Why are ostomates more prone to blockages?

Hey gang,

Maybe it's me, but I notice an uptick in the number of blockage-related posts............which got me thinking. Why would an ostomate be MORE subject to a blockage, rather than less? I mean, they basically cut our intestines and stick the open end out our belly. I would think that would make it EASIER for something not fully digested to exit.............way before it would if your intestines were connected to your ass. Not much digestion occurs in the colon, it's more of a sponge to absorb liquid...........so why do so many have blockage concerns? If something could make its way from your mouth to your ass when you were connected..........how does shortening the length that said something has to travel to get out make it more prone to block you? It shouldn't. Now, I'm not talking about an underlying disease affecting your remaining bowel........then all bets are off. But I've noticed things that cause me to have a blockage aren't like the size of a marble...........they're much smaller. But I don't know why they would tend to get stuck unless there's some restriction that wasn't there when I had all my bowels. When the stoma is attached to the peristomal skin, does that cause a restriction inside the bowel at that point? Just not seeing what would cause a restriction if nothing else is wrong. Might have to stick my finger up in there if no one knows the answer. Anyone??

;0)

Bob

Hey Bob,

I am not sure but a great topic. I am lucky enough to not have had any blockages, but a friend of mine seems to constantly have them. Her circumstances are different and chemo seems to cause a lot of her issues. I am like you, I still feel like there is something put together differently than it was and some twist of some kind is going on. I also feel that I should be able to tolerate all the foods I previously consumed, but that is not true either. I have a colostomy, so my pipes should be basically the same, just exit earlier! Hope there is some discussion on this! It would help others a lot!
Puppyluv

Haven't had a blockage myself but have a friend with an ileo who gets them regularly, she has had several surgeries over the years and her GI told her that scar tissue build up from resections of the small bowel has contributed to the blockages.

That might be only in her case, but I have only had the one surgical procedure (panproctocolectomy) for the ileostomy and have never had any issues as yet in 12+ years.

I have a friend who gets blockages because of adhesions. The intestine bonds to the incision scar which gives the intestine no wiggle room when the innards shift around from time to time.

The surgeons always comment to me while scratching their heads that I don't get adhesions for some reason.

Another friend had an adhesion to an appendix op scar, in a car accident the seat belt wrenched the scar area tearing the intestine, he was in a bit of trouble until they discovered that.

Most of what I have read is because of the things you eat and not drinking enough water. The other main things are adhesions and scar tissue.

Living with Your Ostomy | Hollister

Adhesions take a lot of the blame for food blockages. It's always been the case; we all automatically blame something we've eaten. Just for instance, you could eat an apple today problem-free, but tomorrow you could have a blockage from it. That's why you should always try something at least three times before giving up on it and blaming it for giving you a blockage.

For myself, it's my hernia and desmoid tumors on my small bowel that cause blockages, except for pineapple. That's the only thing that gives me a real food blockage.

Well Bob, interesting topic. I have had one blockage in my 9 years since my plumbing was re-routed. We were able to resolve it at home with massaging around the stoma and drinking hot liquid. The culprit was peanuts not chewed well enough while I enjoyed a few cold ones. The key is chew, chew and chew some more, plus drink plenty of water to lubricate things up. Also, keep in mind our new exhaust pipe is corrugated and not a smooth surface so things can get caught easily. My two cents. BTW...when are you ditching the winter coat and hat and adding a Hawaiian shirt and visor for your summer profile PIX? Stay well everyone. Penguins7

I'm going to have a stab and say a mixture of lack of fluids, not chewing enough.

Bob, several people mentioned adhesions/scar tissue that restricts small bowel output. Another common cause of ileostomy blockages is the sharp turn that some of them are fashioned into when they are sewn into the abdominal wall.

90-degree turn + abdominal muscles + scar tissue + fibrous food = blockage

That is without any complication from a hernia!

Hi MBT!

Yeah, I thought about the 90-degree turn to exit the abdomen, as you say. But when you look at the normal 22 feet of bowel in a normal person, and how it's tucked in the cavity.....there are places where it does a full 360 in a much more confined space. But I think you hit on the answer........there has to be something else contributing...........such as a stricture, adhesions or such. I'm going to ask my Gastro next time I talk to her too.

Thanks,

Bob

What I meant to add is the problem with that 90-degree turn is that it is tethered to the abdominal wall. Depending on the individual, that can be a very firm tether with little give. The 360-degree turns in the abdomen are tethered to each other and the mesentery or omentum. They have comparatively more give...most of the time.

But there is sometimes an adhesion, hernia, or another structure involved.

I have only had a couple of minor blockages early on. These days, I can pretty much eat what I want. I was really paranoid about blockages in my early days and spent a lot of time on the United Ostomates of America website, which is excellent for support and answering questions like this. The consensus among the folks there was that adhesions and the skill of the surgery done were the main factors in either having or not having chronic issues with blockages. The very point you made about the diameter being pretty much the same was well discussed and in theory, nothing should be much different.

Bob, you ask the best questions, and practically answer them, so I will add onto the puppy pile. The problem is often multifactorial: adhesions (if you have had even one surgery), other contents of the existing bowel, dehydration/fluid or electrolyte imbalance, too much booze or mind-altering substance while eating, sedentary existence (rarely is one more active post-ostomy), transit time problems (too fast or too slow are issues), particular fibrous items with membranous integument (citrus, pineapple, nuts, seeds) and structural anatomy at the output.

As for me, I eat everything now, in smaller doses and with committed chewing, but many folks with GI disease never had the best diet particularly in the land of fiber. Tending toward naturalistic solutions, the stuff you buy OTC as fiber is not the same thing as some foods that actually resolve a variety of the above cluster f--- of issues. I had one bad blockage, but caught it early, stayed up all night hydrating with clear fruit juices to create ostomotic push, and spent the night in a hot bathtub until the offending item (I had carrot cake with pineapple and was drinking cocktails before the unpleasantries started) gave itself up. I don't recommend this approach unless someone knows what you are up to because it can be dangerous if you don't decompress. My go-to foodstuffs are plantains, cooked through with a little salt or cinnamon/sugar, but people use all sorts of food remedies to stay 'regular' whatever that means in our post-ostomy anatomy annals.

Please let me hear whatever other foods people use to prevent blockages, especially with the rolling blackouts and crazy high heat. Airway, breathing, circulation, fluids. Stay cool, Ninja girl in California.

Any time I've had a blockage, it was the direct result of eating too much of the wrong food. The last time I had to be hospitalized for a blockage, it was because I ate too many pumpkin seeds topped off with almonds. It really did me in. Another reason, as said on here, is due to a lack of sufficient fluid intake. Just one thing with an ileostomy, it is not just a simple snip and externalization that is done. It is more complex and involves reconfiguring of the lower small intestine. This makes us more prone to blockages.

Xerxes