Chronic Constipation

Some people have a bowel movement twice a day while o.thers may do so three times a week. Constipation typically means a person poops fewer than three times a week or goes more than three days without a bowel movement.1

Chronic constipation with the need for repetitive straining, often for years, is one of the main causes of pudendal neuralgia. Some find it embarrassing to discuss, but severe constipation, besides contributing to PN, can be dangerous to your body such as fecal impaction, colonic perforations, and or stroke. Do not be embarrassed. It is a health issue like any other. If you have any of these symptoms for more than a month, including those of PN, please see Gastrointestinal and/or Rectal surgeon immediately.

I sought out help in my 20s and 30s and was dismissed. I have recently found out that my colon does not work (nerve issue) and is now twice the size it should be with folds that trap stool because of 30 years of constipation. I did not realize the long-term consequences of no intervention or help at the time. The damage has been done. IF this happens to you, find another doctor until someone takes you seriously because this is a serious condition that causes permanent damage to your body and again is a major cause of pudendal neuralgia. 1

Symptoms of Chronic Constipation:

Fewer than three stools a week
Hard, dry or lumpy stools
Straining or pain when passing stools
Digital disimpaction or the need to use fingers to remove stool from the rectum
Enemas required to remove stool, to have complete bowel movement
A feeling that not all stool has passed
A feeling that the rectum is blocked
The need to use a finger to break up to pass stool
Symptoms that make it difficult to do everyday activities.0
Bleeding from your rectum or blood on toilet tissue.
Blood in your stools or black stools.
Stomach pain that doesn't stop.
Rib pain that doesn't stop (stool is stuck usually in transverse colon)
Weight loss without trying
Vomiting

If that doctor does not help you or take you seriously, see another, and another if necessary. There are good doctors out there. We just need to find them. That is why we are creating a list of doctors on this website who are familiar with pudndal neuralgia and the serious, even dangerous conditions, that can cause it. Copy and print these procedures below and bring them with you. Otherwise, it may take years for a physician to order any of them.

Diagnostic Procedures

1. Defecography MRI

Magnetic resonance imaging (MRI) uses a magnetic field, radio waves and a computer to create detailed images. MRI defecography is used to diagnose prolapse, incontinence, pelvic pain or constipation, and allows for a rapid evaluation.

If you've had an MRI before, it is the same exact room. If you haven't, it's a large white, cold room, with a large machine with a table the patient lies on. The table moves into the machine on a track into a tunnel. The technicians will ask you well in advance if you are claustrophobic.

For a regular MRI, you must stay still for 30 min to 45 min. The machine is loud so they will offer you headphones. You can choose the music you like and they will talk to you in an adjacent room. It has a glass wall so you will be able to clearly see the technicians.

For a defecography MRI, you will go into the MRI feet first. The technicians will have everything set up for you. The pillow for your head will be at the farthest point on the table and you will like on your back. The technicians will help direct you.

Your position on the table always depends on the part of the body that needs to be scanned.

will be moving your body and the test is short, so you won't need to listen to music.

The technicians will insert clear gel through a tube into your rectum. They will return to the ops room and instruct you to push, stop, and move your rectal muscles in other ways.

It is completely painless. The gel has no odor and you will not eat for the day before so there really is no odor at all. It takes 20-30 minutes. The techs will come in and clean you up so fast you won't even notice. They try to make it as least embarrassing to the patient as possible. Remember, they do this MRI procedure every day, so it's just a day at work. They care about you but have no issues with the MRI.

2. Analrectal Manometry

This is a painless, noninvasive procedure to evaluate the function of the rectal and anal muscles. This group of muscles, called the anorectal sphincter, controls how stool is released from your body. Anorectal manometry can help determine if these muscles are too loose, too tight or are

not engaging at the right moment. This test

measures the pressures created by the muscles,

the sensation in the rectum (the passageway

between the large intestine and the anus), and

the neural reflexes necessary for normal

bowel movements.

The test usually takes about 30 minutes. Before the procedure, you will need to make sure your digestive tract is empty. Your doctor may recommend using one or more over-the-counter enemas at home before the test.

You will go into a private room with the technician. Remember, this is a normal part of human physiology and they do this every day as their job.

The technician will instruct you to undress and put on hospital garments. There is a regular hospital table with a pillow where you will lie. The technician will sit next to you and give you instructions. There will be a machine next to her about the size of a three-level file cabinet.

3. Sitz Marker Test

This test uses tiny radio-opaque 'markers' to test how fast food is moving through the intestines. It is most often used with patients who are suffering from chronic constipation.

Sitz Marker x-ray shot (again there will be one a Diagram of digestive system (stomach is not visible. Just above.

day for 5-7 days showing all but one marker in

the ascending colon (on your right)

SAMPLE of Results

CLINICAL HISTORY: Other constipation, Rectal prolapse, Outlet dysfunction constipation.

FINDINGS: 5/22/2023. Day 0. No Sitzmarks are currently identified. There is a large amount of stool throughout the entire colon
suggestive of constipation. No obstruction or free air. Lung bases are clear.

5/23/2023. Day 1. All 24 Sitzmarks are identified over the right abdomen. They. Be primarily overlying the right (ascending) colon.

5/24/2023. Day 2. All 24 Sitzmarks are again identified. 23 overlying the right abdomen. One overlies the lower central pelvis.

5/25/2023. Day 3. All 24 Sitzmarks are again identified. 23 overlying the right abdomen. One overlies the right pelvis.

5/26/2023. Day 4. All 24 Sitzmarks are identified. Majority overlying right abdomen as before. 5 overlying the pelvis. One overlying
the left abdomen.

5/27/2023. Day 5. All 24 Sitzmarks are again identified. Majority again overlying the right abdomen. 2 overlies the left abdomen. 6-7 overlying the pelvis.

5/28/2023. Day 6. All 24 Sitzmarks are still identified.

5/29/2023. Day 7. All 24 Sitzmarks are still identified

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You will need to come to a GI Motility Lab to pick up a capsule which contains 24 Sitz markers to swallow. This capsule contains small markers which will show up on x-rays and let the doctor track their progress through your intestines. It is entire painless. You will never even see the markers in your stool because they're so small.
You will need to schedule for an abdominal x-ray for 5 to 7 days once a day. This daily x-ray shot of your abdomen to see if any of the markers are left in your colon or whether they have all been expelled from the body. The more markers you have left in your body, the slower your colon motility. In general, if you are found to have very slow bowel motility (i.e., most of the sitz markers have remained in your body) then you may have slow transit constipation and may have other condition.
You will have a follow-up with your GI doctor to discuss the results and how to move forward. This test reveals a great deal of information about your GI tract.

One Diagnosis: Colonic Inertia - defined as the inability of the colon to modify stool to an acceptable consistency and move the stool from the cecum to the rectosigmoid area at least once every 3 days. Link to detailed explanation and treatments: https://aboutconstipation.org/signs-and-symptoms/colonic-inertia/

Oral Rx Medications

for Chronic Constipation

Note: There are other prescription medications for chronic constipation. The four listed above are the most common.

Make sure to research medications and talk to your doctor(s) about all Rx medication options. Second opinions are always a good idea. We must all advocate for ourselves especially because PN is rare and so few doctors are aware of it. If you're not making progress or you feel you doctor isn't listening to you, get a second and even a third opinion. Chronic constipation is a cause of PN and damage your body. LINK to WebMD info about medications and treatments:

There are also many over-counter-options. We've listed some below in alphabetically order so as not to promote once over the other. If you have chronic constipation is that damaging your colon, rectum, anus, and/or pelvic floor, please talk to your doctor about these and using them in combination with Rx options. The more information the better:

Over-the Counter Chronic Constipation options:

Bisacodyl

Citrucel

Colace

Dulcolax

Magnesium Citrate

MiraLAX

Mineral oil

Senokot (regular and extra strength

SURGERY

Surgery: It's rare for people to need this to treat constipation. Your doctor may consider whether surgery to remove part of the colon may be an option if you've tried other treatments and your chronic constipation is caused by a blockage, rectocele (in which part of the rectum wall bulges/prolapses into the vagina), or an anal tear (fissure) or narrowing (stricture). Surgery to remove all of the colon is rarely needed. Please talk to your doctor and if one recommends it, make sure to get a second opinion. It's not that the first physician is incorrect, but this is a serious and irreversible surgery, so you want to hear confirmation from at least two doctors to be sure. 1

1. https://www.medicalnewstoday.com/articles/319879

2 https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-constipation

3 conditions/constipation/symptoms-causes/syc-20354253

4. https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253#Symptoms

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

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