Hi everyone,
First time poster. I've seen some excellent analysis and advice shared on this board. I'm now asking for your help. I have suffered constipation of an extreme degree since 2016. For those of you who might be able to help, please read my entire post - I believe the answer is somewhere in these details, and I just can't see it.
Symptoms:
-Constipation: Zero bowel movements per week. I have to force them with 20-30mg Dulcolax (biascodyl) twice per week.
-No urge to defacate. Ever. This is not an "I have to poop but I can't!" situation.
-Mild headache in morning, when I'd normally have a BM in the past
-Little to no flatulence. Disturbingly little.
-No ulcers
-No pain
-No nausea; no vomiting
-No diarrhea (except after taking biascodyl)
-I do not have fibromyalgia, weight problems, heart problems, history of cancer, etc
Allergies that I'm aware of:
-Sulfa drugs, some antibiotics (discovered both of these during childhood while treating chronic ear infections)
-No food allergies
Food sensitivities that do not produce an allergic reaction:
-I appear to be incapable of digesting wheat. More on this later
-Potentially dairy, but I'm not sure. Pizza is my worst trigger food for constipation. No diarrhea or stomach pain or gas from dairy
-Unclear whether red meat helps or hurts movement
History of this illness:
-I was a once-a-day kind of guy my entire life with no digestive issues whatsoever. At age 22, in 2011, I began a course of Accutane (isotretinoin), which has been reported to cause IBS or ulcerative colitis. The data is sketchy. 1 year after coming off the drug, I became constipated, and went to the doctor. She prescribed Senna and I was all fixed up.
-Every few months from that point in 2012, I'd find myself constipated, take a small dose of Senna, and clear out. Then it became every two months. Then once a month. Then twice a month. I knew not to take Senna too often, so I switched to fiber supplements, which helped.
-In 2016 I stopped pooping altogether. Senna stopped working. Fiber stopped working. I went to the doctor, who recommended Miralax. It worked for a while, then stopped. I moved to Dulcolax (biascodyl) but used it rarely because I was afraid I'd get addicted or damage my intestines.
-Everything fell apart after this. I tried tons of medicines and had tons of tests done. After seeing three specialists, I was finally diagnosed with slow-transit constipation, but it is a preliminary diagnosis.
Tests I've had performed, by chronological order:
-Fecal blood test: negative
-Standard blood panel: All levels within normal range
-Thyroid-specific panel: All levels within normal range
-CT-scan: Some divurticulosis, no blockage, no tumors
-Gastric emptying study for gastroparisis: Normal emptying speed
-SITZ marker study: Stomach and upper intestine empty normally. Very slow movement of large intestine, especially colon
-Upper endoscopy: normal, biopsies normal
-Lower endoscopy (colonoscopy): Tortuous colon, mild diverticulosis, no obstruction, no tumors, no ulcers, biopsies normal
-Upper/lower endo performed same day. Specifically, no damaged villi, no indication of Celiac's
Tests I'm having performed soon:
-Stool gut flora/parasite test
Medicine I've tried that no longer works:
-Miralax
-Senna
-Docusate: Never worked, just made me nauseous.
-Linzess (linaclotide, 290mcg): Worked fantastically for 2 months, then stopped working at all
-Magnesium citrate powder: For 6 months, produce a BM every morning. Now occasionally produces a BM the next morning, but rarely
-Lactulose: I think it helps with bulking a bit but doesn't move anything
-Coconut oil: never worked
-high fiber, both types. High quality supplements and foods
-Gargling: never worked
Medicine that currently produces BMs:
-Dulcolax: it's extremely painful and makes me feel like vomiting. I absolutely loathe taking it. I take it twice/week
-Magnesium citrate powder: I still feel like this occasionally works but I cannot explain why
Diagnosis:
-Gastroenterologist # 1: Colonic inertia
-Gastroenterologist # 2: "It's not colonic inertia. # 1 is wrong. It's slow-transit constipation. You have nerve damage or dead nerves around your intestines."
Medications I might try soon:
-Resolor (prucalopride): This is a nerve drug that was just cleared in the US for treatment of slow-transit. I think it raises seretonin levels.
-Mestinon: Gastroenterologist # 2 says "I will only put you on this if Resolor doesn't work. It's got a lot of side-effects." Mestinon raises acetylcholine levels.
Normal diet:
-Lots of red meat, tons of bread, tons of wheat cereals. Lots of chicken. Moderate dark-green veggie intake. No fruit. No salad. No fish.
Diet that helps slightly:
-I have cut gluten from my diet on 3 occasions for two weeks each. All three times, passing stool was easier with medicine, and I occasionally had bowel movements with no medication at all. Every single time I eat bread I feel heavy, bloated, and "stuck." But bread has never caused me brainfog/nausea/pain/diarrhea/gas.
-I now eat tons of fruit, tons of cruciferous vegetables, some fish, lots of chicken, moderate red meat. Greasy foods appear not to cause any issue or maybe even help, as long as there's no bread whatsoever. Lettuce-wrapped cheeseburgers.
-I cut dairy for one week and retained gluten. No changes; constipation remained.
Diets I should probably try but have never:
-FODMAP
-Paleo
My questions:
1. Do you agree that this is slow-transit constipation?
2. I've recently discovered the relationship between acetylcholine and constipation. I ordered Parasym Plus. I've also been told to try the following:
-wormwood leaves (chew on one)
-thiamine/B-1 (should I try thiamine mononitrate or thiamin HCL?)
-DGL (a kind of licorice?)
-B-12
-Pantothenic acid/B-5
-Alpha-GPC
Should I try/skip/know anything special about any of these?
3. Any other advice would be appreciated. Thank you so much.
First time poster. I've seen some excellent analysis and advice shared on this board. I'm now asking for your help. I have suffered constipation of an extreme degree since 2016. For those of you who might be able to help, please read my entire post - I believe the answer is somewhere in these details, and I just can't see it.
Symptoms:
-Constipation: Zero bowel movements per week. I have to force them with 20-30mg Dulcolax (biascodyl) twice per week.
-No urge to defacate. Ever. This is not an "I have to poop but I can't!" situation.
-Mild headache in morning, when I'd normally have a BM in the past
-Little to no flatulence. Disturbingly little.
-No ulcers
-No pain
-No nausea; no vomiting
-No diarrhea (except after taking biascodyl)
-I do not have fibromyalgia, weight problems, heart problems, history of cancer, etc
Allergies that I'm aware of:
-Sulfa drugs, some antibiotics (discovered both of these during childhood while treating chronic ear infections)
-No food allergies
Food sensitivities that do not produce an allergic reaction:
-I appear to be incapable of digesting wheat. More on this later
-Potentially dairy, but I'm not sure. Pizza is my worst trigger food for constipation. No diarrhea or stomach pain or gas from dairy
-Unclear whether red meat helps or hurts movement
History of this illness:
-I was a once-a-day kind of guy my entire life with no digestive issues whatsoever. At age 22, in 2011, I began a course of Accutane (isotretinoin), which has been reported to cause IBS or ulcerative colitis. The data is sketchy. 1 year after coming off the drug, I became constipated, and went to the doctor. She prescribed Senna and I was all fixed up.
-Every few months from that point in 2012, I'd find myself constipated, take a small dose of Senna, and clear out. Then it became every two months. Then once a month. Then twice a month. I knew not to take Senna too often, so I switched to fiber supplements, which helped.
-In 2016 I stopped pooping altogether. Senna stopped working. Fiber stopped working. I went to the doctor, who recommended Miralax. It worked for a while, then stopped. I moved to Dulcolax (biascodyl) but used it rarely because I was afraid I'd get addicted or damage my intestines.
-Everything fell apart after this. I tried tons of medicines and had tons of tests done. After seeing three specialists, I was finally diagnosed with slow-transit constipation, but it is a preliminary diagnosis.
Tests I've had performed, by chronological order:
-Fecal blood test: negative
-Standard blood panel: All levels within normal range
-Thyroid-specific panel: All levels within normal range
-CT-scan: Some divurticulosis, no blockage, no tumors
-Gastric emptying study for gastroparisis: Normal emptying speed
-SITZ marker study: Stomach and upper intestine empty normally. Very slow movement of large intestine, especially colon
-Upper endoscopy: normal, biopsies normal
-Lower endoscopy (colonoscopy): Tortuous colon, mild diverticulosis, no obstruction, no tumors, no ulcers, biopsies normal
-Upper/lower endo performed same day. Specifically, no damaged villi, no indication of Celiac's
Tests I'm having performed soon:
-Stool gut flora/parasite test
Medicine I've tried that no longer works:
-Miralax
-Senna
-Docusate: Never worked, just made me nauseous.
-Linzess (linaclotide, 290mcg): Worked fantastically for 2 months, then stopped working at all
-Magnesium citrate powder: For 6 months, produce a BM every morning. Now occasionally produces a BM the next morning, but rarely
-Lactulose: I think it helps with bulking a bit but doesn't move anything
-Coconut oil: never worked
-high fiber, both types. High quality supplements and foods
-Gargling: never worked
Medicine that currently produces BMs:
-Dulcolax: it's extremely painful and makes me feel like vomiting. I absolutely loathe taking it. I take it twice/week
-Magnesium citrate powder: I still feel like this occasionally works but I cannot explain why
Diagnosis:
-Gastroenterologist # 1: Colonic inertia
-Gastroenterologist # 2: "It's not colonic inertia. # 1 is wrong. It's slow-transit constipation. You have nerve damage or dead nerves around your intestines."
Medications I might try soon:
-Resolor (prucalopride): This is a nerve drug that was just cleared in the US for treatment of slow-transit. I think it raises seretonin levels.
-Mestinon: Gastroenterologist # 2 says "I will only put you on this if Resolor doesn't work. It's got a lot of side-effects." Mestinon raises acetylcholine levels.
Normal diet:
-Lots of red meat, tons of bread, tons of wheat cereals. Lots of chicken. Moderate dark-green veggie intake. No fruit. No salad. No fish.
Diet that helps slightly:
-I have cut gluten from my diet on 3 occasions for two weeks each. All three times, passing stool was easier with medicine, and I occasionally had bowel movements with no medication at all. Every single time I eat bread I feel heavy, bloated, and "stuck." But bread has never caused me brainfog/nausea/pain/diarrhea/gas.
-I now eat tons of fruit, tons of cruciferous vegetables, some fish, lots of chicken, moderate red meat. Greasy foods appear not to cause any issue or maybe even help, as long as there's no bread whatsoever. Lettuce-wrapped cheeseburgers.
-I cut dairy for one week and retained gluten. No changes; constipation remained.
Diets I should probably try but have never:
-FODMAP
-Paleo
My questions:
1. Do you agree that this is slow-transit constipation?
2. I've recently discovered the relationship between acetylcholine and constipation. I ordered Parasym Plus. I've also been told to try the following:
-wormwood leaves (chew on one)
-thiamine/B-1 (should I try thiamine mononitrate or thiamin HCL?)
-DGL (a kind of licorice?)
-B-12
-Pantothenic acid/B-5
-Alpha-GPC
Should I try/skip/know anything special about any of these?
3. Any other advice would be appreciated. Thank you so much.
Last edited by a moderator:
. At least every second day, considers everyday bowel-movements a bit too extreme.
