Does anyone know anything about repeated bowel obstructions please?

[Peristalticdistress222]

Asking for a friend! 😄. Female. Aged seventy. Just been admitted to hospital for her third bowel obstruction in nine months.

This time it’s an obstruction of the small bowel caused by the adhesions dilating the bowel.

She has been careful with both diet and portion size and was following a low residue diet up to this point! So a bit of a mystery!

Thank you in advance for any advice or info!

Meant to say; otherwise healthy apart from some arthritis! And healthy weight, exercises witj good,healthy lifestyle.

Are they absolutely sure of the cause?
I'd be wanting investigations like CT/MRI and colonoscopy. Sounds a bit unusual; adhesions from previous surgery?

Sorry not a medic, just wild guessing but could she have ever had endometriosis (there's a silent type)or maybe diverticulitis, Crohn's or colitis,,? Hope she finds a cause.

You could try chat GPT maybe?

https://gutscharity.org.uk/advice-and-information/conditions/adhesions/
This is quite informative

That’s the issue in a nutshell Oneearringlost

First of all diverticulitis was floated as a cause.

But now they seem to thinks it’s adhesions from a hysterectomy years ago.

She was due to have an investigative colonoscopy several months back, following second obstruction, and she did prep, turned up at hospital and the consultant said it was too risky! (Potential perforated bowel apparently.) And here we are with third blockage which is also risky presumably?

But then a consultant she saw recently, said she did need colonoscopy and arranged it, but she has had third blockage before that could be carried out.

Thank you very much for suggestions and this link Cherryripe1 which I will forward to her.

Sounds like a CT colonography would be better for her than a colonoscopy.

I've had numerous severe bowel obstructions due to adhesions from previous surgery, they're a very common cause of obstruction.

Surgery is tricky - it can be quite a high risk operation - but if an obstruction isn't resolving with bowel rest then it's absolutely necessary because bowel obstruction can lead to fatality. Surgery of course can result in further adhesions so surgeons are generally cautious about embarking on surgery unless necessary.

I also follow a low fibre diet to avoid further obstruction, it's very restrictive and there can be a lot of mixed information about what foods you can eat, even from the NHS. Permissable foods do vary a bit across different NHS trusts.

Ultimately, in my experience, obstructions are unpredictable. I can only think of one which was possibly triggered by something I ate, although I've had none since starting a low fibre diet so I think there must be a cumulative affect from fibre.

She should have a ct scan with an obstruction, so they locate it and see the extent. I would assume she's had this?

Adhesions are sticky and web-like, have you ever stretched blue tac between your fingers? Like that.

Further to the above, given that she's had 3 in 9 months they do need to investigate the cause. No way I they'd do a colonoscopy on an obstructed bowel but if the obstruction passes then they could consider it. A barium xray can also show where the problem is, or even a MRI.

I'd be interested in what she ate in the 48 hours prior to obstruction, and if she isn't already she should request to be referred to a dietician specialising in gut problems like this.

They may decide that they have no choice but to operate to remove the effected bowel or divide the adhesions to prevent further obstructions, but as I said, there's risk involved.

Noted Realisation14
thank you

Thank you BeMoreAmanda for this information which is much appreciated. I am very sorry that you have suffered from this unpleasant condition too.

Your post sets my mind at ease to some extent in that it indicates that my friend’s diagnosis and treatment is complicated because the condition itself can be a bit random and complicated, and not because of any NHS incompetence (although the communication could be better).

My friend has been extremely compliant and strict sticking to the low fibre diet but as you say, there could be more clarity about it. She obviously has been unlucky with the adhesions.

I will ask about the CT, thank you.

Thanks again BeMoreAmanda

One of the issues has been that the hospital was so stretched after the first incidence - and still is stretched - that she didn’t have a proper follow up appointment for months and months and then eventually had one by Zoom.

Thanks I think she may have had some advice about diet; she has definitely been following a strict regime.

And yes, I understand better now that it’s one of those conditions where there’s risk involved if you leave it and risk involved if you operate as well. Not easy.

I hope that you are able to manage your condition without further occurrences. Thank you again for your very helpful advice 💐

I have Crohns and a stoma and DM has diverticulitis. We can’t eat things like
Potatoes with skins on
Apple skins
Nuts and popcorn
The white stringy bits on oranges

She definitely needs more investigation but she needs to keep pushing them for it as if you stay quiet they seem to forget about you…….

I’m sorry your friend is unwell. The management will depend if she has small or large bowel obstruction.

Recurrent episodes of small bowel obstruction due to adhesions can occur. Adhesions are the commonest cause of small bowel obstruction. Usually it resolves with conservative (non-operative) management. Operations lead to more adhesions and also are quite major surgery, so operations are avoided if possible. Sometimes though an operation is needed if no improvement occurs with the conservative treatment.

A hysterectomy decades ago often the cause of the adhesions.

Colonoscopy examines the inside of the large bowel so would not help in small bowel obstruction, and certainly not in an acute situation. It may be there were some other findings on the previous CT to suggest that was needed.

Or
Recurrent diverticulitis and then a narrowing due to scar tissue can cause large bowel obstruction so it may be she has that from your OP? In which case a colonoscopy would be needed at some point.

Low fibre diet can help small bowel obstruction but sometimes it occurs despite that which is frustrating.

Thank you, I anticipate more in the future but hopefully not for a long time!

Obstructions are excruciatingly painful so I hope she has adequate pain relief, and when things are moving again she should take it very slowly when she starts eating again. In my experience, some doctors/surgeons are keen to get you eating properly before you're ready, I'm sure partly to free the bed. They don't like to discharge you until you eat a meal but she should take the re- introduction of solids very slowly. My last obstruction occurred hot off the heals of one a couple of days before precisely because I didnt take this slowly enough, so don't let her be bullied by surgeons with god-complexes.

She'll definitely need to chase quite hard for appropriate follow up. Can you say which hospital she's in or where in the country?

Thanks Whatevershallidowithmylife

So sorry that you and your dm are living with these painful conditions.

I will definitely convey the message about being assertive! Not easy when you are feeling weak but sadly necessary nowadays.

Thank you again BeMoreAmanda

I will relay the very helpful advice about taking her time reintroducing food.

I’d prefer not to post any potentially identifying details here if that’s ok, but may I please pm you (very sparingly) if my friend has any specific questions later on?

I hope you don’t have another obstruction for a very, very long time! It must be awful for you having to constantly consider the possibility of it occurring!

Thank you very much for that detailed info
Whamfantastic which is very helpful.

She is in hospital bc of an obstruction to her small bowel atm. I believe diverticulitis has been considered and rejected as a diagnosis.

I’m glad to hear that adhesions can resolve most or some of the time with good management!

Also, that’s interesting about operations potentially causing more adhesions, which BemoreAmanda mentioned too.

May I ask please, are there any guidelines about how many blockages you have to have before the risk of operating is deemed worthwhile?

Thx again.

No, there are no guidelines it is very individual depending on previous surgery and general fitness for surgery.

Another thought - diverticulitis can cause small bowel obstruction due to the small bowel getting stuck onto the inflamed section of large bowel. However this is not common and adhesions much more likely.

You mention good management- even with perfect conservative treatment some patients will not settle and will need emergency surgery.

Hi,
I have been in hospital over 20 times now with bowel obstructions due to adhesions. In hospital the best things are a NG tube to decompress the bowel and good pain management. I follow a low residue diet however this mostly doesn't work for me as my adhesions are too thick.
If you have any specific questions I would be happy to answer

The surgeons will likely be very unwilling to operate as a new operation will inevitably cause new adhesion formation.

Surgery would depend on how well she is to survive an operation and if the episode of obstruction truly can't be resolved any other way.

Thanks again Whamfantastic that’s good to know! It’s very helpful to feel a bit more informed.

I think diverticulitis has been ruled out but she will be having follow up investigations this time hopefully.

Fingers crossed that my friend does not fall in to the latter category you mention!

Oh my goodness @ 20 times! 😲

So sorry to hear that hu22045;
that must be very difficult to handle.

That’s so kind of you to offer and it’s much appreciated. I will ask my friend if she has specific questions and will get back to you if I may. Thx again.