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Forum Name: Gastroenterology Topics

Question: Anal Surgery + Gallbladder Removal= no relief


 ArtTeacher - Fri Jan 01, 2010 5:23 pm

Hello! I am a 25 year old female that hadn’t had any health problems till the last 3 years. It started when I had tremendous amount of pain going to the restroom. I met with an anal surgeon who said I had 2 fissures and was unfortunate enough to be born with a small anus (random I know). So then I had a Fissureratomy and a Sphincterotomy in March of 2008. I recovered but was still having pain going to the restroom because I was constantly had very hard stools that were dark in color. I mentioned this to him at post op checkups and he said for me to take Miralax to help. I questioned if a 23 year old should have to take Miralax everyday and he saw no problem with it. I continued to rely on Miralax and found that while my stools were more comfortable, my problems were growing. I was constantly burping and feeling bloated to the point of major chest and stomach pain. My GYNO ruled out Ovarian Cancer, I went to a Gastroenterologist and he put me through an Ultrasound, Endoscopy and then finally a HIDA scan to conclude that I had gallbladder disease. My gallbladder was functioning at 6%. So I had my gallbladder removed in January of 2009.

All of this background information is to lead to my concern that none of my problems are solved. I still have crazy pain if I don’t take Miralax. I violently burp, have stomach pain and have pressure in my chest that makes sleeping impossible. Is there something else that could explain these symptoms?

It should be noted that I have kept food diaries to try to rule out foods. I do not drink carbonated beverages and I drink a TON of water. It doesn’t seem to matter WHAT I eat… I still remain with hard stools. I can burp and have stomach cramps even if I haven’t eaten anything all day.
(Ultrasound and Endoscopy had no abnormal results)
Thank you for your time.
 Dr.M.Aroon kamath - Wed Feb 10, 2010 8:29 am

User avatar Hi,
Firstly,let me explain to you about burping (belching). There are essentially two types (my own classification, for the sake of explanation!) ...
- 'normal' belching (comes suddenly, involuntarily)
- abnormal (pathological) belching (here, a person belches, believing that there is a lot of gas in the stomach and voluntarily tries to belch it out).
When we eat, we swallow food, but swallow some air as well. How much air one swallows depends on many factors such as hurried eating without chewing the food properly (gulping the food!), talking a lot during meals, hyperventilation etc.

Normally the upper esophageal sphincter is in closed mode to prevent atmospheric air entering the esophagus.It opens only while swallowing.

During 'normal' belching, this sphincter opens and the gas in the stomach which is at a higher pressure than atmospheric pressure comes out.No outside air enters.

Compare this to what happens during abnormal belching...
the sphincter opens, there is no air in the stomach at high pressure to escape out,...so, the outside air enters the esophagus and goes into the stomach! This air may be belched out 'normally'. Then the vicious cycle starts all over again!

Anxiety could cause hyperventilation leading to burping.

You say "I met with an anal surgeon who said I had 2 fissures and was unfortunate enough to be born with a small anus".It appears that you may have a congenital anal stenosis.

Association of Hirschsprung's disease and anorectal malformation is being recognized more often of late.
- the coexistence of imperforate anus, Hirschsprung's disease, and trisomy 21 has been reported.
- Currarino syndrome, a rare hereditary condition, is defined as a partial sacral agenesis associated with a presacral mass and anorectal malformation.A 'Currarino triad' includes Hirshprung's disease.

As you seem to complain primarily about being constipated,one may need to consider Hirshprung's disease as a differential diagnosis.
Good luck!

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