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Is this Irritable Bowel???? Is this Irritable Bowel????

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  #1  
Unread 04-27-2003, 09:55 PM
Is this Irritable Bowel????

Hello sisters

I am 7 months post op and was doing really great until about 3 or 4 months post-op. I had a STAH Sept 11, 2002. I was supposed to have a TAH but doc said part of cervix was adheared to the bowel and thought it was best if he left it in. I was neither here nor there on the cervix issue anyway.
Anyways, now I have been having pelvic pain again. I have been experiencing mini periods since my hysterectomy and at first they were hardly noticeable, now they come and I spot for 2 weeks and I have pelvic pain associated with it. I am really uncomfortable for the duration of the spotting. I also notice that my bowels are different. I have the urge to go frequently for bowel movements but cannot seem to really go much at all. My pelvic area just aches and is causing me back pain in the sacral area only. I don't have pain in my entire abdomen, just in the pelvis. I see my doctor in two days to discuss this further. He has already sent me for an ultrasound to see if there are cysts on my ovaries and I find out on Tues (April 29) the results of that.
He seems to think that because some of my cervix is adheared to the bowel that this is causing the bowels to change during the time that i am spotting.
I just don't know anymore.
I would like to know if anybody else has experienced this also and what exactly does it feel like with irritable bowel.
Is it common with IBS to only have pelvic pain or is it usually the entire bowel or abdomen that hurts when it flares up???
I would really like to know.
I only experience this discomfort and pain during the time that I spot. The rest of the time my bowels are normal.
Your responses would be appreciated.

Thanks,
Karen
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  #2  
Unread 04-27-2003, 10:44 PM
IBS

Dear Karen,

I have had IBS for about 20 years now and I will say that it is always worse just before and durring my period. But, the symptoms of IBS differ for everyone. Some people experience pain and bloating, some get constipation, some get the opposite or a combination of the two. I do know that it is almost impossible for a Dr. to diagnose you with IBS until you have had a bunch of medical tests like the ultrasound you are going to have. The Dr. might also order a sigmoid oscopy and lower GI series (which is what I had). They give you all of these tests first to rule out any other problems like polups, cysts, scar tissue, etc. Often times it is through a process of elimination (no pun intended) that they finally decide that you have IBS.

You don't really say whether or not you were experiencing these symptoms prior to your surgery. My guess is that if you were not having these symptoms before, that this is probably something associated with your surgery. Scar tissue can do a number on the inside of your body, it may be that. It is hard to tell and sounds very suspicious to me. I am glad that your Dr. is concerned enough to order the ultrasound for you. I had adhesions from a C-section that really caused me a lot of pain during my period. They were removed laproscopically and I felt so much better.

Boy, about the cervix thing....... It sure is a bummer that you have to go through all this surgery and recovery and still have your period! I think I would be getting a second opinion on that one. There must be some way they can fix that problem, I think I would really push for a better solution.

If you do end up having IBS I do have a little advice for you. FIBER! Try to find the kind that doesn't cause gas. I am also on the Atkins diet right now, which really works well for me, but it does lack in fiber so I have found that the Atkins protien bars (Chocolate Peanut Butter) are enough to keep me on track. Just plain old Metamucel or Citricel work well too, and they don't have all the calories.....they even come sugarfree!

Good luck with your test, I hope you get some relief soon!

hugs, val
  #3  
Unread 04-27-2003, 10:59 PM
IBS

Thanks for responding Val.

Regarding the cervix issue, my doctor left it in for two reasons. 1- he said it looked healthy and he know it didn't matter to me one way or the other,
2- I didn't do a bowel prep prior to the surgery and had he removed it at the time and caused some damage to the bowel it would of ended up with me having a temporary colostomy while it healed.
I was grateful to him for making this decision.
I met with him last week and I think I will be going back for another surgery to remove the cervix as well as the part adheared to the bowel. I discussed this with my doctor and he told me that as long as I go through a full bowel prep prior to surgery, chance of a temporary colostomy is next to none, which was a major relief. The ultrasound was primarily to rule out ovarian cysts and to determine if I will be losing my ovaries. Personally, I think I am going to keep the ovaries for a while (I'm only 31). I would really like to get rid of the rest of the cervix and hopefully this would eliminate all my pelvic pain.

I did have this pelvic pain prior to surgery but my bowels weren't affected this way before, or at least not that I really remember.
Prior to my surgery I went on the continuous birth control for about 7 or 8 months and I was pain free with no periods. The only problem with that is that I continually gained weight on the pill and I DID NOT want to go the route of hormone meds to eliminate the pain. To me that was not an option. I had enough and wanted an end to the pain---forever.

If anybody else can shed some light on IBS for me I would appreciate it.

thanks, Karen
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  #4  
Unread 04-28-2003, 05:39 AM
Is this Irritable Bowel????

(((Karen))),
I'm sorry your having pain & problems I also have IBS but the pain is different from my Pelvic Pain..I notice lots of bloating, constipation, bowel spams ect...
Have you considered getting a 2nd opinion? Maybe for another Gyn & a GI Dr?
Some of that pain could be due to Adhesions (Scar Tissue) b/c where you stated your Cervix was adhered to your Bowel..this surgery, like any, can result in even more Adhesions I suffer from an extensive amount of them, they cause me problems w/ my bowels also...
Here is some info I have on IBS along with some on Adhesions that might be of some help

http://www.gihealth.com

https://www.hystersisters.com/vb2/sho...threadid=76402

Patient Brochure - Irritable Bowel Syndrome: http://www.fascrs.org/brochures/irritable-bowel.html

http://www.emedicine.com/aaem/topic274.htm

Inflammatory Bowel Disease:
http://www.familydoctor.org/handouts/252.html
http://www.surgical-tutor.org.uk/sys...flam_bowel.htm


  Quote:
What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is an intestinal disorder that causes:

crampy pain
gassiness
bloating
changes in bowel habits
IBS has inaccurately been called by many names:

colitis
mucous colitis
spastic colon
spastic bowel
functional bowel disease
IBS is called a functional disorder because there is no sign of disease when the colon is examined. Because physicians have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen IBS symptoms, research suggests that other factors also are important.

IBS often causes a great deal of discomfort and distress, but it is not believed to:

cause permanent harm to the intestines.
lead to intestinal bleeding of the bowel.
lead to a serious disease such as cancer.
It has not been shown to lead to serious, organic diseases nor has a link been established between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

How does IBS occur?

Colon motility is contraction of intestinal muscles and movement of its contents. It is controlled by nerves and hormones, and by electrical activity in the colon muscle. Movements of the colon propel the contents slowly back and forth toward the rectum, and several times a day strong muscle contractions move down the colon pushing fecal material ahead of them,which can result in a bowel movement.

The person with IBS has a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not affect others. The colon muscle of a person with IBS begins to spasm after only mild stimulation or ordinary events such as:

eating
distention from gas or other material in the colon
certain medicines
certain foods
Women with IBS seem to have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

What are triggers for IBS?

The most likely triggers for IBS are diet and emotional stress. Scientists have some clues as to why this happens.

diet:
Eating causes contractions of the colon, normally causing an urge to have a bowel movement within 30 to 60 minutes after a meal. With IBS, the urge may come sooner, accompanied by cramps and diarrhea.

stress:
Stress stimulates colonic spasm in people with IBS. Although not completely understood, it is believed to be because the colon is partly controlled by the nervous system. Counseling and stress reduction techniques can help relieve the symptoms of IBS, however this does not mean IBS is the result of a personality disorder. It is at least partly a disorder of colon motility.
What are the symptoms of IBS?
The following are the most common symptoms for IBS, however, each individual may experience symptoms differently.

IBS symptoms usually include:

crampy abdominal pain
painful constipation and/or diarrhea.
alternating constipation and diarrhea
mucus may be in the bowel movement
Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS, but indicate other problems. The symptoms of IBS may resemble other conditions or medical problems. Consult your physician for a diagnosis.

Treatment for IBS:

Specific treatment will be determined by your physician(s) based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment may include:

changes in diet
Eating a proper diet can lessen IBS symptoms. Keeping a list of foods that cause distress and discussing the findings with a physician or registered dietitian can help.
medication
Physicians may prescribe fiber supplements or occasional laxatives, and some prescribe antispasmodic drugs or tranquilizers or antidepressants to relieve symptoms.

http://www.umm.edu/digest/ibs.htm
How Your Digestive System Works:
http://www.gihealth.com/html/education/digestive.html


What are Adhesions?
*Adhesions: Fibrous Bands that Connect Tissue Surfaces that are Normally Separated*



  Quote:
Adhesion formation is a natural consequence of surgery, resulting when tissue repairs itself following incision, cauterization, suturing or other means of trauma. Even the most careful and skilled surgeon will inevitably effect tissues inside the abdomen during a surgical procedure. At the places where a surgeon has had to cut, handle, or otherwise manage parts inside the body, tissues which normally should remain separate will sometimes become "stuck" together by scar tissue, defined as adhesions. This process begins immediately and continues for up to 7 days following surgery

The Problem of Adhesions:
The incidence of adhesions is overwhelming. Adhesions develop in 93% of patients following abdominal and pelvic surgery.
Following surgery, adhesions may form, for example, between the incision in the abdominal wall and the small bowel, often causing small bowel obstruction. This obstruction can lead to vomiting and debilitating pain. In extreme cases, the bowel may rupture, necessitating emergency surgery for the patient.

How Adhesions Effect a Patient:

Adhesions can lead to serious complications including small bowel obstruction, female infertility, chronic debilitating pain and difficulty with future operations.

The consequences of adhesions can be substantial. Postsurgical adhesions cause up to 74% of bowel obstructions.3 Postsurgical adhesions are responsible for 20-50% of chronic pelvic pain cases.3 Adhesions also are a leading cause for female infertility, causing 15-20% of cases.3 Quality of life is also potentially impaired.

Quite often a patient will undergo surgery to lyse (cut) adhesions, only to have them re-form. Once a patient has undergone a colorectal procedure, the incidence of re-operation within two years is high - up to 20% of patients will have a subsequent colorectal procedure in that time.4 Many of these surgeries are to remove adhesions. Between 2.3 and 5% of patients will have to undergo adhesiolysis for bowel obstruction within two years of colorectal surgery.4

Re-operations are also complicated by adhesions. Surgeons have to spend a considerable amount of time, anywhere from 10 minutes to several hours, lysing adhesions before the new procedure can begin. This can prolong the patient's recovery time and increase the risk, cost and complexity of the surgery.

Adhesions can range from filmy to dense, with dense adhesions proving to be the most difficult for a surgeon to treat. The use of a physical barrier to separate the traumatized tissue from other tissues will decrease the risk of all adhesion formation.
http://www.genzymebiosurgery.com/opa...el=2&opage=268
  Quote:
Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis. Adhesions occur after abdominal surgery in more than 60 percent of cases, though less than 30 percent are symptomatic.

Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology. Clinically, adhesions present as chronic or acute abdominal or pelvic pain, partial or complete mechanical bowel obstruction, and infertility. Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial. In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions.

Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction._This may be because, from the surgeon’s viewpoint, adhesiolysis is associated with low reimbursement for long operations with high medicolegal risk. Also, adhesions may recur, and the risk of enterotomy (a hole in the bowel) during surgery is very high.

While surgical therapy is withheld, multiple abdominal diagnostic procedures including abdominal CT scan are frequently ordered. The patients are then sent to chronic pain clinics for evaluation. Though few studies exist, a recent report suggests that women with severe, dense vascularized bowel adhesions have a significant reduction in pain after adhesiolysis.
http://www.adlap.com/

  Quote:
Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients._ Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide._ Family and work relationships are strained to the limit._ Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.Adhesions are an almost inevitable outcome of surgery, and the problems that they cause are widespread and sometimes severe._ It has been said by some that adhesions are the single most common and costly problem related to surgery, and yet most people have not even heard the term._ This lack of awareness means that, excluding infertility, many doctors are unable or unwilling to tackle the problems of adhesions, many insurance companies are unwilling to pay for treatment and many patients are left in misery.


Adhesions and Chronic Pelvic Pain (CPP):

ADHESIONS are believed to cause pelvic pain by tethering down organs and tissues, causing traction (pulling) of nerves._ Nerve endings may become entrapped within a developing adhesion._ If the bowel becomes obstructed, distention will cause pain. Some patients in whom chronic pelvic pain has lasted more than six months may develop "Chronic Pelvic Pain Syndrome.”_ In addition to the chronic pain, emotional and behavioral changes appear due to the duration of the pain and its associated stress._

According to the International Pelvic Pain Society:
"We have all been taught from infancy to avoid pain. However, when pain is persistent and there seems to be no remedy, it creates tremendous tension. Most of us think of pain as being a symptom of tissue injury. However, in chronic pelvic pain almost always the tissue injury has ceased but the pain continues. This leads to a very important distinction between chronic pelvic pain and episodes of other pain that we might experience during our life: usually pain is a symptom, but in chronic pelvic pain, pain becomes the disease."

Chronic pelvic pain is estimated to affect nearly 15% of women between 18 and 50 (Mathias et al., 1996)._ Other estimates arrive at between 200,000 and 2 million women in the United States (Paul, 1998)._ The economic effects are also quite staggering._ In a survey of households, Mathias et al. (1996) estimated that direct medical costs for outpatient visits for chronic pelvic pain for the U.S. population of women aged 18-50 years are $881.5 million per year._ Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity.
Not all ADHESIONS cause pain, and not all pain is caused by ADHESIONS.
Not all surgeons, particularly general surgeons, agree that ADHESIONS cause pain._
Part of the problem seems to be that it is not easy to observe ADHESIONS non-invasively, for example with MRI or CT scans.

However, several studies do describe the relationship between pain and adhesions. According to an early study (Rosenthal et al., 1984) of patients reporting CPP, about 40% have adhesions only, and another 17% have endometriosis (with or without adhesions)._ Kresch et al., (1984) also studied 100 women and found ADHESIONS in 38% of the cases and endometriosis in another 32%._ Overall estimates (Howard, 1993) of the percentage of patients with CPP and ADHESIONS is about 25%, with endometriosis accounting for another 28%._ These figures must be understood in their context, and I recommend highly Howard's article.It is important to recognize that emotional stress contributes greatly to the patient’s perception of pain and her/his ability to deal with the pain._ Rosenthal et al. (1984) found that of the patients in whom a possible physical cause of pain (including ADHESIONS) could be identified, 75% had evidence of psychological influences on the pain.

http://www.adhesions.org/pt5cpp.htm
http://www.generalsurgeryinfo.com/gerhart5/index.html
http://www.drcook.com/adca15.html
https://www.hystersisters.com/vb2/sho...threadid=19427
http://www.nurseminerva.co.uk/adhesion.htm
http://homepage.tinet.ie/~pjlb/adhesions.htm
http://www.pain.com/drfiles/cfdradvi...Article_id=121
http://www.adhesions.org/patientguide/index.htm
http://www.ivillagehealth.com/expert...171560,00.html
http://www.adhesions.com/welcome_main.html

  Quote:
"If the adhesions are extensive, and the patient has undergone previous adhesion surgery that failed, I have taken an unorthodox approach to such individuals. Because adhesions begin to form almost immediately, along with the healing process involving the raw anterior abdominal wall, I have in special situations recommended a repeat laparoscopy in one week. At this point, the "new" adhesions are flimsy, soft, do not contain a blood supply, and can be swept away with minimal tissue injury, compared to a conventional adhesiolysis (freeing the adhesions surgically) of old adhesions that are dense, very adherent, and bloody. This is performed in an outpatient setting, and usually takes but a few minutes, compared to the time involved dealing with extensive, dense old adhesions."
http://medseek.com/glennbradley/newsdetail.cfm?ref=264
Good Luck ((Karen)) in finding some answers & relief to your pain..pls keep us posted...(((hugs)))
  #5  
Unread 04-28-2003, 07:51 AM
Is this Irritable Bowel????

Karen, I agree with both valpal and sheri. After much testing and ruling out other things, I was diagnosed with IBS about a year after my hyst. Probably had symptoms for years but it really didn't get serious until about 3 years ago. I found this site to be very helpful: http://www.besthealth.com/library/ibs.html
I had the exact symptoms listed there. I take Metamucil nightly, watch what I eat and take Levsin as needed for spasms. Good luck at the doctors and please let us know what you find out!

Emily s
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