I’ve been meaning to write a post about intestinal blockages, and since I had a small one before flying to NH for Christmas and on the way back, I figured it was good timing to write something.
There’s a communication tool at the hospital that I work at that says, “Have a questioning attitude.” Not only should this guide caregivers, but I believe that patients should always be questioning and looking for answers. As a teenager and younger adult, I was more passive in my care, but over time, I developed the confidence to always be questioning what is best for my health.
Ever since my permanent ileostomy surgery in June 2013, I’ve had trouble with abdominal blockages and obstructions. Right after my surgery, I was working finishing my occupational therapy degree, and that was my main focus. I was looking for quick fixes to get me back to fieldwork so that I could graduate. I spent that summer/fall in and out of the hospital with various complications, such as my intestine protracting out of me and retracting back out (seriously, 6” of intestine was hanging out of me at one point) and having bowel obstructions where I would wait until I was in excruciating pain and throwing up before I would call my parents to come to Boston from NH and take me to the hospital.
I figured at some point, my ostomy would start working properly. But Fall turned into Winter, and I had to have a stoma revision because of a blockage in January 2014. I moved from Boston to Nashville to Anchorage, and had my final revision in October 2014 with small blockages here and there. I was so focused on school and work, that I missed a key learning opportunity that could have saved me many trips to the emergency room and possibly surgeries. The following is what I should have paid more attention to and what I do now to avoid my abdominal blockages from turning into full on dangerous obstructions….
I’m going to back up to a story from Summer 2013. My surgeon, Dr. H fit me into his office schedule, so that I could avoid another trip to the emergency room. My mom drove in from New Hampshire to take me to the appointment. Dr. H. had a medical student that day, so he had the student go and gather some new supplies. Every time I had been to the emergency room or was hospitalized for blockages, the doctors decided that a nasogastric tube would decompress my abdomen and help clear the blockage. And every time, it failed to help. Dr. H had a different idea. He decided to use a catheter and large syringe to suck my poop out of me through my stoma. He inserted the catheter, and it worked. My poop was finally coming out! My abdomen started to return to a normal size. Dr. H inserted the catheter one last time and when he pulled back on the syringe, it backfired. My poop sprayed all over the room. Dr. H took the majority of the hit. I was dying to laugh, but thought it was inappropriate to laugh at an esteemed surgeon (Nowadays, I would definitely laugh at him.). The nurse wiped his glasses, and he just said, “I’ll be back in a minute.” My mom was lucky enough to be right on the other side of the curtain so she was spared. I think the student and ostomy nurse were spared too. Dr. H came back into the room in a new set of clothes, finished up irrigating, and I was on my way. He definitely scored bonus point with me that day, and I’ll always remember him for keeping his cool and helping me.
I came away from that office with a funny story, but it is my opinion that I missed a crucial opportunity that day. I should have asked for irrigation supplies to take home. It took me another two years to speak up for myself.
After moving to Anchorage and having my final ileostomy revision, I didn’t have another blockage until Summer 2015. I asked my friend Devin to take me to the emergency room in the middle of the night. I knew I had an abdominal blockage because of the excruciating abdominal pain. In the ER, it soon became apparent that nobody really knew what to do to help me. I tried explaining that NG tubes didn’t work for me, and luckily the head doctor was willing to listen to me. I knew that I was going to have to be a main player in determining how to decrease my blockage. Finally, it clicked. I thought about my poop spraying all over Dr. H, and knew that irrigating would be the solution. I asked for the supplies and showed the ED doctor and nurse what Dr. H had done back in 2013. It worked again. Slowly, my poop came out and I felt relief in my abdomen. They hospitalized me anyway for observation, but after a day, I was free to go. I made sure to ask for my own irrigation supplies, and that’s the last time I went to the emergency room for a blockage.
Now, I’ve definitely come close to having bad obstructions, and I don’t think that irrigation is magical cure, or that it will work for everyone, but it works for me.
I’ve irrigated in my own bathroom, in public restrooms, in outhouses, in the back of my car (including at an ice climbing festival), in my cook tent on a glacier, on trails in the freezing cold, on trails in the warmth, and just before boarding airplanes. I’ve irrigated in almost every setting (I came close to having to irrigate on an airplane on the way back to Anchorage from New Hampshire this Christmas), and I will say, unless I’m in my own home, every time feels fairly desperate, unsanitary, and like I’m going to get my shit everywhere (pro tip: the shower is the best place to irrigate). But I’ll deal with my own messiness every day if it means I can be out enjoying the adventure of life and not stuck in a hospital.
So for those who have problems with blockages, here’s my basic technique (make sure you talk to your doctor before trying it for yourself):
- Before trying to irrigate, I will first try consuming nothing or only liquids (depending on the severity), use heat on my abdomen, and try abdominal massage. If those techniques don’t work, and I can tell the blockage isn’t clearing, here’s what I do….
- Gather supplies
- syringe
- catheter
- disposal container (toilet, bag, CMC can, wherever I can most neatly dispose of my poop)
- something to protect clothes (towel, paper towel, other clothes, bandana, etc)
- water for rinsing items
- soap or hand sanitizer
- Insert the catheter into stoma.
- Attach the syringe
- Suck out poop
- If nothing comes out, I’ll also try a water flush to get things going
- Deposit poop into a secure container
- Rinse the syringe and catheter, and continue until I feel like enough has come out.
- After irrigating, I usually feel less bloated and have less pain, but it takes a while to have output again. I drink liquids and easily digestible foods for the rest of the day (In the backcountry I will continue eating, knowing that I will have to irrigate more so that I don’t lose my energy reserves)
Hopefully these tips help others. But again, talk to your doctor before trying this yourself.
I recently found this link for more information. It made me feel less like a macgyver, but I’m happy to see more information about irrigation out there.
