What Causes A Bowel Obstruction?

August 26, 2023

Bowel obstruction is a medical emergency where the small or large intestine has become blocked and does not allow food to pass. A blockage in the bowel can cause the individual's intestine to split or rupture. When a bowel obstruction tears or ruptures the intestine, the contents before the blockage can spill into the abdominal cavity and cause a life-threatening infection. Symptoms of a bowel obstruction include constipation, diarrhea, vomiting, cramping, bloating, nausea, severe pain, inability to pass gas, and a swollen belly. A physician can use a physical examination, blood tests, endoscopy, computerized tomography scans, and contrast x-rays to pinpoint and diagnose an obstruction. Bowel obstruction treatment depends on its severity and its underlying cause, though common treatments include stool softening medication, intravenous fluids, nausea medication, pain relievers, antibiotics, use of a nasogastric tube, surgical procedures, and therapeutic enema.

Numerous mechanisms can cause an individual to develop a bowel obstruction. Learn about them now.

Intestinal Adhesions

Bands of fibrous scar tissue that develop in an individual's abdominal organs are referred to as intestinal adhesions, which can cause an individual's intestine to bind to parts of itself or the individual's abdominal wall. Intestinal adhesions develop as a complication of abdominal surgery, certain types of infections, or a condition called endometriosis. Intestinal adhesions are a permanent deformity unless medical intervention is used to cut them. The bands of fibrous tissues around the intestines of an affected individual can partially or fully obstruct the movement of food through the intestine. Part of an individual's intestine that has been obstructed by intestinal adhesions can frequently become blocked and unblocked. Intermittent bouts of symptoms indicate a partial obstruction in someone with intestinal adhesions. Abdominal pain, vomiting, an inability to pass gas, dehydration, and abdominal swelling can occur in a bowel obstruction due to intestinal adhesions.

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A hernia is a condition where an individual's muscular wall that holds the abdominal organs in place or peritoneum becomes weakened or perforated. This perforation or weak spot allows the affected individual's internal organs to bulge outward. Areas where hernias commonly occur include an individual's groin, upper abdomen, belly button, and near any surgical scars. A hernia is less apparent in a patient when they are lying down flat, and more apparent when they are coughing or laughing. Most hernias do not produce symptoms, but straining, standing, and lifting heavy items can cause the affected individual to experience pain, vomiting, nausea, heartburn, and an inability to push the hernia back into place. When the intestine becomes lodged partway through the peritoneum, it can block food from passing or cause an intestinal obstruction. When an individual has an obstruction due to a hernia in their intestine, surgery is required for treatment.

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Twisted Bowels

Twisted bowels describe a condition where an individual's large or small intestine twists abnormally. Adults are more likely to have a sigmoid volvulus or a twist that occurs in their large intestine, where children are more likely to experience a twist in their small intestine. Children develop twisted bowels when there is an issue with how the intestines form that causes them to establish in the incorrect location in the abdomen. An enlarged colon, Hirschsprung's disease, narrow colon base connection, pregnancy, abdominal adhesions, detached colon, and chronic constipation can cause twisted bowels to occur in an adult. When an individual's bowels become twisted, the flow of food through them can become obstructed at the site of the twist. This is referred to as a volvulus precipitated bowel obstruction. Emergency surgery is required to re-open the bowel and restore blood flow to the twisted region of the intestine.

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Intussusception is a condition where one part of an individual's intestine telescopes, or slides into another part of their intestine. The most common location in the gastrointestinal tract for an intussusception to occur is the junction where the small intestine meets the large intestine, but it can occur anywhere in the intestinal tract. The mechanism behind this condition is unknown but is thought to be associated with a virus that causes the intestinal lining to swell and subsequently slip into the intestine underneath it. Intussusception is also thought to be associated with a birth defect in some patients, like a diverticulum or polyp. The part of the intestine that has telescoped into the other can become blocked or obstructed, not allowing food to pass through it. Symptoms of a bowel obstruction due to intussusception include periods of abdominal pain that alternate with periods of relief, lethargy, nausea, vomiting, mucus in stool, and bloody stools. This type of intestinal obstruction is treated using a liquid contrast enema or a surgical procedure to accomplish reduction.

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Diverticulitis is an infection or inflammation in an individual that occurs in small pouches in the intestinal wall. Diverticula describes the small pouches that form on the intestinal wall. The diverticula can develop at any point in the intestines, but most commonly form at the ends of the sigmoid and descending colons. There is an acute and chronic form of diverticulitis. The severity of an individual's diverticulitis can range from a minor abscess to a massive perforation or infection of the intestine. Constipation, diarrhea, boating, thin stools, abdominal swelling, and abdominal pain can indicate a patient's diverticulitis has caused the development of a bowel obstruction. The severe swelling and inflammation that occurs in the intestine of an affected individual are what can cause an obstruction in the intestine that does not allow food to pass.

Antibiotics such as amoxicillin and metronidazole are typically prescribed if an infection is present, and patients with diverticulitis are often advised to follow a diet of clear liquids for a few days. Some individuals may need to have needle drainage or a bowel resection. Since infections can progress rapidly, patients who develop a fever of 104 degrees Fahrenheit or higher should see their doctor immediately, and immediate attention is also necessary if vomiting persists for more than two days or if the patient cannot keep liquids down for twenty-four hours. Surgery or intravenous medication is needed to treat a patient affected by a bowel obstruction caused by diverticulitis.

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Crohn's Disease

Crohn's disease is a chronic condition in which the digestive tract becomes inflamed. The ileum (the lowest segment of the small intestine) and colon are the most frequently affected areas of the digestive tract. Patients with Crohn's disease have symptomatic episodes followed by periods of remission. Some of the most common symptoms include abdominal pain, diarrhea, fever, reduced appetite, weight loss, and blood in the stool. Individuals with severe Crohn's disease could also notice inflamed joints and inflammation of the skin, eyes, bile ducts, or liver. Children with this condition may have delays in growth and sexual development. To diagnose Crohn's disease, doctors may perform a colonoscopy or a capsule endoscopy, and CT and MRI scans might be necessary. Some patients may be advised to have a balloon-assisted enteroscopy, and blood tests for infection and anemia will be completed. Treatments include anti-inflammatory medicines, immunosuppressants, and antibiotics. Patients may be given pain relievers, anti-diarrhea medication, and vitamin supplements as well. In severe cases, a feeding tube could be necessary, and surgery to remove the damaged portion of the patient's digestive tract might be performed as a last resort.

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Impacted Stool

Also known as fecal impaction, impacted stool develops when fecal matter becomes stuck in the colon. Patients with this condition may experience abdominal pain, bloating, nausea, vomiting, and unexplained weight loss. In severe cases, fever, confusion, rapid pulse, and dehydration could occur. Patients may develop impacted stool as the result of a spinal cord injury or complications from colorectal and pelvic surgeries. Individuals who eat a low-fiber diet may be more at risk of experiencing impacted stool, and frequent diarrhea increases the risk as well. Impacted stool requires urgent treatment, and patients with any of the aforementioned symptoms should head to the emergency room. During the diagnostic process, the doctor will perform a physical examination of the patient's abdomen to detect masses, and a rectal examination will be conducted. Patients might need to have abdominal x-rays and ultrasounds, and a barium enema could be recommended. Fecal impactions may be treated with laxatives, manual removal, enemas, and water irrigation.

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Infections such as gastroenteritis and appendicitis can sometimes lead to bowel obstructions. Gastroenteritis (stomach flu) is a viral infection transmitted through the ingestion of contaminated food or water. Patients with this infection could have a fever, and nausea, vomiting, abdominal cramps, and diarrhea are common. Symptoms tend to begin within one to three days of exposure, and patients may be ill for one to ten days. Appendicitis is an inflammation of the appendix, and symptoms typically have a sudden onset. Individuals with appendicitis could experience sharp, sudden pain on the right side of the lower abdomen, and the pain may worsen with coughing and walking. Nausea, vomiting, fever, constipation, and loss of appetite could also occur. This condition is considered a medical emergency, and patients with suspected appendicitis should seek immediate treatment at the emergency room. Surgery to remove the appendix is the standard treatment.

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Colon Cancer

In adults, colon cancer is one of the most common causes of a bowel obstruction. This type of cancer is most frequently diagnosed in patients who are fifty years old or older, and individuals who have Crohn's disease are at an increased risk of this condition. In the early stages of colon cancer, patients often have no symptoms. Potential symptoms of colon cancer include rectal bleeding, blood in the stool, and persistent flatulence, abdominal cramps, and abdominal pain. Patients could notice persistent changes in their bowel habits as well. For example, some individuals with colon cancer have frequent diarrhea or constipation. To prevent colon cancer, patients who are fifty years old or older are advised to have a colonoscopy once every ten years. Several non-invasive screening methods are also available for individuals with a low risk of this condition. If cancer is detected, it may be treatable with surgery. Patients may also receive chemotherapy, radiation, or immunotherapy.

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Gallstones are hard deposits that form in the gallbladder. The deposits are usually composed of undigested cholesterol. While some patients may experience no symptoms from their gallstones, other patients could experience intense pain in the center or upper right quadrant of the abdomen, and pain may also develop in the right shoulder or between the shoulder blades. Gallstones are more likely to develop in individuals who are forty years old and older, and they are more common in women. Eating a diet high in fat or cholesterol could increase the risk of gallstones, and patients who are overweight or obese are at an elevated risk as well. To diagnose gallstones, doctors usually start with an abdominal ultrasound, and an endoscopic ultrasound might be performed as well. Some patients may need to have an endoscopic retrograde cholangiopancreatography procedure. Treatment is generally recommended for symptomatic patients, and surgery to remove the gallbladder is the most common treatment. If patients cannot have surgery, they may be offered medications to dissolve the gallstones.

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