For a few months prior to my first visit to the National hospital in London (2014) I'd been experiencing some bowel urgency issues - basically not being able to get to the toilet quickly enough. This had been happening about once a month, and had been a symptom which had been getting more often. I'd been devising various coping mechanisms - basically carrying extra pants around with me (generally, as well as the "plus one" rule on packing for trips away). Unlike my bladder problems I'd not been experiencing bowel frequency issues. I mentioned this to my GP, and then again at the National.
Another notable feature of my bowel habits is the "two part poo" - where I have a poo as normal, but after this has come out I know that there is more to come out, but I also know that the sphincter has closed and it will be some time before "part two" is going to make an appearance. So, rather than sitting on the toilet and waiting/forcing the rest out I get on with life, knowing I'll be back in a little while. Back at that time the "little while" might be half an hour or so.
I've mentioned various bits of this previously:
First Nov 2013: http://hspjourney.blogspot.co.uk/2013/11/symptoms-update-illness-tiredness.html
Second Jan 2014: http://hspjourney.blogspot.co.uk/2014/01/a-trip-to-doctor.html
Following the trip to the National I had a referral to the "colorectal" team, which I've also previously described: http://hspjourney.blogspot.co.uk/2014/11/a-trip-to-doctor.html.
I have noticed that since taking my bladder medication the bowel issues are pretty much entirely under control, as noted here: http://hspjourney.blogspot.co.uk/2015/02/bladder-medication-update.html
However, that is not the full story....
At one of the clinics I went to they did an anorectal physiology test. This was way back in 2015, and I'm not entirely sure why I've not blogged about this before. The test measures how well your anal sphincter is functioning, and they do this by measuring the pressure inside the bowel, and after that they inflate a balloon in the rectum and ask you to hold on for as long as possible!
The pressure tests were all good for me. The internal sphincter was well above their ball-park indicator, which is a good sign as I am less likely to develop some problems in the future. There were also no worries on the external sphincter.
However, the sphincter didnt relax as easily when I tried to squeeze, and this was described to me as being a bit like trying to get toothpaste out of a tube but with the lid still on - i.e. no matter how hard you squeeze, nothing is going to come out.
The balloon test (known as a balloon expulsion test) was interesting. Essentially the balloon acts like a stool, and the body should then feel the need to go! My sphincter took longer to sense the balloons presence than average - usually this is done within about a minute, but it took about 2 minutes for me.
The advice I was given was to bring my knees up whilst having a poo. I had a follow-up appointment after this, but as the problem had more-or-less gone away we didnt take things any further. Essentially, if things do start to get worse I have a direct route back.
On reflection I think that I have noticed both of the effects mentioned in the tests - Sometimes I know I need a poo, but I can sit down and nothing will come out. The delay in sensing that a poo is there would appear to me to be the urgency issue explained - i.e. the pressure continues to build up, and I only get 'action' when the pressure is so high that I dont have enough time to get to the toilet and the sphincter is going to operate itself.
In the intervening five years (since I've been taking the bladder medication) the issue has generally gone away. There is still the odd time that I cant get to the toilet quickly enough, but this might be one or twice a year rather than roughly every month. The two part poo is still a regular feature - I think that the gap between the two parts is getting longer, and the half an hour I noted back at that time might now be a delay through to the next day sometimes.
Re-reading my notes from the time I also spot that they recommended that I try to regularise my toilet trips so that I can get into a regular routine. This does happen some of the time, but it is more by luck than design. Perhaps another task to put into my daily routine.
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