Post-Myomectomy Bowel Issues: Symptoms and Next Steps

Postoperative care after uterine fibroid surgery?

Hello Dr.
Lee, I have uterine fibroids located lower down, which are compressing my intestines.
Every day when I go to the bathroom, my stools are always thin and I have a feeling of incomplete evacuation.
After undergoing surgery to remove the fibroids in early February of this year, my bowel movements became smooth and plentiful, and I felt completely empty.
However, after about a month and a half, I started to feel that my stools were thin again, the quantity was low, and I had a feeling of incomplete evacuation.
My abdomen also appears similar to being pregnant (the same situation existed before the surgery).
I would like to ask if this is related to the surgery? Is there still compression occurring? What could be the possible symptoms? What examinations should I undergo? Thank you.

Ahua, 40~49 year old female. Ask Date: 2007/08/14

Dr. Li Guanghan reply Obstetrics and Gynecology

Without an examination, it is truly impossible to provide an answer, and we are also unaware of the specifics of your surgery.
We recommend that you consult with your primary surgeon, who can advise you on which tests should be conducted.
Thank you! Hsinchu City Hospital, Department of Obstetrics and Gynecology.

Reply Date: 2007/08/14

More Info

After undergoing a myomectomy, it is not uncommon for patients to experience changes in bowel habits and gastrointestinal symptoms. Your description of having thin stools and a sensation of incomplete evacuation, along with abdominal distension, raises several important considerations.

Firstly, the fact that you experienced an improvement in bowel habits shortly after the surgery suggests that the myoma may have been exerting pressure on your intestines, leading to the previous symptoms of constipation or difficulty in passing stools. The reduction in pressure post-surgery likely allowed for a more normal bowel function initially. However, the recurrence of thin stools and the feeling of incomplete evacuation approximately six weeks after surgery could indicate a few possibilities.

One potential cause is the development of adhesions, which are bands of scar tissue that can form after abdominal surgery. These adhesions can cause the intestines to become tethered or restricted, leading to changes in bowel habits, such as the passage of thin stools or a sensation of incomplete evacuation. Additionally, if there is any residual pressure on the intestines from surrounding tissues or organs, it could also contribute to these symptoms.

Another consideration is the possibility of functional bowel disorders, such as irritable bowel syndrome (IBS), which can sometimes be triggered or exacerbated by surgical procedures. Stress, dietary changes, and alterations in gut motility can all play a role in the development of IBS symptoms.

Given your history and current symptoms, it is advisable to consult with a gastroenterologist or your primary care physician for a thorough evaluation. They may recommend several diagnostic tests, including:
1. Colonoscopy: This procedure allows for direct visualization of the colon and rectum to rule out any structural abnormalities, such as strictures or lesions, that could be contributing to your symptoms.

2. Imaging Studies: An abdominal ultrasound or CT scan can help assess for any adhesions or other structural issues that may be affecting bowel function.

3. Barium Enema: This X-ray test can provide information about the shape and function of the colon.

4. Functional Tests: Depending on your symptoms, tests to evaluate gut motility or sensitivity may be considered.

In the meantime, maintaining a high-fiber diet, staying hydrated, and engaging in regular physical activity can help promote healthy bowel function. If you experience any alarming symptoms, such as significant abdominal pain, blood in your stools, or unexplained weight loss, it is crucial to seek medical attention promptly.

In summary, while your symptoms may be related to the surgery and subsequent changes in your gastrointestinal tract, a comprehensive evaluation is necessary to determine the underlying cause and appropriate management. Your healthcare provider will be able to guide you through the next steps based on your specific situation and symptoms.

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