Severe Constipation and Abdominal Discomfort: Which Specialist to See? - Gastroenterology and Hepatology

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When dealing with severe constipation and abdominal discomfort, it is essential to approach the situation systematically, especially since you have already consulted a colorectal surgeon without satisfactory results. Here are some considerations and recommendations for your next steps.


Understanding Your Symptoms
Severe constipation can be a complex issue, often influenced by various factors, including diet, hydration, physical activity, and underlying medical conditions. Given that you have been consuming a high-fiber diet, staying hydrated, and exercising regularly, it is concerning that these measures have not alleviated your symptoms. The sensation of incomplete evacuation and persistent abdominal bloating can indicate several potential issues, including:
1. Functional Constipation: This is a common condition where the bowel does not function properly, leading to infrequent or difficult bowel movements.

2. Obstruction: A physical blockage in the intestines can cause severe constipation and discomfort. This could be due to fecal impaction, strictures, or other anatomical issues.

3. Neurological Conditions: Conditions affecting nerve function can impact bowel movements, leading to constipation.

4. Medication Side Effects: Some medications can contribute to constipation, including certain pain medications and antacids containing aluminum.


Next Steps: Which Specialist to See?
Given your ongoing symptoms and the fact that you have already seen a colorectal surgeon, it may be beneficial to consult with a gastroenterologist. Gastroenterologists specialize in diagnosing and treating disorders of the digestive system, including complex constipation issues. They can provide a more comprehensive evaluation of your gastrointestinal health and may recommend further diagnostic tests, such as:
- Colonoscopy: This procedure allows the doctor to visualize the inside of your colon and rectum, helping to identify any abnormalities.

- Manometry: This test measures the pressure and function of the muscles in the rectum and anus, which can help diagnose functional disorders.

- Imaging Studies: Additional imaging, such as a CT scan, may be warranted to rule out obstructions or other structural issues.


Additional Considerations
1. Medication Review: Discuss with your doctor any medications you are currently taking that may contribute to constipation. Sometimes, adjusting or changing medications can significantly improve bowel function.

2. Laxative Use: While you mentioned using enzyme supplements, it may be worth discussing the use of different types of laxatives with your gastroenterologist. There are various classes of laxatives, including osmotic agents, stimulant laxatives, and bulk-forming agents, each with different mechanisms of action.

3. Dietary Adjustments: Although you are consuming a lot of fruits and vegetables, consider consulting a dietitian who specializes in gastrointestinal health. They can help tailor a diet that may be more effective for your specific situation.

4. Hydration: Ensure you are drinking enough fluids, as dehydration can exacerbate constipation. Sometimes, increasing water intake significantly can help.

5. Physical Activity: While you mentioned exercising, incorporating specific exercises that promote bowel movement, such as walking or yoga, may also be beneficial.


Conclusion
In summary, given your persistent symptoms of severe constipation and abdominal discomfort, it would be prudent to schedule an appointment with a gastroenterologist. They can provide a thorough evaluation and develop a tailored treatment plan to address your concerns. Remember, it is essential to advocate for your health and seek further opinions if you feel your symptoms are not being adequately addressed.