Bowel Obstruction - Several Disorders Are Known To Cause This Disorder

Bowel or Intestinal Obstruction is a serious medical condition. It is brought upon by the partial or complete blockage of either the small or large intestine (colon). This obstruction blocks the otherwise smooth movement of digested food and fluids through the intestine.

As a result, a phenomenon known as ‘fecal vomiting’ may also occur, since the fecal matter has to be expelled from the body somehow. In prolonged or severe cases, the affected intestinal areas may become necrosed (dead) as well.

Symptoms of Bowel Obstruction

In total or absolute intestinal obstruction, neither feces nor flatus is passed. On the other hand, in case of partial obstruction, flatus is passed easily.

Common symptoms of an intestinal blockage include:

• Constipation
• Lack of gas
• Stiffness or hardness of belly
• Nausea and vomiting
• Diarrhea
• Abdominal distention (swelling) and bloating
• Abdominal discomfort and cramping
• Loss of appetite

Causes of Bowel Obstruction

1. Mechanical Blockage

This form of obstruction initiates due to some physical blockage. This may be in the small intestine or in the colon, and the causes differ accordingly.

Causes of Mechanical Obstruction of the Small Intestine include:

• Intestinal Adhesions – Bands of fibrous tissue that form in the abdominal cavity. These adhesions are often post-op (after operation) complication of abdominal surgery
• Hernia – A weakening of the intestinal muscle which causes it to extend out into other parts of the body
• Volvulus – Actual twisting and knotting of the intestine resulting in complete intestinal obstruction. Immediate surgery is required in most of the cases
• Intussusception – Telescoping of one portion of the intestine into the other; usually seen in the children
• Inflammatory Bowel Disease (IBD) – This includes crohn’s disease only, not ulcerative colitis.
• Tumor obstructing the intestinal wall

Causes of Mechanical Obstruction of the Large Intestine (Colon) include:

• Diverticulitis – formation of divertcula (inflamed bulging pouches) in the digestive tract
• Volvulus – twisting and knotting of the intestine
• Scarring or inflammation – narrowing of colon
• Colon cancer
• Impacted feces

2. Nervous or Muscular loss of coordination

 Causes of such a blockage may include:

• Muscular disorder
• Nervous disorder
• Infection
• Abdominal surgery
• Pelvic Surgery
• Certain pain-relievers and anti-depressants

See Also: Inflammatory Bowel Disease (IBD)

Diagnosing a Possible Bowel Obstruction

• Taking Medical History: This includes questions regarding previous digestive problems, any abdominal surgeries or procedures and any allergies or other medical conditions that you or your family may have. The doctor will ask you questions regarding your signs and symptoms as well.
• Physical Examination: This can include listening for an obstruction by placing a stethoscope to the abdominal area, and feeling the belly for any tenderness or hardness.
• CT-Scan: This can help the doctor locate the exact site and cause of the obstruction. It also helps in assessing whether the blockage is partial or complete. 
• Colonoscopy: This procedure may be performed to visually see the inside of the colon.
• X-rays: This test will reveal a clearer picture of the colon and the obstruction as well.

Bowel Obstruction: Treatment And Prevention

Most intestinal obstructions, especially partial, usually get better without any major treatment. The following procedures may be performed by the doctor to treat intestinal obstruction:

Nasogastric (NG) tube: This will help the patient feel a bit comfortable. Medicine and fluids are administered intravenously (IV). A tiny tube known as a nasogastric (NG) tube is passed via the nose down into the stomach. This tube removes the accumulated gases and fluids from the abdominal area, and helps relieve pressure and discomfort. No eatables will be allowed.  

Enemas: This procedure involves flushing liquids or gas through the anal sphincter to open up the blockage in the bowel.

Small Mesh Tubes: A stent is a small, expandable tube that is used to open up a blocked artery or vein, or in this case, an intestinal blockage. A balloon inside the stent is inflated which helps open up the blockage and ease the flow of fluids and gases.

In such cases, blood supply to the affected area is cut off and surgical treatment becomes necessary. The following procedures may be performed:

Colostomy: This surgery involves removal of a part of the large intestine (colon) or rectum. It may be temporary until the remaining part of the bowel heals, or permanent, if the entire lower colon or rectum is removed.

The surgeon makes an incision (opening) through the skin above the abdomen. The diseased part of the intestine is either removed or left and allowed to heal. The end of the upper part of the intestine (where stool is made) is then sewed to this opening in the skin.

Stool continues to be made in the upper part of the intestine and is expelled from the body via the opening. A disposable bag may be placed over the opening to collect the stool, or a pouch may be created inside the patient’s body, and the stool may be removed via enema.

Ileostomy: This procedure is performed when the lower part of the colon is damaged or diseased, as in the case of Crohn’s disease or ulcerative colitis.

An opening (stoma) is made in the skin above the abdomen. A portion of the small intestine (ileum) is then brought to this opening and is sewed.

A disposable bag may be placed over the opening to collect the stool, or a pouch may be created inside the patient’s body, and the stool may be removed via enema.

Complications from Bowel Obstruction

If left untreated, an intestinal obstruction may get complicated, resulting in the following problems:

• Infection
• Death of affected intestinal tissue - necrosis
• Perforation (physical hole) in the intestinal wall
• Jaundice
• Electrolyte imbalance in blood
• Infections of the lungs and blood in newborns

Prognosis - Outcomes of the treatment

The outcome usually depends on the cause of the obstruction. If the cause is diagnosed and easily treated on time, a full and rapid recovery may be expected. 

See Also: Irritable bowel syndrome

Prevention of Bowel Obstruction

The causes determine the preventive steps to be taken. Appropriate treatment for tumors and hernias can significantly lower the risk for intestinal obstruction. However, certain cases are unavoidable and untreatable.