Ileus and Pancreatitis

 

Ileus is a not uncommon result of pancreatitis and the strong narcotic pain killers that are often prescribed during a flare up of Acute Pancreatitis.

According to Wikipedia:  Ileus is a disruption of the normal propulsive ability of the gastrointestinal tract. Although ileus originally referred to any lack of digestive propulsion, including any bowel obstruction, up-to-date medical terms restricts its meaning to those disruptions caused by the failure of peristalsis, rather than by mechanical obstruction

My Experiences With Ileus and Pancreatitis

I’ve had several problems with Ileus during acute attacks of Pancreatitis and let me tell you that it’s not very fun.  In some cases getting this problem resolved was almost worse than dealing with the original Pancreatitis.

In fact, one of my worst stays in the hospital resulted because of the attempts of a Doctor to solve my Ileus issue by shocking my intestinal tract to get it working again.

The pain was horrible.  Since the Narcotics that I was taking for the pain were suspected of causing the Ileus in the first place they also started to limit access to those pain meds.

This left me in excruciating pain.  It was one of the few times that I all but gave up hope of recovering.

Causes of Ileus and Pancreatitis

A one-two punch of Ileus and Pancreatitis can happen during a flare up of Acute Pancreatitis.

Most of the time when you have an attack of Acute Pancreatitis, your Doctors are going to give you powerful narcotic meds to help ease the pain.

While these pain killers are a big help with the pain of Pancreatitis, they can also cause Ileus, the slowing or stopping of your gastrointestinal tract.

This peristalsis of the gut can be a major problem with severe results and could easily lead to some pretty terrible issues that could keep you in the hospital for days or weeks.

Symptoms

Symptoms of Ileus include but are not limited to:

• A moderate to severe feeling of abdominal discomfort.
• Constipation
• Abdominal distention or bloating.
• Nausea and vomiting, Especially if you eat.
• Vomiting of Bile
• Lack of Bowel Movements
• Flatulence
• Excessive Belching

Your Doctor will also be unable to hear any bowel sounds because the bowel is inactive.  Ileus can happen in one or more sections of you bowels.

Treatments

The traditionally approach to both Ileus and Pancreatitis is to deny the patient anything by mouth, no water and especially no food.

The reasoning behind this is pretty straight forward.  If your Pancreas is inflamed by a bout of Pancreatitis, the last thing that you want to do is to make it work at digesting food.  This gives the Pancreas time to “cool” down and recover.

Similarly, if you are suffering from Ileus, giving the intestinal tract time to recover seems like a good idea.  Especially if the source of the problem could be the narcotics that are being taken for the pain of the Pancreatic attack.

Going Back On Food

After the Pancreatitis has passed most of my Doctors start to feed me a liquid diet.  Testing the waters to see if the pancreas is cooled down.

This can also help to restore motility of the gastrointestinal tract by triggering the guts normal feedback signals so this is often the recommended management for Ileus and Pancreatitis.

Persistent Problems With Ileus and Pancreatitis

But if the patient has severe, persistent signs that their motility has been completely disrupted or if there is an actual blockage in the gastrointestinal tract other things might need to be considered.

Most of these treatments are supportive.  If the cause is suspected to be medication which happens in a lot of cases where there is a combination of Ileus and Pancreatitis, the offending pain or other medication is discontinued or reduced.

In my last hospital stay there was a total lack of motility in the gut.  Whether this lead to the blockage that I experienced or was the result of the blockage was something that I don’t think anyone was real sure about.

There are things like nasogastric suction or  other equally nasty things that can be used to get things going again.

In some cases parenteral nutrition (basically feeding into a vein) may be required to get the patient some nutrition until the gastrointestinal process restarts.

My Doctors, in order to get the gut working again and to break the blockage had me on lactulose, different suppositories and Magnesium Citrate.

The later says on its label that it has a “pleasing lemony flavor” but that was the only pleasing thing about it.

There was even talk of “manual manipulation” which I took to mean someone was going to be pressing and pushing on my already painful stomach.  Thankfully that never happened.

In worst case situations even surgery can be considered.

Avoiding Ileus and Pancreatitis

You need to have a plan to avoid this combination of issues.  Depending upon your insurance and access to Doctors you may not see your normal Pancreatic Doctor if you are in the hospital.

To start with you need to know what Ileus is and understand the fact that you may be susceptible to it when you are suffering from an attack of Acute Pancreatitis.

You should limit the amount of narcotic pain killers that you use when you are having a pancreatic episode.  Believe me when I say that I know how difficult this is going to be.

But the amounts of these narcotics that you take could be the thing that takes a slow moving gut and pushes it into full peristalsis.

If you have suffered through Ileus and Pancreatitis before make sure that your Doctor knows that you are concerned about this happening again.

So, take the narcotic pain killers as little as possible.  Taper of them as quickly as you can.

Also, make sure that when you are taking the narcotics that you immediately start taking something like lactulose to help keep things moving.

Finally, keep moving around!  The longer that you lay in bed the worse a case of ileus can become.  Moving around helps the gut move – so get up and keep moving.

I know how difficult this can be when you are in terrible pain but even just walking around your room can help.  I always take and try walking down the hospital corridor as soon as I am able when I have a flare up.

Final Thoughts

The combination of Ileus and Pancreatitis is something that you want to avoid at all costs.

Make sure that you talk to whomever is treating your Pancreatitis to have a plan to avoid this problem before it happens.

Having to deal with Pancreatitis can be a depressing problem so make sure that you find someone that you can talk to about it.  More than half of the people who suffer from Acute or Chronic Pancreatitis suffer from severe depression.

Finally, get to know the disease you are suffering from and become a pro-active patient.  Make sure that you are involved in your treatment plan.

Not only will it help you feel that you have some control over what is happening, it will also let the Doctor know that you understand what is going on.