sphincteroplasty

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ohcountrybear
Regular Member


Date Joined Mar 2009
Total Posts : 192
   Posted 4/25/2009 6:15 PM (GMT -7)   
Wanted to see if anyone had any advice. As some of you know I had a tumor that was attached to the sphincter muscle of my rectum. The tumor had also created a rectovaginal fistula. I had that surgery on feb 17th. Within a week I was septic with infection and on March 3rd had a temporary ileostomy to help things heal. Now I still had stool in my colon that came out for about a month. Because I have very low motility in my colon I still think I have some in there because yesterday I had stool come out. The thing is I cant feel it at all... I have no feeling of having to have a bowel movement and no control. It would start itching and burning and I would go to the bathroom and wipe and have poo. My surgeon told me to take a ducolax and drink the magnesium citrate. I tried that and most of it went into the bag. I still have poo coming out but I cant push any of it out. It just runs out of me. I feel helpless. The surgeon says he may have to redo it. I have read the more they try to fix it the less of a chance of becoming contient. I would rather have the bag then not being able to control my bowel movements. Anyone have anything like this done?

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 4/25/2009 7:19 PM (GMT -7)   
i dont know what to tell you about the problems, but i can tell you that takign laxatives and stuff can be very very dangerous for people with ileos because we dehydrate so easily. So if you are taking those please make sure you are drinkign a whole lot extra.
hope you feel better!

Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/11/2009 1:02 PM (GMT -7)   
If I understood correctly, you have an ileostoma and it's there to prevent stool from coming through your anus because your anal sphincter cannot maintain continency and your rectum has to heal. But you said that the stool is still coming through it. I think you should look for another surgeon asap. It seems to me that the one who operated you hasn't done his homework and that's why you're experiencing all those problems.

As for sphincteroplasty, I learned that it can be done successfully, but first the postop wound should heal well in stool-free conditions. See here:
www.cchs.net/health/health-info/docs/1800/1806.asp?index=8101

Post Edited (Neuro) : 5/11/2009 1:10:57 PM (GMT-6)


Equestrian Mom
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Date Joined Mar 2008
Total Posts : 3075
   Posted 5/11/2009 1:09 PM (GMT -7)   
temporary ileos have two holes...the one on top empties to your pouch, the one on the bottom empties into your colon(you may have had some matter left after surgery, but you could have new matter, too)...which would make you have bm's. Some people have more bm's than others and some only have mucous. You may just have to make adjustments until you can have a reversal or the ileo made permanent.

Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/11/2009 1:19 PM (GMT -7)   
Sorry, OHIO76, but I have to disagree. A well-performed ileostomy completely prevents the stool from coming through colon and anus. It passes only through small intestine and comes out through ileostoma right into the bag. Therefore this problem has nothing to do with having two holes.

I still think that ohcountrybear's ileostomy was ill-performed.

Post Edited (Neuro) : 5/11/2009 1:25:11 PM (GMT-6)


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5428
   Posted 5/11/2009 2:35 PM (GMT -7)   
Neuro,

A temp ileo does indeed allow for waste to travel both through the ostomy and through the anus. A permanent ostomy does not allow this function.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


ohcountrybear
Regular Member


Date Joined Mar 2009
Total Posts : 192
   Posted 5/11/2009 6:37 PM (GMT -7)   
My surgeon agreed....it is stool coming out but I have no feeling of it...my muscles are not working at all. I will be going in for a permanent ileostomy. Im ok with it, my bag and I have adjusted well together.

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5428
   Posted 5/11/2009 7:04 PM (GMT -7)   

You have been through so much and have such a great attitude!  Yes, you can opt for a permanent ileo or a k-pouch.  Good luck with your decision.

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/12/2009 2:49 AM (GMT -7)   
I know that there is a possibility that stool can pass both ways since temporary ileostoma is bipolar and thus meant to be closed in the second step. But if everything is done well, the stool will pass through one pole only and end up in the bag, and not through the other pole, that leads to pouch/rectum and anus. The other pole is not there for passing stool while patient still has ileostoma. Ileostoma is created exactly with the purpose to temporarily disable the natural path of the stool. The natural bowel continuity will be established in the second step.

Therefore I really think that something's done wrong at the surgery and the surgeon is avoiding to recognize his error. He only told her that he might have to re-operate, but didn't say that the surgery hasn't been done professionally from the start. I know 10-12 people with temporary ileostoma and none of them has such problems as ohcountrybear.

Sorry if I sound a bit angry, but I always feel that way when I see or hear someone suffering unnecessarily, because of his or her doctor's lack of capability or skill.

Post Edited (Neuro) : 5/12/2009 3:01:12 AM (GMT-6)


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3075
   Posted 5/12/2009 5:13 AM (GMT -7)   
I think we all get the 10% speach before surgery...so unfortunately sometimes things are not perfect whether it is because of the disease in our bodies or the prednisone we had to take...educating ourselves and making informed decisions is important and everyone is different as to what they are willing to live with.

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5428
   Posted 5/12/2009 7:01 AM (GMT -7)   
The problem as described does not sound as if it's an ostomy problem but a sphincter problem. The sphincter was damaged due to surgery. Not hard to imagine since the tumor was attached to the sphincter. In the hands of the very best surgeon this is very difficult and the outcome unknown. I am not willing to place blame on the surgeon for the outcome.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


ohcountrybear
Regular Member


Date Joined Mar 2009
Total Posts : 192
   Posted 5/12/2009 11:46 AM (GMT -7)   
Yes.....Im not blaming my surgeon either. He had explained to me before my very first surgery that it depended how deep the tumor was to how much damage to the sphincter. My real problem is my sphincter. My have no muscle tone at all now. I have no squeeze pressure. My manometry states Im 10% contintent.

Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/13/2009 10:14 AM (GMT -7)   
OK. But I didn't say at all that the incontinency occured due to surgeon's mistake. I understand very well that incontinency is the consequence of the tumor you had on your sphyncter.

I said that the ileostomy hadn't been done well, and that is the reason why the stool still passes through anus. If the ileostomy had been done properly, the stool wouldn't end up in the rectum at all. And it is very reasonable to consider it a consequence of the surgeon's professional error. Such things happen to medical amateurs only.

For example, imagine a cardiac surgeon who performs bypass in such a manner that the blood, instead of bypassing it, after the surgery still continues to flow through the damaged part of the blood vessel, continuing to cause severe problems to the patient as if the surgery never took place at all. Such surgery would be useless. Following the same logic but different context, an ileostomy, meant to avoid passing of the stool through large intestine/rectum/anus but created in a manner that stool still passes the natural way, is useless likewise.

I mean, what is the point of ileostoma if you still have to suffer using your anus despite the incontinency? Such surgical logic beats me, and I can't help doubting it.

Post Edited (Neuro) : 5/13/2009 10:23:35 AM (GMT-6)


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5428
   Posted 5/13/2009 2:59 PM (GMT -7)   
Neuro,

You still are incorrect. A temp ostomy diverts to the rectum/pouch. I will introduce you to several hundred temp ostomy patients, myself included, who experienced this phenomena. The small intestine is cut in half (picture a bent hose) with half the intestine sticking out of the belly and the other half hanging down connected to either the rectum/pouch. Those of us who had temp ostomies had the ability to defecate both through the anus and through the ostomy.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


hendersonjames
Regular Member


Date Joined Sep 2005
Total Posts : 88
   Posted 5/13/2009 7:05 PM (GMT -7)   

I understand that some temporary ostomies are two holes and some only one.  (I had a one-holer.)

I thought the reason to fasten the rectal end near the emptying stoma was just to facilitate the reconnection when the time came--not pass contents. 

Why would contents be diverted downward?  Both ends might as well be connected.


Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/14/2009 5:09 AM (GMT -7)   
Sue, I know that in cases of bipolar (two-holed) ileostomy, the small intestine is not exactly cut in half, because it would mean that after such operation we would have two separate parts of small intestine. The surgeon performs an incision on the small intestine that cuts only half through it and then bends it, and thus performs a two-holed ileostoma. As I already said, I know that such procedure theoretically allows the stool to pass both ways, but the stool still must not end up at all in the lower part of the small intestine and rectum if bipolar ileostomy is well-performed. As hendersonjames wrote, both stoma holes are near each other in order to facilitate the second step, the reanastomosis. And unfortunately, in all cases when ileostomy patients actually do defecate both ways, that means that their bipolar ileostomas were ill-performed. I believe you when you say that you know hundreds of them with the ability to defecate both ways (technically speaking, I had that ability, too, but the stool still never ended up in my J-pouch), but how many of them actually do defecate both ways? I know none, and every surgeon that I met would consider such ileostomy a failure. If such results of temporary ileostomy would be considered normal, then I would have to ask what's the point of having ileostomy at all? It would be the same as if you never had it. Especially in cases of UC or rectal cancer, when it is vital for the recovery of the patient that the lower parts of GI system remain stool-free as long as possible in order to heal properly.

Post Edited (Neuro) : 5/14/2009 5:20:23 AM (GMT-6)


Ohio43
Regular Member


Date Joined Aug 2007
Total Posts : 212
   Posted 5/15/2009 11:24 PM (GMT -7)   
Neuro, I'm sorry to tell you, but you are incorrect about the temporary loop ileostomy. Some people do continue to have stool come through their rectum. I have had my "temporary" loop ileostomy for almost two years. I have bowel movements every month. With a loop ileostomy the intestines is not completely severed. That is why they are performed more often than colostomies when diversion is needed temporarily. Unfortunately, my three month temporary loop ileostomy is going on two years (this July). After four operations with a local doctor, I've been going up to the Cleveland Clinic and have a couple of excellent doctors. And, yes there are two "stomas". The second one is called a distal lumen. I wear a light convex flange which helps to keep it up away from my skin.

Neuro
New Member


Date Joined May 2009
Total Posts : 12
   Posted 5/16/2009 5:57 AM (GMT -7)   
Ohio43, thanks for sharing your experience with us. However, here are some explanations from various medical websites on how the loop ileostomy functions. All of these sources state exactly the opposite from what you say about normal ileostoma functioning.

For example:

www.colidoscope.com/patients/glossary.html
Note what is clearly stated here:
"The upstream end of the bowel drains stool from the small intestine, and the downstream end drains mucus from the portion of the small bowel that leads to the J-pouch."

www.nhs.uk/Conditions/Ileostomy/Pages/Introduction.aspx
Note again:
"Once the surgery is complete, it is important that the pouch remains free of waste materials for a few weeks so that it can heal. Therefore, the loop ileostomy allows waste to pass through the stoma without affecting the pouch. Once the pouch is healed the small intestine is connected to the pouch, allowing the stoma to heal."

Etc... Just search for "loop ileostomy" on the Internet and you will find some 45.000 links telling you the same thing. Most of these links are official medical websites.

I'm not saying that it's not possible at all that a loop ileostomy will pass the stool downwards, through the rectum and anus. I'm just saying that such ileostomy is done badly and that, in fact, it leaks downwards and endangers the healing process.

Post Edited (Neuro) : 5/16/2009 6:01:46 AM (GMT-6)


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5428
   Posted 5/16/2009 9:00 AM (GMT -7)   
 
I'm not saying that it's not possible at all that a loop ileostomy will pass the stool downwards, through the rectum and anus. I'm just saying that such ileostomy is done badly and that, in fact, it leaks downwards and endangers the healing process.
 
Neuro,
 
I'd like to know where you get your facts as it relates to endangering the healing process?  If this were true the jpouch surgery would not be done in a 1-step?  There is no danger of effulent leakin downward and endangering the healing process; the area is long since healed when this occurs.  Please site your medical research.
 
Sue<!-- Edit -->
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3075
   Posted 5/16/2009 1:40 PM (GMT -7)   

"There is one stoma with two openings: a proximal (functional) end that effluent empties from and a distal (nonfunctional) end that empties mucus. Keep in mind that there is some continuity of proximal bowel to distal bowel and some stool will enter the distal stoma, thus there may occasionally be passage of stool and/or mucus via the anus."

the above quote is from www.convatec.com or http://www.convatec.com/en/cvtus-optsrgstus/cvt-portallev1/0/detail/0/1579/1912/options-for-surgical-stoma-construction.html/

 

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