Ileostomy blockage - Seeking advice on managing scar tissue and adhesions

Hi Osto-friends.. I have had a permanent ileostomy for 20 years with a couple of trips to the hospital since then.... This past mid-December, I had a partial blockage which sent me to the hospital by ambulance... They were able to get things moving after about 6 hours on IV drip plus meds.. I was able to go home and, of course, told to drink lots of fluid.. It was a horrible week after with emptying bag after bag of water for three days plus being so weak.. By the end of the week, I was able to eat soft puddings and eggs. Last week, I made a tuna sandwich which tasted good and I made sure to chew it really well... Later that night, I vomited for half an hour.. Now I am scared to eat anything solid and am basically living on water, Gatorade, and Ensure.. Toast has been okay and eggs.. I know there is a lot of scar tissue plus adhesions in my abdomen and fear that they are going to continue to be a big problem now that I am in my senior years.. My stoma is on the left side permanently.. It was originally on the right side but moved after a failed reversal.. I know removing scar tissue will create more scar tissue.. I don't have a specialist and have never had an ostomy nurse for some reason... I notice quite a few of you talk about your ostomy nurse.. Sorry for rambling but I live alone and am getting worried.. Not sure what to do. Has anyone else experienced this problem with ileostomy?) :

Ange

Hello Ange. 

I am sorry to hear that you are having these sorts of problems. I must be even more difficult if you are on your own and without a stoma nurse to advise you. I don't have an ileostomy, but I did suffer with blockages at one time. What I did to alleviate the problem was to put all my food in the liquidiser. It's not the same as having a normal meal, but, at least psychologically, I could 'visualise' that all the food that I like was in fact withing the drink. After a while I gradually got back to eating normally and to CHE, CHEW,  CHEW. 

I do hope you find a solution to your problems soon.

Best wishes

Bill 

Hello Again Ange. 

I almost forgot. As I was browsing through past posts last week, I came across a very interesting article copied from another site about this subject.(United Ostomy Associations of America) It was mentioning the fact that under certain controlled circumstances it is possible to irrigate an ileostomy when there are blockages. Now, this is not something to undertake without medical assistance , so it is in no way 'advice' on the subject, but nonetheless it is interesting to know about for when we have discussions with medical staff. I'll copy the article blelow:

Best wishes

Bill

HOW TO TREAT ILEOSTOMY BLOCKAGE
Symptoms: Thin, clear liquid output with foul odor; cramping
abdominal pain near the stoma; decrease in amount of or
dark-colored urine, abdominal and stomal swelling.
Step One: At Home
1. Cut the opening of your pouch a little larger than normal because
the stoma may swell.
2. If there is stomal output and you are not nauseated or vomiting,
only consume liquids such as Coke, sports drinks, or tea.
3. Take a warm bath to relax the abdominal muscles.
4. Try several different body positions, such as a knee-chest
position, as it might help move the blockage forward.
5. Massage the abdomen and the area around the stoma as this might
increase the pressure behind the blockage and help it to �pop
out.� Most food blockages occur just below the stoma.
Step Two: If you are still blocked, vomiting, or have no stomal
output for several hours:
1. Call your doctor or WOC/ET Nurse and report what is
happening and what you tried at home to alleviate the
problem. Your doctor or WOC/ET Nurse will give you instructions
(ex., meet at the emergency room, come to the offi ce). If you are
told to go to the emergency room, the doctor or WOC/ET Nurse
can call in orders for your care there.
2. If you cannot reach your WOC/ET Nurse or surgeon and
there is no output from the stoma, go to the emergency
room immediately.
3. IMPORTANT: TAKE THIS CARD WITH YOU TO THE EMERGENCY
ROOM AND GIVE IT TO THE PHYSICIAN.
4. IMPORTANT: TAKE ALL OF YOUR POUCH SUPPLIES
(eg., pouch, wafer, tail closure, skin barrier spray, irrigation
sleeve, etc.)
United
Ostomy
Associations of
America, Inc.
United Ostomy Associations of America
P.O. Box 66
Fairview, TN 37062
800-826-0826, www.uoaa.org
EMERGENCY ROOM STAFF:
ILEOSTOMY OBSTRUCTION
Symptoms: No stomal output; cramping abdominal pain; nausea
and vomiting; abdominal distention, stomal edema, absent or faint
bowel sounds.
1. Contact the patient's surgeon or WOC/ET Nurse to obtain history
and request orders.
2. Pain medication should be initiated as indicated.
3. Start IV fl uids (Lactated Ringer's Solution/Normal Saline)
without delay.
4. Obtain fl at abdominal x-ray or CT scan to rule out volvulus
and determine the site/cause of the obstruction. Check for local
blockage (peristomal hernia or stomal stenosis) via digital
manipulation of the stoma lumen.
5. Evaluate fl uid and electrolyte balance via appropriate
laboratory studies.
6. If an ileostomy lavage is ordered, it should be performed by a
surgeon or ostomy nurse using the following guidelines:
� Gently insert a lubricated, gloved fi nger into the lumen of the
stoma. If a blockage is palpated, attempt to gently break it up with
your fi nger.
� Attach a colostomy irrigation sleeve to the patient's two-piece
pouching system. Many brands of pouching systems have
Tupperware�-like fl anges onto which the same size diameter
irrigation sleeve can be attached. If the patient is not wearing
a two-piece system, remove the one-piece system and attach a
colostomy irrigation sleeve to an elastic belt and place it over
the stoma.
� Working through the top of the colostomy irrigation sleeve, insert
a lubricated catheter (#14�16 FR) into the lumen of the stoma
until the blockage is reached. Do not force the catheter.
� Note: If it is possible to insert the catheter up to six inches, the
blockage is likely caused by adhesions rather than a food bolus.
� Slowly instill 30�50 cc NS into the catheter using a bulb syringe.
Remove the catheter and allow for returns into the irrigation sleeve.
Repeat this procedure instilling 30�50 ccs at a time until the
blockage is resolved. This can take 1�2 hours.
7. Once the blockage has been resolved, a clean, drainable
pouch system should be applied. Because the stoma may be
edematous, the opening in the pouch should be slightly larger than the stoma.

Hi Ange, it sounds exactly like what I went through in the last 5 years. Before I had resection surgery and my stoma moved from right to left, I would overeat something like pizza or beef stew and within hours, I would be in the bathroom puking and in severe pain. Sometimes, I had to go to the hospital to get it cleared. But the last time that happened, a surgeon was called in and he said it's going to cause a bulge and possible rupture, so I had the surgery. Now, I can practically eat anything with no problems. When I had my old stoma, it was shrunken down and the opening was at skin level, which caused a lot of leaks and sore skin. I was dreading the surgery as I'm twice as old as my original surgery 35 years ago, so I knew recovery was going to be harder. But I'm retired now, so I didn't have to worry about going back to work. Good luck, hope you're feeling better.

Hi Ange,

Yikes... you're bringing back some really bad memories... how could I have forgotten about that stuff so soon? First off, vomiting is bad. Real bad. It means your bowels have sent an SOS to your brain saying "road closed", you ain't getting anything through. You know that. Next up... what to do about it. First thing is to determine WHY. I hear what folks are saying about chewing and liquids and all that... but if your bowels have fistulized (like mine) or twisted, it won't matter how well you chew. So you need to get scanned (CT is better than MRI, but it really depends on the skills of the Radiologist). Not sure how it works in Canada, but here I'd just go to the ER, drop my Gastro's name, and tell them to page her and get me on the CT scanner. Ultimately you do know that surgery most likely is in your future. Not trying to be an alarmist or anything, but once your bowels get to that stage medications are useless. At best they might buy you some time to plan, but the sooner you get it fixed the less you'll wonder why you waited so long. I know it sucks, been there a few times, but each time you come out the other end pain free you're glad you did it. Because you live alone (I think you said that) you can't take as many chances. If you don't act today, then tomorrow at least contact your Gastro and tell them you need to have them figure out what's going on with your blockage. If they give you some shit about scheduling a CT will take weeks then screw them and go to the ER. Just scream your head off until they help you. Squeaky wheel gets the grease! Don't make me come up there and drag your ass to the hospital. I think my passport is expired anyway, so all I could do would be to shout at you from the border. And that's not going to help much except probably get me arrested. Which might cheer you up for a few minutes. Ok, I got to head out, but will check in later. You know what you have to do.

Later,

Bob

How to Manage Emotions with LeeAnne Hayden | Hollister

About three years now without any blockage, so I think I am eating right and doing whatever needs to be done. However, Ange, you gotta get an ostomy nurse in your corner for things like this. Your doctor should offer some information about the nurse. Mine did, and it helps having that nurse in your corner. Living alone does suck, making matters worse. But it's all on you now, babe. I feel for ya, hon. I can't help but stress getting the nurse to talk to. I like what Bill said and his advice from UOAA. Wow, good shit! You don't think your recent fall had anything to do with this? See your doctor, get a nurse. Then, if emergency, get an ambulance to go to the hospital. We all will be with you in spirit. Warrior.

Hi Ange, sorry you are having so much trouble. I can't offer advice on this subject as I have never had this problem. All I can say is what the others have said sounds like you need to get some help. Please keep us updated as it may help others also. Good luck

Thanks all for your suggestions and support...I am scared to death of the thought of more surgery and don't know what they can do...I have a lot of scar tissue which the doctor showed me on a CT scan which is what had caused the previous before this last blockage...he said that cutting out the scar tissue will cause more to form and basically there is nothing to do to prevent the tissue from causing blockage again..they can't move my stoma to right side because it has already been used when first temporary ileostomy was performed... guess all I can do is the best I can with this for now..going to see my GP to have me referred to a surgeon here who has Crohn's disease and has had a couple of bowel resections done..he knows a lot about ostomies and he looked after me when I was an inpatient a couple of times...hopefully he can help.....Thanks again everyone..it's so wonderful to be on this site and be able to tell it like it is to you all who understand.

Ange

A surgeon with Crohn's and a stoma? Sweet!! It doesn't get any better than that! Good luck speaking to him. Take notes. And relay unto us your findings.

Hi Ange,

I too have a permanent ileostomy (30 years) on my left side with lots of scar tissue. Here's what I have learned along the way... I drink aloe vera juice every day and have for at least 25 years. It helps control the amount of inflammation in my intestine. A twisted bowel can cause inflammation which can lead to a partial blockage or worse. I never know for sure what the root cause of my discomfort is, so the daily aloe vera helps with all inflammatory issues. If I feel some discomfort after dinner, I will lie on the living room carpet on my left side and do some breathing exercises until the bowel relaxes and starts gurgling (10 to 30 minutes). This helps me with twisting of the bowel and gas flow. When I get sharp pain, it's usually gas and I will take Gas-X. Gas issues also can cause inflammation and lead to other blockage-type problems. Also, I will lie in a hot bath with no appliance (the morning after a liquid/soft food dinner) for as long as I can before things start flowing. This really helps relax the bowel. My stoma will look stressed when I get into the bath and a bright red healthy color when I'm done. These are mainly preventive measures that I believe work for me and may help you in the future also. Hope you're feeling better soon.

Brian

Hi Brian. Welcome and thanks for sharing. I am a bit confused at your response. I too have a permanent ileo.... on the right side. No problems. But maybe I took a few too many sleeping pills today. And it is Monday.

I have no bowel. I have no large intestine. I do have a rectum and stump just "in there".. but what I am curious about is you mention "bowel" as if you still have part of your large intestine and I thought anyone with a permanent ileo has no large intestine. It's gone. So you say you have inflammation in the bowel and sometimes it's twisted?? Are you meaning the small intestine?? Because that's all I know is left after they remove the large one due to an ileo.. I also have no scar tissue but from reading it sounds that's a result from moving the stoma from right to left. The normal location for an ileo is right side facing forward looking down.. and I am told a colostomy is located on the left side.. but I understand also relocation does take place... I guess they gotta stretch the small intestine from right all the way over to left.. which to me sounds pretty frightening. Thanks for clarifying. Warrior on dope. :0

Sorry, I have no large bowel, just small bowel/intestine. My permanent ileo is on the left side because it was originally going to be reversed but complications resulted in having the large bowel and rectum removed shortly after my colostomy surgery. It was back to back surgeries and the surgeon felt I might have been too weak to move the stoma at that time. The stoma has been good (for the most part) for 30 years so it's never been moved. I had many bowel surgeries when I was younger and all result in scar tissue afterwards. My Crohn's has been in remission for quite some time and moving the stoma would only be done on a need-to basis as disturbing things could cause other problems. Hope that clarifies things...........Brian

Yes, it does Brian. Thanks for sharing.