Post-Operative Bowel Obstruction: Symptoms and Concerns

Intestinal obstruction issues?

Hello Doctor, I would like to inquire about my mother (68 years old) regarding her intestinal obstruction issue.
About two weeks ago, she went to the emergency room at night due to abdominal pain.
After an abdominal X-ray, her attending physician indicated that there was a blockage in the small intestine, necessitating hospitalization for treatment.
She subsequently underwent a series of procedures (nasogastric tube drainage, enemas, and abdominal X-rays every two days to monitor her gastrointestinal condition).
There has indeed been improvement (she no longer experiences vomiting, and normal bowel sounds can be detected).
A couple of days ago, with her physician's permission, she was discharged and even scheduled a follow-up appointment for next week.
However, in the one or two days since her discharge, she has still been experiencing diarrhea and mild bloating.
Although her attending physician informed her before discharge that diarrhea could be a normal phenomenon and prescribed medication to alleviate it, the family feels that it is somewhat unusual.
They wonder why she is still experiencing bloating and diarrhea despite having normal gas passage.
Could you please provide some clarification on this matter?

Ms. Chen, 30~39 year old female. Ask Date: 2023/09/20

Dr. Chen Jiaming reply Surgery

The causes of intestinal obstruction can vary among patients, and each attending physician may have different choices of medications.
It is possible that your mother's attending physician has prescribed some medications to promote (maintain) intestinal motility or laxatives, which could potentially cause the symptoms you mentioned.
I recommend discussing the subsequent treatment and whether long-term use is necessary with the original attending physician, as most doctors will typically only prescribe a portion of the medications based on the situation during follow-up visits.

Reply Date: 2023/09/20

More Info

Post-operative bowel obstruction can be a concerning issue, especially for elderly patients like your mother. It’s great to hear that she has shown improvement after her recent hospitalization, but I understand your concerns regarding her ongoing symptoms of diarrhea and mild bloating.

Bowel obstruction can occur due to various reasons, including adhesions (scar tissue), hernias, or even inflammation. In your mother's case, it seems that the initial obstruction was addressed through medical interventions such as nasogastric tube drainage and enemas, which are standard treatments aimed at relieving the blockage and allowing the bowel to function normally again.

After an episode of bowel obstruction, it is not uncommon for patients to experience some residual gastrointestinal symptoms as their digestive system gradually returns to normal. Here are some points to consider regarding her current symptoms:
1. Diarrhea: Following an obstruction, the bowel can become more sensitive and reactive. The body may produce more fluid in the intestines to help flush out any remaining contents, leading to diarrhea. Additionally, if she was given antibiotics during her hospital stay, this could disrupt her gut flora, resulting in diarrhea. It’s essential to monitor the consistency and frequency of her stools. If the diarrhea persists or worsens, it may warrant further evaluation.

2. Bloating: Mild bloating can occur as the intestines adjust after an obstruction. Even if she is passing gas and having bowel movements, it can take time for the bowel to regain its normal motility and for any residual gas to be expelled. Bloating can also be exacerbated by dietary choices; a diet high in fiber or certain carbohydrates can lead to increased gas production.

3. Dietary Considerations: After a bowel obstruction, it’s advisable to start with a bland diet and gradually reintroduce more complex foods. Foods that are easy to digest, such as bananas, rice, applesauce, and toast (the BRAT diet), can be beneficial initially. Avoiding high-fiber foods, dairy, and fatty foods until her symptoms improve may help reduce bloating and diarrhea.

4. Follow-Up Care: Since your mother has a follow-up appointment scheduled, it’s crucial to discuss these ongoing symptoms with her physician. They may want to perform additional tests, such as imaging studies or lab work, to ensure there are no complications or underlying issues that need to be addressed.

5. Hydration and Electrolyte Balance: Diarrhea can lead to dehydration and electrolyte imbalances, especially in older adults. Ensure she stays well-hydrated and consider electrolyte solutions if diarrhea persists.

6. Signs of Complications: While some post-operative symptoms can be normal, it’s essential to be vigilant for signs of complications, such as severe abdominal pain, persistent vomiting, fever, or blood in the stool. If any of these occur, seek medical attention promptly.

In summary, while your mother’s symptoms of diarrhea and mild bloating can be common after a bowel obstruction, it’s essential to monitor her condition closely and maintain open communication with her healthcare provider. They can provide tailored advice and interventions based on her specific situation. With time and appropriate care, her gastrointestinal function should continue to improve.

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