Recovery pain after 3 weeks, laporoscopic resection

[drift]

Hi,

Pre-surgery condition: inflammation well under control with Humira, drinking 4 ensures per day and restoralax/coffee to have liquid stools and prevent stricture pain/obstruction. active and working 27 hours a week (stocking)

I had surgery on June 12th - an ileocecal resection, laporoscopic.
They expected 2 strictures but found 3 or 4 and took out 30 cm of small bowel and the valve connecting to colon. I woke up in severe pain which lasted 3 days and the painkillers barely helped. I knew I had an obstruction because I've had them before and it was the same feeling. Eventually the doctors got a CT scan and my bowel was distended above the connection, which he said was probably due to swelling at the connection. After about 3 days of not eating I was able to resume clear fluids. I ate a very small amount of 0 fiber food and was passing diarrhea (w/ dark blood). They let me out on day 5 .

I seemed okay for a day or two and started increasing my solid food but then after eating too much at once (which I thought I could get away with), I became obstructed. I spent the night in intense pain and vomited for a few hours. I really dislike spending time in hospitals so I did not call 911 because I managed to have a bowel movement meaning I was only partially obstructed, and decided to wait it out by myself, drinking clear fluids.

Over the next two days I started having bloody diarrhea and it started happening every hour where I was losing a lot of blood and anything I ate went right through me. So I finally decided to go to emergency and my hemoglobin dropped from 126 to 93 within a couple nights at the hospital. Finally the bleeding stopped and I was able to eat low - residue foods in very small portions. My hemoglobin went up to 100 and they let me go, saying I probably had a bleed from the connection.

So now I'm home and on a low-residue diet. I eat a small serving of food spaced at least an hour apart to ensure I don't get obstructed again. But I still get this pain which feels worse the more I eat and it comes in waves. It feels just like obstruction pain but partial and milder, it is internal, my outer incisions don't really hurt. Although I am passing gas and having bowel movements which have no blood. It hurts more when I am standing and I feel tightness, bloating and get acid reflux. After a bowel movement most of the pain is relieved.

The doctors tell me the pain is just part of the healing but I am still paranoid they missed a stricture or something is not right and that if I eat more volume/fiber than I currently am I will become fully obstructed. It has been almost 3 weeks since the initial surgery. I would classify the pain as mild, but moderate if I eat too much (full bowl of pasta eaten over 2 hours gave me cramps in waves for a few hours). I also seem to have dry mouth so I'm trying a lot to drink to avoid constipation.

My main question is if others still had pain 3 weeks post-op? And how much were you able to eat at that point? Did you get cramps from eating too much? And how long before this resolved? How long until you could eat larger meals and more fiber without experiencing pain, tightness, bloating and cramps?

Part of me wants to believe its just normal recovery pain and the connection is trying to heal, so food passing through this area will be painful. But there's another side of me that is paranoid that there is some stricture or complication they did not detect that will need further surgery to correct.

Thanks for any input

 

[UnXmas]

Hi drift, I've had around ten abdominal surgeries, and the one thing I've found is that recovery should be linear; although there will be fluctuations throughout each day (especially increases in symptoms after eating and before bowel movements), each week you should find that your pain, energy and nausea, etc. have improved from the week before. My experience has been that when my symptoms deteriorate, something's wrong, e.g. an infection. So even if progress is slow, as long as you are makiing progress I wouldn't worry. I think some pain at three weeks is to be expected, but do you think your pain has improved over the past couple of weeks?

Your ability to eat should follow the same pattern; I wouldn't say having trouble eating at three weeks is necessarily a bad sign, but I would worry if your appetite and symptoms after eating are not improving.

I don't know if it's the case with all bowel surgery, but I've had some where I've been told to follow a low fibre/low residue diet for six to eight weeks. I think you might do better to stick to low fibre meals, and small but frequent meals for a bit longer yet. And some people have trouble with fibre regardless of surgery.

If you get other symptoms that could signify a blockage, such as vomitting, or if you have an episode of pain more severe than you've been getting up til now, don't hesitate about going to the emergency room. If you don't feel any better now than you did a couple of weeks ago, tell your doctors. If nothing else they may be able to give you better pain relief. But three weeks is not long, so even if there is no complication, you will probably need some more time to recover fully.

 

[drift]

My pain level regarding the outer incisions, or the pain I felt when I sneeze/cough, has gone down since I left the hospital. My energy level has gone down because I had to return to the hospital last week due to a major bleed which the surgeon thought was the connection bleeding. So maybe that complication is prolonging my recovery time since the wound has to re-heal.

I have been told to stay on a low-residue diet for several weeks. However I am being extra-cautious and choosing the easier foods within that diet (avoiding fruits/veggies) and supplementing with Ensure so I can have smaller meals.

The hard part is my pain seems ambiguous. I'm unsure if its just gas pains and indigestion/bloating related to the connection healing, or if there is still some strictured area or some complication they could not detect.

Based on how I felt pre-surgery, the pain feels exactly like the partial blockage pain I used to get from eating, and comes in waves after I eat a larger meal, like its getting stuck. But I'm afraid to eat any more with mild pain and find out, because full obstruction is agony.

I mean all I can really do I guess is continue to eat carefully and see how it goes in 2 - 3 weeks from now. Because if pain after eating is the same at that point, then its probably more than just healing pain. It just sucks not really knowing what's going on and hoping things work out.

Thanks for your insight

 

[UnXmas]

Is it just the CT scan that you've had to check for a stricture?

I'm not sure how easy it is to know the cause of pain by how it feels, you can up to a point, because different conditions cause different types of pain, but there are so many factors. I've had a full blockage, perforated bowel, ileus, and multiple stoma blockages. The only one I could confidently diagnose myself with are stoma blockages.

Can you use other symptoms to give you clues? E.g. nausea and vomiting or a fever are signs of more than just recovery pains. Are you having fairly regular bowel movements? If you're not having stretches with no bowel movements, not passing only thin stools and not passing only very watery stool, that should give you some reassurance there's no blockage.

I don't think it's a bad idea to stick to very easy, low residue foods and Ensure, and have small amounts only. You've really had a major ordeal, it takes time to recover. I don't think you need to pressure yourself to eat more yet if it's already painful. I know I've found eating causes pain when recovering, and it didn't mean there was a stricture, it was just my intestines doing the work of digestion, which is painful when it's not yet healed.

Try not to worry too much. Stick to a safe diet. Seek medical help if things get worse, but give it more time yet before you expect the bad pains to fade.

 

[drift]

Pre-surgery I had an MRI done and they found 10 cm of strictured area. During the surgery though they found 2 more strictures and took out 30 cm of small bowel.

When I was in a hospital right after surgery I had a CT scan and my bowel was distended above the connection. The surgeon said it was probably due to swelling at the connection.

When I returned to the hospital a second time for bleeding the x ray showed no obstruction, but I also had no food in me as I was bleeding quite a bit.

I am having regular bowel movements which are soft and sometimes diarrhea but its also because I'm having a lot of fluid and mostly 0 fiber food (some 4 percent fiber)

So if there is a blockage at the moment its only very partial but I'm also being very cautious because I fear the pain of obstructions so much. I worry and feel like if I tried eating larger meals and higher fiber that I would end up having the same vomiting episode I had when I first left the hospital.

Its the fear of not knowing how things will turn out that bothers me but I can only hope for the best. I'm going to eat very carefully and It's either going to slowly resolve or it won't and I will need tests to find out why. I'm pretty grateful if I can keep my pain level to minimum, even if it means a longer than expected recovery time.