There are several degrees of blockages which may include partial or complete, simple or complicated. Partial obstruction allows some liquid contents and gas to pass through the point of obstruction, whereas complete obstruction impedes passage of all bowel contents. Unlike simple obstruction, complicated obstruction indicates compromise of the circulation to a segment of bowel with resultant ischemia, infarction and possible perforation.
Symptoms of a complete blockage usually include discomfort with distention associated with nausea and vomiting. When you insert your catheter into your pouch, there is NO return of stool. Less severe symptoms can be indicative of a partial blockage.
Intervention is as follows:
- Try to relax.
- If there is output from your pouch and you are not nauseated or vomiting, take some sips of hot tea. Consume clear liquids until ALL your symptoms have passed.
- Take a warm tub bath or use a heating pad to relax your muscles.
- Turn, stretch, and gently massage the abdomen.
- If symptoms intensify and you begin to vomit and have no output for several hours, please go to your nearest emergency room and encourage them to contact your BCIR surgeon.
- If your catheter is not indwelling already, don't forget to take your catheter and any other supplies or information that you may need.
- When you are seen in the ER, one of the first anticipated tests should be a CT scan with contrast. We recommend that you get this test done with your catheter in place (plugged) so your health care team can better define your anatomy. Don't forget to alert the radiologist to the fact that you have a continent reservoir and they may need to wait longer than usual to do your scan, allowing time for the contrast to get to your pouch.
- After the x-ray, keep the catheter in place and ask staff to connect it to gravity drainage or intermittent suction. Remember: if you are using a Foley-type catheter, never let the hospital staff inflate the balloon on the end.
- People without a large colon tend to dehydrate easily. You should anticipate intravenous fluids being started. Pain medication will probably be administered. Sometimes this helps the muscles relax and the obstruction improve.
- With this conservative care, it is the hope that the obstruction will clear.
- In some cases, it does not, and placement of a nasogastric tube in your nose is necessary along with the BCIR catheter. If this does not resolve your issue, surgical intervention may be necessary.
We do hope to maintain a relationship with you over the long term so you are not alone. Stay in contact with your BCIR surgeon and staff.
Ernest Rehnke, M.D.