Very Confused about possible obstruction

[aideen33]

Thursday I started with extreme vomiting. I literally couldnt keep anything down at all, water would come back up still cold. Called my gastro for advice, she proceeded to call in both promethazine and zofran for nausea and told me to alternate between the 2 every 4 hours, and go to a liquid diet for a couple of days but to be watching for increasing pain etc because she was concerned about a possible blockage.
Now, here is the confusing part. everything i have heard/read suggests that even a partial obstruction should be extreme pain, like worse than labor. I am having increased abdominal pain, but not to the level I would have expected. Its like bad cramps, but nothing that has me doubled over or heading for the ER kind of thing.
Whats confused me is that even on lomotil etc I have always had several BMs per day, without fail never less than 4-5. Last few days, maybe 1 per day if at all, very liquidy, but lots of cramping as if i needed to go.

(I will be calling gastro back monday morning regardless and will call emergency number or head to ER if it gets worse but I am very curious if anyone has any insight into this....)

 

[aideen33]

I should note that on the liquid diet of broth/jello/ensure and lots of nausea meds, I am keeping things down but given the amount of anti-nausea meds I dont chalk that up to improvement necessarily

 

[DJW]

It could be enough is getting past the obstructed area to keep you from extreme pain.

 

[aideen33]

Being that Im not in extreme pain yet and something must be getting through and its midday sunday.... unless it gets worse tonight I will hold off and call the office tomorrow when gastro is in office and see what she wants to do

 

[The Real MC]

I have found that indigestion can be confused with blockages. Indigestion is aggravated with Crohns. If you're having regular BM it probably is indigestion. If the pain eases off after about 18 hours, it could be indigestion or the blockage has cleared. If you're vomiting or dehydrated or not having BM it likely is a blockage. More than once I have gone to ER and the pain eased off while there.

I learned recently that too much starch can trigger the cramps. Indeed, my last meal was pasta, the large rigatoni.

If it clears and was indigestion then look into a bland diet for 7-10 days. The intestines are stressed and need to heal. You may feel residual cramps for a few days. Bland diet keeps the intestines from working so hard. The GI in the ER suggested the diet; it worked for me, felt a lot better. Talk to your GI or a dietician. And try to trace what food you ate that may have triggered the cramps. There is no single food trigger for every CD patient.

 

[aideen33]

GI called back today and thinks it may be a combination of a stomach bug (my daughter got sick after i did so thats possible) and/or us attempting once more to lower my steroid dosage. Currently the plan is take the prednisone back up to 20 mg /day where we know im responsive, and try a diet of bland and soft foods for this week. If the pain eases then we will stay with the dosages where they are while we wait for the Imuran to start doing its thing. But she says if Im still having the pain/cramping after this period of the soft diet, then she will bring me in and look into it further to see whats going on.. which basically means my GI just gave me the same advice yall did lol

 

[hawkeye]

I have found that indigestion can be confused with blockages. Indigestion is aggravated with Crohns. If you're having regular BM it probably is indigestion. If the pain eases off after about 18 hours, it could be indigestion or the blockage has cleared.

Good point on this. About 4 days after my large bowel resection I noticed indigestion, went home 2 days later and ended up back in the hospital with a small bowel obstruction. The indigestion (indigestion like I have never had before or since) kept up for a few days and was combined with pain (8/10) at the end (before I went back to the hospital) which felt like a hand squeezing my intestines / under the tip of the sternum.