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Let me start by saying that i recognize that the ultimate answer to this situation is 'go see a doctor, not ask the internet.' I get that, and I'm trying. I found a new specialist I think will be more pouch experience but I can't get in until the end of March. I'm on the priority wait list (if that really exists) and call weekly for cancellations. This is in a new hospital so my internal medicine doctor won't be much help, plus I'm trying to replace him as well. My problem, and the purpose of this thread, is to figure out if this issue is something I can wait on or if this is something I should go into the emergency room with and try to jumpstart the process. Whatever it is, it is slowly but steadily getting worse.

For the last year I've noticed a gradual reduction in my overall health. It was attributed to pouchitis and I've been on and off antibiotics. This current issue I'm reasonably certain is not a pouchitis issue. My symptoms are the following:


  • Food is taking much longer to transit my system. For over a decade I could count on food first appearing around 6 hours after I ate it, and be completely or almost completely gone by hour 10-12. This has gradually lengthened, especially fibrous foods. Most recently I spotted a piece of celery I ate 48 hours prior with lunch.

  • I suffering what I call 'attacks' often at night. They include sharp pains along my scar lines. There is a particular spot near the top just below my sternum that really hurts and then over the next several hours, often as many at 8-10, this pain slowly transits down until there is another particularly painful spot down just below my belly button. This is often accompanied by nausea, often severe, but no vomiting. Also sometimes bloating with the 'upper' particularly painful area. This bloating is enough to be visible through a shirt is you're looking and sometimes gets a little hard to the touch. This transit time is often accompanied by very strong and vocal bowel sounds you can hear from 10 feet away.

  • I have intermittent blood in my stool. Always bright red, sometimes severe in volume but this will go away within 4 hours and won't present again for days at a time.

  • I have a particular area just inside my external sphincter when pushing towards my spine that is very sore to the touch and can become more inflamed causing increased frequency.

  • Stool consistency runs the gambit from completely fluid to very well formed depending on meds, food and days.

  • The pain is always present but is worse with very fibrous foods which I'm avoiding. Bran cereal, salads, vegetables, anything with skins or seeds.

  • I take pepto pills for bowel slowing, a prescription acid blocker for GERD, OTC zyrtec for allergies and am currently taking no other medications or probiotics.

  • I'm not sleeping well at all, if i eat I'm almost constantly in either pain, nauseous, or both. I'm eating basically two small meals a day. I've dropped 18 lbs in 2 months, partly because I was trying but now it's just a byproduct of not eating much.

  • The surgery dates are in my sig. I'm reasonably sure I have a hand sewn pouch which came with a mucosectomy based on how it was originally described to me and by some confirmation later from GI docs.


I recognize this is long, but thanks for reading. I'm torn on what to do. I lean towards waiting, but last time something 'weird' happened to me it ended up being a blood clot and a mass I had to have surgically removed so now I don't know... it's frustrating. I'm thinking maybe adhesion from the surgeries causing small partial obstructions, but I'm not a doctor.

Thanks again, I really am grateful that a place exists that we can come together. It helps me feel less alone during rough times like this.
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Sounds to me like you have more than one thing going on. First, it sounds like you are having frequent partial small bowel obstructions, with specific spots of problematic adhesions. That seems like the source of your pain, bloating, noise, and slow transit times, particularly with fibrous foods. Unless you become completely obstructed, it is not an emergency, and the ER docs are likely to just waste your time and send you home to follow up in the office setting. One way to test this is to switch to a completely liquid diet, just things like shakes, Ensure, pureed soups, etc. If your pain resolves with this, then I think you will know.

Your GERD could be adding extra problems to the mix if it is flaring, making the upper GI symptoms hard to distinguish from the lower. The epigastric pain you describe around your midline incision could be from GERD related symptoms, or it may have since advanced to acute gastritis and/or an ulcer. The fact that it is worse at night might mean a hiatal hernia, and your upper GI symptoms are consistent with that. But, still, not an emergency (yet).

The other thing sounds like an anal fissure, with the bright red rectal bleeding, especially with the painful spot right inside the anus.

But, if the bleeding is in very large quantities, it could be coming from the stomach, even if it is bright red. Hard to know.

Basically, you need to go to the ER if you are vomiting blood, unable to hold down fluids, have not passed any stool in over a day, or the pain is severe or escalating.

You probably need an upper endoscopy and a pouch scope to get this sorted out.

Good luck! I know it is very frustrating when you have to wait for an answer.

Jan Smiler
Thanks to you both for reading. Sounds like I'm fairly safe to wait, I just hope it isn't too much longer. To complicate matters, I'm of course in the middle of the interview process on a job that would be a substantial step forward in my career. When it rains it pours.

If they have to go in and clean up the adhesion/s, if that's what it ends up being, can they do that laparoscopically or am I looking at my 5th full midline? Also, what was your recovery period? If I end up with this job I'd hate to immediately have to take a couple of weeks off. Very bad form in my industry (or I guess any industry) but i just want this done with.
Lionspride, sorry you are going though this. I see you mentioned bleeding. I wish I had some words of wisdom, but I just had an MRI enterography today because I've had some episodes of bleeding going back to October, in some cases quite a bit of blood. I will certainly report back any findings, as they might shed some light on what is happening with others here as well.
I'm sorry you are having so much going on at the same time. The stress has to be awful. Jan and everyone has given you great advice about your health. I'd like to add to please do your best to obtain the new job or promotion. Since you can not predict your medical problems and they might easily be solved I say go for it. You can always turn down a job but if you don't fully commit yourself to obtaining it in the first place you'll feel bad if you don't get it.

I'm concerned about your blood loss and know first hand how alarming it is to look in a bowl of bright red blood. I had the same as you describe with cuffitis big bowl full then recurring intermittently, sometimes weeks apart. Plus I had the burning you describe. I bet you don't have cuffitis because you had the j-pouch connection some of us dream of. I'm wondering if you are concerned about loosing too much blood if you can get your current GP to order a blood test while you are waiting for your appointment.

Also I have GERD as well and a hiatal hernia. I think they usually appear together. They don't seem to be concerned with the hernia unless it causes problems and it involves the stomach so that possibility seems a likely cause. Jan is awesome.

I hope all works out well for you, health and career wise. Smiler

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