Sickle Cell Disease

Health Moment: Sickle Cell and An Ileus

One evening around lunch time, my daughter came to me and said, “Mommie, my back really hurts.” I took a few minutes to look at her back and but I didn’t see a physical problem. About 30 minutes later, she begin to scream because her back pain had traveled to her lower back and buttocks. Because she has sickle cell, my first thought was to hydrate her. Giving her more fluids, always seems to help when she’s ill.

When the pain did not subside after 10 minutes, I thought perhaps she is having a sickle cell pain crisis. The screams were similar, but because her pain was not consistent and would wear off and then return hours later so I felt that something was different.

Children with sickle cell often have protruding bellies, so when her back pain turned into stomach pain, I figured, something was wrong with her stomach. For more than a week, I noticed that her stomach appeared larger than normal and she had a slight fever, but figured that it was just a symptom from having Sickle Cell.

When her pain continued, and I thought of all the possibilities that could be wrong with her and I realized her stomach felt very hard to the touch and I wasn’t able to hear the noises in her stomach that meant it was digesting her food, I knew I needed to act fast because I felt the problem was related to her bowels.

To make a long story short, after trying over the counter medicines for constipation, I took her to her pediatrician who first mentioned to me a possibility of an ileus, which sometimes occurs in sickle cell patients. According to Medical-dictionary.thefreedictionary.com:

There are two types of intestinal obstructions, mechanical and non-mechanical. Mechanical obstructions occur because the bowel is physically blocked and its contents can not pass the point of the obstruction. This happens when the bowel twists on itself (volvulus) or as the result of hernias, impacted feces, abnormal tissue growth, or the presence of foreign bodies in the intestines.
Unlike mechanical obstruction, non-mechanical obstruction, called ileus or paralytic ileus, occurs because peristalsis stops. Peristalsis is the rhythmic contraction that moves material through the bowel. Ileus is most often associated with an infection of the peritoneum (the membrane lining the abdomen). It is one of the major causes of bowel obstruction in infants and children.
After x-rays confirmed there was a slight ileus, we had to act fast. She went to the ER where they immediately began giving her morphine for the pain when they found out that she was a sickler. However, I let the doctors know that the pain was from a blockage in her bowels, and probably not a sickle cell crisis. Fortunately, they listened, and she was given 2 enemas, which helped her bowels pass and then was sent home with a colon cleanse regiment. It took several days to fully relieve her of constipation.

What do we do differently?

Everyday, I encourage my daughter to share her bathroom habits and ask her specific questions about how she is feeling. We continue providing her with a high fiber diet, and I make sure that she starts the day by drinking at least 2 cups of water. In addition, with at least 1 meal she eats a salad made with green leafy vegetables like spinach leaves. I also give her smaller portions, and allow her to eat a snack between each meal. Before this occurred, my daughter really liked eating a huge breakfast. For instance, she enjoyed having 2 bowls of oatmeal, waffles, or cereal and a plate of fruit. All healthy items, but probably too much at one time for her small frame. Now she eats one small bowl of oatmeal, a small bowl of cereal and she enjoys a small portion of fruit at snack time. By making these changes, thankfully she is now regular, her bulging stomach has gone down, and she has not complained of any pain.
 
Sometimes, when a child has sickle cell, our first thoughts are related to pain crisis due to their red blood cells sticking together, but I am sharing my daughter’s experience because it may not be crisis, so it is always good to assess and get to the root of the problem.
 
 
Reader question: Has someone you know who suffer from Sickle Cell ever had an ileus, if so, how was his or her experience similar or different?
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