Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Severe Back Pain And Tightness After A Total Colectomy
Question: I had a total colectomy 4 years ago secondary to ulcerative colitis. I had a jpouch formed and had a temporary ileostomy for 4 months before my takedown. I am very healthy now with no major issues.
When I awoke from my colectomy, I had severe back pain in the mid to low thoracic and upper lumbar regions on either side of the spine. This dissipated with time. Now, however, when I exercise, especially walk, I feel pain in my back in the same place as after my surgery and it feels the same. It goes away after resting. The pain feels like a tightness.
Anatomically, during the colectomy, what structures are involved in the back that would cause this or procedures during the surgery? Any insight would be appreciated. Thank you
When I awoke from my colectomy, I had severe back pain in the mid to low thoracic and upper lumbar regions on either side of the spine. This dissipated with time. Now, however, when I exercise, especially walk, I feel pain in my back in the same place as after my surgery and it feels the same. It goes away after resting. The pain feels like a tightness.
Anatomically, during the colectomy, what structures are involved in the back that would cause this or procedures during the surgery? Any insight would be appreciated. Thank you
Brief Answer:
Get an Xray done and let us know.
Detailed Answer:
Hello Mam.
Back pain after Colectomy could be due to a number of causes. Commonest causes are due to the prolonged positioning during Surgery. Then anesthesia causes could be possible. If they gave Spinal or Epidural anaesthesia or analgesia. Usually Intestinal surgery does not lead to such pains unless the root of mesentery is pulled but this should not happen in Post op period. Therefore I dont think it is anything to do with the intestines. So do not worry
I suggest you consult a Surgeon who can examine you and get an XRay done for the Spine. That would give us a good idea of whether anything is wrong.
Take care.
Dr Rishi, New XXXXXXX XXXXXXX
Get an Xray done and let us know.
Detailed Answer:
Hello Mam.
Back pain after Colectomy could be due to a number of causes. Commonest causes are due to the prolonged positioning during Surgery. Then anesthesia causes could be possible. If they gave Spinal or Epidural anaesthesia or analgesia. Usually Intestinal surgery does not lead to such pains unless the root of mesentery is pulled but this should not happen in Post op period. Therefore I dont think it is anything to do with the intestines. So do not worry
I suggest you consult a Surgeon who can examine you and get an XRay done for the Spine. That would give us a good idea of whether anything is wrong.
Take care.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Muscles are not touched during Colectomy.
Detailed Answer:
Hello Mam.
I am a General Surgeon and I have performed Colectomies.
During colectomy muscles of the back are not touched at all. The colon is separated from the retroperitoneal fascia. Muscles lie far back from the field of Surgery and that plane is not violated.
If you feel that it is muscular then you could take some muscle relaxant medications or you could consult the operating Surgeon for residual queries.
Dr Rishi, New XXXXXXX XXXXXXX
Muscles are not touched during Colectomy.
Detailed Answer:
Hello Mam.
I am a General Surgeon and I have performed Colectomies.
During colectomy muscles of the back are not touched at all. The colon is separated from the retroperitoneal fascia. Muscles lie far back from the field of Surgery and that plane is not violated.
If you feel that it is muscular then you could take some muscle relaxant medications or you could consult the operating Surgeon for residual queries.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your response. It was helpful. I did not realize the back muscles were not touched. Fascia is not innervated so that should not be the cause. It is not bothersome enough to take medications for as it only occurs when i am exercising. I never had this pain before surgery and now only feel while exercising and it quickly goes away with rest. I am just curious as to why it is always in the same position. I am a physical therapist and a professor who teaches neuroanatomy. I dont think it is neural as it is bilateral. It feels like the paraspinal muscles. Are any structures in that region reattached or tethered when colon is removed? Could you tell me the simple steps of when it is removed? Thank you
Brief Answer:
Surgical steps in detailed answer.
Detailed Answer:
Hello Mam,
I presume you would have had an Open Colectomy and not Laparoscopic.
The steps for standard open colectomy would be as below.
1. Midline longitudanal abdominal incision.
2. Inspection of abdominal contents.
3. Colon mobilisation starting from right side. Caecum is mobilized from lateral peritoneal attachments close to the cecal wall and going upwards till hepatic flexure. Here the mesocolon is divided to separate colon from duodenum and pancreas.
4. Some Surgeons at this point divide the ileum from the Caecum with a Linear cutting stapler. Then the mobilized Rt colon is lifted and ileocolic vessels ligated and divided. This facilitates mobilisation till distal transverse colon.
5. Left colon mobilisation is then commenced starting from sigmoid colon whose mesentery is ligated at the base and dissection continues till Splenic flexure.
The transverse colon is then pulled and Splenocolic ligament divided close to the colon. Then the left colic vessels are ligated and divided and this leaves the entire colon mobilized.
6. Next the rectum is mobilized for proximal few centimeters and divided with a linear stapler. The ileo rectal anastomosis can then be fashioned by hand sewn technique or a Circular stapler.
Therefore, muscles are not touched or even seen during the Surgery.
You could be having paraspinal spasm as you rightly suggested and that is why I suggested an XRay of the LS Spine which could show Paraspinal spasm.
You should do Spinal extension exercises which could improve your pain.
All the best.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Surgical steps in detailed answer.
Detailed Answer:
Hello Mam,
I presume you would have had an Open Colectomy and not Laparoscopic.
The steps for standard open colectomy would be as below.
1. Midline longitudanal abdominal incision.
2. Inspection of abdominal contents.
3. Colon mobilisation starting from right side. Caecum is mobilized from lateral peritoneal attachments close to the cecal wall and going upwards till hepatic flexure. Here the mesocolon is divided to separate colon from duodenum and pancreas.
4. Some Surgeons at this point divide the ileum from the Caecum with a Linear cutting stapler. Then the mobilized Rt colon is lifted and ileocolic vessels ligated and divided. This facilitates mobilisation till distal transverse colon.
5. Left colon mobilisation is then commenced starting from sigmoid colon whose mesentery is ligated at the base and dissection continues till Splenic flexure.
The transverse colon is then pulled and Splenocolic ligament divided close to the colon. Then the left colic vessels are ligated and divided and this leaves the entire colon mobilized.
6. Next the rectum is mobilized for proximal few centimeters and divided with a linear stapler. The ileo rectal anastomosis can then be fashioned by hand sewn technique or a Circular stapler.
Therefore, muscles are not touched or even seen during the Surgery.
You could be having paraspinal spasm as you rightly suggested and that is why I suggested an XRay of the LS Spine which could show Paraspinal spasm.
You should do Spinal extension exercises which could improve your pain.
All the best.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
