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Bowel

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Bowel

CONSTIPATION

About
    • Having fewer than three bowel movements a week
    • Stools are dry and hard
    • A bowel movement is painful and stools are difficult to pass
    • A feeling that you have not fully emptied your bowels
Causes
    • Older age
    • Stress
    • Being a woman, especially while you are pregnant and after childbirth 
      • Hormonal changes 
      • The baby inside the womb squishes the intestines, slowing down the passage of stool
    • Changes in your regular routine ie: traveling
    • Not eating enough foods rich in fibre
    • Not drinking enough water
    • Taking certain medications 
    • Having certain neurological and digestive disorders
Symptoms
    • Fewer than three bowel movements/wk
    • Stools are dry, hard and/or lumpy
    • Stools are difficult/painful to pass
    • Stomachache/cramps.
    • Bloating
    • Nausea
    • Incomplete emptying feeling after a bowel movement 
Diagnosis
  • Medical history and bowel movement history
  • Physical exam, including rectal exam
  • Lab tests: Blood and urine tests to check for hypothyroidism/anemia/diabetes
  • Stool sample: To check for signs of infection/inflammation/cancer
  • Imaging tests: Computed tomography (CT), magnetic resonance imaging (MRI) or lower gastrointestinal tract series may be ordered to identify other problems 
  • Colonoscopy:  An internal view of your colon with a scope – may be performed
  • Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines
  • Defecography:
    • A small amount of liquid barium is released through a tube into the colon and rectum
    • An x-ray video is taken that shows how the rectum is functioning
  • Anal manometry:
    • A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
    • Studies the strength of the anal sphincter muscles
Treatment
    • Review your medications and supplements (if you take any) with your doctor so they can be modified if they are causing the problem
    • Self-Care
      • Exercise regularly
      • Check how you sit on the toilet
      • Raising your feet, leaning back or squatting may make having a bowel movement easier
      • Do not read, use your phone or other devices while trying to move your bowels
    • Dietary Changes
      • Drink 2-4 extra glasses of water a day
      • Avoid caffeine-containing drinks and alcohol, which can cause dehydration
      • Add fruits, vegetables whole grains and other high-fibre foods to your diet ie: prunes, bran cereal
      • Add an over-the-counter supplemental fibre to your diet 
      • Eat fewer high-fat foods, like meat, eggs and cheese
      • Keep a food diary and single out foods that constipate you
    • Oral Medication
      • There are a few prescription drugs on the market
      • A very mild over-the-counter stool softener or laxative, mineral oil enemas and stimulant laxatives are available over the counter
        • Ask your pharmacist or doctor for help in making a choice
        • Do not use laxatives for more than two weeks without calling your doctor
        • Overuse of laxatives can worsen your symptoms
    • Surgery
      • If there’s a structural problem in the colon
      • Examples of these problems: Intestinal obstruction/stricture, tear in the anus or rectal prolapse
  •  

INCONTINENCE (BOWEL/FECAL)

About
    • When bowel movements cannot be controlled
    • Stool (feces/waste) leaks out of the rectum at unwanted times with/without awareness
    • Happens more often in women than in men, and often amongst older people
Potential Causes
    • Frequent diarrhea/constipation
    • Muscle damage
    • Older age
    • Nerve damage
    • Inability of the rectum to stretch
    • Reduced rectal storage capacity
    • Rectal prolapse (rectum falls into the anus) or rectocele (rectum pushes into the vagina)
    • Chronic constipation
    • Laxative abuse
    • Radiation treatments
    • Certain nervous system/congenital defects
    • Inflammatory bowel disease
Symptoms
    • The feeling of needing to go and not being able to make it to the bathroom in time
    • Stool leaks out when passing gas
    • Stool leaks out due to physical activity/daily life exertions
    • Stool is seen in the underwear after a normal bowel movement
    • Complete loss of bowel control
Diagnosis
  • Physical exam, including rectal exam
  • Anal Manometry: A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
    • Studies the strength of the anal sphincter muscles
  • Endoluminal (anal) Ultrasound: A small probe is inserted up into the anus and rectum to take images of the sphincters
      • Helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue
  • Pudendal Nerve Terminal Motor Latency Test: Measures the functions of the pudendal nerves, which are involved in bowel control
  • Anal Electromyography (EMG): Determines if nerve damage is the cause and examines the coordination between the rectum and anal muscles
  • Flexible Sigmoidoscopy/Proctosigmoidoscopy: Sigmoidoscope is inserted into the rectum so the bowel can be viewed
    • Evaluates the end of the large bowel/colon, looking for any abnormalities
  • Proctography/Defecography: A small amount of liquid barium is released through a tube into the colon and rectum
    • An x-ray video is taken that shows how the rectum is functioning
  • Magnetic Resonance Imaging (MRI): To evaluate the pelvic organs
Treatment
  • Dietary Changes: Eliminate foods that can cause loose stools from your diet ie: beans, cabbage family vegetables, dairy products, dried fruit, spicy foods, artificial sweeteners
  • Bowel Retraining (Biofeedback): Developing a “going-to-the-bathroom” pattern to gain greater control over bowel movements
    • Have a trained therapist teach you certain exercises to increase anal muscle strength
  • Oral Medication: Anti-diarrheal drugs and bulk laxatives to decrease movement of the stool through the intestine and firm it up
  • Surgery
    • Sphincteroplasty
      • Repairs a damaged or weakened anal sphincter that occurred during childbirth
      • Doctors identify an injured area of muscle and free its edges from the surrounding tissue
      • They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter
    • Rectocele or rectal prolapse correction
      • Can be done surgically to reduce or eliminate fecal incontinence
    • Sphincter replacement
      • A damaged anal sphincter can be replaced with an artificial anal sphincter
      • The device is essentially an inflatable cuff, which is implanted around your anal canal
      • When inflated, the device keeps your anal sphincter shut tight until you’re ready to defecate
      • To go to the toilet, you use a small external pump to deflate the device and allow stool to be released
      • The device then reinflates itself
    • Sphincter repair (Dynamic Graciloplasty)
      • Muscle from the inner thigh is taken and wrapped around the sphincter, restoring muscle tone to the sphincter
    • Sacral nerve stimulation
      • A small device (a neurotransmitter) is implanted under the skin in the upper buttock area
      • The device sends mild electrical impulses through a lead that is positioned close to a nerve located in the lower back (the sacral nerve), which influences the bladder, the sphincter and the pelvic floor muscles
    • Colostomy (Bowel Diversion)
      • Stool is diverted through an opening in the abdomen and a special bag is attached to this opening to collect the stool
      • A last resort treatment

IRRITABLE BOWEL SYNDROME (IBS)

About
    • Colon/lower bowel disorder
Potential Causes
    • Unknown
    • What is known is that the colon muscle in those with IBS contracts more readily than in those without it and those with the condition have a lower pain threshold
    • Triggers include
      • Certain foods
      • Medications
      • Stress
Symptoms
    • Abdominal pain/cramps, usually in the lower half of the abdomen
    • Bloating
    • Constipation in some, diarrhea in others
    • Excess gas
    • Harder/looser bowel movements than usual
Diagnosis
  • Medical history is evaluated
  • Physical exam
  • Blood tests and stool samples: To rule out other conditions
    • Stool examined for bacteria, parasites or bile acid (if you have chronic diarrhea)
  • Flexible sigmoidoscopy: With a flexible lighted tube, the lower part of the colon (the sigmoid) is examined
  • Colonoscopy: Entire colon is examined with a colonoscope
    • If necessary, small amounts of tissue can be taken for biopsy and polyps can be identified and removed
    • *There is no definitive test to diagnose IBS
Treatment
  • Diet
    • Avoid trigger foods (ie: high-gas foods, gluten, certain carbs such as fructose, fructans, lactose, FODMAPs) 
    • Eat fibre
    • Drink plenty of fluids
    • IBS Diet
  • Stress reduction
    • Mindfulness
    • Yoga
    • Psychotherapy
    • Regular physical exercise
  • Oral Medications
    • Fibre supplements/laxatives: For constipation-predominant IBS
    • Anti-diarrheals
    • Bile acid binders: Cholestyramine, colestipol or colesevelam
    • Anticholinergics: To relieve bowel spasms
    • Tricyclic antidepressants: Inhibit the activity of neurons that control the intestines to help reduce pain
    • Pain medications: Pregabalin/gabapentin for severe pain/bloating
    • Medications specifically for IBS: Can help ease diarrhea and relax the colon