Also known as an intestinal obstruction, a bowel obstruction is a condition in which part of the bowel becomes blocked. Obstructions can be caused by hernias, impacted feces, diverticulitis, and volvulus (twisting of the colon).
Crohn’s disease and other types of inflammatory bowel diseases can also lead to bowel obstructions, and they may develop due to the presence of cancer in the colon. In adult patients, the most frequent causes of bowel obstructions are colon cancer and intestinal adhesions that may form after abdominal or pelvic operations.
In pediatric patients, telescoping of the intestine (intussusception) is the most frequent cause of a bowel obstruction. Doctors evaluate patients for possible bowel obstructions with a physical exam.
During the exam, the physician will gently feel the abdomen for any lumps or tenderness, and they will use a stethoscope to listen for the presence of bowel sounds. X-rays, CT scans, ultrasounds, and air or barium enemas may be necessary to properly diagnose a bowel obstruction.
Treatment normally requires hospitalization. Patients may have surgery to remove the blockage, and metal stents are sometimes needed.
Signs and Symptoms of Bowel Obstruction
The symptoms described below are some of those most commonly encountered in cases of bowel obstructions. Since the complications of this condition can be very serious, patients should seek immediate evaluation if they experience any of these signs.
1. Intermittent Abdominal Pain
Intermittent abdominal pain may occur during the early stages of a bowel obstruction. If the obstruction worsens, pain can become severe and persistent. Most patients describe the pain as a cramping sensation.
To assess abdominal pain, doctors will ask the patient about when the pain began, how long it lasts, and if it occurs after eating or other activities. The doctor will also want to know whether the pain is sharp or dull and whether it occurs in a particular part of the abdomen or over a larger area.
When going to an appointment for abdominal pain, patients might wish to bring a list of their current medications, and it can also help to keep a journal noting when painful episodes have occurred and any potential triggers for the pain.
The doctor will perform a full abdominal exam to find out more about the potential causes of the patient’s pain. First, they will need to listen to the abdomen with a stethoscope to check bowel sounds are present and normal. The absence of bowel sounds is a potential indicator of a bowel obstruction.
Next, the doctor will gently feel the patient’s abdomen to check for lumps, hernias, or areas of pain that may provide clues as to the diagnosis. Depending on the results of the exam, imaging studies may be performed. Patients should always inform their healthcare team about any changes in their abdominal pain levels.
Constipation is often a symptom of a complete bowel obstruction. In these cases, no stool can pass through the intestines at all.
Constipation is typically diagnosed if patients have fewer than three bowel movements per week, though it can also be diagnosed if the patient strains during bowel movements or if they pass small, hard, or dry stools.
It can develop as a result of certain inflammatory bowel diseases and cancers, and it might also happen if patients do not get sufficient fiber in their diets. Eating dairy products or foods high in fat and sugar could also increase an individual’s chances of becoming constipated.
While dietary changes may help in mild cases, patients with severe constipation will likely need laxatives, enemas, or surgery to treat this symptom.
3. Loss of Appetite
Loss of appetite frequently develops when an intestinal blockage is present, and it can make constipation worse. Patients with blockages may feel eating increases their abdominal bloating and pain, and individuals who try to eat with this condition may vomit.
If left untreated, prolonged loss of appetite can cause weakness, malnutrition, and unintentional weight loss, and it could also lead to electrolyte imbalances that may be dangerous.
Since a loss of appetite might be due to tumors or other serious bowel conditions, patients who experience this symptom for more than a week should be examined by a doctor. Patients with persistent vomiting also need an examination.
Generally, most patients find their appetite returns to normal after a bowel obstruction is successfully treated.
4. Inability to Pass Gas
An inability to pass gas could be an indication of an advanced, complete bowel obstruction, and anyone who experiences this symptom should seek urgent medical care. Patients who cannot pass gas may notice their abdomen becomes severely bloated, and they may have significant pain.
To prevent tissue death and other serious complications, patients who cannot pass gas will often need emergency surgery to remove a complete bowel obstruction.
During the surgery, doctors will remove the obstruction, and they will also remove any bowel tissue that has died or otherwise become damaged. Some patients may have a procedure involving the placement of a metal stent into the colon.
To place a stent, surgeons attach it to an endoscope passed through the mouth or colon until it reaches the blocked area. The stent will expand once it is inside the colon, allowing the blockage to clear.
Patients who have any type of surgery to clear a bowel obstruction will be monitored closely, and they typically need to spend at least a few days in the hospital.
5. Abdominal Swelling
The abdominal swelling associated with a bowel obstruction can be severe, and it tends to get progressively worse.
While abdominal swelling associated with other conditions might come and go, the type of swelling associated with a bowel blockage can only be relieved with surgery or other specialist treatment; no medications or dietary changes will be effective.
Patients who have a swollen abdomen typically feel an uncomfortable sensation of fullness in the area, and nausea or vomiting may occur.
Eating is often difficult. To assess abdominal swelling, doctors will ask the patient about any personal or family history of bowel conditions and cancers, and they will also want to know if the swelling has changed over time.
During the physical examination, the doctor will gently tap the patient’s abdomen to check for fluid in the abdominal cavity, and they will also measure any abdominal masses that might be present.
The patient will be weighed to check for recent weight loss that could be concerning, and some patients may need to provide a stool sample to check for blood in the stool. In certain cases, the doctor might need to perform a rectal examination to check for fecal impaction.