Self Dilation - Candle??

I have read someone's post on here a while back about using a tapered candle. I would be scared it would break off! Just be careful whatever you do when you self dialate. I was having issues with an anal stricture in the beginning and I just couldn't bring myself to do it even though my surgeon said it was ok to do it myself.

I have a narrowing at my anastomosis also and I do not like this suggestion. I think dilations are left to the experts to do (this is what we pay them for). They can dilate you under anesthesia if they need to hold the dilation in place longer or use a balloon to help expand the area. I understand how frustrating the narrowing can be and how this can require repeat dilations as I have been through this the last two years.
Possibly you can get some assistance with diet modification or miralax(only by suggestion of your GI as mine suggested this to me). I have found things like fresh blueberries, cherries and other fresh fruits really keep things flowing through my stricture, assuming your pouch can handle these.

First off, the notion of self dilation is NOT for breaking up the stricture (which IS best left to the professionals), but for MAINTAINING the opening once the in-office dilation has been done. Daily self dilations help prevent the reforming of the stricture scar.

4 inches sounds about right, as the stricture site would be about 2 inches +/- inside (beyond the anal canal and sphincters). Plus, you need to get beyond the taper end. So that is about only 2 inches or less inside the pouch. If you are worried about it breaking, put the candle inside a finger of an exam glove. If you can get in deep enough with your finger, that is OK too. The candle is essentially the same as a Hegar dilator, just not metal and without the slight curve.

This can be an effective way to avoid having to have repeat visits for painful dilations.

Jan

I share the reaction to the potential for the candle to break - it seems like a fragile choice. OTOH, I suppose the wick cold help hold things together.

Candles come in very different sizes - I'd want to know what diameter was being recommended.

Jan's note is what I was going to say.

I've done them with a tapered candle in a glove. It's not as horrid as you would think. My surgeon was going to give me a Heger dilator, but said I was ok. His advice is to go easy, and pull gently back to your sacrum, as less to injure backwards rather than forward. A one inch Heger was what he was going to give me, before his nurse had a cow that he was handing out a piece of a set of hospital equipment.

They like to dilate to about 15mm, so that is your standard taper, not those silly, skinny things. Think finger sized... It is not too critical.

Jan

I have had my pouch since 1994 with no major problems with emptying. In the past six months, twice now I have had an episode where I just can't go...after about 12 hrs the pain of the built up gas and stool is so bad I ended up in emerg. Of course the docs there have little understanding of what an IAP is so they assume I am constipated and gave me golytely or fleet enemas. Both times, after a painful 7hrs at emerg everything just started working again. My gastro dilated me, saying my anastamosis has a stricture and suggests that I have the dilation done every 6 months. Very painful even with fentanyl (sp).
Interesting to hear people are self dilating and not having to return to the doctor as often...I hadn't heard of this.

I have to say, what Jan mentioned about the daily dilation is too maintain the opening after the initial dialation done by the Dr.

My anastomosis was quite narrowed until about 3 months ago when I had ny first dilation done by ny GI in his office, which he does once a month for me and I maintain by simply using my finger and going past my nuckle and holding for about 10-20 seconds.

Tx UC in August 2011
Meds failed
Total Colectomy/ileostomy April 2012
Loop ileostomy August 2012 with several complications
Takedown October 2012 with several complications
Still on meds for flare ups, adrenal glands, and pain...

Unfortunately, I can't tolerate dilation unless I am sedated.

Several doctors have tried it, and I'm sure I cleared the waiting room with screaming and pleading to stop.

PDX it took me one office dilation for me to tell them never again. they are out of their freaking minds.

LOL dgrtacy.... My old (retired) doc once said he didn't know who was more traumatized by digital dilation attempts... him or me.

Yeah, I had an office dilation years ago and I don't think I ever swore so much in my life. The pain! This last one was apparently smaller, and didn't hurt much at all.

I've been trying the finger self-dilation, and while not pleasant, I do think I might have it down pat, as things are moving better more regularly, at least for the last day or so. That, or I had a small partial obstruction. If things continue going this well, I will continue with the finger thing, but otherwise move on to the taper candle - and glove. OR, as my CRS said, surgical dilation.

Thanks all for the input, much appreciated.

Office dilation =

I have had five in office dilations. The first one they had to peel me off the ceiling. I have given birth two times and it didn't hurt as bad as that dilation! The next 4 did not hurt half as much. I guess because the first time it was so closed up. I have a high pain tolerance though so I just dealt with it. I wanted to be in and out of there without worrying about sedation and a ride home. I definitely recommend being sedated for the faint of heart!

My surgeon will only do bad narrowing dilations with the patient under anesthesia. He says it's as hard on him as it is on us, so he prefers us OUT.

so you go past the first set of constricting muscles to the next tight spot where it feels a bit irregular? ive been having emptying problems and that next tight irregular spot seems quite tight and hard to push the dilator through. any advice is appreciated...

Pouchchington, I can't tell from your post if you are self-diagnosing. Dilation is really something that should only be done in collaboration with someone who has had a good look at the insides. *If* there's a stricture and *if* it needs repeated treatment and *if* you've been properly shown how to do it and *if* you're comfortable with it then self-dilation can be quite valuable. OTOH, sticking a candle up there without someone taking a good look first is just a terrible idea, and you could lose more than your pouch.

Proper instruction would include a clear description of exactly what depth the stricture is at. That would tell you how far to go.

its a hegar. i was shown during my stay at cleveland clinic but im clearly not doing something right.

Your doctor should have shown you on the dilator how far it should go in. But, basically, if you are using an average index finger as a guide, it would be about as far as the second knuckle. The suture line of the anastomosis (where the stricture would be) is inside both the external and internal sphincters. The first "tight ring" is the external sphincter.

You may just want to try using a lubed finger to get a feel for the sphincters and how they relax with a little pressure. But, the stricture does not "relax" at all. The real dilation should have taken place in the doctor's office or OR. What you are doing now is just maintaining it. So, by the time you reach the suture line, there should not be much in the way of resistance, especially with just the tip of the hegar. It does also make a difference whether the hegar is pointed toward your abdomen or spine or straight up. The angle can vary depending on your own anatomy.

Hope that helps. But, please call your doctor back and get reassurance from him so you know you are doing it right.

Jan

will do. sounds like a good idea. are you saying the anastomosis site is between the two sphincters or beyond both?

Jan, i know you say if you can get your finger in you dont have stricture problems. i was diagnosed with a mild stricture among other things but i can get my finger in without any problems. however, when i insert my finger fully i just barely reach the anastomosis site. is that enough to self dilate? also that site feels quite irregular but no cuffitis or pouchitis symptoms at all. i have a straight 18mm hegar that is longer and fatter than my finger and i cant get past the anastomosis site. any advice is appreciated...

If you can't get the hegar in past the stricture site, it could be that either the stricture is already reforming, or you were given too large of a diameter. I'd call your surgeon and tell him what you are telling us. Some discomfort is typical, but you should not have a lot of pain or feel lime you have to force it.

Jan

is there a standard mm size or is it based on docs recommendation? i will call and ask if he suggests a smaller one. thank you...

I have done this. I put saran wrap around the candle and then put hemorrhoid cream on it. It really helped a lot. I like the idea of a glove finger.

I don't know if there is a standard size, but there are different sizes. I would suspect your doctor chose the size based on the size he dilated you. This is why I think it is possible that the stricture is reforming already, if the prescribed dilator will not pass. Using topical anesthetics might be a good idea, but you still should not be forcing it. It should be gradual and even pressure.

Jan

thanks so much