Suggest treatment for urinary incontinence, lower abdominal pain and DDD

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Posted on Tue, 9 Jun 2015 in Abdominal Pain
Question: I have an ileostomy and I am a diabetic who has had urinary incontinence for the last 6 months. Now I am having pain in lower abdomen, around my Stoma, in my perineal area, can't sit for long, have degenerative disc disease and now neuropathy in legs, situation with incontinence getting worse, when ileostomy works Stoma swells and great perineal and abdominal pain, stomach bloated, can't eat much, get full fast. Why do I have so much discomfort if I don't have a rectum or an anus and why is my stomach getting so big and my food taking so long
to come out?



g to come out after I eat?
doctor
Answered by Dr. T Chandrakant 5 hours later
Brief Answer:
Could be gastroparesis with mechanical obstruction near ileostomy.

Detailed Answer:
Hi.
Thanks for your query.

To recapitulate: Female/55 - Diabetes - neuropathy in legs - urinary incontinence - degenerative disc - when ileostomy works Stoma swells and great perineal and abdominal pain, stomach bloated, can't eat much, get full fast. Wants to know the reasons for so much discomfort if you don't have a rectum or an anus and why is the stomach getting so big and the food taking so long.

I can think of the following reasons from the history your have provided:
- When the ileostomy works, the stoma swells indicates that there is obstruction to the outflow of the feces, we have to explore the reasons for.
- The back pressure thus created causes the bloating, pain in abdomen and perineum.
- This in turn causes the feeling of fullness and that you can not eat much.

The probable reasons are:
- Diabetes which has caused neuropathy can cause the condition called gastroparesis.
- The causes of the mechanical obstruction at stoma may be one of the following:
- Stricture at the stoma.
- intususception , in which the mucosa or part of the wall gets advanced to cause a valve like mechanism.

I would do the following in such a case:
- Do the digital examination to asses the size of the opening and to feel any mechanical obstructing factor has appeared or not.
- Ask for the barium study of the ieostomy and preferably a Barium meal and follow through for the whole intestinal tract under fluoroscopy control (where direst visualization is possible of the advancement of the barium in real time).
- Will get you treated for the treatable cause as found on the above investigations.
- I am sure your diabetes is under control and you are taking medicines for neuropathy and seen an Urologist for the urinary incontinence issues.

I would like to know the reasons for which ileostomy was done and when was it done?

I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications or if you feel there is a gap of communication.

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

General Surgeon

Practicing since :1984

Answered : 17977 Questions

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