Digestive Issues After Liver Transplant: Bloating, Pain, and More

Q: Digestive Issues After Liver Transplant: Bloating, Pain, and More

Hello： 1. <br>If you have already undergone a colonoscopy and only have issues with hemorrhoids, then the blood after wiping is more likely to be due to hemorrhoidal bleeding. <br>2. <br>The liver is located on the right side, so there is a high possibility of adhesions from surg

Abdominal bloating, belching, flatulence, abdominal pain?

I have a history of liver transplantation and have experienced bowel sounds for several years, with bowel movements occurring every 1-2 days.
In October of last year, I suddenly started having bowel movements every 2-3 days, accompanied by stomach discomfort and bloating that lasted for almost a month.
I went to the hospital, and the doctor performed an X-ray, which showed excessive fecal retention.
Later, I underwent an upper endoscopy, which was normal, and a stool test for occult blood, which also returned normal results.
After taking medication, my bowel movements returned to normal every 1-2 days.
In April of this year, I experienced constipation and intermittent pain in the lower right abdomen.
The liver transplant doctor suggested it might be due to mild intestinal adhesions.
Concerned, I consulted a gastroenterologist and had a stool test for occult blood, which was positive (+1).
The doctor recommended a repeat test, which came back positive (+2), coinciding with my menstrual period.
Since I have hemorrhoids, the doctor advised that a colonoscopy would be prudent.
The colonoscopy on June 7 showed normal results, but my hemorrhoids were more severe.
The lower right abdominal pain had subsided by mid-May, but in mid-September, I suddenly experienced constipation again, with bowel movements every 2-3 days, along with bloating, belching, and flatulence.
On September 23, I had abdominal pain and the urge to defecate, but the restroom was dirty, so I held it in.
After about half an hour, I found a toilet and attempted to have a bowel movement but felt unable to do so, leading me to strain.
Shortly after the bowel movement, I experienced sudden discomfort and dull pain in the lower right abdomen for about half an hour, similar to the discomfort I had in April.
On September 25, I visited the gastroenterologist again, who asked me to provide a stool sample, which I have not yet done.
On October 13, I underwent an abdominal ultrasound to check my gastrointestinal tract, liver, spleen, and intestines.
Since September 25, I have been taking medications (Lacosamide and Gas-X) and have been having bowel movements once or twice daily, with softer stools and frequent flatulence—at least 15 times a day, sometimes up to five times after meals.
By September 28, my bowel sounds, belching, and flatulence improved significantly, and my bloating also decreased.
However, on September 30, after lunch, I suddenly felt a sharp, rhythmic pain in the lower right abdomen, resembling nerve pain, occurring every few seconds for about two minutes.
After dinner, the same type of pain returned for about 1-2 minutes, again with a regular pattern.
I did not experience pain while sleeping, but when I woke up and stretched in the morning, I felt a sudden sharp pain that quickly resolved.
This time, the pain in the lower right abdomen feels different from the pain I experienced in April-May, although it is in the same location.
Previously, the pain was also due to constipation.
I usually have bowel movements every 1-2 days, and sometimes the stools are quite large and long, visually measuring up to 30 cm.
When the stools are harder, I experience pain on the left side of the anus, and there is blood when wiping.
Is this hemorrhoids? The softer stools do not cause pain.
What is happening with my right abdomen? Could it be related to my previous liver surgery? On September 30, due to abdominal pain, I visited a clinic, and the doctor said my bowel sounds were normal, with no signs of being too fast or too slow.
I had an upper endoscopy last October and a colonoscopy in June of this year, and I also had a gynecological check-up in May.
What further tests do I need?

Wenwen, 40~49 year old female. Ask Date: 2017/10/01

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If you have already undergone a colonoscopy and only have issues with hemorrhoids, then the blood after wiping is more likely to be due to hemorrhoidal bleeding.
2.
The liver is located on the right side, so there is a high possibility of adhesions from surgery.
3.
There are no specific tests to prove the presence of adhesions without obstruction; it is recommended to have daily bowel movements to reduce fecal retention, and to chew fruits and vegetables thoroughly.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2017/10/01

More Info

After undergoing a liver transplant, it is not uncommon for patients to experience various digestive issues, including bloating, abdominal pain, and changes in bowel habits. These symptoms can be particularly concerning for patients who have undergone significant surgical procedures, such as a liver transplant, which can lead to changes in the anatomy and function of the gastrointestinal (GI) tract.

Understanding Digestive Issues Post-Liver Transplant
1. Bowel Habits and Constipation: It is not unusual for liver transplant patients to experience changes in bowel habits. The use of immunosuppressive medications, which are necessary to prevent organ rejection, can lead to constipation or diarrhea. Additionally, dietary changes, reduced physical activity, and the stress of surgery can contribute to these issues. The fact that you were previously having regular bowel movements (every 1-2 days) and then experienced constipation (every 2-3 days) indicates a potential disruption in your normal GI function.

2. Abdominal Pain: The right lower abdominal pain you are experiencing could be related to several factors. Post-surgical adhesions (scar tissue) can develop after any abdominal surgery, including liver transplantation, and may cause discomfort or pain. Additionally, the presence of hemorrhoids, which you mentioned, can also contribute to pain, especially if there is straining during bowel movements.

3. Bloating and Gas: Bloating and excessive gas can be common complaints after a liver transplant. This can be due to dietary changes, the introduction of new medications, or changes in gut flora following the surgery. The fact that you are experiencing increased flatulence and belching after meals suggests that your digestive system may be struggling to process certain foods effectively.

4. Hemorrhoids: The presence of blood during bowel movements, especially if accompanied by pain, is often indicative of hemorrhoids. Hemorrhoids can be exacerbated by constipation and straining during bowel movements. It is essential to manage this condition to prevent further complications.

Recommended Actions
1. Dietary Adjustments: Consider incorporating more fiber into your diet to help regulate bowel movements. Foods such as fruits, vegetables, whole grains, and legumes can be beneficial. Staying hydrated is also crucial, as adequate fluid intake can help prevent constipation.

2. Medication Review: Discuss with your healthcare provider the medications you are currently taking. Some medications can contribute to constipation or digestive discomfort. Your doctor may recommend alternatives or additional treatments to alleviate these symptoms.

3. Follow-Up with Specialists: Since you have already undergone endoscopic procedures (gastroscopy and colonoscopy) that returned normal results, it may be beneficial to follow up with a gastroenterologist if symptoms persist. They may consider additional imaging studies or tests to evaluate for complications such as adhesions or other GI issues.

4. Monitoring Symptoms: Keep a detailed log of your symptoms, including the frequency and consistency of your bowel movements, any abdominal pain, and dietary intake. This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

5. Physical Activity: Engaging in regular physical activity can help stimulate bowel function and reduce bloating. However, ensure that any exercise is appropriate for your post-transplant recovery status.

6. Consultation for Pain Management: If the right lower abdominal pain continues or worsens, it may be necessary to consult with a pain management specialist or a surgeon to evaluate for potential adhesions or other surgical complications.

Conclusion
Digestive issues after a liver transplant can be multifaceted, involving dietary, medication-related, and anatomical factors. It is essential to maintain open communication with your healthcare team and to seek further evaluation if symptoms persist or worsen. By addressing these issues proactively, you can improve your quality of life and overall health following your liver transplant.

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