Liquids after partial obstruction?

[Bob from Midwest]

Good Evening,

I was in the ER earlier this week for what I am certain was a partial obstruction. I had the pain in waves at that 8-9 level, threw up and felt better, threw up more and the pain went away not log after. This has happened 3 times in my life, once since diagnosis. I did liquids for three days and started mixing back in solids. Tonight, I was starting to feel the same way again, so I induced vomiting preemptively, and have decided that I am going back to liquids. How long should I do liquids before I should mix back in solids again? I think I tried to go back to regular food too soon in this instance. And also, thank you all. The people here are wonderful.

 

[Layla]

I could usually go back to solids straight after the partial obstruction was resolved. Carefully of course, low fibre and lots of liquids but once it was flowing again I would be fine on solids.
Are you on any medication? You should address the inflammation that's causing the obstruction if it's that. I was put on 60mg of Pred after the last (full) obstruction but even that didn't do much so a resection was needed as my stricture was due to scar tissue.

Oh, and throwing up was a good way of resolving a partial blockage, for me it was also the sign to go to hospital if that didn't do the trick.

 

[Bob from Midwest]

I am taking Pentasa, though my GI and I know that it doesn't work. Hope to start 6MP soon. I did go to the ER for this, but plain film X-Ray didn't show a blockage, so they basically gave me a lollipop and some hydro, which I haven't had to use yet.

 

[UnXmas]

The X-ray should have showed the blockage if there was one. Did they do an abdominal examination, check your blood pressure, do any blood tests, or anything else? When I had a blockage, the emergency doctor knew what it was from doing an abdominal examination even before it was confirmed by x-ray. But maybe it's different if the blockage is partial? How were your previous obstructions diagnosed?

If the ER doctors only ruled out a blockage without identifying any other problem, you need to keep in mind that whatever caused your pain may still be unresolved, even if it improved temporarily or if the symptoms resembled your previous obstructions (and if your previous obstructions were not confirmed either, it's even harder to use them as the basis for determining what to do about your current problem).

With going back to solid food, you really just have to go by how you feel, there's no set timing, especially as you don't know much about what was going on or where in the digestive system the problem was. Start with small amounts of safe food and build up. Don't stay on liquids alone for more than a few days; if the problem hasn't resolved by that point and you're still not tolerating food well, it might be worth consulting a doctor again.

Also, how did you induce vomiting? There are some ways that can be very dangerous, so make sure you're doing it in a safe way.

 

[Bob from Midwest]

My previous partial obstructions are what I consider myself to have had. I consider that to be accurate from the partial/full obstructions described by others on this board. The pain was in waves, gradually getting worse. I started hurting consistently at a 3-4 before lunch, was at a 6-7 pain level by the time I could go home, and vomited a massive amount for the first time unaided. Felt better for about 20 minutes after this, then it really notched up. After triage, at an 8-9 pain level and unable to fully stand up straight, I did it again unaided and quite thoroughly. I felt nearly normal after this and considered going home, but I knew that this would just be putting it off. So last evening I started to feel it coming on, and just went with the ole finger down the throat. Today I feel a bit better, but not terribly much after some oatmeal, low salt tortilla chips, and tons of water. Really scared of 6MP side effects but if my bloodwork comes back good this week, I will probably start right away. The most annoying EIM that I am dealing with right now is my vision going from super sharp to unfocused, causing me a bit of dizziness. My pupils are both the same size, so I'm fairly certain its just a cruddy EIM.

 

[UnXmas]

You really can't diagnose yourself. Plain X-rays show when there's a blockage. Did they do an abdominal examination or any other tests at the ER?

 

[Sarahwm]

It's tough, as you've been sick the 'obstruction' won't be there to xray- a barium and swallow or MRI would help diagnose it. In regards to a liquid diet (such as modulen or elemental feed) they recommended 2-3 weeks plus some medicine to reduce the inflammation, however if it's bad it might require surgery. I hope you get it sorted soon

 

[UnXmas]

It's tough, as you've been sick the 'obstruction' won't be there to xray- a barium and swallow or MRI would help diagnose it. In regards to a liquid diet (such as modulen or elemental feed) they recommended 2-3 weeks plus some medicine to reduce the inflammation, however if it's bad it might require surgery. I hope you get it sorted soon

A blockage will still show on an x-ray after you've vomited. The main sign on x-rays is, I think, that the bowel is dilated. I've had ileus and a small bowel blockage - in both cases they gave me an NG tube to drain my stomach, and having a completely empty stomach didn't affect what they found with the x-rays.

After the first x-ray I had when I had my last blockage, they did another after having me drink gastrografin, which shows up on the x-ray so they can see how far it gets through your digestive system.

After that I had a third x-ray, because my blood tests, blood pressure, etc. were becoming more abnormal. No gastrografin this time, just a plain x-ray, and this showed my bowel had now perforated.

Plain x-rays should show a blockage, and I was told the gastrografin test was the most efficient test for providing more information about where the blockage is. Doctors do take into account things like your pain level, your heartrate, your medical history as well, and will do tests if they think they're necessary.

I'm also not sure what you mean by this:

a liquid diet (such as modulen or elemental feed) they recommended 2-3 weeks plus some medicine to reduce the inflammation, however if it's bad it might require surgery.

What exactly would require medicine and possibly surgery? So little is known about what is causing Bob's symptoms, how can you speculate about something like surgery? Sorry if I'm missing something, it just sounds a bit strange to me.

Bob - my experience has been that blockages can be easily diagnosed, but my experiences have been with complete blockages; if you are getting partial ones, it may be different. I would just be wary of diagnosing yourself though, because if you're wrong, you may be missing something important. It might be that there's something wrong that needs more than a liquid diet.

If you do have a blockage or partial blockage, I would ask your doctor about it, even if it resolves without medical intervention. There are some things which can result in repeated blockages. Scar tissue, or adhesions, for example. Some can be detected by tests which do not need to be done while a blockage is occurring. I think you said this has only happened to you a few times, but if it does start happening more regularly, it may be a good idea to start investigating it with specialists who should know a lot more about your condition than emergency doctors.

 

[Sarahwm]

Thanks for the info unXmas, I was told differently so good to know, maybe they meant with a partial blockage (as I was told the x-ray only picked up hard matter and not the intestines), save me a lot of frustration in the future ��

 

[UnXmas]

Thanks for the info unXmas, I was told differently so good to know, maybe they meant with a partial blockage (as I was told the x-ray only picked up hard matter and not the intestines), save me a lot of frustration in the future ��

It is confusing isn't it! But I know how I was diagnosed, and I'm pretty sure I'm correct about vomiting not mattering with tests. Though I guess it could be possible that there are certain types of blockage that won't show if you've vomited.... You've made me start doubting myself now

So I checked Wikipedia: http://en.m.wikipedia.org/wiki/Bowel_obstruction

I know Wikipedia isn't entirely reliable, but most of it is and it seems quite a few tests can help diagnose a bowel obstruction.

 

[UnXmas]

Sorry for spamming your thread with replies , but I also wanted to mention this:

The most annoying EIM that I am dealing with right now is my vision going from super sharp to unfocused, causing me a bit of dizziness. My pupils are both the same size, so I'm fairly certain its just a cruddy EIM.

This sounds like something else that should be checked out, sight is so important. Have you had your eyes tested recently? I'm not that familiar with the vision problems that can be associated with Crohn's, but if I remember correctly, uvetis is the main one, and can respond to treatment. Blurred vision is also a very common medication side effect. You don't have to just put up with symptoms, there may be ways to treat them.

 

[Bob from Midwest]

Thank you to all who have replied. I am under care of a GI and have been since T.I. inflammation was discovered in August. So far my treatments have been Pentasa, which we've agreed has failed, and Prednisone for two months to get the inflammation down, now this week my tests should come back to show whether I can try 6MP or not. I have made some dietary changes and take many supplements, but I have good and bad days, many of which seem to hinge on my stress/anxiety level.
The first time this happened two years ago, it was the day before flying to Disneyworld, and I binged on hotdogs (4) and at least half of a large pizza for dinner. This last time it happened, I ate a brisket sandwich quickly followed by a full Chicken Sandwich meal and a large cookie in an airport after a very quick trip to the coast. The next morning, it all started up. Obviously unique travel anxiety and way-too-large dinners are contributing factors, so I've got that figured out. I see my GI again at the end of this month, and I am looking forward to it.

 

[Kip1]

UnXmas you are correct that even after vomiting a partial obstruction will show on xray.

On both the partial obstructions i have had they spotted it on xrays with the bowel loops etc.

It has then been naso gastric tube & bag until it clears.

Obviously its nil by mouth & fluid through a drip until it clears. Normally its been solids straight after the naso gastric tube is removed.

I sometimes can feel when one is coming on now so will switch to fluids for a few days until it passes but some just hit you out of the blue & its a trip to A&E.