Do I have a problem with my stoma?

Question: I had an ostomy 18 months ago.  I cannot stop my bag from filling with liquid. I have very little stool.  I have been to a motility doctor and I take four needles a day. Nothing has been working. I have been everywhere and have had every test. My bag is always breaking and it is not fun for me or my family.  I don’t know where else to turn. Can you help?

Answer: With a stoma, you can usually do your normal activities, but you will have to watch for skin soreness and be aware of your diet. Changes to your diet might be necessary. The ostomy pouches do not allow gas or stool to leak out, and should not break when worn correctly.

It is necessary to empty the ostomy pouch when it is about one-third full. The pouch should be changed every two to four days, or as your doctor tells you.

It is best to see an internist or gastroenterologist to evaluate these concerns.  Dr. Farzana Rashid will be available for appointments beginning in November at Penn Presbyterian Medical Center and at Penn Medicine Radnor. To schedule a consultation with Dr. Rashid or another Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

What type of doctor can help with constipation?

Question: I have lost the urge to have a bowel movement and also cannot force out stool. How do I find a doctor who can help me locate the source of the problem and appropriate treatment?

Answer: The frequency of bowel movements among healthy people varies from three movements a day to three a week.  Individuals must determine what is normal for them. As a rule, constipation is suspected if more than three days pass between bowel movements, or if there is difficulty or pain when passing a hardened stool.*

It is best to see an internist or gastroenterologist to evaluate these symptoms.  To schedule a consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.











*   http://www.gastro.org/patientcenter/digestiveconditions/AGAPatientBrochure_Constipation.pdf

What can go wrong with a child's bowel movement?

Question: What would cause a child's (age 7) bowel movement to be so big it has to be cut up to flush, and hard? He eats vegetables and drinks water and has even taken fiber. The fiber worked for a while, but now he is back to his original state.

Answer:  It appears that the child has constipation. Children often develop constipation as a result of stool withholding. Delaying a bowel movement causes stool to become hard, dry, and difficult to pass—sometimes resulting in a large mass of stool in the rectum called a fecal impaction.

A child should see a doctor if symptoms of constipation last for more than two weeks. A child should see a doctor sooner if the constipation is accompanied by one or more symptoms that may indicate a more serious health problem, including:
• fever
• vomiting
• blood in the stool
• a swollen abdomen
• weight loss
• painful cracks in the skin around the anus, called anal fissures
• intestine coming out of the anus, called rectal prolapse

It is best to have the child’s symptoms evaluated by a pediatric gastroenterologist. To schedule a consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

Do I have a problem with my liver?

Question: I've had lots of symptoms that suggest a problem with my liver such as abdominal pain, bloating, and loss of appetite that started about three months ago. One month ago I had an MRI which did not show anything unusual in the abdomen. In addition, blood tests including liver function appear normal. If my symptoms continue, should I consider a repeat MRI?

Answer: Your symptoms could indicate a wide variety of gastrointestinal issues.  If an MRI didn’t reveal anything, another one may not be necessary. Pain in the abdomen can come from any one of the organs located between the bottom of your chest and your groin. Severe pain doesn't always mean that there is a serious problem. Nor does mild pain mean a problem is not serious. Get medical help immediately if

• You have abdominal pain that is sudden and sharp
• You also have pain in your chest, neck or shoulder
• You're vomiting blood or have blood in your stool
• Your abdomen is stiff, hard and tender to touch
• You can't move your bowels, especially if you're also vomiting

There are many common causes of a decreased appetite and bloating. It is best to see your internist or gastroenterologist to evaluate these symptoms.  To schedule a second opinion consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.