ILEUS - The Other Blockage

Bowel obstructions come in two varieties, mechanical and non-mechanical. Most ileostomates have encountered the mechanical variety, usually when we eat something fibrous and do not chew well enough.

Ileus, also called paralytic ileus, is the non-mechanical variety. It happens when peristalsis stops. Peristalsis is the natural wave-like contractions of the intestines that move material through the bowel. The symptoms can be very similar to those of mechanical obstruction, and include pain, vomiting, constipation and diarrhea. Several causes are cited for ileus: Infection of the peritoneum (the lining of the abdomen and pelvic cavities), or disruption or lowering of the abdominal blood supply. Heart disease or kidney disease, when coupled with low potassium levels, can trigger the condition. Certain orthopedic surgeries, such as joint replacements or back surgeries and some chemotherapy drugs such as vinblastine (Velban, Velsar) and vincristine (Oncovin, Vincasar PES, Vincrex) also can cause ileus.

So how do you know if your bowel obstruction is due to ileus? First, see a physician. Ileus is characterized by few or no bowel sounds, which your physician can easily check with a stethoscope. Diagnosis can be confirmed by X-rays and CT scans. Blood tests can also be useful in diagnosis. If you do have X-rays, note that barium swallows are definitely contra-indicated as they can complicate the situation. Barium enemas can be used to visualize blockages but administration can be a problem in persons with ostomies. A soft catheter should always be used in the case of ileostomies. Colostomates who irrigate should bring their irrigation catheter or ask for something similar.

Hospitalization is indicated. Treatment involves rest and intravenous administration of necessary salts, water and glucose. The stomach/intestinal contents may be removed via a nasogastric tube. Peristalsis usually restarts spontaneously after two to three days of resting the bowel. In cases where a partial mechanical blockage triggered the condition, surgery may be performed.

Fortunately, ileus is a relatively rare condition. The total rate is about one in one thousand for both mechanical and non-mechanical blockages. (Coquitlam editor's note: Unfortunately my source did not say what the rate in ostomates was.)