Colonoscopy in a patient with constipation
This is a view of the inside of the colon in a patient who was having constipation for a long long time. Guess what it is…
These were present throughout the colon and rectum.
No other abnormalities were found.
looks like a reticular lichen planus. got such thing in there one ah??? i ni, simply taroh saje.
What??
Faeces all over. No? Diverticula?
colitis?
1) polyps? 2) ruptured blood vessels? 3) abscesses?
Already used up my 3 guesses…lol
can u pls tell us. i’m a high risk candidate for colonic cancer..and am not doing much to avoiding it…
Well.. none of the above. It’s melanosis coli, or rather… pseudomelanosis coli.
This patient had been having constipation (or perhaps he perceived himself to be having constipation). As a result, he was taking laxatives over-the-counter. The dark patches is a result of the abuse of a type of laxative called senokot. It’s harmless.
He should stop taking senokot and take other measures to improve the consistency of his stools. Such as taking a high fibre diet or using a bulking-forming laxative, e.g. isphagula husk.
Here is an article about melanosis coli.
And here are some more photos of melanosis coli.
Hey Bernard
Constipation, I think its when the stools are hard, lack of fibre and all.
What is the condition when:
- the stools are not hard
- the stools kinda get jammed up in the anus/rectum area first thing you wake up in the morning
- it takes a fair bit of abdominal strength (3 to 5mins) to push the soft stools out (not sure if I am describing it correctly though)
- and usually on an empty stomach (before breakfast), the push is unsuccessful. But it does feel like as if a tennis ball is being stuck in the rectum
Constipation is a symptom of reduced frequency and/or increased difficulty of passage of stools. It is not necessarily due to hard stools. Not passing motion for a few days may be described as constipation.
The symptom that you have described is called “tenesmus”. There is an urge to pass but straining does not result in passage of motion. Tenesmus is a serious symptom and should be examined carefully for serious disease. Do not take it lightly.
Before breakfast, there may actually be no stool in the lower rectum to be passed. After breakfast, the reflex bowel movement pushes the stools in the sigmoid colon and upper rectum into the lower rectum. Then, there’s stool in the lower rectum, ready to be passed. That’s why it’s easier after breakfast.
Hi Bernard,
I went away to monitor my daily habits with what you said. Here is my observation so far.
a) “There is an urge to pass but straining does not result in passage of motion.”
For me, only after about 1 mth of the stapler procedure I did, there is an urge to pass, straining after breakfast does result in passage of motion (plenty came out). Some days I notice, I don’t have to push so hard as well. And I pass motion at least once a day. The straining effort is not the same everyday. And its usually one or two drops at first, the third drop is usually the full load, thereafter completely flushed out. I feel perfectly healthy and am especially happy that I fart regularly (3 to 5 times) these days. Mood and sleep patterns are normal. No blood in stools either. I feel that the stapler have altered my passing motion style somewhat as the day progresses.
How would you describe the amount of effort it takes for a normal healthy person to pass healthy stools out of the body?
b) “Before breakfast, there may actually be no stool in the lower rectum to be passed. After breakfast, the reflex bowel movement pushes the stools in the sigmoid colon and upper rectum into the lower rectum. Then, there’s stool in the lower rectum, ready to be passed. That’s why it’s easier after breakfast.”
- This to me sounded normal, as it would be whats happening to people without bowel problems. Is this true?
Thanks for your feedback Bernard.
Regards
Milo
Milo, it sounds as if you are saying that you’re having to strain a little bit more than you used to to pass. If that is so, perhaps there is a bit of narrowing of the anal passage. I’d say that if the attempt to pass is made when there’s an urge to stool, the effort should not be very great. There should not be any huffing and puffing or waiting in the toilet for 10 minutes or something like that.
(b)Yes, that’s normal physiology (function).
I am monitoring it closely. The last 3-4 days have been good. Passage of stools didn’t have to wait long. Most of which were over and done with under 3 mins. I noticed the amount of fibre intake make a difference as well each time. On top of 1 packet of Fybogel before going to bed each day, if I add 4 prunes in breakfast and 4 prunes after dinner snack, the passage in the morning is relatively smooth. Am still motivated to monitor and adjust according to the body little ‘voice’. Still trying to shoot for that 2 litres of plain water a day. So far, think I am getting to 1.5 litres.
Milo, glad that you’re bowels are functioning as per the doctor’s orders. You are one very motivated person. Hat-tip to you.