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Gastroenterology (Expert Forum)
partial obstruction?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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partial obstruction?
by Melinda2, May 18, 2004 12:00AM
I am a menopausal female with a history of IBS since age about age 12 (diagnosed at age 20) that would always swing between constipation and diarrhea with lots of crampy pain. I have also been told that I have a redundant colon.
For the past three years, I have been on a very low dose of "natural" HRT: about 200mg micronized progesterone and 0.05 mg estrogen compounded into a skin cream. I have become suspicious that the progesterone may be contributing to my problem. Also, I was taking 5mg of Flexeril every night for the fibromyalgia and low back pain, but because Flexeril is an anticholinergic drug, I became concerned that it might be exacerbating the constipation problem, so I have not taken it for about two weeks now.
I was discovered to have H. pylori in early 2001 and put on a regimen of heavy duty antibiotics, plus PPI. It took me several months of special diet and using probiotics before I was able to stop the terrible gastritis caused by the heavyduty antibiotics. During that time, my IBS changed to mostly constipation with only an occasional swing to diarrhea.
In October 2003 my gallbladder was removed because I had gallstones compressed in the gallbladder neck.
Immediately after surgery, my constipation worsened and I developed swelling and crampy pain in the lower left quadrant and also just above hip area (around left waist) across from bellybutton. Additional fiber, water, and laxatives (magnesia 750mg) did not resolve the problem. My BMs were very soft, but it took an incredible amount of straining and willpower just to squeeze out a little bit---even if it was watery. And when I lay on my left side, I felt like I was lying on a lump, a painful lump. Something was in the way.
My GI doctor recently ordered the following tests: blood work, stool hemoccult, and a flex sigmoidoscopy. The blood work came back as "normal". I don't have the results of the hemoccult yet. The last time we tried a sigmoidoscopy, it could not be completed, because the pain was too great when he tried to enter the area where the swelling begins..so I am a bit afraid of having it done again. He thinks it is most likely my IBS again. (I don't think IBS causes such painful swelling in the lower left side.) He gave me Zelnorm. It did not work. It caused liquid rolling around and misery for days, but no BM.
I am presently using stool softeners daily to try to help myself, but not very effective. Occasionally having to use osmotic laxative--which doesn't always work.
Could I have a possible partial blockage? Could I have parasites (there are thousands of white linty things in the toilet water when I have BM)?
For the past three years, I have been on a very low dose of "natural" HRT: about 200mg micronized progesterone and 0.05 mg estrogen compounded into a skin cream. I have become suspicious that the progesterone may be contributing to my problem. Also, I was taking 5mg of Flexeril every night for the fibromyalgia and low back pain, but because Flexeril is an anticholinergic drug, I became concerned that it might be exacerbating the constipation problem, so I have not taken it for about two weeks now.
I was discovered to have H. pylori in early 2001 and put on a regimen of heavy duty antibiotics, plus PPI. It took me several months of special diet and using probiotics before I was able to stop the terrible gastritis caused by the heavyduty antibiotics. During that time, my IBS changed to mostly constipation with only an occasional swing to diarrhea.
In October 2003 my gallbladder was removed because I had gallstones compressed in the gallbladder neck.
Immediately after surgery, my constipation worsened and I developed swelling and crampy pain in the lower left quadrant and also just above hip area (around left waist) across from bellybutton. Additional fiber, water, and laxatives (magnesia 750mg) did not resolve the problem. My BMs were very soft, but it took an incredible amount of straining and willpower just to squeeze out a little bit---even if it was watery. And when I lay on my left side, I felt like I was lying on a lump, a painful lump. Something was in the way.
My GI doctor recently ordered the following tests: blood work, stool hemoccult, and a flex sigmoidoscopy. The blood work came back as "normal". I don't have the results of the hemoccult yet. The last time we tried a sigmoidoscopy, it could not be completed, because the pain was too great when he tried to enter the area where the swelling begins..so I am a bit afraid of having it done again. He thinks it is most likely my IBS again. (I don't think IBS causes such painful swelling in the lower left side.) He gave me Zelnorm. It did not work. It caused liquid rolling around and misery for days, but no BM.
I am presently using stool softeners daily to try to help myself, but not very effective. Occasionally having to use osmotic laxative--which doesn't always work.
Could I have a possible partial blockage? Could I have parasites (there are thousands of white linty things in the toilet water when I have BM)?
Doctor's Answer
by Kevin Pho, MD, May 20, 2004 12:00AM
, May 20, 2004 12:00AM
Irritable bowel syndrome certainly can be considered to cause the symptoms. If a partial obstruction is considered, a CT scan can be done to evaluate this.
You may also want to consider colonic motility studies as well as colonic marker studies to further evaluate the constipation. If the symptoms continue despite appropriate treatment for IBS, a surgery referral can be considered.
Zelnorm as been shown to work with constipation-predominant constipation in women, however this has already been tried without success.
You can also consider anti-spasmodic agents for constipation as well as increasing fiber intake.
If parasites are a concern, the stool can be sent and tested for both ova (eggs) and parasites.
You may want to consider another GI opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
You may also want to consider colonic motility studies as well as colonic marker studies to further evaluate the constipation. If the symptoms continue despite appropriate treatment for IBS, a surgery referral can be considered.
Zelnorm as been shown to work with constipation-predominant constipation in women, however this has already been tried without success.
You can also consider anti-spasmodic agents for constipation as well as increasing fiber intake.
If parasites are a concern, the stool can be sent and tested for both ova (eggs) and parasites.
You may want to consider another GI opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Member Comments (1)
by kazod, May 18, 2004 12:00AM
You said that doc said you have IBS? Yet there was swelling in your colon?...to me sounds like IBD not IBS. I would be questioning the doc a little further about this. If it is crohn's or colitis you will need to get on treatment to stop inflammation or it could lead to blockage. I hope you get this all figured out soon
