Partial bowel obstruction

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Stewsbetty
Posts: 170
Joined: Thu Jul 14, 2016 7:08 am

Partial bowel obstruction

Postby Stewsbetty » Sat Apr 20, 2019 11:18 pm

I am wondering how long it takes for a body to deal with a partial bowel obstruction. This hit me a week ago but I didn’t realize what it was until Thursday. I ate a very limited diet from beginning until Thursday and have been liquid since. Just hoping to get some personal experiences when this might resolve.

Thanks, Beth
42yo At diagnosis. Female in BC, Canada
Dx: CC ascending
Right Hemi colectomy 06/16 clear margins
Adenocarcinoma 6cm High Grade
pT3 pN2a Stage 3
10 out of 16 lymph involved
MSI-h, Kras mut, Braf wild
Finished chemo Feb. 2017
PET scan showing active area April 2017
July 2017 CT showing LN mass and spread to other LN
Stage 4
Aug 2017 failed Fofiri
Sept 2017 keytruda scans every 3 months showing shrinkage and stability
November 2018 CT shows only 1 small tumour left
September 2019 clear CT finally NED!!!

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Partial bowel obstruction

Postby MissMolly » Sun Apr 21, 2019 11:09 am

Stewberry:
A partial small bowel obstruction is most often due to adhesions/scar tissue from prior surgery(ies) that cause a temporary “kink” or narrowing of a segment of intestine.

The small intestine slithers and squirms, in constant sliding motion 24-7, under the moist apron of fat called the omentum. A segment of small intestine can become entwined in a band of scar tissue as it squirms, setting up a scenario for a partial small bowel obstruction. In a small bowel obstruction, some fecal material remains able to pass through the narrowed passageway; some fecal material is not able to pass through. Backpressure increases. The segment of small intestine above the area of narrowing or kink begins to dilate - causing pain and nausea/vomiting.

When to seek an emergency room: 1. Severe abdominal pain, doubling over pain, pain that arrives in successive waves; 2. Continued and persistent vomiting or projectile vomiting; 3. Absence of ileostomy ouput for 4-6 hours (for those with a loop ileostomy).

Helpful tips to ease a partial small obstruction:
1. Liberal dosing with Miralax
Miralax is an osmotic laxative. The goal of using Miralax is to direct water into the digestive tract and liquify the consistency of the fecal matter so that it can pass through any area of narrowing or kink. Miralax helps “flush” fecal matter by liquefying it.
2. Stretching and moving
The intestine is a long tube of smooth muscle. Intestinal motility benefits from body movement and stretching. Stretching and moving is also key in mobilizing adhesions/scar tissue that may be intermittently trapping a segment of intestine. Examples: Lying on your back, bring bent knees up toward the chest, then slowly rocking from left to right. Lying on your back, stretching and elongating, arms up above the head, legs straight. Standing, raise one arm up and over hit head, lean body to the left with arm directing toward the floor, elongating through the right thoracic area.
3. Heat and warmth
Take a warm shower, let the stream of water massage the abdomen. Take a warm bath. Warm water helps to decrease protective muscle spasms that accompany a small bowel obstruction. Easing accompanied muscle tension helps break the cycle that can prolong a small bowel obstruction.
4. Clear fluids
Drink clear fluids. Hydrate and hydrate some more. 100% pure
Grape juice and apple juice have flavonoids that give a boost to intestinal motility. Look for the label to read 100% juice (not a juice blend or juice concentrate). Do not eat any solid foods. You do not want to add any solid food to the digestive tract when the digestive tract is not humming along.

Once a partial small bowel obstruction has cleared, the area of intestine can remain inflamed or swollen or dilated for 7-10 days. You may feel continued mild nausea with a low appetite with intermittent pain. It is often a wise idea to continue with daily Miralax during this post-SBO period. Continue with a primarily liquid diet (creamed soups, yogurt, milkshake) with small portions of soft foods that are easy to digest (1/3 cup of soft pasta with sauce or hummus with a small slice of pita bread). Keep your intact of food to small portions. You do not want to overwhelm the intestinal tract with too much food.

Do contact your physician if your symptoms persist.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Partial bowel obstruction

Postby Pyro » Mon Apr 22, 2019 8:56 am

Did you try magnesium citrate? I get in a 12 or so ounce drink, should liquify everything in your bowel and make it pass, it will dehydrate you! I’m not a doctor, check with yours!
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Mon Apr 22, 2019 1:29 pm

I think this must be what’s happening to me.

I’ve had a persistent, worse than usual pain in my lower left back & hip area. I did have a pre-existing disc herniation that has troubled me for many years, so at first I thought it was that flaring up again.

I have been passing mucous and gas and not much else for several days now. I’ve been taking restoralax 1-2 times a day, and I’ve taken milk of magnesia with varying degrees of success.

I just downed a glass of prune juice a couple of hours ago, and that has at least got things flowing, but it’s mostly water.

I was told to wait 2 weeks after surgery to re-introduce foods, and I suppose I jumped in the deep end. I was eating fiber gummies as well as I was passing very small stools prior to this, but I stopped several days ago.

I’ve been walking and stretching and massaging my belly but it doesn’t really seem to be doing a whole lot to help.

I think I’ll be heading to the hospital if this doesn’t resolve itself very soon.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Partial bowel obstruction

Postby MissMolly » Mon Apr 22, 2019 5:49 pm

CF-69:
I remember seeing your post a day or two ago where you shared your symptoms and wondered to myself if you might be brewing a partial SBO or struggling with slow, sluggish intestinal motility.

It is not uncommon for the intestinal tract to struggle with slow motility following abdominal surgery. Intestinal motility can slow to a crawl or it may be erratic and hapzarad, waxing and waning, like a car sputtering as it heads to a service station.

Adhesions/scar tissue causing partial small bowel obstructions are more problematic during the first year post surgery.

Having bowel movements that are primarily watery are concerning. When a segment of intestine is narrowed by becoming kinked by scar tissue or when motility is disrupted by periods of being slow or stopped, fecal matter will begin to accumulate behind the area of narrowing. As fecal matter accumulates it causes the area to distend due to backpressure. Soon, only fecal matter of liquid consistency can navigate and pass around the accumulated mass of feces.

There is no harm in calling into your physician/surgeon for guidance. A visit to urgent care would be appropriate (a step down from the emergency room). Most hospitals have urgent care satellite clinics. A flat plate x-ray would give an initial impression of what is going on.

It can be dangerous to dose with magnesium citrate or liberal Milk of Magnesia/Miralax with a partial small bowel obstruction that is not resolving with conservative home treatment (as you have been doing). You risk injury to the intestine and possible perforation.

It is time to seek medical guidance when a suspected small bowel obstruction is not resolving. Sometimes you need IV fluids and IV muscle relaxants with a supervised/watchful approach to manage the constipation buildup. There is no shame in seeking medical care. Post-op recovery from intestinal surgery often has unexpected speed-bumps that benefit from a bit of added medical support.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Mon Apr 22, 2019 8:56 pm

Thank you for your reply. I’m at the hospital getting it checked out now.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Wed Apr 24, 2019 12:05 pm

Well they said there was no evidence of blockage, but that I had a lot of stool on the right side.

I’m still not having much luck passing anything substantial. Lots of gas and some matter coming out so I guess things are moving along, albeit slower than I would like.

More prune juice I guess.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

Caat55
Posts: 694
Joined: Sat Dec 23, 2017 6:01 pm

Re: Partial bowel obstruction

Postby Caat55 » Wed Apr 24, 2019 12:31 pm

CF,
What suggestions did they make at hospital? I have read several posts that suggest bringing knees to chest and rocking, have you tried that? I have always had a slow gut, so I totally get your frustration, hang in there and let us know what works.
S
Do at 55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018
PET NED 12/18
Clear Colonoscopy 2/19, 5/20

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Wed Apr 24, 2019 1:07 pm

They said to continue with the Miralax.

The doctor said the pain I have is not related to the surgery, though I find that hard to believe.

But, like I said earlier, I’ve had a herniated disc for several years that I need to constantly maintain, which I have not been able to do since surgery, but I have started the stretches again since the surgeon gave me the green light. I’ve also been walking a few times a week when weather / pain permits.

I guess the old adage “it’s a marathon, not a sprint” applies.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Partial bowel obstruction

Postby MissMolly » Wed Apr 24, 2019 2:08 pm

CF-69:
I was wondering how you were doing and appreciate your post.

Constipation is not a benign, ho-hum issue. Constipation due to slowed intestinal motility can be a very concerning issue after abdominal surgery. What you have, in essence, is a barely functional ileus.

I have been where you are, to varied degrees, as I have had several surgeries related to my grave intestinal perforation.

Helpful tips:
A. Be proactive in clearing the retained fecal matter and gaining an upper hand in the comstipation.
Constipation due to functional slowing of the intestine does not have a quick fix. It may take extended time for the intestine to refind a rhythm of contractions to effectively move digested food material along. In the meantime, expect that the intestine may be stop and start irregularly, wax and wane, which can bring symptoms of nausea, bloating, low appetite.

Key is regular dosing with Miralax (or Milk of Magnesia). Miralax is an osmotic laxative - it will draw water into the intestine and help liquify/loosen fecal material so that it can pass more easily through. Osmotic laxatives also offer a kinetic nudge to encourage the intestine to move. Osmotic laxatives are safe to use long-term without risk of dependency (“lazy colon”).

You may need to take more than the recommended daily dosage, at first. You may need to take 1.5 to 2 times the recommended daily dose of Miralax or Milk of Magnesia to clear the fecal backlog. Magnesium is an essential mineral at a cellular level for normal muscle contraction.

Portion out taking the Miralax throughtout the day, as opposed to taking a large dose 2 x a day. It can be helpful to prepare a 16 oz. flask of a fluid of your choice with a dose of Miralax, and sip on the fluid during the day. This provides a gradual stream of osmotic laxative into your system that can be easier to assimilate.

Continue with Miralax or M of M after the backlog of retained fecal matter clears. You will find a daily dose of Miralax that works for you to keep the intestine humming along - not too much, not too little, a dose that is just right.

B. Fluids, fluids
Be mindful of intaking liberal fluids each day. You need fluids to reboot the intestinal tract to function. Water + Nunn’s tablets provide a refreshing taste without contributing to unnecessary added sugars.

C. Keep portion sizes of solid/soft foods small
You do not want to add a lot of solid food to the intestinal tract when there is accumulated stool due to slowed motility and constipation. Keep portion sizes small, 1/3 to 1/2 cup. Avoid large meals. Keep to easy to digest foods that are low in insoluble fiber (fiber that does not break down easily with chewing, such as membranes of citrus fruits, popcorn, edemamte, asparagus).

D. Exerise and body movement
You need not be a gym-rat. Walking is ideal. Yoga. Simple stretches, such as the knee to chest and rocking suggested above by Catt55. The intestines are a tube of smooth muscle that are influenced by the working of skeletal muscles and a body in motion.

E. When you feel that comstipation is gaining an upper hand, act sooner than later.
Increase dosing of Miralax, decrease intake of solid food, and walk to clear retained fecal matter.

F. Prune juice
Warmed prune juice, 6 oz. a day, is a good measure. 100% grape juice and 100% apple juice (not a juice blend) are also good items to keep on hand. 100% Grape and apple juice have natural flavinoids that aide intestinal motility. Coffee and chocolate also have GI stimulating effects.

Constipation is not a simple problem. Post-operative comstipation can be far more adversely affecting than many people appreciate.

I hope things improve for you over the next few days,
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Wed Apr 24, 2019 5:51 pm

Thanks for all that info.

It hasn’t been fun. I have a pain in my lower left back / Hip area that alternates between a fairly intense ache and shooting pain.

I’ve been drinking coffee, taking the Miralax and drinking prune juice, sometimes heated, sometimes not.

I still haven’t had the big evacuation I’m looking for.

I started eating fruit and yogurt again last week, and that seems to be the beginning of my troubles. I did have a few grilled cheese sandwiches which in retrospect probably wasn’t the best idea. Also Easter dinner on Friday May have been ill advised.

Since last week it’s just been mucous, gas and watery movements with an almost gritty / mucous like mixture.

I can’t imagine it’s a good idea to keep consuming food if I’m not eliminating much of it.

The back pain is awful. I just wish this situation would resolve quickly.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020

Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Partial bowel obstruction

Postby Pyro » Sat Apr 27, 2019 9:36 am

CF_69 wrote:They said to continue with the Miralax.

The doctor said the pain I have is not related to the surgery

.


That is horseshit. I’ve been told the same thing, was treated as a pill seeker at one surgeons office. Now they are telling me it could be a nerve stuck in scar tissue, that pain isn’t getting better anytime soon. I think sometimes it is constipation as well, suffered it my whole life and a blockage scares me. I take 4 senna a day plus miralax, I still need the magnesium citrate at times. It’s a lot, but it works.
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

CF_69
Posts: 109
Joined: Sat Dec 22, 2018 9:44 pm

Re: Partial bowel obstruction

Postby CF_69 » Sat Apr 27, 2019 8:55 pm

Interesting. I’ve been avoiding pain pills since I don’t want to get backed up any worse.

I do have a long history of back problems, exactly where it hurts now. The pain is different though.

I thought maybe it’s because I’ve been spending so much time in bed. Who knows.

I’m doing the McKenzie stretches and I’ve been getting my wife to massage the area for me every few days. I’m planning on calling the surgeon’s office on Monday.

Some positive news is that things are moving again. Now I seem to be swinging to the other extreme though with regards to frequency and urgency. Still small amounts though.

At the moment I am only working one day a week, so I just won’t eat before work that day. I make a smoothie with banana, peanut butter, blueberries and skim milk and that seems to agree with my innards.
47 at diagnosis
Rectosigmoid junction
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0
CEA:
December 2018 - 1.9
September 2019 - 2.5
March 2020 - 2.3
September 2020 - 2.5
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
4 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.
Clear CT - September 2019
Clear CT - October 2020


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