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    hemorrhoidectomy

    I am a T4/5 complete paraplegic woman, 58 years old, 28 years post injury. Among a lot of other problems related to the accelerated aging process I experience the last 2-3 years, i have very frequent episodes of AD every day, specially in the afternoon, 7-9 pm, and so i have to take antihypertensive drugs sublingually (captopril) and then face the hypotension, the sensation of empty or numb head and the tinnitus. I have a third grade hemorrhoidal disease ie mucosal prolapse reducible after manual handling and anal sphincter hypertonia which causes to me difficulties and AD during bowel program. I did not find any other cause for AD, my suprapubic catheter is working, I have done intravescical botulinum injection, plain film (intestine full of gas),cystoscopy, colonscopy, (many polypes) i don?t have any bone fractures, pressure sores, kidneys or gallbladder stones, no syringomyelia and i tend to consider ? maybe i am wrong- the hemorrhoidal disease and the anal sphincter hypertonia as the cause for AD. I feel good only 2-4 hours after the bowel program and if it is a succesfull one, (peristeen) ,the rest of the day, I feel belly discomfort and abdominal pain, non the old pain i am a complete, a new one but is always pain, intestinal spasms with or without AD or with or without sweating which always comes like a rendez vous 7-9 in the afternoons or 11-13 in the morning. The morning all the symptoms are always milder. 2-3 hours after eating i have intestinal spasms and if I do not pass any intestinal gas during the resting postprandial time which is very common for me, I have to suffer the hole afternoon or go back to bed and try to eliminate some gas by pressing my belly. I did a very conservative Lords anal stretch and I drink a medicinal natural herb which helps me to eliminate some gas but not always. After this operation my blood pressure during AD episodes is lower (150/100 instead of 190/110 before operation) but is still present. My surgeon suggested me a Longo stapler hemorrhoidectomy but I am very concern for the operation itself and specially for the postoperative period because of Autonomic Dysreflexia. Does anybody have similar problems or experienced a Longo stapler hemorrhoidectomy? Are there any other alternatives?

    #2
    I think you should consider the surgery as your have persistent AD. Have you tried Nitropaste for the AD?
    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      hemorrhoidectomy

      Originally posted by SCI-Nurse View Post
      I think you should consider the surgery as your have persistent AD. Have you tried Nitropaste for the AD?
      CWO
      I tried nitropaste when i had a very small fissure which is healed, i also use lidocaine gel and stool softener. I am seriously considering the surgery but we do not know which type of operation is more apropriate for sci. My surgeon suggest me Longo stapler but he is wondering for the postoperative period since i am very sensitive to AD and he has no experience with sci. Any bibliography about this method? I am also trying to understand why my dysreflexia comes always in the afternoon, like an appointment, except when the catheter is blocket which can happen any time. Is this because of the accumulation of gas after lunch? Is there anything to help the elimination of gas? All the vegetables and fruits are producing gas, cereals too. Thank you for the reply . Very difficult to find another doctor with sci experience in my place.

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        #4
        I had similar symptoms and saw countless specialists and tried all kinds of drugs and treatments. I got relief with a different diet.

        Maybe change your diet or add some enzymes or HCL Betaine to help your food digest better. Fermentation in your gut is caused as a by product when bacteria eats the undigested food. I used to get terribly uncomfortable and have dysreflexia from the gas in my belly. Antibiotic use can contribute to a bacterial overgrowth especially in the small intestine area. Hypersensitivity from gas pressure in the colon too can cause pain and AD.

        You might experiment by eliminating foods that are fermentable carbohydrates. You can find these food lists by googling FODMAP diet. FODMAP is only meant to be a short term elimination diet, do not stay on it too long and risk starving your body of nutrition.

        google SIBO to learn about small intestinal bacteria overgrowth.

        SIBO is a relatively new diagnosis. In my opinion, SIBO isn't a diagnosis for a disease, it's a symptom of something else. You need to figure out why your body isn't digesting right or why you have a bacterial overgrowth and fix that.

        Comment


          #5
          Do you use the prebiotics and probiotics?- can be found in some yogurt and then over the counter.
          AD can be caused by any irritation so it is possible- have you tried taking antigas medication at lunch time.
          Diet without foods prone to produce more gas?
          CWO
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #6
            Thank you very much, the last days i am on a diet without foods prone to produce more gas. I will try to keep on this diet and see, but i did not find any antigas medication which helped me. I also take prebiotics. When i have my bowel program every day (instead of every other day as usual) i have less intestinal spasms and sweating but AD is always there waiting for me the same time in the afternoon.Thank you again.

            Comment


              #7
              I use prebiotics, i am on diet without foods prone to produce more gas. I tried, in the past, antigas medication without results, i would appreciate any suggestion about these, I have "better" results with a medicinal herb. When i have my bowel program every day (instead of every other day as usual) i have less intestinal spasms and sweating but AD is always there waiting for me the same time in the afternoon. I know i have to do the hemorrhoidectomy but i am scare to death specially for the post operative period, i am so prone to AD, and i do not know if the Longo stapler type, which my surgeon suggests me is appropriate for people with sci.( my doctor has no experience with sci people). I am afraid that i am candidate for my biggest nightmare colostomy.Thank you for the replay

              Comment


                #8
                In my experience:

                PREBIOTICS: Most probiotics are fermentable carbs and if you have a bacterial overgrowth, you will suffer even more. Probiotics are meant to feed the bacteria, something you don't want to be doing if they are the bacteria causing the fermentation that fills you up with gas. Inulin is a common prebiotic, often added to probiotics. I think it is from the hickory root. The tiniest bit ad I would blow up to such painful states, I couldn't handle it. I ate a Fiber One bar and ended up in ER. One of the main ingredients is chicory root. In fact, it's chock full of sugar alcohols and everything restricted on a FODMAP diet. Here's a link that lists the ingredients. Fiber One Bars - Friend or Foe

                YOGHURT - (ACTIVIA ESPECIALLY): Yoghurt can cause gas in your stomach if you are lactose intolerant. Lactose is a sugar that takes the longest to digest. For that reason, many people have a problem with it because it gets down into the small intestine without being digested so its left over for the bacteria to eat and ferment.

                Activia yogurt (Dannon) has its own patented Bifidus Regularis bacteria. At first, I was impressed by the immediate effect eating it had on my bowels. However, after a week, I suffered with AD and terrible intestinal cramping. It was awful. We discussed it on a forum thread here awhile back. Activia & Gas

                ANTI GAS MEDS: Pretty ineffective. Only a
                bandaid that pulls smaller bubbles together to create a larger one that hopefully leaves the body easier.

                Comment


                  #9
                  Thank you again for the suggestions, seems to me that we are facing similar, if not the same, problem. I translated all the FODMAP and SIBO, and i found a lot of food i was still eating which i should not according to the list. For more than a year i do not eat any kind of beans, cabbage, onions, garlic, but in my diet there was in small quantities bread, pasta, apples and beetroots.
                  Never tried activia from fear it should be very drastic, only greek yogurt which is not so bad. I did not find chocolate in the forbidden foods, what do you say about that, i am addicted to the black one. I take probiotics, (lactobacilus acidofilus and bifidobacteria), and not prebiotics as i wrote by mistake in the prior message. For how long do you have this problem, what other treatments did you tried, and how long time you needed to get relief? What about AD? is it gone? I am afraid it is gone a be a long travel .. if it works for me . I started the diet hoping for results, thanks again

                  Comment


                    #10
                    Hi Vaggelio,

                    I had a hemorrhoidectomy and its the best thing I ever did. I suffered terribly for years with the same severity / diagnosis you mentioned.

                    The surgery is not very complicated or technical from the surgeons perspective. The worse part is the lengthy recovery (a good 5 months until fully healed / no seeping. Having to use pads. ) You are not stuck in bed though. I was able to resume sitting the next day.

                    My surgeon used devolving stitches. Staples would worry me as well in terms of A/D and B/P. As I understand it, there are different hemorrhoidectomy techniques.

                    Comment


                      #11
                      The only way to get rid of the hemorhoids is to have them removed. My guess is that your diet has been aggrevating them, and changing that will help in the short term. It may or may not be enough of a change to eliminate the AD completely.
                      If you continue to have AD on a daily basis then you really should consider the surgery. I would encourage you and your doctor to speak with another surgeon who may have more experience in dealing with the issues that sci brings. There are many different procedures that can be used and they should be able to speak to that.

                      CKF
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #12
                        Hi CKF
                        I discovered my new persistent AD episodes the summer of 2014 after swimming, without any other detectable reason. Since then i have been checked for the possible causes, i did the botulinum injection in my bladder to keep it calm, begun bowel program with peristeen and did all the exams i mentioned above. Yes, i have AD episodes every afternoon, from 7 to 9 pm, sometimes in the morning and always 15 min after swimming. Now i am "accusing" my hemorrhoids and my lazy,hypersensitive and full of gas bowel.
                        I do not know, i may be wrong in my "diagnosis", but, my body, so silent for years does not stop chattering now with pain, intestinal spasms, sweating and AD. After a year of peristeen and better evacuation of my bowel the blood pressure is milder, around 150/95-100. With all these AD episodes i do not know what my baseline blood pressure is, i think around 95-105/55-60, i feel not so good after 130/85.
                        Can we use peristeen every day or is bad for our bacterial flora?
                        Do we consider BP as AD after 20 or 40 mm higher from the base line?
                        I am very afraid of the surgery and specially for the control of the post operative period episodes of AD.
                        Do you know any contraindications or precautions about Longo stapler hemorrhoidectomy technique in sci patients? (i have a mucosal prolapse too).
                        Thanks again

                        Comment


                          #13
                          A BP higher than 20 points above what your baseline was is considered the beginning of an AD episode. 40 points you are in it. You can use the Peristeen daily and see if that helps. If you opt for the surgery, there are ways to manage your AD so that you can keep it under control. Pre-medication is the best way - and it would only be for a short period of time. Probably a week or two at most. I don't have any idea about precautions or contraindications for this particular procedure. I would discuss your concerns with both your Primary Care Physician and your Surgeon. They should be able to plan for some of the more predictable complications in order to prevent them. I would also try to find out if you will be admitted and if you will be, the likely nursing unit you will be on. You can speak with the nurse manager about your concerns and care and how your care needs to be managed .

                          CKF
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                            #14
                            Hi CKF
                            I can not discuss my concerns with my primary care physicians because in my country, Greece, there are not spinal units for chronic sci, we have really many good doctors but not for following up people with a chronic sci and our National Health Service is under demolition. I do not feel good writing this, i am also a microbiologist, MD, and worked for 21 years in the NHS. I was taking my specialization in Internal Medicine when i had my car accident and i had to change in something more sedentary which i did with microbiology, you can work without problems in a laboratory being on a wheelchair. That's why i am asking you about the more appropriate procedures of hemorrhoidectomy with mucosal prolapse in sci people very prone to AD and about pre-medication i should take. There is no nurse manager experienced to speak with.
                            Thanks

                            Comment


                              #15
                              I take probiotic capsules and a small bottle of Fermented milk. Also like my baked beans and eat at least 5 pieces of fruit per day. I get pain in the bowl as well and I had not given a thought to to much bacteria causing to much gas which can lead to pain.

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