Can partial blockages come and go?

[KarmaForHire]

Hi all,

Long story short, I was hospitalized in July with bad stomach pains, turned out I had a blockage and was diagnosed with Crohn's in August. I've been on Entocort 9mg since then. Starting a month ago, I tappered down to 6mg of Entocort while starting on Humira. Since I've been undergoing treatment, I've been feeling great, better than I ever have in my entire life actually. Now, here is where my question arises. My GI sent me to get an MR enterography done. Based on the results, he said I have about 10cm of my ileum that is affected by the Crohn's. He said he wasn't able to tell how much of it is scar tissue and how much is residual inflammation. He told me that I may require surgery if it is scar tissue, as there is no other way to relieve symptoms from scar tissue. Since I've been out of the hospital, on occasion, I will get really bad stomach cramps, similar to what I experienced prior to going to the hospital, however they are nowhere near as painful. My stomach also tends to make some really loud noises as these cramps come on. During these cramps, I seem to be still passing everything, as I tend to have 1 BM per day and still passing gas and my tummy still feels soft to the touch. They seem to clear up within a day or two, and then I feel great again. My stool doesn't seem to be narrow and seems normal when I'm getting these cramps. Are these cramps a partial blockage? My GI told me that as long as they go away in a day or two and my stomach doesn't get hard or distended, to not worry too much about it. I'm just concerned because I'm not sure if these are partial blockages, simply pain from having Crohn's and active inflammation, or is this scar tissue that gets aggravated. Does anyone have any experience with symptoms like this?:sign0085:

 

[dave13]

How long do these blockages last? If you are still able to pass stool and not vomiting it is only partial.I would be concerned if they increase in frequency and/or you vomit while they occur.We do have to worry about stricturing with each blockage.It is good to keep your GI in the loop with this,let him know if they get more severe.Listen to your body,you know it best.

 

[KarmaForHire]

The most current set of cramping that have occurred lasted about a day and a half. It started on Sunday morning when I woke up and lasted until Tuesday morning. I'm back to feeling great today. During this time, I'd get intense cramping that lasted for about 5 to 10 seconds and would go away for anywhere between 20 minutes to an hour. During this time, I had no vomiting or nausea and I was still passing formed stool and gas. My stomach also wasn't hard or distended. Taking a hot shower seemed to help relieve some of the cramping. I even was hungry and able to eat. The only similarities between these "cramping attacks" and when I experienced the blockage in July was how the cramps felt, if that makes any sense. They were nowhere near the intensity or frequency of when I experienced the blockage, but the source and sensation of the pain was similar. I'm set to see my GI Dr next Friday. The last time.I brought this up to him he didn't seem too concerned about it. He told me that as long as my stomahe stays soft to the touch, I'm not vomiting and I'm still having regular bowel movements, that its nothing to be too concerned over and to eat lightly during these times. He told me that if anything changes with them, like increased frequency, pain or duration to call him. He relieved some of my fears but didn't really clarify what these cramping attacks are. The only blockage I've ever experienced was one of the most painful feelings I've ever experienced.*warning: some of this might be TMI* Apparently it was so bad that my intestine intusussepted. I couldn't even keep a sip of water down without vomiting. Luckily it somehow cleared itself up overnight at the hospital while I was hooked up to an IV for hydration. I was laying in bed writhing in pain when all of a sudden my stomach made a loud gurgling sound, then it sounded like someone opened a flood gate in my stomach. I spent the next hour on the toilet, I felt so bad for my roommate who had to suffer through those sounds and smells all night, haha. The next morning the Dr. was kind of shocked and baffled that it cleared itself. He said that I was going to be due for emergency resection surgery that morning had it not somehow miraculously cleared itself.

 

[dave13]

It's good to know you are communicating with your GI and seeing him on a regular basis.Ask him to explain to you what is causing the cramping,don't be shy to ask.It is your body he is working on/in.

When talking about our disease on the forum I feel there is no such thing as TMI.We need to feel comfortable here to talk openly,in order for the forum to work properly.You want to ramble about your roommates sister's cousin's ex-partner that bugs you...maybe not the place.What you consider TMI may be the bit of information a fellow crohnie who reads your post has been looking for.

I am familiar with intususseption but have not experienced it.You will get no argument from me or others that blockages are the worse pain a person can feel.I had a partial blockage this past Friday,first time in a little over a year from surgery.I did not miss being in a fetal position feeling like something is trying to slowly rip its way out of my abdomen.Vomiting until your throat is raw and the retching that follows.It lasted 8 hours...good times. :ytongue:

It sounds like you have a good rapport with your roommate.Do they know about you having crohn's disease? I assume they are at least partially in the loop because you can't go through a blockage,partial or otherwise,very quietly.Be thankful you don't have a roommate that puts you on youtube during these moments.

I hope the appointment goes well.Sorry if I rambled a bit

 

[The Real MC]

Ask your GI about bland diet. I had cramps and abdominal noises all year. Sometimes the cramps were from a blockage (abdomen inflamed, belly hard) sometimes it was from indigestion (abdomen NOT inflamed, belly soft). Crohns can aggravate indigestion. Bland diet helped the indigestion and kept the cramps at bay. Certain foods can trigger the cramps, unfortunately no two CD patients have the same triggers it is a trial and error process. I had to stop eating certain foods that never bothered me before. Good luck.

 

[sidney75]

Hi Karma,
I'm relatively new to all of this and am not officially diagnosed, but was hospitalized twice with a full obstruction in my terminal ileum in October. As I am undiagnosed and unmedicated I have been told I will likely have another obstruction at some point, which after having that absolutely horrible cramping, leaves me paranoid when I start to feel the less intense yet very similar pangs from time to time. One Sunday the pangs started to get progressively worse, nowhere near the intensity of my full obstruction but very similar in location and nature. As I now have an absolute fear of going back into the hospital (it was a terrible experience in many ways, I had NG tube for 4 days), I will only go to the hospital if I start vomiting. On this day, however, I found that applying my heating pad to my abdominal area helped relieve some of the cramping and facilitated the "breakthrough" of gas and subsequent release of pressure. I'm not a doctor but I do believe you can have levels of blockage due to inflammation, and heat really helps me with these uncomfortable cramping spells.

 

[Layla]

I've had partial blockages for probably the last 10 years and they sound very similar to yours with the exception that my stomach would be hard and bloated. I would go to hospital if it got to the vomiting stage and the first 2 times they resolved themselves after getting morphine, buscopan and the like.

The last time I was looking at an emergency resection but after 4 days of immense pain, ng tube and lots of hydrocortisone something started moving so the op was avoided, phew!
That was when we started planning a resection which I had a few months ago now.

If you are having obstructions, don't eat anything until it's gone as it could make matters worse but do keep on drinking carefully. I found warmth also helps like keeping a hot water bottle close. I would be talking to my GI if these symptoms come on more frequently to make sure you aren't heading to an emergency resection.

HTH

 

[KarmaForHire]

My GI did warn me that I was on the verge of going in for an emergency resection when I was first diagnosed during the summer, and that there is a good possibility I may need one down the line as the results from the MRI that I took showed about 10 inches of my ileum was strictured. I too have found that heat seems to alleviate some of the pain, so I've taken to using a heating pad even when I'm feeling good.

 

[sidney75]

Karma,
Just wondering what happened as a result of these symptoms. Was it another blockage? I am dealing with a very similar set of circumstances and am curious as to how this episode played out for you. Thanks!

 

[KarmaForHire]

I've talked to my doctor and we still aren't certain yet. I was in really good shape when I was on Entocort, but when I transitioned to Humira was when I started to experience these cramps. I went to the doctors for a visit on the 8th. I told him about what I was experiencing and he wasn't sure what was going on. He said that it could be something I ate that might be too fibrous getting caught in the scar tissue or that the Humira hasn't started working yet, as it can take 3 to 4 months to fully kick in, I started on the Humira in mid November, so I'm just now hitting 4 months. As a precaution he is having me get another MRI this Friday. Going from there, he said we will either be altering the Humira schedule, changing me to a different drug, or discussing surgery to remove the scar tissue. The weird thing is, I've literally not experienced any discomfort since two days before the office visit I had with him, perhaps the Humira is finally kicking in?

 

[dave13]

I hope the Humira is working for you.

 

[Fernando1]

Here are two posts combined I wrote regarding Obstructions

Had a Small Bowel XRay series and the stricture I have at the Anastomosis has narrowed down considerably. The result was documented as a partial obstruction. I have had many, many obstructions in the past, several stays at the hospital waiting for the obstruction to clear, sometimes up to a week.

Over the years I have developed strategies to not get to the full obstruction point:

1) Cut the food in very small pieces: I eat a lot of chicken and I cut it in tiny pieces. Steak is very challenging, one steak sent me to the hospital for 9 days, so I have very small steaks, cut them small and chew-chew-chew each piece completely.

2) Eat food that gets digested into fine grain chyme. This includes rice, noodles, soups.

3) Eat several small meals, do not eat for more than 15 minutes at a time.

4) Monitor your digestion and learn from it. Particularly when we go to fancy restaurants there is a tendency to eat more than usual. See where you are 3 hours after the meal, if you still feel it sitting there learn not to eat that much.

5) If I get the symptoms of an obstruction (sharp pain, vomiting, lack of bowel activity) I usually go on a broth diet. I do a lot of walking since it stimulates my digestion. I do not take pain meds since it tends to freeze my bowels.

So far I have not had a full obstruction since my last surgery in 2010, this year I notice the stricture much tighter, its a matter of time before I have full obstructions and eventually need surgery.
My first bowel resection was on April 1995, it took 15 years to get into a year of full obstructions.

On 1995 I had about 6-7 obstructions that passed in 2-7 days. I lost 40 pounds ( I am already a skinny guy to begin with). Could not wait anymore with the constant pain and vomiting every week. Had my second resection on September 2010, 5 obstructions.

Here is the problem with obstructions: by the time you actually get plugged up there is very little you can do, need to go into a liquid diet, eat a lot of broth (not even noodles), and give it time to dissolve. So you live a life of eating very small meals that are easily digestible. That is where I am today, about once a week I may feel obstructed for about a day, then it passes.

But once a stricture is at this very narrow point (which is all the scar tissue built around the point of the last surgery), its only a matter of time before a little more scar tissue builds up and plugs the rest of it. Humira / Remicade will work on new inflammation but not on solid scar tissue. My GI told me that the stricture is so big that a strictureplasty will not help. Once you get into full obstruction mode then you get another one every month sometimes ending up in the hospital. I was delaying the inevitable, food was pushing and burrowing into the side intestines creating the fistulas. In 1995 I needed emergency surgery (I had 3 fistulas) and the last fistula was burrowing into my bladder in which you can die from septicimia.

So in 2010 after the surgery I started with Humira which I remained in remission until 2012. Then the main Crohns symptoms started again: Lots or yellow watery diarrhea many times a day, perianal symptoms, bloating. Did not have any obstruction symptoms until 2015 so the answer is: 5 years. I can live with Crohns but obstructions is another matter. Once you are in that pain-vomit-clear the obstruction cycle there is no way the obstruction is going to get better. You will know this conclusively the second time you end up in the hospital watching the grass grow.

My goal for EVERY MEAL is that it goes down easy, if not I find out why I ate so much and not repeat the situation. This works for me, its like walking a tightrope which danger always there, I need to be very careful that is all.

My estimate is that I can live another year like this, maybe two. But if I start with the pain, obstruction and vomiting it is time to go back to surgery. Because that is all you will get over and over again. I am trying to avoid this for as long as I can. Every time they cut my bowels I have less and less of them plus the Crohns will start at that point and resume again.

Right now I started Entyvio so hope that it will reduce the inflammation and help me cope with this for the future.

 

[KarmaForHire]

Well, it's almost been a month since my last dr. visit. I went for an MRI on the 20th. I have my next appointment with my dr. tomorrow for the results of the MRI and my latest blood work. The really odd thing is, I haven't had cramping since literally the day of my last dr. visit, which was on March 6th. I'm also now slightly past 4 months of being on Humira. I don't want to get too hopeful, but I'm really hoping that the Humira is finally kicked in and doing it's job, because I've honestly felt great this past 3 weeks. The dr told me at my last MRI that I had the stricture, but he wasn't sure if it was mostly scar tissue or a mix of inflammation and scar tissue. He put me on the Humira in hopes that it was a mix and that bringing down the inflammation would allow me to live with the stricture comfortably. The only thing I've changed is that I'm super careful about what veggies I eat now, I'm pretty sure what caused my last round of cramping was some roasted carrots which I probably shouldn't have eaten but was starving. I've stuck with mostly just potatoes, mushy boiled carrots and mushy string beans. Meats don't seem to bother me at all, I've been eating all sorts of meats with no ill effects. I'm hoping for some good news tomorrow, as I'd like to, if possible, put off the surgery as long as possible. I'm still learning to cope with Crohn's, but I refuse to let it beat me.

 

[Fernando1]

I will divide my answer into two stages:

All these symptoms together

Stage 1 - Need surgery but I am in denial: Partial obstruction stage

Continual loss of weight - dancing around tiny portions of food to avoid blockage
Pain every day - a dependence on pain medication
Continuous diarrheah with no end in sight
Diagnosed by scopes and colonoscopy fistulas and partial blockages
Distention with loss of gas coming out the other end and belching at the top
Throwing up a couple of times a week because of blockage
Remicade and Humira don't work like they used to. This is a key marker since they may not be reducing inflammation if you have a lot of scar tissue.

So l live with these thinking I can manage. Please note that if you only have loss of weight or diarrheah is not an indication for surgery. Its when these are ALL present, the obstructions arrive and the fistulas appear that this post is emphasizing.

Then you move on to the can't wait no more stage:

Stage 2 - Several trips to Emergency room and stays in the hospital
Full blockages with throwing up every day
Major loss of weight and getting worse, continuous pain

Its the second stay at the hospital waiting for the blockage to go away - 5 days - that made me fully realize that no treatment or waiting is working, that I need surgery.

Your risk when you wait and wait: Full blockages that can last a week or more, they begin to reappear every other week. Because of the pressure in the intestine, it presses on the walls and creates fistulas. Some of these fistulas can burrow into vital organs, for example the bladder. You schedule the surgery a month from now but you get another full blockage and go to another hospital stay waiting for the grass to grow.

See where you are in this symptom continuum. The first stage eventually goes into stage 2. In my case is was six months.

Good luck

 

[KarmaForHire]

So I went to my doctor's on Friday and have some good news. When I had my initial MRI in August, it was noted that the stricture was a mixture of fibrotic scar tissue and acute inflammation, however they were not able to tell what was scar tissue and what was inflammation. My latest MRI showed that there is still narrowing, scar tissue and a little acute inflammation still there, but the narrowing has seemed to improved. Which would explain why I have not had cramping in the past 5 weeks. He also noted that there were no abscesses or fistulas forming. Seeing how I was having my most difficult time when I was transitioning off of Entocort and onto Humira, my doctor is of the mindset that it was inflammation causing my discomfort and that the Humira is finally working and reducing the inflammation significantly. He backed up his reasoning by showing me my latest blood work that was taken on Tuesday to the last one which was taken in the beginning of February. My CRP has dropped by 300% in that time frame, as well as an additional marker, which I forget the name of, which was at 17.8 during my February visit, which was sitting at 4.6, which he said is in the high normal range. He wants me to continue my course at the moment unless anything changes, then we will discuss surgery again. At this moment Fernando1, I don't think I'm even in your stage 1. I've been gaining weight since July (when I was first hospitalized with a blockage) - I've gained 22 pounds since then. I've been pretty much pain free for the past 5 weeks, no D and no constipation. I was diagnosed via a colonoscopy in August. The only time I threw up or had distension was right before I went to the hospital in July, when I was first diagnosed. I just started on Humira in November, which my doctor warned me may take up to 4 months to start working, which oddly enough I became relatively pain free at almost exactly the 4 month mark. I'm not going to get my hopes up, I know that surgery is a very real and likely scenario. I'm not scared nor opposed to getting surgery, but at the moment I'm trying to prolong that scenario, which from my doctors point of view, seems to be a very real possibility at the moment.

 

[Fernando1]

That is great news, you may be able to stay prior to Stage 1

Some meals take a while to digest
No pain, no vomiting
***You are producing fecal matter every day, the pipes are moving

So you can manage this way for a long, long time if inflammation is kept down !

 

[KarmaForHire]

Hi all,

Figured I'd give a little update at this point. I saw my doctor again for another follow up on the 15th. My blood tests came back showing that my inflammation markers are now all in the "high normal" area which my doctor was very happy to see. I haven't had any stomach cramps or issues now going on 3 months. The doc said I still and will always have some significant scaring of my terminal ileum, but since I seem to be handling the low fiber diet quiet well, he wants me to continue to gain more weight and we will discuss a resection surgery for next summer. Of course, if anything with my condition changes where I start going downhill, that will be moved up, but for the time being he just wants me to pack on some pounds so that I will be at a nice healthy weight before the surgery. He has now changed my follow up appointments from every month and a half to every 3 months, as he says since I'm doing so well that we can space out the followups more and if anything changes to let him know. Maybe I'm just lucky, maybe he's a very good doctor, I don't know, but whatever it is, my life over the past 3 months has changed so much for the better. These past 3 months have been quite a new experience to me, this is the first time since I can ever remember that my stomach didn't bother me. Apparently I've been affected by Crohn's for so long that I didn't even know what normal felt like. Thanks you everyone for your support!

 

[dave13]

Thanks for the update.It's good your doc got your flaring under control.Definitely keep him in the loop as to how you are doing.I keep a notebook and write down questions/concerns between appointments.I bring it with me to the appointments and I find it helps to reduce the 'Damn,I just got home and I meant to ask my GI...' moments.

Call your doc if you have any questions/concerns you feel need to be addressed before your next appointment.Don't be shy.Keep us posted.

 

[Toni68]

Hi just wondering about blockages. Does everyone vomit?Only as because I was only diagnosed in oct 2012 and after a couple of months of various meds eg pred etc had a continual flare and had a resection in March 2013. Before surgery doc said they'd remove about 6 inches but when they got in had to remove 24 inches. Apparently although continuous bloods didn't show raised inflammatory markers It was a mess, blockage,bowel perforation, ulcers,strictures,inflamed appendix which was also removed, and I never once vomited?mot only that but the next day had to be brought back down and opened up again because my temp spiked to dangerous levels( never REALLY found out why)ended up with ecoli and some other germ and spent 3 weeks in isolation.A few months later was put on humira but had a reaction and am now on simponi for the last 9 months which although primarily is for arthritis( which I also have ) doesn't seem to be working for either so doc is talking about upping it to two injection a month .also I have D all the time NEVER formed but I've found recently although I still get the urgency I'm not going much could a blockage be starting?i know from frequent pillcams most recent march2015 I'm imflammed with ulceration at resection site but also more into the colon now as well. Thanks for listening

 

[The Real MC]

Usually when I have a blockage, nothing passes and I ultimately vomit. Diarrhea on its only could be blockage, but I don't have it every time.

 

[sidney75]

Hi Toni,
That's incredible that you had all of that going on and no vomiting; however, I know some people who do not vomit (my son and his father) ever. I would say if you are looking for warning signs for a blockage, in lieu of vomiting, it's the pain. It's not like other abdominal pain we have with these awful diseases, but it's an intense feeling that your stomach and intestines are tightened and being twisted - and it comes in severe waves (at least for me). It felt like labor contractions but worse. You can have some d at the beginning, but with a full blockage at some point nothing passes through. Severe bloating and hardening of stomach comes along with the pain during a blockage as well. And obviously pay attention to your temperature. If you are not vomiting stuff must be going somewhere and that would cause an immediate infection I would think. Hope this is helpful!

 

[Toni68]

Thanks Sidney ... Yeah I know the pain you're talking about like waves or contractions had those before resection . This pain is slightly different being always on left side and around my back, I personally think it's my descending Colon but I hope I'm wrong

 

[KarmaForHire]

For me it depends. When I had my full blockage, I was throwing up and heaving even when my stomach was empty. I couldn't even hold down a few sips of water without throwing up. When I was suffering from the partial blockages, I never got nauseous, I was just suffering from the waves of pain (albeit nowhere near as intense as when I had the full blockage) and some REALLY loud stomach noises. Hope everything works out for you.

 

[UnXmas]

I've had a small bowel blockage and post-surgical ileus and didn't vomit with either. My blockage was a full blockage which resulted in perforation, but I didn't really find it particularly painful. With both the ileus and blockage I had no stoma output, but they aspirated my stomach. The ileus was really painful because first they gave me a laxative (which produced no stoma output whatsoever), once they realised the problem they aspirated my stomach and the pain eased. Both times my stomach was enormously bloated until aspiration.

 

[Toni68]

Hi I'm still waiting on an mri,3 months now, but over the last few days I have pain where my resection was done but it's on the outside? I can pinpoint it with pressure and it's exactly where the ti once was.I know I've inflammation re pilcam that showed progression of same into the colon calprotectin came back at 366, starting to get worried now , they've upped entocort to 9 mg daily and sticking to 50 mg simponi monthly Til mri us done also going to a coagulation disorder clinic for results of bloods taken to try and figure out all the bruising I know people on here say they bruise so if it's par for the course I'm wondering why the appointment?