Blockage Question

[Aqx99]

Last night I noticed the early symptoms of a blockage in my ileostomy, mainly cramps and the feeling of a knot right near my stoma. I immediately started on clear liquids, went for a walk and started massaging my abdomen. I was gradually getting some very thick, sticky stool to come out. This morning I called my ostomy nurse and told her my symptoms, she said I was doing the right thing, keep it up and to drink white grape juice, it should resolve on its own. I didn't have any white grape juice on hand, but I did have apple juice and regular grape juice. I finished off the half bottle of apple juice then moved on to the grape juice. After a while, a huge clump of thick stool came out. I have since been having a ton of liquid output.

My question is, I still feel some pressure inside, is that just residual sensation from the blockage that will eventually go away, or do I still have some blockage in there? I've tried massaging, but nothing thick comes out, just liquid.

[MissMolly]

Aqx99:
In the case of a partial small bowel obstruction (SBO), the portion of intestine adjacent to the restriction/blockage generally becomes swollen and inflamed. I sense is that the residual pain and internal sensations you are feeling is correlated to residual inflammation and swelling.

That you are expelling copious amounts of liquid output is the norm and is considered a positive sign that the blockage is resolving. Typically, the body produces additional gastric secretions in an attempt to flush out the intestinal tract when the body perceives a SBO. Gastric secretions build up behind the blockage, like a dam. As the SBO resolves, it is the liquid fecal output and gastric solutions that will run through the narrowing and out the stoma. It can have the intensity of a fire hose.

White or purple grape juice and apple juice help alleviate food based bonus obstructions through their kinetic/movement effect on the intestinal tract. The strong flavonoids act as intestinal stimulants.

Most ileoatomates keep a bottle of grape and/or apple juice on hand to use at first inkling of a possible SBO. Be aware that the juice needs to be pure 100% grape or apple juice to be optimally effective. Avoid a juice blend or a juice concentrates or a juice with 15% real juIce. You want 100% pure juice.

Eat gently for the next several days. Small, small portion sizes. Focus more on maintaining hydration than eating solid food. The intestinal lumen will stay inflamed and swollen for 2-3 days post SBO.

It sounds like you did an admirable job in responding to your first SBO. You did all of "the right" things. A first encounter with a SBO can be a harrowing experience. You kept a level head and acted with thoughtful reasoning. Well done !

I hope that your intestines begin to settle down and cause you less grief in the days ahead,
Karen

[Aqx99]

Thank you. I was so scared. I made a mistake by eating a dish that had onions in it for dinner Saturday night. I kept seeing onions in the clumps coming out. I've added them to the list of foods to avoid for now. Luckily, both the apple juice and grape juice I had on hand were 100%. I'll remember to restock and always have some available. The only solid food I have had today so far was crackers. I might go crazy later and munch on some rice cereal right out of the box.

[MissMolly]

Axq99:
A loop ileostomy is more prone to food bolus blockages due to its position high up the digestive tract, where food types may need to exit the small aperature of the stoma before being fully digested and broken down.

Things to avoid:
1. Stringy and fibrous foods.
This includes foods such as asparagus, celery, Chinese vegetables, water chestnuts, fennel, artichoke, onion rings. and pineapple.

The fibrous filaments can coagulate and clump together like a knitted ball of yarn in the intestinal tract.

2. Citrus Foods with membranes.
The membrane covering of oranges, grapefruit, etc.

You can eat citrus foods that are sectioned and the membrane removed.

3. Large sized nuts and legumes
Whole nuts should be avoided. Ex. While walnuts, pecans.

You can eat nuts that have been ground or diced into minute pieces that you would sprinkle in a dish.

Nuts can feel like shrapnel exiting a narrow stoma.

Large legumes can be problematic (ex. Edamante, large black beans would be a risky selection). Small, soft navy beans might be OK As in a soup or crock-pot dish. Keep portion size of any legume choice small due to overt laxative effect.

4. Coconut
Coconut has a unique propensity to ball-up and form a large bolus in the intestinal tract.

You can safely eat ONE maracroon cookie, well chewed and chased down with a glass of water/tea. I would not endorse eating more than one macaroon at a time.

5. Popcorn
It is the husks and I popped kernels that are problematic culprits with a loop ileostomy.

You can eat a small 1/2 cup of popcorn carefully selected to remove all husks and I popped kernels if you genuinely love popcorn and miss its taste.

Better options: Pirates Booty (an air puffed corn snack sold at Whole Foods and other natural grocers) or huskless popcorn.

Keep your eating on the lite side for the next 1-2 days, as your intestinal lumen is likely inflamed and swollen due to the trauma of the fibrous onions. Chew, chew, chew. Drink plenty of liquids.

Often after a SBO I will use the Cuisinart for 1-2 days to pulverize my food to make the process of digestion easier. I have placed everything from Lasagna to an oatmeal cookie in a Cuisinart to soften good consistencies.

Honestly, you responded admirably to your first SBO. You are to be commended. You did all of the right things and in the right order.

Make no mistake, a SBO is a freightening encounter. The pain is excruciating and the liquid output that makes it way around the partial ibstruction comes out with the speed of a torpedo as the body works furiously to unblock the buildup.

Here's raising a glass of grape juice to you !
- Karen -