Took 5 mg at 2 pm. Slight nausea at 7 pm. Woke up a t around 5 am. Mind was hyper. Meditated and slept by 7 pm. Woke up at 9:52 am. Constipation(first bowel movement). Took mirlax. Had taken lexapro on Tuesday and it had caused insomnia. The stool had become a bit solid and had continued till this day. Will not take lexapro today and will instead try it with mirlax + zelnorm next time.
Meanwhile levator ani pain present yesterday night and in the morning somewhat
Saturday, May 26, 2007
Thursday, May 24, 2007
Pain returns
No pain in the morning on waking up. Slight irritiation during bowel movement. Then sitz bath and pain started. Now at work (somehow) but pain continues. It is similar to the day when fissure happened (3rd time). Maybe something got torn inside. Pain more on the right side.
Wednesday, May 23, 2007
Levator ani pain reduces
Not much pain while sitting with legs up.However, there IS pain if slightly disturbed. Maybe the 'wound' is tender and will take time to heal. Have to be very careful. There is pain while sleeping on the side.
Started doing breathing exercises to lower the pelvis instead of holding it up since yesterday. Will try to do it during walking.
Fissure happened around April 16. Cured around May 14. Restarted arond May 16. One week over yesterday.
Started doing breathing exercises to lower the pelvis instead of holding it up since yesterday. Will try to do it during walking.
Fissure happened around April 16. Cured around May 14. Restarted arond May 16. One week over yesterday.
Tuesday, May 22, 2007
Back to sharp pain inside while pushing
Could not sleep due to lexapro. First had gas and bloating. Then woke up after sometime with a mind absolutley awakened. Next few hours had gas / anxiety / all kinds of aches. When the light came on, gas went away but still no sleep. Mind was very calm thoguh. Finally slept for an hour at around 7.
Got loose stools in the second bowel movement(thanks lexapro). Had to push them out (automatic reaction).. Got the same sharp pain in the rectum as when the fissure was healed. Is there something else in the rectum that is there but becomes inflamed every time there is a fissure?
Got loose stools in the second bowel movement(thanks lexapro). Had to push them out (automatic reaction).. Got the same sharp pain in the rectum as when the fissure was healed. Is there something else in the rectum that is there but becomes inflamed every time there is a fissure?
Monday, May 21, 2007
OIther methods of resolving constipation (and pelvic floor disorder)
http://www.ibsgroup.org/forums/index.php?showtopic=87458
acral Nerve Stimulation for Constipation: An International Multi-Centre Study (Abstract #198)
In patients with idiopathic constipation, which occurs with no identifiable cause, in whom conservative treatment has failed, surgical procedures (e.g., colectomy) are associated with a high failure rate and substantial morbidity. Researchers from five European sites set out to explore an alternative approach: modulating the extrinsic nerve supply to the bowel. In doing so, investigators evaluated the symptomatic response and physiological effect of sacral nerve stimulation in patients with slow transit constipation and normal transit constipation with impaired evacuation.
In this prospective, multi-center trial, 65 patients (58 female) who failed treatment with laxatives and biofeedback (retraining pelvic floor muscle coordination using exercises and electronic aids that create feedback when successful muscle contraction occur) underwent test stimulation, each serving as their own control. The effect of temporary sacral nerve stimulation was assessed by a 21-day bowel habit diary. Patients with more than 50 percent improvement in symptoms were eligible for permanent stimulation. Long-term results were assessed by: bowel habit diary, symptom questionnaire, Cleveland Clinic constipation score (CCCS), visual analogue score (VAS) and short form-36 (SF-36) quality of life questionnaire. Primary endpoints included an increase in the frequency of defecation, reduction in straining and reduction in the sensation of incomplete evacuation.
After a median follow up of 12 months, subjects with both slow transit and impaired evacuation benefited from therapy and 43 patients (66%) proceeded to chronic stimulation. Frequency of defecation increased from 3.4 to 6.1 times per week, while evacuation days per week increased from 2.4 to 4.4. Time spent in facilities decreased from 17.6 to 9.3 minutes, straining decreased from 4.4 to 2.9 episodes per week, abdominal pain decreased from 4.4 to 2.0 days per week, and perception of incomplete evacuation decreased significantly.
In evaluating the results of the various assessment tools set forth at the start of the trial, researchers found that: the CCCS (0=no constipation, 30=severe constipation) decreased from 18.0 to 10.2; mean VAS (0=severe symptoms, 100=no symptoms) increased from 18 to 66; and SF-36 subsets of physical functioning, general health, vitality, social functioning and mental health significantly improved.
"While constipation is rarely life-threatening, associated symptoms of abdominal pain, bloating and the sensation of incomplete evacuation can severely affect the physical and emotional well-being of patients. There are many treatment options for the condition and the best approach relies on a clear understanding of the underlying cause," said Thomas Dudding, M.D., of St. Mark's Hospital in London, England, and lead investigator for the study. "This study found that sacral nerve stimulation is an effective treatment for idiopathic constipation that is resistant to conservative treatment. As a result of this stimulation process, improvement occurs in bowel frequency, associated symptoms and overall quality of life."
Dr. Dudding will present this study on Sunday, May 20, at 2:15 p.m. in Room 151A.
acral Nerve Stimulation for Constipation: An International Multi-Centre Study (Abstract #198)
In patients with idiopathic constipation, which occurs with no identifiable cause, in whom conservative treatment has failed, surgical procedures (e.g., colectomy) are associated with a high failure rate and substantial morbidity. Researchers from five European sites set out to explore an alternative approach: modulating the extrinsic nerve supply to the bowel. In doing so, investigators evaluated the symptomatic response and physiological effect of sacral nerve stimulation in patients with slow transit constipation and normal transit constipation with impaired evacuation.
In this prospective, multi-center trial, 65 patients (58 female) who failed treatment with laxatives and biofeedback (retraining pelvic floor muscle coordination using exercises and electronic aids that create feedback when successful muscle contraction occur) underwent test stimulation, each serving as their own control. The effect of temporary sacral nerve stimulation was assessed by a 21-day bowel habit diary. Patients with more than 50 percent improvement in symptoms were eligible for permanent stimulation. Long-term results were assessed by: bowel habit diary, symptom questionnaire, Cleveland Clinic constipation score (CCCS), visual analogue score (VAS) and short form-36 (SF-36) quality of life questionnaire. Primary endpoints included an increase in the frequency of defecation, reduction in straining and reduction in the sensation of incomplete evacuation.
After a median follow up of 12 months, subjects with both slow transit and impaired evacuation benefited from therapy and 43 patients (66%) proceeded to chronic stimulation. Frequency of defecation increased from 3.4 to 6.1 times per week, while evacuation days per week increased from 2.4 to 4.4. Time spent in facilities decreased from 17.6 to 9.3 minutes, straining decreased from 4.4 to 2.9 episodes per week, abdominal pain decreased from 4.4 to 2.0 days per week, and perception of incomplete evacuation decreased significantly.
In evaluating the results of the various assessment tools set forth at the start of the trial, researchers found that: the CCCS (0=no constipation, 30=severe constipation) decreased from 18.0 to 10.2; mean VAS (0=severe symptoms, 100=no symptoms) increased from 18 to 66; and SF-36 subsets of physical functioning, general health, vitality, social functioning and mental health significantly improved.
"While constipation is rarely life-threatening, associated symptoms of abdominal pain, bloating and the sensation of incomplete evacuation can severely affect the physical and emotional well-being of patients. There are many treatment options for the condition and the best approach relies on a clear understanding of the underlying cause," said Thomas Dudding, M.D., of St. Mark's Hospital in London, England, and lead investigator for the study. "This study found that sacral nerve stimulation is an effective treatment for idiopathic constipation that is resistant to conservative treatment. As a result of this stimulation process, improvement occurs in bowel frequency, associated symptoms and overall quality of life."
Dr. Dudding will present this study on Sunday, May 20, at 2:15 p.m. in Room 151A.
levator ani issues
Pain increased on thur/fri/sat. Up higher in the rectum. Digital massage helped. Talked to Dr Wise and will probably register for the clinic. Visited Dr T and was told that they have also not seen any issues with lexapro. She said that people have complained of stomach upset with it initially. However, no one has complained of constipation. Also, constipation can be managed with zelnorm / miralax /amitiza. Based on all this, risking to go ahead with the lexapro.
Little bit of stomachache immediately after taking lexapro. Took 10 mg in the evening. Hopefully that will not become yet another problem to deal with.
Little bit of stomachache immediately after taking lexapro. Took 10 mg in the evening. Hopefully that will not become yet another problem to deal with.
Friday, May 18, 2007
Not going to lift weights
for another month. The main goal now is to somehow remain functional. Being in top form is no longer a goal. Being functional is. Functional means somehow be able to go to work / get groceries eat, sleep and have a bowel movement. One has to compromise
Bowel movement experiences
When bhatta was visiting (on 5/13) sat for 1 hour for second bowel movement. If I would have gottne up, would have lost the sensation. The trick is to stay put / take deep breaths and have faith that the bowel movement would happen.
Also noted on 5/17 - if woke up late at 9:30 - the stool was there but took a long time to come out. That seems to be my destiny - slow moving stool.
Also noted on 5/17 - if woke up late at 9:30 - the stool was there but took a long time to come out. That seems to be my destiny - slow moving stool.
Thursday, May 17, 2007
Fissure or levator ani
May 4 - Friday: Pain increased by the time there was doc appointment. T's assistant said that the she can see the fissure and that she can see new growth. Saturday pain continued. Maybe there should be a new term since it was not really pain. More of a itching sensation that transforms into pain every now and then. Sunday was the same story. Monday went to visit Dr varma. She could not find the fissure. Tuesday still the same. By thursday when bhatta came in pain was reduced. By saturday thought that the cushion in the car should not be used. On sunday played basketball. Little bit of itching after that but subsided.
Slight workout on monday. Anothre workout on tuesday (both days lying down on the back so as not stress the pelvic region in any way). Boom felt a tear happen when sitting down. Pain is back. On wednesday problem continued. More concentrated near the right leg. Wednesday evening dramatic improvement. Absolutely no issue. Thursday(today morning) slight pain when had to bend to shut the tap. Itching / discomfort continued. By evening discomfort turned to itching and pain. Hot water sitz bath did not help. Neither did nifedipine. It is probably as a result of standing for an hour at work.
NOw the pain is near the left leg. DOn't know if it is fissure or levator ani.
As usual no pain during bowel movement.
Slight workout on monday. Anothre workout on tuesday (both days lying down on the back so as not stress the pelvic region in any way). Boom felt a tear happen when sitting down. Pain is back. On wednesday problem continued. More concentrated near the right leg. Wednesday evening dramatic improvement. Absolutely no issue. Thursday(today morning) slight pain when had to bend to shut the tap. Itching / discomfort continued. By evening discomfort turned to itching and pain. Hot water sitz bath did not help. Neither did nifedipine. It is probably as a result of standing for an hour at work.
NOw the pain is near the left leg. DOn't know if it is fissure or levator ani.
As usual no pain during bowel movement.
Thursday, May 3, 2007
fissure pain disappeared
May 3 - woke up in the morning with pain. Pain reduced with bowel movement. Worked with legs up on the sofa. Fissure pain disappeared at 1 pm. Though it is offset by the constipation problem. Sudden reduction continuing until 4:30. There are brief moments of the pain but they disappear again. Maybe it is that the fissure has not been stressed at all. But maybe it is actually reducing. Ray of hope !!
miralax worked probably
the day after idli probably constipated (or was it the sphincter muscle not able to push things out), I had a dream bowel movement. One shot everythign was clean. Things have been ok with the bowel movement. Today however, it has gotten stuck again. Took miralax again and hoping the magic happens. Today and earlier took miralax at around 11 am.
Fissure pain:
Fissure started April 18 when zelnorm to amitiza switch happened. April 19 it reduced. Switched to zelnorm on April 20. Fissure non existent by April 21. Did iron yoga on April 22 and the fissure is back with a vengeance.From Mon - Wed though fissure pain used to go away and then come back but never a big problem. Then on Thursday it increased inexplicably. Friday it was even worse. Called dr varma and took an appt for May 7. Didn't do much on sat and sun. In fact on sunday was sitting with the legs up on the sofa entire afternoon and evening. Still the pain remained
During the week April 30 onwards, pain followed a pattern of less pain in the morning and by night time there was a good deal of pain.
May 2 and May 3: woke with irritation. Pain actually decreased during the bowel movement . It appeared that the stools actually grease the area. The decrease in pain is definitely true (my mind is not playing games on me)
Fissure pain:
Fissure started April 18 when zelnorm to amitiza switch happened. April 19 it reduced. Switched to zelnorm on April 20. Fissure non existent by April 21. Did iron yoga on April 22 and the fissure is back with a vengeance.From Mon - Wed though fissure pain used to go away and then come back but never a big problem. Then on Thursday it increased inexplicably. Friday it was even worse. Called dr varma and took an appt for May 7. Didn't do much on sat and sun. In fact on sunday was sitting with the legs up on the sofa entire afternoon and evening. Still the pain remained
During the week April 30 onwards, pain followed a pattern of less pain in the morning and by night time there was a good deal of pain.
May 2 and May 3: woke with irritation. Pain actually decreased during the bowel movement . It appeared that the stools actually grease the area. The decrease in pain is definitely true (my mind is not playing games on me)
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