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Endometriosis, IBS the connection and reality
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Endometriosis, IBS the connection and reality

Unfortunately reading through the archives I haven't found anything useful to my particular question.

I'm 29, have 2 children (both c-section) having difficulty conceiving the second I had a laparoscopy for suspected Endo.  The results were large adhesions on ovaries and tubes and an hsg was performed clear the tubes.  The results besides continued abdominal pain was that I became pregnant.  My son was born June 4th 1999.  Even prior to delivery I suffered from bouts of diarrhea.  

I was diagnosed with endo (allthough it was not seen during lap) I was told it was so syptomatic it had to be, inside my belly wall perhaps or intestinally.  

The severe pain I get with onset and for two weeks with my period is located just an inch right and an inch below my navel.  It itches alot and diarrhea has also left me in much pain.

I had a stool culture which showed nothing as far as bactaria or toxins.  I also had a sigmoidoscopy and countless ultra sounds before during and after the pregnancy.  I now am doing 6 months of tx for the endo, Lupron Depot 3.75mg IM injections. I am going for my third shot this week.

Not to get too much in the aspects of the Lupron, but the pain is still here, I just noticed that I am bleeding and every time I would get my period (time wise) I get terrible cramps and diarrhea.  I often feel nausious and weak.  

The sigmoidoscopr revealed nothing, The GI I am seeing is calling it IBS, allthough a barium enema has yet to be performed completely after three attempts.

Any ideas or avenues to approach would be helpful.

THank you in advance.

(What connections or related diseases would affect both the reproductive system and lower right quardren, if any)

Jess
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Dear Jess,
Your questions address a difficult problem in the care of patients.  Abdominal pain is a particularly difficult clinical problem because there are often disproprotionate symptoms in the absence of physicial findings or clues to suggest a diagnosis.  A temporal relationship between your symptoms and menstruation/ovulation is circumstantial evidence for endometriosis.  You should know that th ehormonal changes associated with ovulation can alone cause symptoms in the absence of endometriosis.  It is necessary that you have an appropriate evaluation of the gastrointestinal tract including evaluation of colon and small intestine.  Before concluding that your problem is IBS, it is necessary to exclude other treatable conditions of the gastrointestinal tract.

Conditions of young woment that can involve the gastrointestinal tract and the tubes/ovaries can include endometriosis and crohn's disease.

This information is presented for educational purposes only.  Ask specific questions to your personal physician.
8 Comments
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Avatar_n_tn
sorry but there are other things to consider.  I wouldn't really like to go through the numerous symptoms but I feel it's necessary so that I may get some guidence on what tests should be performed.

I know I NEED to complete a contrast BE however three attempts with the 24 hr prep are strongly affecting my daily functioning.  Would there be a similar test that could be performed to rule out things like colitis and colon cancer?  Perhaps something that doesn't require me to be aware or awake.

My Mother dies from pancreatic cancer at a young age (she was 41) I again am 29, and though not wanted to be a hypochondriac have every symptom of this disease.  Down to the jaundice.

I am hopeful that I'm not persuing the wrong avenue of health care in latching on to the idea's of Endometriosis.  If Endometriosis is located in the belly wall or through the intestines what are the chances of me having this diagnosed and through what tests?

I've had the lap and again it showed nothing (other than scar tissue, adhesions and blocked tubes otherwise everything "visible" was clean) Where would you recommend to go from here.  In all seriousness, would you given my history and family history pursue the thought of pancreatic cancer?
Thanks Again
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Avatar_n_tn
Jess,

The only way to really diagnose Endometriosis is via a laparoscopy or laparotomy...the laparotomy is done just like your c-sections were done.  Most times, the laparoscopy is done, as the recovery time is much less than with a laparotomy.  You said the Dr. did not see any Endo, but feels that you have it.  It is my understanding that the GI tests won't show Endo unless it has penetrated the wall of the bowel.  Lupron Depot is a good drug for many, but without a sure diagnosis of Endometriosis, you could be putting your body through more than necessary.  I was on it for seven months, and even with addback therapy of estrogen and progesterone, I still developed Osteoporosis, and a pretty significant case of it.  There are several GYN's/RE's that specialize in the diagnosis and treatment of Endometriosis.  Some of them are, Robert Albee MD and Thomas Lyons MD, both in Atlanta GA; Harry Reich MD (pronounced Rich), in NY and Pennsylvania; David Redwine MD, in Bend Oregon; David Adamson MD, in California.  I don't know if you are near any of these Drs., but if so, you might want to look into one of them.  I had surgery with Robert Albee MD last year, and am quite pleased with the results.

As far as the diarrhea and nausea, that can be attributed to a higher level of prostaglandins in your body during your period.  Have you tried taking drugs such as Motrin or Ponstel to name a few?  

With adhesions, even though the Dr. may disect them, they can reform.  Adhesions can cause a great deal of pain.  I have talked to women that have had surgery for suspected Endo, but the Dr. went in and, while he didn't find Endo, there were plenty of adhesions.  When was your surgery that you had for suspected Endo?  Was it prior to your last c-section?  If so, you could have more adhesions from the c-section, or it could be adhesions from the surgery for suspected Endo.  Also, when you  had the surgery for suspected Endo, did the Dr. biopsy any areas?  Could there have been Endo buried in the adhesions??

Okay, this has become much longer than I had anticipated, but wanted to try and address as much of your post as I could.  I'm *not* a Dr. or any other health care professional.  Just a woman that has Endo.  Good luck to you!!!!!

R
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Avatar_n_tn
Thanks for your reply.

The laparoscopy and hsg I had after my dirst c-section but before the second.  Specifically 7/17/98.  I became preg. on 9/12/98 and delivered 6/4/99.  THere were no biopsy's taken at the time of the lap.  Like I said lysis of adhesions as well as some scar tissue.  My tubes were blocked.  I can only say that what Doc did during the lap helped me get pregnant but nothing else.  I still felt the "endo" pain while I was pg the second time exactly when I would have gotten my period.

I do believe that there is something other than or in addition to the "endo" or female problems.  My Dr also referred me to a GE who has yet to do any blood work.  A sigmoidoscopy and stool cultures were about it.  I was set to do the Contrast BE but failed miserably as I was 3 wk Post Partum from a section and had in those three weeks been so sick with abdominal pain itching and diarrhea, jaundice, fatigue I had lost over 60lbs in those first three weeks.  (Doing the prep test only resulted in loss of another 6 lbs in one night)  

I might add, first when I had my daughter on 4/29/95 after the c-section the incision didn't heal properly and had to be drained (what I was told was liquid fat) for the following three months.  So I know that I am prone to adhesions and scar tissue.

My concerns are now more towards the GI.  and finding out whats really going on.  One Dr refers to it as GYN problems and the GYN refers to it as Bowel problems.

I am not near any of those Dr's but have heard of Dr Redwine.

I should also mention when I was 7 months pg this time around I had terrible diarrhea and the baby became tachy and I was dehydrated.  I was pre eclamptic (suggested by the higher levels of protien in my urine) and also borderline diabetic.  I'm "not" in the medical field myself but all these things and the fact I have family history of Pancreas and Liver problems I would like to address this soon.

The baby was delivered c-section because of his weight (he was 10lbs 1 oz) also born jaundice and low blood sugar.  any connections there (I was told it was all due to his size)

Anyway now I have carried on far to long.  The Lupron was terrible the first two months and YES the bones are aching,  But before the Lupron I have also had many problems with bones and my back.

All these thing give me a red flag to the digestive system, but the majority of symptoms point toward Endo (because it's mainly with meses)

I am probably a good case study for someone here and hope to get some reply from a Dr soon.

Do you know if somehow when I get my period there could be some relief of a bile duct cuild up and when my period calms (after two weeks) I don't have the diarrhea?
Grasping no doubt
Thanks again
Jess
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Avatar_n_tn
Jess-
  As both a med student and someone with IBS, I can appreciate the complexity of your problem.  My spastic colon did not become symptomatic until I underwent a lap chole (excision of the gall bladder necessitated by infection).  Since that time, I've had problems with persistent diarrhea.  I've had a GI follow-thru (drink a radio-isotope and watch as it moves through the system), as well as a colonoscopy.  Both were negative.  The reason it was pursued more heavily was because of heme positive stools.  This might be a good place to start.  If he hasn't already done so, ask your GI or FP to give you at least 3 Hemetest cards.  You will put smears of stool on each card, taking samples of stools from each of 3 different days.  If your cards do not indicate occult blood, you rule out several things.  If they do, however, contain blood, you need to pursue a diagnosis more expeditiously. You may need a LGI follow-thru to rule out Chrone's Disease--it will be radiographically evident as you visualize the ascending, transverse and descending colon (but may not have been visualized during your sigmoidoscopy).  Also, if the cards come back positive, your GI may want to follow up with a more complex colonoscopy.  

In the interim, you may wish to start yourself on some type of fiber suppliment--best would be cirtucel as it has a lower likelihood of causing unwanted gas.  Also, talk to your doctor about adding something for bowel motility (be it Bentyl, Donnatal, Anaspaz, etc...) as well as something to use when your stools are too loose and frequent (such as Imodium (immodium) or Lomotil).

Good luck.
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Avatar_n_tn
try accupunture, helped me for years
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Jess-
A 24 hour prep will interfere with everyone's daily schedule.  If you were my patient and told me that you didn't perform your prep because it interfered with your plans for the day, I would offer two options.  1) Plan to take a day for the prep.  Take off work.  Do not schedule lunch with a friend.  Don't make any trips to the supermarket or mall.  2) Contact me when your serious about finding a difinitive diagnosis.  Sorry to be cruel, but it is in your hands.

CM
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Avatar_n_tn
Your not being cruel, I understand it's in my hands.  The situation was not a problem because I had plans, the first time I completed the 24 hr prep I was a couple weeks Post Partum from a c-section along with severe diarrhea to begin with, I had lost the weight so fast my whole body was in some state of neglect.

The second time I completed the 24 hr prep and they missed the barium and it was all over me.  They left me on the table with the balloon up my but for 20 minutes before they did that, the three lousy pictures they got did nothing.

The third time I threw up projectile with the liquid drink.

Since then I have had liver tests done and there were plent of questions raised as to why mt Alkaline Phosphatase was elevated and AST 4X the normal... Low amylase and so on.

I still am going to do the upper GI, just under a different method, possibly the swallow barium.

Thanks for your input!
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Avatar_n_tn
What is the relationship, if any,  between estrogen, estrogen therapy (HRT, birth control pills etc.) and IBS??
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