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Old 11-22-2005, 05:27 AM   #1
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sorrel2 HB User
obstruction/impaction and colonoscopy

I have had a "msytery illness" for about a year, and one of the manifestations of this was that I developed sudden severe constipation. I was never aware of being constipated since I was actually having chronic diarrhea, but it has shown up on xrays as a severe impaction of the entire colon. I can feel the impaction (rock-hard) when I press on my abdomen. Anyway, it seems to me that a sudden onset of something like this would warrant a colonoscopy. But, my question is, how can a colonoscopy be done if it is IMPOSSIBLE to clear the colon out? I have tried everything, laxatives, enemas, GoLytely, trying to move it manually by pressing through the abdominal wall, etc. Nothing moves this impaction at all. Even GoLytely had no effect. Is there a way to see what is going on in there anyway? I did have a CT scan which was normal except to show the impacted stool. Is it possible that the cause of the obstruction (like a tumor?) could have been missed on a CT, or is the CT sufficient to rule out a structural cause? None of my doctors have suggested a colonoscopy. I am 26, by the way.

 
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Old 11-22-2005, 06:58 AM   #2
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Re: obstruction/impaction and colonoscopy

So sorry you're suffering. Do your doctors have a particular diagnosis in mind, then? A CT scan is pretty good for spotting actual tumors but there are other conditions of the intestine that can cause you all manner of grief which a CT scan might NOT be able to pick up, but which could be visualized during a colonoscopy.

Your doctors might also look at your CEA (blood test) and feel comfortable that you don't have any cancer going on.

Still, if I were you, I'd press for a colonoscopy. It's diagnostic for so many other conditions OTHER than cancer which you can begin to address if you knew what they were.

My mom had a large tumor almost completely blocking her ascending colon. The doctor was STILL able to do a colonoscopy. It just takes them longer. They snip off samples for biopsy.

Good for you for being proactive at 26! I will hope that you're able to find out what's wrong soon.

Best wishes,

Michelle

 
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Old 11-22-2005, 04:43 PM   #3
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CancerDad HB User
Re: obstruction/impaction and colonoscopy

Sorrel:
A CT will NOT show the inside of your colon and what is going on. Is the medical profession recommending the colonoscopy, or are you pushing for one? Either way, I think you should have one. This MAY tell your physician what is causing the blockage... sometimes they can get up there and shoot water and use suction to break up the fecal impaction enough to tell you whether there is a polyp/s causing you to back up.

I'm sorry you are going through this... it must be VERY uncomfortable. The problem is, the laxitives work lower in the GI tract, and for some reason, you are not getting enough perastaltic contraction to move the stool along. You can try drinking more water, and use heating pads to see if you can break some up, but I would definitely go for a colonoscopy for a look... otherwise you may require a resection. Not to scare you, but if the obstruction is so bad, you may need a resection anyway. Try drinking more of a liquid diet, to avoid adding to the obstruction.

Good Luck,
CancerDad
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Old 11-22-2005, 06:21 PM   #4
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Re: obstruction/impaction and colonoscopy

Thanks for your replies. Michelle: my doctors definitely do not have a diagnosis in mind. Everyone has just been baffled and has been sending me off to different specialists willy-nilly. I have had all kinds of bizarre things going on in addition to the constipation issue. So one has a clue.

CD: no one is pushing for a colonoscopy at the moment... but I have been wondering if I should be. My doctors seem to think it isn't necessary, but meanwhile, no one can figure out what's going on! It is especially odd that at the time this impaction apparently formed, I was eating an extremely high fiber diet (I was a vegan health-nut and had kind of an extreme diet, almost nothing but vegetables) and drinking tons of water (5-6 quarts per day.) Now I am consuming almost nothing. I have no appetite at all (that has been a major feature of the "mystery illness" all along) and like you said, I don't want to add to the obstruction by eating. I know I should be drinking water to loosen the impaction ... but.... another weird feature of this mystery illness has been some kind of progressively increasing, whole-body edema, and the ONLY way to control it is to stop drinking water. Literally. No one can explain that either, but it was kind of horrifying to watch myself blow up like some kind of inflatable pool toy, and now that I have figured out how to make the swelling go down the last thing I want to do is start drinking water again and start the whole process all over.

I do use a hot-water bottle on my abdomen, which eases the cramps, but doesn't seem to do anything about moving the impaction. I also lake large doses of magnesium oxide and vitamin C, which should draw water into the bowel and maybe have the same effect as drinking water (but without adding more fluid to my body.)

 
Old 11-22-2005, 07:37 PM   #5
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Re: obstruction/impaction and colonoscopy

Boy, this is a mystery... usually when you are swollen, the more water you drink, the better as your body takes it and almost flushes your system and re-regulates you. Had you recently become a vegan... a lot of times, veggies will get caught up in the colon as they are more fibrous. Espesially if you have a couple polyps, you can easily get an obstruction.

Another possibility is a gyn problem...adhesions can form and slow down the motility of your colon in cases such as endometriosis, etc. There are also weird auto immune stuff-- like lupus. Have you been tested? Is your ANA normal?

Just a thought to try to help???
~CDad
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Old 11-22-2005, 10:32 PM   #6
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Re: obstruction/impaction and colonoscopy

This edema you speak of is very strange. NOT drinking fluids is bad. Swelling and cramps is bad. I would go back to my doctor, with a support person in tow -- preferably a parent or a firm-type friend. I would absolutely INSIST upon a colonoscopy. It's YOUR money. You are the customer. You are the patient. Clearly there is something wrong with you which cannot be visualized on a CT scan.

It is fine and well to exhaust other possibilities but until you have a negative finding on colonoscopy, it is hard to put that one to rest. There are flat type polyps which do not show up on CT scans. There are diseases of the colon which cause pitting and inflammation which do not show up except upon colonoscopy. These really must get ruled out.

I wish I had a dollar for every story I've heard from a cancer patient whose first couple of doctors blew off their symptoms.

Most doctors have to drag their patients to colonoscopy kicking and screaming. Here's a sensible patient like you trying to -- if I dare say -- get to "the bottom" of things -- and he's refusing you a colonoscopy. If he continues to do so, find another doctor who will.

Don't give up. Be polite but persistent.

Keep us posted.

Michelle

 
Old 11-22-2005, 10:49 PM   #7
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Re: obstruction/impaction and colonoscopy

This is a strange one on a few levels.
Do you pass nothing at all now? If so and given the amount of impaction I am surprised they haven't moved more on getting that cleared out.
A colonoscopy cannot be done until the colon is cleared. Golytly not having the desired effect is really not good. The edema is probably the body's way of dealing with water that is not getting to the colon, it has to go somewhere.

An old fashioned enema may be the only way to clear the obstructing fecal matter. There has to be a lower limit to the impaction and IF (if if if) it is a tumour that will be where it is. If it was in the transverse colon the CT scan would show fecal matter to the (your) right of the tumour and nothing further along(to your left). That you state that the entire colon is impacted suggests that IF(if if if) it is a tumour then it is rectal.

An enema is best administered by a nurse or other trained professional.

 
Old 11-23-2005, 03:44 AM   #8
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Re: obstruction/impaction and colonoscopy

Well, I will be moving to a new area soon and will get a whole new bunch of doctors... hopefully, ones who have a clue. I have not been happy with the doctors I have seen. When I saw a gastroenterologist, I did in fact take my parents with me so that maybe the doctor'd take me more seriously. But this doctor (who I did NOT like) rushed me through the appointment so fast that there was no chance to have them argue on my behalf.

My ANA and other inflammatory markers are negative, except for sed rate which is slightly elevated, but that could be anything. I do have a weird rash that has been getting worse along with all my other symptoms, although it does not have the features typical of a lupus or scleroderma rash. (I am seeing a dermatologist next week... maybe she can put this all together somehow... fat chance)

I also don't have any symptoms of endometriosis. I actually have not had a period for 4 years, which was previously attributed to being very thin & an athlete. I did see an endocrinologist, in case the no-periods thing was connected to all of this, but he did a ton of tests and said it is not anything endocrine (and he was the ONLY doctor I've seen in this process who I would trust and who I thought was a thorough and intelligent person.) Oh, and I'd been a vegan for about 3 years when this thing started.

I do still have bowel movements, sort of. Usually very small volumes of material and it's loose/liquid. I figure that's what can "get around" the obstruction. I have had periods of time where I have normal, formed stools. I've tried giving myself enemas, both the small volume Fleets type and the old-fashioned 2-quart tap water type (although I haven't tried that type recently, that was months ago on the advice of an acupuncturist who I saw in a vain attempt to help this whole thing...)

When I press on my abdomen, I can feel the hard impacted stool in a few places, but it seems worst (hardest, largest) just to the left of my navel (my left). That is also where the cramps are localized to. So that seems to be where the major obstruction is, and that is near the end of the colon, so IF (if if if, as jaydees said) it is a tumor, that's probably where it is and would explain why the whole colon behind it got backed up.

Thanks for your input and sorry to foist so much information and whining on you. Obviously I am desperate for answers at this point.

 
Old 11-23-2005, 06:43 AM   #9
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Re: obstruction/impaction and colonoscopy

Sorrel:
I echo JD and Michelle, you NEED a colonoscopy. I disagree though (sorry JD) that you need a professional for the enema, and do agree with him that the old type that you fill up is best. There is no harm in using a warm water bag, trying to maintain the water in the colon for as long as possible, and repeating the process several times. See if you get some relief. But is WILL take several times and make sure to allow sufficient time for the stool to turn into liquid. *I say you can do this yourself b/c this is what I had to do after having my rectum removed at 31 for 1 1/2 years. I developed such a stricture that the ONLY way to get stool out was to liquify the contents (and in my case, use rectal dilators).* I was advised by my colorectal surgeon that it is perfectly safe. Just dont overdue it with the poking (in fact the ONLY thing you should poke if you do it right is some stool (use a well-lubed tip)... you don't want to perforate the rectum, and really run a low risk of doing so if you have used any enema before. Follow the instructions. Some of these colonic cleansing places tend to use more pressurized machines which would NOT be good, and may cause more harm by perforating the colon.

Anyway, sorry I have no other advice right now.

Wishing you all the best.

~CDad
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Old 11-23-2005, 12:00 PM   #10
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Re: obstruction/impaction and colonoscopy

Well to be honest I was just being cautious in the trained enema advice. I would not want anyone to perforate their own colon. As CD says one can do it by yourself but be gentle with yourself.

One thought, with a vegan diet you may have a plain old obstruction caused by a ball of undigestible fibers such as are found in celery and cabbage and corn and asparagus.

 
Old 11-23-2005, 12:43 PM   #11
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Re: obstruction/impaction and colonoscopy

Thanks so much for all your ideas. I'll try the warm water enemas... it is good to know that MAYBE it is possible to dissolve the impaction.

Hmm, I guess that's definitely a possibility about the obstruction caused by vegetable fibers. I really used to eat enormous quantities of fibrous veggies, including things like wild dandelions and yellowdock that I collected outdoors (they tend to be even more coarse and stringy than cultivated vegetables.) So... if that's what it is... what can be done about it?

 
Old 11-24-2005, 08:44 AM   #12
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Michelle M HB User
Re: obstruction/impaction and colonoscopy

Sorry to sound like a broken record, but do not feel safe that "that's what it is." Push for a colonoscopy. If you are able to pass any stool at all, a doctor can perform a colonoscopy on you. My mother had a tumor completely obstructing her colon and they managed to do a colonoscopy!

There are MANY bowel diseases that could be causing your trouble -- not just cancer. You will not be able to figure out your problem without a colonoscopy. AFTER a colonoscopy, if it turns up negative for any known problem, THEN you can begin to explore diet issues.

This resistance to colonoscopy on the part of doctors is nothing short of amazing to me. You'd think you were asking for mind-altering drugs or something.

In an otherwise fit and athletic person such as you, consumption of lots of fiber should NOT be causing the trouble you're having. OK, it COULD be, but good grief, it doesn't sound real likely to me.

DEMAND a colonoscopy. Take your parents. Take statistics about colon cancer in young people. See a colorectal specialist. DOG THEM!!

Michelle

 
Old 11-24-2005, 09:29 AM   #13
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Re: obstruction/impaction and colonoscopy

Michelle, I agree and I am glad to see that others think the same way. There is obviously something really weird going on and I don't understand why my doctors are not being more agressive in finding out what it is. As far as the diet issue, that was my initial thought too... in and of itself, large amounts of fiber should not cause an obstruction... possible I guess, but doesn't seem likely. I guess it's time to get more assertive (read: nasty) in demanding the tests I want.

 
Old 11-25-2005, 04:58 PM   #14
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Re: obstruction/impaction and colonoscopy

I agree , demand a c'scopy. If the obstruction is caused by a ball of undigestable fibers then it could be that you have some type of constriction at one site on the colon/rectum where such a thing would be more likely.

I tend to downplay the idea of a tumour if there are no other signs because some people simply panic at the idea. You do not seem to be that type of person. It could be a tumour, it could be a large beniegn polyp that has started a 'logjam'. Human bodies are strange and complex things so getting in there and looking around would be a good idea. If the bowel cannot be cleaned before the c'scopy they will only be able to see anything as far as the blockage if I am not mistaken. The c'scope would be trying to plow through the imapcted feces any further than that and would also be adding to the pressure by taking up more volume, not to mention that seeing anything other than feces is going to be tough.

 
Old 11-25-2005, 05:43 PM   #15
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Re: obstruction/impaction and colonoscopy

I really appreciate everyone's comments about this whole thing. If anyone's still reading this, I now have a question about enemas. (did I really just say that in a public forum? ah, the joys of anonymity...) Following the advice I got on this thread, I figured I should try giving myself warm water enemas to try to dissolve the impaction. But this is what happened and it did not seem normal to me: after all the water (2 quarts!) was "in," I pretty much couldn't feel it and had no urge to move my bowels. I kept it in 15 min or so and figured that was long enough. But then I had trouble expelling it. Not only did I not feel like I had to "go," but I had to strain to get the water out, and it only came out a little at a time, over the course of hours. Even then I did not get all the water out (I weighed myself before and after so I could tell if I was dissolving and eliminating any of the impacted stool, and I gained weight, meaning not all the water came back out.) Oh, and the water that came out was pretty much clear... no stool in it at all. Am I right in thinking all this is really strange? Any thoughts?

Oh, and I used a 1% salt solution (isotonic to body fluids) instead of plain water because I thought that would keep the water in the colon rather than allowing it to be absorbed. Don't know if that matters.

 
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