Bleeding, gas, cramps. Help, please...

[xoxox]

Hi...A neighbor of mine, a lady in her mid-eighties whom I help and visit with regularly, had a colostomy done about 9 months ago after problems with burst diverticula. Everything was okay for awhile, and she was adjusting to things okay. But about 4 months ago, she started having blockages and would have to go to the emergency room to get relief. It would start with gas, and when the cramping got severe, she'd have to get to the hospital. Sometimes she'd pass a little diarrhea into the bag, other times she couldn't pass anything. She had 8 trips to the emergency room in the last 4 months! And now she's had some bleeding from the opening. (I think it's called a stoma? She said there are two holes and the blood was coming from the bottom one. There was also other discharge with it.) The doctor who had done her surgery was out of town, so she went to her family doctor, who sent her to her surgeon's partner, who told her to wait and see her surgeon. She finally got to see her surgeon the next day. He cleaned out the area and said if it happened again, he'd have to do surgery to find out what was wrong. He didn't tell her why it's happening even though she asked, just hurried on to his next patient. She's getting very discouraged. Has anyone here had a similar problem? She also told me that she used to have some discharge from her natural anal opening, but nothing comes through anymore. (Sorry to be so graphic here.)

She also wants to discontinue taking ducosate capsules (I think that's what they're called...they're some kind of a stool softener, and she's supposed to take two a day.) She thinks they may be the problem. I doubt it, but thought I'd ask whether any of you have had problems with stool softeners and whether some are better than others.

She's also worried about whether she's eating something that is causing all the gas and cramping. I hate to see her so frightened and sad. Can anyone here help?

[Kathy_from_England]

Hi and welcome to the board

I'm not at all sure what is happening here but I will offer a few thoughts.
The blockages could be due to adhesions, which are common after surgery, especially abdominal surgery.

This website contains useful information:
www.adhesions.org/

If it is adhesions, then what she eats will make little difference, although the ostomates golden rule is chew..chew...chew.

I know others will be able to offer advice about your other questions.

[Jason_D]

Hi There,

Unfortunately to me this sounds very much like a situation the surgeon is needed to sort things out.

I dont think there is a vast lot of advice I can help you with which Kathy hasnt already mentioned.

What I can offer you is a list of 50 or so common foods and their various effects on the different ostomies.

It is one of the pages on this website of mine. Heres the URL.
www.ostomy.fsnet.co.uk/foods.html

Basic dietary advice can also be found at
www.ostomy.fsnet.co.uk/diet.html

What I would say is that whilst she is going thru this period of very little stool being passed, if she ever starts to vomit tell her to go to the hospital ER.

If its a blockage and she starts to vomit it means the stool is starting to back up far enough to disrupte the balance in the stomach and make her sick. If left unchecked and she continued to vomit and not pass anything she could reach the horrible stage of vomiting stool which - having been in that situation myself - I know is very distressing and certainly a disgusting experience.

It sounds like she has a loop ileostomy to me - because of the two stomas. One is to let stool out. The other is for rectal mucous to be able to be flushed out etc.

If the surgeon has flushed out the second stoma lately then her mucous discharge will decrease/stop for a while until it builds up enough for it to start being passed again.

Stool Softeners: Yes, you are right in thinking some are better than others. From experience the liquid/powdered drink or syrup based ones are best.

Ive used three different laxatines in my stoma life and I'll quickly list them here for you.

1. Lactulouse. A sugar based syrup available from the pharmacist without prescription in the UK at least, im sure it will be the same in the States too. Its a gentle laxative. Ideal for daily use. 10 - 15ml's a day will help keep things greased, but not much more.

2. Movicol. My laxative of choice, and quite a feirce one. Its a powered sachet, which you add water to and drink. It's very flexable too because you can take up to 8 packs a day. 1 being for very light constipation. 8 being for faecal impaction. I have very hard stool most of the time cos of my illness. So I take 4 a day and it usually keeps things soft enough for me to pass.

3. Picolax. The infamous one. Nitro Glycerin for the bowels. Its mainly used in hospitals only to totally clear the bowels out for surgery or for tests like colonoscopy etc. Its a powdered drink like the movicol, but when you add it to cold water, the powder heats the water!!! It makes the tumbler warm! You drink it down. An hour later, you have another one. About ten mins after the second dose you will have the screaming heeby geebies for the rest of the day, and you basically need a good stock of magazines by the toilet cos you'll be there a long time.

Thats the three popular laxatives I know for ostomists. HOWEVER - **NONE** of these should be taken without medical advice saying it is ok to do so. Esp if you are an ileostomist, and at all times lots of water should be drunk to replace the lost fluids in the body.

In fact, if your friend is taking laxative tablets she should be drinking lots of water anyways, because you can take all the laxatives in the world but if you dont take water to help it along you are wasting your time.

If she is concerned about her lexative tablets she should consult with the doctor before stopping them, because if there is a blockage in the system or rather a constriction in the bowel, the stool needs to be soft to get past it. So please ask her to check with her surgeon or GP or Stoma nurse before doing so.

Im so sorry to hear shes so unhappy with things at the moment. Im also sorry I cannot offer you a magic cure for her problems, but only being a patient myself, and not being a doctor or having any med qualifications, the advice i can offer is limited.

Maybe other ppl on the board who read this will have some answers for you too.

Buh bye for now, and please do let us know how you both get on.

[glow=red,2,300]Jason_D
Webmaster and colostomist
http://www.ostomy.fsnet.co.uk[/glow]