Right sided build-up/blockage

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qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/21/2009 12:15 PM (GMT -6)   
I had my appointment at the hospital yesterday...I stopped the Pred on Fri and my symptoms are back (minus the blood and mucous at this point), I'm getting a lot of urgency and frequency. Anyway they're bombarding me with suppositories etc to try for 2 weeks.
 
I had to have an abdominal x ray which showed up a huge amount of blockage on the right side of my colon (I forget the technical name), so I've been prescribed Movicol to get things moving! I have been having fluctuating diarrhoea and constipation (sometimes I have urgency but even then can't go) so apparently this is what is causing the constipation. And apparently this is why I'm having so much trouble getting rid of the inflammation in my rectum, as the blockage is causing it to be irritated more.
 
What would be causing the blockage?! The nurse said its nothing to worry about and its just build up of stool, but I DO worry because I've never had a colonoscopy (only ever sigmoidoscopy) so how do I know I don't actually have something there causing it?
23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
Just finished course of Prednisolone; 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             


quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/21/2009 2:25 PM (GMT -6)   
It could be a combo of things, but rectal inflammation can cause constipation, and maybe it signals the upper colon to slow down??

I think the point would be to make sure there's nothing specifically causing the problem directly in the ascending colon such as a lazy area.

Are you having a lot of gas as well?

Curious if you're eating regularly or eating sometimes, then going without food sometimes?

The rectal meds should help...but it would have been better for them to give you the retention enemas for the higher medication dosage.

You should also make an appointment for a c-scope and make sure the doc takes lots (at least 30 - 36 biopsies) for a proper baseline at a cellular level.

Hope you feel better soon...keep us posted.

quincy
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/21/2009 2:41 PM (GMT -6)   

Thanks for your reply quincy...

They keep saying that I don't need a colonoscopy because they would be able to tell from the sigmoidoscopy biopsies whether there is any inflammation further up. (The only inflammation they have found apart from my rectum is a slight amount in the sigmoid). This seems fair enough but it seems that absolutely everyone has had a colonoscopy, even if just to take biopsies and check for polyps etc.

They are giving me some enemas which I've yet to collect to combat the slight amount of inflammation I have in the sigmoid, aswell as the suppositories for the rectum.

Not getting a lot of gas no...and I tend to eat little and often at the moment as large meals often give me a lot of discomfort and make me feel nauseous. I do go through periods of little appetite though where I don't eat much.


23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
Just finished course of Prednisolone; 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             


quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/21/2009 2:56 PM (GMT -6)   
Hi..well I disagree regarding them being able to tell about other inflammation in the colon without a c-scope. I still think you should push for one after this gets sorted out regarding the blockage.

Have one now...and if all is fine with biopsies, the sig-scopes can continue for at least 5 years till the next c-scope.

Good to hear you were prescribed the enemas.

Are you still using the motilium?

quincy
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/21/2009 3:14 PM (GMT -6)   

I'm glad you think the same...why would they think they could tell further up!? It doesn't make sense to me but then I'm not a  doctor and I do completely trust my IBD nurse as she has been fantastic so far!

Ive just put in a repeat prescription for the Motilium, it works really well for my nausea and I tend to take it at night or first thing in the morning, as this is when I feel sick most often. Its great - tends to kick in after about 20 mins!

And I've just remembered the term for it - fecal impaction!



23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
Just finished course of Prednisolone; 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             

Post Edited (qwerty1) : 7/21/2009 2:18:15 PM (GMT-6)


seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 7/21/2009 4:07 PM (GMT -6)   
They don't have to see further inflammation because the treatment is largely the same.  It sounds like they are being reasonable and responsible.  You do not have to visualize inflammation to treat it. 

quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/21/2009 5:24 PM (GMT -6)   
No, one doesn't need to see inflammation to treat it.....but to say one who has bowel disease doesn't need on is ludicrous.

Besides that, there are forms of UC where the rectum is involved and the cecum involved but not in between,

There are also polyps that could be seen if one has them, and with the biopsies...to determin any cellular changes in the colon leading toward cancer.

The fact that the ascending colon has impaction....that to me says something's possibly wrong with motility.

Fecal impaction can lead to toxic megacolon if the condition isn't treated and the "why" isn't found out.

Gee, call me cautious..

q
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 7/21/2009 9:42 PM (GMT -6)   
Localized inflammation seen in a flex sig and treated with rectal meds.  Oral meds per signature.  Fecal impaction imaged and treatment initiated.  Again, sounds very reasonable to me given that qwerty was diagnosed in January last year.  ASGE guidelines are similar.  This is a reasonable approach.
 
There are other tests for motility, but it is obviously an issue if there's an impaction.  UC-related cancers are not particularly linked to polyps, rather flat lesions, and it doesn't sound like the time to go hunting for those.  In fact, I'd guess osmotic preps might pose a problem with fecal impaction, anyway.  Again, this is the cautious approach.
 
Rectal inflammation can sometimes prevent stool from entering the rectum, which can lead to constipation in uc.  The rectal meds seem like the way to go in this case.  Qwerty, if you trust your doctor and nurse, what more can you ask for?
 
 
 

quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/21/2009 10:58 PM (GMT -6)   
querty...clearly as per seconder's posting...you'll be just fine, so that means there's nothing to worry about..lol.  devil

I must say, however, I'm grateful my doctor doesn't treat me with such remiss.


q


*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 7/22/2009 1:03 AM (GMT -6)   
Yes, I do think qwerty will be fine.  I'm optimisitic that way.  I am also suggesting that qwerty continue to trust the medical advice she has received and to think rationally about a subject prone to emotional overreation.  All of the worst-case scenarios you present are distant concerns right now.
 
I also caution against confusing medical attention and increased diagnostic procedures with improved treatment or outcomes.  Very often the exact opposite is true and these procedures do harm both physically and emotionally.  There's ample anecdotal evidence on this forum that "two colonsocopies and a flex sig" etc. has done nothing to improve the treatment or outcome of another recent poster's uc -- and they provoke ample emotional distress in the process.  That is remiss.
 
If a procedure is not going to improve treatment or outcomes, it is unnecessary.  GIs disregard treatment guidelines and perform colonoscopies for many reasons, among them patient impatience.  Just as you have done many times before, Quincy, I am also suggesting qwerty be patient and give her treatment some time to work.

qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/22/2009 1:09 PM (GMT -6)   
Thankyou quincy and seconder! You've both said a lot of helpful points and I guess I'll just wait and see how this treatment works, I go back to the hospital in 2 weeks anyway. smilewinkgrin
23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
(Just finished course of Prednisolone), 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             


quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/22/2009 4:58 PM (GMT -6)   
Of course she has to wait for her meds to work, and optimism doesn't change the outcome or the truth that she's never had a colonoscopy.

Again...there's NO reason or way a doctor will know that there isn't inflammation higher if it's "ass"umed it's UC. CD can mimic UC if it follows the pattern, and blockages are classic with CD rather than UC. Not that it cannot happen...but....sigh.

querty...once the blockage has been cleared, find out why things are stalling in the ascending colon. I don't think it's common for constipation to be there...more so in the descending, especially if it's UC or IBS.

Always pushing for one to be in the know rather than being passively accepting.

quincy
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 7/22/2009 7:28 PM (GMT -6)   
I'm not even going to argue with you the finer points of micropathology, nor mention that the basic meds for Chron's and uc are the same, nor mention that remission is remission is remission.
 
I'll leave you now to go pick arguments with pb4.

quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/23/2009 1:13 AM (GMT -6)   
whatever....qwerty will have the say in her care obviously.....all I can offer is an opinion, just as you do.  Neither of us has control whether she has a c-scope...and again, I'm relieved I get mine on a regular basis.
 
q
 
 
 
 
 
 


*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 

Post Edited (quincy) : 7/23/2009 12:17:28 AM (GMT-6)


qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/23/2009 5:00 AM (GMT -6)   
Although I agree that the treatment is much the same etc, I'd rather be in the know as to what is actually going on rather than just being given medication for what they 'think' it might be.
 
quincy - I will be trying to find out why the blockage is there in the first place, once its cleared of course. Why is it more classic for UC/IBS blockages to be in the descending colon, rather than the ascending?? 
23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
(Just finished course of Prednisolone), 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             


quincy
Elite Member


Date Joined May 2003
Total Posts : 30984
   Posted 7/23/2009 2:15 PM (GMT -6)   
I would believe that most of the blockages would happen in the distal part of the colon because most of the severe inflammation is there. That's where it starts, in the rectum, and climbs upward.

CD inflammation can be anywhere, going deeper into the digestive wall causing actual cellular thickening and change in how the colon works, etc.

One thing, you may have an area that's just plain lazy and it may have NOTHIng TO DO WITH uc...hence my concern regarding the assuming.

You may also have inflammation around the cecum and nothing in between....that might have something to do with why that area is slower...although, I would think that it could be faster...but like I wonder..what's actually going on.

The bowel is a very lazy organ when it has the opportunity.

Maybe with that blockage, no signals are getting to the lower part of the colon and it's just stopped requesting movement, etc.

I'm relieved that you'll push for a scope eventually...if it's all unremarkable and their assumptions were correct, at least all has been done. There's no harm in knowing where if there was something going on and their assumption was wrong....how does one say oopsie??

keep us posted.
quincy
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


qwerty1
Regular Member


Date Joined Feb 2009
Total Posts : 402
   Posted 7/23/2009 4:20 PM (GMT -6)   
Thanks for your input - its good to bear all that in mind at least :-)
23 year old female from the UK. Diagnosed with Ulcerative Proctitis Jan '08. Hospitalised Jan '09 for 3 days; Hospitalised Feb '09 for 7 days.
  
Currently taking daily: 
(Just finished course of Prednisolone), 100mg Azathioprine, Asacol suppository 500mg, 1g Mesalazine granules x 2 
Motilium (anti sickness), 1.5mg Zopiclone (taken when needed for sleeping), 10mg Citalopram (anti-anxiety), Probiotic Multivitamins.
                             
                             

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