The Colon Club

Hello All,
I have a friend who had surgery for a low rectal tumor where they were able to save the rectal stump and perform a surgery to reattach things. He had a tough time with recovery from the first surgery and some issues with the second, but over the past year to 1.5 years he has had five bowel obstructions with two of them requiring surgery. He just had another and the surgeon said this would be a permanent part of his life.

I'm wondering if anyone else has experienced this and what did you do? Also, looking on the east coast, are there any GI surgeons/docs anyone would recommend for a second opinion?

Thanks all,
James B.

Hi James, my colorectal surgeon is Dr. Jeffrey Aronoff, affiliated with Lenox Hill Hospital in NYC. I recommend him highly. He has over 25 years experience and is board certified. Don’t know where you are located but that’s my recommendation from personal experience. I hope your friend can get this figured out.

Hi James,
Sorry to hear about your friend.
Do you know where the blockages are occurring?
Is it at the reconnection site, or somewhere else?
Has anyone mentioned adhesions being a potential cause of the blockages?
Is your friend on a special diet?
Is a permanent colostomy a possibility?

A second opinion sounds like a good idea.

Best Wishes,
peanut

James:
I can definitely relate to your friends’ plight with multiple small bowel obstructions post abdominal surgery.

In my case, as may be true for your friend, my history with repeated obstructions was due to scar tissue/adhesions that would tether and restrict a segment of intestine. I have had several hospitalizations with NG tube decompression and three surgeries for lysis of adhesions. However, be aware that each surgery to snip adhesions to clear an obstruction can also serve as a physical trauma and stimulus for the body to react by forming additional scar tissue and adhesions - an ongoing cycle of misery.

My surgeon did share that the highest likelihood of post operative adhesion-based obstructions is within the first 12–
16 months post surgery. He indicated that that nature of scar tissue morphs and changes and is less likely to cause acute attacks at the 12-16 month mark.

Here is what has worked for me in lessening my incidence of small bowel obstructions:
1. Adopt a regular, daily program of yoga stretches. This has been the most beneficial of approaches for me. The gentle stretches and connective tissue mobilization that yoga provides serves to keep scar tissue subtle and mobile. Yoga serves like internal massage to keep adhesions from becoming fixed and tacky. Yoga also acts to keep the digestive system moving along, similar to kneeding a tube of toothpaste. You need not be a human pretzel with hyper flexibility to reap the benefits of yoga. Gentle, basic yoga postures and movements serve as a powerful basis for health and well-being.

2. Take Mira-Lax or Magnesium Citrate or other osmotic digestive agent daily.
The key is to keep the fecal/stool output toward a more fluid consistency to ease transit through possibly tight intestinal passageways. Your friend has a colostomy so should be tolerant of taking Mira-Lax or Milk of Magnesia or Magnesium supplement without risk of undue dehydration (individuals with an ileostomy should NOT take an osmotic laxative without physician guidance). Your friend can titrate a daily dose that works for him - the goal is to direct more fluid into the large intestine to make the fecal consistency easier to pass. A stool consistency of “mushy oatmeal” would be beneficial to easing of fecal backup that ours in the presence of adhesions/scar tissue.

3. Find a physical therapist or massage therapist for abdominal massage.
Hands-on massage and tissue mobilization as well as body stretches (rotation of the torso; elongation of the torso) can do wonders to minimize the static effects of dense/thick scar tissue.

4. Exercise and keep the body moving
Move, move, stretch and move. Scar tissue that is mobilized is less likely to become problematic. Walking. Swimming. Shooting a few basketball hoops. Golf. Almost any physical sport or activity will have beneficial effects. Of course, use common sense in knowing your own body, medical history, and personal tolerance for activity. It need not be strenuous exercise to be beneficial. In fact, gentle movement and slow/sustained stretches are much preferred to dynamic/quick stretch movements that can cause inflammation and additional adhesion formation.

5. Turmeric as a supplement
Turmeric is available as a supplement and has powerful
anti-inflammatory properties. Have your friend consult with his with MD as to any contra-indications. Turmeric is in the same family as cumerin, an India-based spice, that is used in many dishes/recipes.

6. Avoid foods that are high in insoluble fiber
Avoid skins of apples. Avoid the internal membranes of oranges or grapefruits. Avoid or limit stingy, fibrous foods such as asparagus spears, celery, mushrooms, coconut. Be cautious of beans and lentils. Foods that can form a large bolus in the digestive tract can be difficult to move through and out. If your kitchen disposal would have a difficult time grinding through something, take pause before eating for yourself.

There are positive steps that your friend can take to lower his risk of adhesion-based small bowel obstructions. See what in the list above might appeal to him and integrate a few of the ideas into his daily routine. I have found benefit in each of the above, to one degree or another.
Karen

Hi, I too have suffered from repeated bowel blockages after surgery. I have had five bowel obstructions in the past year and half, every couple months, but since my last obstruction I have been obstruction free for 6 months! Knock on wood. For me the key has been hydration, chewing well, soft foods and exercise. Hydration is key. A cup of water before and after eating. Exercise is key, while walking you can feel the food moving through the system. I have eliminated hard fibrous foods such as broccoli, celery, nuts, carrots unless well cooked. I don't worry so much about low fiber, low residue as the food being mallable. For instance I eat small soft fruits: citrus, berries, lettuce. I try not to eat large meals. I eat slowy and chew well so that when I swallow all pieces are well masticated and small.

rectal cancer Diagnosed 3/15
failed Xeloda, 5FU due to cardio vasospasm
radiation 6 weeks
permanent colostomy 6/15
PET scan 9/15 shows mets to livers and lungs
IROX + avastin 9/15-12/15
6 months NED
1/16- 12/17
IROX + avastin
avastin removed because of bowel obstruction 1/17
oxaplatin removed because of neuropathy 7/17
4 more bowel obstructions
disease progession on ironitecan only
failed clinical trail MGD007 due to stage IV diaherra (my intenstial lining sloughed off)
currently getting IMRT to liver mets lung mets untreated