Bowel Obstruction and Blockage

Your small and large intestines normally work in a coordinated system of movement. If something interrupts these coordinated contractions, it can cause a functional intestinal obstruction.

Understanding an Intestinal Obstruction

An intestinal obstruction means that something is blocking your intestine. Food and stool may not be able to move freely.

When your intestine works normally, digested food moves from your stomach to your rectum. Along the way, your body breaks food down into usable parts and turns the rest to feces (stool). You eventually eliminate it through a bowel movement.

An intestinal obstruction may partially or completely block this natural process. A complete blockage is an emergency and needs medical attention right away.

Among the many possible reasons for an intestinal obstruction are:

• Abdominal adhesions. These are growths of tissue in bands that may force your intestines out of place.
• Hernia. A hernia is a split in the muscle wall of your abdomen. Hernias can cause bulges and pockets. These may block your intestine.
• Volvulus. A volvulus happens when part of your intestine twists around itself. This creates a blockage.
• Intussusception. This condition means that a segment of your intestine slides into another segment. This narrows but may not block your intestine.
• Scarring. When your body heals small cuts (wounds), scar tissue forms. This can happen inside your intestine as well. These scars can build up and create partial or total intestinal blockages. Scarring can result from tears in your intestinal wall, belly (abdominal) or pelvic surgery, or infections.
• Inflammatory bowel disease. Crohn’s disease and ulcerative colitis are 2 examples.
• Diverticulitis. Tiny pouches (diverticulae) can grow off the large intestine lining. These may become inflamed.
• Tumors. Growths may be cancer or harmless (benign). Either way, they can block your intestine completely or partially.
• Foreign objects. Nonfood objects that you swallow on purpose or accidentally may cause partial or complete intestinal obstruction.
• Meckel diverticulum. About 2 in 100 people are born with this additional small pouch inside the intestine.

Symptoms

Symptoms of intestinal obstruction are:

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• Severe pain in your belly
• Severe cramping sensations in your belly
• Throwing up
• Feelings of fullness or swelling in your belly
• Loud sounds from your belly
• Feeling gassy, but being unable to pass gas
• Constipation (being unable to pass stool)

Who’s at risk

You may be at risk of an intestinal obstruction if you have:

• Abdominal surgery. This can increase the risk for scar tissue or other growths. They also increase the risk for hernias.
• Diverticulosis. This condition means that something irritates the lining of the intestine. It may cause inflammation, infection, and scarring, which can lead to blockage.
• Cancer
• Inflammatory bowel disease
• Swallowed foreign objects
• Chronic constipation

Diagnosis

To diagnose your condition, your healthcare provider will consider your overall health and health history. He or she will ask you about your symptoms. Tell your provider where your pain is and how strong it is. Also tell your provider if you have had changes in your bowel movements or appetite. Tell your provider if you have any other unusual symptoms, such as digestive sounds or a feeling of being bloated.

Your provider will give you a physical exam. You may also need certain tests. These may include:

• Abdominal X-ray
• Barium contrast study
• CT scan
• MRI
• Contrast fluoroscopy

Treatment

The treatment your healthcare provider recommends will depend on what is causing the blockage. For a simple blockage you may need to have only fluids and no solids to eat. Your provider will work to fix any metabolic problems. You may have an intestinal decompression. This is usually done with a nasogastric tube. You may also have bowel rest.

You will need surgery right away if your intestinal obstruction is more complicated. This could be from a tear (perforation) in the intestine or a problem with blood flow. You may also need surgery if other treatment does not remove the blockage. The goal is to remove the blockage and repair your organs.

Your provider also might recommend using a small, flexible tube to keep your intestine open, instead of having more invasive surgery.

Complications

Complications are problems caused by your condition. Complications of intestinal obstruction include:

• Pain
• Constipation
• Loss of appetite
• Inability to keep food or fluids down
• Fever
• Infection
• Tear (perforation) of the intestine
• Death (rare)

Prevention

Abdominal adhesions that occur after surgery may be prevented if your medical team takes certain measures. These include keeping the incision site moist instead of dry. Discuss in advance what steps your medical team can take to reduce your risk for adhesions after surgery.

When to call the doctor

Get medical help right away if you have symptoms of intestinal obstruction. These include severe abdominal pain, vomiting, and inability to pass stool.

How to manage or live with this condition

Follow your doctor’s instructions. If he or she has told you to change your diet as part of your treatment, stick to the new plan. The goal of the diet is to reduce the work that your digestive tract has to do, while still giving you the nutrition you need.

Find a Doctor

• Rectal Bleeding
• Malabsorption
• Mesenteric Arterial Insufficiency

• Motility Disorders
• Short bowel syndrome
• Superior Mesenteric Artery Syndrome
• Swallowing Disorders
• Proctitis
• Abdominal Pain
• GI Tract Motility Disorders
• Bowel Obstruction
• Nausea
• Clostridium Difficile

At Another Johns Hopkins Member Hospital:

• Howard County General Hospital
• Sibley Memorial Hospital
• Suburban Hospital

Find a Treatment Center

Find Additional Treatment Centers at:

• Howard County General Hospital
• Sibley Memorial Hospital
• Suburban Hospital

Bowel Obstruction and Blockage

An intestinal obstruction happens when your intestines become blocked so that digested foods and fluids buildup. If not treated, a blockage can lead to a dangerous rupture.

Digested food particles must travel through 25 feet or more of intestines as part of normal digestion. These digested wastes are constantly in motion.

However, intestinal obstruction can put a stop to this. An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food.

If intestinal obstruction happens, things will build up behind the site of the blockage. This buildup includes:

If enough pressure builds up, your intestine can rupture, leaking harmful intestinal contents and bacteria into your abdominal cavity. This is a life threatening complication.

There are many potential causes of intestinal obstruction. Often, this condition can’t be prevented. Early diagnosis and treatment are crucial. An untreated intestinal obstruction can be fatal.

Intestinal obstruction causes a wide range of symptoms, including:

• severe bloating
• abdominal pain
• decreased appetite
• nausea
• vomiting
• inability to pass gas or stool
• constipation
• diarrhea
• severe abdominal cramps
• abdominal swelling

Some symptoms may depend on the location and length of time of the obstruction. For example, vomiting is an early sign of small intestine obstruction. Vomiting may also occur with an obstruction of your large intestine, if it’s ongoing.

A partial obstruction can result in diarrhea, while a complete obstruction can make you unable to pass gas or stool.

Intestinal obstruction may also cause serious infection and inflammation of your abdominal cavity, known as peritonitis. This occurs when a portion of your intestine has ruptured. It leads to fever and increasing abdominal pain. This condition is a life threatening emergency requiring surgery.

An obstruction can be partial, which may get better without surgery. A complete blockage is more likely to need intestinal surgery.

Mechanical obstructions

Mechanical obstructions are when something physically blocks your intestine. In the small intestine, this can be due to:

• adhesions, which are made of fibrous tissue that can develop after any abdominal or pelvic surgery or after severe inflammation
• volvulus, or twisting of the intestines
• intussusception, a “telescoping,” or pushing, of one segment of intestine into the next section
• malformations of the intestine, often in newborns, but can also occur in children and teens
• tumors within your small intestine
• gallstones, although they rarely cause obstructions
• swallowed objects, especially in children
• hernias, which involve a portion of your intestine pushing outside the muscle or tissue in your body or into another part of your body
• inflammatory bowel disease, such as Crohn’s disease

Although less common, mechanical obstructions can also block your colon, or large intestine. This can be due to:

• stool stuck in your colon or rectum (impacted stool)
• adhesions from pelvic infections or surgeries
• ovarian cancer
• colon cancer
• meconium plug in newborns (meconium is the stool babies first pass)
• volvulus and intussusception
• diverticulitis, the inflammation or infection of bulging pouches of intestine
• stricture, a narrowing in the colon caused by scarring or inflammation

Nonmechanical obstruction

Your small and large intestines normally work in a coordinated system of movement. If something interrupts these coordinated contractions, it can cause a functional intestinal obstruction.

This is generally known as a nonmechanical obstruction. If it’s a temporary condition, it’s referred to as an ileus. It’s called a pseudo-obstruction if it becomes chronic, or long-term.

Causes for an ileus include:

• abdominal or pelvic surgery
• infections, such as gastroenteritis or appendicitis
• some medications, including opioid pain medications
• electrolyte imbalances

Intestinal pseudo-obstruction can be caused by:

• Parkinson’s disease, multiple sclerosis, and other nerve and muscle disorders
• Hirschsprung’s disease, a disorder in which there’s a lack of nerves in sections of the large intestine
• disorders that cause nerve injury, such as diabetes mellitus
• hypothyroidism, or an underactive thyroid gland

First, a doctor may push on your abdomen to examine it. They then listen with a stethoscope to any sounds being made. The presence of a hard lump or particular kinds of sounds, especially in a child, may help determine whether an obstruction exists.

Other tests include:

• blood tests to check for:
  • blood counts
  • liver and kidney function
  • levels of electrolytes

  Treatment depends on the location and severity of the obstruction. Do not attempt to treat the problem at home. The appropriate treatment depends on the type of intestinal obstruction.

  For partial obstructions or an ileus, it may be possible to treat by simply resting the bowels and getting intravenous (IV) fluids. Bowel rest means you’ll be given nothing to eat, or clear liquids only, during that time. If the cause of the obstruction is known, your doctor treats that as well.

  Treating dehydration is important. A doctor may give you IV fluids to correct your electrolyte imbalance. A catheter may be inserted into your bladder to drain urine.

  A tube may need to be passed through your nose and down into your throat, stomach, and intestines to relieve:

  If your problem is due to the use of narcotic pain medications, your doctor can prescribe medication that reduces the effect of the narcotics on your bowels.

  Surgery will be required if these measures fail or if your symptoms become worse. Treatment in this case typically requires a hospital stay. You’ll be given IV fluids, because in addition to relieving dehydration, they help prevent shock during surgery.

  A severe complication of a bowel obstruction can be permanent damage to your intestine. If this occurs, a surgeon will perform an operation to remove the section of dead tissue and rejoin the two healthy ends of your intestine.

  While prescription medications can’t treat the obstruction itself, they can help reduce your nausea until further treatments are performed. Examples of medications your doctor may prescribe include:

  • antibiotics to reduce infection
  • anti-nausea medicines to keep you from vomiting
  • pain relievers

  You shouldn’t ignore the symptoms of an intestinal obstruction or attempt to treat an intestinal obstruction at home.