Ostomy Uncovered: Blockages

Disclaimer: This information is based on my own research into this particular aspect of stoma care as well as some personal experience and should not be used as medical advice or a diagnostic tool. The suggestions given within are taken from sources laid out in the references header.  If you seek advice regarding the things you experience within your own disease, please contact your SCN  for medical advice.

If you are looking for the entire ‘Ostomy Uncovered‘ series, you can find them all here.

What is a ostomy blockage?

An ostomy blockage is when a stoma becomes blocked. This can happen for many reasons, some simple and easy to resolve, others abit more tricky. But, in any circumstances, ostomy blockages should not be taken lightly.

Symptoms are:

• Thin, clear liquid output with foul odour
• Cramping abdominal pain near the stoma
• Decrease in amount of or dark-colored urine
• Abdominal and stomal swelling.

What can cause them?

First of all, it’s important to note there are two types:

1. A physical obstruction called a mechanical obstruction, or
2. The loss of the normal muscle contractions in the intestine, called peristaltic waves, that help move material through the digestive tract. An obstruction due to the absence of peristalsis is called an non-mechanical obstruction.

Mechanical obstructions are more common, and happen largely in the small bowel. They can be caused by:

1. Adhesions – scar tissue formed from the healing process from previous surgeries
2. Undigested food getting stuck
3. Inflammation in the bowel with diseases such as IBD and divierticulitis
4. Strictures in the bowel due to scarring and inflammation.

Non-mechanical obstructions happen when there is an interruption of peristalsis in the bowel. If this is temporary it is called ileus, caused by abdominal or pelvis surgery, infections such as gastroenteritis or appendicitis, opiate pain medication or electrolyte imbalance. If the lack of peristalsis becomes chronic or long term it is then called pseudo-obstruction linked to muscle and nerve disorders like Parkinson’s and MS, Hirschsprung’s disease and nerve injuries.

If caught in time, a blockage can be resolved at home without medical intervention. But knowing the symptoms is key:

1. Bloating and / or a swollen abdomen
2. Abdominal cramping and / or pain
3. Nausea and / or vomiting
4. No output at all from your stoma
5. Or watery output from your stoma
6. A swollen stoma
7. Signs of dehydration – dry mouth, increased thirst, tiredness, decreased urine output, dizziness or a headache

Not all of these symptoms will occur, or happen at the same time. There is variation from person to person, and it best to identify which symptom would be most troubling to you.

How are they resolved?

To help resolve the blockage you can:

1. Stop eating solid food – putting more material in will not push the blockage through.
2. Increase your fluids – keeping yourself hydrated is key. As the bowel above the blockage uses peristalsis to help move it, it will push fluids through to loosen it. This results in unexpected liquid output and can dehydrate you quickly. Tea and Coke have been suggested, as the hot fluid can help break up the blockage, so can the carbonation from the Coke.
3. Remove your stoma bag – by wearing nothing over the stoma or reapplying a bag with a larger opening, you give it chance to ‘relax’ and hopefully release some pressure.
4. Abdominal massage – this can help get the blockage broken up and moving. Usually above or around the swelling.
5. Soaking in a hot bath or having a hot shower. The act of heat on the abdomen will hopefully help dissipate the blockage somewhat.
6.  Relax  – the pain caused by a blockage can make you tense up and this will not help aid peristalsis.

 How are they managed in hospital?

If those steps don’t work and the conditions persist for more than 2 hours or if you start vomiting; seek medication attention from either your SCN or your hospital A&E department. 

Once you have sought medical attention, your treatment will probably begin with intravenous therapy to replace the fluid, sodium, and potassium you have lost; and the administration of pain medication. An x-ray or other diagnostic test is conducted to determine the source of the obstruction. Depending on the patient and the suspected culprit for the obstruction, a NG tube may be inserted into the intestine via your nose to (1) decompress the built-up pressure, and/or (2) try to relieve the source of the blockage. Sometimes mechanical (dynamic) bowel obstructions caused by disease or scar tissue require surgery.

Why is being aware important?

Preventing blockage in the first place is good practice. You should chew food slowly and thoroughly, eat small amounts of new foods and limit high fibre foods.

Beware of foods that are known to cause blockage problems such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, Chinese vegetables such as bamboo shoots and water chestnuts, raisins, dried fruit, potato skins, apple skins, and orange rinds.

Blockages are more of a concern during the initial 6-8 weeks after surgery, when the bowel is swollen from surgical manipulation. While the swelling is temporary, it does narrow the lumen (inner opening of your bowel), particularly as the bowel comes through the many layers of your abdominal wall. A narrow opening may prevent certain foods from passing through your stoma easily. Small amounts of tough to digest foods are unlikely to cause problems, but larger volumes or poorly chewed/cooked fruits and vegetables may give you some difficulty. After those initial couple of months, you should be able to eat most foods without concern.

My Experience

In the almost two years since having my ostomy, I have had three admissions due to blockages that needed medical intervention to resolve. I have also had several partial blockages in that time too. Neither of these are preferable over the other; as they are painful, annoying and frustrating. However, they do need to be taken seriously. My admits have lasted from 48 hours in the shortest instance and up to 10 days in the longest instance. Each time, I vow to do better for the next time, and I try to not beat myself up too much; these things happen! Knowing the warning signs and being able to manage them at home is always preferable to an admission.

However, Eric from VeganOstomy had some great tips on being able to eat these but avoid a possible food-related blockage that have really stuck with me:

• “Take your time. Eating should be something to do mindfully, and when you rush, you aren’t giving your body the time to chew, digest and assimilate your meals properly.
• Chew!! Perhaps the most important thing you can do is to chew your food until it’s nearly liquid!  This is especially important because some food do not break down much in your stomach or gut.
• Go easy on your portion sizes! 
• Drink with your meals. Drinking before, during and after a meal will help to move things along and prevent your output from becoming too thick and slow.
• Experiment with new foods slowly. This is crucial in the first month or so after your surgery, and you should try small portions of new foods to see how it affects you before using it in a full meal.
• Keep a food diary.”

My previous blog posts on this topic can be found below:

Ostomy Blockages: How to Cope  – December 8th, 2017

Oh The Pain! Flapjackgate: My First Ostomy Blockage – November 15th, 2016

I ran a Twitter poll for this post, result can be found here.

Have you ever had a stoma blockage? What caused yours? How was it resolved? Have you ever been admitted for a blockage?

Do you have any questions or queries? Or just want to share your own experiences? Leave me a reply or tweet me @sapphire20 or find my blog page on Facebook!

Sources:

The Ileostomy Assosiation (IA): Bowel Obstructions

Pelican Healthcare:  Ileostomy Blockages

VeganOstomy: Dealing with Ostomy Blockages

SoBadAss: ‘What to do with a Stoma Blockage’

United Ostomy Assosiation of America (UOAA) : How to treat ileostomy blockage