Running with Crohn’s: Bowel Obstruction
Typical warnings apply.
This entry includes graphic descriptions of biological functions and
surgical interventions.
I had a bowel obstruction this week. This interfered with work (causing me to miss two hours of an important meeting), interfered with running (I missed a 3 mile run), and meant I spent 8 hours traveling on airplanes with severe abdominal pain. Thank goodness I had left-over hydrocodone to help with that!
Definition
One part of my life with Crohn’s Disease has been suffering
from Bowel Obstructions. A bowel
obstruction is a blockage of your intestines that keeps anything else from moving
through your bowels. People without
damage to their bowels rarely (if ever) experience these painful issues.
Typically, only people with bowel disease or people who have
had surgery on their bowels experience them.
Bowel obstructions usually occur for mechanical reasons; meaning damage
to the bowels creates scar tissue that narrows the bowels. Doctors call this narrowing a “stricture.”
Warning: the
following contains graphic descriptions of biological functions. Some people may find it disgusting.
I possess strictures both from my Crohn’s Disease (because
Crohn’s Disease creates ulcerations that over time generate scar tissue) and a small bowel resection performed on me back in
1998. A normal human small bowel has a
diameter of about 1 – 1 ¼ inch. At least
one of my strictures narrows to smaller than 1/3 of that diameter. The bowel obstruction occurs when a high
fiber food item (such as chunks of raw fruits and vegetables) successfully passes through
the rest of my bowels but cannot pass through this narrow stricture. This is very much like a clogged drain or
toilet. Once blocked, nothing else can
pass through my bowels without first removing whatever caused the clog.
Strictures internal to the intestines due to adhesions (lighter fibrous strands). Typically these form after surgery. They account for 50%-70% of intestinal strictures.
Symptoms
When I am suffering from one of these “episodes”, I
experience many symptoms:
- Intense sharp pain, as if I am being stabbed repeatedly by knives in the gut
- Obvious bloating of my abdomen, so that sometimes I look like I am 7-8 months pregnant
- Intense cramping, that feels slightly different from my normal Crohn’s cramping (it has a slightly sharper edge to the pain) and different from the sharp pains described above
- Hardening of the abdominal muscles until they feel almost rigid
- I also experience very full feeling as if I ate an extremely large meal. With this, I sometimes experience severe nausea that may or may not result in vomiting. Often this feeling makes the thought of eating very repulsive, even if I have not eaten for a day or more
- A full gut feeling like you need to poop, but I am not able to.
- A general sense of trauma in my abdomen that makes me want to not bounce around (I do not want to run or jump!).
- A general sense of anxiety or unwellness – sometimes accompanied by a light sweat.
The pain from a bowel obstruction can be (but for me is not
always) excruciating, so excruciating in my case that I sometimes require
hospital grade pain killers – which I can only get through admittance into the
emergency room. However, after
experiencing 1-6 bowel obstructions per year for the last 15 years or so, I now
rarely seek admission to the hospital.
Warning: I am not a medical professional, if you suspect you are
experiencing a bowel obstruction and are not familiar with the symptoms, get
yourself to an emergency room and get evaluated as soon as possible. Bowel obstructions *ARE LIFE THREATENING*. If
the obstruction is not removed, you could die!
If you go to the emergency room because you think you have a
bowel obstruction, you can expect the doctor to:
- Ask you a variety of questions about the location and type of pain.
- Ask you a variety of questions about your medical history, especially in regards to bowel disease.
- Probe your abdomen with his hands and ask you to describe the pain/sensitivity you feel from the probing.
- Listen to your intestinal noises to determine whether the gut muscles are paralyzed (one of the symptoms of a bowel obstruction).
- If the doctor thinks a bowel obstruction is likely, they will order some imaging tests that may include drinking a barium milkshake as x-ray contrast, followed by taking x-ray images of your gut over a period of time; a CT Scan with oral and IV contrast, an MRI (much less likely), or an ultrasound (also less likely).
Treatment
If the hospital admits you with a suspected bowel obstruction,
the treatment consists solely of denying you anything to eat and treating your
pain with pain medication. If your body
does not clear the bowel obstruction on its own, the doctors will intervene
with surgery. Nonspontaneous clearing of
a bowel obstruction (your body clearing the obstruction) results in either
starvation from not eating (to prevent further pressure on the blockage, which
results in death) or a burst bowel (which results in death if not treated). My
body has always cleared the bowel obstruction without requiring surgical
intervention.
For me this treatment lasted as long as I display symptoms
of a bowel obstruction. My small bowel
obstruction episodes have lasted from a few hours to 5 days (the longest so far). A typical episode for me lasts 1-2 days. During this time, I treat myself with pain
medications as needed (do not use NSAIDS), anti-cramping medications as needed
(Bentyl and Levsin), only consuming liquids, and reducing my physical activity
to minimum essentials.
By now you may be wondering how I know that my body has
cleared the obstruction. Usually my body
clears the obstruction through a combination of violent vomiting and
diarrhea. The process can take several
hours requiring many bouts of both diarrhea and vomiting. Sometimes I only experience vomiting and
sometimes I only experience diarrhea.
Lately I have experienced much milder symptoms of blockage and a much
more gentle process of clearing the blockage.
It still always results in vomiting, diarrhea, or both but the process
has not been quite as violent. I do not
know why.
Diet
After I am certain that I cleared my blockage, I resume
eating but I adopt a diet called “low residue.”
If you think you have experienced an intestinal blockage, speak to your
doctor about the episode. He will most likely want you to check yourself into the hospital the next time the symptoms arise (they will want confirmation about exactly what is happening). If they do confirm that you are experiencing partial bowel obstructions, then your doctor will need to discuss treatment plans (so that they stop happening), what to do for the next one, and a change in your diet.
For years, my diet has excluded anything that has high fiber (avoiding fruits, vegetables, nuts, whole grains, etc.) and trying to eat things like eggs, cream of wheat, milk, and coffee. After a couple of days I do start adding these things back into my diet but I do so gradually and begin with things like V8 juice, prune juice, applesauce, and other foods in which the fiber has been pureed. In fact, I am attempting to increase my fiber intake while reducing my chances of experiencing more bowel obstructions by adding those items to my regular diet.
For years, my diet has excluded anything that has high fiber (avoiding fruits, vegetables, nuts, whole grains, etc.) and trying to eat things like eggs, cream of wheat, milk, and coffee. After a couple of days I do start adding these things back into my diet but I do so gradually and begin with things like V8 juice, prune juice, applesauce, and other foods in which the fiber has been pureed. In fact, I am attempting to increase my fiber intake while reducing my chances of experiencing more bowel obstructions by adding those items to my regular diet.
Foods that I know have caused my small bowel obstructions
include:
- Vegetable heavy oriental stir-fry
- Oranges
- Popcorn
- Coconut
- Carrots
- Celery
- Onions
- Vegetable heavy pizza
- Any raw fruit or vegetable with a lot of fiber
When I do eat these foods now, I attempt to chew them
thoroughly. On advice of my GI
(gastroenterologist) I try to chew them 20 times before swallowing, this is not
as easy as it sounds.
If you have strictures, even wearing tight
fitting clothes around your waist can initiate a bowel obstruction. So in addition to watching your diet, do not
wear tight fitting clothes!
On a personal note, I rarely take sick days now for things like the cold or flu. These bowel obstructions are the reason. I never know when one will happen and I *have* to take sick leave when they strike. I am simply in too much pain to do anything productive. I try to save all of my leave (I have combined vacation and sick leave now) to cover the days I might require for one of these obstruction "episodes" that I experience.
Online resources also state that if you are admitted for one of these (an obstruction or partial obstruction) you will be given an NG (naso-gastric) tube (which goes up your nose, down your throat, and into your stomach) to help eliminate gases in your stomach and help with pressure. They also say that the hospital will insert and IV and perhaps a peripherally inserted central catheter (PICC) line (for providing you nutrition directly into your arteries). The hospital does not permit an obstruction patient from taking anything by mouth.
I have been admitted perhaps six times for obstructions with a stay of 3-5 days each and have NEVER gotten the NG tube or PICC line for it (I have had an NG tube before but not for an obstruction). I can state that I have always gotten the "nothing by mouth" policy until after my body can pass gas or liquids through the stricture.
11/22/2014 - Since I originally wrote this blog, I have had two PICC lines inserted. They were inserted so I could give myself hospital grade IV antibiotics at home rather than total parenteral nutrition (TPN).
On a personal note, I rarely take sick days now for things like the cold or flu. These bowel obstructions are the reason. I never know when one will happen and I *have* to take sick leave when they strike. I am simply in too much pain to do anything productive. I try to save all of my leave (I have combined vacation and sick leave now) to cover the days I might require for one of these obstruction "episodes" that I experience.
Technical Stuff:
Medically speaking there is a difference between a "bowel obstruction" and a "partial bowel obstruction". The main difference is that with a partial bowel obstruction your body may be able to pass gas and/or liquids through the stricture and it is possible that your body could clear it spontaneously. For diagnostic purposes, it may only be possible to determine whether your obstruction was "partial" if your body clears it on its own. From this technical medical diagnostic perspective all of my obstructions have been partial (I did eventually clear all of them on my own).Online resources also state that if you are admitted for one of these (an obstruction or partial obstruction) you will be given an NG (naso-gastric) tube (which goes up your nose, down your throat, and into your stomach) to help eliminate gases in your stomach and help with pressure. They also say that the hospital will insert and IV and perhaps a peripherally inserted central catheter (PICC) line (for providing you nutrition directly into your arteries). The hospital does not permit an obstruction patient from taking anything by mouth.
I have been admitted perhaps six times for obstructions with a stay of 3-5 days each and have NEVER gotten the NG tube or PICC line for it (I have had an NG tube before but not for an obstruction). I can state that I have always gotten the "nothing by mouth" policy until after my body can pass gas or liquids through the stricture.
NG tube |
My PICC line |
Pushing saline flush through a PICC line |
If I had to actually look at the vomit or poop it might gross me out, but just reading about it is actually very interesting. I'm really sorry you have to deal with it, but if you're willing to write about it I'm interested in reading it.
ReplyDeleteYou know I never really thought about all of the issues that I deal with until I started writing about them. In my day-to-day life I live like most other people. I need to keep these things and how to deal with them in the back of my mind but they *usually* don't bother me too much.
ReplyDeleteThe one thing I have done (mostly subconsciously) is that when I feel good, I have an almost maniacal need to do all that I can. I think this is because I know that these problems can crop up anytime and keep me from doing things I love. I also think its because I'm worried that the issues will catch up with me and make me permanently disabled.