One afternoon I was feeling sick in my stomach .I realised that my ileostomy pouch (bag) had less content in it than when I had checked it the last couple of times . I also noticed that my stoma looked bigger than before. I was really feeling quite sick, with abdominal cramping. I could hear and feel my stomach. There was occasionally an overwhelming churning in my abdomen with occasional cramps, that were making we feel very sweaty and nauseated. As I went through the day, the pain was becoming worse as the day went on. That night the cramps got a lot more severe and I began to vomit. I was also noticing at this time that there was nothing coming into you pouch at all now. I was feeling quite dreadful and I was thinking "what could be wrong with me."

DO I HAVE A BOWEL OBSTRUCTION?

A bowel obstruction is usually referred to as a bowel (blockage), and is caused when there is something that is preventing stool from passing through the intestine in the normal way. If you were to use the following analogy of a garden hose to better understand just what it is that is taking place when you have a Bowel Obstruction:It would go like this:

If you were to stand on a garden hose, the water is unable to pass through it. The tap tries to keep pumping water through it, but it is unable to get past the shoe that you have put on the hose. Soon, as the pressure from the tap continues to pump the water, the portion of the hose above your shoe starts to expand and swell up with the backed up water. If you don't take your shoe away from the hose , the pressure inside the garden hose will cause it to break open and start leaking. You could say that it is the same policy with your own intestines.

A Bowel Obstruction can be caused by a (1) Physical Obstruction, this is the foot on the garden hose analogy), This is usually called a Dynamic or a Mechanical Obstruction,or (2) the loss of the normal muscle contractions in the intestines, which is called peristaltic waves< this helps move the material through the digestive tract.

When there is an absence of peristalsis, the name given to this type of obstruction is called an Adynamic Obstruction, Paralytic Ileus or just simply an Ileus.

An Ileus can be caused by a severe electrolyte inbalance, an infection in the bowel, or the manipulation of the intestine during surgery. The symptoms of this ileus are the same as the Mechanical Bowel Obstruction. However when you listen to the bowel sounds, normal bowel sounds cannot be heard and the abdomen sounds very quiet.

Despite the actual cause of a Mechanical (dynamic) blockage, the intestine above the level of the blockage overreacts and it constantly tries to push the abdominal contents (through very strong peristaltic waves) past the blockage. This then causes the cramps and pain to increase as the pressure in the intestine continues to build up. As a result of this happening, the intestine below the blockage can and will collapse on top of itself. When this happens, it brings about a reversal of the direction of the peristaltic waves as the bowel tries to empty its contents, and relieve some of the pressure. The contents of your intestine then moves up and comes out and this is called (Vomiting). It is interesting to note that a bowel obstruction can occur in the Large and Small Intestine - this means that people with ileostomies as well as those who have colostomies, can experience a Bowel Obstruction

Blockages in our Large Intestine usually occur gradually, while you usually find that when we have a blockage in the Small Intestine, it usually happens very fast, without a lot of warning. However, in both cases, it is important to note that mineral balances in our bodies, such as Sodium and Potassium, can become upset and the possibility of dehydration can occur rapidly. When you have a Bowel Obstruction, it can be one of two categories.

Partial Obstructions: A Partial Obstruction is when a small amount of fluid, or some other intestinal contents, can work their way around the the blockage. Therefore, you might end up having some discharge, or mucus-type output coming out of your stoma.

A Complete Obstruction indicates that nothing is getting past the blockage, this is represented by the absence of anything coming out of your stoma.

There are many causes of bowel obstruction. If you get any worrying symptoms, you should not ignore, because if you do have a bowel obstruction, they can very quickly turn nasty into an emergency situation. If you do not have any luck with your symptoms getting any better, you should let your doctor and also your stomal therapy nurse, know. If your pain becomes severe, and you are suffering from vomiting, dehydration and muscle cramps, and if this has lasted for more than eight hours, you should seek medical help.

SIGNS AND SYMPTOMS TO LOOK FOR

• Swollen Stoma
• Cramping and Abdominal Pain
• Nausea and Vomiting
• Distension of the Abdomen
• Minimal of No Stoma Output
• Dryness of the Mouth with a decrease in urine output
• Muscle Cramps

If you think that there is a chance that you may be in fact, suffering from a Bowel Obstruction, then there are several things that you should be aware of that you should Never Do. Once you have had a diagnosis made and it is confirmed that you have a Bowel Obstruction, your treatment will probably begin as follows:

• Put on Intravenous Therapy in order to replace the fluids that you have lost through vomiting, as well as the Sodium and Potassium lost.
• Given Pain Relief to alleviate the pain
• X-Rays will be taken of the abdomen to determine the source of your obstruction.

Sometimes, a tube has to be inserted via the nose to go into your intestine, which is used to (1) Decompress any built-up pressure

(2) Sometimes, it is used to try and relieve the source of the blockag

If you think that you may be suffering from a Bowel Obstruction, look for the early signs and symptoms which would be as follows:-

• Partial Blockage usually presents with the symptoms of abdominal pain, cramping, watery output that also has an unpleasant odour. There will also be abdominal distension and possibily swelling of the stoma. Nausea and vomiting will more than likely be present also.
• Complete Blockage is usually presented by having no output at all, as well as cramping and abdominal pain and swelling of the stoma. There will also be accompanying nausea and vomiting.

Whether it is one or the other, you should never delay in getting proper medical attention if suspect that you may have either a Partial or a Complete Bowel Obstruction.

WHAT YOU SHOULD DO IF YOU SUSPECT YOU HAVE A BOWEL OBSTRUCTION

DO'S

1. Stop eating solid foods
2. Increase fluid intake. If your stoma has become swollen, you should remove your pouch, and replace it with one with a large opening for your stoma
3. Soak in a warm bath to relax the abdominal muscles
4. massage your abdomen or try putting your knees up against your chest
5. Call your Doctor if the pain becomes very severe, or if you have symptoms of dehydration, regardless of whether or the symptoms have not been for eight hours.
6. Have someone drive you to your local General Practitioner or the Hospital

DONT'S

1. Take any laxatives or other medication without talking to your Doctor first.
2. If you are vomiting, or if you haven't passed anything through your bowel, do not eat or drink anything at all.
3. Inserting anything at all inside the stoma should never be done unless otherwise instructed to do so by a Doctor or Healthcare Professional.
4. Don't wait too long before your seek Medical intervention.

I can honestly say from my own personal experience of having had several Bowel Obstructions, that the sooner you identify with the symptoms you are suffering from, the better it is for you. When you start to get that first pain and the distension of your abdomen that usually accompanies it, you should act on it. To delay in seeking Medical advice could ending up costing you dearly. I hope that what I have put in this hub will not leave any room for doubt in people's minds in regard to :-

HOW TO KNOW IF YOU HAVE A BOWEL OBSTRUCTION, AND WHAT YOU SHOULD DO

                               BEFORE YOU CALL YOUR DOCTOR