How to tell if its an obstruction?

[nogutsnoglory]

how to tell if its an obstruction?

Right now I have the feeling of a knot on my right side its been there for a few hours. Earlier today I was pain free (don't get to say that a lot)

How would I know the difference is the knot/pinch feeling is an obstruction and something is lodged there and stuck versus just constant food going through an inflamed area and hence the feeling of pain in that one place.

 

[imisspopcorn]

For me when I am obstructed I have sharp pain that would come and go with the normal peristalsis of my gut. Kind of like labor pains. I also had non-stop vomiting to the point all that was left was bile. My stomach is always tender to the touch, but that is just from the inflammation.

 

[nogutsnoglory]

well i know that vomiting would be a sign, and thankfully i havent had that, but i hear its not always the case and sometimes you can have an obstruction and not vomit and thats what confuses me.

 

[imisspopcorn]

My doctor told me that you can still pass food through the opening the diameter of a spaghetti noodle....He never said what kind of food so I'm assuming low residual soft. Its not the obstruction so much that's dangerous, its if you perforate your bowel. If you think your obstructed you can go to an urgent care for an abdominal xray. Its not an absolute diagnosis but they can tell if there maybe a blockage. The pain was excruciating, I knew i needed to go to the ER.

 

[nogutsnoglory]

mine is mildly painful it just feels kinda stuck, but i suppose going based on what you said if its more serious id be like in super pain and puking. so i hope that this is just a little inflammation or scarring and it will go away.

 

[imisspopcorn]

See if a Tylenol helps with the pain. Try not to worry.

 

[shazamataz]

I expect imiss is right. I'm still newish to this and every slight twinge gets me worried! Tho I expect if anything is obstructed or heading that way it would hurt A LOT!

 

[nogutsnoglory]

very true imiss nerves are probably half the enemy in this fight

shaz i know what you mean about being nervous about every twinge, it can make you nuts but its better to be safe than sorry

 

[seaofdreams]

For me when I am obstructed I have sharp pain that would come and go with the normal peristalsis of my gut. Kind of like labor pains. I also had non-stop vomiting to the point all that was left was bile. My stomach is always tender to the touch, but that is just from the inflammation.

This is how I feel when I have C and what I was feeling when I was put into hospital with a suspected obstruction.

 

[Regular Joe]

Hi NGNG,

I agree with imisspopcorn. My first experience with a flare was several years ago, and lord have mercy, the pain, nausea, and vomiting landed me in the ER. The pain was excruciating, slightly above my waist in the stomach area - 10 on a 10 point scale. And mine was only a partial obstruction.

The small intestine is normally about 1" (30-40mm) around, maybe a little more, a little less in places. When I had the flare years ago, my illeum tapered from about 1.5" (32mm) to about 1/4" (12mm) at it's end. When imisspopcorn said it can get small as a speghetti strand, she's totally correct. The inflammation thickened my ileum so there was only 1/4" diameter hole for the food to leave the small intestine. In other words, that's about the diameter of the average ink pen. That's a mighty small hole to try and push a Quarter Pounder and fries through.

Liquid diet for a couple days was the only thing I could tolerate. That worked, and I began slow into eating solids. That whole episode was a turning point in my diet and eating habits. If the ileum would have progressed to total obstruction, they would have to go in for surgery, and probably remove the blocked section of my intestine, or do exploratory to find whatever was causing a total blockage. A full obstruction is very bad news, and you can die from it, so surgery is usually the only option.

So if you have even a partial obstruction, you will be nauseated and vomit, and vomit, and maybe vomit some more. You will have terrible pain that says "Get to the ER NOW or I'm gonna die!" If it's a total obstruction, you will probably undergo emergency surgery. There's also a good chance you'll be constipated too.

I hope that's not where you're at right now.

 

[nogutsnoglory]

I'm doing much better Joe so thank God it appears it was just the crohns pain and not something much worse. So your obstruction went through eventually without surgery? I thought if you have an obstruction surgery is a must in most situations. How do they ease it through without removing it?

 

[Regular Joe]

Yes. They like to say "It resolved itself".

It wasn't "an obstruction". It was a "partial obstruction" which is a totally different animal than an "obstruction" which means a complete or total blockage or stricture. A complete obstruction almost always requires surgery - I think its called resection.

A partial obstruction can have many different causes, and (from what I found out today) it's handled conservatively in the ER. They have a protocol, and they use X-rays and CT scans to rule in or rule out certain causes. With me they couldn't find anything "mechanical" such as an organ or bone or something literally crushing the ileum to make it narrow, and they couldn't find any tumors either, except the one on my lung which quickly took the limelight away from the partial obstruction.

At first they had me on IV for a while, then they sent me home after the inital X-rays and CT. Apparently they determined it was a partial obstruction, then they kick in the conservative protocol. They had me drinking liquids for 48 hours, but I didn't want to take any chances so I went 72 hours on liquids. Then they told me to ease into easy to digest solid foods like soups, crackers (regular saltines), soft-cooked eggs (poached) - basically low residue stuff like BRAT. I was supposed to do that for a week, but I still had pain and stretched it out a little longer than a week. They told me to come right back to the ER if I start vomiting again or if I become constipated or see blood in my stools.

I was supposed to follow up with my primary care doctor. But the lung tumor got everyone's attention. The partial obstruction "resolved itself" probably because I was afriad to eat anything. So I slowly added solid food in and altered my diet and eating habits to low-fat, small meals, nothing hot or spicy. This began a lasting "healthy eating" lifestyle which I do today. My mistake was not following up because the flare symptoms were easing. And the "mass" on my lung scared the hell out of me, so that became the top issue. The big mistake here was not asking for, or insisting upon, a colonoscopy.

Well as it turned out, the lab reports indicated a partial obstruction with an unknown etiology, it described the thickening intestinal wall and it gave the sizes of the ileum and the openings. I still haven't got all the records back so I think there's a missing report or two. It took about 6-7 weeks feel better, but I knew whatever it was was getting better, especially after I started healthier eating and supplementing vitamins.

That was probably my first instance of a CD flare, although I didn't know it then. I agree with the GI (today) that my Crohn's is "mild" and the onset was also "mild". I've read that some GI doctors have Crohn's patients find relief with only OTC medicines - no prescriptions needed. It appears diet and conscious lifestyle eating changes seemed to bring about my own "spontaneous" remission without any residual symptoms.

My guess is that my ileum was "active" and the inflammation narrowed the intestine walls. Liquid diet and soft food diet over 2-3 weeks allowed the inflamation to tone down by resting my digestive track. However it happened, I know was painstakingly careful about what I ate.

Thanks for asking about this because it helped me remember things better.

 

[dustydshook]

When the illeum swells the pain is like 15 out of 10. Deffinate trip to the E.r.. Mine landed me a four day stay in the hospital. First three days only allowed to have iv fluids then stuff like chicken broth and hot jello I was on this diet for about a month. The pain was so bad injections of morphine didn't take it away. delaudid worked better for pain but dropped my blood pressure down to 60/42. I had no blood in the stools, no vomiting, and no D, which is normal for my flares usually just the horrendous pain.

 

[cheeky]

for me when i get obstruction. i feel really bloated, slight pain and then begin vomiting. then after vomiting the cramping pain becomes stronger. in these milder episodes, the pain/bloating decreases on it's own... within 2 days usually.

my GI recently warned me that if i get bloated or vomit, it's an obstruction and i need to go to emergency immediately.

i hadn't realized that before and this has happened to me a few times.

the worst time was in december when i first learned i had crohn's...i went to emerg...i was VERY blocked... had pain and bloating for a month (the gas and bloating was extremely painful and uncomfortable)...it hurt to walk, hurt to get in and out of bed, hurt to go up the stairs, hurt to get in and out of a car.... i was in constant pain on my right side. i also experienced episodes of severe cramping.... didn't have an appetite.. and i was constipated.... i also was extremely tired.


btw, the cramping episodes... the cramp pains fade in and out... like intervals of severe pain. a brief period of relief/lesser discomfort in between... then the severe pain returns.... makes me feel very nauseous too and feverish

 

[nogutsnoglory]

Joe thanks for sharing that, really great info that I hope I never need to know or use but in the event I am really happy to hear about partial obstruction and how to handle it without surgery.