Suggest Treatment For Chronic Constipation After Total Hysterectomy

Posted on Fri, 25 Sep 2015

Question: I have severe endometriosis, had a total hysterectomy 2 yrs ago and it's still active. I have just had another laproscopy (3rd since hysterectomy) which showed still very active. I seem to have a lot of pain associated with my bowel and this is how the endo first presented. I have pain in the thoracolumbar region, low back, posterior and anterior pelvic, pubic bone, vagina. I seem to feel better with a completely empty bowel (eg just prior to a colonoscopy). Colonoscopy has shown NAD, scar tissue was just removed from the bowel but pain in the associated areas persists. I have been tested for lactose and fructuose intolerance with breath tests which were negative. I have chronic constipation and when it's not constipated, diarrhea. I have tried the FODMAP diet to no effect. I have just seen another gastroenterologist who is referring me for coeliac blood test. Suggestions?

Answered by Dr. Srilatha Myaka (3 hours later)

Brief Answer:
endometriosis is a rare possibility

Detailed Answer:
Hello dear,welcome to healthcare magic.I understand your concern.
In my opinion the endometriosis is treated by three options depending on the age,severity,infertility due to endometriosis like :-
1)Medical management.
2)Laparoscopy.
3)Laparotomy-Hysterectomy.
Recurrence is common after laparoscopy ie.,10% at the end of 1 st year and 25% at the end of 3 years.
After the hysterectomy the ovarian effect is also lost within 1-2 years.And the chance of recurrence is rare after hysterectomy.
So your complaints due to endometriosis is less possibility.
As you are comfortable with empty bowel and varying with bowel distension the complaints might be due to bowel pathology.
Usually the celiac disease respond to diet therapy.But as there is no response a gastroenterologist opinion might be needed to rule out any other bowel abnormalities.
But there is less possibility of gynaecological cause.
Hope this satisfies your query.
Feel free to discuss furthur.
Best regards...Dr.Srilatha

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Srilatha Myaka (17 hours later)

Hi Dr. Srilatha, I've had 3 laproscopic surgeries following the total hysterectomy including oophrectomy and there have still been active endometriosis lesions which were found on biopsy. I am apparently a very extreme case. The gastroenterologist I just saw is having blood tests for gluten antibodies and as I removed most carbohyrates from my diet 7 years ago (bread, pasta, grains) I am having a few days of gluten containing foods before I have the test done so that antibodies will show up if I have an issue. Any exposure I have to gluten now would be in sauces or breadcrumbs on meat occasionally. I also am finding a metallic taste in my mouth after eating certain foods. Honestly I'm just hoping for an answer (whether it's celiac or others) It's been 6 years that I've been unwell and haven't been able to work full-time since then. I have a gastrocopy scheduled for October.. Will that show any duodenal damage (gluten) if I've cut most gluten from my diet anyway? I've also heard that gluten antibodies in blood isn't a definitive test anyway?

Answered by Dr. Srilatha Myaka (6 hours later)

Brief Answer:
Antiendomysial antibodies are sensitive for celiac disease

Detailed Answer:
Hello dear,I got your query.I am very sorry for your condition.
In my opinion total hysterectomy along with bilateral salphingoopherctomy (TAH +BSO)is the definite treatment for endometriosis.
In very rare occasions there might be persistence of symptoms even after TAH+ BSO.
Antiendomysial antibodies are 95% specific and sensitive for celiac disease.
Usually we will advise biopsy in the patients
with positive antibodies.
Most of the patients with celiac disease will have an episode of celiac disease in childhood which disappears and reappears in later life.
So I suggest you consider speaking with your doctor regarding biopsy.
This biopsy is endoscopic guided.
Gastroscopy alone might not help in diagnosis of celiac disease.
And also new HLA based test like DR2/DR8 will help to rule out celiac disease.
Hope this satisfies your query.
Feel free to discuss furthur.
Best regards...Dr.Srilatha

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