Bowel Obstruction

A bowel obstruction can be a serious condition, which can occur in the large or small bowel. A small bowel obstruction commonly occurs where loops of intestine can easily get blocked or twisted. A blockage can be partial or total, mechanical (caused by an object) or non-mechanical (caused by paralysis of movement to the bowel). A blockage can stop the passage of all food, liquid and gas and cause considerable pain. In severe conditions the bowel may leak, perforate or burst, a toxic dilation: Toxic megacolon may occur or a gram negative septicaemia. These are all very serious life threatening complications which require urgent hospital treatment.

Small Bowel Obstruction

There are many reasons why a small bowel obstruction may happen including:

  • Mechanical obstruction
  • Adhesions – fibrous tissues that develops usually after abdominal or pelvic surgery
  • Volvulus – otherwise known as a twisted bowel
  • Intussusception – ‘telescoping’ of the bowel, when a segment of bowel pushes into another segment causing it to collapse
  • Tumours – more likely in the large bowel. Small bowel cancer is still relatively rare
  • Hernias – which can cause strangulation of the bowel
  • Swallowed objects – Foreign objects swallowed by children can get stuck in the bowel
  • Inflammatory Bowel Disease – diseases like Crohn’s and Ulcerative Colitis can cause strictures or narrowing in the bowel which can cause obstructions
  • Impacted stool: Severe constipation usually in elderly or in bedbound or wheelchair bound patients.
  • Infection: appendicitis, pancreatitis, intra-abdominal sepsis or abscess.
  • Diverticulitis: a chronic blockage of the sigmoid large bowel from out-pouchings in the bowel wall.

Non-mechanical obstruction

A non-mechanical obstruction is also referred to as ‘ileus’ or ‘paralytic ileus’, this is when the natural movement of the bowel called peristalsis fails to happen. Ileus is usually temporary. Some medical conditions can cause this to have a long term effect and this is called ‘Intestinal pseudo-obstruction. This can be caused by:

  • Abdominal or pelvic surgery
  • Infections such as gastroenteritis or appendicitis
  • Opioid pain medications such as morphine or codeine
  • Parkinson’s Disease: A progressive neurological degenerative brain disease.
  • Diabetes Mellitus: An abnormal metabolism of sugars in the body.
  • Hirschsprung’s Disease: A congenital childhood condition where an abnormal segment of the bowel is non functional and causes obstruction.
  • Hypothyroidism: A low level of circulating thyroid hormone which causes a slowing down of general metabolism.

Symptoms of a bowel obstruction or a small bowel obstruction

Bowel obstruction symptoms of a bowel obstruction can be painful and distressing. You may experience the following symptoms:

  • Severe abdominal pain, cramps and bloating
  • Decreased appetite or inability to eat, weight loss
  • Nausea and/ or vomiting, progressing to bile vomitting (green bile fuid)
  • Inability to pass faeces or stool and possibly in severe cases gas.
  • Constipation or diarrhoea
  • Abdominal swelling

A bowel obstruction becomes an emergency if your abdominal pain increases and you start to experience a fever. This could be a sign of intestinal rupture, which can become life threatening.

How is a bowel obstruction diagnosed?
Your doctor may feel around your stomach to feel for any obvious signs of swelling or a lump. You may be sent for x-rays or a CT Scan to see if there is anything causing an obstruction. You may also have a colonoscopy, which is a camera inserted via the rectum to view the inside of the colon to check for any abnormalities.

Treatments for Bowel Obstruction

The treatment for a bowel obstruction will depend on what is causing it. For a total mechanical blockage, surgery will most likely be required. Most bowel obstructions will need some form of hospital intervention to relieve the problem. If you suspect that you have a bowel obstruction, you should seek medical advice as soon as possible to avoid the situation becoming life-threatening.

CONSERVATIVE TREATMENTS

Nasogastric Tube (NG Tube)

In order to help you feel more comfortable and release any pressure, your doctor may insert a small tube through your nose and down into your stomach. The tube will remove any fluids or gas trapped in your stomach and relieve any pain and vomiting. You will not be able to have anything to eat or drink to avoid adding any pressure or bulk to the blockage.

Watchful Waiting

If a paralytic ileus is suspected then your condition may be monitored for a few days to see if it resolves on it’s own accord. Most cases of ileus just require the bowel to be rested. You will be given fluids via a drip to keep you hydrated.

Therapeutic Enema

A barium or enema may be used to diagnose and treat an intussusception. During the procedure air or a liquid containing contrast is injected through the rectum into the bowel. The air or liquid will create pressure in the large bowel which will hopefully push out the folded piece of bowel. This is not always successful though and further surgery may be required.

Surgical Treatments

For a total blockage or severe stricture, surgery will be required to rectify the problem. There are several surgical procedures that can be performed depending on the cause of the blockage. It is common for someone with a chronic illness such as Crohn’s or Ulcerative Colitis to require surgery in order to relieve blocked or narrowed intestines. Some of the surgical procedures may require you to have a stoma in the form of a colostomy or ileostomy on a temporary basis.

Large Bowel Resection

The blocked or diseased part of your colon or large bowel may be removed surgically if you have a total blockage. The surgery can be performed laproscopically (via keyhole) or may be done as open surgery in an emergency. If the two pieces are bowel left are healthy then the ends will be stitched together or you may be given an colostomy where the colon is routed through an opening cut into your abdomen. You will then need to wear a stoma bag over the top to collect the waste.

Small Bowel Resection

A small bowel resection is when the diseased or blocked part of the small bowel is surgically removed. The surgery can be performed laproscopically (via keyhole) or may be done as open surgery in an emergency. If the two pieces are bowel left are healthy then the ends will be stitched together or you may be given an ileostomy where the small bowel is routed through an opening cut into your abdomen. You will then need to wear a stoma bag over the top to collect the waste.

Strictureplasty

This operation may be performed on patients with Crohn’s disease at this mostly affects the small bowel. Crohn’s disease can cause narrowing or strictures which can block the bowel and cause extreme pain. A strictureplasty is when the narrowed section is cut and sewn horizontally to widen the intestine.

Disclaimer: This information is only provided for general and background reading. The information should not be relied upon for treatment. The views provided are not necessarily those of the author or of the website. You should always take advice from your own general practitioner or treating specialist before a treatment is commenced or altered. In individual circumstances liability is not accepted for any reason by my-ileostomy.co.uk