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83 yo, horrible feeling of tenesmus. %u201Curge to go%u201D 6x

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I am 83 years old. I am suffering ~2 years of this horrible feeling of tenesmus. “urge to go” 6 times a day. It interrupts my sleep. It makes me afraid to eat. I lost ~ 50 lb. I now weighs only 119 lb (5’9” male). I want to eat normal and but constant rectal spasms gastrologist then haunted by tenesmus feeling. I have done the following check-ups and the results are normal: Stool test, blood test, colonoscopy, hemorrhoid check (not believed to be issues), small intestine test, no blood, no pain whatsoever, no diahreia. 50% of the times the stool is medium hard and 50% is loose. Hard or loose, it’s hard to pass. It leaves a feeling of incomplete evacuation thereafter. It bothers me all day long. Beginning of this year, I had a heart attack ~ possibly from forceful bowel straining. Now the life-threatening sign is gone, but I'm still haunted by feeling of tenesmus. I felt that if this goes on, I'll die from a next heart attack. Would like know what to do about this?

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replied August 18th, 2014
Digestive and Bowel Disorders Answer A48803
Thank you for asking

With all the labs clear and reports normal, the only likelihood left is functional bowel disease and IBS is on the top of the list. Tenesmus and frequency and incomplete evacuation and alternating constipation with diarrhea makes it confirmed.

Diet and lifestyle modifications for the functional Gi troubles, More fibres, less fats and carbohydrates, small meals of frequent durations that few larger ones, use of healthy lifestyle and exercise, losing weight if an issue, controlling lipid profile in a limit and compliantly using hypertensive medicines and staying in touch with your doctor is advised.
Fiber supplementation improve symptoms of constipation and diarrhea. Polycarbophil compounds (eg, Citrucel, FiberCon) may produce less flatulence than psyllium compounds (eg, Metamucil).

Judicious water intake is recommended and should be followed. Minimum of 2 litres in a day is advised.

Caffeine avoidance may limit anxiety and symptom exacerbation. Legume avoidance may decrease abdominal bloating. Lactose and/or fructose should be limited or avoided Take care to supplement calcium in patients limiting lactose intake.

Gluten intolerance has been further associated with irritable bowel syndrome. so try gluten free diet and see if it helps.
Meanwhile some prokinetics like metoclopramide and domperidone and erythromycins would keep the propelling work and make the bloating less but it needs a work up as i mentioned to sort out the most likely functional cause as IBS etc.

Management of irritable bowel syndrome consists primarily of providing psychological support and recommending dietary measures. Pharmacologic treatment is adjunctive and should be directed at symptoms.

Although evidence is mixed regarding long-term improvement in GI symptoms with successful treatment of psychiatric comorbidities, the American College of Gastroenterology has concluded the following:

Psychological interventions, cognitive-behavioral therapy, dynamic psychotherapy, and hypnotherapy are more effective than placebo
Relaxation therapy is no more effective than usual care
Pharmacologic agents used for management of symptoms in IBS include the following:

Anticholinergics (eg, dicyclomine, hyoscyamine)
Antidiarrheals (eg, diphenoxylate, loperamide)
Tricyclic antidepressants (eg, imipramine, amitriptyline)
Bulk-forming laxatives
Serotonin receptor antagonists (eg, alosetron)
Chloride channel activators (eg, lubiprostone)
Guanylate cyclase C (GC-C) agonists (eg, linaclotide)
Antispasmodics (eg, peppermint oil, pinaverium, trimebutine, cimetropium/dicyclomine).

Nut shell, All your symptoms are functional bowel IBS result and need Management. Seek a gastroenterologist for further management.

I hope it helps. Visit our IBS health centre for further guidance.

Take care

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