Bowel obstructions are something that many with IBD have to deal with, whether it be on an occasional basis or something more frequent if issues other than food consumption are at play. For potential obstructions, there are a few signs to look out for: severe abdominal pain (not sure if everyone’s is the same, but the only way to describe mine is that it starts out like someone is kicking me in the stomach and usually culminates with me feeling like I’m being ripped in half at the midsection; this usually is paired with some Linda Blair-like head spinning once I’m at the point of going to the ER until the happy juice is administered), nausea, vomiting and a lack of bowel function (for full obstructions, you will be unable to defecate or pass gas, though you may be able to have some very liquid stool with a partial obstruction). What I will detail below is simply my own personal plan of attack when the initial signs of an obstruction hit; I want to be clear that being seen by a medical professional is always advisable in this case, and if I don’t feel as though things are moving at all and I get to the point of nausea, I head to the ER immediately. In the event that you cannot get to medical attention right away, or if it seems as if it’s only a partial obstruction you have, I recommend everyone have a good, reliable heating pad (I have one super charged infrared model and then three basic backups) and Welch’s 100% grape juice on hand.
First, if you suspect you may have a bowel obstruction, stop eating and drinking (with the exception of the grape juice instructions below). Should you end up in the ER, going NPO (nil per os in latin, meaning to withhold oral food and fluids from someone) is the first thing they are going to do anyway. Get a tall glass of the grape juice and lie down with a heating pad on your stomach. This will likely not be a quick process; obstructions can take anywhere from a few hours to a few days to pass on their own, even with medical intervention. Sip the grape juice slowly and let the heat relax the muscles in your abdomen a bit. The purpose of the grape juice is that very sugary drinks often have a laxative effect on IBD patients, and this can help get things moving in the right direction in some instances. Though you will be in pain, get up to walk around at regular intervals for 10-15 minutes at a time, as walking can help to move things along as well. At this point, you basically wait things out until the obstruction passes (you may feel it begin to move through your system, the pain will lessen, and you will be able to eventually pass gas and/or stool) or you reach The Point of No Return. Given my frequency having obstructions and after discussing this subject at length with my surgeon, I have defined that point for myself as that when I begin to get severely nauseous and/or I begin vomiting. If that happens, from my experience the obstruction is likely not going to pass on its own and I need to get my ass to the ER.
Sad but true, I keep a small overnight bag packed with supplies at all times in my closet for just this sort of occasion. The bag has some comfortable, hospital-friendly clothes, a few of my own designer hospital gowns (we’ll get there), my basic toiletries, etc. For times like this, it’s great to know that everything I need is with me in less than five seconds in the event of a hospital admission. Remember that little side note about the glorious My Medical app? This is where it comes in handy. My husband grabs one of the printed copies that we keep at home from the My Medical app (as I noted earlier, we also keep one copy in each car in case this should happen while we are out and about) and we head over to the local ER, which is about 15 minutes from our home. Generally speaking, I have found that Urgent Care centers don’t tend to deal with patients with complex issues, so the ER is my go to. Once checked in, the nurse takes us back and my husband gives him or her the copy of my medical history or “owner’s manual”, as we lovingly refer to it. By this point, given that I’ve had roughly about 25 obstructions needing some sort of hospital care over the last 13 years, we know the “cocktail” that usually tends to do the best job when administered to get things moving again. If it’s your first time or even your third, explain your condition to the medical staff and let them do their job. Don’t overthink it. Once you’ve had a few of these under your belt, if you’re in a good hospital where they know you, generally they will focus more on asking questions as to what has worked best for you in the past in these situations. Again, all heed the My Medical app. When your pain is at a level 14 out of 10 and your head is spinning backward, you’ll be grateful that you or your significant other can simply hand over the information rather than having to recite it in a voice that will probably sound slightly demonic.
Usually the “cocktail” in question will involve some saline fluids, a painkiller to ease some of the abdominal cramping and help the smooth muscle tissue stop going into spasm, and an anti-nausea medication to alleviate the nausea and vomiting that may be occurring at this point. Occasionally, a drug facilitating intestinal motility will be administered at the discretion of the doctor. Different combinations will work for different people; once these meds are administered they can begin the testing process, which will usually involve a urine sample, bloodwork, an x-ray and possibly a CAT scan.
In some cases, the administration of the appropriate medication and some time will be all the treatment you may need to clear an obstruction. There are times, however, that even antinausea medications cannot suppress the vomiting, and an NG (nasogastric) tube will need to be inserted to drain the digestive system of its contents, therefore allowing the stomach, bowel and surrounding areas to rest. I am not going to lie even a little here – this device is a modern form of torture and it is going to suck – but a few things can help you deal with it.
Basically, a thin plastic tube is inserted up your nose, down the back of your throat and continues down the esophagus to the stomach, where it drains gastric secretions out the tube and into a container that is normally mounted on the wall behind the hospital bed. The insertion of the tube isn’t painful per se, but I have found it extremely uncomfortable, and staying relaxed to allow the tubing to be inserted isn’t the easiest thing in the world. Should it become necessary to have an NG tube inserted, check with the doctor or nurse to see if they will approve a dose of Ativan (an anti-anxiety medication that also can assist with muscle relaxation) before the tube is inserted. This will help ease some of the anxiety you may have, as well as relieve some of the involuntary muscle contractions that occur when one becomes highly anxious and/or stressed. Also, if you ask to have a glass of water present, this will help you to encourage swallowing, which will assist the nurse in getting the tube inserted properly as it passes down your throat. It is possible that you will vomit as the tube is inserted (I have done it several times), as the tube going down your throat can trigger a sensitive gag reflex. Don’t worry about it, as the medical staff are used to it (or at least that’s what they told me when I tossed my cookies). Once it’s inserted completely, they will adhere the tube to the bridge of your nose with some tape so it doesn’t move around too much. Hopefully if one has to be inserted, it is only in for a brief time; after one of my surgeries I had it for three weeks and was so happy when it was finally removed that I actually cried.
During the time that the NG tube is in, you will be unable to eat or drink, though in moments of desperation, sometimes you will occasionally be allowed ice chips. I will fully admit that at one point during the lengthy time I had the awful thing, I convinced a family member to smuggle me in some Rita’s water ice, figuring the NG tube was just going to suck it out of my stomach anyway. I was halfway through a pint of it when one of the nurses caught me and confiscated the remaining half pint. I think I may have tried to windmill her.
Once they believe the obstruction has cleared, the tube will be removed; the removal isn’t nearly as uncomfortable as the insertion, but it is still a very odd feeling to say the least, almost as if someone is trying to pull your brain out of your nose. It’s over very quickly and then you may have a sore throat for a few days, but beyond that, you shouldn’t have any other issues after it’s out. From there, you should be allowed a clear liquid diet, and if that is tolerated well, a progression to full liquids and then soft solids are generally given before you are given the all clear.
If you haven’t had to deal with an obstruction or an NG tube before, hopefully this will give you a little idea of what to expect and some pointers on how to cope. I hope you never need the info, but if you do – voila!