Persistent Bowel Urgency: A Guide for Patients - Gastroenterology and Hepatology

Q: Persistent Bowel Urgency: A Guide for Patients

Hello： Constipation is a frustrating issue. <br>If you have undergone a colonoscopy and no tumors were found, but you experience the urge to defecate and urinate at night, it is advisable to consult a urologist to check for any prostate issues. <br>Medication may help improve the

Constant urge to have a bowel movement throughout the day?

I am a person with a disability and have been experiencing constipation for the past three years.
I have seen doctors and undergone a colonoscopy, but each time the doctor only prescribes laxatives.
While the medication helps when I take it, the problem persists when I don't.
Currently, my biggest concern is that every time I feel the urge to have a bowel movement, I also feel the urge to urinate.
Throughout the day, I experience intermittent urges for both bowel movements and urination.
Whenever I have the urge to defecate or urinate, I also experience urinary incontinence.
Every night, I wake up at 2 AM and, upon waking, I immediately feel the urge to have a bowel movement and urinate, which keeps me awake until dawn.
This cycle repeats every night, causing me significant distress.
The doctors at National Taiwan University in Yunlin have not been able to help with my condition.
Is it possible that constipation is also related to my symptoms?

A Sheng, 40~49 year old female. Ask Date: 2012/06/28

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: Constipation is a frustrating issue.
If you have undergone a colonoscopy and no tumors were found, but you experience the urge to defecate and urinate at night, it is advisable to consult a urologist to check for any prostate issues.
Medication may help improve the condition.
Pelvic issues, such as tumors, can also cause difficulty in bowel movements.
If there are no organic problems, constipation may need to be managed through activity, diet, and medication.
It is recommended to follow up on treatment.
Wishing you good health.
Sincerely, Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2012/06/28

More Info

Understanding persistent bowel urgency, especially in the context of a disability, can be quite complex and distressing. It seems you have been experiencing significant issues with bowel and urinary urgency, which are affecting your quality of life. Let's break down your symptoms and explore potential avenues for management and treatment.

Overview of Symptoms
1. Bowel Urgency: You have described a persistent urge to have a bowel movement, which is accompanied by urinary urgency. This dual urgency can be particularly challenging and may suggest a connection between the two systems.

2. Incontinence: The leakage of urine when you feel the urge to defecate indicates a possible overlap between bowel and bladder control issues. This can be exacerbated by the urgency you experience.

3. Sleep Disruption: Waking up at 2 AM due to these urges is not only uncomfortable but can lead to significant sleep deprivation, impacting your overall health and well-being.

Possible Causes
1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) can lead to symptoms of urgency and may coexist with urinary symptoms. IBS can cause altered bowel habits, including constipation and diarrhea, which might explain your experiences.

2. Pelvic Floor Dysfunction: Given your symptoms, it’s possible that there is an issue with the pelvic floor muscles, which can affect both bowel and bladder control. This dysfunction can lead to urgency and incontinence.

3. Neurological Factors: Since you mentioned being a person with a disability, there may be neurological factors at play that affect the communication between your brain and your bowel/bladder. Conditions such as multiple sclerosis or spinal cord injuries can lead to these types of symptoms.

4. Medication Side Effects: The use of laxatives, while sometimes necessary, can also lead to dependency and may not address the underlying issues. Additionally, some medications can affect bladder control and bowel function.

Management Strategies
1. Comprehensive Evaluation: It may be beneficial to seek a comprehensive evaluation from a gastroenterologist who specializes in functional gastrointestinal disorders. They can assess your symptoms in detail and may suggest tests such as a colon motility study or pelvic floor assessment.

2. Dietary Modifications: Keeping a food diary to track what you eat and how it affects your bowel movements can be helpful. Increasing fiber intake gradually, staying hydrated, and possibly working with a dietitian may improve your bowel regularity.

3. Pelvic Floor Therapy: Engaging in pelvic floor physical therapy can help strengthen the muscles involved in bowel and bladder control. A specialized therapist can provide exercises and techniques to improve your symptoms.

4. Behavioral Techniques: Techniques such as bladder training and bowel training can help manage urgency. This involves scheduled bathroom visits and gradually increasing the time between visits to help train your body.

5. Medication Review: Discuss with your healthcare provider the possibility of reviewing your current medications. They may consider alternatives that do not exacerbate your symptoms or explore medications specifically for bowel management.

6. Sleep Hygiene: Improving your sleep environment and establishing a calming bedtime routine may help mitigate some of the sleep disturbances you are experiencing.

Conclusion
Persistent bowel urgency and associated urinary symptoms can significantly impact your quality of life. It is crucial to approach this issue holistically, considering both gastrointestinal and urological perspectives. Collaboration with healthcare professionals who understand the complexities of your condition is essential. If your current healthcare provider is not addressing your concerns adequately, seeking a second opinion or a specialist may provide you with the relief and management strategies you need. Remember, you are not alone in this, and there are pathways to improve your situation.

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