"Farting with confidence..." (My Experience of Digestive Disorders)

Member Name: nikkisly

Product:	My Experience of Digestive Disorders
Date:	27/12/01 (3093 review reads)
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As you read this opinion, I want you to keep one fact uppermost in your mind. That is that I am not a doctor and I have no medical qualifications - however, what I do have (unfortunately) is a lot of personal experience of the problem I am about to describe. That problem is adhesions.

Adhesions are fibrous bands of internal scar tissue that attach themselves to organs and tissue causing them to stick together. In other words, they form abnormal connections between two parts of the body. These 'pull' as you move, often causing severe and persistent pain. They can be caused by infections, by chemotherapy and radiotherapy and by medical conditions such as endometriosis, but are most commonly a side effect of abdominal surgery. In addition to causing severe pelvic pain, they can also cause infertility and bowel obstruction. I have had experience of all three, but am particularly addressing the latter in this opinion. Bowel obstruction can and does occur suddenly and unexpectedly, even many years after the surgery or event that originally caused the adhesions and it is very serious indeed - it can be life threatening and, in my experience, is certainly both frightening and unpleasant.

The most common symptoms of bowel obstruction can be any or all of the following:

 Tender, enlarged abdomen.
 Cramp-like abdominal pain.
 Nausea.
 Vomiting.
 Failure to pass wind and/or bowel movements.
 Dehydration
 Fever
 Diarrhoea followed by Constipation.

Obviously, there are other causes for bowel obstructions such as hernias or tumours but adhesions are the most common and are thus usually the first to be suspected. It is estimated that between 60 and 70% of all cases of small bowel obstruction involve adhesions. (Ellis, 1997) There are illnesses whose symptoms may mimic an intestinal blockage, such as Irritable Bowel Syndrome or even a simple
upset stomach. But, since adults have around 21 feet of small intestine between the stomach and the large bowel, all of which is crammed into a relatively small space, it's plain to see how easily this can become blocked, constricted or obstructed.

My own experience of bowel obstructions caused by adhesions is now such that I can usually recognise the onset. (It's certainly familiar enough for me to be on "Not again!" terms with the nurses at the two hospitals nearest to my home.) However, my first ever obstruction was a terrifying affair, not just for me, but also for those friends and family who witnessed the consequences. After a few days of feeling vaguely ill, I suddenly began vomiting with such violence that I burst a blood vessel. My doctor decided to admit me to hospital and my husband volunteered to drive me. However halfway there I collapsed, at which point he sought advice at a small cottage hospital en route. I rapidly became delusional, convinced that I was not in hospital but was actually in Tesco's, where people were trying to remove my clothes. I objected very strongly and eventually had to be sedated until an emergency ambulance could be called, after which I spent the entire journey telling the driver that he was going the wrong way and trying to get out of the ambulance in protest at his incompetent navigation.

However, that's very much in the past as the symptoms are now all too familiar. Initially, I feel very, very nauseous with no obvious cause. At this stage, I begin a well-rehearsed 'damage limitation programme' - more of that later - which, in itself, is often sufficient to clear the obstruction without medical intervention. If not, then within a couple of days, my abdomen becomes enlarged, bloated and painful and I get chronic diarrhoea, followed by constipation and ultimately vomiting. By now, I am a "medical emergency" and need to head for the nearest A&E unit as soon as
possible. A suspected bowel obstruction is almost always cause for admission into hospital since, if the blood flow to the affected part of the bowel is cut off (known as strangulation), the bowel wall begins to die. It is estimated that up to a third of bowel obstructions involve strangulation, hence the importance of early diagnosis and treatment.

Doctors in A&E usually listen to my abdomen through a stethoscope for the sounds made by a normal working bowel - the absence of these sounds, coupled with the symptoms listed above, necessitates admission. After admission, I am normally given an immediate X-Ray to try to pinpoint the site of the blockage. Once this has been done, the next step is to relieve the pressure within the bowel using a naso-gastric tube. This is a fine tube that is passed up the nose, down the throat and gradually swallowed until one end reaches the stomach, allowing its contents to be drained into a bag. (It's mildly uncomfortable but insertion is no big deal so you shouldn't be apprehensive - it sounds/looks at lot worse than it is.) Next comes an intravenous drip, inserted in the back of the hand, to prevent dehydration and replace fluids and electrolytes lost through vomiting and diarrhoea. Antibiotics are usually added to the drip. Then, we wait...

Once the bowel is completely empty, it will (hopefully!) disentangle itself from the constricting adhesions and allow the normal passage of food through the digestive system. Usually, by day three of my hospital stay, I am allowed a few sips of water (although what I really, really crave by then is a nice cup of tea!) If the water stays down, I progress to tea, soup and jelly, with a normal meal the following day. When the normal meal has successfully followed its normal course through the normal channels and emerged at the other end, I am pronounced cured and discharged.

Only once so far has this tried and tested procedure not worked. On that occasion, I
had to have keyhole surgery (five keyholes to be precise!) to relieve the obstruction. Doctors will take surgical steps to rectify the problem if necessary but usually only as a last resort - their dilemma is that more surgery causes more adhesions which, in turn, can cause more problems.

So, what can anyone learn from my experience? Well, firstly, anyone who has ever had any form of abdominal surgery should be aware of the symptoms of bowel obstruction, even if that surgery was in the long-distant past. Secondly, prevention is better than cure and there are some measures that you can take to help yourself. Again, I must stress that I am only imparting information that has been given to me personally - all cases are different and if you have any queries or concerns you should see your own doctor without delay.

As I understand this condition, some people seem more "prone" to the effects of adhesions than others are. There are now various barrier materials on trial to try and prevent adhesions forming after surgery, ranging from gold film, to Teflon to animal tissues. Since very few have been officially approved for human use to date, these are unlikely to prove a reliable preventative for some years to come. However, there are various methods that have proved effective, including special gels. Some doctors routinely flood the operation site with saline solution during surgery in the belief that it helps to prevent adhesions forming and most recommend gentle but regular exercise as soon as possible after your operation. Yoga, walking and very gentle stretching exercises are ideal, as is swimming.

Sufferers can - and should - adjust both their diet and eating habits. Some practitioners recommend a high fibre, low fat, low cholesterol diet, although any increase in fibre intake should be done gradually, since a sudden increase can precipitate an attack. Having said that, other doctors specifically recommend a diet that is low i
n fibre, so it really is a case of doing whatever suits you best. The watchwords for those who have a tendency to bowel obstruction are "little and often" - you should eat small, regular meals rather than big blowouts and should also try to avoid eating late at night. You should chew your food thoroughly and avoid talking while eating to prevent swallowing gulps of air.

At the first signs of the nausea heralding a possible obstruction, I stop eating completely and drink only clear fluids for at least 48 hours. (If absolutely necessary, I am allowed to eat chocolate in small quantities to raise my blood sugar levels and prevent fainting - however, this has to be ordinary chocolate - no nuts, biscuit or other niceties.) After two days, I can eat slightly more substantial liquid foods such as soup (without lumps) or jelly. If, at that stage, I still have any cause for concern, I am advised to go straight to A&E without further delay. This advice is also applicable to more common stomach upsets but, if your bowel movements do not return to normal after this starvation routine, you should see your doctor immediately.

It has been suggested that anyone facing any kind of surgery should take Vitamin E supplements, both before and afterwards, to promote quick healing and diminish the formation of adhesions. Following one operation, I participated in a clinical trial to try and establish whether or not this was effective - the official results were "inconclusive". Vitamin E seemed to help some patients but not others, hence the theory that some people are more susceptible than others are. Yet findings at the autopsies of traffic accident victims have shown that 67% of patients who had undergone any surgery had adhesions, with 81% of those who had had major surgery and 93% of patients who had undergone multiple surgeries being sufferers. (Weibel and Majno, 1973). Thus, the severity of the effects of adhesions on individuals seems to
be very much the (bad) luck of the draw.

The purpose of this opinion, then, is not to frighten you but to make you aware that this severe and potentially very dangerous condition exists. Again, I stress that I am not a doctor - but there are three things that you should draw from my experiences.

1. If you are scheduled to have a surgical procedure, especially one involving the abdomen, you should ask your doctor in advance about the possibility of adhesions.

2. You should be aware of the symptoms of bowel obstructions, particularly if you have had any type of abdominal surgery in the past. Don't worry about them unduly, but keep them in the back of your mind.

3. If you do suffer from any of the symptoms described above, or know anyone who does, you should not hesitate to get them checked out by a qualified doctor, especially if they are of sudden onset and cannot be simply explained by a virus, tummy bug or by eating something unusual.

Oh, and the title of the opinion is a quote from one of the consultants I see regularly as a result of having this condition. His opening remark, on seeing me cluttering up his hospital ward is invariably "Oh dear, here again! Never mind - we'll soon have you farting with confidence."

You have to laugh...

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