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Hey everyone just a couple of questions for those that have been through the dilation process. I had a Drs appt which I scheduled for today my original appt was supposed to be on the 27th. The reason for my going in earlier is because of some issues I was noticing which seemed out of the "normal" to me. First I had 2 days of absolutely terrible gas pressure. The pain was terrible and extremely uncomfortable. This happened about a week ago and the pain still lingers a little bit today. I guess you would describe it more as a sore feeling now located around the rectal area on the right side. Then I noticed a loss of appetite and a feeling of naseua for those couple days. I took it easy with solid foods and was taking Beano and Pepto Bismal. The gas pressure seemed to subside somewhat. Then I noticed a decrease in bowel movements from my normal 6-7 times a day to 2-3 times a day which is what we all hope for as an end result to this surgery but thought it was too much of a drastic change overnight. I also noticed a couple nights of leakage which is out of the normal for me because I haven't had that since the beginning of my takedown. So my Dr. obviously had to check things out down there and we all know what that means, lay on your side with your knees to your chest and let the plumber have a look see. He checked my pouch and my prostate because he stated that could be causing issues also which confused me a little but forgot to ask about the prostate before I left how it was related. He said that my pouch is more narrow and then left his finger in there for a minute or so to dilate it as much as he could. While Mr. Plumber was hanging out in the deep dark tunnel of what is now called my digestive system he gave me 1 of 2 options to choose from. I could either allow him to use his handy tools to dilate my pouch to the proper size while laying there eyes wide open barely able to breathe or I could choose the much easier and appealing way and get it done under anesthetic. I chose to go with the second option. Not only because I dread even the thought of pain after my surgeries but also because I could not relax my sphincter muscle and kept tightening it over and over to the point where he had to slowly take his finger out a cm at a time because I could not relax it. I fugured if he had a hard time doing what he had to do with his finger then I couldn't imagine a metal rod double in thickness going in and out of there. It seemed like the better option for me and why not I've already been to hell and back with my surgery I'm aloud to take the easy way out now without feeling any less of a man.

So anyway my questions are for you if you had to get this procedure done under anesthetic how did you feel afterwards? Did any of you who had this procedure develop pouchitis afterwards due to not being to empty fully for a little while? What should I do up until the time of the procedure which is 20 days away to prevent any further damage? I already know the answer to this but just going to ask anyway to make myself feel better, do you think the dinner I had the prior night could be the cause of the issues. I had Stuffed Zucchini which had a variety of vegetables in it. I thought to myself it was not a good idea yet to experiment with all those vegetables but also didn't want to make my wife feel bad after making something new. I also reassured myself that it was cooked good enough that the vegetables were mushy so it wouldn't be an issue. Thanks in advance for the help.
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Take my thoughts with a grain of salt, since I have not had any issues with anal stricture.

First of all, you probably got some decent dilation during your appointment. Your sphincters were in spasm, and that was why you could not relax them (only the external sphincter is under conscious control anyway). Spasms are a normal response to pain stimulus, so it is totally not your fault! So, once the spasms subsided, you may find things are flowing better. With any luck, this will last you at least until your dilation under sedation.

As to your meal the night before, it was probably OK, even though it had a fair amount of veggies in it. Sounds like it was pretty soft, and if it was predominantly zucchini, that is pretty easy on the gut. But, I would avoid raw fruits and veggies until you are sure how things are flowing. And, be sure to take in more fluids than you ordinarily would.

The prostate can be an issue because it surrounds the urethra. This places it between your urethra and rectum. When it enlarges, it can reduce your urine flow and/or encroach on the rectum (or pouch in your case). This proximity is why they do rectal exams to palpate the prostate. Hope that helps make some sense.

Jan Smiler
I have had five in office dilations with my surgeon wide awake. It wasn't fun but I didn't want to be bothered with sedation and having to get a ride there and home, ect. (I have a pretty high pain tolerance though).It took those 5 times for the stricture to finally stay open and all has been good since then....It never came back. It's been almost 3 years. Good luck with the procedure. Hopefully you will only need it done once.
Hi! I have been battling an anal stricture this summer (courtesy of my OB/GYN doc-should say my ex-OB/GYNWink). My doc has been dilating me in office every two weeks and this last time it was three weeks(small progress!). When the stricture starts retightening, the area becomes achy. A bath with Epsom salts help the ache a lot. Hope you are feeling better soon!
Thanks for the responses. Yeah I'm a wuss with pain anymore. Anytime I can avoid pain and uncomfortable situations I usually do. Like I said my Dr said my muscles down there were spasming a mile a minute and I couldn't do anything g to control it at all so I was just thinking how difficult it was to dilate with his finger that it was gonna be hell to go to the next step. With the way my muscles were spasming attempting to shove that nasty thing in would have not given me the ability to drive home. I will pass on that for now. Is there any suggestions on foods to eat for the time being. I don't wanna starve myself for 20 days and lose all the weight it took so hard to gain.
phonix,

I have had several dilations (both in office and under anesthesia). I am actually having a balloon dilation this month as my doc could only get the tip of his finger in my pouch when doing my last dilation and even under anesthesia, he indicated they had to give me more medicine as I moved from the pain. I think you are smart going under for the dilation. As others have indicated, drink a lot of fluids, eat smaller meals, exercise (walking always helps me empty my pouch easier) and be careful what you eat (avoid nuts, seeds, corn and things of that nature). Good luck. Let us know how you make out? What is he using to dilate you?
Unfortunately, my doc did not offer me any pain meds or I too would have taken that. I definitely think you chose the right path with the pain meds. I can not imagine having that done with spasms and an instrument.For me, in the beginning, I avoided the fruits and veggies. That is starting to get better and now I'm finding some soluable fiber ( like oatmeal and peeled apples) is pretty good.
Last edited by phoenix08
phonix,

I would think that the fact that he was even able to get his finger all the way in during the exam is a good sign that this stricture is not too bad and should respond well to balloon dilation or more vigorous digital dilation under sedation. It is when they cannot get a finger or scope in that things are really tight.

But, once things are closing down, it is easy for the area to become irritated and inflamed, and spasms to set in. The spasms just make things worse.

Along with the dietary advice, you could try something like Pepto Bismol or antacids to keep the burn to a minimum.

Jan Smiler
I narrowed to where my CRS couldn't put his pinky through... have had a few dilations under anesthesia. He will *only* dilate under anesthesia, says its even too painful for him to dilate people when they're awake, lol.

The first one was the worst, because things were so narrow, but it wasn't "painful" but more achy. I walked like John Wayne for a day or two. The next ones were much easier; the last, in fact, didn't cause me any discomfort at all.

I only ask for IV Tylenol, Propofol, and/or Versed (sedation) for my procedures, because Fentanyl and Dilaudid make me nauseated. If I get them, I make sure they give me Zofran for the nausea, or I'm puking on the way home.
I have gone months in between with still having symptoms at times with no real problem. I think a couple of weeks should be fine. I know they like to treat this up front as it is easier to treat the sooner recognized. I too have an opening that is very small I am wondering Rachel if you juSt had a manual finger dilation or a balloon dilation? Also, do you think your stricture had anything to do with your abscesse formation? I get infections every time I go off cipro and I think it is because the opening Is so narrow and I cannot fully empty my pouch which leads to further straining and anal ulcers and fissures. It becomes excruciatingly painful and I then go back on cipro to control my symptoms. I worry that without the cipro I could form an abscess from the chronic infection I seem to get at my anastomoses connection.
Jan
You just perfectly explained what happens to me. The pain becomes unbearable, the anal ulcers act up and I get fissures and sphincter spasms that bring me to tears. I struggle to empty the pouch and strain and never feel completely emptied. All of this just further aggravates the cuff area causing more inflammation and I get repeat infections which is why cipro calms everything down for me and Canasa and anucort really do not work for me.

I am having my first balloon dilation in two weeks. I am a bit worried as I do have an ulcer on one side of the anastomoses that does bleed on occasion and I hope this procedure does not further aggravate this. I also worry about perforation especially since you are not awake to judge the pain threshold of the procedure being done.

I know how tight my anastomoses is as I have taken others suggestions and tried to self dilate a few times using a glove and cream. I can barely get the tip of my middle finger in the opening yet while on cipro I can empty my pouch with no straining and things just work so much better. No pain, burning, bleeding or straining and constant irritation.
Jeane, he used his finger in the office and did as much as he could and he said to me "man your sphincter muscle is spasming a mile a minutes and it was without my control so he showed my the metal tool that he would be using but the one he showed me was a smaller one. He says its smaller at the end and then gets bigger the farther it get put it. There is no reason for me to deal with that awake especially not being able to control the spasms. He was basically fighting to get his finger back ha ha. Ahh well he did what he good. I hear a lot of horror stories about some peoples surgeons but I am blessed with such a caring compassionate Dr. He lives not to far from me and has even made house calls in my time of need or has dropped off prescriptions at my door when he was off duty for the weekend. I chose the first surgeon I talked to because I'm a good judge of character being in sales for a decade and I saw something in him when we spoke that made me trust him and I'm glad I did. He even helped me and my wife get through things with some in office counseling. And he always gave it to me straight and didnt try and sell this as his miracle cure for UC
I actually knew all the positive and negatives before I signed that paper. He also told me him and me were going to be like we were married. It was gonna be a rollercoaster ride and we would experience good times and bad times together, boy he was right. He's great.

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