Yes, I know, sounds backwards, but stay with me here.  I just need to bounce some ideas off ya's.

Can anyone think of any reason why fat would CAUSE constipation/slow motility in the intestines? I swear I have like a fat threshold.  It's like low fat = hard constipation, high fat = poop "stuck" in my intestines.  Sometimes, no joke, I can feel it sloshing around, getting "stuck" or "held up" in the upper part of my abdomen...yet I cannot actually go to the bathroom!

Is this a gallbladder/bile thing?  I don't have a gallbladder anymore, but I'm not ruling out some sort of bile duct problem or whatever.  How can I tell?

It's just...I was getting constipated, and I'd add more and more fat because that is what I THOUGHT was supposed to make things better, and yet, it was backwards.  Things were worse.  I was drinking my weight in water, trying trying TRYING to get things to pass, and when I finally would go, everything was very smooth, soft, floaty.  Very light in color.  Sometimes pencil thin, or I'd have lots of mucus on the toilet paper.

Theoretically, everything should have been smooth moving because the stool was soft.    But it's kinda like my intestines were having trouble "grabbing hold" of it to move it on through.  It was pretty sticky...I dunno if anyone knows what I'm talking about.  I even resorted to enemas a couple times last week and even THAT was not very helpful...because the stool is really smooth and sticky.  Miralax was not helping, either.  I already eat a high-fiber diet.  2-3 cups of veggies/day, high protein cereals, etc, but I often eat the high fiber stuff with lots of fat, butter, and cream. 

Does anyone have information on this?  I backed down on my mayo consumption and have been adding some low fat/high fiber meals (textured veggie protein, skipping my morning heavy cream coffee, no butter on my veggies), and things SEEM to be better, but I'm not holding my breath...I've been having incomplete evacuation problems for a year and a half.  At first I thought flagyl was my lifesaver.  Then I thought Primal Defense Ultra was it.  And now...I'm puzzled again!

My next GI doctor appt is on Tuesday and I want to go in with some ideas.  How would a bile problem be diagnosed?  Stool sample?  Colonoscopy?  Does this even make sense?

Thanks guys!

ETA: I've already had a CT scan with contrast (oral and IV).  Though, it was over a year ago.

Now I'm wondering about a possible biliopancreatic limb problem?

 may be  bowel partical (SP) obstruction or  kinked bowel. CT scan can tell
Good Luck
Vicki

Hi there Kayla...heres a little more reading regarding bowel obstructions...they can be a long time coming and are hard to diagnose in our rearranged anatomies.  Hope you find some resolve soon! 

Obstruction, Small Bowel

Author: Brian A Nobie FACEP, MD, Director of Recruitment, Consulting Staff, Florida Emergency Physicians, Florida Hospital, Celebration Health
Contributor Information and Disclosures

Updated: Nov 12, 2009

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• Overview
• Differential Diagnoses & Workup
• Treatment & Medication
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What is the role of single-pill combination therapy in helping patients reach BP goal? Learn about therapeutic options in patients who are likely to need more than one agent to reach BP goal. Review data

Introduction

Background

 

A small-bowel obstruction (SBO) is caused by a variety of pathologic processes. The leading cause of SBO in developed countries is postoperative adhesions (60%) followed by malignancy, Crohn's disease, and hernias, although some studies have reported Crohn disease as a greater etiologic factor than neoplasia. Surgeries most closely associated with SBO are appendectomy, colorectal surgery, and gynecologic and upper gastrointestinal (GI) procedures. One study from Canada reported a higher frequency of SBO after colorectal surgery, followed by gynecologic surgery, hernia repair, and appendectomy. Lower abdominal and pelvic surgeries lead to obstruction more often than upper GI surgeries.

SBOs can be partial or complete, simple (ie, nonstrangulated) or strangulated. Strangulated obstructions are surgical emergencies. If not diagnosed and properly treated, vascular compromise leads to bowel ischemia and further morbidity and mortality. Because as many as 40% of patients have strangulated obstructions, differentiating the characteristics and etiologies of obstruction is critical to proper patient treatment.

 

Small bowel obstruction.

[ CLOSE WINDOW ]

Small bowel obstruction.

 

 

Pathophysiology

Obstruction of the small bowel leads to proximal dilatation of the intestine due to accumulation of GI secretions and swallowed air. This bowel dilatation stimulates cell secretory activity resulting in more fluid accumulation. This leads to increased peristalsis both above and below the obstruction with frequent loose stools and flatus early in its course.

Vomiting occurs if the level of obstruction is proximal. Increasing small-bowel distention leads to increased intraluminal pressures. This can cause compression of mucosal lymphatics leading to bowel wall lymphedema. With even higher intraluminal hydrostatic pressures, increased hydrostatic pressure in the capillary beds results in massive third spacing of fluid, electrolytes, and proteins into the intestinal lumen. The fluid loss and dehydration that ensue may be severe and contribute to increased morbidity and mortality.

Strangulated SBOs are most commonly associated with adhesions and occur when a loop of distended bowel twists on its mesenteric pedicle. The arterial occlusion leads to bowel ischemia and necrosis. If left untreated, this progresses to perforation, peritonitis, and death.

Bacteria in the gut proliferate proximal to the obstruction. Microvascular changes in the bowel wall allow translocation to the mesenteric lymph nodes. This is associated with an increase in incidence of bacteremia due to Escherichia coli, but the clinical significance is unclear.

Frequency

United States

SBO accounts for 20% of all acute surgical admissions.

Mortality/Morbidity

Mortality and morbidity are dependent on the early recognition and correct diagnosis of obstruction. If untreated, strangulated obstructions cause death in 100% of patients. If surgery is performed within 36 hours, the mortality rate decreases to 8%. The mortality rate is 25% if the surgery is postponed beyond 36 hours in these patients.

Clinical

History

Obstruction can be characterized as either partial or complete versus simple or strangulated.

• Abdominal pain (characteristic with most patients)
  • Pain, often described as crampy and intermittent, is more prevalent in simple obstruction.
  • Often, the presentation may provide clues to the approximate location and nature of the obstruction. Usually, pain that occurs for a shorter duration of time and is colicky and accompanied by bilious vomiting may be more proximal. Pain lasting as many as several days, which is progressive in nature and with abdominal distention, may be typical of a more distal obstruction.
  • Changes in the character of the pain may indicate the development of a more serious complication (ie, constant pain of strangulated or ischemic bowel).
• Nausea
• Vomiting, which is associated more with proximal obstructions
• Diarrhea (an early finding)
• Constipation (a late finding) as evidenced by the absence of flatus or bowel movements
• Fever and tachycardia - Occur late and may be associated with strangulation
• Previous abdominal or pelvic surgery,  previous radiation therapy, or both (may be part of patient's medical history)
• History of malignancy (particularly ovarian and colonic)

Physical

• Abdominal distention
  • Duodenal or proximal small bowel has less distention when obstructed than the distal bowel has when obstructed.
  • Hyperactive bowel sounds occur early as GI contents attempt to overcome the obstruction.
  • Hypoactive bowel sounds occur late.
  • Exclude incarcerated hernias of the groin, femoral triangle, and obturator foramina.
  • Proper genitourinary and pelvic examinations are essential.
  • Look for the following during rectal examination:
    • Gross or occult blood, which suggests late strangulation or malignancy
    • Masses, which suggest obturator hernia
  • Check for symptoms commonly believed to be more diagnostic of intestinal ischemia, including the following:
    • Fever (temperature >100°F)
    • Tachycardia (>100 beats/min)
    • Peritoneal signs
  • No reliable way exists to differentiate simple from early strangulated obstruction on physical examination. Serial abdominal examinations are important and may detect changes early.

Causes

• The most common cause of SBO is postsurgical adhesions.
  • Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later.
  • The incidence of SBO parallels the increasing number of laparotomies performed in developing countries.
  • The second most common identified cause of SBO is an incarcerated groin hernia.
• Other etiologies of SBO include malignant tumor (20%), hernia (10%), inflammatory bowel disease (5%), volvulus (3%), and miscellaneous causes (2%).
• The causes of SBO in pediatric patients include congenital atresia, pyloric stenosis, and intussusception

 Hmmm   sounds a bit like what I've gotten in the last few days, although I haven't had bad constipation ..  It started out as "pudding" diarrhea, which oddly enough was tough to get out, and now what does come out looks normal in length (for the usual DS floating "medusas") for the most part, but is about as big around as a drinking straw (or pencil) ..   First thought was, "ut oh, bowel obstruction", but I'm not having any pain, fever, swelling, etc.    I do have this sensation after eating a meal as though I have a ton of acid in my sleeve, however .. . 


  As to Kayla's question, "LauraP" had a BP limb obstruction that required emergency surgery a year or two ago  ..   Maybe she can post here again what her symptoms were ..  

Hi Paul...this is a symptoms check list of a bowel obstruction that I post often.  If you were having an obstruction you would have lots of pain around your belly button...I have posted on other posts what it was like when I had my obstruction. 

Bowel Obstruction - Symptoms

 

 

The symptoms of a bowel obstruction depend on whether the blockage is in the small intestine (small-bowel obstruction) or the large intestine (large-bowel obstruction).

Small-bowel obstruction

• Abdominal pain. Most small-bowel obstructions cause waves of cramping abdominal pain. The pain occurs around the belly button (periumbilical area). If an obstruction goes on for a while, the pain may decrease because the bowel stops contracting. Continuous severe pain in one area can mean that the blockage has cut off the bowel's blood supply. This is a medical emergency. Call your doctor immediately.
• Vomiting. Small-bowel obstructions usually cause vomiting. The vomit is usually green if the obstruction is in the upper small intestine and brown if it is in the lower small intestine.
• Elimination problems. Constipation and inability to pass gas are common signs of a bowel obstruction. But when the bowel is partially blocked, you may have diarrhea and pass some gas. If you have a complete obstruction, you may have a bowel movement if there is stool below the obstruction.
• Bloating. Blockages may cause bloating in the lower abdomen. You may also hear gurgling sounds coming from your belly. With a complete obstruction, your doctor may hear high-pitched sounds when listening with a stethoscope. The sounds decrease as movement of the bowel slows.

Large-bowel obstruction

• Abdominal pain. Blockage of the large intestine usually causes abdominal pain below the belly button. The pain may vary in intensity. Severe, constant pain may mean that your intestine's blood supply has been cut off or that you have a hole in your intestine. This is a medical emergency. Call your doctor immediately.
• Bloating. Generalized abdominal bloating usually occurs around the belly button and in the pelvic area.
• Diarrhea or constipation. Either of these symptoms may occur, depending on how complete the obstruction is. Your stools may be thin.
• Vomiting. This symptom is not common with a large-bowel (colonic) obstruction. If vomiting occurs, it usually happens late in the illness.

Blockages caused by cancer may cause symptoms such as blood in the stool, weakness, weight loss, and lack of appetite.

Bowel obstructions in newborns

Key signs of obstruction in newborns are green vomit and failure to pass the first stool, which is made of a thick, greenish black substance called meconium.

Several other conditions can cause similar symptoms.

Thanks for posting all the info, Colene ..  

  No, no pain at all, so I guess it's not a BO ..   Just some strange stool habits for now ..    I have been taking 2 Nullos a day, plus Primal Defense daily (just ran out 2 days ago, btw), and no Flagyl in awhile ..  I don't know if that might have anything to do with what's going on or not  ..    

okay , now I am freaking out... I had some trouble healing from open revision.... had would vac as late as October...  I have a sensation there all the time... feels like something is going to pop out.  The other night, it woke me up and seemed to move .  It is located mid abdomen, left side of scar,,, it seemed to move down toward my belly button, and the area right around my belly button was really sore to the touch,,, almost felt bruised.  I got up and was dizzy,, and had some pretty hard pains.  I woke up dh, and then had to lay back down and it passed, the pain went away.  I still have the sensation in the old infection area, but it is a little more pronounced now.... 

Hi Shele...one of the first red flags to look for is pain in and around the abdomen.  Especially if you no longer have your gall bladder or appendix.  Bowel obstructions in DS patients can be difficult to diagnose as many times we can pass gas and have bowel movements.  Its usually not until late that we no longer are able to do these things.  This is a current link where Melody and I share our experiences with obstructions/partial obstruction.  Hope this can answer some of your questions/concerns.  The pain I felt I describe as more painful than child birth!  And did not go away...though I was not diagnosed until the obstruction became strangulated.  If you question how you are feeling and have pain that is constant your best option is to go and get it checked out...

http://www.obesityhelp.com/forums/DS/4103019/Partial-small-b owel-obstruction/#33449573

Okay... the whole description of your poo... TOTALLY mine 100%. The mucus on the toliet paper and everything.. I though the mucus was coming from the other hole.. ya know.. like the TP accidently touched that area and I was at the right point in my cycle.  Mine is always soft and sometimes pencil thin.

I should tell my GI doc about you... Maybe our docs can put their heads together.

LOL - I just emailed you this thread.  I'm glad to see you're on it.