Foreword: Bowel obstructions do not afflict everyone after bowel surgery. Don’t be struck in fear that these symptoms might afflict you. But rarely do people raise surgical complications, which doesn't help those that face these issues.
The Problems with Diagnosis
Bowels can be tricksy creatures.
Sources of bowel pain are often misunderstood; issues go long undiagnosed.
For myself after cancer, I experienced horrible abdominal pains - worse than I'd even encountered before.
I went to A&E, called my hospital team… my GP. But the CTs proved I was all clear; the colonoscopies found no obvious cause of pain. While this was amazing news, it got me no nearer to understanding what was happening to my body. It took some months for my consultant to suggest the cause of my woe. I suspect he didn’t want to give it a name, as he knew there was little he could do.
My bowel was getting blocked – I was experiencing bowel obstructions.
Now to the uninitiated, this might sound like a little constipation. A friend who recently had a baby, stated, ‘Oh yes, I had that.’ I found it hard to stifle the tremors of frustration, but managed to say calmly, ‘No, no you did not.’
Once obstructions were suggested, I tried to find information on why I seem so cursed with them. I do not have a permanent stoma, which seems to be a strong link. Alas, there is just no research on the topic, and worse, no guidance on how to deal with them.
I’m just clutching at straws.
So what are Bowel Obstructions?
After surgery, you will form scar tissue as your body heals. Adhesions are bands of internal scar tissue, we all have them after operations, and they only cause problems if they interfere with movement of other organs. In my case, my hospital team believe that these adhesions obstruct my bowel, blocking it so that food and liquid cannot pass.
And so pain follows.
This isn't your usual stomach gripe. In my worst moments, I imagine my intestines haunted by some Mephistophelean bowel demon, determined to ruin my life.
Obstructions might feel different from person to person, but this is what they are like for me:
It starts with a strange unease in my stomach, as if I am being partly stretched, partly pressed upon. It comes from just above the belly button. This strange unease I liken to a change in pressure just before the storm. It is my barometer warning to batten down the hatches and find somewhere safe to ride it out.
Because soon, the stretching, pressing feeling grows more and more intense. First there’s cramps and then spasms. Convulsions spread across the abdomen. Pain grows, stretching across the front and then round into my back.
You start to sweat, your face grows red, and the pain reaches to your ribs. Your sight can darken, your legs weaken, breathing becomes difficult. Your whole body is so focused on relieving whatever is blocking the intestines.
By this stage, you need to be sick and usually this helps, though sometimes the awful pain can rack your body for hours.
It can take days to recover.
I get obstructions often and because they’re unpredictable, it plays huge havoc with my life. Gone are the days of being spontaneous and carefree. I also cannot work in any normal way. It’s taken me a few years to get my head around all this.
If you are in extreme pain, your abdomen is distended, you can't poo or fart, and you're vomiting a lot, you may have a bowel obstruction that will not resolve on its own - you need to go to A&E. The emergency team can then prescribe morphine and support you to relieve the obstruction.
The coping strategies below are for occasions when the obstructions don't reach the 'unresolvable' stage.
Always discuss with your medical team when it's appropriate to go to A&E.
I found that no painkillers touched the pain – right up to tramadol and oromorph, with the exception of injected morphine - a trip to A&E then!
After quite some time, I found a breakthrough.
If I take my clothes off and lie flat with pressure on my stomach, this can relieve whatever is going on.
I’m not sure how or why this helps. Perhaps it stretches out the intestines, or relaxes more muscles than when you’re standing or sitting.
It also helps if, while lying on your front, you rest on your elbows so that the pressure is exerted most just below the ribcage.
Sometimes if it’s really bad, resting on my stomach doesn’t work and makes the pain much worse. In these cases, I stretch out onto my side and I just have to wait for it to pass.
A friend has found that by lying on her front every night before bed, it has reduced the obstructions that she gets – so perhaps worth a try too!
While lying on my front, I’ve found that having someone put their hands around my waist and giving a light massage also helps to relieve the pain and spasms. It needs to be very light. The massage makes you feel like you’re being squeezed like a tube of toothpaste.
Obstructions prevent me from going too far from home, unless I know there’s a clean disabled toilet nearby. One of the awesome new Changing Places toilets is even better, so you can use the folding bed on which to stretch.
If no bed, I take a plastic poncho along and spread it out on the floor, using it to lay down on my front. I wait for the pain to pass and then make my way home. Of course, lying amongst the urine-splattered floor is never very pleasant!
I can’t wear tights anymore. If I’m going out to dinner, it’s best to wear a loose dress.
If I start to feel a bit squeezed, I undo my bra.
Once I know I’m home for the evening, the PJs go on straight away – the loosest of all clothing! Sexy times.
Sometimes bowel relaxants help, sometimes they don’t. My GP prescribes me Buscopan, but there are others like Colofac.
I long to buy a campervan to allow me to be carefree again. It’ll offer somewhere to retire to if I become ill. It’s an expensive investment, though would save money on hotel rooms for the times you can’t reach home!
These are the strategies of our founder, Laura. Everyone is different, so please tell us what worked for you!
And these are all ideas for those without a stoma, if you have stoma-related tips, we’d love to hear about those too.
Finally, to repeat, these are all coping strategies for obstructions that can resolve themselves - you may not find any of this useful and thus A&E is your salvation.