Digestive Health Understanding a Bowel Perforation Symptoms, Causes, and Treatments for a Hole in the Colon By Julie Wilkinson, BSN, RN Julie Wilkinson, BSN, RN LinkedIn Julie Wilkinson is a registered nurse and book author who has worked in both palliative care and critical care. Learn about our editorial process Updated on January 21, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Priyanka Chugh, MD Medically reviewed by Priyanka Chugh, MD LinkedIn Priyanka Chugh, MD, is board-certified gastroenterologist with a background in internal medicine. She practices with Trinity Health of New England in Waterbury, Connecticut. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Frequently Asked Questions Your colon is the final part of your digestive tract, before it reaches the anus and stool passes from the body. It is made of layers of smooth muscle and mucous membranes that line the twisting, tube-like colon. Bowel perforations occur when a hole is made in the mucosa, the most inner layer of this lining. Whether from a surgical procedure or a serious bowel disease, this is a true medical emergency. It requires immediate medical attention. This article explains how such a hole in the colon tissues can cause its contents to leak out into the space in your abdomen. It details the causes, risks, symptoms, and treatment of a perforated bowel. Phynart Studio / Getty Images Bowel Perforation Symptoms The symptoms of a bowel perforation can vary. They may start slowly or be quite fast, depending on the cause. Symptoms may include: Pain, often severe and spread across your abdomenSevere cramps in the stomach regionBloating, or a feeling of tightness or swellingNausea and vomitingA change in your bowel movements or habitsBleeding from the rectumFever, which is usually delayed Body chillsFatigue, or feeling tired Recap A bowel perforation is a hole in the lining of your colon. When this happens, the contents of your digestive tract can leak out from the affected site. This may lead to a life-threatening or even fatal infection. Seek emergency care right away if you have symptoms. Complications The contents of the bowel can leak out through the hole in the colon wall. Gastric acids, bacteria, and food particles can leak into the abdominal cavity that contains many of your internal organs. It is normally sterile, meaning it is free from such contamination. The leaked bowel contents can lead to infection and inflammation. It also can cause an abscess, or pus-filled space, to form in your abdomen. Usually, this will cause a great deal of pain. When this happens, it is called peritonitis. This painful infection can lead to a body-wide infection called sepsis. These conditions are life-threatening and often fatal when they are left untreated. Complications of an untreated perforation may include: BleedingInfection leading to sepsisDeath Factors that affect the severity of a bowel perforation include your overall age and health. The outcome also may depend on how much time it takes to diagnose and treat the problem. This is why it's so important to act quickly if you experience any symptoms. Recap An infection in the normally sterile abdominal cavity can lead to a painful condition called peritonitis. This can lead to sepsis when left untreated. Bleeding also may occur due to a bowel perforation. Abdominal Pain - When to See a Healthcare Provider Causes You can have a hole in your colon that happens by itself. This spontaneous type of perforation is usually due to a medical condition, such as inflammatory bowel disease (IBD). Bowel perforations also can be caused by a medical procedure that's done in or near your digestive tract. Some procedures rely on instruments that can create a hole in the colon by accident. Trauma, caused by some type of accident or force, also can cause a bowel perforation. This is especially true of blunt trauma to the abdomen, such as occurs with a direct kick or a long fall. Causes Linked to a Procedure Several medical procedures can lead to a bowel perforation. These causes may include: Enema: Most enemas use a tube that's inserted into the rectum. If this is done with too much force, or done the wrong way, it can rip or push through the colon lining. Bowel preparation for colonoscopy: It's rare, but the bowel cleansing that you do before a colonoscopy can create a hole. This is more common in people with a history of constipation. Sigmoidoscopy: The endoscope is a tool used to perform a flexible sigmoidoscopy. It's also used safely for other procedures. But perforation remains a risk, even if it is rare. Colonoscopy: It's possible for the tip of the endoscope to push through the inner lining of the colon. This is a rare complication and is not seen in a virtual colonoscopy. A hole created by a colonoscopy is more common when polyps are removed during the procedure. Abdominal or pelvic surgery: Surgery, especially for colon cancer, may create the risk of a perforation. Canadian researchers looked at more than 96,000 colonoscopies to evaluate the complications with them. Bowel perforations occurred at a rate of 6 per 10,000 people. Bleeding after a colonoscopy happened at the rate of 26 per 10,000 cases. Spontaneous Causes Other causes of a bowel perforation are not linked to a medical procedure. They may include: IBD conditions such as Crohn's disease and ulcerative colitis. The lifetime risk of bowel perforation with Crohn's disease is between 1% and 3%, making this a very common cause. Severe bowel obstruction, especially when the colon is "weakened." This can be due to a diverticular disease, cancer, or another underlying health condition. Trauma or injury to the bowel Ischemic bowel disease, with some type of interference in the blood supply to the colon Colon cancer A foreign object, such as a fish bone, bone fragments, or other non-food item Bowel impaction, with feces you can't pass because of severe constipation Fecal Impaction Symptoms, Causes, Treatment, and Prevention Risk Factors Several factors may raise your risk of a bowel perforation including: Recent or prior abdominal surgery Recent or prior pelvic surgery Age greater than 75 History of more than one medical problem Trauma to the abdomen or pelvis, as with an accident History of diverticular disease History of IBD Colon cancer Taking Yervoy (ipilimumab) as part of cancer treatment Scar tissue in the pelvis, usually from a previous surgery Being assigned female at birth, because the colon is more easily injured during a procedure Recap Some bowel perforations are caused by a chronic or underlying medical condition like Crohn's disease. Others happen when a hole is accidentally created during a procedure, such as a colonoscopy. You are at greater risk if you are older, have a digestive tract disease, or were assigned female at birth. Diagnosis If your healthcare provider thinks you have a bowel perforation, they likely will order some tests. A simple X-ray may show that you have gas outside of your colon but usually is not enough for a diagnosis. Often, you'll need to have a computed tomography (CT) scan of your abdomen. A barium enema may be needed, but this procedure to introduce a contrast liquid for better imaging may itself be a risk for bowel perforation. A complete blood count may reveal that your level of white blood cells is high. This is common with infection and suggests a hole in your colon wall may have been there for a while. Your blood tests also may show signs of anemia due to bleeding. Smaller perforations may be harder to diagnose, and that may mean more time and imaging tests. What to Expect When Undergoing a CT Scan Treatment In most cases, you'll need surgery to repair a bowel perforation. This depends on the size and the site of the tear. A gastroenterologist or colorectal surgery specialist may be able to fix it through an endoscope. However, this is not an option for everyone. Open bowel surgery is more complicated. In some cases, it may result in a stoma and colostomy. A procedure is done to create the stoma, an intentional opening outside of your stomach. Your stool then drains into a small bag until the colon is healed. Do You Need A Colorectal Surgeon or Gastroenterologist? Recovery At the start of your recovery, you will not be able to drink or eat anything by mouth. This is called resting the bowels. It gives the inner lining of the colon the time to heal properly. You will also have a nasogastric tube in place to drain the contents of your stomach for a period of time. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. You'll want to get back to your normal routine, to be sure. But it's important to give your colon the time to heal properly and follow your healthcare provider's orders. Recovery After Bowel Surgery Can Be Both Physical and Emotional Summary A bowel perforation is a hole in the lining of your colon. It can happen for a variety of reasons, some of them related to medical conditions that people already have, such as IBD or colon cancer. These holes also can be caused by injury, including the rare perforation that happens during a medical procedure like a colonoscopy. The contents in your colon can leak out through the hole caused by a perforated bowel. This can cause bleeding, as well as a painful and serious infection. A bowel perforation usually can be treated with surgery. If left untreated, though, the infection it causes can lead to death and disability. If you think you have symptoms of bowel perforation, don't wait. Seek medical care immediately. A Word From Verywell People who have chronic digestive disorders may not think that a symptom like constipation is all that serious. It can be, and it can even lead to a bowel perforation. Be sure to keep your healthcare provider up-to-date on what you're experiencing. Frequently Asked Questions How long can someone live with a perforated bowel? Life expectancy should not be affected at all when you seek immediate treatment. But if it's not treated and you develop sepsis, the chances of a life-altering condition or death are high. About one-third of people who develop sepsis die. Those who live may experience organ failure, chronic pain, or other problems. What does a perforated bowel feel like? The most common thing a person physically feels due to perforated bowel is severe abdominal pain. Chills, fever, and nausea are also symptoms. Was this page helpful? Thanks for your feedback! Gas pain? Stool issues? Sign up for the best tips to take care of your stomach. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 15 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Jones MW, Zabbo CP. Bowel Perforation. StatPearls Publishing. Doklestić SK, Bajec DD, Djukić RV, et al. Secondary peritonitis - evaluation of 204 cases and literature review. J Med Life. 2014;7(2):132-8. Yamauchi A, Kudo SE, Mori Y, et al. Retrospective analysis of large bowel obstruction or perforation caused by oral preparation for colonoscopy. Endosc Int Open. 2017;5(6):E471-E476. doi:10.1055/s-0043-106200 Holmer C, Mallmann CA, Musch MA, Kreis ME, Gröne J. 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Pediatr Surg Int. 2017;33(5):605-608. doi:10.1007/s00383-017-4075-6 Serrano Falcón B, Barceló López M, Mateos Muñoz B, Álvarez Sánchez A, Rey E. Fecal impaction: a systematic review of its medical complications. BMC Geriatr. 2016;16:4. doi:10.1186/s12877-015-0162-5 Shah R, Witt D, Asif T, Mir FF. Ipilimumab as a Cause of Severe Pan-Colitis and Colonic Perforation. Cureus. 2017;9(4):e1182. doi:10.7759/cureus.1182 Kothari K, Friedman B, Grimaldi GM, Hines JJ. Nontraumatic large bowel perforation: spectrum of etiologies and CT findings. Abdom Radiol (NY). 2017;42(11):2597-2608. doi:10.1007/s00261-017-1180-x National Institute of Diabetes and Digestive and Kidney Diseases. Lower GI series. Schmidt A, Fuchs KH, Caca K, Küllmer A, Meining A. The Endoscopic Treatment of Iatrogenic Gastrointestinal Perforation. Dtsch Arztebl Int. 2016;113(8):121-8. doi:10.3238/arztebl.2016.0121 Levack MM, Madariaga ML, Kaafarani HM. Non-operative successful management of a perforated small bowel diverticulum. World J Gastroenterol. 2014;20(48):18477-9. doi:10.3748/wjg.v20.i48.18477 Sepsis Alliance. Perforated bowel. Additional Reading Holmer, C., Mallmann, C., Musch, M., Kreis, M., and J. Grone. Surgical Management of Iatrogenic Perforation of the Gastrointestinal Tract: 15 Years of Experience in a Single Center. World Journal of Surgery. 2017 Mar 21. (Epub ahead of print). Kim, J., Lee, H., Ye, B. et al. Incidence of and Risk Factors for Free Bowel Perforation in Patients with Crohn’s Disease. Digestive Diseases and Sciences. 2017. 62(6):1607-1614. Kothari, K., Friedman, B., Grimaldi, G., and J. Hines. Nontraumatic Large Bowel Perforation: Spectrum of Etiologies and CT Findings. Abdominal Radiology. 2017 May 10. (Epub ahead of print). Yamauchi, A., Kudo, S., Mori, Y. et al. Retrospective Analysis of Large Bowel Obstruction or Perforation Caused by Oral Preparation for Colonoscopy. Endoscopy International Open. 2017. 5(6): E471-E476.