Gastrointestinal Issues: From Constipation to Treatment Options

Gastrointestinal discomfort?

Hello, Doctor: I have a few questions I would like to ask you.
Before I got married, I used to have diarrhea after eating, but after marriage, my bowel movements became more regular, and I had natural deliveries.
Recently, I experienced abdominal pain, nausea, and vomiting, so I went to the emergency room.
They diagnosed me with abdominal pain due to constipation and advised me to see a gastroenterologist.
When I visited the gastroenterologist, they reviewed my X-rays and said my colon and small intestine were filled with stool, almost to the point of overflowing from my stomach.
I was admitted to the hospital for bowel decompression and stayed for nine days, taking laxatives three times a day and having an enema every morning.
I was on a fasting diet for the first three days and only received IV fluids, with bowel movements limited to just water during the enemas.
On the fourth day, I managed to pass a small amount of stool.
On the seventh day, I had another X-ray, and the doctor said I still couldn't be discharged.
After clearing my colon, my small intestine became obstructed again.
They said I could be discharged if I paid out of pocket for a colonoscopy, which would require taking two packets of laxatives and 2000 cc of laxatives the day before to ensure a clean bowel.
I was discharged on the third day and scheduled for a colonoscopy and endoscopy on the fifth day.
The results showed excessive stomach acid, gastroesophageal reflux, and a bend in the terminal ileum, which makes me prone to constipation.
They advised me to take laxatives daily until I have watery stools and to take soft stool medications.
I would like to know if the bend in the terminal ileum is indeed a permanent condition.
When I asked the doctor, he said it was something I would have to live with for life, but I don't want to rely on laxatives for regular bowel movements.
If I stop taking laxatives, I experience bloating and stomach pain after eating, and after having a bowel movement, I suffer from cramping and stomach pain.
Is surgery an option? I prefer to endure short-term pain rather than long-term discomfort.
When my mother asked the doctor if surgery was necessary, he said it wasn't at that stage, but relying on laxatives long-term could lead to gastrointestinal issues, right?

Ah Huadan, 20~29 year old female. Ask Date: 2016/09/05

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, constipation is a common benign issue that can fluctuate and may not completely resolve.
It is important to pay attention to diet, hydration, and exercise, but many people still require long-term medication assistance, which typically does not affect overall health.
Surgery is an option; however, due to the associated risks and potential for postoperative adhesions, it is not currently recommended.
Changhua Hospital cares about your health.
Sincerely, Chen Shih-Tien.

Reply Date: 2016/09/05

More Info

Understanding gastrointestinal issues can be quite complex, especially when symptoms like constipation, abdominal pain, and gastroesophageal reflux disease (GERD) are involved. Your situation highlights a common challenge faced by many individuals dealing with gastrointestinal disorders.
From your description, it seems you have experienced significant gastrointestinal distress, leading to hospitalization and the use of laxatives to manage your symptoms. The fact that you were told your intestines were filled with stool indicates a severe case of constipation, which can lead to abdominal pain, nausea, and vomiting. This condition, if left untreated, can result in more serious complications, such as bowel obstruction.

The diagnosis of GERD and the mention of a "curved terminal ileum" suggest that there may be anatomical factors contributing to your symptoms. The terminal ileum is the last part of the small intestine, and if it is curved or has any structural abnormalities, it can affect the passage of stool and lead to constipation. While some anatomical variations are indeed lifelong conditions, they do not always necessitate surgical intervention.
Your concern about relying on laxatives is valid. Chronic use of laxatives can lead to dependency, where the bowel becomes less responsive to natural stimuli for bowel movements. This can create a cycle of needing more laxatives to achieve the same effect, which is not ideal for long-term health. It’s essential to address the underlying causes of your constipation rather than solely relying on medication.

In terms of treatment options, here are several strategies that may help:
1. Dietary Changes: Increasing your fiber intake through fruits, vegetables, whole grains, and legumes can help promote regular bowel movements. Fiber adds bulk to the stool and can improve its passage through the intestines. Additionally, staying well-hydrated is crucial, as adequate fluid intake can help soften stool.

2. Physical Activity: Regular exercise can stimulate bowel function and help alleviate constipation. Even simple activities like walking can be beneficial.

3. Medication Review: Discuss with your healthcare provider the possibility of adjusting your current medications. There are various types of laxatives, and some may be more suitable for long-term use than others. Additionally, medications that promote gut motility may be considered.

4. Behavioral Techniques: Establishing a regular bowel routine can be helpful. Setting aside time each day to sit on the toilet, even if you don’t feel the urge, can train your body to recognize when it’s time to go.

5. Surgical Options: If your doctor believes that the curvature of your terminal ileum is significantly contributing to your symptoms and other treatments have failed, surgical options may be explored. However, this is typically considered a last resort after conservative measures have been exhausted.

6. Follow-Up Care: Regular follow-up with a gastroenterologist is essential. They can monitor your condition, adjust treatment plans, and ensure that no further complications arise.

In conclusion, while your gastrointestinal issues may seem daunting, there are multiple avenues to explore for relief and management. It’s important to have open communication with your healthcare provider about your concerns and preferences for treatment. Together, you can develop a comprehensive plan that addresses both your symptoms and the underlying causes, aiming for a better quality of life without reliance on medications.

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