Constipation after bowel resection

[lvfrogs]

Hello everyone,
I am new to this forum, having just recently (3 weeks) had a bowel resection, emergency operation, vertical incision, not a laparoscopy.  My question to anyone, is this:  I am still constipated (just like before the operation), bloated and eating little.  What have you all done for this? My doctor says that I can eat whatever I want, but that is not the case. If I eat very light, soups, some fruit, I am ok.  Anything more and I am nauseous and miserable.  I can only go to the bathroom if I take a laxative.  I know that I am only 3 weeks out but would love to start feeling better soon. I am also extremely tired and would like to know if this is normal. I find talking to other people that have gone through something similar is better than talking to the doctor.  Any help is greatly appreciated.
Thanks!

[BettyCM]

Hi Ivfrogs,
Do you think the bloating is due to gas or being constipated?  I have taken Gas-X sometimes and that has helped.  My gastro dr fell during exercise, so I couldn't get an earlier appointment.  My appt is Jan. 20.  I asked the office to schedule my follow up colonoscopy as soon as possible. My surgery was near my rectum, so it's not too far in.  She was able to see the mass during the first colonoscopy, so she should be able to see if there's a problem where the surgery took place.  That is scheduled for Jan 30.   On a side note, a friend of a friend had this surgery and she said recovery took about a year.  Maybe there is hope!!

[lvfrogs]

To BettyCM,
I had my surgery in June, thankfully all benign, but am still having bloating (extreme), can't eat much at one time, and constipation.  My gastro has me on Miralax and Senokot-S - the Senokot has helped my constipation, but still have the other two issues. I am thinking scar tissue too?  I am curious what your doctor will say. Mine just keeps saying it is normal, takes awhile for your colon to get back in order, but this bloating is not normal. It is just like before the operation.  Let me know if you don't mind, and thank you.

[BettyCM]

I had a large colon resection in July (6 months ago).  Fortunately, mine was benign.  I have been constipated in spite of eating better than I ever did.  Miralax made me go constantly, so I stopped that.  I had been managing it though bran cereal, fiber tablets, lots of fruit & water: going often, just one small bm at a time.  Isn't that weird?  I don't know why I can only get one stool out at a time. Then this week, I wasn't able to go at all;  just a small ribbon-like bm a few times.  So I took correctol (3 tabs) and had diarrhea today.  I had to come home from work for a little while to wait for it to end.  I called my dr to meet with her sooner.  I'm thinking I may have scar tissue build up.  Because instead of getting better, I've gotten worse.  Like you, I wonder if I have to live with this the rest of my life.

[cham58]

Any comments - I had colon cancer (Stage 3) - had colostomy, then reversal, THEN of couple surgeries for herniation and adhesions.  Just had a sphincteroplasty for continence -- but I continue to alternate between going small amounts constantly and constipation.  The stomach pain, bloating and continence issues are definitely problematic.  I teach full time and am having trouble experimenting with diet.  Now I alternate between Lomotil  and Miralax... anyone out there go back to the ostomy?  Could anyone make a physician reccommendation of a surgeon associated with The Cleveland Clinic?
Thx!

[Bad_Luck_Gut]

Sue i am glad that is working out for you.  I am thinking the pain is here to stay for a while.  Well....well.... What a crazy time.....  i didn't make it through Monday.  Ended up in the ER where the 8 week old incision burst opened as a result of a large abcess.  Yikes....  that is what all that pain was.   It took all that time to surface and then when it did, it popped through.  OUCH!!!!   So I just got out of the hospital again. I was soooo sick.  On Tuesday...I was thinking that dying wouldn;t be soooo bad.  I don't think i can ever walk into a hospital again.  They transfered me by ambulance from one hospital to aonther.   Can't wait to see this bill....but I was tooo busy wishing for death at the time to care.,,,  hope everyone else is doing better.  

[Sue357]

Hi. I had a great visit with my surgeon yesterday.  He conducted an exam and said everything feels okay.  As for a CT scan to determine scar tissue/adhesions, he said the only way is to open me back up....NO WAY  lol.  He is running a cbc for infection and will probably do a colonoscopy to look up there.  I actually feel better as he was saying that some people have some pain up to a year or even 2.  It could be foods I am eating that are irritating the colon.  He was very nice and didnt treat me like a neurotic woman, like my GI did.  

[Sue357]

Hi.  I am sorry that you are experiencing pain.  Your doc is probably wanting you to stay away from fiber to give the colon a break.  They did that with me before my surgery.  I am glad you have an appt. with your PCP but you may want to discuss with surgeon who did the surgery.  I go see mine, this afternoon, and will let you know what he says as I am going to ask for a CT, for peace of mind.

[Bad_Luck_Gut]

Hi......I am sorry to hear of your pain as well.  My doc suggested that I stay away from fiber, carbinated beveages, fruits, greens....carbs.....

I am throwing in flag..  i can't stand this pain amy more.  I believe mine is muscular.  My lower abdomin is extrememly painful.  It started about 3 weeks after surgery and has not gotten any better.  I called my PCP today and they set me with an appointment for Wednesday.  What's another couple days of hell when it's been more than 4 weeks of this pain?

I am soooo done with pain.  There seems no hope as it is not getting better on it's own.

[Sue357]

Thanks for your encouragement.  I have an appointment with my surgeon this week.  He had said, a few months ago, that if I was still having pain, in July, he was going to order a CT.  I am not sure if I am taking in too much fiber or the possiblity of adhesions/scar tissue.  I am going to politely demand one as I am one of those people who has to SEE to feel that this is normal.  Also, the hospital that I had the surgery done is where he does the majority of his resections.  I am disgusted with my GI so am going to ask my PCP for a referral for another one.  I have the type of insurance that I do not need a referral but want a recommendation.  I will keep all posted.  PS.  I am doing a little better today, as far as pain goes.  I am also blessed in that my best friend is an RN and talks straight to me. I am not spiking fever, vomiting or in EXTREME pain so thinks I am okay waiting to see my doc this week, as I was considering a trip to ER ( where I had the surgery) today.  

[Morecambe]

Hi again - I am really sorry to learn about your on-going pain - and sympathies to all the others who have posted here.

I'm at a bit of a loss really because, after my surgery, I was fortunate enough to be one of those patients for whom life slowly returned to normal.  I did not have to cut out anything from my diet.  Hence I think the observations of fellow patients for whom life did not return to normal - and who had to adjust their diet/lifestyle - might be more helpful.

All I can suggest is to get a second opinion at a hospital where colon surgery/resection is carried out several times per day.  That should enable a complete spectrum of after-surgery experiences to have been encountered with the appropriate follow-up treatment.

Sorry not to be able to suggest anything more practical.

Wishing you all a complete recovery eventually.

Morecambe

[Bad_Luck_Gut]

I can't do much because it is sooo painful.Eating is not an issue. I don't eat every much these days.  I know what foods are good and what aren't.   The pain is physical.  I see the doc again on the 21st.  I don't have any pain killers (would like some) so I don't move very much.  I think if she did give me some, I would feel good enough to at least move and walk around so I could try to gain strength to get beyond the pain.  But for now....I just lay around...bored!!!

[beentrying2quit]

After reading these posts I would like you to begin searching Celiacs Disease and check out the symptoms.  This is a disease where your body is no longer able to tollerate a protein callge gluten which is found in wheat, barley and rye products.  I too had my sigoid colon removed 3 years ago after a diverticulum ruptured.  Shortely after that I had my gall blader and appendix removed.  

For the past year I noticed that I constantly had lower abdominal pain with really bad gas and indegistion.  Went to the doctors several times and they finally said "we dont know what to do."  Talk about a sinking feeling.

After months of research and suffering I finally ran across Celiacs disease by accident and all of my symptoms fit.  Please not that it is also very common for people with Celiac disease to also be lactose intollerant.  I have both problems.

Before January nobody could ever convince me that our diet could cause health issues.  I always felt something other than food was causing mankinds aliments.  After 5 days I was feeling better and noticed that my symptoms were going away.  I was totall amazed.

I hope this helps you.  Let me know what you think.

[Sue357]

Hi there.  I am also still experiencing problems after my colon resection, over 5 months ago!  My GI thinks I am neurotic and suggested counseling and yoga.  I do have GAD ( Generalized Anxiety Disorder) which seems to have gotten much worse after this hellish going on a year.  I am going back to my surgeon, on July 15th, and after reading your post to Bad Luck, I wanted your feedback.  I, too, think that I should be over the pain.  I cut back on fiber, today, as I was in so much pain yesterday ( and the last few) that I have started back on pain meds, after work.  I don't know if it is what I am eating or what but have followed enough posts on this site to know that scar tissue could me an issue.  I am not exhibiting the things they told me to watch for: fever, chills and vomiting but am sooooo tired of pain.  Thanks so much.  

[Morecambe]

Based on my experience you ought to be pain free by now and I suggest that you definitely request your surgeon to come up with a lasting solution - apart from pain killers.  It is their duty to "finish off" all matters arising from your surgery.

Good luck
Morecambe

[Bad_Luck_Gut]

I think the pain is from the wound or it is muscular. Extrememly painful though and burning below the belly button.  I have been taking Aleve and Tylonol, but  it's not helping much.  Oh and I am taking Gabapentin.... Getting around is no easier now than 3 weeks ago.

[Morecambe]

Hi - what an appropriate name - but I hope that you can re-name yourself "Happy Gut" or "Painless Gut" soon!!

It is over two months since your surgery and I would have thought that you ought to be pain-free by now.  I was pretty much pain free after the wound had healed (2-3 weeks) and up to then, I recall that any pain was more associated with the wound rather than with "anger" from my remaining intestines.

I suggest you ask your surgeon to differentiate between pain associated with the wound and pain associated with your intestines and treat accordingly.  If the pain is identified with your intestines, maybe some imaging tests can identify the cause,  I really hope that you do not need a follow-up operation.

Good luck
Morecambe

[Bad_Luck_Gut]

Thanks for all the advise earlier, I had ileorectal anastomosis surgery on the 28th of May.  I am still in a great deal of pain.  I was hoping for a quicker recovery.

[lvfrogs]

To Morecambe,
Thank you for your advice. I see my surgeon next Tuesday and I have kept track of everything since my last visit 2 weeks ago.  I will see what he says and in the meantime will do some research into a colectomy. Thank you for your help!

[Morecambe]

Hi Ivyfrogs - thank you for your clarification.  My (unqualified) viewpoint would be that the one foot of removed intestines (for suspected appendicitis) was insufficient to reverse the constipation.

What to do now?  If you are prepared to undergo another (bigger/more traumatic - as you will have seen in the posting to which I referrred you) surgical operation and if your present situation is intolerable - I would ask your surgeon on Tuesday "Look although it may be quite drastic, would a total colectomy solve everything for once and for ever?"

I recall Dr Pho (on the "ask an expert" part of the G.I. forum) saying that surgery can be a last resort for chronic constipation.

Good luck - let me know how it goes - Good luck

Morecambe

Whatever676:-

a total colectomy is the removal of the colon.  It is also called an ileorectal anastomosis.  An incision in the most distant part of the ileum is made and also an incision in the top of the rectum.  The two incisions are sutured (= an anastomosis)together.  It's a bit like cutting out a few feet of a garden hose that is split open and leaking - and then joining the remaining sound parts together.  The split part of the colon/garden hose is then thrown away.  Depending on the "geometry" of the two open parts a colostomy bag may/may not be required.  My surgeon said that hit is necessary in ~2% of cases.  But there are probably other reasons why, during the operation, the surgeon may have to decide to insert a colostomy bag.

Try typing in "total colectomy" or "ileorectal anastomosis" into google/yahoo etc and you will find thousands of clips - some of which originate from prestigious hospitals and which include a diagram.

Good luck

Morecambe

[whatever676]

What is a total colectomy? Do you have to wear a bag or something after the surgury?

[lvfrogs]

For over a year, I have had bloating, constipation - change in bowels, not always constipation, sometimes I would go 4 or 5 times in a couple of hours (morning), fatigue and when I ate, I ate very little but felt like I had eaten a big Thanksgiving dinner. I was having some gyn problems too and I thought it was related to that. In the meantime, I had been going to my primary, my gastro doc and my gyn. They all knew of these complaints.  About 5 months ago, I started having severe stomach cramping that would come and go but it was bad, like really horrible labor pains. I was told to eat more fiber, you have a stomach virus, etc.  The last time it happened, 3 weeks ago, I went to the ER because I just could not take it again.  My white blood cell count came back at 20,000 so they ordered a CT scan.  The CT scan showed an inflamed appendix so they thought I had chronic appendicitis, where it flairs up and backs down over and over.  So they scheduled emergency appendectomy.  When they operated for that, the appendix didn't look that bad, so the surgeon took a look around and he found a foot long section of my instestine that was scarred, twisted in two places and obviously blocked.  So he did major surgery to remove and resection that.  I hope this helps more with my explanation and sorry it is so long!

I see the surgeon on Tuesday of next week and plan to ask him about the ongoing constipation.  He is concerned about that but it's been two weeks since I have seen him last and in these two weeks, was the first time that I had really started eating more substantially (or trying).

Thanks for your advice and help.

[Morecambe]

Hi again - I'm a bit perplexed by your comments.  From the tenor of your posting I am assuming that the original bowel resection was to overcome serious constipation?  If so, then why not cut out the part of the bowel (i.e. the colon - or most of it) that acts as the constraint to defecation?  Why only cut out a small part that allows constipation to continue??

Or was your bowel surgery for another complaint (e.g. an ulcer) which cut out only a very small section that would have made no difference to your underlying constipation?

If indeed you are suffering from chronic (incurable??) constipation, you might want to ask your doctor/surgeon "is it still possible to have another operation that will definitely cure the problem - i.e. a total colectomy???)."  Obviously quite drastic - but if it gives you back your life.....

Wishing you well
Morecambe

[lvfrogs]

Hello Morecambe,
I did not have a total colectomy, like you did. I just had an intestinal removal and resection.  I am drinking lots and lots of water, eating prunes, other fibre and if I have to, taking Milk of Magnesia.  The doctor had me take Magnesium Citrate one time, he thought that would get it going.  Of course, I went, but since then have only gone once on my own. I see him next Tuesday so plan to ask him some questions.  

I didn't even know what an ileus was? So thank you, I will ask him about that. I looked it up on the internet.  Your post that you referred me to was very informative, thank you! You have been a big help.

Take care!

[Morecambe]

Hi - I underwent a total colectomy four years ago.  Log on to:-

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

to read my own description which I posted in answer to another patient's question.

I am surprised by your experience in regards to a continuing constipation rather than frequent liquid motions which are characteristic of a total colectomy.  The colon storesd water and when it is removed there is supposed to be much more water that passes through the remaining shortened large intestines.

You could try dringing more water and following my "more fibre" recommendation.

I wonder if you might have a lingering ileus?  Suggest to ask your surgeon.

Do revert with any further questions.

regards
Morecambe