Here is what you do to get the info I was referring to; it's really easy and the best patient article I have ever seen all summed up in two pages.
1. Google this: Physiological Testing of the Colon, Rectum and Anus.
2. Then there is a button to click to down load it for free.
3. Up comes Dr. Bruce Orkin's article and you can print it right out for free.
Bascially for defecation issues there are structural tests: xrays and scopes. Then physiological tests to check the function or how things work: Manometry, Balloon capacity and compliance, balloon evacuation. Neurological Tests: Pudental nerve terminal maotor latency, electromyography, Concentric needle EMG Single fiber EMG (the needles into the nerves can be skipped. Just as much info can be gained with electrodes that are pasted onto the anus and surrounding muscle. Colonic and transit studies such as you are having. Then the defecogram. Then anorectal ultrasound. This is an informational article and not meant to substitute for medical advice. BUT I was only given a defecogram and an MRI to look for structural things. Then THAT was misinterpreted and I went down the road I did. Turns out my transit was fine. Mine, as you know, was a result of mal-practice, but as a rule docs are honestly trying to find out how to really help a person. i for some reason, was one who got stuck in a whirlpool of those who were out to make a buck with very poor pre-op dx and no follow up to complications and surgery done wrong. This is not the norm. So get this article and ask your doc about all these tests.
If you could not poop out the balloon, it means that you have the outlet issue.. If this cannot be relieved by PT, then you need the nerve function tests. Sometimes a nerve that controls the puborectalis muscle may not be working right and any surgery done on the pelvic floor can make things worse. A botox shot into the end plates of the puborectalis muscle (while you are completely under deep general anesthesia) may be a good test to see if you truly have non-relaxation of the puborectalis muscle. This is the sling muscle that comes off the levator ani whcih encircles the rectum and controls rectal angulation. On a defecogram, if you have an indentation that holds the rectum at 90 degrees whether at rest, push, or evacuation, that means you have nonrelaxation of the puborectalis muscle. Mine prior to my 2006 original surgery for the sigmoidocele which wasn't, showed totally normal anorectal angle widening for defecation. Norms for this are approximately anorectal angle 90 at rest, 120 or so at strain and 150-180 at evacuation, then return to 90 degrees when done. These are only rough estimates, check this out on google and I did not have my results with me when I wrote this, but the idea is that the puborectalis mucle relaxes when you poop allowing the anorectal angle to widen, then it tightens and closes the angle for continence. In my case my levator ani was scarred or some nerve to it was injured so after the disaster surgery, the angle stayed closed at 90 degrees.
If you have this outlet issue that cannot be cured and you have CI (as in sitz markers not being moved through your colon), and you have normal small bowel transit, it is logical that an ileostomy would be the cure. Folks on here with CI who have had the small intestine hooked to their rectum still have issues as they also have pelvic floor issues. So be sure to get all the testing you need BEFORE doing anything. It is amazing how many docs of patients on here do not do or know of the full scope of testing needed. I know in my heart all these docs are NOT the way mine were and are trying to help people. I really think, aside from my case, the whole understanding of the gut system and intereactions with nerves/muscles in the pelvic floor is really still in its infancy. A prior hysterectomy can precipitate structural and neurological damage to everything. The HERS web site tells about all this. Unknown to me at the time I had what turned out to be the unneeded hysterectomy back in 1995.
Google anorectal angles for a printed explanation. Rosemary PS This post is just based on my own experience and not meant as medical advice as I have no MD degree.