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Rectal constipation with ileostomy

Posted by bebbers, on Sat Dec 27, 2008 5:06 pm
Help! I've had an loop ileostomy for 4 months (colostomy for 10 months prior to this).
I still have a small amount of faecal matter passing through my large bowel and due to the Imodium to slow my bowels done, I am now really constipated.
I've tried Fleet Enemas, Microlax, Fleet Mineral Oil, Cooking Oil and water but nothing is shifting it and I'm in a lot of pain.
Does anyone have any suggestions?
Nurse
Reply by Whoa, on Sun Dec 28, 2008 2:42 pm
Hi Bebbers
dont know all your history, and not sure that matters at this point.

I would suggest seeing your surgeon or GI specialist, getting an xray to check if the pain IS from fecal impaction.   They can be dangerous if prolonged and difficult to clear.  

Has this been done yet?

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by bebbers, on Sun Dec 28, 2008 5:08 pm
Thanks very much for your help. I've managed to get hold of the Ostomy Nurse at the hospital and she is presently organising to get me in to hospital so they can investigate.
Thanks again!
All I wanted for christmas was a poo!!!!!
Nurse
Reply by Whoa, on Wed Dec 31, 2008 11:35 am
That's a first for a Christmas list!! Shocked  Smile

Though possible it could be stool,an intact colon even if severed (end ileostomy) or stool diverted higher (loop diverting ileostomy or colostomy) up will still make mucus which is often passed in hard balls; it can get stuck and make you feel constipated as if it were stool and be painful, cause problems.  I'm glad you took action to check it out.

I'd like to know what they find.   Hope you are feelig better and get this resolved.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by bebbers, on Thu Jan 01, 2009 2:25 am
I too believe it is both mucus, which has hardened, and some faecal matter. I've started passing a bit, a tiny bit, over the last couple of days, and I think that's due to the softening up from all the enemas. The ostomy nurse at the hospital has spoken with the surgical teams available at the hospital at the moment (my surgeon and GI specialist are on christmas holidays) - none of them think there can be anything there and are just monitoring me over the phone - but the nurse is now on holiday for new years!
12 months ago I had a sigmoid colectomy due to diverticula disease - then had a leak - then Hartmanns procedure - then various abdominal and wound infections - then a Hartmanns reversal and a ileostomy rising - then just before xmas I had a CAT scan due to high WCC and abdominal pain and they have found a complex cyst on my left ovary (which was previously infected from leak). It's been a bit of a rocky road, but must say this constipation is the most frustrating as I've spoken to everyone and anyone and don't seem to have an answer to flushing it out!
Thanks for your kind words and happy new year!!!
Nurse
Reply by Whoa, on Thu Jan 01, 2009 4:38 pm
Hey Bebbers!

The further away the fecal stream is diverted from the rectum, the more mucus you will make.  It sounds like your ileostomy is a temporary diverting loop to protect where they sewed your colon back together, from what you say.  So, that is a lot of bowel to make mucus.  In my experience, some people are big mucus makers, others not.  I have had patients require GI intervention to remove the mucus with scopes as it can get very hard and uncomfortable.    Another consideration is the anastamosis is strictured (narrowed) and things can't pass through easily;  or the nerve endings may just be touchy giving you the urge to go.  There may be other reasons too, those come to mind first..  

The anastamosis (reconnection site) usually heals in 8-12 weeks, but given your prior complications  it sounds like they are giving it extra time before doing a take down of your stoma and reconnecting your intestine..which is wise.

   Flushing things out:  I would advise checking with the physician before doing any enemas/using anything rectally just to be sure the anastamosis is not injured by inserting things into your rectum.  I would also advise getting in to be checked to make sure all is ok.  I am concerned that you mentioned things look like fecal matter. Given prior leak, new abominal pain, you should be checked.   If the pain gets worse or you do pass what appears to be more stool, I would advise going to the emergency room.   It's always better to err on the side of caution, esp. with what you have been through!

I hope I don't sound like doom and gloom....given your symptoms and history, it is very reaonsable to  be checked, and you should be more comfortable!

I hope you feel better, and would like to know what happens.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by bebbers, on Tue Feb 10, 2009 11:47 pm
Hi Whoa
Finally a reply! I ended up going to see my GI consultant, his immediate thought, after examination, was that the contrast enema xray I'd had earlier had now set like a rock in the rectum. He sent me off for an xray, and yes there was something. I did reassure everyone that it wasn't anything I had sat on! Anyway off to emergency room, and booked in for an operation. Happened next day - oh, lah, lah - problem solved. Surgeon and GI consult say it was a barium enema, and if not flushed, would set. My ostomy nurse disagreed, as she said they don't use barium. My discharge notes said to take regular laxatives - crickey, now that would be fun! I am passing fecal matter on a reasonably regular basis, but I can live with that. Apparently I had a very full bowel. And here's me thinking this department was having a wee holiday.
Hey Whoa, thanks for sharing your knowledge and being there to offer advice - I do believe, another who should be called a saint, rather than a nurse.
Nurse
Reply by Whoa, on Fri Mar 06, 2009 6:28 pm
Hey Bebbers
Glad everything came out alright ....  bad one , huh???

They do sometimes use barium in the rectum to check for leaks, even in rectal stumps.  Nasty stuff when they forget to give you something to get it out...have had others with and without stomas go through this.  It does harden like rocks and wreaks havoc..I'm glad you went in.    Xrays....the best diagnostic tool!

The interns often write orders for stool softeners and laxatives for ileostomates where I work....the patients usually catch it and tell me!  Listening to my drivel after all!

St. Whoa.... interesting sound to it......!

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by Rubyjack, on Sat Nov 18, 2017 11:28 am

Hi I have had an isleostomy for eighteen years after four major bowel operation due to obstructions caused by endometriosis scans show adhesion twisted the small amount of bowl I had left hat was six years ago I have had some problems with mucus from my anus passed some quite large rock hard after enemas and suppositories now I have pain in my stomach feel very sick and feel like something is stuck in my anus and cant pass it tried suppository etc no result gp exam showed normal bowel sounds and my isleostomy is working normally I have a very complicated medical history and yesterday saw a new consultant who did not have my notes he did have a six year old scan he told me I don’t have an isleostomy but a colostomy my bowel looks ok the problem can’t be mucus in my anus cos it’s sewn up and if my bowel is obstructing due to maybe adhesions there’s nothing he can do until it obstructs he said I will have a scan in eight weeks or so I am very worried be grateful for any advice 

 

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