Chronic small bowel obstruction from adhesions

Posted by ginpene @ginpene05, Apr 6, 2017

This is my 5th SBO with hospitalizan in 18 months, due to adhesions. No surgery yet, but am considering Small Passage treatment. Last 3 times happened in the last 4 months. This is getting old. Any idess?

@nancybev

@marciakeren , welcome. I actually gasped out loud when I read that you got an obstruction on a transcontinental flight…I'm almost afraid to travel any more, for fear that that could happen (and I used to be a travel writer!).
How long have you been having the obstructions, and do you know what causes them? Do you have a gastroenterologist? My obstructions are caused by adhesions from several abdominal surgeries (I also think that gluten MIGHT aggravate the situation by causing inflammation, so I've been gluten-free for years). I finally figured out that the problem is really a mechanical one–my sbo's are NOT triggered by what I eat (I still get them even though I'm gluten-free)…it's just that sometimes the adhesions get stuck together or something so that nothing can pass through. So far I have not been able to get answers about what makes this suddenly happen, but the bottom line is that, for me at least, the priority is eating healthy food that will be digested quickly and easily–reducing the chances of anything getting stuck behind the place of obstruction. I've posted a lot here about how and what I eat these days to try to avoid trouble, or at least make obstructions SOMEWHAT more manageable. I think I've had some success. I really don't think it matters if you're vegan or anything else–if there is food in your digestive tract–especially larger, harder to digest pieces–it's going to cause problems if you get an obstruction.
But, again, you need to know what's causing your obstructions. I strongly suggest that you go to an ER if you have one again (if you don't already do that–I know it would be hard if you're traveling!). They can be very dangerous, and a CT scan or something might help determine where the problem is.

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I have had a half dozen surgeries related to infertility including surgeries to take care of three ectopic pregnancies and a hysterectomy… the adhesions have been an issue for 20+ years but they are now getting more frequentl… three eepisodes in the last three or four months. I need to find a gi doctor who has some answers. My doctor just keeps telling me there’s nothing to do and I should just eat slowly, drink water and yadda yadda… alll the stuff I’ve heard before. After this last episode I’ve had enough.

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@marciakeren , I totally get the "Yadda yadda" thing–I've found it so frustrating that I've never found a single doctor who can offer any useful advice or information.
At this point, I don't think anyone has discovered a way to keep them from happening, and it's therefore an issue of damage control (especially if you're now having them so often–I'm sorry about that!). You may want to consider doing what I've been doing–sticking as much as possible to really healthy smoothies (I've posted some recipes somewhere in here), juices, and soups. For now, I'm just going to repost something I wrote recently, to another member here, to make it easier for you to read. I hope it helps:

"For myself lately, though, I TRY to imagine that everything I eat will need to pass as quickly as possible through a tube the size of a straw or smaller, as quickly as possible, and yet still be nutritious.
Obviously, if I get caught with an actual obstruction and food behind it in my digestive tract, I'm probably in trouble. But by at least reducing the chances of something big getting stuck, I feel a lot less anxious–and because of this new strategy–I think–I was able to make it through my last obstruction without going to the ER (although in general one should probably go, to be safest), and vomiting only once instead of 5-15 times!
I've also started to stretch and move around/take walks after each meal, especially reaching upwards over my head, arching back, and moving side-to-side. It just seems that this MIGHT have a chance of "ungluing" adhesions when they start to stick together. I'm not sure about that, but it's worth trying (and stretching feels good anyway)!
I also chew everything–even juices–like crazy to get the digestive process going."
That last part about stretching is just a guess based on visualizing the adhesions starting to stick together again for whatever reason–it just seems like moving and stretching might encourage them to open up again. I'll try anything that makes sense!

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@nancybev

@marciakeren , I totally get the "Yadda yadda" thing–I've found it so frustrating that I've never found a single doctor who can offer any useful advice or information.
At this point, I don't think anyone has discovered a way to keep them from happening, and it's therefore an issue of damage control (especially if you're now having them so often–I'm sorry about that!). You may want to consider doing what I've been doing–sticking as much as possible to really healthy smoothies (I've posted some recipes somewhere in here), juices, and soups. For now, I'm just going to repost something I wrote recently, to another member here, to make it easier for you to read. I hope it helps:

"For myself lately, though, I TRY to imagine that everything I eat will need to pass as quickly as possible through a tube the size of a straw or smaller, as quickly as possible, and yet still be nutritious.
Obviously, if I get caught with an actual obstruction and food behind it in my digestive tract, I'm probably in trouble. But by at least reducing the chances of something big getting stuck, I feel a lot less anxious–and because of this new strategy–I think–I was able to make it through my last obstruction without going to the ER (although in general one should probably go, to be safest), and vomiting only once instead of 5-15 times!
I've also started to stretch and move around/take walks after each meal, especially reaching upwards over my head, arching back, and moving side-to-side. It just seems that this MIGHT have a chance of "ungluing" adhesions when they start to stick together. I'm not sure about that, but it's worth trying (and stretching feels good anyway)!
I also chew everything–even juices–like crazy to get the digestive process going."
That last part about stretching is just a guess based on visualizing the adhesions starting to stick together again for whatever reason–it just seems like moving and stretching might encourage them to open up again. I'll try anything that makes sense!

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The last blockage I had was in December while in the hospital, while they were getting the diverticulitis infection under control and seeing if the sigmoid stricture would open up more. I can't say for certain where it occurred, if it was just backing all the way up from the stricture, or someplace in my small intestine, but it was real obvious to me that I had the dreaded NG tube in my immediate future! Started feeling nauseous, burping, then vomiting up that delightful green bile. They did the X-ray with contrast and within the hour the surgeon was walking in my room. I knew exactly what he was going to say. Sometimes I don't think they can exactly pinpoint where you are blocked, although it is probably obvious sometimes. I made them give me a dose anti anxiety med beforehand because the last time I had to have one it was a horrible experience. They tried 11 times in the hospital room (I was NOT at Mayo), before they sent me to radiology to get it done. The floor nurse at Mayo came in and they got it done the first time out. As horrible as it is, it does work and then also caused the back end to start working as well and I was able to go home over the holidays and wait for surgery.
As well as things are going now, I am with you as being nervous about traveling, especially out of the country! Which is a bummer, because one of my daughters works for an airline and we get her flight benefits. Starting with a short anniversary trip in May and as long as things go ok, maybe I will get braver!
I hope you get some answers and the blockages are few and far between!

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@marciakeren

I have had a half dozen surgeries related to infertility including surgeries to take care of three ectopic pregnancies and a hysterectomy… the adhesions have been an issue for 20+ years but they are now getting more frequentl… three eepisodes in the last three or four months. I need to find a gi doctor who has some answers. My doctor just keeps telling me there’s nothing to do and I should just eat slowly, drink water and yadda yadda… alll the stuff I’ve heard before. After this last episode I’ve had enough.

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Hello @marciakeren and welcome to Connect's discussion on adhesions and obstructions. I see that Members @thull and @nancybev have already responded to you with their thoughts. As you can tell, these two have unfortunately had a lot of experience with obstructions due to adhesions. You couldn't want for better thoughts than theirs.

It sounds like your previous surgeries have set you up for these adhesions and you are trying to deal with it as best you can. From my experience some of the best ideas have already been stated by @thull and @nancybev. I would just add bed rest when the pain starts and you begin to feel uncomfortable.

@nancybev's idea of doing mild stretching exercises after meals is also good. Many of us have also tried massaging the abdomen to get things moving along. It does seem to be a constant problem and one that is always on your mind. Like @nancybev said we all try to keep our meals as nutritious and as easy to digest as possible. When I feel an attack coming on, I resort to liquid nutrition drinks, juices (as clear as possible) and a lot of bed rest until the discomfort begins to subside (along with the abdominal massage and gentle stretching).

I also avoid binding clothes. Tight waist bands, belts, etc. Keeping clothing as loose as possible around the waist and abdomen are also helpful to me.

Feel free to ask any other questions. Will you post again and let us know how you are doing?

Liked by thull, nancybev

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@hopeful33250

Hello @marciakeren and welcome to Connect's discussion on adhesions and obstructions. I see that Members @thull and @nancybev have already responded to you with their thoughts. As you can tell, these two have unfortunately had a lot of experience with obstructions due to adhesions. You couldn't want for better thoughts than theirs.

It sounds like your previous surgeries have set you up for these adhesions and you are trying to deal with it as best you can. From my experience some of the best ideas have already been stated by @thull and @nancybev. I would just add bed rest when the pain starts and you begin to feel uncomfortable.

@nancybev's idea of doing mild stretching exercises after meals is also good. Many of us have also tried massaging the abdomen to get things moving along. It does seem to be a constant problem and one that is always on your mind. Like @nancybev said we all try to keep our meals as nutritious and as easy to digest as possible. When I feel an attack coming on, I resort to liquid nutrition drinks, juices (as clear as possible) and a lot of bed rest until the discomfort begins to subside (along with the abdominal massage and gentle stretching).

I also avoid binding clothes. Tight waist bands, belts, etc. Keeping clothing as loose as possible around the waist and abdomen are also helpful to me.

Feel free to ask any other questions. Will you post again and let us know how you are doing?

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I really believe the massaging of my belly area during the small bowel obstruction helped. I would lay in bed and do gentle circular massage on the bloated area where the surgeon thought the blockage was. And some deep cleansing breaths

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Just checking in to say that after four days I am feeling better, but I still feel that someone is squeezing my ribs.. this is how my attacks usually start – severe pain in my upper abdomen, just below the sternum and the sense that someone has their hands on my waist, just about lower rib level and is squeezing them. Right now i just feel a bit tight in the ribs. I have called a nutritionist, and my GP… I've been mostly eating soup and soft food.. Does anyone else experience the same onset pain?

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@marciakeren

Just checking in to say that after four days I am feeling better, but I still feel that someone is squeezing my ribs.. this is how my attacks usually start – severe pain in my upper abdomen, just below the sternum and the sense that someone has their hands on my waist, just about lower rib level and is squeezing them. Right now i just feel a bit tight in the ribs. I have called a nutritionist, and my GP… I've been mostly eating soup and soft food.. Does anyone else experience the same onset pain?

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@marciakeren
I'm glad to hear that you are feeling better now. Probably everyone's experience with pain depends on where the obstruction or adhesions are located, so there is no "one-size-fits all."

Have you tried the massage or stretching exercises yet? That might be helpful in addition to the diet.

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Thank you for your answer. I do stretch and move around; I do massage when it starts to hurt… but not in any systematic way. I would love to find someone who could help me massage more effectively… As for diet, I would liike to find a nutritional beverage (like Ensure) – plant protein, no dairy etc… someone suggested Kate Farms Komplete, but I read the reviews on Amazon and the reports are that the ingredients have been changed and it is not as good as it was… other suggestions are Orgain and Owyn. I want to maintain my weight but make sure that I am getting enough nutrition. I really need a nutritionist who understands this condition, but have not had much luck in finding one… can anyone recommend a nutritionist? I don't think I have to see the person in "real life" – my husband (whose issues have nothing to do with any of this thread!) has a nutritionist he consults with via phone but she is not appropriate for me… Any ideas? Thanks in advance

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@marciakeren

Thank you for your answer. I do stretch and move around; I do massage when it starts to hurt… but not in any systematic way. I would love to find someone who could help me massage more effectively… As for diet, I would liike to find a nutritional beverage (like Ensure) – plant protein, no dairy etc… someone suggested Kate Farms Komplete, but I read the reviews on Amazon and the reports are that the ingredients have been changed and it is not as good as it was… other suggestions are Orgain and Owyn. I want to maintain my weight but make sure that I am getting enough nutrition. I really need a nutritionist who understands this condition, but have not had much luck in finding one… can anyone recommend a nutritionist? I don't think I have to see the person in "real life" – my husband (whose issues have nothing to do with any of this thread!) has a nutritionist he consults with via phone but she is not appropriate for me… Any ideas? Thanks in advance

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When they had me on clears in the hospital and then at home while I was waiting for surgery, I drank Boost Breeze. They provided it in the hospital, but I had to order it from Amazon when I got home.
I like the peach and also the berry. I have not tried the orange.
250 calories, 9 grams of protein in 8 oz. This is what I lived on and I still drink them when I feel like I need more protein. All clear, no dairy. My nutritionist is at Mayo in Phx. The gastro dept set up my appointment. I saw her once and the rest has been over the phone.
Take care & I hope you get to feeling better!

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@judibutter

Hi, I am new to this group. Last year I was admitted twice for small bowel obstruction having to have NG tube twice. I had an UGI series with small bowel follow through. Barium didn't come through for over 24 hours. I was never given a reason for the blockage. A month after that I had a totally non functioning gall bladder requiring surgery. I continue to have issues with bloating, pain, terrible gas and flatus. I have small pellet like stools and an hour later a normal bowel movement. I feel very over full many times after a meal and am unable to eat the next meal. I find there is nothing that has helped me. I have done the high fiber diet, no help. I have done the low fiber diet no help. Liquids do seem to help sometimes. I assume my problems stem from past abdominal surgeries, appendix, total abdominal hysterectomy and now the gall bladder. I have had no help from my physicians and the symptoms are beginning to impact my quality of life. Any suggestions would be greatly appreciated.

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I know there are others much more qualified to answer this other than me, but my mother has been experiencing the same things. She has found that staying on a soft diet helps, but she has also greatly increased her "water" intake and established a routine of walking more. She has an colostomy so that causes her other issues, but in drinking 60 ounces of just water a day, cutting out carbonated drinks and eating more frequent small meals, she has been able to manage her obstructions at home. I am sorry you aren't getting the answers you need. We went to 3 different hospitals before we found someone who actually took an interest in her case and provided us with information.

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@judibutter

Hi, I am new to this group. Last year I was admitted twice for small bowel obstruction having to have NG tube twice. I had an UGI series with small bowel follow through. Barium didn't come through for over 24 hours. I was never given a reason for the blockage. A month after that I had a totally non functioning gall bladder requiring surgery. I continue to have issues with bloating, pain, terrible gas and flatus. I have small pellet like stools and an hour later a normal bowel movement. I feel very over full many times after a meal and am unable to eat the next meal. I find there is nothing that has helped me. I have done the high fiber diet, no help. I have done the low fiber diet no help. Liquids do seem to help sometimes. I assume my problems stem from past abdominal surgeries, appendix, total abdominal hysterectomy and now the gall bladder. I have had no help from my physicians and the symptoms are beginning to impact my quality of life. Any suggestions would be greatly appreciated.

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Thank you for your reply. I know I need to do better with water intake but I do not drink soft drinks already, maybe once a month or so only. I try to walk 2 to 3 miles each day but have been limited lately because of chest pain on exertion. I think I will try a total fast for 24 hours then start a soft diet of just a couple of things for a week. Then, I will introduce other food items one at a time. I can’t think of anything else to do. Again, thank you for taking the time to answer me.

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@judibutter

Hi, I am new to this group. Last year I was admitted twice for small bowel obstruction having to have NG tube twice. I had an UGI series with small bowel follow through. Barium didn't come through for over 24 hours. I was never given a reason for the blockage. A month after that I had a totally non functioning gall bladder requiring surgery. I continue to have issues with bloating, pain, terrible gas and flatus. I have small pellet like stools and an hour later a normal bowel movement. I feel very over full many times after a meal and am unable to eat the next meal. I find there is nothing that has helped me. I have done the high fiber diet, no help. I have done the low fiber diet no help. Liquids do seem to help sometimes. I assume my problems stem from past abdominal surgeries, appendix, total abdominal hysterectomy and now the gall bladder. I have had no help from my physicians and the symptoms are beginning to impact my quality of life. Any suggestions would be greatly appreciated.

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Hello @judibutter

I am pleased that you posted this concern. We have had many members on Connect who have posted about this problem. I would like to invite @thull and @nancybev who have had experiences similar to yours and might be able to offer you some suggestions. Do you see a gastroenterologist?

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@hopeful33250

Hello @judibutter

I am pleased that you posted this concern. We have had many members on Connect who have posted about this problem. I would like to invite @thull and @nancybev who have had experiences similar to yours and might be able to offer you some suggestions. Do you see a gastroenterologist?

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When my small bowel obstruction was total, they did the NG tube and finally had to put me on TPN because I was basically starving and needed nutrition. Once some stuff started getting through, I was on the TPN until I could handle enough calories to maintain my weight. My obstruction was due to adhesions from my colostomy reversal surgery. Liquids are great….I like high protein Boost and Boost Breeze which is clear. Important to get calories and protein. Low residue diet, which is very low fiber. Nothing over 1 gram of fiber per serving. To me, the liquids are my safe space. I know those feed me and get through.
Slow baby steps are best . Add things gradually and in small amounts. Like a couple bites of scrambled eggs, a few bites of applesauce or pudding. See how it feels.
I am heading back into Mayo this Friday to have an outpatient procedure on my incision scar.
I hope some of my suggestions help

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@judibutter

Thank you for your reply. I know I need to do better with water intake but I do not drink soft drinks already, maybe once a month or so only. I try to walk 2 to 3 miles each day but have been limited lately because of chest pain on exertion. I think I will try a total fast for 24 hours then start a soft diet of just a couple of things for a week. Then, I will introduce other food items one at a time. I can’t think of anything else to do. Again, thank you for taking the time to answer me.

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Hello @judibutter

I encourage you to read the suggestions by @thull. She has experienced a lot of these problems in the past.

Some other suggestions are to try some stretching exercises after eating. Such as stretching your arms up in the air and to the sides. Also, stomach massage can often help the digestive process. Here are some Youtube videos about exercises for digestive problems,
https://www.youtube.com/results?search_query=exercises+for+gastroparesis

I look forward to hearing how you are doing. Will you post again?

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I am currently in the hospital with my 6th SBO. The same protocol is followed each time. The surgeon thinks that I have scar tissue that stems from a laparoscopy I had back in 1980. So this was my only abdominal surgery before the obstructions began 3 years ago. I did have an exploratory surgery in August to determine the amount of scar tissue. I did not come away with much information, but have been warned that more surgery results in more scarring. I honestly don’t know what to do since the frequency of these obstructions is increasing. Are you talking about Clear Passage? If so, I’ve read about that also and definitely would consider that since my doctors don’t seem to have any suggestions other than to come into the hospital each time and go through the protocol. Such a painful thing! And I don’t know what to eat!

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