Is This Normal After Surgery

[tennesseegal]

For 10 plus years doctors have been telling me that I have IBS; however, 2 months ago I went to the emergency room for severe stomach pain and vomiting.  X-rays revealed that I had an intestinal blockage which was caused by radiation treatments in 1989.   The surgeon removed 15 to 18 inches of the small intestine.  Since the surgery I have violent watery episodes of diarrhea (now 10 to 12 a day, after the surgery 15 up to 25 or 30) along with flatulence.  While being evaluated for IBS, I was tested for celiac disease, H Pylori, parasitic infection, lactose intolerance -- all negative!  Have had colonscopy, endoscopy and upper and lower GI series all within the last 9 months.  Thyroid and cholesterol tested and normal.  I also had my gall bladder removed in 2003.  I have not been tested for bacterial overgrowth.

I am on a high protein diet (cheese, eggs, meat), taking monthly Vitamin B12 shots and using Lomotil, Loperamide, Pamine Forte to control the diarrhea (which doesn’t work) and Welchol and Metamucil (twice daily) to firm up the stool.  My GI doctor has taken me off a high fiber diet.  I am 5’8”, 59 years old and lost 14 pounds after the surgery.  I now weigh 142 pounds and am struggling to keep from losing more weight.  I continue to be seen by a GI doctor and an internal medicine physician in addition to the surgeon.

My stool is somewhat formed (soft) in the morning and I have movements immediately upon getting up each morning.  After breakfast and meals, the violent episodes of watery diarrhea start. The diarrhea occurs from 15 to 30 minutes after each meal and continues until colon is empty.    My doctors have indicated that this is to be expected and will take maybe up to a year for the colon to adjust.  Is this normal?  

Are there any additional tests that should be performed?

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation for your diarrhea.  The only other test I would consider would be for bacterial overgrown (using specific breath tests or a jejunal aspirate) or sending the stool off to test for fat malabsorption.

If the tests come back non-revealing, this may be a side-effect of the surgery.

Another opinion could be sought at a major academic medical center.

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.

Kevin, M.D.
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