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Dr. David
Dr. David, Board Certified MD
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Advice please, I had an infralevator posterior exenteration

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Dear Sir, advice please, I had an infralevator posterior exenteration and vulvo vaginal reconstruction in 2005 for a squamous cell carcinoma. Subsequent to that I had an abdominal wall reconstruction with a parastomal hernia repair.
This developed an enterocutaneous fistula which was partially repaired with another laparotomy and bowel resection. ( the fistula did not close completely and I have a bowel protusion with healthy skin over , this is not painfull )
My problem is that after the bowel resection in 2014 and I understand that only 4 ft of the small intestine was left ,I have little or no solids from the stoma.
I was advised to take 16 mg daily of Loperamide to rectify this.
This has not been of much assistance and I never know what the bowel will do and therefore I wear drain able pouches in an effort to manage the situation.
However I now find that I am experiencing nausea on a daily basis and some chest pain, this in conjunction with the problem of having to get up 3 or 4 times a night to empty the pouch I am finding exhausting.
I have recently tried (for 4 weeks)stopping the Loperamide in the hope that the bowel might educate itself, regretfully this has not happened , and the throughput is now like water or at its best cream. This has also made the stoma quite sore and nights are very difficult, it is also restricting my daily life not only the output but the noise when the bag fills.
I have now today started again on Loperamide to see if anything has changed.
Is there anything you might suggest that would help me in anyway?,
Many thanks *****
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. David replied 8 months ago.

This is Dr. David

I am sorry you have had such surgery and have only 4 ft of small intestine.

you can ask your doctor for prescription Lomotil which can be used with Loperamide to help slow down your bowels

also medications like cholestyramine could help as well

you may benefit from eating foods like rice, bananas, cheese which could slow down your bowels as well and cause less diarrhea.

you may need to take a daily multivitamin to help supplement your diet as your bowels may have difficulty absorbing nutrients with only 4 feet of small bowel

let me know if you have questions.

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45228
Experience: Board Certified Physician
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Expert:  Dr. David replied 8 months ago.

Lomotil is Diphenoxylate (2.5mg) and Atropine (0.025)

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