Suggest treatment for gastric pain after hernia repair

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Posted on Tue, 16 Jun 2015 in Lump
Question: Does anyone address symptoms/pain/change in gastro after hernia repair. I know that big problems started after this surgery; I reported to the surgeon; he is no longer there. But, so much time has gone by as provider didn't recommend anyone and kept on treating chronic pain. Abdominal wall? When movement goes through, the area at top of mesh has been stretched; pain in site of colon removal and hernia repair and my toilet habits changed drastically. Probably doesn't do any good answering because nobody wants to deal with another surgeon's mess - so I've been told.
doctor
Answered by Dr. Grzegorz Stanko 1 hour later
Brief Answer:
You should have colonoscopy and CT enteroclysis.

Detailed Answer:
Hello!

Thank you for the query.

Can you please give some more details? When was the large intestine removal done and for what reason? When was the hernia surgery done? Was it a hernia in the surgical scar?

If you have bloating, cramps, bowel movement changes, and you clearly find it painful in the scar area, most likely your problem is caused by adhesions inside the abdominal cavity. It is also possible that someone has stitched the intestine into a abdominal wall.
Both this conditions can give pain and stool pattern changes.

I do not think gastroenterologist is a correct address at this point. You should rather have colonoscopy done (to see if there is no junction narrowing) and CT enteroclysis (to find out if there is narrowing in the small intestine). Have this two results can help in deciding about the next step (which seems to be surgery).

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 19 hours later
I had large intestine removed 31 Dec 2012; unnecessary, but that's history. July 8, 2013 I had hernia repair and from that time on I had changes in bowel from constipation, to incontinence, to normal. Last four days I had "normal" movements except one was so large; cramping before and today cramping. The area at top of mesh and side is so compromised; I had a colonoscopy in October - couldn't empty; then barium enema - exploded everywhere; then, told colon is fine; left the Military Provider , who only addressed issue with drugs; since then I pulled something on side where resection (end to side) was done and stool fell out. First time I had incontinence in some time, I happen to be at Mayo Clinic in XXXXXXX and, unfortunately, had incontinence which threw the Gastroenterologist off; he arranged for an MRI on 15 May, but, because there are other complications I was told to return home, find a provider, and get things in a row - I've compromised area under mesh so many times and, prior to hernia repair, didn't have any issues with gastro (in fact, there was no need for sigmoid resection, however, was told the prolapse (minute) could become an emergency and removal could help with back pain - I sent this report it says "Patient thinks surgery will help with back pain." So, life goes on, no doctor since I left the system that failed to address anything and I've been on your site asking questions. I'm to the point of being so scared; so unsure and not trusting anyone at this late date. I have something poking me in tailbone/rectum area which I reported so many times. We noticed stranding in area, but no follow up. My tests are too old so the gastroenterologist at Mayo said to have repeat. I don't know how one looks at circumference of mesh, and the abdominal wall. FYI, the surgeon who did the hernia repair was sued because of issues with working on women's abdominal wall. I don't know more than that but, I called him and also so much pain, told to go to ER. It's been almost two years and I've suffered so long I don't know where to start or who to trust. There is narrowing in the colon, but surgeon said it's not a problem. I can send old files, but it takes a lot of research (and tears) to do this. Is this clear enough? Never would I imagine a human being could be so lost! Thank you

Yes, it was a hernia where the colon was removed. My notes show that I started pain in area soon after. My breathing was also compromised.
Pain, when passing fecal matter radiates to low back; rectum, when I sit on it is slightly painful. Many changes because nothing has been taken seriously.
If I knew how to send CD's, I would. I'll google this and see if I can send. Something was noted while viewing with doctor and he said he'd send to radiologist at Mayo; however, did not. I am telling you, CHRONIC PAIN is in the back of minds that has left me doubling over in pain; something poking me in rectum/tailbone area and I'm afraid to trust a soul.
doctor
Answered by Dr. Grzegorz Stanko 8 hours later
Brief Answer:
You need CT enteroclysis.

Detailed Answer:
There is a lot you have gone through indeed. This is quite surprising how long it lasts and you are still in the point of no diagnosis.
If the tests you have had are year or more old, you need to have new ones for sure.
To make things clear, in my opinion this is what you should do:
1. CT enteroclysis or MRI entoregraphy at first. No doubt in that. You pain and other symptoms are clearly caused by narrow intestine caused by adhesions. This adhesions are most likely located in the mesh area. It may be hard to prepare to this test as whole intestines must be clean. But this is the most important test right now.
2. Having the result of this test, you should consult good general surgeon. In my opinion you need surgery to release the adhesions.

Nothing more needs to be done for now. Painkillers wont solve the problem. Intestinal pain can sometimes radiate to back.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 8 hours later
This idea makes the most sense; however, I'm pretty much worn out. After four bm's ripped through me my insides are feel like I've had a war going on. I can't lie on my tailbone/rectum or either side now without pulling. It sounds bizarre, doesn't it? A provider, who was fired, ignored symptoms for two plus years. Surgeon who did first surgery admitted he failed - his biggest failure was knowing I was lying in a mess when he discharged me with an infection; the second was having to have hernia repair. I had never had any gastro pain; anything except back pain from MVA. To listen to the surgeon who said colorectal surgery could help with back pain makes me have STUPID written all over my forehead. I tried a new provider who said she'd see me in 6 weeks. I told you I'm off of all opiates after four years of up to 8 Percocet/day plus Fentynol patch - 50 mg - that was the treatment for pain after two surgeries. Thank you for your time. Why can you see this need but it's ignored here? Probably because I spend more time explaining to you. Read about XXXXXXX healthcare. I expected more from the military doctors, however. Bless you.
doctor
Answered by Dr. Grzegorz Stanko 16 minutes later
Brief Answer:
Back pain can be due to surgery or spinal cord compression.

Detailed Answer:
Lets focus a little on your back pain. Please note that during sigmoid colon removal there is a possibility to harm nerves located on the sacral bone. Especially if the sigmoid colon is removed with small part of rectum. There must be done intestinal junction so the part of rectum needs to be released from surrounding tissues. During this procedure, its easy to harm nerves.
If your back pain is strictly associated with bowels movements, there must be connection between back pain and intestines problem.
However if your back pain is rather separate thing, and it radiates to lower legs, so you can feel pain or just burning, hypersensitivity of lower legs, the source is spinal cord compression or nerve compression in the pelvis.

For spinal cord compression we perform MRI of specific area. Maybe this should be done as well? And if there will be found some compression, neurosurgeon can fix this.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 6 hours later
You are most knowledgeable. I am in no position since the four bm's to function. I did not have gastro pain until hernia repair. The bowel movements fire area where resection is and that area is poking me. My rectum has never felt ache; it does now. I'm in San XXXXXXX TX and I do not have a doctor and I do not trust the Army Hospital any more. Again, I had back pain after MVA that was years ago. The pain was deep insider after resection. It all was ignored; totally, only covered with drugs. It was bound to happen. I couldn't clean out for colonoscopy; barium enema I exploded and dr said "motility" issue. You see, not one doctor paid much attention because of the MVA so many years ago. I never had pain in my abdomen except when I had children. You are so kind. I know I should go in to ER, but, since I don't have a doctor I'd get someone who would probably decide to do a colotomy. I sound like a raving idiot; I know I do, but, two years after surgery,I've been totally ignored. I'm quite frightened. I should have stayed at Mayo Clinic as dr had MRI scheduled, but he was off track because I happened to have incontinence then - hadn't in ages. One thing for sure, this doctor, from XXXXXXX was the finest doctor I've met in some time. I feel like a war is going on inside - it was bound to happen but I don't know what "it" is. Thank you for thinking this through. Pain in leg is only when I lie on my rectum/tailbone which has something poking in so there is no comfortable position. I had asked about leg burning because of when it happens. So complex; ignored, as you can see by my tons of questions to your site, for so long, what hope is there that someone won't go in and mutilate me more. I never should have had that first surgery; I know that. I am tempted, because I do think the colorectal surgeon was not malicious - I don't think he meant harm - he said "prolapse could become an emergency and might help with back pain" I trusted him. He may be my best solution as far as getting the right help. Then again, he won't want involved. I have to figure a way to get my mind off of this; it is intolerable. Thank you for playing psychiatrist, also. My psychiatrist was my idea because I asked to be helped safely withdrawn from the tons of Xanax thrown at me. It's like being up a creek without a paddle and I've fought so hard because I knew things were bad inside. Wish you could XXXXXXX me. My best...

I do not have back pain as one would think of it. Once I start walking pressure very low (sacrum or coccyx) restricts my movement. But, since the huge amounts passed through my "gut" it also passed through resection at side of colon and something is poking me there. As I said, no pain in abdomen until hernia repair; after repair, it is noted I called in many times with severe pain in transverse area. Colonostomy was beginning of issues more severe then I pulled something on rside of rectum and stool fell out - nobody knows about this because I left the Army Hospital. Unfortunately, incontinence while at Mayo got things off track; however, the good doctor put in for an MRI; I should have stayed there, but again, if one doesn't realize that gastro pain so severe but occasional, started after hernia repair. Also the issue of poking; pressure near resection - that I mentioned to my provider so many times. CHRONIC PAIN It's awful to try so hard to get someone to listen to me only to reach this point. An MRI showed issue in sacrum, but, again, no follow through. I understand you probably can't believe this could happen in XXXXXXX My brother-in-law, a doctor, cannot believe it either. Just too afraid and living where I do, I trust nobody. When you have little to do, check out health care in TX - or XXXXXXX - doctors have told me they don't want to deal with my problem. The CEO of the hospital where I lay in a mess, discharged with dirty bandages, saw me after he knew he couldn't be sued and agreed that no doctor wants to clean up another's mess. How I got into this situation, I will never know, but, I'm too spent to keep searching right now. By the way, the movements that passed were "norma" not like I was constipated; but, four in four days was too much. You might also want to know that I had a hysterectomy with bladder sling; a year later, the anterior/posterior wall was repaired - mesh holding up bladder. The vaginal wall and area where colorectal surgeon were are shared; then MVA then hernia then surgery for hernia. Immediately I contacted my provider , the colorectal surgeon, and the surgeon who did repair - their response was things would be fine. After trying to get help for so long at Army Hospital and only getting drugs, I left there; now no provider; we had just moved here when this started - to share in the XXXXXXX of our grandchildren, so we knew nobody and had no recommendations for a doctor. I'm sorry to go on an on. I don't remember a day that I've been sick. Blood pressure, cholesterol, heart, blood work, I'm healthy. I just got into a situation I can't get out of because I made an awful choice to have that colorectal surgery. Grace is what I must have; I do not. Again, forgive me for rambling. I'm so at a loss.
doctor
Answered by Dr. Grzegorz Stanko 18 hours later
Brief Answer:
MRI s the key.

Detailed Answer:
I can see you are very tired of being in this situation. It is understandable. Asking for help and getting nothing always cause pain and suffering. Sometimes even more than physical pain. I do understand that.
Mesh placed in the pelvis for prolapse is something that could cause pelvis nerves injury and pain as well as colon removal and MVA.
I want you to start it over. Try to not think what was before. And try to focus what should be done to fix the problem. I know it wont be easy, but this is necessary to get proper solution. When you meet a doctor and give him/her so much information at once, this doctor wont be able to get from all this information the most important thing and put you to proper diagnosis.
You need to clearly point out the problem when you next time meet a doctor.
We can not get forward without two simple tests:
- lower spine andpelvis MRI
- MRI entregraphy or CT entoreclysis
- neurosurgeon consult with this results and colorectal surgeon

If its possible to get back to Mayo Clinic please try to do that.
I can not help you any more without this tests.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 2 hours later
I will swallow my pride and have military hospital order tests - they owe me that much. I will also follow through with exactly what you have said. Too many years; too much information; I see what you mean and I try to tell it to a doctor and it just comes out like there's no sense to any of it.
I'm lying here wondering how this all went about then saw your answer. Perhaps you are an answer to prayer. I am scared beyond all imagination because of not being heard.
Give bowel movements, cramping in area of transverse or hernia repair = it is too hard to tell, but, it is not normal and it didn't happen until hernia repair. But sigmoid resection was 8 months prior. I did pull something in resection area. I'd have to know what the doctor needs to request as the radiologist only looks at the area the doctors submits. Thank you. A little encouragement was needed. I hope I can be well again. I have fought a battle too long. Thank you for believing in me. By the way, I know opiates don't do anything for neuropathic pain. It's curious why I only have it while lying on rectum. Thank you so very much. I will write to the Commander asking for tests immediately. They know their mistakes; too many doctors fired for mishandling not only me but others. If I have done something to prevent another from this nightmare, I am glad. Bless you.

The "back pain" is right above and on each side of rectum. Coccyx or sacrum has been questioned. I do not have back pain like one would think. In fact, my spine MRI from a year ago looks remarkably good - as if it were from a 40 year old. Amazing that mild stenosis in the cervical disappeared. I wrote letter to Commander and have my marching orders. Thank you for giving me some hope. And yes, once I have tests, I can return to Mayo.

Would you be interested in seeing the actual cd's of tests? Reports, I find often, say "to be checked clinically" but nobody checked. As I said, after two major surgeries, my provider did indeed only give opiates which, I also told you I am off. She was not malicious; she was out of her league. She was fired. I mean no harm on anyone but no doctor should practice when he/she only medicates. i won't bother you until I have all the tests. I have been given a ray of sunshine. But, guarded. It's been a long 2 plus years then the two years prior from MVA - that's a lot of drugs. My best.
doctor
Answered by Dr. Grzegorz Stanko 2 hours later
Brief Answer:
Pelvis nerves must have been injured.

Detailed Answer:
Cramps before bowel movements simply indicate narrow intestine. Please imagine that there is a narrow pipe. You try to put hard stone through it. You push it harder and harder as the stone can not go through it freely. This pushing and pushing is nothing more than cramps. Intestine muscles give you pain when the stool can not be pushed through narrow intestine. And when it finally does, there might be explosive stool excretion and cramping disappearance.

The compression does not have to be in spine. It can be in pelvis. Due to mesh or sigmoid resection. Please see this image http://www.medicalexhibits.com/obrasky/2010/10159_06X.jpg . It should help you a little to undestand about the nerves I am thinking of. Some of this nerves must have been injured. Some could get cough into stitches. Especially during mesh insertion.

Pain while sitting can be due to this nerves compression. But without mentioned tests we can not go forward.

CDs should be checked by a doctor who will be deciding about surgery. This is neurosurgeon in my opinion.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 30 minutes later
Why did I have "to go to India" to be heard and get some incredible attention. I should hear from Commander of Hospital tomorrow. He knows he can't deny me. I have to be specific in what is read by radiologist. Did you get my message that the pressure/pain in tailbone/sacrum/side where resection was done (I pulled it a couple of months ago and stool fell out) I will go to site. Also, if there is a way to send actual films, I will. As I've said, radiologist only look at area specified. We caught something in coxxyc or sacrum as dr was scrolling through. Don't know what was done with that. Yes, by the way, there are good doctors here. In fact, the doctor who did my hystectomy/bladder sling/repair, is wonderful. I know hurts for me but when rank is involved, hands are tied. Promise I will get tests. You certainly came through for me - I think I got on you for not listening - maybe we are helping each other - I've always been on the giving end. I'd go XXXXXXX if it would help and I mean that. But, I would imagine my insurance won't cover it. Thank you for giving me a ray of hope and hanging in with me. You don't know how much you've helped. Do you want me to close discussion until I have tests?
doctor
Answered by Dr. Grzegorz Stanko 17 hours later
Brief Answer:
I hope you will find the good solution.

Detailed Answer:
I hope you will find the solution. I know it is possible. Just start with the mentioned tests.
You do not have to close the discussion. Its all up to you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 1 hour later
I have a provider (necessary before I can have tests) on Tuesday. Commander agreed to do tests with provider's instructions - I will give him your recommendations.
Anything about the hernia area? It wouldn't be near colon, am I correct.
The pushing in of tailbone and movement in abdomen makes for not feeling so great.
I will let you know. You have been a faithful doctor with kind dedication and advice. I've spent more time with you than a doctor here would allow. I will let you know when I know something. Will get the recommended prescription and, if there is anything you recommend that is detailed - exactly where the radiologist should focus, please advise, as a body has a lot to look at but he/she won't address anything that isn't on the request. Thank you.
doctor
Answered by Dr. Grzegorz Stanko 11 minutes later
Brief Answer:
Detailed below.

Detailed Answer:
The radiologist should ask to this questions:
1. Possibility of intestine being stitched to the abdominal mesh.
2. Visible signs of large and small intestine narrowing.
3. Possible nerve/pelvis mesh conflict.
4. Possibility of spine disc herniation and/or spinal cord compression in the lumbal and sacral area.

All of this can be hard to diagnose with single MRI. So MRI enterography should be suggested as well.

I`m am glad I could help you even there is so much to do and you can not be sure my diagnosis is correct (there is no possibility to perform physical examination and to go through your medical history with details). But for sure mentioned tests are necessary.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 36 minutes later
I'm having both tests. A big concern is what is poking me in the tailbone which moves? It also is near resection - where he put the colon on side of rectum. I pulled something right near there and continue to feel it - that is when stools fell out. I'm sorry if I repeat myself as I've asked several doctor on your site.
I was told to go see Gastroenterologist. Do you agree?
The fewer doctors the better.
I may be breaking rules asking you so many questions so please advise.
Would you know why there is so much movement under mesh? Forgive me if I'm asking things outside of your specialty - I learned the hard way not to ask a doctor about anything that isn't related to his/her specialty. I can tell you this, after such huge movements, more changes have taken place. Colonoscopy, barium enema; but nobody addressed the awful pain in/near rectum. If I'm asking too many questions, let me know, or the moderators will. I just want a life and two years plus of ignoring this; just drugging me for pain hasn't helped matters. Soon, we'll know.
doctor
Answered by Dr. Grzegorz Stanko 19 hours later
Brief Answer:
Gastroenterologist is not a correct address at this point.

Detailed Answer:
Well, I do not think gastroenterologist is the correct address. You need to have mentioned tests first. And most likely general surgeon (or colorectal surgeon) is the correct address.
Tailbone pain can be due to mesh being stitched to nerves or nerves injury during large intestine removal. I have been talking about it few times. This is why You should have MRI done. Narrowing (which has been diagnosed before) can be the case as well. This should be diagnosed with mentioned tests.

Movement under the mesh means that there is no muscles between mesh and intestines (it is simply called hernia). The other possibility is that intestines have to do much more work than regular as adhesions cause narrowing. This will also be visible in MRI enterography.

So please try to wait till this tests and see what the results will be.

And you can ask as much as you need. Do not feel like asking too many questions.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Grzegorz Stanko

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