Q. Why am I having severe constipation after sigmoidectomy?

Answered by
Dr. Sameer Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 14, 2018

Hi doctor,

I have had small cysts in the past that would come and go during childbearing or menstruating years. I also have IgA deficiency, chronic inflammatory arthritis, autoimmune hypothyroid and low WBC count. My present condition is, for past several weeks I have been having pain in the lower left area of abdomen that goes into my left lower back and on the side of left hip or front at times. I also get pain into the lower pelvic area and sensations in my bladder like it is being kicked like when I was pregnant. I have decreased appetite, abdominal bloating and swelling on the left side of my abdomen. It is quite uncomfortable to have a bowel movement and I have increased constipation. Most of the time I have very little appetite and when I do eat I get full very quickly. I also have nausea on and off and at times it is so bad I feel as though I am going to vomit, but I have not. Three months back, I had sigmoidectomy for chronic diverticulitis. After two months that is last week due to the above symptomology, I had a CT and flexible sigmoidoscopy done as my treating doctors felt there could be a narrowing of the colon formed during the healing process. Both test were good, no problems or obvious issues (other than constipation) seen. Now I am on Prozac, Synthroid, Hydroxychloroquine, Methotrexate, Folic acid, Prevacid and Flonase. However, the pain and other symptoms have continued and actually worsened since. I am now thinking it is a cyst on my left ovary. How concerned do I need to be? And how soon should I see a doctor? I have attached my reports for your reference. Kindly guide.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology


Welcome to icliniq.com.

The symptoms and an abdominal lump in the left lower abdomen with constipation and bladder symptoms with bloating and decreased appetite do indicate a possibility of a large adrenal mass which could be a developing and growing ovarian cyst or mass, which should be ruled out with an urgent ultrasound pelvis scan.

As the possibility of a colonic stricture obstruction has been ruled out three months back, a sudden increase in the size of abdominal lump with pressure symptoms do indicate a possible fast growing mass or cyst.

This can be a late manifestation of post sigmoidectomy stricture which was not evident then, but the possibility of an ovarian mass or an ovarian tumor cannot be ruled out.

I suggest an urgent ultrasound pelvis scan and hence, please seek an early appointment with your gynecologist. Please follow up to discuss the progress.

Revert back after the investigation to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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Hello doctor,

The CT was two weeks ago and was normal. There is no lump and I am aware of, just all the symptoms I listed. What do you mean by a late manifestation of post sigmoidectomy stricture? Again, had the flexible sigmoidoscopy five days ago and was normal and also everything healed well. Would not the CT have shown something if present? Or is ultrasound best for this? Thank you.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology


Welcome back to icliniq.com.

If the flexible sigmoidoscopy was done just five days ago, then there is no indication or possibility for the colon to be involved in post-operative stricture.

Also, as of now that you have mentioned that CT scan was done two weeks back and the symptoms have been persistent before that, in that case an ovarian mass or cyst would have been easily diagnosed in the pelvis, if present.

The other possibility is likely to be post-operative localized adhesion formation which is common and more likely over the left side.

It can cause a pull and tug over the surrounding structures like ovary, bladder and the small intestine (the ileum part of small intestine) which can cause some pressure, pain, and stretch symptoms.

Constipation is likely to be present for one to two weeks, but it has to be avoided with increased water intake.

Bloating and gastritis are due to secondary post-operative gastroparesis which causes decreased motility of intestine through decreased peristalsis and shall subside in few weeks.

You should get an ultrasound pelvis scan done with an aim to look for adhesion in the perioperative area.

As there is no accompanied fever, there is no suspicion of either pelvic inflammatory disease or UTI, so possibility for adhesions post-operatively is more likely. Please discuss the possibility with your surgeon and opt for an ultrasound pelvis scan.

Revert back after the investigation to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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