Partial Obstruction Colon

[lewis0001]

Last year I was diagnosed with acute Diverticulitis. I am a 51 yr old male. I've had two acute episodes with mild LLQ abd pain and tenderness. Both times I was treated as an outpatient with Cipro and Flagyl and the symptoms improved within one week. Last CT was in January and was clear of wall thickening and fat stranding.

Current Meds: Prednisone 20mg/day Asthma
                       Miralax 17G/Day
                       Flomax .4mg day  BPH
                       Theo-Dur 300mg Bid  Asthma
                       Lunesta 3mg Sleep

Was taking Zelnorm until ten days ago..

Current problem: Mild abdominal pain LLQ and periumbilical area comes and goes
                            Bloating after meals
                            Small soft stools, narrow caliber 2 per day (last five days)
                             Incomplete evacuation
                             No fever, no blood in the stool

I often have pain in the LLQ which was always better after a bowel movement. GI doc thought I probably had IBS-C secondary to the inflammation from the acute diverticulitis. The current pain is different in quality and does not seem to be better after defecation.

I tried increasing Fiber three days ago, and had much more gas, but no change in stool frequency or caliber. Some increase in pain (probably due to the extra gas)

Visited my family practitioner on Thursday, and talked to my GI doc the same day. After a brief exam of my abdominal area and discussion of my history the FP gave me an Rx for Levsin. He said that he thought the pain was coming from colonic spasms and thought the Levsin would stop the pain. The GI doc thought the same and suggested Symax.

I don't understand the RX rationale. Both of these drugs have contraindications for BPH, and both drugs can cause more constipation.

Finally my question: Why would both of these doctors prescribe a medication that increases constipation, and is contraindicated for BPH?

I have not taken the Levsin.

[Kevin Pho, MD]

I can't speak for the doctors' rationale.  It is possible that they are not fully aware of your medical history and overlooked the BPH.  Also, it is possible they weighed the risks and benefits and concluded that the BPH effects were outweighed with the treatment of the IBS.  

Levsin is a routine treatment for IBS that can stop the spasm associated with the constipation.  There is a significant chance that this may not be effective, as there are no proven treatments for the disease.

You may want to consider further testing to exclude more dangerous causes of constipation.  A colonoscopy can be considered, as well as a CT scan to exclude masses or cancer.  

More specialized tests to exclude colonic motility or neuromuscular damage can be considered as well.  

These options can be discussed with your personal physician.

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.
kevinmd_

[Jaybay]

I'd bet money you have bowel adhesions (scar tissue) as a result of the diverticulitis. Any injury or infection to tissue results in scar tissue formation, and if it forms on intestines, it can cause the type of symptoms you have.  Good luck in proving it though - unless a full obstruction presents, the scar tissue tends not to show up on any tests.  The only way to get rid of it is with surgery, and since more surgery causes more scar tissue formation, many surgeons are loathe to pursue it and try to simply treat the symptoms.  I have lived with this condition for many years, and rejoice that my pain and vomiting symptoms are finally being treated.  No more surgery for me unless it's a life-threatening condition where I'm throwing up feces.