Chronic Incomplete Evacuation. Cause?

Kindly do connect and consult with me for better treatment plan and advice on your case

Hello, thank you for your question and for sharing your detailed medical history. I have reviewed your 3-year history of bowel symptoms alongside your test results. Your case is quite interesting and complex because there is a slight disconnect between your physical symptoms and what your scans/biopsies are showing. Your colonoscopy showed some superficial ulcers at the very end of your small intestine, the ileum, and the biopsy mentioned "chronic inactive ileitis." However, because your CRP and Fecal Calprotectin are completely normal, it suggests that there is no major, highly active inflammatory bowel disease driving this at the moment. Sometimes, mild, inactive inflammation here can be an incidental finding or related to past medications like pain killer usage . That's my first question. Do you use use pain killer often ? Your sensation under the right rib matches the endoscopy finding of mild antral gastritis , especially since it worsens after meals. It can also be aggravated when you are constipated, as a full bowel can increase pressure in the abdomen. Your complaints—straining daily, a feeling of incomplete emptying, spending 20-30 minutes on the toilet, and fragmented or flat stools—actually point away from a simple dietary constipation and more toward an evacuation or pelvic floor issue. When the muscles in the pelvic floor do not relax properly during a bowel movement, stool gets trapped or comes out in small, flat, or sticky fragments, leading to prolonged toilet times and significant straining. That's my second question - Even though you strain heavily, is the stool itself physically hard and dry, or is it soft/sticky but  incredibly difficult to push out? Have you ever noticed actual blood in your stool (bright red or dark black)? Have you experienced any unexplained fevers or joint pains? Also a very important part of reaching the correct diagnosis is , What laxatives, fiber supplements, or treatments have you already tried, and did any of them give you relief?

To definitively diagnose the cause, the following specialized workup is required - Anorectal Manometry (ARM)to evaluate rectal sensation, sphincter pressures, and muscle coordination during simulated defecation MR Defecography or Barium enema Evacuation Repeat  Fecal Calprotectin in 4/5 weeks . If you have not tried a regular fiber supplement yet, this is our starting point to correct the "sticky" consistency of the stool and help it form into a normal shape. Use Isabgol of any company of your choice ,1 to 2 tablespoons in a full glass of water, taken daily at bedtime. You must drink at least 2.5 to 3 liters of water daily for this to work effectively; otherwise, it can worsen constipation If Isabgol does not give you relief within a week, or if you have already tried it without success, we will try an osmotic laxative to soften the stool and make it physically easier to pass. Syrup Lactulose ( like syrup Looz) 15 ml once daily, usually at night . But , If bloating occurs: Polyethylene Glycol sachet (Pegmove powder)  can be used . 1 scoop/sachet dissolved in a glass of water daily. To treat the mild antral gastritis (burning under your right rib ) Tab Pantoprazole 40 mg 1 tablet daily, strictly 30 minutes before breakfast for 2–4 weeks. Prucalopride 1 mg  1 tablet daily in the morning

To facilitate easier bowel movements, elevate your knees above your hips using a toilet footstool or by adopting an Indian-style latrine posture . This anatomical adjustment reorients the rectum, promoting a more mechanically efficient passage of stool. Limit each toilet attempt to no more than 5–10 minutes. If no bowel movement occurs within this timeframe, it is advisable to discontinue and try again later. This practice helps prevent straining-related complications, such as hemorrhoids or fissures.

Indigestion

Avoid fried and spicy food Water intake more Green leafy vegetables more Fiber meal Do connect and consult

Can help you, kindly consult and provide detailed history for proper diagnosis and further management

There are multiple possibilities in this case. 1. Functional bowel disorder like inflammatory bowel syndrome (constipation) or defecatory disorders 2. Intestinal ulcer such as chrons disease Since there is no weight loss , no mention of anemia I am hoping possibility of ulcers is very very less. Some more information on sumptoms like blood in mucus and frequency of passing stools will help narrow down the diagnosis a little bit.

Patient should go on to do few more investigations such as Vitamin B12, CBC, iron studies and MRE to rule out chrons and structural disorders. Symptoms can also account to celiac sprue for which total IgA count should be done.