Suggest treatment for pain due to colorectal surgery and hernia repair

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Posted on Sat, 11 Oct 2014 in Abdominal Pain
Question: It has been 20 mod now since I had colorectal surgery - 24" colon removed for rectal prolapse; dr discharged me with wet bandages hence infection which I packed for 6 weeks then a hernia requiring my abdomen to be covered in mesh. I have pain at sight of colon removal and I cannot wear a bra because it pushes on the mesh. Swallowed the pill with rings which, with X-rays will show exactly why I cannot have normal bowel movements but have pain around the mesh as bowel moves down and at the site of removal, has not been addressed. If you were to ask my pain level, I'd say a 10 plus, but I don't like that way explaining pain because I can force myself to function if I have to. My MRI, in the beginning, was focused on spine because I was rear ended and doctor said I've had MRI's not even knowing that the MRI only was of spine so "Chronic Pain" has been the label thus not listening to the reports from the colorectal surgery or the hernia repair until the last few weeks when I finally got the attention of a colorectal specialist but he's not a specialist in hernia repair. What kind of test would show what is going on between stomach and mesh that restricts amount of food I can take in and the pressure of a bra? Health Care is crazy - if a specialist doesn't know the answer then it would be nice if he/she knew enough to recommend that I see the type of doctor specializing in this. The surgeon who did the initial removal of colon admitted I didn't need surgery; he was a flake; left two hospitals and is at his third office so that tells you that I made a bad call in letting him operate,but he was so smooth. I've learned one thing - just because a doctor shows a good bedside manner doesn't mean he is good and this doctor has ruined my life. I am reduced to being dependent - after being a General Officer's wife and the responsibilities included up to that point, I was independent and very healthy. At the stroke of a knife, I am ruined until the new doctors can identify problem. I have bladder mesh, colon mesh and mesh covering entire abdomen and I am in extreme pain; unable to have regular bowel movements and pain at the site where he cut a hole in the side of my rectum to connect colon. If my question is unclear, please state, as I have 20 months of garbage floating around in my brain with nobody to try to do anything, until lately, but treat me with drugs.
doctor
Answered by Dr. T Chandrakant 7 hours later
Brief Answer:
Ct scan / Enteroclysis / Alternative therapies

Detailed Answer:
Hi Madam.

Thanks for an elucidate history and for the opportunity you give me to be of assistance, which I will try my best.

I can understand the plight you are going through as this is a persistent problem occupying 24/7 and concerns with day-to-day activity.

To recapitulate: 20 months- 24" colon removed for rectal prolapse- with mesh at the abdominal wall for incisional hernia, mesh in the pelvis for prolapse of rectum and bladder mesh- Pain at the sites you explained- 10 + level- Pain at rectal examination- Rt leg pain / weakness- MRI spine ( probably normal )-

After reading the history provided by you and with reference to your previous questions and the answers our panelist had given you I would like to suggest a few things which may help us to get what is going on and what next can be done: I hope this will help you as it helps my all other patients.

Contrast enhanced CT scan of the abdomen - this will help us to get to know about the reduced capacity of the stomach, whether there are adhesions of the intestines / stomach to the abdominal wall at the site of incision ( this is the commonest problem), whether there is stricture ( constriction ) anywhere along the course of intestines till anal canal, intestinal obstruction and so on.

As for the pain- What is the nature of pain, I mean it is burning / throbbing / pricking / or so ?
Pains in your case look to me due to nerve entrapment in the scar tissues which are tough and widespread in some patients. The body's response in some patients is far more advanced than others thereby the internal scars being large and entrap more nerves/ more tightly causing all sort of pains.

The probable answers are: release or lysis. Releasing surgically helps. Lysis is destruction by cutting or injection is usually permanent and may last for 3 years to lifelong and the pain is reduced to bearable level or may be relieved. This will help the pain caused by bra too.

You may also try alternative therapies like acupuncture / Acupressure. An expert can really help you a the greatest of the extent and helps to relive the stress and anxiety which add on to all the problems you have.

Once the CT scan or Enteroclysis ( with barium studies ) is done the cause of other problems can be diagnosed and treated accordingly.
Please feel free to ask more if you need to.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 26 minutes later
Type of pain in the area where colon was re attached is like a toothache. If I remain totally still as in lying down, the pain
is less bothersome but once I stand up the pressure in that area causes movement to start feeling like an open wound or a toothache. It cripples me. The area above the mesh, abdomen is irritating as I cannot eat very much at one time as it seems too close to stomach and can't take much in. the abdominal pain is excruciating cramps; not a daily thing, but since the sitzpar test, I can feel areas where the bowel may be hung up. The site the colon was removed is painful but nothing compared to where he reconnected the bowel. i had a barium enema and it was an awful experience because, a first I'm told by the clinician, I exploded and fecal matter was everywhere. Something happened during that surgery to change everything and, in my opinion, under the mesh, although I don't have a hernia, I was never checked for type of infection, no blood work done before hernia surgery and no follow ups with the colorectal surgery because I had the infection and no follow ups with the repair because it was to be perfect and last forever. As you can see, I have had some doctors play "God" Does this answer your questions? I will
find out where the rings are with an X-ray on Friday, but, why would I have more pain now than before taking the pill and, I forgot to mention that I had a colonoscopy a few weeks ago and, once again, I was not totally emptied. To have an unnecessary surgery and have been in such good health, it is unbelievable that this has happened. Sure, doctors make mistakes, but, to send me home after 2 days, without checking bandages and then thinking the infection was no big deal and the hernia "a piece of cake" has me afraid that I will no longer have a life. I am grateful,however, that the new colorectal surgeon, after the colonoscopy started the test and seems to be active in finding the problem, but, it's been a long, painful journey; with hope dwindling. Thank you so much.
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Investigations to pinpoint cause and acupressure

Detailed Answer:
Thanks for your feedback , Madam.

I could get the following things: The pain in the lower area is less bothersome in lying down position- but like a toothache or open wound.
It can be best diagnosed by a high resolution CT scan, whether there is a collection or some other problem.

The pain above the mesh- irritating, can not eat much,

The abdominal pain - it is excruciating cramps- this is suggestive of an intestinal obstruction. Again a CT scan with oral contrast can help in diagnosis.
A simple X-ray abdomen in standing position also helps sometimes as it may show the signs of intestinal obstruction. This can cause the inability take sufficient food intake and causes the feeling of bowel is hung up.

I hope the New Doctor has told you the diagnosis on barium enema and colonoscopy.

Please let me know the report of all the tests including that of the pill with rings.
You may please discuss all these points with your new Colorectal Surgeon and his opinion on examination and investigations. Also think of re-exploration is there are signs of intestinal obstruction or so on.

Get properly investigated since this will give a guidance for the further management.Please discuss about multivitamins, probiotics and prebiotics, liquid diet.

Give a thought about alternative treatment like acupuncture or so.

I hope all your problems are still treatable and manageable to the extent of cure.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17967 Questions

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