DS - constipation/slowed transit/colonic inertia?

Hi

i am considering DS without the gastric restrictive part and the malabsorbtive intestinal part as a treatment for my bile reflux.
its my understanding that the DS was originally designed to treat that problem rather than for weight loss.

i am not overweight, not at all but i cant finf much info about the DS or bile reflux, most time its mentioned in the context of WLS. so please excuse me that I am stumbling in this forum...but maybe you could help me anyway.

i have a severe chronic digestive disease (dysmotility of the entire GI tract). I have read many posts dealing with constipation problems which are sometimes severe enough to require intensive medical or even surgical treatment.

this is not something I can afford with my slowed transit. so I would like to know how many of you had significant constipation and/or slowed transit after surgery?
i know that without the intestinal part the bypass would rather resemble the proximal roux gastric bypass. but with the proximal roux gastric bypass, constipation seems to be even more frequent.

does anybodyknow the cause for the slowed transit after these procedures? does it have anything to do with altered digestive hormone levels? i read that PYY is often increased after surgery which slows intestinal transit.

thanks!

Welcome to our forum.  I am sorry to hear about your slowed motility.  I have been diagnosed with colonic inertia after my WLS (though I am now exploring the possibility of this being an incorrect diagnosis--long story). 

Could you explain more about how your gut configuration will be?  I don't understand how you can get a DS without a malabsorption component.  Is the surgeon just going to do a very minor Y-configuration of the intestines, with a limb taking digestive juices just a small-ish distance away from the stomach? 

Please do keep in mind that any significant malabsorption is going to increase the volume of your stool, and shoveling an increased amount of stool into a colon that doesn't work properly is not going to be pleasant.

I know what PYY is and what it does, but I do not know how surgery effects it, sorry.  I guess it could be due to our decreased intake leading to nutritional deficiencies, causing the body to want to slow transit in order to get more nutrients from food, but that's just a stab in the dark.

I do think that gut hormones are a lot more important than than they are often given credit for.

Again, best of luck...feel free to respond and I'll try to give any perspective that I can.  I have chronic difficulty emptying my bowels post-WLS and I know that constipation can pretty much ruin your whole life and I'm sorry you're going through this.

Kayla,

 

thanks so much for answering.

First of all, I had severe colonic inertia as my dysmotility affects the entire GI tract. I had multiple colon resections; finally, I had a total colectomy with creation of an ileostomy since I can’t evacuate due to rectal dysmotility/inertia.

My small bowel and stomach are also slow. My bladder does not empty any more; that’s why I have a permanent bladder catheter. I can’t eat normally due to the dysmotility; I have been on enteral and parenteral feeding for some time to restore my weight. I continue to have digestive symptoms and pain/nausea etc  but thankfully it’s not as bad as it was prior to the ileostomy. But to understand this one must know that before this surgery, I was in a state of chronic sub-occlusions. It’s not mechanical in my case, but those were pseudo-obstruction meaning that there is no mechanical blockage but just the impaired peristalsis.

“Could you explain more about how your gut configuration will be?  I don't understand how you can get a DS without a malabsorption component.  Is the surgeon just going to do a very minor Y-configuration of the intestines, with a limb taking digestive juices just a small-ish distance away from the stomach? “

Yes, I think you already got it. It’s also called a suprapapillary roux gastroduodenojejunostomy. There is a 60cm long Roux limb attached to the first few cm of the duodenum which is left in continuity with the stomach (stomach is left intact, too).

The biliopancreatic limb is pretty short, only about 25-30cm long and it’s reconnected with the Roux limb by a jejuno-jejunostomy.

So all in all it’s pretty much the same procedure but the Roux limb and the biliopancreatic limb are shorter and being reconnected much higher up .

That’s why I said that this configuration might resemble the proximal Roux gastric bypass as with the short limb variant the  biliopancreatic limb anastomosis is also higher up (in contrast to the long-limb variant).  With the bile diversion alone, the anastomosis is even a little bit higher up. So 30cm consisting of duodenum and a very small portion of jejunum do not see food.

BTW…I am sorry for my English…but I am from Germany.

So why do you think the diagnosis of colonic inertia may be wrong? and did you have any constipation issues before surgery? Do you know if your small bowel transit is fine? 

Do you know why one can read pretty often that people with proximal Roux gastric bypass with a short limb are more prone to have constipation issues?
thanks for answering!

Ah, ok, so you have had a colon resection.  The thought has crossed my mind and there are days I have cursed my colon.  But jeez--you have been through the ringer.  I feel even stupid for whining about my issues after all that you've been through!

Do your doctors think you have a problem with several areas of smooth muscle in your body?  Is there a neurological disorder or something that is contributing?  Is your esophagus slow too?

As for the constipation issues with RNY -- as far as I know, there are a couple of theories about the cause, and most of them aren't from decreased peristalsis.  Understand that after having a weight loss surgery, we are required to take a significant number of vitamin and mineral supplements and sometimes the large doses of these supplements can cause constipation (namely: iron & calcium).  Also, there is a very specific diet that is followed.  Weight-loss surgery patients have small intakes at first, and much of that intake is protein.  Low carbohydrate diets are often associated with constipation.  In RNY patients, I have also seen it theorized that since they often follow a low-fat diet as required by their doctor and therefore, that can often lead to a much firmer stool texture.  With the small stomach size, there can also sometimes be an impaired intake of fluid, so dehydration could play a part.

Another concern I would have for you may be a persistent bacterial overgrowth situation.  You may have even already dealth with it due to the decreased persistalsis.  But with no food ever passing in that biliopancreatic limb, it does increase the chances of bacteria overgrowth. 

Is the eventual goal to have you eating by mouth again?  I am very concerned that with such poor motility that you might not ever be able to consume enough food.  :(  That really is the pits.

As for me, I did a colon transit study and the markers were cleared within 2-3 days, so though I do know I have an extra long, extra wide colon, I think that for the most part, the muscles work ok.  I recently discovered that I have severe pelvic floor dysfunction and a very large rectocele as well, so right now I am just focusing on getting these things taken care of and seeing if maybe just having an outlet problem contributing to my severe constipation.  So I'm going to revisit the colonic inertia thing later if my problems are not fixed by fixing the outlet problems.  I don't have many symptoms of nausea/vomiting so I would not expect that I have small bowel transit issues at all.  I did not have any major constipation issues prior to surgery. 

I think a significant part of my discomfort is really volume of stool.  DSers have so much stool that any sort of impairment to emptying it out can put us into discomfort more quickly than it would a normal person.

thanks.

"Do your doctors think you have a problem with several areas of smooth muscle in your body?  Is there a neurological disorder or something that is contributing?  Is your esophagus slow too?2

my esophagus is ok. the cause is not defintely known. in general, either the nerves or the smooth muscles of the GI tract can be damaged or degenerated, and sometimes even both. There seem to be a degenerationsof the nerves in my gut, as well as some smooth muscle defects.
But as the tissue which was examined was not of good quality there is no definte statement.

It could be that my hollow visceral organs (bladder, uterus etc) have the same alterations.
anyway, my bladder does not function and my uterus seems to have impaired outflow peristalsis as well.

Sympathy only...I had esophageal dysmotility secondary to the LapBand, so I ahave a SMALL idea of what that is about.  And it resolved fully about eleven weeks post-op.  But I think the resolution was more the result of the absence of the band than the reconfiguration.

Best wishes to you...

Sue