Bowel obstruction experiences and advice?

I ended up in the ER last weekend where a CT scan confirmed a bowel obstruction. I was admitted and the plan was to insert the dreaded NG tube to see if that helped move things and if not then surgery. Somehow, by asking to wash up before the tube went in, and all nursing staff disappearing, I avoided the tube. At about 1:30 a.m and 28 hours of no output in the colostomy I had luck and output. They discharged me the next day.

Now my question is this. The doctor said it was not related to food and there was nothing I could have done to avoid the obstruction. I tried what I could at home...warm bath, stretching, rubbing my gut, to no avail. The doctor said it would be a lifelong problem because of adhesions in the gut. Has this been what other people have heard and experienced? It was a completely miserable experience that I do not want to ever repeat. I personally thought eating an orange followed by pistachio nuts might have "clogged" the pipe so to say. Perhaps that is ignorant and superstitious to think I have that kind of control over this.

Wonder what other people have had happen and been told?

I was told that I should stay away from oranges due to the skin and membranes and also any kind of nut - now I have an ileostomy but I don't think that makes any difference. When they did the first op, the surgeon removed just enough to give me a colostomy and then closed me up due to the severity of the problem, my weight, and a ton of scar tissue from a previous cancer surgery. But apparently, my body likes to make scar tissue and I was told that I might have problems like yours down the road. I did have what I believe was a small blockage several months back - but I've not had it again. Could they not remove the scar tissue now or would it only make more problems for you?

Any GP that told you the oranges and the nuts weren't the likely cause is an idiot.

Then again, that's why they are GPs and not internal specialists. If it was an internal specialist that told you that, he's not a very good one.

Oranges and nuts are our enemy, just grind those babies up as much as you can. I'm hooked on hazelnuts and when I have a few drinks and then start pounding those things into me without chewing them all up, I'm in big trouble the next day.

Take care, I don't know how many times this happened to me and I end up in out-patients for a shot of morphine or Demerol. The relaxation of the body and bowel seems to clear it up within a few hours.

Thank you Tess45 and Tinminer. The doctor who told me food wasn't the cause is the Chief Resident of Surgery on my surgeon's team. I will see my actual surgeon for follow-up in a few weeks and he is great, so I will see what he has to say.
Tess, the doctor said there may be some anomaly, problem in that part of the bowel that caused the blockage and should it happen again, perhaps surgery should be considered to repair it. But the surgery is another navel to pubis!! What I call "why didn't they put in a zipper?" since I have had 4 of them due to cancer and complications of radiation. And of course, every time they cut, there is yet more scarring and more adhesions. Ugh.
Tinminer, I was interested that they gave you a shot of morphine or Demerol and it helped. I will ask my surgeon about that. I begged and they finally relented and gave me two Tylenol. Yes. After I threw up all the contrast solution for the CT scan, they gave me anti-nausea meds. Only one dose since they think anti-nausea meds are constipating and no one wanted that. And in fact, post-op I have found morphine stops everything.
Without being too gross...well, really I HAVE to be...when I finally started producing and I looked at what was there, I saw a piece, a hunk sort of, of the fibrous part of the orange and a lot of nut pieces. Now I was told I could eat whatever I want, but it isn't worth it.

Thank you!

I used to suffer from this problem 2 or 3 times a year. It started out with trips to the ER and the dreaded NG tube a few times before I started figuring out the warning signs and how to handle it.

First of all, I pretty much eat whatever I want just in moderation but that's different for everybody. What is important is hydration - drinking water and not allowing yourself to become dehydrated. Almost every visit to the hospital was preceded by not drinking enough or overworking myself. I also stopped taking decongestants which apparently can dry out your digestive system as well as your nose and sinuses. This kind of sucks in September as I have allergies but I've learned to deal with it.

Prevention: if you feel a blockage coming on, deal with it immediately. If I start to get a stomach ache and haven't had significant output that day, I will immediately irrigate my colon with a 50 ml syringe that I get from my ostomy supplies provider. I just take a cup of warm water and gently insert the plastic tip into my stoma and fill 'er up. THIS NEEDS TO BE DONE KNEELING OVER A TOILET. I snap on a large drainable pouch once I have shot in some water and wait. Usually it starts draining in about 30 minutes and usually a hard "plug" that was the blockage comes out in this time.

If you have waited too long and have started vomiting, go to the hospital but take charge of your treatment. Demand to get hooked up to IV fluids right away, even while you are in the waiting room. It starts to make you feel better quickly, even though you may still be throwing up. Once you are on an IV, do the irrigation that I mentioned above in the bathroom - the hospital can get you a 50 ml syringe and bottles of sterile water to use... Then wait for movement. It sometimes takes a while but it beats the NG tube. Usually the combination of fluids from both sources will clear my blockage. I have had my ostomy since 2003 and I haven't had an NG tube for many years because I figured this out.

Keep some 50 ml syringes around the house as well as the large drainable pouches. I use small Coloplast 2-piece closed pouches most of the time but keep other supplies in the house for circumstances such as these.

Dear torontoguy.
Very interesting. One of the questions the doc's PA asked me was, "Did I put my hand into my stoma?" God no, said I. No one showed me or told me you could even think about that. However, the doctor at the hospital, after I was admitted, did shove his hand in there and feel around. Who showed you how to do the syringe thing?? I don't know that I could try that without being shown. However, desperate enough, I might.

Also, I was hooked up to an IV right away... it didn't really help me with the nausea. Of course, the nausea got much worse when I had to drink the vile CT contrast stuff.

Do you get the 50 ml syringes from Coloplast??

This is very helpful and exactly what I hoped to find when I posted this. I KNOW there is a way to prevent and cope with this problem.

Many thanks!!

Yep, see - the oranges and the nuts... that's what finally came out after - if I were you, I would stay away from them - if you must have nuts, the best advice is to chew, chew, chew and drink lots - as for the oranges, I was told that tangerines and mandarins would be fine - less fibrous than oranges. As for the pain meds and the anti-nausea meds, what you were told is total BS - they sent me home with morphine and I was given all kinds of anti-nausea meds in the hospital - stuff stronger than gravol. I have never found anti-nausea meds constipating at all, and I take gravol all the time - as a matter of fact, I use it to help me sleep. I am not sure why you have been told these things, perhaps you have certain conditions that are different from mine? But I would suggest that you do indeed talk to your surgeon and perhaps ask for a referral to a gastro specialist. Information can be confusing and contradicting.

It has been a while, but I think it was my home care nurse who first showed me how to do this. It is just a generic 50 ml syringe, with a thick plastic tip. You have to hold it firmly (but gently) against your stoma to try and prevent the water from squirting out. I can't believe you used the word "shoved" in relation to your stoma... I hope he was gentler than that sounds. I happen to know from past x-rays during my blockages that I tend to get them in the same place, which could never be reached by a finger!

It has a 1-1.5" tapered tip and they call it an irrigation syringe on one of these sites:

http://www.tradekey.com/product_view/id/1683443.htm
http://www.ecvv.com/product/3108600.html
http://www.ecvv.com/product/3188537.html

The place where I buy my ostomy supplies can supply them, so start there. You could also beg one from a hospital.

Hi Tess,

I agree that I will avoid oranges and nuts. Not a real hardship. I did actually take codeine for years to stop the constant diarrhea I suffered with. And when I had bowel resections (I had 4) and was too stubborn to have an epidural for pain and insisted on the morphine pump...the morphine did stop my bowels from working. The last go around I went for the epidural and it was much, much better for both pain control and bowel functioning. In my years of trying to fix my gut problems, I saw 4 different gastroenterologists and they each had their own take and their own bag of tricks and yes, different information. One of the "perks" I hoped when I had the colostomy done was to never, ever again have to see a gastroenterologist. I will make a list of what people have written and suggested in my post and run it past my surgeon. He was always my go-to guy when the weird gastro people would lay another thing on me.

Thank you so much for your response!

My husband bought a pediatric enema bottle at Walgreens and it works with warm saline - I'm a small person so this size works for me - it was shocking when 'stones' came out a couple of weeks ago, but I still seem blocked - I see a surgeon on Friday - my husband gave me a puréed meal tonight as he is afraid that solid foods will just add to the blockage - at the moment I am extremely 'liquid'.

Good luck, Cee - let me know what your surgeon says - I'm curious.

We learn by trial and error. I would be very suspicious about the pistachio nuts, given the timing. Sometimes I get away with eating borderline foods if I chew 50 times.

Personally, I'd avoid pistachios like the plague. Bowel obstructions are not good things no matter what causes them. Good luck and congratulations on avoiding the NG tube!

Hi.

I feel like a real idiot, but I'm going to ask anyway. I've had no problems with my ostomy, but it's good to have info like this just in case. As soon as I saw the word "irrigation", I assumed you're talking about colostomy. For obstructions, can this process be used with ileostomies as well?

Thanks and please excuse my ignorance.

Lalu

I had my colostomy surgery in 2003 as a result of colorectal cancer. My first procedure for the division of adhesions was in 2005. I had several bad blockages up to this point. Since then, I have had blockages with monotonous regularity. I tried everything to prevent them from happening, but block up I did anyway. If you suffer badly from this curse, then there is little you can do other than diet. Even this is a problem. Oranges are indeed very difficult to digest. However, skin them and cut them into slices about 6mm thick. They are fine then. I can eat shoestring-size fries but not the thicker type from fish and chip shops.

I DO NOT RECOMMEND SURGERY. I was forced into surgery in January 2010. It didn't go to plan, and I ended up with peritonitis, septic shock, renal failure, etc. I came home on May 24 but still had the nurse and physio coming to my home for the following 12 weeks. It was a very bad time. Another point to bear in mind is our spouse and family. My very dear wife suffered along with me. I know that the wedding vows mention "as in sickness as in health," but she sure copped the wrong end of that.

I have had tremendous problems since 1994 (we have been married for 48 years), and she has been there for me through it all. Please do not suggest that it is her duty. That REALLY annoys me. An acquaintance made that mistake and received the benefit of my ire. Duty doesn't enter into it.

I steam all vegetables into a soft consistency, avoid fatty foods, red meat has to be minced and mixed with a sauce. Do not have bread with seeds in it, and avoid nuts of any kind. They are deadly. When dining out, take care of what you order. I need easy-to-digest foods. It isn't simply a blockage sometimes; the bowels all being glued together prevents them from working normally.

Take care

Doug

NO - people with ileostomies do NOT irrigate! And don't let just anyone even put a tube in your ileostomy because that's asking for trouble - with an experienced doctor, they can put fluid in and it would force a blockage out, I believe - but ONLY someone very experienced in this procedure would be safe to use. What I learned when I first had my ileostomy was CHEW-CHEW-CHEW! And DRINK-DRINK-DRINK.

No nuts, no seeds, nothing with membranes (like oranges), be careful of raw veggies like carrots or broccoli, be careful of fruits with skins...the list goes on and on, but almost anything can be eaten in moderation if you CHEW and DRINK.

I have an ileostomy and was told by the surgeon never to allow anyone to irrigate or give me any sort of an enema through my stoma. He also said never to take any sort of laxative as it could blow my intestines apart.

As for obstructions, I get them 2-3 times a year and have been in and out of the ER too many times. For the most part, I know that after I eat the giant bag of popcorn at the movies with the extra butter, I KNOW I'm gonna pay for it. For the most part, I avoid anything with a skin or peel it, then chew it really well. Nuts? Forget it...I don't even go there anymore. I stick to eating relatively soft foods to make sure things can flow easily to avoid the dreaded NG tube. However, there have been 2 occasions I have actually gone into the ER and said, "GIVE IT TO ME NOW!!!" Even reinserted it once MYSELF because when I told the nurse it was going to fall out, she didn't believe me. A good cue for me is when I start throwing up the blacky/greenish bile.

Lalu, you are not an idiot!!!

Irrigation is most definitely a colostomy thing. I irrigate every 48 hours as a normal routine. This gives me a much better sense of control. Coloplast makes a setup for irrigation and it fits in with their Sensura two-piece click series of bags. The setup consists of a graduated water bag with a hand controller and a soft rubber cone that is inserted into the stoma. I run about a liter of 38 degrees C water into the bowel. There is a sleeve that click connects to the base plate which is attached to you (also takes the bag range). That channels the output to the toilet pan.

Having said all that, it is imperative that intending irrigators discuss this with their stoma nurse or surgeon or even both.

You do not need to be excused for anything. It is all a big learning situation. We all had to start somewhere.

Doug

I've had an ileostomy for 30 years now, and for years I was plagued with bowel obstructions due to adhesions until I figured out what foods to eliminate from my diet and how to deal with the onset of an obstruction.

First, I slowly started eliminating the obvious roughage from my diet ... raw fruits and vegetables, including salads with "leathery" greens, such as spinach. It made a world of difference; however, I still sometimes get an obstruction on occasion, which usually starts out as a sharp pain in my gut right after I get up in the morning.

#1 - Do not eat anything else until the obstruction is cleared. Then, for several days, eat soft foods until your gut settles down. I find that I can go right back into an obstruction if I start eating anything but soft foods for a few days afterward.

#2 - If you feel you have an obstruction (pain in gut or no output) - try this. Drink right down a large glass of water that is as hot - or very warm - as you can stand it without burning your mouth/throat. Go lie down in bed immediately and begin to roll side to side and onto your back every 5-10 minutes. If that fails, I drink one more glass of hot water and repeat the rolling routine. I have saved myself dozens of trips to the ER for the dreaded NG tube and a hospital stay of several days. I try to adhere to a 12-hour rule, meaning that if the obstruction hasn't cleared in 12 hours, you need to head for the ER.

BTW - If I have to call in sick to work, I feel it's better to take a day to beat an obstruction than to maybe be out for a week or more in the hospital - let alone a surgery, to free an obstruction.

Cary

Thank you all for the info. In the past, I heard of irrigation only for colostomies, but wanted to check just to be sure.

Lalu

I also recently had an obstruction due to adhesions all over my abdomen. This is the second time in 6 months. Then I had a second surgery for an infection. I hope this does not happen often. It seems that this is how I heal. Do any of you have the same problem? Renee

I believe obstructions can be caused by adhesions and that for some reason, MDs really do seem to like to diagnose the cause of an obstruction as such. I know, however, from personal experience, that it most definitely can be related to food or dehydration. Almost every time I have had an obstruction, I can relate it back to what I had eaten (and had a sneaking suspicion that I may regret what I had just eaten) or that I hadn't been drinking enough fluids. The last 3 times it happened, it was quinoa, spaghetti squash, and shirataki or "miracle" noodles (so much for trying to be healthy and keep my girlish figure o)). If it gets bad enough, I go to the ER, tell them I have a bowel obstruction, need an IV and a CT. The last time, even knowing it could slow down my bowel activity, I took a Percocet before I went to the ER in hopes of staving off the pain intensity. It helped initially. Pain still came later but I think I am glad I took it and may take it again if it happens again. Also, the last time, they gave me enemas, which didn't seem to do anything, and I also walked the halls (walking has always helped to get things moving after surgeries) and later they gave me Miralax which did the trick. Maybe it was the combination of all 3 but I am very glad to know about Miralax (I always thought this type of med would plug me up even worse) and have some on hand in the event that, if I feel an obstruction coming on, I will take the Miralax early on.

As far as the oranges, I just had some this evening and, as gross as it may be (and I generally don't do it unless I am alone), I still get to enjoy the orange and the juice by chewing it and then discarding the skin. I don't do this often but when I am craving them, this is the only way I will eat an orange and other fruits (ex: grapes) otherwise, I don't eat them at all. I always peel apples before eating them. Take care everyone! o)

Thank you everyone for your response to my post. Even though I had it on "notify me," I haven't been getting the prompts that there were new messages. I pulled it up because tomorrow I meet with my surgeon and I took notes on what everyone said to run things past him. Regardless of what he says (and I love him as a good and gentle person), I believe the orange and nut binge along with the area of adhesion or scarring in my small bowel led to the obstruction. I haven't touched a nut since and haven't missed them at all. The oranges I threw out. A small price to pay to avoid the horror of obstruction and ER and, God forbid, NG tube. Although I concur with the person who said there are times when you beg for it...the throwing up of the black bile times.

Shudder, shudder.

I will post tomorrow and tell you what the good doctor says.

Hi all,

I met with the doctor today and discussed the entire episode of the obstruction. He seemed a little annoyed with me actually because, I think, I complained about going through the 8 hours in the ER. Like why do I have a private doctor? Whatever. I told him about what you guys do with the warm water and the irrigation. He said he had no problem with it but it depends where the blockage is. Mine was in the small intestine and it was clear from the CT that it was filling and filling and more mucus is made to try and move the bowel along. He thought I had a kink or an adhesion there. He defended himself and said he told them to "go slow" with me in the hopes it would clear without surgery. Which it did, thank God. I didn't even discuss the food issue since honestly, I think they are clueless and I believe my peeps who say "avoid oranges and nuts" and it is a small price to pay to not have an obstruction. Why give the kink another shot at making me more than miserable?

Thank you everybody for your words of wisdom.

Cee

I was in the hospital for about six weeks - 15 minutes before a small bowel exam, colostomy was working perfectly - minutes after they brought me back to my room, stoma stopped working and for nearly four weeks now it has not had any activity...(I am on intravenous fluids - 12 hours at night) - about four days ago, the mucous side of the stoma started working - I am praying that the stoma itself will start doing something - I finally found a stoma center and hope to get an appointment this week (all my doctors have 'written me off')!

I have had an ileostomy for 13 months. I hardly watch what I eat, I was just at the movies and had a succulent big basket of buttered popcorn. I do not eat oranges because of the excessive amount of fiber it contains. I eat nuts and apples with the skin, and I'm not sure I chew as well as I should. Am I a blockage waiting to happen? I have not had a blockage yet. I eat tomatoes, salsa, corn, chips, etc., and I love Mexican food, Italian, etc. After reading these posts, I'm thinking perhaps I need to start being careful with my diet.

I am in the hospital now. I didn't know anything about blockages but thought I just had the flu. Vomiting, weakness, and overall feeling awful? My husband insisted I go to the ER where they admitted me and put the NG tube in. YUCK! It has now been 4 days since I have had anything to eat and I'm praying I can get this tube out tomorrow. Why do the stoma nurses and our surgeons not educate us in this.