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Crohn's Disease Forum » Surgery » Strictures & Obstructions » Possible Narrowing or Stricture


10-23-2013, 03:58 PM   #1
Daunting
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Possible Narrowing or Stricture

HI Everyone.

I went to see my GI yesterday and we think we know why i am having so much problems as of these past few weeks. Which could also explain why I am so down in the dumps.
He thinks I may have a possible parial blockage or stricture in the ileum and has prescribed me prednisone of 50mg for one week and will see me next week to see how it goes. And than I may need possibly another colonosocopy. JOY.
Does this sound like a blockage.
No appetite
Extreme pain on lower belt line and on right side that feels like a jabbing pain.
Diarrhea, howeve very thin and narrow.
Not alot of Diarrhea at a time
Some Nausea, Hardly urinating, Yellow urine, feeling dehydrated
Loss of weight as I am not eating because of D and pain.
Pain is immense in the morning when I wake up and slowly goes away after using the loo. But for example last night had only 2 dry toast went to the bathroom at least 4 times with small amounts of diarrhea narrow and thin.

I am suppose to have mild crohns of the distal terminal ileum, but can someone with mild still get strictures or partial blockages.

I have never been this much in pain since being diagnosed, usually it is the diarrhea that is my symptom.
When this all started 4 weeks ago I was upped from 2entocort to 3 and put on pentasa which was later changed to salofalk.

Is there any other tests other than a colonoscopy to see if I have one?? and what do they usually do for this??
And does this sound like it.
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Finally been told I have Crohns


B12 injections started on 14/03/2013
Astmatic (ventolin when needed)
Paxil 15mg started again 18/09/2013
Synthroid .075mg
Lomotil as needed
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Doctor switched me from Salofalk to Mezavant
Not sure why
10-23-2013, 04:17 PM   #2
shamrock15
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Well, the ribbon stools do definitely smack of a narrowing. Hopefully it responds to the meds. I do get that from my stricture in my rectum (note that inflammation can cause that as well, it doesn't mean you have a stricture). You may have additional inflammation as well - ribbon stools wouldn't be cause by an issue at the ileum. Make sure you keep your fluid levels up, but don't get excessive with it. It's a tricky balance some times - more isn't always better. Try a soft or full fluid diet, and low residue so there isn't anything to snag on the way through narrowings. Hope it settles down for you.
10-23-2013, 06:53 PM   #3
Daunting
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@ Shamrock

Thank you for you post, I think I miss explained my myself - I really didn't want my description to be too graphic, the diarrhea is lose and funny formed.
I am trying a full liquid diet, water, juice, broth from chicken noodle, I did snatch a fry from my husband earlier I am going to regret that tomorrow. The big Issue is I am still trying to work and everything is coming out so I am still using Lomotil but only 1/2 to 1 a day so I don't think that is too bad, I wait to use it until I go to the bathroom at least 3 - 4 times. I have lost about 9 pounds I about 7 days so far, and probably more in the next few days

Do narrowings happened in the ileum frequently or strictures? Even though they say it is mild. Like you said it could be inflammation, if the prednisone doesn't help does this mean it is a stricture or a partial narrowing Ah so many questions. Can wait to see him again.

I am so frustrated of hearing him say it is mild you will be okay??
Is surgery always needed for this??

.
10-24-2013, 12:38 AM   #4
Jennifer
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Strictures can be caused by inflammation, scar tissue or both. These can cause partial blockages or full blockages. The symptoms you described sound like you're dealing with partial blockages. Surgery is usually done as a last resort unless its extremely affecting your quality of life or causing repeat blockages. Balloon dilation (not permanent but stretches out the stricture temporarily) may be possible or a strictureplasty (by cutting a section and sewing it back together) if you're a candidate for either. Generally medication is tried first so hopefully the steroid will do its job and help clear up the inflammation if that's the main cause.

Being told that you have a mild case of Crohn's only has to do with the treatment options you need at the time. So someone could easily go from "mild" to "severe" or from severe to mild. Here's a link that describes it more in detail: http://www.crohnsforum.com/showthread.php?t=51899 Crohn's disease causes inflammation whether you require mild treatment or more aggressive treatment. Chronic inflammation builds up scar tissue over time and can create a narrowing/stricture.

I have a stricture currently in my ileum from a previous resection and from active inflammation at my resection site. It causes partial blockages for me like you described in your symptoms, so I follow the low residue diet to reduce symptoms. My GI suggested that I go on a liquid diet if the pain is more severe or if I start vomiting or if the nausea is really bad. He said that if I vomit up liquids as well then to go to the ER. If you have symptoms of a full blockage (lots of pain, nausea, vomiting, and/or fever) then go to the ER/hospital.

Tests that could show a narrowing do include a colonoscopy (if its near enough for the scope to see, it can peak into the ileum but can't see too far), a small bowel follow through, MRI, MRE, CT scan and a pill cam (if you did have a pill cam be sure to take the dummy/fake pill first to try and avoid having it surgically removed if the real pill gets stuck).

Please keep us posted.
__________________
Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
10-24-2013, 07:14 AM   #5
Daunting
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@ Jennifer

Thank you for the explanations, they really help. So if I get any vomiting I will definitely go see the ER
I started Prednisone yesterday so lets hope it works.

I think the only reason why he describes my disease a mild is because when he went in with the colonoscopy in Sept 2012 only a small portion of my ileum was inflamed about less than 10 cm, I did have a pill cam in April of 2012 as well and nothing showed from that. But even though I have only a small part of inflamed and diseased area I am so symptomatic, I think they should consider me more Moderate to severe, wouldn't you think. On my visit I had asked him about the risks of Imuran and said the cancer risks were very small but because of my mild disease he would not suggest it just yet. So really what is next, are we going to be playing with prednisone and entocort forever. I know that surgery is not an answer as it can recur at the reconnection, but there is a part in my mind that is wanting surgery as I have read that there is so many that have had wonderful remissions afterwards, but if I am so much activity with just this much of infected area, sounds to me I may get it back real soon after surgery.
I know I am grasping at straws for answers.
10-24-2013, 04:56 PM   #6
Jennifer
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I know the feeling of wanting surgery. I had a nice long 14 year remission after surgery but now I'm in another flare since my resection. I'd like to have that back but what happens in another 14 years or less when it just comes right back? Another resection? Maybe another after that and another? We only have so much bowel to work with and every time you take some out you're one step closer to needing a stoma or even worse than that, active disease after already taking out all that you can. What happens then? We know the possible answer to that and none of us wants that to happen so its best to avoid surgery if medication will work.

If your GI isn't willing to treat you with more aggressive medication (which Crohn's generally needs) then it may be best for you to find a new GI. Even if your current one were your best friend in the whole world, without prescribing medications you may need to get better, they're making you worse by allowing the inflammation to go untreated. Steroids are meant to be temporary because they can do a lot of damage themselves so if your GI just wants to do course after course of steroids then find another GI.

You have a lot of symptoms so it doesn't really matter if you're mild or severe or whatever, you need to be treated for what's happening now and focus on preventing this from happening again in the future once this is hopefully under control.
10-24-2013, 06:13 PM   #7
Daunting
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@Jennifer

I can completely understand what you are saying about the whole thing. But to be honest this is the first doctor who is willing to treat me with medications. He is not my first doctor, let me say he is my fourth. The others didn't believe I had crohns because the damage seen in the pill cam and the colonoscopy are insignificant, and they believe it is more IBS than anything however.
On my next visit I am asking to have a ct scan and another colonoscopy done, I want to know if things are escalating or not, because I feel they are immensely. I know that surgery is not a cure and that I completely understand.

May I ask how much of your intestines were removed and where? Do you have diarrhea from the resection?? Were you placed on medication after the resection?? How old were you during the resection?
10-24-2013, 06:27 PM   #8
Jennifer
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I had 8 inches (total) of my TI and cecum removed. I am able to have solid stools. Yes I stayed on medication after my resection (Asacol and 6MP). I was 17 years old.

Maybe there's a way for you to persuade your current doctor to try stronger medication. I understand not wanting to have your diagnosis taken away and have your symptoms dismissed as IBS but there must be a way to get more treatment so you can avoid needing surgery in the first place. Hopefully they will be willing to do more testing.
10-24-2013, 06:51 PM   #9
Daunting
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At first I was okay with him not wanting to prescribe bigger medications but after these past few days, I am not so sure anymore.
Yes I am going to try to persuade him into more testing that is for sure, enough is enough
On my last visit he wanted to try a high dose of prednisone and then introduce entocort again. I think after that he will have to add another drug, but first I really want more testing.
Although you have to admit 14 years with in remission because of a resection doesn't sound too bad.
10-24-2013, 07:36 PM   #10
MCPayne
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Another test you can do to see if there's a stricture is the barium enema, although that's not fun. You still have to prep for it, but unlike a colonoscopy, you aren't put under for that.

I had one because a couple years ago there was some narrowing when they went in to do a colonoscopy, but they couldn't get by it, even with an upper endoscopy scope. When they did the barium test, at first the tech couldn't see the stricture, but I guess when he read it further, he saw some smooth narrowing. However, after my latest colonoscopy, they were able to get all the way through using a pediatric scope, although the narrowing must have gone away, because the doctor thought that even though he used a pediatric scope, he thought he could have gotten by with an adult scope.

FYI, I just turned 30 a few weeks ago, and was diagnosed at the age of 8.
10-24-2013, 08:17 PM   #11
Daunting
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@McPayne.

Thank you for your post, I forgot about the SBFT that they can do here, but its a full day and I have to drink some white stuff. I do not think he would do the barium you are talking about because my colon was completely clear last time I had a colonoscopy. So I think he would want to do the SBFT first than go from there. To be honest I wonder which of all the tests would be the best. I think that will be next question.

I see you posted you have had it for 22 years, how do you cope, what meds are you on??
Happy belated birthday.
10-24-2013, 08:57 PM   #12
Jennifer
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I had a small bowel follow through first that showed nothing. Less than 2 months later I was in the hospital with a full obstruction which a CT scan clearly showed inflammation and scar tissue. Then had an MRE a couple months later to check the extent of the damage of the stricture and it didn't show anything. Usually a CT scan gives the clearest picture but it gives out a lot of radiation so you really want to try and keep those limited if possible. I'd start with the SBFT unless your symptoms are more severe then you could try for an MRI or CT scan.
10-24-2013, 09:52 PM   #13
MCPayne
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Daunting, I'm on Lialda, 6MP, and Ranitidine for reflux. My symptom is normally blood in my stool, and I may be having a minor flare. If it continues for another week or so I'll call my doctor. I won't digress too much. I'll start a new thread if necessary.

I've been in remission for quite some time now, so I normally don't have to cope, so to speak. I normally just deal with it.

The Small Bowel Follow Through is something different, which I've also had. The barium enema is where they stick an enema in you, then you move around on the table letting gravity do the work as the enema goes through your colon. Once they get the pictures, they'll take the enema out, then let you go to the bathroom.
10-25-2013, 06:58 AM   #14
Daunting
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@Mcpayne

I have never had that one. My brother in law on my husbands side has had it several times and I know what it is he had severe uc II don't know if it would be required for me or not as the narrowing Will most likely be in the ileum as he said my colonoscopy for my colon was clear.

I think I am in more shock than anything thr doctor keeps saying I have a good prognosis because I do not have a lot damage but what about the narrowing now.. sigh
10-25-2013, 07:37 AM   #15
jjk308
 
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Try CT Enterography so you really know where the problem is.
10-25-2013, 08:01 AM   #16
Daunting
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Hi

Problem with that one the solution they give me goes right throught me instantly.


Sucks
10-29-2013, 05:39 AM   #17
Daunting
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Hey guys

Had a few good day friday. Still was on a liquid diet. Started getting appetite back. Ate a few things on the weekend. Nothing bad. Monday had no pain during the day. At supper had a small tuna sandwiche and about 45 minutes later had a lot of pain gurgling and cramps.
Felt as if something was stuck. System kept forcing with a lot of pain and pressure. On my third trip, solid vs extreme liquid. Than a lot of gassy liquid.
Woke up this morning with a lot of discomfort and some blood in my stools. More like mush. I don't know what happened. Have an apt with doctor tonight.

I hope he tells me he wants to do a colonoscopy right away. Would be nice to finally find out.
10-29-2013, 05:31 PM   #18
AdamJC
 
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Keep us posted - Am following this thread with interest now.. good luck!
10-29-2013, 10:13 PM   #19
Sarah50
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Hey guys

Had a few good day friday. Still was on a liquid diet. Started getting appetite back. Ate a few things on the weekend. Nothing bad. Monday had no pain during the day. At supper had a small tuna sandwiche and about 45 minutes later had a lot of pain gurgling and cramps.
Felt as if something was stuck. System kept forcing with a lot of pain and pressure. On my third trip, solid vs extreme liquid. Than a lot of gassy liquid.
Woke up this morning with a lot of discomfort and some blood in my stools. More like mush. I don't know what happened. Have an apt with doctor tonight.

I hope he tells me he wants to do a colonoscopy right away. Would be nice to finally find out.
Daunting, I had the same or similar symptoms as you. My gastro had me do a barium ex rays in my upper and lower GI tract. It definitely showed a stricture where Crohn's is located- terminal ileum. Doc put me on Asacol 400 (discontinued and switched me too Asacol 800 - still on it). I was told to eat only a low fiber/low reside diet. But when I was in a lot of pain (lower right abdomen), vomiting, no appetite, night sweats- the thing that helped a lot was mostly a liquid diet with some soft food- protein drinks with almond milk and banana, etc.

When I stayed on a liquid/soft food diet for a week or so- I would feel so much better- although I really believe that Asacol helped a great deal, as well. Then I stayed on a strict low fiber AND low residue diet- if I ate anything not on that diet I would go back to having lots of pain!!! So this is what I would recommend for you until you find out for sure about the stricture. You sure have the symptoms of one. Ask about getting a upper/lower GI barium ex ray.

All of my Crohn's/stricture symptoms went away after about 6 -8weeks of low fiber/low residue diet and Asacol. I also got the vitamin D that was recommended on here and liquid iron that greatly helped with my anemia with no side affects.

Best wishes. Keep us posted.
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Crohns since Fall 2012

Currently on Asacol
Low Residue Diet - this totally works for me (I have a stricture)
Multi Vitamin, Calcium/Vitamin D, Pro-Biotics

I seem to be in remission: I believe from the Asacol / Low Residue Diet / Probiotics and NO STRESS!
10-30-2013, 12:55 PM   #20
Daunting
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Hi.

I went to see the doctor last night, unfortunately he didnt have much time for me or to do much as he was late for a conference, go figure.
He did prescribe me librax, and I took one last night, the pain did go down and the spasms slowed down, however I still have an aching pain on my right side, that pain is almost always there but not this bad.
I think my biggest issue with my doctor is when they did the colonoscopy there was hardly no damage and that was a year ago. He is really unsure if i have crohns or not sometimes, he thinks more and more that it is IBS. He wants to see me again next week. At least he is keeping a close eye on me.
I am taking everyones advise tho, and staying on a liquid diet for a little while, at least to let things calm down.
I never had the chance to ask him for another colonoscopy but that will be my next plan of action.
Has any of you tried LIbrax. He said it is a muscle relaxantant and with xanax added to it. Most of the other Gi relaxants make me very sick and he thinks because of the sedating effect of the xanax I might have some luck.
Maybe my bowels just need rest.?
11-03-2015, 09:51 AM   #21
Santajoe
 
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I was just diagnosed with what was described as a narrowing I'm my colon 4mm in size. My Biopsy should that it's not cancer. My surgery is in 3 weeks, where they'll remove that section of the colon. I'm ver nervous about the surgery and would to find an alternative but I was told there was a strong chance it would become blocked. Any advice, comments would be greatly appreciated.
11-03-2015, 10:31 AM   #22
ronroush7
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I would probably have the surgery. I don't know of any alternatives. Keep us updated.

2
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Diagnosed in 1990. On Humira, Imuran, Gabapentin, Colestipol, Synthroid, Lialda. Resection in April of 2010. Allergic to Remicade, Penicillin, Flagyl, Doxycycline. Thyroid issues and psoriasis and neuropathy and mild cerebral palsy. Mild arthritis in my lower back.
11-22-2015, 10:16 AM   #23
warn81
 
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yeah, my current gi is nice to talk to, but after two years I still feel horrible, so I'm letting her go. She thinks I'm too small for bigger meds, but it's B. S. I'm in pain every day of course I will need something stronger. Found a new guy...Michael P Glick in NYC. Hope he can help me. He's young though.

11-22-2015, 10:44 AM   #24
ronroush7
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Best to you

11-22-2015, 12:15 PM   #25
my little penguin
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Hope you get answers from your new Gi
Never heard too small for bigger meds
They use humira in kids as young as 4 for JIA
My kiddo was started on remicade at age 8
So somehow I think even if you were tiny
They could manage a pediatric dose of needed


Fwiw my now 11 is on an adult dose of humira (40 mg)
Every week plus mtx

Good luck
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11-22-2015, 01:10 PM   #26
Maya142
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My daughters have been on adult doses of meds (Humira, Simponi) even when they were 80 lbs. I've never heard of anyone being too small for biologics - MLP is right, they use Humira in 4 year olds with JIA and there have even been studies with 2 year olds in JIA.

Definitely get that second opinion. Mount Sinai in NYC is supposed to have great GI's and a great IBD program.
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Mom of M (20)
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Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
11-22-2015, 03:03 PM   #27
warn81
 
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Thanks you two. I think she was trying to go the natural route. I'm 4' 11" and skinny, but she said she was afraid of me getting glaucoma or brittle bones from other meds. She did say I had inflammation in my stomach and intestines. Just very tired trying to find a good doc that listens.
11-22-2015, 03:04 PM   #28
ronroush7
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Best to you

11-22-2015, 03:06 PM   #29
warn81
 
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Best to you
Thank You Ron.
11-22-2015, 03:10 PM   #30
ronroush7
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Crohn's Disease Forum » Surgery » Strictures & Obstructions » Possible Narrowing or Stricture
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