All or nothing bowel movements? Detailed stool descriptions ahead.
July 22, 2016 3:54 PM   Subscribe

For the past 8 months I have been having substantial bowel movements only about once every 5 to 7 days. These substantial movements are ... big. Like it appears to be literally 5-7 days worth of movements all at once. Doctor suggested more fiber, this just gave me gas and did not help. What's up, does this line up with some IBS style and is this a thing to elevate to a GI doc?

I'm a 28 year old female who eats well and exercises regularly. I take 100mg Wellbutrin, 10mg Adderall and fish oil daily. I have endometriosis (more on that below) but no other health issues.

I had really great bowel movements up until about 8 months ago. I would generally go to the bathroom almost every day after drinking my coffee in the morning. It was one of my favorite parts of the day!

I started experiencing constipation a few weeks after I started taking iron supplements after getting low ferritin levels (~12) back on some routine bloodwork. I knew constipation might be a side effect of iron supplements and stopped taking them after about 2 months - the constipation wasn't painful, I was still going about twice a week.

However, months after stopping with the iron I am still not having regular movements, and when the constipated spell "breaks", I have these momentous movements. TMI poop details: First I have what looks like an almost textbook perfect poop - a nice long snake and passes quickly and humbly. I return to my desk at work, and about 10 minutes later I start experiencing abdominal cramps/spasms and end up spending about 15-20 minutes on the toilet. The cramps are pretty severe and I pass A LOT of matter. I am not straining to do this though and it is not dehydrated, it is just a lot that comes out. I generally feel pretty wiped out after this and will return to the toilet a few more times over the course of the next 2-3 hours. It varies, but sometimes the latter trips get smaller and looser, like a 5 or maybe 6 on the Bristol stool scale.

And then... nothing. Maybe a couple small isolated pieces in the days until my next marathon, but no normal snakey stuff.

I have tried fiber increased in my diet and then as fiber supplements and get gas sometimes but no effect on my movements. I don't get the feeling that I need more "mass", I just feel like nothing moves until I'm so completely full of shit that it all evacuates at once. Three months ago I cut out fried foods, red meat and dairy as part of an anti-inflammatory diet. I eat a lot of chicken, fish, vegetables and rice.

This pattern is not altered by my menstrual cycle - it's consistent the whole way through. However, I am a little suspicious of my endometriosis being involved. I was only recently diagnosed - and it happened because I ended up getting an emergency appendectomy that turned out to be not a burst appendix but gigantic burst endometrial cyst on my right ovary that exploded black goo all over my internals (I have pictures it's cool!). I've heard its possible to have endometrial adhesions on the intestines as well. My GP wasn't familiar with this so I didn't press about it last time. I had a brief appointment with my gyno after my emergency surgery and was just told to go on birth control (haven't found a version that doesn't make me want to die yet), but I hadn't made the connection to the constipation at this point.

So. What's up? Should I try to see a GI doctor? My constipation isn't particularly painful - it's annoying when I have to have 4 trips to the bathroom over 3 hours, and the cramps/spasms kinda suck, but the rest of the time I'm fine. I just want to poop every morning or so again, and I'm a little concerned that there might be some endometriosis involved but I'm not sure if GI people can determine if that is the cause. I'm not sure if my gyno would know what to do with weird bowel movement stuff that isn't tied to my menstrual cycle.

Definitely interested in hearing about what has caused this pattern in other people!
posted by supernaturelle to Health & Fitness (18 answers total) 4 users marked this as a favorite
My GP wasn't familiar with this so I didn't press about it last time.

Time to bring in the big dogs. You need a specialist in this issue. The questions on this page may help you when you do get a referral. It is indeed possible to have adhesions on your intestines and this is no laughing matter. Some people do have longer times between poops, larger stools, etc., but given that this is a new issue and you have confirmation of endometriosis and fiber isn't doing anything for you, I think your instinct that this isn't right is what you should pay attention to. Your regular gyn is probably not the right person to see abou this. But hopefully she can refer you.
posted by amanda at 4:02 PM on July 22, 2016 [4 favorites]

I would ask for a pelvic ultrasound. GI's love to start with colonoscopies, but with endo it makes sense to start with the reproductive system. They say constipation or changes in bm are signs of ovarian cancer ( NOT Saying you have that!) but makes sense also as signs of an ovarian cyst.

I would also suggest diet changes but you have that covered. I personally saw a huge improvement in bm when I cut out cheese but added yogurt and fruit.
posted by charlielxxv at 4:08 PM on July 22, 2016 [1 favorite]

I'd say you really need a colonoscopy and I'm kind of amazed your GP hasn't given you a referral already. What you describe has happened to me as a result of colon polyps blocking me up. I turned out to have colon cancer, and a genetic condition that makes me prone to more polyps and more cancer. So... get your ass to a gastroenterologist. I don't mean to scare you and this could well be something totally benign and minor, but you really need to get it looked at soon.
posted by Ursula Hitler at 4:27 PM on July 22, 2016 [5 favorites]

IANYD. That said, I have Crohns and have spent the last 25+ years talking about shitting with doctors. I'm a toxicologist and a public health type, so this isn't a naive response.

Ultrasounds and colonoscopies aren't called for if you aren't experiencing discomfort, aren't having related symptoms that cause concern, and haven't changed your meds. Then again, a colonoscopy is still pretty front-line (you do need one every now and again, for monitoring purposes that an ultrasound can't yet resolve). If a colonoscopy is in your future, it's not something to fear. It's an essential diagnostic tool, plus now hypnotic sedation is standard so you don't even know it's happening (it used to be, uh, worse).

Fiber supplements are (sorry, pun) shit. You can get a full RDA of fiber from the foods you choose to eat. Can you track your fiber intake with a nutrition app like MyFitnessPal? If you're getting lots of dietary fiber and can substantiate this to your general physician if your issue persists, it would be informative for the doc. And, paradoxically, increasing fiber can make you have bigger, less frequent poos. You say you've cut out fried foods, which suggests you're eating less oily stuff generally. Cutting out things like that will change your poo frequency and schedule. Likewise, and not to be pedantic, but vegetables tend to bring along a few specific types of fiber. If you're getting a lot of one kind of fiber, you can set yourself up for bloating, discomfort, and let's say "variable consistency"poo. Are you varying your fiber sources (e.g. fruit, leafy greens, brassicas, and so on)? I follow a variety of the inflammatory diet, and it's been helpful, but I've also kept a food diary for years to track how changes in diet choices affect things like poo schedule, comfort, etc. In my case, refined oils are a culprit--replacing something like a croissant with a slice of toasted baguette, for instance, can make the difference between a messy, uncomfortable poo and a comfortable solid poo.

You're probably not dealing with intestinaladhesions. They tend to be painful and cause other symptoms. I can't speak to other adhesions.

Lastly, it sounds remedial but poos change over time and there's a lot of built-in inconsistency (ha!) to the system. Don't hesitate to prod your doctor about this--hey doc, yes, I'm getting more fiber but this just feels off, so what's the next step to understanding it better?

Be well!
posted by late afternoon dreaming hotel at 4:31 PM on July 22, 2016 [8 favorites]

See a urogyne. If you had an adhesion that big, they need to check to make sure your intestines aren't adhering to anything. They'll also give much better advice than just birthcontrol, but birthcontrol is one of the primary treatments.
posted by AlexiaSky at 4:33 PM on July 22, 2016

I'd really see a urogyne and then see GI.
I have an awesome urogyne in Chicago, if you happen to live there and want his name just message me.
posted by AlexiaSky at 4:38 PM on July 22, 2016

I think it's likely to be endometriosis-driven adhesions too.

I started experiencing constipation a few weeks after I started taking iron supplements after getting low ferritin levels (~12) back on some routine bloodwork. I knew constipation might be a side effect of iron supplements and stopped taking them after about 2 months - the constipation wasn't painful, I was still going about twice a week.

However, months after stopping with the iron I am still not having regular movements . . .

My guess is, the unaccustomed fullness in your intestines brought about by the iron supplements caused surfaces that were previously separated to rub together, and endometriosis made them stick.
posted by jamjam at 5:39 PM on July 22, 2016 [2 favorites]

As a fellow unhealthy pooper, please bug your doctor until they give you the tests and blood work you need. My general opinion(from experience) is that while something might not be painful now, the time to be seeking medical answers is not when it starts becoming painful and life-altering.

Also, eating tons more fibre is often a bad idea. It creates more bulk in the intestines and for me, a high fibre diet caused me to develop a blockage, on top of my other troubles. I do much better reducing my fibre intake and eating a low fodmap diet. While I still need medication, eating like this has massively improved my day-to-day. This is stuff that can be done by yourself, so it's worth giving it a shot I'd say.
posted by InkDrinker at 5:52 PM on July 22, 2016 [1 favorite]

I don't think this is dietary - it's a bowel motility issue (because stuff isn't "moving" properly, in the usual timeframe), most likely, possibly related to the endo. Nthing a GI specialist... I don't know if you'll get a definitive answer without at least some imaging studies.
posted by julthumbscrew at 7:17 PM on July 22, 2016 [1 favorite]

Sounds like the endo may be having fun adhering bits of your insides to other bits that shouldn't be sticking together. I say this because my wife, who has severe endo, has similar issues. (Add in the pooping difficulties caused by the pain medication and you can imagine why she often can't decide whether to deal with the really bad endo pain and avoid optiate-induced constipation or take the pain meds for the endo and deal with bowel issues.) And please allow me to suggest that it's very important to get a physician who understands endo or a physician who listens to your specialist who understands it, because it's not uncommon for endo to cause this exact problem. (That's not a dig at your GP -- endo is something they usually get very little, if any, training for, unless things have quickly changed for the better at the med schools.)
posted by alaaarm at 7:36 PM on July 22, 2016 [3 favorites]

IANAD I was a rock star pooper, right up until I started taking Wellbutrin. Slowed my digestion down big time. Now I drink Metamucil in the morning, and take a (non-laxative) stool softener around 6pm. Made a big difference.
posted by dorkydancer at 7:46 PM on July 22, 2016 [2 favorites]

I need supplemental magnesium, and it's not in Flintstone's vitamins, so I picked up some powdered magnesium at the grocery store yesterday. I was reading the label, and it said "When bowels are comfortably loose, this is a good guage of the optimal amount."

I mean, it sounds like you've got some other stuff going on and maybe a doctor to visit, but in the meanwhile it might a magnesium supplement could be worth a shot.
posted by aniola at 9:37 PM on July 22, 2016

Agreeing with aniola. Magnesium Citrate fixes this same problem for me.
posted by Nerro at 10:15 PM on July 22, 2016

Glycerine suppositories really help me when I get a little stopped up. Definitely, definitely see a specialist, get a scan, etc and get to the bottom of this (oops, bad pun) but in the meantime suppositories.
posted by hazyjane at 10:46 PM on July 22, 2016

I'm going to nth the 'push for a specialist' - not least because the fact your Dr told you to take fibre when that sounded like the opposite of what you needed is a bit of a flag that they haven't listened/taken this seriously.

That said, in the meantime, it might be worth upping your water intake. I don't know the specific mechanisms of the drugs you're taking, but your poo experience sounds a lot like mine on a couple of antihistamines: I'm usually super regular, and all of a sudden I was going days without one, then it was enormous (and a bit painful) and followed by all the other poos I'd failed to have. It seems like the first one gets big and dry and blocks stuff up. Avoiding the drugs and drinking a lot more water when I did take one eased the issue a bit (and 'eat more fibre' is TERRIBLE advice in this situation, and yet so often the knee-jerk response). It's certainly not going to hurt you to hydrate more, so worth trying until you get a proper opinion.
posted by AFII at 12:33 AM on July 23, 2016 [1 favorite]

Endo can mess with your GI tract. There was a thread here about just this thing not too long ago. I'd start with a visit to a gastroenterologist to rule out anything there and go back to the GYN once the gastro sees you. If your GYN doesn't want to listen, please find a new one. There are wonderful GYNs who'll listen because, you know, uterine tissue growing outside the uterus tends to fuck things up a little.
posted by ImproviseOrDie at 2:20 AM on July 23, 2016

I agree that you should go to a doctor and make sure everything is okay. But for the time being, you might consider eating a serving of canned peaches and/or pear nectar every day. Keeps my toddler regular, at least.
posted by PhoBWanKenobi at 9:51 PM on July 23, 2016

Have your gallbladder checked.
posted by raisingsand at 1:56 PM on July 24, 2016

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