Bowel Obstruction or Intestinal Obstruction: Causes, Risk Factors, Symptoms, Signs, Treatment, Investigations
What is Bowel Obstruction or Intestinal Obstruction
Bowel Obstruction or Intestinal Obstruction is a medical condition where there is blockage in the intestines which prevents the food or liquid from passing through to the small intestine or large intestine (colon). The cause for intestinal obstruction may be fibrous bands of tissue in the abdomen (adhesions), diverticulitis, hernias or tumors. If treatment is not done immediately, then the blocked regions of the intestine die (necrosis) causing serious problems. With immediate medical care, intestinal obstruction can be successfully treated.
Causes and Risk Factors for Bowel Obstruction or Intestinal Obstruction
Common Causes for Mechanical Obstruction of the Small Intestine
- Intestinal adhesions (bands of fibrous tissue) which form after abdominal or pelvic surgery in the abdominal cavity.
- Hernias where portions of intestine pushes into another part of body.
- Tumors in the small intestine.
- Inflammatory bowel diseases, e.g. Crohn's disease.
- Twisting of the intestine known as volvulus.
- Intussusception which is the telescoping of the intestine.
Common Causes for Mechanical Obstruction of the Colon
- Cancer of the colon.
- Twisting of the colon (volvulus).
- Impacted feces.
- Narrowing of the colon due to inflammation and scarring (stricture).
Paralytic Ileus is a condition which can cause signs and symptoms of intestinal obstruction without an actual physical obstruction.
Causes for Paralytic Ileus Include:
- Abdominal surgery.
- Pelvic surgery.
- Certain medications such as antidepressants and pain killers which affect muscles and nerves.
- Disorders of muscles and nerves such as Parkinson's disease.
Risk Factors of Bowel Obstruction or Intestinal Obstruction
- Abdominal or pelvic surgery can cause adhesions resulting in intestinal obstruction.
- Crohn's disease causes thickening of the intestinal walls thus resulting in narrowing of the passageway.
- Abdominal cancer, especially after surgery to remove an abdominal tumor or radiation therapy.
Signs and Symptoms of Bowel Obstruction or Intestinal Obstruction
- Intermittent, crampy abdominal pain.
- Inability to have a bowel movement.
- Inability to pass gas.
- Abdominal distention or swelling.
Treatment for Bowel Obstruction or Intestinal Obstruction
Treatment depends on the cause and usually requires hospitalization.
- Fluids are given via intravenous (IV) line into the vein.
- For relieving the abdominal swelling, an NG tube is put through the nose and into the stomach to suck out air and fluid.
- Catheter is placed into the bladder to drain and collect urine for testing.
- In partial obstruction, some food and fluid is able to pass through and patient may not require further treatment till he/she is stabilized. A special low-fiber diet is recommended by the doctor, so it is easy to digest. If the obstruction does not clear on its own, then surgery may be required.
- In complete mechanical obstruction, nothing is able to pass through the intestine; and surgery is the choice of treatment to relieve the blockage. The surgical procedure done depends on the cause of obstruction and the part of intestine which is affected. Surgery commonly comprises of removing the obstruction along with any part of the intestine which is damaged or has died.
- Instead of surgery, the doctor may treat the obstruction using a self-expanding metal stent. This stent helps in forcing open the colon so that the obstruction is cleared. Generally, these stents are used for treating people who have colon cancer or for those patients who are at high risk of emergency surgery. Once these patients are stable, they may still require surgery.
- Treatment for paralytic ileus: If the patient's signs and symptoms are caused by paralytic ileus, then the doctor may monitor patient's condition for a couple of days in the hospital. Paralytic ileus is a condition which is usually temporary and gets better on its own. If it does not, then the doctor may prescribe medications which cause muscle contractions and help in moving food and fluids through the intestines. If the cause of paralytic ileus is an illness or medication, then the doctor will address the underlying illness first or stop the medication which is causing the problem.
Investigations for Bowel Obstruction or Intestinal Obstruction
- Medical history and physical exam reveals swollen or tender abdomen or a lump, if present, in abdomen. The doctor may also listen for bowel sounds with a stethoscope.
- Imaging tests such as abdominal X-ray or CT scan help in confirming the diagnosis. The tests also help in determining if the obstruction is from paralytic ileus or whether it's a partial or complete mechanical obstruction.