An Overview of Bowel Obstruction

Bowel obstruction can be life-threatening but it is treatable

Stomach with and without hernia
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In This Article

A bowel obstruction occurs when a section of the small or large intestine becomes partially or completely blocked. Symptoms include abdominal pain, fevers, constipation, and vomiting.

This can be a dangerous condition, potentially increasing the risk of a severe infection or a perforation (hole) in the intestine. Certain medical illnesses such as Crohn's disease increase the risk of bowel obstruction.

If you are prone to this condition, you should work with your doctor to come up with a preventative plan. In some cases, an obstruction can be treated without surgery, but surgical treatment is often the safest and most definitive option.

Symptoms

A bowel obstruction can begin suddenly or may progress gradually over several weeks or days. Before a complete bowel obstruction develops, you may experience some warning signs caused by a partial bowel obstruction.

Symptoms that often precede a partial or complete bowel obstruction include a decreased appetite, cramping pain or discomfort, bad breath, or changes in your bowel movements.

The most common effects of a bowel obstruction include:

While it is less common, you can experience diarrhea due to a partial bowel obstruction if a small amount of liquid stool can pass beyond the point of the obstruction.

A complete bowel obstruction prevents stool and gas from passing through. This situation is known as obstipation.

Complications

A bowel obstruction can lead to serious problems. A major infection can develop due to the buildup of bacteria in the bowels. In some instances, areas of the bowel may become necrotic (dead tissue). Necrosis leads to severe infections and/or gangrene.

A perforation in the intestine can occur, resulting in the leakage of bowel contents and/or blood. The symptoms of a bowel perforation include severe pain, abdominal distension, fevers, hypotension (low blood pressure), and loss of consciousness. A perforation is a medical emergency that requires immediate surgery.

Causes

There are several causes and risk factors for bowel obstruction. In a mechanical bowel obstruction, the stool is physically blocked from moving through the intestine. This may be caused by a structural change of the intestines (such as twisting), by something inside the intestine preventing stool from passing through, or by tight constriction outside the intestine.

Obstruction can affect any section of the small or large intestine and can occur near the stomach, close to the anus, or anywhere in between.

A bowel obstruction can be caused by:

Herniation: A hernia, such as an inguinal hernia or an epigastric hernia, is a weakness in the abdominal lining that keeps the intestines in place. A portion of the intestine can become caught in a hole and the intestine can become squeezed and inflamed, preventing the passage of stool and gas.

Intestinal mass: Swelling, cancer (such as colon cancer), or infection can grow inside the lumen (opening) of the intestine, making it difficult for the intestinal contents to pass through.

A large object: A large, hard stool or an ingested non-food item can become fixed in place, preventing anything from getting past it.

Intussusception: This is a condition which occurs when a section of the bowel slides into itself, shrinking the size of the lumen.

Adhesions: Scar tissue, which can develop after trauma, surgery, or radiation therapy may cause a tight band-like constriction around the intestine.

Twisting: A volvulus is a twist or kink in the intestine, which can occur due to inflexible scar tissue or to gastrointestinal (GI) disease.

Impaired intestinal movement: Sometimes myopathy (muscle disease) can impair the movement of the intestines, resulting in a collapse of the lumen, abnormal movements, and obstruction.

Ischemia: Rarely, the bowels may become ischemic (lose blood supply) due to a blood clot. This can happen due to a blood clotting disorder.

Crohn's disease, colitis, lupus, irritable bowel disease, and other inflammatory conditions increase the risk of bowel obstruction through several mechanisms, including constipation, inflammation, and swelling.

Diagnosis 

The diagnosis of bowel obstruction is made based on your medical history, physical exam, and diagnostic tests. If you have severe abdominal pain, you need to get prompt medical attention. After a physical examination, you may have urgent diagnostic imaging tests. Depending on the results, your medical team may also recommend an invasive diagnostic test.

Physical Examination

The bowel normally makes sounds, such as gurgling and clicking, which can be heard with a stethoscope placed on the abdomen. If you have an obstruction, your doctor may hear high-pitched sounds while listening to your abdomen. If the obstruction has been present for some time, there may be a complete absence of any bowel sounds.

Abdominal tenderness (pain in response to touch or pressure) can also give your medical team an idea of how severe your problem is. If your abdomen appears swollen or enlarged, this can also help with the diagnosis.

Diagnostic Tests

X-Ray (abdominal radiograph): An X-ray is normally the first test used to determine if you have an obstruction. It is a non-invasive test that can be performed relatively quickly. Your x-ray may show small, tight areas or enlargement of the intestines and can sometimes identify a mass.

Abdominal CT scan: Abdominal CT scans are done similarly to x-rays, and a contrast solution must be taken by mouth, enema (through the anus), or intravenously (IV). A CT scan may show a more detailed image of the abdomen than an X-ray.

Colonoscopy: This is an invasive test in which a scope (tube with a camera) is inserted into the rectum to observe the colon from the inside. A colonoscopy can be very helpful to your medical team, but there is a risk involved, so it is not always the right option, and it is used only after non-invasive imaging tests.

Endoscopy: An invasive test in which a scope is placed in your mouth, endoscopy is used to assess the upper parts of your GI system—your esophagus, stomach, and upper small intestine. Like a colonoscopy, there are some risks and use of this test is guided by preliminary information gathered from your non-invasive imaging tests.

Treatment 

A bowel obstruction is a serious condition that requires urgent treatment within a few days of diagnosis—and sometimes treatment is necessary within a few hours. Treatment can include medical management, decompression of the intestine, and/or surgery.

Medication

In some cases, a stool softener may be considered to help relieve the obstruction. This approach may be considered if you have a partial bowel obstruction. Because the complications of untreated bowel obstruction are serious, your medical team may consider proceeding to an interventional procedure if medical management does not relieve your obstruction.

Intestinal Decompression

In some cases, the intestine can be decompressed with the assistance of a nasogastric (NG) tube. This procedure involves placement of an NG tube through the nose and down into the GI system. Your imaging tests would guide your medical team with the placement of an NG tube, and this treatment approach would be considered if your obstruction is caused by an object (such as stool) that can be safely moved out of the way.

In some situations, a stent, which is an open tube, is placed inside an area of the intestines to keep it open.

Surgery

Surgery may be needed to relieve a bowel obstruction, and sometimes surgery is also necessary to treat complications, such as a bowel leak.

There are several types of surgery, including removal of an intestinal mass or tumor, resection (cutting away) of scars and adhesions, and repair of blood vessels. Sometimes, cutting away an area of inflamed or necrotic intestinal tissue is necessary.

After surgery for treatment of intestinal obstruction, you may need a temporary or permanent colostomy or ileostomy. This is essentially a procedure in which the intestine is actually open to the skin, and waste material is collected in a bag. Often, the colostomy or ileostomy can be reattached with the remainder of the intestine at a later time.

Recovery

It takes a while to recover after treatment of a bowel obstruction. Your medical team will frequently check on you to make sure that your pain is improving and that you can pass gas before you will be permitted to eat and drink. In the meantime, you will need IV fluids to maintain nutrition.

Once you can safely start eating again, your diet will advance slowly—to allow your intestines a chance to adjust to the food and to quickly catch any signs of recurrent obstruction.

As you are healing, you will have to avoid certain medications, such as opioids (which can cause constipation, increasing the risk of obstruction) and nonsteroidal anti-inflammatory medications (NSAIDS), which can increase the risk of bleeding.

A Word From Verywell

If you are at risk for recurrent bowel obstruction, you need to be cautious regarding your diet—avoiding foods and habits that predispose to constipation. Be sure to seek medical attention if you experience symptoms of a bowel obstruction.

A bowel obstruction is not a rare event, and, while treatment is urgent and recovery can be a slow process, most many people are able to safely eat a healthy diet after treatment.

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Article Sources

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