So, it happened again. A day of increasing abdominal pain, nausea, trip to the ER, twisted bowel diagnosis, hospital admission for bowel rest. It is almost with exact regularity that I get these.
The last one was exactly seven months ago to the day. The previous one was between six and seven months earlier. So frustrating!
If you’ve been struggling with repeated SBO (small bowel obstruction) aka twisted bowel, you might have tried a bowel adhesion diet already.
I have not, because none of my surgeons ever committed to the answer that my repeated hospital visits are due to what I eat. In fact, this last time, my discharge papers recommend an immediate return to a full-fiber diet.
Still, I might try a different approach for a while and see if it helps or not. Here is what I researched and learned about the bowel adhesion diet.
- What Is SBO or Twisted Bowel?
- What Are the Symptoms Of a Twisted Bowel?
- How Dangerous Is An Intestinal Obstruction?
- How Is a Twisted Bowel Treated?
- Can This Vicious Cycle Be Prevented?
- What Are Adhesions?
- Can Anything Be Done to Prevent Twisted Bowel From Adhesions?
- The Bowel Adhesions Diet
- The Main Principles Of the Bowel Adhesions Diet
- Final Thoughts
What Is SBO or Twisted Bowel?
Small bowel obstruction is a condition that happens often to those who underwent abdominal surgeries in the past.
Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine.The Mayo Clinic
Some of the causes of small bowel obstruction include:
- fibrous bands of scar tissue (adhesions) in the abdomen that form after surgery
- hernias (also often a result of surgery)
- strictures from an inflamed intestine (often with Crohn’s disease or diverticulitis)
- some medications
Small bowel obstruction can be caused by many pathologic processes, but the leading cause in the developed world is intra-abdominal adhesions.
Small bowel obstructions can be partial or complete and can be non-strangulated or strangulatedNational Institutes fo Health Publication
In my case, the cause is certainly adhesions.
If you follow my blog, you know that I was diagnosed with colorectal cancer in 2014, underwent chemo and radiation treatments to the pelvic area (which weakened the tissues in that area), and then had two abdominal surgeries.
Part of my treatment was a temporal ileostomy, which was reversed several months later.
At the specific place where my intestine was reconnected after the ileostomy was removed, there is a band of adhesion now, clearly visible on the CT, every time I get my bowel obstruction.
In other words, this is exactly the spot, where stuff gets stuck and won’t budge.
What Are the Symptoms Of a Twisted Bowel?
When this happens, I experience the following symptoms which increase with time:
- Sense of fullness in the bowel
- Bloating that becomes painful with time (it feels like my abdomen is going to explode there seems to be so much trapped gas in there)
- No bathroom trips for BM or gas (everything is blocked from the point of blockage downward)
- At first, a dull belly ache, like with indigestion, but then it changes into very painful cramps
- Nausea and burping
- Sometimes, vomiting
- Chills and sweats
How Dangerous Is An Intestinal Obstruction?
I’ve been lucky so far and all my obstructions (too many to count, at least 15) have resolved either on their own at home or after a short stay at the hospital.
No surgical intervention was required.
However, if unrecognized and untreated, a twisted bowel can be a life-threatening condition for two reasons.
If the obstruction cuts off blood supply to a part of the intestine, that part might die and has to be surgically removed.
If the intestinal wall breaks due to obstruction or as a result of tissue death, the contents of the intestine can leak into the abdominal cavity and cause a life-threatening infection.
How Is a Twisted Bowel Treated?
In my case – since I am such a veteran – I can pretty much recognize the signs of an incoming obstruction pretty fast.
I know that the most important part is to stop any intake of food and drink as soon as possible.
Basically, what has to happen, is that the bowel gets needed rest so that the pressure on the blockage point is relieved and the bowel can untangle itself.
In order to provide that rest, you have to stop putting things into the bowel.
This includes water, just because of the need to stop adding more volume to the already present stuff in the gut when the obstruction happens.
A few times, I managed to ward off a trip to the ER by following these steps:
- Stop intake of food and drink
- Rest with a heating pad on the belly
- Apply castor oil pack to the abdomen
Probably depending on how severe the obstruction is, taking these steps resulted in unblocking within 10-12 hours.
Other times, the pain kept increasing and I was forced to visit the doctor or ER and was admitted every time with a partial bowel obstruction.
You can read about my experiences during the treatment in the hospital here.
It’s not pretty, but still better than going under the knife or having any of these life-threatening possibilities occur like tissue death or infection.
Can This Vicious Cycle Be Prevented?
I’m laughing at the term “veteran” but it’s not a laughing matter. I am literally sick of it.
In the last six years since the initial cancer surgery and five years since my reconnection, I’ve been admitted to the hospital at least ten times for SBO.
The nurses recognize me. The doctors wring their hands and feel sorry for me. And I keep asking, what can I do to prevent this from happening?
What Are Adhesions?
So, we know, that my obstructions are caused by adhesions. What are they?
Most simply put, adhesions are fibrous bands of tissue that connect two parts of the body that normally would not be connected. I like to think of them as two-sided tape or Velcro, only there is no way to open them up easily.
An adhesion develops when the body’s repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation, resulting in inflammation.
Although adhesions can occur anywhere, the most common locations are within the abdominal cavity, the pelvis, and the heart.Adhesions, General and After Surgery
Checks out for me. Surgery, check. Radiation, check. Abdominal cavity, check. No wonder, twisted bowel is my “new normal.”
Turns out that adhesions are really rather common.
According to WebMD, “abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery.”
While most adhesions are painless and won’t be even noticed, those that cause trouble are responsible for over 60% of small bowel obstructions in adults.
Can Anything Be Done to Prevent Twisted Bowel From Adhesions?
Apparently, the only approved method to deal with adhesions is another surgery to remove them.
However, it is almost certain that new adhesions will be formed as a result of adhesion-removing surgery. Crazy, right?
I discussed this option with my surgeon whom I trust with my life (he saved it once after all).
He advises against the surgery. And I agree.
The problem is that the obstructions I get now are partial, there has never been a high danger of tissue necrosis or spillage of the intestine contents.
What if the new adhesions would form in a more dangerous spot and a complete blockage would be more likely?
The Bowel Adhesions Diet
Now, to start with – none of my medical team, not the surgeon, not the GI doctor, or any of the attending doctors during my obstructions said that changing a diet would result in fewer chances of getting an obstruction.
Basically, the thinking goes, you might be adhering to the bowel adhesion diet 99% of the time, and you slip up once or twice and an obstruction could happen.
This is the most annoying thing about the whole situation. It’s a crapshoot whether and when it will happen or not.
Sometimes I get them after eating a soup, other times after eating a handful of nuts. Sometimes it’s mashed potatoes, other times it is corn kernels. So, go figure!
Still, here is what I found out about the dietary approach.
I’m going to give it a try for a while. As long as I can stand it.
The Main Principles Of the Bowel Adhesions Diet
Because obstruction happens when food cannot pass through the stricture in the bowel, it makes sense that large chunks of undigested food should be avoided.
Chew your food really, really well.
Avoid eating raw food.
Avoid any stringy food (celery, mango, pineapple)
All insoluble fiber should be avoided (stalks of veggies, dried fruit, nuts, seeds).
Skins and seeds of fruits and vegetables are to be avoided.
It’s better to eat more often but in small portions and always chase with copious amounts of liquid.
Whenever possible, food should be pureed or blended.
Basically, baby food for adults. As a foody who loves food experiences, I will not be happy about this.
Here is a link to a comprehensive brochure with allowed foods and foods to be avoided on the bowel adhesions diet.
It is in PDF format and comes from a trusted source (an Australian governmental agency).
It also provides a suggested meal plan which might be useful if you struggle with meal planning.
I’ll be honest. I will not be happy about eating this type of diet. I’m in my early 50s, and I do not want to eat baby or geriatric food before my time.
Food means more to me than nutrition. Food is also company and fun. I love to experience different flavors and textures of food also while traveling. I find joy in learning about different cultures through their food practices.
But I also do not want to find myself with a twisted bowel searching for an ER somewhere overseas during my summer vacation in Europe and go through what I just went through again.
So, I might as well just jump in and try this diet and see where it takes me.
I’ll keep you posted.