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kblgal
Hi,

Having post-op problems again. Had my reversal surgery 6/12/13 and got to leave the hospital 2 days later after having bowel movements.

My normal doctor is on vacation and the doctor I saw a few days said today that I should probably go to the ER due to my most recent symptoms.

My xray a few days ago had just shown constipation and Ileus. She prescribed stool softeners and clear liquids until my abdominal cramps lessened and I had more bowel movements. And started tapering off Oxycontin.

Since then, I've had clear liquids, then low residue diet, then today went back to clear liquids. I went on stool softeners but did not take them -yesterday- because I was having too many bowel movements. Also -yesterday- is when I ate solid food. I think I ate too much in one sitting because my appetite suddenly came back. Since then, I've had terrible abdominal cramps again and was constipated. It was really hard to have any bowel movements and I had to strain. I had a lot of trouble sleeping due to the pain and wouldn't have slept if I hadn't had sleep medication.

Today is a tiny bit less painful now being on clear liquids again - the cramps are more spread apart and aren't as bad. I took stool softeners again last night and today. But my pain is always worse at night so I'm worried about that.

Am I putting off the inevitable in not going to the hospital now or at what point do I need to go?

Replies sorted oldest to newest

Jan DollarJan DollarModerator, RN, retired
I think it all depends on how you feel. Yesh, you probably over did it with the solid foods yesterday, but it does not sound like you are seriously blocked.

What you need to ask yourself is what would they be doing different in the hospital than you are doing at home? Keeping you awake with noise and bed checks doesn't count. Neither does making you sleep on a plastic matress and pillow.

More than likely, they'd be keeping you on clear liquids until you are passing gas well. You can do that at home. If you cannot tolerate clear fluids, then you'd need medical attention for IVs, but if you are taking in enough to urinate several times a day, you should be OK. If you were seriously blocked, you'd need an NG tube, but it does not sound like you are there yet.

But the main thing might be better control of opiate withdrawal symptoms. But even that you can do at home (unless over the counter meds don't help and you can't get a prescription because your regular doctor is out of town).

Bottom line, it is what your comfort level is. I'm the type that avoids the ER and hospital like the plague, so things have to be REALLY bad before I'll go in. Probably not the best role model... I think you'll know when it is time for you.

Hope this quickly turns around, making the question moot.

Jan Smiler
Jan Dollar
SpookySpookyMember
I'm with Jan; I try to avoid the ER as much as possible. That being said, I was given some helpfu guidelines by my GI years back, which can help you decide when you should/should not go in:

- passing no bms or gas at all for 12 hours (8 with an ileo)
- no bms and you are vomiting (go immediately if this is the case)
- severe abdominal pain (obviously this is subjective, only YOU can decide what you can and cannot tolerate)
- symptoms of a partial obstruction that persist for more than 24 hours (that is, you have cramping, etc, and you are still passing very liquid stool or gas, but have had no solid bms)
- go immediately if fever is accompanied by any of the above symptoms

Hope that helps!
Spooky
kblgalkblgalMember
quote:
- symptoms of a partial obstruction that persist for more than 24 hours (that is, you have cramping, etc, and you are still passing very liquid stool or gas, but have had no solid bms)
- go immediately if fever is accompanied by any of the above symptoms


Okay, so I thought that all the BMs would be not exactly solid so I'm sorry for the graphic question, but how do you know if the BM is more liquidy or more solid? Also, I'm on clear liquids so wouldn't that make it more liquidy anyway?

Also, I've had a fever and nausea with the cramping before (couple days ago) but I figured that was from pain meds withdrawal.
kblgal
Jan DollarJan DollarModerator, RN, retired
Yes, if you are on liquids only, you get less output. Still, if you have been backed up for a long time, once things really get moving, you'll be sorry you were wishing for more poops! Sort of like the dam breaking and everything coming down at once. Even if there is no physical obstruction, the result is the same once the ileus finally resolves and your gut wakes up.

My surgeon told me the opposite though about the gas. He told me that unless you are passing gas, you can still be obstructed. Liquid stool can generate beyond the obstruction, or if you have impacted stool, go around it. But, with an ileus, passing gas is a reason to celebrate.

And you are right, that with the opiate withdrawal, there are overlapping symptoms. Perhaps that was why the other doc suggested going to the hospital. Basically, so you don't have to worry about it. Since the fever/nausea has resolved, no need to worry about that now.

Keep sipping on those clear liquids, including fruit juices. But go easy on the apple juice, as that can increase the cramping, if things aren't moving well yet. White grape juice tends to be good for getting the sluice box to open!

I don't know why, but chewing gum also can stimulate peristalsis that seems stuck.

Jan Smiler
Jan Dollar
Jan DollarJan DollarModerator, RN, retired
Things become more "normal." When you eat or drink, it stimulates the gut and things move. You will definitely "KNOW" because you will wonder where all that stuff came from, and why does it not STOP! Once things are moving and then settle down after a few days, a more predictable pattern will evolve.

And yes, passing gas is passing gas. All ways are normal ways, as long as it comes out of your butt. I don't dare fart without being on the toilet (always a shart, never a fart). Most of the time, my BMs are followed by a rush of gas.

Jan Smiler
Jan Dollar
kblgalkblgalMember
Thanks... I think I'll stay on clear liquids today and then try "full" liquids tomorrow. See if the abdominal pain comes back. If it does, I will be at a loss and may not have a choice in going to the hospital. But yeah, I've been in the hospital 3 times in the last 7-8 weeks so I'm kind of refusing to go back there. :P
kblgal
Jan DollarJan DollarModerator, RN, retired
Just try not to get discouraged. An ileus can be very stubborn, but I have never heard of one lasting forever (it just seems like it!). The one thing that you may want to do is have your electrolytes checked soon. A low serum potassium can perpetuate an ileus. Oral potassium supplements are pretty vile, so IV replacement might be preferred (especially if you are prone to nausea and vomiting).

Jan Smiler
Jan Dollar
SpookySpookyMember
I recommend Pedialyte or the coconut water (the no-pulp variety and without sugar added) as better hydration than some of the sports drinks, which can be ridiculously high in sugar. The coconut is very high in potassium too, which is important (my potassium is always the first thing to crash when I have hydration issues). You get about 5-10x as much from a can of that as you would from a bottle of Gatorade, and without all the dyes and other crap that goes with it.

As for the liquid stool, I understand the confusion. When you are early out, sometimes it's hard to know what a good consistency is! (I remember asking the surgeon who did my initial emergency surgery, how I was supposed to know if I had diarrhea, and then she giving me a quizzical look). If it helps, when I was partially blocked, I was passing bile - basically a greenish brown liquid. It had the consistency of pure water. That's what I would consider liquid output. Smiler But I also had other symptoms of a blockage accompanying that: pain, bloating, feeling as if nothing was passing, nauseous, and generally feeling unwell.

The times in my life when I've been blocked I've felt the worst I've ever felt in my entire life. Ileus was dreadful. For me it took about 10 days to clear; I was hospitalized the entire time.
Spooky
kblgalkblgalMember
Oh, Pedialyte. Thanks for that. I tried coconut water a couple of days ago and it made me want to gag. I guess I better get used to the taste.

I didn't have to go to the hospital. Smiler But I'm still struggling with gas pains constantly. Gas-X wasn't doing anything so I'm going to try Beano before each meal for now and start taking the probiotic gummis. I hope that helps because these gas pains have been frustrating.
kblgal
SpookySpookyMember
Believe it or not, gas pains are actually a good sign at this stage. It means the bowel is waking up. I had very painful gas/cramping as my bowel finally started to move again. Walking can help with this (I was strolling the hospital halls at 4 am at one point. Memorieeeeeeeeeeeees. *LOL*). But consider that proof that your bowel is starting to get back to normal functioning. The pains should begin to subside as everything else normalizes. For that type of gas pain, Gas-X and even Beano probably won't do much. They can't hurt, though, so you could always try and see if you get some relief. My GI just recommended tylenol.

I've never really minded the taste of coconut water, and in fact I drink it a lot; I like it after a workout. There is a version of Pedialyte that tastes a lot like apple juice. That's the one I usually go for when necessary. There is also a clear one that is more or less tasteless; it's like slightly sweet water.
Spooky
Jan DollarJan DollarModerator, RN, retired
Give it a few weeks and try not to get discouraged. After you've had an ileus, the gut is very "touchy," as it is inflamed and sensitive after the trauma of food going in, and not moving through. Keep the meals small and easy to digest. Take Beano WITH the meal, not before. No surprise Gas-X didn't work, since it does not prevent gas at all, just helps you get rid of it. But, if the gut is sluggish, no help there.

So, until you are over this gas trouble, don't try to treat diarrhea much. Be careful with fiber supplements too, since psyllium can increase gas and be a slight irritant, but it varies from person to person. Citrucel is less likely to cause gas.

If you haven't already, check out the dietary guidelines, particularly the one on foods that cause gas and odor. You might be surprised at some of the offenders:
https://www.j-pouch.org/diet.html

Jan Smiler
Jan Dollar

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