constipation or obstruction info please....

Hello all,

I've been lurking in the background reading questions and answers. You all have helped me so very much. Thank you all for sharing. It helps to know when to take a deep breath or when to run to the doctor.

I was diagnosed in 2015. They made it retro to 2014. I have severe agressive fistulizing Crohns. I was prescribed Remicade and methotrexate. (after 3 gi's, multiple hospital stays.....etc) It's been working pretty good. I still go to the bathroom 6-8 times a day plus fistula leakage.

Last infusion was 2 weeks ago. Bathroom visits went to once a day. One week ago I started feeling "full". Six days ago....no bathroom breaks needed. Then I started puking occasionally. Called doctor. Liquids only and miralax. Fri., Sat. And Sunday...only miralax made me sicker. Monday Dr. Said to take a break and start milk of mag today.

When I go..sorry this is graphic......hard pieces surrounded by liquid. I can feel stuff sloshing around....but I don't feel like I have to go. When I bear down...
Nothing happens. Occasionally I'll get liquid or a little piece..

Has anyone else gone through this? Any advice? First time this has happened to me. Thanks guys.....

Are the hard pieces very hard? It is sounding more like constipation than obstruction to me. I have had bouts of severe constipation with my Crohn's, where I couldn't pass anything for several days. Eventually when I did go, I would pass hard, impacted faeces followed by liquid stool - this liquid stool can sometimes seep past the impacted stool in the colon or rectum, and is known as 'overflow diarrhoea' - I thought you'd want to know ;p

Glycerin suppositories worked great for me. Just make sure you have the next hour free and are close to a bathroom.

If you do develop severe abdominal pain, then go to the ER like scifigal said. I wouldn't worry about the Remicade causing strictures: it's possible, but I think that theory has been largely been debunked now.

*googles* Er, maybe not as debunked as I thought: www.medscape.com/viewarticle/729747

From personal experience, I did seem more prone to developing obstructions after starting Remicade. I had a recognised stricture, but it was mainly inflammatory and would disappear if I went on steroids. So I dunno how much the Remicade had to do with it really.

Clo - I'm sorry you're having this experience.

For me, my two experiences with partial obstructions (one more serious than the other) involved groups of very intense symptoms happening together -- things that did not seem within the range of normal. Simultaneous D and vomiting. Sharp pain. Fever, chills, shaking, cold sweats. In one case, I fainted. I feel I would recognize that set of feelings/symptoms very clearly if I felt them again.

Hearing your story, I think I agree with others that it sounds constipation and / or Remicade related.

Everyone's experience is different. Please keep communicating with your doctor and don't let them brush you off!

Be well.

Thanks everyone for your responses and concern. I don't know how to work this site on my smart phone so I am unable to respond to you indivifually.

I do not have a fever. My tummy is gurgling and nothing is happening. Its been like that for the last two days. On Friday I felt like someone was twisting my intestines. ..pretty intense pain. No pain since then. I get these waves of feeling like I am going to vomit. I feel like from my naval down is sloshy water.

Will speak to doctor in am. Scope was set for Thursday 715 am. Hope they can do it and tell me what is wrong. Hope I can hang on that long. I've gained three pounds yet haven't eaten since Friday???? That's weird.

I would go with your gut feeling (no pun intended). If you're really concerned, it might be worth an ER visit. You know your body.

Well, you all were right. Currently in the hospital....wearing diapers and looking forward to my next morphine fix.... Thankfully??? The laxatives have all kicked in so my fistula thinks it is a firehose. Scope scheduled for tomorrow sometime. We have to figure out if there's narrowing? Yikes!!! What's that look like?

No tube down my nose for now as I am belching a lot. Xray of tummy showed it full of trapped gas. How do they get that out if its in your colon and not your stomach?

An NG tube should keep your intestines free of gas, so if it's very painful they may resort to that. NG tubes SUCK (pun?) but they are pretty effective at keeping pain and nausea at bay. Is the hospital giving you laxatives? I feel like things should move along on their own once the obstruction is cleared and then they will probably want you on a liquid diet for a few days to give your intestines a rest. Hope you feel better soon!

You have to be a bit careful with laxatives; take too many of them and it can confuse the bowels even more. I wouldn't conclude from this episode that you don't respond well to laxatives.

A few years ago, after a decade of diarrhoea, I started becoming more and more prone to constipation to the point that I took miralax every day for a while. I'm hazy on the exact timeframe, but about a year or two after that my stricture was finally discovered on a scan - I think it had come on a couple of years before then though. Anyway, I wouldn't be at all surprised if a stricture was discovered in your case. Good luck with the scope.

Glad to hear they found the source! That's a stricture and yep, I've got one too. Did your doctor say where it is located though? I'm getting my second balloon dilation of it next week.did your gi try dilating it? I'm not sure what the cut off is but over a certain length they will not do dilation and if it is too narrow. If he called the surgeon he must be leaning towards resection or steictureplasty. How long have you had the fistula?

Hang in there Clo! I know the pain with them is outrageously bad. Probably being made worse with the miralax and colonoscopy prep because your body is struggling to push everything out and it can't get through. when I was preparing for my last colonoscopy it was unknown that I had a stricture before hand. I drank all the prep and felt decent and then a few hours later I was hit with some of the worst pain ever. I couldn't even take a step and had to role myself out of bed in the middle of the night to try to get a phone to call the doctor. It was terrible and I was never was so happy to be knocked out as I was for that colonoscopy to get away from the pain. But as long as you are on liquids for a while the pain should subside but by that time I would think they would have treated it. Yes dilating is risky if you have active or recent inflammation in the area and yes the scar tissue will often times heal back over after it is stretched and create an even smaller opening. Though there are plenty of people who have had success with it and I'm hoping a second try at mine will work so I can avoid surgery, though surgery will get rid of it. I had a perineal fistula for about three years. it was open and draining and the doctor I had at the time did not want to do anything about it so I had a terrible time living with it until I started humira. What have you tried with it so far? There are others on here that would have better advice on how to deal with yours.

Oh man, that sounds so incredibly difficult. I am so sorry. :( I think it might be a bit soon to disconnect your IV and throw solids at you, unless they're sending you home to do the surgery further down the road instead of during this hospital stay. The pain sounds rough, but since pain meds just clog you up, that would make this all even worse.

Oh dear! Hang in there! I agree with SciFiGal, I feel like you should not be off IVs yet. Especially when you've been all those laxatives, you'll get dehydrated really easily. I remember how I was when I started this journey with the stricture back in April, it took several tries and two weeks to reintroduce solid food. It's terribly rough to feel like that and be stuck in the hospital. I'm glad though that they are being cautious about operating though because from what others have said on here it would be very dangerous considering how bad the doctor said it had been. It's horrible waiting though. That was basically why they never did anything much to fix the fistula I had early on. There was too much active disease and I think the doctor figured it would only make things worse to attempt anything.

Oh boy, sorry it's been so rough for you! Yes, this all sounds very similar to what I went through this spring and am still dealing with (minus the cdiff). It can be a long long process but it does get better. Have they talked about any other drug options or do they feel that the remicade has just been working very slowly and needs more time? I was in the hospital for two weeks during which it took most of that time on IV steriods and several tries to get back to solid food. I had some amazing nurses that got me through it because the nausea meds did nothing to combat the urge to throw up when the food got to where the Narrowed section was and they tried everything to help me even though there wasn't much that helped. Started remicade and 6mp before I left. Then about two days later ended up with the constipation at home that wouldn't improve with miralax and suppositories similar to what you describe. It got so bad I was shivering and feeling disoriented and sick so went back to ER. They did Cts and gave enemas and stuff that eventually helped went home, GI had me start Metamucil. Ended up back to hospital with a PUlmonary embolism for two weeks. I was still complaining of nausea so GI did an upper endoscopy which came back fine. Went home but noticed I was having more trouble with nausea. so got colonoscopy right away and found the stricture in the TI. Was better for three days slowly getting worse again. Got fevers and aches and went through MRE which was fine and blood work I'm waiting to hear about. Now going back for another dilation of the stricture the end of this week and desperately hoping I can make it to the next colonoscopy with out an obstruction. If that doesn't work or if it hasn't held since the last time we'll be thinking about surgery. So yes it can take several hospitalizations to get any where. I was lucky that the GI has been great at giving me an idea of possible outcomes and directions that can be taken to alleviate my symptoms which helps with dealing because I can have an idea of what to expect and you should see if you can get that kind of info from your doctor.