HomeAnswersMedical Gastroenterologylaser adhesiolysisWhy do I have abdominal pain, indigestion, and bloating after adhesion removal surgery?
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My symptoms persist even after adhesion removal surgery. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ajeet Kumar

Medically reviewed by

Dr. Vinodhini J.

Published At February 2, 2021
Reviewed AtAugust 30, 2023

Patient's Query

Hi doctor,

I am 36 years old. Since last week, I have been dealing with rectal discomfort. There is no bleeding. I tried to self-check, and the pain is on the back of the rectum, and the discomfort lowers when I lay on my side rather than my back. This discomfort seemed to happen after four straight days of mild diarrhea. I have had a history of soft stool for years with indigested food, but that is getting better with probiotics. I looked at my anus and noticed a skin tag on the rectum, so I wonder if it is a previous anal fissure re-opened? I contacted another doctor online and received Ciprofloxacin and Metronidazole. Please help.

Thanks.

Answered by Dr. Ajeet Kumar

Hello,

Welcome to icliniq.com.

I understand your concern.

Generally speaking, only a few patients with adhesion show symptoms of it. Your symptoms are more likely due to small intestinal bacterial overgrowth (SIBO). It would help if you had some relevant testing to confirm it and then need antibiotics for three weeks. I will tell you whether you need a colonoscopy after I see your complete workup, which has been done already. Kindly upload it.

I hope this information will help you.

Thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

I have attached the report. Since I am in horrible pain, I took Clavam 625 gm for seven days. My symptoms were less, but they were still there. Most fruits and veggies worsen the symptoms. But better, I still have the symptoms, including undigested food in stool. I have attached the relevant reports.

Thank you.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

I understand your concern.

I have seen your reports, which you shared(attachment removed to protect patient identity). I do not know any testing for stools in this. Secondly, given your CT scan report, I do not need to go for another invasive test, such as a colonoscopy. Given the history of minor bowel surgery with adhesion, it is highly likely that some blind bowel loop has formed, fostering the growth of bacteria leading to excessive gas formation. Bloating, indigestion, gas, and some degree of pain are explainable by SIBO. However, the abdominal pain is of little concern to me. Do you have severe abdominal pain? What is the location of pain? And what type is it, like a spasm, which relieves after you pass wind or stools and is brought in when you take meals? If I ask you to score this pain from 1 to 10, how would you score that? And lastly, does this pain come in the middle of the night while you are asleep? And does it resolve with anti-spasmodic medications like Immodium, Buscopan, or such drugs? If abdominal pain is not of that severity, I suggest you take a course of tablet Rifaximin 200 mg thrice daily for 21 days. Plus, use Ispagol husk two tablespoons complete daily with water. There was no need to take Clavam (amoxicillin and potassium clavulanate). It is an antibiotic that can further worsen your gut-related symptoms. The other way is to suggest more testing, including stool tests and a breath test, to confirm if this is SIBO. And then consider giving you treatment. The diet of low FODMPAs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is perfect.

I hope this information will help you.

Thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

The surgery was adhesiolysis. The SIBO test is unavailable in our country, and the online purchase will take up to six weeks. The abdominal pain was severe before the surgery. But now I can rate it to three. It comes and goes but is not always present. It gets triggered when I eat. The pain is like spasms, yes, sometimes throbbing-like. The pain location is random but never on the right side, especially on the upper left (just after the rib cage) and lower left. The stomach pain is like burning pain, which is not relieved even by PPI. And yes, the passing wind gives me relief. The wind and stool also have a very foul smell. The pain is not so severe that I wake up in the middle of the night. But when I force flatus, I feel pain in the upper left (under the rib cage), which lasts about 10 minutes and then resolves. I have also lost 6 kg in eight weeks.

Thanks.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Thank you for providing more information into your history. Well, I think some weight loss is possible in this peri-operative period. But I also think that I can not simply deny that it can not be due to some inflammatory process going on in the abdomen.

To rule out any inflammatory process, I need to suggest you some stools and blood tests. Plus, I want to suggest you some treatment for now and assess if it improves your symptoms.

Tablet Rifaximin (antibiotic) 200 mg thrice daily for 21 days irrespective of meal timings, tablet Mebervine (antispasmodic) 200 mg once to twice daily depend upon pain and diarrhea. Morning and evening 20 minutes before meals.

Get the following tests:

1. Blood IGRA for tuberculosis.

2. Serum albumin, serum Na and K.

3. Serum osmolarity.

4. Stool detail report and ova parasites.

5. Stool for calprotectin.

6. Stool for occult blood for three consecutive days.

7. Stool for fecal elastase.

8. Stool for Spot Na and spot K.

9. Stool for C-difficle toxin.

Patient's Query

Thank you doctor,

I am back with preliminary results, which I think require your attention. I will however, continue for the three days stool analysis. The IGRA test is currently unavailable here. I have tested positive for pylori. Could it be the causative of all these? I am attaching the results.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

No, H.pylori does not seem related to your symptoms. I cannot see reports. Kindly upload them.

Patient's Query

Thank you doctor,

Rifaxamin is also unavailable in my country. I have ordered online, and they will arrive in two weeks time. Kindly advise me so that I can get some relief. Antibiotics used since the problem started are Tinidazole, Ciprofloxacin, and Augmentin.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

I have seen your report (attachment removed to protect patient identity), it is completely fine. I would wait for other tests to come.

Well, the Rifaximin is the best choice among others, for the treatment of SIBO. The antibiotic you have used already, have also some role in treatment of SIBO, but not that effective, and carry a significant side effect profile. I suggest you to wait for it. The rifaximin is going to solve your problem in long term. We may repeat the course if your symptoms recur. And it is completely safe and effective in case if the first course did not help much, and you recur the symptoms. Mebever is for symptomatic relief. And it is effective in controlling your gaseous symptoms, plus diarrheal symptoms. Plus it would control the pain as well. So you should start it now, and would see how you perform. Plus avoid High FODMPAS.

Patient's Query

Thank you doctor,

What about the H.pylori results? Should I also hold the colonoscopy idea, for that matter?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Yes, no colonoscopy for now. I did not suggest you H.pylori test. There is no need to do it.

Patient's Query

Thank you doctor,

Meanwhile, I do not take any medicine for H.pylori? The local doctor ordered H.pylori. The hospital did not agree to do the test based on the message only.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

No, I do not think that testing H.pylori is required.

Patient's Query

Hi doctor,

Thank you for your help.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

Patient's Query

Thank you doctor,

Thank you for Mebeverine. I am feeling better except for the upper left quadrant pain. I have also received Rifaxamin 550 g instead of 200 g. They are not available here. So I purchased it online. Even if I cut it into half, it will still be 275 g? Should I proceed this way?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

No problem, I am happy that you have felt improvement. The discomfort in the upper abdomen is secondary to excessive gases. This will resolve with Rifaximin. You can take 550 mg twice daily for 14 days instead. Do not break the tablet. Plus mean while for excessive upper abdominal gaseous discomfort use.

Tablet Metoclopramide 40 mg once daily half an hour before breakfast. If it is not available in 40 mg strength, you can use 10 mg twice daily, half an hour before major meals in a day, not more than two weeks. Then I will decide, based on your symptoms, to continue with it or not.

Patient's Query

Hi doctor,

Thank you so much for your help.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

Patient's Query

--file attached--hello Dr my stomach symptoms have recurred severely. I have severe bloating and gas. I.can't eat anything except steamed rice, which still causes bloating anyway. the bloating is so severe that I get diaphragmatic spasms and chest flutters. I have yellow watery diarrhea for 4 weeks. colonoscopy is normal. OGD shows mild gastritis and plenty of bile in stomach. currently on antepsin 2 grams by, dexpure 20mg bd, GIT 150g od, rifaximin 550g bd. I also take ayurvedic medicines "himalaya gasex" there is 0 improvement. please advise me way foward
Answered by Dr. Ajeet Kumar
Hello Dear Hasina. we have chat almost a year back, so you were alright these days? when did you start feeling symptoms now? I mean since how long you recurred the symptoms ? secondly the ogd report is normal as It was expected, the pool of bile is obvious there is no problem with that. Tell me the following do you have abdominal distension as well with feeling of bloating ? or it is just that you feel gas but no obvious distention of the abdomen? diarrhea- is everytime you open bowel it is in large quantities like up to a glass of watery stools? any pain in the abdomen ? ayurvedic medications for how long?

Patient's Query

1. a month ago my CRP levels were 112. ER suspected covid and immediately started me on heparin injection, aspirin, ceftriaxone, and dexamethasone. I was negative though (they confirmed later). since I had mild fever and malaise I was discharged on ibuprofen. immediately after hospital discharge I started severe yellowish watery diarrhea with no abdominal pain. I started, on my own rifaxamin 550g bd. since then my stomach has never been the same. 2. yes I was alright all the days after completing rifaximin last year. 3. symptoms have persisted for almost a month now 4. yes there's severe growling gas with abdominal distention (like months preg). I rarely pass flatus, its very difficult. 5. diarrhea is up to 6 times a day and its so much, more than a glass of water. 6. there is no obvious pain unless the tummy is bloated. but burning sensation in tummy is very severe 7. ayurvedic medication is only 1 day, which worsens I think. even when I take antespin the bloating becomes severe. 8. generally the symptoms developed very acutely. Unlike the other time where rifaxamin and mebeverine gave me a relief in just day 3, this time its not the same. Unfortunately the severe stomach bloating is causing some palpitations and diaphram spasms. I notice them most when there is so much gas in tummy.
Answered by Dr. Ajeet Kumar
Dear Hasina, do not be worry, hopefully it will resolve with right approach and management. The problem seem to be that ER admission with lots of antibiotics and dexamethasone. followed by discharge on ibuprofen. this would trouble everyones gut not just you. So after understanding your history here is what I think Your SIBO have got worse leading to diarrhea which is profuse and explosive with lots of water bloating and gas again due to the same condition Absence of high grade pain suggest that there is no serious thing like ulcers. you should follow instructions below and let me know how you feel in coming few days stop antepsin, dexpure, stop Rifaximin for now avoid taking milk and milk products take Ecotec sachet thrice daily Tab immodium or tab lomotil 2 tablets thrice daily for 3 days Tab rececodril 200 mg thrice daily for 3 days oral rehydration solution ORS adult , mix one sachet in one liter of water tab vermox 500 mg only one tablet Tab NT-TOX 500 mg twice daily for 3 days Get a stool detail report stool for fecal calprotectin stool for ova parasites stools for clostridium difficle antigen - if not available clostridium difficle toxin follow up with the results

Patient's Query

What about the GIT capsules? The ecotec sachets are not available in my country. online purchase will take 4 weeks to reach me. please any alternative?
Answered by Dr. Ajeet Kumar
if Ecotec not available, ask pharmacy if they have any probiotic with lactobacillus and fusobacterium in it. enterogermina, or any other brand containing these bacterial species You should stop git for now since it worsen diarrhea. try to use above regimen as advised, will see if I need to add any other medication instead of git. but at.moment not needed

Patient's Query

Thank you
Answered by Dr. Ajeet Kumar
no pb

Patient's Query

Hello Dr. I have completed 3 days treatment. diarrhea has stopped but not bloating. the bloating and distention is worse when I take the probiotic. please advise way forward
Answered by Dr. Ajeet Kumar
I have seen the report. few pus cells are normal otherwise. so continue with the treatment as mentioned above and let me know in 3 days if there would be no improvement would ask for some other investigations and will change the treatment

Patient's Query

Hello Dr. I have completed 3 days treatment. diarrhea has stopped but not bloating. the bloating and distention is even worse when I take the probiotics please advise way forward The stomach gas is so severe that I get palpitations followed by sudden cough. its like the gas irritates something. quite strange
Answered by Dr. Ajeet Kumar
hello Dear Hasina.. Kindly stop the probiotic for now Start cap Rifaximin 200 mg thrice daily for 2 weeks. if not available you can use 550 mg make it half and take thrice daily for the 2 weeks. keep avoiding milk, milk based diets, sweets, white flour, , chikepease, and raw salads yeah it is gas related. also use Tab Levopraid (levosulpride) 50 mg thrice daily half hour before meals for 3 days to 1 week, depending upon symptoms relief

Patient's Query

Okay thank you. so I keep discontinuing the rest? GIT, dexpure and antepsin?
Answered by Dr. Ajeet Kumar
git and dexpure can be continued. But if you feel loose stools then git be stopped. no need of antepsin . levopraid and git are same thing so you can take any one of those

Patient's Query

Thank you. I have a pacemaker removal next week. I know I will be given a course of antibiotics again. shall I use the probiotic during treatment?
Answered by Dr. Ajeet Kumar
yes. you should continue with probiotics and ask your physician do not overburden with antibiotics have good days ahead

Patient's Query

Hello Dr I developed sudden severe nausea and yellowish diarrhea for 7 days. I had fever and had 4 diclofenac injection, symptoms developed thereafter. I have no much stomach gas. no vomiting but nausea is so strong like an early pregnancy. I checked blood and stool, I have attached the results. Dr prescribed metronidazole 400 3 times a day, pantocid 2 times a day and mebeverine 2 times a day. there is no improvement in any of the symptoms. the nausea is very bad and I have lost appetite completely. please advise I have tried rifaxa on my own for 3 days but symptoms never improved
Answered by Dr. Ajeet Kumar
welcome. no problem hello dear Hasina.. There is one abnormalities in the labs your hemoglobin is low and stools have bacteria however no parasite is seen. It seems acute GASTRoentetitis which causing you nausea..You received lots of dicloran injection this may cause stomach inflammation. I suggest you go stop metronizole and pantocid and mebervine. instead use ORS in water 2 liter per day plus cap Esomprazole 40 mg once daily before meals tab ondansetron 8 mg thrice daily half hour before meals if unable to take orally use Inj onset 8 mg IV now.

Patient's Query

I have been on IV fluids since then. Will bacteria seen in stool disappear on its own? After onset injection nausea disappeared but came back very strong in less than an a hour, the stool has also a lot of mucus Dr.
Answered by Dr. Ajeet Kumar
Dear Hasina, then you need to get some testing such as CBC Urea creatinine electrolytes, serum amylase, liver function tests. the medications I suggest are very effective medicines, failing to completely settle down your symptoms suggest that may be more severe problem.. Get the blood tests. and continue with IV onset 8 mg thrice daily. if possible for you to go along at home then ok, otherwise consider admitting yourself for a day or two till and get complete intravenous therapy

Patient's Query

Thank you Dr
Answered by Dr. Ajeet Kumar
I will wait for your reports

Patient's Query

I have attached the reports Dr. thank you The dr suggested for ultrasound after elevated liver enzymes results. I also attach the report
Answered by Dr. Ajeet Kumar
I could not see the ultrasound. your blood tests complete blood count shows low hemoglobin and low white blood cells. Yes liver enzymes are altered, but are not significant abnormal to necessitate any further testing. I believe this is acute gastroentetitis. upload ultrasound or get it and show it to me.. for Low hemoglobin go and check serum ferritin and iron profile. I suggest you to continue with the medications as advised. there is no change required..

Patient's Query

I have re attached the ultrasound report, They want to admit me for gallbladder removal?? May be I should also mention that I had mild Covid-19 last 2 weeks with mild fever?
Answered by Dr. Ajeet Kumar
ultrasound abdomen is also normal.. you do not have gall stones, nor you need to undergo for any surgery. it is possible that you have acute hepatitis, but this is also resolving you need not to do anything just wait for couple of days and use medicines as suggested

Patient's Query

Hepatitis A,B,C all negative Thank you Dr I will get back ,
Answered by Dr. Ajeet Kumar
sure. it is probably a viral infection, which has all caused this. it will resolve spontaneously.

Patient's Query

Could COVId 19 be the cause? sorry dr many questions
Answered by Dr. Ajeet Kumar
yes it can cause all of your symptoms. but it seems resolving

Patient's Query

Hello Dr. I have completed 7 days medications, diarrhea has resolved but I still feel nauseous and weakness like early pregnancy. I also now feel bloated with gas with or without food. how do I proceed Dr. I have liaised with iclinic to include this chat in our previous conversations for easy record tracking. the previous history is not seen Hello Dr. I have completed 7 days medications, diarrhea has resolved but I still feel nauseous and weakness like early pregnancy. I also now feel bloated with gas with or without food. how do I proceed Dr. I have liaised with iclinic to include this chat in our previous conversations for easy record tracking. the previous history is not seen
Answered by Dr. Ajeet Kumar
for 7 days or till your symptoms resolve , which one is lower

Patient's Query

Hello Dr. I have completed 7 days medications, diarrhea has resolved but I still feel nauseous and weakness like early pregnancy. I also now feel bloated with gas with or without food. how do I proceed Dr. I have liaised with iclinic to include this chat in our previous conversations for easy record tracking. the previous history is not seen Correction to the above msg. diarrhea has not completely resolved but frequency is reduced like 2 times a day only. but general body malaise and nausea still persists in addition to bloating and excessive stomach gas and acidity. I watch what I eat, very few selected food that I eat but I still get gas
Answered by Dr. Ajeet Kumar
hello dear Hasina. I can see previous history as well. it seems resolving Hepatitis. meaning liver inflammation. this will take some more time before complete resolution. for your gas trouble I add one more medications to the existing regimen of yours tab Ecotec twice daily this is probiotic medication this will help improve your gas trouble. plus continue with tab ondansetron 8 mg thrice daily Esomprazole 40 mg once daily half hour before meals avoid milk and milk based foods take home made foods you can take wheat, rice, chicken fish, and other vegetables but all should be well cooked give some time and it will improve itself.. drink at least 2 liters of water and add some ORS for few days. sorry for late reply, I had some issue with internet that's why could not reply you on time. let me know in a day or two if symptoms still persist

Patient's Query

Thank you. the diarrhea has changed from watery yellow to mucus. Also ecotec probiotic is not available in my country
Answered by Dr. Ajeet Kumar
ok. see if you can find any other brand containing lactobacillus species in it stool form will improve with time Do not worry

Patient's Query

Thank you Dr. for how long should I continue with esomeprazole, ondansetron and probiotics?
Answered by Dr. Ajeet Kumar

for one more week for one more week you are welcome

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar
Dr. Ajeet Kumar

Medical Gastroenterology

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