So, in continuation of my personal story, found here, 3 years and 2 months after my initial diagnosis of Crohn’s disease, located in the small bowel I was feeling just alright. I had been taking Humira, which was failing. Some symptoms were returning and my Dr’s office had prescribed Remicade but my insurance company, infusion center and specialty pharmacy couldn’t get their act together fast enough and my Remicade was delayed. I started noticing some decrease in the amount of my stool which caused me to feel constipated. I also started noticing that I was having a lot of gurgling and weird sounds coming from my stomach. I did not really have any stomach pain, I felt pressure and bloating but not really any pain. Then one evening after a beautiful day at the beach (while on vacation) I ate dinner and started feeling stomach pain and nausea. By 10pm that evening I was in excruciating pain. It came in waves, one minute I was ok, the next I was doubled over in the most excruciating abdominal pain I had ever felt. I tried forcing down some hot tea. I tried having my husband rub my back (usually helps me with gas). I tried laying in various positions to relieve the pain but nothing worked. I lasted until about 3am and then had my husband take me to the emergency room. I had developed an intestinal obstruction.
I knew that I had an obstruction. I knew it as soon as I felt that pain. I just was trying everything that I could to avoid what I knew was coming at me. I thought that maybe it wasn’t completely obstructed or that I could somehow push things through with hot water or changing positions. Nothing worked and on the hour car ride to the hospital I vomited out two grocery bags worth of stomach and intestinal contents. It was…awful. There isn’t a word to describe how awful I felt. I was praying for relief in any way that I could get it.
After arriving at the emergency room I was fast tracked and given a CT scan of my abdomen (had to drink barium, that was very difficult) and told that I had an obstruction at the terminal ileum (where my disease was most active). The GI consult came in and told me that the best course of action would be to laparoscopically remove the section that was diseased and now obstructed. They placed an NG tube down my nose and into my stomach to relieve the pressure and any stomach contents (pleasant…) and I was admitted pending surgery.
I had already met with a surgeon for this very reason a few months before it happened. I hadn’t made up my mind to do elective ileocecetomy (removal of the terminal ileum and ileocecal valve) but now it looked like I didn’t have a choice. So, we went ahead with the surgery and everything was done the day after I was admitted. I recovered just fine and went home 3 days after. I was feeling a lot better and a lot lighter!
The Crohn’s disease eventually came back and I ended up on Remicade to reduce the potential risk of another obstruction.
So, what causes an obstruction when you have some form of IBD?
An obstruction is usually caused by inflammation, as this was true in my case, and is true in most cases with people that have IBD.The diseased area of the bowel will inflame to the point of closure. This is very dangerous as it an cause a rupture of the bowel which can in turn cause death.
There are also other reasons why there would be an obstruction in the bowel in an IBD patient. These can be, but not limited to…
1. Scar tissue build up. Over years of the bowel wall breaking down and building back up, scar tissue can form. This can cause a blockage or partial blockage in the bowel and usually needs surgical intervention. Or in the event of past surgeries adhesions can build over time causing an obstruction.
2. Food or foreign substance obstruction. This would be when the bowel is inflamed and food or a pill or something gets stuck in the narrowing which causes an obstruction. This can sometimes be fixed with non-surgical remedies, depending on the size and location.
3. Twisted Bowel. This is where the bowel will twist itself closed. This can happen in IBD patient’s and non IBD patients alike but is not very common. This also usually requires a surgical intervention to fix.
How can I prevent an obstruction from happening?
There are a few things that we can do to try to increase our odds of never having an obstruction happen to us. One thing is to listen to the Dr. and take some sort of medicine to control the inflammation in the bowel that is caused by the disease. There are also dietary remedies to try to prevent obstructions from happening. These include
1. Eating smaller meals throughout the day. This allows only minimal food to run through the bowels, as opposed to a huge meal trying to get through all at once. This is especially important if you already know that you are dealing with a partial obstruction.
2. Chewing your food all the way. The mouth is the first line of digestion. Taking out time to eat and chewing our food completely is helpful in all areas of digestion.
3. Drinking enough water (or liquid) with meals. This will help lubricate the food and keep it moving through the bowels as well as keep you hydrated!
If an obstruction does happen, just know that you are not alone. This is pretty common and often times can be fixed without surgery. It is an awful to go through. Please know that you are not alone. Reach out and find some support. Hang in there, things will get better!