Hey guys, I need some help. I’m 2 months post takedown. Feeling really great aside from this one issue....

I am not fully emptying. I strain pretty bad, but not all the time!? Sometimes I have a big bowel movement but other times like the last 2 days...I am feeling like I can’t get it all out. There’s no urgency, no blood, no leakage. My rectal area is a little sore but nothing crazy. My stomach is very crampy today. I felt constipated earlier and felt like I was going to throw up. I just saw my surgeon 3 days ago. She said she could feel a stricture and manually dialated me in the office. It hurt pretty dang bad. I feel like it did not help at all and I actually feel like it made things worse!

Do you think she could have made something worse? What about an internal prolapse?

 

thanks!

Original Post

Hi KH,

I have been suffering from straining since my takedown 6 months ago now.  I want to start off by saying I didn't have a stricture, I have cuffitis.  But here's a couple things you might try to help you out.  One is to buy one of those stools you can raise your feet up so you are in a proper position.  Have you tried different positions and do they help?  Another thing is warm water.  Soak in the bathtub up to your belly for a few minutes or run warm water over your abdomen and buttocks while on the toilet. 

Also, are you still on narcotics?  I was on narcotics for a long time after takedown and that may contribute to being back up.  If that's the case you may want to tread slowly with some forms of laxative.  Don't overdue it cause butt burn is just as bad.  

Remember you are still 2 months post surgery, so foods with fiber and bulk can back you up.  What's your diet like?  Be very careful with things like popcorn, vegetables, and nuts.  Especially if you have a stricture.  That may be contributing.

Also, remember you've just had multiple surgeries and the pelvic floor muscles aren't the same.  You may need a round of pelvic floor therapy to correct the fact that some of the muscles might not be working like they should.  Some people tend to clench more after these surgeries for fear of incontinence.  That can contribute to straining.

As you can see there are a lot of factors.  Also it takes time for the J Pouch to function well.  I'm NOT a doctor, but my guess is that there's some foods or narcotics potentially contributing to that stricture, and that constipation is becoming painful.  Post again with all the details of your diet and meds.

Cheers

KDavid posted:

Hi KH,

I have been suffering from straining since my takedown 6 months ago now.  I want to start off by saying I didn't have a stricture, I have cuffitis.  But here's a couple things you might try to help you out.  One is to buy one of those stools you can raise your feet up so you are in a proper position.  Have you tried different positions and do they help?  Another thing is warm water.  Soak in the bathtub up to your belly for a few minutes or run warm water over your abdomen and buttocks while on the toilet. 

Also, are you still on narcotics?  I was on narcotics for a long time after takedown and that may contribute to being back up.  If that's the case you may want to tread slowly with some forms of laxative.  Don't overdue it cause butt burn is just as bad.  

Remember you are still 2 months post surgery, so foods with fiber and bulk can back you up.  What's your diet like?  Be very careful with things like popcorn, vegetables, and nuts.  Especially if you have a stricture.  That may be contributing.

Also, remember you've just had multiple surgeries and the pelvic floor muscles aren't the same.  You may need a round of pelvic floor therapy to correct the fact that some of the muscles might not be working like they should.  Some people tend to clench more after these surgeries for fear of incontinence.  That can contribute to straining.

As you can see there are a lot of factors.  Also it takes time for the J Pouch to function well.  I'm NOT a doctor, but my guess is that there's some foods or narcotics potentially contributing to that stricture, and that constipation is becoming painful.  Post again with all the details of your diet and meds.

Cheers

Thanks for your reply! Sorry you’ve been straining too. It’s awful.

A stool is a good idea...I’ll look into getting one. I’m not on any narcotics, haven’t been since a few days post op! I’m actually not on any medicine. Imodium makes me constipated. My stool is rather thick most of the time probably do to diet. I do eat a lot of veggies. Mostly cooked but raw too. I eat pretty clean. Salads, cooked veggies, beans, hummus, very little meat. I do eat bread and crackers and stuff like that too. I have not had popcorn or corn though, that’s about the only thing I don’t have! I feel like I push pretty well but maybe I’m not? Sometimes leaning forward or to the side helps empty a bit. A pelvic floor problem could definitely be possible. Apparently my surgeon thinks I have proctalgia fugax (problem spelled that wrong)...because from time to time I get hit with a nerve type pain deep in my bladder/pelvic area and it’s awful but then it just disappears! I do need to remember I’m only 2 months postop but I’ve been doing great and so I’m so confused why I’m having trouble emptying now, even after the surgeon just dialated me a few days ago??

If it’s a stricture it can sometimes take multiple dilations to keep things open. A prolapse is possible, but wouldn’t be my first guess. The test to diagnose a prolapse is a defecogram. It is still early days for you, and many early issues do sort themselves out with patience.

Scott F posted:

If it’s a stricture it can sometimes take multiple dilations to keep things open. A prolapse is possible, but wouldn’t be my first guess. The test to diagnose a prolapse is a defecogram. It is still early days for you, and many early issues do sort themselves out with patience.

Thank you! I’m going to contact my surgeon and let her know what’s going on. She did the dialation a few days ago and said she didn’t need to see me for 6 months! I’m like hmmm ok...I would’ve thought she wanted to see me for more dialations? I’m guessing the stricture was pretty bad bc it was very painful having the dialation. I almost couldn’t handle it. Terrible pain. 

It’s reasonable to be optimistic about a dilation working the first time, but then adjust the plan if more is needed. Dilation without sedation can be pretty brutal, but sedation makes everything more complicated and expensive. Did she do a finger dilation or use an instrument? Some folks who need repeated dilations learn to do self-dilation, but of course you can’t push beyond reasonable comfort limits.

If the dilation was that difficult then a stricture seems very, very likely.

Scott F posted:

It’s reasonable to be optimistic about a dilation working the first time, but then adjust the plan if more is needed. Dilation without sedation can be pretty brutal, but sedation makes everything more complicated and expensive. Did she do a finger dilation or use an instrument? Some folks who need repeated dilations learn to do self-dilation, but of course you can’t push beyond reasonable comfort limits.

If the dilation was that difficult then a stricture seems very, very likely.

It was definitely brutal! It was in her office. Finger dialation. There was pressure and a deep burning/searing pain. She kept telling me to breathe through it but that did not help lol. Even though it hurt, I’d probably do it again without sedation bc I’m cheap and don’t want to deal with sedation. I’d love to be able to do myself. My doctor is two hours away and so annoying to be driving there all the time! I’ll ask her about self dialation.

thanks!

It's tough cause we always have to keep in mind that your takedown was so recent it could just be that you need time. But it's always good to be cautious and observant.  Try backing off the greens and fiber for a few days and see if you notice any changes.  This advice is coming from my experience alone, so just keep that in mind everyone is different.  But i had a rough time and still have a rough time with vegetables/fiber.  They back me up like crazy.  You would think bread and constipating foods would do that, but i do just fine with bread.  Do some pelvic floor exercises daily, but don't over due it.  You only need to do a small amount, the key is doing them everyday not harder or more often.  

These are things you can try, keeping in mind you do have a very real issue that is may be the only cause of your discomfort and pain right now and that is the stricture.  Please keep us posted when you do start to feel better or worse just so we can have the info, it's always nice to see what the ultimate solution was.

KDavid posted:

It's tough cause we always have to keep in mind that your takedown was so recent it could just be that you need time. But it's always good to be cautious and observant.  Try backing off the greens and fiber for a few days and see if you notice any changes.  This advice is coming from my experience alone, so just keep that in mind everyone is different.  But i had a rough time and still have a rough time with vegetables/fiber.  They back me up like crazy.  You would think bread and constipating foods would do that, but i do just fine with bread.  Do some pelvic floor exercises daily, but don't over due it.  You only need to do a small amount, the key is doing them everyday not harder or more often.  

These are things you can try, keeping in mind you do have a very real issue that is may be the only cause of your discomfort and pain right now and that is the stricture.  Please keep us posted when you do start to feel better or worse just so we can have the info, it's always nice to see what the ultimate solution was.

Thank you so much. That’s very helpful. I will definitely keep you all posted on what I do and find out.

Scott F posted:

If a finger can’t get in easily then there’s an issue that has to be dealt with. I suppose it might be possible for spasm to cause it, but a stricture seems more likely.

Yes I agree. She could get it in there but it was very painful. She wasn’t even moving her finger. Just held it in there still and it hurt awful. 

I have been 12 years with j-pouch and straining has been my issue for a bit for me.  Always thought it was strictures, too.  After an anal manometry I found I am having difficulty with emptying my j pouch.  Went to a PT for severe pelvic floor dysfunction and she helped me out a tremendous amount.  Learned that I naturally have strengthened pelvic muscles due to trauma, surgery, etc.  Needed to learn how to relax through pelvic exercises and deep breathing exercises through going to this PT for pelvic floor issues.  Highly recommend looking for someone with this knowledge.  You may ask your GI dr. for a specialist in this area.

Roberta

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