Obstruction as Flares

[tantris]

I am new to this forum, but not new to Crohn's. I was diagnosed about 10 years ago and have been on most of the conservative treatments (not the new ones, like Remicade). I am on the Breaking the Vicious Cycle Diet, which keeps me healthy almost every day except two a year (I am not here to promote the book, but I am a changed-my-life adherent).

Those two days, however, are pretty brutal. Generally, I get a bowel obstruction -- very painful cramps, audible bowel sounds, etc. I generally go on bowel rest for 24 hours, meaning no food, no liquids, nothing. My doctor also prescribed 50 mg of prednisone for when these occur. I generally take two tabs, spaced 6 hours apart. I'm not sure how well they help in the recovery, but knowing how potent of a drug it is, it probably helps. Sometimes, when I feel an obstruction coming, I take the prednisone and am pretty sure it prevents a full-bore obstruction and makes it very mild.

Sometimes, when I was in college, I would go to the health clinic to hook myself up to an IV, because the worse part about it is the dehydration.

Again, I am generally very healthy, except for these 2 or 3 days a year (probably 4 or 5 days really, but the steroids prevent half of the potential obstructions from being actual ones). Usually, it takes about a week to fully heal from one of the actual obstructions (I think that has to do with the "shock" to my system because the healing is usually gas-related and other things that may relate to messing with bowel pressure like an obstruction does).

Does anybody else have similar issues? My doctor believes it might have something to do with a stricture at the anastamosis where the surgeon reconnected my bowel after surgery. When my bowel inflames, the anastamosis is ripe for turning into an actual obstruction.

Any advice, similar issues, etc? Thanks.

 

[D Bergy]

Hello, and welcome to the forum.

I would watch for foods that may cause swelling of the restricted area. I found out only in the last couple of years that both Onions and Malt will swell my intestines. This feels identical to what my stricture felt like before it was removed. Had I not identified the food responsible, I would have thought the stricture was back.

I have no problems until I accidentally eat something that contains one of these foods. I also suspect there is one other thing, but I cannot identify it. Whatever it is, Egg Nog has it in it.

Maybe you have similar foods that cause your relatively rare flare ups?

Dan

 

[tantris]

I think you're right Dan. I've had two in the past two weeks (way more than average) and both followed a big dried mango binge, which are very fibrous. Also, over the years, I've noticed salads aggravate the anastamosis area (and I've noticed I don't digest it completely on the way out). I think it definitely is diet related. What I can't put my finger on, however, is why these things pop up so infrequently.

Also, every time I get a flare like that, does the "healing process" create strictures? Or are strictures from chronic inflammation in the area over a long period of time?

 

[D Bergy]

I wish I knew the answer to that question. Since it took me over forty years to develop a stricture, I would lean to the "constant irritation" theory.

There is a difference between fibrous foods irritating the area and direct swelling. At least I can tell the difference. When I swell, all food stops moving for over two hours. I feel nauseated, and uncomfortable. I also can sometimes feel food rubbing on the surgical area. This is just a momentary feeling, with no trouble afterwords. I am guessing it is simply scar tissue.

Salad is tough to digest. I try to eat them with other food as it seems to digest better that way.

I am guessing my stricture was caused by an h-pylori infection, but that is not provable by me or anyone else. I actually think there are a few bacteria involved with Crohn's.

These are the ones I think are involved. At least one strain of E-Coli, H-Pylori, Mycobacterium Tuberculosis (MAP), and Fungus(Candida Albicans).

The one I think is always present with Crohn's is Mycobacterium Tuberculosis. The E-Coli helps the MAP thrive and the H-Pylori is just a opportunistic co-infection that anyone can have. Candida Albicans is in everyone, but can cause additional problems when it gets out of control.

I think the terminal ilium problem I had before was the MAP bacteria. I do not believe it is there anymore, but I will have to gets the scope before I can say for sure.

Have you ever had that sensation that the food is not moving at all?


Dan

 

[kello82]

this is nothing other than my own thoughts and opinions but:
to me the healing process could lead to strictures. when you heal your body creates scar tissue and that tissue is rigid and inflexible. then, when your intestines normally stretch to accomodate food passing through, the scarred part cannot stretch and is a tighter than the surrounding area.
ive kind of always felt that this is what caused my rectal stricture. i had an abcess that wrapped around my colon and it wasnt until right after it healed that the stricture formed.
in my opinion, as the abcess healed around my colon, it turned into a ring of scar tissue and thats what was squeezing the rectum.

never had any of that confirmed by any doctor, its just how i see it in my mind and how the timeline pieces seem to fit.