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What Causes Constipation, Gastric Issue, Nausea And Abdomen Pain After Abdominal Adhesion?

Posted on Tue, 4 Oct 2016

Question: I had extensive large bowel adhesions removed sept 2. I was on citromag daily 1/2-1 bottle. since mid July as nothing would pass through the adhessed bowel. I am 2 weeks post op and my bowels will not work with citromag. I have no feeling or ability to move the bowels. Very little gas moving. My dr says continue citromag, I am concerned my bowel have stopped working because of this prep. I am nauseated and in pain everyday, housebound.

Answered by Dr. T Chandrakant (8 hours later)

Brief Answer:
X-ray of abd in standing position and serum electrolytes.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: Female/44 - Operated Sept 2 - extensive large bowel adhesions removed - 2 weeks post op - bowels not moving with citromag half to one bottle a day and plenty of water - no feeling or ability to move bowels - very little gas moving - nausea - pains - housebound - no opiates - huge distension - very little sounds ...
My thoughts:
- Citromag is an osmotic laxative meaning it draws water from the intestinal wall and helps softening stool. If it is not working means there is a problem.
- What foods/liquids are you allowed to take or taking since surgery?
- Since you are symptomatic, there is a problems. Needs clinical evaluation and examination along with investigations:
I would advise you the following:
Visit your Doctor/Surgeon / ER
X-ray of the abdomen in standing position will give an idea about the dilated bowels, whether there are fecoliths or not and the level of obstruction if any.
Blood electrolytes will give an idea whether there is any deficiency of potassium which has to be normal for the bowel muscles to act. If it is less, simply supplementing potassium can help move the bowels. Please get this asap.
These two investigations can helps you to know the reasons for the symptoms you have and also helps in management.

I hope this answer helps you to get an early and proper diagnosis and treatment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (6 hours later)

I meant to day the bowels will not work without citromag

Answered by Dr. T Chandrakant (7 minutes later)

Brief Answer:
Bowels work/ should work without any laxatives

Detailed Answer:
Not necessarily.
Citromag enhances the normal movement by drawing and retaining water into the large colon. This softens the stool and stimulates the rhythmic movement of the muscles in the colon, leading to a bowel movement.
Ideally the bowel movements should occur without any assistance.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. T Chandrakant (10 minutes later)

Yes. My concern is that the bowels do mot move without citromag. Ive been on it for 9 weeks and now have no feeling, no bowel noises, no movement with citromag. Hige distension, no urge, no ability to strain unless i take citromag

Without citromag there is nothing happening in bowel. Zero

Answered by Dr. T Chandrakant (2 hours later)

Brief Answer:
Additional investigations as advised

Detailed Answer:
This is the necessity for having additional investigations as advised above.
Please get these done and post the reports.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. T Chandrakant (22 hours later)

I went to ER. They said CT scan in the next 3 weeks.
I will never make it 3 weeks

Answered by Dr. T Chandrakant (2 hours later)

Brief Answer:
Insist

Detailed Answer:
You may have to insist.
What about serum electrolytes?
And plain X-ray of the abdomen in standing position?
These would get an idea and may be admission to the hospital for proper management.
Try to consult you operating Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (7 minutes later)

Ok. Thanks.
They said contact my GP for an urgent referral to geberal surgeon monday morning. Xray showed colon completly full includfibg rt side. Said do enema at home. Enema failed to work. I will have to return to ERas pain is worsening.

Answered by Dr. T Chandrakant (8 hours later)

Brief Answer:
Serum Electrolytes.

Detailed Answer:
Yes, this is what I was trying to tell.
You need urgent care as per the clinical findings and investigations.

Please get the electrolytes done as less potassium in the blood can also cause such a problem and simple potassium supplement as per the report can solve your problem.
Please insist on serum electrolytes urgently.
Go to ER.
Insist on Serum electrolytes and other investigations of blood.
Request for enema or whatever they can do for evacuation. You need evacuation of the colon.

I can understand the plight you must be going through.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (15 minutes later)

Thank you. I appreciate the reply. I am in a great deal of pain and need help now, not when then arrange CT and surgeon. I will try ERagain.

Answered by Dr. T Chandrakant (3 minutes later)

Brief Answer:
As detailed below.

Detailed Answer:
Hopefully they arrange necessary things in ER.
Please insist on serum electrolytes as explained above.
Request for evacuation by whatever means they can do as enema at home has failed. For the enema to act, one needs active and contractile colon and rectum.

Please give feedback.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (9 minutes later)

Alright. I will. Thankyou

Answered by Dr. T Chandrakant (8 minutes later)

Brief Answer:
Please give feedback of the developments

Detailed Answer:
Most welcome.
I shall be happy to assist you till you get alright.
All the best.

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar