CD and strictures?

[jaxgirl]

Have had CD for several years, having had one SB resection. Almost 18 months without a flare and then this week, pow! Ended up in the ER but no obstruction per the CT scan. Just inflammation, per the dr. Now taking Cipro, but have a huge distended belly. Haven't had the normal colonoscopy in some time. Can someone advise how strictures present? Would the CT scan not have detected strictures? Very worrisome and look forward to some insight from others. Thnx.

 

[Pointy_ears]

I'm sorry to hear your not feeling well right now. My understanding of structures is they first present as thickening of the bowel and therefore should show on a CT scan. Are you still able to poop and pass wind with ease? If so the distension may be due to the inflammation. Hosever if you're in a lot of pain and are in happy with the answers then push for more tests. I find if you kick doctors hard enough you usually get your own way. Good luck and I hope you feel better soon!

 

[jaxgirl]

Thanks so much for the reply. I continue having problems with a distended gut but no pain and not a lot of bubbling gas. Today, I did learn that Miralax with lots of liquid might help with bowel movement. Also, I found a GI here who can see me next Wednesday. That has taken away some of the stress I was feeling. I just don't want to return to the ER.

This evening, I recalled that when my last colonoscopy/endoscopy was done a year or so ago, the opening where the small bowel was reattached after the resection, was very, very small. Not sure why the CT didn't bring that to the attention of the ER doc.

Thanks again!

 

[AJC - Australia]

hi jaxgirl....it could also be scar tissue at the surgery site from 18months ago....if you are generally feeling ok, not like you were feeling before surgery last time, if you are feeling ok and just get bloating it could be scar tissue and food getting caught at the surgery join/site....i have had this and the tummy blows up and you feel like you need to do a gargantuan fart the size of a swimming pool! Is that how it feels? Or is there pain every time you eat and no appetite?

 

[Mimzim]

I have a stricture too and have no idea what the symptoms I missed were. It didn't bother me until it was nearly blocked, which stinks. I hope to figure it out and if you do, please share! BTW, I'm a Jacksonville native too!

I'm definitely going to ask my GI after my surgery how I can more closely monitor this and avoid another one. I'm thinking with all I've read on here, there may not be that tell-tell sign, except annual colonoscopy's every year, even while in remission. I hope you're feeling better today.

Donna

 

[Crohn's gal since 1989]

I have a stricture too and have no idea what the symptoms I missed were. It didn't bother me until it was nearly blocked, which stinks. I hope to figure it out and if you do, please share! BTW, I'm a Jacksonville native too!

I'm definitely going to ask my GI after my surgery how I can more closely monitor this and avoid another one. I'm thinking with all I've read on here, there may not be that tell-tell sign, except annual colonoscopy's every year, even while in remission. I hope you're feeling better today.

Donna

A colonoscopy isn't going to locate a stricture in the small intestine as it only reaches a very small portion of it.

 

[jaxgirl]

Thanks happy poo poo... Appreciate your response. As it turned out, a couple of days ago, ended up in the ER and they did the CT and gave me Cipro. Will see the GI on Wednesday and schedule the colonoscopy, for sure. Last time I had an endoscopy/colonoscopy, learned I have a pencil sized opening where I had the surgery before. Imagine that's the problem, but now I've switched from constipation to diarrhea. Just hanging on right now with the Cipro, and Entocort. Thanks so much for responding. :smile:

 

[alex_chris]

Hi jaxgirl,

What meds have you been on in the last 18 months. If none, did you have regular blood tests to check out your inflammation levels?

As people said above, constant inflammation (even if you don't have big flares) can lead to scaring and strictures.

 

[LodgeLady]

Still very new to all of this, but I have a stupid question. If one has a stricture, does the "poop" look thin, pencil like, or smaller is circumference than a regular, "larger" bowel movement?

Gosh, I feel so dumb asking this type of question, but hope on this forum I'm not the only one who is monitoring their end product....:redface:

 

[Jennifer]

LodgeLady - Yes it can look thin or flattened out. What I've also noticed is that you don't tend to have full bowl movements and tend to let out smaller amounts each time which can make it seem like you're going more frequently even if its formed each time.

I have a stricture from scar tissue at my resection site as well jaxgirl. Since my resection 14 years ago my disease has become active again and I now have inflammation at the resection site. Your CT scan showed inflammation which was likely at the resection site. It can be hard to tell if what they are seeing is inflammation or scar tissue when generally they see a narrowing and wall thickening. Knowing your history and doing blood work will likely tell them that its both scar tissue and inflammation (unless your inflammation is not at your resection site although it is common for it to return at the resection site).

When I went to the ER in June this year they did a CT scan and it showed a narrowing and wall thickening along with a mass. I was was kept in the hospital for a few days and was given IV steroids to get the inflammation down. The distention went down overnight along with the pain, nausea and vomiting. Luckily the IV steroids worked to clear the mass and since I've been trying to get the inflammation under control with different meds at home (Entocort, 6MP 25g and Methotrexate .3ml/week). For me this treatment is not enough. Even though my inflammation markers have gone down in my blood work I still get symptoms of a partial blockage from time to time (like today I have an increase in gas, pain, distention and more frequent bowel movements which are sometimes thin and in smaller amounts. I also don't have much of an appetite). Hopefully your GI will adjust your medication and hopefully that will be enough. If not then its possible that you may be facing another surgery (might not be a resection, you may be able to have a strictureplasty or balloon dilation) in the future if symptoms persist (that may be where I'm at now. I'll be seeing my GI next week on the 16th).

Keep us posted.

 

[Mimzim]

Hi Bonnie,

What about a stricture in the colon? That is where mine is. I have an MRI on the 17th to study my small intestine. Hopefully, there won't be one there.

Thanks,
Donna

 

[AJC - Australia]

hi jaxgirl...it is not nice when they tell you that. I remember waking up from colonscopys and being told 'pencil' thickness....'couldnt get the camera' through, etc. The thought of surgery is so overwhelming, again. BUT as Jennifer said, you might get away with a strictureplasty or balloon dilation and not need a resection. A resection of under 10cm might make the problem go away....ahhh, its all not fun to think about. I once saw the barium meal xray and the stricture site just looked dead. the rest of the intestine was moving and happy, but the stricture site was grey and just looked like it had died. I made the decision then to have it operated on, again.

Strictures are no fun.
Surgery is no fun, but I would rather have surgery in 2013 than in 1990!

 

[Justanothercp]

I had a bowel resection a number of years ago. I might be facing another. My question is: has anyone had the balloon dilation surgery for strictures rather than resection? And did it work?

 

[LodgeLady]

Ok I am starting to get real concerned. I have a Disney trip planned in 2 weeks. I get my small bowel series this Thursday which puts me about 10 days out before we leave. What happens if they find a stricture? Is that something that requires emergency surgery? Won't I have time to schedule it like when I get back? Hopefully if they do find any I can treat it with meds?

I did buy trip insurance but I REALLY need to go on this trip!

 

[Jennifer]

I had a bowel resection a number of years ago. I might be facing another. My question is: has anyone had the balloon dilation surgery for strictures rather than resection? And did it work?

I have to find some older threads but many people have done the balloon dilation and it does work for a while. The main thing to keep in mind is that it isn't permanent. Talk to your GI about whether or not you qualify for the procedure.

Ok I am starting to get real concerned. I have a Disney trip planned in 2 weeks. I get my small bowel series this Thursday which puts me about 10 days out before we leave. What happens if they find a stricture? Is that something that requires emergency surgery? Won't I have time to schedule it like when I get back? Hopefully if they do find any I can treat it with meds?

I did buy trip insurance but I REALLY need to go on this trip!

A stricture does not require emergency surgery. Many people live life with them for quite some time before needing surgery (whether its balloon dilation, strictureplasty or a resection). If its severe and causing a lot of symptoms then you'll likely set up a surgery date. The one thing you don't want to do is wait for it to become an emergency by allowing the stricture to cause a full obstruction which can perforate the bowel and that can be life threatening. Its best to continue monitoring it and keep track of your symptoms before scheduling surgery.

If its inflammation then your medication can be adjusted to help get rid of the stricture and surgery likely wont be necessary (unless it creates a full obstruction then you may still need emergency surgery).

Depending on your symptoms I don't see why you wouldn't be able to go on your trip.

 

[LodgeLady]

I have to find some older threads but many people have done the balloon dilation and it does work for a while. The main thing to keep in mind is that it isn't permanent. Talk to your GI about whether or not you qualify for the procedure.



A stricture does not require emergency surgery. Many people live life with them for quite some time before needing surgery (whether its balloon dilation, strictureplasty or a resection). If its severe and causing a lot of symptoms then you'll likely set up a surgery date. The one thing you don't want to do is wait for it to become an emergency by allowing the stricture to cause a full obstruction which can perforate the bowel and that can be life threatening. Its best to continue monitoring it and keep track of your symptoms before scheduling surgery.

If its inflammation then your medication can be adjusted to help get rid of the stricture and surgery likely wont be necessary (unless it creates a full obstruction then you may still need emergency surgery).

Depending on your symptoms I don't see why you wouldn't be able to go on your trip.

Thank you so much Jennifer!! This is just coming at the absolute worst time. At least I will know the severity from the test in plenty of time.
I am already with holding starting any new drug until I get back from my trip.

It is amazing how all of you have the strength and patience dealing with this disease. :hug:

 

[AJC - Australia]

hi lodge lady...i have lived for months and at one stage for over a year with a stricture...just battling it, trying to make it go away, but it never did. Some say that once it is strictured it will never heal, but I dont believe that.

Has anyone had a stricutre that has healed?

If they say it is strictured, you really just need to eat tiny portions and very little fibre (apples, salads, nuts, bananas, pocorn, etc) until you work out how to deal with the stricture.

 

[Jennifer]

happy poo poo - Strictures can be caused from inflammation, scar tissue or a combination of both. Inflammation can be treated with medication which will widen the narrowing allowing food to pass easier. There is no way to reverse scar tissue as its damaged tissue. Chronic inflammation can cause more scar tissue so its best to treat the inflammation right away to avoid more scar tissue. Inflammation can be healed, scar tissue cannot. Scar tissue can be stretched (not permanent and also weakens the tissue) or removed.