Adhesions and Constipation

[alexandria]

Can you tell me if adhesions from laproscopic surgery can cause severe, chronic constipation? I am a 36-year old female with a history of severe IBS, redundant sigmoid colon and mild endometriosis. I've also struggled with chronic stress, anxiety and worry (due to the unresolved issues below). I've always had constipation predominant IBS, but any episode could be easily cured by changing my diet, eating more fiber and 2 tablets of Equalactin per day. About a year ago, I underwent laproscopic surgery for fertility and had a myomectomy (surgical removal of fibroids). There was no endometriosis found on the bowel. Most of the work was done on my lower left side of the uterus and the surgery was about 3 hours. After the surgery, I experienced abount 6 weeks of loose stools and finally was given Librax to slow things down. From that point on, I began experiencing mild constipation that turned into severe and chronic constipation. Many medications were tried to get things moving - Pamine, Phazyme, Equalactin, Zelnorm, Miralax, Lexapro, Lactulose and finally Senokot S. Before I began the Senekot, I was in real trouble. Each medication listed above worked for a short time and then stopped working. After 2-3 days without a BM, my bowel in the sigmoid region would distend, causing severe pain. The only release came after using Senekot. A plain abdominal x-ray showed that stool was backing up in the recto-sigmoid region of the colon. I've been treated by a GI doctor for the past year and have had the following tests: plain x-rays, blood tests, CBC, pancreatic and liver enzymes, gluten tests, thyroid levels, CAT scan, upper GI, small bowel series, lower GI, colonoscopy and colon transit marker study. All were fine (except the marker study was run on a day that I had an IBS attack which resulted in 3 days of very quick transit - not the norm).I've consulted with my general doctor, my GI specialist and 2 colon surgeons. All have told me that it's just IBS and that it will right itself eventually. Here are my questions:

1. Is it possible to have IBS so severe that the colon stops functioning on its own? The severe constipation has been such a drastic change from my typical IBS.
2. Can numerous medications (as listed above) going in and out of my body have caused this problem?
3. Is there a possibility that adhesions from the surgery could cause this type of problem? The doctors have told me that they don't feel that adhesions are a possibility since I am very symptomatic of IBS and are not willing to pursue a laprospcopic second look. Should I consider pursuing this as an option?

I would greatly appreciate any suggestions or recommendations you could offer. I do have a consult with a GI doctor who specializes in IBS on Jan 7th. Is there anything I should ask?

Please note: I've consulted with two surgeons who will not pursue any kind on colon resection surgery as both believe that IBS is the main problem and that surgery could present more problems.

[clintmd]

I am concerned that you may have severe adhesions of the sigmoid colon causing near obstruction.  I recommend that you ask the transit study be repeated (it should show the markers hanging up in the sigmoid colon region), and get a barium enema, which should show the sigmoid to be densely adhesed in the pelvis.  

  An effective treatment may be to have the sigmoid colon removed with a low pelvic anastamosis... this would prevent recurrent kinking from sigmoid adhesions.  Let me know what your doctors think (I would go to a colorectal surgeon)

[Kevin Pho, MD]

You have already had a very thorough evaluation for constipation, including the tests mentioned in the question.   To answer your questions:

1) There are varying degrees of constipation-predominant IBS.  I am not sure if there can be IBS so severe that the colon stops working completely.  If your tests are alright, it is unlikely that a serious GI disorder (i.e. a mass) is present.  

2) It is unlikely that the medications listed above is causing your problem.  Most of those medications are used to treat constipation, not cause it.

3) Partial small bowel obstruction may be a possibility after surgery.  This can result in obstruction-like symptoms (like constipation).  However, if the CT scan was normal, this scenario is unlikely.  The laparoscopy would be definitive, but you may want to avoid more surgery if possible - since it can cause more problems (as your other surgeons have stated).  

A second opinion to optimize treatment for IBS is a good idea.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[kevinmd]

I will be away until January 4th.  I will answer your question when I return.

Happy holidays,
Kevin, M.D.