Bowels

Now there's a change from pictures of the grandchildren! Don't complain. I could have chosen a bowel picture that you would have found much more disagreeable.

For the last couple of weeks I have been in close contact with my bowel, learning so much more about this wonderful organ. For starters, the bowel consists of the small intestine, on average around 7 m long, and the large intestine or colon, about 1.5 metres long, or in my case around 0.4 m, since I had about a metre removed in December 2008. In October 2010 I had another 0.4 m of small intestine removed, in total, from various places.

The bowel is more than a piece of plumbing. The small intestine especially, is intersected by vast numbers of nerves and blood vessels. It is a semi-independent organ with a mind of its own. And it does not like to be obstructed.

For the past 10 days, I have been experiencing small bowel obstructions. It ain't pleasant. The cause is almost certainly adhesions associated with the peritonectomy surgery I had last October. It's not likely to be due to abdominal tumours, since my latest CT scan has still only identified one obvious tumour in the xiphisternum region of the upper anterior abdomen and not really a nuisance to my small intestine.

The symptoms start with an intermittent colicky abdomen pain and a swelling in the abdomen. The pain becomes extremely severe. Next comes burping and then nausea. Over a few hours the abdomen becomes harder and nausea builds until the stomach contents are completely vomited, and if incomplete, then be assured, you will retch violently and repeatedly until the last morsel is out. With the emptying of the stomach, some relief is felt and for many hours the most noticeable symptoms are hardness of the abdomen, the intermittent pain, and a feeling of utter exhaustion.

I know bowel obstructions well. The first was my large bowel blockage in 2008 which led to emergency surgery to remove the section of bowel hosting the tumour obstruction. The second and third occurred in early 2010 after I had been diagnosed with abdominal tumours. One had me hospitalised-it passed in about 4 hours. The next followed a week later, and passed in an hour or two, none of the most severe symptoms being experienced.

For a year and a half I have had none. But, on the night following my return from New Zealand, and while staying with daughter Catherine in London, I had a small event that cleared in three hours, before the emptying of my stomach. On Sunday last I had a more severe event which displayed the full panoply of symptoms. I got myself to Chris, my surgeon son, who put me to bed and examined me, with the advice that adhesion-related obstructions generally clear within 24 hours and we would wait and see. It took 10 hours to clear, the final confirmation being a delightful relief of symptoms followed by a stupendous passing of wind and ejection of remaining large bowel contents.

Last night I had an even nastier obstruction. At 2 am I called Chris to come and get me. We followed the same procedure. This time it took 16 hours to clear and when it did, a feeling of near euphoria swept my body and I sank into a deep sleep, only to be awakened by Miang who had, by good timing, just returned from Africa to take charge of my nursing arrangements.

It's a binary business. When the blockage clears, you are well, if tender in the abdomen and somewhat fearful of ingesting the food you desperately need. But I will gingerly drink soup and eat yoghurt and ice cream until, after a day or so, I try some soft solid food. When I do get back to a fully recovered bowel, which is my intent, I will no longer swallow whole nuts or large pieces of hard peach, as I foolishly did in recent days.

Why now all of a sudden? Hard to say. What if it doesn't clear in 24 hours? That's a tricky one. For a patient whose abdomen was not a battleground of scar tissue like mine, surgical intervention might be an option. In my case, it might be harder to persuade the surgeons. I think I need to learn to chew my food a bit better, and take each day without a bowel obstruction as a day of grace.

PS: The Bowel picture is from Wikipedia