Colonic inertia

I have had issues with chronic constipation following a laparoscopic hysterectomy 15 months ago.  Initially I thought I might have a post op ileus, but the KUB was negative.  After losing 20 pounds on clear liquids because of severe symptoms which made me afraid to eat because of how I'd pay afterward, I had a CAT scan with contrast that showed colon narrowing but was otherwise unremarkable.  An EGD a month later was significant for two peptic ulcers and I had my esophagus dilated.  (Not surprising after two months of drinking magnesium citrate just to get by).  The colonoscopy was "structurally fine."  

I have spent the last 15 months trying every over-the-counter conservative treatment I could imagine. I'm a registered dietitian, so I have tried MANY things in MANY combinations, some prescrition and some over-the-counter. I have been completely obstructed once. I prayed for death, and obviously the answer was "no."  I did not trust the surgeon on-call at the time, so I stayed home and pushed fluids and exercised until I thought I might have cleared it, then got an abdominal film to make sure prior to eating again.  I have seen specialists, and I have had a thorough workup to include barium enema, defacography, sitz marker study, anorectal manometry, biofeedback, enterocolitis study, etc.  The only thing to have helped in the least is a combination of Exlax and Senekot. Miralax and all other bulk fiber just creates more stool that takes forever to pass.

The anorectal manometry was equivocal, meaning I partially failed and partially passed it.  The marker study was 100% ABNORMAL, meaning all 24 markers were readily seen after five days. Bowel movements are not possible without excessive laxative use, sit-ups, excessive fluid intake (about 4 L/day). I generally have the sensation that I am completely loaded with stool and cannot evacuate it, or enough of it, to feel good. In the past 15 months I have had ONE day I felt great, and that was after the partial obstruction and subsequent starvation with push of excessive fluids for one week.  If I don't eat at all, I feel great. If I do, I pay. I have often wondered how long I could do this, but usually after 4-5 days of no eating I'm too exhausted to function and I eat something little. It's worse than gastroparesis diet if you ask me!

I saw a colorectal surgeon yesterday, who told me that my marker study was the gold standard diagnostic tool for colonic inertia and that my only options were to put up with over-the-counter therapies and their side effects and hope that I can avoid obstipation/obstruction, or consider colectomy.  I am somewhat resistant to surgery as my issues started with a surgery in the first place.  There are likely some pelvic floor relaxation issues as well as my children were all three weeks early with weights of 8, 9, and 10 pounds. (All delivered via C-section.)  This surgeon told me I can do Kegel exercises and work out until I'm dead and it will likely not fix that portion of the problem.  

So, I'm finally resigned to considering surgery.  However, I would like to know the the potential complications from this and any suggestions that I might try conservatively before signing up for a colectomy. I will consider any idea unless I have already tried it.   Any suggestions would be appreciated.  After all those tests, I'm not proud and I've lost whatever dignity I had during the workup process.  

Hoping to avoid surgery but almost resigned to it as my only option to get better, G

[Morecambe]

Hi - in response to a patient who was suffering from chronic colon inactivity I described by own experience of a total colectomy.  Now my reason was different (torrential diverticular bleeding) but I guess that the after effects will show some similarities to those where the surgery is performed to alleviate colonic inactivity.

Try logging on to:-

http://www.medhelp.org/posts/show/523166

I hope that this helps you to arrive at a final decision.

By the way the patient with whom I communicated previously was MIFEGR and I think the date of the exchange was about 20 August 2007.  You may like to try and read her posting in order to see whether there is any additional information that could help you.

Good luck
Morecambe