Dealing with Small Bowel Obstructions - When to Seek Medical Help?

In the nearly thirty years since I had my surgery for colon removal, I have only had small bowel obstruction twice.
The first time was in 2005. That got me five days in the hospital with lots of pain and a nasogastric tube. The NG tube was a fun time. It hurt like hell in your
sinus cavities after about twelve hours and sucked out a lot of swampy-looking green stuff (bile). I came very close
to having surgery, but the obstruction spontaneously resolved on its own, and I was released from the hospital.
The second time was in 2019. I started feeling a dull ache in my abdomen on a Thursday morning. It got worse as the day went on, but I did
not have as much pain or the nausea and vomiting I had in 2005. I tried to tough it out and spent a sleepless Thursday night, but I knew I was in trouble
by Friday morning when things had not resolved. I knew what was happening, and I tried everything to get it to resolve. I had read that standing on your head
had worked for some people, so I even did a handstand against the wall. No luck.
I ended up going to the emergency room since the pain was getting worse. I squirmed around in pain and waited for nine hours to finally see a doctor. During that time, the pain became really intense
and I was on the verge of vomiting. All of a sudden, I felt a weird warm sensation in my abdomen, and the pain and nausea suddenly disappeared. I felt 100% normal again. It must have worked itself loose.
I really regretted going to the emergency room, especially since the care was so poor and they did not seem to know how to triage patients. I'm just wondering, for those of you
who have dealt with obstructions, do you go to the hospital pretty quickly when you start to feel the sensations, or do you give it some time to fix itself?

I am glad you posted this and look forward to any responses you may get. Thanks....

Me personally, I wait as long as possible to go to the hospital. In the meantime, I try several different things from grape juice, which is a small bowel laxative, to laying on your side with a heating pad, manipulating your stomach in order to get things moving, laying still for long periods of time to give the bowel a rest to allow digestive enzymes to work, taking a long hot bath. If the pain's not too bad, I will eat soft items like pudding to try to get the bowels moving. With that being said, I have had six bowel-related surgeries and actually sat in on a seminar where a surgeon said that most blockages are caused from adhesions, which is scar tissue that chokes off the bowel. So going to the hospital sooner than later is the best bet. You have access to fluids, pain meds, and other opinions. Blockages are nothing to take lightly, so my best advice is to go to the hospital. They will fly you to if something goes wrong! In other words, go to the best hospital possible, even if you have to drive further. I drive by 3 other hospitals to go to the one the others will transport me to if something goes wrong, and I have made that mistake and had to be transported before.

Hope that helps and will pray you don't have more.

Cplumber

Hi JohnofCal,

I've experienced two blockages and each time I stopped eating for a day or so and drank a ton of water while massaging the belly area often to get things moving. It appeared to do the trick for me as I never had to go to the hospital. I wasn't vomiting though, so yours may have been much worse in which case I would seek medical attention at that point.

I had quite a few blockages in my earlier years of having an ileostomy, until I learned what I could eat and to chew my food better. Only the first two times I went to the hospital, but there was really nothing they could do. After that, I learned to deal with it myself by forcing myself to vomit and then drinking lots of water. Drinking Coca Cola seems to work best. The pain was unbearable, but all I could do is wait it out, usually overnight. Sometimes I would have to vomit two or three times. I know that sounds bad, but vomiting is what helps move things along, plus relieves the pain in your stomach. Drink Coca Cola when you have a blockage, it's like drain cleaner.

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Hi all, in my 30 some years with an ileo due to Crohn's, I've had several blockages. And I usually drink green tea until I throw up. And if that doesn't work, I go to the hospital.

I've had my ileo for just over one year, and only had my first blockage around three months ago. I did go to the hospital after lying down and massaging my abdomen didn't work and the pain was getting pretty bad. I was there for two days before it resolved itself, but the reason the blockage cleared was because they gave me something to drink that was a contrast fluid taken prior to a type of X-ray they were planning on doing. It just so happened that this contrast fluid also had a laxative effect, and that is what did it. I have since learned that I need to be more vigilant about keeping hydrated and chewing my food really well. I've had a couple of close calls, where I felt like a blockage was starting. Drinking a small bottle of Coke did the trick in pretty short order. It has to be the real Coke, not sugar-free. I don't think I would go to the hospital nearly as quickly next time. They can't really do much other than give you pain meds. I would probably stick it out a little longer, lie down, use a heat pad on your abdomen, massage around your stoma, try to relax, drink water, then if none of this works, drink a Coke. If the Coke didn't work, I think I'd give up and go to the ER.

Terry

Thanks to everyone who responded to this post. Some of you have certainly had more experience with this problem than I have. I picked up some really good tips. Hopefully I won't ever have to use them

in the future!

I had a similar event in October. I had my sigmoid colon, rectum, and anus removed due to cancer in 2017. In 2018, a CT scan found another different type of tumor in the small intestine, so I had the terminal ileum and ileocecal valve removed and the small intestine was connected to the colostomy. I did well for almost 3 years except for profound weight loss. At age 81, I didn't want surgery again unless absolutely necessary.

In October, I had severe right lower quadrant pain and realized I hadn't passed anything in the pouch for 2 days. So initially, I tried a Dulcolax tablet, repeated it 2 hours later with no results, so I went to the Emergency Room. I was taken in pretty quickly. The ER doctor tried to pass an N-G tube twice, and I felt like I was drowning in the water they were forcing me to drink while trying to pass the tube. Finally, I said "pull the darn thing out - no more". The CT scan had shown a partial obstruction of the small intestine. The ER doc must have told surgical residents that I wouldn't allow her to attempt to pass an N-G tube a third time, so the surgical residents came in wanting to try again. The head resident said he would try, and I told him NO. He told me "then we have nothing else to offer you". Having worked for doctors for more than 30 years, I wasn't going to take this type of talk from a resident and told him, fine, I will go home and tell my family that they have nothing to offer me and if I die it will be their fault. They then decided to let me calm down and sleep for a while. The next thing I knew, they were moving me to a bed as an in-patient.

Early the next morning, my colo-rectal surgeon came to visit. He explained that they were going to watch and wait for a day or two. Even though the CT scan showed a partial obstruction, he said that often the small intestine doesn't have an actual obstruction but has kinked like a hose sometimes does. Until you unkink the hose, nothing can go through, but sometimes the intestine does "unkink" itself. Thus, giving me another laxative wouldn't work. I asked if he did a colonoscopy, could it "unkink" the intestine. He said sadly colonoscopy doesn't usually go down that far. I had nothing but ice chips the first two days. On the third day, they allowed me bouillon, and liquid started showing in the pouch. The next day, I was allowed soft food, which revealed more success. On the 5th day, I was allowed to go home on a soft food diet for 2 weeks.

Two weeks later, I had the same type of belly pain, but the ostomy was working well, and I suspected the stone in my gallbladder acting up. I went back and ended up having surgery to remove the gallbladder. I asked if the surgery could be done laparoscopically, but the surgeon told me that due to the location of the gallbladder and needing to use 4 laparoscopes to remove it, it would be much too close to the colostomy, and he would be afraid of damaging it with a scope. So, I had the surgical cholecystectomy, which was a fairly easy surgery.

If one is having severe belly pain and not passing anything in their pouch, I would definitely go to the Emergency Room or see your doctor the same day as gastrointestinal obstructions can be life-threatening.

Hi there - I have had many blockages which started in year 4 of having my ileo. At first, I could trace them back to unwise food choices. But then it seemed everything I ate caused a blockage. In late 2020, I had laparoscopic surgery for lysis (cutting) of adhesions. After a difficult recovery period, I started having blockages again. The bottom line is that surgery causes adhesions. Some people have problems with them, while others do not. The official stats show that 97% of abdominal surgeries result in adhesion growth. So if you have random pain, it could be from adhesions.

I am at the point now where I can head the blockages off if I catch it early enough. I feel tightness under my breasts in my upper abdomen. My output has slowed. I can "feel" some hardness when I bend forward. I immediately switch to warm liquids and keep that up until I see a change in output. If it persists for more than two days, I drink broth and have jello. Again, these are early stages with no pain, just discomfort. Then when I feel it is safe, I start adding some food back like applesauce. Keep drinking warm liquids, use a heating pad, massage the area.

If I am in a situation where I am in pain, I still follow the above protocol. If the pain persists and I start throwing up, I may need to go get fluids. I try to continue drinking to help things break up. I don't like to go to the ER as they often don't understand and want to take drastic measures. I am lucky that I can recognize the early signs and try to head them off. This is now a way of life for me as my adhesions are severely obstructing my small bowel. So I eat mostly soft foods, no fiber, no cheese. Drink 72 oz or more a day. I hope this helps.

Thank you for the suggestions, Bruce Fan. They are very helpful.

I had been beating myself up trying to figure out what had been causing the obstruction/kinking. I hadn't eaten foods that would have caused it. When I had my small intestinal surgery, the surgeon spent a full 2 1/2 hours just carrying out lysis of adhesions from former surgeries before he could remove the small intestinal tumor. Thus, I also wondered if that could have been the cause with new adhesions that had formed. It is a real probability.

Thank you again for taking the time to reply. It is much appreciated.

I walk a lot and of course drink and drink! Blockage occurred last week due to large polyps in colon! Guess you could call it a weird blockage! Anyway, in 2 weeks colon coming out!

Do you have an end ileostomy? Tks

I am getting an end ileostomy! Colostomy now! It has been good!