Incomplete Bowel Movements: Causes and Treatment Options

Incomplete evacuation?

Hello, Dr.
Ke! I have been experiencing incomplete bowel evacuation for two years now.
I have a bowel movement every day, and during this period, I have undergone two colonoscopies, both of which showed no issues.
Additionally, I had a defecography done at the Veterans General Hospital, where the doctor mentioned that my puborectalis muscle does not relax, which is the main cause of my symptoms.
He recommended biofeedback therapy for the anal-rectal area, but he said that this treatment is not available in Taiwan, only in the U.S.
I found out that only the Tri-Service General Hospital in Taipei has this equipment, but their director said it is broken.
I also went to Cathay General Hospital for defecography, where two doctors provided different opinions.
One said I have a sigmoid colon hernia, which compresses the puborectalis muscle, causing increased straining during bowel movements and resulting in more obstruction.
The other said I have rectal intussusception.
Both advised me to take medication first.
I have tried many medications, such as Moshu Weiqing, Lema Ke, Kang Ci Er powder, stool softeners, and laxatives, but there has been no improvement.
I consulted a neurologist, thinking it might be a sympathetic and parasympathetic nerve issue, but that was also ineffective.
I have been out of work for two years, so I should be under no stress.
Finally, I visited the colorectal surgery department at National Taiwan University, where I underwent a barium enema (cross-sectional comparison).
The doctor said the intestinal structure is fine, but there is intestinal spasm.
He suggested trying medication first, and if that doesn’t work, we would identify which segment of the intestine is problematic, remove it, and then suture it.
I would like to ask the doctor which of these opinions aligns best with the cause of my symptoms.
Thank you!

A-Zhi, 30~39 year old female. Ask Date: 2016/01/18

Dr. Ke Fangxu reply Surgery

The act of defecation is actually quite complex, involving the coordination of pelvic muscles, the angle of the rectum, and the anal sphincters.
If there is poor coordination among these three components, it can lead to difficulties in bowel movements.
To be honest, this issue is challenging to resolve; most treatments involve the use of stool softeners combined with biofeedback therapy, although the results are often not entirely satisfactory.
Patients can engage in pelvic muscle training, such as Kegel exercises, which are commonly referred to as pelvic floor exercises, and this can provide some relief from symptoms.
However, if you are seeking a method that can completely and quickly resolve the issue, that may be difficult to achieve.
Generally, it is recommended that patients utilize a combination of the aforementioned methods to gradually improve their symptoms.

Reply Date: 2016/01/18

More Info

Understanding incomplete bowel movements can be quite complex, especially when multiple medical opinions and diagnostic tests yield varying results. Based on your description, it seems you have been experiencing significant challenges with bowel movements for the past two years, despite undergoing various diagnostic procedures, including two colonoscopies and imaging studies.
The primary issue you mentioned is the sensation of incomplete evacuation, which can be frustrating and uncomfortable. This symptom can arise from several underlying causes, including functional disorders, structural abnormalities, or even psychological factors. In your case, the doctors have suggested different potential causes, including pelvic floor dysfunction, rectal prolapse, and possibly even bowel spasms.

Potential Causes
1. Pelvic Floor Dysfunction: This is a common issue where the muscles of the pelvic floor do not relax properly during bowel movements. This can lead to difficulty in passing stool and the sensation of incomplete evacuation. The fact that you were advised to consider biofeedback therapy indicates that your healthcare provider suspects this may be a significant factor. Biofeedback can help retrain your pelvic floor muscles to relax appropriately during bowel movements.

2. Structural Abnormalities: The mention of a sigmoid colon hernia or rectal intussusception suggests that there may be some structural issues affecting your bowel function. A hernia can cause a portion of the bowel to protrude, potentially leading to obstruction. Rectal intussusception occurs when part of the rectum folds into itself, which can also obstruct stool passage.

3. Bowel Spasms: The diagnosis of bowel spasms indicates that your intestines may be experiencing irregular contractions, which can lead to discomfort and incomplete evacuation. This is often associated with conditions like Irritable Bowel Syndrome (IBS).

4. Neurological Factors: You mentioned consulting a neurologist regarding potential issues with the autonomic nervous system. While less common, neurological conditions can affect bowel function, leading to symptoms like those you describe.

Treatment Options
Given the complexity of your symptoms and the various opinions you've received, a multidisciplinary approach may be beneficial. Here are some potential treatment options:
1. Biofeedback Therapy: If pelvic floor dysfunction is a significant factor, biofeedback therapy can be very effective. This therapy involves using sensors to provide real-time feedback on muscle activity, helping you learn how to relax and coordinate your pelvic floor muscles during bowel movements.

2. Dietary Adjustments: A diet high in fiber can help improve stool consistency and promote regular bowel movements. However, if you have bowel spasms, it may be beneficial to identify and avoid trigger foods that exacerbate your symptoms.

3. Medications: Since you have tried various medications without success, it may be worth discussing with your doctor the possibility of trying different classes of medications. For instance, medications that target bowel motility or muscle relaxation may be helpful.

4. Surgical Options: If structural abnormalities are confirmed and conservative treatments fail, surgical intervention may be necessary. This could involve correcting any hernias or addressing issues like rectal intussusception.

5. Psychological Support: If stress or anxiety is contributing to your symptoms, working with a mental health professional may provide additional coping strategies and support.

Conclusion
In summary, your symptoms of incomplete bowel movements could stem from a combination of factors, including pelvic floor dysfunction, structural abnormalities, and bowel spasms. It is crucial to continue working closely with your healthcare providers to explore these options further. A comprehensive evaluation by a specialist in pelvic floor disorders may provide additional insights and treatment options tailored to your specific needs. Remember, managing bowel health often requires a holistic approach, including dietary changes, physical therapy, and sometimes medication or surgery.

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