Tag Archives: obstruction

Dealing with intestinal obstructions

I am never not surprised by how debilitating an obstruction is. It’s so much more than an obstructed feeling in your stomach. For me, it makes my entire body ache. It makes me feel run down. More often than not, my first sign of an obstruction is simply feeling bleh. (Yes, I believe that’s the technical term.) Even before noticing a lack of output or stomach pains.

This morning, I woke up not feeling great. Sort of nauseated and tired. It wasn’t until after breakfast (which I didn’t eat) that I noticed my bag filling up with liquid. That’s when I realized why I had been feeling run down, even last night. Now it’s the afternoon and I haven’t eaten anything all day, but I have emptied several bags of liquid output, and everything hurts and I really wish I could curl up in a ball and stay there, praying that it passes. However, I have a 15-month-old, so that’s probably not going to happen.

I have written about blockages a couple of times in the past (See: My first major blockage – which still makes me laugh that I considered it a “major” blockage. After having a major blockage later on, trust me, it wasn’t. And see: Intestinal blockages during pregnancy), but since they are an ongoing concern, I wanted to address them again.

So how do you deal with an intestinal blockage or obstruction?

blockage obstruction intestinalThe first step is doing what you can to avoid them. You do this by hydrating (which I have not been doing well) and by watching what you eat (which also could have used some work this week).

But once you have a blockage of some sort, the next step is to get back to hydrating. Whether you’ve been staying hydrated or not prior to the obstruction, do it after a blockage starts. A blockage can be caused by dehydration and it also causes dehydration by pushing out only liquid output. Hydration can be helpful in getting the blockage to start moving again, as well as simply helping you stay healthy outside of that.

Next, be cautious what you eat. If you’re anything like me, you likely don’t want to eat anything anyways, but if you are hungry, I suggest sticking with non-solids, such as smoothies, yogurt, applesauce, etc. This way you can continue to take in nutrients, but these foods shouldn’t add to the blockage that has formed.

From here, there are a few things you can try… Massage your stomach. This can help get things moving, possibly even break up a smaller obstruction. Use a heating pad. Of course be careful of putting heat on your skin, but the warmth does help your muscles to relax which can get food moving again. Take a warm bath. Another way of trying to relax your muscles. You can also simply wait for it to pass, which it will sometimes.

A lot of blockages can be taken care of at home in these ways, but do be willing to go to the doctor or hospital if things get worse. Severe blockages can lead to more complications, so if you feel that the blockage is not going to pass easily, the hospital is your next option. Only you know your body, so pay attention to the signs it gives you. If you start vomiting or are dealing with extreme pain, it’s time to get medical help. The hospital will make sure you are staying hydrated and getting the nutrients you need, even if you are unable to eat anything. They may opt for using an NG tube, which is not pleasant at all, but it really does work. If a blockage gets too severe, they may consider surgery, but that’s a last option.

Once a blockage passes, you may still deal with some lingering issues. I like to call it an “obstruction hangover,” because the next day I usually still don’t feel quite right, even if I am feeling a lot better than before. I try to take it easy, drink lots of water and stick with either liquids or easily digestible foods. And usually after that, I feel back to normal.

I hope you never have to deal with an intestinal blockage, but if you do, these are some of the things I have found along the way that have helped me get through them. For those who have been through an obstruction, what has your experience been? Do you have other tips that might help somebody get through a blockage?

Third trimester of pregnancy with an ostomy

pregnant baby conceive ostomies advice tips tricks stephanie hughes out of the bag colostomy ileostomy crohn's disease ulcerative colitis inflammatory bowel disease ibd ostomy blog stolen colon ileostomy colostomy urostomy third trimesterFor anyone who followed along with my pregnancy, you’ll know that the third trimester was not particularly kind to me. I had 4 separate hospital stays during weeks 32-35 for bowel obstructions (which you can read more about here and here), the last of which resulted in an induction and the birth of my son at just shy of 36 weeks.

Thankfully we were mostly done with all of the things that needed to be taken care of before baby’s arrival, but when the doctors first started discussing me delivering early, we jumped into high gear on wrapping up everything that was left to do. Here’s a little of what the final 3 months of my pregnancy were like.

  • I am happy to report that I did not have any major issues with my ostomy bags. They stayed put for about the same amount of time that they did previously without me really changing much in my routine. However, I’m sure this might be very different for other women, depending on how their stomach grows.
  • My stoma got huge! Seriously, it was kind of crazy how big it was. It was at least 20 mm bigger than it was prior to my pregnancy, so this is what changed most in my ostomy routine. I had to order larger size bags, because the wafers I normally use were not big enough. Cut-to-fit has definitely been the way to go, since I never knew quite how big it was going to be, and I just measured it every time before cutting.
  • Even though the stoma was a lot bigger, it was less prolapsed than it had previously been. During the 2nd trimester, I felt that my stoma was hanging out a little far. During the 3rd trimester is was still out far, but more rounded and looked basically like my stoma did previously, just twice the size.
  • Bowel obstructions are no joke. I definitely know now to pay more attention to what I eat during those final weeks, when baby and your intestines are running out of room. In any future pregnancies, I will probably restrict myself to a liquid diet starting much earlier.
  • Eating becomes a lot more complicated when you’re pregnant, because you have to consider not just what you’re eating, but what you’re feeding your child. This becomes even trickier when moving to a liquid diet. It’s difficult to get enough calories, while making sure you are consuming healthy calories, protein, calcium and all of the vitamins that you need. I had to start getting creative with the foods that I ate.
  • Hydration is so important!! I can’t stress this enough. I know I’ve had hydration issues for a long time, which were then compounded by getting an ostomy and have increased further since getting pregnant. It is so hard to stay fully hydrated, and I’m sure dehydration played a role in my bowel obstructions.
  • nst baby ostomyI started getting a bunch more tests done once I started getting bowel obstructions. I had a number of what’s called a non-stress test, which monitors the baby for an extended period of time, making sure the heart rate stays where it should. They have to wrap these straps around you, and almost all of the nurses were concerned about bothering my bag, but it really didn’t cause any issue for me at all.
  • The bag remained easy to empty. I was worried about the logistics of trying to empty it into the toilet, but found that it was really not any different from before. I just had to sit a little farther back on the toilet seat.
  • I mentioned previously that my ostomy became more visible through my clothes, and that definitely remained the case. Thankfully, there are lots of options to help keep it less visible, such as wearing flowier tops or wearing a maternity band.
  • Sleeping was not easy, no matter what you do. Pillows help, but my bag did get in the way sometimes, especially since you’re supposed to lay on your side and it can get squished. However, I did not have any actual incidents with it leaking because I was laying on it or anything like that.
  • I did NOT have a ton of people touch my belly. (Hallelujah!) And no strangers felt the need to do so. Not really a big fan of people touching my stomach at any time, pregnant or not.
  • Thankfully, my pregnancy did not really bother my stoma site. On occasion I got a kick over in that direction, but nothing too bad. Again, I assume this could be very different based on the baby’s position, but I’m glad to not have had to deal with it during this pregnancy.
  • Of course I did end up giving birth 4 weeks early, but thankfully the delivery went smoothly and my son was born perfectly healthy. I’ll share more on his birth in the future.

For any other mommas out there who have been through/are going through pregnancy with an ostomy, what was your experience like? For those who have not, what are some of your concerns if you decide to do so?

Here’s a little more about my experience getting pregnant with an ostomy and my first trimester and second trimester with an ostomy. 

My first NG tube experience

It’s probably pretty rare for someone who has had Crohn’s disease for 16 years to have never had an NG tube. While I have dealt with my share of complications from IBD, I have never dealt with a true bowel obstruction, either before my surgery or after. I have had a couple of times where I have had smaller blockages since getting an ostomy (and I realize now that saying “major” blockage was a gross overstatement) and wrote a post last week about my first two hospitalizations during my pregnancy. Well I just wrapped up my third hospitalization, making it 10 days in the past 3 weeks that I’ve spent there. And this one was by far the worst.

So let me just say that an NG tube is one of the least enjoyable things I have ever had to deal with because of Crohn’s disease. I’m not trying to scare anyone who is faced with getting one, but I also want to be honest about my experience. Especially because for something like this, it really helps to be prepared prior to getting one.

For anyone who doesn’t know, an NG tube is a tube that goes in through your nostril, down your throat and into your stomach. It can be used to pump food or medication straight into the stomach or can be used to suction out what’s already inside.

This story started around midnight last Thursday, when again I woke up with pain around my stoma and almost no output. I spent the day dealing with the pain and praying it would pass. Then, around 5:00 that evening, I started throwing up. Occasionally at first, but by the time I went to bed I was getting up every half-hour to hour to throw up, even when there was nothing in my stomach. I couldn’t even get water down at this point. My husband ended up driving me to the ER around 2:00 a.m. despite how much neither of us wanted to go back there.

They checked me into the Labor & Delivery floor to make sure that everything was fine with the baby, and thankfully everything was. I was begging for IV fluids at this point because I was so severely dehydrated. They started talking about an NG tube, but since I hadn’t thrown up since I’d arrived they held off at first. But once I threw up again, they decided it was time.

For me, I needed the NG tube in order to pull out all of the contents of my stomach and some of my intestines. The idea is to remove as much as possible in order to allow your intestine to relax and move the rest of the contents along. When the nurse first came in, she straight up told me that it was not going to be pleasant. Of course I knew this, but I wasn’t quite prepared for how difficult it would be.

They insert a long plastic tube that goes in one nostril and once it starts moving down your throat, you have to keep swallowing in order to help move it down to the stomach. Now I don’t consider myself to have a particularly strong gag reflex, but as soon as that thing got past my nostril and into my throat I couldn’t help but start gagging, and ended up coughing it out my mouth and having to start over.

ng tube crohnsOn the second try, they were able to get it down my throat, despite my crying and gagging and, yes, puking, as it went down. What made it worse, though, is the fact that since my internal organs are all out of sorts because of my pregnancy, they weren’t exactly sure how far in it needed to go. They ended up having to twice move it down even farther. I don’t really like showing pictures of myself like this, but this was the reality of how I was feeling after finally getting that thing down my throat.

I kept hoping once it was in that I would just get used to it and at least somewhat forget it was there. No such luck. It felt like I had the worst sore throat of my life, as every time I swallowed or spoke I could feel the tube rubbing my throat. Then you have this giant tube coming out of your nose and connected to something else that will either pump things in or pump things out, which makes it very difficult to really do much of anything. I slept a lot that day, I think just so I didn’t have to be so conscious of it.

With all of that said, I do have to admit that it made a huge difference. I had the tube in for probably 30 hours, which I realize is a very short time compared to what many others have been through. I have so much more respect for those of you who have dealt with NG tubes much more often and for longer periods of time. Within about 12 hours for me, it alleviated so much of the pressure that had built up in my system and things started really moving along! (To the point that I woke up and my bag was coming off it was so full. Tons of fun at 3 a.m.) But I was thankful that it meant everything was starting to move again and the fact that I was able to leave the hospital just 2 days later. And I was in so much pain from the blockage previously that regardless of how horrible the tube was, it was worth it.

I was being cautious before about what I was eating, but now I am having to stay super vigilant with what I eat for the final few weeks of this pregnancy in order to ensure that I don’t have to return to the hospital for any reason besides a baby on the way! (And hopefully no more NG tubes.)

Intestinal blockages during pregnancy

I have known all along with this pregnancy that I could have some complications because of my ostomy. I even mentioned in my post on the second trimester that I was concerned about the possibility of blockages as things progressed. Turns out, it was a valid concern.

Sorry if this is a little long, but I’ll try to tell this story as succinctly as possible. It started last Monday evening. I started feeling a little funny at work and by the time I got home, I was having a decent amount of pain around my stoma. I also realized that I really hadn’t emptied my bag much at all that day. I tried to take it easy that evening, drinking a lot of fluids and staying away from solid food, putting a warm compress around the area, massaging it the best I could and eventually taking a warm bath, all of the old standbys for dealing with a blockage. But this all becomes a little more complicated when you’re pregnant, since you have to be careful about heating your body up too much, plus it’s just hard to submerge a big belly in a bathtub. But hospital ERafter the bath, I was feeling a lot better. I tried to sleep it off and told myself that if things weren’t better in the morning then I would go to the ER. Well, in the morning I was feeling better, but still was having very little output. I decided to go to the ER out of an abundance of caution since I’m also responsible for another life now.

At the ER, they checked everything out and decided it would be best to admit me in order to give me some IV fluids since I was dehydrated and to keep an eye on my output. Normally when someone has an intestinal blockage, the doctor can sort of thump on the belly to listen for certain sounds, and they will usually do an X-ray or a CT scan to find out if a blockage actually exists and where it is. But none these are options when you’re pregnant. The belly thumping is pointless and the X-ray and CT scan can be potentially harmful to the baby because of the radiation, so really all I could do was wait. Not eat anything and wait.

I ended up staying for 2 days, getting lots of fluids and keeping a close eye on the baby during that time. By then my output was getting back on track and I was able to eat solid foods again. So home I went on Thursday.

We had a family wedding going on that weekend, so it was very busy. I felt fine all day on Friday and even when I woke up Saturday morning, my output was completely normal. But about noon, I started feeling blocked up again. At the wedding, I was in a decent amount of pain, but this time it was not focused around the stoma, but rather right between my uterus and my ribs, which is where your small intestine gets smushed up when you’re pregnant. I was also very nauseous. I tried to stick it out as long as I could, but I couldn’t touch any of the food there and was honestly concerned I was going to vomit at any moment. I couldn’t even get water down at this point. I left the wedding early to go home and go to bed.

I felt better being in bed, but when I woke up Sunday morning, I was still in a lot of pain, I hadn’t had any output for close to 24 hours, and I was still nauseous. I knew I needed to go back to the hospital, no matter how much I didn’t want to. This time, as soon as I arrived they took me straight to Labor & Delivery. They checked for any signs of early labor, but the baby was stephanie hughes hospital blockageperfectly content to stay put. While thankfully everything looked great with the little one, I was in pretty excruciating pain. I was literally scared that I could get a perforated bowel that could put both me and baby at a huge risk. I got some more IV fluids which really seemed to help at first, but then the pain and nausea came back just as strong. This time, I did actually throw up some horribly vile looking stuff, which is the first time I’ve actually thrown up from a blockage. I was again admitted to the hospital.

By now I hadn’t eaten anything in over 30 hours, yet I was burping repeatedly, but thankfully did not throw up again. Since I was still having at least a minimal amount of output and I wasn’t throwing up anymore, the doctors figured it wasn’t a complete obstruction, but likely a partial one due to a kink or something like that in my small intestine.

I was still in pain the next day, even after 2 days of not eating and lots of fluid, but it eventually started to subside. They put me on a clear liquid diet and by day 3 I was getting more output, and the cramping was down to a minimum. Still causing a little discomfort, but nothing as frequent or intense.

stephanie hughes pregnant bellyOne upside was I went down for an ultrasound that morning to check on the little one, who seemed to be completely unfazed this entire time, which helped me to relax. It was difficult not knowing what was going on with the baby this whole time. I was on a prenatal floor the entire time, so I was glad knowing we were in good hands and that they were keeping an extra close eye on both of us.

I was able to go home by day 4, feeling a lot better, even though a little worn down. All of this to say that blockages are a real concern when you’re pregnant. And I assume even more so when you’re short like me and there’s just not a lot of room for all of the baby and uterus and bowel and everything else. I would think this would be true for anyone who has had bowel surgery, whether you have an ostomy or not. My surgeon told me that the baby itself is rarely the cause of a blockage and it’s usually due to scar tissue. So I take that to mean that it’s most likely an area of my intestine that has scar tissue that also got jammed up because of my growing belly and the lack of available space.

After spending 7 of the last 10 days in the hospital, I think I’ve decided that I need to stick to a low-residue, mostly liquid diet for the remainder of this pregnancy. (I do not recommend doing this unless you speak with your doctor or nutritionist first!) Both my OB doctor and the dietician said that it should be fine for me and for baby, especially since I’m as far along as I am, but I need to make sure that I am getting enough protein and enough good calories, not empty ones from sugar and such. I know it will be hard, but thankfully it’s only for a limited number of weeks. We will see how it actually goes in practice because I really love food! But I also really love not being in the hospital.

Have you dealt with intestinal blockages while pregnant? Are there any tips you have found for avoiding them? Or for helping them to pass once one starts?