Bowel cramps

[GinaCampbell 434]

Hi everyone!

I am 8 weeks out from VSG and as most of you know, I have had some complications.

My bariatric nurse is away for two weeks on holiday so I have no one to ask advice from.

For the past four days, I have been having bowel cramps and diarrhoea. My poop is orange (sorry).

Because I have IBS-d, my surgeons etc, have not been concerned about this. And I myself am unsure what IBS-d looks like after a VSG.

I first put this episode down to experimenting with new soft foods.

So I stuck to trusted things like chicken Soup (broth). Still cramping and pooping.

I figured my bowels now are just angry and inflamed and hoped sleeping would help. By bedtime, my belly is swollen (like with IBS), but cramps don't wake me up while sleeping.

This morning, I woke up with a soft flat belly. Lying there, I hoped for the best. Within minutes of waking up, the spasms started again.

The surgeon had an ultrasound done Saturday looking for anything unusual like gallstones etc.

All looked well. I do still have the abdominal abscess at 3 cm.

So the big question, when are bowel spasms and cramps not IBS-d? They feel like they are on fire, angry and inflamed.

I am not on pain meds so it is possible that I am simply feeling the pain more acutely.

I am keeping hydrated as much as possible due to the episodes of diarrhoea. (spasms at least once an hour now).

The thought of being in A&E waiting in a hard chair for eight hours, in pain and using the public toilets for these spasms, fills me with dread if this is not a serious problem.

Advice?

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[biginjapan 647]

First of all, I'll be the first to say you should talk to your doctors and go with their advice. Since it hasn't been that long since you've had surgery, this could be a short-term inconvenience for you. However....

I haven't had WLS yet, but I do suffer from ulcerative colitis (after 20 years of non-specific IBD), and the pain and spasms you are describing is something I deal with almost every day. Mornings are worst, but evenings can be bad as well (usually the daytime is fine). When I have a bad flare-up I might go to the toilet 10-30 times in the morning before I leave for work. Usually waking up and walking around will awaken the bowels as well, but since the first thing I do in the morning is have a glass a Water, that usually gets me going almost immediately. Even in my more normal periods, I still get cramps and pain like you describe (diarrhea is a part of my daily life), although it no longer happens every day. I understand the pain and frustration of not wanting to use public toilets when you might have explosive diarrhea and a lot of moaning involved as well. (I use the handicap toilets to get around this issue, if I can).

If things don't get better, maybe a colonoscopy would be in order to see if it something more serious? I take both oral (pills) and rectal (liquid enema) meds for my condition and the enema meds are fantastic for dealing with the cramping fire pain in the lower bowel (pills don't make it that far). I only need to take it once or twice a week for it to calm down the bowels completely. However, over-the-counter meds like Tums or Gas-X helps relieve the pain and pressure as well.

I don't know if any of this helps, but I definitely feel for you! Hope you can get some relief soon.

[GinaCampbell 434]

Thank you for replying! I have had IBS-d severely for thirty years and to be honest, like you, I just dealt with the runs as you do. Over here treatment varies but I have a home colonic kit prescribed by my GP to be used to empty my bowels so I can leave the house. I don't have any enema medication, the system just uses Water. I feel that if I could just calm my bowels down, soothe them. Things would be better.

I do have Gaviscon and lansoprazole for the upper parts. My stomach feels okay, not even gassy or burny, it's just my intestines.

I can feel my stomach empty, the noises start, then the minute Fluid gets lower, cramp and spasm starts.

I do have imodium for diarrhoea but it stops everything and I can't get Fluid in so I have taken the codeine phosphate only 15 mgs) the incontinence clinic prescribed for the diarrhoea hoping it might calm things down.

Unfortunately, my bariatric team are overloaded and a bit disjointed so it might be a couple of weeks before I can see anyone there to discuss things.

I am also trying to heal before they insist on removing my gallbladder.

I think that I will make an appt with my GP to see if there is anything he can do or try to get a referral back to the incontinence clinic.

How did you find out that you had gone from IBD to ulcerative colitis?

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[biginjapan 647]

How did you find out that you had gone from IBD to ulcerative colitis?

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(I apologise in advance. This is going to be long and maybe a little graphic).

Good question! I was moving from Japan back to Canada and with the stress of that the cramps and bowel movements became more pronounced. In particular, the stool was really different. It became very loose to pure liquid. Every colour of the rainbow came out, even a kind of translucent stool which I guess was solidified mucous. Even then I didn't think of going to the doctor until blood started appearing, which freaked me out. Unfortunately I had a trip planned to Vietnam before returning home, and I couldn't handle waiting for 3 weeks so I went to an international clinic there and they did a bunch of tests and told me they thought it was Crohn's or UC (and not cancer, which of course was my first assumption). They gave me meds and anti-inflammatories to deal with until I got back to Canada and could get tested properly. After my first colonoscopy I was told it was Crohn's-Colitis, but having seen a much better surgeon here in Japan he told me it was UC. He gave me the meds that I'm currently on (Pentasa, in both pill and enema form) and I've been happy with that. Unfortunately I have never lived in the same city as him, so going to see him regularly was a problem in the past, and now nearly impossible because of where I live now. I have yet to find a good gastroenterologist to replace him. So, instead of taking meds regularly, I take them when I have a flare-up, since I'm almost out.

The problem with being obese is that a lot of doctors don't believe you could have a disease that often leaves people at the very low end of the BMI scale. One doctor in Japan told me I had diarrhea and to eat more fibre, without doing a single test to prove himself right and me wrong! This was when I was in a really bad flare-up and basically had blood and mucous pouring out of my a$$ many times a day (I know, TMI, but that's often the case with this disease). Similarly, the doctors in Canada were very reluctant to believe I had this condition until the tests came back from the colonoscopy (in fact, I remember seeing the infected areas as I was very awake (i.e. high on meds) during the entire procedure). I almost said "told you so" to the gastroenterologist when he told me I had Crohn's Colitis. He was clearly shocked at the diagnosis. I was very happy when I found my gastroenterologist here in Japan (he is not Japanese BTW) who took me seriously from the start and moved his schedule around so he could a colonoscopy the next day because he was so worried about my condition. Anyway, I have since found research articles that indicate up to 30% of people with Crohn's or UC are obese, which they can't explain.

The problem with abdominal cramping and loose stools is that there are a lot of conditions that have similar symptoms, like lactose intolerance and celiac disease. I did go gluten-free for a month once (it was hard to maintain, mostly because I liked my beer in the summer months) and that helped tremendously with the symptoms (i.e. they disappeared). So clearly, even though I don't have celiac disease I have some level of gluten intolerance which causes flare-ups. Similarly, while most dairy I eat now is cheese or yogurt, when I add other things like normal milk or ice cream I get a lot of cramps so some lactose intolerance appears to be there too. But other things, like fibre (whole grains, gassy veggies, lettuce, fruit or vegetable peels, nuts, oatmeal, barley) are really problematic for me, as is alcohol (I'm off it now because I just can't deal with it). So...(sorry, this is really long!)

UC symptoms include severe abdominal cramping - most of mine was in the 'corners' of the large intestine. Cramping could be caused by food or stress (sometimes delayed). Often a person has to go (#2) multiple times a day - this doesn't necessarily mean something will come out, but your rectum will be in full cramping mode, regardless of what's in your body. For me, once food or Water hits my stomach it will trigger a response in the lower GI tract, even though I know it's impossible for it to move that fast. That said, when symptomatic, food would pass through my system so fast I couldn't take any pills - birth control, Tylenol, whatever, would be sitting at the bottom of the toilet bowl an hour or two after I took it. The only time I've ever seriously lost weight is when I've been symptomatic with UC. One of the posters in the doctors office referred to "rectal urgency" which I thought was a great phrase to describe the feeling of needing to go "right now" - 30 sec or less, because you didn't know how long to hold back the cramping. I've had some accidents. The whole "never trust a fart" after weight loss surgery is true for Crohn's and UC patients as well. Sometimes the cramping is in my large intestine, sometimes the rectum. And sometimes it feels like I'm sh*tting fire acid out of my butt - like the digestive juices or something. It's very painful.

If you look at the infographic here, I think a lot of UC patients have the bottom 3 types of loose stool (from loose and feathery to pure liquid). Blood and mucous are also usually part of the deal too.

Even though it's always the lower bowels that are affected, I have found that antacids like Gaviscon, Tums, Pepto Bismol help reduce symptoms. I don't know why. Sometimes eating helps stop the cramping as well, which seems counterintuitive, but at least for me it would work.

Okay, I gotta stop.

[GinaCampbell 434]

Oh no! Alot of what you are describing is what is happening to me! Severe urgency, cramping with or without poop, the "fire out the a$$" stuff. Also the eating thing, it hurts less if I eat. It can't be a coincidence though that I am eight weeks out from VSG and this starts.

I would really love to be sure it's not surgery related but the person available (dietician) said that they didn't touch my bowels and I had IBS-d severely before.

And these symptoms don't match gallbladder issues. The orange/yellow poop could be due to rapid transit.

Very painful but the codeine phosphate seems to be helping.

Just worried, that's all.

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[biginjapan 647]

For your sake, I hope it's not! It could be a complication from the surgery. However, people who have IBD are much more likely to develop Crohn's or UC so maybe this was going to happen anyway? That said, I'm hoping that having this surgery will help my UC (I've read many accounts that seem to indicate that WLS alleviates a lot of symptoms of UC).

I guess the best thing would be to get some tests (colonoscopy, blood, and stool samples) done to either confirm or rule out a Crohn's or UC diagnosis.

[KristenLe 5,979]

The orange/yellow poop could be gallbladder, liver or pancreas. I don't think (with all of the complications you've experienced already) that it's wise to guess what might be wrong. Wasn't it recommended that you have your gallbladder removed? This could definitely be caused from a gallbladder issue if a stone is blocking the bike ducts. It could also be infectious diarrhea. Don't wait to find out.

[GinaCampbell 434]

I had an ultrasound which didn't show any gallbladder issues so the bariatrics are putting the diarrhea down to my severe IBS-d which I had before surgery. I had a sample test after my last clinic appt (a few weeks ago) that ruled out any infections.

Obviously, I am concerned and would prefer to have proper investigations by my surgical team rather than guessing, but health care here can be hit and miss.

It will be at least two weeks if not more before I see someone in the bariatric team about both the gallbladder and the bowel issues.

My GP is seeing me Thursday but because my symptoms could be a range of issues, she would normally just refer me to a hospital consultant.

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