Intestinal obstruction is a partial or total blockage of the small or large intestine, which impedes the normal passage of digested matter through the intestinal tract, preventing the excretion of feces and, in cases of total blockage, even gas. Symptoms depend on the location of the obstruction and whether it is partial or complete. Blockage in the small intestine causes intense episodes of abdominal pain and vomiting that may lead to dehydration and shock. Symptoms (intractable constipation and pain) develop more slowly in large-bowel (colon) obstruction. Blockage of the small intestine is much more common than blockage of the large intestine.
A partial blockage that allows only liquid to pass can result in diarrhea instead. The most obvious feature of intestinal obstruction is progressive abdominal swelling as gas, fluid, and fecal matter build up. If the obstruction restricts blood supply to the intestine, there is an increased risk of tissue death or intestinal perforation (bursting), both life-threatening conditions. Complete blockage of the small intestine, if left untreated, can cause death within hours to days.
What Causes Intestinal Obstruction?
- A strangulated hernia (a portion of small intestine protruding through a weak spot in the abdominal wall, so that its blood supply is cut off)
- Adhesions (internal scar tissue) from prior abdominal surgery
- Complications following intra-abdominal surgery
- Mesenteric ischemia (inadequate blood supply to the abdomen)
- Intraperitoneal infection
- Injury to the abdominal blood supply
- Kidney or thoracic disease
- Medications, especially narcotics
- Colon cancer
- Volvulus (a twist or knot in the bowel)
- Intussusception (collapse of one segment of intestine into another, much like a telescope)
- Impacted food or feces
- Rarely, a swallowed foreign object that becomes lodged in the digestive tract
- In paralytic (or adynamic) ileus, the intestine is not blocked but ceases to contract and move its contents along. It almost always follows abdominal surgery and lasts a few days before resolving on its own (unlike most other causes).
Intestinal Obstruction Symptoms
- Intermittent bouts of painful cramping
- Increasingly painful abdominal swelling
- Progressive constipation, leading to an inability to pass feces or, sometimes, even gas
- Uncontrollable hiccupping or burping
- Diarrhea (occurs with partial obstruction)
- Low-grade fever (less than 100°F)
- Weakness or dizziness
- Bad breath
- Pass gas or inability to have a bowel movement
- Abdominal fullness, gaseous
- Abdominal tenderness
- Crampy abdominal pain that comes and goes (intermittent)
- Failure to pass gas or stool ( constipation )
- A feeling of intense dislike for food
- Weight loss
- Muscle cramps
Prevention of Intestinal Obstruction
- Follow a high-fiber diet.
Intestinal Obstruction Diagnosis
- Patient history and physical examination
- X-rays to locate the site of obstruction
- Colonoscopy (use of a flexible, lighted viewing tube to inspect the large intestine)
- X-rays following enemas using barium or Hypaque, which provide a clear image of the colon
- Manometry measures the level and stage of the disease.
- Biopsy observes and examines both muscles and nerves under a microscope
How to Treat Intestinal Obstruction
- Intestinal obstruction is a medical emergency requiring immediate professional treatment. Do not attempt to treat it yourself using enemas or laxatives.
- Initially, doctors decompress the distended abdomen by removing fluid and gas through a flexible tube passed through the nose or mouth.
- In most cases, surgery is necessary to clear a mechanical intestinal obstruction. Six to eight hours of preoperative preparation are often necessary to restore fluid and electrolyte (essential mineral) balances, in order to prevent dehydration and shock.
- Bowel resection may be necessary. After removal of the affected portion of the intestine, the severed ends may be rejoined, although ileostomy or colostomy (surgeries in which an abdominal opening is made so that intestinal waste products may empty into an external bag) may be necessary.
When to Call a Doctor
- EMERGENCY If you have symptoms of intestinal obstruction, get immediate medical attention.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media