Bowel obstruction is the small or large bowel blockage preventing food or liquid from passing through. This blockage can be partial or total.
Many causes can lead to bowel obstruction. They can be mechanical or functional causes. Most of them happen within the small bowel as it accounts for approximately 80% of the events. Inside this article, you will find explanations for some of the most common inquiries about intestinal obstruction. But before reaching this point, there will be brief explanations on fundamental concepts of the bowel and its blockage.
By reading this article, you will gain significant insights about Bowel Obstruction, its causes and symptoms, complications of the disease, and many others. Please proceed reading to acquire pearls on this particular subject by the hand of a Doctor.
What is a bowel obstruction?
Within the human body exists the gastrointestinal tract; it goes from the mouth to the anus. The food goes in through the mouth, and the digestive process begins. The stomach dissolves the food and turns it into a liquid state. Later the small bowel absorbs the nutrients within the food and water, and the large bowel absorbs the remaining of the water. Finally, the result of this process is the feces or stool.
When a bowel obstruction happens, there is a blockage that prevents the intestines’ content from passing normally through the digestive tract. The block causes a dilatation of the bowel firstly; then, there is an obstruction within the GI tract.
After the blockage within the affected gastrointestinal segment, the bowel collapses. There are different types of intestinal blockage; they can either be a mechanical or functional obstruction. Also, the cause of the obstruction can be inside or outside the bowel.
Inside the bowel, a tumor or swelling can fill and block the inside passageway of the intestine. Outside the bowel, there are possibilities for an adjacent organ or area of tissue to cause compression or a bowel wall segment twist.
Bowel obstructions may be classified as partial, complete, or closed bowel loops. A closed-loop obstruction indicates a kind of block in which there is a complete obstruction on both ends of a bowel segment. The result of a partial or total blockage of the bowel is constant vomiting.
Frequent episodes of vomiting may lead to fluid deficits and electrolytic abnormalities. If the condition is left untreated, it may worsen; the bowel wall enlarges and creates a so-called third space. After this, it can become a life-threatening condition that may injure the patient’s tissue and even cause death.
What causes a bowel obstruction or gastrointestinal blockage?
There are many possible causes for intestinal obstruction; they can either be extrinsic, intrinsic, or intraluminal. Here is a list of some of the most common causes of bowel obstruction; after the list, there will be a brief explanation of each disease.
- Intestinal Adhesions
- Colon Cancer
- Intussusception (Most common cause in children)
- Meckel’s diverticulum
- Meconium Ileus
- Inflammatory Bowel Disease (Crohn’s disease or ulcerative colitis)
- Impacted feces
- Intestinal volvulus, among them, the cecal volvulus.
In the small intestine, the most common causes of bowel blockage are the following.
The adhesive small bowel obstruction is the most common cause of small bowel obstruction. It accounts for 50% to 70% of all the cases. Adhesions are areas of tough and fibrous connective tissue that resembles scar tissue. These areas develop outside of injuries on intestines or pelvic organs after surgeries or infectious diseases.
While in surgery, the surgical team temporarily shifts the organs from their normal positions. This may stimulate the excessive formation of scar tissue as well.
Sometimes adhesions do not cause symptoms when they first form. The bowel movement causes the adhesions to act like strings stretching with the action of the intestine. An area of adhesions may cause obstructions of the small bowel.
The adhesions act within the small bowel like a constricting band, and from the outside, it seems like a pinched portion of the small bowel. This will ultimately slow down the flow of intestinal contents. These symptoms may appear and suddenly go; this will cause an area of the intestines to become blocked and unblocked.
Adhesions are very rare in patients who have never had abdominal surgery. However, in people who have had multiple abdominal surgeries, adhesions may be common.
The abdominal wall may have structural weakness in the muscles and fibers within it. If this is the case, a small portion of the small intestine may come out through this weakness. This segment that comes out of the abdominal wall receives the name of hernia.
These intestinal sections that protrude are the second most common cause of bowel blockage. The small intestine may become obstructed if the portion is tightly pinched through the abdominal wall. If left untreated, there are cases in which the hernia may complicate over time, causing small bowel strangulation. This means that the blood flow and the blood supply to this portion cuts off. This will ultimately lead to bowel ischemia and tissue death, becoming a life-threatening condition.
Hernias will appear as lumps in specific locations. The most common hernias are the following:
- Umbilical hernia: It appears as a lump near the navel.
- Ventral hernia: Between the navel and the breastbone.
- Incisional hernia: Usually appear at the site of a surgical wound after it heals.
- Inguinal hernia: Appears near the groin
- Femoral hernia: Appears at the front of the upper thigh
Although the tumor does not begin in the small bowel in most cases, cancer metastasizes to the small bowel from the colon, lung, breast, or other parts of the body. These tumors cause malignant bowel obstructions that progress slowly and block the way for the intestinal contents. However, this accounts for a small percentage of the causes of small bowel obstructions.
On the other hand, in the large intestine, the most common causes of colonic obstruction are the following.
Colorectal Cancer (also known as Colon Cancer)
This is the third most common cancer type, either in women or men. Most patients do not know they have colon cancer until they feel changes in their bowel movements. If undiagnosed, it can grow, causing a gradual narrowing of the large bowel.
Colorectal cancer patients begin with periods of constipation that will become more frequent until the bowel ultimately obstructs. These patients also tend to suffer from various symptoms, including abdominal pain, bloody stool, weakness, or fatigue. Nonetheless, most of the patients will not feel any symptoms in the first stages. The symptoms will vary according to the size and the location of the tumor.
Volvulus consists of a portion of the large bowel that twists abnormally around itself. This twist will ultimately obstruct the intestinal content. It consists of a closed loop of bowel with a base that is pinched.
It is a condition that is far more common in older adults above 65 years old that have a history of chronic constipation. However, there are cases in which this condition may affect children. Children with congenital disabilities like intestinal malrotation are at more risk of suffering a volvulus.
Diverticulums are small protrusions of the large bowel. They are small poaches with the shape of a balloon. These small pouches can become infected. If this happens, the condition will receive the name diverticulitis.
Many causes can lead to infection of these diverticulums. After the infection, diverticulums go through a healing phase in which they form scars on the colon wall. These scars receive the name of stricture and may become tighter with time. Strictures can finally cause a partial blockage or full blockage of the colon.
What is intestinal pseudo-obstruction?
It is a condition that resembles an intestinal blockage. Still, when the doctor performs the pertinent tests, there is no sign of physical obstruction. This condition also receives the name of paralytic ileus.
In this disease, there is a disruption of the coordination in muscle contraction of the intestines. The origin of this disruption may be trouble within the muscle or the nerves of the bowel, leading to a slowing or stopping the motion of the intestines and the food movement through the gastrointestinal tract.
There are many possible causes for paralytic ileus to happen; among the most common are the following.
- In abdominal or pelvic surgery, paralytic ileus accounts for one of the most common complications after any abdominal or pelvic surgery.
- Infectious diseases
- Medications that may affect the nervous system
- Muscle and nerve disorders like Parkinson’s disease.
What are the symptoms of bowel obstruction?
The symptoms of the bowel obstruction will depend on the bowel. There are overall similar symptoms for a small bowel obstruction and large bowel obstruction. Nonetheless, these are symptoms that a doctor should check and perform imaging tests to make an assertive diagnosis. Imaging will help the doctor to see if the suspected bowel obstruction is really an obstruction.
Among the symptoms are the following:
Small Bowel Obstruction or Large Bowel Obstruction symptoms
- Cramping abdominal pain. Usually comes in waves; if it becomes constant, that may be a symptom of a complication.
- Abdominal or belly pain that can vary on its intensity
- Nausea and vomiting
- Abdominal swelling
- Abdominal distention (bloating)
- Unable to fart as no gases go through the colon and rectum
- Unable to defecate
- Loss of appetite
Symptoms that could precede a bowel obstruction
- Constipation (less than three bowel movements a week). In some patients, this was a long-lasting or chronic symptom.
- Bloody stool in case of colorectal cancer.
- Narrower feces
- Pain in the lower and left portion of the abdomen for months or years.
How is a bowel obstruction diagnosed?
There are several ways to identify and diagnose a bowel obstruction. The first one and the most important is the physical exam. The doctor will perform a series of questions to recognize the symptoms and family history.
The doctor will also look for bowel obstruction signs by inspecting the abdomen and hearing the bowel movement with a stethoscope. After this, the doctor may ask for a series of imaging tests to make an assertive diagnosis.
The following tests will help your doctor.
- X-Ray: Although it is very simple, many obstructions can be seen with an abdominal x-ray. On the other hand, some intestinal obstructions cannot be identified with this test.
- CT scan: It is a more powerful tool that enables the doctor to see the abdomen from different perspectives. These images have more information than a simple X-Ray, enabling the doctor to identify both the bowel obstruction and its possible cause.
- Ultrasound: Ultrasound is a type of test that enables the doctor to see soft tissues within the abdomen—for example, the bowels. On children, this is a very common test used if they suffer from an abdominal obstruction. Nonetheless, it also helps with identifying the condition in adults.
How is bowel obstruction treated?
Initially, this is a condition that generally requires hospitalization. First of all, doctors should look to stabilize your situation. In order to achieve this, there are two basic things to do.
The first one is to place an Intravenous line through the veins to hydrate the patient. The second one is to place a nasogastric tube through the nose that reaches the stomach to suck out air and relieving the abdominal distention.
Partial blockages may improve within very few days after the stabilization of the patient. Doctors will introduce little by little liquids into the patient diet to check the tolerance. After this, the doctor may include solid foods.
On the other hand, if it is a complete bowel obstruction, the scenario can be a little bit more difficult. Most of the time, these obstructions require surgery to correct the problem. Surgery will help to remove the cause of obstruction, repair the hernia, or fix the bowel.
What are the potential complications of bowel obstruction?
Bowel obstruction can lead to more serious conditions if left untreated. These complications can be life-threatening and may even lead to death. The complications can be the following:
- Strangulation/Tissue Death: If the intestinal obstruction is too tight, it can reduce the blood supply to any part of the intestines. This lack of blood will ultimately cause the intestinal wall to die due to a lack of nutrients and oxygen. The tissue death may also cause that the wall becomes fragile, causing a perforation in the bowel.
- Peritonitis: After the bowel perforates, the intestinal content will go into the abdominal cavity. The intestinal content will cause an infection and swelling within the abdominal cavity that receives the name of peritonitis. It is a life-threatening situation that requires urgent medical attention and surgery to fix the cause.
Do you think you have a bowel obstruction?
This tool is a Bowel Obstruction Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this ailment. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of a bowel obstruction. Using the tool is free and would only take a few minutes.