Intestinal Blockage - When to go to ER?

[Anna]

Hi everyone,
Last week after eating quite a bit of yoghurt, I suddenly started having these unbelievable abdominal pains. Never felt anything like it before (and I've had some fairly serious abdominal pain before); it was all I could do to not pass out. No one else was home so I was going to call an ambulance, howeverafter about 20-30 mins the pain passed. Felt ok for the rest of the day, but still pretty tired from the ordeal.
I have heard about intestinal blockages, but I always thought they involved vomiting and didn't sort themselves out 20 mins later. I thought they were always a medical emergency. However, I told my GI about it today and he said it was a blockage.
Anyway my question is, if this does happen again, should I go to ER? How do you know whether you're actually dangerously blocked, or whether food is just having a hard time getting through and is causing pain?
I've obviously never been treated in hospital for a blockage before so I don't know what it involves, but I have read that it's horrendous. Probably want to avoid it at all costs, but also don't want to die!

 

[AndiGirl]

It could have been a mild blockage. Not all blockages cause vomiting. It think it depends on the location and severity. I had a mild blockage this past May. I was nauseated and in pain, but I didn't vomit. It was very painful and I spent a lot of time in the ER. I think it's always best to error on the side of caution.

 

[Anna]

Thanks AndiGirl, how long did the pain last for? Pain would probably have to last more than 20 mins for me to go to the hospital. Do they still make you wait for hours in ER or do they consider it not that serious?

 

[Absentminded]

So sorry you're going through this.
I had a quite serious blockage the year before last. I think now that I left it too long to get help. I went about a week without being able to keep anything down. Within 10 minutes of eating I'd get excruciating pains and then throw everything back up. By the time I was admitted I couldn't even keep liquids down.
They gave me IV steroids for a couple of days and then I started on Remicade.

The moral of the story is.....if you think that you have a problem, get it looked at sooner rather than later!

 

[AndiGirl]

My pain had started on the last day of school (I'm a teacher). The last day for teachers was the next day. I had suffered with waves of nausea and moderate cramping for about two days. I wanted to close up my classroom and be done with it, when I should have paced myself some. I wasn't taking care of myself. On my last day, it kind of hurt for me to bend and move in certain ways. My husband ran me to the ER that night when the nausea and pain stepped up even more. I think I waited in the lobby for about 20 minutes. They took me back and the nurses got me comfortable: IV solutions, pain killers, and anti-nausea meds. It was a crazy night in the ER. They had several accidents and an alcohol poisoning case. The doctor didn't see me or start the work ups right away, but the nurses made sure to keep me as comfortable as possible during my wait. I was placed on Predinose and then Entocort. I hope this helps some, Anna. Please don't wait if you are in pain. I'm glad I went when I did. I could have tried to wait it out and possibly ended up with an even worse blockage.

 

[DustyKat]

Hey Anna,

I don't have CD, my children do and I reckon you will you know when it is time to go. Roo had vomiting with her perforation and severe pain. My rule of thumb with the kids is if they are complaining of severe pain and it doesn't respond to the OTC medication at home then I head to the hospital, so I would say persistent, severe pain that lasts longer than about 45mins. I don't take into account any other symptoms 'cause to me if the pain alone is that bad then they at least should get some relief from that.

We have never had to wait longer than the time it takes to do the paper work but I don't know if that is because they adolescents and I am with them.

HTH,
Dusty

 

[partlycloudy]

I've had a couple of blockages in the past that passed on their own. This was the year before I was diagnosed, but looking back it's obvious what was going on.

Each time I'd eaten a lot of fibery food. The pain and vomiting were horrible and lasted about 4 hours. That's when I'd break down and go to the ER. CT scans and x-rays were done and showed no blockage.

My ER experiences depended on what time I went. I've literally sat in the waiting room for hours during a busy time but gotten right back in at 3 a.m.

My advice is to have your blockages in the middle of a week night.

Both my GI and an ER doc gave me some guidelines if it happens again. Take my Zofran/narcotics. If in a couple of hours I'm still in extreme pain take another dose of the narcotics. Give that about an hour and if I'm still having problems get to the ER as it's probably not going to resolve itself.

 

[katiesue1506]

I've never had a blockage, but I have heard from others if its just a mild blockage, sometimes drinking hot/warm water can really help pass it.

 

[Anna]

Thanks for all the advice.
I almost wish I hadn't learnt about this blockage thing, because now I'm getting a bit paranoid.
This morning my partner told me I have had really foul breath for the past 2 days (funny seeing as I don't eat dairy) which is pretty rare for me. Didn't really improve after brushing my teeth or taking breath mints. Also, my abdominal distention on the right side of my abdomen is getting worse. When I put my hand on it I can feel it sort of bubbling, and it makes quite a bit of noise. That said, I'm not in much pain and I have been having normal BMs and no vomiting.
Interesting to see where this goes. I've got an appointment with a GP tomorrow so maybe I will ask her what she thinks then.

 

[AndiGirl]

Do you have acid reflux, Anna? I have it pretty bad and it can leave a bad taste in my mouth. I only have that taste when my reflux acts up.

 

[Anna]

I don't know for sure but I'm beginning to think I do have acid reflux. I have been having weird chest pains for months, and have always argued with doctors who suggested it was reflux because I didn't have any other reflux symptoms apart from the pain. That said, however, yesterday I took some Pariet and the chest pain went away. Go figure.

 

[dreamintwilight]

When I had my partial blockage I would have described the noises in my stomach as gurgling and bubbly. Every once in a while the sound of rushing liquid would go through them. It was the most intense pain I've ever experienced. I was not passing any gas either, which is another sign of blockage. I've also heard that while some people constipate when they blocked (duh), there's also the opposite reaction that can occur with the body overcompensating for the blockage and liquidy stool will try to force its way out.

I am confused though. If your doctor said you had a blockage, why ddi he not tell you to go to the ER ASAP?? If it is indeed a blockage, that can cause problems with bowel rupture--obviously not something that sounds pleasant and can actually lead to sepsis.

I don't know how it works where you are, but I've been told if you go into the ER and say you have Crohn's and think you may have a blockage, they should NOT make you wait. When I went in it was first thing in the morning and luckily enough I was one of the only people in there, so I was taken right away. They put me in an ER room and made me get a CT scan immediately, which showed the blockage.

Have you had any imaging done lately? If it's not exactly a blockage, it could be an abscess, or really severe inflammation that needs stronger meds. I am not trying to scare you, but all sorts of things can happen when inflammation isn't controlled properly--even fistulas, which can turn into abscesses.

Let us know what your GP says! When do you see your GI again?

 

[partlycloudy]

.I don't know how it works where you are, but I've been told if you go into the ER and say you have Crohn's and think you may have a blockage, they should NOT make you wait.

I'm going to sound angry but it's directed at our ER, not you.

You're right, they shouldn't, but that's not been my experience at all. While I never actually said the word "blockage" I did give them my symptoms and said I had Crohn's and I still sat in the waiting room for hours (before I was dx'd I just gave my symptoms, which were attributed to a intestinal bug since CTs showed no blockage).

In fact, last time I was there for so long that I began to feel better and left, however, it was just a "mild" attack (severe nausea but no vomiting, typical painful cramping).

You can bet the next time I'm in...if there is a next time....I'll be bellowing the phrase "Crohn's blockage" at the top of my lungs.

I live in a large city in the Midwest, but my understanding is our hospital has a shortage of beds so if you're in the ER with something that's going to require a bed/room you're just sh&t out of luck if things are busy.

Sorry for the cursing but it's a huge pet peeve of mine as I've sat by so many times while people check in to get stitches out (at the ER??!!) while I'm sitting there with a legitimate need.

 

[dreamintwilight]

Partlycloudy - I hear you. Don't get me wrong...the first time I went to the hospital (before Dx) I had a KNOWN abscess in my abdomen. I even said that when we checked in and we waited for about 4 hours before getting a bed. I can't say every hospital would immediately take you in (unfortunately), but I have heard that actually saying the words "blockage," increases the likelihood of being at the front of the line because a blockage is an emergency situation. Though, I would imagine you should probably have some symptoms that corroborate that, otherwise it may be obvious you are not in an emergency type situation, haha.

And I do admit I could have been really lucky going in at the time that I did when I was actually experiencing a blockage. It was an early Monday morning, so I guess there weren't many people yet.

Yeah...point being...if you have any inclination you may have a blockage, it can't hurt to explicitly say that when checking yourself into the ER.

 

[partlycloudy]

Wow, a known abscess. Uh, don't get me started.

The times I've had the most luck getting in quickly were also in the wee morning hours of a weekday.

Rule to live by: Schedule your ER visits for Mon-Thurs from 1 a.m. to 6 a.m. unless it is your preference to die a slow death, writhing in pain on the nasty waiting room floor.

 

[Anna]

Hi Dreamintwilight. Well I had the terrible "blockage-esque" pains last wednesday, and they passed after about 20-30 mins. I was ok after that. I saw my gastro on Tuesday this week and I asked him about what could have caused that pain. He just said it would have been a blockage and that that's to be expected with Crohn's. I remember asking him once when I should go to the hospital and he said "you'll know - it'll be the worst you've ever felt in your life." What I had must have been a blockage that sorted itself out....

I saw my GP today - it was fairly disappointing. She is a private GP so it is costing me AU$130 per session, and all she did was review my blood test results (which were normal) and tell me to go and get a stool sample done (to check for parasites - I've had about 6 of these done and nothing ever grows) and that she was probably going to refer me on to another doctor who had more experience with bowels. This is so frustrating.

I'd be pretty impressed if my ER ever admitted me without making me wait for at least 4 hours, unless I was on my deathbed. The last time I was in ER they made me wait 7 hours, then admitted me, then made me wait two days til they decided I probably needed a colonoscopy. They're a model of efficiency this hospital. HA!

 

[ArmyWife]

Hi Anna!
I am new to the forum but in the 2 years I've been diagnosed with Crohn's all I've experienced is what you are describing. I was admitted to the hospital 3 times in the past 6 months with partial obstructions. I am usually vomiting pretty violently with mine, but not always. I will usually try to stick it out for a few hours (as long as I am still passing gas- if not it could be a complete obstruction which can be VERY serious) before going to the emergency room as mine frequently resolve on their own as well. But it really is the worst pain I've ever experienced, so I really feel for ya.

I just had bowel resection in January and I can't even believe how good I feel. It has helped me tremedously. I really hope you get better soon because I know you must be suffering!

 

[partlycloudy]

I'd be pretty impressed if my ER ever admitted me without making me wait for at least 4 hours, unless I was on my deathbed. The last time I was in ER they made me wait 7 hours, then admitted me, then made me wait two days til they decided I probably needed a colonoscopy. They're a model of efficiency this hospital. HA!

I read some stuff online lamenting the state of waiting times at ERs here in the States. The gist of these articles was basically how awful and horrible that waiting times are sometimes an HOUR long.

An hour? An HOUR? Excuse me while I fall on the floor laughing.

Seriously, I'm sorry you got so little help at your GPs and hopefully the doc she referred you to can help.

 

[dreamintwilight]

I agree with PartlyCloudy...I hope the new doc has more useful insight!

 

[Anna]

Thanks everyone. I've just about had my fill of doctors. At the moment they're just wasting my money!
My gastro tripled my dosage of Prednisolone on Tuesday and since then I've started feeling a bit better. I suppose being on a higher dose of steroids would make a blockage far less likely as the inflammation would be going down.
Hopefully this all gets under control soon!

 

[partlycloudy]

I'm glad you're feeling better. My understanding is what you said about steroids/blockage/inflammation is correct. My doc pointed out to me that when my intestines are inflamed they're swollen thereby making the passage smaller so they can get blocked easier.

 

[dreamintwilight]

Yes, that should hopefully be the case. I know when I had my blockage they put me back on Entocort, which helped immediately. But then they upped my other medications (because I had already been on Humira) because they obviously weren't strong enough to keep the inflammation down.

I hope this does the trick for you.