Bowel Obstruction

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Introduction

What is bowel obstruction?

The bowel, or intestine, is the part of the digestive tract that absorbs nutrients and fluid from foods we eat. The residue of digested food passes through the bowel and is excreted during elimination, the final stage of digestion. This process can be interrupted or halted by the presence of a bowel obstruction, which is a blockage that prevents the passage of intestinal contents. The cause of the blockage can be mechanical, meaning that there is a physical obstruction. Mechanical blockage may be caused by scar tissue, adhesions, entrapment through a hernia, foreign bodies, gallstones, tumors, impacted feces, and volvulus (twisting of the intestines). Treatment for mechanical obstruction generally involves removing the source of the blockage, if possible.

Ileus, a malfunctioning of the synchronized contractions of the bowel, is another type of obstruction. Causes of ileus include electrolyte imbalances, gastroenteritis (inflammation or infection of the stomach and intestines), appendicitis, surgical complications, and obstruction of the mesenteric artery, which supplies blood to the abdomen. Certain drugs and medications can cause ileus, such as opioids and sedatives, which slow down peristalsis, the contractions that propel food through the digestive tract.

Bowel obstruction can produce symptoms, such as a distended abdomen, fullness, gas, painful spasms, constipation, diarrhea, nausea with or without vomiting, and foul-smelling breath. Treatment options include surgical placement of a tube through the stomach or nose to alleviate the distension and remove the obstruction. Some forms of bowel obstruction, such as those caused by paralytic ileus, may go away on their own.

Bowel obstruction is a serious medical condition that should be evaluated immediately by a health care provider. Seek immediate medical care (call 911) if you develop symptoms of bowel obstruction, such as abdominal pain, distension, or bloating, and are unable to eliminate feces or pass gas.

Symptoms

What are the symptoms of bowel obstruction?

Symptoms of bowel obstruction primarily affect the gastrointestinal system and include vomiting, diarrhea, abdominal fullness and distension (bloating), stomach pain and spasms, and constipation.

Common symptoms of bowel obstruction

Symptoms of bowel obstruction primarily affect the gastrointestinal tract and include:

  • Abdominal swelling, distension or bloating
  • Constipation
  • Diarrhea
  • Foul-smelling breath
  • Gas
  • Nausea with or without vomiting
  • Stomach pain and spasms

Symptoms that might indicate a serious condition

Bowel obstruction can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have these serious symptoms including:

  • Abdominal swelling, distension or bloating
  • Absent bowel sounds
  • Fever
  • Inability to eliminate feces or pass gas
  • Nausea with or without vomiting
  • Stomach pain and spasms
Causes

What causes bowel obstruction?

A bowel obstruction occurs when there is a blockage that prevents the passage of intestinal contents that should be excreted. Blockages can be mechanical or caused by ileus.

Mechanical causes of bowel obstruction

Mechanical obstructions are physical blockages due to various causes including:

  • Adhesions (scar tissue from previous surgery or infections)

  • Diverticulitis (inflammation of small pouches of the bowel)

  • Foreign bodies

  • Gallstones

  • Hernias

  • Impacted feces

  • Intussusception (sliding of part of the intestine into an adjacent part)

  • Tumors

  • Volvulus (twisting of the intestines)

Causes of ileus

Ileus, a malfunctioning of the movement of the bowel, is another type of obstruction. Causes of ileus include:

  • Appendicitis

  • Certain drugs and medications, such as opioids and sedatives, which slow down peristalsis, the contractions that propel food through the digestive tract

  • Electrolyte imbalances

  • Gastroenteritis (inflammation or infection of the stomach and intestines)

  • General anesthesia

  • Obstruction of the mesenteric artery, which supplies blood to the abdomen

  • Recent abdominal surgery

What are the risk factors for bowel obstruction?

A number of factors increase the risk of developing bowel obstruction. Diseases and tumors of the gastrointestinal tract are risk factors associated with bowel obstruction including:

  • Abdominal cancers

  • Hernia

  • Opioid drug use

  • Prior surgeries or radiation therapy that created scar tissue or adhesions

  • Recent general anesthesia

Treatments

How is bowel obstruction treated?

Treatment of bowel obstruction begins with seeking medical care from your health care provider, who will likely admit you to the hospital for treatment. Treatment usually involves placing a tube through the nose or stomach to alleviate the symptoms. In some cases, surgery is needed to clear the obstruction or treat the underlying cause.

Treatment to relieve the swelling or distension

The following measures are often used in the treatment of abdominal swelling from bowel obstruction:

  • Dietary restrictions to allow the obstruction to pass
  • Intravenous fluids to provide nutrients
  • Placement of a nasogastric tube to release the air and drain the fluid

Treatment for a mechanical obstruction

Surgery may be required to treat a mechanical obstruction. Procedures may include:

  • Surgery to reposition or remove strangulated intestinal tissue
  • Surgery to remove the obstruction

Treatment for obstruction caused by paralytic ileus

The following methods may be used to treat obstruction related to paralytic ileus:

  • Medication to induce peristalsis (intestinal contractions)
  • Monitoring in the hospital
  • Nasogastric tube placement

What are the potential complications of bowel obstruction?

Complications of untreated bowel obstruction can be serious or even life threatening. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of bowel obstruction include:

  • Intestinal tearing or perforation (hole)
  • Necrosis (death) of tissues and gangrene, which may require removal of the dead tissues
  • Spread of cancer
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Intestinal obstruction. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001306/.
  2. Intestinal obstruction. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000260.htm.
  3. Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13:432.
  4. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
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