Right hemi-colectomy pain after 9 weeks

Please feel free to read, share your thoughts, your stories and connect with others!
Kdriver
Posts: 4
Joined: Thu Dec 13, 2018 2:22 am

Right hemi-colectomy pain after 9 weeks

Postby Kdriver » Thu Dec 13, 2018 3:04 am

Hi all,

Firstly I feel happiness finding this forum to read other people's journeys, and helping me through own when recovery feels blurry and not what I anticipated!

I had a right hemi-colectomy 9 1/2 weeks ago to remove a cecal volvulus, 1/3 of my large colon was removed. Recovery has been a journey, 3 extra trips back to hospital with it put down to pain/fainting/being normal. From 5-7 weeks I was feeling great and recovering so well, at 5 weeks at the surgeon follow-up he said I had healed internally and I could start eating normally and begin to exercise again. I thought this was weird as it seemed pretty soon, but he said as I'm 33, fit, usually healthy and I was recovering well it was safe. I went for a few runs starting at 3kms going up to 7kms, and at the 7 week mark I overdid for my birthday weekend - a few nights out drinking alcohol, eating too much and a vegan burger which turns out caused an impacted poo they found over a week later in hospital! Since then, the pain has returned in crampy, wave-like spasms around where the internal join is, since then I haven't been exercising, and eating very carefully a low-residual diet, but it's not helping. The volvulus was caused from a birth defect where my bowel isn't attached to my abdominal wall, so there is a risk to it happening again on the other side, and the surgeon said not to get constipated.

At the hospital visits the doctors don't want to do a CT scan, but the X-rays don't show anything. From reading it seems that this may be normal given it was major surgery and can take months to heal, but as I felt good previously, and the pain now is consistently intermittent, exhausting and worrying, I'm anxious is could be a hernia, internal tear or another obstruction from scar tissue, as they said not to get constipated, maybe the impaction last week caused something. Any advice if resting, eating well can help or should I push for a CT scan if it gets worse?

What a rollercoaster the recovery is, when you expect to feel a better normal but then things can easily change.

Deb m
Posts: 558
Joined: Tue Jan 14, 2014 10:08 am

Re: Right hemi-colectomy pain after 9 weeks

Postby Deb m » Fri Dec 14, 2018 10:34 am

My husband surgery was also on his right side. He had his cecum and pretty much all of his acceding colon removed. I can't say he had any of those issues. He was back to doing everything normal about 2-3 months after surgery. My first thought was a hernia? I think you should have a ct scan done.

deb m

User avatar
Maggie Nell
Posts: 1150
Joined: Wed May 27, 2015 1:57 am
Location: Central Highlands, Victoria, Oz

Re: Right hemi-colectomy pain after 9 weeks

Postby Maggie Nell » Sun Dec 16, 2018 12:46 am

Crampy wave-like spasms are suggestive of an obstruction.

Easy for the doctors to not want to do a CT scan, they're not the ones in pain. Nor are
they the ones who will have to pay for it. Change hospitals, change doctors; get medical
professionals on your team who take your concerns seriously. Half the recovery journey
is in recognising when you are talking to the block and not the butcher.
DX April 2015, @ 54
35mm poorly diff. tumour, incidental finding following emergency R. hemicolectomy
for ileo-colic intussusception.
Lymph nodes: 0/22
T3 N0 MX
Stage II CRC, no adjuvant chemo required.

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Right hemi-colectomy pain after 9 weeks

Postby MissMolly » Mon Dec 17, 2018 6:56 am

Kdriver:
The intestinal lumen (inside lining) of the intestinal tract can remain inflamed and swollen for several weeks and up to 4-6 months after surgery. The intestines are sensitive to being handled and manipulated with surgery and weigh in with their displeasure by being cantankerous.

Adhesions, too, are a common culprit. Bands of scar tissue that can tether a segment of intestine to another segment of intestine, to an adjacent organ, or to the abdominal wall. The effect can be to form a “kink” or narrowing or stricture - each of which will impede the smooth flow of digested food material from top to bottom.

Your physician commenting that you are young and fit and giving you an unrestricted “Green Light” concerning diet and intake may have been to your detriment. Young and fit individuals are not exempt from post-operative intestinal inflammation and a functional motility slowing of intestinal movement. Cramping, retained gas, distension, and rolling waves of pain are symptoms that correlate with a possible partial obstruction.

The perfect storm lending to a partial obstruction: Adhesions that kink and narrow the intestinal passageway; too much food volume in the intestinal tract, food volume exceeds the ability of the healing intestinal tract to process; delayed or slowed intestinal motility, a functional disorder often experienced post-op.

A CT scan is not able to visualize or “see” scar tissue or adhesions. Neither an X-ray nor an MRI.

CT scans and x-ray or other imaging can identify an intestinal obstruction when there is sufficient effect that the upstream segment of bowel is grossly dilated. Or when back-up constipation becomes pronounced.

Keys to easing your distress if related to intermittent partial vowel obstruction due to adhesions or retained food more than the intestine can process:
1. Daily use of an osmotic laxative or supplemental magnesium
Daily dosing with Miralax or Milk of Magnesia or supplemental magnesium (500 mg capsule or powdered “Natural Calm” magnesium citrate). Drawing water into the bowel makes it easier for food to pass narrowed intestinal passageways. Magnesium also provides a needed “nudge” of motility to keep things moving.
2. Exercise for the body
The intestines are a tube of smooth muscle and take benefit from exercise of the body at large. Walking aids intestinal motility. Yoga postures provide a form of intestinal massage.
3. Keep to a soft, easy to digest diet and keep food portions small
The key is to not overwhelm the intestinal system.
Snack and graze as opposed to consuming a large meal.
Focus on hydration and keeping fluid intake up more than on chewing solid food. Soups are a good choice. Mashed potatoes with meat loaf. Eat from a salad plate instead of from a dinner plate to keep portions smaller.

Healing and recovery after abdominal surgery is very much individualistic. Being young and healthy is to your benefit but does not exempt you from experiencing a few speed bumps. I think your surgeon was too early in giving you full liberty to resume food consumption at will.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

Kdriver
Posts: 4
Joined: Thu Dec 13, 2018 2:22 am

Re: Right hemi-colectomy pain after 9 weeks

Postby Kdriver » Fri Dec 21, 2018 4:09 pm

Thank-you Deb, Maggie and Miss Molly.

@MissMolly this is verrrrry helpful thanks so much!
I visited my GP and have a specialist appointment booked for mid-Jan, although I'm not pining for any improvements as it was this last app where the surgeon said to go for it, and in the public system is highly likely I'll get someone who doesn't know my history and after a quick summary read will attempt some advice.

I've been constipated the past two weeks and even with a mainly smooth diet, coffee, movical, kale drinks still feel I'm not clearing everything. But increasing the exercise and will be more careful so hopefully improves. My GP thinks a partial obstruction, constriction of the pathway, so as healing is slow will take all these precautions.

Thanks so much :)

Kdriver
Posts: 4
Joined: Thu Dec 13, 2018 2:22 am

Re: Right hemi-colectomy pain after 9 weeks

Postby Kdriver » Fri Dec 21, 2018 4:14 pm

@MissMolly I forgot to ask, can partial obstruction go away over time through taking the precautionary measures you suggested? Or will it always be there and if too much volume, wrong foods etc can stir things up anytime permanently?

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Right hemi-colectomy pain after 9 weeks

Postby MissMolly » Fri Dec 21, 2018 8:12 pm

Kdriver:
Kdriver wrote:@MissMolly I forgot to ask, can partial obstruction go away over time through taking the precautionary measures you suggested? Or will it always be there and if too much volume, wrong foods etc can stir things up anytime permanently?


It would be premature to venture a guesstimation as to whether this partial obstruction is a one-time hiccup (post-op functional slowing of small bowel motility + too generous refeeding freedoms advanced by your surgeon + inflammation/swelling of intestinal mucosa) or something that may reappear from time to time (remaining adhesions/tethering with formative stricture).

For now, I would garner on the former. That this partial small bowel occlusion is a post-operative phenomena.

That you are feeling some relief/lessening of symptoms is Good News. That gives you a barometer that you are heading in the right directions as far as initial measures that you are implementing.

I have had several small bowel obstructions. I cannot reinforce enough that clearing of a small bowel obstruction is rarely a light-bulb event.

That is, rarely is it as simplistic as one minute the intestine is kinked and symptomatic (rolling waves of pain/cramping; projectile vomiting; distention) and the next minute the small bowl announces an All Clear and that it is open for full food transit.

The more common sequelea is that the small bowel remains inflamed and swollen due to the insult of the small bowel obstruction and that it takes 7-10 days of caution and monitoring. There is a full-on assault body response that accompanies a SBO. This full-on assault also equates into a recovery period following an SBO. With a SBO, body releases powerful hormones as a stress response (cortisol, adrenaline) as well as anti-inflammatory agents (catecholamines, macrophages) as well as infuses the intestine with fluid/water/lymph in order to “flush” what the body rightly registers as an impingement. All of these responders need time to ease and rebalance. An SBO really is a substantial insult to the body, at many levels.

All to say . . . Time and patience are your best friends. Treat yourself kindly and with care.

For now . . .
1. Keep solid food intake to a small volume. Focus more on hydration as your source of nutrition and calories.
2. Never underestimate the value of simple prune juice (warmed, in the microwave) for its value in regulating bowel function. 6-8 oz a day.
3. Dividing your daily dose/intake of Miralax (or Milk of Magnesia or magnesium or similar osmotic agent) into 2-3 doses speed throughout the day is often preferred to guzzling down a single dose. Filling a Nalgene bottle or flask with water/juice and your decided dose of Miralax and then sipping intermittently through the day often has a better outcome in terms of facilitating digested food material to move along.
3. Experiment with your dose of Miralax (or Milk of Magnesia or other). Titrate the dose up a bit for a few days to see if you have a better clearing effect. Ex. If you are using one cap a day, increase to 1.5 caps a day for a few days. The nice thing about MiraLax is that you can individualize the dose best for you, based on your bowel results.
4. Yoga and simple stretches of the torso/pelvis really do help intestinal motility. Think of it as massage for the intestines. Google “simple beginners’ yoga poses” for a few ideas. Elongation of the torso (arms up and over the head, then side leaning to the left, pause, then sideleaning to the right) and rotation of the torso in relation to the pelvis (knees bent, lying on the floor, drop/rotate knees to the left, pause, reverse and rotate knees to midline and then drop to the right) are basic poses that are generally well tolerated by most people.
5. Hot showers. The directed spray of warm water helps relax tense muscles of the abdomen/back that are contracting to guard the area. Use of a hot pack or microwave buckwheat pack are also helpful.

Partial small bowel obstructions are fairly common, unfortunately, during recovery of abdominal surgery. Sometomes people chalk it up to indigestion and the episode clears within a few hours. Other times, the partial SBO is more malingering . . . symptoms ebb and flow.

Spending time discussing partial SBO’s here will help other members be aware of symptoms and steps to take to help quell the discomfort and distress.

When to go to the ER? Crippling abdominal pain (pain that literally brings you to your knees); nausea with repeated vomiting or projectile vomiting; no fecal output for those with a temporary ileostomy; absent passing of gas/flatulus. With these findings, proceed to the ER. Do not Pass Go, do not collect $200.

Kdeiver, Sending you positive “vibes” that this partial small bowel continues to ease for you. Small bowel obstructions are no fun. A small bowel obstruction is unnerving because its onset has no warning and the pain/nausea can be intense. It leaves an imprinted memory that you do not soon forget.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: Thomasnug and 115 guests