I Am In The Hospital
If you are hospitalized with a bowel obstruction, you are not alone. According to a recent study from the Journal of the American Medical Association (JAMA Surgery), bowel repair is the 2nd most common emergency surgery in the USA. You have likely been told, “Let’s wait and hope it clears on its own. If not, we’ll have to perform a surgical repair.”
Even your doctor will tell you, “Surgery is not the ideal answer.” Physicians perform surgery as a last resort for several reasons.
- Because the body’s response to surgery is to create scar tissue, new adhesions form after most surgeries. The more surgeries you have, the more adhesions tend to form.
- Bowel surgery is complex; JAMA reports that bowel repair has the highest complication rate of any emergency surgery (47%). Hospital readmissions occur within 30 days of surgical repair in nearly one in every five patients. Reasons include:
- If a drop of bowel contents escapes during surgery and remains in the body before the doctor ‘closes’ your surgical site. Set free in the warm, moist, dark environment between your bowel loops, the bacteria can grow and spread infection throughout your abdomen in a condition called peritonitis. When this occurs, the surgeon may be forced to perform another surgery, generally an open one, to help treat the infected area. A drainage tube may be inserted to drain fluid build-up from the surgical area.
- When adhesions are extensive, it can be difficult for the surgeon to distinguish between organs and adhesions in the abdomen’s tightly packed internal anatomy. Thus, doctors can mistakenly cut through the wall of a nearby organ (an inadvertent enterotomy), damaging one organ while trying to repair the bowel.
Adhesion formation after surgery is regarded by most physicians as the primary cause of small bowel obstruction (SBO). The surgery that saves your life can become the cause of another obstruction months or years later. Some people find themselves in a lifetime cycle of surgery-adhesion-obstruction – with no end in sight.
Why Do I Keep Obstructing?
Internal scars called adhesions are the main cause of SBO. While they initially form from tissue damage earlier in life (e.g., injury, surgery, infection, radiation therapy), the bonds they create can pull on organs, creating a state of ongoing inflammation as time passes. The body has no way to decrease adhesions on its own; they remain the same or grow throughout life. Unless the adhesions are cleared by surgery or Clear Passage®, they will continue to pull on structures, causing more inflammation – and more adhesions. Surgery is widely regarded as the primary cause of bowel obstruction.
How To Stop An Obstruction
Here we present a few non-surgical approaches that some of our patients found useful to relieve an obstruction and avoid surgery. Keep in mind that we do not know you, have never evaluated you, and do not know your history or present condition. TRY THESE ONLY WITH YOUR DOCTOR’S PERMISSION.
These methods will not decrease the adhesions that are the cause of most obstructions. Only surgery or Clear Passage® therapy has been shown to decrease adhesions. The intent of these procedures is to decrease spasm and temporarily change the biomechanics or anatomy of the bowel enough to allow food to pass, so you can avoid surgery for a present obstruction.
COMPRESSION TO DECREASE SPASM:
Muscles within the intestinal walls are designed to push food along in a process called peristalsis. During an obstruction, those and surrounding muscles can tighten and go into spasm, preventing food from passing by squeezing the bowel shut. A method we developed can generally decrease or eliminate abdominal spasm and allow food to pass through the bowel, temporarily ending the obstruction. The steps are shown here; go slowly and try to relax while doing them:
- Lie on your back.
- Place a pillow at each side of your waist, so you can rest your elbows on it.
- Slowly allow the full surface of your hands and fingers to sink into the front of your abdomen, one on each side, like they are sinking into moist clay (30 seconds).
- Now bring your two hands toward each other, ‘scooping’ the abdominal contents within them. Bringing LEFT toward RIGHT tends to decrease the pressure, allowing the muscles to ‘unwind’ under your hands (two to five minutes).
- While doing this, bring your knees up, so you are simultaneously relieving pressure in a TOP to BOTTOM plane. If you do this in a chair, you can bend your torso towards the floor as a final step, further decreasing pressure in a TOP to BOTTOM fashion.
- Repeat as often as you like.
- When you get good at this, you can often feel what areas are tight; they will feel hard. Allow your hands to sink in on either side of these areas and slowly compress them in, towards each other.
ALTERNATE HEAT AND ICE
Ask the nurse to bring you a moist heat pack now, then an ice pack a half-hour later. Place the heat pack on your abdomen or pelvis where you are experiencing pain. Leave it there for 20-30 minutes.
After that 20-30 minute period, remove the heat pack and allow your body to relax for 5-10 minutes.
Now, place an ice pack on your abdomen or pelvis where you are obstructing. If it feels too cold, put it in a pillowcase first. Leave it on your body for 20-30 minutes.
Wait 5-10 minutes, then repeat the cycle, or go directly into COMPRESSION again.
SOME MEDICATIONS MAY HELP
Ask your doctor if s/he feel comfortable prescribing LEVSIN SL. We often find this effective for decreasing intestinal spasm. SL stands for “sub-lingual,” meaning “under the tongue,” so it gets into your body quickly. It may be useful to have in your pocket and available whenever your gut is in spasm. We have not witnessed any negative side effects, but ask your MD. Another medication used to decrease intestinal spasm is DONNATAL. Again, consult your MD; either medication requires a physician’s prescription.
Note: Many patients report good results from having a supply of LEVSIN SL nearby at all times to decrease intestinal spasm that can occur from time to time for people with a history of SBO. This prescription is only available via a physician’s prescription in most places. An over-the-counter medication patients find useful is Chewable Gas-X. Many report good results chewing several of these tablets when boarding a flight to help prevent the change in air pressure at altitude from causing discomfort or obstruction symptoms.
REQUEST A JUVENILE N-G TUBE
Your doctor may want to insert a nasogastric (NG) tube through your nose, down your esophagus, and into your stomach to relieve pressure and pump out stomach fluids. While the tube can be quite uncomfortable and used for days on end, your doctor may agree to try a “Juvenile N-G Tube.” The smaller diameter is more comfortable and may do the job for you just as well.
ENEMA
Ask if an enema may help. While it’s not a pleasant experience, nothing about having a bowel obstruction is pleasant – with the possible exception of IV pain medications. In rare cases, patients have told us their obstruction cleared after having an enema.
What To Ask My Doctor
PRE-SURGERY
What signs will tell you I can go home before surgery?
How long can we wait before you decide you need to do surgery?
Can you prescribe a medication like LEVSIN SL to help the gut relax?
Is it OK with you if I or my partner does some gentle massage on my gut?
IF I NEED SURGERY
Are adhesions the cause of my obstruction?
How many bowel repair surgeries have you done?
Please describe the procedure you envision for me.
What are the chances that post-surgical adhesions will form?
How long will I have to stay in the hospital after the surgery?
What are the chances I will experience another obstruction in the future?
Would you do a laparotomy (open surgery) or a (less invasive) laparoscopy?
Have you ever had an inadvertent enterotomy (mistakenly cut into another organ)?
After you cut the bowel, how do you keep bowel contents from escaping into the abdomen?