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Bowel problem after total hip replacement

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Irritable Bowel Syndrome
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Posted 7/13/2012 8:09 AM (GMT 0)

Folks,

My right hip needed replacement; at the time of surgery I was taking 1, 0.4mg flomax/day for prostate issues, but before I went for the spinal anesthesia I remarked to my wife that "if there's one thing that's been AOK for at least 20 years now are my bowel movements (BMs).

When I came to I had the usual catheter bag for urine and immediately started physical therapy with 3 x 5mg of oxycontin every 4-6 hours (I asked for the 3 without Tylenol). Things went fine for the first couple days but the nurses picked up that I was constipated and started stool softeners every 4 hours. (Because the blood loss during surgery made me anemic, they had me on very heavy dosage iron 3x/day.) My first straining BM brought pellets and a bowl of blood (I flushed before the nurses saw the blood, but Ive had a case of hemorroids that would activate on a dime since I was 20 years old (52 years ago). 

To make a long story short: I left the rehab facility 2 weeks later with the urine bag in place and with the worst constipation that I ever experienced in my life (I assumed it was from the oxycontin and iron combination). The bag came off after the urologist upped my flomax dose to 2, 0.4 flomax/day. As the weeks went by I self-treated my constipation with middling dosage Metamucil and 3-4 slices of double fiber Nature's Pride bread. At that point my BMs went from small-hard to moist-heavy almost diarrohea-like and with heavy light tan mucus I had never experienced before. It was invariably mixed with bright red blood. I also had trouble "holding" the moist slippery stools in and have an "edge of fecal incontinence" issue; I also have gas and bloating like I've never had before in my long life. I also have 1X/day bowel urge that results in nothing but bloody mucus. Besides the Metamucil I have not taken a laxitive, nor have I used an enema or suppository (yet)! 

I've been trying to adjust the fiber, fruits and my other diet to ease back the diarrohea-like situation; it has now been 6 months since the hip surgery wherein the ONLY THING that worked out is the hip. My urologist is measuring me for a TURP to roto-rooter out my prostate; I know that as soon as I see a gastroentorologist he'll have me measured for all kinds of goodies on his end. I'm trusting that it's not cancer since this all onset the day aftermy surgery, but...

I need your thoughts and advice,

Ted

Posted 8/22/2012 6:23 AM (GMT 0)

Because my symptoms and overall condition had not improved and showed no indication that it would I was finally forced to seek professional help in early  August. The Gastroenterologist ran a colonoscopy in which he determined that I had no trace of cancer or even a single polyp but had a condition called "Ulcerative Proctitis" or inflammation of the lower rectum near my anal opening. A quick online read confirmed that likely to be the case symptom-by-symptom. The doctor assured me that he would devise a suppository-based treatment schedule that he was confident would help.

In going over my total hip replacement I had recognized that the surgeon recommended that I undergo a high single dose of x-radiattion to the right hip area the day following my surgery. He did so because my original hip had become frozen by massive amounts of extra bone growth (heterotopic ossification) as seen in x-rays and at surgery, which would likely impinge around the artificial joint in perhaps just months. The radiation was artfully delivered because it had to be blocked/shadowed at the femur and acetabulum areas where new bone had to "grow into" the prosthesis components.

Unfortunately, one of the side-effects of high dose radiation delivered at the lower pelvis is Ulcerative Proctitis! While I've got to personally believe that the radiologist team that delivered my hip irradiation and should have been well-aware of this and would have masked/shielded accordingly, the circumstances fit too well to be ignored. So, while I'd like it not to be the case, it's conceivable that I ended up with a Foley catheter (very high spinal injection dose at surgery) for three weeks and Ulcerative Proctitis (for who knows how long) from side effects of total hip replacement. 

When I mentioned both problems to my surgeon, he remarked that your new hip is well-seated and you're walking fine for me, the "other stuff" can be followed up with a Urologist and a Gastroenterologist. ("I've done what I was supposed to do for you and we should both be delighted"!) I just turned 73; I think I've entered the "late stage medical merry-go-round" (one surgery/test after another) syndrome that I've seen so many others do in my life time!!!

Posted 8/22/2012 3:43 PM (GMT 0)
So sorry that you've had this result of your hip replacement.  I never knew that radiation to the pelvis could result in ulcerative proctitis!  You might find more support at the UC forum where there are plenty of people that suffer from this condition.

The suppositories that you will likely be prescribed should be very effective.  Look for mesalamine suppositories, and/or steroid suppositories.  You might also find steroidal foam easy to use and very effective.  You shouldn't use steroids on this condition for very long because it can thin the tissue of your rectum.  I would be curious to know if your GI thinks mesalamines will resolve the inflammation since it's due to radiation damage and not a supposed autoimmune condition like UC.

You are self-treating with fiber and that is great.  Are the hemmorhoids all gone?

Posted 1/30/2014 12:14 AM (GMT 0)
theoarthur, were you able to squat after the hip op. do you squat to defacate. i had a consult with a naturista doc. told me to eat only fruit for a few days. matt1
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