Chronic Abdominal Pain following Partial Colectomy

[ron76]

Hi! Although I realize this support forum is primarily for people with colon cancer, I thought I might be able to get some help because the problem results from a partial colectomy.
In early December, I underwent a laparoscopic partial colectomy for colonic inertia following failed trials of diet, Miralax, Linzess, Trulance, Amitiza and Motegrity. I had significant pain and basically no bowel movements unless I used magnesium citrate for 2 days which I would do after 2 weeks.
The surgery was complicated by an ileus which developed, although it seemed to resolve after 10 days in the hospital.
Since the surgery I have been experiencing daily abdominal pain in a band just below my navel with aching and cramping components, some gas. It tends to be less in the AM and worse in late afternoon and evening. My bowel movements tend to be small, soft and formed and occur in 2-4 very small amounts daily and require some straining. I have had repeat CT scans which appear normal except for some gall bladder "sludge". I have just had a gall bladder scan although the pain is not characteristically gall bladder like – awaiting results. My surgeon also did a "short" colonoscopy which appeared normal. I have been keeping a food diary but there is not a strong correlation with particular foods. I have been taking Colace twice daily. We retried Trulance two months after the surgery but it produced severe diarrhea for several hours so didn't continue it. Benefiber increased pain but I am thinking of trying an insoluble fiber like Citrucel. Also considering a retrial of Miralax but worried about gas or cramping as a side-effect. I have been drinking a lot of water, tried exercising but not a lot of help so far. I also use a heating pad which helps some. Trying to avoid use of pain medications or antispasmodics because of their constipating effects. Although I do not have diarrhea, nausea, vomiting or excessive amounts of gas, I did raise the possibility of SIBO with my gastroenterologist but he is not doing breath testing for SIBO right now because of COVID. Since it has now been over three months since the surgery, I feel worn down and discouraged by the daily pain. I would appreciate any thoughts anyone might have or shared experiences with this. Thank you!

[Gravelyguy]

Hi Ron,

Sorry you are going through this. I am not sure I can be of any help but I have gone through some similar stuff. I had a gall bladder attack just over a year after my surgery. They ended up taking it out. It was very painful but up under my rib cage so higher than what you are experiencing.

I take a good probiotic at higher than maintenance dosage and that seems to keep me pretty regular.

I am a few years post surgery and things continue to get better. Hope you can get to the bottom of the pain!

Dave

[I_will_fight]

Not sure I can help,

My surgeon told me that when they do a partial colectomy they need to "mobilize" a large portion of the bowel and pain can appear even far from the resected area.

I got some dull pain towards the right side of my abdomen even though my surgery resected the left side of my colon. (so I get worried about liver ... but that is a different story)

Regarding constipation I certainly had difficulties for the two weeks following surgery but improved after that.

I have a small hernia from the surgery but I am otherwise quite OK. Doctor advised me against putting on weight as this would put more pressure in the hernia...so I am exercising regularly.

Maybe someone can contribute something better... this forum is a bit slow, but people are helpful.

Best regards

JC

[ron76]

Thanks for your support

[Green Tea]

.. Since it has now been over three months since the surgery, I feel worn down and discouraged by the daily pain. I would appreciate any thoughts anyone might have or shared experiences with this. Thank you!

Ron -
I'm sorry to hear about your continued problems with pain and bowel distress. It's quite a long ordeal to endure. I don't have any relevant experiences of my own to share, but there are some sources of information here and elsewhere that you might find of interest -- if you have not already run across them before:

• MissMolly's Insightful Posts
  ColonTalk member MissMolly posted a number of messages in the past, many of which pertain to bowel problems, pain, medications, etc. You can use the link below to explore some of her past posts by using keywords such as: "abdominal pain","digestive distress", "digestive enzymes", "healing pelvic pain", etc.
  https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=58013&p=457009&p=456986#p456986
  
  http://coloncancersupport.colonclub.com/search.php?st=0&sk=t&sd=d&sr=posts&keywords=+adhesions&author_id=97334
  .
• "Hostile Abdomen" Club posts
  https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=52932&p=417606#p417565
  .
• Book on gut bacteria
  https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=53006&p=418212#p418212
  .
• SIBO Small Intestinal Bacterial Overgrowth
  https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/diagnosis-treatment/drc-20370172
  
  https://www.webmd.com/digestive-disorders/sibo-overview-what-is-it
  .
• Helicobacter pylori infestations
  https://www.mayoclinic.org/diseases-conditions/h-pylori/diagnosis-treatment/drc-20356177
  .
• SitzMarker test for low bowel motility (added in edit)
  https://www.ibstales.com/sitz-marker.htm
  .
• Medications used so far
  
  • Miralax ( polyethyline glycol) - osmotic laxative
  • Linzess (linaclotide) - chronic constipation Rx
  • Trulance (plecanatide) - chronic idiographic constipation
  • Amitiza (lubiprostone) - chronic constipation due to pain meds
  • Motegrity (prucalopide) - chronic idiopathic constipation
  • Colace (ducolax) - stool softener
  • Citrucel (methylcellulose) - bulk-forming laxative, insoluble fiber
  • Benefiber (wheat dextrin) - soluble fiber supplement
  • Citroma (magnesium citrate) - laxative for occasional constipation
  .
• Special diets used so far
  Which special diets have you tried so far, for example:
  
  • High-fiber diet?
  • Low-fiber diet?
  • Gluten-free diet?
  • Elimination diet?
  • Low-fat diet?
  • Low FODMAP diet?
  • BRAT diet?
  
• Some Questions on Diagnosis
  Apparently, your diagnosis was "colonic inertia". When they did the partial colectomy, which part of the colon did they take out? Why did they take out that part rather than some other part? Prior to surgery did they have any evidence that that part of the colon had a particular problem? After the surgery, what did the pathology report say about the resected specimen-- did the pathologist find any problems, like diverticulosis, ulcerative colitis, etc? Where, with respect to your navel, was the incision made where they removed the resected specimen : above, or below?

[ron76]

Thank you for all the resources.
I will look through all the posts.

To answer your questions:
The diagnostic evaluation for the colonic inertia included a colonoscopy (showed a tortuous/redundant colon, removed 2 polyps), a Sitz marker test (no rings passed further than the transverse colon after 5 and then 7 days),
an MRI of the pelvic floor (normal) and rectal manometry (mostly normal but some rectal tension).
The surgery removed the first 2/3 of the colon leaving about 12" with an ileal anastomosis to the remaining colon.
I don't know that there was a pathological examination done since cancer was not a concern.

[ron76]

One other reply.
The laparoscopic incisions included a small incision above the navel and a larger incision below the navel

[ron76]

With regards to diet- I was on low residue after the surgery then a "normal" diet after 6 weeks.
I am currently following a gluten free and lactose free diet.
I have tried increasing fiber with Benefiber (caused pain) have recently started Citrucel as insoluble fiber instead.
I have tried adding more fiber foods to the diet.
I have restricted dairy and high fat foods.
I am eating in small amounts.
I did lose 30 lbs (20 lbs before the surgery and 10 lbs after)
I haven't been able to regain weight but I suspect that is because my calorie intake is low due to limiting food intake because of the pain.
Thanks again

[Green Tea]

Thank you for all the resources...

You're welcome.

If you need more resources, just post another message. Take care ...

[ron76]

I have been reading about the use of antidepressants for visceral hypersensitivity, in my case post partial colectomy.
I was wondering if anyone has had experience with use of the antidepressants for chronic pain following partial colectomy.
I know that they use low doses of the tricyclics like amitriptyline but given that I tend toward constipation and the TCA's can cause constipation, I have been considering a trial of duloxetine(Cymbalta) an SNRI which might be helpful.
Has anyone had experience with this?

[ron76]

Hi everyone! I thought I would give you an update since may last post. I have been continuing to struggle with abdominal pain since my partial colectomy for colonic inertia in early December.
Since I tend toward constipation, I tried adding Citrucel with minimal improvement (previously Benefiber made my pain worse), then added Miralax. The Miralax pushed me in the other direction with diarrhea and cramping so I am now trying a low dose, starting with just ¼ of the recommended daily dose. Interestingly, when I tried Miralax and several motility drugs before my surgery, they had no effect so I guess my remaining GI tract is more sensitive. I've noticed however that even when I get relief from the constipation such as from the Miralax, or earlier from a Fleets enema, it doesn't reduce the pain. In fact, it may temporarily increase the pain due to irritating my bowel. Although I have been keeping a food diary, the pain doesn't seem to correlate much with what I eat.

Recently I had an MRI and a HIDA scan because of sludge noted in my gallbladder on earlier CT scans. Unfortunately, the results show multiple gallstones, delayed filling and only a 27% ejection fraction suggesting chronic cholecystitis. I discussed this with my gastroenterologist. He said since I was not having clinical symptoms of gall bladder disease at this point and my pain was not gall bladder - like, he was in no rush to suggest surgery. This was a great relief to me because I didn't feel I could face another surgery at this point, still dealing with the aftermath of the partial colectomy in December.
My weight remains low having lost about 30 lbs before and after the surgery. I haven't been able to regain weight probably because I try not to eat too much fearing making the pain worse although I try to snack more frequently. I am also restricting fat because of the gall bladder issues so that also makes it hard to gain weight. When I tried adding a supplement like Ensure earlier, it caused diarrhea and cramping. This has all gotten a bit overwhelming!

I also just started taking a low dose of antidepressant to see if that will help the pain. Usually they use a low dose of a tricyclic antidepressant like amitriptyline(Elavil) but since a side-effect of these is constipation, I asked if I could try duloxetine (Cymbalta), an SNRI used for other pain that may be helpful for GI pain as well, but doesn't risk constipation so I am starting on just 20 mg/day. If duloxetine doesn't work, I might re-consider the amitriptyline. I keep hoping I will find a way to reduce the pain either medically or with time but at times it is hard to feel hopeful about that.
I am keeping my fingers crossed!