Hi:

Well, it's a long story. J Pouch created on Jan 18, 2008, TD on April 10th, 2008.

Last May 27th I had a balloon dilatation because I had an anal stricture. Symptoms of stricture were difficult defecation and pain in the anastomosis site (where the stricture was located). After dilatation I felt an important improvement in my recently created pouch. I could even reach down the great number of 5 BM/day!

However, about 10 days ago I felt again a strong pain in the anastomosis site, more located at the right side of the tailbone, although this time there was not a noticeable difficult to defecate. My surgeon was not in the city, so I was assisted by his substitute, a only 33 years old surgeon. He said that it was again the stricture, but this time he only did a digital dilatation. In contrast to the balloon dilatation, this time I didn't feel an important relief. So I went back to his office next day and he again checked. The diagnose was that stricture was not anymore there, and that I had only a kind of intestinal contraction. He prescribed an analgesic "stadium" (DEXKETOPROFENO-TROMETAMOL) but didn't help.

Today my doctor was already available, so I went again to his office. The doctor didn't find any stricture, and said the pain was caused because a muscle called Elevator of ("I-don't-know-what") was contracted. Probable causes: stress or just that the anastomosis is very close to it, so they could have disturbed the muscle (and pain comes 5 months after surgery?!)

He discarded other conditions because I don't have any fever.

So I don't have any stricture, diarrhea, fever neither bleeding. Only an increased number of urgencies and an intermittent pain in the mentioned site. I mean, it's not a constant pain. It comes as a set of episodes about each 3 hrs, specially after meals. Pain feels like if I were having a digital dilatation or like a terribly strong urgency; it starts in the right side of the tailbone and while it lasts (about 10 seconds) I hold the urgency produced, and pain expands to the pouch. After 10 seconds pain goes away, but after some minutes, maybe 20 or 10 or 5 it comes back, each time more often, until I can't stand it and I go to the toilet. Relief comes and I have 2-3 hrs of rest. Then it repeats. It also hurts for some seconds after being sitting down for several minutes, but in this case it only comes for one time. It doesn't hurt when I walk, but if it happens while I'm walking I have to stop in order to avoid an accident!

Now, I wonder if it could be an abscess. I know they can be sometimes hard to detect. Or could be a kind of mild pouchitis. Again: No fever, no diarrhea... but problem has been for about 8-10 days... maybe a slow development. Last night was terrible: BM each 2 hrs, (total 11 for the day) and only a clear liquid (is that diarrhea?)... despite I took what the doctor prescribed (Lexopan=Bromazepan 3mg /12 hrs). Today it has been less painful... but my condition changes continually! Frequency seems to increase and I now I also suspect of irritable pouch syndrome.

Or just the doctor is right and the Elevator of (what?) is contracted...

I really appreciate your advice. If my doctor is wrong I need strong arguments. Also, if it's an abscess or pouchitis or something else, what would be the way to detect it?

Thanks again.

This message has been edited. Last edited by: Jimmy Neutron,

hi...i have no idea if your doctor is right but i have experience with muscle pains and an abcess...

all that stuff you described sounds a lot like my muscle pain...like how it comes in episodes and you feel urgency...as the muscle contracts i get a wave of intense pain. i had my pouch for years before this without muscle problems but now it is a major issue...in my case it is caused by painful fissures.

when i had an abcess i had a ct scan that didnt show it...and finally an MRI showed it but it took 3 months to find it and get it fixed. they can be hard to see.

good luck, hope you figure this out...maybe someone else can be more helpful...if it were me i would ask more questions about what causes your contractions and see if you can fix that...

What you are describing does sound like muscle spasms, probably levator ani. This can be caused by irritation of the muscle and/or nerves in that area.
http://www.healthscout.com/ency/68/373/main.html

It is also possible that you do have an abscess that just is not diagnosable at this point and you will just have to wait it out. Could be from your anal strictures and dilations. You might inquire about muscle relaxants for this or pelvic floor physical therapy. It should resolve on its own in time, but if it persists, I'd ask about a CT to rule out abscess. Sometimes they are there, even without fever. Does not sound like pouchitis to me.

Jan

Hi, Jan:

Thanks very much for your response, I talked to my dr. and said what you advised, he totally agreed. He prescribed a Magnetic Resonance of pelvic floor (is that a CT?), and I will have it tomorrow. If it indeed results an abscess, well, I know I will need to stay in the hospital, but if not, I already made an appt. with my psychiatrist and psychologist, in order to work on my anxiety, which can be another cause of my frequent urgencies. And both the psychiatrist and the surgeon will have to agree on what kind of relaxant fits me, if it results the muscle problem.

Again, Thanks very much... you are like the compass that guides me in this dark moment.

MRI (magnetic resonance imaging) is not the same as CT, but equally good at finding abscesses. It is just more expensive and takes longer to do. Some consider it better because there is no x-ray exposure. Hope your diagnostic imaging was helpful in figuring out what is going on.

Jan

Hi, Jan:

OK, MRI didn't show any abnormality in surgery stuff. The muscle contraction hypothesis got stronger since pain decreased with relaxants, but also dr. prescribed levofloxacine (antibacterial), just in case of a small infection. Also said it could be an irritation in the pouch. It's curious, I reduced my BM trips from 11 to 4 the first 3 days after diagnose! Well, now I am going more often again, but it's probably because I'm trying new things in my diet (pasta)

Let's see how I do in the next weeks...

Thanks again.

Don't forget that anxiety also plays a role. Also, you can have irritable pouch syndrome (IPS), just the same as irritable bowel syndrome (IBS). Antispasmotics and antidepressants are the treatment and can really reduce the pain and spasms.

Jan