Bowel Obstruction

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What is a bowel obstruction?

A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes.

This topic covers a blockage caused by tumors, scar tissue, or twisting or narrowing of the intestines. It does not cover ileus, which most commonly happens after surgery on the belly (abdominal surgery).

What causes a bowel obstruction?

Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstructions.

In the small intestine, scar tissue is most often the cause. Other causes include hernias and Crohn's disease, which can twist or narrow the intestine, and cancer, which can cause tumors. A blockage also can happen if one part of the intestine folds like a telescope into another part, which is called intussusception.

In the large intestine, cancer is most often the cause. Other causes are severe constipation from a hard mass of stool and twisting or narrowing of the intestine caused by diverticulitis or inflammatory bowel disease.

What are the symptoms?

Symptoms include:

• Cramping and belly pain that comes and goes. The pain can occur around or below the belly button.
• Vomiting.
• Bloating.
• Constipation and a lack of gas, if the intestine is completely blocked.
• Diarrhea, if the intestine is partly blocked.

Call your doctor right away if your belly pain is severe and constant. This may mean that your intestine's blood supply has been cut off or that you have a hole in your intestine. This is an emergency.

How is a bowel obstruction diagnosed?

Your doctor will ask you questions about your symptoms and other digestive problems you've had. He or she will check your belly for tenderness and bloating.

Your doctor may do:

• An abdominal X-ray, which can find blockages in the small and large intestines.
• A CT scan of the belly, which helps your doctor see whether the blockage is partial or complete.

How is it treated?

Most bowel obstructions are treated in the hospital.

A partial blockage may go away on its own, or you may need treatments that don't require surgery (nonsurgical treatments). These treatments include using liquids or air (enemas), small mesh tubes (stents), or medicine to open up the blockage. You will stay in the hospital while waiting to see if the blockage goes away. If these treatments don't work, you'll need surgery to remove the blockage.

Surgery is almost always needed when the intestine is completely blocked or when the blood supply is cut off. Surgery is often done laparoscopically. This means that the surgeon uses a lighted scope and tools inserted through a few small cuts rather than making a large cut.

If your blockage was caused by another health problem, such as diverticulitis, the blockage may come back if you don't treat that health problem.

Frequently Asked Questions

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	Bowel disease: Caring for your ostomy

The symptoms of a bowel obstruction depend on whether the blockage is in the small intestine (small-bowel obstruction) or the large intestine (large-bowel obstruction).

Small-bowel obstruction

• Abdominal pain. Most small-bowel obstructions cause waves of cramping abdominal pain. The pain occurs around the belly button (periumbilical area). If an obstruction goes on for a while, the pain may decrease because the bowel stops contracting. Continuous severe pain in one area can mean that the blockage has cut off the bowel's blood supply. This is a medical emergency. Call your doctor immediately.
• Vomiting. Small-bowel obstructions usually cause vomiting. The vomit is usually green if the obstruction is in the upper small intestine and brown if it is in the lower small intestine.
• Elimination problems. Constipation and inability to pass gas are common signs of a bowel obstruction. But when the bowel is partially blocked, you may have diarrhea and pass some gas. If you have a complete obstruction, you may have a bowel movement if there is stool below the obstruction.
• Bloating. Blockages may cause bloating in the lower abdomen. You may also hear gurgling sounds coming from your belly. With a complete obstruction, your doctor may hear high-pitched sounds when listening with a stethoscope. The sounds decrease as movement of the bowel slows.

Large-bowel obstruction

• Abdominal pain. Blockage of the large intestine usually causes abdominal pain below the belly button. The pain may vary in intensity. Severe, constant pain may mean that your intestine's blood supply has been cut off or that you have a hole in your intestine. This is a medical emergency. Call your doctor immediately.
• Bloating. Generalized abdominal bloating usually occurs around the belly button and in the pelvic area.
• Diarrhea or constipation. Either of these symptoms may occur, depending on how complete the obstruction is. Your stools may be thin.
• Vomiting. This symptom is not common with a large-bowel (colonic) obstruction. If vomiting occurs, it usually happens late in the illness.

Blockages caused by cancer may cause symptoms such as blood in the stool, weakness, weight loss, and lack of appetite.

Bowel obstructions in newborns

Key signs of obstruction in newborns are green vomit and failure to pass the first stool, which is made of a thick, greenish black substance called meconium.

Several other conditions can cause similar symptoms.

Your doctor can diagnose a bowel obstruction through:

• Your medical history and a physical exam. What your doctor finds in your medical history and physical exam may strongly suggest that you have a bowel obstruction. For your medical history, your doctor will ask questions about your pain, your symptoms, and other digestive conditions or abdominal surgeries that you have had. During the physical exam, your doctor will feel your abdomen for tenderness or bloating and will listen with a stethoscope for bowel sounds. He or she will then confirm the diagnosis through other tests.
• An abdominal X-ray. This type of X-ray can detect blockages in the small and large intestines. See a picture of a blocked bowel.
• A CT scan of the abdomen. A CT scan can help your doctor distinguish between a partial and a complete obstruction and can help in diagnosing most cancers. It also can show signs that help your doctor find out whether the blood supply has been cut off (strangulated) to the affected part of the bowel.

The following health professionals can diagnose a bowel obstruction:

• Internist
• Family medicine doctor
• Pediatrician
• Gastroenterologist
• Surgeon
• Nurse practitioner
• Physician assistant
• Emergency medicine specialist

Your doctor may order a test called a complete blood count to check for infection or dehydration. While this test does not help in diagnosing a bowel obstruction, it will help your doctor find out how sick you are.

If you have a partial or complete bowel obstruction, you will probably enter the hospital for treatment. Treatment usually starts with supportive care, such as IV (intravenous) fluids and medicines to relieve symptoms while waiting to see whether the bowel obstruction goes away on its own.

If these treatments fail or if you are diagnosed early as having a complete bowel obstruction, you may need surgery to remove the obstruction. You may also receive antibiotics through an IV to prevent infection.

If you have had partial small-bowel obstructions in the past, you may be able to watch and wait to see whether your symptoms improve. But this is done only in certain cases under a doctor's close supervision. You will be on a liquid diet until symptoms improve.

Nasogastric suction

Fluids and gas may build up because they are not able to move past a blockage. When this occurs, a tiny tube called a nasogastric (NG) tube is placed through your nose and down into the stomach to remove fluids and gas and help relieve pain and pressure.

Nonsurgical treatments

Nonsurgical treatments may help relieve symptoms, clear a bowel obstruction, or allow time for you to gain strength before surgery. These treatments may include:

• Enemas. Using enemas of air, barium, or a product such as Gastrografin usually can clear an obstruction that occurs when one part of the intestine folds like a telescope into another part (intussusception). For more information, see the topic Intussusception.
• Stents. In some cases of obstruction, doctors may place expandable metal tubes called stents in the large intestine to help intestinal contents move forward. If you need surgery, a doctor may place stents to help you gain strength before surgery. Stents may also provide an alternative to surgery, allowing you to avoid a colostomy and a colostomy bag.¹
• Medicines, which can help relieve pain, nausea, and vomiting or help reduce the amount of stomach secretions.

Surgery

You may need surgery if nonsurgical treatment is not able to clear a partial obstruction. If the bowel is completely blocked or the blood supply to the bowel is cut off (strangulation), surgery may be the first treatment.

During surgery, a general surgeon or a colon and rectal surgeon removes the blockage or the section of blocked intestine. Surgery for bowel obstruction, including obstructions related to diverticulitis, Crohn's disease, twisting of the intestine, and some cancers, is often done laparoscopically. This means that surgery is done with a lighted scope and instruments inserted through a few small incisions.

You may need a colostomy or an ileostomy after surgery, temporarily or permanently. The diseased part of the intestine is usually removed and the remaining part of the intestine is sewn to an opening in the skin.

• A colostomy is created when the colon (part of the large intestine) is brought to the abdominal wall to form a stoma.
• An ileostomy is created when the ileum (the lowest part of the small intestine) is brought to the abdominal wall to form a stoma.

After either procedure, stool continues to be made in the remaining intestine and passes out of the body through the colostomy or ileostomy. The stool collects in a disposable bag that you place on your skin over the stoma. See a picture of a colostomy pouch.

Special considerations

Treatment for an obstruction caused by twisting of the intestine includes several methods, such as straightening out the twisted segment. This treatment is often used if it is necessary to delay surgery.

If you have an obstruction caused by inoperable cancer, your doctor may use stents to allow the intestines to function and medicines to reduce the amount of digestive fluid.

If your doctor instructs you to wait for a partial bowel obstruction to resolve on its own, home treatment measures may help relieve your discomfort. Follow your doctor's instructions, which usually include eating a liquid diet to avoid complete obstruction. Watch for signs of complete blockage, such as:

• The return of abdominal pain. Severe pain is a sign that the blockage may have cut off the bowel's blood supply. This is called a bowel strangulation and requires emergency treatment. Call your doctor immediately.
• Bloating.
• Inability to pass stools or gas.

If you have had surgery to remove an obstruction, watch for signs of infection. Call your doctor if you have a fever, if the area around the wound looks red and feels hot, or if liquid leaks from the wound.

Many cases of bowel obstruction cannot be prevented. But a high-fiber diet and plenty of water can prevent constipation and possibly diverticulitis, which can cause narrowing of the large intestine. It is important to avoid constipation, but don't overuse laxatives. Ongoing constipation and laxative use are associated with obstructions caused by twisting of the sigmoid colon or cecum.²

If you have a colostomy as a result of bowel obstruction surgery, talk to your doctor about how to care for it and prevent infection and to learn what foods to eat to avoid excess gas.

Bowel disease: Caring for your ostomy

Organizations

Related Information

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Colorectal Cancer
• Crohn's Disease
• Diverticulitis
• Intussusception
• Nausea and Vomiting, Age 12 and Older
• Ulcerative Colitis

Citations

1. Sebastian S, et al. (2004). Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. American Journal of Gastroenterology, 99(10): 2051–2057.

2. Turnage RH, et al. (2006). Intestinal obstruction and ileus. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., pp. 2653–2677. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Parangi S, Hodin R (2006). Intestinal obstruction. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd. ed., pp. 819–833. Philadelphia: Saunders Elsevier.