Wednesday, March 20, 2013

Gastric Bypass, Pouch Size, Enlarged Stomas and Weight Gain

Before we start this post, I want to make sure everyone understands what happens to our guts during gastric bypass surgery.  I am going to post a photo I found on Google.  I know it's completely illegal but I am going to link back to their website so you can read up on their information as well:


This photo borrowed.  Please visit: http://www.njbariatricspc.com/bariatric-surgery-types/gastric-bypass-surgery-nj/
So your food travels down your esophagus and into your pouch for minimal processing before it passes through the stoma on it's way to your newly-attached intestine.  The purpose of bypassing some of your intestines is so you (initially) do not absorb all calories eaten (some reports state that this calorie malabsorption may only last a short time because of the body's amazing ability to adapt to "trauma").  In the long run, it also means you are not absorbing all of your necessary vitamins and minerals, which can cause other health issues. 

Most people believe that if you gain weight after you have had gastric bypass surgery, it is because you have stretched your stomach back out to it's old or "normal" size, thereby allowing you to eat more.  Most likely, however, you are either eating (grazing) too often throughout the day, or your stoma may have enlarged, which allows the food to just slide on through without spending much time in your pouch. 

From an article about understanding your pouch:

Our pouches will GROW over time. Yes, it's a living organ and your body tries to compensate for the rearranging we did to it during bariatric surgery and it will grow to help get in as much nutrition as possible. A mature pouch is anywhere from 6 ounces to 9 ounces in size... and can naturally stretch to hold up to 12 ounces of food at a time. A pouch reaches maturity at about the 2-year mark. By 6 months after RNY gastric bypass surgery your pouch has grown to about 2/3 of it's maturity level. Once you are a year out, your pouch is no longer 1 ounce in size ... it's more like 3 ounces or 4 ounces and can hold 6 to 8 ounces of food.

Studies have shown that the size of your pouch has very little to do with your overall success with weight loss. Your success has more to do with how well you follow your eating and exercise plan and how well you follow the "rules of the pouch."

Click HERE for some pouch rules.  Worried that your pouch has grown too much?  Click HERE for the cottage cheese test.  (I am now 9 years out...about two years ago, I did the cottage cheese test and found that my pouch was about eight ounces.)  For the fun of it, here's the link to a study called Pouch Rules For Dummies.

What happens if the stoma, the opening at the bottom of your pouch, enlarges, allowing your food to slide through faster, and leaving you hungry sooner?  I see ads all the time for gastric bypass revisions.  Often, those are fixes for an enlarged stoma (they generally aren't re-cutting your pouch to be smaller again).  A potential non-surgical option is listed HERE.  For an article about surgical revisions, click HERE.  For information about the non-surgical ROSE procedure, click HERE.

The purpose of this post isn't to list EVERY option available but to make everyone aware that weight gain can and does happen, that it isn't always "your fault," and that there is help available if you fall into certain categories.  For the most part, for those of us dealing with weight gain, we may have fallen back into old habits, or are dealing with health issues that make our metabolism slow down.  I certainly know why I have gained weight.  I am sensitive to medications, which affects my metabolism (meaning, I need to eat fewer calories to make up for it), and I am an all-day grazer, who uses food to deal with my emotions (meaning, I need more therapy).  Do you feel like your pouch may have stretched too much or maybe your stoma is enlarged?  And, have you figured out what makes you over-eat?  Tell me how you're doing and, if you've run into problems, how you're going about making them better!

15 comments:

  1. I am 12 year's out and experiencing terrible bloating, gas and constipation no matter what I eat. my ct scan showed a dilated pouch and small intestine. I go bk to see my Dr on Monday. I hope I can get care for this despite being 5'7, 150 pounds. I can't live like this. I look 6 months pregnant after I eat! I'm starting the 5 day pouch test in efforts to self cure....thank you for this post!

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    1. You poor thing!! I hope that they are able to help you. Have they said what can cause it??

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  2. Will the pouch and or stoma shrink with say a liquid diet for a while? Please email me missvitah@gmail.com

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  3. Will the pouch and or stoma shrink with say a liquid diet for a while? Please email me missvitah@gmail.com

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    1. There are certainly "back on track" diets that you can try. Also, you can use the "cottage cheese" test to see how large your pouch is. You should check out Pouch Rules for Dummies. Google all of that and you'll have somewhere to start.

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    2. Actually the pouch rules are linked above. :)

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  4. I am thinking about a revision of my 9 year old roux-n-y. But after finding the pouch rules and cottage cheese test, I will definitely try these first before going any further with a revision. Thanks so much for this article!

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  5. I am thinking about a revision of my 9 year old roux-n-y. But after finding the pouch rules and cottage cheese test, I will definitely try these first before going any further with a revision. Thanks so much for this article!

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    1. I hope you are also going to therapy. I find that the problem wasn't my stomach, but my brain! <3

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  6. I'm doing the "cottage cheese test" in the morning. Was just diagnosed with an ulcer and enlarged stoma. Praying for revision. 6 years out; 40lb gain

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    1. How did the cottage test go? Will they consider a revision for 40 pounds of weight gain? I recently cut out a lot of sugar and have started losing weight again.

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  7. I am 12 years post op and have regularly stayed under my goal weight and if I did get close to that weight of 170 my body seemed to recognize it and I would lose weight. Have stayed between 152-165 faithfully then suddenly it seems like my upper portion from belly button up stays bloated and I've had a weight gain to 175 lbs within like a 3 week period or that's at least when I noticed. I'm in tears I don't have my surgeon anymore and try g to find a new doctor but after years of not feeling full I actually started feeling full in the last 4 years.but seem to still eat more than I should. What do I do? I almost was wondering if this was hormonal because I did the self assessment and had most symptoms but not sure.

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    1. I am in the same boat as you are.

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    2. I am in the same boat as you are.

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    3. It is very possible something you are eating is causing it. My nutritionist is amazing. I encourage you to contact her. http://abalancedtable.net/

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