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13 replies

was doing good till a rectal exam..4 weeks post takedown.

dgtracydgtracyMember
so my takedown was April 30th. i was doing pretty good until last thursday my surgeon wanted to do a rectal exam to check for a stricture. during the exam i was not expecting her to go as far as she did or whatever it was that she did but it hurt real bad, started shaking, the nurse had to hold me down..was not good..i got home and ever since then its kinda hard to go to the bathroom. i have alot of trips at least 13-16 per day, sometimes hardly anything comes out yet i had to rush in there. there is no blood though i actually just finished a round of antibiotics a week ago for pouchitis, at least thats what they thought it was. when i sit down i also feel so much pressure on my rectum that its uncomfortable..im sitting on a pillow right now in my computer chair and its still a bit of pressure..i already called my surgeon and left a message, got a call back from a nurse whos exact words were "i never heard of this before, maybe you need antibiotics im just not sure but i will get the message to her..." and this is coming from a nurse who works at MUSC a well known hospital...what do you guys think?
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mgmt10mgmt10Member
Did you have a stricture or was she just checking for one? I had a stricture dilated at my surgeons office about 4 weeks after takdown because I couldn't empty fully and had lots of pressure...it was actually painful to sit sometimes. I felt better instantly after but 1 week later it started all over again. I had to repeat the dilating 5 times in his office over the course of 2 months before it finally got resolved and everything stayed open on its own. Not sure if this is what's happening to you but it's just a thought.
Jan DollarJan DollarModerator, RN, retired
I would suspect that you actually did have a stricture, and what you got was a dilation without sedation, evidenced by you having to be held down! How draconian... Eeker

Usually, if you were tight, the dilation would improve things. But, if the stricture was not causing problems (yet), the trauma of the dilation could cause swelling and pain. Sounds like some long hot soaks in the bathtub are in order! Hope your doc gets back to you soon.

Jan Smiler
Jan DollarJan DollarModerator, RN, retired
See, this is where I am confused. Unless you had a stricture, it should not have been so painful that you needed to be held down.

The only other explanation would be that you were having spasms in your sphincters and/or a fissure (possibly caused by a forceful digital exam).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048443/

I have had digital rectal exams since I was 15 (I am now 57), and they never have been painful (other than the initial pressure when I had a severe UC flare going on). Your surgeon causing a fissure could explain why she found no problems, but you are now in pain. Seems too suspicious to me. You'd think there would be bleeding, but it does not always occur.

Jan Smiler
dgtracydgtracyMember
During a digital exam it sounds like they use an instrument of some sort but she just had her fingers that she was using. I don't have pain after a trip to the bathroom and the only pain I have while in the bathroom is the straining that is uncontrollable. I was Prescribed bentyl for that but it does not seem to help
Jan DollarJan DollarModerator, RN, retired
I figured it was just the finger (a "digit"). But, you say "fingers." Did she insert more than one at a time? My docs only use one finger, sweep around to feel the rectal cuff, that sort of thing.

It definitely sounds like you are having spasms in your sphincters or possibly other pelvic floor muscles. Could have been overstretched, causing trauma. Since you do not have pain during a BM, probably not a fissure. If the Bentyl does not help, it either is too small of a dose, or too much spasm. That leads me back to the hot soaks and sitting on a heating pad. Add tincture of time and it should get better.

It is possible that this is levatator ani syndrome, which is a type of pelvic floor dysfunction. It makes you feel like you need to have a bowel movement, because of the spasm. It is one of the possible complications and could require pelvic physiotherapy. Maybe the exam triggered it.
http://www.pelvicpainhelp.com/...evator-ani-syndrome/

Jan Smiler
Jan DollarJan DollarModerator, RN, retired
Either she was not completely forthcoming regarding her findings, or she is just stabbing in the dark in regard as to what to do. If it is not a fissure or cuffitis, it probably is muscle spasm. It could have been there was something going on before she got in there (those early weeks it is hard to tell what is normal or not), and all the manipulation was like smacking the hornet's nest with a bat. There can be a lot of swelling/bleeding into those surrounding tissues during surgery, and it can take a very long time to resolve. Basically, it would have been like punching a bruise. Hopefully, she did not start any new internal bleeding. Be sure to call back if the pain gets worse, you feel faint, or you are unable to empty your pouch.

I doubt that Canasa would help with what you have going on unless, like I said, she did not tell you everything.

Hot soaks, narcotics if you have them, and give the antispasmodics another go.

Jan Smiler
Jan DollarJan DollarModerator, RN, retired
If I were you, I would hold off on the Canasa and call your doctor back and report your reaction to it. I suspect it was not the drug contained in the suppository, but the anal irritation caused by suppository insertion. Something appears to have been traumatized by the exam and it will take a while to get better. I was looking something up for another post here and it got me thinking. I wonder if your doctor moved your coccyx (tailbone) during the exam, and that set it off. If you have a hematoma or something left over from the surgery that has not yet absorbed, that could do it.

Sorry you are having such a rough time.

Jan Smiler

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