? Obstruction

This sounds like an obstruction to me, likely a partial one. It sounds like you're taking good care of yourself. If your urine gets dark (or stops) then your fluid intake by mouth isn't doing the trick. The vomiting is often considered a sign that you need medical attention, but if it's only when you try solid food you could back off from solids for a while. It's hard to describe when the pain indicates that you need to be evaluated for emergency surgery, but certainly if it gets much worse you need professional assistance. I don't think the Cipro is doing you any good, since the symptoms have evolved and clarified that this isn't pouchitis.

Jmatec,

Sounds about right...yup, that is what my obstructions feel like...it is the expression 'waves of pain' that lets me know that it is an obstruction and not something else.

I have a specific spot that blocks and then either I get very little output, lots of cramps or nausea or all together and need a heating pad to survive.

My cut off point is if I can get nothing down, not even water, for 24hrs I hotfoot it to the ER...no point waiting beyond that. If I can still get liquids down and am not throwing up too badly then I try to wait it out.

I roll around on a mat using yoga balls and walk a lot to try to open it up on its own but if nothing goes through I have no quams in heading for the ER.

Just monitor the intake and output...if you are distended and in pain and less and less is coming out then it is time to call your doctor back.

Still, as Scott says, stay on fluids, (hot is best) and let it work itself out if possible.

Sharon

I am sitting in emergency after x-rays show obstruction. How complicated is surgery and what do I need to consider?

Once you're in a hospital dehydration is no longer a risk. Surgery would generally be advised if the bowel is at risk of rupture or the blood supply were cut off. The surgery isn't particularly complicated, but it's an open procedure with the usual recovery time. Often patience is the better long-term approach, as most obstructions clear up on their own.

Bill, sorry this has happened. Most often surgery is not necessary and the worst is usually just the dreaded N/G tube. Your use of morphine to slow the gut may have backfired on you. Hope this resolves quickly.

Jan

I hope that this opens up on its own and that you do not need surgery...as the others said, the surgery is usually strait forward but none the less open surgery...  most doctors have their own protocol of when to stop waiting and start cutting.

Good luck...I hope that it resolves on its own

Sharon

I have a question. Jens post could have been my own. 3 year old jpouch and all the symptoms of a partial obstruction every 7 to ten days. So far they resolve after several days of misery. Cat scan and scope both look normal. Gastro thinks it's adhesions from 4 surgeries in 4 years and recommends going to hospital if it doesn't resolve. 

Has anyone found something that can prevent these episodes? I take welchol for bile and protonix for reflux, now have lung infiltrates from nausea and vomiting... But take no pain or sleep meds. 

Up and working on my feet 10 hours a day, no lack of excercise.

my diet is awful as I'm afraid of fresh fruit, vegetables or whole grains. Pretty bad gastroparisis. Allergic to wheat and nuts. Any thoughts or suggestions would be appreciated!

What at am I doing wrong and what can I fix without surgery?

Hi. Everyone. I'm  going to put my two cents in here.  Jeffrey had an obstruction after his surgery three weeks ago.  They did two contrast studies.  One was for him to drink oral contrast which did not work.  He drank three tablespoons and gave it back in spades.  They did the study any way, I believe it was a CT scan.  I'll have to ask him about it because at this point I forget, it was a week ago.  The next day they did a contrast study but rectally.  They injected the contrast up his rectum. He said it hurt like hell, and all the rest that goes with this.  The point was that the force of the contrast might open up the obstruction, which fortunately it did.  We don't know how large the obstruction is/was or how closed off it was.  But obviously it was not completely blocked.  If it was completely blocked he was have needed another surgery.  It sounds like it your case Jen that you may not be completely blocked.  Jeff is still on clear liquids.  He will be for another few weeks.  He has not had solid food since January 26.  Also, earlier this week he thinks that the obstruction finally opened up as he was in the bathroom a lot and lots and lots of stuff passed.  So it might be able to break up the obstruction with out surgery.  Good luck.  Bill, good luck to you too.  

They cscan last night in emergency showed partial block above the jpouch. They ruled out a couple of things and I am to see colon rectal surgeon next week. I have no nausea or only occasional fever. My pain is not severe. I am on liquid and have stopped lopermide and fiber. 1/4 dose of morphine and continue on vsl3ds. Increased 2 times daily to 4 times.

I was not subjected to hose down the nose. Understand they plan a rectal scope before any action. Would like to avoid surgery as they were initially predisposed to consider. Seems  they agree at this point. Still my passing of bowels. Any advise appreciated    Thank you

There is no one right answer...first off there are different types of blockages...mechanical due to either outside forces (adhesions strangling the bowl) or inside like undigested foods building up inside the bowel...then there are kinks when the gut litterally twists on itself or  narrowing of the bowel due to a surgical site or inflamation etc...

Then there is our favorite ileus when the bowel swells or does not wake up post op or slows down & just goes to sleep for any number of reasons (certain opiate meds, diseases and treatments...)

Each kind of blockage requires a different approach whether partial or total...Some require (hot) fluids, massage and lots of walking while others require NG tubes and I.V...then still others require surgery.

I had never heard of it opening up thanks to an enema but why not?? Anything that helps us to avoid surgery is worth trying...

Sharon

Sharon, Jeffs obstruction was most likely due to adhesions and bowels not waking up post-op.  They have been shut down since last March.  The surgeon had said that the contrast might force things along, which it seems to have.  This new surgeon we have is wonderful, I love hm.  He is so calming, almost Zen like.  Jeff seems to be having an off day today, seems to have slept all day.  Hasn't had anything to eat either.  I'm back in the chicken soup business, haha! 

Bill, try to avoid surgery if you can.  Hope you feel better!

All great advice - have had obstructions that have passed on their own in hospital.  I don't mind the ng tube at all - I always ask for dilaudid when this happens.  So ng tube does not bug me.  It has usually take 4 - 6 days to go away - the IV keeps you hydrated.  I hope this works out for you.  I had one time when I had to have surgery - but only once and that was also due to a multitude of other factors - sure hoping no surgery needed.  The pain of an obstruction - especially as I tend to stay home too long and try to tough it out - is so awful - I could not walk.  Nothing left inside and so dehydrated - which is quite dangerous and means get thee to the ER pronto.

NG tubes or I love the expression, hose down the nose suck but they work.

and Jeff's mom is spot on, regarding an ileus which may occur post operatively, CT scan process the nature of the dye seems to stimulate and awaken the bowels I had a friend who's surgeon did this for her and bam, floodgates opened.

but as Sharon well described there are various reasons for obstructions so best to try and identify the root cause. this unfortunately is not always a simple task.

good luck and I hope you can get resolved without too much further discomfort.

AKT2 posted:

I have a question. Jens post could have been my own. 3 year old jpouch and all the symptoms of a partial obstruction every 7 to ten days. So far they resolve after several days of misery. Cat scan and scope both look normal. Gastro thinks it's adhesions from 4 surgeries in 4 years and recommends going to hospital if it doesn't resolve. 

Has anyone found something that can prevent these episodes? I take welchol for bile and protonix for reflux, now have lung infiltrates from nausea and vomiting... But take no pain or sleep meds. 

Up and working on my feet 10 hours a day, no lack of excercise.

my diet is awful as I'm afraid of fresh fruit, vegetables or whole grains. Pretty bad gastroparisis. Allergic to wheat and nuts. Any thoughts or suggestions would be appreciated!

 

What at am I doing wrong and what can I fix without surgery?

 

Welchol is seems to be not recommended for people who have bowel obstructions: 

Do NOT use Welchol if:

• you are allergic to any ingredient in Welchol
• you have a history of certain bowel problems (eg, blockage, paralysis, slow movement of the bowel muscles) or major stomach or bowel surgery, or you are at risk of bowel blockage
• you have very high triglyceride levels or a history of inflammation of the pancreas (pancreatitis) caused by high triglyceride levels