Small bowel obstruction

Hey Maddie,

Have had the pouch 30 years.  Two obstructions during that time.  Other things have occurred, but all have been dealt with.  Hard to know about what you are experiencing.  Depending on all kinds of factors (and I have never really figured out exactly what works and what does not) - I often feel the food moving through, the feeling of distension, gassiness - I also had a spot for a long, long time that felt like things got "stuck" there.  I would put a heating pad on it, rub and push on it, etc. - but it would happen here and there - I never could figure it out. 

Years later, I had surgeries for other health issues and they cleaned up a lot of adhesions and that "place" that felt tender has been better ever since.  I don't think you should panic and worry it will be chronic - the obstructions did not become chronic for me - hope other people will chime in. 

I'm sure you are watching what you eat, etc. to try to make things go through as smoothly as possible.  If in another couple weeks you still feel tender, I'd go in (I know you don't want to) and see what doctor says.  You are probably pretty young, and I know how frightening it is when something goes wrong with the pouch - you think, "I cannot go through this over and over again" - etc. - I have found that whatever it is, they can usually fix it. 

Also, for me, working was very stressful and that definitely added to my pain and discomfort through the years.  I was a workaholic and a bit of a perfectionist - and that was something I regret - I wonder if I had not been so hard on myself and had reached out for help at work if I might not have lasted longer - I really did not share about the pouch at work except with close friends. I felt it was private and I would be viewed as a "complainer" - well, I should have explained more to my bosses over the years. I do not work now, and the low stress has really helped - I retired very early at age 45 - but that was not only because of the pouch - many reasons that I just could not do that job anymore - I'm 52 now.   I'm throwing a lot of ideas at you here - but I wonder if you have a stressful job and if so, maybe some meditation, biofeedback, or something would help you cope.  Most importantly, I don't think you need to panic that the obstruction will be a chronic issue.  Good luck and know you are not alone.

hey Maddie, were they able to discern what was the proximate cause of the SBO?

reading other posts here the thoughts seem to be that adhesions (which are a natural byproduct of surgeries) are tough to manage, and ironically to go in and cut them only sets you up for more.

separately if it was a stricture or multiple strictures then you have the possibility of dilating those and thereby reducing the likelihood or risk of obstructions. I for example had a mid pouch stricture and another less onerous one that lies just above the jpouch opening, I get these balloon dilated quarterly. its expensive, its time consuming etc but its a hell of a lot better than getting obstructed. there were a few years where I was routinely ending up in the ER a few times a year because of obstructions. additionally for me a med adjustment to adding methotrexate to my weekly humira also seems to have helped.

while we can presume you choose carefully what you eat, tend to low residue diet, low fiber, but this is sometimes a controversial topic as people have different opinions and for that matter different tolerances to food. that said, I would say that especially immediately after an obstruction clears especially if you became extremely distended during that you will experience pain for some days until your intestines calm down and relax and return to normalcy. during that time I would be extremely gently, maybe even stepping all the way back to a liquid diet to be very very gingerly introducing foods.

good luck. I feel your pain. the other point I would make is that many times when I felt an obstruction developing I would immediately step down to a liquid diet to help things ease up and clear before I would resume routine eating. I am convinced this saved me at least a few ER trips. also chew chew chew. you want to masticate your food to death so its nice and soft going down the hatch. and eat slowly, do not inhale your food, for example I once obstructed myself after inhaling an egg bagel breakfast sandwich. chew chew chew. oh and chase the food with water.

Maddie, sorry to hear you're having problems!  I am almost 19 years post takedown. So far I've only had 2-3 SBO. The first was due to adhesions which lead to a minor surgery to clean those up. I've had many more partial obstructions. Sometimes I'm sure it was due to what or how well I chewed my food. Additionally over the years I've developed several strictures or narrowing of my small intestine. 

I usually stick to softer foods; avoiding anything with high fiber. My Dr. said sometimes it can't be avoided. Due to the movement of the small intestine and the extra space without the colon the small intestine can kink up on itself. When that's happened I was just taken off food for a day or two then gradually my diet would be stepped up to regular food. 

Good luck!

I've only had one SBO and it happened soon after takedown and was caused by twisting of my small intestine.  Painful beyond painful!!!!!  Surgeon admitted me to hospital, kept me on IV hydration, etc. for four days and morphine, as well.  He also ordered the insertion of an NG tube. Thank God for the morphine!  Every time he visited me (maybe twice a day) he would firmly press on my abdomen as though he was feeling for something.  He also told me he had the O.R. reserved so if needed he could surgically take care of my problem.  Well, after four days, my small intestine untwisted and I was sore but no longer in excruciating pain.  I was discharged on the sixth day.  No problem since but every time I feel a twinge in the area I immediately try to copy what my surgeon did by pressing hard all over my abdomen......hoping to head off any problems.  It must be working because I've never had another problem.  I had my SBO in 2003.

Yeah - yes- pressing around on those spots helps me too - have had 2 or 3 SBOs over 30 years - 2 undid themselves, one needed surgery - have been free and clear of them for 7 years. I do press around on these areas on by abdomen if I feel that sensation coming on.  Also - for me - tons of hydration - gaterade or propel, etc. can help unclog things.  Maybe that will help someone out there.

I have had my j pouch since 2007 and have had 2 children and had bowel complications both times. I just had my second daughter last month and 3 days later had an emergency surgery for a bowel obstruction. Since then I've been in severe pain and I too feel like I sometimes can feel stuff trying to move through. I had another ct scan and it looks the same as before surgery including an 8 cm bowel loop. I can barely stand this pain and not sure what to do.

If you are in severe pain - you must push your doctor for help or find another doctor...this is not something to mess around with.  No need to panic - but you need someone better.  I don't know where you live but the very best help is at Cleveland Clinic - people fly there from all over the world and get help when people who are "the best" in their area can't fix things.  Also - it would seem like you would be on some type of relaxer type medication which relaxes the bowel muscles...it's been awhile and I forget what it is called.  Others are more up to date and I hope they post some help for you.  I hope also you have family to support you if you are trying to raising little ones and in this pain - and a very supportive husband...will keep you in my thoughts - this can get better...but you may need someone in your circle to advocate for you if you are too tired to do it for yourself.  Don't give up - keep pushing for help and relief.  I've been thru many ups and downs and have had pouch for 30 years - and you can get thru this - but you need to reach out for help!