Why do my bowels not work?
For those that suffer constipation or painful diarrhoea due to faecal loading treatment needs to focus on three key elements.
Unless you address them all you will not have success
1/ a rectum that senses the faeces and provides
For those that suffer constipation or painful diarrhoea due to faecal loading treatment needs to focus on three key elements.
Unless you address them all you will not have success
1/ a rectum that senses the faeces and provides
The urge to defecate, teemed with a correct defecatory technique and adequate pelvic floor function.
Most of my pts have dyssynergia defecation. When the patient tries to push the faeces out, instead of relaxing the EAS
Most of my pts have dyssynergia defecation. When the patient tries to push the faeces out, instead of relaxing the EAS
(external anal sphincter) they either fail to relax it or actively contract the sphincter.
This leads to a feeling of incomplete emptying and a rectum that contains faeces after defecation (the rectum is supposed to be empty u til just prior to defecation)
This leads to a feeling of incomplete emptying and a rectum that contains faeces after defecation (the rectum is supposed to be empty u til just prior to defecation)
Not only does dyssynergic defecation further slow down colonic transit it leads to rectal hyposensitivity. If left unchecked over years the pt will end up with a non functioning mega rectum that won’t ever work. Potentially needing a loop ileostomy.
Do NOT underestimate the importance of #Pelvicfloorphysiotherapy
2/ faeces that are of a soft enough consistency that the colon can move the faeces out.
In pts with POTS hypovolaemia leads to further dehydration and hardening of faeces. The faecal loading causes nausea and loss of appetite which reduces oral salt and water
In pts with POTS hypovolaemia leads to further dehydration and hardening of faeces. The faecal loading causes nausea and loss of appetite which reduces oral salt and water
This leads to less water in the colon and exacerbation of faecal loading, as well as driving the POTS which is causing the faecal loading in the first place
Gentle osmotic laxatives
3/ a colon that has enough motility. Post Covid GI dysfunction hEDs related
Gentle osmotic laxatives
3/ a colon that has enough motility. Post Covid GI dysfunction hEDs related
GI dysfunction leads to floppy bowels, with poor contractility. Further worsened by the connective tissue changes that lead to ptosis of the transverse colon and retention of faeces in the right colon.
Use a pro motility agent like Prucalopride.
Use a pro motility agent like Prucalopride.
If Prucalopride doesn’t work it usually means the faeces are still “too hard” to be moved by colonic peristalsis.
IV fluids a few litres a week for a few weeks will rehydrate the faeces from within, allowing the Prucalopride to start working.
IV fluids a few litres a week for a few weeks will rehydrate the faeces from within, allowing the Prucalopride to start working.
#hEDS #POTS #MCAS #LC #faecalloading #constipation
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