I had a fistulotomy and seton placement for a rectal-vaginal fistula last week, along with removal of several skin tags. Since then I have had an increase in bouts of incontinence. Even before the fistula, I have experienced some stool leakage (for several years) but it was generally manageable by using either toilet paper or cotton in the anal area and wearing pads. However, since the fistulotomy my incontinent episodes are more frequent and more severe (greater volume of stool- probably around a few milliliters each time; consistency of my stool is generally comparable to that of applesauce). I do not feel the urge to empty the pouch at all now, and only realize that I had a bout of incontinence after it has happened (this sometimes happened prior to the fistulotomy). But then while in the bathroom, I can't pass anything substantial (usually just a small amount is seeping out, continuously, even after 20 minutes or so on the toilet); this is new since the fistulotomy. A few minutes after I leave the bathroom, I experience another bout of incontinence. It is getting to the point where I am wondering how I will get through the work day (I bring plenty of cotton, extra pads, and even extra clothes with me) and while I am at work I spend a ridiculous amount of the day in the restroom (I take a trip at least once an hour in an attempt to head-off any problems). One of my primary concerns is that I do not feel the urge to empty the pouch- is there possibly some neurological issue? I was miserable when I had an ostomy and do not want to go through that again if I can help it, but am wondering if anyone ever has a temporary one on more than one occasion. I just don't know how much surgery my body can handle.

I know the fistulotomy had some risk of damaging the anal sphincter muscles during surgery, but I don't think that can explain the lack of urge. Is it likely that the urge to empty the pouch will return and/or that the incontinence that will improve with time? Or when the seton is removed (does its placement prevent a tight seal)? Right now, I feel fairly confined to my house but am going to work. I have an appointment with my surgeon in a week.

My brief history: Ulcerative colitis diagnosed November 2000, Two flare-ups requiring hospitalization in February 2003 and September 2005, Colectomy with ostomy and j-pouch creation in January 2006, Ostomy takedown in April 2006, Bowel obstruction (due to scar tissue) requiring surgery in June 2006, Ileus formation following C-section in February 2012, and Fistulotomy in June 2012.

Thank you for any advice you can provide!
Original Post
This close to the procedure, I would assume that your symptoms are related to traumatized nerves. If after a few more weeks your sensation is not returning, you may want to have some tests. But even then, it may be too soon. It can take a very long time for nerves to repair themselves, and it depends on the degree of damage. In most cases, it is related to swelling from the procedure, which is minor damage, and resolves more quickly. More severe damage can take up to a year to regenerate. Only after that long wait can you assume it is permanent.

Of course, up to a year is too long to be messing your pants. That is why I said to give it a few more weeks to begin turing around. If it becomes intolerable, you can opt for a temporary ileostomy while you wait out the healing process. That is not an uncommon option.

Jan Smiler

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