT Scan, colonoscopy, gastroscopy, untrasound scan and stool test came back as normal. I have been advised that I have been tested for everything they could test me for. The doctor also confirmed that I do not have the symptoms for classical IBS. He said that he does not know what is wrong with me. I should also tell you that apart from the symptoms I detailed before I also get the feeling that feces is stuck just before my rectum and feels like it is ready to come out but it doesn't come out. I can feel this for hours on end. I wonder if having considered my symptoms that you may have any idea what is wrong or where I might try for more help please?

ANSWER: Hi Steve - I'm so sorry for all you're going through. You may want to see a gastroenterologist who specializes in motility disorders. You may have something along these lines - IBS is a motility disorder but there are also others.

You may want to look into gut directed hypnotherapy. There are practioners listed here http://www.ibshypnosis.com/IBSclinicians.html and there is an at-home program you can listen to here http://www.helpforibs.com/shop/books/hypnoibs.asp  

The program is specific to IBS but as it physically changes the way the nervous system of your gut works, and the way that nervous system interacts with your brain, I would suspect that this approach would help with any bowel motility disorder.

Best,
Heather

---------- FOLLOW-UP ----------

QUESTION: Hello Heather

You were so helpful in the past and so I hope you won't mind me coming back to you for further advice.

Things ave moved on a little since you last wrote to me. Acting on your advice I have made an appointment to see a Hypnotherapist for next Monday. I have also seen my Gastroenterologist again and this time he was talking about IBS with regards to myself as he says that IBS often presents itself with untypical symptoms and he cannot find anything physically wrong with me.
Anyway I wanted to ask you some questions please, I hope you will be kind enough to help:-
1) I have been prescibed Mebeverine. Do you think this is worth a try?
2) My doctor has also prescribed Fybogel (psyllium husk supplement), as I often feel that feces are stuck in my rectum as well as a feeling of incomplete evacuation. Do you think this is a reasonable suggestion and in your experience does this work or may something else be better? I should say that I normally open my bowels 1 to 3 times per day nad my stools are soft but nevertheless I still get the feelings I mentioned.
3) I have read the following webpage http://www.youngerthanyourage.com/13/constipation.htm which seems to go against anyhting else I have read about the subject of constipation. I am wondering what you think of this page?
I would be very grateful for your thoughts.
Regards
Steve

Answer
Hi Steve - Please make sure your hypnotherapist has training in gut-specific or gut-directed hypnotherapy. Just general hypnosis won't be nearly as helpful. There's a list of US practitioners with this training here http://ibshypnosis.com/IBSclinicians.html

Mebeverine is just an antispasmodic, it might well help. There's IBS drug info here http://www.helpforibs.com/footer/medications.asp

Peppermint oil capsules would do the same thing without the side effects. I'd try the drug and see if it helps you, if it does you might try the caps instead for the comparable results without the dry mouth and sleepiness the drug can cause. Peppermint cap info is here http://www.helpforibs.com/shop/suplmts/pmintcaps.asp

Psyllium is not my top choice for a fiber supplement. You're likely better off with a pure soluble supplement (psyllium has both soluble and insoluble). Psyllium also thickens in the glass and is unpleasant to take, and causes gas and bloating for a lot of folks. There's soluble fiber info here http://www.helpforibs.com/supplements/sol_fiber1.asp and some better alternatives to psyllium.

I read that page and wouldn't agree with any of it. There's no clinical support for their assertions at all. Grain proteins don't cause constipation unless you have an intolerance like celiac disease, which is an autoimmune disorder your doc should have already ruled out. The evidence that a lack of fiber causes constipation is incontrovertible, as is the evidence that a high fiber diet reduces your risk of everything heart disease to colon cancer. Animal products will not help constipation at all, and in fact can worsen it (particularly red meat and dairy proteins).

Best,
Heather