Crohn's Disease Forum » Surgery » Strictures & Obstructions » So tell me more about strictures.

07-18-2014, 09:53 AM   #1
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So tell me more about strictures.

Oh, how I do hate having to write about poops ! LOL
Guess I'd better get used to it, though

So help me understand the strictures thing. From everything I've experienced the past two months, I would swear I've had (may still have) some serious stricture(s) going on. I actually thought I was obstructed except that I never had any N/V. Just severe pain everywhere, and absolutely could not poop. (Total reversal for me... I had always gone 3-4 times/day.) All of a sudden, I was having to take Miralax daily.. just to go at all. And even then, all I could get out was tiny pellets, or squiggly little strings, sometimes little "shreds". The "strings" were no greater in diameter than a shoe string. This went on for two months. During those 2 months is when I also dropped 25 lbs, all of a sudden.

Had a CT scan done 2 weeks ago for an unrelated issue, but nothing on the abdominal CT mentioned anything about strictures. Had I been constricted, surely this would have shown up? It was a contrast IV CT and I also had to drink the "milkshake" prior to the scan. And if I wasn't constricted, then why the weensie, stringy, thready bms and the bee-bee pellets for so long?

Now that I'm on Mesalamine (day three), I've had a few good (soft) bms, but still squeak out some little snakey "threads" here and there as well. Will the Mesalamine do away with any strictures, if indeed there were any? What else might have caused this crazy new bowel pattern? And why would it not have shown up on CT?

OOPS ! Just browsing through more of the forum and found the "Obstructions and Strictures" section. Guess this needs to be over there, yes? My bad. (still new to the forum) Perhaps a mod would be kind enough to move it over there. Thanx!
IBS 40+ years
IBD probably the majority of the above 40 years..(just didn't know the difference)
Crohn's diagnosed July 2014

Mesalamine (Apriso)

Fish Oil
Vitamin D3

Last edited by jnette; 07-18-2014 at 11:10 AM.
07-20-2014, 04:44 AM   #2
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Strictures ought to appear on a CT, mine did but had disappeared by the time I had a scope. Adhesions could cause obstructive symptons as could inflammation. Balloon dilation is probable if you have strictures. However the bowel could be thicked inside and the scope will show this. Good luck.
07-21-2014, 06:18 AM   #3
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Hi there

You have described what i was going through for ages.
The first thing you will need to do is determine if the strictures (which i believe it to be) is either inflammation or scar tissue.
If its inflammation then you will need to tweek your meds and maybe go on a course of steroids to reduce it.
If its scar tissue then thats where things get a bit tricky. A balloon dialation could help (depending where the stricture is).
But strictures can become serious if you dont get them checked. so my advice to you would be too drink maybe 3-5 miralax daily and book yourself in for a colonoscopy/biopsy.

I wish you all the best

07-21-2014, 09:10 AM   #4
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I've been experiencing similar symptoms so I'm interested to see what others say. So sorry you're dealing with this too!
07-21-2014, 10:39 AM   #5
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So help me understand the strictures thing. Thanx!
Ahh strictures, the narrrowing of the bowel, that I am all too familiar with. I first learned of stricures in 1992. I had several in my large colon. Inflammation is the culprit and that is where the cycle begins. First your body begins to target an area(s) for inflammation as a faulty defense mechanism. Inflammation of the bowel (small or large or both) swells and narrows the passage. As the inflammation reduces (via meds or on its own), then the swelling reduces and the narrowing recedes but a bit of scar tissue is laid down in the process. Over time the cycle repeats and each time a bit more scar tissue is built. While initially only the inflammation is causing swelling/narrowing, as it goes along the scar tissue begins to play a more significant and permanent role. At most times people that stricture have both inflammation and the scarring. Meds will work on the inflammation and either stricturplasty or surgical removal is needed to manage the scarred down tissue. So you can see its not simply one or the other but understanding that its both and at what point to step in to deal with the scarred section. That can be the most difficult decision point because it differs wildly between persons so is a very personal issue to address.

In short, I had my large bowel resected in 2002 after 10 years of stricture/obstruction issues. I later developed a small bowel stricture in my ileum and after 6 obstructions and the biologics all failing because the scar tissue was overwhelming the ability of the meds to clear the inflammatory swelling, I had a small bowel resection last Tuesday and am recovering quite nicely.

About CTs: I am a bit limited in this area but there is a specific CT for Crohn's, which is a CT Enterography. I had it done twice and my surgeon was pleasantly surprised that the findings were identical to what he saw when he was visually inspecting my bowel during surgery last week. So I would suggest talking to your GI about the CT you did have and see if it was sensitive enough to visualize the bowel for strictures and inflammation. If not, then perhaps a CT Enterography would be indicated.

About the poops and don't ever feel weird discussing that here or with medical personal or family for that matter because we all do it (those with IBD and those without!) its just a fact of life and integral to our well-being. The stringy and pellet poops that you were noting are likely due to the length of time your system is taking to move along the material rather than a stricture actually "shaping" the stool. The large bowel's purpose is to absorb water. The longer the stool remains in the large colon, the greater the chance for constipation and varied types of stools. If it goes thru quickly then you should note diarrhea. Some foods can also account for stringyness such as leafy foods that do not fully digest might come out stringy. Some people take immodium to slow down the digestive process (many pain meds also slow the process) and eat meals without liquid to help manage diarrhea. Others take daily stool softeners to manage constipation. There is not a "all fits one" fix since we all vary with our symptoms and our bodies have different needs to deal with the issues.

I hope I have helped to understand a bit more about strictures. Good luck in your disease management!

07-21-2014, 05:25 PM   #6
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Thanks, Darin. Well done.

I guess I'm just flubbed because of so many decades of knowing nothing BUT loose stools, extreme urgency, and close calls. Now for the past two months suddenly just the opposite. I have never, ever been constipated in my life. Nor have I had shoe string poops or rabbit pellets.
I did have to resort to Miralax for a couple weeks before my CT scan. I went seven days without a bowel movement, so I had to do something. It helped SOME, but more often than not, was still only minute amounts. Until the scan. Of course THAT day, I had to jump off the table mid-scan.. and pooped like I was making up for the previous two months! And the following two days as well. (Was probably all that barium prep drink coming out of me).

Haven't used Miralax since, and for a few days I thought the Mesalamine I was rx'd last week was working quite well. Tummy seems to have quieted down.. no more loud gurgles and "fireworks" going off in there. (Maybe all that previous "noise" was simply the Miralax doing its thing.)
But the past 4-5 days (no Miralax for well over a week now) I've been getting back to my pre-scan nonsense of no poops at all or only a few tiny strings or pellets. I was hoping my bowels would get back to their usual with the Mesalamine, but it doesn't appear that way now. *wah!*
I go back to my GI on Wednesday. He'll want to know how the Mesalamine is working. Guess we'll take it one step at a time. Will inquire about inflammation/scarring and see what he wants to do next. And I'm still losing weight. I can't afford to lose even one more pound.
The scan I had did use contrast. I had both oral and IV contrast. I googled the CT Enterography and it doesn't appear any different than the one I had done?

Thank you for the input, and I do hope you continue to heal well !

Last edited by jnette; 07-21-2014 at 05:41 PM.
07-22-2014, 07:04 AM   #7
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I too suspect I have a stricture (still not entirely sure what they are, I just know they cause obstructions) and your experience sounds identical to mine.

I never really had what I could describe as severe pain before and then suddenly I was doubled over with it. Also, like yourself, one minute I was going to the toilet all day long and then in correlation to the pain starting, nothing would come out other than what you described ingeniously - weensie, stringy bits. A lot of mucus too. But no actual full BM.

The pain got worse so I started rubbing my stomach quite vigorously in hope I'd shift whatever was stuck there and then suddenly I felt the urgency to go and out popped a unusually solid and large BM. The rubbing must have some how helped it get past the narrowed part of my bowel. All the pain stopped and I could suddenly go again.

Sorry I'm not much help, I just wanted to let you know that you're not alone!
07-22-2014, 07:21 AM   #8
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In relation to Lewis's experience. Sometimes i feel like i must have an obstruction in my colon but its really just my colon thats dried up and it gets sluggish. Like inflammation in other parts of the body, it can get scaly and dry in there and it can make it extremely hard to go to the loo.

Give me diarrhea to constipation any day of the week. There is nothing worse than having a major urge to go to the toilet and nothing coming out and the spasms and pain you get whilst sitting there.

In my own experience, alcohol tents to dry up my colon and ive spent the full day the next day straining on the toilet and nothing coming out. its hellish.

Ive been lucky recently, ive not had much constipation because i take 1-2 stool softners daily and that helps everything move much smoother.

I highly recommend stool softners to people that have trouble going to the toilet only.

08-12-2014, 04:33 PM   #9
Join Date: Aug 2014
I do not like the strictures, even if you can't "go". Having repeated back-to-back bathroom trips with no output at 4:00 am really ticks me off, especially when I don't think I'll make it in time.

I think that strictures are a pain, although temporary (for me), but obstructions are a lot more serious.

Crohn's Disease Forum » Surgery » Strictures & Obstructions » So tell me more about strictures.
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