Chronic Constipation and Digestive Issues: Seeking Solutions and Answers

Severe constipation with the use of stool softeners has not improved?

Hello Doctor, due to being unemployed recently, I have been using the computer at home every day, which has resulted in low physical activity and a lack of exercise habits.
I have been overweight.
Around October, I noticed that I would experience stomach pain after dinner, and in the following days, I felt very bloated and even nauseous.
My sleep schedule became irregular because I often felt uncomfortable in my stomach and couldn't sleep at night.
I also started experiencing constipation (which I had previously managed by drinking more water and eating more fiber).
Later, I visited a family medicine clinic, and the doctor said my abdomen was full of stool.
They advised me to improve my diet and prescribed a brown stool softener to take before bed, which helped somewhat.
In November, the same symptoms recurred; I often felt bloated after just a couple of bites of food, had difficulty passing gas, and frequently felt hungry at night.
I subsequently visited the clinic several times, and the doctor continuously adjusted my medication, including the brown stool softener, but my constipation did not improve.
My bowel movements varied between watery stools and diarrhea, and I still experienced abdominal pain and had a poor appetite.
The doctor then suggested I visit a large hospital for further examination.
Around December, I consulted a gastroenterologist, who prescribed some medications along with the same brown stool softener for three days and scheduled a nasogastric endoscopy three days later.
The results showed no issues with my stomach or gallbladder, and the doctor indicated that it might be a problem with my intestines, suggesting that my intestinal function might be impaired.
If I had concerns, they could arrange for a colonoscopy, but the doctor believed it might not be necessary.
They prescribed medication for two weeks, including the brown stool softener.
I tend to be an anxious and nervous person; I had taken medication for autonomic nervous system disorders a year ago.
The doctor mentioned that anxiety could also affect gastrointestinal function and advised me to change my water-drinking habits, walk after meals, massage my abdomen, and alter my eating order (since I previously didn't like drinking water, I would drink a lot at once when I remembered, rather than sipping slowly.
Additionally, I love soups, and the doctor suggested drinking soup before meals instead of after).
I have been taking the medication for over a week now, and I walk for 30 minutes and massage my abdomen after meals.
I still eat very little daily.
Although I feel the urge to have a bowel movement upon waking, I only produce unformed watery stools and often feel like I haven't completely emptied my bowels.
I tried drinking soup before meals once, but it caused excessive bloating, so I haven't had soup in the past two weeks.
In three days, I will finish the two-week course of medication.

1.
I would like to ask the doctor what might be the cause of my symptoms (as I have not had any blood in my stools so far).
Is there a possibility that I may need to be hospitalized?
2.
Is a colonoscopy necessary? If I want to undergo a colonoscopy, will it affect my work? If I need to take leave, how many days would be appropriate? My work hours are from the afternoon until around 10 PM, and I am concerned that a colonoscopy might interfere with my job, especially since I have been unemployed for a long time and am under financial pressure.

3.
After finishing the medication, should I observe my symptoms for a few days before returning for further evaluation, or should I return immediately after finishing the medication?
4.
Is it normal to have unformed watery stools after taking the brown stool softener (but I have not had any blood in my stools since October)?
Thank you very much, doctor, for taking the time to read this.
I am really quite troubled...

Niming, 20~29 year old female. Ask Date: 2021/12/24

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to first use medication, improve dietary fiber intake, and take a walk after meals.
Keep a record of bowel movements, return for follow-up appointments as scheduled, and if necessary, perform a fecal occult blood test.

Reply Date: 2021/12/24

More Info

Chronic constipation and digestive issues can be quite distressing, especially when they are compounded by anxiety and lifestyle changes. Based on your description, it seems that your symptoms have evolved over time, and you are experiencing a combination of gastrointestinal discomfort, irregular bowel movements, and feelings of incomplete evacuation. Here’s a comprehensive approach to understanding and addressing your situation.

Possible Causes of Your Symptoms
1. Dietary Factors: Your history of constipation suggests that dietary habits play a significant role. A diet low in fiber can lead to hard stools and difficulty in passing them. Additionally, your recent changes in eating habits, such as eating less and possibly consuming more processed foods, can exacerbate constipation.

2. Sedentary Lifestyle: With your current situation of being less active, this can contribute to slower bowel motility. Physical activity is crucial for stimulating the digestive system and promoting regular bowel movements.

3. Anxiety and Stress: Anxiety can significantly affect gastrointestinal function. The gut-brain connection is well-documented, and stress can lead to symptoms like abdominal pain, bloating, and changes in bowel habits. Your previous experience with autonomic nervous system disorders may also indicate a sensitivity to stress that can impact your digestive health.

4. Medication Effects: The brown softening medication you mentioned may have side effects that include diarrhea or loose stools, especially if not taken as directed. It's important to monitor how your body responds to any medication and communicate this with your healthcare provider.

Recommendations for Improvement
1. Dietary Adjustments: Focus on increasing your fiber intake through fruits, vegetables, whole grains, and legumes. Aim for a balanced diet that includes plenty of fluids, ideally water, to help soften stools. Since you mentioned discomfort with drinking soup before meals, consider experimenting with smaller amounts or different types of liquids that might be easier on your stomach.

2. Regular Physical Activity: Incorporate daily physical activity into your routine. Even light exercises, such as walking for 30 minutes after meals, can help stimulate digestion and improve bowel regularity.

3. Mindfulness and Stress Management: Since anxiety can exacerbate gastrointestinal symptoms, consider practices such as mindfulness, meditation, or yoga. These can help reduce stress and improve your overall well-being.

4. Medication Review: Continue to work closely with your healthcare provider regarding your medication. If you are experiencing side effects or if your symptoms persist, it may be necessary to adjust your treatment plan.

Follow-Up and Further Evaluation
1. Need for Colonoscopy: Given your symptoms and the duration of your issues, a colonoscopy may be warranted to rule out any underlying conditions, especially if your symptoms do not improve with conservative management. Discuss with your doctor the potential need for this procedure and any concerns you have about taking time off work.

2. Monitoring Symptoms: After completing your current medication, it’s advisable to monitor your symptoms for a few days. If there is no improvement or if symptoms worsen, schedule a follow-up appointment with your doctor to reassess your condition.

3. Understanding Bowel Movements: It’s not uncommon for softening agents to cause loose stools. However, if you are consistently experiencing watery stools, it may indicate that the dosage needs to be adjusted or that another underlying issue needs to be addressed.

Conclusion
Your situation is complex, and it’s understandable to feel overwhelmed. By addressing dietary habits, increasing physical activity, managing stress, and maintaining open communication with your healthcare provider, you can work towards improving your digestive health. If symptoms persist or worsen, further evaluation may be necessary to ensure there are no underlying issues that require attention. Remember, taking care of your mental health is just as important as addressing physical symptoms, and seeking support can be beneficial.

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