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Bowel obstruction

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What is bowel obstruction?

Bowel obstruction is a blockage of the bowels (intestines) that prevents food and liquid contents from passing through the small or large bowel as normal.

The blockage can be partial or complete, and it may be caused by a physical obstruction or due to problems with the muscles or nerves of the bowel.

Common causes of bowel obstruction include hernias, tumours or scar tissue from previous surgery (adhesions).

Bowel obstruction is an emergency that needs immediate treatment to remove the obstruction and reduce the risk of permanent tissue damage. If you have, or suspect you may have, bowel obstruction, see your doctor or go to hospital immediately.

What are the symptoms of bowel obstruction?

Bowel obstruction often causes cramps or tummy pain that tends to come and go, eventually becoming constant.

Other symptoms of bowel obstruction may include:

  • tummy swelling
  • nausea and loss of appetite
  • vomiting and constipation
  • not being able to pass wind
  • diarrhoea or soft stools
  • tiredness

What causes bowel obstruction?

Bowel obstruction can arise when there is a physical blockage (mechanical) or when the bowels stop functioning normally (pseudo-obstruction).

The most common causes of obstruction are bands of scar tissue (adhesions) from previous abdominal surgery, hernias or tumours.

Other causes of bowel obstruction include:

  • treatment for previous cancer - including radiation, chemotherapy and surgery
  • bowel disease - such as Crohn’s disease, appendicitis and diverticulitis
  • foreign bodies - including gallstones that have passed into the gut and items that have been accidentally or intentionally swallowed
  • volvulus - when a loop of bowel twists around itself
  • intussusception - when 1 segment of bowel ‘telescopes’ into another
  • faecal impaction - from severe constipation
  • stricture - a narrowing of the bowel, sometimes from diverticular disease

How is bowel obstruction diagnosed?

Your doctor may suspect a diagnosis of bowel obstruction based on your symptoms, medical history and an examination of your abdomen and back passage.

You may also need imaging tests to diagnose bowel obstruction. These include:

  • X-rays - a dye (contrast) may be added to help see the obstruction better
  • CT scan
  • MRI or ultrasound

In some cases, your doctor may recommend other tests, including:

  • blood tests
  • endoscopy (sometimes with a biopsy) - this can be used to diagnose and treat bowel obstruction
  • laparoscopy or laparotomy - a procedure in which a surgeon looks into your abdomen through a cut or with a small tube that has a camera attached to it

What is the treatment for bowel obstruction?

Bowel obstruction is an emergency condition that needs to be treated quickly.

If you have bowel obstruction, you will usually be admitted to hospital for treatment. The treatment you receive is likely to depend on the specific cause of the obstruction.

Supportive treatment

In general, treatment for bowel obstruction includes:

  • IV fluids and electrolyte (mineral) replacement - given directly into your veins to correct dehydration
  • stomach decompression - a tube (nasogastric tube) is passed through your nose and into your stomach to reduce the flow of stomach contents towards the blockage
  • bowel rest - avoiding eating and drinking until your bowels are working well again
  • medicines - including painkillers and anti-sickness medicines
  • antibiotics - to reduce the risk of infection if you need surgery

If you have pseudo-obstruction, supportive treatment may be the only treatment you need to restore normal bowel function.

Surgery

You may need surgery or another procedure to help you if:

  • your bowel is completely blocked
  • your symptoms do not get better with supportive treatments
  • you develop complications
  • you have bowel strangulation
  • you have, or are at risk of developing, a hole in your bowel (perforation)

The type of surgery you need will depend on the cause of the bowel obstruction and the part of the bowel affected. Your doctor will usually remove the blockage and any damaged parts of your bowel.

Non-surgical procedures

Bowel obstruction can sometimes be treated using procedures that don’t involve surgery. These include:

  • sigmoidoscopy - a tube is inserted into the bowel (through the back passage) to clear an obstruction caused by a twist in the bowel (volvulus)
  • stenting - a narrow tube is inserted into the bowel, using an endoscope, to keep it clear and open
  • air or fluid enema - if you have bowel intussusception, air or a special fluid can be pumped into your bowel through your back passage to clear the obstruction

Once the blockage has been cleared, you may also need to have treatment for the underlying cause of the bowel obstruction, if it is known.

Can bowel obstruction cause complications?

Bowel obstruction is a serious condition that can lead to complications if it is not treated quickly.

Possible complications can include:

  • dehydration
  • electrolyte imbalances
  • kidney damage
  • bowel tissue damage - perforation (a hole may form in the bowel) or bowel tissue death
  • sepsis and peritonitis

Related articles

Bowel cancer

Constipation

Inflammatory bowel disease

Diverticular disease and diverticulitis

Inguinal hernia

Date of last review: 24 July 2020

References

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Dynamed.com. (2019). [online][Accessed 25 Jun. 2019]. Available here.

Jenkins, J., Pring, E. and Malietzis, G. (2019). Small bowel obstruction - Symptoms, diagnosis and treatment | BMJ Best Practice. [online] Bestpractice.bmj.com. [Accessed 25 Jun. 2019]. Available here.

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