Removing entire colon vs. most of the colon

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Savannah
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/18/2010 5:56 PM (GMT -6)   

Hi everyone –

I’m new at this and am hoping to give informed answers as well as receive them regarding colonic inertia. I am a 52 year old lady who is considering having my colon removed. My constipation began when I started taking medications for chronic pain/fibromyalgia about 24 years ago.

I’ve seen 2 colon surgeons who both think surgery (laproscopic) is warranted. One would remove my entire colon and join my small bowel to my rectum. The other one (who has much more experience) would leave 6 – 8 inches of my sigmoid colon. Does anyone know which of these is most often done for colonic inertia? Is one more effective than the other?

In addition, the one taking my entire colon would join the small bowel to the rectum at a right angle. The other one would attach the small bowel going straight down into the sigmoid colon. Does anyone know which of these techniques is best? It seems like going straight down would be but I’m not sure.

Thanks much!


HopingForAnEnd
Regular Member


Date Joined Feb 2010
Total Posts : 42
   Posted 2/18/2010 7:06 PM (GMT -6)   
I am new to all this as well but from reading I will try to help you. Most people that I have read on here who have CI get their whole colon removed. Most who have had the subtotal or colon ressection still experience constipation. What tests did the doctor do? Do you have severe CI? Some of what you tell people will help them better answer your question.

Marsky
Veteran Member


Date Joined Jul 2007
Total Posts : 1956
   Posted 2/19/2010 6:54 AM (GMT -6)   
Hi there, I am living without 90% of my sigmoid. Due to rectal cancer. And consequently experiencing multiple daily bm's. My surgeon explained to me that the sigmoid is the GI tract's reservoir, it can swell and collect stool, holding it back allowing for the normal range of bm's - 1 to 4 within a 24 hour time period. Since my "new" reservoir is actually a higher up part of my colon that cannot swell and hold back stool for very long, this is the primary reason why I spend so much time in the bathroom. I can actually feel the stool slide down and then the pressure to go is intense sometimes. But after that bm I notice the amount of passed stool is a very small amount. Again, without a sigmoid, this is what my body has had to adjust to.

If I were you, I'd ask the surgeon that wants to leave the sigmoid intact (and bravo for him), would this lead to future inertia or constipation for you. You wouldn't want to end up right back where you are now. But if he says no, leaving the sigmoid is the best way to go, I'm here to tell you that I miss my sigmoid. Never even knew how good I had it either until it was gone.

But mine did have to go since my malignant tumor was barely inside.

Best wishes for relief and a better quality of life.........

Mary/Marsky
- Rectal CA 4/29/99, Stage I, 90% sigmoid/15" of colon/GB removed, temporary colostomy, reversed 6-26-99
- Chronic IBS/D symptoms, multiple bm's, on low residue diet
- Colace 50 mg each evening


tinkerbell2
Regular Member


Date Joined Jun 2009
Total Posts : 418
   Posted 2/19/2010 10:57 AM (GMT -6)   
I have the opposite issue of Marsky. I "think" I have colonic inertia.. test indicate it, and GI doctor says I do.. colon surgeon said no (however, he never even asked about my constipation I had for years - we was focused on fixing a mechanical obstruction). My colon is extremely redundant - the transverse is really long and floppy, and the sigmoid WAS.

I had my entire sigmoid removed and the upper part of the rectum just over 2 months ago. I HAVE to take MiraLax every single day - or I would be constipated. That said.. I am at least having a BM and even 2 a day.. a big difference then before when I would normally go a week (and then use a laxative). I still have issues having a BM, but I think it is due to my pelvic floor - more than my colon... never ending
~Jenise~

Chronic Constipation - last 20+ yrs.
Stage lll Pelvic Floor Prolapse ( rectocele, rectal, vaginal, bladder) Rectopexy, Sacral Colpopexy, TVT Sling - 8+ hr surgery - March 2009
Constipation increased, could not move bowels without excessive straining or laxatives - March 2009
TVT Sling Released - April 2009
Redundant, Twisted, Prolapsed colon found - causing mechanical obstruction Oct. 2009
Rectosigmoid Colectomy w/low anterior Anastomosis & Revised Rectopexy - Dec. 2009
Perineorrhaphy & Posterior Colporrhaphy (rectocele repair) - Dec. 2009
Today - using MiraLax daily and things are much improved!

Post Edited (tinkerbell2) : 2/19/2010 10:00:58 AM (GMT-7)


Savannah
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/20/2010 1:43 PM (GMT -6)   
Thanks for the responses HopingForAnEnd, Marsky and tinkerbell2 -
 
My CI is severe according to the Transit Time Study.  I hadn't had a bm in 8 days when the x-ray was taken so all 120 markers were still inside me.  In addition the vast majority were still on the right side of my colon.  It took 2 Fleet enemas and a hydro-colon session over the next 3 days to get the impacted stool out!
 
I had an Upper GI with Small Bowel Follow Through that was normal but mentioned delayed transit of barium through the GI tract.  Both colonoscopies I had mentioned my colon is tortuous throughout and prone to significant looping.  I will be having a Defecography this week to see if there's any problem with my pelvic floor muscles.
 
I currently take 8 Senokot and 4 colace a day (half in the morning and half at bedtime).  about once a week I also need Ducolax or some other stronger laxative which makes be nauseous before it works.  In the last week I have had 4 bm's which is pretty good for me.
 
 I have lost 20 lbs. over the last 24 years of having constipation which again began when I started taking medications for chronic pain - fibromyalgia.  I now weigh 107 lbs. and am 5'7" (was thin to begin with).  For a long time I was managing ok with fiber, magnesium and diet but the last 5 years I have needed stimulants to go.  Amitiza, Miralax, Lactulose helped at first but stopped working after 3 or 4 weeks.  I've decreased my meds as much as possible.  We've tried different meds but that hasn't helped.
 
The older surgeon that wants to leave 6 - 8 inches of my sigmoid colon said my chances of having a good outcome were good but did mention the possibility that it could stretch out over time and constipation could return.  He would then have to go back in and remove the sigmoid and maybe part of the rectum.  I sure wouldn't want that to happen!
 
The younger surgeon wants to take the entire colon said I had a 75% chance of a good outcome.  He said an Ileostomy would work for sure but the thought of a stoma and a bag freaks me out a bit.  I'm in the pool quite a bit but he said it wouldn't be a problem.
 
I'm not sure which of the 3 options would be best for me.  I'm also not super confident in either surgeon.  I asked the older one for phone numbers of a few prior patients that had similar surgeries and he said ok but he hasn't followed through yet.  For a second opinion I requested to see the Chief of Colorectal Surgery at UCI but after reviewing my history they didn't allow me to see him.  They had me see a 37 year old surgeon that I know nothing about and he wasn't very talkative.
 
I don't know if we're allowed to ask for referrals on this forum?  I live in Southern California.  

answers4me2
Veteran Member


Date Joined Dec 2008
Total Posts : 1321
   Posted 2/20/2010 5:10 PM (GMT -6)   
Savannah, please join us on total colectomy part 32. That is where all of us with colonic inertia meet.
Welcome, Tracy
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