Bowel Obstructions

How to Know if You have one, and what to Do Before You Call the Doctor

Bowel obstructions, or blockages, can occur in colostomies but are far more common with ileostomies. An obstruction is usually caused by eating something fibrous or difficult to digest, such as popcorn, celery, or tough meats (see section on nutrition). Eating quickly, not chewing food well enough, or introducing solid foods after surgery can result in a bowel blockage. Blockages can be mild and resolve themselves, or they may be extremely painful and require hospitalization. It’s essential to know how to avoid them, identify them if you think you have one, and what to do should you experience a blockage. Be alert to the early signs and symptoms of bowel obstruction.

Signs and symptoms of an ostomy blockage

A partial blockage usually manifests through:

cramping pain in the abdomen (may be near the stoma or the entire belly),
watery output with a foul odour,
swelling of the abdomen and stoma,
followed by nausea and vomiting.

A complete blockage with an ileostomy is evident when:

there is a total absence of output for more than 4 hours,
severe cramping pain,
abdominal and stomal swelling,
and nausea and vomiting.

Symptoms may become severe or last for more than 24 hours. There are several things you should do if you suspect you have a bowel obstruction and several things you absolutely should not do.

If you suspect a blockage:

Do not eat solid foods

Take laxatives or pain killers

DO NOT EVER insert anything in the stoma

Stop eating and sip non-carbonated fluids, warm fluids or fluids containing electrolytes.

Check to see if your stoma is badly swollen; if so, remove the flange and replace it with one that has a larger opening.

Relax the abdominal muscles by soaking in a hot bath or use a heating pad on a low setting.

Most food blockages occur just below the stoma, so it may help to dislodge the blockage if you massage the abdomen around your stoma. You can also try a knee-to-chest position; or take a short walk if possible.

Call your doctor or NSWOC or go straight to emergency (but do not drive yourself) if vomiting and other severe symptoms are not going away.

Bring your ostomy supplies with you as they may not have your specific products.

Treating A Blockage

Treatment for a severe blockage may include an IV to replace the fluid, sodium, and potassium you have lost and the administration of pain medication. An X-ray or other diagnostic test may be conducted to determine the source of the obstruction

Preventing Blockages

Some common blockage-causing foods are popcorn, nuts, heavy fibre (such as in the stalks of celery), fruit skins, and poorly chewed meat. Strip tough fibre out of celery stalks and peel fruits such as apples. Cut meat into small pieces and chew your food correctly. Introduce fresh fruit and vegetables slowly to your system in small amounts.

Source: A Handbook for New Ostomy Patients. Used with permission from Debra Rooney, Vancouver Ostomy Chapter

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