Bowel Blockage or Obstruction

Question:

I had ulcerative colitis, have had my large intestine removed, and have an ileostomy. I simply got out of hospital after having experienced a bowel obstruction. Tin this happen again?

Answer:

A bowel obstruction is when the normal motion of nutrient, fluid, or gas is prevented from occurring within the bowel (intestines). Obstructions can exist either partial, pregnant some of the fluid and gas passes through, but ordinarily solids don't, or consummate, meaning zip is able to pass through the bowel. About 20% of people admitted to hospital with an acute abdomen (or an abdomen that quickly becomes firm, is tender to touch and painful), accept an obstacle of their bowel. Of these 20%, the majority (80%) will take a small bowel obstruction like the one you experienced. There are several reasons why bowel obstructions occur, however, with your type of surgery and stoma, the two more mutual are adhesions (scar tissue) or food obstruction. Each of these will be discussed beneath.

Adhesions are bands of tissue, like scar tissue, that can abnormally connect or bind side by side sections of the bowel together, or demark the bowel to other organs inside the abdomen, or tack the bowel to the within of the abdominal wall. This scar tissue tin can and so prevent the normal movement of food, fluids, and gas through the intestine. About scar tissue results from some sort of event that disrupts normal tissues. Every bit the body repairs the disruption, information technology creates scar tissue. Events that can initiate this process include surgery, an infection within the abdomen, trauma, or radiation therapy. Adhesions are the about common complexity of surgery, occurring in more than ninety% of people who undergo a surgical procedure. The adhesions brainstorm to course within days subsequently surgery. In most instances, adhesions do non crusade any pain or complications, and people are not aware of their presence. However, adhesions may non cause problems until months or even years after the initial surgery. If adhesions were the cause of your bowel obstruction, there is a take chances that it may occur again.

The other type of obstruction that could occur is from food that becomes stuck, commonly as it is trying to pass through your ileostomy. This is more than of a concern during the initial 6-viii weeks after surgery, when the bowel is bloated from surgical manipulation. While the swelling is temporary, it does narrow the lumen (inner opening of your bowel), particularly as the bowel comes through the many layers of your abdominal wall (run into our article on diet and ileostomies for more discussion). A narrow opening may prevent certain foods from passing through your stoma easily. Foods that are typically of concern are those with cellulose (fruits, vegetables, nuts, grains) or those with casings (similar sausages and cold cuts) or tough cuts of meat, like beef. Small amounts of these are unlikely to cause issues, but larger volumes or poorly chewed/cooked fruits and vegetables may give you lot some difficulty. As mentioned, this type of blockage is usually only of business organisation in the showtime half dozen-eight weeks after surgery while the swelling settles. Afterwards this signal, you should be able to eat most foods without concern.

There are some typical symptoms associated with a bowel blockage. People may take waves of crampy abdominal hurting and may feel bloated. Sometimes the hurting is very severe and abiding. There may be a loss of appetite, and nausea and/or vomiting. The output from your ileostomy may modify. With a partial small bowel obstruction, the output may be very liquid (you won't find any solids) and be very forceful and noisy. With a consummate obstruction, there volition be no liquid, solid, or gas output. If yous suspect a bowel obstacle, it is important that you seek medical attending and that you don't try to diagnose the problem yourself. You tin practice some things for yourself while you seek aid, such equally overstate the opening of your ostomy appliance/flange to accommodate whatsoever possible stomal swelling. If you are not airsickness, y'all should stop eating solid nutrient and you tin attempt to drink fluids (water is all-time).

Urgent intendance is required if you are vomiting, have severe/constant pain, or if there has been no output from your stoma for 12 hours. In these circumstances, you should go to your closest emergency section for assessment and treatment. The md volition ask you questions about your medical and surgical history, volition do a physical examination and gild some investigations such as bloodwork and an ten-ray or CT browse of your abdomen. Initial handling may include stopping any oral nutrition, supporting you with intravenous fluids and with medications that volition save some of your symptoms. Y'all might take a nasogastric tube inserted, which is a modest tube that goes through your olfactory organ and into your stomach to help drain fluid from your tummy and salve your vomiting. It may take a few days for the obstruction to resolve, at which bespeak a normal diet will slowly be reintroduced (commonly starting with fluids, and then progressing to solids). Y'all volition exist monitored for any signs of ongoing problems. Sometimes, depending on the severity of the obstruction or if information technology fails to resolve with the conservative medical direction, you may require surgery to right the problem.

While 2 possible sources of obstacle have been discussed, there are other potential reasons for an obstruction that have not been reviewed. No one can say definitively if you will experience another bowel obstacle. However, given your history of surgery, you lot are at greater risk for another episode. Most importantly, if you lot experience any of the symptoms described, then you need to seek medical attention to help support you through intendance and management of the obstruction.

This series of ostomy intendance articles is authored by Jo Hoeflok, RN, BSN, MA, CETN(C), CGN(C), who is a Registered Nurse specializing in enterostomal therapy care. The information provided is not meant to supercede intendance by or consultation with healthcare professionals.