Incontingence and pain after colon surgery

[cscgc]

About 1 1/2 yrs. ago I had a portion of my colon removed due to prolapse.  I am 38 now.  I have lost all the muscle tone and use of the sphincter muscle.  I have seen 3 drs. (2 specialists).  I have rectal bleeding and a lot of pain.  I have BM's every time I use the bathroom.  Fiber has been giving me a lot of gas and bloating and leads to more bathroom visits and more pain and bleeding.  Today I was prescribed Questran and encouraged to research online.  I am exhausted every day due to the pain.  I am 135 lbs (not overweight), but stay bloated and gassy.
The drs. said that an artificial sphincter may work, but it is not performed around here.  Another option could be removal of the colon and wearing a bag.  I am frustrated and don't know where to turn.  The drs. seem as flustered as me.  I have pain radiating from my rectum every day and night and aches down the back of both legs midway down my thigh.  All the drs. say this is not a typical symptom and I might want to see a neurologist.  I feel this would be a waste of time.  It seems to make sense, that if there is bleeding and irritation of the rectum, there would also be pain. Sometimes the pain makes it so it hurts to walk.  I also had surgery on Nov. 1st, 2003 to have my ovaries and appendix removed due to ovarian cysts rupturing and endometriosis wrapping around the appendix, ovaries (my uterus was already gone) and bowels.  The drs. are wondering if nerve damage could have occurred.  I know this sounds like a lot, but I want to be back to my old self.  Please help.  Any input would be appreciated.

[Kevin Pho, MD]

You may want to consider an opinion at a major tertiary medical center.  The option of an artificial sphincter should be considered. This device consists of an occlusive cuff implanted around the anal canal, a pressure-regulating balloon implanted in the prevesical space, and a control pump with a septum port implanted in the labium or scrotum. The user is able to squeeze the control pump to permit defecation.

Studies have shown that in those who can tolerate the sphincter (up to 37 percent had to have it removed) the majority had an improvement in their quality of life.

Other option would be nerve stimlulation.  It has been found to restore continence in patients with structurally intact muscles.  This is still an experimental approach and can be discussed with your specialists.

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.

Bibliography:
Robson et al. Fecal incontinence.  UptoDate, 2004.

[surgeon]

I'd suggest seeing a colorectal surgeon at a major hospital; depending on your location, that might mean a medical school hospital, or a large referral hospital or clinic. What's going on and what to do will depend in part on how your operation was carried out; whether it was just a resection, or whether some procedure was also done to fix the colon in position to prevent further prolapse. It's not an easy problem at this point, but the best chance of help, I'd say, would be as I mentioned.

[JIm553]

A related discussion, bladder was started.