Question..

[TroubledTeen]

For some reason, a lot of doctors and well educated people say that constipation is the leading cause of IBS. I read that it's because the stool hardens and the liquid undigested stool behind it seeps through and leaks outside.

So, I have two real questions:

1. How is that possible?

2. I've had constipation problems all my life, where I could go a week without having a "leaking" issue. How long is it that the "leaking" period is supposed to occur?


I know for the most part you're all a little more knowledgeable then doctors in the fact that most of you have experimented, so I think the questions are answer-able.

 

[ricky]

I've never heard of having a leaking problem while being constipated at the same time. I've had constipation problems myself, and Encopresis too as a kid, but never a leaking problem. That is, not until I lost all control 5 years ago, but I don't think that's the kind of "leak" you're asking about. I take narcotics for pain, and have to take stool softners and another prescription to control the constipation because of that.

I would suggest you try researching your question on a medical forum.

 

[daria7483]

I've heard of this as well. Here's a wikipedia explanation - I know wiki is not a credible source of medical info, but this makes sense to me:

"The colon normally removes excess water from feces. If the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation, so much water is removed that the stool becomes hard, and becomes painful for the child to expel in an ordinary bowel movement. A vicious cycle can develop, where the child may avoid moving his/her bowels in order to avoid the "expected" painful toilet episode. This cycle can result in so deeply conditioning the holding response that the Rectal Anal Inhibitory Response (RAIR) or anismus results. The RAIR has been shown to occur even under anesthesia and voluntary control is lost. The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the RAIR. Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product. These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies."

Encopresis - Wikipedia, the free encyclopedia

Anyway, as far as the leaking part goes, I just imagine it to be physics and gravity -- the hard stool is packed in the colon, but not so tightly that liquid can't get by it, so the more liquidy soft stool slides past it and because the person has little control left, it comes out of the anus before he/she is aware of it. But like all medical problems, some people are more likely to be affected than others. Just because you're constipated doesn't mean it's going to turn into encopresis.

 

[Spaz]

For some reason, a lot of doctors and well educated people say that constipation is the leading cause of IBS.

I disagree. I've had IBS all my life and go through periods of bowel incontinence. From what I understand, there are two types of Irritable Bowel Syndrome: a constipation type and a diarrhea type. In my case, it's IBS-D. I am rarely constipated. It's the unruly nerves in the colon that cause retention of bowel movements (constipation) or unexpected loose movements (diarrhea). Either way it's not good. A lot of people get diarrhea or constipation. IBS is extreme and is ultimately caused by nerves.
Spaz

 

[ryan_]

I disagree. I've had IBS all my life and go through periods of bowel incontinence. From what I understand, there are two types of Irritable Bowel Syndrome: a constipation type and a diarrhea type. In my case, it's IBS-D. I am rarely constipated. It's the unruly nerves in the colon that cause retention of bowel movements (constipation) or unexpected loose movements (diarrhea). Either way it's not good. A lot of people get diarrhea or constipation. IBS is extreme and is ultimately caused by nerves.
Spaz

Or the third type, like what I have, where you're constipated all the time and then have to go all of a sudden. Almost always when you're out with friends. Fun times.

 

[IncompleteDude]

The last thing I read about IBS is that no one is really sure why it happens.

Anyways, I unfortunately experienced the type of leakage described in that article. I was prescribed enemas, but I refused to do use them, and was too little to do it properly. My mom had to hold me over her knee and enema me. The sexual implications of that will forever haunt me...

 

[bob111]

Leakage can also occure with encopresia.

Encopresia is a syndrome that have both psychological and phisical symptomes. But it's mainly psychological.

The child with encopresia will usually hold it's stools for so long that he will develope a forme of constipation. Leaks can occure.

What's special about encopresia, is that the kid will often defecate in unnacceptable places and sometime smear it on stuff. Those acting-out are direcly related to frustration and opposition to autority.

Diapers are not a recommended solution to encopresia. Only in the last stage of the treatment when only the phisical simptomes of bowel incontinence are presend and the psychological simptomes are adressed and controlled.

Encopresie usually subside before the age of 12 years old. I personnaly know a case that is still deeply affected at 13 years old. He is in the last phase of his treatments and it's more considered a physical problem mixed with a severe lack of personnal hygiene. Pullups diapers are worn to school, at the request of his school educator, wich suprise me a little.

 

[TroubledTeen]

So what is being said here is that, it's not a time related issue, it can differ completely on who is meant to have it at a younger age?

That seems a bit far fetched.

 

[bdb2004]

Basically we don't know why it happens in some kids and not in others.

As a basic overview of what happens in the Large intestine (and I will try to stay away from too many medical terms) stool is ejected from the ileum (the lower portion of the small intestine) at the cecum and enters the proximal colon, it is in the proximal colon that most of the water is reabsorbed, basically the muscles in the colon allow for it to undergo different forms of contractions, one form mixes the stool but doesn’t move it a whole lot, especially once it becomes more solid, the other type causes large movements from one area of the colon to another. So basically this process goes on, and the stool eventually makes it to the rectum, at this point what usually happens in the presence of stool in the rectum causes the relaxation of the internal anal sphincter, which is an involuntary muscle, and when the rectum is about 25% full you will have an urge to defecate, you control this through the external anal sphincter which is a voluntary muscle and in a normal situation everything works out ok, once you defecate the internal anal sphincter will return to its normal state of contraction and the process will repeat.

However, one of the problems in constipation is that due to the presence of stool in the rectum the internal anal sphincter is continuously relaxed, so liquid stool is able to leak around the impacted stool, leak out the open Internal Anal sphincter, and you have fecal incontinence. However, as I said in the beginning, sometimes kids with constipation have this symptom, other times they don't and there really is no good explanation about why the individuals who suffer from fecal inconstancies experience the symptoms.

IBS is a completely different issue, and a lot of things about it remain uncertain, one mechanistic reason behind the difference between constipation and diarrhea is that in diarrhea there are reduced segmentation contractions (contractions which allow for the mixing of fecal matter in the proximal colon) and therefore you have less water reabsorption, and that leads to diarrhea with constipation being the opposite (Increased segmentation contractions->greater water reabsorption->harder stools->constipation). However the underlying pathophysiology is still largely unknown.

So basically,
1) Yes, liquid stool can leak around impacted fecal matter leading to fecal incontinence, but that is a separate issue from IBS and is just a constipation associated fecal incontinence.

2) There really is no time frame, some people might just build up stool in there large intestine, you would be amazed how much it can hold if there is a severe structural/physiological impediment to stool, such damage/desensitization of the nerves that innervate a section of the colon without the patient experiencing incontinence.

 

[TroubledTeen]

So you're saying it's fecal incontinence but it's not IBS.

It's my understanding that constipation is constipation, no matter what changes.


But that's pretty interesting to say the least.

 

[bdb2004]

I went back and looked at some literature again just to make sure I didn't miss anything, but from what you describe in your first post, it is not the traditional presentation or cause of IBS, one set of diagnostic criteria for IBS are actually as follows:

* abdominal discomfort or pain for at least 12 weeks (not necessarily consecutive) in preceding 12 months
* abdominal discomfort or pain has 2 of the 3 following features
o relieved with defecation
o onset associated with change in stool frequency
o onset associated with change in stool form (appearance)
* supportive symptoms
o fewer than 3 bowel movements per week
o more than 3 bowel movements per day
o hard or lumpy stools

I also looked at some other sources about the suspected pathophysiology and some of the suspected causes and found the following:
-Neurologic or muscular hypersensitivity in the colon causing a motility disorder
- changes in colonic muscle nerve signals
- Increased gas production in colon (especially H)
- Indiciations of increased sensitivity to visceral (think organs/tissue such as the heart, lungs, colon, stomach, etc) stimulation
- bacterial overgrowth in the small intestine
Also a likely risk factor is a recent history of acute infectious gastroenteritis
Two other possible risk factors are:
- aerophagia - poorly fitted dentures, post-nasal drip, hiatal hernia
- antibiotic use associated with functional bowel symptoms over subsequent 4 months

So probably more then you needed to know, but where I am going with this is that IBS is generally a diagnosis of exclusion, there are a number of organic causes of many bowel disorders that should be examined first. In the case you described, sure, that could be a symptom (though not a cause) of IBS, however, there are a number of other likely diagnosis especially in populations at a lower risk of IBS that should be examined first.

As far as constipation being constipation... it gets complicated, and there are a number of different causes of constipation and the exact presentation has different clinical implications... for example constipation in a kid can mean something completely different then constipation in an adult, and the cause might also be unrelated, but then we get into a lot more complex anatomy and physio and such then we need here

 

[h3g3l]

I've not posted here yet, but I will do so now with a website:

poopreport.com. It'll have quite a ... load ... of information on IBS, etc.

 

[TroubledTeen]

hegel

please link directly to that information

I find that website disgusting in many ways, and honestly it's rather hard to navigate.