Bowel neuroanatomy and physiology

Submitted by louiseds on April 29, 2009 - 12:10am
Body: 

Hi All

I rave a lot about the complicated brain feedback pathways involved in pooing vs not pooing. Well, I have found a document that explains it all. A warning: it is complicated, but there is nothing in it that cannot be decoded with primary schooling in human biology, a good anatomy book and some commonsense. There is also a good glossary of laxatives etc at the end. Don't be put off. Dive right in, and you too can be an armchair gastroenterologist! ;-)

www.sci-health.org/RRTC/presentations/PPT/Bowel_Neuroanatomy_and_Physiol...

No, I don't fully understand all the words either, but I have saved the document for a rainy day, when I will curl up on a couch with an anatomy book and figure out what it all means. Really????

However, a few lightbulbs did go on while I was reading different parts of it.

Even if you can't understand much of it, it does show how complicated gastrointestinal functioning really is, and how much the GI tract relies on the brain and nervous system to keep it working properly. No wonder there is so much constipation and IBS about! No wonder it can be so difficult to tame your own bowel!

Happy reading.

Louise

louiseds

May 6, 2009 - 10:03pm

Hi All

I had another Aha! moment this morning while I was sitting in the bathroom pondering the universe. Here's the theory.

Pressure on the inner sphincter of the anus seems to be the main sensor of a full rectum. If there is a significant rectocele the rectum will just balloon out into the vagina, and the inner sphincter will not clearly experience the pressure needed to trigger the brain into being aware of the need to empty the rectum. (The fascia around the rectum will normally contain the rectum at a maximum volume which will create pressure eventually.) The act of splinting pushes the rectocele back into its space and compresses the rectum, which usually triggers the peristalsis needed to empty. If the rectodcele is very large I doubt that pressure from a thumb on the posterior vaginal wall will produce enough extra pressure to trigger emptying. However, if that thumb pressure can be exerted on the inner sphincter, and the inner sphincter is still capable of activating its sensor, it should be possible to trigger emptying with this thumb pressure.

I had a mug of tea first thing this morning, eventually needed to pee, and as I got to the toilet, I realised my body wanted a poo too. So I had my pee, then the urge to poo suddenly went away. I got buried in a magazine article while I was sitting there, then realised that I had a feeling of fullness on the righthand side of my vulva. Sure enough, my perineum was a bit distended, which is unusual, but I discovered that my rectocele was enormous, even though I wouldn't have even thought about it five minutes before. There was no longer the urge to go, though clearly my rectum was full. I splinted high while bearing down slightly, which would have made the bladder push the base of my thumb against the rectocele. It must have exerted enough pressure on the length of the rectocele to irritate the inner sphincter. Nothing happened for a minute. I moved my thumb downwards, then everything started to move. Voila, enormous poo. This rectocele experience doesn't happen to me often, but next time I will try finding the inner sphincter and putting a bit of constant pressure on it straight away.

Anyone care to join my little experiment, with the aim of collaboratively gaining a better understanding of the urge to go?

Cheers

Louise

karrymae

May 7, 2009 - 3:36pm

wow.. I have been thinking about this for awhile and I am soooo glad you brought it up. I have been thinking that I have sphincter damage because I don't really feel the urge to go anymore. So now, I am thinking that maybe this is a "normal" feeling for women with rectoceles??? I am interested in hearing from others too.

I have 4 POP's and my rectocele is the worst of the 4. I never, ever feel the urge to "poo" anymore.. unless I am really FULL and then after I empty, my rectum is very, very, sore (probably from being stetched) So I do try to "catch it" . When I feel the stool moving through my colon (usually in the morning) I will sit on the pot and wait so that it doesn't sit in my rectum but just passes through. Usually I can empty within 10-20 minutes without straining. (I know you are asking "Who has that kind of time?") I don't either, but I get up 30 minutes earlier than I need to.. just to accomodate this and then I have a pretty good day. I don't splint. (Maybe I should try ) I do however use Christine's balms every morning to "lube" and I have discovered when I touch the back of my vaginal wall I must be pushing on the sphincter because then I do feel the "urge" until I push it back into place and then I feel OK.

~karrymae

Mae

May 7, 2009 - 6:50pm

Well, considering all that's going on around here, I needed a good laugh! Louise's Poo Experiment! That stinks, coming from the lady that couldn't be coaxed into a Carrot Pessary Experiment! LOL! You are too much, or maybe I'm making much ado about nothing!

Back to my patient..but thank you for the chuckle! You are a wise, but wild woman!

~Mae

louiseds

May 9, 2009 - 10:22am

I had a really nasty, stressful experience on Thursday, which resolved by Friday afternoon. To cut a long story short, I came to the conclusion that somebody in my Mum's nursing home was stealing her stuff, cash, jewellery etc. By Friday afternoon I had undertaken a really thorough search of her room and the cash and jewellery in question had been located. What a sense of relief.

Over 24 hours I had experienced several hours of stress to the point of nausea and Sahara Desert mouth, twice; the first on Thursday afternoon when I came to the ghastly conclusion, and the second on Friday morning when I had to front up to the Health Services Manager of our local health service and make my allegation.

As a result of this stress, so much water was sucked out of my tissues *and* out of my gastrointestinal tract, leaving me with a nasty dose of constipation. I eventually managed to solve that without too much trouble, but it drew my attention to the degree to which stress will affect my body physically, and how quickly it can happen. On the whole, I do not lead a stressful life these days, which may account for the lack of trouble I generally have with my rectocele. The constipation in itself is enough to set up a major stress response in me, let alone anything really stressful on a continuing basis. I can also see how I became constipated during marriage difficulties a few years ago, and during the process of leaving my home, children and a marriage of 25 years to get away from a relationship that I felt was progressively killing me. The constipation was one of the things that was not good for my body, and brought my POPs to the point where I needed to do something about them.

So how do others deal with stress that follows them every waking hour, and perhaps during sleep as well. How do you manage stress-induced constipation if you never wake from the nightmare, if the nightmare is your reality? How do you de-stress and allow your body to recover its function continence?

I count myself lucky that the source of my stress was transitory, caused mainly by my Mum's dementia, which has caused her to uncharacteristically move some things of sentimental value to me from their normal positions in her room and forget where she had hidden them. The solution was to just remove them, with her blessing. If only life were always that simple.

Louise

Connie54

May 9, 2009 - 12:49pm

I am glad your found your mother's belongings. I would have been in a fit too! You raise a good question about stress. I am at a place too where my days are usually pretty calm, but lately I worry way more about silly things than I should. To calm down, I take a Xanax, which helps, but causes constipation. So I take a stool softner and extra magnesium and I am usually back to normal bm's. But I wonder too how people who live with daily, horrible stress manage all their other problems too without being backed up for days! I am now worrying about a probably minor health condition my granddaughter has, but I have built into a major thing. Is this just hormones that makes a women get like this? I am so tired of always worrying about something. At least I have put the cystocele on the back burner for now. Connie

goldfinch1

May 9, 2009 - 2:43pm

Stress can take a toll on the body in many ways. Three years ago, we sold our home which consisted of 5 bedrooms, a full basement (by full I mean FULL of stuff where there were little pathways to maneuver around) and a 2 car garage with 1 side full of 'stuff'. The problem was, we had six weeks to get packed and close and I was working full time. Two weeks into the six week deadline I developed the shingles - below my waist and on my left side, including places that made it impossible for me to sit down. I missed 1 week of work, and I'm sure getting the shingles was due to stress. I don't remember being constipated, but I do remember having a hard time sitting on the toilet.

Now stress is back, as my husband has been out of work since last October. So I am still working full time at 60 years of age and carrying all of the responsibility. (One of the reasons why I do not post on this site very often.) Yes, I have had days when I've been constipated, and I can usually track them back to days at work that have been stressful, and there are quite a few of them every week.

Even though I take psyllium and colace every day, I sometimes have to resort to 1 Exlax sometimes at night. I know I cannot let myself get constipated to the point of pushing, and the Exlax guarantees that I'll be OK. It's a vicious circle. Listening to the news at night about the economy, more and more jobs being lost, dh's unemployment benefits running out soon. I worry more about getting shingles again. I know there is a vaccine, but I don't like the thought of having that in my body. Maybe I should get the shot - I don't know.

I usually don't have trouble sleeping, because I'm always so dead tired at night that I can't wait to close my eyes. Sleeping is the best part of the day. Yes, the stress is my reality, day to day. I know it's taking a toll on my health. I just missed 7 days of work for a cold that developed into bronchitis. It took 2 different antibiotics to get it. I know I would have bounced back sooner if not for the stress and my weakened body.

Anyhow, I'm glad your stress was transitory, Louise, and that you found your Mother's things. I really don't know how to de-stress when stress is my life 24 hours a day. I try to breathe when it gets really bad, and now that the weather's warm I'm trying to walk at night after dinner.

I hope everyone has a happy Mother's Day.

louiseds

May 9, 2009 - 10:41pm

Hi Goldfinch

Good to hear from you again. Just wondering if you have ever tried any sort of meditation, or just some time every day when you can simply stop all the coping, and just be 'in the moment by yourself' in some way that works for you.

I think we sometimes get so into the rhythm of living with stress that we don't really appreciate the enormity of what we are dealing with. It becomes the new norm and the responses our body makes are not seen as being anything out of the ordinary.

Sometimes we can't see a way to get the stressor out of our lives, or convert it to a less toxic form, so living with it is the only option we see.

However, sometimes if we can think about it clearly enough, we can see that there are things we can change, that will lessen the stress. This may result in a temporary increase in stress before it settles at a lower level. The only way to see how wound up we are getting is actually to wind down, to a point where we can see how wound up we have been. Does this make any sense?

This is what trips and holidays are about for me. They take me somewhere else, where I am away from the clutter (I relate strongly to the state of your old cellar!!), the phone and the worries, and life is very simple, and day to day.

I think if I could make myself take some time every day to get off the merrygoround and just "be", for twenty minutes, I would see the rest of my life more clearly, and begin to know instinctively the actions I could take to reduce the stress.

I had a very itchy eyelid last night before bedtime. Some allergy eyedrops settled it enough to get to sleep. It is still tingly this morning, but more diffused. I am also feeling a little tingly on my scalp and parts of my face on the same side. I hope shingles is not stalking me, and will be carefully tracking it until Monday, when I can tyr and get in to see a doctor if it has not settled. Might up the fresh pineapple and ginger today.

Cheers

Louise

bgp

May 10, 2009 - 9:30am

Hi Goldfinch, I also had shingles a few years back. I had them on my face, ugh. They are often brought on by stress, but most adults who get shingles will not get more than one case. Just wanted to pass that info along.

goldfinch1

May 10, 2009 - 9:42am

How I wish that were true! My Mother, who passed away 3 years ago at age 87, had shingles 2 times. And one of her dearest friends who is still alive, June, had them 3 times (June also had them on her face). I don't know if getting the shingles shot would protect me going forward, but I'm not big on inoculations.

Goldfinch